Clinical Spotlight on Akkermansia Muciniphila

Written by Rachel Bartholomew BA (Hons), Dip ION, mBANT, CNHC, GHW on 10th October 2019

The intestinal tract is colonised by thousands of bacterial species, and the diversity and relative abundance of different species is a crucial marker not just of gastrointestinal health, but of optimal health overall.

The intelligent ecosystem that inhabits the gastrointestinal tract is now the subject of extensive research moving forward at lightning pace. Science continues to delve deeper to understand more intimately the individual parts of the gut microbiome, and how they work together to impact wider health.

Akkermansia muciniphila is one bacterium which has received much scientific attention since it was first isolated 15 years ago.1 A. muciniphila belongs to the Verrucomicrobio phylum and is part of the normal flora of the intestinal tract. It represents 3-5% of the microbial community in humans and has been identified as a crucial part of a healthy gut mucosa.

From a functional medicine perspective, A. muciniphila is of special interest due to its vital role in maintaining and protecting a healthy gut lining. When low levels of A. muciniphila present on a comprehensive stool panel, it’s an immediate flag to consider whether altered intestinal permeability is part of a client’s health picture.

The name itself gives some clue as to the beneficial activities of this important bacterium*. Akkermansia is derived from Dutch microbiologist Antoon Akkermans; recognised for his contribution to microbial ecology, and muciniphila means ‘mucin-loving’; which is a vitally important characteristic of this bacterium.1 A. muciniphila is a mucin-degrading bacterium, and this is key, because the mucin layer creates a protective barrier over the epithelial layer and prevents harmful agents such as toxins, acids and harmful bacteria from having direct contact. The mucus layer is complex and dynamic, and its thickness is known to be an important measure of intestinal permeability.2-4

It may seem counter intuitive that a bacterium which works to degrade mucin actually supports a healthy, thick mucin layer. Yet human and animal studies have shown that despite its own use of mucin as a source of nutrients, A. muciniphila is positively associated with increased mucus thickness and intestinal barrier integrity.5,6 The specific mechanisms by which it promotes mucus thickness are still not well understood; one theory is that A muciniphila degrades mucin and produces short chain fatty acids (SCFAs) as a by-product. These SCFAs may then be used as a preferred energy fuel for the gut epithelium which produces and secretes mucin.7

Not only is A muciniphila positively associated with gut barrier integrity, research has also identified an inverse correlation with body weight, metabolic syndrome, obesity, type 1 & type 2 diabetes, inflammatory bowel disease (mainly ulcerative colitis), autoimmune disorders, inflammation and atherosclerosis. Levels of A. muciniphila have been found to be higher in the gut of healthy patients than in those with bowel disorders, diabetes, metabolic disorders and obesity.8-13

Considering its widespread benefits within a healthy gut, much research is currently focused on how to increase levels of Akkermansia muciniphila as a therapeutic aim. In a 2017 review on strategies to promote abundance of the important bacterium, researchers found that, “available evidence from animal studies showed that supplementation with prebiotics FOS (Fructo-oligosaccharides) was able to consistently promote A. muciniphila in the gut”. In addition, they found that, “supplementation of B. animalis could also increase A. muciniphila by producing SCFA and facilitating mucin growth to feed the bacterium”.14

Keep sight of the bigger picture

A. muciniphila is one of thousands of species of bacterium that make up our intelligent internal ecosystem. Its role in maintaining gut barrier integrity and supporting wider health make it a highly valued member of the microbial community. As research accelerates in this fascinating area though, it is important also to keep sight of the bigger picture, and to maintain perspective on its relevance. Whilst A. muciniphila is undoubtedly a highly significant part of a healthy gut, it is also just one piece in a big puzzle. And when dysbiosis occurs, it’s vital to consider what triggered it in the first place and what’s keeping it there too.

References:1. Derrien M, Vaughan EE et al. Akermansia muciniphila gen. nov., sp. Nov., a human intestinal mucin-degrading bacterium. Int J Syst Evol Microbiol. 2004 Sep; 54(pt 5): 1469-762. Everard A, Belzer C, et al. Cross-talk between Akkermansia muciniphila and intestinal epithelium controls diet-induced obesity. Proc Natl Acad Sci USA.2013;110:9066–713. Wells JM, Rossi O et al. Epithelial crosstalk at the microbiota-mucosal interface. Proc Natl Acad Sci USA. 2011;108(Suppl 1):4607–46144. Capaldo CT, Powell DN et al. Layered defense: how mucus and tight junctions seal the intestinal barrier. J Mol Med (Berl): 2017; 95(9): 927-9345. Collado MC, Derrien M, et al. Intestinal integrity and Akkermansia muciniphila, a mucin-degrading member of the intestinal microbiota present in infants, adults, and the elderly. Applied and Environmental Microbiology. 2007;73(23):7767–7770.6. Everard A, Belzer C,et al. Cross-talk between Akkermansia muciniphilaand intestinal epithelium controls diet-induced obesity. Proceedings of the National Academy of Sciences. 2013;110(22):9066–9071.7. Shin NR, Lee JC, et al. An increase in the Akkermansia population induced by metformin treatment improves glucose homeostasis in diet-induced obese mice. Gut. 2014;63(5):727–7358. Karlsson CL, Onnerfalt J, et al. The microbiota of the gut in preschool children with normal and excessive body weight. Obesity (Silver Spring) 2012;20(11):2257–22619. Hansen CHF, Krych Ł, et al. A maternal gluten-free diet reduces inflammation and diabetes incidence in the offspring of NOD mice. Diabetes. 2014;63(8):2821–283210. Brahe LK, Le Chatelier E, et al. Specific gut microbiota features and metabolic markers in postmenopausal women with obesity. Nutrition & Diabetes. 2015;5: e15911. Hansen CH, Krych L, et al. Early life treatment with vancomycin propagates Akkermansia muciniphilaand reduces diabetes incidence in the NOD mouse. Diabetologia. 2012a;55(8):2285–229412. Hansen CHF, Krych L, et al. Early life treatment with vancomycin propagates Akkermansia muciniphilaand reduces diabetes incidence in the NOD mouse. Diabetologia. 2012b;55(8):2285–2294.13. Png CW, Linden SK, et al. Mucolytic bacteria with increased prevalence in IBD mucosa augment in vitro utilization of mucin by other bacteria. The American Journal of Gastroenterology. 2010;105(11):2420–2428.14. Zhou K. Strategies to promote abundance of Akkermansia muciniphila, an emerging probiotics in the gut, evidence from dietary intervention studies. J Funct Foods 2017 Jun; 33: 194-201

Credits:*Thanks to Emma Beswick @ LifeCode GX for the inspiration to delve a bit deeper into what’s behind a name.