Lampe agreed that researchers, especially nutrition researchers, need to focus more on “who is really active and doing what.”

  • Continue to explore the role of commensal microbes in disease.

    • Both Vincent Young and Richard Darveau touched on the notion that pathogenic disease ensues not just from the presence of a “bad bug,” but rather from an imbalance in the indigenous microbial community. Darveau suggested expanding microbiome studies to explore this phenomenon in greater depth.
  • Continue to explore fetal, infant, and pediatric microbiome biology.

    • Josef Neu urged continued exploration of the relationship between fetal microbial ecology and prematurity. Evidence suggests that contrary to conventional thought, some infants acquire their initial microbiome prior to birth during the third trimester. What microbes are present in the amniotic fluid, and what is their impact on fetal physiology?
    • Neu also urged continued exploration of microbiome differences between cesarean section (C-section) and vaginally delivered infants, given the growing prevalence of C-section deliveries worldwide and the growing number of diseases being associated with C-section delivery (e.g., celiac disease, type 1 diabetes). For example, how does mode of delivery impact development of the immune system in the first year of life?
    • Sharon Donovan urged expanding sample collection in pediatric populations, but in a well-controlled manner. She suggested that research on the infant microbiome could perhaps “piggyback” onto some ongoing or planned large national studies to get a better sense of what is happening in the infant microbiome over time (e.g., the National Children’s Study)—for example, by including a fecal sampling protocol. Also, as the Human Microbiome Project moves forward, the inclusion of younger individuals should be considered, Donovan emphasized. Another workshop participant suggested that perhaps some of the longitudinal studies being undertaken around the world, outside the United States, might offer alternative opportunities to collect that type of information. She suggested looking into one of the Scandinavian countries, Japan, or other countries with unified health systems that might make it easier to track study subjects.
    • Donovan also encouraged collection of nutrient intake data as part of any pediatric microbiome study. In her opinion, nutrition


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