Leveraging Microbiome Science From the Bedside to Bench and Back: A Nursing Perspective.
Leveraging Microbiome Science From the Bedside to Bench and Back: A Nursing Perspective.
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DOI：
10.1097/nnr.0000000000000475
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发表时间：
2021
期刊：
影响因子：
2.5
通讯作者：
Wallen GR
中科院分区：
文献类型：
--
作者：
Maki KA;Joseph PV;Ames NJ;Wallen GR
护士现在和过去都接受过培训，能够将患者视为不仅仅是其各部分的总和，并了解多个身体系统对人类健康的复杂性和相互关联性（Knisely & Draucker，2016）。尽管这种患者评估方法和基于多系统的方法正被包括医学在内的许多学科采用（威尔斯等人，2015），从护理透镜研究微生物组在人类健康中的作用所需的多维培训通常没有得到很好的理解。许多护士科学家在遗传学和基因组学博士课程和博士后培训先进的教育。这种先进的培训使他们很好地成为临床前微生物组研究和临床/转化研究之间的联系，促进临床护理和患者结局的改善。整体护理的背景是研究假设的基础，这些假设测试了身体，精神和环境因素对微生物组中细菌群落的影响，以及微生物组如何对临床干预和患者健康产生影响。通过这一代“床边到长凳和背部”的研究，护士处于转化微生物组研究的最前沿。从护理的角度来看研究，使护士科学家联合收割机结合患者为中心的问题，从他们的临床经验与尖端的基因组技术雕刻，以了解复杂的人类-微生物组-环境相互作用（图1）。微生物组由生活在人体内和人体上的细菌群落及其集体遗传信息组成（Ursell等人，2012年）。微生物测序技术的进步促进了这些微生物群落的快速知识积累。微生物组的临床和治疗潜力已经通过将微生物组中的破坏与疾病联系起来的研究的激增而得到证实（吉尔伯特等人，Lynch & Pedersen，2016）。以调节微生物组为中心的疗法，例如粪便微生物群移植（将粪便从健康人“移植”到患病患者），已经有效地治疗了复杂的临床病症，例如艰难梭菌定殖和结肠炎（Allegretti等人，2019年）。临床结果的改善是标准抗生素方案无法比拟的（Allegretti等人，2019），暗示了一旦我们全面了解这些细菌群落对宿主生理学的影响以及微生物组破坏对疾病的影响程度，微生物组疗法可能具有的潜力。重要的是，微生物组与人类健康的联系支持了长期以来的护理理念，即一个身体系统的致病变化会影响整体的稳态和健康。目前由护士领导的研究小组正在探索与人类微生物组相关的疾病示例包括早产、睡眠中断、肠易激综合征的症状特征和再生障碍性贫血治疗并发症。早产和婴儿发病率是重要的公共卫生问题，非洲裔美国妇女受到严重影响。在由国家护理研究所资助的一项正在进行的研究中，研究人员正在研究口腔、阴道和肠道微生物组对早产发生率的贡献（Corwin等人，2017年）。如果正在研究的独特生物标志物能够识别具有早产风险的非裔美国妇女，这项研究的结果对临床医生具有快速转化的意义。这些生物标志物可以作为治疗靶点。
Nurses are, and have been, trained to evaluate patients as more than a sum of their parts and to appreciate the complexities and interconnected nature of multiple body systems on human health (Knisely & Draucker, 2016). Although this method of patient evaluation and multisystems-based approach is being adopted by many disciplines, including medicine (Wells et al., 2015), the multidimensional training required to study the role of the microbiome in human health from a nursing lens is not generally well understood. Many nurse scientists have advanced education in genetics and genomics from doctoral programs and postdoctoral training. This advanced training makes them well posed to be the link between preclinical microbiome research and clinical/translational research that facilitates improvements in clinical care and patient outcomes. A background in holistic care is foundational for the development of research hypotheses testing the effect of physical, mental, and environmental factors on the bacterial communities in the microbiome and how the microbiome may have implications for clinical interventions and patient health. With this generation of “bedside to bench and back” research, nurses are at the forefront of translational microbiome research. Viewing research from a nursing perspective allows nurse scientists to combine the patientcentered questions carved from their clinical experience with cutting-edge genomic technologies to understand complex human–microbiome–environment interactions (Figure 1). The microbiome is made up of the communities of bacteria that live in and on the human body and their collective genetic information (Ursell et al., 2012). Advances in microbial sequencing technologies have enhanced rapid knowledge accumulation of these microbial communities. The clinical and therapeutic potential of the microbiome has been witnessed by the explosion of research linking disruptions in the microbiome with disease (Gilbert et al., 2016; Lynch & Pedersen, 2016). Therapies centered on modulating the microbiome, such as fecal microbiota transplantation (“transplanting” stool from a healthy person to a diseased patient), have effectively treated complex clinical conditions such as Clostridium difficile colonization and colitis (Allegretti et al., 2019). The improvement of clinical outcomes, unmatched by standard antibiotic protocols (Allegretti et al., 2019), hints at the potential that microbiome therapeutics may have once we have a comprehensive understanding of the influence that these bacterial communities have on host physiology and the extent that microbiome disruption contributes to disease. Importantly, the connection of microbiome and human health supports the longstanding nursing philosophy that pathogenic changes in one body system influence overall homeostasis and well-being. Examples of disorders that are currently being explored by research teams led by nurses in relation to the human microbiome are preterm birth, sleep disruption, symptom profiles of irritable bowel syndrome, and aplastic anemia treatment complications. Preterm birth and infant morbidity are significant public health problems, and African American women are disproportionally affected. In an ongoing study funded by the National Institute of Nursing Research, researchers are studying the contribution of the oral, vaginal, and gut microbiome to the incidence of preterm birth (Corwin et al., 2017). Results from this research have rapid translational implications for clinicians if the unique biomarkers under investigation are able to identify African American women with preterm birth risk. These biomarkers could serve as therapeutic targets …