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Microbiome for Pediatricians 2016

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Elisa Margolis

on 4 April 2018

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Transcript of Microbiome for Pediatricians 2016

which have already impacted newborn's risk for:
Modified from: Goldenberg et al. Obstet Gynecol 1996(85):656-660. & Leitich and Kiss. Best Pract Res Clin Obstet Gynecol 2007(21):375-390.
becoming familiar with your patient's 3 trillion bacteria
Microbiome for Pediatricians
Hype
how are you impacting
your patients microbiome?
Placenta has its own microbiome
issue: contamination
Responsible for Autism
what are some reasons that autistic children have different microbiomes?
hype:
particular microbiome associated with metabolic disease markers
Asthma
in
Apply to humans?
Turnbaugh. Nature 457, 480-484(22 January 2009)
Antibiotics
Jakobsson et al. PLoS ONE 5(3): e9836.
Probiotics
Fecal Transplant
23,000 genes
1,000,000+ genes
adopted from New Yorker 2012
only 40% have been cultivated

Ellie Margolis
emarg2@uw.edu
May 2016

hype:
bacteria on blood
Adapted from Amar et al. Diabetologia 2011 and
Rajendhandren et al. Int J Cardiol. 2013 Oct 12;168(5):5118-20
Aargard et al. Science Translational Medicine. 2014
prescribed more antibiotics
more GI problems
does fixing GI symptoms treat autism?
Yes! All of our behavior improves when we are not having GI discomfort
Niehus. J Dev Behv Ped 2006, 27(2)
Valicenti-McDermott et al. J Dev Behav Ped 2006 Apr;27(2)
Ileal Biopsy
Cecal Biopsy
Williams et al. PLoS One 2011; 6(9)
cell paper 2013:
Mice treated with probiotics whose autism improved

associations NOT equal to causality
could the same factors which cause those metabolic markers to be high lead to the distinct microbiome?
NEC
-entire field is preliminary
-proper controls (nothing is sterile)
-causality v association
-lack of mechanisms and mechanism testing
-mistaking symptom for disease etiology
train immune
system
Arnold et al. JCI 2011; 128(8):3088-93
metabolic
profile
Ley RE et al. Obesity alters gut microbial ecology. PNAS 2005; 102:11070–11075
influence labor & neonatal infections
Hyman et al. Reproductive Sci 2014; 21(1): 32-40
protect against
pathogens
Pettigrew et al. Appl Envrion Microbiol 2012; 78(17):6262-70
Hyman et al. Reproductive Sci 2014; 21(1): 32-40
Ley RE et al. Obesity alters gut microbial ecology. PNAS 2005; 102:11070–11075
very efficient/
competitive advantage
with simple sugars
can transfer to
germ free mice
Firmicutes
Bacteroidetes
Fecal Transplant
as of today, approx 30 children in the US received for c. diff (youngest 18 months), and 50 for UC/CD (7-21 yo) however there are more than 15 clinical trials focusing on pediatric IBD recruiting
donor (tested for good community, communicable diseases)
stool into tupperware
prepared in biosafety hood:
mixed w/ skim milk, particulate filter
placed by ND (Europe) or Colonoscopy (US)
1958 first fecal transplant for c. diff
Nod et al. NEJM Jan 31, 2013
hyped as treatment for:
inflammatory bowel disease
type 2 DM/metabolic syndrome
Colic
FTT/malnutrition
@home: instructions on the web
mice allergen sensitized and infected as neonates w/ h pylori- less airway responsiveness or airway inflammation than uninfected sensitized or antibiotic treated - mediated by T cells
Arnold et al. JCI 2011; 121(8):3088-3093
within minutes of vaginal delivery,
newborns body is coated in mother's vaginal bacteria
new
rn
ch
en
d
teen
Ferrer et al. Environmental Microbiology 2012 15(1):211-226
Bacteroidetes
Firmicutes
Bacteroidetes
Firmicutes
Adolescent
Adolescent
Turnbaugh et al. Nature 444, 1027-131(21 December 2006)
D'Onofrio et al. Chemistry & Biology 17, 254-64, March 2010
bacteria on washed sand
hype:
Microbiome
is the fix modifying the microbiome? or is the microbiome just another symptom of the disease
MAJOR caveat:
murine models still have some way to go to 'mimic' the complexity that is autism and its comorbidities
Hsaio et al. Cell Volume 155, Issue 7, p1451–1463, 19 December 2013
Far away from the lungs in the stomach:
True in humans?
obesity
Behavioral Difficulties
Failure to Thrive
Malnutrition
Diabetes
Graft v Host
Colic
IBD
One RCT, 64 Bolivian hospitalized children
1 to 23 months with rotavirus had reduced duration of diarrhea (median 60 v 84.5 hours) not statistically significant (p value=0.06) with some unspecified strains of L acidophilus, L rhamnosus, B longum and S boulardii
Grandy et al. BMC Infect Dis 2010; 10:253
Szajewska et al.
Process
?
Why is there so much
DNA extraction
Sample
broad
range
sort
classify
blast
phyla NOT EQUAL to particular bacteria species
Kissing: microbial detector for partner compatibility
from NYtimes
My
Preliminary
Data
* if you know anyone who is pregnant who would like to know this about their baby tell them about my study
starts
probiotics
antibiotics
first solids:
oatmeal
Switched
Cow Milk
if you need another reason not
to prescribe anitbiotics for viral cold...
mice treated with anitbiotics had reduced
immune response to influenza
Ichinohe T, Pang IK, Kumamoto Y, Peaper DR, Ho JH, Murray TS, & Iwasaki A (2011). Microbiota regulates immune defense against respiratory tract influenza A virus infection. Proceedings of the National Academy of Sciences of the United States of America, 108 (13), 5354-9 PMID: 21402903
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