Microbiome research in practice: priorities for clinical translation and impact.

BACKGROUND: Rapid advances in microbiome science have sparked clinical and commercial enthusiasm for interventions, yet translation into practice risks outpacing both mechanistic understanding and the infrastructure required for safe adoption. OBJECTIVES: To outline a coordinated research, clinical, social, and policy agenda for advancing safe, effective, and equitable microbiome-based interventions. SOURCES: We convened an interdisciplinary Royal Society-funded expert workshop (Leeds, UK, October 2024) with international leaders in microbiome science, clinical trials, regulation, and social science. Thematic analysis of workshop discussions and written contributions identified priority domains for translation. CONTENT: Three intersecting priorities emerged: scientific credibility, practical viability, and stakeholder engagement. Scientific credibility demands investment in multiomic and strain-level characterisation of host-microbiome interactions on a large scale, benchmarking of clinical and microbiological endpoints, and harmonisation of trial conduct and reporting. Clinical adoption requires fit-for-purpose regulation, diversified investment to address funding bottlenecks, and coordinated capacity building. Meaningful stakeholder engagement with clinicians, patients, policymakers, and the public is essential to foster confidence, develop clinically relevant research questions, and ensure equitable implementation of any new technology. IMPLICATIONS: To realise the clinical impact of microbiome interventions, sustained collaboration across disciplines is essential. This Review offers a translational roadmap and actionable priorities to accelerate safe, effective, and equitable microbiome-based interventions - ensuring the field fulfils its clinical potential and delivers real-world impact.