Microbiome discovery

[Rando21]

“The balance between bacterial communities in the gut affects the likelihood of a positive response to drugs called checkpoint inhibitors.”

nature.com/articles/d41586-...

[AussieNeil Partner Administrator]

It's not only checkpoint inhibitor drugs that are affected by our gut microbiome, this effect has been observed with other chemo drugs.

With respect to CLL treatment with checkpoint inhibitor therapy, the anticipated effectiveness from that seen in other cancers is yet to be realised. I suspect that's due to the way CLL adversely impacts different aspects of our immune system, in particular how it drives our T cells to exhaustion.

Neil

[LeoPa]

This sounds like expensive woodoo to me. Why do they keep mentioning the colon? The gut is the small intestine. If colon bacteria get up into the small intestine they can cause big problems. The small intestine should be pretty much hosting only symbiotic good bacteria. If it hosts anything else it should be investigated why it does so. Low stomach acid comes to mind as one of the possible reasons. Perhaps made worse by taking proton pump inhibitors. So my simplistic way of thinking about this is that they should not be comparing a random set of peoples eating all kinds of diets and trying to figure out things so complex that they probably will never be figured out. It would be way easier to take a bunch of fanatics from left to right on the spectrum. Starting with raw vegans and ending up with strict carnivores. Then compare the state of their gut and colon microbiome. And see which group responds better to immunotherapies. Because changing our diet is the only thing we can do to change our gut and colon microbiome and it costs nothing either! Because no matter what we do we have to eat something! Now I would be very interested in the result of such a study but I would bet the house that it's not coming anytime soon 🥲

[SeymourB in reply to LeoPa]

LeoPa -

The famous C. diff study used duodenal (beginning of the small intestine) infusion of the fecal sample:

nejm.org/doi/10.1056/NEJMoa...

Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile

Published January 31, 2013. N Engl J Med 2013;368:407-415

Bacteria imbalance in the small intestine is indeed a potential problem, but in practice, I think screening prevents problems. That said, I'm not sure that fecal transplant is a good mainstream idea for immune compromised or surpressed.

This study tried to look for post-transplant GI diagnoses and changes, and didn't find many.

ncbi.nlm.nih.gov/pmc/articl...

Long-Term Efficacy and Safety of Fecal Microbiota Transplantation for C. difficile Infections Across Academic and Private Clinical Settings

J Clin Gastroenterol. 2023 Nov-Dec; 57(10): 1024–1030.

=seymour=

[LeoPa in reply to SeymourB]

I read good things about fecal transplants but unless the recipient changes his diet to reflect the diet of the donor the effect would be temporary I think. There's a reason to why someone needs the transplant and someone else can provide it. Both are diet related IMO. I didn't know that they tried to cure c. Diff infections with fecal transplants. I knew about Crohn's and other large intestine problems treated with it