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Intestinal Microbiome: Functional Aspects in Health and Disease Nestlé Nutrition Institute Workshop Series

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Intestinal Microbiome: Functional Aspects in Health and Disease Nestlé Nutrition Institute Workshop Series Intestinal Microbiome: Functional Aspects in Health and Disease Nestlé Nutrition Institute Workshop Series Vol. 88 Intestinal Microbiome: Functional Aspects in Health and Disease Editors Erika Isolauri Turku Philip M. Sherman Toronto, ON W. Allan Walker Charlestown, MA Nestec Ltd., 55 Avenue Nestlé, CH–1800 Vevey (Switzerland) S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) www.karger.com Library of Congress Cataloging-in-Publication Data Names: Nestlé Nutrition Workshop (88th : 2016 : Playa del Carmen, Mexico), author. | Isolauri, Erika, editor. | Sherman, Philip M., editor. | Walker, W. Allan, editor. Title: Intestinal microbiome : functional aspects in health and disease / editors, Erika Isolauri, Philip M. Sherman, W. Allan Walker. Description: Basel ; New York : Karger, [2017] | Series: Nestlé Nutrition Institute workshop series, ISSN 1664-2147 ; vol. 88 | Includes bibliographical references and index. Identifiers: LCCN 2017010377| ISBN 9783318060300 (hard cover : alk. paper) | ISBN 9783318060317 (electronic version) Subjects: | MESH: Gastrointestinal Microbiome--physiology | Fetal Development | Infant | Intestines--microbiology | Congresses Classification: LCC RC816 | NLM WI 102 | DDC 616.3/3--dc23 LC record available at https://lccn.loc.gov/2017010377 The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived. Great care has been taken to maintain the accuracy of the information contained in the volume. However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for any consequences arising from the use of the information contained herein. © 2017 Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher. Printed on acid-free and non-aging paper (ISO 9706) ISBN 978–3–318–06030–0 e-ISBN 978–3–318–06031–7 ISSN 1664–2147 e-ISSN 1664–2155 Basel · Freiburg · Paris · London · New York · Chennai · New Delhi · Bangkok · Beijing · Shanghai · Tokyo · Kuala Lumpur · Singapore · Sydney Contents VII Preface IX Foreword XI Contributors Evolution of Human Microbiota 1 The Pregnancy Microbiome Neuman, H.; Koren, O. (Israel) 11 Microbial Composition of the Initial Colonization of Newborns Rautava, S. (Finland) 23 Bacterial Colonization of the Newborn Gut, Immune Development, and Prevention of Disease Walker, W.A. (USA) 35 Epigenetics in Gastrointestinal Health and Disease: Spotlight on DNA Methylation in the Intestinal Epithelium Zilbauer, M.; Kraiczy, J. (UK) 45 Gut-Brain Axis and Behavior Martin, C.R.; Mayer, E.A. (USA) 55 Summary of Evolution of Human Microbiota Walker, W.A. (USA) Normal Development of Gut Microbiota and Dysbiosis 57 Dysbiosis in the Neonatal Period: Role of Cesarean Section Neu, J. (USA) 67 Early-Life Antibiotic Exposure, Gut Microbiota Development, and Predisposition to Obesity Azad, M.B. (Canada); Moossavi, S. (Canada/Iran); Owora, A. (Canada/USA); Sepehri, S. (Canada) 81 Microbiota and Necrotizing Enterocolitis Patole, S. (Australia) V 95 Microbiota and Obesity Isolauri, E. (Finland) 107 Microbiota in Functional Gastrointestinal Disorders in Infancy: Implications for Management Abrahamsson, T.R. (Sweden); Wu, R.Y.; Sherman, P.M. (Canada) 117 Diet and Gut Microbiota in Health and Disease Shen, T.-C.D. (USA) 127 Summary of Normal Development of Gut Microbiota and Dysbiosis Isolauri, E. (Finland) Human Milk Oligosaccharides 129 Enzymes in Human Milk Dallas, D.C.; German, J.B. (USA) 137 Compositional Analysis and Metabolism of Human Milk Oligosaccharides in Infants Kunz, C.; Rudloff, S. (Germany) 149 Differential Establishment of Bifidobacteria in the Breastfed Infant Gut Lewis, Z.T.; Mills, D.A. (USA) 161 Regulatory Aspects of Human Milk Oligosaccharides Salminen, S. (Finland) 171 Summary on Human Milk Oligosaccharides Sherman, P.M. (Canada) 173 Subject Index For more information on related publications, please consult the NNI website: www.nestlenutrition-institute.org VI Contents Preface Over the last decade, major attention in clinical research has been focused on the importance of the intestinal microbiome in health and disease. This is of par- ticular importance during the first thousand days of life (from conception until 2 years of age) when the newborn infant has to adjust to the extrauterine envi- ronment. It is now apparent that exposure to microbes in utero represents an important initial impact on fetal development, in part through epigenetic pro- cesses. The nature of the pregnant mother’s health impacts on the fetus through microbiota in the maternal gut entering the blood stream and traversing through the placenta to access the amniotic fluid. The mother’s intestinal microbiome changes during pregnancy, particularly during the third trimester, principally under hormonal influences. This also has an impact on fetal microbial exposure. The nature of delivery (cesarean section vs. vaginal delivery) and perinatal antibiotic treatment can influence initial mi- crobial colonization and the development of appropriate intestinal defense mechanisms which, in turn, can affect the expression of disease (e.g., allergy, autoimmune disease, and brain function) later in life. Current research is under- way to determine whether the microbiota or metabolic changes are primary, causative factors in the complex interrelationships. As mentioned, modification of the intrauterine environment can affect fetal development. We now know that microbes and their metabolites can influence fetal development by epigenetic mechanisms. The nature of initial colonization influences newborn infants at a time when the newborn is developing defenses. Appropriate colonization is associated with healthy immune defense mecha- nisms, whereas inappropriate colonization (dysbiosis) can result in immune- mediated disease in later life. Diseases associated with dysbiosis at birth include necrotizing enterocolitis, obesity, allergy, functional bowel disorders, and im- paired mental health. An important environmental factor influencing the nature of colonization is diet. At no time in life is diet more important than during the colonization that VII is part of the postpartum period. Exclusive breast feeding for 4–6 months in con- junction with full-term vaginal delivery without antibiotics is the ideal setting for normal initial bacterial colonization and appropriate development of host defenses. Oligosaccharides contained in human breast milk (nondigestible com- plex carbohydrates) have a profound effect on intestinal microbiota and their metabolites. These major constituents of breast milk provide nutrition for the stimulation of health by promoting bacteria and release of short-chain fatty ac- ids as well as other metabolites which can influence immune function towards immune homeostasis, including the development of tolerance to innocuous an- tigens and commensal bacteria. These complex carbohydrates can also interact with pathogenic bacteria and viruses within the intestine to prevent disease and have a direct impact on enterocyte and lymphocyte responses to microbial inva- sion. In this Nestlé Workshop, the importance of microbiota in the setting of both health and disease has been addressed. Erika Isolauri Philip M. Sherman W. Allan Walker VIII Isolauri · Sherman · Walker Foreword The importance and role of gut microbiota in human health and disease are top- ics attracting research interest and attention in clinical practice during the last decades. A large number of bacteria and microbes invade the infant’s gut during the first days and weeks of their life. Neonatal gut microbiota establishment rep- resents a crucial stage in gut maturation and metabolic and immunologic pro- gramming, and, consequently, affects the short- and long-term health status. The 88th Nestlé Nutrition Institute Workshop entitled “Intestinal Microbi- ome: Functional Aspects in Health and Disease” was held in Playa del Carmen (Mexico) on September 22–25, 2016. We have chosen an incredible international faculty led by distinguished Chairmen: Prof. W. Allan Walker (Conrad Taff Professor of Nutrition and Pe- diatrics, Harvard Medical School, USA); Prof. Erika Isolauri (Head of the De- partment of Clinical Medicine, University of Turku, Finland); and Prof. Philip M. Sherman (Hospital for Sick Children, University of Toronto, Canada). The first session on the Evolution of human microbiota, chaired by Prof. W. Allan Walker , was focused on the development of the human microbiome and the importance of normal colonization of the newborn gut in immune de- velopment and disease prevention. The speakers have presented available scien- tific data supporting a role of microbial changes during pregnancy and infancy for a healthy start in life. Special focus was given to existing evidence of environ- mental factors (e.g. diet, nutrition, and infections) on human health and epigen- etic mechanisms which could provide a plausible framework for the develop- ment of many multifactorial diseases, including inflammatory bowel disease. The session has also illuminated a crucial role of the gut microbiota in bidirec- tional brain-gut interactions and the potential role of the brain-gut axis in influ- encing health
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