Targeting Gut Microbiome Interactions in Service-Related Gastrointestinal and Liver Diseases of Veterans

Abstract

I n response to a Request for Applications to support meetings to develop a novel roadmap for the Department of Veterans Affairs with focus on gastrointestinal (GI) illnesses that primarily affect returning veterans, a team of GI experts was invited to address these medical conditions affecting Veterans. A meeting was held on May 17, 2019, in San Diego, California, focused at developing a roadmap for targeting gut-microbe interactions in service-related GI diseases of veterans. This meeting was funded by Office of Research and Development (Dr Sharma and Dr Iqbal) and led by Dr Pradeep Dudeja and Dr Jasmohan Bajaj. Initial discussion based on the talks from Drs. Bajaj and Dudeja focused on the current state of gut microbiome data in veterans' diseases and the overall significance of gut microbiome. It was agreed that, to date, there are no systematic, controlled, longitudinal, and sufficiently powered studies available on the role of gut microbiome in GI illnesses of veterans. Also, few studies examining the microbiome in Gulf War illnesses (GWI) veterans and traumatic brain injury (TBI) are underway. The meeting focused on the role of gut microbiome in (1) diarrheal diseases, pain, and the gut-brain axis, (2) liver diseases, and (3) inflammatory bowel diseases (IBD). The overall discussion was focused on the potential role of gut microbiome in some of the key veterans service-related diseases GWI, post-traumatic stress disorder (PTSD) and TBI and its connections to the 3 focus areas.

Prevalence of gastrointestinal disease in US Military Veterans under outpatient care at the Veterans Health Administration

“…However, it is also worth reviewing the potential that environmental exposures in Asian countries such as chemical toxins (Agent Orange), infections, or parasites may have contributed to the alteration of the gut microbiome. 11 …”

“…In a review of GI conditions in Veterans, the authors suggested that increased incidence of diarrhea in Veterans may be related to food- or water-borne pathogens or deployment-related stress, both of which can alter the gut microbiome in the short term, and contribute to disease in the long term, as infectious gastroenteritis is a risk factor for the development of IBS. 11 , 12 The authors also offer other suggestions for factors that may contribute to the development of GI disease in Veterans, such as chronic stress, infections, toxins, and nonsteroidal anti-inflammatory medications that contribute to leaky gut. However, further research is necessary to investigate the mechanisms underlying the development of GI disease in Veterans.…”

“…However, further research is necessary to investigate the mechanisms underlying the development of GI disease in Veterans. 11 …”

Biomimetic Gut Model Systems for Development of Targeted Microbial Solutions for Enhancing Warfighter Health and Performance

“…In instances such as endurance activities, physical and environmental stress responses have been linked to dysbiosis (35)(36)(37). Comorbidities such as heat stress and physical exertion are commonly encountered by warfighters and have been linked with increased GI permeability (38).…”

“…Diet exerts a large effect on the gut microbiota composition, but some bacteria thrive independently of dietary changes by colonizing the mucus layer as a reservoir and are maintained regardless of food intake (14). Thus, microbiome-host studies could target this mucus layer reservoir as a starting point to characterize gut resilience, and a systems biology approach to determine gut microbe interactions in enteric disease, pain, and the gut-brain axis must be considered (36).…”