A new revolution in Life Science and Healthcare called “Microbiome”

Any new development in life science and healthcare starts with baby steps and slowly but surely takes the world by storm. Whether it is small molecule based, high-end genomics guided targeted cancer therapy or the immuno-checkpoint inhibitors which are taking cancer treatment to the next level of personalization and precision.

In the last decade one small buzz word has created quite a noise and is bringing hope that indeed wellness and personalized treatment is a possibility – enter the world of the “microbiome”. The term microbiome means the entire genome of the microbiota ecosystem. The advent of microbiome research parallels the advancement in next generation sequencing (NGS). Before NGS came into the picture, microbiology-based study could rely only on culturing microorganisms in the lab which had its own drawbacks. Now, with advanced sequencing technologies and smart algorithms it is possible to dissect the microbial ecosystem without the need to culture microorganisms in the lab.

Human intestine harbors the maximum number of commensal organisms which are into a delicate relationship with the host. It is therefore not a surprise that maximum gut microbiota based studies are published which look into how gut microbiota plays an important role in human health and wellness.

Do you know:-

Ø   Metagenomic sequencing of fecal samples has identified 3.3 × 10⁶ nonredundant  microbial genes from up to 1,150 different species, outnumbering human protein-coding genes by about 150-fold

Ø     Each person is estimated to host at least 160 different species 

Ø  In 2007, only 14 NIH grants contained the word “microbiome” in their titles or abstracts, and the number went up to 1,043 in 2017

Ø   More than 10000 papers published in the last 3 years on “gut microbiota”

With new studies and developments in the gut microbiome space, it would suffice to say-

“If eyes are the windows to the soul, then gut microbiome is the window to your health”

The industry has also taken a leaf and are dwelling into various aspects of the microbiome space. Companies like Leucine Rich Bio (India), Day Two (Israel), Viome (USA), UBiome (USA), Microba (Australia) etc. are taking the developments in the research to consumers directly by providing easy to use at home gut health tests. And there are companies like Enterome (France), Vedanta Bioscience (USA), Seres Therapeutics (USA) etc. that are looking into tapping the therapeutic potential of the microbiome and thus bringing new paradigms in treatment of various type of cancer, IBD, IBS etc.

Investors especially in the Western world have and are putting lot of faith in these new age companies. Most notably Seventure Partners that have funded a slew of microbiome companies in Europe and the US.

Although, lot many research and studies will be needed in future to validate the interesting leads that the microbiome domain throws up yet it is pertinent that all stakeholders especially clinicians and investors in Asia also support this with less skepticism and more openness as the success of the microbiome can lead to a new era of healthcare and wellness

 

Human microbiome – the new frontier in medicine?

‘Antibiotics heal but they also cause damage’- this adage is well known and now probably better understood. With the advent of Next Generation Sequencing (NGS), exploring the world of the micro organisms has become easier. And as they say, ‘truth is stranger than fiction’; the results of such studies are giving some startling facts about the bacteria that co-inhabit our bodies. Like each individual has a unique DNA or fingerprint, it is now being realized that we might have unique microbiome signature!!!!

The microbiota in our body is known to influence our good health. Recent evidence has linked the microbiome with different diseases. In fact, at least one parasitic protozoa - Toxoplasmosis gondii - has been shown to affect behaviour in rats. The protozoa reproduces only in cats, and studies have shown that when mice or rats are infected with it, the protozoan makes them less afraid of cats, and they are, therefore, more likely to be eaten by them.

Understanding microbiome and their interaction not only with their host but also between themselves are giving lot of food for thought in channelling our views of manipulating this micro-ecosystem in our body for desirable results. A case in point here is the role  and benefit of probiotics and as Prof David Relman (one of the pioneers in the field of microbiome research) puts it “The hesitation right now is there aren't a lot of good data. Most clinicians will say, 'I don't personally think it's doing much, but it can't hurt so if you feel better, why not.' I think there may be some real benefits, but I also think we have imprecise probiotic options now. So we're giving these somewhat irrelevant microorganisms to people, and yet they do seem to have some beneficial effects”(source -http://www.sfgate.com/health/article/Sequencing-of-human-microbiome-fills-knowledge-gap-3683156.php)

Therefore now is the right time to make maximum use of the data we derive from studying our microbiota and look at these organisms in a different perspective rather than thinking about them as our “enemies”. Also, I sincerely hope that pharma/biotech and nutraceutical companies collaborate to find better solutions to the diseases that we face today!

Personalized Medicine – Ethics Vs Need

In this era of modern genomic tools, it is getting pretty much apparent that we are closing in on a scenario where in the genome of an individual can be sequenced in a matter of few hours. Question 1)– What do we intend to do with it? Question 2)- Sequencing is just one part of the puzzle but do we actually understand the finer details? Now, assuming that the bioinformatics hurdles are taken care of, then with the important data in hand how do we proceed? How much do we disclose to the patients? How much should the physicians or relatives know? Well, in other words it is the ethics versus need debate. Recent article in American medical news throws some light on this (http://www.ama-assn.org/amednews/2012/04/02/hll20402.htm)

Step towards personalized medicine is not only about the hardware/software part of it but also it is about proper training at physician, geneticists and lab scientists’ level. First is to have a meaningful understanding of the data which can be made ‘easy to understand’ for the care giver (physicians). Then comes the question of what sort of data should be discussed with the patient and their relatives. This is a tricky scenario as unless we as scientific community is absolutely clear of the data and the predisposition risks therefore, I guess it would not be good idea to share such info with patients as they would be upset and would get scared. 

There is a section in the community that believes that family history of the patients should be looked into and only diseases which a patient is predisposed to should be looked into in detail. I would presume it is a thought in the right direction; however, it defeats the whole purpose of whole genome sequencing. Also, as our genome stores a treasure trove of data, it is important to know what else we are predisposed to apart from what our family history suggests! Another ethical issue which might crop up in the near future is that people may want to see the ‘genome map’ of a prospective partner before marriage to avoid getting genetic diseases in the offspring. Now, this might be good but it might lead to all sort of complications and less randomization of the gene pool!!!

Finally, if the people are made more aware, whole genome sequencing, in the future would let us take preventive measures knowing what is in store for us (not astrologically but genetically) and be better prepared for any eventuality.