Gut microbiome diversity and composition
How many different kinds of bacteria live in the gut and which ones dominate. Higher diversity and certain species are linked with better immunotherapy response; antibiotics and poor diet reduce both.
Alpha diversity (within a person) and specific taxa (Faecalibacterium, Ruminococcaceae, Akkermansia muciniphila, Bifidobacterium) associate with checkpoint-inhibitor response, though the taxa differ between cohorts and countries, and no microbiome test is validated for clinical use. Diet (fibre), antibiotics, proton-pump inhibitors and probiotics are the main modifiable determinants. Causality is supported by mouse FMT experiments and by early human FMT trials.
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