Modern medicine
Microbes maketh man
People are not just people. They are an awful lot of microbes, too
Aug 18th 2012 | from the print edition

POLITICAL revolutionaries turn the world upside down. Scientific ones
more often turn it inside out. And that, almost literally, is
happening to the idea of what, biologically speaking, a human being
is.

The traditional view is that a human body is a collection of 10
trillion cells which are themselves the products of 23,000 genes. If
the revolutionaries are correct, these numbers radically underestimate
the truth. For in the nooks and crannies of every human being, and
especially in his or her guts, dwells the microbiome: 100 trillion
bacteria of several hundred species bearing 3m non-human genes. The
biological Robespierres believe these should count, too; that humans
are not single organisms, but superorganisms made up of lots of
smaller organisms working together.

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It might sound perverse to claim bacterial cells and genes as part of
the body, but the revolutionary case is a good one. For the bugs are
neither parasites nor passengers. They are, rather, fully paid-up
members of a community of which the human “host” is but a single (if
dominating) member. This view is increasingly popular: the world’s
leading scientific journals, Nature and Science, have both reviewed it
extensively in recent months. It is also important: it will help the
science and practice of medicine (see article).

All in this together

The microbiome does many jobs in exchange for the raw materials and
shelter its host provides. One is to feed people more than 10% of
their daily calories. These are derived from plant carbohydrates that
human enzymes are unable to break down. And not just plant
carbohydrates. Mother’s milk contains carbohydrates called glycans
which human enzymes cannot digest, but bacterial ones can.

This alone shows how closely host and microbiome have co-evolved over
the years. But digestion is not the only nutritional service provided.
The microbiome also makes vitamins, notably B2, B12 and folic acid. It
is, moreover, capable of adjusting its output to its host’s needs and
diet. The microbiomes of babies make more folic acid than do those of
adults. And microbiomes in vitamin-hungry places like Malawi and rural
Venezuela turn out more of these chemicals than do those in the guts
of North Americans.

The microbiome also maintains the host’s health by keeping hostile
interlopers at bay. An alien bug that causes diarrhoea, for instance,
is as much an enemy of the microbiome as of the host. Both have an
interest in zapping it. And both contribute to the task. Host and
microbiome, then, are allies. But there is more to it than that. For
the latest research shows their physiologies are linked in ways which
make the idea of a human superorganism more than just a rhetorical
flourish.

These links are most visible when they go wrong. A disrupted
microbiome has been associated with a lengthening list of problems:
obesity and its opposite, malnutrition; diabetes (both type-1 and
type-2); atherosclerosis and heart disease; multiple sclerosis; asthma
and eczema; liver disease; numerous diseases of the intestines,
including bowel cancer; and autism. The details are often obscure, but
in some cases it looks as if bugs are making molecules that help
regulate the activities of human cells. If these signals go wrong,
disease is the consequence. This matters because it suggests doctors
have been looking in the wrong place for explanations of these
diseases. It also suggests a whole new avenue for treatment. If an
upset microbiome causes illness, settling it down might effect a cure.

Yogurt companies and health-food fanatics have been banging this drum
for years. And in the case of at least one malady, irritable-bowel
syndrome, they are right. So-called probiotics, a mixture of about
half a dozen bacterial species found in yogurt, do act to calm this
condition. But there is little evidence that consuming probiotics has
the tonic effect on healthy people that certain adverts suggest.

A handful of doctors are taking a more fundamental approach to another
microbiome-related disease, infection with Clostridium difficile. This
bacterium, which causes life-threatening distension of the gut in some
people who have been treated with antibiotics and thus had their
microbiomes disrupted, is a bane of hospitals. It kills 14,000 people
a year in America alone. But recent experiments have shown it can be
eliminated by introducing, as an enema, the faeces of a healthy
individual. “Stool transplants” are a pretty crude approach, to be
sure, but the crucial point is that microbes are much easier to
manipulate than human cells. For all the talk of superorganisms (and
despite the yuck factor of what is being moved from one body to
another), transplanting a microbiome is far easier than transplanting
a heart or a kidney.

Disgusting but useful

Two other areas look promising. One is more sophisticated deployment
of the humble antibiotic, arguably the pharma industry’s most
effective invention. At the moment antibiotics are used mainly to kill
infections. In the future they might have a more subtle use—to
manipulate the mix of bugs within a human, so that good bugs spread at
the expense of bad ones.

The other field that may be changed is genetics. Many of the diseases
in which the microbiome is implicated seem to run in families. In
some, such as heart disease, that is partly explained by known human
genes. In a lot, though, most notably autism, the genetic link is
obscure. This may be because geneticists have been looking at the
wrong set of genes—the 23,000 rather than the 3m. For those 3m are
still inherited. They are largely picked up from your mother during
the messy process of birth. Though no clear example is yet known, it
is possible that particular disease-inducing strains are being passed
down the generations in this way.

As with all such upheavals, it is unclear where the microbiome
revolution will end up. Doctors and biologists may truly come to think
of people as superorganisms. Then again, they may not. What is clear,
though, is that turning thinking inside out in this way is yielding
new insights into seemingly intractable medical problems, and there is
a good chance cures will follow. Vive la révolution!

http://www.economist.com/node/21560559