With 30 years of clinical research experience, St Vincent’s Gastroenterologist Professor Michael Kamm has long been at the forefront of gastroenterology research, making many discoveries into inflammatory bowel diseases.
But Prof Kamm is as excited as a fresh faced PhD student when talking about the next frontier in gastroenterological research, the incredibly complex gut microbiota.
‘We are but a minority of ourselves,’ Prof Kamm says.
‘The gut microbiota, made up of viruses, bacteria and fungi that live in our digestive system, constitute about 90% of the cells in our body.’
Researchers have known the gut microbiota exits for many years, but haven’t had the ability to explore it.
Thanks to improvements in technology, Prof Kamm and his international team of collaborators are studying the gut microbiota more closely. ‘Exploring the gut bacteria is a whole new horizon.
It might be the most interesting development in any part of medicine at the moment. Having been neglected for so long, it is now akin to an undiscovered organ. It is like the Amazon of the human body.’
‘Research and developments in this area are paradigm changing. Traditionally treatment for inflammatory bowel disease has involved immune suppressing drugs.
Unfortunately they can adversely suppress the immune system in other unwanted ways as well, increasing the risk of infection and cancer.
‘We are now discovering that we can manipulate the microbiota and change the ecosystem that exists with our gastro intestinal tract.’
Prof Kamm recently led a clinical trial, named the ‘FOCUS’ study, looking at faecal microbiota transplantation (FMT) for patients with active ulcerative colitis, a condition that inflames the bowel.
This trial, conducted in the three eastern Australian states, had very positive results, showing that more than half of all patients responded to the treatment.
This study has been published recently in one of the world’s leading clinical journals, the Lancet.
‘These were patients who had disease that was resistant to many established drug therapies,’ Prof Kamm explains.
‘This really nails it and proves that it is an effective therapy and should be part of the offering for patients with active ulcerative colitis resistant to standard therapies.’
Prof Kamm and his team are now collaborating with scientists at Mt Sinai Hospital in New York to pinpoint which bacteria are important.
They have also begun collaborating with international companies with expertise in faecal transplant, to streamline and simplify what is an otherwise cumbersome process.
‘At the moment FMT involves collecting samples and extensive screening of donors and patients. It is not really practical for every day clinical use.
We hope to progress to using capsules that can deliver the benefits of FMT in a much easier way.’ Research in this area has also revealed that gut bacteria may be responsible for a number of other diseases that have become very common in a short space of time.
‘We now think that diet and the resulting changes in the gut microbiota probably play a big part in conditions like type 2 diabetes and non-alcoholic fatty liver disease.’
If you want to figure out the cause of a condition, a great place to look is where it is changing. Prof Kamm has been involved in epidemiological studies in 13 countries in South East Asia looking at inflammatory bowel disease.
‘Inflammatory bowel disease was unheard of in Asia 30 years ago, now a third of all gastroenterology inpatients in China have these conditions. In a short time China will have more patients than the western world.’
By looking at the changing patterns of disease and comparing it to patients in Australia, it may be possible to determine what in the environment may be producing these changes.
‘Our hypothesis is that changes in the bacteria in the gut in the Chinese population has led to the emergence of these diseases. What is making the bacteria change?’
‘One theory we have is that it may not be diet itself but dietary additives in prepared foods. An increase in manufactured foods in Asian diets.
These foods contain a range of additives, such as emulsifiers, that may directly alter the gut microbiota.’