In the latest issue of Mayo Clinic Proceedings, Mayo Clinic researchers reviewed the importance of the microbiome as a key component of personalized medicine to improve diagnosis, reduce disease risk and optimize early detection and treatment. The microbiome is the combined genetic material of the microorganisms in a particular environment.

“The ability to characterize the microbiome, which includes all the microbes that reside within and upon us and all their genetic elements, using next-generation sequencing, allows us to now incorporate this important contributor to human disease in developing new preventive and therapeutic strategies,” says Purna Kashyap, M.B.B.S., a Mayo Clinic gastroenterologist and lead author of the review.

Potential role of the microbiome in human disease

Here are some applications which highlight the role of the microbiome at the frontier of personalized medicine:

• Microbial fingerprints could serve as precise, noninvasive, accessible and economical tools that could be used for personalized disease diagnosis, including phenotypes (observable physical characteristics of an individual) severity and prognosis.
• The role of the microbiome in the metabolism of many chemical compounds makes it a key player in determining drug availability, effectiveness and harmfulness. This could be indispensable for developing personalized drug therapies.
• The ability to change the microbiome makes it appealing in developing personalized treatment approaches targeting specific microbial pathways tailored to an individual’s microbiota. This may help development of treatments for disorders such as inflammatory bowel disease, obesity and diabetes.
• Other possibilities include altering the microbiome by using genetic engineering approaches, next-generation prebiotics selectively fermented by gut microbes that confer a health benefit, personalized dietary therapies such as microbiome markers to optimize dietary interventions, and changing the diet based on the microbiome.

A current challenge is how to collect, sequence and analyze microbiomes in a standardized way so results are consistent and reproducible.

According to Dr. Kashyap most current studies are based on disease association. Researchers need to define the mechanisms by which microbiota influence aspects of human disease to develop more reliable biomarkers.

More research is needed to appreciate the contribution of other microorganisms, such as fungi, bacteriophages and parasites. Unraveling aspects of these complex interactions will spur development of more robust strategies to address the impact of microbiome on the host.

Microbiomes are changeable therefore microbiome-based dietary interventions are complicated. Beneficial dietary interventions can be developed based on an individual's microbiome, however, the intervention could change the microbiome itself. Therefore, understanding the diet-microbiome interaction requires systematic prediction of many individual variables.

“These challenges apart, the incorporation of microbiome-based diagnostics and therapeutics with other components of precision medicine, such as pharmacogenomics and epigenomics, will be an integral part of the new era in patient care," says Dr. Kashyap. "This integration will further enhance our ability to find the precise treatments for patient care."

This review is an example of Mayo Clinic's Model of Research which is dedicated to addressing unmet patient needs by continuously transforming the practice of medicine that improves care for patients all over the world.

This work was supported in part by National Institutes of Health grants R01 DK114007 and R03 DK111850.