A bélmikrobiom-vizsgálat előnyei a klinikai gyakorlatban

Why are nutrition professionals in the best position to take advantage of detailed information on the gut microbiome in their clinic?

Each person has a unique gut microbiome. There is growing evidence linking the organisms that live in our gut to different states of health and disease, and now is an ideal time to gain a deeper understanding of these connections.

For a healthcare professional, being able to help patients using personalised methods is crucial; and delving into their unique microbiome can be a valuable tool for clinical practice.

What can a gut microbiome tell us?

The analysis of the gut microbiome using metagenomic sequencing delivers detailed knowledge that allows healthcare professionals to assess, improve, and monitor their patients' gut health.

• Assess the gut, to understand the patient's current status and see what problems they are facing
• Improve gut health through personalised diet and lifestyle changes to nourish beneficial microbes specific to the patient's gut
• Monitor the gut microbiome to ensure the patient follows the guidelines and achieves the stablished objectives

This translates into a more efficient clinical practice to make evidence-based choices and move forward with certainty.

Why is metagenomics the best choice for gut microbiome testing?

There are many types of stool tests for different aspects of gut health. For example, screening for bowel cancer (which detects haemoglobin from blood in stool) or tests that look for specific bacteria or parasites (such as pathogen screening or microscopic examinations). These tests use methods that provide specific answers but do not take into account the microbiome as a whole.

Current research indicates that a patient's gut health should be assessed by looking at the microbial population as a whole rather than aiming for a subgroup of select organisms.

Microbiome tests aim to observe the community of bacteria living in the gut microbiome and predict their function. This is done using DNA sequencing. There are currently two main types of DNA sequencing analysis: 16S sequencing and shotgun metagenomic sequencing.

16S sequencing analyses a small portion of a single gene found within bacteria and tries to predict the types of bacteria that might be present. This region is 10,000 times smaller than the entire bacterial genome. The resolution achieved using such a small piece of DNA is limited, so the information is only about groups of bacteria present, and it is not a method capable of providing accurate information about the functions of any specific organism.

The best way to explore the gut microbiome is through metagenomic sequencing, as this analyses the entire DNA of the microorganism.
Metagenomic analysis sequences all the genetic information present in a sample, providing a high-resolution view of the gut microbiome, with detailed information about which bacteria live in a person's gut (species), what they are capable of doing (metabolic potential) and what kinds of foods those bacteria need for energy (prebiotics). In addition, it can provide information on the connection of these elements to other major organs of the body and to health. Healthcare professionals are encouraged to use this information in their daily practice together with their clinical competency to create a plan to improve their patient’s overall health.

What is the value of this type of analysis in the clinic?

Today, doctors can use gut microbiome analysis in their practices to help their patients with evidence-based solutions to improve their gut health. There are many details in a metagenomic report that can help in clinical decision-making, from examining the metabolites produced by the patient's microbiome to checking which prebiotics will be best to feed the good bacteria in their gut.

Some examples of details from the report that may be useful in consultation:

• Diversity level of the gut microbiome - the level of diversity is important and can show overgrowth of some bacteria. Clinicians can use this information to make dietary interventions or suggest a more varied diet to increase microbial diversity.
• Abundance of human DNA - normally, little or no human DNA is found in stool. If /when found in excess it may indicate inflammation or serious gastrointestinal problems, which should prompt further investigation.
• Fibre digestion potential - the ability to digest fibre is associated with health, and a low ability may indicate the need for a change in diet.

Another key aspect of the myBIOME report is to understand the patient's ability to produce metabolites that influence their health. These metabolites can interact with our immune, metabolic and nervous systems and have been associated to numerous health problems. Some metabolites are beneficial to health, while others are harmful. Understanding the ability of a patient's gut microbiome to produce different metabolites can provide insights into how the gut microbiome might affect overall health.

The majority of metabolites produced by microorganisms in the gut are soluble and can be absorbed by intestinal cells where they can then enter a large blood vein (portal vein) that connects the intestinal cells to the liver. From the liver, the blood is distributed to the rest of the body entering they can affect numerous organs. Additionally, neurotransmitters produced by gut bacteria can travel through the vagus nerve directly to the brain and influence mood. Image inspired by: Sharon et al. 2014

Some examples of important metabolites from the myBIOME report:

• Butyrate – important Short Chain Fatty Acid (SCFA) necessary for gut cell function. Low butyrate production is considered unhealthy and can cause inflammation and other harmful effects. A low result calls for specific dietary changes, for example by increasing the intake of resistant starch, a precursor for butyrate production.
• Trimethylamine (TMA) – high levels are associated with cardiometabolic disease and may indicate an increased risk of disease and require dietary change.
• Lipopolysaccharide – this inflammatory compound is produced by some types of bacteria, causes systemic problems and its absorption is increased in the presence of saturated fats. A high level may signal the need for dietary change.

What can I do from here?

The information that can be obtained and used from a gut microbiome analysis is immense, but how do you maximise its value? The first step is to better understand the test and learn how to interpret the report. Any healthcare professional who enjoys the use of technology in their practice and wants to offer it to their patients can do it.

SYNLAB offers healthcare professionals interested in myBIOME an online course. Additionally, SYNLAB make available a Healthcare Support Team that can help you use the reports and analyse aspects of your patients' reports through personalized calls. There are also clinical resources for healthcare professionals to access support guides. The Healthcare Portal will be nurtured in the near future with videos, articles and blogs of interest.

How could gut microbiome analysis help in the practice?

‘Gut health’ is now constantly discussed around the world and there is a growing interest in how to get a healthy gut and what to eat to stay healthy on the inside. Now is the best time to capitalise on this interest and use a tool such as gut microbiome analysis to attract new clients and to improve the assistance to existing patients.

Ask SYNLAB how to use myBIOME analysis in your practice.

Note:

Sharon, G., Garg, N., Debelius, J., Knight, R., Dorrestein, P. C., & Mazmanian, S. K. (2014). Specialized metabolites from the microbiome in health and disease. Cell Metabolism, 20(5), 719–730. doi.org/10.1016/j.cmet.2014.10.016