Clinical OMICS

NOV-DEC 2017

Healthcare magazine for research scientists, labs, pathologists, hospitals, cancer centers, physicians and biopharma companies providing news articles, expert interviews and videos about molecular diagnostics in precision medicine

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Page 30 of 47 November/December 2017 Clinical OMICs 29 bial communities found in other parts of the body. Gregory Buck, Ph.D., and colleagues from Virginia Com- monwealth University are researching the vaginal microbi- ome and how it affects women's health, particularly during pregnancy. In contrast to the gut microbiome, simplicity is key for the vaginal microbiome. "A homogeneous vaginal microbiome has traditionally been considered healthy, usually one con- sisting primarily of Lactobacillus species," Buck explained. He and his team are working on a longitudinal study that is part of the larger NIH-funded Human Microbiome Project. The Multi Omic Microbiome Study-–Pregnancy Ini- tiative is looking at changes in a number of different micro- biomes in pregnancy. "There is evidence that adverse outcomes in pregnancy, including preterm birth, are influenced by the microbiome of the female reproductive tract," said Buck. "We think adverse outcomes are loosely associated with having a com- plex microbiome, which is the microbiome type that would traditionally be associated with bacterial vaginosis. So some of the usual suspects for urogenital health are also usual suspects for adverse outcomes in pregnancy." Future Directions While research into the microbiome is picking up steam, these efforts have only produced limited improvements in patient care to date. Fecal transplantation has improved the lives of many patients with recurrent C. difficile infection, and will no doubt continue to do so. It's thought it could also serve as a treatment for other conditions, but research is still at an early stage. For example, there have been four random- ized controlled trials published using fecal transplants to treat ulcerative colitis and three of them showed significant promise. "Targeted, microbiome-based therapies could hope- fully remove some of the possible risks associated with fecal microbiota transplantation," suggested Wilcox, "par- ticularly given the potential far reaching consequences of manipulating this powerful 'organ' within us." When asked about the future, Wargo emphasized the importance of diet. "We know that the diet and microbiome are tightly related, and so I think with research in that area we are going to be able to counsel patients much better to have a diet that facilitates a more favorable microbiome." Mangalam and his team are also interested in the impact of diet. "We are investigating how gut bacteria might affect the host physiology through metabolism of common food. Our pilot studies suggest that small metabolites from phy- toestrogens and bile acid metabolism can regulate immune system development," he said. The view of researchers seems to be that while it is now common knowledge the microbiome plays a critical role in human health, more in-depth understanding about the mechanisms behind the observed effects is needed for the development of effective new treatments for disease. "This is undoubtedly the era of the microbiome," said Wilcox. "I believe that we'll soon be able to target therapeu- tics more effectively via an improved understanding of their desirable and unwanted effects on patients' microbiomes." McIlroy concluded: "Moving from correlation to cau- sality will allow us to develop precision microbiota-based diagnostic and therapeutic tools for currently unmet clinical needs." University of Iowa's Ashutosh Mangalam, Ph.D., with a colleague. National Institute of Allergy and Infectious Diseases, National Institutes of Health Visualization and localization of commensal bacteria by Fluorescence in situ Hybridization (FISH) in the small intestine of Toxoplasma gondii- infected mice.

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