Antonio Gasbarrini – Microbiome clinic and personalised medicine

The microbiome clinic is a new concept
that actually is not yet present in the gastrointestinal
department that is a new kind
of laboratory where you can have
in the same time the presence of a gastroenterologist and a clinical microbiologist. Why do we have to add
a microbiome clinic in our unit, in our hospital? The main reason is
the microbiota revolution completely changes
our approach to disease in both in healthy
and sick people. Basically the microbiota
revolution told us that there is no doubt
about the fact that a microbiome demodulation
or a microbial dysbiosis is somehow responsible of the
development of ulcerative colitis, multiple sclerosis, Parkinson disease,
Alzheimer’s disease hepatic encephalopathy and
many other disorders, not only of the gastrointestinal tract. The main problem is
that at the moment the microbiota revolution told us that when the baby is
born the gut is colonized by this miscellaneous of bacteria,
viruses and yeasts that make the microbiome. The microbiota is basically 1kg of microbes that give to the human body
more than 2,000,000 genes that work with the 30,000 human genes. All these genes are absolutely
crucial for the survival of the person and somehow they are able to increase
inflammation or anti-inflammation and somehow they educate
the immune system. The main issue is that for many reasons, this microbiota could be dysbiotic. You can be dysbiotic since childhood, for example if you take many
antibiotics during the first year of life, or if experience violence or malnutrition. The issue is that if the immune system
is educated in a bad way, the ratio between microbiota and
immunity can be quite bad. In this case it’s quite common
that this dysbiotic microbiota can be responsible of diseases, for example ulcerative colitis or
Crohn’s disease. In this case, how the new knowledge
on the microbiota can help the physician of the future? No doubt that we need very specialized
gastroenterologists and microbiologists. And they have to know the literature,
be up-to-date and know very well the new technologies. They, for example, have to know what is
a metagenomic map of the microbiota. They have to be able to tell the patient or the physician that sent the patient, as a microbiome clinic, how often you have to perform
a metagenomic map or dare to if there is a sense or not at
all to assess with the metagenomic map the genes of this person. And also they have to know how is possible
to modulate the microbiome, in particularly they have to know
the effect of each single nutrient on the microbiome. For example, they have to tell you if you have to take beans every day
or meat or if you can eat cereals or if it’s better to take a lot of fruit and how much water you have to drink. We know that the microbiota is highly
sensitive to what we eat. In other cases the microbial clinic can tell you
what kind of antibiotic you have to use for example to treat a C.difficile infection. The microbiome clinic has to tell you,
and this is already happening, how often you have to perform
a fecal microbiota transplantation if you have a recurrent C. difficile infection. Somehow it’s a new way to approach diseases. Probably in the future we will have any
kind of specialties that know very well the microbiota. The microbiota will be
somehow part of the culture of the pneumologist, of the gynecologist,
of the neurologist, of the rheumatologist and of the gastroenterologist. At the moment, however, we don’t have all this knowledge in the specialists. So, a good way to proceed
is to develop microbiome clinics and in particular in the Gemelli Hospital
we have a highly-specialized microbiome clinic that can help physicians and patients
in order to assess the best way to define and design
the microbiome of each person.

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