The Future of Microbiome Medicine – An Editor’s Perspective

The microbiome field continues to grow at an exponential rate with sophisticated approaches that are pushing the frontiers of science and translating fast into clinical practice. The past year has witnessed sustained progress in microbiome research with a shift towards high quality mechanistic studies, Artificial Intelligence-Machine Learning approaches and clinical trials with microbiome therapeutics. However, there are TWO fundamental areas of research that have lagged behind and are in desperate need of resolution. The first is the comprehensive characterisation of the so-called “healthy microbiome”, and the second is the establishment of robust longitudinal clinical studies where the starting point, or baseline state, predates the development of the disease or condition. The advances in microbiome science over the past year are too numerous to mention and this lecture will offer an update on the most exciting stories so far! One particular area that has seen exciting recent progress is the greater understanding of the impact of diet on the microbiome and vice versa. A key publication has explored the signatures of vegan, vegetarian and omnivore diets and their relationships to health outcomes. This work reinforces how humans can shape their own gut microbiomes, and by extension their health, directly through simple dietary choices as well as more indirectly through agricultural and food production practices. Other work has shown how microbial transformation of dietary xenobiotics shapes the gut microbiome composition and explains why the same dietary compounds can have different effects on the microbiomes of different individuals. More work has looked at how the cardiometabolic benefits of certain diets (e.g., non-industrialised diets and African Heritage diets) are linked to microbiome modulation. The finding that species from the Oscillibacter genus are associated with decreased faecal and plasma cholesterol levels is noteworthy and offers the prospect of potential benefits for lipid homeostasis and cardiovascular, renal and metabolic health. This is the more exciting with the very recent discovery of the hormone Cholesin, which is capable of inhibiting cholesterol synthesis in the liver, leading to a reduction in circulating cholesterol levels. The lecture will also discuss recent advances in microbiome therapeutics and will conclude by discussing some of the recent guidelines related to microbiome research (e.g., establishing causality, use of pre-clinical models and therapeutic applications), development of live biotherapeutic products and microbiome testing in clinical practice. Finally, we will lay out a vision for the future of how microbiome medicine could be integrated into routine clinical practice.