Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-18T21:02:22.728Z Has data issue: false hasContentIssue false
  • English
  • Français

Are we Ready for a “Microbiome-Guided Behaviour” Approach?

Published online by Cambridge University Press:  17 September 2019

ANDREA LAVAZZA  and
VITTORIO A. SIRONI
Get access Rights & Permissions [Opens in a new window]

Abstract:

The microbiome is proving to be increasingly important for human brain functioning. A series of recent studies have shown that the microbiome influences the central nervous system in various ways, and consequently acts on the psychological well-being of the individual by mediating, among others, the reactions of stress and anxiety. From a specifically neuroethical point of view, according to some scholars, the particular composition of the microbiome—qua microbial community—can have consequences on the traditional idea of human individuality. Another neuroethical aspect concerns the reception of this new knowledge in relation to clinical applications. In fact, attention to the balance of the microbiome—which includes eating behavior, the use of psychobiotics and, in the treatment of certain diseases, the use of fecal microbiota transplantation—may be limited or even prevented by a biased negative attitude. This attitude derives from a prejudice related to everything that has to do with the organic processing of food and, in general, with the human stomach and intestine: the latter have traditionally been regarded as low, dirty, contaminated and opposed to what belongs to the mind and the brain. This biased attitude can lead one to fail to adequately consider the new anthropological conceptions related to the microbiome, resulting in a state of health, both physical and psychological, inferior to what one might have by paying the right attention to the knowledge available today. Shifting from the ubiquitous high-low metaphor (which is synonymous with superior-inferior) to an inside-outside metaphor can thus be a neuroethical strategy to achieve a new and unbiased reception of the discoveries related to the microbiome.

Keywords

microbiotabrain-gut axisfecal transplantationmetaphorneuroethics
Type
Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 28 , Special Issue 4: Clinical Neuroethics , October 2019 , pp. 708 - 724
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Damasio, AR. Descartes’ Error: Emotion, Reason and the Human Brain. New York: Putnam; 1994;Google Scholar Feldman, Barrett L. How Emotions Are Made: The Secret Life of the Brain, New York: Houghton Mifflin Harcourt; 2017.Google Scholar

2. Gershon, M. The Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine. New York: Harper Collins; 1999;Google Scholar Kundu, P, Blacher, E, Elinav, E, Pettersson, S. Our gut microbiome: The evolving inner self. Cell 2017;171(7):1481–93.CrossRefGoogle ScholarPubMed

3. Lyte, M, ed. Microbial Endocrinology. New York: Springer; 2010.CrossRefGoogle ScholarPubMed

4. Sender, R, Fuchs, S, Milo, R. Revised estimates for the number of human and bacteria cells in the body. PLoS Biology 2016;14:e1002533.CrossRefGoogle ScholarPubMed

5. Qin, J, Li, R, Raes, J, Arumugam, M, Burgdorf, KS, Manichanh, C, et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature 2010;464(7285):59–65.CrossRefGoogle ScholarPubMed

6. Gareau, MG. Microbiota-gut-brain axis and cognitive function. In: Lyte, M, Cryan, JF, eds. Microbial Endocrinology: The Microbiota-Gut-Brain Axis in Health and Disease. New York: Springer; 2014:357–71.CrossRefGoogle Scholar

7. Liu, R. The microbiome as a novel paradigm in studying stress and mental health. American Psychologist 2017;72(2):655–67;CrossRefGoogle ScholarPubMed Stamper, CE, Hoisington, AJ, Gomez, OM, Halweg-Edwards, AL, Smith, DG, Bates, KL, et al. The microbiome of the built environment and human behavior: Implications for emotional health and well-being in postmodern Western societies. International Review of Neurobiology 2016;131:289–323.CrossRefGoogle ScholarPubMed

8. Rakhilin, N, Barth, B, Choi, J, Muñoz, NL, Kulkarni, S, Jones, JS, et al. Simultaneous optical and electrical in vivo analysis of the enteric nervous system. Nature Communication 2016;7:11800.CrossRefGoogle ScholarPubMed

9. Nemeroff, CB. Psychoneuroimmunoendocrinology: The biological basis of mind-body physiology and pathophysiology. Depression and Anxiety 2013;30(4):285–7;CrossRefGoogle ScholarPubMed Dinan, TG, Cryan, JF. Microbes, immunity, and behavior: Psychoneuroimmunology meets the microbiome. Neuropsychopharmacology 2017;42(1):178–92.CrossRefGoogle ScholarPubMed

10. de Vos, WM, de Vos, EA. Role of the intestinal microbiome in health and disease: From correlation to causation. Nutrition Reviews 2012;70(suppl-1):S45-S56;CrossRefGoogle ScholarPubMed Cho, I, Blaser, MJ. The human microbiome: At the interface of health and disease. Nature Reviews Genetics 2012;13(4):260–70.CrossRefGoogle ScholarPubMed

11. Börnigen, D, Morgan, XC, Franzosa, EA, Ren, B, Xavier, RJ, Garrett, WS, et al. Functional profiling of the gut microbiome in disease-associated inflammation. Genome Medicine 2013;5:65.CrossRefGoogle ScholarPubMed

12. Forsythe, P, Kunze, W, Bienenstock, J. Moody microbes or fecal phrenology: What do we know about the microbiota-gut-brain axis?. BMC Medicine 2016;14:58.CrossRefGoogle ScholarPubMed

13. Lyte, M. Microbial endocrinology in the microbiome-gut-brain axis: How bacterial production and utilization of neurochemicals influence behavior. PLoS Pathogens 2013;9:e1003726;CrossRefGoogle ScholarPubMed Mayer, EA, Knight, R, Mazmanian, SK, Cryan, JF, Tillisch, K. Gut microbes and the brain: Paradigm shift in neuroscience. Journal of Neuroscience 2014;34(46):15490–6.CrossRefGoogle ScholarPubMed

14. Bested, AC, Logan, AC, Selhub, EM. Intestinal microbiota, probiotics and mental health: From Metchnikoff to modern advances: Part III–convergence toward clinical trials. Gut Pathogens 2013;5:4.CrossRefGoogle ScholarPubMed

15. Foster, JA, McVey Neufeld, KA. Gut–brain axis: how the microbiome influences anxiety and depression. Trends in Neurosciences 2013;36(5):305–12;CrossRefGoogle ScholarPubMed Dinan, TG, Cryan, JF. Melancholic microbes: A link between gut microbiota and depression?. Neurogastroenterology & Motility 2013;25(9):713–9.CrossRefGoogle ScholarPubMed

16. Bravo, JA, Forsythe, P, Chew, MV, Escaravage, E, Savignac, HM, Dinan, TG, et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proceedings of the National Academy of Sciences 2011;108(38):16050–5.CrossRefGoogle Scholar

17. Harach, T, Marungruang, N, Duthilleul, N, Cheatham, V, Mc Koy, KD, Frisoni, G., et al. Reduction of Abeta amyloid pathology in APPPS1 transgenic mice in the absence of gut microbiota. Scientific Reports 2017;7:41802;CrossRefGoogle ScholarPubMed Mulle, JG, Sharp, WG, Cubells, JF. The gut microbiome: A new frontier in autism research. Current Psychiatry Reports 2013;15:337.CrossRefGoogle ScholarPubMed

18. Yano, JM, Yu, K, Donaldson, GP, Shastri, GG, Ann, P, Ma, L, et al. Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis. Cell 2015;161(2);264–76.CrossRefGoogle ScholarPubMed

19. Tillisch, K, Mayer, EA, Gupta, A, Gill, Z, Brazeilles, R, Le Nevé, B, et al. Brain structure and response to emotional stimuli as related to gut microbial profiles in healthy women. Psychosomatic Medicine 2017;79(8):905–13.CrossRefGoogle ScholarPubMed

20. Foster, JA, Rinaman, L, Cryan, JF. Stress & the gut-brain axis: Regulation by the microbiome. Neurobiology of Stress 2017;7:124–36.CrossRefGoogle ScholarPubMed

21. Sudo, N, Chida, Y., Aiba, Y, Sonoda, J, Oyama, N, Yu, XN, et al. Postnatal microbial colonization programs the hypothalamic–pituitary–adrenal system for stress response in mice. The Journal of Physiology 2004;558(1):263–75.CrossRefGoogle ScholarPubMed

22. Dinan, TG, Stanton, C, Cryan, JF. Psychobiotics: A novel class of psychotropic. Biological Psychiatry 2013;74(10):720–6.CrossRefGoogle ScholarPubMed

23. Sarkar, A, Lehto, SM, Harty, S, Dinan, TG, Cryan, JF, Burnet, PWJ. Psychobiotics and the manipulation of bacteria–gut–brain signals. Trends in Neurosciences 2016;39(11):763–81.CrossRefGoogle ScholarPubMed

24. Burokas, A, Arboleya, S, Moloney, RD, Peterson, VL, Murphy, K, Clarke, G, et al. Targeting the Microbiota-Gut-Brain Axis: Prebiotics Have Anxiolytic and Antidepressant-like Effects and Reverse the Impact of Chronic Stress in Mice. Biological Psychiatry 2017;82(7):472–87.CrossRefGoogle ScholarPubMed

25. Ma, Y, Liu, J, Rhodes, C, Nye, Y, Zhang, F. Ethical issues in fecal microbiota transplantation in practice. The American Journal of Bioethics 2017;17(5):34–45.CrossRefGoogle ScholarPubMed

26. Borody, TJ, Khoruts, A. Fecal microbiota transplantation and emerging applications. Nature Reviews Gastroenterology and Hepatology 2012;9(2):88–96.CrossRefGoogle Scholar

27. Kremer, W. The brave new world of DIY faecal transplant, 2014, BBC; available at http://www.bbc.com/news/magazine-27503660 (last accessed 19 May 2019).Google Scholar

28. See note 26, Ma et al. 2017.

29. Cryan, JF, Dinan, TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature Reviews Neuroscience 2012;13(10):701–12.CrossRefGoogle ScholarPubMed

30. Friedrich, MJ. Unraveling the influence of gut microbes on the mind. JAMA, 2015;313(17):1699–701.CrossRefGoogle ScholarPubMed

31. Dinan, TG., Stilling, RM, Stanton, C, Cryan, GF. Collective unconscious: How gut microbes shape human behavior. Journal of Psychiatric Research 2015;63:1–9.CrossRefGoogle ScholarPubMed

32. Zheng, P, Zeng, B, Zhou, C, Liu, M, Fang, Z, Xu, X, et al. Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism. Molecular Psychiatry 2016; 21(6):786–96.CrossRefGoogle ScholarPubMed

33. See note 12, Forsythe et al. 2016.

34. Möhle, L, Mattei, D, Heimesaat, MM, Bereswill, S, Fischer, A. Alutis, M, et al. Ly6C hi monocytes provide a link between antibiotic-induced changes in gut microbiota and adult hippocampal neurogenesis. Cell Reports 2016;15(9):1945–56.CrossRefGoogle ScholarPubMed

35. Beever, J, Morar, N. The porosity of autonomy: Social and biological constitution of patient in biomedicine. American Journal of Bioethics 2016;16(2):1–12.CrossRefGoogle ScholarPubMed

36. Knight, R. Follow Your Gut: The Enormous Impact of Tiny Microbes. New York: Simon & Schuster; 2015.Google Scholar

37. See note 2, Kundu et al. 2017.

38. Rees, T, Bosch, T, Douglas, AE. How the microbiome challenges our concept of self. PLoS Biology 2018;16:e2005358.CrossRefGoogle Scholar

39. Vuong, HE, Yano, JM, Fung, TC, Hsiao, EY. The microbiome and host behavior. Annual Review of Neuroscience 2017;40:21–49.CrossRefGoogle ScholarPubMed

40. See note 38, Rees at al. 2018.

41. See note 35, Beever, Morar 2016.

42. Collen, A. 10% Human: How Your Bodies’ Microbes Hold the Key to Health and Happiness. New York: HarperCollins; 2015.Google Scholar

43. Beever, J, Morar, N. Bioethics and the challenge of the ecological individual. Environmental Philosophy 2016;13(2):215–38.CrossRefGoogle Scholar

44. Cf. Baker, LR. Persons and Bodies. A Constitution View. Cambridge: Cambridge University Press; 2000.CrossRefGoogle Scholar

45. Cf. Rhodes, R, Gligorov, N, Schwab, AP, eds. The Human Microbiome: Ethical, Legal, and Social Concerns. New York: Oxford University Press; 2013.Google Scholar

46. Zhong, CB, Liljenquist, K. Washing away your sins: Threatened morality and physical cleansing. Science 2006;313(5792):1451–2;CrossRefGoogle ScholarPubMed Chapman, HA, Anderson, AK. Things rank and gross in nature: A review and synthesis of moral disgust. Psychological Bulletin 2013;139(2):300–27.CrossRefGoogle ScholarPubMed

47. Cf. Lavazza, A, De Caro, M. Not so fast. On some bold neuroscientific claims concerning human agency. Neuroethics 2010;3(1):23–41;CrossRefGoogle Scholar De Caro, M, Lavazza, A. Free will as an illusion: Ethical and epistemological consequences of an alleged revolutionary truth. Social Epistemology Review and Reply Collective 2014;3(12):40–50.Google Scholar

48. Jašarević, E, Rodgers, AB, Bale, TL. A novel role for maternal stress and microbial transmission in early life programming and neurodevelopment. Neurobiology of Stress 2015;1:81–8; see note 2, Kundu et al. 2017.CrossRefGoogle ScholarPubMed

49. Schmidt, CW. The yuck factor when disgust meets discovery. Environmental Health Perspectives 2008;116:A524.CrossRefGoogle ScholarPubMed

50. Kao, D, Roach, B, Silva, M, Beck, P., Rioux, K, Kaplan, GG, et al. Effect of oral capsule–vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection: A randomized clinical trial. JAMA 2017;318(20):1985–93.CrossRefGoogle ScholarPubMed

51. Zipursky, JS, Sidorsky, TI, Freedman, CA, Sidorsky, MN, Kirkland, KB. Patient attitudes toward the use of fecal microbiota transplantation in the treatment of recurrent Clostridium difficile infection. Clinical Infectious Diseases 2012;55(12):1652–8.CrossRefGoogle ScholarPubMed

52. See note 26, Ma et al. 2017.

53. Brandt, LJ. Editorial commentary: Fecal microbiota transplantation: Patient and physician attitudes. Clinical Infectious Diseases 2012;55(12):1659–60.CrossRefGoogle ScholarPubMed

54. Moossavi, S, Salimzadeh, H, Katoonizadeh, A, Mojarrad, A, Merat, D, Ansari, R, et al. Physicians’ knowledge and attitude towards fecal microbiota transplant in Iran. Middle East Journal of Digestive Diseases 2015;7:155–60;Google ScholarPubMed Ma, Y, Yang, J, Cui, B, Xu, H, Xiao, C, Zhang, F. How Chinese clinicians face ethical and social challenges in fecal microbiota transplantation: A questionnaire study. BMC Medical Ethics 2017;18:39.CrossRefGoogle ScholarPubMed

55. Curtis, V, de Barra, M. The structure and function of pathogen disgust. Philosophical Transactions of the Royal Society B: Biological Sciences 2018; online first, DOI:10.1098/rstb.2017.0208.CrossRefGoogle ScholarPubMed

56. Much information on the metaphor in a linguistic sense is here taken from Ervas, F, Gola, E. Che cos’è una metafora. Roma: Carocci; 2016.Google Scholar

57. Black, M. Models and Metaphors: Studies in Language and Philosophy. New York: Cornell University Press; 1962.Google Scholar

58. Lakoff, G, Johnson, M. Metaphors We Live By. Chicago: University of Chicago Press; 1980.Google Scholar

59. See note 58, Lakoff, Johnson 1980, at 14.

60. See note 58, Lakoff, Johnson 1980, at 58.

61. Davidson, D. What metaphors mean. Critical Inquiry 1978;5(1):31–47.CrossRefGoogle Scholar

62. Rossi, MG. Metaphors for patient education. A pragmatic-argumentative approach applying to the case of diabetes care. Rivista Italiana di Filosofia del Linguaggio 2016;2:34–48.Google Scholar

63. Demmen, J, Semino, E, Demjén, Z, Koller, V, Hardie, A., Rayson, P., et al. A computer-assisted study of the use of violence metaphors for cancer and end of life by patients, family carers and health professionals. International Journal of Corpus Linguistics 2015;20(2):205–31.CrossRefGoogle Scholar

64. Benedetti, F. Placebo Effects: Understanding the Mechanisms in Health and Disease. New York: Oxford University Press; 2014.Google Scholar

65. See note 58, Lakoff, Johnson 1980; Lakoff, G, Johnson, M. Philosophy in the Flesh. New York: Basic Books; 1999.Google Scholar

66. Rotter, JB. Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs: General and Applied 1966;80(1):1–28.CrossRefGoogle Scholar

67. Haidt, J. The new synthesis in moral psychology. Science 2007;316(5827):998–1002;CrossRefGoogle ScholarPubMed Schnall, S, Haidt, J, Clore, GL, Jordan, AH. Disgust as embodied moral judgment. Personality and Social Psychology Bulletin 2008;34(8):1096–109.CrossRefGoogle ScholarPubMed

68. Ozolins, A, Sandberg, C. Development of a multifactor scale measuring the psychological dimensions of touch avoidance. International Journal of Psychology: A Biopsychosocial Approach 2009;3:33–56.Google Scholar

69. See note 2, Kundu et al. 2017.

70. See note 2, Kundu et al. 2017.

71. Rothschild, D, Weissbrod, O, Barkan, E, Kurilshikov, A, Korem, T, Zeevi, D, et al. Environment dominates over host genetics in shaping human gut microbiota. Nature 2018;555:210–5.CrossRefGoogle ScholarPubMed

72. See note 24, Burokas et al. 2017.

73. Kao, ACC, Harty, S, Burnet, PWJ. The influence of prebiotics on neurobiology and behavior. International Review of Neurobiology 2016;131:21–48.CrossRefGoogle ScholarPubMed

74. Suez, J, Elinav, E. The path towards microbiome-based metabolite treatment. Nature Microbiology 2017;2:17075.CrossRefGoogle ScholarPubMed

75. See note 58, Lakoff, Johnson 1980.