The Gut Microbiome: Reaching the Promise Through Discovery— Advancing Knowledge and Discovery of the Gut Microbiome in the Age of Precision Medicine

Abstract

The gastrointestinal tract is home to nearly a trillion microbes that are comprised of bacteria, viruses, fungi, and other microorganisms which are collectively called the gut microbiome. Why have them, considering the potentially dire consequences of any entering the blood stream? As it turns out, we live in harmony with these microbes and they are of actual benefit to us, providing important cues for immunological, organismal, and metabolic development to name a few. However, are all gut microbes equal in this task or does this require teamwork by microbial communities and consortia? These queries beg the question of what is a “healthy” gut microbiome? As obvious as the answer might seem, one has not been found or agreed upon by general consensus. Many studies have shown that the gut microbiome can be affected by shifts in diet, lifestyle, antibiotics, and environment commonly associated with modern societies. However, can these events and factors lead to a skewing or imbalance of the gut microbiome that leads to mismatches in host-microbe interactions and increased risk for disease, particularly those that are occurring with alarming frequency in the modern age like cancer, metabolic diseases, complex immune disorders, and aging and frailty? If so, how can we leverage the knowledge gained by studies of the gut microbiome to develop new approaches to not only prevent and treat diseases, but to maintain health and quality of life? The goal of this special issue of Gastroenterology on the Intestinal Microbiome will touch upon these topics with the intention of providing insights to these provocative questions. This being said and despite the rapid evolution of technologies and advance made in this field, we are still far from translating knowledge into clinical practice. Each article of this issue will discuss some of the limitations and challenges that we currently face, but will also provide a look forward to the potential and promise of microbiome-based medicine in the era of precision management.