only kill the cancer cells, but also kill the gut microbes as well. That conflict of killing off things that give you energy leads to fatigue.

This condition is not limited to cancer patients, as it also affects those suffering from such gastrointesti- nal maladies as inflammatory bowel disease, bacterial infections and chronic diarrhea. A fecal transplant is one of the most effective ways to treat these condi- tions, as the new bacteria transplanted into the patient fights off the bad microbes and reestablishes the good ones. It s one of the most remarkable things I ve seen in science, says Dr. Morrow. The procedure has a 90 percent success rate. Within 24 to 48 hours, these patients are up walking around and having normal bowel movements, which they haven t had in years.

There are two other areas related to the microbiome that UAB researchers are currently studying. One is the oral cavity, which contains anywhere between 500 to 650 different species of bacteria around 20 billion microbes. Variances in the oral microbiome, which would include the mouth, teeth, saliva and tongue, can provide indications of potential oral cancers.

The other major area being studied is the skin. Scientists have identified more than 200 different spe- cies of bacteria that live on the skin, with the forearms having the most diverse microbes, but the nostrils, ears and the area between the legs and groin having the most stable environments.

Microbiome researchers at UAB have begun studies with Craig Elmets, M.D., chair of the UAB Department of Dermatology and Cancer Center senior scientist, on the impact of ultraviolet (UV) radiation on the skin and the microbiome. When skin cells are dam- aged by UV radiation, they die to be replaced by new skin cells, or they can possibly become cancerous. Dr. Elmets and his group are examining how skin microbes respond to these damaged skin cells as well as the new skin cells, and how this impacts the human host.

While the oral cavity, the gut and skin comprise the majority of UAB s microbiome research, there are ongo- ing projects in other areas as well. Researchers in the Department of Infectious Diseases are examining the microbiome s impact on sexually transmitted diseases and the vaginal tract. Physician-scientists in the UAB

Division of Gynecologic Oncology, including Cancer Center investigators Britt Erickson, M.D., Charles Landen, M.D., and Warner Huh, M.D., are studying samples from the reproductive tract to characterize the

microbes there to see which might be predictors for early carcinogenesis or developments of cancer.

All of this work is being done with the goal of developing a microbiome management program , where we can interact with the scientists and physicians who want to do these studies, Dr. Morrow says. We want to encourage them to incorporate sample collections for microbiome data into their research projects, so that we can provide them with output data for their studies.

The Impact of the Microbiome

Knowing that microbes are everywhere, the pri- mary question scientists must now ask is what impact certain microbes have. That question will be answered over several phases, Dr. Morrow says. The first phase is to understand what microbes are present normally. The second is to look at what remains after disease or as a result of disease. The big question is do the microbes cause that disease, or do they respond to the host having that disease?

U A B C O M P R E H E N S I V E C A N C E R C E N T E R 5

The big question

is do the

microbes cause

that disease,

or do they

respond to the

host having that

disease?

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