• Michael Misialek, MD

The Microbiome: How it is Important in Health and Disease

The microbiome consists of microbes that colonize all body surfaces. It is estimated that there at least 10 times more microbial cells in the human body than human cells. There has been an exponential growth in publications and commercial opportunities as a result of our understanding of the importance of the microbiome in health and disease.

It is estimated that 100% of the US population has been or will be affected by microbiome-promoted diseases and conditions. Some of the important conditions and impact on people are presented in the below chart.

The microbiome represents the trillions of organisms that live in and on us. It plays a key role in health and disease and changes in the usual state of our microbiome, termed “dysbiosis”, have been linked to a variety of disorders. Research is underway and there are multiple storage registries and databases cataloging the organisms present in microbiomes. Novel computational models have been used in this research including “longitudinal dynamics”, how the composition of the microbiome changes over time, as well as predicted outcomes from these and other changes using complex computational methodologies. Researches are assessing functional biology by the use of gnotobiotics, germfree or sterile animals into which defined microbial species or complex microbial communities can be introduced, as well as assessment of their microbiological phenotype and genotype. There are labs already taking part in clinical trials employing the microbiome for therapeutic and diagnostic purposes.

Current applications for the microbiome in daily use include the diagnosis of C. difficile colitis as well as screening of fecal microbiota transplantation (FMT) donors. Next-gen sequencing (NGS) and whole genome sequencing (WGS) are used to study environmental and in some cases clinical samples in an unbiased manner to screen for pathogens. Future applications will evolve as we understand more of the microbiome and its effects on disease and therapies so that specific microbes and/or microbial products, or derivatives of microbial products, may be used. Future applications will not be targeted just to the microbiome of colonized surfaces, but will include effects on more distant organs and systems such as the endocrine, CV and CNS systems as well as applications to carcinogenesis and cancer management.

Pathologists are crucial in each step of the research and study of the human microbiome. Intersecting with all medical specialties, pathologists serve an important role on the care team. Additionally, pathologists help guide other clinicians in the appropriate utilization of lab testing. Pathologists are natural teachers. In fact, the content for this article comes from the College of American Pathologists (CAP) Short Presentations in Emerging Concepts (SPECs). Seek out your pathologist. They are an important member of your medical team.

#microbiome #cancer #cdiffcolitis #sequencing #inflammatoryboweldisease

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