title: Atopic dermatitis prevention in children following maternal probiotic supplementation does not appear to be mediated by breast milk TSLP or TGF-β.
abstract: BACKGROUND
  The Probiotics in Prevention of Allergy among Children in Trondheim (ProPACT) study, a randomised, placebo controlled trial, demonstrated that maternal supplementation with probiotic milk reduced the incidence of atopic dermatitis (AD) in infancy. The mechanisms behind this effect are incompletely understood and breast milk cytokines have been postulated as possible mediating factors. In this study we aimed to assess whether breast milk TLSP and TGF-β are affected by a maternal probiotic supplementation regime, and their contribution to the preventive effect of this regime on AD in the offspring.
  
  
  METHODS
  TSLP and TGF-β isoforms (TGF-β1, TGF-β2 and TGF-β3) were measured using ELISA and multiplex assays, respectively, in breast milk samples collected at 10 days and 3 months postpartum from women participating in the ProPACT trial (n = 259). The natural indirect and direct effects of maternal probiotics on AD, due to changes in breast milk cytokines, were estimated using causal mediation techniques.
  
  
  RESULTS
  Probiotic supplementation tend to lead to high levels of breast milk TSLP at 10 days postpartum (p = 0.062), but this change did not contribute to the prevention of AD according to the mediation analysis. Probiotics had no apparent effect on TSLP at 3 months or TGF-βs at either time points. Thus, these are unlikely to be mediators of the effect of maternal probiotics on AD in offspring.
  
  
  CONCLUSIONS
  Whilst maternal probiotic supplementation resulted in higher breast milk concentrations of TLSP at 10 days postpartum, this does not appear to be a mechanism for prevention of AD by maternal probiotics. Trial registration The original trial protocol is registered in ClinicalTrials.gov (identifier NCT00159523).
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway ; Det medisinske fakultet, Instiutt for samfunnsmedisin, MTFS, NTNU, Postboks 8905, 7491 Trondheim, Norway.
authors.forename: Melanie Rae
authors.initials: MR
authors.lastname: Simpson
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Immunology and Transfusion Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Anne Dorthea Bjerkenes
authors.initials: AD
authors.lastname: Rø
authors.affiliation: Department of Dermatology, University Hospital of North Norway, Tromsö, Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Grimstad
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Roar
authors.initials: R
authors.lastname: Johnsen
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Ola
authors.initials: O
authors.lastname: Storrø
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Øien