December 04, 2019

Microbiome transplant: cooties can cure you

By Conor McKechnie and Dodi Axelson

Microbiome transplant: cooties can cure you

Conor has what he calls "microbiomania". Whatever the topic, he can bring it back to microbiomes in about three sentences. So, imagine his excitement when he got to meet up with two fellow microbiome enthusiasts, Colleen Cutcliffe, CEO of Pendulum and Jacques Ravel, professor at University of Maryland.

CONOR: So, Dodi, I'm going to share a dirty secret of mine with you and I hope you can keep it to yourself…

DODI: How dirty is it?

CONOR: About 18 months ago I stopped washing with soap. I only use water in the shower.

DODI: And I can vouch for the audience that you do not stink. I'm standing right next to you.

CONOR: Well thank you for that, I have wondered whether or not my colleagues and friends and family and just being polite, but no, I stopped washing with soap. And I stopped washing with soap because I read a book, which was given to me by a colleague, which suggested that overwashing soap was damaging to our microbiome.

DODI: And you are obsessed with microbiome. So, I'm going to guess that's what matters in this episode of Discover Matters.

CONOR: It is exactly what matters in this episode.

[Intro music]

DODI: So, you've stopped showering with soap. All in the name of your love of microbiomes. Tell us more.

CONOR: Isn't it nice to think that we are accompanied on this life journey by hundreds of millions of bacteria and viruses that co-inhabit our bodies with us.

DODI: We're walking ecosystem.

CONOR: Yeah, we should love them rather than wash them off us.

DODI: And do you have proof that that's an okay thing to do?

CONOR: So, I don't have proof I am n equals 1 as a sample. So, we need to find somebody who really knows what they're talking about. And recently we did.

COLLEEN CUTCLIFFE: I think there's no doubt that things like allergies and asthma are on the rise and that one of the theories, is that as we become more and more sterile, and more and more hygienic. We have actually been getting rid of microbes that are supposed to co-evolve, they’re supposed to help us, you know, protect us from things. For example, we’re supposed to have a layer of microbes on our skin that protects us from the allergens from the world outside of us. But because we shower, some of us multiple times a day, and we use all these products that get rid of all these microbes, those allergens in the air are directly now interfacing with our immune system. And then we wonder why everybody has a heighten immune system, that we’re allergic to everything now.

So, I think that there’s part of this is actually that we’ve gotten rid of things that are beneficial and helping to protect us. But I think another part of it is that we have been processing foods and processing foods and consuming them without really understanding how those processed foods are impacting us. So, the notion of being allergic to gluten is also a new idea because I mean it even know what gluten was, you know, just 15 years ago. So just knowing what it is and how it might impact us in addition to changes in our microbiome in our environment. I think all of that's converging to create these situations where you have now have five thanksgiving tables.

DODI: So, who is that?

CC: I am Colleen Cutcliffe, I am the co-founder and CEO of Whole Biome.

DODI: And how did Colleen get into the world of microbiomes?

CONOR: Well, we’re starting to find out with this podcast that it’s really personal. Not just about the bugs and viruses that live on you, it’s people around you. You see, Colleen’s daughter was born 8 weeks premature.

CC: And when you have a baby that is born that prematurely you as a mother get to see it for about four seconds, and they whisk it off to the ICN and the protocol is that they get multiple doses of antibiotic treatment and this is a prophylactic. They don't actually have an infection. It’s just to make sure that they don't get an infection because they're so fragile. And since kind of going through that my daughter, she's now 12 years old and she's relatively healthy, but she definitely has food sensitivities and you know GI distress and things like that the rest of the people the family don’t have and I become more and more convinced that that early start to life in those big antibiotic treatments, which completely decimated her microbiome have a lot to do with the different development of the microbiome that she has and that that for me personally is was a reason that I got into space and I think there's a lot of opportunity for helping people who are missing or lacking certain microbes for environmental reasons that have nothing to do with them.

CONOR: And Colleen believes that the microbiome is a real opportunity for health and therapeutics.

CC: You have all of these bugs, these bacteria and viruses and fungi that live inside of you and on you and we have always historically thought of them as things that are bad for us. We should eradicate the we should take antibiotics, have antibacterial soaps, antiseptic wipes. And the big idea is transforming the way that we view these microbes as things that are beneficial for our health. And so, what we are creating are a new category of products that are derived from bacteria that are actually helpful and beneficial for battling diseases and improving health. Cooties can cure you.

DODI: Cooties can cure you, I love that.

CONOR: Yeah, me too. And hearing Colleen say this made me think of dogs that eat their own faeces and all sorts of horrible unspeakable things and the fact that we love our children running around and being filthy outside. So, I asked Colleen, have we always kind of actually known that there's something in the folk memory of people that just knows that dirt is just good for you?

CC: In this sense. I think animals might be more evolved than we are, so they do eat their own and each other's stool when they're not feeling well. They also roll around in the mud and that sort of creates a nice coating of microbes on your skin. But I think even as humans we have this inherent belief that there's something about bacteria that is good for us. So, probiotics and yogurts have been on the market for decades and they haven't really had any science or medicine to back them up. But we inherently believe these are healthy for us or something good about them. And so I think the idea that now we can create products that do have the science and medical backing. Is something, it is really tapping into something that we inherently feel is part of who we are.

DODI: Huh?

CONOR: Okay, tell me what's up.

DODI: Well, one of us always has to play The Devil's Advocate. So…

CONOR: So, you're worried about…

DODI: Well, I'm thinking of that Simpsons episode where Homer and his dad made this phony homemade revitalizing love tonic.

CONOR: You're thinking about science and charlatans favorite topic we both have.

DODI: I, yeah, that's right. And how do you protect the public from these charlatans who say that this magic skin cream made from poo will cure you?

CC: Of course, I don't have control over what other people say but the FDA and the FTC do and so I think we depend on our regulatory agencies to come in and help protect the public from false claims. And it is going to be tricky world for consumers to try to navigate when people start making these false claims, but we have to depend on our system to try to filter those out and help people make the right choices.

CONOR: So, through Colleen’s work inspired by her daughter being eight weeks premature, she got an investment from the Mayo Clinic to go and co-develop a preterm labor potential product. And that is how she met Jacques Ravel.

JACQUES RAVEL: I'm a professor of microbiology and immunology at the University of Maryland School of Medicine, and I'm also the the associate director for genomics at the Institute for Genome Sciences. My work has been focused on studying the vaginal microbiota and how it relates to women's health.

DODI: And when Jacques says women's health, what does he mean exactly?

JR: We look at it from a very broad perspective anywhere that really, we span the lifespan of a woman all the way from childbirth. So even in baby girl, all the way through adolescence, reproductive years, as well menopause.

CONOR: Jacques has been immersed in the world of human microbiomes for so long now, more than 15 years. And in fact, the world is really starting to wake up and take a lot of notice.

JR: This explosion of interest in the human microbiome has been very beneficial and for good reason because it is actually the data really shows strongly the importance of the microbiota the microbiome in human health in many many different aspects of human health nowadays. And it's becoming basically a major target for intervention. And there are a lot of companies that have been started but even academics who are trying to develop new ways to modulate the composition and the function of the human microbiome to actually treat disease to treat different conditions. And the vagina is no different to the gut to that respect. I for myself, my lab, my laboratory is very much involved in developing some of those therapies that aim to modulate the composition and function of the vaginal microbiota to treat several different conditions.

DODI: So, it strikes me that owning one, you know, this topic of the vagina is socially pretty interesting and also, you know, being an American ex-pat living in Sweden where there’s not as much, what’s the word for American being so…

CONOR: Prudishness!

DODI: Prude, exactly. So being raised a prude and then going, moving to Sweden has been incredibly interesting. The vagina was a forbidden word when I was growing up. I’m one of four daughters! You know, we called it a booboo. We used the word for mistake for our genitals.

CONOR: Oh, wow.

DODI: So, I wonder, has Jacques had to deal with these issues due to our own prudishness as humans?

CONOR: Well, we talked about this issue and he does agree with you. In fact, you and your family are not the only ones.

JR: I remember back in the early 2000s when I was giving talk people giggling in the audience when I was you know, mentioning the word vagina. I think nowadays it's, at least in the scientific community, it's a lot more accepted. But just as an example, I was recently interviewed, and I could not say the word vagina. And so, it was very much an awkward interview to describe my work without being able to say the word vagina.

CONOR: And it seems that yes, the scientific world and the public at large has been a little bit shy about the vagina as well. Jacques says that before his research into the microbiomes in the vagina, all that was really known about it scientifically came through a search into sexually transmitted diseases.

JR: And through that work, we started to learn a lot about the immune environment, the metabolomic environment as well as the microbial environment in the vagina. But when it comes to health and you know, helping and favoring health, there was very very little work in a vagina for quite some time. But over the last, I would say, 10 years I think the field is kind of shifted and there's quite a focus on improving the healthy and micro environment and a vagina and not solely focus on protection against sexually transmitted infection or understanding sexually transmitted infection pathogenesis. From a scientific perspective we are a lot better off than we were 10 years ago.

When it comes to the public it's very interesting, I think they are a major interest in this environment in the vagina, especially obviously among women. I think they the fact that now we talk about microbes being present in the vagina and microbes are very important. I think women are a lot more aware of their vagina and how to take care of them and to make sure that those microbes are you know, they understand the importance of the microbes. The problem is that they are also left with very little option to take care of it, to take care of the microbe or replenish the microbes. I think that's, you know, we have a lot more option for doing this for our gut. But when it comes to the vagina, we’re really left with very very little option.

When you think about urinary tract infection, for example, there was an article in the New York Times just recently and, you know, describing how terrible of a disease it is. Women are plagued with it. It's recurrent. They just can't get rid of it. And at the end of that article the main suggestion was you need to wipe from front to back. And I think that's really a shame that that's the only advice we can give to women to prevent you know urinary tract infection. And I think that's the same for a lot of other condition, whether it's bacterial vaginosis or even in menopause some other condition like dryness and sexual pain. We just don't know what to do. And I think that's the big problem. So, women are becoming more aware of their vaginal microbiota and this should take care of it, but there's very little option for them to do so and very little recommendation from the medical community. So, there's an enormous need to address that.

DODI: Amazing. So how did Jacques and Colleen meet?

CONOR: Well, they met about four years ago when Jacques was on a sabbatical in Paris.

JR: We had this amazing lunch looking at the Eiffel Tower, it was fantastic, and we had amazing discussions about the human microbiome and how it can be translated. And then we kept in touch over the years. She actually at some point was very interested in the vaginal microbiotas, especially as it related to pregnancy outcome. One of the things that we discussed a lot is obviously some of the you know, some aspect of where the field is going and how does a startup and basically industry can actually make an impact on this field and what other hurdles in front of such Enterprise from both, with research, but also regulatory aspect. And so we've been spending a lot of time talking about regulatory because I think that's the biggest hurdle.

I think there are a lot of ideas in the field, but to take those ideas from the concept to a product, something therapeutic that somebody's going to use in medicine can be prescribed and thing it's a long road. And the regulatory is very interesting because a lot of it stems from this the field of probiotics. You know, because what we're doing is basically trying to restore the microbiota using live organism so we know what should be there and it's right now it's not there and we would like to basically put it back. We’re basically delivering a live bacteria or cocktail of live bacteria to a human. And this, a lot of people, especially when it's delivered orally, consider this a very safe practice and, you know, there's all those the field of probiotic has been has been kind of paving the way for all this.

DODI: So, looking at the future of the field of microbiomes, what has to happen to move it forward?

CONOR: Well, if you ask Colleen is pretty simple, it all comes down to money.

CC: The microbiome is like any new field that thing that gives it the lift is investment dollars.

DODI: Well that's getting straight to the point.

CONOR: But other than money she does see a future. In fact, she thinks that in the near future a very real dream will come true.

CC: There will be multiple microbiome products targeting multiple diseases both in the therapeutics as well as in the consumer space. There are a lot of amazing companies or really smart people developing these interventions. And clinical trials are start starting to come out now showing that there's positive data. And, so I think everyone who can stick on this path and actually create these products are going to find that they're actually going to create this new category of products for the world.

CONOR: Just so we're clear, Colleen doesn't mean that these are products made of poo that you would be putting on your face as skin cream.

DODI: So still no poo smearing on our faces?

[Outro music]

CONOR: No, my inner five-year-old child is not being satisfied by the progress of the science.

CC: I think there will hopefully be more refined and manufacturable FDA approvable products than shit.

DODI: Well, I think after listening to Colleen and Jacques you've convinced me of one thing, Conor.

CONOR: Go on.

DODI: I think I'm gonna start to shower without soap.

CONOR: Okay. Look it's a personal choice. It may work for some, it may not work for others. But what we've learned is it's a lot more complicated than just trying to get every ounce of dirt off your body in the shower.

DODI: There’s a lot more to learn.

CONOR: There's a lot more to learn and I'm looking forward to maybe another episode, where we can dig into this wonderful world of eco-diversity that is our very own body.

DODI: Thank you for listening to this edition of Discovery Matters.

CONOR: Goodbye.