Prebióticos, Probióticos y Simbióticos en Alergia y sus aplicaciones clínicas.

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Conferencia dictada en el XVII Congreso Latinoamericano de Alergia, Asma e Inmunología, Cartagena, 2012 por el Dr.
Bruno Paes Barreto

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Prebióticos, Probióticos y Simbióticos en Alergia y sus aplicaciones clínicas.

  1. 1. Bruno Paes Barreto Doutor em Ciências pela Universidade Federal de São Paulo/Brasil Professor Adjunto de Pediatria da Universidade do Estado do Pará/Brasil Membro do Comitê de Alergias na Infância da Associação Brasileira de Alergia Prebióticos, probióticos ysimbióticos en alergia y sus aplicaciones clínicas
  2. 2. DISCLOSURES/2012I certify that all my affiliations with or without financialinvolvement in any organization or entity with respect to thesubject matter or materials discussed, are fully expressed below: Advisory Board – Probiotics Speaker • Danone • Mantecorp- • Sanofi-Aventis Farmasa • Takeda
  3. 3. LESSON PLAN• Concepts• Theoretical basis• Clinical applicability – Immune regulation – Allergic Diseases • Prevention • Treatment
  4. 4. LESSON PLAN• Concepts• Theoretical basis• Clinical applicability – Immune regulation – Allergic Diseases • Prevention • Treatment
  5. 5. HYGIENE HYPOTHESIS: PROPOSED CHANGESISOLAURI, 2010 PAST PRESENT TIME
  6. 6. “WE ARE MORE HUMAN OR MORE BACTERIA?” Self- maintenance Consume, store and self- and distribute repair by energy means of self- Different Mediate replication strains physiologically Inter-species important 100 trillion communication chemical Genome 10x with the host transformations greater than the human Metabolic capacity equal to the liver
  7. 7. WHAT ARE THEFUNCTIONS OFINTESTINALMICROBIOTA?
  8. 8. FUNCTIONS OF INTESTINAL MICROBIOTA
  9. 9. • Due to the altered • Being atopic, has microbiota, the child changed its becomes atopic? microbiota?
  10. 10. Does the use of pre, pro orsymbiotics in childhood or evenearly in pregnancy could favor aprocess of immune regulation and less development ofchronic inflammatory (allergic or autoimmune) diseases?
  11. 11. LESSON PLAN• Concepts• Theoretical basis• Clinical applicability – Immune regulation – Allergic Diseases • Prevention • Treatment
  12. 12. FACTORS GOVERNING THE COLONIZATION AND STABILITY OF INTESTINAL MICROBIOTA Pediatria (São Paulo) 28 (2):117, 2006 INTESTINAL IMMUNE SYSTEM IMMUNE REGULATION
  13. 13. Th2 RESPONSE PLACENTAL CELLS Treg PROFILETh1 RESPONSE DECREASED IMMUNOLOGY OF PREGNANCY
  14. 14. Early T cell development is different in allergic children?Th2 RESPONSE AMPLIFIED Th1 RESPONSE GREATLY DECREASED IMMUNOLOGY OF PREGNANCY
  15. 15. “We don’t yet know whatis causing these differences,but these works confirmed thatabnormal immune developmentbegins much earlier than previouslysuspected, and even before birth” Susan Prescott
  16. 16. Microbiota/Probiotics TLrs Transcription factors
  17. 17. • STp  peptide from Lactobacillus• Stimulates IL-10 production by dendritic cells• Absent in patients with IBD  biomarker for homeostasis• Future: “Nutraceuticals products”
  18. 18. Stress X Immune Response L. casei defensis CORTISOLSTRESS ↓RISK ↑RISK OF IMMUNE RESPONSE INFECTION ANXIETY Marcos, A. Eur J Nutr. 2004. 43: 381-9
  19. 19. LESSON PLAN• Concepts• Theoretical basis• Clinical applicability – Immune regulation – Allergic Diseases • Prevention • Treatment
  20. 20. •Pregnancy: •Placebo or Lactobacillus GG (1 x 1010 UFC) •2 to 4 weeks before delivery•After delivery: • Exclusively breast feeding  Mother (Pb or LGG) or children (Pb or LGG) for 6 months
  21. 21. • Coorte  Isolauri and cols. (Lancet 2001)• After 7 years: risk for eczema was significantly lower in the LGG group • 42,6% x 66,1%; • RR, 0,64; 95% CI, 0,45-0,92• SPT  7 years: (ns) • LGG: 32% • Pb: 33%
  22. 22. N=187 (92 i/95 c) Age: 2-5 years • Time for immune modulation? • End point (ns) • loss of adherence? • 80%59,9%• Rhinitis group: number of episodes/year • 80%68% • Intervenction: 3.2 (2.4-4.1) • Control: 4.8 (3.5-6.1) • Difference: 1.6 episode/year (p=0,04)
  23. 23. 9, 313-323 (May 2009)The gut microbiota shapes intestinal immune responsesduring health and diseaseJune L. Round1 & Sarkis K. Mazmanian1
  24. 24. FACTORS THAT INFLUENCE THE DEVELOPMENT OF ALLERGIC DISEASES epigenetics ENVIRONMENT GENETICS MUCOSAL/ EPITHELIAL INTESTINAL NERVOUS MICROBIOTA / SYSTEM PROBIOTICS IMMUNE SYSTEM CLINICAL MATERNAL-FETAL EXPRESSION INTERACTION OF THE DISEASEKalliomaki et al. J Nutr. 2010; 140: 713s-721s
  25. 25. Twentieth century was of Antibiotics 506,706 publications (8% Reviews)Bacillus LactobacillusBifidobacterias Saccharomyces (Fungus) XXI Century is of Probiotics 15,466 (28% Reviews) Rijkers GT et al. J. Nutr (2010), 140: 671S- 676S
  26. 26. DID YOU EAT YOUR BACTERIA TODAY? brunopaesbarreto@terra.com.br

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