New Year, new vision: Meet a scientist who spends his days studying the microscopic world of the microbiome

Over the past 100 years the medical world has been focusing on a few dozen key pathogens that cause diseases. But in the past decade or so, new technology has given us a more detailed idea of the thousands and thousands of organisms that live in and on our bodies, known as the microbiome—and that’s led to a big conceptual shift.

We now recognize that the microbes present in and on us are not always pathogenic—most of the time they’re neutral or even beneficial. So we need to approach our health with more precision and preserve those beneficial microbes—or even leverage the ways in which they could benefit our health.

Evidence is now mounting that doing so could play a central role in managing conditions like autoimmune diseases, metabolic disorders, neurodegeneration and cancer.

Today there are more than 200 start-ups developing more than 400 different microbiome-based products. Most of them are focused on treating diseases in a traditional way, but at the JHMI, we also believe in the unique value that the microbiome can offer in disease interception, that is, arresting the disease prior to the appearance of symptoms. And those are the solutions we are targeting.

The science is still emerging, but in the last year, we’ve gotten a much better idea of what a microbiome product that could potentially correct this trajectory toward disease looks like, whether that’s a therapeutic, like a probiotic that’s delivered as a pill, drink or lotion; a diagnostic tool or digital app designed to personalize microbiome solutions; or even precision editing of the microbiome, which removes certain organisms that have been shown to be detrimental to our health.

It’s important to understand that the microbiome can be influenced by diet, stress and our environment, and in the past 50 years, much has changed in those areas.

Medication and disease can also impact the microbiome, which in turn impacts the body. Microbes send signals to the host—your body—in multiple ways, whether that means producing certain hormones or modulating our immune systems to protect us from infections.

Our hypothesis is that microbiome development in early life is critical for a healthy immune system. If we can make sure the microbiome develops properly, we believe we can influence what would otherwise be a trajectory toward disease.

A good example is type 1 diabetes, which results when the body starts to see its own insulin-producing cells as foreign and attacks them. Ideally, we’d like to prevent this “immune misunderstanding” from occurring in the first place.

Well before the disease is diagnosed, you start seeing changes that could indicate someone is at a much higher risk for developing type 1 diabetes, regardless of a genetic predisposition. If, for example, we see a process called seroconversion—the development of a particular antibody—occurring in a baby’s body toward the end of his first year, there’s more than a 90% risk of him developing type 1 diabetes, whether that’s in a few months or 10 years.

The JHMI is working to track this kind of development during the first years of life, to assess abnormalities and intercept any changes from taking the route to disease.

We’re also looking at how the microbiome connects with low-grade, chronic inflammation, which we see playing a role in metabolic disorders, cancer and neurodegeneration. We believe that the microbiome could potentially provide an interesting option to explore the early interception of lung cancer, in particular.

Dr_Microbe/Getty Images/iStockphoto

A recent study in the New England Journal of Medicine showed that biologics—drugs produced from living cells—targeting low-grade inflammation bring benefits in the reduction of the incidence of lung cancer. That opened up an interesting opportunity: It’s a proof of principle that the trajectory of lung cancer can be changed, so we have the potential to intercept and prevent the disease through our work with the Johnson & Johnson Lung Cancer Initiative by harnessing the promise of the microbiome.

In 2017, we partnered with the Weizmann Institute of Science in Israel, and found that an algorithm based on sequencing the DNA in an individual’s microbiome could deliver a personalized nutrition plan to help control glucose levels, a risk factor for type 2 diabetes and obesity. That microbiome-based intervention resulted in a company called DayTwo, and the microbiome-based nutritional advice product is now on the market in the U.S. We also currently have a clinical trial underway to test if we can change glucose control in a way that would reduce type 2 diabetes.

Another area where there is significant opportunity is targeting bacterial pathogens and pathobionts (a potentially disease-causing organism) of various human microbiomes using precision therapies. Our recently announced agreement with Locus Biosciences, Inc., through our Janssen Infectious Diseases Therapeutic Area, is pursuing this with the company’s unique CRISPR-Cas3 Phage (crPhage^TM) platform, which aims to destroy with precision specific unwanted bacteria without harming other bacteria.

The potential impact that the microbiome can have on course-correcting diseases makes me very excited. I came to Janssen because they have a very bold vision of how the microbiome can impact diseases going forward, and therefore we have built a very strong team with deep expertise. We’re positioned to remain agile and react to this very dynamic field by connecting quickly with new opportunities.

I’m looking forward to what’s next.