Emerging Microbiome Treatments and Commercial Opportunities for 2030 - Innovation Exchange Panel Discussion

Emerging Microbiome Treatments and Commercial Opportunities for 2030

July 22, 2021 – By Jennifer Sullivan, Marketing Specialist – Mayo Clinic Innovation Exchange

The Mayo Clinic Innovation Exchange recently hosted a panel of experts to discuss advances in the microbiome industry, and microbiome innovations that are likely to benefit patient care. Drs. Nicholas Chia and Purna Kashyap, associate directors of Mayo Clinic’s Center for Individualized Medicine Microbiome Program, and Kelly Krajnik, senior director for business development with Mayo Clinic Ventures, were among the panelists who spoke with the Exchange community.

Dr. Nicholas Chia is an associate professor of surgery and the associate director of Mayo Clinic’s Center for Individualized Medicine Microbiome Program in Rochester, Minnesota. He is currently researching the human microbiome and its role in metabolism and colorectal cancer. Dr. Chia hypothesizes that certain characteristics within the microbiome can help diagnose colorectal cancer and possibly treat it, by manipulating the microbiome with prebiotics, probiotics, or antibiotics. Dr. Chia is part of a research collaboration with scientists from NASA that aims to understand how we can monitor and modulate the health of astronauts in space.

Dr. Purna Kashyap is a gastroenterologist and the associate director of Mayo Clinic’s Center for Individualized Medicine Microbiome Program in Rochester, Minnesota. He also serves as a consultant in the Department of Internal Medicine and the Department of Physiology and Biomedical Engineering. Dr. Kashyap is currently researching the influence of gut bacteria and dietary carbohydrates on host physiological function, such as gastrointestinal motility. His long-term goal is to develop new biomarkers and microbiota-targeted therapies to treat gastrointestinal disorders.

Kelly Krajnik is a senior director for business development with Mayo Clinic Ventures (MCV). Prior to joining MCV in 2006, Krajnik worked at Mayo Clinic as a senior research technologist in the microarray core facility, was a member of the Institutional Review Board, and worked in the Department of Laboratory Medicine and Pathology to develop new molecular diagnostic assays. Krajnik is a senior member of MCV’s management team. Among her responsibilities, Krajnik leads business development efforts for the Center for Individualized Medicine’s Microbiome Program, including Mayo Clinic’s engagements with companies in the microbiome space.

Q: For our audience who are not scientists, can you explain what the microbiome is, and why we are excited about this area in terms of healthcare innovation?

NC: The microbiome is a collection of microbes, diverse microbial species in and around your body that work collectively. These produce metabolites which impact your immune system by interacting with your epithelial layers, in ways which can both promote health or cause diseases.

They’re really part of us. We have co-evolved with them. We’re really used to having them around, across evolutionary history. Many of the functions that we carry out are vitally carried out by parts of our microbiome. They are not genetically a part of us, but they are intrinsically a part of who we are, and how we are healthy or diseased in life.

That’s one of the reasons why they are so exciting: they’re modifiable. They’re important to health, which means we have the opportunity to alter someone’s disease or their immune system, or otherwise try to impact their health positively. With probiotics and prebiotics, we can impact someone’s overall health, and modify someone’s immune and gut health without a severe therapy that may lead to a lot of side effects.

Q: How might the microbiome have the greatest impact related to disease prevention, screening, or therapeutic strategies in your sphere of work?

PK: Microbes are essentially part of us — they function in harmony with the host, they depend on the host for nutrition and housing. In some ways, it’s a mutualistic relationship, and they play an important role in maintaining homeostasis, a person’s healthy state.

Because microbes are dynamic, they’re a modifiable target. This is as opposed to genes, which were traditionally considered non-modifiable. That excited people early on. But just because we can change something doesn’t mean it’s going to be easy. One lesson we’ve learned over the past decade is that just because we can change something, it doesn’t mean that we can improve health at the drop of a hat.

It requires a good understanding of how these microbial communities are interlinked to each other and to the host before we can consider how to alter the environment that they’re living in, which will result in long lasting change. And that’s sort of the strategy to try to use it as a therapeutic.

But it’s not just changing the microbiome to treat disease or to maintain health. Microbes are also good indicators of disease states, which means that at any given point of time, if somebody has a disease or an adverse response to something, microbes may be playing a role. They might give a snapshot indicating why somebody is developing a disease, progressing in a disease, or responding (or not responding) to medications.

In some ways, it’s the counterpart of human genetics, which has not been as deeply understood. And together, they likely determine how our health and disease states progress.

KK: From a business point of view, it’s interesting to see that of the more than $4 billion invested in this space, where those dollars have gone has evolved. Early on, it was primarily on associations, and how you could impact those associations and looking at fecal microbiota transplantation (FMT), to alter the fecal microbiome of the recipient for the purposes of treating certain diseases. Now it’s shifting to more targeted therapies and measurements — as a biomarker of relative health or disease, as Dr. Kashyap mentioned. Of course, there’s a lot to learn, and the hypotheses will be refined and the investment thesis that follows will as well.

Q: Kelly, in your business development role at Mayo Clinic Ventures, you were involved in the high-profile intellectual property collaboration with Evelo Biosciences around monoclonal microbials. How would you characterize the potential for corporate partners in microbiome — are there fewer of them given the emerging nature of much of the science?

KK: Well, like I said, there’s been more than $4 billion invested, so it’s already an active field. Many investors are waiting to see what the first approved product will be, and which therapies will be shown as most effective. The more data we have to support that the microbiome can indeed be manipulated and measured in a meaningful way, then that certainly will add to the enthusiasm of the space.

Evelo is a great opportunity and we also have invested in other high-profile microbial startups, such as Seres Therapeutics, which are among the companies to potentially have one of those first approved products. With Dr. Chia’s and Kashyap’s help and partnership at Mayo, we’ve been quite active in this space.

Q: Dr. Kashyap, as an associate director for the Mayo Clinic Center for Individualized Medicine’s Microbiome Program, alongside Dr. Chia, how do you see genomics playing a role in the future of microbiome-based therapies most?

PK: The microbiome is essentially an extension of our genetics. Microbes also have their own genes, genes that are responsible for metabolic pathways which are very similar to the host, but they may also be unique to the microbes. In some ways they’re adding to the metabolic capabilities of the host by adding more genes to the mix.

When we think of genomics, I consider it only one part of the equation in terms of predicting how a human being will develop disease or respond to treatment. In that regard, the microbes are complementary. What makes it more complicated is that the genes may also dictate what kind of microbes you are harboring. In some ways, they’re interdependent on each other, which means that the genes may dictate the type of microbes.

We don’t know if those microbes are selected because of their superior capabilities, if they’re complementary, or if they’re good for the host. But in some ways, if you have certain genes which are incurred by the host and you’re missing some which are bought in by the microbes, one could imagine that they can complement each other. It’s important to understand both before we go on to make any conclusions.

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