Matt Kelly explains how biofilms form on your mucous membranes and why they resist antibiotics. Normal biofilms protect you, but pathological ones grow into multispecies structures that cause chronic infections and treatment resistance, especially after antibiotics or steroids.
The first thing is that biofilms are in nature all over. It's not just a mammal or human thing. They're most known about in oceanography because they're how microbes— you can imagine in the ocean, a microbe could get lost from its community very easily. It's how microbes survive, you know, in wet areas. And we'll just restrict it to people, but basically all mammals. Anywhere where you have moisture in your body, mostly mucous membranes, can also be vascular stuff like that. But most of your mucous membranes, which includes your respiratory membranes, your gut membranes, and also genitourinary membranes, those are places where biofilms grow. And this is something that when I'm teaching healthcare providers, I try and talk about first because early on, you know, when I was trying to sort of change the way people thought about this, it would have people, you know, say, well, biofilms are normal. It's like, this is not a pathological thing, right? And so I've kind of had to add a little bit of context to my rap, as it were. So the context Is I say, well, think of it this way: on the left-hand side of a spectrum, you have what are called normal biofilms in any mucous membrane. We're supposed to have those. It's very analogous to normal good bacteria, good flora in the gut, right? Well, we also have normal and appropriate biofilms. So that is true. Everybody has biofilms. Those are not a problem. Those are called physiologic biofilms, just like your good flora is physiologic. It's there to help you, right? But then if you move from the left side of that spectrum over. Over a little bit and you've been sick for a while, or accelerated by things like GI autoimmunity, GI inflammation, certain drugs given to GI tract— maybe you don't have GI problems but you take drugs through the mouth, they go in there— then what'll happen is those normal happy biofilms will be kind of hijacked by some inappropriate, usually bacteria that start, but there's other types of microbes that can start them. And these other bacteria will say, well, what we're going to do is we're going to not only overgrow, but we're going to protect ourselves because we know that we're not supposed to be here in large amounts in your GI tract. And I'm sure they exactly have this conversation in whatever, whatever way bacteria do this, you know, but, but through various sensing mechanisms and things, they're like, well, if we, okay, we've, we've multiplied, we're kind of taking over because they took a round of antibiotics or because their inflammation was whatever, you know, or they're on steroids or something, but we have to protect ourselves. So what they do then is they start to build a pathological biofilm using similar Basically same structure, just bigger than previous. And then just to make sure we finish this metaphor, because it's— I think this is very crucial to understanding not only what's going on, but, but why treatment changes over time. If we keep moving to the right of the spectrum and that person's been sick a long time and maybe been on lots of medications that create trouble, or they've had wildly unchecked GI disease, which, you know, happens sometimes too— people just put up with symptoms— the beginner pathological biofilms will then be high hijacked by more organisms and they become bigger and bigger biofilms. And so the way I teach it, and some of the terminology has caught on in places, is there's the physiologic kind, which are great. We all have, we don't want to get rid of those. Then there's sort of a phase 1 pathological kind and a phase 2 pathological kind. And I always say phase 1 is like somebody built a stick-built house, you know, like a regular old house in a neighborhood. Phase 2 is like a skyscraper. And the trouble that happens is the bigger the biofilm gets, the more organisms go into it. So you might have started with one bacteria just trying to protect itself. Now you can have parasites and viruses and fungus and other bacteria and all, and even things that don't make biofilms will get in there and they create a hive. And then in some cases, when you're really sick, these things share DNA. And so, and this, this is not just like something I dreamed, like this is actually the Big biofilm. The big biofilm world of researchers. And what they say is now you're not dealing with the individual constituents who live there. The biofilm is like a hive or a community that has its own genetics that are different from other bugs, and you have to deal with them as a community, or you just, you know, you're chasing your tail as you go. So just from a big picture point of view, you know, there's the normal physiologic, then pathogenic kind of have a part 1, part 2 You know, smaller but still not good for you. Bigger, harder to deal with. And I think because it matches where we're at when you're treating somebody with these worse biofilms, there comes a point where you work backwards from the right-hand side to the middle to the left. And so you don't just keep coming in and yeah, and and you don't keep doing you know high-level biofilm work forever and ever because once that's gone, you don't need it anymore. You have to kind of work backwards. What got me you know more interested in this all those years ago was. At the time, we were kind of assessing all biofilms that were pathologic, like those middle ones, the phase one, a little easier to get at, which is fine. That's true. A lot of people have those, but a lot of our sicker patients had made these hives and these big skyscrapers and you couldn't get to them. And so that was really where we saw the big difference. Now, people always ask, well, how, you know, is there a test and all of this? And you can test for these things and stuff, but for the most part, if somebody's been sick, especially I would say starting with GI illness, but also a lot of chronically ill people without known GI illness, because most of them have some GI illness, but without known GI illness. Chronically ill people are often on the same medications that would engender more biofilms, you know, whether they would be anti-inflammatories, steroids, antibiotics, or other anti-infectives, you know, on and on. So I think that what I always have people look at is how severe is what you're dealing with, how resistant to treatment is it? And then the big question is, Have you had it, you know, 1 or 2 years, or have you had it 5 or 10 years or 30 years? The longer a person's been sick, the more you can just assume that the resistance factors— and biofilms are one of your cornerstone resistance factors— are big. They're protecting themselves.
