MICROBIOME’S OMNIPRESENT UNSEEN GUESTS

Much of health care is delivered at the level of treating acknowledged symptoms, but it is what exists at less visible layers, such as the human microbiome housing several trillion microbial cells, that can be of critical importance. Patients and their caregivers in the clinical setting engage in transactions in which one group arrives with a concatenation of symptoms while the other group is confronted with the task of interpreting these signs correctly in order to develop an effective treatment plan.

An example of the value of comprehending and appreciating layers of increasing complexity is afforded by a painting completed by Salvador Dali in 1956 called Nature Morte Vivante, which in English translates into “Living Still Life.” Influenced by Nobel Laureate physicist Werner Heisenberg’s work in quantum mechanics, the title is a play on words characterized by the basic notion of something being perfectly still, yet continuing to be in motion simultaneously. The seeming paradox is explained by the fact that although an object may not appear to be moving, it is composed of millions of atoms that are in rapid motion.

A closer look at the canvas reveals other features that may not appear to be obvious upon cursory examination. Mathematics did not escape Dali’s attention as evidenced by his employment of the Fibonacci sequence, a generator of spiral images that appear throughout the painting. He associated the spiral with a key element of nature and became even more intrigued by it when he learned of the masterpiece 852-word article, highly unusual for its brevity, by James Watson and Francis Crick that was published in the April 25, 1953 issue of the journal Nature. These researchers suggested a spiral structure (a helix) for the salt of deoxyribose nucleic acid (DNA), one “with novel features of considerable biological interest.”

This helix would revolutionize genetics. Essentially no recognition was given, however, of the work of chemist Rosalind Franklin, whose x-ray diffraction studies in crystallography provided the imagery that inspired Watson and Crick. Assuming that Dali was unaware of her contribution, it is likely that he would have been fascinated to learn about this hidden layer of meaning that subsequently accrued to the enormous advantage of her newly more world famous colleagues.

Allied health clinicians and their patients often interact on the basis of seeking and providing relief from symptoms involving aches, pain, discomfort, and physical immobility. Additional layers that lack such clarity are semiotics (non-language features reflecting patient and caregiver differences based on age, sex, gender, race/ethnicity, and health literacy), genomics, proteomics, metabolomics, and the microbiome. The latter unseen guests continue to attract a significant amount of attention as demonstrated by the following examples of papers in the professional literature: Disruption of maternal gut microbiota during gestation alters offspring microbiota and immunity (Microbiome, July 2018), The gut microbiota and dysbiosis in autism spectrum disorders (Current Neurology and Neuroscience Reports, November 2018), and Researchers link gut bacteria to heart transplant success or failure (Journal of Clinical Investigation Insight, October 4, 2018).

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