How far is it from infant formula to human milk? A look at the human milk oligosaccharides

Background: Human milk is the gold standard for the nutrition of infants. Human milk oligosaccharides (HMOs) are structurally diverse sugars highly abundant in human milk but not present in infant formula. The interest in HMOs has gradually increased in recent years due to their beneficial functions on infants. Scope and approach: Here we summarize the structures and composition of HMOs, and compare the differences of oligosaccharides in human and other mammals. The absorption and metabolism of HMOs are discussed. Then we discuss existing studies on the functional biology of HMOs. Additionally, the structure-function relationships of HMOs are presented. Finally, this review summarizes the oligosaccharides in recent infant formula as well as limitations and future perspectives of HMOs research. Key findings and conclusions: The structures and composition of HMOs are affected by many factors. Large amounts of HMOs are metabolized by gut microbiota, and few are absorbed into circulation to perform physiological functions. Evidences from in vitro and in vivo studies, as well as clinical trials suggest that HMOs modulate gut microbiota, reduce pathogen adhesion, modulate epithelial cell and immune responses, reduce the risk of necrotizing enterocolitis and promote brain development and cognition. The specific structure determines different functions. Currently two HMOs, 2′-fucosyllactose and Lacto-N-Neotetraose, have been demonstrated safe and well-tolerated to be added into infant formula. However, the application in HMOs has been limited due to their insufficient availability. Thus, basic and clinical studies of HMOs need to be further elucidated.