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TWiM 12 Letters

Merry writes:

Hi, Vincent,

I've been listening to the evolution of TWIM, week by week, and want to say that I am delighted by the direction it has gone. I listened to #11 yesterday and found the format especially informative and interesting. By format, I am referring to the selection of, in this case, two papers, both of which were introduced well to orient the listener to the context and the topic. In each case there followed a real discussion among the co-hosts that was accessible to listeners with varied backgrounds. Acronyms and specialized terms were defined, or replaced by more common words.

As if that weren't enough, the viewpoints presented this week were particularly relevant and important vis a vis our microbiota, allergies, antibiotic usage, agricultural practices, and such. This information needs to be widely disseminated, and TWIM make an excellent contribution to that process.

Carry on!

All the best,

Merry Youle

Jennie writes:

Hello there Vince and friends!

I'm Jennie - an RN who has very much enjoyed your work (or is this play?) through TWIV, TWIP and now TWIM. Thanks for making fascinating subject matter approachable and fun. I've listened to your programs while traveling & caring for ill & dying family members - your voices helped me use the solidity of science as a kind of ballast during difficult times.

You'll probably pick & choose from this email what to discuss since I know I'm asking too many questions. Enjoy the choice!

Going back to TWIM # 5 - perturbation of Arctic soil using nanoparticles (gives me the willies) - one of your guests mentioned a thought - spraying human skin with nanoparticles to stop MRSA - yikes - another shiver of concern.

BUT WAIT! Way before I had a foundation for pro and pre biotics I quietly theorized that skin infections were an imbalance in the living systems that are usually on our skin - or that imbalancing the microbes there may be a prerequisite to skin infection. Also, I understand that when some pathogens invade the gut, one of the first tasks is to launch an attack on the commensal microbes that hold territory there.

Back to the skin & nasal mucosa. I understand now that the Human Microbiome project has identified many, many bacterial species on the skin that live in a complex interdependence on us. I believe a current CA-MRSA therapy is judicious use of antimicrobials & topical intranasal mupirocin - and that limiting use of mupirocin to avoid drug resistance is a concern for this treatment as it is for all antibiotic therapy.

So, let me make my case for this idea I have for a study - and perhaps personalized medicine. Attempted transplant of a cocktail of known NON-resistant commensal skin organisms to the skin (and nasal mucosa?) of person with CA-MRSA - perhaps after a reduction in bacterial numbers using a method that does not linger - so that the reduction method wouldn't interfere with the colonization of the new commensals. Perhaps drying? Perhaps phage?

Of course, not being a microbiologist, I don't understand the niche selection pressures for microbes, nor do I get why some colonize & why some are transient.

Related questions - I understand that, in some cases, simply by going for a while without anti-infectives, some people clear MRSA because of the lack of selective pressure for resistance - but that its not at all a sure thing - wonder what the odds are on that clearance - and what the factors are? Wonder how important it is that we have resistant microbes in our gut - is this a super complicated world of many kinds of plasmids - & are those plasmids in communication with our skin & nasal mucosa organisms?

Related questions on Triclosan & surfaces: do you think that Triclosan use in households selects for resistant microbes? What can you tell us about what you know on Triclosan in our homes & environment? I also wonder about the surfaces that we touch now - so many modern plastic or plastic coated surfaces instead of metal, wood & cotton. I was very much interested in your discussion on copper surfaces and know that wooden cutting boards are better antimicrobial surfaces than plastic after wash & dry.

And I leave you with a crazy idea. Of course I teach people to wash hands just before leaving work. How about washing, carefully drying - then recolonizing them with complex normal flora on their way out the door every shift - kind of like a handshake...? I can imagine one problem with this crazy idea might be - the complexity of microbes can't live off the human body long enough. I suppose there is nothing like a human handshake to transplant human commensals.

Alternatively - after washing & drying - apply a solution that selects NOT so much AGAINST MRSA etc. but provides conditions that FAVOR commensals - kind of like a pre-biotic for the skin. We would want to know what conditions make it a little shaky for pathogens while providing the best chance for beneficial commensal recolonization. Then, that recolonization might happen next time you touch another person - like your child when you come home...

Thanks for listening to my silly questions!

Warmest regards



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