The Gastrointestinal Microbiome: An Evolving Understanding
the microbiome is considered a marker of health. Decreased diversity has been associated with disease.12,22 The presence of pathogens or potential pathogens can indicate imbalance and may require treatment.
A NOVEL INFLAMMATION - ASSOCIATED DYSBIOSIS SCORE An Inflammation-Associated Dysbiosis (IAD) score was introduced in a recently published paper.16 The score differentiates patients with Inflammatory Bowel Disease (IBD) from those with other diagnoses including irritable bowel syndrome (IBS), celiac disease, and healthy patients. The score is based on a specific pattern seen upon analysis of 24 commensal bacteria. The strength of this data set and score is that it is based on 173,221 stool tests. The score is unique because it was derived from the microbiome’s association with inflammatory test biomarkers including fecal calprotectin, eosinophil protein X, and secretory IgA. Additionally, it was validated in two separate studies that distinguish IBD from healthy and other diseases. This score is the first of its kind that incorporates stool biomarkers with microbiome markers.
This group also created another dysbiosis condition score that is opposite the IAD score (unpublished data). The creation of these types of scores provides the clinician with a meaningful synthesis of the data that guides treatment.
THERAPEUTIC OPTIONS
Chen L, Reynolds C, David R, Peace Brewer A. Development of an Index Score for Intestinal Inflammation-Associated Dysbiosis Using Real-World Stool Test Results. Digestive diseases and sciences. 2019.
It is not known whether dysbiosis is a cause or consequence of intestinal inflammation. It is likely a vicious cycle.23 The IAD score shows an association – not necessarily causation, although the authors do discuss root cause. Another interesting aspect of this study was that it reinforced the pathogenic community concept discussed earlier. When the 24 individual organisms were assessed individually, a correlation with IBD could not be made – the score takes the community into account.
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The creation of these types of scores are helpful because they can cause a clinician to change their treatment plan based on results. There is no consensus in the literature on targeted strategies for correcting a certain pattern of dysbiosis. More outcome studies are needed. A unique aspect of the IAD score was a negative association with total commensal abundance. Theoretically, if the IAD score is elevated and abundance is low, antibiotics may be detrimental to the already reduced abundance. However, if the IAD score is high and abundance is high, if antibiotics are warranted, it would likely be a safer option than if the abundance were low. More studies are needed to confirm this.
Rather than focusing on targeting individual organisms, it is important to treat the microbiome and human host as a system. Simply identifying organisms and reporting their amounts presents a challenge for the clinician’s clinical utility. What does it mean when some are high, and some are low? Does each one require treatment? It is not possible to target only one commensal organism with a therapeutic since they function as a community.
It is important to remove the factors that are damaging or destabilizing to the microbiome while supplying the commensal bacteria with what they need to thrive. Antibiotics, stress, environmental toxins, and a Western diet can all contribute to dysbiosis. Conversely, a fiber-rich plant-based diet, prebiotics, probiotics, physical activity, and stress management can promote a healthy microbiome.22 It is not surprising that the accumulating data that links healthy diet and lifestyle to longevity and health also happens to be the factors that make for a healthy microbiome.
ANTI-AGING MEDICAL NEWS
• SUMMER 2020
