Immune Modulation In Infancy Abdulwahab Telmesani FRCPC, FAAP Associate prof. of Pediatrics College of Medicine and Medical science Umm Al-Qura University Immune Modulation In Infancy

Cranberry Fruit

Cranberry Fruit التوت البرى

A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women The Canadian journal of urology. 2002 EBM Reviews - Cochrane Central Register of Controlled Trials

Cranberry prevents bacterial adhesion to the genitourinary system and acidify the bowel ecosystem which promotes probiotics growth

What dose the literature say about probiotics and its role in health?

Studies reviewed and quoted in this presentation, mostly published the year 2000 onward

Probiotic

Probiotic = For Life

Probiotics are defined as “live microorganism which, when administered in adequate amounts confer a health benefits on the host”

Lactobacillus Bacteria Probiotic e.g. Lactobacillus Bacteria Bifidobacteria spp

Prebiotics defined as “Non digestible substances that provides a beneficial physiological growth or activity of a limited number of indigenous bacteria”

Lactobacillus as a probiotic for preventing urogenital infections A. Andreu Reviews in Medical Microbiology 2004

The main indications for probiotic Lactobacillus use in urogenital tract infections would include recurrent urinary tract infection in healthy pre-menopausal and post-menopausal women, post-infection prophylaxis to re-establish the vaginal flora and prevent future episodes, bacterial vaginosis and recurrent vaginal candidiasis.

Are probiotics useful in controlling gastric colonization by Helicobacter pylori? GOTTELAND Alimentary Pharmacology & Therapeutics. April 2006.

Probiotics do not eradicate H Probiotics do not eradicate H. pylori but maintain lower levels of this pathogen in the stomach; in combination with antibiotics, probiotics may increase eradication rate and/or decrease adverse effects.

Colonic Ecosystem In the Newborn Baby?

The colon of the fetus is sterile Colonic Ecosystem The colon of the fetus is sterile

Colonic Ecosystem Maternal Vaginal flora Personnel present at birth Mothers breast milk, etc. In 2 days colonic flora up to 10 to power 8 per gram stool

Colonic Ecosystem In the following days selection among the colonic bacteria occurs

Colonic Ecosystem In exclusively breast fed baby 90 – 95% of the colonic bacteria will be Bifidobacteria

Why Bifidobacteria?

Breast Milk Is Bifidogenic

Bifidogenic Ingredients Low protein High whey protein Low phosphorus content Acidic intestinal environment Growth of acid- tolerant Bifidobacteria

Intestinal flora of breastfed and formula-fed infants Harmsen HJM et al. JPGN 2000

Bifidobacteria counts in intestinal flora (Fish method) Palermo study 2002

Bacteria-Epithelial Cross-Talk Refers to the communication or interaction process between bacteria and the epithelial cells Through this, bacteria can colonize the gut, maintain health or cause disease Possibly due to certain glycoconjugate receptors on the cells Glycoconjugate = conjugates of carbohydrate, bound to protein or lipid cores Walker WA, 2000

Porbiotic or no probiotic ?

Recent current research and publications are more pro probiotic Porbiotic Recent current research and publications are more pro probiotic

A study of oral Bifidobacteria supplement to preterm and newborn babies showed a correlation between lacking Bifidobacteria predominance and sepsis. Z. Geburtsh Neonatology 1999

Administration of Lactobacillus rhamnosus GG to preterm babies for 7 days can influence the incidence of NEC, sepsis and UTI Dani C, et al Biol Neonate 2002

rhamnosus GG significantly reduced the risk of nosocomial Regular intake of Lactobacillus rhamnosus GG significantly reduced the risk of nosocomial diarrhea among hospitalized infants and toddlers Szajewska H, et al J Pediatr 2001

Lactobacillus rhamnosus GG prevents diarrhea in undernourished A placebo- controlled trial of Lactobacillus rhamnosus GG prevents diarrhea in undernourished children in underdeveloped countries Oberhelman RA J Pediatr 1999

ORS enriched with Lactobacillus rhamnosus GG reduces the duration of diarrhea ameliorate the course and help early discharge from hospital Multicenter European Trial J Gastroenterol Nutr. 2000

Guarino A. et al. JPGN 1997

Rotavirus shedding Guarino A. et al. JPGN 1997 Rotavirus excretion on day 6 in children receiving probiotic treatment and in control subjects. Guarino A. et al. JPGN 1997

T Cell Imbalance Th1 ___ Th0 _______Th2

T Cell Balance Th1 ________ Th0 _________ Th2

The Th cell balance helps in reducing Atopic manifestations

Early predictors of asthma Jennifer K. et al Allergy and Clinical Immunology 2002

Early development of atopy is a strong predictor of later asthma Jennifer K. Allergy and Clinical Immunology 2002,

Prenatal factors predicting asthma Parental atopy and asthma Early or threatened labour, Restricted growth and Malposition of the foetus

Prenatal factors predicting asthma Cont. Gestational age greater than 40 weeks low levels of IgE at birth greater than 40 weeks Malaria parasites in cord blood were strong risk factors for later asthma ??

Cont. Breastfeeding has been documented as a factor that protects against asthma in many studies Jennifer K. Allergy and Clinical Immunology 2002,

Cont. It has also been suggested that probiotic milk could reduce the incidence of respiratory infections and atopy by modifying the intestinal microflora and their metabolic activities.

Cont. The attraction of giving probiotics in milk is that it is a simple intervention to administer and has no adverse side-effects. Jennifer K. Allergy and Clinical Immunology 2002

Bengt B et al Primary prevention of atopic asthma Current Opinion in Allergy and Clinical Immunology 2001,

Primary prevention of atopic asthma A prospective study, in which a strain of Lactobacillus or placebo was given prenatally to mothers with at least one 1st-degree relative with atopic disease

Primary prevention of atopic asthma Cont. The incidence of atopic eczema in the Lactobacillus group was half of that of the placebo group, i.e. 23% vs 46%

Probiotics & Allergy management Eczema severity (SCORAD score) Isolauri E et al. Probiotics in management of atopic eczema..Clin Exp Allergy 2000

Intestinal flora and allergy Colonisation frequency Björksten Bet al Allergy development and the intestinal microflora during the first Year of life. J Allergy Clin Immunol 2001

Probiotics for the Developing World Gregor Reid et al J Clin Gastroenterol 2005

Probiotics for the Developing World In summary, probiotics represent a potentially significant addition to the interventions to prevent HIV in women and improve the quality of life of patients with AIDS.

Porbiotic Studies 2000 - 2005 Four weeks of LGG improved the intestinal inflammation in infants with atopy and CMA In vitro LGG and Bb modified the cytokines In mice Probiotic prevented the Th2 dominance caused by antibiotics in mice Probiotic help in decreasing the rate of sensitization of infants during their weaning period LcS suppressed IgE and IgI in a food allergy model

Are probiotics totally and full proof safe?

Treatment of Short Gut Syndrome Two Cases of Lactobacillus Bacteremia During Probiotic Treatment of Short Gut Syndrome Anjali N. et al Journal of Pediatric Gastroenterology and Nutrition April 2004

Studies shows that probiotics bacteremia occur with inflamed gut e. g Studies shows that probiotics bacteremia occur with inflamed gut e.g. ulcerative colitis, short bowel

Why probiotics did not gain confidence and momentum among physicians? The Question Why probiotics did not gain confidence and momentum among physicians?