Prakriti phenotypes as a stratifier of gut microbiome: A new frontier in personalized medicine?

Ayurveda has a rich history and its significance woven deeply in the Indian culture. The concept of prakriti (a person’s “nature” or constitutional type determined by the proportion of three doshas, namely - vata, pitta and kapha) in Ayurveda is deeply rooted in personalized health management. While the attributes of prakriti has been established to have a genomic basis, there is dearth of elaborate evidences linking prakriti with manifestation of diseases. Next generation sequencing studies have provided a causal link between variation in the gut microbiome and its effect on an individual’s fitness. Separately, reports have identified gut microbial patterns associated with several host variables such as geography, age, diet and extreme prakriti phenotypes. Recently, few reports have identified a “core gut microbiome” consisting of Bacteroides, Faecalibacterium, Prevotella and Ruminococcus prevalent across the Indian population; however, a few bacterial genera were specifically enriched in certain prakritis. Hence, in this review we aim to analyse the role of prakriti variations on dysbiosis of the gut microbiome and concomitantly its effect on human health. We suggest that prakriti phenotyping can function as a potential stratifier of the gut microbiome in a given population and may provide evidence for the conceptual framework of personalized medicine in Ayurvedic system of medicine.

Understanding the association between the human gut, oral and skin microbiome and the Ayurvedic concept of prakriti

Ayurveda is one of the ancient systems of medicine which is widely practised as a personalized scientific approach towardsthe general wellness. Ayurvedic prakriti is broadly defined as the phenotypes which are determined on the basis of physical,psychological and physiological traits irrespective of their social, ethnic, dietary and geographical stature. Prakriti is theconstitution of a person, which comprises vata, pitta, and kapha and is a key determinant of how one individual is differentfrom the other. Human microbiome is considered the ‘latest discovered’ human organ and microbiome research reiteratesthe fundamental principles of Ayurveda for creating a healthy gut environment by maintaining the individual-specificmicrobiome. Hence, it is important to understand the association of human microbiome with the Ayurvedic prakriti of anindividual. Here, we provide a comprehensive analysis of human microbiome from the gut, oral and skin samples of healthyindividuals (n=18) by 16S rRNA gene-based metagenomics using standard QIIME pipeline. In the three different prakritisamples differential abundance of Bacteroides, Desulfovibrio, Parabacteroides, Slackia, and Succinivibrio was observed inthe gut microbiome. Analysis also revealed prakriti-specific presence of Mogibacterium, Propionibacterium, Pyramidobacter, Rhodococcus in the kapha prakriti individuals Planomicrobium, Hyphomicrobium, Novosphingobium in the pittaprakriti individuals and Carnobacterium, Robiginitalea, Cetobacterium, Psychrobacter in the vata prakriti individuals.Similarly, the oral and skin microbiome also revealed presence of prakriti-specific differential abundance of diversebacterial genera. Prakriti-specific presence of bacterial taxa was recorded and only 42% microbiome in the oral samples and52% microbiome in the skin samples were shared. Bacteria known for preventing gut inflammation by digesting theresistant starch were abundant in the pitta prakriti individuals, who are more prone to develop gut-inflammation-relateddisorders. In summary, human gut, oral and skin microbiome showed presence

Concepts of body constitution in traditional Siddha texts: A literature review

Analysis of body constitution has been in practice in most complementary and alternative systems ofmedicine. Siddha system of medicine practiced in South India consists of fundamental classical literaturethat stress on the importance of tri-humoral makeup of individuals. Guidance has been given in theclassics for identifying specific types of body constitution, various dietary recommendations and diseasesusceptibility. In validating such important traditional fundamental aspects, analytical systematic literature framework is the first robust step. The present study has been conducted to provide an updatedintegrative framework of information about body constitution given in various Siddha literatures inquantitative systematic method by using Whittemore and Knafl's five stage approach. This descriptiveaccount may be useful to construct a suitable questionnaire for Siddha based udaliyal assessment.© 2019 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciencesand Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Status of Indian medicinal plants in the International Union for Conservation of Nature and the future of Ayurvedic drugs: Shouldn't think about Ayurvedic fundamentals? / 中西医结合学报

The present market for herbal drugs is estimated about ₹40 billion, which is expected to increase by 16% in next 3-4 years. The current production of many Ayurvedic herbs is less than their market demand, which incentivizes adulteration in the Ayurvedic drug supply chain. The present work aims to highlight the most used Ayurvedic plants that have been listed in the International Union for Conservation of Nature's "red list" of endangered or vulnerable plants. The future of Ayurvedic medicines from these listed plants is uncertain, as the collection of herbs from their natural habitat is prohibited and their cultivation does not meet market demands. Many of these plants, such as Taxus baccata and T. wallichiana, are endangered and are only grown in their natural habitats; their cultivation in other areas is impractical. This is the present state, and will worsen as demand continues to grow, with increasing populations and increasing adoption of this system of medicine. It is possible that in coming years most of the Ayurvedic drugs will be adulterated, and will cause only side effects rather than the therapeutic effects. The Ayurvedic fundamentals are under-explored areas where the Ayurvedic practitioners and research scientists can work together. The scientific work on the basic principles will unravel many unknown or little-known facts of this ancient science. Hence, the present review emphasizes the conservation of Ayurvedic herbs, minimization of the use of medicinal plants and the promotion of the research based on Ayurvedic fundamentals.

Development and initial standardization of Ayurveda child personality inventory.

Background: Ayurveda inventories for prakriti (constitution) have been developed and validated for adults. Children, however, require different categories of quarter and questions, for example, to assess the intelligence, the questions can be related to their scholastic performances. Objective: To develop and standardize an inventory to assess the prakriti of the children, and to compare with Child Personality Questionnaire (CPQ). Materials and Methods: A 135‑item Ayurveda child personality inventory (ACPI) scale was developed on the basis of translation of Sanskrit verses describing vataja (A), pittaja (B), and kaphaja prakriti (C) characteristics and by taking the opinions of experts (ten Ayurveda experts and three psychologists). Study was carried out in Maxwell public school, Bangalore. The scale was administered on parents of children of the age group 6-12 years. CPQ was administered on children of the age group 8-12 years. Results: The ACPI was associated with excellent internal consistency. The Cronbach’s alpha for A, B, and C scales were 0.77, 0.55, and 0.84, respectively, and the Split‑half reliability scores were 0.66.0.39 and 0.84, respectively. Factor validity coefficient scores on each items was above 0.5. Scores on vataja, pittaja and kaphaja scales were inversely correlated. Items of V, P, and K scales showed significant correlation (values ranging from 0.39 to 0.84) with subscales of CPQ, which indicates that Eastern and Western psychology concept have good correspondence. Conclusions: The prakrti of the children can be measured consistently by this instrument. Scores on V and P scale showed good correlation with the anxiety primary scale of CPQ.

Determinants of Prakriti, the Human Constitution Types of Indian Traditional Medicine and its Correlation with Contemporary Science.

Background: Constitutional type of an individual or prakriti is the basic clinical denominator in Ayurveda, which defines physical, physiological, and psychological traits of an individual and is the template for individualized diet, lifestyle counseling, and treatment. The large number of phenotype description by prakriti determination is based on the knowledge and experience of the assessor, and hence subject to inherent variations and interpretations. Objective: In this study we have attempted to relate dominant prakriti attribute to body mass index (BMI) of individuals by assessing an acceptable tool to provide the quantitative measure to the currently qualitative ayurvedic prakriti determination. Materials and Methods: The study is cross sectional, multicentered, and prakriti assessment of a total of 3416 subjects was undertaken. Healthy male, nonsmoking, nonalcoholic volunteers between the age group of 20-30 were screened for their prakriti after obtaining written consent to participate in the study. The prakriti was determined on the phenotype description of ayurvedic texts and simultaneously by the use of a computer‑aided prakriti assessment tool. Kappa statistical analysis was employed to validate the prakriti assessment and Chi‑square, Cramer’s V test to determine the relatedness in the dominant prakriti to various attributes. Results: We found 80% concordance between ayurvedic physician and software in predicting the prakriti of an individual. The kappa value of 0.77 showed moderate agreement in prakriti assessment. We observed a significant correlations of dominant prakriti to place of birth and BMI with Chi‑square, P < 0.01 (Cramer’s V‑value of 0.156 and 0.368, respectively). Conclusion: The present study attempts to integrate knowledge of traditional ayurvedic concepts with the contemporary science. We have demonstrated analysis of prakriti classification and its association with BMI and place of birth with the implications to one of the ways for human classification.

Immunophenotyping of normal individuals classifi ed on the basis of human dosha prakriti.

Background: Human variations related to immune response and disease susceptibility is well-documented in Ayurveda. Prakriti (body constitution) is the basic constitution of an individual established at the time of birth and distinguishes variations, into three broad phenotype categories such as vata, pitta and kapha. Variation in immune response is often attributed to and measured from the difference in cluster differentiation (CD) markers expressed in lymphocytes. Currently, there are no reports available on the expression of CD markers related to prakriti. Objective: This is a pilot study performed to evaluate a panel of lymphocyte subset CD markers in dominant prakriti individuals. Materials and Methods: Immunophenotyping was carried out using whole blood from a total of healthy 222 subjects, who are grouped into kapha (n = 95), pitta (n = 57) and vata (n = 70) prakritis. CD markers such as CD3, CD4, CD8, CD14, CD25, CD56, CD69, CD71 and HLA-DR were analyzed using fl ow cytometry method. Differences between groups were analyzed using one-way ANOVA or Kruskal-Wallis analysis of variance (ANOVA) and multiple comparisons between groups were performed by Bonferroni or Mann-Whitney U test with corrections for type I error respectively. Signifi cance was evaluated by ANOVA and Pearson’s correlation. Results: We observed a signifi cant difference (P < 0.05) in the expression of CD markers such as CD14 (monocytes), CD25 (activated B cells) and CD56 (Natural killer cells) between different prakriti groups. CD25 and CD56 expression was signifi cantly higher in kapha prakriti samples than other prakriti groups. Similarly, slightly higher levels of CD14 were observed in pitta prakriti samples. Conclusion: Signifi cant difference in the expression of CD14, CD25 and CD56 markers between three different prakriti is demonstrated. The increased level of CD25 and CD56 in kapha prakriti may indicate ability to elicit better immune response, which is in conformity with textual references in Ayurveda.

Prakriti and its associations with metabolism, chronic diseases, and genotypes: Possibilities of new born screening and a lifetime of personalized prevention.

Ayurveda is one of the oldest health sciences of the world with concepts of tridosha and prakriti being core philosophies. These core concepts allow implementation of ways for not only personalized medicine and treatment but also personalized prevention. In the light of modern or current science, evidence has surfaced connecting the concepts of tridosha and prakriti with metabolic pathways, chronic diseases, and various genotypes. Such evidence has thrown up insights about the universality of Ayurvedic concepts as well as their apparent association with concepts in current science. This review was undertaken to consolidate the evidence of such associations which exist between prakriti and metabolic systems, chronic diseases, and genotypes with the objective that a case can be made for drawing out the clear linkages that might exist for prakritis being distinct phenotypes representing certain genotypes. A corollary to such discoveries can be the possibility of newborns being screened for their prakriti by genetic testing, which will enable the prevention of various chronic diseases for such children via the implementation of various dietary, lifestyle, and habitual changes, as required, from an early age. This implementation of preventive practices from an early age may result in such children leading healthy, disease-free, more productive lives. Thus, eventually, this can be an opportunity to practice personalized preventive health, which is not a possibility in other systems of medicine especially western systems of medicine. Personalized preventive health is one step further than personalized medicine and is a very novel idea with far-reaching implications.