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A series of studies in recent years have performed culture-independent methodologies, such as 16S rRNA gene sequencing of bacterial DNA extracted from patient clinical samples, to infer the microbiota of different human niches and to differentiate between health and disease. Such studies of respiratory samples from people with cystic fibrosis (CF) have demonstrated that the lower airway microbiota evolves with age. Importantly, increased bacterial richness during early life progresses to a loss in bacterial community diversity and increased dominance by the common and historically recognised CF taxa such as Pseudomonas and Burkholderia.1–4 The latter features are also typical of those with the most advanced or progressive respiratory disease and are likely to be at least, in part, driven by antibiotic exposure.1 The lower airway microbiota has also been compared between disease stability and pulmonary exacerbations and changes in the relative abundance of taxa may be indicative of the onset of an exacerbation in some patients.5 Despite these important findings, it remains unclear how knowledge of the lower airway microbiota could be exploited in routine clinical practice.
Given the paucity of longitudinal culture-independent studies of the CF lower airway microbiota and associations with clinical outcomes, the paper by Acosta and colleagues published in Thorax this month is timely.6 The work provides evidence that ecological indices calculated from the lower airway microbiota could potentially be applied as ‘biomarkers’ to predict those who are at risk of early disease progression.
In the study,6 16S rRNA gene sequencing of biobanked sputum samples, collected prospectively over two decades from a cohort of 104 clinically stable young adults with CF (18–22 years old), was performed and related to clinical outcomes in years following sample collection. The primary outcome was end-stage lung disease (death or lung transplantation <25 years) and the secondary outcomes were accelerated …
Contributors LJS and SCB cowrote the editorial with input into the concept, writing and final proof reading.
Funding This study was funded by Health Innovation, Investment and Research Office (grant no: 50007), National Health and Medical Research Council (grant no: 1102494), The Prince Charles Foundation (grant no: ER2015-17).
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Commissioned; externally peer reviewed.
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