What I’m Working On: How Microbes Contribute to Health

Posted by Katie Alexander

Green Fluorescent Protein (GFP) labeled bacteria

As a member of the Elson lab at UAB, I examine the relationships between a certain cell type, regulatory T cells (Tregs), and the microbiota. Tregs are major players in immune tolerance and homeostasis, the policemen of the immune response. They are essential in anti-inflammatory mechanisms. Recently, researchers have shown that certain species of bacteria effectively induce Tregs and anti-inflammatory responses (1). Conversely, other types of bacteria encourage pro-inflammatory cells to thrive and can damage the immune system. During IBD, the microbiota becomes unbalanced, and the bacterial species associated with inflammation tip the scales in their favor, ousting the beneficial bacteria. This is also what happens when a person is infected with the bacterium Clostridium difficile (C.diff).

Additionally, bacteria can interact with components of our food directly. A recent report by Suez et al. (2) outlined the relationship between non-caloric artificial sweeteners (NAS) and the microbiota. NAS are ubiquitous in the Western diet, with saccharin and aspartame being some of the most commonly used. Interestingly, our bodies do not recognize NAS and therefore cannot absorb or use them as energy sources. For that reason, numerous health officials have considered these sweeteners harmless, or in the case of a person with diabetes, beneficial. Suez and colleagues demonstrated that NAS interact closely with intestinal bacteria, causing shifts in the balance of good and bad bacteria. In fact, mice subjected to a diet supplemented with NAS were susceptible to increased glucose intolerance. This finding was recapitulated in a small-scale human study. It is obvious that microbes affect countless aspects of human health, and therefore further research into understanding how to maintain a healthy population of microbes will contribute profoundly to overall human wellbeing.   

References:

  

Atarashi K. et al. Induction of colonic regulatory T cells by indigenous Clostridium species. Science. 2011. Jan 21:331(6015):337-41.

Suez J. et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014 Oct 9:514 (7521):181-6.

What I'm Working On: Better Health, Better Care, at Lower Costs for our Veterans

Posted by Tonya L. Breaux-Shropshire

As recent media coverage has shown, few issues are as important to this country as healthcare for veterans. What most people don’t see, however, when they read the headlines, is the research that takes place behind the scenes on new solutions to our vets’ most common medical problems. For example, hypertension is the number one reason for a primary care visit, and that is one of my areas of research as a Veterans Administration (VA) Quality Scholar Fellow at the University of Alabama at Birmingham (UAB) School of Medicine. In particular, I facilitated first steps in how to boost blood pressure control in hypertensive veterans by using quality improvement tools, such as a process map, SWOT analyses, check sheets, and evidence-based interventions like “a hypertension bundle.” This bundle, which has been successful in one patient aligned care team (PACT) in the Primary Care Clinic at our VA Hospital, employs the electronic medical record, medication adherence assessment, and appropriate nontraditional care visits to achieve greater patient engagement, hence superior care for vets. What is more, the bundle could potentially lower costs by helping vets avoid expensive emergency room visits for what could be routine care.

Research into hypertension is not new for the VA system, which has led the way to blood pressure treatment and control. As early as the 1960’s, for example, the VA conducted pioneering studies to determine that blood pressure was a disease that needed to be treated to prevent heart attacks, strokes, kidney disease, and death. In addition, VA conducted one of the first studies that determined that step care, or medication intensification starting with one medication, is required for blood pressure (BP) control. Admittedly, much more needs to be done to improve primary care and access to care for vets. Yet, on many fronts, we are making real progress, including the availability of user-friendly resources, such as the My Healthy Vet program (https://www.myhealth.va.gov/index.html), TeleHealth (http://www.telehealth.va.gov/ccht/), and the Get Well Network (http://www.getwellnetwork.com/). Today, VA blood pressure control rates and target goals are higher than national goals, and I think that make sense, given the strategic and human importance of keeping our vets healthy. In fact, at the Birmingham VA, we recently improved blood pressure control over and above the VA target goal rate within 6 months. You might not read about that in the headlines, but that doesn’t mean we aren’t working 24/7, for better health, better care, at lower costs, for our veterans.