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Part 1 - Bacteria, Breast-feeding, and CD

The recent work with the common gut bacteria, Bacteriodes thetaiotaomicron,
at Washington University School of Medicine in St. Louis has revealed just
the tip of the iceberg in a whole new world of understanding the important
symbiotic relationship between intestinal microflora and the gut.
(See "Gut Check", below.)  Such gut microbes may be critical to the health
and development of newborns and may be equally important to the health of
adults.  B. thetaiotaomicron has been shown to play a significant role in
natal development of intestinal blood vessels, in the ability of the
intestine to synthesize fructose, and in enabling Paneth cells of the
intestine to produce antimicrobial defense chemicals.  B. thetaiotaomicron
actually controls and affects the activity of genes within the host's
cells.  But B. thetaiotaomicron is merely one of a myriad of microbes which
colonize the gut.  What symbiotic roles in the development and health of
human beings do these many other microbes play?

Breast-feeding has long been thought to delay or reduce the risk of
developing celiac disease in children.  This effect has been attributed to
a number of potentially protective milk components and antibodies passed
from the mother.  Recent research shows that breast milk also passes
bacterial flora from mother to newborn.  The possibility that these
microflora play critical symbiotic roles in the development of the
intestine and its immunological functions has not yet been considered as a
factor in the onset of celiac disease.  Perhaps it may some day be possible
to isolate a particular microbe which when given to infants as a probiotic
will prevent CD from ever occuring.  And the onset of CD in adults, later
in life, might be explained as the result of a disruption of specific
symbiotic microflora which had been protecting the gut from the effects of
gluten... possibly triggered by an illness, use of antibiotics or drugs,
stress, or pregnancy.  Again, a probiotic of a specifically identified
symbiotic microbe might protect adults from developing CD.

These are exciting times, and there is much research yet to be done.

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Science News Online - May 31, 2003; Vol. 163, No. 22

Gut Check: The bacteria in your intestines are welcome guests
John Travis

http://www.sciencenews.org/20030531/bob9.asp

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J Pediatr. 2003 Dec;143(6):754-8

Human milk is a source of lactic acid bacteria for the infant gut.

Martin R, Langa S, Reviriego C, Jiminez E, Marin ML, Xaus J, Fernandez L,
Rodriguez JM.

Departament of Nutricion y Bromatologia III, Universidad Complutense de
Madrid, Madrid, Spain.

OBJECTIVES: To investigate whether human breast milk contains potentially
probiotic lactic acid bacteria, and therefore, whether it can be considered
a synbiotic food.Study design Lactic acid bacteria were isolated from milk,
mammary areola, and breast skin of eight healthy mothers and oral swabs and
feces of their respective breast-fed infants. Some isolates (178 from each
mother and newborn pair) were randomly selected and submitted to randomly
amplified polymorphic DNA (RAPD) polymerase chain reaction analysis, and
those that displayed identical RAPD patterns were identified by 16S rDNA
sequencing. RESULTS: Within each mother and newborn pair, some rod-shaped
lactic acid bacteria isolated from mammary areola, breast milk, and infant
oral swabs and feces displayed identical RAPD profiles. All of them,
independently from the mother and child pair, were identified as
Lactobacillus gasseri. Similarly, among coccoid lactic acid bacteria from
these different sources, some shared an identical RAPD pattern and were
identified as Enterococcus faecium. In contrast, none of the lactic acid
bacteria isolated from breast skin shared RAPD profiles with lactic acid
bacteria of the other sources. CONCLUSIONS: Breast-feeding can be a
significant source of lactic acid bacteria to the infant gut. Lactic acid
bacteria present in milk may have an endogenous origin and may not be the
result of contamination from the surrounding breast skin.

PMID: 14657823 [PubMed - indexed for MEDLINE]

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Acta Paediatr Suppl. 2003 Sep;91(441):48-55

Intestinal microflora in early infancy: composition and development.

Fanaro S, Chierici R, Guerrini P, Vigi V.

Department of Clinical and Experimental Medicine, Division of Neonatology
and Neonatal Intensive Care Unit, University of Ferrara, Italy.
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The neonatal intestinal microbiota is a complex ecosystem composed of
numerous genera, species and strains of bacteria. This enormous cell mass
performs a variety of unique activities that affect both the colonic and
systemic physiology. Its primary activities include nutritive, metabolic,
immunological and protective functions. Most studies of infants have been
based on faecal samples using the classical plating techniques with
culturing on specific media. The limitations of these methods must be taken
into account when evaluating the varying results of the different studies.
The establishment of the gut microbial population is not strictly a
succession in the ecological sense; it is rather a complex process
influenced by microbial and host interactions and by external and internal
factors. The climax intestinal flora is attained in successive stages. The
foetal intestine is sterile and bathed in swallowed amniotic fluid.
Following delivery, multiple different antigens challenge the intestine of
the newborn. The maternal intestinal flora is a source of bacteria for the
neonatal gut. The bacterial flora is usually heterogeneous during the first
few days of life, independently of feeding habits. After the first week of
life, a stable bacterial flora is usually established. In full-term infants
a diet of breast milk induces the development of a flora rich in
Bifidobacterium spp. Other obligate anaerobes, such as Clostridium spp. and
Bacteroides spp., are more rarely isolated and also enterobacteria and
enterococci are relatively few. During the corresponding period, formula-
fed babies are often colonized by other anaerobes in addition to
bifidobacteria and by facultatively anaerobic bacteria; the development of
a "bifidus flora" is unusual. In other studies the presence of a consistent
number of bifidobacteria in infants delivered in large urban hospitals has
not been demonstrated, whether the babies were bottle fed or exclusively
breastfed. The predominant faecal bacteria were coliforms and bacteroides.
According to these studies, environmental factors may be more important
than breastfeeding in gut colonization after delivery. Environmental
factors are indeed extremely important for the intestinal colonization of
infants born by caesarean section. In these infants, the establishment of a
stable flora characterized by a low incidence of Bacteroides spp. and by
the isolation of few other bacteria is consistently delayed. In extremely
low-birthweight infants, hospitalization in neonatal intensive care units,
characterized by prolonged antibiotic therapy, parenteral nutrition,
delayed oral feedings and intubation seems to affect the composition of the
intestinal microbiota. The gut is colonized by a small number of bacterial
species; Lactobacillus and Bifidobacteria spp. are seldom, if ever,
identified. According to the few studies so far performed, the predominant
species are Enterococcus faecalis, E. coli, Enterobacter cloacae,
Klebsiella pneumoniae, Staphylococcus epidermidis and Staphylococcus
haemolyticus. Hygienic conditions and antimicrobial procedures strongly
influence the intestinal colonization pattern.

PMID: 14599042 [PubMed - in process]

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Continued in Part 2

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