Entry 24
Probiotic science page
Supports gut microbiome development in preterm infants as part of multi-strain formulations, with RCT evidence.
Overview
B. bifidum BB-02 (also designated Bb-02) is a probiotic strain from Chr. Hansen. It is used primarily in multi-strain synbiotic and probiotic formulations rather than as a standalone strain [1,2]. The most substantial clinical evidence for BB-02 comes from the ProPrems multicenter randomized controlled trial. In that trial, it was used as part of a three-strain probiotic combination in very preterm infants for prevention of late-onset sepsis and necrotizing enterocolitis (a severe gut disease in premature babies) [3,4]. Note: published literature uses the strain code “BB-02” for at least two distinct bifidobacterial strains from different species (B. bifidum and B. longum subsp. infantis). This entry focuses on the Chr. Hansen B. bifidum BB-02 designation [taxonomic note: strain identity documentation is sparse].
Mechanism
BB-02 has been characterized in the context of multi-strain formulations. Attributed mechanisms include competitive exclusion of harmful bacteria, production of short-chain fatty acids (fuel for gut cells), primarily acetate, and tuning of the immune system through interaction with cells lining the gut [1,2]. In the ProPrems trial formulation (combined with B. longum subsp. infantis BB-02 and Streptococcus thermophilus TH-4), the three-strain combination established colonization in the preterm infant gut. Bifidobacterium was detected in 92% of supplemented infants vs. 63% of controls at postnatal week 3 [4] [in vitro and RCT evidence]. Bartosch et al. (2005) demonstrated that synbiotic supplementation containing B. bifidum increased fecal bifidobacterial counts from 7.9 to 8.7 log10 CFU (colony-forming units, a live bacteria count)/g in elderly subjects [2] [RCT].
Health Benefits
The ProPrems RCT (Jacobs et al. 2013, n=1,099 very preterm infants <32 weeks gestation) demonstrated that the three-strain combination containing BB-02 significantly reduced late-onset sepsis (RR 0.66; 95% CI 0.48–0.90). It did not significantly reduce necrotizing enterocolitis incidence or all-cause mortality [3] [RCT, multi-strain]. A sub-study of ProPrems confirmed probiotic colonization correlated with microbiota changes in supplemented infants [4] [RCT]. A synbiotic formulation containing B. bifidum in elderly subjects increased beneficial bifidobacterial populations in a pilot clinical trial (n=18) [2] [RCT, small sample]. The ESPGHAN 2020 position paper references the ProPrems trial and the multi-strain formulation in its evidence review for probiotic use in preterm infants. It notes the need for strain-specific data [5] [position paper, review]. Standalone RCT evidence for B. bifidum BB-02 as a single strain is absent.
Biology
Taxonomy: Bifidobacterium bifidum (valid species, type species of genus Bifidobacterium). It is Gram-positive, only grows without oxygen, non-motile, and non-spore-forming. It often presents as irregular, club-shaped or bifurcated rods. It ferments carbohydrates via the bifid shunt. Key differences from other Bifidobacterium species: it does not ferment starch, gluconate, or D-xylose. It is positive for lactose and galactose utilization. Habitat: adult and infant gastrointestinal tract. It is found as a commensal (normally harmless resident) at lower relative abundance than B. longum or B. breve in most populations.
Bibliography
Smith AR, Macfarlane GT, Reynolds N, O’May GA, Bahrami B, Macfarlane S. (2012). Effect of a synbiotic on microbial community structure in a continuous culture model of the gastric microbiota in enteral nutrition patients. FEMS Microbiol Ecol. 80(1):135-45. PMID: 22176141
Bartosch S, Woodmansey EJ, Paterson JC, McMurdo ME, Macfarlane GT. (2005). Microbiological effects of consuming a synbiotic containing Bifidobacterium bifidum, Bifidobacterium lactis, and oligofructose in elderly persons, determined by real-time polymerase chain reaction and counting of viable bacteria. Clin Infect Dis. 40(1):28-37. PMID: 15614689
Jacobs SE, Tobin JM, Opie GF, Donath S, Tabrizi SN, Pirotta M, et al. (2013). Probiotic effects on late-onset sepsis in very preterm infants: a randomized controlled trial. Pediatrics. 132(6):1055-62. PMID: 24249817
Plummer EL, Bulach DM, Murray GL, Jacobs SE, Tabrizi SN, Garland SM; ProPrems Study Group. (2018). Gut microbiota of preterm infants supplemented with probiotics: sub-study of the ProPrems trial. BMC Microbiol. 18(1):184. PMID: 30424728
van den Akker CHP, van Goudoever JB, Shamir R, Domellof M, Embleton ND, Hojsak I, et al. (2020). Probiotics and Preterm Infants: A Position Paper by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Committee on Nutrition and the European Society for Paediatric Gastroenterology Hepatology and Nutrition Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr. 70(5):664-680. PMID: 32332478
Available Products
Chr. Hansen supplies BB-02 as a component of multi-strain blends (frozen and freeze-dried concentrates). It is used predominantly in the ProPrems hospital probiotic formulation (ABC Dophilus Probiotic Powder for Infants, manufactured by Solgar under license) in Australian NICUs. It is also used in various synbiotic formulations for enteral nutrition and infant feeding products [3,4].