Dr. Nayak – The Second Human Genome

Dr. Nayak – The Second Human Genome

As the role of the gut biome becomes increasingly more recognized in health and disease profiles, this biome is often being considered as the “second genome.” With a unique set of skills and experience in Biology, Computer Science, and Clinical Rheumatology, Dr. Renuka Nayak, an ANRF researcher and University of California, San Francisco scholar, is in a position to investigate the influence of the human gut biome in the treatment of rheumatoid arthritis.

In her research, Dr. Nayak identifies how medications for treating rheumatic conditions need to be metabolized (broken down into its usable form) in order to be affective. Methotrexate, a common drug used to treat autoimmune conditions, has a large amount of variability in effectiveness. Research on mice has shown that this drug is metabolized by the microbiota. It has also been established in patients that do respond to methotrexate treatment have increased levels of polyglutamated MTX (PG-MTXn), the metabolite which is the active form of the drug.  This raises interesting questions which, if answered, could go a long way in explaining the large variety of patient responses to the same drug, a problem all rheumatologists battle with. These questions include: Is it possible that a patient may not respond to a medication because of his/her microbiome? Could bacteria in the gastrointestinal tract be metabolizing the medication even before it gets into the patient’s blood stream? Alternatively, could specific bacteria, which are only present in some patients, be turning the drug in to a more active version that is more effective?

As a rheumatologist, Dr. Nayak is frustrated at the trial-and-error approach, often necessary in order to find a drug which the patient responds to. Currently, rheumatologists have no way of predicting individual patient response. As it takes between 2-3 months for most drugs to exert their full effect, patients who are ultimately deemed to be non-responders suffer from continued pain and potentially sustain permanent damage during that window. Through her research, Dr. Nayak remains encouraged the data she generates will provide a foundation to create a predictive tool that helps to identify patients as non-responders, allowing them to start alternative therapies sooner.

Article Author
Arthritis National Research Foundation

The Arthritis National Research Foundation's mission is to provide initial research funding to brilliant, investigative scientists with new ideas to cure arthritis and related autoimmune diseases. There are several ways to support research through the ANRF. Find out more and donate today.

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