Microbioma, Harvard’s expert: « Acting in the first two years of life is a form of prevention comparable to that of vaccinations »

There is an invisible instructor who trains our immune system from birth: the microbioma. In the first 1,000 days of life – from conception to two years – that training can make the difference between health and illness. To explain it clearly is Alessio Fasano, Director of Mucosal Immunology and Biology Research Center of Harvard Massachusetts General Hospital And among the greatest world experts in the field of interactions between microbioma, immune system and chronic inflammatory diseases. In his lectio magistralis at the 80th Congress of the Italian Society of Pediatrics (SIP), Fasano proposes a real paradigm change: «Acting on the microbioma in the first two years of life is a form of primary prevention comparable to that of vaccinations. It means programming an immune system capable of distinguishing what to fight from what must be tolerated ».

A silent revolution that starts from the intestine

So far there has been much about microbioma, but rarely has been connected with such precision to the « critical window » of the first 1,000 days. « It is in this period that a lasting balance is built between organism and microbes. If disturbed – from an unnecessary cesarean delivery, an unbalanced diet or excessive use of antibiotics – The immune system can be programmed badly and become hyperactive, favoring chronic inflammations»If genetically predisposed, explains Fasano.

Allergies, obesity, celiac disease, type 1 diabetes, but also neurosvilizing disorders such as autism and ADHDare some of the increasingly widespread conditions in pediatric age which – according to research – they can find origin in an early « dysbiosis ».

What can we already do today

There is no shortage of scientific evidence. And some actions are already within the reach of pediatricians and families:

• Promote vaginal birth When possible: the newborn inherits a « selected » microbioma and compatible with its genetic profile.
• Limit the unnecessary use of antibioticsespecially in the first two years of life: many viral infections do not require antibiotic treatments, which can alter the balance of the microbioma.
• Promote breastfeeding and generally a healthy and fiber -rich dietalready from weaning: « What we eat, also eat it our microorganisms. And if we give ‘junk food’, we nourish the wrong bacteria », underlines Fasano.
• Avoid excessive stress and too westernized habits In the first months of life, when the microbioma is still under construction and looks for an « agreement » with the body.

« These results further strengthen the centrality of the first 1,000 days of life in the development of future health. It is in this period of time that pediatricians and parents can, together, build the foundations of a healthy immune system. Pediatricians are responsible for guiding and orienting, to families to put into practice aware choices: from nutrition to responsible use of antibiotics, to lifestyle. It is an alliance that can really make the difference»,, underlines the President of the SIP (Italian Society of Pediatrics), Rino Agostiniani.

Towards a tailor -made medicine: the microbioma as an early risk marker

The great challenge is to move from an empirical approach to one precision medicine on a microbial basis. « We cannot think of administering the same probiotic to everyone: a personalized and targeted analysis is needed, to know which bacteria they are missing and how to restore them », takes Fasano.

The technologies to do it already exist, but they are still expensive and not very accessible. Analyze in detail the microbioma costs more than 1,000 euros today, and few professionals are trained to interpret the data. «When the sequencing of the microbioma will cost as a standard analysis of the stool – and will happen soon – then we will have a very powerful tool in hand: the microbioma will become a true early marker of risk for many chronic diseases », concludes Fasano.

A new ground for prevention

A new phase of prevention is therefore opening: not only infections, but also chronic inflammations, metabolism and neurosviluppo disorders. The microbioma is no longer a niche search topic: it is the ground on which the health of tomorrow is built today. Pediatric medicine has already contributed to defeating large infections through primary prevention with the use of vaccines. Now he has to collect the second challenge: prevent chronic inflammatory diseases by intervening in the early years of life, on the microbioma. It is a revolution already underway.

The five pillars of early chronic inflammation

According to prof. Alessio Fasano, there are 5 pillars that transform a genetic predisposition into conclated disease. Two of these – microbioma and intestinal barrier – are modifiable, and that’s where we can act.
1. Genetics. It is the hereditary heritage with which we are born. It cannot be changed, but alone it does not determine the appearance of multifactorial diseases.
2. Environmental factors. Air pollution, climate change, chronic stress: elements often out of individual control, but with a strong pro-inflammatory impact.
3. Intestinal permeability. When the intestinal barrier is compromised, harmful substances can enter the circulation and activate an inappropriate immune response.
4. Hyperactive immune system. If planned badly in the early years of life, it also reacts in the absence of real threats, favoring a state of chronic inflammation.
5. Microbioma. It is one of the most influenced elements. In the first 1,000 days of life, factors such as cesarean birth, use of antibiotics, nutrition and lifestyle (including a sedentary life, indiscriminate use of electronic devices, or sleep hygiene) can alter or favor their balance. A healthy microbioma helps to correctly modulate the immune response.