Background: Human microbiome research has the potential to transform the practice of medicine, fundamentally shifting the ways in which we think not only about human health, illness and disease, but also about clinical practice and public health interventions. Drawing from a larger qualitative study on ethical, legal and social dimensions of human microbiome research, in this article, we document perspectives related to the translation of human microbiome research into clinical practice, focusing particularly on implications for health, illness and disease. Methods: We conducted 60 in-depth, semi-structured interviews (2009-2010) with 63 researchers and National Institutes of Health project leaders (‘investigators') involved with human microbiome research. The interviews explored a range of ethical, legal and social implications of human microbiome research, including investigators' perspectives on potential strategies for translating findings to clinical practice. Using thematic content analysis, we identified and analyzed emergent themes and patterns. Results: We identified 3 themes: (1) investigators' general perspectives on the clinical utility of human microbiome research, (2) investigators' perspectives on antibiotic use, overuse and misuse, and (3) investigators' perspectives concerning future challenges of translating data to clinical practice. Conclusion: The issues discussed by investigators concerning the clinical significance of human microbiome research, including embracing a new paradigm of health and disease, the importance of microbial communities, and clinical utility, will be of critical importance as this research moves forward.

Keywords:
Clinical genomics, Human microbiome, Translational genomic research
1.
Relman DA: Microbiology: learning about who we are. Nature 2012;486:194-195.
2.
Juengst E, Huss J: From metagenomics to the metagenome: conceptual changes and the rhetoric of translational genomic research. Genomics, Society and Policy 2009;15:1-19.
3.
Cho MK: Translating genomics into the clinic: moving to the post-Mendelian world. Genome Med 2009;1:7.
4.
Hasnain SE, Banerjee S, Ehtesham NZ: Translating advances in genomic research into clinical practice: the challenges ahead. Med Prin Pract 2010;20:392-394.
5.
Rizkallah MR, Saad R, Aziz RK: The Human Microbiome Project, personalized medicine, and the birth of pharmacomicrobiomics. Curr Pharmacogenomics Pers Med 2010;8:182-193.
6.
Turnbaugh PJ, Ley RE, Hamady M, Fraser-Ligget CM, Knight R, Gordon JI: The Human Microbiome Project. Nature 2007;449:804-810.
7.
Turnbaugh PJ, Hamady M, Yatsuneko T, Cantarel BL, Duncan A, Ley RE, Sogin ML, Jones, WJ, Roe BA, Affourtit JP, Egholm M, Henrissat B, Heath AC, Knight R, Gordon JI: A core gut microbiome in obese and lean twins. Nature 2008;457:480-484.
8.
The Human Microbiome Project Consortium: Structure, function and diversity of the healthy human microbiome. Nature 2012;486:207-214.
9.
Aagaard K, Riehle K, Ma J, Segata N, Mistretta T, Coarfa C, Raza S, Rosenbaum S, Van den Veyver I, Milosavlijevic A, Gevers D, Huttenhower C, Petrosino J, Versalovic J: A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PLoS One 2012;7:e36466.
10.
Wylie KM, Mihindukulasuriya KA, Sodergren E, Weinstock GW, Storch GA: Sequence analysis of the human virome in febrile and afebrile children. PLoS One 2012;7:e27735.
11.
McGuire AL, Achenbaum LS, Whitney SN, Slashinski MJ, Versalovic J, Keitel WA, McCurdy SA: Perspectives on human microbiome research ethics. J Empir Res Hum Res Ethics 2012;7:1-14.
12.
Slashinski MJ, McCurdy SA, Achenbaum LS, Whitney SN, McGuire AL: ‘Snake-oil,' ‘quack medicine,' and ‘industrially cultured organisms:' biovalue and the commercialization of human microbiome research. BMC Med Ethics 2012;13:28.
13.
Creswell JW: Qualitative Inquiry and Research Design: Choosing Among Five Approaches. Thousand Oaks, Sage, 2007.
14.
The Human Microbiome Project Consortium: A framework for human microbiome research. Nature 2012;486:215-221.
15.
National Institutes of Health: The Human Microbiome Project: funded demonstration projects. 2013. http://www.commonfund.nih.gov/hmp/fundedresearch.aspx.
16.
MacQueen K, McLellan-Lemal E, Bartholow K, Milstein B: Team-based codebook development: structure, process, and agreement; in Guest G, MacQueen K (eds): Handbook for Team-Based Qualitative Research. AltaMira, Lanham, 2008, pp 119-155.
17.
Neu J, Mshvildadze M, Mai V: A roadmap for understanding and preventing necrotizing enterocolitis. Curr Gastroenterol Reports 2008;10:450-457.
18.
Chen T, Yu WH, Izard J, Baranova OV, Lakshmanan A, Dewhirst FE: The human oral microbiome database: a web accessible resource for investigating oral microbe taxonomic and genomic information. Database (Oxford) 2010;2010:baq013.
19.
Zhou Y, Lin P, Li Q, Han L, Zheng H, Wei Y, Cui Z, Ni Y, Guo X: Analysis of the microbiota of sputum samples from patients with lower respiratory tract infections. Acta Biochim Biophys Sin (Shanghai) 2010;42:754-761.
20.
Young VB, Kahn SA, Schmidt TM, Chang EB: Studying the enteric microbiome in inflammatory bowel diseases: getting through the growing pains and moving forward. Front Microbiol 2011;2:144.
21.
Huse SM, Ye Y, Zhou Y, Fodor AA: A core human microbiome as viewed through 16S rRNA sequence clusters. PLoS One 2012;7:e34242.
22.
Costello EK, Stagaman K, Dethlefsen L, Bohannan BJM, Relman D: The application of ecological theory toward an understanding of the human microbiome. Science 2012;336:1255-1262.
23.
Eckburg PB, Bik EM, Bernstein CN, Purdom E, Dethlefsen L, Sargent M, Gill SR, Nelson KE, Relman DA: Diversity of the human intestinal microbial flora. Science 2005;308:1635-1638.
24.
Fierer N, Hamady M, Lauber CL, Knight R: The influence of sex, handedness, and washing on the diversity of hand surface bacteria. Proc Natl Acad Sci USA 2008;105:17994-17999.
25.
Nasidze I, Li J, Quinque K, Tang M, Stoneking M: Global diversity in the human salivary microbiome. Genome Res 2009;19:636-643.
26.
Costello EK, Lauber CL, Hamady M, Fierer N, Gordon JI, Knight R: Bacterial community variation in human body habitats across space and time. Science 2009;326:1694-1697.
27.
Fierer N, Lauber CL, Zhou N, McDonald D, Costello EK, Knight R: Forensic identification using skin bacterial communities. Proc Natl Acad Sci USA 2010;107:6477-6481.
28.
Schloissnig S, Arumugam M, Sunagawa S, Mitreva M, Tap J, Zhu A, Waller A, Mende DR, Kultima JR, Martin J, Kota K, Sunyaev SR, Weinstock GM, Bork P: Genomic variation landscape of the human gut microbiome. Nature 2013;493:45-50.
29.
Gevers D, Pop M, Schloss PD, Huttenhower C: Bioinformatics for the Human Microbiome Project. PLoS Comput Biol 2012;8:e1002779.
30.
National Institutes of Health Human Microbiome Project Data Analysis and Coordinating Center. 2012. http://www.hmpdacc.org/tools_protocols/tools_protocols.php.
31.
Ursell LK, Metcalf JL, Wegener Parfrey L, Knight R: Defining the human microbiome. Nutr Rev 2012;70(suppl 1):S38-44.
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2013
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