Czy stosowanie Lactobacillus rhamnosus GG modyfikuje skład mikrobioty jelitowej u noworodków i niemowląt?

Does Lactobacillus rhamnosus GG change intenstinal microbiota in newborns and infants?

Iwona Jańczewska, Iwona Domżalska-Popadiuk

Gdański Uniwersytet Medyczny

Iwona Jańczewska
Gdański Uniwersytet Medyczny
ul. M. Skłodowskiej-Curie 3a
80-210 Gdańsk
Tel.: 58 349 11 11

Wpłynęło: 08.06.2018
Zaakceptowano: 07.07.2018
Opublikowano on-line: 24.08.2018

Cytowanie

Cytowanie: Jańczewska I, Domżalska-Popadiuk I. Czy stosowanie Lactobacillus rhamnosus gg modyfikuje skład mikrobioty jelitowej u noworodków i niemowląt?
Postępy Neonatologii 2018;24(1):39–46.
doi: 10.31350/postepyneonatologii/2018/1/PN2018002

WERSJA ELEKTRONICZNA

Streszczenie:
Mikrobiota jelitowa wpływa na wiele aspektów ludzkiej fizjologii, zawiera geny, które nie występują w komórkach ssaków, a są niezbędne do utrzymania zdrowia. Zaburzenie mikrobioty w krytycznym okresie życia (0–24 tydzień życia) ma długotrwały wpływ na funkcjonowanie układu immunologicznego. Poszukuje się więc sposobów naprawy mikrobioty jelitowej, to bowiem mogłoby zapobiegać wystąpieniu niektórych chorób. Duże nadzieje wiąże się z zastosowaniem probiotyków. Najczęściej stosowanymi u ludzi probiotykami są bakterie z rodzaju: Lactobacillus i Bifidobactrium oraz drożdże Saccharomyces boulardii. Najlepiej ocenionym probiotykiem jest Lactobacillus rhamnosus ATCC 53103 (Lactobacillus GG – LGG). Działa on antybakteryjnie i przeciwzapalnie, przyczynia się również do uzyskania tolerancji pokarmowej. Udowodniono jego skuteczność w zapobieganiu biegunce infekcyjnej, poantybiotykowej i szpitalnej. Probiotyk ten ma także wpływ na zapobieganie NEC u wcześniaków. Zaleca się jednak ostrożność w stosowaniu probiotyków w grupie najmniejszych noworodków. Szczególne korzyści ze stosowania probiotyków mogą odnieść noworodki urodzone przedwcześnie, przez cięcie cesarskie oraz leczone antybiotykami. Dopasowywanie mikrobioty do ich potrzeb może polegać na stosowaniu probiotyków, ograniczaniu empirycznej antybiotykoterapii, promowaniu karmienia pokarmem naturalnym wszystkich noworodków.

Słowa kluczowe: mikrobiota jelitowa, dysbioza jelitowa, Lactobacillus rhamnosus GG, probiotyki, wcześniak, karmienie naturalne

Abstract:
The intestinal microbiota is important for many aspects of the human physiology. Itcontains genes that are now present in mammalian cells and that are essential for maintaining health. Problems with the microbiota in the critical period of life (0–24th week of life) have an long-lasting effect on the immune system. Thus, new ways of improving the intestinal microbiota could help prevent some diseases. The use of probiotics is promising in that respect. The Lactobacillus and Bifidobactrium bacteria and the Saccharomyces boulardii fungi are the most commonly used probiotics in people. The Lactobacillus rhamnosus ATCC 53103 (Lactobacillus GG – LGG) is the best studied probiotic with an antibacterial and anti-inflammatory action. Moreover, Lactobacillus rhamnosus ATCC 53103 improves food tolerance and is effective in the treatment of infectious diarrhea, antibiotic-associated diarrhea, and nosocomial diarrhea. This probiotic is also used to prevent NEC in premature newborns. However, probiotics should be used with caution in the smallest newborns. Probiotics may be effective particularly in preterm newborns, newborns delivered via the cesarean section, and newborns who receive antibiotics. Actions important for preserving the microbiota include probiotic use, cautious use of empiric antibiotic therapy, and using natural formulas in all newborns.

Key words: intestinalmicrobiota, intestinaldysbiosis, Lactobacillus rhamnosus GG, probiotics, preterm newborn, natural formulas

  1. Olszewska J, Jagusztyn-Krynicka EK. Human Microbiome Project – Mikroflora jelit oraz jej wpływ na fizjologię i zdrowie człowieka. Postęp Mikrobiol 2012;51(4):243–256].
  2. DiBartolomeo ME, Claud EC. The developing microbiome of the preterm infant. Clin Ther 2016;38(4):733–739 [doi: 10.1016/j.clinthera.2016.02.003]].
  3. Faa G, Gerosa C, Fanni D, Nemolato S i wsp. Factors influencing the development of a personal tailored microbiota in the neonate, with particular emphasis on antibiotic therapy. J Matern Fetal Neonatal Med 2013;26(Suppl 2):35–43 [doi: 10.3109/14767058.2013.829700]].
  4. Goulet O. Potential role of the intestinal microbiota in programming health and disease: Figure 1. Nutr Rev 2015;73(suppl 1):32–40 [doi: 10.1093/nutrit/nuv039]].
  5. La Rosa PS, Warner BB, Zhou Y i wsp. Patterned progression of bacterial populations in the premature infant gut. Proc Natl Acad Sci 2014;111(34):12522–12527 [doi: 10.1073/pnas.1409497111]].
  6. Cao S, Feehley TJ, Nagler CR. The role of commensal bacteria in the regulation of sensitization to food allergens. FEBS Lett. 2014;588(22):4258–4266 [doi: 10.1016/j.febslet.2014.04.026]].
  7. Weng M, Walker WA. The role of gut microbiota in programming the immune phenotype. J Dev Orig Health Dis 2013;4(3):203–214 [doi: 10.1017/S2040174
  8. de Vos WM, de Vos EA. Role of the intestinal microbiome in health and disease: from correlation to causation. Nutr Rev 2012;70(Suppl. 1):S45–S56 [doi: 10.1111/j.1753-4887.2012.00505.x].
  9. Penders J, Thijs C, Vink C i wsp. Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 2006;118(2):511–521 [doi: 10.1542/peds.2005-2824]].
  10. DiGiulio DB. Diversity of microbes in amniotic fluid. Semin Fetal Neonatal Med. 2012;17(1):2–11 [doi: 10.1016/j.siny.2011.10.001].
  11. Aagaard K, Ma J, Antony KM, Ganu R i wsp. The placenta harbors a unique microbiome. Sci Transl Med 2014;6(237):237ra65-237ra65 [doi: 10.1126/scitranslmed.3008599].
  12. Bäckhed F, Roswall J, Peng Y i wsp. Dynamics and stabilization of the human gut microbiome during the first year of life. Cell Host Microbe. 2015;17(5):690–703 [doi: 10.1016/j.chom.2015.04.004].
  13. Dominguez-Bello MG, Costello EK, Contreras M i wsp. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci 2010;107(26):11971–11975 [doi: 10.1073/pnas.1002601107].
  14. Hill CJ, Lynch DB, Murphy K i wsp. Evolution of gut microbiota composition from birth to 24 weeks in the INFANTMET Cohort. Microbiome 2017;5(1):4 [doi: 10.1186/s40168-016-0213-y].
  15. Chu DM, Ma J, Prince A i wsp. Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery. Nat Med 2017;23(3):314–326 [doi: 10.1038/nm.4272].
  16. Pannaraj PS, Li F, Cerini C i wsp. Association between breast milk bacterial communities and establishment and development of the infant gut microbiome. JAMA Pediatr 2017;171(7):647 [doi: 10.1001/jamapediatrics.2017.0378].
  17. Chichlowski M, De Lartigue G, BruceGerman J i wsp. Bifidobacteria isolated from infants and cultured on human milk oligosaccharides affect intestinal epithelial function. J Pediatr Gastroenterol Nutr 2012;55(3):321–327 [doi: 10.1097/MPG.0b013e31824fb899].
  18. Yu ZT, Chen C, Newburg DS. Utilization of major fucosylated and sialylated human milk oligosaccharides by isolated human gut microbes. Glycobiology 2013;23(11):1281–92 [doi: 10.1093/glycob/cwt065]/
  19. Urbaniak C, Angelini M, Gloor GB i wsp. Human milk microbiota profiles in relation to birthing method, gestation and infant gender. Microbiome 2016;4(1):1 [doi: 10.1186/s40168-015-0145-y].
  20. Le Huërou-Luron I, Blat S, Boudry G. Breast- v. formula-feeding: Impacts on the digestive tract and immediate and long-term health effects. Nutr Res Rev 2010;23(1):23–36 [doi: 10.1017/S0954422410000065].
  21. Arboleya S, Sánchez B, Milani C i wsp. Intestinal microbiota development in preterm neonates and effect of perinatal antibiotics. J Pediatr 2015;166(3):538–544 [doi: 10.1016/j.jpeds.2014.09.041].
  22. Wang Y, Hoenig JD, Malin KJ i wsp. 16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enteroco litis. ISME J 2009;3(8):944–954 [doi: 10.1038/ismej.2009.37].
  23. Gregory KE, LaPlante RD, Shan G i wsp. Mode of birth influences preterm infant intestinal colonization with bacteroides over the early neonatal period. Adv Neonatal Care 2015;15(6):386–93 [doi: 10.1097/ANC.0000000000000237]
  24. Pammi M, Cope J, Tarr PI, i wsp. Intestinal dysbiosis in preterm infants preceding necrotizing enterocol itis: a systematic review and meta-analysis. Microbiome 2017;5(1):31 [doi: 10.1186/s40168-017-0248-8].
  25. Claud EC, Keegan KP, Brulc JM, i wsp. Bacterial community structure and functional contributions to emergence of health or necrotizing enteroc olitis in preterm infants. Microbiome 2013;1(1):20 [doi: 10.1186/2049-2618-1-20].
  26. Mai V, Young CM, Ukhanova M i wsp. Fecal microbiota in premature infants prior to necrotizing enteroco litis. Chakravortty D, ed. PLoSOne 2011;6(6):e20647 [doi: 10.1371/journal.pone.0020647].
  27. Hussey S, Wall R, Gruffman E i wsp. Parenteral antibiotics reduce bifidobacteria colonization and diversity in neonates. Int J Microbiol 2011;2011:1–6 [doi: 10.1155/2011/130574].
  28. Cotten CM, Taylor S, Stoll B i wsp. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enteroco litis and death for extremely low birth weight infants. Pediatrics 2009;123(1):58–66 [doi: 10.1542/peds.2007-3423].
  29. Stefka AT, Feehley T, Tripathi P i wsp. Commensal bacteria protect against food allergen sensitization. Proc Natl Acad Sci 2014;111(36):13145-13150 [doi: 10.1073/pnas.1412008111].
  30. Cox LM, Yamanishi S, Sohn J i wsp. Altering the intestinal microbiota during a critical developmental window has lasting metabolic consequences. Cell 2014;158(4):705–721 [doi: 10.1016/j.cell.2014.05.052].
  31. Hill C, Guarner F, Reid G i wsp. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11(8):506–514 [doi: 10.1038/nrgastro.2014.66].
  32. Cukrowska B. Znaczenie programowania mikrobiotycznego w rozwoju przewlekłych chorób nieinfekcyjnych. Standardy Medyczne. Pediatria 2016;13:1019–1028].
  33. Blázquez AB, Berin MC. Microbiome and food allergy. Transl Res 2017;179:199–203 [doi: 10.1016/j.trsl.2016.09.003].
  34. Jurkowski M, Błaszczyk M. Charakterystyka fizjologiczno-biochemiczna bakterii fermentacji mlekowej. KOSMOS Problemy Nauk Biologicznych 2012;61(3):493–504].
  35. Kolaček S, Hojsak I, BerniCanani R i wsp. Commercial probiotic products: A call for improved quality control. A Position Paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr 2017;65(1):117–124 [doi: 10.1097/MPG.0000000000001603].
  36. Ashraf R, Shah NP. Immune system stimulation by probiotic microorganisms. CritRev Food SciNutr 2014;54(7):938–956 [doi: 10.1080/10408398.2011.619671].
  37. Di Caro S, Tao H, Grillo A i wsp. Effects of Lactobacillus GG on genes expression pattern in small bowel mucosa. Dig Liver Dis 2005;37(5):320–329 [doi: 10.1016/j.dld.2004.12.008].
  38. Guarino A, Ashkenazi S, Gendrel D i wsp. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases. Evidence-based guidelines for the management of acute gastroenteritis in children in Europe. J Pediatr Gastroenterol Nutr 2014;59(1):132–152 [doi: 10.1097/MPG.0000000000000375].
  39. Szajewska H, Kołodziej M. Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults. Aliment Pharmacol Ther 2015;42(10):1149–1157 [doi: 10.1111/apt.13404].
  40. Szajewska H, Canani RB, Guarino A i wsp. Probiotics for the prevention of antibiotic-associated diarrhea in children. J Pediatr Gastroenterol Nutr 2016;62(3):495–506 [doi: 10.1097/MPG.0000000000001081].
  41. Hojsak I, Szajewska H, Canani RB i wsp. Probiotics for the prevention of nosocomial diarrhea in children. J Pediatr Gastroenterol Nutr 2018;66(1):3–9 [doi: 10.1097/MPG.0000000000001637].
  42. Deshpande GC, Rao SC, Keil AD i wsp. Evidence-based guidelines for use of probiotics in preterm neonates. BMC Med 2011;9:92 [doi: 10.1186/1741-7015-9-92].
  43. Elgin TG, Kern SL, McElroy SJ. Development of the neonatal intestinal microbiome and its association with necrotizing enteroco litis. Clin Ther 2016;38(4):706-715 [doi: 10.1016/j.clinthera.2016.01.005].
  44. Alfaleh K, Anabrees J. Probiotics for prevention of necrotizing enteroco litis in preterm infants. Evidence-Based Child Heal 2014;9(3):584-671 [doi: 10.1002/ebch.1976].
  45. Underwood MA. Impact of probiotics on necrotizing enteroco litis. Semin Perinatol 2017;41(1):41–51 [doi: 10.1053/j.semperi.2016.09.017].
  46. Parker R. Probiotic Guideline for necrotizing enteroco litis prevention in very low-birth-weight neonates. Adv Neonatal Care 2014;14(2):88–95 [doi: 10.1097/ANC.0000000000000043].
  47. Fernández-Carrocera LA, Solis-Herrera A, Cabanillas-Ayón M i wsp. Double-blind, randomised clinical assay to evaluate the efficacy of probiotics in preterm newborns weighing less than 1500 g in the prevention of necrotising enteroco litis. Arch Dis Child – Fetal Neonatal Ed 2013;98(1):F5–F9 [doi: 10.1136/archdischild-2011-300435].
  48. Stoll BJ, Hansen NI, Bell EF i wsp. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010;126(3):443–456 [doi: 10.1542/peds.2009-2959].
  49. Patole S. Probiotic supplementation for preterm neonates–What lies ahead? Nestle Nutr Inst Workshop Ser 2015;81:153–162 [doi: 10.1159/000365905].
  50. Bernardo WM, Aires FT, Carneiro RM, Sá FP de, Rullo VEV, Burns DA. Effectiveness of probiotics in the prophylaxis of necrotizing enteroco litis in preterm neonates: A systematic review and meta-analysis. J Pediatr 2013;89(1):18–24 [doi: 10.1016/j.jped.2013.02.004].
  51. Sadowska-Krawczenko I, Paprzycka M, Korbal P i wsp. Lactobacillus rhamnosus GG suspected infection in a newborn with intrauterine growth restriction. Benef Microbes 2014;5(4):397-402 [doi: 10.3920/BM2013.0074].
  52. Cabana MD, McKean M, Caughey AB i wsp. Early probiotic supplementation for eczema and asthma prevention: A randomized controlled trial. Pediatrics 2017;140(3):e20163000 [doi: 10.1542/peds.2016-3000].
  53. Durack J, Kimes NE, Lin DL i wsp. Delayed gut microbiota development in high-risk for asthma infants is temporarily modifiable by Lactobacillus supplementation. Nat Commun 2018;9(1):707 [doi: 10.1038/s41467-018-03157-4].
  54. Szajewska H, Chmielewska A. Growth of infants fed formula supplemented with Bifidobacterium lactis Bb12 or Lactobacillus GG: a systematic review of randomized controlled trials. BMC Pediatr 2013;13(1):185 [doi: 10.1186/1471-2431-13-185].
  55. Berni Canani R, Sangwan N, Stefka AT i wsp. Lactobacillus rhamnosus GG-supplemented formula expands butyrate-producing bacterial strains in food allergic infants. ISME J 2016;10(3):742–750 [doi: 10.1038/ismej.2015.151].
  56. Rautava S, Salminen S, Isolauri E. Specific probiotics in reducing the risk of acute infections in infancy–a randomised, double-blind, placebo-controlled study. Br J Nutr 2009;101(11):1722 [doi: 10.1017/S0007114508116282].
  57. Hojsak I, Snovak N, Abdović S, Szajewska H i wsp. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: A randomized, double-blind, placebo-controlled trial. Clin Nutr 2010;29(3):312–316 [doi: 10.1016/j.clnu.2009.09.008].
  58. Laursen RP, Larnkjær A, Ritz C i wsp. Probiotics and child care absence due to infections: a randomized controlled trial. Pediatrics 2017;140(2):e20170735 [doi: 10.1542/peds.2017-0735].

Nie zgłoszono.

MAVIPURO POLSKA Sp. z o.o.
ul. Wyspowa 2/13
03-687 Warszawa
Tel.: +48 22 110 03 81
Fax:   +48 22 378 28 51
e-mail: kontakt@mavipuro.pl

 

POLITYKA PRYWATNOŚCI