Sara Moukarzel, PhD, Nutrition and Education Researcher at UC San Diego School of Medicine talks about HMOs found in breastmilk and what that could mean for adults.
Interview conducted by Ivanhoe Broadcast News in February 2019.
Tell me a little bit about your research about using breast milk.
SARA: We’ve been working on breast milk, specifically on human milk oligosaccharides or HMOs for almost 20 years. And these compounds are highly abundant in human milk, but not in infant formula. So you can imagine that infants are exposed to HMOs based on whether they are breastfed or formula fed. And basically what we do is try to understand how the mother makes them, but also why are they there? What is their importance for both the mother and the baby? We’ve come to learn so much over the years. We’ve come to learn that they act as prebiotics so they help shape the infant microbiome. This is the gut bacteria that now is being linked to health and disease all the way from obesity, diabetes and even maybe autism. We’re making a lot of parallels from infant nutrition up to adulthood, and trying to find ways where we can use these compounds to treat adult diseases.
Tell us a little bit about that.
SARA: I’ll start perhaps by one of the most exciting endeavors that we’re taking. As I just said, we’ve learned that HMOs help to shape the baby’s microbiome in a way that’s healthy and sets them up for a healthier life. Now, there’s lots of adult diseases that also involve disruptions in the microbiome. So the question is: what can we learn from Mother Nature and now use these compounds to treat diseases later on in life? What we are learning is that HMOs act as anti-microbials so they help protect against both viral and bacterial pathogens. One of the outbreaks that’s out in the news a lot is norovirus outbreaks on cruise ships. So what if we can actually use HMOs to help limit or contain these outbreaks? Other things that we’re also interested in are conditions that relate to chronic inflammation, think about arthritis, cardiovascular disease, atherosclerosis. A lot of the mechanisms that lead to these conditions might be mediated by HMOs. So, we’re learning from Mother Nature how to stop or prevent even diseases during adulthood.
So are you actually going to use – and you’re not doing it yet, right? It’s still in theory.
SARA: Right now, we’re at the early stages and we have pretty good data that shows support for these theories based on cell cultures and animal models. But given the fact that these are safe for babies, we can assume that they are safe to adults. They’re large-scale availability right now and them becoming more cost-effective allow us to do human trials to show they are safe and effective in adults.
When do you anticipate that starting?
SARA: Oh boy, much faster and shorter than other synthetic compounds, but some of the efficacy trials are already being done right now. We would suspect five, 10 years would be more than plenty.
For trials?
SARA: Completion.
To actually be available to people?
SARA: Yep, in fact right now, there are some products that are available on the market, but again from a research perspective, it’s really important to conduct rigorous research to make sure these compounds are safe and effective for the specific diseases that we claim they are protective against.
So is it going to be the actual milk or is it going to be recreated in a lab or how are you going to deliver?
SARA: Our idea is not actually to use human milk itself, but to learn from what is in the milk and synthesize it. Think about bioengineered microbes, for example: Some microbes that have been altered in a way that would allow us to produce these compounds as easy as possible. That’s the way to do it. Our goal is not to use actual human milk because we believe human milk is a rare commodity. If we were to give it, we’d rather give it to those that need it the most. Those would be the preterm infants and the sick infants.
Because it’s baby’s milk.
SARA: Exactly.
What do you anticipate which – and you kind of already answered this but I’m going to go over it again. Which conditions will be first? That you would go and try the HMOs on?
SARA: I would divide them into a few categories rather than just first, second and next. First step would be the abnormalities related to the gut microbiome. I would think about obesity as one of them. That’s a huge epidemic in the US and now worldwide that needs to be addressed in novel ways. A really interesting endeavor though that is very pressing nowadays relates to antibiotic resistance. Because HMOs have been shown to be anti-microbial and because we’ve shown that you would end up needing less antibiotic if you are exposed to HMOs in case of an infection, then the next question is well now: can we use HMOs with less antibiotics? This would help with a major problem that we’re having nowadays. The third discovery that’s really interesting stemming from infants is the fact that one specific HMO can protect against necrotizing enterocolitis. This is an inflammatory gut disorder that is often deadly among the preemies. What we’ve learned from this is that it helps reduce the inflammation associated with the disease in infants, but also adults have inflammation in the gut! Think about Crohn’s Disease, ulcerative colitis. Therefore, I pretty much summarized HMO effects as changes in the gut microbiome, chronic inflammation and then acute conditions.
It’s interesting that the answer to treating all these things might have been right under our nose the whole time.
SARA: Yes exactly. We almost always say, look here, what if we’re looking in the wrong place? We’ve looked at synthetic compounds. We’re looking at novel ways but maybe the answer is truly here.
How do you envision this to be sort of in what form?
SARA: This is also so exciting because what if we are able to provide these compounds in ways that are less invasive and less complicated with no injections? Maybe it’s possible one day for us to have these natural and safe compounds in a pill form or powder form in a way that’s easily accessible to patients.
How are you going to do it in the trial, have you decided yet?
SARA: So far a lot of the compounds that are available, are available in powder form so you either mix it up in a drink of some sort. But in the long term it’s all going to relate to what the person feels more suitable for them and easy to access. We’re so excited. I cannot wait to see what we can learn about this.
What kind of trials are those?
SARA: What we have to and maybe this is something important to mention. There are more than 150 HMOs in breast milk and each mother makes a different set of HMOs. Really the scientific challenge is to identify which HMO or sets of HMOs are appropriate for specific disease conditions. Right now only a few are available. We could just have a couple of those available either for research in amounts that are appropriate for more than just an animal study. Because you can imagine an animal needs a little bit. A human would need much more. And as well as identifying — not just to claim what is it for– but really identifying what disease it is able to prevent and how.
Are you still collecting – how did you get the breast milk for your studies?
SARA: Kudos to the moms that donate the milk. We heavily rely on the support of mothers in our communities to donate milk. What we do is we process that milk all the way from this amazing fluid all the way down to extracting the HMOs in powder form. Once this is in powdered form then if we’re doing animal studies we can mix it up in the foods that they’re eating. Oftentimes even with the milk, this is the way that we do it.
Is that part of it’s still going on?
SARA: Yes, every day. In fact, one of the biggest things that we do is actually producing HMOs for science every day.
So you’re still collecting breast milk from moms as well?
SARA: All of the time.
So then the next step then would be what – as far as your trials and getting this to market or to people?
SARA: There are a series of studies that we’re conducting on several diseases and some are going at faster paces than others. So some of them are now moving from cell cultures to animal studies, and some are moving from one specific animal model to another. So let’s say we start off just with a newborn baby mouse. Now we go perhaps to a baby mouse that’s predisposed to cardiovascular disease to understand the different mechanisms by which these HMOs are functioning. Cohort studies are also big. These are studies we do with our community to understand associations between disease risk and exposure to HMOs. For example, is it correct that babies that are consuming a higher proportion of one HMO are protected against say diarrheal diseases? These are the kind of questions that we’re looking on right now.
END OF INTERVIEW
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