The ESPGHAN 49th Annual Meeting was held in Athens – Greece that was divided into three events, as follows:
Courses on IBD, PG and AHP courses on Wednesday 25 May 2016 in Hilton Hotel (not attended by me)
Working Groups on Wednesday 25 May 2016 in Hilton Hotel (for members only), and
Scientific Program on 26 – 28 May 2016 in Megaron International Center
Amongst the Scientific Program, I am very interested to attend symposia related to the Happy-Tummy or healthy gut presented by Dr. Christina West from Department of Clinical Sciences, Pediatrics at Umea University, Ume, Sweden. She presented her topic on “The Gut Microbiota and Its Role in Allergic Disease” focusing on the following outline:
Development of early life gut microbiota and immune tolerance:
Microbial imprinting may start in utero:
DNA from bacterial taxa in the feto-placental unit
Microbes may travel via the blood stream from the oral cavity to the placenta (Aagand et al, Sci Transl Med, 2014)
Translocation over the gut epithelium also suggested
Transmission of administered labeled bacteria strains from the mother to her offspring in mice (Jumenez et al, Res Microbial 2008).
Postnatal establishment of the gut microbiota as genetic and primary exposure (Salminen S, 2005):
Delivery/birth è caesarian section delivery associated with increased risk of allergic and autoimmune disease (Kristensen K et al, JACI 2016)
Predictable micobiome development (Subramania S et al, Cell 2015):
The early gut microbiota abundant in bifidobacteria
Microbes that characterize early stages of development are more capable of metabolizing nutrients associated with breast feeding
Later stages have a gut microbiota enriched in genes that can help digest solid foods
Microbiota establishment is influenced by diet and environmental exposures perinally and in childhood.
Parallels the development of innate and adaptive immune pathways
High biodiversity by short-chain fatty acid production and induction of Treg cells. Low biodiversity /dysbiosis by IgE production and pro-inflammatory responses
Under optimal conditions, postnatal exposures promote tolerance, however modern condition are not optimal and rising immune disese
The development of tolerance is an antigen-driven process:
TLRs expressed on epithelial and endothelial cells, leucocyte subsets in blood.
Sense conserved structural components of microbes
TLR activation can increase or decrease the suppressor activity of Tregs, thus providing link between innate and adaptive immunity.
Dysbiosis in early life microbiota and allergic diseases
Reduced relative abundance (RA) and a diversity of Bacteriodetes in infancy before onset of IgE- associated eczema and asthma (Abrahamsson, Jenmaim et al, JACI 2012 and ClinExp Allergy 2014)
Reduced RA of Ruminococcaceae at 1 yr, 5 times more likely in food-sensitized infants in the CHILD cohort study (Azad, Kozyrsky et al, Clin Exp Allergy 2015)
Reduced RA of Ruminococcaceae at 1 week preceded onset of IgE- associated eczema; the RA of Ruminococcus was inversely correlated with TLR2-induced IL-6 and TNF-α (West, Prescott et al, Clin Exp Allergy, 2015)
Transiety lower RA of Lachnospira, Veillonella, Faecalibacterium and Rothia in infants at risk of asthma; reduced fecal acetate levels, dysregulation of enteroheaptic metabolites (Arrieta et al, Sci Transl Med 2015)
Innate immune responses in allergic disease:
Increase inflammatory responses following TLR-activation (Tullic JACI 2011)
Immature Th1 function (Tulic JACI 2011)
Immature Treg function (Smith JACI 2008, Schaub JACI 2008))
Current evidence on pre/pro/synbiotics for allergy management (prevention and treatment):
Prebiotics, oligosaccharides are the third largest fraction in human milk and confer many potential benefits in breastfed infants. Prebiotics have the potential to promote gut colonization with bifidobacteria, and some studies have demonstrated immune stimulating effects. Increase the production of short-chain fatty acids, with nutritive and anti-inflammatory effects
Synbiotics is combination of pre and probiotics, anticipated to have more global effects on colonization. Meta-analysis eczema treatment, the effect most evident in children >1 yr and if the symbiotic contained a mix of bacterial strains (Chang YS et al, JAMA Pediatr 2016)
International expert bodies do not generally recommend pre- pro- or synbiotics for treatment and prevention of allergic disease
Probiotics, there is a likely net benefit from using probiotics resulting primarily from prevention eczema at high risk of allergic disease (WAO guideline panel 2015)
Prebiotics, suggest using prebiotic supplementation in not-exclusively breastfed infants and using prebiotic supplementation in exclusively breastfed infants for allergy prevention (WAO guideline panel 2016).
The gut microbiota develops to a complex and diverse ecosystem during the first years of life
Aberrant intestinal colonization and reduced biodiversity have been associated with allergic diseases
Pre- pro- and synbiotics have the potential to promote healthy gut colonization and immune maturation in allergic disease
To date, significant heterogeneity between conducted studies precludes general recommendation on their use
I would like to thank you Nestle Indonesia to sponsor me to the event.