1.
Targeting the gut-lung axis by synbiotic feeding to infants in a randomized controlled trial.
Sjödin, KS, Sjödin, A, Ruszczyński, M, Kristensen, MB, Hernell, O, Szajewska, H, West, CE
BMC biology. 2023;21(1):38
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Infants are at increased risk of infections, and respiratory tract infections are a leading cause of morbidity and mortality globally. Although the respiratory and gastrointestinal tracts are separate, they share a mucosal immune system called the “gut-lung axis.” The aim of this study was to compare the impacts of feeding prebiotic infant formula with the same prebiotic infant formula supplemented with probiotic Lactobacillus F19 (synbiotics) until 6 months of age on infant gut microbiota development in the first year of life. This study was a multicentre, double-blind randomised controlled study. Infants were randomised to control group - prebiotic formula or experimental group - synbiotic formula. Results showed additional benefit of feeding specific synbiotics to formula-fed infants over prebiotics only. In fact, synbiotic feeding led to the underrepresentation of Klebsiella [bacteria], enrichment of bifidobacteria, and slight increases in microbial degradation metabolites. Authors concluded that their findings support future clinical evaluation of synbiotic formula in the prevention of infections and associated antibiotic treatment as a primary outcome when breastfeeding is not feasible.
Abstract
BACKGROUND Formula-fed infants are at increased risk of infections. Due to the cross-talk between the mucosal systems of the gastrointestinal and respiratory tracts, adding synbiotics (prebiotics and probiotics) to infant formula may prevent infections even at distant sites. Infants that were born full term and weaned from breast milk were randomized to prebiotic formula (fructo- and galactooligosaccharides) or the same prebiotic formula with Lactobacillus paracasei ssp. paracasei F19 (synbiotics) from 1 to 6 months of age. The objective was to examine the synbiotic effects on gut microbiota development. RESULTS Fecal samples collected at ages 1, 4, 6, and 12 months were analyzed using 16S rRNA gene sequencing and a combination of untargeted gas chromatography-mass spectrometry/liquid chromatography-mass spectrometry. These analyses revealed that the synbiotic group had a lower abundance of Klebsiella, a higher abundance of Bifidobacterium breve compared to the prebiotic group, and increases in the anti-microbial metabolite d-3-phenyllactic acid. We also analyzed the fecal metagenome and antibiotic resistome in the 11 infants that had been diagnosed with lower respiratory tract infection (cases) and 11 matched controls using deep metagenomic sequencing. Cases with lower respiratory tract infection had a higher abundance of Klebsiella species and antimicrobial resistance genes related to Klebsiella pneumoniae, compared to controls. The results obtained using 16S rRNA gene amplicon and metagenomic sequencing were confirmed in silico by successful recovery of the metagenome-assembled genomes of the bacteria of interest. CONCLUSIONS This study demonstrates the additional benefit of feeding specific synbiotics to formula-fed infants over prebiotics only. Synbiotic feeding led to the underrepresentation of Klebsiella, enrichment of bifidobacteria, and increases in microbial degradation metabolites implicated in immune signaling and in the gut-lung and gut-skin axes. Our findings support future clinical evaluation of synbiotic formula in the prevention of infections and associated antibiotic treatment as a primary outcome when breastfeeding is not feasible. TRIAL REGISTRATION ClinicalTrials.gov NCT01625273 . Retrospectively registered on 21 June 2012.
2.
Systematic Review with Meta-Analysis: Lactobacillus reuteri DSM 17938 for Treating Acute Gastroenteritis in Children. An Update.
Patro-Gołąb, B, Szajewska, H
Nutrients. 2019;11(11)
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Acute gastroenteritis (AGE) is a common health problem in children and, globally, diarrhoea is one of the leading causes of death in children younger than the age of 5 years. Probiotics have been extensively studied as a supportive treatment regimen in children with AGE and shown to be effective in reducing both diarrhoea duration and severity, and potentially reducing the duration of hospitalization. The aim of this systematic review and meta-analysis of four randomised controlled trials including 347 children was to provide an update on the research into a particular strain of Lactobacillus reuteri for the treatment of AGE. The meta-analysis showed a significantly reduced duration of illness and hospitalisation, as well as increased cure rate on day 1 and 2, but not 3, 4 or 5. Based on two of the four trials there was no difference in number of watery stools on day 1, 2, 3 or 4. The authors note that the clinical relevance of the findings was limited due to the small effect size and methodological limitations of the included studies.
Abstract
The effectiveness of Lactobacillus reuteri DSM 17938 (L. reuteri) for the management of acute gastroenteritis (AGE) has been recently questioned. We performed a systematic review to update evidence on L. reuteri for treating AGE in children. We searched MEDLINE, EMBASE, the Cochrane Library databases, and additional data sources from January 2016 (end of search for our 2016 systematic review) to August 2019. The primary outcomes were stool volume and duration of diarrhea. Four RCTs were included. None of them evaluated stool volume. Compared with placebo or no treatment, L. reuteri reduced diarrhea duration (four RCTs, n = 347, mean difference, MD -0.87 days, 95% CI [-1.43, -0.31]). L. reuteri use was also associated with a reduced duration of hospitalization (three RCTs, n = 284, MD -0.54 days, 95% CI [-1.09, 0.0]). The small effect sizes of limited clinical relevance and methodological limitations of the included trials should be noted when interpreting these findings.