“Probiotics can be used to reduce pathogens or strengthen the immune system, without impacting the delicate natural ecosystem within the infant’s gut
Even in Russia, where the probiotics market has been growing, and their use is relatively advanced, many clinicians still seem to believe that any probiotic strain can be used to address a broad range of symptoms.
However, in recent discussions at the Summit of the Paediatricians of Russia, Fonterra scientists have uncovered an appetite for more information. Russian clinicians seem hungry to learn about the multiple applications and benefits offered by different strains, and they are keen to explore opportunities for clinical research, which could pave the way to expand general knowledge of probiotics and their potential benefits.
PROBIOTICS IN RUSSIA
“The awareness of probiotics is very high among Russian clinicians,” says Sergey Ukraintsev MD, Senior Research Scientist for Fonterra and a specialist in paediatrics. He says it is common in Russia for infants to be offered probiotics for a large range of indications, and especially for gut-related issues. But while general knowledge among clinicians is very good, he says recent studies offer insights into how the wider context of probiotic science could offer significant advances both in Russia and beyond.
“There is still a tendency for some clinicians to believe that any probiotic can do the job at hand, or that it only matters what species is used rather than which strain,” says Ukraintsev.
“There is also the question of probiotic use - which probiotic should be used, at what dosage and for how long. At the moment, this is more often based on the personal view or experience of the clinician, rather than backed by rigorous scientific research,” says Ukraintsev.
The good news is that Russian clinicians are making their best efforts to identify indications, and select the right probiotic strains according to their findings. In fact, faecal microflora analyses are common when assessing health status in infants, and prescription of a probiotic is often based on these results.
Dr James Dekker, Senior Research Scientist for Fonterra and a leading specialist in probiotics, says using faecal microflora analysis might work in adults because they have stable microflora, but infant microbiota is hugely varied over the first two years of life. “No
‘norms’ or reference values for infant microflora analyses can actually exist,” he says.
Probiotics can be used to reduce pathogens or strengthen the immune system, without impacting the delicate natural ecosystem within the infant’s gut. But to do this, clinicians must be savvy. They must first understand the impact that specific probiotic strains might have on different pathogens, and so be in a position to suggest the most effective strain and enumeration.
UNDERSTANDING THE JOURNEY OF INFANT MICROFLORA
Our mix of gut microflora changes markedly throughout our lives – we move from an essentially sterile gut at birth, through to a relatively stable microflora that forms in childhood and which continues to change as we move through into adulthood.
In infants, gut microflora is chaotic – species come and go apparently at random or in response to changes in diet, age or health status. With advances in technology around genetic analysis techniques, researchers are starting to piece together some of the influences on early microflora, and why each person ends up with an unique collection of bacteria resident in their gut.
A study by Koenig et al, published in 2011 is an ideal example. The study took regular samples from a single infant over the first two years of life, and related the kinds of bacteria present in the gut to lifestyle changes. Soon after birth, only a few species are present in the gut so the overall phylogenetic diversity is low.
Over time, this diversity of the microflora increased, but even at the end of the testing period, it had still not reached the level of diversity of the adult microflora (as shown in the top left of the graph).
It is also noteworthy that marked shifts in diversity can occur with exposure to antibiotics, presence of illness, or changes in diet. However, this progression from low to high diversity is not predictable, as it appears that not all antibiotics impact diversity. Variety in the gut microflora seems to be important, as a number of studies have shown that low overall diversity is associated with various disease states or conditions. Hence, current thinking suggests that even though we have only little understanding of microflora development in the infant, the maintenance of diversity in the ecosystem seems to be crucial for good health.
From this it could be argued that longterm exposure to some antibiotics should be avoided, and that encouraging exposure to a range on non-pathogenic gut bacteria may be desirable.
DIFFERENT STRAINS HAVE DIFFERENT BENEFITS
To realise the potential benefits of probiotic consumption, clinicians have to be steered away from the idea that all probiotics offer the same set of health benefits – even two probiotics of the same species, yet different strains, may differ in their benefits.
It is clear that there is room to educate clinicians on the targeted use of probiotics, and equally clear that they are eager to learn which probiotic to prescribe based on those most suited to the job. Such evidence is beginning to emerge.
Figure 1, taken from a recent publication from the Wellington Asthma Research Group at the University of Otago, shows how a clinical trial with two different strains of probiotics and a placebo affected the probability of participants developing eczema over time.
The results clearly show that of the two strains used in the study, only HN001™ was shown to be effective. The other probiotic strain - HN019™ - has shown health benefits in other areas, but in this particular study it was not markedly different to the placebo group.
Based on such results, Dekker is adamant that benefits must be shown at the strain level. “The ideal would also be that each strain is supported by a body of evidence, rather than a single study.”
A handful of other probiotics have also been successful in clinical trials for infant eczema, and could be an attractive proposition given their relatively low cost compared to antibiotics – not to mention their potential to offer additional benefits. However, further analysis of the research questioned many of these strains in terms of the extent of the anti-eczema benefits, and possible adverse effects into childhood.
“To date, HN001™ is the only strain that has exhibited long-term benefits in reducing the risk of eczema development in susceptible infants,” says Dekker.
RUSSIAN CLINICIANS WANT TO UP THEIR GAME
So where can manufacturers develop this proof? According to Ukraintsev, there is a huge opportunity for manufacturers of probiotics and infant nutrition products to conduct clinical trials in Russia with willing support of clinicians.
“Russian clinicians are keen to offer research opportunities, in order to develop their own knowledge, so that they can use probiotics more effectively,” he says.
However, the previous tendency to pitch probiotics as an “end all, cure all” has resulted in this burgeoning sector losing some credibility among consumers, as they don’t believe that a single probiotic can cure every ailment for their infant.
To combat this, specialists want to establish their expertise and regain the trust of consumers. They very clearly see ongoing clinical research and proof of efficacy helping to build that expertise and credibility.
“Clinicians firmly believe that with more understanding around the role that different strains play in supporting an infant’s health,
they’ll be able to recommend appropriate strains at relevant levels with differing and demonstrated benefits,” says Ukraintsev.
OPPORTUNITIES FROM HERE
Russia is well placed to set the precedent for the international probiotic market.
“There is global opportunity to develop new applications for probiotics with multiple benefits if they are backed by sound clinical evidence,” says Dekker. “But it’s not just about proving efficacy – we also need to show that our strains are safe, and stable.”
Fortunately, safety and stability are areas in which Fonterra excels. The research approaches developed by scientists at the Fonterra Research & Development Centre and the breakthroughs the Company has achieved in probiotics over the last 15 years makes it ideally placed to help infant formula manufacturers capitalize on these opportunities now and in the future.
To find out more about Fonterra’s probiotics and infant nutrition expertise contact email@example.com