Every day I learn more about the influences of our "external organ": our microbiome inside and outside of our body'. These ± 1,5 kilogram of micro organisms are more important than most of us knows. And there is still a lot to learn about this living not human organ. Therefore I was very happy that I could join the 5th Microbiome R&D Forum which this year took place in the World Trade Center in the centre of Rotterdam. Last year I was lucky to visit the same Forum in Amsterdam, and again I was able to meet an interesting group of people, most researchers and scientists from all over the world, and the rooms were filled with plenty of international microbes in the air. I listened to interesting scientific lectures about new insights of our human gut and skin microbiome in relation to health and disease, research information and the newest developments about probiotics for human health. I am a skin therapist and editor for the Dutch Journal for Skin Therapy (NTVH) in the Netherlands and therefore I was especially interested in the lectures about skin microbes and I also enjoyed to listen to other subjects. In this blog I want to share some of my insights during this Forum. 1: Cutibacterium acnes (P. acnes) not such a bad ‘guy’ as we thought? Acne vulgaris is a common inflammatoir skin disease and the Propionibacterium acnes is still supposed to be responsible for this disease. The P. acnes, has received a new name: the Cutibacterium acnes (C. acnes) and maybe this new name can give this bacteria some more credits as it has more benefits than most of us know. There are new insights which makes the role of this bacteria different and clearly not only pathological. This anaerobe commensal skin microbe is able to produce antioxidants, especially because the bacteria doesn’t like oxygen itself. And these antioxidants might benefit the humans as well. And there are about 90 strains of C. acnes, which are not all responsable for causing diseases. More kinds of strains of C. acnes live together in niches of individuals (Scholz et al, 2016). The C. acnes plays an important role in sebum and skin hydration. Using antibiotics not only inhibits and kills the pathogene C. acnes strains but also the ‘good strains’ and also reduces the overall human skin microbiome. Therefore in this lecture Dr. Bernhard Pätzold (S-Biomedic) surprised us about the world of C. acnes strains and the good and bad side of these microbe. For me the take home message was: C. acnes is definitely not as bad as they learned me on school years ago, and just trying to kill all C. acnes strains is not the way to heal acne vulgaris as it doesn’t solve the real problem and causes even more other problems instead. 2: Food allergy and the use of probiotic therapy
In the USA there are about 15 million people who suffer from food allergy, and in every school class there are at least 2 children with food allergy. This might lead to diseases like anaphylactic shock (for example by peanut), airway conditions like astma, mucosal (allergic rhinitis) or skin diseases like allergic dermatitis AD. In case of peanut the Tolllike receptor TLR-4 signaling plays an important role, and this TLR-4 is triggered by commensal flora. A changed microbiome goes together with more risk for foodallergy. There are many factors which plays a role in changing the human microbiome, like the use of antibiotics AB, the Western diet, enteropathogenic H. pylori, vaccinations, the way of delivery (vaginally or via caesarean section CS), breastfeeding, Helminths etc. Even the consumption of meat can change our microbiome because of the use of AB in meat industry. A mouse study showed that using AB for 7 days, it changes the gut microbiome in ileum (the part where food is absorbed) and there was a decrease of bacteria, specially Firmicutes. Clostridia, one of the 2 dominant bacteria in mouse, protects the intestinal mucosa permeability by upgrading the expression of the cytokine IL-22, which helps preventing food allergy responses. The conclusion of Prof. dr. Cathryn Nagler (University of Chicago USA): after using AB: take care of increasing IL-22 and/or supply more Clostridium to help restore the gut microbiome. People with cow milk allergy have a less diverse composition of the gut microbiota (Bifido's, Lacto's, Entero's) and using the probiotic bacteria Lactobacillus GG during 12 months can benefit. Therefore healthy microbes can protect against food allergy. 3: The many benefits of Lactobacillus rhamnosus LGG
Long time ago, in 1908, researcher and Nobel Prize winner Elie Metchnikoff, already discovered the benefits of the Lactobacillus rhamnosus, and this knowledge was later used to produce commercial healthy drinks like Yakult, Activa, which contain strains of Lacto’s and Bifido’s. A lot of research has been done on the Lactobacillus rhamnosus LGG (among children and adults) and there is strong evidence that this bacteria is protecting against infections. They produce pili to attach to the gut mucosa and presumably they help bacteria to colonize. It is benefit in preventing infections and allergic diseases and even preventing preterm birth. There are cases that report a 100% recovery from peanut allergy by using this L. rhamnosus LGG. Johan van Hylckama Vlieg (Austria) describes the enormous increase in drug development using this bacteria, not only in medication, but also in probiotics, food and cosmetics. But his take away message is: “simply just adding ‘some’ microbes may not be enough!”
4: Alcohol abuse causing liver cirrhosis: even our microbes don’t like it!
Dr. Angela Horvath (University of Graz, Austria) takes us early in the morning in the world of alcohol abuse and liver cirrhosis, due to this abuse. Liver cirrhosis has consequences for the gut microbiome. The gut shows a decrease of diversity of microbiota, and there are not only quantitative changes, even qualitative changes has been reported in oral and gut: the so called dysbioses of the microbiome. In the small intestinal there is an overgrowth of bacteria. The immune system responds to this overgrowth with an increase of inflammation and disturbed tight junctions (TJs). The liver responds on these inflammations and this creates a vicious circle. Due to the disturbed and weakened TJs – leaky gut – more bacteria and their by-products can pass through the intestinal wall and trigger the immune system by the presence of endotoxins in the blood. This endotoxemia can be reduced in liver cirrhosis by using specific probiotics for at least 6 months which will upregulate the IL-10 expression. Probiotic therapy used by patients with liver cirrhosis, improves the immune system, it upregulates the expression of AMP strategy, improves neutrophils and liver function. The quality of life improved remarkably and maybe this has to do with a better dopamine production. The probiotics used in this research where Lactobacillus lactis and Lactobacillus brevis and E. faecium. Beta blockers and proton pomp inhibitors, medications commonly used for treating liver cirrhosis, contribute to exacerbation of gut inflammation and a decrease of gut microbiota. Therefore it might be interesting in changing therapy by using harmless and yet effective probiotics.
5: Psosiasis and gut: what’s their connection? The inflammatoir skin disease psoriasis is an immune mediated disease, according to dr. John Zibert (Den mark), and 2% of the people worldwide suffers from this chronic disease, it effects more Caucasian and less African, Afro-American and Asian people. About 65% of the patients have a mild form of psoriasis, and many patients have gastro-intestinal diseases like Crohn, ulcer colitis are common, about 10% of psoriasis patients suffer from Irritable Bowel Disease (IBD). IL-23 plays a key role in the pathogenesis of psoriasis by increasing inflammation. Both innate and adaptive immune system are involved and one specific key in the pathogenesis is an increased production of antimicrobial peptides AMPs and S-100 what leads to increased inflammation. The microbiome of the skin is different than compared to healthy skin. There is a cross-talk between gut- and skin microbiota. IBD gut microbiome has a changed composition with less Faecalibacterium prausnitzii and an increase of E. coli, which is also seen at psoriasis gut microbiome. Dr. Zibert suggests that IBD therapy might be a good alternative in treating psoriasis. A mediterranean diet might help in decreasing inflammation, even in psoriasis. 6: Gut-skin axis in health and probiotic therapy Atopic dermatitis AD is an inflammatoir allergic skin disease and changes in fillagrin is one of the main causes of AD. But this is not the only cause, according to dr. Cath O’Neil, dermatologist (Manchester UK). She explained about the Gut-Skin Axis and the influence of the gut and their microbiome in health and diseases of the skin. Not only oral probiotics can be used as therapy for skin diseases, but also local probiotics, for example to inhibit S. aureus infections, to improve tight junctions and wound healing. More research is still required.
After listening to so much information and writing it down for my blog, I went home with many thoughts in my mind. Therefore on my way home it was nice to give my brains some rest, and I gave them some healthy ‘food for thoughts’ by enjoying a nice healthy snack. My gut started to cooperate with my mind and made me feel satisfied and relaxed. If I wasn't already convinced about the existance of the brain-gut-axis , than it was definitely clear after this congres. When I again realised how we are constantly in mutual action with our microbes, it made me humble and during this philosophic thought I felt goosbumps as a sign of another axis: the brain-skin(-gut) axis! And my gut feeling says this is an issue absolutely worth writing and learning about more! To be continued!
And for now I wish you all the best and a healthy happy skin and gut microbiome. Marcelline Goyen, Skin therapist BHS, editor NTVH and gut therapist
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"Een gezonde huid van buiten en van binnenuit!"
Marcelline Goyen