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The connections between different parts of the human body are full of surprises, but you might not have thought about it: can something that causes dandruff on your head also contribute to your digestive problems?
It's a mystery that scientists are trying to solve with research on the fungi that live in your gut. Although the bacteria that colonize our intestines have been a scientific target for over a decade, fungal creatures are beginning to attract more attention.
Already, these studies have revealed striking links between fungi and several chronic diseases, including Crohn's disease and ulcerative colitis. As is typical in medical science, a simple explanation (A because B, which can be cured by C) is unlikely.
But the potential to improve the lives of hundreds of thousands of patients – and to discover complex processes that we had never understood, was at the root of these diseases – made the fungal field attractive for medical researchers.
"This is an exciting field of science," said Dr. David Underhill, Chair of Inflammatory Bowel Disease Research at Cedars-Sinai Medical Center in Los Angeles. "I think that over the next five years, and certainly 10, we will develop a very different understanding of this area."
Dr. Underhill's team is studying the links between fungi in the gut and inflammatory bowel diseases such as Crohn's.
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Researchers began to be interested in studying the microbiome when advances in DNA technology facilitated the identification of microorganisms in and on the human body. Earlier work, Dr. Underhill said, focused primarily on bacteria, because they are much more numerous in our body than any other type of organism.
There are billions of bacteria in the digestive tract, and no less than 100 different species. Mushrooms number in the hundreds of thousands, with only a handful of different species. For years, mushrooms have been treated scientifically.
Now that our understanding of the bacterial microbiome is better established, researchers have turned to fungi, which some call the mycobiome. It quickly became clear that these organisms play a distinct role in our health.
Malassezia is one of the mushrooms at Dr. Underhill's research center. Although his name may be unknown, you are currently coated.
The fungus is ubiquitous on a healthy human body; it colonizes the skin shortly after birth. For some people, malassezia on the scalp creates irritation that causes dandruff.
But it also appears in our body, along the digestive tract. Underhill and his colleagues recently published a study in the journal Cell Host & Microbe suggesting a link between Malassezia in the intestine and Crohn's disease.
People with Crohn's disease had high levels of Malassezia on the walls of their intestines, while healthy patients had practically none. The researchers then demonstrated that simply adding this type of fungus to the gut – at least in the mouse – was enough to worsen the Crohn's inflammation.
This work builds on a growing body of evidence linking fungi to inflammatory bowel disease. As early as 2010, researchers reported that antifungal drugs had helped I.B.D. patients go into remission. In 2012, Malassezia in particular was associated with this type of disease.
In 2016, French researchers published a study showing that fungi populations in intestinal people were very different from those observed in healthy patients.
"These are small pieces that we assemble," said Mathias Lavie-Richard, a microbiologist at the Micalis Institute in France and co-author of this study.
The race is open to build these links and add to the growing body of evidence. The results could benefit hundreds of thousands of people.
Crohn's disease, for example, is commonly treated with anti-inflammatory drugs called TNF inhibitors. But these treatments are only effective for about 60% of patients, according to the Crohn's and Colitis Foundation.
The drugs are also expensive: the anti-TNF drug Humira can reach $ 38,000 a year, depending on the patient's insurance.
The link between Crohn and Malassezia raises the possibility – not yet proven – that something as simple as a generic antifungal drug could bring relief: Remove the fungus, remove the inflammation. Dr. Underhill and his colleagues are now embarking on clinical trials. This is just one of many teams willing to test the idea.
Montreal scientists are pursuing a similar clinical trial, whose treatment has already begun this summer, according to Martin Laurence, researcher and creator of the Malassezia project, which follows the research published on this particular organism.
It's not just inflammatory bowel disease that has been linked to mycobioma. A study published last year showed that altering the composition of gut fungi in mice exacerbated the symptoms of asthma. Some preliminary evidence suggests a link between fungal infections and prostate cancer.
"Technology is improving every year, and we are increasingly identifying organisms and their role in treating diseases and symptoms," said Dr. J. Curtis Nickel, a urologist at Queen's University in Canada.
Dr. Nickel is the co-author of future research that suggests links between Malassezia and interstitial cystitis, a chronic, painful bladder condition.
He said the next step for many researchers was to study how these fungi interact with and are affected by other organisms that live alongside them.
"I personally suspect that this is an interaction between different bacteria, fungi and viruses," said Dr. Nickel. "An unhealthy population of these organisms exacerbates the disease and maybe even – that's the next step – the cause. But my boy, we are not there yet.
Although we are far from saying that antifungals are the panacea for intestinal disorders, scientists are optimistic that new research on mycobioma will help solve the mysteries surrounding these inflammatory diseases and could even offer new forms of treatment.
"When you talk about this research to people with these diseases, it's like a new light in the dark," said Dr. Lavie-Richard. "It's new hope."
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