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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
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
I certify that all my affiliations with or without financial involvement in any organization or entity with respect to the subject matter or materials discussed, are fully expressed below:
DISCLOSURES/2012
Advisory Board – Probiotics • Danone • Sanofi-Aventis
Speaker • Mantecorp-Farmasa • Takeda
LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
– Immune regulation
–Allergic Diseases
• Prevention
• Treatment
LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
– Immune regulation
–Allergic Diseases
• Prevention
• Treatment
HYGIENE HYPOTHESIS: PROPOSED CHANGES
ISOLAURI, 2010 PAST PRESENT TIME
“WE ARE MORE HUMAN OR MORE BACTERIA?”
100 trillion
Genome 10x greater than the human
Metabolic capacity equal to the liver
Different strains
Inter-species communication with the host
Consume, store and distribute energy
Mediate physiologically important chemical transformations
Self-maintenance and self-repair by means of self-replication
WHAT ARE THE FUNCTIONS OF INTESTINAL MICROBIOTA?
FUNCTIONS OF INTESTINAL MICROBIOTA
• Due to the altered microbiota, the child becomes atopic?
• Being atopic, has changed its
microbiota?
Does the use of pre, pro or
symbiotics in childhood or even
early in pregnancy could favor a
process of immune regulation
and less development of
chronic inflammatory (allergic
or autoimmune) diseases?
LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
– Immune regulation
–Allergic Diseases
• Prevention
• Treatment
FACTORS GOVERNING THE COLONIZATION AND STABILITY OF INTESTINAL MICROBIOTA
Pediatria (São Paulo) 28 (2):117, 2006
INTESTINAL IMMUNE SYSTEM
IMMUNE REGULATION
IMMUNOLOGY OF PREGNANCY
Th2 RESPONSE
PLACENTAL CELLS Treg PROFILE
Th1 RESPONSE DECREASED
IMMUNOLOGY OF PREGNANCY
Th2 RESPONSE AMPLIFIED
Th1 RESPONSE GREATLY DECREASED
Early T cell development is different in allergic children?
“We don’t yet know what
is causing these differences,
but these works confirmed that
abnormal immune development
begins much earlier than previously
suspected, and even before birth”
Susan Prescott
Microbiota/Probiotics
TLrs
Transcription factors
• STp peptide from Lactobacillus
• Stimulates IL-10 production by dendritic cells
• Absent in patients with IBD biomarker for homeostasis
• Future: “Nutraceuticals products”
Stress X Immune Response
CORTISOL
ANXIETY
STRESS ↑RISK OF INFECTION IMMUNE RESPONSE
L. casei defensis
↓RISK OF INFECTION
Marcos, A. Eur J Nutr. 2004. 43: 381-9
LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
– Immune regulation
–Allergic Diseases
• Prevention
• Treatment
•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
• 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%
• Rhinitis group: number of episodes/year • Intervenction: 3.2 (2.4-4.1) • Control: 4.8 (3.5-6.1) • Difference: 1.6 episode/year (p=0,04)
• Time for immune modulation? • End point (ns)
• loss of adherence? • 80%59,9% • 80%68%
N=187 (92 i/95 c) Age: 2-5 years
The gut microbiota shapes intestinal immune responses during health and disease June L. Round1 & Sarkis K. Mazmanian1
9, 313-323 (May 2009)
FACTORS THAT INFLUENCE THE DEVELOPMENT OF ALLERGIC DISEASES
MUCOSAL/EPITHELIAL
INTESTINAL MICROBIOTA /
PROBIOTICS
NERVOUS SYSTEM
IMMUNE SYSTEM
GENETICS ENVIRONMENT
MATERNAL-FETAL INTERACTION
CLINICAL EXPRESSION
OF THE DISEASE
Kalliomaki et al. J Nutr. 2010; 140: 713s-721s
epigenetics
Twentieth century was of Antibiotics 506,706 publications (8% Reviews)
Rijkers GT et al. J. Nutr (2010), 140: 671S- 676S
Bacillus Lactobacillus
Bifidobacterias Saccharomyces (Fungus)
XXI Century is of Probiotics 15,466 (28% Reviews)
