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Milk Microbiome and Neonatal Colonization: overview
Samuli Rautava
Tuesday, Sept. 24, 2019 · 9:04 a.m. · 52m 14s
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00:00:01
oh
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good morning in fact your remote for the nice introduction or whatever it's in order
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and pleasure to be here thank you i will also like to thank the organisers
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and it is my task to give an overview of the milk micro by
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on an unit localisation and the current state of knowledge as i see it
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what i will be talking about since i'm a physician that will begin with l.
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breastfeeding an elf infant got mike about breastfeeding an elephant those are topics
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we have already covered but i can't help but mention goes a son
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as an uh an introduction to the human milk micro bile
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what we know about its composition origin we will have separate talks about those but
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i'll i'll touch on that uh the last part of my talk is what we
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know about the significance of it shouldn't know quite go by on to infant got
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colour station and i can reveal at this point that we actually know precious little
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and what we know about the clinical significance of the milk like abound
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we know it less and perhaps some ideas for future research
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they're so there's only four buttons
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okay well i know i'm preaching to the choir here telling you that breast feeding
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is probably one of the most important interventionist
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see uh improve infant health are so beautiful
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a grin the last a couple years ago which are recommends
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everybody has seen it doctor hustled alluded to this already uh yesterday
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and based on the paper and based on the at at niles is in the paper it's been estimated that the risk
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of death of an exclusively breastfed infant is only twelve percent
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of that away form the fat infant in the developing world
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it's been estimated that breastfeeding could we could read and prevent about half
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of all die real disease and about one third of all respiratory infections
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and consequently breast feeding exclusive breastfeeding could
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save more than eight hundred thousand lives annually
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so it's really a the perfect intervention we have at our disposal
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and these results are actually kind of easy to understand we what we
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heard beautiful spirit talks yesterday about the protective molecules in in human male
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so protection from a infections during breastfeeding
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is probably largely mediated by those protective factors
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i think it's also safe to say that in many parts of the world an infant
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to sex kills you press that is not exposed to contaminated water to the extent that
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the uh form look at infant might be so that might
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be a simple a simple mediating factor us well however what is
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perhaps more interesting and more a baffling is the long term health impact the breast feeding
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it's been estimated that the risk of overweight and obesity is about one fifth
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a smaller in infants who have been at breast fed in in later life
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it's been estimated that breastfeeding could prevent about one third of all cases of to the type two diabetes
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which becomes manifest that at the age we start to
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gain weight and become middle aged so much later than breast
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there's no data on a a supporting the notion that breastfeeding might actually have any impact of
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either a metabolic manifestations such as hypertension or dislike between yeah
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it's interesting that breastfeeding has been linked to reduce risk of the key me a reduced risk of type one diabetes
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the jury is still out in terms of asked monday topic permits
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antitrust analogies we heard beautiful talks yesterday there's some uh suggestion about
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breastfeeding having a an association with the risk of a autistic spectrum disease
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an inflammatory bowel disease but these are very very difficult things to study
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the diseases become manifest much longer so we need long followup times and as we all know it's
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both practically energetically impossible to do randomised trials with breast feeding so we are
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we have to rely on operational data which is confounded after confounding in terms of obesity
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we know that the most important risk factor for childhood obesity is having an obese mom
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we know that obese moms tend to breastfeed less i shorter periods of time they tend to
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give birth by alexis elective c. section they pass on their microbiology back pass on their uh
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directory have it so it's really difficult to tease out what
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the impact of a breast feeding might be into the whole context
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we heard yesterday that breast milk contains live
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cells any monetary molecules that might might program
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or module late union maturation in the infant and that's a hobby area of of um
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research but it's very very difficult to tease out what molecules are important
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and which models that play a role in terms of any given disease
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it's also important to note that breast feeding is not a controlled substance in the sense that we don't differ moms have
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abreast not concrete that breast milk is different from at different stages a lactation but we also know that
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different conditions maternal uh characteristics have an impact on
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the content of breast milk we know that allergic moms had different in you might different
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new molecule concentrations in their breast milk and non allergic moms so it's pretty much a mess
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so that's what i'm concentrating a simple thing they got my at that michael by uh which is actually by no means simple
00:06:07
we know uh and what i find really interesting that the got micro by on has
00:06:12
been related to the development a lot of a chronic diseases later like you later in life
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there's a list that kind of resembles the diseases that had been linked to breast feeding there's
00:06:24
a topic disease all b. c. d. and it's called more but it might be more abilities
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neckties in a enter clyde is which is important for me uh simulates how it just
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but also chronic inflammatory disease like infantry bell disease
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uh type one diabetes some years like a psychiatric uh disorders
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no have not showing that they got mike about uh in
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a person with a disease or disorder is different from got
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mike about uh from uh in a person who doesn't have the disorder is a long way from somewhere showing any causal
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relationship between the two and what i find more interesting is the study showing that
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very early life got like about that is already already
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different in in individuals later to develop disorders and diseases like
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o. b. c. d. overweight a topic disease and we're getting more
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more uh studies like that and it is and we need studies like
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and they need to be combined with a more mechanistic reductionist animal and uh the board tree models
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but anyway there seems to be a connection with that like a
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banana and chronic disease and there seems to be a a connection with
00:07:33
breastfeeding and chronic disease so we have to see connections maybe they are the same connection to some
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point well as we all know the breast feeding has an impact on the got mike about it
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there's a graph from our swedish friends from a few years back showing the got michael by the development in
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inference to the first twenty four months of life on very droll filing level and we see
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these huge changes taking place in that mike about a composition especially during the first months of life
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which coincide with breast feeding the introduction of solid foods and withdraw breast
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there there was a beautiful study nature last year from
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the teddy study showing that actually exposure to breast milk
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is the most important determinant of got mike about a composition in infancy
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an interesting ways actually the cessation of breast feeding
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that causes significant changes not so and they're more than
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the introduction of solid foods so there's something in breast milk that actually has an impact and got michael but
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there are many paper showing differences in formula fed and a and a breast
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milk third had infants and we know that they got michael battle of breasted infants
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seems to be dominated but the the bacteria this this has been the conventional wisdom for a long time it still seems to hold true
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interesting interesting one of the other members of the audience has shown a couple years
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back but actually the impact a breast milk on got mike about is those dependent
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and we know we're great deal about the factors that promote the growth of
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the growth of the for bacteria and certain other bacteria in the infant get
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we we will have talks on human not caught sack rides but they're also
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protein substances in breast milk that promote the growth of the bacteria
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so one is role of human milk microbes in this context as i wanna do
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we don't know a great deal but we know something and that's what we're going into
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so the human no biker about this is something we have been talking about for about a decade and a half
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to this date about two hundred bacterial species had been detected in mail
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and uh this is just from the study we publish this year this
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about uh i believe forty moms and if we look at the yep
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a compositional breast milk at my combined in this study we
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see at the med major file active bacteria battery d. t.'s
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for me cute and probably bacteria present and on speeches level
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it there's a great deal of several caucus trap the caucus
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and there's also a great deal of as of yet on and on identified bacteria
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if you look at different studies the yeah got mad the human milk micro by um composition seems to vary
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we don't know if it's because of the stage of lactation or the geographical
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a location there are number of things that have any impact on that michael had on the milk micro bile
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but also we need to think what we're actually measuring when we're measuring the micro by on the in milk
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thea microbes in our milk samples my maybe drive from the memory of this helium
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their speech data showing that even non lactate in memory but feeling harbour
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some micro by um and people who are interested in breast cancer or are
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actually interested in the role of the note mike uh that remembered one micro
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bile into the development cancer but when we take samples we also take uh
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get bacteria from the skin and actually we might get bacteria that
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originated in the infant mouth because the mouse and the trial socks on
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the nipple and we collect the mail that comes from the nipple so big when might actually be looking at infant had mouth mike about it
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interesting however in addition to strip the caucasus that'll caucus we constantly find
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all the good and i wrote like be the bacteria back to roy these close trivia in milk
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which in my mind is some indication that were actually measuring a micro by um
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specific to the mammary gland and not like this so much the aerial or scared
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so we know something about microbes and factors that might have an impact
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on that note mike about this is a study by mechanically i don and co workers and
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from a few years back and they looked at the milk micro by on and they found
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interesting thing is first if you look at they collected samples from a large number
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of sites in the much uh in the mother they collected eternal feet will samples
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don't be causal michael bile samples skin samples
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oral samples national samples and milk samples and
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in a simple principle corridor analysis they show that the male micro brian
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was very distinct from eternal feces maternal skin or maternal mouth and even
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the birth canal so there's a distinct microbiology and interesting we they had
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some moms who had given yeah who had delivered by elective c. section
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and those books samples were clearly distinct from them actually delivered uh
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mom's uh no examples and they resemble perhaps the skin and when when they look at on
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the family engines levels it's a little bit small text but here we have on the family level
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magically limit mother should build it gradually mothers should delivered with a
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c. section an elective c. section and the like the c. section
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mailed micro by almost to stand on that
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family and genus level whereas the of actually delivered
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add the mother should deal with gradually or the mother should be limited by
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sector by c. section after the onset of labour there was really no difference
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so this is an indication that something might actually be going on during labour
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that has an impact on the mel micro by on or that labour is
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needed for a normal milk micro by um and we'll get back to that
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the other interesting observation in the study was that all these moms seem to have a less diverse not
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likable so the maternal metabolic state seems to have an impact on uh on that note michael by now
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we do not know what the significance of that is in the development of all all the c. d. in the child
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other things that might have an impact on um on that note micro by on this
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is a small study we did with uh not to bowl who's yeah you're in the um
00:14:08
in the audience we measured from a small number of mothers we measured uh
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the milk micro by on just like u. p. c. r. certain selected
00:14:17
a species and we measured human male qualities accurate concentrations and it looks like
00:14:24
human male colleague a sec right concentration correlates with the bacteria in
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male can interesting the things like be for the battery long term
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or possibility correlated with ellen ellen t. which is analogous arc
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right we know that that's specific bacterium is capable of utilise
00:14:41
so it's tempting to think that already the milk micro by always shaped by h. m. o.'s we have
00:14:47
really no data to show what the direction of causality
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is but it's it shows that this is a complex system
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and already in milk we see these correlations with mike about that
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and all this actress we need to continue that line of investigation
00:15:05
other things when we think of things that might have an impact on
00:15:07
maternal michael but uh and the maternal milk mike about is of course antibiotics
00:15:13
we saw the studies that the mode of delivery has an impact on a note micro by on
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we started thinking maybe it's not the mode of delivery maybe it's actually
00:15:22
the antibiotic profit lexus often given it see section so we did a study
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this was about forty fifty moms with who had delivered
00:15:30
magically with or without antibody prof lexus for group b. strep
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ideally delivered by c. section or elective c. section
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with or without antibiotics at that time in our unit there
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was no universal antibody prefer black says for a elective c. sections
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now there is but this was at a time where we're able to actually tease
00:15:51
out the impact of antibiotics and see section and you would see in a bad
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principal korean and now says that the light blue and
00:15:59
red dots really cluster together and they are the match
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all the livery once with or without antibiotics so we don't see a whole lot of effect of the antibiotics
00:16:08
but to see section babies cluster differently so it's not so much the antibiotics it's more the um
00:16:16
model delivery when we looked in more detail we should we see that the inter party money but it does have some effect
00:16:22
but these are milk samples that were collected that one month of age so we see only traces
00:16:27
of the antibiotic effect the richness and diversity in the antibody to expose moms is a little bit higher
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so that's again one of the things that might have an impact and um
00:16:39
inter party man about excess one of my favourite subjects because we know that
00:16:44
we need inter parliamentary body prefer lexus to prevent group b. strep disease there's no question
00:16:48
about that even though the clinical studies are not so great but after the adoption of
00:16:53
screening purposes and a prophylactic as we have seen a massive decline in group b. strep sepsis
00:17:00
what i'm more worried about is the maternal out is the proper alexis for
00:17:04
c. section and for other reasons hand if you look at the cochran review
00:17:10
on the info on the impact of the efficacy of inter pardon
00:17:14
antibody pro flexes or prior to see section they said that it prevents
00:17:20
uh one infections it prevents you trying infections in the moms and
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there's horrible sentence that's the says the impact on the trial is unknown
00:17:29
and for somebody who's taking care of the child i think that's horrible sentence so uh we
00:17:34
are in the process of looking at what's into parliament about it might to to the child
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and we are looking at large record that i don't have acted to
00:17:43
share yet but we did a small study of babies with infants alcoholic
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and compare them to healthy non crying infants and we could
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see that all the prenatal and perry nail factors that might
00:17:56
be related to call that we saw that in two party
00:17:59
many bikes increased risk of infants are coloured by factor five
00:18:04
and the the only protective factor we sought was exclusive breastfeeding again
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it's in japan and about except it's exclusive breastfed we know that colour 'cause somehow probably related to you
00:18:16
they got mike about serb again more questions than answers but i think there's a very important area of study
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okay moving on so we know that there is a microphone in milk and we know that um it is
00:18:33
different related or associated to certain maternal factors o. b.
00:18:38
c. d. model birth uh has about x. h. m. o.s
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what about what what does it come from i know i know there's a separate talk about this i'm not going into detail
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but we have some fascinating ideas as i mentioned earlier we know that we find
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probably get anaerobic bacteria such as b. for the bacterium back to reduce power back to readies
00:19:02
how closely uh in human milk and those are usually associated with it got so it's it's a um
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sensing idea that there might be an entry memory pathway for microbes as well
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we know from clinical studies where we have a
00:19:19
studies in which probity bacteria are at ministry that mom
00:19:23
to prevent is using the child or to prevent or treat my stylus
00:19:28
investigators in sweden and in spain had been able
00:19:31
to find those specific provided bacteria in no examples
00:19:36
it might be contamination from the skin but i think it's it's
00:19:41
it's um
00:19:43
tend to to speculate that they actually go through an internment memory pathway end up in the milk
00:19:49
we have done quite a quite a few studies some pregnant i'm breastfeeding mean bit when using probably onyx
00:19:55
like the solution noses g. g. sort of different bacteria and i have to say we have tried hard but we
00:20:00
have not found those in mock i would've loved to phone doesn't know but we can't but other investigators were probably
00:20:07
better than us have have found that's i have found them in milk and i think that is really uh
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fascinating if we think of the engine memo pathway
00:20:17
there are nice study showing that in experimental animals
00:20:21
in the prenatal period they got becomes more permeable you might
00:20:25
remember i showed you data that being borne by like two section
00:20:29
elective c. section without the ah sort of labour has an impact on got
00:20:33
my at no mike about composition i think it's intriguing to speculate maybe that happen
00:20:38
it's even if you don't go through labour got doesn't open up and they enter memory pathway might not be function
00:20:44
this is all speculation but i think it's really interesting speculation
00:20:50
this is an old study from twelve years ago and investigators in
00:20:55
france looked at maternal fickle samples a small number moms for moms
00:21:00
a maternal vehicle samples lot samples milk samples
00:21:04
any infants easy samples and with the uh
00:21:08
with the methods they had available at that time they were able to sort of find certain
00:21:13
strains of bacteria here and see a staff to build your dream it is and and
00:21:19
strip the caucus s. on various they found them constantly you maternal
00:21:22
feces in literal blood samples in milk samples and in the infant
00:21:27
uh i don't micro bile again and be long them and again this is no uh direct proof
00:21:34
that that is the way that show uh the child acquire suspect your
00:21:38
but i think it's interesting and they were actually able to stay in those
00:21:42
bacteria in in maternal cells in human milk
00:21:45
and in lymphocytes in a maternal or in immune
00:21:50
cells in the uh in maternal blood so i think this is a really fascinating area of investigation
00:21:57
okay i'm not gonna talk more about the origin of the moment micro since we have
00:22:02
a separate talk on that subjects and now let's move on to what i was actually supposed to be talking about um
00:22:08
the impact of that got my added milk micro bile on infant got compensation and i'd
00:22:13
be stalling because there isn't a whole lot to say but there are some nice studies
00:22:19
whether we can fly we can prove that the microbes in milk actually columnists in front
00:22:26
or not is a matter of we need really sophisticated study thus far we
00:22:30
have really only done studies where we collect samples from the mom for maternal got
00:22:35
from elk and from the infant mouth and got antsy correlations and this is pretty much where we are at
00:22:42
this is uh one of the first that is that this was conducted in in finland already um
00:22:48
more than ten years ago is about sixty mom's an eternal vehicle
00:22:53
samples human milk samples and infant vehicle samples were collected and uh
00:22:59
if you have the presence and uh abundance of the the bacteria work
00:23:03
looked at but you can see our at that time and constantly different species
00:23:09
or groups of different bacteria were detected in india
00:23:15
a in the uh up in all the sample types so this might be an indication
00:23:21
okay we'll find the body in in the maternal got an in milk and the infant got
00:23:25
this might be an indication that something is going on but when they
00:23:28
actually looked in detail there is a strong correlation between the maternal got
00:23:34
different bacteria and inferred got bacteria but there's really no correlation with the milk with the abundance and presence in their work
00:23:40
so something is going on but whether the mail of bacteria email car just an innocent
00:23:45
bystander not absolute cool nice enough in our cool it's hard to say based on this study
00:23:51
moving on
00:23:53
it's a beautiful study from about five years ago only seven mothers but
00:23:58
multiple techniques and nice sample collection again samples from in bed maternal got
00:24:05
milk an infant got an sixteen s. sequencing so
00:24:09
more uh advanced methods and the data on filing level
00:24:14
and also on the generous level and the investigators fine the same bacteria present in
00:24:22
maternal feces in human male and in if it's feces interesting there are some and
00:24:30
some i do yeah a general actually the modesto rest on yeah that only
00:24:34
present in male and then not exacted indians and or in the maternal got
00:24:39
but but the investigators did they also culture and they especially people back to him
00:24:44
brother they found viable be brave the in the in the metro got inhaled anything
00:24:51
okay against circumstantial evidence something might be going on
00:24:58
the author of this paper is in the audience i'm not going to
00:25:00
spend too much time beautiful study more than a hundred mother infant pairs
00:25:05
and they looked at it the contribution of milk micro by on and the
00:25:09
breast skin micro by um and they could show that unit dose dependent matter
00:25:14
it seems that they actually have to the use of a source tracker technique
00:25:19
actually in infants for more than seventy five percent breastplate about fifty percent of the into my
00:25:25
dad got microbes originate from the milk and what they did is really interesting at the age of
00:25:31
about six weeks that got micro by on of an
00:25:35
infant resembled more closely to his or her own mom's
00:25:38
milk another meet examples which is an indication that maybe
00:25:42
the mail is actually a source of bacteria to the child
00:25:48
moving on this is probably the lady study from this year
00:25:52
it's a lesson twenty kids but nice sample collect collection eclectic
00:25:57
infant feces sample sender and from them arm mom both um
00:26:02
uh if people samples and mail samples and most mike abound samples and mouth like a bios samples
00:26:08
from the child as well and if we look in detail infancy says he read it's kind
00:26:14
of all over the place as it tends to be whereas the maternal fees is much more clustered
00:26:19
and we see that the and milk michael by on is clearly distinct from that of the uh
00:26:27
maternal my provider that mike about that and also from the
00:26:30
infant got mike about as actually a bit closer to people like
00:26:33
about uh both in the infant and the child and by source
00:26:36
tractor they show that on dates you'll want some very very early
00:26:42
only about five percent of them uh all the got mike
00:26:44
about or originates in milk aspirant source tracker analysis and at
00:26:49
six months of age the contribution of the note mike abided
00:26:52
to got mike about this really negligible it's point three percent
00:26:57
so maybe it contributes more to the world like a banana which is an understudy subject
00:27:03
we published a study on the oral mike about a couple years back unless you actually
00:27:09
and we looked at thirty five moms i'm children we looked at the
00:27:13
oral like about and the child and the breast milk mike about that
00:27:16
uh and we look at it actually sort of they were quite
00:27:19
similar on on the interaction ami can now says but all the other
00:27:26
twenty two general detected in the study only eight were shared
00:27:31
by both male can big and the infant mouth and the
00:27:35
micro shared were against it the caucus and stuff like caucus and when we tried to see whether
00:27:41
a child's mouth micro by um was more closely related to his or her own want another moms who weren't able to do that
00:27:47
so it doesn't look like the might not micro by on giving contributes greatly to infant mouth conversation
00:27:55
so what goes on very early life you might remember from the previous slide that um
00:28:02
that we show that it's more important in the first days alive this is the study would published
00:28:07
a few years ago about fifteen mother infant pierce and usually all children born by elective c. c.
00:28:13
we wanted to have a uniform a group and we actually wanted to avoid contamination during delivery
00:28:20
and we looked at um for the purposes of this talk we looked at the moment and eternal
00:28:26
the call micro by on which were a clustered nicely
00:28:29
in a group and had very little resemblance with the other
00:28:33
sample types with the technical in human like lou and looked at uh infant feces at about
00:28:39
one week of age in dark blue and we see a shift to a first week alive
00:28:45
if you look close you might imagine that the actually the light blue dot shift
00:28:49
in this direction and perhaps resemble collection more closely so
00:28:55
maybe something is happening during the first week of life
00:28:58
what is also important is classroom my the colours formica by almost nothing
00:29:03
like the maternal got michael bile and if we believe in an entry memory system
00:29:09
to be a very selective system and this we see time and time again
00:29:15
what about later in the neonatal period this is on published yeah
00:29:19
data from any deal didn't who's a p. h. d. student in in
00:29:24
in two we looked at about this about thirty preterm
00:29:28
infants between the gestation wages of twenty five and thirty
00:29:31
five weeks so it's a very heterogeneous group of read
00:29:34
preterm infants and we did serial samples of the infant
00:29:40
got microbiology examples at three days of age green which are really all over the place
00:29:47
at seven days wages approve coloured dots and based start to cluster bit more nicely
00:29:52
and twenty eight days of age at one month of age and this is one old ladies were receiving breast milk
00:29:58
all of them were receiving the same breast milk of three days of age but at twenty eight days of like
00:30:03
a days of age all but one were exclusively uh actually fed
00:30:08
and we see that the twenty eight day people
00:30:10
sample start to cluster so that the chaotic initial conversation
00:30:15
kind of draws to work a cluster at twenty eight days of age the moms
00:30:21
fickle samples collected right after delivery on day one or two the first
00:30:25
stool the mom passed after delivery they cluster nicely but they don't really resemble
00:30:31
the infant got microbiology and then breast milk collected at one month old age so at the same time as these
00:30:38
yellow samples in red and it's pretty much all over the place if anything
00:30:42
it resembles the very early may cornea micro by but these receive really no
00:30:48
no clear connection with the with the preterm infant a microphone not these are all
00:30:54
instance in the new too so it's a very an actual a very unnatural uh
00:31:00
situation i think all but one or two of the inference had received antibiotics at some point
00:31:05
but what we can draw from that is again the milk micro baum
00:31:09
is nothing like the maternal get michael by um and it bears little resemblance
00:31:13
to the uh to the developing infirm got mike about how we are
00:31:18
doing source tracker analysis as we speak i don't have updated quite yet
00:31:24
okay so we see that something's going on there's
00:31:27
definitely lie bacteria milk which the baby can just
00:31:31
they might have some uh some uh impact on the mouth market micro by on
00:31:36
they might have some impact on the dot michael bile depending on the study
00:31:39
it's negligible to fifteen percent and we don't really know why they are they are
00:31:46
i've tied with an idea close to to uh to what doctor hassled
00:31:52
told us yesterday that maybe the bacteria you milk are not there to call
00:31:56
a nice maybe they are there to tall arise in the context of the
00:31:59
taller jack me view of the mail we don't know this is all speculation
00:32:04
somebody said yesterday that nothing happens for no apparent reason
00:32:08
i think the microbes in milk i therefore reason i believe
00:32:13
we have i think we have reason to believe that there is an active system by which they are
00:32:18
a percentage email kind they must play some biological role but we don't really have any grasp of
00:32:24
what that might be now if we think of the clinical significance of the male micro by on
00:32:29
that also remains an open question i think one of the
00:32:32
first indications that the microbes and milk might actually have some
00:32:36
clinical relevance is a paper with published last year where we
00:32:40
looked at this was about twenty mother infant pearson we looked at
00:32:45
again we got mike about in the mom during last trimester of
00:32:49
pregnancy and one month month after delivery we've looked at the infant
00:32:54
dubbed micro bile at one month away japan six months of age and we'll look at the milk michael by now
00:33:00
in clash from the first days alive and one month old
00:33:04
age and just by the first glance we see that um
00:33:11
and this is on dean's level we see that the milk michael by
00:33:14
on this nothing like the infant got michael by um it's nothing like the
00:33:18
the trial my that michael by on which the true but michael bios seems
00:33:22
to be kind of stable in the last trimester of pregnancy and after delivery
00:33:28
in from that michael by normal undergo some changes i would say from
00:33:32
one month to six months but the mailed michael by m. resembles do then
00:33:38
not at all and it again we see a lot of stress the caucus
00:33:41
we see a lot of stuff a caucus some change over the course a lactation
00:33:47
but what is really interesting when we looked at the number of antibiotic resistance genes
00:33:52
in these samples we see that inference actually harbour a large abundance of antibiotic resistance
00:33:58
genes and the sort term healthy instance we have never been exposed to any by next
00:34:03
they actually have more antibiotic resistance genes in there that mike about other their moms
00:34:09
and have way is the milk micro bile there's large abundance of
00:34:13
antibiotic resistance genes in the mom and when we put him on
00:34:19
again in a two dimensional space we see that the maternal sent vehicle samples
00:34:24
via and white resistance genes in the metro people samples big are pretty stable
00:34:30
doing the last trimester of pregnancy and a one month
00:34:34
after delivery and we see that the antibiotic resistance genes in
00:34:38
the infants are clearly distinct and these are not antibody
00:34:42
exposed infants and they really overlap with the profile in milk
00:34:48
so i know that it's not a nice thing to say that nope i might be
00:34:51
doing some harm but we actually might be passing art show nice but resistance genes can mail
00:34:58
again non x. back exposed infants get un backed resistance genes at least partially
00:35:04
from male so they're paying the price for the past activities in the mountains
00:35:11
what is a relief though is when we looked at the impact the breast feeding
00:35:16
on the number of antibiotic resistance genes which you have almost universally
00:35:21
think in france who work a breast fed at six months
00:35:24
had less antibiotic resistance genes interfaces so first i was saying that
00:35:31
okay they give you for milk but if they're breast had to have less how does that work
00:35:37
explanation we have for that is that most of those at about resistance genes are in um
00:35:42
in the product area they are actually answer back to equalise
00:35:46
the most important character of antibiotic resistance genes indians i got
00:35:52
and the number of those bacteria is lower impress that instance breastfed infants again in this
00:35:57
study harbour more bitter bacteria which were protected a protective of the ads about increases the strips
00:36:03
and again my favourite subject engine part many bikes
00:36:07
increase the amount of ice but increases the strings so
00:36:12
from a practical point of view we cannot help the past anybody cues of the moms and we
00:36:18
cannot help how many antibiotic resistance genes the mom carries actually might be passing them to her infant
00:36:24
partially through breast milk but the two wise things we can do to reduce that is
00:36:29
not to use as about x. men that they are not needed and promote resting okay
00:36:36
like really i can turn this into promotion breastfeeding but is a little bit alarming at first
00:36:41
breastfeed promote bitter bacteria degrees the abundance of e. coli another entry bacteria
00:36:48
in the engine got and you reduce the amount of antibiotic resistance genes
00:36:52
well i said this is the first indication of
00:36:54
clinical relevance um whether he's actually halves clinical relevance we
00:36:59
don't know yet but it is alarming so a lot of things are going on in terms of the bill
00:37:06
okay
00:37:08
so what have we discussed what have i tried to convince you of today
00:37:13
well first of all there's such a thing as a human milk mike
00:37:16
about home and it seems to be affected by a number maternal factors
00:37:21
the maternal metabolic state patrol overweight mode of delivery is specially if a
00:37:26
c. section is performed without the onset of labour it looks like it
00:37:30
the mammary gland doesn't know if the board babies more by c. m. c. section
00:37:34
not but the mammary glands seems to know whether that mother has experienced labour are not
00:37:40
and abiding seem to have an effect
00:37:43
what we don't know in are pretty nice study we saw we had
00:37:47
a wide range of premature infants and we stood still no impact of
00:37:51
the duration of gestation between twenty five and thirty five weeks on the
00:37:54
money up like a buyer but i think we need to study that more
00:37:58
the impact of the station wage the impact of lactation all to this
00:38:02
stage the impact of geographical area those are all open areas of investigation
00:38:09
we have will will have a talk about the uh the origin of the male micro microbes in milk but i
00:38:17
think there are good grounds to hypothesise that there is an
00:38:20
active system by which metro got bacteria are transported into milk
00:38:26
why that maybe we have little or no understanding of
00:38:31
how would feed milk microbes effect got conversation is an open question there some
00:38:37
medication they might be there some studies showing that they really have no impact
00:38:42
my pets hypotheses that there at least partially there to colour eyes
00:38:46
the child to the mike about uh the child is going to
00:38:49
have absolutely no data to back that at at this point it's hypothesis
00:38:54
and the whole program clinical significance of the milk microbiology is an open question and and
00:39:00
we can say that it's a it's frustrating we know nothing about it i think it's motivating that we know
00:39:05
that nothing about it and we should really get to work and find out why the bacteria in milk out there
00:39:12
in the end i'd like to thank all the people who actually did the work from our lab which i showed i
00:39:18
borrowed a lot of stuff from a lot of authors but these are the people who directly contribute to papers from from uh
00:39:25
thank you very much for trust ah e.
00:39:39
very interesting and very important studies thank you for sharing doodles
00:39:43
uh not too important to issues to to to consider it what is it
00:39:49
is the mike about will sell for yourself or should you do such a large quantity of
00:39:54
italy or shells micro what a pretty little cells not hard is no those
00:40:01
do you think what use he is really sell free material
00:40:04
of i did made an attempt to see a lot of social
00:40:09
that's one question the second question i have is there's a lot of antibody activity they look
00:40:16
to any and all that you talked about what have you looked at it as a shelf
00:40:22
your complexes and try to break it down in terms of how much of
00:40:28
audiences of antibody free of it but yes she did
00:40:33
regulars are excellent questions and i think inter related uh we haven't done
00:40:39
any systematic studies in that fashion i think we need to do that
00:40:42
i think at this point when people are relying on sequencing methods they just isolate d. n. a. and we should we have
00:40:49
ways of trying to see whether there are hints are bacteria or bacterial d. n. i. but
00:40:53
we should also be looking at whether the bacteria might be interest solar i see i see say
00:40:58
that was the whole study for fresh showing that they actually can stay the bacteria in cells
00:41:03
and the next question would be that if they are free voting are they coded with our antibodies and i don't think
00:41:10
i had of these i am not aware of any study with that has been looked
00:41:13
at but that would have a huge impact and very very vexing in distinguishing in indigo
00:41:22
or
00:41:27
really with millions of it all really ask what is different about
00:41:30
the about the or free or well you know all of the
00:41:35
hold it in the evil with the body which is why would you little
00:41:39
thing that in any of the thirty and yeah that's for sure is that they
00:41:44
i think that actually see by specific it but a local i. m. h.
00:41:49
now you showed us south which i don't think about it i was so that is it is it pacific so
00:41:56
the ecstasy of rice at this though but that's what we mean oceans full of o. g. i. e.
00:42:02
have you ever called the the that they have tremendous importance
00:42:06
for that show but i email him but also which oh
00:42:11
because i coated with a ga so it'll be free but we would but they called it with cable
00:42:20
so uh i think of you looking at the height of the bodies or my protection
00:42:28
affect your point is extremely well taken i don't think anybody has system
00:42:32
could done that we're in the very first pages but so that's it
00:42:35
very important point we need to consider it so
00:42:41
yeah
00:42:44
thank you very much uh are you a nice addition
00:42:48
today we are reading yeah we you being in the yeah you
00:42:53
said is all about you know you do the feeling to relax
00:43:01
uh i first you mother
00:43:07
to to let them do to you and good ideas to the mother
00:43:12
so is there a difference you you wrote this year i mean why these directly
00:43:21
oh you do the model and then i mean uh uh literally to
00:43:25
them you know the difference though you you you are to the market
00:43:32
oh this is really beyond my expertise but i think it's the mommies
00:43:35
injustice that it's been processed by the moms insisted that it might be
00:43:39
delivered in a union so it affects excel in a. p. c. and
00:43:43
it might be coded with that with antibodies easy ravioli every a lot
00:43:48
i'm not sure how well some of those provide batteries so i but i know there are studies improving child oral health
00:43:54
but they have actually a pacifier which chooses to probably ought to read the mouse i think the aerial that might be
00:44:00
reading material which i do not recommend is might be
00:44:03
a similar approach have thinking questions yeah we need to realise
00:44:09
you know in many many cases that we need to be the mothers
00:44:12
are see maybe you can hear ahead on multiple pregnancies multiple multiple images
00:44:19
i'll be a good idea i mean give i go oh that's
00:44:22
maybe not every little so sometimes you use a very good model
00:44:27
but but we don't listen to me is not happy with what you need you you disconnected from standard model
00:44:33
in that case it's uh i maybe forty fire can be used for premature babies
00:44:39
but i do not know the nestle i i is question it would be nearly two
00:44:44
yeah they have a big reasons for being into a problem
00:44:48
but yeah i yeah i'm coming up we go before where so that
00:44:52
we can we can you mean forty we're for an email from my there
00:44:57
to provide for them to be rigid babies moderately you see are you know yet and she
00:45:03
so uh can we get region are you know that that's a that's a number of excellent questions about
00:45:10
the now premier in our small creamy studies we looked at a number maternal factors and their impact
00:45:15
on on the field mike by um and we see nothing depending on the cost of immaturity and i'm
00:45:21
and a number of things more birth we see absolutely nothing in the premature baby
00:45:26
micro by on i'm not sure if the premature baby needs the micro by on but
00:45:30
uh i i'm not i'm not familiar with using surrogate mom's like my uh maybe it's
00:45:37
i thought why are we part of it is not my my view is that my commute is rest yeah right yeah
00:45:43
well well there's a point i want to make about using surrogate moment is that if the mom a
00:45:48
surrogate mom is has not given birth year premature baby
00:45:51
that might not be appropriate no from about premature baby
00:45:56
there is a notion that premature baby in mom's monster premature babies
00:46:00
have different mailed in composition not only in in in in my
00:46:04
combative and other things like e. g. s. and that's an adaptation
00:46:08
to serve the premature baby i have a very hard time believing that
00:46:12
in order for that to be an adaptation it would've had to uh or for
00:46:18
survival benefit at before the last century i don't think any less than thirty weaker survived
00:46:24
in order to actually have that evolutionary drive i don't think
00:46:28
the premature baby supply they they can't be adaptation is human male
00:46:32
i think it more it's more likely that it's a sign of an image or a memory what at that stage of
00:46:37
pregnancy so i think in my opinion it doesn't matter if
00:46:41
if you use a donor milk or circuit mount whether the donor
00:46:46
delivered a premature baby i think we should pay attention but would you call us from early may well we don't have a lot
00:46:52
of donated class from but we should pay attention at what stage of lactation the notes have last meeting now in terms of uh
00:46:59
for the patient there are forty fires you can use in in human milk and doesn't matter if
00:47:03
it's a on the surface to uh understand the question because you can use them on a on it
00:47:10
uh_huh okay we'll country okay but we we need to follow right okay i didn't appreciate that and i
00:47:19
well i'm simple in its our just i i'm sorry i can't help but that is a problem if
00:47:27
yeah in continuation with the idea of the probe ionic not
00:47:32
appearing in press you know i wonder if anybody has done
00:47:36
like the label you off the propriety with nitrogen
00:47:41
fifteen for example which is a non radioactive isotope
00:47:45
and then seeing incorporating encouragement in breast milk
00:47:50
just to see if the protein although probably on it you know michael not
00:47:54
go beyond pass a independent system but it could contribute it uh in some way
00:48:02
to a protein or something in the in bristol
00:48:08
that that's an excellent question which i can answer and i directed to doctor rodriguez will give x. talk
00:48:15
maybe you can address it
00:48:18
uh_huh
00:48:23
uh_huh
00:48:25
uh_huh i would just like to i really if you for us you mean what if we
00:48:35
for for companies please e. for me how
00:48:41
if they want to be like you can see it's you i think
00:48:48
we uh sorry it's respective countries which two more weeks it for us
00:48:55
uh it is also something which is really a big hole in terms of
00:48:59
e. h.'s residuals in jewels in the countries i mean it's it's not issue
00:49:07
i believe it is the views expressed i think to some extent right because what we got
00:49:15
oh mother just i'm me e. c. e. o. so this is not a
00:49:23
or something how nice i'm not really from
00:49:29
c. p. h. d.s which ah whoa i mean
00:49:39
yeah
00:49:43
the form it's a different thing for hate agree it all
00:49:49
spatial who for between its ones on which so sorry to see
00:50:00
are there any more questions
00:50:05
just not so am thank you very much
00:50:16
thank you
00:50:23
t. i. f. i. c. s. i. c. e. o.'s huh
00:50:37
i know i i thank you
00:50:42
yeah yeah i know it yeah yeah yeah i i also ah i have to confess i have absolutely no knowledge of that
00:50:55
yeah
00:50:58
well uh yeah okay uh up in case of a
00:51:04
second into like this actually we uh don't keep that is
00:51:09
paid for something real time on that i would be providing
00:51:14
speed even for the prevention of the networking to collect is
00:51:21
oh that's a discussion on in it all just wants to enter
00:51:27
yes uh well
00:51:30
i believe there are very few instances when a premature baby shouldn't receive breast milk
00:51:35
and those are instances when we are afraid to use the got at
00:51:39
all and i i think that those times i wouldn't give products either
00:51:44
when the baby receives breast milk i think if you are along those who believe in probably onyx whenever
00:51:49
the baby's receiving breast milk you can keep robotics as well but if the baby easy and go before
00:51:55
reason related to the interesting i would keep robotics but that's that's my opinion i'm not even sure if
00:52:00
that's an expert opinion but that's my opinion i'm not
00:52:03
so if if doctor newhouse other inside her from one
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