Always keep your balance – mentally, inside and outside

“Keeping the balance” is the 21st century’s mantra. We came to terms that we need a “work-life-balance” to stay happy, we need to act responsibly and sustainably with our resources, meaning we should not take more than can grow at the same time. Yoga and its lifestyle have entered the Western mindsets. Keeping inner and outer balance is the credo of our daily lifestyle.

At the same time, we see ecosystems worldwide collapsing, biodiversity being depleted, and the whole planet threating to tip over. And now we learn that even on and within us are ecosystems that can be in or out of balance.

The myth of good and bad bacteria

What goes for the state of the planet is also true for our microbiome: There are practically no exclusively good or bad bacteria. It is important for a flourishing coexistence that the bacterium is located at the right place in the correct amount on or within our body. With these pre-conditions set, the bacterium is capable of supporting us in defending pathogen intruders or help us digest food.

But when a bacterium is dislocated, that very same harmless, useful bacterium can suddenly cause sepsis, inflammation or other infection that often even leads to death. Here are a few examples.

Corynebacterium jeikeium – the opportunist

Let us start off with one of the most frequent residents on our skin, Corynebacterium jeikeium. Studies on the bacterium have been conducted in the so-called Bielefeld study and were published by the Journal of Bacteriology (1). It is not very common with children and youths, but increases constantly starting with puberty, becoming one of the most common bacteria on the skin of a healthy adult. The bacterium feeds on substances found in the fat layer on our skin and with the help of lyases produces metabolic substances that are – among others – responsible for malodor (2). Apart from that, no particular threat comes with the bacterium or its metabolic products, in the first place.

This changes when the bacterium enters our body, through open wounds, for instance. This happens mostly in hospitals during operations or wound care. For that reason, problems with dislocated Corynebacterium jeikeium are often in the context of hospitals. When the lipophile bacterium enters our system, it can cause endocardial inflammation by damaging the tissue or sepsis. And what is even more alarming: The bacterium is now increasingly resistant to antibiotics and can only be fended with the intake of high dose antibiotics like Vancomycin and Teicoplanin. Both types come with significant side-effects.

Staphylococcus epidermidis – fighter with potent weapons

Even more prevalent on our skin is Staphylococcus epidermidis. Millions of it dwell on our skin and prevent it from being colonized by pathogens. And again, the problems start, when the bacterium gets into our body, as an article by the Frankfurter Rundschau summarizes (3). If that happens, a particular characteristic of the bacterium shows: with the help of surface proteins, it clings to every foreign object almost magnetically, as the article says. And this is often fatal for patients carrying prostheses, artificial heart valves or coronary vessels, artificial veins or other implants.

The foreign objects are colonized in a very short time and the bacterium reproduces with the common generation time of bacteria, which is approximately every 50 minutes. This makes one single bacterium increase exponentially within one day. Eventually, it builds up a hardly attackable mucous-coated biofilm that makes it almost impossible to get hold of. Often, neither the leukocytes and antibodies or our immune defense nor antibiotics can fend off that invasion. The consequence is an insidious chronic inflammation that turns into a sepsis in the worst case and is often immune to antibiotics, as well. As many as 25% of the cases have a fatal course.

Why the treatment of infested implants is so complicated

A study by a team of Prof. Friedrich Götz at the University of Tübingen summarizes the complications in trying to treat infested implants (4). Both the body’s immune response and antibiotics are transported over the veins. Implants, however, are mostly located in regions poorly supplied with blood and the substances cannot get to the implants. Mostly, infested implants have to be taken out. This is the cause for 2 % of artificial hips and even 30 % of permanent catheters, the research team states. Researchers are currently working on solutions with different coatings of the material. Silver-ions showed to be less prone for being colonized by bacteria, but also this approach comes with a risk: there is no evidence so far that the coating does not diffuse into the body over time. So far, long-term studies are lacking that prove the material itself is not harmful.

Prevotella copri – friend or foe?

The previously mentioned examples show bacteria that enter the body during operations or injuries and then cause damage. An even more perfidious example is the bacterium Prevotella copri that is found in the gut. Our ancestors had as many as four different strains of P. copri in their intestines. Stool samples of well-preserved mummies confirm this. The most prominent European example should be Ötzi, the ice-man who had all four strains of the bacterium. Also, a group of well-preserved mummies found in a Mexican cave dating back to the 7th century contained all four strains (5).

Today, all four strains ofP.. copri are common with a few indigenous people, while industrialized nations only have one strain left. This decline in variety comes with an increase in so-called civilization diseases like Morbus Crohn, irritable bowel syndrome, and other inflammatory diseases (6).

It seems like a paradox that the decrease of a bacterium causes inflammatory diseases of the intestinal tract, while at the same time that bacterium causes autoimmune diseases (7) like rheumatoid arthritis (8) and the increasing prevalence of that bacterium in the gut suppresses other microbes like Bacteroidetes (9). This is an excellent prove of how little we still understand in terms of the microbes living on and within us. What we do know is that the right location and amount is the key to a well-balanced system. But we are far from being able to intervene or even understand the totality of all functions.

A place for everything and everything in its place

This insight should guide our actions. We do not know what effect it will cause when we use antibacterial detergents in our bathrooms. All we do know is that until today our interfering with the complex system did more harm than good.

So, it would be wise to accept microbes as part of our balanced world and bodies and we should accept that we do not understand their functions fully. We should keep an eye on letting them stay where they are supposed to be (in the toilet and not in open wounds) and other than that we should accept that we are best off in a peaceful coexistence.

Sources / References:

(1) Ein bakterieller Hautbewohner mit lebensgefährlichem Potenzial - Bielefelder Forscher entschlüsseln das Genom von Corynebacterium jeikeium, (2005), https://ekvv.uni-bielefeld.de/blog/pressemitteilungen/entry/ein_bakterieller_hautbewohner_mit_lebensgef%C3%A4hrlichem

(2) Emter R, Natsch A, The Sequential Action of a Dipeptidase and a -Lyase Is Required for the Release of the Human Body Odorant 3-Methyl-3-sulfanylhexan-1-ol from a Secreted Cys-Gly-(S) Conjugate by Corynebacteria, Journ of Biol Chem (2018), https://www.researchgate.net/publication/5336373_The_Sequential_Action_of_a_Dipeptidase_and_a_-Lyase_Is_Required_for_the_Release_of_the_Human_Body_Odorant_3-M

(3) Daschner, Franz: Wir fürchten und wie brauchen sie, FR (2008), https://www.fr.de/wissen/fuerchten-brauchen-11574468.html

(4) Dem Infektionserreger auf die Schliche kommen, Eberhard Karls Universität Tübigen (1999), https://idw-online.de/de/news9258

(5) Baumgartner B, Das Artensterben im Bauch, eurac research (2019), http://www.eurac.edu/de/research/health/iceman/Pages/newsdetails.aspx?entryid=134323

(6) DoXmedical, Die Rolle des Darmmikrobioms bei Autoimmunerkrankungen (2018), https://www.rosenfluh.ch/doxmedical-2018-04/die-rolle-des-darmmikrobioms-bei-autoimmunerkrankungen

(7) Drago L, Prevotella Copri and Microbiota in Rheumatoid Arthritis: Fully Convincing Evidence? J Clin Med (2019), https://pubmed.ncbi.nlm.nih.gov/31683983/

(8) Pharmazeutische Zeitung, Rheumatoide Arthritis: Entzündung aus dem Darm (2013), https://www.pharmazeutische-zeitung.de/2013-11/rheumatoide-arthritis-entzuendung-aus-dem-darm/

(9) Galvet E J, Iljazovic A et.al, Distinct polysaccharide utilization determines interspecies competition between intestinal Prevotella spp., Cell Host & Microbe (2020), https://www.analytica-world.com/de/news/1168491/forscher-finden-das-leibgericht-eines-darmbakteriums.html