1. 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

5. Cranberry Fruit

6. Cranberry Fruit
التوت البرى

7. 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

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

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

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

12. Probiotic

13. Probiotic = For Life

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

15. Lactobacillus Bacteria
Probiotic e.g.
Lactobacillus Bacteria
Bifidobacteria spp

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

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

19. 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.

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

21. 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.

23. Colonic Ecosystem
In the Newborn Baby?

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

25. 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

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

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

28. Why Bifidobacteria?

29. Breast Milk Is Bifidogenic

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

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

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

33. 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

35. Porbiotic or no probiotic ?

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

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

38. 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

39. 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

40. 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

41. 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

42. Guarino A. et al. JPGN 1997

43. 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

44. T Cell Imbalance
Th1 ___ Th0 _______Th2

45. T Cell Balance
Th1 ________ Th0 _________ Th2

46. The Th cell balance helps in reducing Atopic manifestations

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

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

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

50. 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 ??

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

52. 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.

53. 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

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

55. 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

56. 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%

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

58. 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

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

60. 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.

61. Porbiotic Studies
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

62. Are probiotics totally and full proof safe?

63. 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

64. 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

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