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Transforming growth factor beta in human milk and allergic outcomes in children: A systematic review

机译：将生长因子β转化为儿童的人乳和过敏性结果：系统审查

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Abstract Background Human milk (HM) transforming growth factor beta (TGF‐β) is critical for inflammation regulation and oral tolerance promotion. Previous reports suggested that variations in HM TGF‐β levels are associated with allergic outcomes. Objective We undertook a systematic review (PROSPERO 2017 CRD42017069920) to reassess the evidence on the relationships between HM TGF‐β and allergic outcomes in children. Methods Electronic bibliographic databases (MEDLINE, EMBASE and Cochrane Library) were systematically searched. Two independent reviewers screened reference lists, extracted the data and assessed risk of bias using the National Institute for Clinical Excellence methodological checklist. Results A total of 21 studies were identified. Sixteen studies assessed relationships between HM TGF‐β and risk of eczema; 14, allergic sensitization; nine, wheezing/asthma; six, food allergy; three, allergic rhinitis/conjunctivitis. Five cohorts (5/18, 28%) reported a protective effect of TGF‐β1, while 3 (3/10, 30%) suggested increased risk of allergic outcomes development and 1 (1/10, 10%), a protective effect of TGF‐β2 on eczema. Meta‐analysis was not possible due to significant heterogeneity in methodology, age of outcome assessment and differing statistical approaches. 71% (15/21) of studies carried a high risk of bias. Conclusion and clinical relevance In contrast with previous findings, we did not find strong evidence of associations between HM TGF‐β and allergic outcomes. Differences in studies' methodology and outcomes do not allow unconditional rejection or acceptance of the hypothesis that HM TGF‐β influences the risk of allergy development. Future studies on diverse populations employing standardized methods, accurate phenotyping of outcomes and evaluation of the effect of TGF‐β in combination with other HM immune markers, microbiome and oligosaccharides are required.
机译：摘要背景，转化生长因子β（TGF-β）的人乳（HM）对炎症调节和口腔耐受促进至关重要。之前的报道表明，HM TGF-β水平的变化与过敏结果有关。目的我们进行了系统审查（Prospero 2017年CRD42017069920），以重新评估关于HM TGF-β与儿童过敏结果之间的关系的证据。方法系统地搜索电子书目数据库（Medline，Embase和Cochrane库）。两个独立的审稿人筛选了参考列表，用国家临床卓越方法检查表中提取了数据并评估了偏见的风险。结果共鉴定了21项研究。十六研究评估了HM TGF-β与湿疹的风险之间的关系; 14，过敏性敏化;九，喘息/哮喘;六，食物过敏;三，过敏性鼻炎/结膜炎。五个队列（5/18，28％）报告了TGF-β1的保护作用，而3（3/10,30％）表明过敏性结果的风险增加，1（1/10,10％），一种保护作用TGF-β2对湿疹。由于方法论，结果评估年龄和不同的统计方法，因此不可能进行META分析。 71％（15/21）的研究具有很高的偏倚风险。结论与临床相关性与先前的发现相比，我们没有发现HM TGF-β和过敏结果之间的关联的有力证据。研究的差异“方法论和结果不允许无条件的拒绝或接受HM TGF-β影响过敏发育风险的假设。未来研究采用标准化方法的不同人群，需要准确的结果表型结果和TGF-β与其他HM免疫标记的影响的评价，微生物组和寡糖组合。

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