Is the human gut microbiota the critical mediator of health?

In a review this month, Greer and co-authors present interesting information on just how much our health depends on the well-being and communal balance of the microscopic symbionts in our gastrointestinal tract [Journal of Allergy and Clinical Immunology 2013; 132(2): 253-262].  They begin their review noting that, until fairly recently, immunity, metabolic functions and gut physiology had been studied as separate biological systems.  In light of growing evidence that the delineation between these is arbitrary, the authors point out that systems biology has developed new methods for investigating the interactions between the intestinal microbiota and immune and metabolic outcomes.

Greer et al covers two broad categories, small intestine enteropathies and obesity with metabolic syndrome.  They describe current animal models used to study immunodeficiency enteropathies, celiac disease, inflammatory bowel disease, obesity and lipid metabolism dysregulation.

The authors discuss notable findings from mouse models that have been employed to study enteropathies.  For example, B lymphocyte deficient mice are known have fat absorption issues, which correlate to IgA deficiency.  B cell secreted IgA is required for maintaining a proper balance between immunity, fat metabolism and gut microbes.  They note that B cell deficient mice have intestinal gene expression profiles that are very similar to those seen in HIV/CVID patients.

They note that gut microbiota contribute to dyslipidemia and insulin resistance in obese mice and induce intestinal inflammation in response to increased fat intake.  Greer et al discuss also the physical changes in the ileum that cause increased uptake of fats in the diet-induced obese mice.  Interesting, they comment that TLR5 knock-out mice have increased weight gain, pointing to innate immune interactions in fat metabolism.

Greer et al discuss evidence on short chain fatty acid balance and metabolism as critical to maintenance of a “core” microbiota.  Transplantation of microbes from diet-induced obese mice to control mice results in obesity in the control mice without increase in food intake.  The authors suggest that this points to persisting changes in gut microbiota that may be causally related to obesity and altered fat metabolism.  Concluding, Greer et al suggest that the gut microbiota is a cardinal mediator between the immune system and gastrointestinal epithelium. 

In answer to the question, "In your opinion, does manipulation of the gut microbiota present a therapeutic intervention for obesity and/or lipid metabolism disorders?", the authors responded, "Yes, we believe that manipulation of gut microbiota presents great potential for therapeutic interventions in a range of diseases, including obesity and metabolic syndrome, but we need first to understand which taxa or which microbial genes might be most beneficial and in each case."

A novel mode of cell death in active versus resting eosinophils: a potential pathway for treatment of asthma and allergic disease

Apoptosis was previously thought to be the only mode of regulated or programmed cell death in eosinophils, as necrosis was regarded as unregulated cell death.  However, Kano et al., have discovered that the activated eosinophils, found in abundance in asthma and allergic disease, can die by means of a type of regulated necrosis in response to Siglec-8 ligation [J Allergy Clin Immunol 2013; 132(2): 437-445]. Siglec-8 is a cell-surface receptor protein that is highly and selectively expressed by human eosinophils, as well as mast cells and basophils. The authors show that Siglec-8 ligation in the presence of IL-5 triggers necrosis in activated eosinophils in a reactive oxygen species (ROS)–dependent manner. Further, they explain why IL-5 promotes cell death in this system even though it is typically a pro-survival signal.  They demonstrate that ROS switch IL-5’s function from pro-survival to cell death enhancement by augmenting ERK phosphorylation and this serves as a decisive trigger of necrotic cell death. These discoveries indicate that necrotic eosinophil cell death can be regulated by signal transduction, suggesting that potential therapeutics targeting regulation of the mode of cell death could be beneficial in various eosinophilic diseases.

Pattern recognition receptors in obesity and metabolic disturbances

Highlighting the role of innate immunity in the evolution of obesity and associated metabolic disorders, Jin and Flavell deliver a concise review of mechanisms involving pattern recognition receptors that produce pathology in liver, pancreas, brain and intestinal microbiota [J Allergy Clin Immunol 2013; 132(2):287-294]. 

The authors provide a summary of the biology of the major types of pattern recognition receptors [PRR], with emphasis on toll-like receptors [TLR] and NOD-like receptors [NLR].  They discuss briefly their activity in response to pathogen infection and endogenous injury.  Several NLRs can coalesce into multiprotein complexes called inflammasomes which have proven to be importantly involved in the development of insulin resistance. 

Jin and Flavell review PRR mechanisms in five critical physiologic areas: brain, pancreatic islet, and vascular inflammation, induction of peripheral insulin resistance, and disruption of intestinal microbiota homeostasis.  They note that PRRs can directly mediate and sustain inflammation in response to excessive nutrient resulting in abnormal lipid metabolism and insulin resistance in multiple tissues, which accounts for comorbidities such as type 2 diabetes and atherosclerosis.

In the gut, the authors point out that PRRs are critical to sensing and regulating the microbiota as well as responding to pathogenic insult.  TLR/NLR deficiency-associated microbial imbalance has been associated with obesity risk, insulin resistance, and fatty liver.  Interestingly, transplantation of abnormal microbiota from obese mice into wild-type mice results in reproduction of the obese metabolic phenotype that can be corrected by antibiotic treatment.  This points to a causal relationship between disrupted intestinal microbiota and the development of metabolic syndrome. 

Regarding the recent AMA announcement that obesity is a disease as opposed to lifestyle that results in a disease state, I think this is supported by findings from basic research that the development of obesity is not simply due to a lifestyle exemplified by overeating and inactivity, but also profoundly impacted by intrinsic genetic factors in metabolic system, immune system and intestinal microbial ecosystem. Recognizing obesity as a disease will help the community pay more attention to this emerging health issue and also hopefully stimulate research to understand the complex pathophysiology of obesity.