Thorough understanding of the initial colonization process of human intestines is important to optimize the prevention of microbiota-associated diseases, and also to further improve the current microbial therapies. In recent years, therefore, colonization of the human gut has gained renewed interest.
1. Introduction
The human gut community is a complex, dynamic microbial network comprising of bacteria, yeast, and viruses. Due to its relevance to the host’s health and the multiple physiological functions it performs, it is sometimes referred to as the hidden organ of the body. The intestinal microbiota assists in digestion of insoluble fibers, thereby providing nutrients (short-chain fatty acids, SCFAs) for the colonic epithelial cells
[1]. Besides its digestive function, it also protects the host from pathogens by occupying the available niches (space and nutrients) and plays a crucial role in the development of the host’s immune system
[2][3]. The latter function is thought to be heavily impacted by the developing gut microbiota during the first years of life. The adult human colon is densely populated by bacteria with estimated numbers being as high as 10
14 bacterial cells per gram in the luminal content
[1]. The massive colonization of the intestines is assumed to start gradually from birth onwards until the dynamically more stable adult state is reached. Interestingly, disruptions in this colonization process have been shown to coincide with increased incidences of allergic diseases during childhood
[4][5].
Regardless of the continuing research, the knowledge on intestinal colonization in humans is far from complete. Major knowledge gaps appear to result from the lack of datapoints per infant, which necessitates deduction-based conclusions and hampers in-depth insight in succession and colonization of specific bacteria in the intestinal microbial network. As dense sampling and high-quality collection of fecal samples of newborns is not straightforward for humans and key factors affecting the microbiota development (major dietary and environmental changes) are not standardized, resesarchers here summarize the colonization of the porcine gut, in comparison with what is known in infants. After all, anatomically and physiologically speaking, pigs closely resemble humans
[6]. In addition, early development of the porcine gut microbiota community is more standardized, given the more consistent duration of lactation and co-habitation, for instance. For piglets, four subsequent growth phases are described, which are each well-defined, namely lactation, nursery, growing, and the final phase of weight increase named finishing. During the lactation stage, the piglet is co-housed with littermates and the mother sow. The piglets are then separated from the sow (weaning) and are co-housed with piglets of a similar age throughout the subsequent growth phases until they have reached their adult market weight. Due to these more standardized circumstances, projecting the knowledge of the porcine gut colonization on the human gut colonization might assist in a better understanding of the latter.
2. Human Bacterial Gut Colonization
Intestinal bacterial colonization in humans has been established as a sequence of different bacterial waves that support and replace each other. As most data are available for vaginally delivered breastfed infants, researchers summarize the state of the art based on data from those children. The process of developing a complex microbial community has shown to display consistent, distinguishable colonization waves which succeed each other. In humans, subsequent waves of colonization occur over the course of the first two years of life, leading to a more stable and adult-like microbiota around the age of 2 years
[3]. While it was formerly proposed that bacterial colonization already started in utero
[7], this has been refuted by recent studies
[8][9]. Therefore, it is now generally accepted that newborns encounter their first bacteria during birth. As such, from all bacteria that the newborn encounters at birth, the first stable colonizers (first colonization wave) in humans comprise mostly facultative anaerobes such as enterobacteria and bacilli such as
Streptococcus,
Enterococcus, and
Staphylococcus [10][11][12][13]. These bacteria remove the oxygen from the gut and thereby set an important prerequisite for the next colonization waves, which comprise strict anaerobes
[14][15][16].
Once anaerobic, the genus
Bifidobacterium (second colonization wave) expands rapidly, becoming the dominant member of the gut microbiota of the newborns with an exclusive milk-based diet at that time.
Bifidobacterium degrades mucin and human milk oligosaccharides (HMOs), a major constituent of breastmilk. The molecules resulting from degradation of HMOs can then be further metabolized by other bacteria that cannot or only partly metabolize HMOs, a mechanism called cross-feeding
[17]. As such,
Bifidobacterium in turn helps to create a favorable environment for colonizers of the third wave, which comprises of
Bacteroidota and other strict anaerobic bacteria belonging to the
Clostridiales. Additionally, several butyrate-producing bacteria such as
Anaerostipes,
Roseburia, and
Faecalibacterium are described to become part of the infant gut’s bacterial community at that time
[13][18][19]. The transition from second to third wave appears to co-occur with weaning (when the infant is no longer breastfed)
[10]. Some publications
[12][18] also describe a distinct fourth colonization wave which comprises the further increase in
Clostridiales, more specifically,
Lachnospiraceae and
Ruminococcaceae. The latter has been related to a shift in diet enriched in plant-based products
[10], which is in line with data on the impact of dietary interventions on adult microbiota composition
[20].
Some factors, however, impact this colonization pattern. The delivery mode is the most important factor, the one with the most profound repercussion on the gut microbiome development
[21]. During vaginal birth, a newborn encounters maternal faecal, vaginal, and skin bacteria. While not all these bacteria have the ability to establish themselves in the infant gut
[10], this microbial exposure at the start is markedly different from birth via caesarean section (CS), which is performed in a sterile manner. In contrast to vaginally born infants, infants born via CS have a lower abundance of
Bifidobacterium and an almost complete lack of
Bacteroidota. Furthermore, CS infants often have a higher abundance of
Klebsiella oxytoca,
Klebsiella pneumoniae,
Enterobacter cloacae,
Enterococcus faecium,
Staphylococcus aureus, and
Clostridium perfringens, several of which are typically hospital-associated bacteria and potential pathogens
[21][22][23][24]. CS-associated alterations in the gut microbiota composition are most pronounced up to 6 months after birth, but even a much more prolonged effect on the gut microbiota is suspected
[10]. In a large adult population (
n = 1106), compositional differences based on the delivery mode could, however, no longer be identified
[25], but long-term health effects are still under investigation. Additionally, formula feeding, resulting in a decrease in
Bifidobacterium, and antibiotic use, resulting in an increase in facultative anaerobes such as
Escherichia and
Klebsiella, largely influence the developing gut microbiota compared to the colonization process described for breastfed, vaginally delivered babies
[21].
Cooperation and dependence between different waves have been comprehensively described, yet this knowledge remains insufficient as it is deduced from interval sampling. The timing and length of the different colonization waves differ between infants, even when major colonization routes are similar (delivery mode, breastfeeding, etc.)
[13]. With only limited timepoints, it is very difficult to reconstruct and understand the biological grounds for these differences, as a much more detailed view on the gut microbiota transitions would be required. However, since pigs have a more standardized course of their lives during the first weeks (birth, suckling, co-habitation), they might prove an elegant solution to learn how external factors influence the development of the gut microbiota, and more specifically, which events are inextricably linked to changes in the gut microbiota composition.