In the battle against cancer, microbes could be the answer


Can your microbiome fight cancer? WIRED Health speaker and Evelo Biosciences CEO Simba Gill is trialing ways to harness microbes against an array of cancers

In 2015, Thomas Gajewski was researching new treatments for cancer when he noticed something unusual in his lab mice. Gajewski is a professor of medicine and pathology at the University of Chicago, and his lab gets its mice from two different suppliers, Jackson Laboratory (JAX) and Taconic Biosciences (TAC). When the scientists implanted small tumours under the skin of the JAX mice, the animals’ immune systems fought the cancer rigorously. The TAC mice, in contrast, would show only a weak immune response. Mix the two sets together in a cage for a few weeks, and the difference was abolished. The TAC mice were able to fight the cancer with the same vigour as the JAX animals.

Gajewski realised that the difference could be explained by discrepancies between the animals’ microbiomes, the teeming mass of bacteria and other microbes that live in the gut of all living creatures. Something in the gut of the JAX mice dramatically improved its ability to deal with cancer, and the effect was transferred to the TAC mice after the two sets swapped bacteria (endearingly, mice eat each other’s poop). The close connection between the gut microbiome and the immune system has only recently been made. Gajewski’s finding pointed to a way to exploit the connection – to improve the body’s resilience by manipulating the gut.

This is the sort of finding that greatly interests Simba Gill, the chief executive of Evelo, a biotech company based in Cambridge, Massachusetts. Evelo was established three years ago in order to develop a suite of new medicines based on the understanding that the gut-body network plays a critical role in our biology and immunology. The company has so far raised $100 million; investors include Flagship Pioneering, Google Ventures and Mayo Clinic.

Evelo’s remit goes beyond cancer. The company is currently investigating treatments for multiple sclerosis, rheumatoid arthritis, asthma, inflammatory bowel disease and diabetes, to name a few. This year, Evelo will begin clinical trials of some of its medicines, called monoclonal microbials – “monoclonal” because each medicine harnesses a single microbe strain. It was recently issued a patent for a cancer treatment based on Gajewski’s work. “The core of what we’re doing now is in recognition of the fact that the gut is networked to the rest of the body and drives many of the central aspects of how we fight disease,” Gill says. 

Gill has worked in biotechnology for three decades. After his PhD at King’s College, London, he worked for Celltech in the early days of antibody engineering. Later, he worked at a company that uses stem cells to treat diseases, and spent a decade collaborating with biotech entrepreneur Alejandro Zaffaroni. “I’ve focused my whole career on big, bold platform biotech ideas,” Gill says. “What I mean by platform is a new modality of medicine which has very broad applicability, that can allow for many products to treat diseases in ways which have not otherwise been possible.” In 2015, he joined Flagship Pioneering, a builder and funder of platform biotech start-ups.

For centuries, medical science ignored the trillions of microorganisms that share our bodies – it was the dangerous invaders that needed attention. In the past decade, we have come to appreciate better the role that these microbes play in an array of bodily functions, from digestion and immunity to organ health and even things like mood, sleep and stress. The gut contains 99% of the body’s microbial mass, representing thousands of species. “Humans evolved together with microbes,” says Gill. “What we hypothesised was, because of that reason, it was very likely that there were specific, individual microbial strains which have evolved to act through the gut with the immune system to modulate our systemic biology.” If Evelo could only find these individual strains, they might use them to develop a new class of medicine.

Monoclonal microbials work by commandeering one of the body’s routine immunological processes. The idea is to load a capsule with a single strain – perhaps tens of billions of microorganisms. After the capsule is swallowed, it makes its way to a part of the small intestine that is lined with gut-associated lymphoid tissue. Through the tissue interface, dendritic cells sample the gut and alert the lymphatic system to changes. Depending on which microbe is detected, a specific immune response is hatched. In the case of cancer, Gajewski’s team found that when Bifidobacterium (Bifs) was introduced to the digestive track of a mouse, it boosted the ability of animal’s immune system to attack tumour cells.

Gill admits that a lot of work still needs to be done. “It’s very difficult to find the strains which have the [desired] type of activity,” he says. And while models (mouse and computer) have been encouraging, trials in humans need to be carried out. It is in people that most promising new medicine falls down.

But if trials are successful, Gill believes that microbes could be harnessed against an array of cancers including colon, lung, melanoma, renal, bladder and head and neck cancer, either alone or in combination with existing immunotherapies. In the lab, when specific strains of Bifs were combined with a type of immunotherapy drug called a checkpoint inhibitor, the tumour growth in mice was nearly abolished.

More broadly, Gill sees a gap in the market for effective early-stage treatments for disease. “Modern medicine is still very limited,” he says, pointing out that many conditions are not treated until the late stages because the treatment might be expensive, have side effects or require professional administration. Monoclonal microbials, in contrast, could be swallowed at home. He thinks that they could be used as a preventative medicine, one that ensures that the gut-body network stays in healthy, homeostatic balance. Such a thing is not a new concept, he points out. It was just that, for a long time, he found it hard to imagine how it could be done.

Simba Gill, the chief executive of Evelo Biosciences, will be speaking at WIRED Health 2018 on March 13 at the Francis Crick Institute, London. See all the WIRED Health speakers here.


Bacteria Living in Our Gut Are Hijacking And Controlling Our Genes


Your gut microflora isn’t just sitting silently waiting for you to wolf down your next meal – it turns out there’s a constant conversation going on between these bacteria and your body’s genetic code.

New research has found a chemical produced by ‘good’ bacteria in our digestive system has an unusual effect on the chromosomes in nearby cells, a discovery that could help us better understand links between our diet and the development of one of the world’s most deadly cancers.

A team led by scientists from the Babraham Institute in the UK that discovered DNA in the epithelial tissues of the human colon contain an unusual level of a chemical known to act as an epigenetic switch, turning genes on and off.

What’s more, they found these levels were elevated in just one other part of the body: our brain.

Crotonylation is a recently discovered genetic editing process not unlike the more familiar form of genetic manipulation called methylation.

Both processes change how genes are expressed by tweaking the surrounding chemistry, without altering the actual code itself.

While methylation involves the addition of a methyl group (CH3) to a nucleotide base – usually cytosine (C), but occasionally adenosine (A) – crotonylation clips an acetyl group onto proteins called histones that help keep strands of DNA neatly ordered.

Finding crotonylated histones in gut tissue suggests something is preventing the body from removing those acetyl groups. And the researchers suspected they knew what it could be.

Small organic molecules called short-chain fatty acids (SCFA) are produced when the fibre in our fruit in veg is fermented by our resident microbes.

Previous research had suggested there were links between the cell’s metabolism and crotonylation, pointing to SCFAs as the culprit.

The researchers analysed tissue from the colon, brain, liver, spleen, and kidney, and found higher levels of histone crotonylation in the brain and colon.

Why this occurs in the brain but not the other organs is still something of a mystery.

Yet this new study demonstrates it’s the bacteria that are ultimately responsible for the modification.

“Short chain fatty acids are a key energy source for cells in the gut but we’ve also shown they affect crotonylation of the genome,” says lead author Rachel Fellows from Babraham Institute.

Specifically, SCFAs produced by the kinds of bacteria found in a healthy human colon promote crotonylation by preventing an enzyme called histone deacetylase 2 (HDAC2) from removing the markers.

To confirm bacteria were indeed responsible, the researchers dosed mice with a cocktail of antibiotics to wipe out most of the bacterial microflora in their guts. Not only did the SCFAs drop, so too did the crotonylation of the histones in their gut lining.

Exactly what benefits the bacteria might get – if any – wasn’t addressed by the study.

But the research could have implications in how our genes are affected by our diet, which could go some way to help flesh out the links between dietary fibre and bowel cancer.

With around 770,000 deaths from colorectal cancer each year, finding more ways to prevent and treat the disease is a high priority for researchers.

Meanwhile, it’s a good reminder for us to check our diet and make sure it’s not just our bodies that are being well fed, but our tiniest citizens as well.

“Our intestine is the home of countless bacteria that help in the digestion of foods such as plant fibres,” says the study’s lead scientist, Patrick Varga-Weisz.

“They also act as a barrier to harmful bacteria and educate our immune system. How these bugs affect our cells is a key part of these processes.”

This research was published in Nature Communications.


How to Optimize Your Gut Health


What is Gut Health?

Although Hippocrates hypothesized that all diseases begin in the gut over 2,000 years ago, research is recently beginning to truly understand the massive impact that gut health has on overall health, wellbeing and disease control.

The truth is, the gut and its functions are extremely complex. The human body is composed of equal if not more bacteria than cells. We are basically bacteria-bipeds wandering this planet. Only about 10% of our cells are truly human, while the majority is microbial.

We are in an age when transplanting fecal matter (poop) from one person into another is a “thing.” An extremely effective “thing” curing over 90% of patients with Clostridium difficile. But nonetheless, that’s how damaged human’s microbial systems have become.

Better questions we can now answer: How did this happen? And how do we fix it?

The human body is one ecosystem with trillions of micro-organism inhabitants. This is called the human microbiome. We could not live without this massive colony of bacteria. They are in our eyes, skin, digestive and respiratory system.

The largest colony of microbes reside in our digestive system. There’s an entire world going on in there, with certain species performing different functions. Without gut flora, humans would not be able to survive.

Gut flora can be categorized into three groups:

● Beneficial (essential) flora: These are the most important and most abundant microbes (bacteria) found in a healthy individual. Key beneficial players: Bifidobacteria, Lactobacteria, Propionobacteria, E. Coli (physiological strains only), Peptostreptoccocci and Enterococci.

● Opportunistic flora: These microbes have various functions in different combinations. In a healthy body, opportunistic flora is tightly controlled and regulated by the beneficial bacteria. However, in a compromised immune system, these guys can stray and cause health problems. Key opportunistic players: Bacteroids, Peptococci, Staphylococci, Streptococci, Bacilli, Clostridia, Yeasts, Enterobacteria, Fuzobacteria, Eubacteria, Catenobacteria, etc.

● Transitional flora: These microbes are consumed on a daily basis through the environmental toxins and processed food. As long the gut is protected by beneficial bacteria, these microbes will pass through our digestive system without harm. But if it’s damaged, transitional flora can lead to disease. Key transitional players: toxins, chemicals, parasites, bacteria in undigested food and drink.

Immune System & Gut Health

Approximately 80% of our immune system is located in the gut. Basically if your beneficial microbes are M.I.A., there’s a good chance you’re getting sick, my friend. The Mucosal Barrier of the Gastrointestinal (GI) tract is built to allow very small fully digested particles through.

However, when the GI tract becomes stressed, the tight junctions between the cells lining of our GI tract or enterocytes become loose. This allows the unchecked entry of bigger particles into the bloodstream. Your body then sees these larger particles as foreign and activates the immune system just like it would for any pathogen.

The problem is that your immune system has a great memory (via memory B cells). They don’t care what exactly that large particle is. To your immune system, it’s just an intruder that needs to be pulverized. Thus, if you have intestinal permeability depending on what larger particles get through, your immune system can start attacking literally any items that you commonly eat like tomatoes, garlic, cucumbers, even a lean piece of grass-fed steak.

The problem doesn’t end there because if a large particle gets through that looks similar to thyroid, ovarian, adrenal, or mucosal tissue, you may have just set the stage for an auto-immune disease – your own immune system now sees yourself as foreign. This is called molecular mimicry and this chain of events is not something to take lightly.

Energy Metabolism

Without a well-balanced gut flora, digestion and absorption cannot be optimal. This bacteria has the ability to break down protein, carbohydrates, fat and fiber. “By-products of bacterial activity in the gut are very important in transporting mineralsvitamins, water, gases and many other nutrients through the gut wall into the bloodstream.”

Take Away: Even if you followed a ‘perfect’ diet consuming all the “superfoods” in the world, you cannot combat a damaged gut flora. It’s essential to heal the gut first. Then you will be able to able to efficiently digest and absorb healthy foods and supplements. Fiber and lactose (milk sugar) are two substances that require good bacteria for digestion.

Most people don’t produce lactase–the enzyme that breaks down lactose–after infancy. But why then can some people handle dairy while others cannot? This is because these individuals have a lot of lactose-digesting bacteria; one of the most notable ones being E. Coli. Yes, this is same bacteria that also can make us sick.

However, if your gut is populated by physiological strains of E. Coli, you are better equipped to fight off the pathogenic (bad) species of E. Coli.

What Compromises the Microbiome?

The integrity of the gut flora has its roots far before your parents conceived you. Did dad follow a strict Ramen-noodle diet in college? Was mom hanging out with Ben & Jerry on the reg while you were in her tummy? Not to put the blame on our folks’ diet, but it is one contributing factor to a baby’s microbiome among many other factors, including:

Birth & Infancy

● C-section babies
● Bottle-fed babies


● Penicillins
● Tetracyclines
● Aminoglycosides
● Antifungal antibiotics
● Antibiotics wipe out all bacteria–the bad and the good. So, although necessary at times, a dose of these drugs will inherently leave you immune-compromised.

Other Drugs

● Pain killers
● Steroids
● Contraceptives
● Sleeping pills
● Heartburn medication

Processed Foods

● Sugar & processed carbohydrates
● Grain fiber
● Food sensitivities – common allergens and food sensitivities wreak havoc on your digestive system eventually leading to GI tract shutdown, a blunted brush border, dysbiosis, and poor gut health.


● Infectious disease
● Viral infections
● Chronic illness
● Alcoholism
● Dysbiosis – or inappropriate ratio of good vs. bad bacteria residing in the gut. This is the topic of entire books and articles, but in the simplest terms: you are the wolf that you feed. Healthy bacteria thrive on colorful fruits and vegetables, bad bacteria thrive on sugar, artificial  sweeteners, and unhealthy fats. Also, if you have transit time issues, it is very likely that you have some kind of dysbiosis and brain to gut axis issue.


● Short-term stress (recovers fairly easy)
● Prolonged stress (permanent damage)

Other Factors

● Old age
● Over physical exertion
● Surgery
● Pollution
● Toxic substance exposure/ingestion
● Extreme climates
● Environmental Toxins – items like BPA, BT Toxin (found in GMO corn), and Glyphosate (AKA Round-Up).
● Intestinal parasites, microbial infestations, or fungal overgrowth – this is much more common than you might think. 80-90% of our population is believed to have some kind of unwanted GI intruder.

Take away: Think twice before taking antibiotics and popping any over-the-counter or prescribed medication. Please, do not take this fundamentally. Just don’t go running to the doctor the second you have the sniffles. Sure, a Z-Pack will probably make you feel better in the short term, but you’re wiping out all of the good bacteria along with the bad. Plus, overuse of antibiotics leads to antibiotic resistance. So when you really need those meds to work, they may not.

Avoid processed food. It sounds simple, but it’s not with over 80% of the American food supply being altered or processed in some way.

Control “extreme” behaviors. This can be any obsessive act or habit from partying too much to over-exercising to everything in between. Too much of a bad OR good thing causes stress to the body and damages the gut flora.

Practice TLC in the most natural environment possible. You probably won’t witness the lasting effects of recycling that glass bottle but your body will. By removing yourself from life’s stressors aka your 8×8 work cubicle and entering a local park surrounded by lots of green, you will inherently avoid many of those damaging factors.

How to Establish a Healthy Gut?

The information on how to help fix gut health could fill an entire book, let alone an article. While we obviously can’t go into that kind of detail here, we can give you some simple fixes that will get you started on the right track.

Restore Stomach Acid Production

The first step in restoring stomach acid production is addressing any factors that are inhibiting it. This means getting tested for H. pylori if you suspect it, taking steps to manage chronic stress and avoiding acid-suppressing drugs.

The next step is to take hydrochloric acid (HCL). Taking HCL can often help kick start the body’s own acid production. HCL helps limit digestive problems as well as the potentially serious consequences of low stomach acid (such as decreased nutrient absorption, bacterial overgrowth, and increased susceptibility to infection.

Be aware that HCL should always be taken with pepsin — or, better yet, acid-stable protease — because it is likely that if the stomach is not producing enough HCL, it is also not producing enough protein digesting enzymes.

Replace Digestive Enzymes

As mentioned above, the single most important step in increasing digestive enzyme production is by restoring stomach acid production.

This will give the chyme entering the small intestine the proper pH level (acidity), which is what stimulates the pancreas to produce enzymes. Managing chronic stress and ensuring adequate micronutrient (co- enzyme) intake are also important.


This one is a little harder to give a quick overview of, because there are so many potential causes, and some of those causes require a fairly complex approach. What we can do is give you a few general tips that are helpful in most circumstances, regardless of the cause.

The first step would be to cut out gluten. Gluten leads to increased intestinal permeability if you have a gluten allergy/sensitivity or not (via activation of the zonulin pathway). Gluten is not your friend.

Also, just two alcholic beverages will cause damage to the intestinal lining and in turn intestinal permeability. A night of bottle service and pizza is a fantastic way to ramp yourself for an incredible inflammatory response and maybe even good ol’ autoimmune disease.

None of this sounds sexy or fun. Sorry, but we don’t make the rules and we’ve found a fair number of people who are weight loss resistant in our practice.

These people try everything but can’t lose body fat and constantly crave sugar. This is because whenever your immune system is running wild, you will be in a perpetual state of sugar burning and have zero shot at burning stored fat no matter how little you eat or how much you exercise.

Fixing the GI tract and securing up the junctions between our enterocytes is the first step on the road to putting out the inflammatory fire and having a real opportunity to incinerate visceral fat or the bulge around the middle.


The next step would be trying some tweaks to your existing Paleo or “real food” diet. (You are on a Paleo or “real food” diet, aren’t you? If not, that is the first step. Here are three diet fixes we’ve found to be helpful, and they’re listed in the order we suggest you try them:

● Add Fermented Food. Raw, fermented foods like sauerkraut, kimchi, kefir or beet kvass are rich in enzymes and should be consumed regularly if tolerated.
● Try an Elimination diet. Cut out all gluten, dairy, and sugar for a minimum of two weeks (6 weeks is ideal). Begin to add one food back into your diet. A piece of sprouted, whole-grain bread is a good start. Now you begin the waiting game.
● GAPS diet. The GAPS diet is a comprehensive, anti-inflammatory, gut-healing diet. It’s especially helpful with SIBO, dysbiosis, and inflammatory bowel disease (IBD).

How to Optimize Your Gut Health

Along with these diet tips, we suggest you start adding these probiotic strains and supplements to you daily protocol. Supplemental nutrients can be helpful for immediate relief. These include:

● Ox bile. While not technically an enzyme, ox bile is one of the most effective supplements for improving fat absorption.
● Acid stable protease. Improves protein digestion; acid-stable protease is able to survive the low pH of gastric juices to further aid in protein assimilation.
● Pancreatin. A mixture of enzymes produced by the pancreas, including lipase (fat digesting), protease (protein digesting) and amylase (carbohydrate digesting).
● Bromelain. An enzyme found in pineapple that helps with protein digestion, and may have systemic anti-inflammatory effects.
● Ginger. A time-tested digestive remedy. As with HCL, in most cases you will only need to take these nutrients temporarily, until you are able to address the underlying issues. But they can be incredibly helpful in the meantime.

Probiotic Bacteria

More and more research has shown the effectiveness of daily probiotic supplementationon energy metabolism, immune system strength and disease controlProbiotics are strains of beneficial bacteria. Of course, there are thousands of strains of probiotics, so it’s virtually impossible to get every single strain through one probiotic supplement, but there are some heavy hitters that are widely available and crucial to take on a daily basis.

● Lactobacillus acidophilus
● Lactobacillus plantarum
● Lactobacillus rhamnosus
● Bifidobacterium infantis
● Bifidobacterium lactis

Probiotic Yeast

● Saccharomyces Boulardii


● Organic Jerusalem Artichoke (root)
● Organic Dandelion (leaf)

Digestive Enzymes

● Amylase
● Protease
● Lipase
● Cellulase
● Alpha Galactosidase
● Maltase
● Lactase
● Glucoamylase
● Pectinase
● Xylanase
● Beta Glucanase
● Invertase
● Hemicellulase
● Serratiopeptidase
● Pepsin

Bitter Herbs

Another way to stimulate acid production in the stomach is by taking bitter herbs. “Bitters” have been used in traditional cultures for thousands of years to stimulate and improve digestion. More recently, studies have confirmed the ability of bitters to increase the flow of digestive juices, including HCL, bile, pepsin, gastrin and pancreatic enzymes. The following is a list of bitter herbs commonly used in Western and Chinese herbology:

● Dandelion
● Fennel
● Gentian root
● Ginger
● Beet root
● Goldenseal root
● Milk thistle
● Peppermint
● Wormwood
● Yellow dock

Hydrochloric Acid

● Betaine Hydrochloride


1. Mutzel, Mike. Belly Fat Effect: The Real Secret about How Your Diet, Intestinal Health, and Gut Bacteria Help You Burn Fat. Print
2. Arrieta, M. C. “Alterations in Intestinal Permeability.” Gut 55.10 (2006): 1512-520.
3. Kharrazian, Datis. Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal: A Revolutionary Breakthrough in Understanding Hashimoto’s Disease and Hypothyroidism. Garden City, NY: Morgan James, 2010. Print.
4. Davis, Reed. “Functional Diagnostic Nutrition – Lecture Series 4.” FDN Certification. 8 Aug. 2015.


Exercise can beneficially alter the composition of your gut microbiome


Jacob Allen, left, Jeffrey Woods and their colleagues found that exercise alters the microbial composition of the gut in potentially beneficial ways (Credit: L. Brian Stauffer)

Two new studies led by researchers at the University of Illinois have delivered the first clear evidence that the composition of gut bacteria can be changed by exercise alone. Designed to isolate the effects of exercise from other factors that could influence gut bacteria, these dual studies build on an increasing body of evidence affirming the role of exercise in determining the makeup of a person’s gut microbiome.

The first study, focusing on a mouse model, took fecal samples from sedentary mice and exercised mice then transplanted that material into germ-free sedentary mice to analyze the effects of the different gut flora.

The results were significant, with the mice that received the exercised gut bacteria displaying an enhanced microbial diversity and a higher volume of butyrate-producing microbes. Butyrate is a short-chain fatty acid (STFA) known to be vital to colon health, energy production and thought to protect against colon cancer.

“We found that the animals that received the exercised microbiota had an attenuated response to a colitis-inducing chemical,” says Jacob Allen, co-lead of the research. “There was a reduction in inflammation and an increase in the regenerative molecules that promote a faster recovery.”

The second study looked at humans and involved 18 lean and 14 sedentary obese subjects. All the subjects maintained their normal diets but were put on an exercise program consisting of up to an hour of cardiovascular activities, three times a week for six weeks. Each participant’s microbiome was sampled before and after the program.

The results of this study were fascinating with notable increases in fecal concentrations for STFAs seen in the lean subjects, but only modest increases seen in the obese subjects. Six weeks after the program was completed, these positive increases had declined following the participants return to a sedentary lifestyle.

“The bottom line is that there are clear differences in how the microbiome of somebody who is obese versus somebody who is lean responds to exercise,” says Jeffrey Woods, co-lead on the research. “We have more work to do to determine why that is.”

These two studies build on earlier work suggesting a strong correlation between exercise and diversity of healthy gut bacteria. This compelling new discovery, revealing that the effects of exercise could be dependent on obesity status, offers scientists a strangely unexpected new focus of study, and further affirms how mysteriously complex the gut microbiome seems to be.

The first mouse study was published in the journal Gut Microbes, while the second human study was published in the journal Medicine & Science in Sports & Exercise.

Source: University of Illinois

Onze bron:

Het ideale ziekenhuis? Dat wemelt van de bacteriën!


Het verrassende antwoord op de antibioticaresistentie: bacteriën meer ruimte geven.

Elk jaar sterven ongeveer 700.000 mensen door toedoen van infecties die niet meer te behandelen zijn met antibiotica. De bacteriën die deze infecties veroorzaken, zijn gaandeweg resistent geworden, wat betekent dat ze niet langer doodgaan als ze worden blootgesteld aan een antibioticum. Deze onoverwinnelijke bacteriën vind je wereldwijd en ze winnen terrein: naar verwachting zijn ze als het zo doorgaat tegen 2050 verantwoordelijk voor zo’n 10 miljoen doden per jaar.

Uitstel van executie
Dat doemscenario willen onderzoekers natuurlijk voorkomen. En dus zoeken ze hard naar een oplossing voor het probleem dat antibioticaresistentie heet. In veel gevallen richt die zoektocht zich op de ontdekking van nieuwe antibiotica. Maar die zoektocht verloopt moeizaam. Bovendien lijkt het een kwestie van tijd voor bacteriën zich aan eventuele nieuwe antibiotica hebben aangepast. Uitstel van executie dus. Genoeg reden om het over een andere boeg te gooien, vindt microbioloog Remco Kort, auteur van het onlangs verschenen boek ‘De microbemens‘. “De resistentieproblemen worden alleen maar groter door onze eenzijdige aanpak. We moeten wat meer lef tonen, de gebaande paden verlaten en andere oplossingen vinden door naar de natuur te kijken,” zo vertelt hij aan

Een ander veelbelovende manier waarop antibioticaresistentie wellicht het hoofd kan worden geboden, is door de inzet van fagen. Je kunt er hier alles over lezen. Kort verwacht er – ondanks dat het een veelbelovend alternatief voor antibiotica is – op korte termijn echter weinig van. Hij schrijft in zijn boek dat er maar weinig onderzoek gedaan wordt naar fagen en dat dat verschillende oorzaken heeft. “Over het algemeen is de mens behoudend, en geeft hij er de voorkeur aan door te modderen met wat er voorhanden is. Bovendien: de agenda wordt bepaald door de farmaceutische industrie. En die zoekt nog naar een verdienmodel. Zolang dat er niet is, zal er vanuit die hoek niet worden geïnvesteerd in onderzoek.”

Haat en liefde
Microben: wij mensen hebben er een haat-liefdeverhouding mee. We kunnen niet zonder, maar willen er tegelijkertijd eigenlijk niets van weten. Het is volgens Kort allemaal te herleiden naar de gloriedagen van Louis Pasteur en met name Robert Koch, de voorvaderen van de bacteriologie, die voor het eerst de technieken ontwikkelden om bacteriën te kweken. “De gevolgen van die bacteriën zijn meteen zichtbaar,” vertelt Kort. “De bacteriën veroorzaken een infectie en dat leidt tot allerlei symptomen: dat is een heel helder verhaal.” En dus ook een verhaal dat mensen gemakkelijk omarmen. Maar het is niet het hele verhaal. Want naast de ziekteverwekkende bacteriën zijn er ook nog de – veel talrijkere – ‘goede’ bacteriën die in, op en rondom ons leven en van groot belang zijn voor onze gezondheid. “We zijn ermee ge-co-evolueerd,” stelt Kort. “Sterker nog: wij zijn een succesvol product van de evolutie geworden door een samenwerking met microben. Wij geven ze te eten en zij beschermen ons.”

Wij mensen worden steeds ‘schoner’: we gebruiken antibiotica, antibacteriële zeep, desinfectiemiddelen, wonen vaker in steden en bevallen steeds vaker middels keizersnedes. Het resulteert allemaal in een verminderde blootstelling aan microben. Die verminderde blootstelling wordt in verband gebracht met een verhoogde kans op allergieën, astma, diabetes type I en MS.

Het is een succesvolle symbiose. Maar toch kunnen wij mensen het idee van die paar ziekteverwekkende bacteriën maar moeilijk loslaten. “We laten ons leiden door angst,” stelt Kort. En dus staat er antibacteriële zeep op het aanrecht en desinfecterend schoonmaakmiddel in de trapkast en zijn we maar wat blij als de huisarts ons na een weekje kwakkelen een antibioticum voorschrijft. Want bacteriën: daar willen we liever niet aan worden blootgesteld. Maar met die agressieve bejegening zorgen we er niet alleen voor dat de ‘slechte’ bacteriën het loodje leggen: de ‘goede’ exemplaren vallen net zo snel om. En dat is een probleem. Niet alleen omdat die goede bacteriën van belang zijn voor onze gezondheid op lange termijn (zie kader). Maar ook omdat die goede bacteriën ons kunnen helpen om de ‘slechte’ bacteriën – zonder tussenkomst van antibiotica – te bestrijden.


De goede bacteriën zouden ons met name in ziekenhuizen – waar naar verhouding veel resistente bacteriën rondhangen – een grote dienst kunnen bewijzen, aldus Kort. “Nu wordt er met hygiëne-maatregelen in ziekenhuizen eenzijdig ingezet op het verdelgen van bacteriën.” Het resultaat: je verkrijgt ruimtes die vrijwel bacterie-vrij zijn. De droom van elke ziekenhuisdirecteur, maar in werkelijkheid een nachtmerrie. “Want wat is in een ruimte zonder bacteriën de enige bron van bacteriën? Andere patiënten.” Die daar niet voor niks liggen en dus waarschijnlijk ziekteverwekkers onder de leden hebben. En dankzij de schoonmaakploeg die alle bacteriën – op de exemplaren die in en op patiënten leven na – heeft uitgeroeid, hebben die ziekteverwekkers vrij spel en is de kans op een infectie groter. “Je kunt veel beter ook onschadelijke bacteriën uit de omgeving in ziekenhuizen toelaten, zodat zij als concurrentie kunnen dienen voor de ziekteverwekkers.”

Het is een bijzonder toekomstbeeld, waar Kort wel enkele voetnoten bij wil plaatsen. Allereerst benadrukt hij dat hij er zeker niet voor pleit om het nieuwe protocol nu al uit te rollen: dat moet eerst onderzocht worden. Zo moet er bijvoorbeeld gekeken worden in welke ruimtes we het beste onschadelijke bacteriën kunnen toevoegen, “want het is duidelijk dat we geen risico’s kunnen nemen als het om kwetsbare patiënten gaat”. Het goede nieuws is dat alle technieken die nodig zijn om dergelijk onderzoek te verrichten, voorhanden zijn. Daarnaast onderstreept Kort nog eens dat hij zeker niet tegen hygiëne is. Sterker nog: zijn aanpak zou je hygiënisch kunnen noemen. “Hygiëne betekent letterlijk het voorkomen van ziekteverwekkers en ik wil dat doen door onschadelijke bacteriën toe te voegen. Dat is iets waar onderzoek naar gedaan zou moeten worden, omdat het een belangrijke oplossing zou kunnen zijn waar nu nauwelijks naar gekeken wordt.”

De meeste ziekenhuizen omarmen de niets ontziende desinfectiemiddelen. Slechts mondjesmaat worden er momenteel schoonmaakmiddelen die microben bevatten, ingezet. “Terwijl studies hebben aangetoond dat op deze wijze de aantallen hardnekkige ziekenhuisbacteriën onderdrukt kunnen worden, waaronder de beruchte Pseudomonas aeruginosa, Acinetobacter baumannii en Klebsiella pneumoniae,” zo schrijft Kort.

Hoe mooi het in theorie ook is: het vereist wel een cultuuromslag in ziekenhuizen die nu nog gebrand zijn op het verdelgen van alle micro-organismen. Toch denkt Kort dat zijn van bacteriën wemelende ziekenhuis op korte termijn werkelijkheid kan worden. “Het kan vrij snel gaan als er door antibioticaresistentie zoveel doden vallen dat er geen andere optie meer is.”


TedTalk: the surprisingly charming science of our gut


Een interessante TedTalk over onze darmen.

Ever wonder how we poop? Learn about the gut — the system where digestion (and a whole lot more) happens — as doctor and author Giulia Enders takes us inside the complex, fascinating science behind it, including its connection to mental health. It turns out, looking closer at something we might shy away from can leave us feeling more fearless and appreciative of ourselves.