25 Jul, 2019

Dr Sonya Abraham on biologics, arthritis and the gut microbiome

This week we had the pleasure of hosting Dr Sonya Abraham, a researcher from Imperial College London, on our genetics podcast.

Dr Abraham has worked on a number of common health conditions including arthritis, psoriasis and ankylosing spondylitis. Her work largely focuses on biological therapies, also known as biologics, and how the gut microbiome might affect the ways in which we respond to these treatments.

What’s the difference between biologics and other kinds of treatment?

Most of the treatments and therapies we use today are made of chemically derived molecules, which is the case in medications like anti-inflammatories, steroids and antibiotics. In contrast to this, biologic drugs are produced from living organisms or contain components of living organisms and are therefore made of protein, so the actual matter they’re made of is different to traditional treatments.

Biologics include recombinant proteins, tissues, genes, allergens, cells, blood components, blood, and vaccines. They are used to treat numerous diseases and conditions, like rheumatoid arthritis. Dr Abraham says that rheumatoid arthritis was one of the first conditions that started using biologics and patients tend to do well when being treated with them.

However, she agrees that research in biologics has quite a lot of space at the moment because there are many conditions that haven't been thoroughly studied in regards to these type of therapies. In particular though, Sonya says that there’s plenty of research to be done in how the microbiome interacts with these treatments.

How does the Microbiome affect biological therapies?

There’s been an influx of interesting research conducted into the microbiome recently. Suddenly, we’re able to understand that the microbes that sit within the body, primarily in the gut, affect our genetics and it’s transformed the way we think about biological therapies.

Now we can measure the microbial content of our bodies, we want to understand how it relates to disease. At the moment we're left with numerous unanswered questions; is the microbiome different between healthy people and those with a condition? Is the microbiome stable? What are the effects of food? How does the microbiome affect immune cells? What part does it play in the production of chemicals that drive immune cells to be overactive, inactive, underactive, etc? We're sure these questions are going to be researched in the near future - so we'll keep you posted!

What's known about the microbiome in psoriatic arthritis already?

There has already been a publication showing that there is a difference in the microbiome of psoriatic arthritis and healthy volunteers. This difference wasn’t necessarily in the number of bacteria in the gut, but the balance of them. Research has also shown that there are certain species of bacteria that are more prevalent in psoriatic arthritis patients than in healthy volunteers.

What isn’t known, however, is whether or not those microbial changes are just what naturally occurs in that person, because all the samples have only been taken at one time. Therefore, we don’t yet know whether the microbiome is stable, whether it changes over time or even if it changes when the disease is active or the patient is in remission. This then leads to further questions about the possibility of drugs being able to change that bacteria to make it more normalised or if those bacteria are set and we can't do much about it.

What distinguishes the third of psoriasis patients that develop psoriatic arthritis?

At the moment this isn't a question we’re able to answer due to the lack of evidence - though it’s definitely a space for research in the future. Dr Abraham says that it’s likely to be to do with genetic background and possibly even differences in the microbiome.

The number of bacteria in the microbiome is so massive that the proteins they produce cause the body to behave in all sorts of ways, and often at different times. So even if there are genetic influences on whether or not a psoriasis patient will go on to develop psoriatic arthritis, often this may be manipulated by the microbiome. Our genes are set but the ways in which those genes are expressed can be influenced by environment, diet, behaviour and other factors too, including the microbiome.

It’s likely that more research will be conducted into the difference in the microbiomes of psoriasis patients and those who develop psoriatic arthritis. This should lead to better diagnosis and also further understanding about what causes this type of arthritis. We’ll definitely keep you updated!

What does the future hold for biologics?

Biologics are still in their infancy of effectiveness and Dr Abraham believes they have many more capabilities to be explored. The future of biologics may even lead to a new generation of therapies, perhaps based on modifying the microbiome or even a cocktail of therapies that work together. Sonya thinks an interesting subject for the future would be altered food or nutritional substance that could affect the bacteria in the gut. This could be used to treat conditions or even alter the microbiome enough for other treatment to have affect.

As well as the massive range of new research subjects, Sonya suggests that the ways we do research might also change. At the moment, it’s been difficult to keep tabs on food consumption and use multiple samples in research relating to psoriatic arthritis. She is currently using food diaries for the week before participants give samples but this leaves quite a lot outside of researcher control. She hopes that there might be a better way to monitor this in the future, perhaps a piece of technology that can measure food intake more certainly. In addition to this, existing studies have only measured samples at one point in time so we haven't been able to see how or if the microbiome changes. That’s why she’s using multiple samples in her new research project.

In the future she hopes that we can create personalised mixtures of therapies based on learning about what makes up each individual case of arthritis. With psoriatic arthritis, there is still so much more to know, so Sonya is excited about the possibilities of new treatments.

Take part in the study

Dr Sonya Abraham and Imperial College London are working on a research study into the role of the gut microbiome in arthritis and ankylosing spondylitis.

They are looking for 100 people with psoriatic arthritis (50 to be measured at one point in time and another 50 to monitor change over time), 50 volunteers with ankylosing spondylitis and 50 healthy volunteers. There are still places left so make sure that you sign up here if you’re interested.

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