March 11, 2016: For diagnosing or predicting metabolic diseases such as obesity, insulin resistance or type two diabetes (T2D), doctors commonly make use of biomarkers such as body mass index or glucose levels. These “classical” parameters are now joined by the gut microbiota composition as a new kind of biomarker. Prof. Max Nieuwdorp (University of Amsterdam / The Netherlands) explained at the 5. Gut Microbiota for Health World Summit 2016 (March 5 – 6, Miami) that this is based on rapidly mounting evidence that the gut microbiota composition is significantly altered in patients with metabolic conditions.
As Prof. Nieuwdorp pointed out, not all kinds of changes of the microbial composition in patients with metabolic disease can be regarded as biomarkers of their condition. This is due to the fact that not only antibiotics but also other drugs including anti-diabetic medications might impact the gut microbiota. “We recently demonstrated that subjects with T2D who used the anti-diabetic drug metformin had increased levels of Enterobacteriaceae and decreased levels of Clostridium and Eubacterium compared to those without this medication. Thus in cases like these the true microbial T2D profile may be masked by metformin or other drugs.”
However, after having excluded such biasing factors, it becomes plain that there truely are direct and tight connections between metabolic disease development and the intestinal microbial composition. Prof. Nieuwdorp presented the audience with studies performed by himself and other scientists that provide an increasingly detailed picture of what is going on: This includes for example the finding that an enrichment of Lactobacillus gasseri and Streptococcus mutans in the gut serves as a good predictor for the development of insulin resistance which like obesity is a potential precursor to T2D. Equally important is the observation that the amount of bacteria that produce butyrate – a beneficial short chain fatty acid (SCFA) – such as Roseburia and Faecallibacterium prausnitzii is reduced in patients with this condition.
Examinations of the microbiota may thus help to identify individuals at an early stage who are at risk to develop metabolic diseases. What is more: Distinguishing different types of microbial composition and connecting these with classical clinical biomarkers may provide diagnostic patterns that allow to select the kind of prevention or treatment which is best suited for the individual patient. Personalization of treatment would be highly welcome as it would narrow down the broad range of possible health improving measures: While lifestyle interventions such as taking up sport activities might be appropriate for some patients others might need specific diets, prebiotics, probiotics, specific drugs or – in severe cases – bariatric surgery.
Recent studies have demonstrated that the gut microbiota has not only disease indicating but also modulating potential. It could be shown that fecal microbiota samples from healthy donors that were transplanted into the guts of patients with metabolic syndrome improved insulin sensitivity. “This suggests that treatment of T2D in the future may, at least in part, be based on microbiota interventions. However, since fecal transplantations are associated with some risks, for example transferring of pathogens, safer and more appealing strategies need to be developed,” said Prof. Nieuwdorp. One promising path is the mining for bacterial strains with therapeutic potential that might serve as novel probiotics, adding to the spectrum of already known microbes with beneficial effects. Another future option might be vaccination. According to Prof. Nieuwdorp a strain of Enterobacter sp that fulfills the necessary criteria and is suited to this purpose was recently isolated from an obese individual. “These kinds of approaches may provide us with vaccines to treat metabolic diseases”, said Prof. Nieuwdorp.
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