Dorrestein teamed up with Knight, Doug Conrad — director of UCSD's adult cystic fibrosis clinic — and others to develop a rapid microbial diagnostic test. Cystic fibrosis causes a build-up of mucus in the lungs, which can periodically become infected with bacteria. These infections require aggressive treatment with antibiotics — and sometimes the bacteria can develop resistance. Dorrestein and his collaborators have shown5 how analysing mass-spectrometry data on a phlegm sample from someone with cystic fibrosis can identify microbial communities that standard medical culturing techniques miss.
Louis-FĂ©lix Nothias-Scaglia, a postdoc who joined Dorrestein's lab this year, is mapping the skin of people with psoriasis, a condition thought to be triggered by an overactive immune system. If molecules produced by certain bacteria are present when the condition flares up but not when the skin is healthy, Nothias-Scaglia explains, they might point to drugs that could treat or even prevent the disease. Even being able to use microbial changes to predict when a flare-up is coming would enable patients to reduce their use of immune-suppressing drugs.
Turning such data-intensive techniques into standard lab tests will be a challenge. “Cynics would say it's too complicated, it's never gonna go anywhere,” says Conrad. “To a certain extent, I can understand that. But that's a good way to keep going the way things are.”
Dorrestein definitely wants to change the way things are, particularly for the blossoming field of microbiome research. He views the discipline as passing through phases: the first has centred on determining the identity of microbes. The second phase is working out what they're doing, using techniques such as mass spectrometry.
What drives the establishment of these communities? What metabolic processes are under way, and how do they interact with each other and with a host? “If you fundamentally understand that,” Dorrestein says, “you can start to take control of it.” And that's the third phase, he says — taking control. By monitoring microbial communities, is it possible to add the necessary ingredients to change a person's health, their mood, their athletic performance? Dorrestein thinks that the answers to these questions are right in front of him. He just has to look a little closer.