Probióticos, prebióticos y simbióticos en alergia y sus aplicaciones clínicas. Dr. Bruno Paes Barreto

1. 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

2. 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

3. LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
–Immune regulation
–Allergic Diseases
• Prevention
• Treatment

5. LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
–Immune regulation
–Allergic Diseases
• Prevention
• Treatment

7. HYGIENE HYPOTHESIS: PROPOSED CHANGES
ISOLAURI, 2010
PAST PRESENT TIME

9. “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

10. WHAT ARE THE
FUNCTIONS OF
INTESTINAL
MICROBIOTA?

11. FUNCTIONS OF INTESTINAL MICROBIOTA

14. • Due to the altered
microbiota, the child
becomes atopic?
• Being atopic, has
changed its
microbiota?

15. 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?

16. LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
–Immune regulation
–Allergic Diseases
• Prevention
• Treatment

17. FACTORS GOVERNING THE COLONIZATION AND
STABILITY OF INTESTINAL MICROBIOTA
Pediatria (São Paulo) 28 (2):117, 2006
INTESTINAL
IMMUNE
SYSTEM
IMMUNE
REGULATION

19. IMMUNOLOGY OF PREGNANCY
Th2 RESPONSE
PLACENTAL CELLS
Treg PROFILE
Th1 RESPONSE DECREASED

20. IMMUNOLOGY OF PREGNANCY
Th2 RESPONSE AMPLIFIED
Th1 RESPONSE GREATLY DECREASED
Early T cell development is different in allergic children?

21. “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

22. Microbiota/Probiotics
TLrs
Transcription
factors

23. • STp  peptide from Lactobacillus
• Stimulates IL-10 production by dendritic cells
• Absent in patients with IBD  biomarker for homeostasis
• Future: “Nutraceuticals products”

24. Stress X Immune Response
CORTISOL
ANXIETY
STRESS ↑RISK OF
INFECTIONIMMUNE RESPONSE
L. casei
defensis
↓RISK OF
INFECTION
Marcos, A. Eur J Nutr. 2004. 43: 381-9

25. LESSON PLAN
• Concepts
• Theoretical basis
• Clinical applicability
–Immune regulation
–Allergic Diseases
• Prevention
• Treatment

29. •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

30. • 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%

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

35. The gut microbiota shapes intestinal immune responses
during health and disease
June L. Round1 & Sarkis K. Mazmanian1
9, 313-323 (May 2009)

36. FACTORS THAT INFLUENCE THE
DEVELOPMENT OF ALLERGIC DISEASES
MUCOSAL/
EPITHELIAL
INTESTINAL
MICROBIOTA /
PROBIOTICS
NERVOUS
SYSTEM
IMMUNE
SYSTEM
GENETICSENVIRONMENT
MATERNAL-FETAL
INTERACTION
CLINICAL
EXPRESSION
OF THE
DISEASE
Kalliomaki et al. J Nutr. 2010; 140: 713s-721s
epigenetics

38. 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)

39. DID YOU EAT YOUR BACTERIA TODAY?
brunopaesbarreto@terra.com.br