Prof Fergus Shanahan shares success in microbiome medical science at this week’s IOM Symposium

Prof Fergus Shanahan will discuss how lifestyle changes are affecting the human microbiome at RCPI Institute of Medicine’s upcoming November Symposium on 28 November. He will be awarded the Bryan Alton Medal, in honour of Dr Bryan Alton, a physician and senator, who, among his achievements, was a founding member of the Irish Society of Gastroenterology and oversaw the founding of RCPI’s institutes and faculties while serving as the college’s president.

Professor Emeritus of Medicine at University College Cork, Prof Shanahan initially trained in immunology before later specialising in gastroenterology. He founded APC Microbiome Ireland, one of the world’s first microbiome research centres.

Prof Shanahan once worked with Dr Alton. “In my lecture, I will emphasise the importance of clinical curiosity as a special attribute of Dr Bryan Alton, to whom my lecture is dedicated, and with whom I once worked. I hope to show young and not-so-young clinicians that good translational research is always possible if one remains curious and engaged with patients and their stories.”

“Much of increased disease risk can be related to changes in lifestyles associated with increased industrialisation and socioeconomic development. This, I will show in my lecture, has modified the microbiome, and increased the risk of a multitude of chronic disorders in the modern world” he says.

His lecture is entitled “No Stool Left Unturned – lessons from outliers.” We caught up with Prof Shanahan in advance of the symposium to learn more about his career and work.

Prof Shanahan, you are Professor Emeritus of Medicine at University College Cork. Can you give us a sense of your role and the work involved?

In Ireland, an academic professor of medicine is a curious – some would say impossible - role. When I was first appointed, I was asked to be an agent of change. At that time, the traditional clinician-researcher was thought to be an endangered species, but I have been privileged to pursue a career that has allowed me to be a teacher, a clinician, a researcher, a leader, an entrepreneur and an author. My research has been curiosity-driven, usually prompted by clinical questions raised by patients.

Your lecture is titled “No Stool Left Unturned – lessons from outliers.” What was your starting point for this research?

 The starting point for this research is the question that many patients now ask: “Doctor, is my microbiome normal?” I will tell a uniquely Irish story of research that challenges current concepts of a normal microbiome and has global clinical implications for precision medicine, public health policy and even the use of uniform dietary guidelines. I will show the changing nature of the microbiome and the clinical importance of differences among ethnic and migrant minorities.   

I imagine your own perspective is filtered through your specialty of gastroenterology. Where did the passion to pursue that specialty come from?

I would have been happy in almost any specialty in medicine and I first trained as a clinical immunologist, but gastroenterology offered more opportunities for the clinical questions that I wanted to study. Two epiphanies confirmed my passion for gastroenterology. The first epiphany was research with germ-free animals which showed that microbes in the gut have a profound influence on almost every aspect of the physiology and pathophysiology of the gut and beyond. The second epiphany was the story of Helicobacter pylori as a cause of peptic ulceration and stomach cancer. The big lesson from that discovery was that there are some diseases, the solution for which will never be found by research focussed exclusively on human systems, unless the microbial creatures living in and on the human body are addressed. As a gastroenterologist and immunologist, I was fortunate to be in the right place at the right time to study the human gut microbiome.

Over the arc of your career, how have you seen the specialty of gastroenterology evolve? Are there currently exciting new developments in the specialty?

Gastroenterology has changed enormously during my career. Specialists will usually point to advances in endoscopy and radiology (which have undoubtedly improved patient care) but I believe that the increasing burden of chronic disease is of greater significance to society. Much of the increased disease risk can be related to changes in lifestyles associated with increased industrialisation and socioeconomic development. This, I will show in my lecture, has modified the microbiome and increased the risk of a multitude of chronic disorders in the modern world.

What is the key take home message you would like participants to leave the symposium with?

I have three messages.

Firstly, I will emphasise the importance of clinical curiosity as a special attribute of Dr Bryan Alton, to whom my lecture is dedicated, and with whom I once worked. I hope to show young and not-so-young clinicians that good translational research is always possible if one remains curious and engaged with patients and their stories.

Secondly, I will show some clinical questions that patients asked and helped me to investigate and which led to changes in clinical practice or policy.

Thirdly, I will show some of the success stories in microbiome medical science and give a uniquely Irish story which has global implications … but people need to come to the lecture to learn about that.

Attend the symposium.