The Hidden World Inside Us: The Gut Microbiome and Its Potential Role in ITP

The Hidden World Inside Us: The Gut Microbiome and Its Potential Role in ITP

Imagine a bustling city inside your body, a hidden metropolis where trillions of tiny residents—bacteria, viruses, fungi, and other microbes—work together in harmony to maintain your health. This thriving community, known as the gut microbiome, resides primarily in your intestines, and although it is invisible to the naked eye, it plays a monumental role in your everyday health. From digestion and immunity to mood regulation, the gut microbiome is far more than just a collection of microorganisms. In fact, it may even hold the key to understanding complex diseases such as Immune Thrombocytopenia (ITP), a rare condition in which the immune system mistakenly attacks platelets in the blood.

A World We Are Just Beginning to Understand

The story of the gut microbiome began in 2007 with the launch of the Human Microbiome Project (HMP), an ambitious scientific endeavour to map the microbes living on and inside the human body. The findings were nothing short of groundbreaking. Scientists discovered that the number of bacterial cells in our bodies actually outnumbers our human cells! If that wasn’t astonishing enough, the microbes in our bodies contribute between 2 to 20 million genes (sections of DNA that carry instructions for making proteins), far more than the 20,000 human genes in our DNA (which is the blueprint for life, providing the instructions for how our cells grow, function, and reproduce).

This discovery shifted our thinking about health. For decades, we had focused on the idea that the body’s health depended primarily on our own cells and genes. But now, we were starting to realise that the microbes living inside us were active participants, influencing everything from digestion and metabolism to our immune system and even our mental health.

A New Connection: The Gut Microbiome and Autoimmune Disease

As scientists continued to study the microbiome, they began to notice something remarkable: autoimmune diseases like SLE, Type 1 Diabetes and MS—conditions in which the immune system attacks the body’s own tissues—were often linked to the gut microbiome. This realisation opened up new avenues of research, suggesting that the microbes in our gut could play a significant role in conditions such as ITP.

ITP is a rare blood disorder where the body’s immune system destroys platelets, the blood cells responsible for clotting. It is a condition that often leaves patients with bruising, fatigue, and sometimes severe bleeding. But could the gut microbiome, the invisible world inside us, be influencing this autoimmune response?

Clues from ITP Patients: The Gut Connection

Patients with ITP have long reported experiencing unusual symptoms beyond the typical bleeding and bruising. Some mention gastrointestinal (GI) issues such as bloating, diarrhoea, or stomach discomfort. These reports prompt us to wonder: could there be a link between the gut microbiome and ITP?

At Hammersmith Hospital in London,  prior to starting a research study investigating the gut microbiome in patients with ITP, a group of six patients was asked about their experiences with both ITP and gut health. During a small clinic consultation, the patients shared their personal journeys. Four of them had already wondered whether their gut microbiome could be playing a role in their disease. For instance, one patient had diarrhoea and malabsorption issues before being diagnosed with ITP, while another recalled suffering from a stomach bug just before their diagnosis. One patient even noticed a rise in their platelet levels during the long fasting periods of Ramadan, suggesting that changes in gut health or diet might play a role in ITP.

Interestingly, when asked about the potential connection between the gut microbiome and ITP, only two of the six patients said they’d never considered it before. Yet, when they learned about the idea, they were supportive of researching how the microbiome might be involved in ITP.

A Complex Puzzle: What Does the Microbiome Have to Do with ITP?

The bacteria in our gut help train our immune system to fight off harmful invaders like viruses and bacteria, while leaving our own body cells alone. The connection between the gut microbiome and ITP is still unclear. The hypothesis is that when the balance of good and bad bacteria in the gut is disrupted, the immune system can get confused and start attacking the body’s own cells, like platelets in ITP.

This could happen in two ways:

1. An unhealthy microbiome might make the gut walls leak, letting harmful bacteria pass through. These bacteria can then spread through the body and cause the immune system to attack not only the bacteria but also its own cells.
2. Or, the immune cells in the gut itself might become confused and start attacking the body, including organs or platelets, by sending harmful cells to other parts of the body.

Hope on the Horizon: Can We Modify the Gut Microbiome to Treat ITP?

While the idea of manipulating the gut microbiome to treat diseases like ITP is still in its early stages, it presents an exciting prospect. Although we are not there yet, several strategies could be explored, provided we can first prove that the gut microbiome plays a role in ITP:

Probiotics and Prebiotics: Probiotics are beneficial bacteria that can help restore the balance of the gut microbiome. Prebiotics are substances that encourage the growth of these helpful microbes (essentially ‘food’ for the microbes). Some people opt to take prebiotics or probiotics to alleviate various symptoms. However, these are considered food supplements rather than medicines, and therefore their quality can vary. Further research is needed to determine whether they are truly beneficial, and which type of probiotic may be helpful for specific conditions.

Dietary Changes: What we eat has a profound impact on our microbiome. Diets rich in fibre, fruits, vegetables, and fermented foods are thought to promote a healthy microbiome, while diets high in processed foods and sugars may foster an unhealthy balance. Research is needed to determine whether specific dietary changes could help manage autoimmune diseases like ITP.

Intestinal Microbiota Transplantation (IMT): IMT (also known as FMT, or faecal microbiota transplantation) involves transferring healthy bacteria from one person’s gut to a patient’s gut. This procedure is often used to treat gut-related infections. While still experimental, IMT has shown promise in treating conditions like Clostridium difficile infections, and in the future, we may need to explore whether it could also be used to treat autoimmune conditions like ITP.

Antibiotics: For some people, antibiotics can help eliminate harmful bacteria from the gut. However, antibiotics are not selective—they kill both bad and good bacteria. Therefore, they should only be used when necessary.

Conclusion: A New Chapter in Understanding ITP

The gut microbiome is much more than a passive collection of microbes—it’s an active, influential part of our body’s immune system. For patients with autoimmune conditions like ITP, the microbiome could play a key role in understanding and managing the disease. As research into the microbiome continues, we may discover new therapies that target the gut-immune axis, offering fresh hope for people living with ITP and other autoimmune disorders.

As we move forward, it is crucial for patients, researchers, and healthcare providers to work together to advocate for more research studies. By understanding how the microbiome influences ITP, we can hopefully pave the way for better treatments and improved quality of life for those affected by this condition.

 

Camelia Vladescu

Hammersmith Hospital, London

Camelia.vladescu@nhs.net