Jobst Henker

Detection of four human milk groups with respect to Lewis blood group dependent oligosaccharides

Neutral oligosaccharides in human milk samples from approximately 50 women were analysed applying a recently developed high-pH anion-exchange chromatographic method. Three different oligosaccharide patterns could be detected in accordance with milk groups that had been already described. These oligosaccharide groups correspond to the Lewis blood types Le(a−b+), Le(a+b−) and Le(a−b−). In addition to these oligosaccharide patterns, a new carbohydrate pattern was detected in a milk sample from a Le(a−b−) individual. Here, only nonfucosylated oligosaccharides and compounds bearing a1,3 linked fucosyl residues were found, whereas structures with a1,2 and a1,4 fucosyl linkages were missing. This finding led to the hypothesis that there are four different oligosaccharide milk groups that fit well to the genetic basis of the Lewis blood group system.

Probiotic Escherichia coli Nissle 1917 versus placebo for treating diarrhea of greater than 4 days duration in infants and toddlers.

Background: Administering probiotics can prevent or cure some forms of diarrhea. The efficacy of probiotic Escherichia coli Nissle 1917 (EcN) in infants and toddlers with diarrhea >4 days was tested by a double-blind trial. Methods: One hundred fifty-one children aged 1–47 months with nonspecific diarrhea were randomized to receive either EcN suspension (N = 75) or placebo (N = 76). Diarrhea had to meet the following definition: >3 watery or loose nonbloody stools in 24 hours of a diarrheal episode persisting for >4 consecutive days but ≤14 days. All children were well nourished or only moderately malnourished, mildly dehydrated, and received oral rehydration at study commencement. They were treated orally with 1–3 mL EcN suspension (1 mL contains 108 viable cells) or placebo daily for 21 days. Primary objective was to confirm a better response rate (reduction of daily stool frequency to ≤3 watery or loose stools over ≥4 days) with EcN. Results: The 7-day response was higher for the EcN group than placebo (EcN 78.7%, placebo 59.2%). Significant differences were observed on days 14 (EcN 93.3%, placebo 65.8%, P = 0.0017) and 21 (EcN 98.7%, placebo 71.1%, P < 0.001). Kaplan-Meier survival analysis resulted in a significant difference of 3.3 days between the groups (P < 0.0001); median time to response for EcN was 2.4 and 5.7 for placebo. EcN was safe and well tolerated. Conclusions: In the conditions of this trial EcN was a suitable remedy for diarrhea >4 days in young children.

Sensitivity and specificity of quantitative determination of pancreatic elastase 1 in feces of children.

BACKGROUND The secretin-pancreozymin test has been accepted as the gold standard for testing exocrine pancreatic function. However, this test is invasive, time-consuming, and expensive. Therefore, in daily practice, more simple, indirect methods are proposed. METHODS The fecal concentration of human pancreatic elastase (E1) has been assessed for diagnostic sensitivity and specificity. For sensitivity, fecal E1 determination in 23 healthy children were studied. RESULTS Sensitivity to detect pancreatic insufficiency was 100% and specificity 96%. CONCLUSIONS Fecal E1 concentration appears to be a more sensitive and specific test of pancreatic function than other tests.

Indirect pancreatic function tests in children

Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland; 4th Department of Pediatrics, Aristotle University, Thessaloniki, Greece; Klinik und Poliklinik für Kinderund Jugendmedizin des Universitätsklinikums Dresden, Germany; University Children’s Clinic, Tübingen, Germany; Department of Pediatric Gastroenterology, Erasmus MC-Sophia, Rotterdam, The Netherlands; Department of Child Health, University of Wales Swansea, Singleton Hospital, Swansea, United Kingdom

Detection of Four Human Milk Groups with Respect to Lewis-Bloodgroup-Dependent Oligosaccharides by Serologic and Chromatographic Analysis

Oligosaccharides from human milk samples obtained from individual donors were analyzed using high-pH anion-exchange chromatography. Three patterns of neutral oligosaccharides were detected corresponding to milk groups already described. These oligosaccharide groups correspond to the Lewis blood types Le(a-b+), Le(a+b-), and Le(a-b-). A new carbohydrate pattern was detected in a milk sample from a Le(a-b-) person in which only nonfucosylated oligosaccharides and compounds bearing alpha1,3-linked fucosyl residues were found. This finding led to the hypothesis that there exist 4 different oligosaccharide milk groups that fit well to the genetic basis of the Lewis blood group system.

Pancreatic elastase 1 in feces of preterm and term infants.

Background Determination of fecal pancreatic elastase 1 (E1) is a reliable and noninvasive test of exocrine pancreatic function. Adult reference values of greater than 200 &mgr;g E1/g feces do not seem to be applicable to early infancy because of immature pancreatic function. Because reference values for infants do not exist, the current study was aimed to define reference values for preterm and term infants up to 12 months of age. Methods The authors measured pancreatic E1 concentration in feces of 148 infants up to 12 months of age. Infants with known bowel or pancreatic disorders were excluded from the study. Results The authors found that 96.8% of all children had E1 concentrations greater than an adult lower limit after 2 weeks of life, independent of gestational age. Up to 48 hours after birth, none of the preterm infants had an E1 concentration of greater than 30 &mgr;g/g meconium, whereas 43% of the term infants had normal adult values. Conclusions The adult reference value for pancreatic E1 of greater than 200 &mgr;g/g feces can be applied to infants older than 2 weeks, independent of gestational age, birth weight, and the type of nutrition.

Successful treatment of gut-caused halitosis with a suspension of living non-pathogenic Escherichia coli bacteria : a case report

Abstract. In up to 90% of cases, severe halitosis is a result of gastrointestinal or orolaryngeal problems. This case study reports on a girl with bad breath caused by increased formation of malodorous intestinal gases (halitosis), which could be successfully treated with a suspension of living non-pathogenic bacteria Escherichia coli. Conclusion: in unclear cases of bad breath, an increased formation of intestinal gases should also be considered.

Variations of neutral oligosaccharides and lactose in human milk during the feeding

SummaryThere exist only few data concerning the variation of oligosaccharides in human milk. In this study the variations of neutral oligosaccharides and of lactose in human milk during the feeding were determined from five women at day 8 and at day 57 post partum. The milk of the investigated feedings was divided in four parts of equal volumes during sampling; the concentrations of neutral oligosaccharide fractions were determined by gel permeation chromatography on Fractogel TSK HW 40 (S) columns. No significant differences in the concentrations of the neutral oligosaccharide groups monofucosyllactoses, difucosyllactose, lacto-N-tetraoses, monofucosyllacto-N-tetraoses and difucosyllacto-N-tetraoses and of lactose were found in the four milk parts. The results of this study favor the use of socalled mid-feed samples, a simple and convenient sampling method for analytical studies of human milk. Mid-feed samples are representative of the whole feeding as concerned for neutral oligosaccharides.ZusammenfassungÜber die Variation von Oligosacchariden in Humanmilch liegen nur wenig Daten vor. In dieser Studie werden die Änderungen von neutralen Oligosacchariden und von Lactose während des Stillvorgangs bei 5 Frauen am Tag 8 und am Tag 57 nach der Geburt bestimmt. Die Milchproben der untersuchten Stillvorgänge wurden zu jeweils 4 Teilen gleichen Volumens gesammelt. Die Konzentration der neutralen Oligosaccharide wurde durch Gelchromatographie mit Fractogel TSK HW 40 (S) Säulen bestimmt. In den jeweils 4 Milchteilen der Stillvorgänge waren bei den Konzentrationen der neutralen Oligosaccharidgruppen Monofucosyllactosen, Difucosyllactose, Lacto-N-tetraosen, Monofucosyllacto-N-tetraosen und Difucosyllacto-N-tetraosen und bei Lactose keine signifikanten Unterschiede festzustellen. Die Ergebnisse dieser Studie stützen die sogenannte „mid-feed“ Sammeltechnik als eine einfache und praktische Probennahmemethode für analytische Milchstudien. Die „mid-feed“ Proben sind bezüglich der Oligosaccharide repräsentativ für die gesamte Milch eines Stillvorganges.

Imerslund-Gräsbeck syndrome in a 15-year-old German girl caused by compound heterozygous mutations in CUBN

Imerslund-Gräsbeck syndrome (IGS) is a recessive disorder of intestinal cobalamin (Cbl) absorption and renal tubular protein reabsorption sometimes accompanied by urinary tract malformation. Mutations in the cubilin (CUBN) and amnionless (AMN) genes have been described as causal defects. CUBN and AMN proteins form the cubam complex that functions as the receptor for the intrinsic factor-Cbl (IF-Cbl) complex in the ileum and for proteins found in the primary urine in the kidney. We report the case of a 15-year-old German girl who presented with megaloblastic anaemia and funicular myelosis due to Cbl-deficiency and selective proteinuria. We clinically diagnosed- and for the first time in a patient of German ancestry-genetically confirmed IGS by detecting a compound heterozygous gene deletion and missense mutation in the CUBN gene. In conclusion IGS should be considered in paediatric patients presenting with symptoms like megaloblastic anaemia, funicular myelosis and benign proteinuria. Diagnosis should be confirmed genetically to avoid further invasive diagnostics, administer proper lifelong treatment and offer genetic counselling.

Simultaneous Determination of Fecal Fat, Nitrogen, and Water by Near-infrared Reflectance Spectroscopy

BACKGROUND Determinations of fecal fat and nitrogen reveal evidence of malabsorption and assist in estimating the efficacy of pancreatic enzyme treatment. Seventy-two-hour stool collection, with chemical analysis of fecal fat, and Kjeldahls method for measurement of fecal nitrogen are generally accepted as standard methods for making these determinations. However, these traditional methods are expensive, time-consuming, and cumbersome. This study evaluated the efficiency and validity of an alternative method, using near-infrared reflectance spectroscopy (NIRS) and compared results with those of the standard methods. METHODS Near-infrared reflectance spectroscopy is a secondary method: The instrument first has to be calibrated with samples analyzed by the standard method. Sixty-three stool samples with known fat content (range 4.79-292.5 mg/g), 24 samples with known nitrogen content (range 5.36-19.38 mg/g), and 24 samples with known water concentration (range 60.1-82.22%) served for calibration. A further 69 samples were analyzed to validate the procedure. RESULTS There was a satisfactory correlation between the measurements produced by near-infrared reflectance spectroscopy and those produced by standard methods: fat r = 0.97; nitrogen r = 0.94; water r = 0.96. CONCLUSIONS Near-infrared reflectance spectroscopy appears to be a reliable, simple, and rapid method of measuring different fecal components-as precise and accurate as the standard methods. Stool samples should be analyzed immediately after collecting or stored only a few days before analyzing.