Gastrointestinal

Pick one of the articles and describe how this technology could be used by you to improve health in an underserved community. Community could be kids,
the elderly or college students… any community you choose.
https://www.sciencedaily.com/releases/2021/10/211001135901.htm
https://www.newhavenindependent.org/index.php/archives/entry/wastewater_covid
Article 1.Researchers at Cedars-Sinai have found that aging produces significant changes in the microbiome of the human small intestine distinct from those
caused by medications or illness burden. The findings have been published in the journal Cell Reports.
“By teasing out the microbial changes that occur in the small bowel with age, medication use and diseases, we hope to identify unique components of the
microbial community to target for therapeutics and interventions that could promote healthy aging,” said Ruchi Mathur, MD, the study’s principal investigator.
Research exploring the gut microbiome, and its impact on health, has relied predominantly on fecal samples, which do not represent the entire gut, according
to Mathur. In their study, investigators from Cedars-Sinai’s Medically Associated Science and Technology (MAST) Program analyzed samples from the small
intestine which is over 20 feet in length and has the surface area of a tennis court-for examination of the microbiome and its relationship with aging.
“This study is the first of its kind to examine the microbial composition of the small intestine of subjects 18 years of age to 80. We now know that certain
microbial populations are influenced more by medications, while others are more affected by certain diseases. We have identified specific microbes that
appear to be only influenced by the chronological age of the person,” said Mathur, an endocrinologist, and director of the Diabetes Outpatient Treatment &
Education Center.
The 21st century has been referred to as the “era of the gut microbiome” as scientists turn considerable attention to the role trillions of gut bacteria, fungi,
and viruses may play in human health and disease. The microbiome is the name given to the genes that live in these cells. Studies have suggested that
disturbances in the constellations of the microbial universe may lead to critical illnesses, including gastroenterological diseases, diabetes, obesity, and some
neurological disorders.
While researchers know that microbial diversity in stool decreases with age, Cedars-Sinai investigators identified bacteria in the small bowel they refer to as
“disruptors” that increase and could be troublesome.
“Coliforms are normal residents of the intestine. We found that when these rod-shaped microbes become too abundant in the small bowel-as they do as we
get older-they exert a negative influence on the rest of the microbial population. They are like weeds in a garden,” said study co-author Gabriela Leite, Ph.D.
Investigators also found that as people age, the bacteria in the small intestine change from microbes that prefer oxygen to those that can survive with less
oxygen, something they hope to understand as the research continues.
“Our goal is to identify and fingerprint the small intestinal microbial patterns of human health and disease. Given the important role the small bowel plays in
absorption of nutrients, changes in the microbiome in this location of the gut may have a greater impact on human health, and warrants further study,” said
Mark Pimentel, MD, director of the MAST program and a co-author of the study.
This research is part of Cedars-Sinai’s ongoing REIMAGINE study: Revealing the Entire Intestinal Microbiota and its Associations with the Genetic,
Immunologic, and Neuroendocrine Ecosystem.
https://www.newhavenindependent.org/index.php/archives/entry/wastewater_covid/
Article 2. That message came Thursday from an expert who has been studying the city’s sewage to help officials get out in front of the spread of Covid-19.
“The sewage facilities measure primary sludge every day, and send us results three times a week,” said Yale engineering professor Jordan Peccia. (Primary
sludge is wastewater solid that’s separated by settling to the bottom.)
Peccia spoke about the Covid-19 poop analysis Wednesday on Connecticut Public Radio’s “Where We Live” program hosted by Lucy Nalpathanchil. They
were joined by Yale doc and gubernatorial Covid-19 adviser Albert Ko and Stamford Mayor David Martin, whose city is also working with Peccia’s team. After
the show, Peccia spoke to the New Haven Independent in a separate interview.
Why Sewage
Measuring wastewater was initially used to fight polio. As infected people could be asymptomatic or have mild symptoms, fecal samples helped pinpoint
hidden polio outbreaks.
Peccia wanted to try the same strategy with Covid-19.
“Covid is part of a class of pathogens that infect different tissues in the body,” he said. “Although it’s often in the lungs, it can also be present in the gut,
meaning we can detect Covid samples through sewage.”
Peccia and his team of three began measuring fecal samples on March 19t, starting with New Haven’s sewage facility. Although the facility serves over
200,000 people, Peccia was able to pinpoint new COVID cases on a granular level.
“We collect 40-milliliter samples each day, and use the same techniques as a nasal swab test,” he said. His team then measures the concentration of virus
strands to determine new cases.
“If there’s 1,000 virus strands per milliliter, then we know there’s at least one person infected per 100,000 people,” explained Peccia.
His team can’t always find single cases, “but if there are three or four, we’ll detect it pretty quickly,” he said. And since it takes about 15 hours for sewage to
go from being flushed to being tested, the samples can be mapped to real time.
Over several months, Peccia began to notice an interesting pattern. When his team mapped their sample results to reported cases of COVID, they saw thatthe samples mirrored the peaks and falls of reported cases. However, the samples indicated those peaks and falls about seven to ten days earlier.
In other words, data from wastewater became “the proverbial smoking gun,” said Dr. Ko.
This is fundamentally different, he said, from “lagging metrics such as hospitalizations and deaths.” By its very nature, lagging data meant that the
“community transmission had probably occurred weeks before.” While lagging data could help in the future, it couldn’t do much about current outbreaks.
“Waste is unique,” said Ko, “because it can help us identity outbreaks and transmissions ahead of time, allowing us to respond preemptively.”
To help others across Connecticut, Peccia’s team expanded to surveying five other cities: Hartford, Bridgeport, Stamford, and Norwich, and New London,
reaching approximately one million people.
How Cities Use The Data
Stamford took interest in this new tool early on, said, Mayor Martin. In March and April, testing was not nearly frequent nor fast enough to track the spread.
And as he crafted Stamford’s response to the pandemic, this seemed like “the perfect early warning indicator.”
“I have a degree in biology,” Martin said. “So this made a lot of sense to me.”
Using sewage samples could provide crucial information for cities with vulnerable populations. “Targeting waste in cities is very smart, where transmission
risks are high,” said Ko.
Martin was similarly concerned about Stamford’s low-income neighborhoods, which have dense high-rise housing.
There isn’t a precise bright line where the number of cases becomes concerning, said Peccia. “We don’t have enough data quite yet to develop a formal
statistical analysis. So we just analyze graphs and their trends.”
Although rudimentary, this data has already saved lives. “One day, we got an email at 1:30 saying that our sewage had higher Covid levels and we needed to
pay attention,” Martin said. “By 4:30, we sent out a letter to communities and warned them of this early increase.” The samples were correct: In ten days,
Stamford saw the predicted increase of cases, although levels dropped quickly again.
“I think we got it under control because communities took the warning to heart,” said Martin. “It was a good reminder, especially since people have pandemic
fatigue.”
In New Haven, waste samples have yet to find a concerning increase in cases.
“We communicate with Mayor [Justin] Elicker and Director of Health Maritza Bond at least once a week,” Peccia said. Public reports are also published for
the community on Mondays, Tuesdays, Thursdays, and Fridays. Last week’s public sample report can be found here. https://covidtrackerct.com/wastewaterreport/“It’s no guarantee, but New Haven’s data has been relatively calm this last week,” said Peccia. “We’re making progress.”
Peccia’s research on waste samples, published by the journal Nature Biotechnology, can be found here. https://www.nature.com/articles/s41587-020-0684-z