How can we manipulate the human gut microbiota to affect host metabolism? Group 3

Transcription

1 How can we manipulate the human gut microbiota to affect host metabolism? Group 3

2 Patrice Cani Prebiotics and metabolism in humans Michiel Kleerebezem Lactobacillus and metabolism in humans Sarah O'Flaherty Genetically modified Lactobacillus Liping Zhao Traditional Chinese medicine in metabolic disease. Does it work by altering the gut microbiota? Max Nieuwdorp Fecal transplants in humans demonstrate a therapeutic role for the microbiota in type 2 diabetes. Carel le Roux/Fredrik B Are the positive effects from bariatric surgery mediated by altered gut microbiota Harry Flint Isolation of novel probiotics

3 The prebiotic effect: Revised and corrected? Prebiotics MORE THAN 100 TAXA MODIFIED 16 of them more than 10 Fold

4 EM. Dewulf, PD Cani $, SP Claus $, S Fuentes, PGB Puylaert, AM Neyrinck, LB Bindels, WM de Vos, GR Gibson, JP Thissen, NM Delzenne Prebiotics specifically changes gut microbiota in obese subjects correlated with metabolic outputs Before After Lactobacillus spp. Faecalibacterium prausnitzii Clostridium cluster XVI Bifidobacterium spp. GUT IN PRESS

5 Michiel Kleerebezem Probiotic impact on plasma lipid profile 13 studies Differences in: Strains Dosage Intake regime..

6 Michiel Kleerebezem Probiotic impact on plasma lipid profile Effect dominated by LDL cholesterol No effect on HDL cholesterol Mixed effects on triglycerides Population dependent; cholesterol levels at the start of the trial?

7 Michiel Kleerebezem Nutrigenomic analysis of probiotic effects in humans 6 HOUR ORAL INTAKE PROBIOTIC STUDY Healthy human volunteers, all males (n=8) 4 interventions, randomized, placebo-controlled double-blind, cross-over design. 2 week wash-out Probiotic consumption Biopsy duodenum RNA analysis 6 hour intake regime (every 30 min a probiotic drink) L. acidophilus Lafti-L10 (DSM, the Netherlands), L. casei CRL-431 (Chr. Hansen, Denmark), and L. rhamnosus GG (Valio, Finland) L. plantarum WCFS1 (log-, stat-, dead-stat) Reconstituted freeze dried bacterial preparations in maltodextrin suspension (placebo = no bacteria) Van Baarlen et al. PNAS, 2009; 2011

8 Michiel Kleerebezem L. acidophilus modulation of cholesterol metabolism

9 (Mohamadzadeh et al., Klaenhammer, PNAS, 2011) Sarah O'Flaherty DSS-induced colitis: Pre-feeding with L. acidophilus LTA deficient mutant Untreated DSS treated WT+DSS treated NCK2025+DSS treated NCK2025 = LTA - mutant NCK56 = Wild type

10 (Mohamadzadeh et al., Klaenhammer, PNAS, 2012) Sarah O'Flaherty Abating colon cancer polyposis- L. acidophilus LTA deficient mutant Colon Polyps Untreated NCK2025 (LTA - )

11 Liping Zhao Berberine: a compound from TCM herb Coptis Berberis Berberine for bacterial diarrhea

12 Liping Zhao Efficacy on metabolic diseases Berbeine shows beneficial effects on metabolic syndrome by modulation of glucose and lipid metabolism.

13 Liping Zhao Paradox: high performance, but low bioavailability Concentration needed for in vitro activity AMPK activation: 5 μg/ml (Lee et al., 2006) Upregulation of LDLR: > 2.5 μg/ml (Kong et al, 2004) Induction of glycolysis: 1.68 μg/ml (Yin et al., 2009) Anti-inflammatory: 10 μg/ml (Jiang et al., 2010) Plasma concentration (Cmax) Human (i.g. 0.4g BBR): 0.4 ng/ml (Hua et al., 2007) Rat (i.g. 100mg/kg BBR): 4 ng/ml (Liu et al., 2009) Total oral bioavailability in rats: 0.36% (Liu et al., 2010).

14 Changes in body weight and adiposity index Adiposity index was calculated as epididymal and perirenal fat pad weights per 100 gram of body weight

15 Key phylotypes responding to berberine treatment Berberine-mediated modulation of gut microbiota may help decrease the antigen load to the host 175 out of the 268 identified key OTUs were eliminated or decreased.

16 Max Nieuwdorp Procedure Duodenal tube (gastroduodenoscopy/core track) Bowel lavage with cetomacrogol (4-6 h) Infusion faeces (healthy screened donors)

17 Max Nieuwdorp Allogenic gut microbiota infusion (n=9) Hyperinsulinemic clamp Small intestinal biopsies Fecal gut microbiota composition Exposes both small and large intestine! Autologous gut microbiota infusion (n=9) Hyperinsulinemic clamp Small intestinal biopsies Fecal gut microbiota composition Randomisation Baseline 6 weeks

18 Max Nieuwdorp Effect donor faeces on periferal insulin sensitivity A.Vrieze, Gastroenterology 2012

19 Small intestinal biopsies before and after lean donor feces A.Vrieze, Gastroenterology 2012

20 Carel le Roux/Fredrik Backhed Composition of the fecal microbiota VBG CTR GBP Simulated p-value: d = 0.5 Faecalibacterium prausnitzii Ruminococcus sp. 5_1_39BFAA Eubacterium rectale Alistipes putredinis Bacteroides sp. D20 Eubacterium hallii Ruminococcus obeum Bacteroides sp. 4_1_36 Bacteroides dorei Bifidobacterium adolescentis Ruminococcus sp. Bacteroides uniformis Dorea longicatena Ruminococcus torques Bacteroides sp. 4_3_47FAA Collinsella aerofaciens Bacteroides sp. 3_1_40A Ruminococcus bromii Dorea formicigenerans Roseburia intestinalis Roseburia inulinivorans Parabacteroides merdae Bacteroides sp. 9_1_42FAA Eubacterium siraeum Escherichia coli Coprococcus comes Ruminococcaceae bacterium D16 Phascolarctobacterium sp. YIT Alistipes shahii Bacteroides sp. 3_1_33FAA Relative abundance log 10

21 Basal RQ Carel le Roux/Fredrik Backhed Transplantation into germ-free mice 90 RQ for lowest VO * 70 GBP VBG Control obese GF Fat metabolism

22 Fat gain (%, d14-d1) Carel le Roux/Fredrik Backhed GBP microbiota cause reduced adiposity in ex-gf mice 4 Fat gain 3 2 ** * 1 0 GBP VBG obese ctr

23 Harry Flint Isolation of novel probiotics Specific metabolic transformation (eg. degradation of oxalate, cholesterol, lactate utilization) Supply of specific metabolites (eg. propionate, butyrate) Suppression of pathogens Regulation of host physiology (eg. fat metabolism, insulin response, immune signalling)

24 Harry Flint Approaches for recovering new bacterial diversity (examples) Targeted isolation (using molecular probes/primers) of under-represented phylogenetic groups. Targeted isolation of particular functional groups selective media, enrichment cultures, molecular screening methods. Adhesion properties eg. culturing of particle-associated bacteria, antibody binding. Different sources (gut samples rather than faecal samples, volunteers from different regions/ dietary habits). High-tech approaches eg. micromanipulation, Facs-sorting, high throughput screening Devise selective strain isolation procedures for species considered to have probiotic potential

25 Questions to address 1. What is the evidence in humans for altered gut microbiota in metabolic disease? 2. Is anything known about mechanisms in humans? 3. Which diseases are suitable for microbial interventions? 4. Will traditional pre- and/or probiotics work to treat metabolic diseases or do we need to isolate new ones?

26 1. What is the evidence in humans for altered gut microbiota in metabolic disease? Limited. Conclusions based on few studies. However, prebiotic, probiotic and fecal transplants suggest a potential application. Additional studies needed. LPS/LBP increase in patients with obesity and type 2 diabetes

27 2. Is anything known about mechanisms in humans? Only associations from few pre- and probiotic studies. Potentially hepatic insulin resistance (Vrieze)? Butyrate production?

28 3. Which diseases are suitable for microbiotatargeted interventions? Potentially all. Potentially group obesity, diabetes, and CVD under metabolic syndrome in order not to confuse the public by suggesting that the microbiota is the cause of all diseases.

29 4. Will traditional pre- and/or probiotics work to treat metabolic diseases or do we need to isolate new ones? Further evaluate existing pre- and probiotics and establish mode of action. Traditional prebiotics to identify potential beneficial microbes (e.g. F. prau and Akkermansia) for development of novel probiotics. Berberine might be a new prebiotic. Fecal transplants and gastric bypass stool samples may constitute new sources of probiotics.

30 What is needed? Biomarkers (health and disease) based on host and microbiota. Stratification and phenotyping of individuals. Number needed to benefit. Endpoints vs biomarkers (US vs EU). Focus on one succesful case to prove importance of microbiota in one pathology. Move from association to causality. Standardization of microbiome study design and protocols.

31 Delivery of probiotics? cultures? food products? capsules (oral/ rectal) spores?

32 Perfect experiment Identify and apply pro- and/or prebiotics that prevent and/or treat disease. Proof of causality in humans. Experiments to identify mechanisms. Large prospective population based study. Preferentially individuals (twins?) followed from birth.