Will there be a battle for the microbiome?
Simply defined, the microbiome is the population of microbes (bacteria, archaea, fungi and even viruses) that live with the human body. Probiotic is the term used for dietary supplements that add beneficial bugs to the body. Theoretically, microbiome therapy started before anybody had ever used the terms microbiome, probiotics and prebiotics - as early as the 1400s, yoghurt that naturally contained microbes was used as a cure for diarrhoea. We now know that we walk around with trillions of foreign cells in and on our body. The most obvious places to find them are the parts of the body that are open to the exterior such as ear, nose and throat, lungs, gut and colon, genitals and surface of the skin. The balance and interactions between these and our own cells can be beneficial and even vital to our well being but they can also cause problems. Imbalances in bug species in the body have been associated with everything from diabetes, obesity and urogenital infections to Crohn’s disease cancer and Alzheimer's. A study published earlier this year showed that there is a serious imbalance in the lung microbiome of patients with cystic fibrosis.
The launch of the Human Microbiome Project in 2007 precipitated a huge increase in interest in the bugs in our bodies. Everyone from microbiologists, biotechnologists and drug companies, to natural health gurus, food manufacturers and organic farmers may have something to gain from the project.
But is there a battle brewing over who can own, control and manipulate it?
The regulatory issues over probiotics are not very clear and that could make the battle ground even messier.
- For pharmaceutical companies, that generally like to identify molecules and patent them, the money lies in finding the interesting molecules that the beneficial microbes produce, identify their mode of action and enhance them.
- For the biotechnologists the interest lies in identifying the microbial genes that benefit the human body and clumping as many as possible together in a ‘supermicrobe’.
- The food industry may well want to jump on the bandwagon by fortifying a broader range of foods with microbes much in the same way that lactobacillus and bifidus are developed in yoghurts.
- The probiotic manufacturers may well be feeling uneasy. After years of developing their products and fighting against a medical community that denied the existence of any benefits, their industry may well be getting hijacked and they almost certainly do not have the financial means to fight the regulatory issues in court.
- The organic farmers and natural health therapists should also be interested in any new research and even carrying out their own. What if research showed that organic food naturally contained a better balance of microbes than none organic? What if research proved that certain honeys encouraged specific beneficial bacteria and inhibited others? What if research showed that it is simply a case of eating a certain food to increase levels of a specific beneficial bug? An article published in Nature has already shown that it only takes forty eight hours for the microbiome to change substantially when moving from a meat to vegetarian diet. An increase in dietary fibre also led to substantial increases in certain gut flora. The human microbiome project will provide information on thousands of new species that nutritionists are as yet unaware of.
- The national health services that pay the bills have to look at the financial advantages. If a rebalance of the microbiome through simple low cost faecal transplants from slim healthy donors to obese patients can solve the obesity problem, it would save the billions that bariatric surgery is costing them. In fact a recent study indicated that bariatric surgery does not change the amount of calories that a patient eats but has an immediate effect of changing the gut flora and that this could be a major contributor to its efficacy.
The true benefits however lie in the potential of microbiome therapy to be individualised. Even though there are clear indications that certain excesses or lack of some species are associated with certain diseases, patients are not all equal even if they suffer from the same illness. The beauty of the microbiome treatment lies in the potential to create a mix of the right species to balance the microbiome according to a patient’s individual needs.
Maybe one day patients will be able to go to the microbiomist and pick up a probiotic nasal spray, eye drops, ear drops, an inhaler, a stomach tonic or skin cream that contains all the bugs they need to treat a health problem.
Hats off to the people who initiated the Human Microbiome Project. The development of advanced microbiome therapy could be one of the most exciting things to happen in medicine this century. But who will win the battle to own it?
Or is it just possible that this time around, everyone will work together for the benefit of patients?