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   NEWS & PERSPECTIVE › MULTISPECIALTY    
      
   Do Autoimmune Diseases Begin in the Gut?    
   Stephen Paget, MD Disclosures    
   December 17, 2014    
        
   My name is Dr Stephen Paget. I am the physician-in-chief emeritus at Hospital   
   for Special Surgery, and professor of medicine at Weill Cornell School of   
   Medicine in New York City.    
      
      
   Today I am going to talk about the microbiome, an extraordinary concept that   
   is probably not well understood by most physicians but that truly defines us   
   as people. The microbiome is those bacteria that live in various parts of our   
   bodies, particularly    
   the intestine. There are 100 times more genes in the bacteria inside us than   
   each of us has as human beings. Our immune systems are defined by the   
   microbiome and the interactions with those bacteria, almost 80% of which are   
   not the usual bacteria that we    
   know about.    
      
   It now has become clear that the makeup of those bacteria can define whether   
   we are healthy or have disease. What is truly extraordinary is that we now   
   have ways to change a person's bacterial growth and microbiome.    
      
   FROM GUT TO IMMUNE SYSTEM    
   People who have persistent, antibiotic-resistant Clostridium difficile colitis   
   are undergoing fecal transplant to enhance microbiomes that are not   
   functioning well. Fecal transplant can be accomplished in various ways, even   
   in pill form, to change the    
   flora and the balance within the person's intestine, and heal them completely.    
      
   Animal models of different types of arthritis have shown that an animal that   
   lives in a germ-free environment may not develop a certain type of arthritis.   
   As soon as the animal is moved to an environment with specific bacteria,   
   however, those bacteria    
   interact with the animal's genetics and other environmental factors internally   
   and externally to cause arthritis.    
      
   Thus, as we learn more about autoimmune diseases and types of arthritis, we   
   have a tremendous opportunity to make a huge difference. Some scientists have   
   shown that periodontal bacteria may play a significant role as a stimulus for   
   rheumatoid arthritis.    
   Similarly, intestinal bacteria play a significant role as a cause of various   
   types of spondyloarthritis, including ankylosing spondylitis and psoriatic   
   arthritis.    
      
   This is a new world and a new age. We are coming to grips with who we are as   
   organisms, both the organism that is visible on the outside and the organism   
   that is inside us, with both working together in health and in disease.    
      
   http://www.medscape.com/viewarticle/836491   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)