The discovery of the impact of human intestinal microbiota on health and well-being is constantly evolving. The collective genome of the intestinal microbiota, termed microbiome, is estimated to contain at least 100 times more genes than our own genome (Qin et al., 2010).
Certain microbiota components can have beneficial effects, therefore modulating the microbiome towards a healthier composition has received more and more scientific interests, especially in the early-life period where the microbiota is progressively established, which leaves more rooms for modulation. Strategies of antenatal and early-life intestinal microbiome modulation are the most effective approaches to promote a resilient, diverse, and healthy microbiota, which has the greatest long-term potential to benefit health (the programming effect).
Probiotics, prebiotics, synbiotics, and more recently postbiotics – all these “biotics” have the potential to modulate the intestinal microbiome but acting differently. The Food and Agriculture Organization of the United Nations and the WHO (FAO/WHO) defines probiotic as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” (Hills et al., 2014). Several probiotic strains have been identified, tested safe for use in infants and conferring health benefits in diverse areas. More research is needed to uncover new probiotic strains and/or on new health benefits.
The concept of prebiotics has been introduced about 20 years ago. Recently, to reflect the latest scientific developments, its definition has been updated to “a substrate that is selectively utilized by host microorganisms conferring a health benefit” (Gibson et al., 2017). Fructans, such as fructooligosaccharides (FOS) and inulin; galactans, such as galactooligosaccharides (GOS) were the most documented prebiotics on their health benefits when the concept of prebiotics was introduced. More recently, the naturally present prebiotics of breastmilk – human milk oligosaccharides (HMOs) and the technological progress in the production of HMOs in sufficient amounts have enabled clinical trials with these specific prebiotics.
HMOs are the 3rd most abundant component of breastmilk, after lactose and lipids. More than 200 HMOs have been identified to date. The beneficial effects of HMOs have been reported in intestinal microbiota modulation, anti-adhesive properties against pathogens, gut barrier function enhancement, immune system development and intestinal epithelial cell response modulation (Morrow et al. 2005; Bode 2012). Future research would be needed to confirm that the observed effects translate into measurable short and long-term health benefits for infants.
By combining the rational of pro- and pre- biotics, the concept of synbiotic was introduced. More than simply a mixture of pro- and pre-biotics, some synbiotics are designed to function cooperatively. Therefore, the concept of synbioitc has been recently updated to “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host” (Swanson et al., 2020). The subset of synbiotic designed to function cooperatively are the “synergistic synbiotic”, where the substrate is selectively utilized by the co-administered microorganisms. Some recent studies on the “HMObiotic”, which is a synergistic synbiotic containing HMO (as prebiotic) and probiotic, has shown that the probiotic strain Bifidobacterium infantis M-63 had a significantly higher growth rate when grown on the HMO 2’FL, compared to another B. infantis strain R0033 (Walsh et al., 2022). Therefore, the cooperation between the probiotic and prebiotic are strain and substrate specific, more research in the ‘synergistic synbiotic’ area is warranted.
The newest member in the “biotics” family is the postbiotic, which is a "preparation of inanimate microorganisms and/or their components that confers a health benefit on the host" (Salminen et al., 2021). Effective postbiotics must contain inactivated microbial cells or cell components, with or without metabolites, that contribute to observed health benefits. The effects of postbiotic have been studied essentially in fermented infant formulas. Some limited data of postbiotics on acute gastroenteritis and common infectious diseases exist but showed either no effect or inconsistent results (Corsello et al. 2017, Nocerino et al 2017; Sharieff et al 2006). Further studies are necessary to explore and determine the safety and potential health benefits of different postbiotics.
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