Ilaha Isali, MD, and Laura Bukavina, MD, on the microbiome and bladder cancer

In this video, Ilaha Isali, MD, MSc, and Laura Bukavina, MD, MPH, MSc, discuss bridging the gap between microbiome research and therapeutic applications. They are authors of the recent Urologic Oncology paper “State-of-the-Art review: The Microbiome in Bladder Cancer.” Isali is a urology resident at Weill Cornell Medicine in New York, New York, and Bukavina is an assistant professor of urologic oncology at Cleveland Clinic Glickman Urologic Institute and the translational science lead in GU oncology at Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio.

Transcription:

The abstract suggests that microbiome surveillance, metagenomic sequencing, and metabolomics could be integrated into clinical trials. What specific methodologies or technologies do you envision being most impactful in bridging the gap between microbiome research and therapeutic applications?

Isali: I think integrating microbiome surveillance into clinical trials can bridge the gap between research and also therapeutic applications. Metagenomic sequencing and metabolomics are poised to make significant impacts. I will say, for metagenomic sequencing, which provides a high-resolution analysis of microbiome populations and enabling the identification of potential biomarkers for disease progression and also treatment response. When it comes to metabolomics, I will say we know it captures functional data, such as microbiome metabolics such as short chain fatty acids and bile acids, which influence tumor biology and immune responses that there is a research going on, and, of course, advanced analytics, because machine learning models trained on microbiome and also clinical data, I think, can further enhance predictions of treatment efficacy, which was demonstrated in recent studies exploring neoadjuvant chemotherapy responses. I think such tools will facilitate personalized medicine by tailoring therapies based on patients' unique microbiome profile.

Bukavina: Just to give some background about how I think about the microbiome, is that the microbiome is just 1 little tab in a full-page summary. If you're studying stool microbiome in patients who are receiving cancer therapy, whether it's chemotherapy or immunotherapy, just knowing what bugs are different and associating that to a better response; we don't know the mechanism. We don't understand what exactly is going on with those bugs. Are those bugs priming your immune system? Is it an immunogenic effect? Are those bacteria changing the drug itself? Is it metabolizing the drug? Is it releasing it back into circulation, and if it's releasing it back to circulation, is it actually helping or harming? So if you just know the bacteria without understanding the effect or the mechanism by studying the metagenomics and the metabolites that are produced by that bacteria, you really are just getting part of the picture, and you're seeing an association and not seeing the mechanism, because the hope is down the line, if you're able to understand the mechanism, potentially altering that mechanism, without even involving big studies with fecal microbiota transplant or even involving gut depletion of that specific bacteria could be done if we just hone in on what exactly is happening.

This transcript was AI generated and edited by human editors for clarity.