In this episode of Inside Matters, I'm joined by Dr Johan van Hylckama Vlieg, Chief Scientific Officer at Freya Biosciences. As a global leader in microbiome research, Freya is pioneering innovative approaches to women’s health through biotherapeutics that are rooted in groundbreaking microbiome science. 00:00 Introduction to Dr. Johan van Hylckama Vlieg and Freya Biosciences01:39 The Potential of the Microbiome03:08 Challenges in Translating Microbiome Science to Treatments05:29 The Rise and Fall of Microbiome Hype08:58 Immunotherapy and the Microbiome20:37 Women's Health and the Microbiome35:01 Tools for Measuring Vaginal Dysbiosis35:31 Intervention Studies and Donor Programs36:23 Engraftment and Immune Response37:39 Strain-Level Analysis and Engraftome39:08 Vaginal Microbial Transplantation44:13 Single Strain vs. Consortia47:15 Freya's Development and Future Vision50:04 Lessons from Kaleido01:00:47 The Gates Foundation and Global Health01:03:45 Predictions for the Microbiome Field A Hidden World with Huge Potential Dr van Hylckama Vlieg has spent more than 20 years exploring the vast and complex world of the microbiome — the trillions of microbes that live in and on our bodies. These tiny organisms play a huge role in our health. Over time, science has moved from simply identifying these microbes to understanding how they influence our immune system, metabolism and overall wellbeing. Yet despite this progress, turning those discoveries into real treatments remains a challenge. Dr van Hylckama Vlieg explained that while the science is compelling, the industry needs solid clinical data to bring investors and pharmaceutical companies on board. He sees microbiome-based immunotherapy as a particularly exciting area where transformative breakthroughs could lie ahead. Why Women’s Health Matters Freya Biosciences has chosen to focus on the female reproductive tract — a part of the body where the microbiome is less complex than in the gut but just as important. Dr van Hylckama Vlieg spoke about the key role of lactobacilli in maintaining vaginal health. When these helpful bacteria are dominant, they protect against infections and support fertility. When the balance is lost, a state known as dysbiosis, the risks rise significantly. He also highlighted a wider issue — the historical lack of funding and focus on women’s health. This is something Freya and others in the field are determined to change, and their research is already moving things in the right direction. A Bold New Treatment: Vaginal Microbiota Transplantation One of Freya’s most innovative developments is vaginal microbiota transplantation or VMT. Inspired by the success of faecal microbiota transplants for gut health, this approach involves transferring a healthy vaginal microbiome into someone with dysbiosis. Early results are promising. Many women show a successful shift to a healthier microbial state. Looking ahead, the goal is to leverage the successes of these natural transfers and develop targeted microbial treatments that can be scaled up. This could lead to safe and widely available therapies that restore balance and improve reproductive health. Challenges and the Road Ahead Reflecting on his previous experience at Kaleido, another microbiome venture, Dr van Hylckama Vlieg spoke about the need for strong links between science, clinical design and commercial strategy. Though Kaleido faced setbacks, the underlying science remains solid and is being explored by others in the field. His outlook remains positive. With more trials underway and deeper understanding of how microbiomes influence disease, there is hope that these therapies will move from the lab into everyday medicine. Particularly in areas like immunotherapy, the potential to address root causes rather than just symptoms could be a game-changer. Final Thoughts Dr van Hylckama Vlieg’s insights offer a compelling look into a rapidly evolving area of science. As researchers and companies like Fre