Microbiome at the Frontier of Personalized Medicine

Abstract

The genomic revolution promises to transform our approach to treat patients by individualizing treatments, reducing adverse events, and decreasing health care costs. The early advances using this have been realized primarily by optimizing preventive and therapeutic approaches in cancer using human genome sequencing. The ability to characterize the microbiome, which includes all the microbes that reside within and upon us and all their genetic elements, using next-generation sequencing allows us to now incorporate this important contributor to human disease into developing new preventive and therapeutic strategies. In this review we highlight the importance of the microbiome in all aspects of human disease, including pathogenesis, phenotype, prognosis, and response to treatment, as well as their role as diagnostic and therapeutic biomarkers. We provide a role for next-generation sequencing in both precise microbial identification of infectious diseases and characterization of microbial communities and their function. Taken together, the microbiome is emerging as an integral part of precision medicine approach as it not only contributes to interindividual variability in all aspects of a disease but also represents a potentially modifiable factor that is amenable to targeting by therapeutics.

Figure 1

Gut microbiome as a determinant of human health and response to therapeutic intervention. Gut microbiome plays an important role in an individual’s response to interventions raging from dietary and lifestyle changes to medications and surgical interventions; hence in addition to host genetics it is important to consider the role of gut microbiome when selecting appropriate therapy. Gut microbiome unlike host genes represents a modifiable factor that can be targeted by probiotics, prebiotics, diet as well as community replacement approaches such as fecal microbiota transplantation.