A last topic for this column is the role of the microbiota in autoimmune diseases. In particular, I find it fascinating to learn that aberrant, unstable intestinal microbiota can lead to a leaky intestinal mucosal barrier. Combined with inadequate innate immune responses in the gut, progression may occur that allows antigens from microbes that cross-react with antigens of self in the pancreas to stimulate autoimmune antibodies. Similar pathogenic mechanisms may contribute to inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and other autoimmune diseases.
I anticipate future research will establish the makeup of a healthy microbiota associated with protection from the diseases mentioned here. With that knowledge, the next efforts in research will focus on how to convert an unhealthy microbiota to a healthy one. If the efforts succeed, I see new promising treatments in the future.
Dr. Pichichero, a specialist in pediatric infectious diseases, is director of the Rochester (N.Y.) General Research Institute. He is also a pediatrician at Legacy Pediatrics in Rochester. The microbiome research at the Rochester General Hospital Research Institute is supported by the National Institutes of Health and the National Institute for Deafness and Communication Disorders. To comment, e-mail him at pdnews@ frontlinemedcom.com.