Journal of Leukocyte Biology
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Originally published online as doi:10.1189/jlb.0607372 on December 26, 2007

Published online before print December 26, 2007
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(Journal of Leukocyte Biology. 2008;83:461-466.)
© 2008 by Society for Leukocyte Biology

The re-emerging role of the intestinal microflora in critical illness and inflammation: why the gut hypothesis of sepsis syndrome will not go away

John C. Alverdy*,1 and Eugene B. Chang{dagger}

* Laboratory for Surgical Infection Research and Therapeutics, University of Chicago, Chicago, Illinois, USA; and
{dagger} Martin Boyer Laboratories, Department of Medicine, University of Chicago, Chicago, Illinois, USA

1Correspondence: University of Chicago, Laboratory for Surgical Infection Research and Therapeutics, 5841 S. Maryland MC 6090, Chicago, IL 60025, USA. E-mail: jalverdy{at}surgery.bsd.uchicago.edu

ABSTRACT

Recent advances in the ability to genetically interrogate microbial communities within the intestinal tract of humans have revealed many striking findings. That there may be as many as 300 unculturable and unclassified microbes within the human intestinal tract opens the possibility that yet-unidentified microbes may play a role in various human diseases [1 ]. Technologically, the regional and spatial aspects of intestinal microbial communities can now be better appreciated by emerging genetic and in vivo imaging systems using a bioinformatics approach [2 ]. Finally, in situ PCR of tissues and blood now allows the detection of microbes at concentrations that would otherwise remain undetected by culture alone [3 ]. In the aggregate, these studies have empowered clinicians to readdress the issue of how our microbial partners are affected by extreme states of physiologic stress and antibiotic use through the course of critical illness. The role of microbes in systemic inflammatory states, such as systemic inflammatory response syndrome, as well as in primary intestinal mucosal diseases, such as necrotizing enterocolitis, inflammatory bowel disease, and ischemia-reperfusion injury, can now be more completely defined, and the microbial genes that mediate the immune activation during these disorders can be identified. The 2008 roadmap initiative at the National Institutes of Health to fully define the human microbiome is further testament to the power of this technology and the importance of understanding how intestinal microbes, their genes, and their gene products affect the course of human disease and inflammation.

Key Words: genomic screening • quorum sensing • pseudomonas • epithelial barrier




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