Entries in Prevention (27)

Tuesday
Dec012015

THE HUMAN MICROBIOME 2016: the future in diagnostics and therapeutics

The Dolder Grand Health
Long Life & Vitality

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine


The future in diagnostics and therapeutics has arrived already today.

We look at a person's microbes and ensure the right balance is there and make adjustments if necessary to keep that person in optimal health.

Here we present 

 

  • An overview of the human microbiome project
  • Integrated omic analyses: including concomitant metagenomics, metatranscriptomics, metaproteomics, and metabolomics
  • Case studies: the microbiome and its role in inflammation, obesity, immunity, diabetes and cancer
  • Potential for microbiota-directed therapies
  • Skin microbiome - acne, eczema and wound healing
  • Oral microbiome
  • Impact of preterm birth prevention and management strategies on the vaginal microbiome
  • The lung microbiome and potential diagnostics and therapeutics
  • The microbiome-gut-brain axis and its impact on behaviour, addiction, and neurodegenerative diseases
  • Personalized nutrition and microbiome research
  • Impact of specific nutrients on the early life window
  • The development of next generation probiotics

 

The Human Microbiome has a well-documented and significant impact on human health and well-being. The advances in next generation sequencing technologies have aided scientific research in connecting an imbalanced microbiome (dysbiosis) to conditions as diverse as cancer, pulmonary, metabolic, inflammatory and mental/neurodegenerative disease.

Despite the recency of much of this research numerous applications are rapidly emerging. The strong evidence that gut microbiome transplantation/transfer (an individual biological therapy) is spectacularly efficacious in treating certain infectious or difficult-to-treat diseases and the percetion that the microbiome is uniquely manipulable is proving very exciting for researchers, physicians and patients alike.

Collaborations and research consortia are underway around the world surveying human microbiota at different body sites, characterising them, understanding their interactions with their host, their cause and effect role in diseases, and designing therapeutic or dietary interventions.

Whilst no on-the-shelf therapeutics exist yet, links between humans and bacteria are said to be on the cusp of a revolution in biological therapeutics. 

 

PD Dr. med. Rainer Arendt
FMH Cardiology, Internal Medicine
Regenerative Medicine 

SWISS  PREVENTION  CLINIC
Klausstrasse 10
CH-8008 ZURICH
T +41 43 336 7260
M +41 78 825 0803
F +41 43 336 7261

rainer.arendt@swisspreventionclinic.ch

www.swisspreventionclinic.ch
www.patientcircle.org

Saturday
Jul182015

"No More Dying. The Conquest Of Aging And The Extension Of Human Life" (Joel Kurtzman & Philip Gordon)

Fixing the ‘Problem’ of Aging: A Practical Scientific Approach to Life Extension in Good Health And Vitality

 

The Dolder Grand Health
Long Life & Vitality

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine


We offer gut microbiome exchange (transplantation) as novel opportunity for lifespan extension, prevention and treatment of various and so far difficult to treat ailments (auto-immune diseases, multiple sclerosis, vision loss due to uveitis, metabolic disorders, neuro-psychiatric diseases, Parkinson and addictions, cardiovascular disease, endocrine disorders and infertility, cancer).

 

It is the rich array of microbiota in our intestines that makes us the human beings we are, preserves our health, and determines our lifespan.

 

"Just as a vintage car can be kept in good condition indefinitely with periodic preventative maintenance, so there is no reason why, in principle, the same can’t be true of the human body."

 

As it appears, we have come closer to “solve aging” and get people to live, healthily, up to the apparent maximum of the human lifespan of about 120 years (the longest known/confirmed lifespan was 122 years) or even longer. Already today, we are able to restore vitality and extend lifespan by restoring the epigenetic control of our genome (it is epigenetics, the environment we carry with us in our gut that determines aging, not genetics, we do not need to change genes, we just change the gut bacteria that control our genes), by replenishing / restoring the youthful richness of our gut microbiome.

Our microbiomes contain well over 1 million genes, compared with our 23,000 genes. Furthermore, the commensal microbiome accounts for 90% of the cells in our bodies. Among other functions, these gastrointestinal symbiotes help form and maintain our immune system and aid in digestion, so their health is critical to our health. The understanding of how microbiota contribute to our mental and medical well-being is rapidly advancing.

 

A modern version of the age old dream of tapping the fountain of youth – is emblematic of the current enthusiasm sweeping the research community, to reverse engineer the biology that controls lifespan and “devise interventions that enable people to lead longer and healthier lives“.

Aubrey de Grey is enjoying the new buzz about defeating ageing. For more than a decade, he has been on a crusade to inspire the world to embark on a scientific quest to eliminate aging and extend healthy lifespan (he is on the Palo Alto Longevity Prize board). It is a difficult job because he considers the world to be in a “pro-aging trance”, happy to accept that aging is unavoidable, when the reality is that it’s simply a “medical problem” that science can solve.

His claims about the possibilities, and some unconventional and unproven ideas about the science behind aging, have long made de Grey unpopular with mainstream academics studying aging. But the appearance of Calico and others suggests the world might be coming around to his side, he says. “There is an increasing number of people realising that the concept of anti-aging medicine that actually works is going to be the biggest industry that ever existed by some huge margin and that it just might be foreseeable.”

De Grey isn’t the only one who sees a new flowering of anti-aging research (mostly been aimed at extending “healthspan”, the years in which you are free of frailty or disease, rather than lifespan, although an obvious effect is that it would also be extended, healthy people after all live longer). “Radical life extension isn’t consigned to the realm of cranks and science fiction writers any more,” says David Masci, a researcher at the Pew Research Centre, who recently wrote a report on the topic looking at the scientific and ethical dimensions of radical life extension. “Serious people are doing research in this area and serious thinkers are thinking about this.”

Life expectancy has risen in developed countries from about 47 in 1900 to about 80 today, largely due to advances in curing childhood diseases. But those longer lives come with their share of misery. Age-related chronic diseases such as heart disease, cancer, stroke and Alzheimer’s are more prevalent than ever.

“If a consequence of increasing health is that life is extended, that’s a good thing, but the most important part is keeping people healthy as long as possible,” says Kevin Lee, a director of the Ellison Medical Foundation, founded in 1997 by tech billionaire Larry Ellison, and which has been the field’s largest private funder, spending $45m annually. (The Paul F Glenn Foundation for Medical Research is another.) Whereas much biomedical research concentrates on trying to cure individual diseases, say cancer, scientists in this small field hunt something larger. They investigate the details of the aging process with a view to finding ways to prevent it at its root, thereby fending off the whole slew of diseases that come along with aging.

 

The standard medical approach – curing one disease at a time – only makes that worse, says Jay Olshansky, a sociologist at the University of Chicago School of Public Health who runs a project called the Longevity Dividend Initiative, which makes the case for funding aging research to increase healthspan on health and economic grounds. “I would like to see a cure for heart disease or cancer,” he says. “But it would lead to a dramatic escalation in the prevalence of Alzheimer’s disease.”

 

By tackling aging at the root that could be dealt with as one, reducing frailty and disability by lowering all age-related disease risks simultaneously, says Olshansky. Evidence is now building that this bolder, age-delaying approach could work. “We have really turned a corner,” says Brian Kennedy, director of the Buck Institute for Research on Aging, adding that five years ago the scientific consensus was that aging research was interesting but unlikely to lead to anything practical. “We’re now at the point where it’s easy to extend the lifespan…,” says David Sinclair, a researcher based at Harvard.

 

One of the novel approaches being tested is using gut microbiota from the young to reinvigorate the old, to help them live longer.

This appears to work by simulating the internal chemical properties of a young body. In The Selfish Gene, Richard Dawkins describes an approach to life-extension that involves "fooling genes" into thinking the body is young.  Dawkins attributes inspiration for this idea to Peter Medawar. The basic idea is that our bodies are composed of genes that activate throughout our lifetimes, some when we are young and others when we are older. Presumably, these genes are activated by environmental factors (inside our gut), and the changes caused by these genes activating can be lethal. It is a statistical certainty that we possess more lethal genes that activate in later life than in early life. Therefore, to extend life, we should be able to prevent these genes from switching on, and we should be able to do so by identifying changes in the internal chemical environment of a body that take place during aging... .

The aim is to begin clinical studies of aging but these are difficult because of the length of our lives, though there are ways around this such as testing the length of telomeres in blood cells, the telomeres of young cells are longer than the telomeres of middle-aged cells, which, in turn are longer than the telomeres of old cells, and looking for signs of improvements in other conditions at the same time. Actually, the gut microbiome exchange appears to delay aging in every part of your body. As to when you might begin treatment, we suggest you could start treatment sometime between the age of 35 and 70 “because it keeps you healthy at least 10 years longer”.

 

 

 

“A lot of people spend their lasts decade of their lives in pain and misery combating disease,” says Craig Venter, San Diego based pioneering biologist and billionaire entrepreneur, …“I think it is possible to begin to do more about that than we are doing.” “I am not sure our brains and our psychologies are ready for immortality,” he says. “[But] if I can count on living to 100 without major debilitating diseases I would accept that Faustian bargain right now.”

“We’re tackling aging, one of life’s greatest mysteries,” we have a desire to make each day of our lives count, to make the most of life, to live longer and healthier.

 

 

 

PD Dr. med. Rainer Arendt
FMH Cardiology, Internal Medicine
Regenerative Medicine 

SWISS  PREVENTION  CLINIC
Klausstrasse 10
CH-8008 ZURICH
T +41 43 336 7260
M +41 78 825 0803
F +41 43 336 7261

rainer.arendt@swisspreventionclinic.ch

www.swisspreventionclinic.ch
www.patientcircle.org

Saturday
Jun132015

THE INSIDE STORY OF THE  MICROBIOME

The Dolder Grand
Health & Rejuvenation

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine

 

by Clive Cookson, the FT’s science editor, Financial Times, June 12, 2015

Photograph: Alexandr Khrapichev/University of Oxford/Wellcome Images

 

Cross-sections of some of the fruit and vegetables that make for a healthy microbiome, as captured by magnetic resonance imaging (MRI)

 

What is the greatest advance in scientific understanding of the human body so far this century? With due respect to the progress made in human genetics, oncology and neuroscience, my answer is appreciation of the microbiome: the vast population of microbes that live within all of us and play a vital role in our health and wellbeing.

Although microbiologists have known for many decades that everyone hosts resident bacteria, beneficial and malign, their diversity and biological significance are only now becoming clear as scientists deploy new techniques of molecular biology to probe the microbiome. A healthy adult is made up of about 10tn human cells; microbial cells are smaller but there are 10 times more of them, weighing in at 3lb in total, roughly the same as the brain.

Recent research shows that the hundreds of microbial species populating this teeming inner world play essential roles in the most fundamental processes of our lives, from digestion to immune response and even behaviour. Imbalances in the microbiome, caused by aspects of the modern lifestyle such as medication, sanitation and diet, have been linked with diseases from obesity and diabetes to asthma and eczema.

The microbiome is fertile territory for popular publishing, combining as it does exciting and fast-paced science with medical self-help — how to adjust your own microbiome for a healthier life. The three titles reviewed here are good examples of this new biomedical genre. All focus on the gut, where the bulk of our bacteria live and work, while looking, too, at the significant populations inhabiting mouth, skin, genitals and other parts of the human body. And all three are models of clear, accessible and entertaining science writing by active researchers.

Tim Spector, author of The Diet Myth, is professor of genetic epidemiology at King’s College London — and famous for leading the Twins UK team that compares identical and non-identical twins to untangle the genetic and environmental influences on disease and physical appearance. He also leads the British Gut Project and is currently using DNA sequencing to study the microbiomes of 5,000 twins. Spector’s book is the most comprehensive of the three, with dietary advice detailing what is known about the impact on the microbiome of different categories of food ingredient (fats, proteins, carbohydrates, fibre, vitamins and sweeteners) as well as alcohol, caffeine, antibiotics and other drugs.

Rob Knight, who wrote Follow Your Gut with science journalist Brendan Buhler, is another high-profile author: a professor of paediatrics, and computer science and engineering, at the University of California, San Diego, and co-founder of the American Gut Project. His book is relatively concise but still manages to pack in colourful stories.

Giulia Enders, the author of Gut, is a young medical researcher working on her doctorate at Frankfurt’s Institute for Microbiology. Her book was originally published last year in German as Darm mit Charme (“Charming Bowels”) and the text retains a charming freshness in David Shaw’s translation, leavened further with some sweetly naive illustrations by the author’s sister, Jill Enders.

 

The average American child goes through 17 courses of antibiotic, most of them unnecessary

 

The key point made by all three books is that you cannot maintain a healthy diet if you ignore the impact of food and drink on your gut microbes, which are essential intermediaries in the digestive process. Indeed, Spector claims that examining the DNA of our microbiome is much better for predicting obesity than looking at human genes.

Over millions of years we have evolved together with microbes for mutual survival, yet recently this fine-tuning and selection has gone wrong. Studies comparing urban Americans and Europeans with people living in the Amazon rainforest or rural Papua New Guinea, enjoying rich and varied diets and without antibiotics, show how much microbial diversity has been lost in the industrialised world.

We are endowed with a microbiome at birth. A baby born in the conventional way is swarming with millions of microbes by the time she emerges from her mother, as Spector puts it. The first dose consists of vaginal bacteria from the birth canal. “Then because of their close proximity and the pressure on all the body’s sphincters, a light mixture of urinary and faecal microbes are sprinkled onto her face and hands, followed by a different set of microbes covering the rest of her body as a result of rubbing against the skin of her mother’s legs.”

All three authors point out the microbial deprivation suffered by babies born by caesarean section, who cannot pick up bacteria in the same natural way. Caesarean births are associated with higher rates of a broad range of diseases associated with the microbiome, according to Knight. Spector quotes a study showing that C-section birth increases the risk of obesity by 20 per cent. And Enders blames her own caesarean delivery and her mother’s inability to breastfeed her — maternal milk provides another good dose of bacteria — for the multiplicity of health problems she suffered during childhood.

Although the best advice for parents is to opt for natural childbirth and breastfeeding, an emergency may make a C-section unavoidable — which is what happened to Knight’s partner Amanda. “Our daughter was born via an unplanned caesarean section, and I was holding her 20 minutes later,” he writes. “But today’s medical technology doesn’t supply everything. When it came to her microbes, we took matters into our own hands and swabbed her with samples from Amanda’s vagina. Our baby needed those microbes.” A clinical trial of this process, now called “vaginal inoculation”, has started in Puerto Rico.

The microbiome grows and diversifies further during early childhood, picking up beneficial bacteria from the environment. Here we encounter the “hygiene hypothesis”, first formulated in the 1980s to explain the exploding epidemic of autoimmune and allergic disorders such as asthma and eczema. In its original form the hypothesis proposed that the young immune system needs “training” through exposure to diverse bacterial and viral pathogens; problems emerge in excessively clean modern homes that fail to provide sufficient immunological challenges.

The current version of the hygiene hypothesis focuses more on the essential role that the microbiome plays in our immune defences. As Enders points out, about 80 per cent of the human immune system is located in the gut. It has to be extremely careful to suppress its defensive instincts and allow the many beneficial bacteria to live there in peace, while recognising dangerous elements in the crowd and weeding them out.

All of which requires careful training through exposure to multiple microbes, good and bad, Spector explains. Gut microbes communicate with the human immune system through so-called regulatory T-cells, or Treg cells, in the intestinal walls. High Treg levels are generally healthy because they damp down excessive activity in the immune system.

Evidence to support the hygiene hypothesis is growing fast. For instance, Erika von Mutius of Dr von Hauner Children’s Hospital in Munich, a pioneer in this field, has shown that exposure to farming in early life reduces substantially the risk of allergies and asthma — and some of this effect can be explained by children’s contact with farm animals and unpasteurised raw milk.

“In general,” says Knight, “exposure to diverse microbes, whether through older siblings, pets, or livestock — or through good old-fashioned playing outdoors — seems to help, even if scientists are still sorting out the specific microbes involved. It may be that diversity itself is most important.”

Enders goes further. “Disinfectants have no place in a normal household,” she writes. “The aim of cleaning . . . should be to reduce bacteria numbers, but not to eliminate them. Even harmful bacteria can be good for us when the immune system uses them for training — a couple of thousand salmonella bacteria in the kitchen sink provide our immune system with the opportunity to do a little sightseeing. Salmonella become dangerous only when they turn up in greater numbers.”

Needless to say, all these authors advise against antibiotics unless you need them to fight a serious drug-sensitive infection, because the side-effects of killing beneficial bacteria alongside the pathogens can also be serious. Yet the average American child goes through 17 courses of antibiotic before reaching adulthood, most of them unnecessary, according to Spector.

How, then, can people restore their ravaged microbiomes? Besides eating a varied diet rich in fruit, vegetables and nuts, taking probiotics and prebiotics may help. To illustrate the difference between these two easily confused categories, Knight invites us to think of our microbiome as a lawn. Prebiotics are like fertilisers; they are mostly soluble vegetable and fruit fibres that can be fermented by bacteria in the large intestine to provide essential nutrients. Foods rich in prebiotics include artichokes, chicory, leeks and celeriac.

Taking probiotics is more like reseeding an unhealthy lawn with desirable grasses. Probiotics, often referred to as “good bacteria” or “helpful bacteria”, are typically yoghurt-based foods or drinks containing a few species of live microbes. Although taking these will do you no harm, there is not much convincing evidence of their benefit from well-conducted clinical trials. As Spector says, this is probably because we all have different microbiomes to start with; without knowing which microbes to replace, it is a lottery whether particular yoghurt concoctions will work for you. In the future it may be possible to tailor probiotics for people to compensate for their individual microbial deficits.

A more drastic option, which Knight compares with ripping out a weed-infested lawn and laying down fresh turf, is to have a faecal or stool transplant from someone with a healthy microbiome. This procedure has proven remarkably successful in curing people who are seriously ill with Clostridium difficile infection and have very abnormal gut microbes. Research is now under way to extend faecal transplants to other disorders.

If you want to discover the health or otherwise of your own microbiome, this is now possible through the British Gut Project or American Gut Project, in return for a contribution to their research funds (a minimum £75 for UK residents). Just Google them to discover how to proceed.

But bear in mind Knight’s cautionary words: “Much of the news you hear about disease in the microbiome can be confusing, contradictory, or sometimes overhyped . . . This complexity is worth keeping in mind anytime you hear sweeping claims about it or simple fixes for a variety of its ailments.”

Although the authors of these three books are enthusiastic practitioners of microbiome research, they stop short of making excessive claims. The revelation that each of us depends on our individual living world, with far more inhabitants than there are people on earth, is surely sensational enough.

 

The Diet Myth: The Real Science Behind What We Eat, by Tim Spector, Weidenfeld & Nicolson, RRP£14.99, 320 pages

Follow Your Gut: The Enormous Impact of Tiny Microbes, by Rob Knight with Brendan Buhler, Simon & Schuster, RRP£7.99/RRP$16.99, 128 pages

Gut: The Inside Story of Our Body’s Most Underrated Organ, by Giulia Enders, Scribe RRP£14.99/Greystone Books RRP$17.95, 272 pages

 


We offer gut microbiome exchange (transplantation) as novel opportunity in prevention and treatment of various and so far difficult to treat ailments (auto-immune diseases, metabolic disorders, neuro-psychiatric diseases and addictions, cardiovascular disease, endocrine disorders and infertility, cancer).

 

PD Dr. med. Rainer Arendt
FMH Cardiology, Internal Medicine
Regenerative Medicine 

SWISS  PREVENTION  CLINIC
Klausstrasse 10
CH-8008 ZURICH
T +41 43 336 7260
M +41 78 825 0803
F +41 43 336 7261

rainer.arendt@swisspreventionclinic.ch

www.swisspreventionclinic.ch
www.patientcircle.org

Monday
Apr132015

Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down

The Dolder Grand
Medical Wellness & Rejuvenation

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine

 

 

My approach to patients with atrial fibrillation (AF) has changed. Completely and fundamentally. This is a before-and-after moment in AF care.

Before: We saw atrial fibrillation as a disease rather than seeing it as a result of other diseases. That explains why our treatments (drugs and ablation) have performed so poorly. It is a wrong-target problem. It is akin to stenting an artery and saying atherosclerosis is fixed or prescribing an antipyretic for bacterial infection.

After: Atrial fibrillation in the vast majority of patients (excluding those with brief episodes that are a form of focal atrial tachycardia) is a sign that something is awry in the body—usually exposure to an excess. The atria, with their sensitivity to stretch, neural connections, and plastic cells, are a window onto overall health.

Year after year I have watched the drugs fail and the AF return after ablation. It is a relief to (better) understand AF and to be able to cite evidence that supports the concept that the atria fibrillate for a reason. And that reason is the main therapeutic target.

 

You may know the story. A group of researchers in Adelaide have shown—first in animal models [1,2] and now in humans [3,4]—that promoting basic health dramatically improves AF burden. Their methods and results have taught us how AF happens. Although work remains, it is clear that lifestyle diseases (with inflammation due to diet-induced intestinal dysbiosis, see below), via pressure- and volume-induced atrial stretch, inflammation, or neural imbalances, induce disease in and around the cells of the heart.

 

The coolest part about these data are that treatment of lifestyle diseases—mostly, the removal of excesses—not only reduces AF burden but also improves the structure of the heart. Even fibrosis (aka scar) can regress, which is a novel way to think about cardiac biology.

This "upstream" approach to AF is no longer a radical idea. Nearly all the leaders in cardiology agree. It changes the way doctors should treat people with AF. Namely, the idea that AF is fixable with rhythm drugs or ablation is as wrong as thinking a stent fixes atherosclerosis or that treating fever cures infection.

Before I go on, let me make a note of caution. I am not saying AF drugs or ablation have no role. They do. But their (much smaller) role now is similar to stents or beta-blockers in patients with coronary artery disease: to stabilize an acute situation or to help transiently restore regular rhythm so that patients can feel well enough to exercise and enjoy life—things that make the atria healthier.

I no longer think of an antiarrhythmic drug as long-term therapy. For instance, I cardiovert and medicate so that patients can feel well enough to exercise every day they eat. I buy time. Then patients can lose weight or address other lifestyle issues, such as sleep disorders, alcohol intake, and perhaps overexercise and overwork. This improves glucose handling, lowers blood pressure, and relieves inflammation. People start to feel better. When they come back for follow-up, I discuss stopping the rhythm drugs—because they have served their adjunctive purpose.

On the matter of stroke risk: think about what it means to improve high blood pressure, diabetes, inflammation, and hyperlipidemia. Now think what it means to do so in millions of people.

You can see how this new approach upends the role of AF ablation. It is one thing to prescribe a pill; it is yet another to deliver 60 to 80 burns to the left atrium. Recall that patients who choose AF ablation walk into the hospital the morning of the procedure. They may not be perfect, they have AF after all, but they are alive and functioning. What awaits them in the EP lab is nothing small. They will endure 2 to 3 hours of general anesthesia, vascular access in both legs, two transseptal punctures, a fluid load, and purposeful damage to the heart done in proximity to the esophagus, phrenic nerve, pulmonary veins, and the thin left atrial appendage.

And . . . that $100 000 procedure, with its (real-world) 5% to 7% risk,[5] often fails. Repeat procedures are required in one of four patients. Even when the procedure is done well, recent research [3] shows that long-term success is fivefold lower when patients do not remove excesses from their lives.

This new approach to patients with AF has significant implications for the cardiology and healthcare community.

Consider those affected:

•             Hospitals invest in expensive ablation labs. They have banked on the epidemic of new atrial-fibrillation patients who will "need" procedures. Recently, I did a marketing video for my hospital on AF treatment. We filmed in our EP lab, the ablation machines as the backdrop. I was excited to speak about the new discoveries in AF care. But I stammered when the interviewer asked me about the "procedures we do here." I thought to myself: we do procedures here, we do them well, we do them safely, but we are sure to do a lot fewer in the future.

•             Doctors—like me—have reaped the rewards of AF misthink. We are paid well to do and redo AF ablation. The financial reward for helping people help themselves pales in comparison. Yet I urge you not to blame overtreatment on fee for service. The main reasons doctors overtreat are do-something bias and the disease model of care. First, doing things is what we are taught, and it is what society expects. We might give cursory mention to lifestyle but then we rush to drugs and procedures. Second, the disease model of care tricks us into putting problems—like AF—into silos (cardiac, renal, pulmonary, etc), which we treat in isolation. So ingrained is the silo model that it has been daring to use the word holistic. As if things are not connected in the body.

•             Workforce needs will be disrupted. A few years ago, cardiology groups and hospitals felt like they needed more electrophysiologists to handle the epidemic of atrial fibrillation. Now it is clear that what we need more of is not people with catheter skills, but people with people skills. The painful truth is that American cities and American hospitals do not need more EP labs.

•             Policy makers and payers are bound to notice. Think about the billions of dollars spent to care for the millions of patients with AF. Why would any insurer pay for drugs and procedures that are doomed to fail unless lifestyle measures are addressed? I wonder whether this could be the spark that gets payers to see the value of helping people live healthier lives?

•             Industry will have to adjust. Imagine the boardrooms of pharmaceutical and medical device companies in the past decade: they saw atrial fibrillation as a major opportunity. We will develop drugs, catheters, and mapping systems to treat the millions of afflicted patients. What these companies should see now is that AF drugs and ablation will go the way of renal denervation—useful in very selected cases, but no gold mine.

•             Patients are most affected by this new discovery. Although there will be small numbers of people afflicted by fluky focal AF (a confusing fact), the vast majority of patients with AF will enjoy the best results when they and their caregivers treat the root causes. From now forward, when a patient with AF sees a doctor who recommends rhythm drugs or ablation without first exploring how that person sleeps, eats, drinks, moves, and deals with stress, it will be a signal to get another opinion. Rushing to drugs or ablation will be as wrong as prescribing antibiotics for a viral infection.

This discovery about atrial fibrillation teaches us that focal (easy) solutions for systemic diseases due to lifestyle are destined to fail. Given the rise of lifestyle-related diseases, this is a critical lesson, one we should learn sooner rather than later.

Source: John Mandrola, Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down. Medscape. Apr 07, 2015.

References

1.            Abed HS, Samuel CS, Lau DH, et al. Obesity results in progressive atrial structural and electrical remodeling: Implications for atrial fibrillation. Heart Rhythm 2013; 10:90-100. Article

2.            Mahajan R, Brooks AG, Shipp N, et al. AF and obesity: Impact of weight reduction on the atrial substrate. Heart Rhythm Society 2013 Annual Scientific Sessions; May 8-11, 2013; Denver, CO. Abstract YIA-01

3.            Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol 2014; 64:2222-2231. Article

4.            Pathak R, et al. Long-term effect of goal directed weight management in an atrial fibrillation cohort: A long-term follow-up study (LEGACY Study). J Am Coll Cardiol 2015; DOI:101016/jacc.2015.03.002. Abstract

5.            Deshmukh A, Patel NJ, Pant S, et al. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: Analysis of 93 801 procedures. Circulation 2013; 128:2104-2112. Article

Sunday
Apr122015

Gut microbiota serve as new targets for the prevention and treatment of cardiovascular disease

The Dolder Grand
Medical Wellness & Rejuvenation

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine

 

We are living in a bacterial world, and it's impacting us more than previously thought.

 

 

 

Recent studies reveal a contribution of intestinal microbes in the expression of metabolic or cardiovascular disease. The mechanisms through which intestinal microbiota and/or their metabolic products alter systemic homoeostasis and cardio-metabolic disease risks are just beginning to be dissected. Intervention studies in humans aiming to either selectively alter the composition of the intestinal microbiota or to pharmacologically manipulate the microbiota to influence production of their metabolites are crucial next steps. The intestinal microbiome represents a new potential therapeutic target for the treatment of cardio-metabolic diseases.

Vinjé S1, Stroes E, Nieuwdorp M, Hazen SL.: The gut microbiome as novel cardio-metabolic target: the time has come! Eur Heart J. 2014 Apr;35(14):883-7. doi: 10.1093/eurheartj/eht467. Epub 2013 Nov 11.


 

The human gastrointestinal tract is home to trillions of bacteria, which vastly outnumber host cells in the body. Although generally overlooked in the field of endocrinology, gut microbial symbionts organize to form a key endocrine organ that converts nutritional cues from the environment into hormone-like signals that impact both normal physiology and chronic disease in the human host. Recent evidence suggests that several gut microbial-derived products are sensed by dedicated host receptor systems to alter cardiovascular disease progression. In fact, gut microbial metabolism of dietary components results in the production of proatherogenic circulating factors that act through a meta-organismal endocrine axis to impact cardiovascular disease risk.

Brown JM1, Hazen SL.: The gut microbial endocrine organ: bacterially derived signals driving cardiometabolic diseases. Annu Rev Med. 2015;66:343-59. doi: 10.1146/annurev-med-060513-093205.


 

It has recently been discovered that certain dietary nutrients possessing a trimethylamine (TMA) moiety, namely choline/phosphatidylcholine and L-carnitine, participate in the development of atherosclerotic heart disease. A meta-organismal pathway was elucidated involving gut microbiota-dependent formation of TMA and host hepatic flavin monooxygenase 3-dependent (FMO3-dependent) formation of TMA-N-oxide (TMAO), a metabolite shown to be both mechanistically linked to atherosclerosis and whose levels are strongly linked to cardiovascular disease (CVD) risks. Collectively, these studies reveal that gut microbiota serve as new targets for the prevention and treatment of cardiovascular disease.

Tang WH, Hazen SL.: The contributory role of gut microbiota in cardiovascular disease. J Clin Invest. 2014 Oct;124(10):4204-11. doi: 10.1172/JCI72331. Epub 2014 Oct 1.



We offer gut microbiome exchange (transplantation) as novel opportunity in prevention and treatment of cardiovascular disease.