Dr. Hibberd>> I also just want to touch base on something that
most people wouldn't even think of as a probiotic,
but guess what?
Fecal transplant meets every single word
in the definition of a probiotic.
And as we all know, it's an innovative approach
for recurrent C. diff.
There hasn't been a huge number of trials,
and unfortunately like everything in probiotics,
there's a lot of variability.
A lot of variability of the preparation,
a lot of variability as to how these fecal transplants
are occurring.
In general, the published results show
that the results are positive.
And that the microbiome of the person who gets the transplant
is much more like the donor.
These are some data from January
in the New England Journal of Medicine.
After just one infusion of donor feces,
there was already a huge percentage of cure versus the
routine Vancomycin therapy.
In fact, this trial was stopped early.
Probably some of you have heard of alternative approaches
because people are concerned, well how on earth do you safely
give people other people's poop?
So what the Canadian group are doing is they're actually
choosing 33 organisms that they think are probably safe,
and essentially transplanting those 33 organisms.
These are all being reported at the patient level at this stage,
but in general, it seems like providing these organisms is
able to change the microbiome in these people.
So the scary thing is, what's next?
Fecal transplants are already —they've already been done
for people who have metabolic syndrome,
getting improvement in insulin resistance.
And one of the things I'm a little scared about is we may
have some very interesting data from Jeff Gordon's mice,
but that doesn't tell us that we're ready to do fecal
transplants for obesity, but I have a ghastly feeling
we're going to hear about it really soon.
So the bottom line is, what do we need omics to do?
It's very clear to me that we cannot test every single
organism that could be a probiotic.
We won't get a single answer or a whole set of answers for a
hell of a long time, and it's not helpful.
We must find ways to move the field forward such that we can
make assessments of likely safety of particular organisms,
likely ability to prevent disease,
likely ability to treat disease,
and also who may be likely responders.
And I am pretty sure that it's going to take a combination
of methodologies.
But somehow, we need to do this efficiently,
cost effectively, and with valid data.
So with that, I'd like to conclude and say that since
2001, when probiotics was such a simple concept,
I think enthusiasm for probiotics has persisted,
but the scientific basis and mechanism studies still
lag‚ we're not there yet.
I think omic tools are rapidly evolving.
They're in their infancy right now,
but I think they will help us understand the microbiome.
I think there are lots of issues about whether lobbing in a
single organism or multiple organisms or whole microbial
communities, as in fecal transplants,
raises an interesting question, but I think right now,
we're too early in the field to make any real predictions about
how to make this go forward.
But probably the simpler, the better.
And finally, this is a multidisciplinary approach.
It needs to bring many, many people together
to figure out whether probiotics are
hope, hype, or reality.
I would like to thank the incredible team that I work
with, specifically pointing out Dr. Fraser who is here,
and Dr. Gloria, who is also here, and a huge thank you to
Dr. Linda Duffy, who has really shepherded this work and enabled
us to move at least something forward.
Thank you.
And thank you for your attention.
[applause]