Individuals who test positive for anti-cyclic citrullinated peptide/protein (CCP+) and experience musculoskeletal symptoms but do not exhibit clinical synovitis are at an elevated risk of developing rheumatoid arthritis (RA). This CCP+ at-risk population has evidence of increased prevalence of periodontal disease (PD). This study investigates the association between the subgingival microbiome and RA susceptibility.
A UK cohort of 86 CCP+ at-risk individuals, 34 new-onset RA (NORA) patients, and 38 control subjects (HC), with and without periodontal disease, were recruited. All participants underwent a comprehensive periodontal assessment by a dentist. Subgingival dental plaque samples from both healthy and diseased periodontal sites were used for DNA metagenomic sequencing using the Illumina NovaSeq platform. Taxonomic profiling was performed using Metaphlan4.
A total of 744 bacterial species of 16 phyla were detected. At both healthy and diseased sites, there was no significant difference in bacterial alpha- and beta-diversity among HC, CCP+ at-risk individuals and NORA patients. However, bacterial differences at the phylum and species levels were observed. At species level, keystone periodontal pathogens associated with RA were found to be enriched in both CCP+ at-risk individuals and NORA patients. Compared to control subjects with periodontal disease (having both healthy and diseased sites), Porphyromonas gingivalis (P.g.) was more abundant at healthy sites and Aggregatibacter actinomycetemcomitans (A.a.) was significantly increased at diseased sites in CCP+ at-risk individuals. Additionally, P.g. was less abundant and A.a. was more abundant at diseased sites in NORA patients than in CCP+ at-risk individuals.
Our findings demonstrate a distinct subgingival microbiome profile in CCP+ at-risk individuals and NORA patients compared to control subjects. There was an increased abundance of A.a., particularly in diseased sites, suggesting the possible role of the oral microbiome RA development. Further research is warranted to elucidate the mechanisms by which the subgingival microbiome contributes to RA pathogenesis.
 

Hormonal alterations during women’s aging significantly reshape the composition and structure of the microbiome, potentially influencing disease susceptibility and microbial infections. We investigated the association of circulating salivary estrogens (estradiol and estrone) with oral microbial niches, including the dorsum of the tongue, buccal mucosa, and supragingival and subgingival plaque. Our ecological approach revealed significant findings on how these estrogens influence bacterial diversity, richness, and community structure within these niches. Higher estradiol levels are linked to increased beneficial bacteria while suppressing potential pathogens like Porphyromonas and Neisseria. Estrone significantly affects microbial diversity, especially in the tongue dorsum and subgingival plaque. Understanding these interactions is crucial for developing personalized treatment strategies to address hormone-related changes in the oral microbiome, potentially leading to improved overall health and quality of life.

Antimicrobial resistance (AMR) is a global challenge, causing over 4.95 million deaths annually, with 1.27 million directly attributed to drug-resistant infections(cite). AMR poses significant public health risks, especially in Low- and Middle-Income Countries (LMICs) with limited antibiotic regulation and antibiotic misuse.

My pilot study focuses on Bangladesh, where antibiotics are readily available over-the-counter. A recent report revealed that 36 antibiotics were ineffective in controlling common infections. contributing to >26,000 deaths from Jan'22-Jun'23. This data only covers hospital cases.

I aim to understand antimicrobial use in the general population, AMR spread through food and the environment, and its impact on communities, particularly regarding antimicrobial use (AMU), access (AMA), and quality (AMQ).

In 2023, I began a proof-of-concept project in Dhaka, Bangladesh, to understand antimicrobial practices. Significant knowledge gaps were identified, especially among impoverished individuals. Low wages lead to reliance on antibiotics for quick return to work. Pharmacists often dispense drugs without prescriptions, contributing to misuse. This project aims to evaluate the impact of unrestricted antibiotic use in marginalised communities across Bangladesh, comparing urban, peri-urban, and rural environments.

Beside direct human consumption, our research extends to indirect antibiotic exposure through food (fish, chicken, cattle, goat), soil, water, and other environmental samples. Using Metagenomics and One health framework, we plan to obtain over 3500 samples including human, animal, and environment to study microbial composition, and AMR gene content. Multivariate statistics will integrate microbiome data, health-lifestyle-food questionnaires, and blood reports to uncover AMR patterns and drivers. We aim to understand the implications of antibiotic usage on overall well-being and the impact of traditional diets versus modern lifestyles by comparing extremely rural communities with urban.

This presentation will focus on uniting a massive microbiome project with an interdisciplinary approach under the One Health framework, involving several international partners, rather than on data analyses and results.