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The role of gut-associated lymphoid tissues and mucosal defence

Published online by Cambridge University Press:  08 March 2007

Maria Luisa Forchielli  and
W. Allan Walker
Maria Luisa Forchielli
Affiliation:
Department of Pediatrics, University of Bologna, Bologna, Italy Department of Pediatrics, Harvard Medical School, Boston, MA, USA
W. Allan Walker*
Affiliation:
Department of Pediatrics, Harvard Medical School, Boston, MA, USA Harvard Medical School, Mucosal Immunology Laboratories, Massachusetts General Hospital, Boston, MA, USA
*
*Corresponding author: Professor W. Allan Walker, fax +1 617 432 2988, email [email protected]
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Abstract

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The newborn infant leaves a germ-free intrauterine environment to enter a contaminated extrauterine world and must have adequate intestinal defences to prevent the expression of clinical gastrointestinal disease states. Although the intestinal mucosal immune system is fully developed after a full-term birth, the actual protective function of the gut requires the microbial stimulation of initial bacterial colonization. Breast milk contains prebiotic oligosaccharides, like inulin-type fructans, which are not digested in the small intestine but enter the colon as intact large carbohydrates that are then fermented by the resident bacteria to produce SCFA. The nature of this fermentation and the consequent pH of the intestinal contents dictate proliferation of specific resident bacteria. For example, breast milk-fed infants with prebiotics present in breast milk produce an increased proliferation of bifidobacteria and lactobacilli (probiotics), whereas formula-fed infants produce more enterococci and enterobacteria. Probiotics, stimulated by prebiotic fermentation, are important to the development and sustainment of intestinal defences. For example, probiotics can stimulate the synthesis and secretion of polymeric IgA, the antibody that coats and protects mucosal surfaces against harmful bacterial invasion. In addition, appropriate colonization with probiotics helps to produce a balanced T helper cell response (Th1 = Th2 = Th3/Tr1) and prevent an imbalance (Th1 > Th2 or Th2 > Th1) contributing in part to clinical disease (Th2 imbalance contributes to atopic disease and Th1 imbalance contributes to Crohn's disease and Helicobacter pylori-induced gastritis). Furthermore, a series of pattern recognition receptors, toll-like receptors on gut lymphoid and epithelial cells that interact with bacterial molecular patterns (e.g. endotoxin (lipopolysaccharide), flagellin, etc.), help modulate intestinal innate immunity and an appropriate adaptive immune response. Animal and clinical studies have shown that inulin-type fructans will stimulate an increase in probiotics (commensal bacteria) and these bacteria have been shown to modulate the development and persistence of appropriate mucosal immune responses. However, additional studies are needed to show that prebiotics can directly or indirectly stimulate intestinal host defences. If this can be demonstrated, then prebiotics can be used as a dietary supplement to stimulate a balanced and an appropriately effective mucosal immune system in newborns and infants.

Keywords

Development of gut immunityPrebiotics and intestinal host defencePrebiotics and microbial function
Type
Research Article
Information
British Journal of Nutrition , Volume 93 , Issue S1 , April 2005 , pp. S41 - S48
Copyright
Copyright © The Nutrition Society 2005

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