Ethics, Medicine and Public Health 18 (2021) 1—2

Available online at

ScienceDirect
www.sciencedirect.com

EDITORIAL

Could health only be defined by an

equilibrated microbiome? A COVID-19
reappraisal

The microbiome has become one of the major determinants of health [1]. We have recently
KEYWORDS proposed that the equilibrium of Man in Nature could be recognized as a determining
Health; factor in defining health (not only human but certainly beyond all animal species) [2]. As
Fundamental a consequence, could a qualitative/quantitative evaluation of the microbiome constitute
research; an exclusive marker of health, ignoring WHO’s (now old) definition?
Gut; The role and consequences of the microbiome are superimposed, without one being
Skin dis- able to disentangle one from the other. Is the disease related to an imbalance of the
eases/immunology; microbiome, or are the abnormalities of the microbiome favored by any pathology? Maybe
Auto-immune disease both, but the precise mechanism is still unknown. One can only observe the existence of
a vicious circle of self-maintenance disequilibrium/disease both on the infectious levels
and on autoimmunity.
Previous studies show that microbiome (gut, skin, vagina) in healthy individuals is asso-
ciated with its strong variety: ‘‘we found the diversity and abundance of each habitat’s
signature microbes to vary widely even among healthy subjects, with strong niche spe-
cialization both within and among individuals’’ [3]. These authors have shown that most
variation in the human microbiome is not well explained by these phenotypic metadata:
‘‘Other potentially important factors such as short- and long-term diet, daily cycles,
founder effects such as mode of delivery, and host genetics should be considered in future
analyses’’ [3].
Other studies show the possibility of reconstitution of microbiome imbalances in the
appearance of infectious processes [4]. The juxtaposition of metagenomic results, both
chronologically and geographically, but also the comparison of taxa distributions with
pathological and environmental data, allows us to better understand their evolutionary
processes [5].
Would the possibility of adaptation of the microbiome to its environment be a charac-
teristic element (maybe the only characteristic, at the microbiological scale) of health?
In other words, a functional lacking, an increased competitiveness between bacte-
rial/viral/mycotic species or a loss of mutualistic interactions would all be markers of
a present or future disease, at least a factor favoring the development of a pathology. To
paraphrase the French poet Boileau, ‘‘illness was born one day of uniformity’’. . .

https://doi.org/10.1016/j.jemep.2021.100699
2352-5525/© 2021 Elsevier Masson SAS. All rights reserved.
 P. Charlier
So, can health only be defined by an equilibrated micro-
biome? Reasonably no, this heading question is only a
provocation (even if microbiome-focused therapies are in
current development [6], and even if the link between
microbiome perturbation as an emerging risk factor for
cardiovascular and cerebrovascular disease has recently
been pointed out) [7]. Microbiome analysis if absolutely
fascinating and of high interest for the interaction host-
environment, but we do not have to ask too much to
microbiome. Health cannot be only related to it, as a pierre
angulaire or the Holy Grail.
While for almost two years a global pandemic has
affected almost the entire world population (COVID-19), has
forced us to change all of our social, eating and behav-
ioral habits, will our health remain the same? The prolonged
wearing of the mask will he have consequences (lasting?
reversible?) On our facial skin microbiome (with the develop-
ment, in particular of what is called ‘‘maskne’’) [8], oral,
nasal (and overall respiratory)? The use of hydroalcoholic
gel in profusion will it modify in a prolonged way our skin
microbiome at the level of our hands? We still do not know
the long-term consequences of these changes on our health
and on the definition of it which remains to be asked.
Disclosure of interest
The author declares that he has no competing interest.
References
[1] Thursby E, Juge N. Introduction to the human gut microbiota.
Bioche J 2017;474(11):1823—36.
[2] Charlier P, Coppens Y, Malaurie J, et al. A new definition of
health? An open letter of autochthonous peoples and medical
anthropologists to the WHO. Eur J Intern Med 2017;37:33—7.
[3] Huttenhower C, Gevers D, Knight R, et al. Structure, func-
tion and diversity of the healthy human micro biome. Nature
2012;486:207—14.
[4] D’Argenio V, Torino M, Precone V, et al. The cause of death of
a child in the 18th century solved by bone micro biome typing
using laser microdissection and next generation sequencing. Int
J Mol Sci 2017;18:109.
[5] Warinner C, Herbig A, Mann A, et al. A rebuts frame-
work for microbial archaeology. Anna Rev Genom Hum Genet
2017;18(13):1—36.
[6] Stalenhoef JE, Terveer EM, Knetsch CW, et al. Fecal microbiota
transfer to multidrug-resistant Gram-negatives: a clinical suc-
cess combined with microbiological failure. Open Forum Infect
Dis 2017;4(2) [ofx047].
[7] Ascher S, Reinhardt C. The gut microbiota. An emerging risk
factor for cardiovascular and cerebrovascular disease. Eur J
Immunol 2018;48(4):564—75.
[8] Rudd E, Walsh S. Mask related acne (‘‘maskne’’) and other facial
dermatoses. BMJ 2021;373 [n1304].
P. Charlier a,b,c
aLaboratory Anthropology, Archaeology, Biology
(LAAB), Paris-Saclay University, 2, avenue de la
Source de la Bièvre, 78180
Montigny-Le-Bretonneux, France
b Department of Research and High Education,
musée du quai Branly—Jacques Chirac, 222, rue de
l’Université, 75007 Paris, France
c Fondation Anthropologie, Archéologie,
Biologie—Institut de France, 23, quai de Conti,
75006 Paris, France
E-mail address: philippe.charlier@uvsq.fr