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Today on The Fundamentals, we talk with Dr. Ariangela Kozik, an assistant Professor in Molecular, Cellular, and Developmental Biology at the University of Michigan, and member of U-M Precision Health. Dr. Kozik's primary work involves conducting translational microbiome research to understand inflammatory diseases. Her interests also include the application of biopsychosocial models of disease, and she is an advocate for equity in science and academia. She is the co-founder and vice president of the Black Microbiologists Association, also known as Black In Microbiology. We talk with Dr. Kozik about her work, her advocacy and her vision for the future of academia and scientific research.

You can learn more about the work Dr. Kozik's lab is doing by visiting their website, and you can follow Dr. Kozik @dr_kozik and the Black Microbiologists Association (Black in Microbiology) @BlackInMicro on Twitter.

Resources

• Find out more about the research stories mentioned at the top of the show at the links below:
  • Gut bugs control the body’s thermostat
    Study reveals the microbiome’s role in regulating body temperature
  • Algorithm predicts females have higher risk for kidney damage after aneurysm repair
    The risk was higher regardless of a female patient’s kidney function or aneurysm size
• Learn more about other exciting research happening at the University of Michigan, by checking out Health Lab, Michigan Medicine's daily online publication featuring news and stories about the future of healthcare.

Transcript

Kelly Malcom:

Welcome to The Fundamentals, a podcast focused on the incredible research and researchers here at Michigan Medicine. I'm your host, Kelly Malcom.

Jordan Goebig:

And I'm Jordan Goebig, and this week's episode we're going to talk with a UM researcher about our microbiomes, and more specifically the lung microbiome and how it impacts asthma.

Kelly Malcom:

Asthma is caused by inflammation, and inflammation as a topic is a research priority area for the medical school. It's a really important one because inflammation affects almost every bodily system. But before we jump into our interview today, let's share one research story that we found interesting this week.

Jordan Goebig:

Okay, I'm going to go with the microbiome theme. I did some digging in our online science publication Health Lab and found an article about researchers at the medical school who led a study that points to the gut microbiome as a potential regulator of body temperature. There was to me a fascinating quote from the article that I just wanted to read out loud, which said that, “Human genetics haven't meaningfully changed in the last 150 years, but changes in diet, hygiene and antibiotics have had a profound effect on our gut bacteria.”

Kelly Malcom:

A story I found interesting was that Michigan researchers were able to develop an algorithm that can be used to determine who's at risk for kidney damage after surgery for a very scary sounding condition called abdominal aortic aneurysm, which is an enlargement of the aorta.

Jordan Goebig:

As always, we'll provide links to the full articles and info about our featured guest in the show notes.

Now let's get to the guest.

Kelly Malcom:

Dr. Ariangela Kozik is a research investigator at the University of Michigan in the division of pulmonary and critical care medicine. Dr. Kozik's primary interest is conducting translational microbiome research to understand inflammatory diseases. She is interested in the application of biopsychosocial models of disease and an advocate for equity in science and academia. She is the co-founder and vice president of the Black Microbiologists Association, also known as Black In Microbiology. Welcome, Ari.

Dr. Ariangela Kozik:

Thank you. Happy to be here.

Jordan Goebig:

Very excited to get to know you. I've also heard that you are kind of a podcast veteran, so ...

Dr. Ariangela Kozik:

I don't know if I'd say that.

Jordan Goebig:

Well, again, I think I mentioned I'm a big time listener, first time host for any of these, so I'm excited to have you here. As Kelly and I had mentioned, we're The Fundamentals, so we want to jump into some of those fundamentals to give our audience an understanding, a kind of baseline understanding of your research as we dive deeper throughout this episode. The first question that I was curious about as I was going through your wonderful website, by the way, is about the human microbiome. I know that's the major component to what you do and what you study, so I was curious if you could just walk through and answer if a person's microbiome can change and what type of factors would typically impact your microbiome?

Dr. Ariangela Kozik:

Right. So microbiomes do change. When we're talking about microbiome, we're talking about not only the microorganisms that are on us and in us, but also their genetic content, so all of their genes. We get our microbiomes very, very early in life, and they are not static. They're very dynamic. They change as we grow. They change in response to our surroundings and things that we are exposed to. So that's one of the reasons why this is a really interesting discipline because there's so many things that we don't know about how the microbiome is interacting with our other body systems, but we know that it's really important. One of the major things that we know now from studying the microbiome of the gut is diet is really important, what you eat, because our microbial residents help us digest our food, they help protect us from infections, from pathogens.

But beyond just diet, medications can change it, your environment can change it. We are finding out that a lot of factors around how and when you're born make a difference. So whether or not you are born by C-section or vaginally, whether or not you are breastfed or formula fed, all of those things impact the assembly of your microbiome that stays with us for our whole lives. So it's really cool.

Kelly Malcom:

I agree that it's super cool.

Jordan Goebig:

It is. It's so interesting. Although I'm sure too ... I generally know what a microbiome is. It's so funny, though. My in-laws, they'll drink kombucha and after a week they're like, "It messed with my microbiome too much." I'm like, "Does it? Did it? Did it really hit you that quickly? Or maybe you're just getting older and the acidity was a little too much." I think it is really fascinating. It's really interesting. As somebody who gave birth via C-section unexpectedly, I knew nothing about it, so after the fact I was researching and did not realize that it can have an impact on my daughter Lennox's microbiome. Correct?

Dr. Ariangela Kozik:

Yes. Yes.

Jordan Goebig:

It's so fascinating. But as I talk about myself having a C-section, I also thought it was really interesting that the path that you've gone down is actually very different, which is asthma. I'm so curious to hear more about ... I know so many people with it, it impacts ... I feel like it impacts everyone's lives in a way because even if you don't have it, you live with somebody who has it or you have a close friend or family member who may have been impacted by it. I'd love to hear what led you down that path to studying asthma in the microbiome.

Dr. Ariangela Kozik:

So after graduate school, I really wanted to ... I have been working on animal models of inflammatory bowel disease, and I was really interested in moving into the translational space and working with human data sets. I also really enjoy bioinformatics and data science and so I was really ... I'm looking for an opportunity to get more training in how we do that in a more clinically relevant setting. I took a postdoc here at Michigan in the pulmonary division with Yvonne Huang who does asthma and COPD research as it relates to the microbiome, and so I was fascinated by that because most of my training had been in the gut microbiome space and so the respiratory microbiome was a newer area. We didn't used to think that the respiratory tract had a microbiome. It was one of those areas where there was a lot more things that we didn't really understand.

I was, I guess, inherently interested in asthma because I struggled with it as a child and I know a lot of people in my life who deal with it. I've always recognized it as one of these conditions where we don't know everything that there is to know, because sometimes you go to the doctor and it's like, okay, well some people have ... smoke will set off their asthma symptoms. For me, it was exercise induced as a child, so in gym class I couldn't recover from the things that we were doing. There's all the differences in things that trigger people's asthma, so I knew this is a really interesting disease because it doesn't present the same way.

So the research we were doing in the lab was trying to understand why that is actually. So knowing that asthma isn't just one uniform condition that manifests the same in everyone, it's very heterogeneous. There are different manifestations of it. Some people respond to the treatments that exist, some people don't at all. Some people have easier times, some people have very severe disease that really impacts their quality of life. Knowing that the microbiome was involved was fascinating to me and so I wanted to continue to do research to understand what was going on there and why the disease manifests so differently. That's how I went from gut microbiome and IBD to respiratory microbiome and asthma.

Kelly Malcom:

One of the biggest shocks to my system when I started working at Michigan was learning about the lung microbiome before I had covered some of the research coming out of the division of pulmonary and critical care medicine. I didn't know that. Ari, you have in particular taught me a lot about that and it's interesting to think that we have bacteria that are doing probably good things in our airways. When we think about bacteria in our airways, we're thinking about being sick, but it's really intriguing that there are bacteria there that have functions that we probably don't fully understand yet. But I also wanted to kind of talk about inflammation because asthma is an inflammatory condition and inflammation as a whole, we kind of touched on it in our first podcast with Dr. Kunkel. Inflammation is behind a lot of the diseases that afflict us, and it's one of the med school's priority research areas. So why are you in particular interested in studying inflammation?

Dr. Ariangela Kozik:

Because inflammation is one of those things ... I feel like it kind of gets a bad rap sometimes because it is behind a lot of health conditions. But inflammation as a mechanism is a normal part of our body's response to things. It's one of the ways that our body goes, "Hey, something's wrong. We got to get our defense mechanisms in gear to figure out what's going on." It serves a really important function because it activates a lot of the mechanisms that we have to protect us and to heal, repair, or to start repair when there's damage. But the problem happens when there's inflammation that happens someplace where it shouldn't or if the inflammation never resolves. If there is some sort of inflammation that just continues to go on in a chronic fashion, then you can have ongoing damage that is bad for you.

So that kind of dynamic is underneath a lot of the chronic conditions that people have, things that you can get that don't go away. The chronic inflammation related diseases are things that we don't really have good answers for how to make that information stop or understanding what the balance ... whatever it is that went off balance that kickstarted the whole process. So that is something that's really important to study and I think if we can understand the dynamics of what's going on there, especially how the microbiome is involved, the impact could be exponential because there are so many diseases that could be affected by that dynamic.

Kelly Malcom:

Right, exactly. You kind of touched on it when you were talking about being interested in asthma. I mean, my dad had asthma as a child. He did have symptoms as an adult as well, because he is super handy. He was refinishing our basement, I remember this vividly because my mom was traveling and my dad was doing DIY projects in our basement, and some of the dust was triggering his asthma symptoms, and he felt like he had to sleep in a chair sitting up because he wasn't sure if he'd be able to breathe, and it was really, really scary to me as a child. I know that asthma is one of these conditions that really is different from person to person, and I know that you're really interested in that element, that diseases vary from person to person, and that in order to address those diseases, you need to take a very precise look at how diseases manifest in people.

Can you talk a little bit more about your interest in precision health? I know that you are a member of the Precision Health Initiative. Can you kind of explain what that means to you as a researcher and the types of questions that you want to answer?

Dr. Ariangela Kozik:

Precision health or precision medicine is this idea that we should be able to provide the right interventions to the right people at the right time and the right place. It's kind of different from approaches that are very generalizable where there's a general process that applies to a large number of people or things that we can find out through research where we're looking at a particular trend across a really large sample size and knowing that for the most part, A plus B equals C in this large group of people. But we also know that that's not how life works. I mean, it's one of the things that the pandemic has, I think, taught everyone is that it's really brought home the fact that a pathogen can impact people's bodies wildly differently. There are people I know who got COVID and it was barely ... they had the sniffles for a few days, maybe they sneezed once or twice, and then it was fine.

But there are other people I know who it affected them in really huge ways and who have had it two years ago and they still don't feel like themselves. They don't feel back to normal. So it was a really impactful thing for a lot of people to realize that we don't really know how something is going to interact with everyone's body, and we don't have good ways to predict what that's going to be. We don't have good ways to be able to have treatments that maybe some folks would need that other people don't need. So that is what drives me in thinking about how precision health and precision medicine is relevant, because ideally, we want to be able to help everybody and understand what's going on in everyone's condition so that everybody can have care that can really help them.

I think that that is not always ... well, I mean, not even always. It's not easy to do because it requires a really good understanding of what the basic mechanisms are and then how those things can differ from person to person. But it also is going to be a really data intensive endeavor. As a practitioner of data science, knowing that there are so many different omes that we can study. There's the genome and then there's the epigenome and the transcriptome and the metabolome, and understanding how all those different pieces fit together in each person. I think there is an enormous amount of potential there for us to be able to get at some of these more unique situations where we have the same process or the same pathogen that can impact people so differently.

There's so many conditions where we have thought that this was one way and it was affecting everybody, but now there's subtypes of these different conditions like diabetes or obesity. Asthma is another one, COPD. There are so many, and usually inflammation of some type is involved. That's another reason why I'm like, "Huh, okay, I wonder what's going on there." But I think the promise of precision medicine, it will help us better understand human diversity because there is a lot that we don't really know how all these pieces fit together, and I think it's really important.

Kelly Malcom:

I think we all know that certain groups of people have higher amounts of risk factors for developing asthma through no fault of their own. Black people have higher rates of asthma. I think Detroit is one of the hardest hit areas in the country for asthma. How does this fact factor into you looking at asthma and you as a Black scientist, and I guess this is sort of a way for you to also talk about the Black Microbiologists Association. What does it mean to work at that intersection of being a Black scientist, being a Black person, knowing that there are diseases that affect Black people at higher rates?

Dr. Ariangela Kozik:

Right. So that's one of the things that's really important to me because I think I'm really invested in trying to correct the record because a lot of diseases where we see differential risk or differential rates by whatever group, especially if it's a racial or ethnic group, a lot of times we ask questions that have an underlying assumption that there's some sort of different biology at work within these different groups of people, and that's not the case. What we know, especially in the US as different racial groups, those terms are social in nature. They are not biological in nature. We assume that our constructs that we talk about, we're talking about different racial groups, means that there's some underlying mechanisms, like that my body functions a different way than someone who is not Black. But those descriptors that we use, actually, I argue that we're doing ourselves a huge disservice by relying on them because they don't parallel meaningful biology.

If we're talking about a particular disease in Black people, what do we mean by that? Do you mean African-Americans as an ethnic group? Does that include people from the Caribbean? Does that include recent African immigrants? There's a lot of diversity that is caught up in these terms that we just use. So when we are thinking about them from a medical or scientific perspective, I think it's really important to start to deconstruct the way that these terms are used, because I really think that it obscures what we could otherwise be seeing in data if we stop relying on these things. Now, I don't want that to sound like I'm saying that we shouldn't pay attention to the differences in the groups, but it's more so that knowing that the differences that we pick up are more than likely the result of equal social factors in environment or these other structural or systemic things and not inherently based in the biology.

Asthma is a really great field to be in to look at this because one of the things that we know impacts your asthma risk or your respiratory health is pollution, for example. We also know that because of historical practices, like redlining, communities of color have been concentrated in very densely populated areas that have been zoned near industrial areas, and so we are more likely to be exposed to industrial pollutants at high levels. We know that in places like Jackson, Mississippi, right now where they're dealing with a crisis with not having safe water to drink, the same thing in Flint, Michigan, we are continually, for systemic, structural and historical reasons, having these prolonged exposures that damage our health. So when we see outcomes where there's ... Black American children are four times more likely to die from asthma than white American children, our question shouldn't be like, "What's different about their bodies?" Instead, "What's different about their surroundings? What's different about the systems that they exist in?"

So part of my work is really trying to bring that reality to the forefront and I think the pandemic also has helped in this regard as well, because we, again, had people of color who were much more severely impacted, especially early on, and there were people who were trying to figure out, "Well, maybe there's some gene, or maybe there's some specific thing", but it's like or it could be that we are more likely to be in jobs that don't let us stay home when we are sick, and so we're more likely to be exposed at higher rates. I think typically those kind of conversations have existed around the periphery of medicine and science, but we really, really, really need to integrate them into what we understand because I think that's really important to understand the context of the things that we're studying so that we can actually get to the bottom of the mechanisms and not miss something important because we're focused on these other constructs that don't have anything to do with the pathology of what's happening.

Kelly Malcom:

That's why I was so excited to have you on. I really wanted you to be able to explain that to our listeners, so thank you.

Dr. Ariangela Kozik:

You're welcome.

Jordan Goebig:

Yeah, it's really fascinating and thank you. You kind of went back to some of the questions that I had earlier, and shifting gears slightly to other areas in your professional experience, I saw, and as a social media person, you have a very active Twitter for your Black Microbiologists Association. It looks like a really wonderful, thriving community and from your background, I'd seen that this was something that you've been a founder in, so I'd love to just get a little bit more on when was the Black Microbiologists Association born? How's it going and what's going on in that space?

Dr. Ariangela Kozik:

Sure. So the BMA, as we affectionately call it, is the, I guess, phase two of what became of Black in Micro, and so that started in August of 2020 after we were in the middle of the pandemic. As Black microbiologists, a friend of mine and I had really been really involved in our own personal circles and communities and trying to educate people, usually our families and friends, about "This virus is real, there are real impacts, you need to protect yourselves", trying to help them wade through the mountain of disinformation that they were encountering online or in other social media platforms. So we were talking to each other as part of trying to find support, and then this is also around the time where we witnessed a lot of racial violence in that summer, or that was kind of at the end of the summer.

So as a response to some of those events, there were other groups that took to social media to raise awareness of the fact that Black people, we are scientists, we are doctors, we are here in society, and we are dealing with this kind of discrimination and it's exhausting. So we were watching ... Black Birders Week was one of the first ones that really caught my attention, and then there were others, Black In Genetics, Black In Neuro, Black In Chemistry, and so her and I were like, "We are in the middle of a pandemic from this virus. We definitely need a Black In Microbiology." So it started with her sending out a tweet, "We need a Black In Micro. Who wants to help us do that?", and it really took off from there.

Six weeks later, we were able to have our first Black In Micro week, which was just an online virtual conference where we had different talks and community building where people ... one of my favorite parts of all of the Black In X, as we now call the umbrella group of all these different disciplines, I think there is more than 80 separate Black and whatever the topic is now. One of the hallmarks of the weeks is having what we call a roll call where people tweet, "Here I am, my name is Ari, I work on the microbiome, the respiratory tracts, and I'm here." That was a huge way for other people to go and see and find other Black scientists in their discipline and really connect. That was something that I think was revolutionary because we typically don't get that in the professional sphere. I think it was back in 2014, there was a #BlackinSTEM that was started by a graduate student. I think her name was Stephanie Page, but the roll call I think was modeled after that, because having these hashtags that people can follow and then find other people and their community is really impactful.

The community really came together around that. I went from knowing no other Black microbiologists besides my friend to now our membership has grown to over 300. One of them now who is one of the co-founders of the association, Dr. Spriggs, is also here at Michigan. We had been here at the same institution for I think two years and I had no idea, and she had no idea that we were here. Now she's one of my best friends and colleagues. So it's been a really, really impactful experience to be able to create community where we did not have it before. Because we came together for that week, after the week, we were like, "Well, we can't go back now", because it was really obvious that we had created something to really fill a gap.

So we wanted to be able to have an organization that could be dedicated to providing that community space and really hoping to advocate in a larger way for raising awareness about the needs of Black scientists in all career stages, but especially those in training that are in institutions where they are often the only or one of few Black trainees in their departments or on campus period. So it's been a really crazy, wild, fast, overwhelming at times journey, but we are working towards financial sustainability so that we can have programming and professional development opportunities and resources so that we can help people make it through their programs to be able to pursue whatever career in microbiology they are passionate about. It's definitely filled a void for me personally, but also just in society. We're really excited to see where things go from here on out.

Jordan Goebig:

That's awesome. I'm just curious, since I work in social, were you pretty active on Twitter beforehand?

Dr. Ariangela Kozik:

I was a notorious lurker. I had Twitter, I followed people's accounts, but I think my own profile, there were zero tweets. I was really nervous about new social media platforms. It seemed really exhausting to think through what you're going to post and there's a character limit, and I'm like, "How do you all these things?" But that was really when I started being a little bit more active was when I started noticing these groups come together. Then once Black In Micro happened, that was it, because I couldn't not tweet at that point. It's been a really crazy journey because it's like what's happening in real life at the institution, and then social media is its own other forum, I guess, where you can interact with people outside of what you normally would encounter day to day.

It's definitely been a learning curve for me because I'm typically your classic introvert and so putting my ideas and thoughts out there ... I'm not someone to just tweet stream of consciousness because I don't do that and I know there are people that do, but it's definitely been a learning curve for me to be able to engage in that way without feeling like, "Whoo, the internet is forever, so whatever you put out there is out there forever."

Jordan Goebig:

That's amazing. That's a great story and it's a reminder of those positives too. I feel like we live in this world where there's lots of negative news thrown at you and to hear ... obviously there was a need for this, which could be seen as a negative, but to see the positivity and like you said, the community building is just a really cool and amazing thing, and that you started it in just a few years and during a pandemic, and the growth is amazing.

Dr. Ariangela Kozik:

It's been a really cool journey for sure.

Kelly Malcom:

It's been great to witness as a science communicator as well. The representation means a lot to me, and I know it means a lot to other people of color in the sciences because it is really isolating when you can't just walk down the hall and see someone who looks like you. To be able to have these online spaces and now these actual associations of people who understand what you are dealing with and can provide support is really important. It's just the first step because obviously we also have some really big systemic changes in academia and in STEM to increase the number of Black scientists, scientists of color, people from underrepresented groups. I know that you have some thoughts on this. What are some of the things that academia can start to do, changes they can start to make these fields more accessible?

Dr. Ariangela Kozik:

One of my things that if I could stand on top of the mountain and shout, it would be "Hire more diverse faculty, please. Immediately. ASAP." Because academia is a really special place in society because it's kind of the gateway to so many other sectors. Education is critically important to society and so this space, this higher education space is a place people can come to and pass through and then go on to the private sector. They can go on to government, they can go on to whatever. So the experiences and training and things that happen in this place, it can be a really powerful force for moving towards justice. So I think that that is really important. It's one of the reasons why I hope to stay in the academy because I believe that there's a lot of good that can be done here.

I think one of those things, though, is students having people that they can relate to, people from all walks of life who have been through lots of different experiences that life in the US can have. So bringing folks through to this place so that they can have role models and professors and people in labs, and being able to see people who share your lived experience in multiple positions is really, really, really important. Because depending on where students are coming from, they may feel like they are out of place. Like, "I don't belong in this place. I don't belong in this discipline." There are many folks who never see ... students who may never see a Black professor at all at any point of their training. So that is something that we really need to do and so I really think that that needs to be a priority. We really need to diversify our professoriate.

Another thing is making spaces on campuses for students to build and find and have thriving communities that are supported, I think is also really important. I mean, learning complicated, complex topics, it's hard. It can be exhausting. You need support. So being able to provide that support is important. Also, I think as education continues to be more accessible, you have a broader number of students who are coming from more challenging socioeconomic backgrounds, people who are the first in their families to be able to go to a college or university, and so being able to make sure that those students have the same access as others, and that goes beyond just undergrads, but even graduate students and post-doctoral fellows. So thinking about is there scholarships or travel grants so that we can go to conferences? Is there making sure there is support for people to be able to live?

Childcare is another one of my things I could talk about forever, but affordable, accessible childcare for trainees is really, really, really important because those are real life issues that will keep somebody out of this space if they can't figure out a way to make it work. I would love to see institutions be more agile in the way that they can pivot to support the changing face of the learners that they are serving. I think that can go a huge way in one being more welcoming as a community of learners, but also be really effective and ready to engage with society and do the role that higher education can be and fulfill that promise of higher education and learning. I know I'm obviously an idealist, but I think that is something that we can ... that's ideals that we can work towards at least.

Kelly Malcom:

Absolutely.

Dr. Ariangela Kozik:

Also, I want to add that it also helps us be able to engage with the global community at large better, especially because we're facing a lot of challenges globally where we ... I mean, climate change is a big one where we really need to come together as a community of humanity and how do we engage with that? Connecting scholars and learners from different countries is another really important way to build human coalition to work through the bigger challenges that we're facing worldwide.

Jordan Goebig:

Some of those global connections I feel like could really ... kind of bring it back to your lab, your research, could be impacting your research, like you were just talking about, all these environmental factors, and then you think about climate change and how is that going to impact asthma and our microbiomes. It's really interesting and a little terrifying. Bringing it back to you, are there any specific projects that you're working on right now or any collaborators or upcoming or current publications that you want to give a shout-out to?

Dr. Ariangela Kozik:

I always like to shout out BMA and our fabulous leadership team, that we are all Black women led, which is exciting. It is Women's History Month, so I have to put that out there. All of us are early career also, so just shout out to y'all for doing the thing. I also want to shout out my mentors here at Michigan, Yvonne Huang in the pulmonary division, and Gary Huffnagle in also pulmonary, but also micro, but also in LSA. They've been really instrumental in providing a really great and enriching training environment for me, but also being very supportive of the other more outward facing activities and advocacy that's been really important to me during my career, so I really appreciate them.

Kelly Malcom:

I was going to ask you, if you had all the grant money in the world, what would you study and what question would you be trying to answer?

Dr. Ariangela Kozik:

If I had all the grant money in the world, I would do a new human microbiome project that was full of a very, very, very, very, very diverse population, and I would kind of throw away the categories that we use to classify people and just look at the data in relation to their diets, where they are, what they're exposed to, and really try to piece together how the microbes are responding to these very different lifestyles that can exist within a relatively confined geographic area, and see how that could impact people's experiences of certain conditions. I would love to do that over time from childhood to adulthood to just really track what's going on. I tend to be of the mind where more data is better, the more data the better.

So just really collecting lots of different samples from lots of different body sites, and then being able to do lots of cool microbiome mapping to kind of really understand what's going on with humans and how our microbial diversity is reflected in our human diversity and the implications for inflammatory diseases. It would take a long time. It would be super expensive, but it would be great. I'd be really excited about it.

Kelly Malcom:

I would too. Okay, you hear that, foundations [inaudible]

Dr. Ariangela Kozik:

Yes.

Jordan Goebig:

The gut microbiome is what everybody ... again, my in-laws know about it. They eat something that doesn't fit with them, and it's like "My gut microbiome isn't happy." So now I've got the respiratory and the lungs. Are there any other areas of the body that are just really interesting to you? Any other microbiomes that you haven't really explored, but you ... again, if you could just get a crazy amount of money to focus in that body area, that part of the body or that area, is there anything you'd be interested in exploring more?

Dr. Ariangela Kozik:

I would probably continue to devote resources to the respiratory microbiome, but there's also the skin microbiome. There's the vaginal microbiome. I mean, pretty much wherever on your body, there are microbes there. I really think the potential for the microorganisms to impact our brain is really fascinating. This gut-brain axis, gut-lung-brain axis, the lung-gut axis, so trying to put the pieces together and understand how the microorganisms in your gut are communicating with the ones in your lungs that are communicating with your brain somehow and vice versa, that would be super complex. But that, I think, would be really cool to understand. Maybe not necessarily for the commercial reasons, but just for the sake of understanding why.

Because I think a lot of the gut microbiome stuff is people are looking for ... probiotics have been great, but personally I don't think there's not going to be a probiotic to rule them all, that's going to fix all the things. I really think we're going to have to understand the nuances of how the different microorganisms come together and how that's impacted by various things. And also knowing that there's more than just bacteria in your microbiome. There's also viruses, there's also fungi, and we know far, far less about what they're doing, so being able to throw some money at that would also be great.

Kelly Malcom:

I appreciate having you on speaking truth to power, putting out there into the universe that there is someone who has your enthusiasm, who really wants to tackle these super hard questions and figure some of this out, and it makes me feel good inside to even know you. So thank you.

Dr. Ariangela Kozik:

Thank you.

Jordan Goebig:

Yes. It makes the climate change stuff a little easier.

Kelly Malcom:

Right? Thank you, Ari. Thank you Dr. Kozik so much for joining us and for enlightening us and our listeners, hopefully. I know that you claim to be idealistic, but I feel in my heart as long as we have researchers like you and the rest of BMA and everyone else, we can start to address some of these challenges. So thank you.

Dr. Ariangela Kozik:

You are so welcome. It was a pleasure.

Jordan Goebig:

It was so nice to meet you. I do feel like I've learned so much from you, and I really think that what you're doing is just so important with BMA, which I will happily shout out and give social media love from my channels too. But also, like I said, I just personally hadn't really thought much about my respiratory microbiome and the other areas of my body, and I just think that this stuff is so important for people to hear about and understand and think about. I really appreciate the awareness that you're raising in all of these areas.

Kelly Malcom:

Thanks for listening. The Fundamentals is part of the Michigan Medicine Podcast Network and produced by the Michigan Medicine Department of Communication in partnership with the University of Michigan Medical School. Find us and subscribe wherever you get your podcasts.