2015-jul-aug

Healthcare Journal of new orleans

JUL / AUG 2015

the set point, the

response, and the fun-

damental status of the

immune system.

Editor

Can you talk a little bit about fecal

transplants, their efficacy, and ways we can

change our microbial identity?

Sonnenburg

Fecal transplants are right now

primarily used in the clinics for treating a

type of colitis caused by clostridium diffi-

cile at a really stunning cure rate, close to

100 percent.The disease for those individuals

was simple to eradicate, and a relatively small

percentage can only be cured with antibiot-

ics, which was the original standard of care

for this. So fecal transplants for a recurrent

sequence of colitis are really one of these

kind of miracle cures that you rarely see in

biomedicine. It’s incredibly crude right now

and there are companies that are working

on creating defined cocktails of microbes for

accomplishing the same effect for curing c.

difficile colitis, rather than giving a slurry of

stool sample. But it leads to this possibility of,

as you say, of changing ourmicrobial identity

through fecal transplant.

If it turns out that microbes are really a

critical contributor to obesity or inflam-

matory bowel disease, all these diseases

that are connected to the microbiota, it

leads to the possibility that there may be

similar fecal transplant-like therapies out

there for these. But, it’s early days. There’s

nothing else established right now…there’s

many, many clinical trials proceeding in the

U.S. and in other parts of the world to look

at the applicability of fecal transplants to

treat other diseases and this is going to be

an exciting coming era of what many in the

field are calling microbiota reprogram-

ming—the ability to reprogram or

reboot your microbiota if it’s

crashed.

Editor

I believe they are talk-

ing about the microbiota in

terms of anti-aging and age-

defying treatments. Is there

some relationship between the

aging process and the microbiota?

Sonnenburg

I know people are look-

ing into this. Looking at whether there is

a particular microbiota for instance that

defines or is associated with people who

are exceptionally long-lived. I think a lot of

those studies have shown that in different

populations you end up with different sorts

of microbiotas. I think it is very early days,

but I think with how fundamental the micro-

biota is to so much of our biology, playing a

role in cardiovascular health, it appears to

influence the development of certain types

of cancers, it’s connected of course to auto-

immune diseases, I think there undoubtedly

will be a connection between the microbiota

and longevity. Just because the microbiota

is so profoundly connected to so much of

the biology in the human body.

But in terms of finding a microbiota that

is optimal for promoting longevity I think is

going to be a really long road. Part of that is

just understanding the biology of how the

microbiota connects to longevity. But the

other part of the complexity is that each

one of us has a different human genome

and each one of us has a different microbial

community that we’ve developed with. So

understanding exactly how they intervene

to promote longevity is going to be a very

complicated thing that may take decades to

iron out.

Editor

You touched on this earlier, but can

you talk about the future of the microbiota

as it relates to healthcare and some of the

things we might be looking at doing differ-

ently in the future?

Sonnenburg

I think the real key here is that

there’s no going back. I thinkwhat’s happened

over the past ten years has been an awaken-

ing that we have this really important part

of our biology that will forever now impact

how medicine is practiced. The microbiota

will become more and more fundamentally

incorporated into the clinic and howwe view

health and how we view treating disease. I

think there has been this true paradigm shift

in how we think about the human body and

howmedicine needs to be practiced.

The other part of this that is really impor-

tant is this malleability of the microbiota. If

we have something that is such a big lever

on our biology and we can change it then

that means that there is probably a tremen-

dous future in using the microbiota to opti-

mize health, prevent disease, and treat dis-

ease. There are a lot of companies that are

being developed to create therapies focused

around the microbiota. And you can also

think about it in terms of how diseases are

diagnosed. Instead of just going in and hav-

ing a blood panel done at the clinic, youmay

actually find clinics at some point in the not

too distant future taking a stool sample and

characterizing your microbiota and trying

to understand if there are particular prob-

lems there. So I think this will just become

a more and more accepted medical practice

going forward.

A US Healthcare Journals One on One

the

microbiota

is in continual

cross talk

with your

immune

system