Dark Matter: The New Science of the Microbiome

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We are also running a long-term study to help us understand the evolution of the microbiome in very early life and its importance for influencing your risk of disease later in life. This involves following two cohorts of children from birth and studying how their gut microbiome evolves as they grow up in varying circumstances. What prompted you to write your book, Dark Matter? He is performing clinical research at Imperial College London and at the Royal Marsden Hospital. The aim is to develop novel biomarkers for the early detection of bowel cancer, and to develop novel therapies for its treatment based on a deeper understanding of how the microbiota that reside in the gut influence tumour biology and the response of cancer to treatment. James Kinross is a London trained laparoscopic and minimally invasive colorectal surgeon. He specialises in colorectal cancer and benign disease of the colon and rectum. He has a general practice and offers services in hernia repair and benign conditions of the skin. Mr. Kinross is also an expert in the gut microbiome and performs research into probiotic and prebiotic therapies for colonic health. He works at Imperial College London and he practices privately at the Lindo Wing, W2 1NY and The King Edward VII Hospital, W1G 6AA. Areas of interest Some of these studies are extremely encouraging and offer treatments where few effective medical therapies exist. For example, FMT appears to be a promising treatment for irritable bowel syndrome and a recent study suggests that its benefit can last for many years: 125 patients were randomly assigned to receive either 30g or 60g of faeces from the same donor or a placebo transplant containing their own faeces. Researchers not only found that the FMT improved the symptoms, but there was a lasting benefit three years after it was given. Kinross J. How surgeons will use data to inform intra-operative decision making. Intelligent Health. London, September 2020.

What inspires me is my patients. I feel very privileged to be able to do what I do and it’s a great honour to be able to look after people when they are unwell. My patients are truly extraordinary and they are the reason I get out of bed every morning. There’s a lot of science in the book to support my hypothesis. It’s for anyone who is interested in how we can improve our health and who wants to understand why we get disease and how to prevent it, so I have tried to make it easy to understand. He is a senior lecturer at Imperial College London, a prolific researcher and contributes to the Huffington Post as well as many other publications. We are also running a long-term study to help us understand the evolution of the microbiome in very early life and its importance for influencing your risk of disease later in life. This involves following two cohorts of children from birth and studying how their gut microbiome evolves as they grow up in varying circumstances.It might be seen as gross,” he admits. “[But] there are arguments that actually what we’re really experiencing [in modern life] is the catastrophic loss of exposure to really important bugs.” Here Kinross explains why getting up close and personal with a diverse range of people, and things, could help diversify our gut health. Lots of sex is good for the gut But what if I told you that faeces was not toxic waste and that it contained the secret to human health? Would you eat it, if your life depended on it? What if it was rebranded as a faecal microbiota transplant (FMT) or, more accurately, a faecal milkshake given through a tube that passes through the nose into the stomach? You could even take it in the form of a capsule – or “crapsule” – if you wanted.

In 2023, looking after the gut has become a popular pastime for the health-conscious. And for good reason. According to Cancer Research, Bowel cancer is now the fourth most common cancer in the UK, yet 54 per cent of cases are preventable. The human microbiome represents the most important new therapeutic target that we have for treating the greatest threats to human life in the 21st century and for preventing future pandemics of pathogens. This was not only important for Ray – it is critical for all of us: without a stable and diverse microbiome, we may well lose our minds. Behind all this is a simple message: microbes are not the enemy. Dr James Kinross a Consultant surgeon specialising in the gut microbiome at Imperial College London and Imperial College Healthcare NHS Trust has published a new book, Dark Matter. the book explains the role of micro-organisms in our bodies and the impact on our health of their imbalance in our system and the world around us.Can you tell us about your career path, and how you got to your current position as Senior Lecturer in Colorectal Surgery and Consultant Surgeon? The iKnife technology works by coupling two existing processes including surgery using electricity and mass spectrometry. The iKnife delivers high level of electricity on the tissue surface and this produces gas fumes as a by-product. We used to just dispose of these fumes as a waste product but my colleague, Professor Zolta Takats, decided to pass this smoke through a mass spectrometer. Within that smoke phase, there is a lot of interesting data on lipid chemistry and as it turns out, cancer actually has a very reproducible lipid chemistry and this tells us a lot about the molecular biology of that cancer. This can be used to help us identify what type of tissue is present. Our gut microbiome is being badly damaged in our early lives. This not only promotes inflammation and sensitises us to a poor diet, but our microbiomes are less resilient and diverse. That’s why at a population level we’re seeing alarming increases in the risk of colorectal cancer, asthma, allergies, rheumatoid arthritis and other chronic conditions. The partnership between Imperial and EnteroBiotix, in addition to helping explore the safety, tolerability and efficacy of IMT based drugs for a range of conditions, is expected to help place microbiome research onto a more systematic footing. This trial will exploit another important advantage of the capsules, namely that their components are manufactured in a very standardised way, which is both better for patient safety, and allows researchers to start exploring the specific mechanisms as to how IMT may beneficially impact upon patients’ immune system and other aspects of their health. By studying these tools, we can learn about the microbiome and the very specific mechanisms that make microbiome treatments work. Dr James Kinross Department of Surgery & Cancer

Yet it is only now, as we are beginning to discover the microbiome's enormous potential, that we are realising it is in grave danger, being irrevocably destroyed through the globalisation of our diets, the war on bugs and the industrialised world. Kinross J. The Digital Surgeon. Association of Colorectal and Proctological Surgery. Edinburgh, September 2020.Spector hopes his tests – which don’t just test for microbes, but also assess blood fat and blood glucose responses to specific foods – will change this. “We’re just starting to get to the point where we can suggest individualised foods. This is not just isolated microbiome testing,” he says. “We have trials in place to quantify this, but the initial results are exciting, with nearly everyone reporting weight loss and improved energy levels without any calorie counting or traditional weight loss methods. Previous microbiome tests have been sub-optimal [but the] ZOE approach is completely different: using state of the art sequencing allows us to detect species and strains and find strong associations between these microbes and both foods and health.” I was keen to bring together all the work going on in microbiome science, because it creates such a compelling argument for taking it seriously. It’s not just about the gut: it’s about the human microbiome. Dr James Kinross, a clinical senior lecturer and consultant surgeon in the Department of Surgery & Cancer, says: “At the moment, IMT is a new science and is still a very blunt tool. It's a wholesale change of the ecology of the gut. But donors and patients with very variable gut ecologies and we don't know precisely which bugs need to go into which patients and for what reason – and then when those new bugs are transferred to a patient, how we sustain them to allow them to grow.”