Tiny Health Colibactin Metric Walkthrough

Hi everyone, my name is Emily Cerda. I'm a microbiome specialist here at Tiny Health. Today we're introducing colibactin. This is a new practitioner-only metric launching here in September 2026. This metric is available on practitioner-only reports and only for adults ages 18 and up. So colibactin is a compound that certain bacteria, most commonly E. coli, and some of those related related Enterobacteriaceae are genetically capable of producing. When it's produced, it can affect the DNA and barrier function of cells lining the gut, and it may also shape the broader composition of the microbiome. So research has associated ongoing exposure with gut inflammation and with conditions like ulcerative colitis, Crohn's disease, and colorectal cancer. But let's put that association into context. So, although that research association is real, we're not going to downplay it, but it's worth being really, really precise about what that science actually means. So, colobactin's genetic potential is most directly tied to gut inflammation and barrier disruption. Conditions like IBD and colorectal cancer are downstream possibilities that researchers have studied, but they're not the expected outcome of a flag. So it's important to understand that these are population-level associations, not individual predictions. Finding more colibactin-capable bacteria in a group of colorectal cancer patients tells us something about shared biology across that group. It doesn't tell us that any one person with that flag is headed toward disease. So, in most cases, a flag is better read as a marker of inflammatory potential than as a signal for any specific condition. So what does this metric actually measure? Here, this is a functional metric. So we're looking for the functional genes with the potential to produce colibactin, and this will only be flagged positive when the full set of core genes needed to build and release colibactin are detected together. This will only be available, like I said, on adult reports ages 18 and up and test version 5.0 and higher in a practitioner-only test. And we'll talk a little bit about what that means at the end. If a result is flagged, here's what that means and what it doesn't. It means the microbiome carries the core genes needed to build and release colibactin. It does not confirm active production, gut damage that is current, or any disease. Evidence on targeted intervention, um, is still emerging, and there's no established protocol shown to reduce the production of colibactin specifically. But what we do know is that E. coli can be kept in check by fiber fermenting bacteria, and a wide range of plant fiber supports the production of short-chain fatty acids that make the gut a harder place for E. coli to establish itself. So, when you're reviewing a flagged result with a patient, here's a simple way to frame it. You want to explain this as genetic potential, not active harm or diagnosis. Those genes may not be active. Um, read it alongside the patient's broader clinical picture and symptoms, like we do with every other metric on the test. We're not going to act on it in isolation. And then, where appropriate, we can use this as an opening to talk about diversity of the diet and also fiber intake. And if the patient has symptoms or a history consistent with IBD, colorectal concerns, just like we would otherwise, we would refer for clinical evaluation. You do not need the flag. to know that, how to take care of your patient within the metrics or within the parameters of that patient presentation. Okay, so where you'll find this metric will be again on those practitioner-only tests which were purchased on or after September 3rd, 2026, and the colabactin metric will appear in the portal under disruptive functions and then colabactin potential capacity. If you're looking for the next practical steps to discuss with your patients, again, we're talking about fiber. This could be inulin-rich foods, and there is a whole list here. And this could also include antimicrobial spices such as Ceylon cinnamon, cumin, oregano, raw garlic. These can support an environment that's less favorable for E. coli to establish itself alongside that fiber intake, short-chain fatty acid production, and maybe a little bit of those antimicrobials. So to recap, colibactin does require a full set of core genes to trigger a flag. A few genes alone won't do it. When those core genes are present, we're also going to show an abundance score, and that reflects the relative genetic potential. This metric applies only to adult reports, and since the research connecting it to disease risk or any health outcomes— really not disease risk— is isn't well established yet, we're not reporting on, on younger populations at this time. If you have a patient that tested before September 3rd, retroactive updates are available, and this slide will tell you how to go about that depending on their test version. You can reach out to hello@tinyhealth.com and our team can help you. So a few common questions. Will this show up for all ages? No. Adults 18 and up only. When will it appear? Only on tests purchased on or after September 3rd, and results are going to be expected in late September for that batch of tests. Is this diagnostic? Absolutely not. It reflects the microbiome composition and genetic potential. It's not a diagnosis of any disease. It's not predicting anything, including cancer or IBD. And then does a flag increase someone's actual risk of developing cancer? No, it means the microbiome has the genes needed to potentially produce colibactin, but not that that toxin is active or causing any damage. And then why not just rely on E. coli? And why would we even include colibactin? And that's because not all E. coli behaves in the same way. This metric can help identify specifically when E. coli may be carrying This potential. So I appreciate your time. Thank you for watching. Please reach out to our microbiome specialists anytime you'd like to talk through a specific result. You can go right up in your portal and click on book a call, and we would be happy to meet with you. Okay, take care.