Nestlé Health Science’s HMOs slash respiratory tract infections in infants with cow’s milk protein allergy

08 Jun 2020 --- Adding two human milk oligosaccharides (HMOs) to Nestlé Health Science (NHSc)’s infant formula Althéra can reduce respiratory tract infections in infants with cow’s milk protein allergy (CMPA). This is according to the latest findings from the nutrition giant’s CINNAMON study, which were presented at the digital European Academy of Allergy and Clinical Immunology (EAACI) annual congress. Amid a surge in concerns for breathing difficulties during the ongoing global pandemic, this research update contributes to the ever-growing research on the benefits of HMOs for early nutrition.

“In general, all formula-fed infants with cow’s milk protein allergy would benefit in terms of a reduction in common respiratory infections. About 2 to 3 percent in the infant population in Europe, North America and Australia are believed to be milk-allergic. A proportion of milk-allergic infants are breastfed and should continue breastfeeding for as long as possible,” an NHSc spokesperson tells NutritionInsight. 

The two HMOs supplementing the Althéra formula are 2’fucosyl-lactose (2’FL) and lacto-N-neotetraose (LNnT), which are two of the ten most predominant HMOs found in breast milk. “Surprisingly, there was a statistically significant reduction in the frequency of upper respiratory tract infections by more than 40 percent, [from the time of enrolment to 12 months of age, compared to infants receiving the control formula without the HMOs],” the spokesperson notes. 

The incidence of middle ear infections in the per protocol group was also significantly reduced, adds the spokesperson. “These findings were not seen in the healthy infant population.”

Cow’s milk protein allergy: HMOs to the rescue
The research is particularly critical considering the immune system of infants with CMPA’s are more susceptible to infections, according to Professor Anna Nowak-Wegrzyn, Allergy and Immunology, Department of Pediatrics Hassenfeld Children’s Hospital, New York University Langone Health, US.

Professor Nowak-Wegrzyn presented some of the data results during the NHSc Symposium at the EAACI Digital Congress 2020. She underscores that HMOs eliminate some pathogens through a decoy effect, while also strengthening the gut barrier and guiding the maturation of the immune system. She further explains that the benefits of HMOs added in Althéra included reduced related medication use, as well as a lower protein intake to infants with CMPA that cannot be breastfed.

The NHSc spokesperson also details that the majority of infants outgrow CMPA by three years of age. However, adding HMOs to specialty infant formula may promote faster oral tolerance to cow’s milk protein. “This would enable infants to consume cow’s milk protein earlier without any allergic reactions. There is encouraging evidence on tolerance induction by HMO in mice, but human data are not yet available,” they affirm.

Building on previous research
The initial CINNAMON trial involved Althéra supplemented with 2’FL, LNnT and with a reduced protein content (2.2 g per 100 kcal). It was compared to Althéra without the HMOs and a higher protein content (2.5 g per 100kcal) in infants with CMPA. The primary outcome was growth measured by daily weight gain on the Althéra test formula with the reduced protein content. 

The latest CMPA-specific results build upon the study’s findings from last October that Althéra with the two selected HMOs supports normal growth and is well tolerated in infants with CMPA. NHSc also confirmed the hypoallergenicity of the HMO in infants with CMPA in an initial safety trial last June. 

“In another clinical trial done by Nestlé in healthy infants, a 55 percent and 70 percent risk reduction for lower respiratory tract infections (LRTI) and bronchitis, respectively, was seen when infants who were fed a standard infant formula supplemented with the same two structurally identical HMOs (2’FL and LNnT). Similar trends were seen in the CINNAMON study for LRTI,” the spokesperson explains.

In other research on the potential benefits of HMOs, Jennewein Biotechnologie’s norovirus research program discovered that HMOs may inhibit the binding of noroviruses – for which there is no vaccine – to human receptors. A study published in the PLOS ONE journal also found a link between 2’FL and the improved cognitive development of babies.

Althéra is an extensively hydrolyzed, hypoallergenic formula rich in vitamins A, C and K, and folic acid, potassium and calcium. It provides first-line relief from the symptoms associated with CMPA, including eczema, colic, vomiting, diarrhea and constipation.

Breast is best
Despite NHSc’s promising results, the company’s spokesperson affirms that breastmilk is unequivocally the gold standard in infant nutrition. “There is still so much that we can learn from it. HMO biology is currently one of the most exciting areas of research in infant nutrition.” Notably, a report released by the World Health Organization is calling for new legal measures to prohibit the promotion of breast milk substitutes to health workers and in health facilities amid the COVID-19 crisis.

“NHSc is at the forefront of HMO research in infants with CMPA. It is possible that the addition of HMOs to specialty infant formulas will become standard of care so that all infants with CMPA who cannot be breastfed may benefit from them,” they continue.

Further clinical trials are needed to assess if HMOs when added to specialty infant formula reduce the risk of other allergies later in life which are more common in infants CMPA, for example, eczema, other food allergies, asthma or hay fever, the NHSc representative highlights.

HMOs: Applicability for all ages
NHSc highlights that the biotechnological production of HMOs in infant formula is “extremely challenging.” Earlier this year, DuPont Nutrition & Bioscience released a study finding that commercially produced HMOs can mimic some of the health-promoting effects of the HMOs present in human milk. Meanwhile, Singapore-based biotech start-up TurtleTree Labs produced a complete nutritional biomatch to human breast milk when it showcased the world’s first human breast milk created using cell-based technology.

In other developments within the space, NutritionInsight spoke with industry experts on the potential of HMOs in personalized solutions for all ages. Lallemand Health Solutions previously shared how the complex sugar molecules can act as a prebiotic to boost the digestive health of adults, while BASF spotlighted HMOs for personalized functional foods and supplement applications.

By Anni Schleicher