Resident Rohit Mittal 1st author of Top-10 paper

March 2015

"Redefining the Gut as the Motor of Critical Illness" has been selected as one of Trends in Molecular Medicine's Top 10 articles of 2014. Written by Emory PGY3 resident and first author Dr. Rohit Mittal in collaboration with Dr. Craig Coopersmith, vice chair of research of the Emory Department of Surgery, the article was submitted during Dr. Mittal's research sabbatical in Dr. Coopersmith's lab.

The article supports the hypothesis that the gut plays a central role as an instigator in the progression of sepsis and multiple organ dysfunction syndrome. Drs. Mittal and Coopersmith describe how critical illness can alter and compromise the various components of gut integrity, after which cascading inflammation can transform the gut into a mechanism that fuels distant organ failure.

"Although each of these abnormalities is likely to be detrimental in isolation, a feed-forward loop probably exists in which damage to one component of the gut leads to local and systemic injury, which, in turn, damages other components of the gut," says Dr. Mittal. "Our view is that unless this process is broken, a continuous cycle of injury/amplification/repeat can be set into motion that can lead to devastating consequences."

In order to uncover which strategies will be most effective in inhibiting the gut's role in spreading critical illness, the authors conclude that further studies need to be performed that view the gut as a multi-component organ. Investigators must also examine such local and systemic processes that can affect the health of the gut as its coexistence with microbiome, the complex community of microorganisms that live in the digestive tract.