The incidence of C. difficile infection (CDI) has risen markedly over the last decade, with recurrence rates as high as 20-30%. Undefined elements of the healthy intestinal microbiome protect against the development of CDI. Bile salts may function as a critical regulatory pathway that either stimulates (primary bile salts) or inhibits (secondary bile salts) the growth of C. difficile. We have demonstrated that secondary bile acids were significantly elevated in the stool of controls compared to both first time CDI (fCDI) patients and recurrent CDI (rCDI) patients and primary bile acids were significantly elevated in the stool of rCDI patients compared to controls. These may serve as novel biomarkers.
The microbiota represents the diverse microbial ecosystems that live on and in us. Microbes colonize our skin, gut ,and other exposed surfaces. They provide critical functions in our development and maturation through their production of essential vitamins, maturation of our immune system, and life-long interactions with our bodies. The microbiota can also contribute to a variety of diseases including inflammatory bowel disease, susceptibility to infections and development of allergic and auto-immune diseases.
Rheumatoid arthritis (RA) is a systemic autoimmune disease that causes inflammatory arthritis. Patients with RA have excess cardiovascular and respiratory morbidities and have excess mortality compared to the general population. Our group is using precision medicine to understand the etiology, optimize treatment, and decrease the morbidity burden for patients with RA using clinical trials, observational cohort research studies, and harnessing the wealth of data in electronic medical records.