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- W1977968008 abstract "This issue of The Journal provides pediatricians with novel insights on the role of a specific component of human milk, 2-linked fucosylated oligosaccharides (2-FOS) in the prevention of enteric infections.1.Morrow A.L. Ruiz-Palacios G.M. Altaye M. Jiang X. Guerrero M.L. Meinzen-Derr J.K. et al.J Pediatr. 2004; 145: 297-303Abstract Full Text Full Text PDF PubMed Scopus (339) Google Scholar Throughout the past several decades we have come to acknowledge the powerful evidence documenting significant benefits of human milk not only as a food supplying essential nutrients and energy, but also in the provision of cellular and humoral factors with significant anti-infective properties. This in part justifies the ruling of the global health authority (World Health Organization) calling for exclusive breast-feeding to 6 months of age as the optimal feeding for term infants. What is new about the report by Morrow et al in this issue of The Journal? First, to most of us oligosaccharides will sound like Greek, something you vaguely remember from the distant past, perhaps chemistry of sugars “101.” You are correct: oligo- is the Greek term for a few as opposed to poly-saccharides used for many sugar residues linked to form a molecule. Human milk oligosaccharides (HMOS) comprise the third largest solid component in mature human milk (12-14 g/L) after lactose and fat; there are more oligosaccharides than protein in breast milk.2.Kunz C. Rudloff S. Baier W. Klein N. Strobel S. Oligosaccharides in human milk: structural, functional, and metabolic aspects.Annu Rev Nutr. 2000; 20: 699-722Crossref PubMed Scopus (822) Google Scholar HMOS are resistant to digestion in the small intestine and are able to reach the colon intact. There they exert their effect directly by promoting the growth of specific microbial flora.3.Brand-Miller K.C. Mc Veagh P. McNeil Y. Messer M. Digestion of human milk oligosaccharides by healthy infants evaluated by the lactulose hydrogen breath test.J Pediatr. 1998; 133: 95-98Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar, 4.Wang B. Brand-Miller J. The role and potential of sialic acid in human nutrition.Eur J Clin Nutr. 2003; 57: 1351-1369Crossref PubMed Scopus (255) Google Scholar They can be absorbed and excreted in the urine and may protect from urinary tract infections. Indirectly they may also act through their fermentation, modifying colonic pH, generating substances that may affect colonic cells, gut-associated immune cells, and other bacteria. In contrast, cow's milk contains relatively minor amounts of oligosaccharides. The physiologic effects of oligosaccharides in the gut are related to their support of the growth of lactic acid-generating bacteria, a so-called “prebiotic” effect. This conditions an acid environment that prevents the growth of gram-negative and other potentially pathogenic bacteria (Figure). In addition, their secondary structure allows them to act as receptor analogues for cell-surface sites in the gut epithelium, preventing the adhesion of microbes to the gut mucosa. Human milk-fed infants have a characteristic predominance of bifidobacteria species that generate lactic acid and acetate, which protect the enterocyte from pathogens and may contribute to mucosal integrity. Sugar-containing amino compounds such as N-acetyl glucosamine (NAcGl) oligosaccharides are important cell wall components for bifidobacteria.2.Kunz C. Rudloff S. Baier W. Klein N. Strobel S. Oligosaccharides in human milk: structural, functional, and metabolic aspects.Annu Rev Nutr. 2000; 20: 699-722Crossref PubMed Scopus (822) Google Scholar Recent evidence in mice indicates that there are specific fucosylated oligosaccharides (FOS) generated during gut development that contribute to selecting the bacterial flora during early colonization by promoting their growth or attachment to the colon.3.Brand-Miller K.C. Mc Veagh P. McNeil Y. Messer M. Digestion of human milk oligosaccharides by healthy infants evaluated by the lactulose hydrogen breath test.J Pediatr. 1998; 133: 95-98Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar, 4.Wang B. Brand-Miller J. The role and potential of sialic acid in human nutrition.Eur J Clin Nutr. 2003; 57: 1351-1369Crossref PubMed Scopus (255) Google Scholar, 5.Nanthakumar N.N. Dai D. Newburg D.S. Walker W.A. The role of indigenous microflora in the development of murine intestinal fucosyl- and sialyltransferases.FASEB J. 2003; 17: 44-46PubMed Google Scholar It is likely that HMOS are partly responsible for the bifidus factor studied by Gyorgy some years ago.6.Gyorgy P. Jeanloz R.W. Von Nicolai H. Zilliken F. Undialyzable growth factors for Lactobacillus bifidus var. Pennsylvanicus.Eur J Biochem. 1974; 43: 29-33Crossref PubMed Scopus (72) Google Scholar The complex chemical nature of the hundreds of oligosaccharides present in human milk is determined by the combination of glucose, galactose, fucose, NAcGl, and sialic acid in their oligosaccharide chains. These are commonly 5 to 8 units long but may contain as many as 30 or more sugar residues. Most HMOS have a lactose unit at the reducing end and commonly contain variable fucose residues at the nonreducing end of the sugar.2.Kunz C. Rudloff S. Baier W. Klein N. Strobel S. Oligosaccharides in human milk: structural, functional, and metabolic aspects.Annu Rev Nutr. 2000; 20: 699-722Crossref PubMed Scopus (822) Google Scholar What is the truly novel discovery and its potential significant implications? 2-FOS are indeed fascinating compounds. 2-FOS have an alpha 1,2 linkage catalyzed by a fucosyltransferase (Se FUT2). This enzyme is coded by the secretor blood group type gene, whereas other Se FUT2s are coded by the Lewis and related blood type genes.1.Morrow A.L. Ruiz-Palacios G.M. Altaye M. Jiang X. Guerrero M.L. Meinzen-Derr J.K. et al.J Pediatr. 2004; 145: 297-303Abstract Full Text Full Text PDF PubMed Scopus (339) Google Scholar, 7.Newburg D.S. Ruiz-Palacios G.M. Altaye M. Chaturvedi P. et al.Innate protection conferred by fucosylated oligosaccharides of human milk against diarrhea in breast fed infants.Glycobiology. 2004; 14: 253-263Crossref PubMed Scopus (196) Google Scholar This knowledge led to the demonstration that the FOS composition of human milk is linked to blood group subtype. In addition, the content of 2-FOS in human milk varies in accordance with the expression of specific genetic polymorphisms of the Se FUT2 gene.7.Newburg D.S. Ruiz-Palacios G.M. Altaye M. Chaturvedi P. et al.Innate protection conferred by fucosylated oligosaccharides of human milk against diarrhea in breast fed infants.Glycobiology. 2004; 14: 253-263Crossref PubMed Scopus (196) Google Scholar In parallel studies using in vitro models, the authors demonstrated that specific viral and bacterial antigen binding to host cells could be inhibited by 2-FOS, leading them to question whether human milk 2-FOS content was associated with the capacity of human milk to prevent specific infections.8.Ruiz-Palacios G.M. Cervantes L.E. Ramos P. Chavez-Munguia B. Newburg D.S. Campylobacter jejuni binds intestinal H(O) antigen (Fuc alpha 1, 2Gal beta 1, 4GlcNAc), and fucosyloligosaccharides of human milk inhibit its binding and infection.J Biol Chem. 2003; 278: 14112-14120Crossref PubMed Scopus (468) Google Scholar The availability of breast milk samples from previous field studies that monitored incidence of diarrheal disease allowed them to verify that a higher ratio of 2-FOS relative to other human milk FOS, was associated with a lower risk of symptomatic infection with enterotoxigenic Escherichia coli in breast-fed infants.7.Newburg D.S. Ruiz-Palacios G.M. Altaye M. Chaturvedi P. et al.Innate protection conferred by fucosylated oligosaccharides of human milk against diarrhea in breast fed infants.Glycobiology. 2004; 14: 253-263Crossref PubMed Scopus (196) Google Scholar The findings reported in this issue of The Journal, based on banked human milk samples from 93 breast-feeding mother-infant pairs followed prospectively from birth to up to 2 years of age, indicate that human milk 2-FOS provide significant and clinically relevant protection against diarrhea. Moderate to severe diarrhea occurred less often in infants receiving human milk with a high 2-FOS to total-oligosaccharides ratio. Microbe-specific protective effects were observed for Campylobacter and calicivirus diarrheal episodes.1.Morrow A.L. Ruiz-Palacios G.M. Altaye M. Jiang X. Guerrero M.L. Meinzen-Derr J.K. et al.J Pediatr. 2004; 145: 297-303Abstract Full Text Full Text PDF PubMed Scopus (339) Google Scholar These data suggest that genetic selection of populations, based on polymorphisms linked to blood group types, may in part explain the differences in 2-FOS content of human milk. Infection was and still is a potential major selective force in human evolution. If human milk 2-FOS confer selective advantage to infants from mothers with specific polymorphisms, we would move from random assortment of sugar residues to selection of specific sugar residues, based on their capacity to act as decoys and prevent microbial binding to enteric attachment sites. The protective inhibition of binding by human milk FOS has also been observed for bacterial (Streptococcus pneumonia and Haemophilus influenzae) binding to pharyngeal and buccal epithelial cells. The published evidence indicates that specific HMOS have the capacity to act as analogs to prevent binding of given pathogens to cell membrane receptors.7.Newburg D.S. Ruiz-Palacios G.M. Altaye M. Chaturvedi P. et al.Innate protection conferred by fucosylated oligosaccharides of human milk against diarrhea in breast fed infants.Glycobiology. 2004; 14: 253-263Crossref PubMed Scopus (196) Google Scholar The current list of microbes includes several subspecies of pathogenic E coli, Helicobacter pylori, Candida albicans, Pseudomonas aeruginosa, S pneumoniae, H influenzae, Mycoplasma pneumoniae, and Influenza virus A, B, and C.9.Newburg D.S. Human milk glycoconjugates that inhibit pathogens.Curr Med Chem. 1999; 6: 117-127PubMed Google Scholar Clinical evaluation of prebiotics has been limited to documentation of the effects on colonic flora and stool characteristics. Moro et al tested two formulas supplemented with either 0.4 g/dL or with 0.8 g/dL oligosaccharides (mixed galactose and fructose oligosaccharides compared with a maltodextrin placebo group). The authors observed a dose-dependent enhancement of the growth of bifidobacteria and Lactobacilli in the intestine, resulting in softer stool with increasing dosage of supplementation.10.Moro G. Minoli I. Mosca M. Fanaro S. Jelinek J. Stahl B. Boehm G.J. Dosage-related bifidogenic effects of galacto- and fructooligosaccharides in formula-fed term infants.Pediatr Gastroenterol Nutr. 2002; 34: 291-295Crossref PubMed Scopus (408) Google Scholar Boehm et al studied preterm infants with a mixture of 90% galactose-oligosaccharides and 10% fructose-oligosaccharides. They reported an enhanced growth of bifidobacteria, as well as more frequent and softer stools.11.Boehm G. Fanaro S. Jelinek J. Stahl B. Marini A. Prebiotic concept for infant nutrition.Acta Paediatr. 2003; 91: 64-67Google Scholar The scant data on prebiotics is in contrast to the systematic assessment of probiotics which have yielded significant clinical benefits in terms of incidence and duration of diarrheal episodes. The study published in The Journal is the first report of clinically relevant beneficial outcomes of prebiotics in a field setting.1.Morrow A.L. Ruiz-Palacios G.M. Altaye M. Jiang X. Guerrero M.L. Meinzen-Derr J.K. et al.J Pediatr. 2004; 145: 297-303Abstract Full Text Full Text PDF PubMed Scopus (339) Google Scholar Although not truly a randomized trial, this study provides strong evidence in support of the protective effect of 2-FOS for diarrheal disease. This report will likely reactivate interest in research in prebiotics and their anti-infective effects. The possibility was raised more than a decade ago of preventing enteric infections such as rotavirus diarrhea and systemic infections such as HIV/AIDS by blocking pathogen adhesion to the intestinal cells by glycoproteins and glycosaminoglycan present in human milk.12.Yolken R.H. Peterson J.A. Vonderfecht S.L. Fouts E.T. Midthun K. Newburg D.S. Human milk mucin inhibits rotavirus replication and prevents experimental gastroenteritis.J Clin Invest. 1992; 90: 1984-1991Crossref PubMed Scopus (273) Google Scholar, 13.Newburg D.S. Viscidi R.P. Ruff A. Yolken R.H. A human milk factor inhibits binding of human immunodeficiency virus to the CD4 receptor.Pediatr Res. 1992; 31: 22-28Crossref PubMed Scopus (78) Google Scholar Perhaps with new knowledge and the tools of biotechnology designer-constructed oligosaccharides, we may fulfill the promise of preventing these epidemics that affect children worldwide. The addition of these compounds to infant formula when breast-feeding is not possible, and providing a microbe-specific oligosaccharides cocktail as a daily supplement constitutes a challenge for the future." @default.
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- W1977968008 title "Novel oligosaccharides in human milk: understanding mechanisms may lead to better prevention of enteric and other infections" @default.
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