Waste makes Haste
One person’s waste is another’s treasure. Results published January 16th in NEJM and featured in The New York Times and other media showed the clear value of fecal transplantation to resolve recurrent C. Difficile infection in patients. Overall, 15 of 16 patients treated had resolution, versus 4/13 of the vancomycin treated group. The efficacy of the fecal transplantation group is a striking 93%. This comes at the cusp of an evolution of thought – the pendulum is finally swinging from viewing bacteria as our foe to seeing them as our friends.
What does the microbiome do?
It turns out that there are ten times more bacterial cells in and on our bodies than there are human cells. The Human Microbiome Project (HMP) has spent $170 million over the past five years to catalyze this research, and the results suggest that our microbes, called the microbiome, play a major role in health and disease. Our microbes help digest food, strengthen our immune systems, and keep bad bugs in check. Researchers like Eric Alm at MIT take it to a more personal level. On a recent visit to his lab, Dr. Alm rolled up his sleeve to show me the sites of two punch biopsies. “I’m looking at the difference between two yogurts and the bacteria in them and the effects on wound healing.”
This ecosystem between humans and microbes provides access to more than 3 million microbial genes (versus our 20,000 human genes). This brings an enormous expansion of added capabilities to defend against disease, adapt to new environments, exploit a diverse diet, and thrive as a species. It also means that disruption of the normal composition of our microbiome can lead to a variety of acute and chronic health conditions.
Recent research has implicated microbiome imbalances in disorders as diverse as cancer, obesity, inflammatory bowel disease, psoriasis, asthma, and possibly even autism (Science, 2010, 2011, 2012; The Economist 2012; NY Times 2012).
New discoveries about disease yield new therapies.
If disruption of the microbes in our system can lead to disease, modulating the microbiome can improve health. This opens up whole new areas of research on human disease, and completely new avenues for development of therapeutics. Microbiome-based therapeutics could take many forms, a few of which are listed here:
- Genetically engineered human microbes with new desirable functions that treat disease or promote health.
- Small-molecule and biological drugs that affect community composition in a targeted way. This could take the form of promoting resiliency of healthy microbial communities, or perhaps modulate pathways between the microbiome and the immune system. Vendata Biosciences is one example of a new company focused in this area.
- Novel microbial molecules could be identified and developed into traditional drugs to modulate health and disease.
- Healthy microbiome communities as therapeutics. As the results of this recent clinical trial show, sometimes the simplest solutions are the best. Uncovering single molecules that modulate the microbiome in a desirable and predictable way is likely to be many years away. Rebiotix is focused on this simplest of solutions. It is set to be the first industry player to reduce the practice of fecal transplants to a commercially viable, therapeutically effective solution for the treatment of recurrent C Difficile.
Waste, coming soon.