2. Name:
Academic Degrees:
Institutional
Affiliation:
Address:
Publications
/ Achievements:
Dr. Asha Benakappa FIAP,
MD,DNB, DCH,DHHM,LMC,AH).
HOD of Pediatrics
Dr. Chandramma Dayananda Sagar Institute of
Medical Education and Research, DEVARAKAGGALAHALLI,
HAROHALLI, Kanakapura Rd, Kanakapura, Karnataka 562112
ACHIEVEMENTS ,PUBLICATIONS &
•WABA-HCP- Task force member.
•Founder trustee lactation helpline.
•Many new innovation Director IGICH
•Deccan Chronicle July 1st on Doctor’s Day 2009 selected as one of the five Best Doctors of the City.
•Listed in “Who’s Who” of WABA General Assembly
3. Publications
/ Achievements:
AWARDS AND RECOGNITION:
FIAP award
Two gold medals in MBBS and recipience of Second rank
WBW award from BPNI more then 10 times
Doordarshan Chandana Award 2012 on 16.11.2012 for significant contribution rendered in Health (One of the Navaratna’s)
Harivu Film won the 62nd Best Regional Film Award 2015 is based on The Story written by Dr. Asha Benakappa
Received over 30+ awards and felicitation.
PUBLICATIONS AND PRESENTATIONS
• International 16 , National 25 , and State 30 Presented
• Guest Lectures/ webinars: 200+ at International/National/ State and IAP district.
• Books: NICU Companion, Breastfeeding “The Basic Instinct”, Kannada book on Bf, Flip charts on BF in Kannada and English, FAQs on Bf
in English and Kannada, IGICH Pediatric: Generic Drug Pharmacopeia
5. Introduction
◍ A mother is gifted with breastmilk,a natural source of
nutrition for her infant.
◍ It has a wealth of macro and micronutrients.
◍ It has micro-organisms-few of which originate from the
mother,while others are acquired from the mouth of the
infant and the surroundings.
◍ These microorganisms initiate and help the development
of the milk microbiota as well as the microbiota of the
GIT in infants and contribute to developing immune
regulatory factors such as cytokines,growth
factors,lactoferrin etc 5
6. Cont..
◍ These factors play an important role in reducing chronic
diseases like T2Diabetes,asthma and others later in life.
◍ Breastmilk microbiota has a cross talk with the immune
system in breastfed babies during the early years of life.
◍ Breastmilk is a dynamic and complex microsystem that
contains a microbial signature that is transmitted to the
newborn baby and is essential for immune system
development and education
6
7. The Amazing Microbiome
◍ Approximately 100 trillion micro-organisms (mostly bacteria, but also
viruses, fungi &protozoa)exist in human GIT.
◍ Microbiome is the virtual organ of the body
◍ Human genome consists of about 23,000 genes.
◍ Microbiome encodes for three million genes producing thousands of
metabolites which replace many of the functions of the host
influencing the hosts fitness, phenotype &health
7
8. Good starter kit!
◍ Rupture of the membranes during labor contributes
to the early microbial seeding of the newborn.
◍ Transfer of microbes from mother to her baby during
delivery, is like a starter kit that will help expand the
infant’s microbiota.
9. Definition of microbiome
◍ The term microbiome was first used by Joshua Lederberg
for the ‘ecological community of commensal,symbiotic
and pathogenic micro-organisms that literally share the
human body’
◍ Microbiome : collective genomes of the microorganisms in
a particular environment
◍ Microbiota : community of microorganisms themselves
10. ◍ Probiotics: live bacteria &yeast that when adminstered in a
viable form &in adequate amounts are beneficial to human
health.eg yoghurt &food supplements.
◍ Prebiotics: substrate that is selectively used by host
microorganisms conferring a health benefit
◍ Symbiotic: contain a mixture of prebiotic &probiotic
11. Dysbiosis
◍ Microbiota changes associated in diseased states.
◍ Diseased states can lead to changes to the Gut
microbiome through various mechanisms, including
changes in eating habits, bowel functions well as through
the addition of medications such as antibiotics.
12.
13.
14. Breast milk microbiota and health
◍ Breastmilk is home to diverse microbiome: human milk
microbiome(HMM)
◍ Early life environmental exposure can affect fetal and infant
programming, resulting in change in health status(DOHaD)
◍ Early life microbiota is a key participant in DOHaD
contributing to infant health status in short and long term.
15.
16. Origin and sources of the human milk
microbiota.
Breastmilk is a source of microbes for the establishment of oral and gut
microbiota in breastfed infants.
◍ ‘Retrograde transfer’: external bacteria could enter mammary gland from
sources such as areola skin, infant oral cavity, and /or breast pumps.
◍ ‘Enteromammary pathway’: bacteria from mother’s gut are translocated to
the mammary gland via immune cells and colonize the available niche.
◍ ‘Oro –mammary translocation’: microbes in the mother’s oral cavity will
translocate to the mammary gland.
17. Where do bacteria come from mother’s milk
◍ Externally from baby’s mouth to mammary gland via
mammary duct
◍ Streptococcus(saliva)
◍ Staphylococcus(skin)
◍ Corynbacterium(skin)
◍ Internally via entero-mammary pathways: translocation of
bacteria from mother’s gut to mammary gland through
dendrite cells and macrophages
18. Sources of micro biota
◍ Amniotic fluid
◍ Meconium :MB originates from uterus of the mother
◍ Maternal vagina
◍ Maternal feaces
◍ Skin
◍ Breast milk
◍ Surroundings –as clean as possible
◍ 10000000 cells /ml of breastmilk
◍ 7-8 billion bacterial cells formed each day.
19.
20. Factors influencing the composition of
human milk microbiota
1. Stage of lactation: colostrum is abundant with BMM
2. Method of BM expression: DBF is associated with higher
abundance of oral cavity genera. Indirect BF is associated with
increased prevalence of potential opportunistic pathogenic
families.
Direct BF allows the acquisition of oral associated micro-organisms.
Indirect BF favour the colonization with environment related
organisms that could compromise infant’s immune system and
increased risk of diseases.
22. Factors influencing the composition of human
milk microbiota contd..
3. Lifestyle and diet of Mother: mother’s diet effect on BMM
via enteromammary pathway. During pregnancy and
lactation bacteria from maternal gut translocate into the
mammary gland ,altering the mammary and BMM.
4. Maternal factors: link between BMM changes and women’s
BMI, mothers with high BMI have a more homogenous
bacterial composition.
23.
24. Implications of microbiome on health
◍ Infections,
◍ Allergic sensitization, asthma
◍ Necrotizing enter colitis
◍ Celiac disease
◍ Inflammatory bowel disease
◍ Autoimmune disease
◍ Irritable bowel syndrome
◍ Obesity
◍ Type1 diabetes
◍ Kwashiorkor
◍ Mastitis
◍ Cancer
◍ Autism(decreased conversion of
glutamine to GABA)
◍ Stress, Depression,
Schizophrenia, Parkinson’s,
other neurodegenerative
diseases
25. Function of gut micro biome
◍ Metabolize barely digestible polysaccharides results in the synthesis of short chain fatty
acids(SFA)which are rich source of energy for the host
◍ Synthesis of vitamin K, other components of vitamin B, conversion of glutamine to
GABA,breakdown of various polyphenols (fruits, vegetables and green tea)
◍ Detoxifying toxic products and has an effect on drug metabolism
◍ Maintenance of structural integrity of the gut mucosal barrier
◍ Serves as a barrier against pathogens
◍ Development of host immune system.
26.
27.
28.
29.
30. Development and maintenance of immune
function
◍ Born with TH2 bias to protect them from intrauterine rejection, when
baby is in womb
◍ Bacteria stimulate dendritic cells
◍ It allows naïve helper cells(THO) to create balanced subclass of TH cells
◍ Bacteria is taken up by dendritic cells to mesenteric lymph nodes &
presented to B cells resulting in polymeric Iga which is shuttled across
the epithelium to help contain bacterial attachment and penetration.
31. Development of immune tolerance
◍ Antigens taken up by dendritic cell to the lymph nodes stimulates
TGF(transforming growth factor)induces differentation of naïve T cells to T
reg.
◍ Production of IL-22 by gp 3 innate lymphoid cells(ILC3)
◍ IL-22 induces antimicrobial peptide production by paneth cells & mucus
production by goblet cells thereby strengthening gut barrier
◍ This prevents transfer of dietary antigen across the barrier and therefore
allergic sensitization.
32. Development of immune tolerance
contd.
◍ IDO (indolamine dioxygenase) gets activated in response to
allergen induced immune activation
◍ IDO: metabolize tryptophan to kynurenine which exhibit
tolerogenic effect by causing T cell anergy(absence of normal
immune response) &adoption
◍ This also induces T reg leading to attenuation of allergic
response
33. Human milk oligosaccharides
◍ HMO’s are lactose based unconjugated carbhohydrates.
◍ Food for bacteria.
◍ Bacteria here are microbiome.
◍ Colostrum in the golden hour is the source of gut
microbiome
35. Human milk oligosaccharides(HMO’S)
◍ Group of structurally diverse unconjugated short chain as well as
long chain glycans found uniquely &abundently in breast milk
◍ 20-23gm/ml in colostrum &5-20gm/ml in mature milk
◍ Preterm milk has higher amount
◍ HMO’S are resistent to gastric acidity,hydrolysis by host enzymes
&GI absorption
36. Human milk oligosaccharides(HMO’S)
◍ HMO’S reach the distal small intestine &colon intact and at high
concentration
◍ Bifidobacterium longum,sub species infantis grows well
compared to B.infantis
◍ These bacteria produce SCFA and other metabolites that favour
the growth of commensals over potential pathogens
37. Functions of HMO : food for microbiota
◍ Prebiotic bifidus factor that serves as a metabolic substrate for
desired bacteria
◍ Shapes an intestinal microbiota composition by keeping harmful
bacteria in check as they compete for limited nutrient supply
◍ Prevents pathogen attachment to infant mucosal surfaces and
lower the risk of Viral e.g., rota virus noro virus, HIV ,Bacterial
E.coli, H.pylori, C.jejuni Protozoan infection E.histolytica etc
38. HMO …..contd
◍ Modulate epithelial cell and immune cell response thereby modulating
gene expression
◍ Reduce rolling of leucocytes on endothelial cells decreasing extensive
leucocyte infilteration &activation
◍ Lower the risk of NEC
◍ Provide infant sialic acid as a potential essential nutrient for brain
development and cognition
44. Gut brain axis
◍ Refers to bidirectional biochemical communications between GI and brain.
◍ It influences production, expression and turnover of neurotransmitters such as
serotinin,GABA,brain derived neurotrophic factor(BDNF)
◍ It contributes to intestinal barrier, tight junction integrity, there by attenuating Hypothalamo-
Pituitary adrenal axis and ANS function
◍ Metabolite of some gut microfilmed like SCFA,serotonin,kynurinine,can exert effect on brain
◍ Immunological pathway both systemic and mucosal immune play in regulation of gut brain axis.
45. Gut brain axis …
◍ The concept of micro biome-gut –brain axis is emerging
◍ It is involved in diverse form of neuroimmune conditions like
multiple sclerosis
◍ Neural, endocrinal and metabolic mechanisms are critical
mediators of the micro biome-CNS signaling which are involved
in neuropsychiatric disorders like autism,anxiety,depression and
stress.
46. Summaries:
◍ Microbiome:ecological community of commensal,symbiotic
and pathogenic microorganisms that literally share the human
body.
◍ microbiome refers to the collective genomes of the
microorganisms in a particular environment and microbiota is
the community of organisms themselves
◍ The breastmilk(BM)is a dynamic and complex microecosystem
that contains a microbial signature that is transmitted to the
newborn baby and is essential for immune system
development and eduction
46
47. Cont…
◍ Breastmilk is a natural source of nutrition for the infant.
In addition to the wealth of macro/micro
nutrients,human milk contains many micro-
organisms,few of which originate from the mother,while
others are acquired from the mouth of the infant and the
surroundings.
◍ Delivery mode appears to be an important factor in the
development of the infant gut microbiota.
◍ These microbes initiate and help the development of the
milk microbiota as well as the microbiota of the GIT and
contribute to developing immune regulatory factors. 47
48. Objectives of microbiome research
◍ Predict the risk of disease development.
◍ Develop newer techniques to diagnose related
diseases.
◍ Evolve therapeutic approaches for manipulation of the
human microbiome for betterment of mankind
48
49. acknowledgments
◍ Dr Rupal Dalal MD,IBCLC Adjunct professor
IIT Mumbai
◍ Dr Sharadadevi Mannur Y. HOD microbiology
CDSIMER.
