University of Dundee, Dundee, UK
Microbial dysbiosis in bronchiectasis and cystic fibrosis
University of Dundee, Dundee, UK.
Bacterial infection is central to our understanding of the pathophysiology of bronchiectasis and cystic fibrosis. Traditional culture based microbiology techniques have revealed the importance of well characterised pathogens such as Haemophilus influenzae, Pseudomonas aeruginosa and Moraxella catarrhalis in bronchiectasis, and Staphylococcus aureus and Burkholderia cepacia in cystic fibrosis among many others. The management of these diseases and drug development efforts have been largely devoted to antimicrobial therapies targeting these pathogens. P. aeruginosa represents a special case, having been shown to impact prognosis in both diseases and being both frequently multidrug resistant and difficult to eradicate.
The availability of next generation sequencing technologies and particularly characterisation of the bacterial lung microbiome are causing an evolution in our understanding of the disease. Previously unrecognised organisms are found to dominate the microbiome in some patients, while studies characterising the airway microbiome following antibiotic treatment show remarkable resistance of bacterial communities to change. The addition of fungi, viruses and Mycobacteria adds to the complexity of understanding the host/pathogen interaction is these polymicrobial lung diseases.
Key questions still need to be addressed with regard to the microbiome in bronchiectasis and CF, including the extent to which sequencing provides clinical information beyond that provided by culture, whether antibiotic treatment can be targeted based on microbiota profiles, and whether prognostic information can be gained. Finally, it is important to determine if the microbiome can be used to evaluate therapeutic response or give insights into adverse effects of antibiotics such as emerging of new pathogens or loss of bacterial diversity.
James Chalmers. Senior Lecturer and Honorary Consultant at the University of Dundee. His research is focused on understanding interactions between bacteria and neutrophilic inflammation in the lung, with a particular focus on bronchiectasis, COPD and cystic fibrosis. He is chair of the European Bronchiectasis Registry (EMBARC), an initiative of the European Union and European Respiratory Society to accelerate research and clinical trials in non-CF bronchiectasis. He is associate editor of the European Respiratory Journal and a member of the international advisory board of the Lancet Respiratory Medicine. He has published more than 120 papers with an H index of 30. He is chair of the European Bronchiectasis guidelines group, which will produce clinical practice guidelines for bronchiectasis towards the end of 2016.
He is also involved in continuing medical education and is the secretary of the European Board for Accreditation in Pneumology, and is active in the European Respiratory Society and American Thoracic Society.