PROBIOTICS

1. Probiotics new generation in pediatrics Carlos D. Ramos-Perea M.D. F.A.A.P Catedrático Asociado Escuelas de Medicina Ponce y Central del Caribe Pediatra- Neonatólogo- Cuidados Intensivos HOSPITAL MATERNO-INFANTIL SAN ANTONIO MAYAGUEZ, P.R.

3. Define :PROBIOTICS AND PREBIOTICS

4. Understand factors that affect bacterial colonization of the intestinal tract.

5. Review data supporting clinical benefits of probiotics particularly bifidobacteria and that is safe and well tolerated by infants and children.

7. PROBIOTICS:

11. PH gets lower, and creates poor environment for growth.

12. Lactobacillus contains lactase within their cell wall, adhering to the intestinal microvillus, digesting lactose.

13. Non fermented milk containing L.bulgaricus significantly reduced both breath hydrogen results and symptoms of lactose int. De verse et all am j clin nutr 2001:73

15. Trillions of bacteria

16. Important for healthy intestinal function & nutrition

17. Motility, digestion, intestinal trophism

18. Critical for immune system development and response

19. Gut barrier function and immuno-modulation7

21. INTESTINAL ANATOMY GALT

26. Infections

28. Stimulation of immune functions

29. Aid in digestion and/or absorption

30. Synthesis of vitaminsProteus Staphylococci Clostridia Enterococci E. coli Lactobacilli Streptococci Eubacteria Potential Probiotics Bacteria (When Ingested) Bifidobacteria Bacteroides Adapted from: Gibson 1995

32. Ingestion of Bacteria (Transient Intestinal Bacteria) have a Lengthy History 15 Monks Perfect Fermentation Pasteurization Sumerians (Cheese) Celts & Huns(Kefir) Abraham (Milk & curds) 2000 3500 BC 2000 BC AD Antibiotics Probiotics In the last 100 years, we drastically changed our ingestion of microbes and our microbial environment

34. Lactic acid bacteria are important for human health and longevity

35. Ingested bacteria can have positive influence on health:16 Elie Metchnikoff (1845-1916)

37. B. lactis (Bb12)

38. B. longum

39. B. breve

40. B. infantis

41. LACTOBACILLI

42. L. casei

43. L. rhamnosus (GG)

44. L. reuterii

45. L. plantarum17

46. Live Active Cultures of Bacteria in the Food Supply 18

48. Produce short chain fatty acids: acetate and lactate

49. Survive intestinal digestion and appear in stool

50. Predominant flora of breast fed infants19 Bifidobacterium lactis Nomenclature: B. lactis also: B. animalis sub-species lactis, also B. bifidum, strain Bb12

51. Bifidobacteria Supplementation can Increase colonization with Bifidobacteria 20 Langhendries 1995

52. Number of Scientific Publications on Probiotics 21

54. Translocated bacteria influence colonization of infant bowel contribute to education of infant gut.

56. Diet in early life is a mayor factor for this ecosystem.

59. 80% of immunologically active cells are contained in the gut.(GALT)

60. Germ free animals revealed underdeveloped mucosal inmune system with very small PEYER patches,decreased lymphocytes in mucosa and absent IGA producing cells.

62. Antimicrobial activities of probiotics include the (1) production of bacteriocins/ defensins , (2) competitive inhibition with pathogenic bacteria, (3) inhibition of bacterial adherence translocation, and (4) reduction of luminal pH. Probiotics bacteria can also enhance intestinal barrier function by (5) increasing mucus production.

65. (mechanical defense) Mucus layer Categorized depends on cytokine profile Promote- eos recruitment Encourage T cell prolif. And macrophage activ. Inflammatory defense The balance between T lymph important role in modulating immune response Over expression proinflamatory

66. Peyer patch cell,presentor to APC

68. Inhibits Ige production Th2 Th1 Protective Immunity Allergy

70. Beneficial increased production of cytokines.

71. Enhance mucosal resistance against GI infections.

72. Increase Th1 cytokine interferon g allergic response.

73. Increases in acetic acid and scfa similar to breast.

75. A” healthy” microbial balance will promote Th1 responses and decrease Th2 decreasing allergic and atopic disease.

76. Bifidobacteria and lactobacilli given orally will modulate GALT toward a balance T helper response and stimulate production of I-1O all of them having roles in immune response.

78. Decrease gut permeability and enhance natural killer cell activity, macrophage activation and phagocytosis.

79. Increase IGA,IGG,IGM secreting cells.

80. Increase specific secretory IGA in serum and interstitial lumen.

83. Reduce incidence of diarrhea in chronically hospitalized, malnourish infants and neonates.

84. Lower prevalence of diaper rash.

85. Reduce severity of antibiotic induce diarrhea.

86. Lower incidence of atopic dermatitis.

89. Colonization of host friendly bacteria.

90. Improve weight gain and tolerance to lactose containing formulas in neonates.

92. Immature microvillus with mucus deficiency and iga with permeability to macromolecules, microorganism and toxins. This starts NEC.

94. Iga ,lysozyme, complement, macrophages, growth factors, PAF-ACETYLHYDROLASE, and production of anti inflammatory cytokines.

95. Pufa in breast milk modifies cytokine and endotoxic response in rat model.

97. NEC DR.RAMOS-PEREA-ATOPSIA CMM 1995

98. NEC

104. PILOT STUDY February 2009

105. 60 children properly diagnosed, receive 2 sprays per nostril for 10 days with LACTOBACILUS rhamnosun compare with 60 with placebo.30 ptes.(50%) Showed clinical cure of the process vs. only one with placebo.

107. Diagnosis ??

109. To date 70 clinical studies involving more than 4000 children and infants(term & preterm)consuming infant formula and food containing microbial ingredients with no reports of probiotics adverse side effects.

111. Predominate in breast fed infants

112. No pathogenicity reported

113. B. lactis-containing yogurt is consumed worldwide

114. Infant formula with B. lactis: 15 years, 30 countries

115. Only bacterium with FDA authorization for use in infant formula53

117. Partially hydrolyzed whey proteins

118. Facilitate digestion(break down to simple a. acids.

119. Decrease risk of sensitization and development of allergy (atopic dermatitis)*1

120. Probiotics cultures: Bifidobacteria lactis.

121. Help maintain a healthy balance of intestinal flora.54 GINI TRIAL * Von Berg 2007

122. Expertos Recomiendan Niveles Medios de LCPUFAs en la Leche Humana para Formulas Infantiles de Niños a Termino % de Acidos Grasos DHA ARA ~0.4 ~0.4 ~0.35 ~0.7 ~0.35 ~0.5 0.2 0.35 Grupo Expertos British Nutrition Foundation (BNF; ‘92) Food and Agriculture Organization World Health Organization (FAO/WHO; ‘94) Expert Panel convened by NIH/ISSFAL (‘99) Child Health Foundation, Germany (‘01)

123. Composición de Fosfolípidos de Corteza Cerebral (% de ac grasos totales) * * * p< 0.05 Farquharson Lancet 92

126. FORMULA CON DHA + ARA

127. FORMULA DHA-ARA

128. DHA

129. DHA

130. Benefits of GOOD START NATURAL CULTURES 63 Less curd formation Faster gastric emptying Easy protein digestion Greater stool softness Potential for allergy prevention A good balance of intestinal florasupports a healthy immune system

132. Muchas gracias ; preguntas ?