06. Microbiome in COPD: Pitfalls and Progress

Sanjay Sethi.
University of Buffalo, Buffalo, USA.


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Microbiome in COPD: Pitfalls and Progress


Sanjat Sethi.
University of Buffalo, Buffalo, USA.

Microbiome studies of respiratory secretions have provided exciting new observations regarding the bacterial causation of exacerbations of COPD, and the impact of treatment of the exacerbation on the airway microbiome.  Bacterial exacerbations likely represent abrupt major changes in the microbiome with resultant large increases in airway and systemic inflammation.  Microbiome studies could lead to discovery of new pathogens that have been difficult to obtain with standard culture techniques.

The Vicious Circle Hypothesis embodies the likely contribution of an altered microbiome to COPD progression, with an unhealthy microbiome driving the inflammatory process in stable COPD. While studies with conventional microbiology found potential pathogenic bacteria to be virtually absent in bronchoscopic samples in healthy controls, smoking and development of COPD was associated with 35–50% incidence of isolation of pathogenic bacteria.  In contrast, recent microbiome studies have found no or minor differences from controls in smokers and COPD. These contradictory findings could be explained by the extreme sensitivity of the microbiome technique to upper airway contamination.

Several challenges need to be tackled to fully utilize the benefits of microbiome research in COPD. Paramount is the issue of upper airway and environmental contamination of lower airway samples. Significant concentration thresholds in microbiome data need to be defined.  The microbiome differs in sputum, bronchoalveolar lavage and lung parenchyma samples obtained from patients with COPD.  Determination as to which of the various new microbes that will be identified in microbiome studies are pathogenic is still unclear, especially for unculturable pathogens. Though various obstacles need to be surmounted, ultimately lung microbiome studies will provide new insights in to how infection contributes to COPD.

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Sanjay Sethi. Professor in the Department of Medicine at the University of Buffalo at the State University of New York (SUNY) in Buffalo, NY. He is Chief of the Division of Pulmonary/Critical Care/Sleep Medicine, Assistant Vice President for Health Sciences and Director of the Clinical Research office at the University at Buffalo.  Dr Sethi’s main research interests include chronic obstructive pulmonary disease (COPD) and respiratory infections, focused on the specific areas of exacerbations, new therapeutics and innate lung defense in COPD. Dr Sethi has co-authored more than a 180 research articles, reviews and book chapters in many peer-reviewed medical journals.  He is a member of the editorial board for several pulmonary journals.. He was a member of the lung cellular, molecular, and immunobiology study section of the National Institutes of Health (NIH) and the Pulmonary study section of the VA, and is an ad hoc reviewer for several North American and European research funding agencies. Dr. Sethi is currently active in several professional organizations including the American Thoracic Society where he has chaired the Clinical Problems program committee, and is chair for the Clinical Problems Assembly.


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