Effect of chemotherapy on the microbiota and metabolome of human milk, a case report

The development of probiotics for women’s health

The idea you could use lactic acid bacteria to treat and prevent recurrence of vaginal infections was ridiculed in the early 1980s. Bacteria were the bad guys to be eradicated by current and emerging antibiotic classes. Thirty years later, probiotic administration of microbes is widespread worldwide, including for vaginal and bladder health in women, and the scientific basis and clinical efficacy data for this and multiple other applications prove the viability of this concept. The development of this approach, the creation of a definition for probiotics, and the expansion to other areas of women’s health form the basis of this review.

Got bacteria? The astounding, yet not-so-surprising, microbiome of human milk

Contrary to long-held dogma, human milk is not sterile. Instead, it provides infants a rich source of diverse bacteria, particularly microbes belonging to the Staphylococcus, Streptococcus, and Pseudomonas genera. Very little is known about factors that influence variation in the milk microbiome among women and populations, although time postpartum, delivery mode, and maternal factors such as diet and antibiotic use might be important. The origins of the bacteria in milk are thought to include the maternal gastrointestinal tract (via an entero-mammary pathway) and through bacterial exposure of the breast during nursing. Currently, almost nothing is known about whether variation in microbe consumption by the infant via human milk and that of the mammary gland, itself, impacts short-term and/or long-term infant and maternal health although several studies suggest this is likely. We urge the clinical and public health communities to be patient, however, in order to allow human milk and lactation researchers to first understand what constitutes 'normal' in terms of the milk microbiome (as well as factors that impact microbial community structure) prior to jumping the gun to investigate if and how this important source of microbes impacts maternal and infant health.

The human milk microbiome and factors influencing its composition and activity

Beyond its nutritional aspects, human milk contains several bioactive compounds, such as microbes, oligosaccharides, and other substances, which are involved in host-microbe interactions and have a key role in infant health. New techniques have increased our understanding of milk microbiota composition, but few data on the activity of bioactive compounds and their biological role in infants are available. Whereas the human milk microbiome may be influenced by specific factors - including genetics, maternal health and nutrition, mode of delivery, breastfeeding, lactation stage, and geographic location - the impact of these factors on the infant microbiome is not yet known. This article gives an overview of milk microbiota composition and activity, including factors influencing microbial composition and their potential biological relevance on infants' future health.

Systematic Review of the Human Milk Microbiota

Human milk-associated microbes are among the first to colonize the infant gut and may help to shape both short- and long-term infant health outcomes. We performed a systematic review to characterize the microbiota of human milk. Relevant primary studies were identified through a comprehensive search of PubMed (January 1, 1964, to June 31, 2015). Included studies were conducted among healthy mothers, were written in English, identified bacteria in human milk, used culture-independent methods, and reported primary results at the genus level. Twelve studies satisfied inclusion criteria. All varied in geographic location and human milk collection/storage/analytic methods. Streptococcus was identified in human milk samples in 11 studies (91.6%) and Staphylococcus in 10 (83.3%); both were predominant genera in 6 (50%). Eight of the 12 studies used conventional ribosomal RNA (rRNA) polymerase chain reaction (PCR), of which 7 (87.5%) identified Streptococcus and 6 (80%) identified Staphylococcus as present. Of these 8 studies, 2 (25%) identified Streptococcus and Staphylococcus as predominant genera. Four of the 12 studies used next-generation sequencing (NGS), all of which identified Streptococcus and Staphylococcus as present and predominant genera. Relative to conventional rRNA PCR, NGS is a more sensitive method to identify/quantify bacterial genera in human milk, suggesting the predominance of Streptococcus and Staphylococcus may be underestimated in studies using older methods. These genera, Streptococcus and Staphylococcus, may be universally predominant in human milk, regardless of differences in geographic location or analytic methods. Primary studies designed to evaluate the effect of these 2 genera on short- and long-term infant outcomes are warranted.

Microbiota in Breast Milk of Chinese Lactating Mothers

The microbiota of breast milk from Chinese lactating mothers at different stages of lactation was examined in the framework of a Maternal Infant Nutrition Growth (MING) study investigating the dietary habits and breast milk composition in Chinese urban mothers. We used microbiota profiling based on the sequencing of fragments of 16S rRNA gene and specific qPCR for bifidobacteria, lactobacilli and total bacteria to study microbiota of the entire breast milk collected using standard protocol without aseptic cleansing (n = 60), and the microbiota of the milk collected aseptically (n = 30). We have also investigated the impact of the delivery mode and the stage of lactation on the microbiota composition. The microbiota of breast milk was dominated by streptococci and staphylococci for both collection protocols and, in the case of standard collection protocol, Acinetobacter sp. While the predominance of streptococci and staphylococci was consistently reported previously for other populations, the abundance of Acinetobacter sp. was reported only once before in a study where milk collection was done without aseptic cleansing of the breast and rejection of foremilk. Higher bacterial counts were found in the milk collected using standard protocol. Bifidobacteria and lactobacilli were present in few samples with low abundance. We observed no effect of the stage of lactation or the delivery mode on microbiota composition. Methodological and geographical differences likely explain the variability in microbiota composition reported to date.

Integrated network-diversity analyses suggest suppressive effect of Hodgkin's lymphoma and slightly relieving effect of chemotherapy on human milk microbiome

We aim to investigate the effects of Hodgkin’s lymphoma and the chemotherapy for treating the disease on the human milk microbiome through integrated network and community diversity analyses. Our analyses suggest that Hodgkin’s lymphoma seems to have a suppressing effect on the milk microbiome by lowering the milk microbial community diversity, as measured by the Hill numbers profiles. Although the diversity analysis did not reveal an effect of chemotherapy on community diversity, bacterial species interaction network analysis shows that chemotherapy may help to slightly restore the milk microbiome impacted by Hodgkin’s lymphoma through its influence on the interactions among species (or OTUs). We further constructed diversity-metabolites network, which suggests that the milk microbial diversity is positively correlated with some beneficial milk metabolites such as DHA (DocosaHexaenoic Acid), and that the diversity is negatively correlated with some potentially harmful metabolites such as Butanal. We hence postulate that higher milk microbial diversity should be a signature of healthy mothers and beneficial to infants. Finally, we constructed metabolites OTU correlation networks, from which we identified some special OTUs. These OTUs deserve further investigations given their apparent involvements in regulating the levels of critical milk metabolites such as DHA, Inositol and Butanal.

Reservoirs of Non-baumannii Acinetobacter Species

Acinetobacter spp. are ubiquitous gram negative and non-fermenting coccobacilli that have the ability to occupy several ecological niches including environment, animals and human. Among the different species, Acinetobacter baumannii has evolved as global pathogen causing wide range of infection. Since the implementation of molecular techniques, the habitat and the role of non-baumannii Acinetobacter in human infection have been elucidated. In addition, several new species have been described. In the present review, we summarize the recent data about the natural reservoir of non-baumannii Acinetobacter including the novel species that have been described for the first time from environmental sources and reported during the last years.

Metagenomic Analysis of Milk of Healthy and Mastitis-Suffering Women

BACKGROUND

Some studies have been conducted to assess the composition of the bacterial communities inhabiting human milk, but they did not evaluate the presence of other microorganisms, such as fungi, archaea, protozoa, or viruses.

OBJECTIVE

This study aimed to compare the metagenome of human milk samples provided by healthy and mastitis-suffering women.

METHODS

DNA was isolated from human milk samples collected from 10 healthy women and 10 women with symptoms of lactational mastitis. Shotgun libraries from total extracted DNA were constructed and the libraries were sequenced by 454 pyrosequencing.

RESULTS

The amount of human DNA sequences was ≥ 90% in all the samples. Among the bacterial sequences, the predominant phyla were Proteobacteria, Firmicutes, and Bacteroidetes. The healthy core microbiome included the genera Staphylococcus, Streptococcus, Bacteroides, Faecalibacterium, Ruminococcus, Lactobacillus, and Propionibacterium. At the species level, a high degree of inter-individual variability was observed among healthy women. In contrast, Staphylococcus aureus clearly dominated the microbiome in the samples from the women with acute mastitis whereas high increases in Staphylococcus epidermidis-related reads were observed in the milk of those suffering from subacute mastitis. Fungal and protozoa-related reads were identified in most of the samples, whereas Archaea reads were absent in samples from women with mastitis. Some viral-related sequence reads were also detected.

CONCLUSION

Human milk contains a complex microbial metagenome constituted by the genomes of bacteria, archaea, viruses, fungi, and protozoa. In mastitis cases, the milk microbiome reflects a loss of bacterial diversity and a high increase of the sequences related to the presumptive etiological agents.

Clinical impact of human breast milk metabolomics

Metabolomics is a research field concerned with the analysis of metabolome, the complete set of metabolites in a given cell, tissue, or biological sample. Being able to provide a molecular snapshot of biological systems, metabolomics has emerged as a functional methodology in a wide range of research areas such as toxicology, pharmacology, food technology, nutrition, microbial biotechnology, systems biology, and plant biotechnology. In this review, we emphasize the applications of metabolomics in investigating the human breast milk (HBM) metabolome. HBM is the recommended source of nutrition for infants since it contains the optimal balance of nutrients for developing babies, and it provides a range of benefits for growth, immunity, and development. The molecular mechanisms beyond the inter- and intra-variability of HBM that make its composition unique are yet to be well-characterized. Although still in its infancy, the study of HBM metabolome has already proven itself to be of great value in providing insights into this biochemical variability in relation to mother phenotype, diet, disease, and lifestyle. The results of these investigations lay the foundation for further developments useful to identify normal and aberrant biochemical changes as well as to develop strategies to promote healthy infant feeding practices.

Human milk: mother nature's prototypical probiotic food?

The concept of "probiotic" is generally attributed to Dr. Ilya Mechnikov, who hypothesized that longevity could be enhanced by manipulating gastrointestinal microbes using naturally fermented foods. In 2001, a report of the FAO and WHO (2001 Oct, http://www.who.int/foodsafety/publications/fs_-management/en/probiotics.pdf) proposed a more restrictive definition of probiotic, as follows: "a live micro-organism which, when administered in adequate amounts, confers a health benefit on the host." As such, answering the fundamental question posed here-"Is human milk a probiotic?"-requires first grappling with the concept and meaning of the term probiotic. Nonetheless, one must also be convinced that human milk contains bacteria. Indeed, there are scores of publications providing evidence of a paradigm shift in this regard. Variation in the human-milk microbiome may be associated with maternal weight, mode of delivery, lactation state, gestation age, antibiotic use, and maternal health. Milk constituents (e.g., fatty acids and complex carbohydrates) might also be related to the abundance of specific bacterial taxa in milk. Whether these bacteria affect infant health is likely, but more studies are needed to test this hypothesis. In summary, a growing literature suggests that human milk, like all other fluids produced by the body, indeed contains viable bacteria. As such, and recognizing the extensive literature relating breastfeeding to optimal infant health, we propose that human milk should be considered a probiotic food. Determining factors that influence which bacteria are present in milk and if and how they influence the mother's and/or the recipient infant's health remain basic science and public health realms in which almost nothing is known.

Human milk: mother nature's prototypical probiotic food?

The concept of "probiotic" is generally attributed to Dr. Ilya Mechnikov, who hypothesized that longevity could be enhanced by manipulating gastrointestinal microbes using naturally fermented foods. In 2001, a report of the FAO and WHO (2001 Oct, http://www.who.int/foodsafety/publications/fs_-management/en/probiotics.pdf) proposed a more restrictive definition of probiotic, as follows: "a live micro-organism which, when administered in adequate amounts, confers a health benefit on the host." As such, answering the fundamental question posed here-"Is human milk a probiotic?"-requires first grappling with the concept and meaning of the term probiotic. Nonetheless, one must also be convinced that human milk contains bacteria. Indeed, there are scores of publications providing evidence of a paradigm shift in this regard. Variation in the human-milk microbiome may be associated with maternal weight, mode of delivery, lactation state, gestation age, antibiotic use, and maternal health. Milk constituents (e.g., fatty acids and complex carbohydrates) might also be related to the abundance of specific bacterial taxa in milk. Whether these bacteria affect infant health is likely, but more studies are needed to test this hypothesis. In summary, a growing literature suggests that human milk, like all other fluids produced by the body, indeed contains viable bacteria. As such, and recognizing the extensive literature relating breastfeeding to optimal infant health, we propose that human milk should be considered a probiotic food. Determining factors that influence which bacteria are present in milk and if and how they influence the mother's and/or the recipient infant's health remain basic science and public health realms in which almost nothing is known.