Trends in Microbiology
Volume 19, Issue 9, September 2011, Pages 427-434
Journal home page for Trends in Microbiology

Opinion
Investigating the biological and clinical significance of human dysbioses

https://doi.org/10.1016/j.tim.2011.06.005Get rights and content

Culture-independent microbiological technologies that interrogate complex microbial populations without prior axenic culture, coupled with high-throughput DNA sequencing, have revolutionized the scale, speed and economics of microbial ecological studies. Their application to the medical realm has led to a highly productive merger of clinical, experimental and environmental microbiology. The functional roles played by members of the human microbiota are being actively explored through experimental manipulation of animal model systems and studies of human populations. In concert, these studies have appreciably expanded our understanding of the composition and dynamics of human-associated microbial communities (microbiota). Of note, several human diseases have been linked to alterations in the composition of resident microbial communities, so-called dysbiosis. However, how changes in microbial communities contribute to disease etiology remains poorly defined. Correlation of microbial composition represents integration of only two datasets (phenotype and microbial composition). This article explores strategies for merging the human microbiome data with multiple additional datasets (e.g. host single nucleotide polymorphisms and host gene expression) and for integrating patient-based data with results from experimental animal models to gain deeper understanding of how host–microbe interactions impact disease.

Section snippets

Dysbiosis and disease etiology

Human-associated microbial communities, particularly those of the gastrointestinal (GI) tract, provide myriad beneficial services. For instance, gut microbes transform otherwise indigestible plant polysaccharides into absorbable short chain fatty acids (SCFAs) [1] and participate in the development and maintenance of immune homeostasis 2, 3. Disruption of any of these mutualistic relationships through shifts in microbial community composition (i.e. dysbiosis [4]) could compromise human health

Coherence: integration of the microbiome and human genomics/post-genomic data

Determining whether enteric dysbiosis modifies the incidence and progression of IBD will require integration and correlation of large-scale surveys of microbial communities with rigorously characterized human genotypes and molecular phenotypes (microarray data, proteomic data and histologic imaging data) in both Crohn's disease and non-Crohn's disease cohorts (Figure 2). Moreover, collection of a very large number of well phenotyped clinical specimens is necessary to accurately link potentially

Experimental support: human interventions and animal models

The strongest evidence that dysbiosis contributes to human disease could be obtained through double-blind, randomized controlled experiments with agents that normalize dysbiotic profiles in individuals with disease or create dysbiosis in normal individuals. Under these conditions, the causal relations between exposure to dysbiosis and subsequent development of pathology can then be defined. However, ethical and practical considerations (how to artificially create a dysbiosis that precisely

Temporality: modeling causal relationships in a systems biological framework

In addition to experimental animal and human microbial manipulation approaches, longitudinal observational studies represent a crucial means of assessing the causal relationship between dysbiosis and disease occurrence. In principle, these studies would determine whether a particular exposure (e.g. alterations in microbiota) precedes development of overt disease. Despite their clear utility, few if any such trials have been conducted to date, although technological innovations in studying human

Concluding remarks and future directions

Rather than discovering exotic new pathogens, the application of microbial metagenomics to human health has instead provided compelling, although not conclusive, evidence that disruption of host–microbe mutualism might be central to a variety of pathologies. In these cases microbial communities, not individual parasitic microorganisms, could play the role of pathogen [96]. However, other than in exceptional cases we are not likely to observe disease-associated dysbioses that neatly satisfy all

Acknowledgments

This work was supported by Mucosal and Vaccine Research Colorado (D.N.F.), Crohn's and Colitis Foundation of America (R.B.S. and E.L.), Helmsley Foundation (R.B.S.) and National Institutes of Health grants HG005964 (D.N.F.), DK053347 (R.B.S.), RR018603 (R.B.S.), DK034987 (R.B.S.) and HD059527 (E.L.). We thank Norman R. Pace for his conception of the microbial community as potential pathogen and Gail Teitzel for her editorial insight.

References (96)

  • H.J. Flint

    Polysaccharide utilization by gut bacteria: potential for new insights from genomic analysis

    Nat. Rev. Microbiol.

    (2008)
  • L.V. Hooper et al.

    Immune adaptations that maintain homeostasis with the intestinal microbiota

    Nat. Rev. Immunol.

    (2010)
  • J.L. Round et al.

    The gut microbiota shapes intestinal immune responses during health and disease

    Nat. Rev. Immunol.

    (2009)
  • C.P. Tamboli

    Dysbiosis in inflammatory bowel disease

    Gut

    (2004)
  • V.B. Young et al.

    Antibiotic-associated diarrhea accompanied by large-scale alterations in the composition of the fecal microbiota

    J. Clin. Microbiol.

    (2004)
  • J.Y. Chang

    Decreased diversity of the fecal microbiome in recurrent Clostridium difficile-associated diarrhea

    J. Infect. Dis.

    (2008)
  • D.N. Fredricks

    Molecular identification of bacteria associated with bacterial vaginosis

    N. Engl. J. Med.

    (2005)
  • B.B. Oakley

    Diversity of human vaginal bacterial communities and associations with clinically defined bacterial vaginosis

    Appl. Environ. Microbiol.

    (2008)
  • J. Ravel

    Vaginal microbiome of reproductive-age women

    Proc. Natl. Acad. Sci. U.S.A.

    (2011)
  • G. De Palma

    Intestinal dysbiosis and reduced immunoglobulin-coated bacteria associated with coeliac disease in children

    BMC Microbiol.

    (2011)
  • P.D. Scanlan

    Culture-independent analysis of the gut microbiota in colorectal cancer and polyposis

    Environ. Microbiol.

    (2008)
  • I. Sobhani

    Microbial dysbiosis in colorectal cancer (CRC) patients

    PLoS One

    (2011)
  • J.K. Harris

    Molecular identification of bacteria in bronchoalveolar lavage fluid from children with cystic fibrosis

    Proc. Natl. Acad. Sci. U.S.A.

    (2007)
  • C.J. van der Gast

    Partitioning core and satellite taxa from within cystic fibrosis lung bacterial communities

    ISME J.

    (2011)
  • Z. Pei

    Bacterial biota in reflux esophagitis and Barrett's esophagus

    World J. Gastroenterol.

    (2005)
  • D.N. Frank

    Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases

    Proc. Natl. Acad. Sci. U.S.A.

    (2007)
  • H. Sokol

    Analysis of bacterial bowel communities of IBD patients: What has it revealed?

    Inflamm. Bowel Dis.

    (2008)
  • C.D. Packey et al.

    Commensal bacteria, traditional and opportunistic pathogens, dysbiosis and bacterial killing in inflammatory bowel diseases

    Curr. Opin. Infect. Dis.

    (2009)
  • J. Qin

    A human gut microbial gene catalogue established by metagenomic sequencing

    Nature

    (2010)
  • B. Willing

    Twin studies reveal specific imbalances in the mucosa-associated microbiota of patients with ileal Crohn's disease

    Inflamm. Bowel Dis.

    (2009)
  • B.P. Willing

    A pyrosequencing study in twins shows that gastrointestinal microbial profiles vary with inflammatory bowel disease phenotypes

    Gastroenterology

    (2010)
  • D.N. Frank

    Disease phenotype and genotype are associated with shifts in intestinal-associated microbiota in inflammatory bowel diseases

    Inflamm. Bowel Dis.

    (2011)
  • A. Kassinen

    The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects

    Gastroenterology

    (2007)
  • E. Malinen

    Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR

    Am. J. Gastroenterol.

    (2005)
  • J. Matto

    Composition and temporal stability of gastrointestinal microbiota in irritable bowel syndrome – a longitudinal study in IBS and control subjects

    FEMS Immunol. Med. Microbiol.

    (2005)
  • C. Codling

    A molecular analysis of fecal and mucosal bacterial communities in irritable bowel syndrome

    Dig. Dis. Sci.

    (2010)
  • Y. Wang

    16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitis

    ISME J.

    (2009)
  • J.N. Krieger et al.

    Bacteria in the chronic prostatitis-chronic pelvic pain syndrome: molecular approaches to critical research questions

    J. Urol.

    (2002)
  • M.A. Tanner

    Prevalence of corynebacterial 16S rRNA sequences in patients with bacterial and “nonbacterial” prostatitis

    J. Clin. Microbiol.

    (1999)
  • M. Mshvildadze

    Intestinal microbial ecology in premature infants assessed with non-culture-based techniques

    J. Pediatr.

    (2010)
  • R.E. Ley

    Obesity alters gut microbial ecology

    Proc. Natl. Acad. Sci. U.S.A.

    (2005)
  • R.E. Ley

    Microbial ecology: human gut microbes associated with obesity

    Nature

    (2006)
  • H. Zhang

    Human gut microbiota in obesity and after gastric bypass

    Proc. Natl. Acad. Sci. U.S.A.

    (2009)
  • S. Komanduri

    Dysbiosis in pouchitis: evidence of unique microfloral patterns in pouch inflammation

    Clin. Gastroenterol. Hepatol.

    (2007)
  • S.D. McLaughlin

    The bacteriology of pouchitis: a molecular phylogenetic analysis using 16S rRNA gene cloning and sequencing

    Ann. Surg.

    (2010)
  • G.C. Zella

    Distinct microbiome in pouchitis compared to healthy pouches in ulcerative colitis and familial adenomatous polyposis

    Inflamm. Bowel Dis.

    (2011)
  • L.C. Paulino

    Molecular analysis of fungal microbiota in samples from healthy human skin and psoriatic lesions

    J. Clin. Microbiol.

    (2006)
  • S.E. Pryde

    The microbiology of butyrate formation in the human colon

    FEMS Microbiol. Lett.

    (2002)
  • R.J. Xavier et al.

    Unravelling the pathogenesis of inflammatory bowel disease

    Nature

    (2007)
  • R.B. Sartor

    Microbial influences in inflammatory bowel diseases

    Gastroenterology

    (2008)
  • R.B. Sartor

    Genetics and environmental interactions shape the intestinal microbiome to promote inflammatory bowel disease versus mucosal homeostasis

    Gastroenterology

    (2010)
  • A.B. Hill

    The environment and disease: association or causation?

    Proc. R. Soc. Med.

    (1965)
  • A.S. Evans

    Causation and disease: the Henle-Koch postulates revisited

    Yale J. Biol. Med.

    (1976)
  • D.N. Fredricks et al.

    Sequence-based identification of microbial pathogens: a reconsideration of Koch's postulates

    Clin. Microbiol. Rev.

    (1996)
  • F. Backhed

    Host-bacterial mutualism in the human intestine

    Science

    (2005)
  • S. Rautava et al.

    Commensal bacteria and epithelial cross talk in the developing intestine

    Curr. Gastroenterol. Rep.

    (2007)
  • J.J. Faith

    Creating and characterizing communities of human gut microbes in gnotobiotic mice

    ISME J.

    (2011)
  • A.L. Goodman

    Extensive personal human gut microbiota culture collections characterized and manipulated in gnotobiotic mice

    Proc. Natl. Acad. Sci. U.S.A.

    (2011)
  • Cited by (143)

    • The inflammatory microenvironment and the urinary microbiome in the initiation and progression of bladder cancer

      2021, Genes and Diseases
      Citation Excerpt :

      Immunological studies have shown that some resident commensal and probiotic bacterial strains have the capability to attenuate mucosal inflammation by downregulating the NF-κB pathway, IL-6 and IL-8.178 Commensal microbial communities in urine are thought to have a positive impact on human health by eliminating inadequately working immune cells and protecting hosts from pathogens (Fig. 2B).179 Dysbiosis of these microbes with protective abilities may cause lower urinary tract dysfunction.157

    View all citing articles on Scopus
    View full text