Understanding the Gut Microbiome: Changing the IBD Paradigm

An understanding of the gut microbiome, how it changes, and its role in the development of inflammatory bowel disease (IBD) is needed and can change the paradigm of IBD, according to a Keynote session at the 2018 AIBD Meeting.

The global increase in IBD incidence is attributable to industrialization, changes in lifestyle, or changes in the microbiome, which are often related. Other factors also play a role, including genetics.

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"There is almost certainly a genetic basis, but the genetic basis is not sufficient by itself to cause disease,” Dr Chang, the Martin Boyer Professor of Medicine at University of Chicago, said during his presentation, said. “There are other factors that have to contribute too, which is why we think environment is important, as well as changes in gut microbiome. It is really convergence of these factors that leads to the development of IBD.”

How the factors come together to increase the risk of IBD is misunderstood because the understanding of the gut microbiome is very poorly developed. Also, limitations of cross-sectional studies in IBD are common.

“[Due to limitations], It’s not surprising we haven’t found any trends that have been useful in our understanding of the gut microbiome,” he said.

Chang said gut microbes are important for development and conditioning of the immune system, as well as digestion and processing of nutrients.

“Thinking of it as an organ is a fairly good way of thinking about it because we really do need it,” Chang said.

However, there is a “dark side” to gut microbes, according to Chang’s presentation, and they are implicated in different diseases such as infection, cancer, and various immune disorders, including IBD.

Specialists have relied on culture-based technologies to evaluate gut microbes. However, microbes are taken from the body and grown under artificial conditions, which often leads to limited information.

“You can only grow 20% of these microbes under standard conditions,” Chang said. “When you take these microbes out, they function different from the environment.”

The emergence of new technologies allows gut microbes to be evaluated in comprehensive ways. However, technology doesn’t tell you what they are doing.

All the limitations have contributed to why a pathogen for IBD has yet to be identified.

“Maybe we are looking for the wrong thing…We have to change our strategies,” Chang said, adding that [gastroenterologists] should be playing closer attention to genetic pathways of the gut microbiome.

“If there is really a genetic signature, then it could change the paradigm for IBD,” he said.

The clinical implications and future goals are to develop biomarkers—based off genetic pathways—that could be used for the following:

• risk assessment;
• identifying patients that could benefit from prevention;
• treatment;
• stratification; and
• cure.

Reference:

Chang E. KEYNOTE: Listen to the Gut: Lessons for IBD from the Microbiome. Presented at: Advances in Inflammatory Bowel Diseases; December 13-15, 2018; Orlando, FL. https://www.consultant360.com/meetings/aibd.