Editors' ChoiceAsthma

Of Bugs and Men: Antibiotics, the Gut Microbiota, and Risk of Developing Allergic Asthma

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Science Translational Medicine  16 May 2012:
Vol. 4, Issue 134, pp. 134ec87
DOI: 10.1126/scitranslmed.3004288

When it comes to their children’s health, parents take no prisoners. At the slightest sign of a sniffle, many parents go to their pediatrician and request treatment. The likelihood that their illness is caused by a viral infection often falls on deaf ears. Why not prescribe an antibiotic, just in case? However, there may be consequences of antibiotic use in developing children. Adults and children alike need bacteria to survive and live healthy lives, especially in the gut. Russell et al. show that changes in gut microbiota caused by antibiotic use can increase susceptibility to allergic asthma in a neonatal mouse model.

The authors studied experimental allergic asthma induced by ovalbuman in neonatal (in utero and after birth) and adult (7 weeks old) C57BL/6J mice in the presence and absence of antibiotics commonly used in the clinic. They found that streptomycin treatment had little to no effect on the microbiota and on the development of allergic asthma in neonatal mice. Treatment with vancomycin, on the other hand, reduced gut microbial diversity, shifted the bacterial population, and enhanced disease severity as measured by lung inflammation, airway hyperresponsiveness, and OVA-specific immunoglobulin E (IgE) titers. In adults, however, neither antibiotic had a significant effect on the development of disease. The authors then determined that the vancomycin effect in neonates might be mediated by reduced numbers of colonic CD4+CD25+Foxp3+ regulatory T cells (Treg cells). Vancomycin depleted Clostridiales, which correlated with a reduction in cells expressing CD4+Foxp3+ Treg cells in the colon but not in the lung. These data suggest—although do not confirm—a role of Treg cells in the development of allergic asthma in this model.

The importance of this work is that it directly links antibiotic use with alterations in gut microbiota and the subsequent development of allergic asthma. Although the generalizability of the findings is limited by the diversity and type of antibiotics used, this work offers a framework for future human studies relating childhood antibiotic use and allergic asthma and provides yet another reason to limit antibiotic use to only when it’s truly needed.

S. L. Russell et al., Early life antibiotic-driven changes in microbiota enhance susceptibility to allergic asthma. EMBO Rep. 5, 440–447 (2012). [Abstract]

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