Diabetes research shows: What the microbes in our gut do, matters!

The MUST study (Diabetes MUltiplex family STudy) was one of the first projects initiated by the Personalised Medicine Consortium of Luxembourg in an effort to bring together clinicians and researchers to drive clinical innovation that ultimately benefits patients. Families where more than one member suffers from diabetes were recruited for the study with the help of Dr Carine de Beaufort (CHL/LCSB) and the Clinical and Epidemiological Investigation Center (CIEC) at the Luxembourg Institute of Health (LIH). The volunteers donated blood, urine, saliva and stool samples, which were collected and processed by IBBL. In addition, the biobank was in charge of project management and co-funded the study. The analysis of these microbiome samples was then led and carried out by scientists of the LCSB. “We studied the bacteria in the stool samples from these people,” says Dr. Anna Heintz-Buschart, first author of the paper. “We also analysed stool samples from healthy close relatives of the patients with diabetes.” The researchers discovered that there is much less of a difference in bacterial species composition between people with and without diabetes than had long been believed. “However,” Heintz-Buschart continues, “there are clear differences in what the bacteria do.”

In type 1 diabetes, these differences presumably arise when the body’s immune system attacks its own insulin-producing cells in the pancreas. The resulting damage can radically upset the composition of digestive juices. “The gut bacteria have to adapt to the changes in their environment,” Heintz-Buschart explains. “They do this by adjusting their metabolism, or in other words they change the amounts of proteins or vitamins they produce, such as thiamine. What matters here is that a change in the body’s thiamine levels can exacerbate the course of the disease.” The once beneficial bacteria thus become a health risk and can worsen the sufferer’s condition.

Such precise descriptions of disease-related changes in the microbiome and insights into their functional effects in the body were not possible until now, stresses Prof. Paul Wilmes, head of the LCSB Ecosystems Biology Group: “While we had been able to determine the species composition in the gut ecosystem by conventional DNA analyses, we were in the dark as to what was actually going on there at a given point in time. To use the analogy of human society: we were able to carry out a census of different individuals without knowing what they might do as a profession. Now we know who does what and when.” The breakthrough came when they combined different analytical techniques: “We looked at genomic, transcriptomic and proteomic information together for the first time, meaning we simultaneously studied the DNA, RNA and proteins of the microbiome. Thus, we are now able to study which genes are transcribed and what proteins are produced at a given point in time. This simultaneous study at the three levels gives us an entirely new picture of the functional processes occurring in the gut, for example in relation to metabolism.”

The medical professionals with whom Wilmes and his team collaborated see great hope in the new research approach. This includes Prof. Dr. Carine de Beaufort, who conducts research at the LCSB and treats patients  at the CHL. She was instrumental in finding families in which healthy and sick members were willing to participate in the study. “We expect these studies to help us identify biomarkers,” she says. “These are molecules, such as proteins, that are produced or whose body levels change in the early stages of a diabetic condition. Such biomarkers would make diagnosis easier, so that we could already take preventive or therapeutic action at a very early stage.”

In order to drive the search for these biomarkers, the study must go on, Paul Wilmes asserts. “We now wish to work together with families who have children with early forms of diabetes,” he says. “For young people especially, it is important to detect indicators of the disease as early as possible. After all, the earlier doctors can intervene, the better they can assure a life with as few limitations as possible.” Wilmes envisages detailed mechanistic studies that will give us a better understanding of the complex functions of the microbiome: “This way, we can learn how functional differences in, say, the biosynthesis of the vitamin thiamine by the gut microbiome relate to type 1 diabetes. Studies like MUST are crucial for this, as hypothesis generators.”

MUST core group

The MUST project was carried out in collaboration between groups at the LCSB, IBBL, the CHL and the CHEM. The project has been initiated within the Personalised Medicine Consortium and received financial support from IBBL and the Luxembourg National Research Fund’s ATTRACT, CORE, INTER and AFR funding programmes.


  1. Integrated multi-omics of the human gut microbiome in a case study of familial type 1 diabetes. A. Heintz-Buschart, P. May, C. C. Laczny, L. A. Lebrun, C. Bellora, A. Krishna, L. Wampach, J. G. Schneider, A. Hogan, C. de Beaufort, P. Wilmes Nature Microbiology, DOI 10.1038/nmicrobiol.2016.180


  1. © Shutterstock
  2. © LCSB. The “core” team behind the publication. From left to right: Paul Wilmes, Linda Wampach, Laura Lebun, Patrick May, Anna Heintz-Buschart, Carine de Beaufort and Angela Hogan.