Might patients with immune-related diseases benefit from probiotics?

Exploring Innovative Approaches for Managing Spinal Cord Injury: A Comprehensive Review of Promising Probiotics and Postbiotics

Spinal cord injury (SCI) affects millions of people worldwide annually, presenting significant challenges in functional recovery despite therapeutic advancements. Current treatment strategies predominantly focus on stabilizing the spinal cord and facilitating neural repair, yet their effectiveness remains uncertain and controversial. Recent scientific investigations have explored the potential of probiotics and postbiotics to modulate inflammation, influence neurotransmitters, and aid in tissue repair, marking a potential paradigm shift in SCI management. This review critically evaluates these innovative approaches, emphasizing their ability to harness the natural properties of microorganisms within the body to potentially enhance outcomes in SCI treatment. By analyzing the latest research findings, this review provides valuable insights into how probiotics and postbiotics can revolutionize inflammation management and neurological recovery following SCI, underscoring their promising role in future therapeutic strategies aimed at improving the quality of life of SCI patients globally.

Effects of nutritional supplements and dietary interventions on rheumatoid arthritis: An umbrella review of meta-analyses of randomized controlled trials

BACKGROUNDS

The effects of nutritional supplements and dietary interventions on rheumatoid arthritis (RA) are still unclear.

OBJECTIVES

This study aimed to evaluate the impact of nutritional supplements and dietary interventions on RA patients.

METHODS

The online databases of PubMed, Web of Science, Embase, and Cochrane Library were used to search the relevant literature from inception to December 2024. Meta-analyses with the inclusion of randomized controlled trials were selected to assess the effects of nutritional supplements or dietary interventions on RA. We accessed the methodological quality of included reviews using AMSTAR 2 and evaluated the quality of evidence for intervention effects using GRADE. Data synthesis and analysis were used by R 4.4.1 and STATA 17.

RESULTS

A total of 14 articles were included, evaluating the effects of nutritional supplements and dietary interventions on RA management. Among these, 3 studies were rated as high quality, 6 as low quality, and 5 as critically low quality by AMSTAR2. The quality of evidence for intervention effects ranges from low to very low quality. The interventions assessed included polyunsaturated fatty acids (PUFAs), probiotics, total glucosides of paeony (TGP), anti-inflammatory diets (AIDs), and others. TGP was the only intervention to significantly reduce both the disease activity score and erythrocyte sedimentation rate, although the quality of evidence for these effects was low. Probiotics contributed to significant reductions in C-reactive protein and visual analogue scale scores, with both outcomes rated as low quality. PUFAs demonstrated significant improvements in tender joint count, swollen joint count, and morning stiffness, though, like the other interventions, these effects were also rated as low quality.

CONCLUSION

There was relatively strong evidence supporting that PUFAs, probiotics, TGP, and AIDs may show some benefits on RA. However, the low quality of evidence highlights the need for further high-quality research and real-world evidence to confirm their effectiveness.

Reutilization of Fruit Waste as Potential Prebiotic for Probiotic or Food-grade Microorganisms in Food Applications: A Review

Food waste has been a global issue with 2.5 billion tons generated globally in 2021. Approximately 46% of the food waste is contributed by fruit and vegetable waste. Due to improper waste handling, these fruit by-products have a negative impact on the environment through soil and water pollution, the greenhouse effect, global warming, and eutrophication. However, research has shown the potential to reuse fruit waste in various applications for sustainability owing to their high source of valuable components and potential health benefits. In recent years, researchers have also explored the potential of reutilizing fruit waste as a prebiotic. Hence, literatures from the past 10 years has been critically analyzed and presented in this review. This review focused on the potential of fruit waste as a prebiotic for probiotic and gastrointestinal microorganisms and its food applications. The nutritional composition and bioactive compounds of the fruit wastes had been introduced to reflect their potential as prebiotics. Moreover, the increase in bioactive compounds and bioactivities in probiotics with the presence of fruit wastes has been reviewed. The impact of fruit by-products on the growth of the probiotic and its survivability in food matrices as compared to established prebiotic and the absence of prebiotics have also been extensively discussed in this review. This review also highlighted some of the factors that might contribute to the negative effect of fruit waste on probiotics. The safety concerns and future prospects of reutilizing fruit wastes for food applications have been emphasized. The review article is beneficial for researchers exploring fruit wastes as prebiotics and industrialists who are interested in incorporating fruit wastes as an added-value ingredient for food applications.

Exploring the Potential of Postbiotics for Food Safety and Human Health Improvement

Food safety is a global concern, with millions suffering from foodborne diseases annually. The World Health Organization (WHO) reports significant morbidity and mortality associated with contaminated food consumption, and this emphasizes the critical need for comprehensive food safety measures. Recent attention has turned to postbiotics, metabolic byproducts of probiotics, as potential agents for enhancing food safety. Postbiotics, including organic acids, enzymes, and bacteriocins, exhibit antimicrobial and antioxidant properties that do not require live organisms, and this offers advantages over probiotics. This literature review critically examines the role of postbiotics in gut microbiome modulation and applications in the food industry. Through an extensive review of existing literature, this study evaluates the impact of postbiotics on gut microbiome composition and their potential as functional food ingredients. Research indicates that postbiotics are effective in inhibiting food pathogens such as Staphylococcus aureus, Salmonella enterica, and Escherichia coli, as well as their ability to prevent oxidative stress-related diseases, and they also show promise as alternatives to conventional food preservatives that can extend food shelf life by inhibiting harmful bacterial growth. Their application in functional foods contributes to improved gut health and reduced risk of foodborne illnesses. Findings suggest that postbiotics hold promise for improving health and preservation by inhibiting pathogenic bacteria growth and modulating immune responses.

Postbiotics as Potential Detoxification Tools for Mitigation of Pesticides

Pesticides possess a pivotal role in the realm of agriculture and food manufacturing, as they effectively manage the proliferation of weeds, insects, plant pathogens, and microbial contaminations. They are valuable in some ways, but if misused, they can cause health issues like cancer, reproductive toxicity, neurological illnesses, and endocrine system disturbances. In this regard, practical methods for reducing pesticide residue in food should be used. For reducing pesticide residue in food processing, some strategies have been suggested. Recent research has been done on detoxification processes, including microorganisms like probiotics and their metabolites. The term "postbiotics" describes soluble substances, such as peptides, enzymes, teichoic acids, muropeptides generated from peptidoglycans, polysaccharides, proteins, and organic acids that are secreted by living bacteria or released after bacterial lysis. Due to their distinct chemical makeup, safe dosage guidelines, lengthy shelf lives, and presence of various signaling molecules that may have antioxidant, anti-inflammatory, anti-obesogenic, immunomodulatory, anti-hypertensive, and immunomodulatory effects, these postbiotics have attracted interest. They also can detoxify heavy metals, mycotoxins, and pesticides. Hydrolytic enzymes have been proposed as a potential mechanism for pesticide degradation. Postbiotics can also reduce reactive oxygen species production, enhance gastrointestinal barrier function, reduce inflammation, and modulate host xenobiotic metabolism. This review highlights pesticide residues in food products, definitions and safety aspect of postbiotics, as well as their biological role in detoxification of pesticides and the protective role of these compounds against the adverse effects of pesticides.

Stability and programmed sequential release of Lactobacillus plantarum and curcumin encapsulated in bilayer-stabilized W1/O/W2 double emulsion: Effect of pectin as protective shell

In order to overcome the problem that traditional W1/O/W2 double emulsions do not have targeted release performance, thereby better meeting the health needs of consumers, ovalbumin fibrils/pectin-based bilayer-stabilized double emulsion (OP-BDE) co-encapsulated with Lactobacillus plantarum and curcumin was constructed with pectin as the outer protective shell, which was expected to be used in the development of novel functional foods. The effects of pectin coating on the viability of Lactobacillus plantarum under conditions including storage, pasteurization, freeze-thaw cycles and in vitro simulated digestion were investigated. Results showed that pectin as protective shell could significantly enhance the tolerance of Lactobacillus plantarum to various environmental factors. Besides, the adsorption of pectin endowed OP-BDE with higher lipolysis and stronger protective effect on curcumin, remarkably improving the photostability and bioaccessibility of curcumin. In addition, in vitro simulated gastrointestinal release study indicated that OP-BDE possessed programmed sequential release property, allowing curcumin and Lactobacillus plantarum to be released in small intestine and colon, respectively. OP-BDE is the first reported co-delivery emulsion system with programmed release characteristic. This study provides new insights into OP-BDE in constructing co-delivery systems and programmed sequential release of active substances, and has potential reference and application value in actual food production.

A comprehensive overview of juvenile idiopathic arthritis: From pathophysiology to management

Rheumatoid Arthritis (RA) is a progressive autoimmune disease. It is among the most widespread chronic illnesses in children, with an annual incidence of 1.6 to 23 new instances per 100,000 adolescents. About 1 child in every 1000 develops Juvenile Idiopathic Arthritis (JIA) type of chronic arthritis. The cause of JIA is not well known but what known is that it involves inflammation of the synovium and destruction of tissues in joints which can cause early-onset of oligo articular JIA. It is challenging to diagnose the condition in some children who initially complain of pain and joint swelling as there is no blood test discovered that can confirm the diagnoses of JIA. As JIA patients are immunosuppressed due to the use of drugs, making them vulnerable to catch infections like COVID 19 which can lead to cardiovascular diseases having high rate of morbidity and mortality. The comorbidity like Diabetes has higher incidence in these patients resulting in synergistic effect on inflammation. Currently, the connection of genetics in JIA provides evidence that HLA Class I and II alleles have a role in the pathophysiology of various subtypes of JIA which includes inflammation in the axial skeletal. The primary objective of therapy in juvenile idiopathic arthritis is the suppression of clinical symptoms. The pharmacological approach includes use of medications like DMARDs, NSAIDs etc. and non-pharmacological approach includes physiotherapy, which helps in restoring normal joint function and herbs as adjuvants which has the benefit of no side effects.

The Oleaster (Elaeagnus angustifolia): A Comprehensive Review on Its Composition, Ethnobotanical and Prebiotic Values>

BACKGROUND

Oleaster or Elaeagnus angustifolia is a deciduous plant from Elaegnacea family and is well-known for its remedial applications.

OBJECTIVE

This paper presents a comprehensive review of the potential application of Oleaster's flour incorporated in some food products. Emphasis is given to the physicochemical, biochemical, and functional properties of Oleaster's flour.

METHODS

A comprehensive search was carried out to find publications on Oleaster's flour and its application as a prebiotic. The results of the related studies were extracted and summarized in this paper.

RESULTS

Oleaster's flour as a prebiotic ingredient enhances antioxidants, polyphenols, fiber, flavonoids, Sterols, carbohydrates, and protein content of food products.

CONCLUSION

Further advanced investigations on Oleaster and its functional ingredients revealed that these are efficacious and can be applied as a substitute source in pharmacological industries for medical applications.

Optimization of prebiotic sucrose-free milk chocolate formulation by mixture design

The purpose of the current research was to determine optimal situation by applying Simplex lattice mixture design for the formulation of prebiotic sucrose-free milk chocolate. Chocolate samples were prepared using two different sugar alcohols containing xylitol and maltitol along with galactooligosaccharide as prebiotic substance. The effects of sugar alcohols and prebiotic blends on rheological attributes and some physical characteristics were assessed. The outcomes represented the high coefficient of determination (≥ 90%) of fitted models. The optimization of the variables indicated that using 20.857 g maltitol, 7.131 g xylitol and 5.012 g galactooligosaccharide generated the optimized chocolate with the highest desirability (1.00) without undesirable changes in the rheological and physical properties. Furthermore, the optimum formulation was prepared to validate the optimum model. The sensory evaluation of the optimized formulation of chocolate pleased the consumer needs.

Prebiotics can change immunomodulatory properties of probiotics

Beneficial effects of probiotics and prebiotics are mainly related to modulation of compositions and activities of gut microbiota as well as manipulation of immunological reactivity in autoimmune diseases. In the present study, we examined whether metabolic products from different strains of Lactobacillus brevis cultured with different prebiotics have similar immunomodulating properties on immune cells under normal and inflammatory conditions, using mouse model of collagen-induced arthritis (CIA). Two strains of Lactobacillus brevis (3448 and 8429) were cultured with four different prebiotics, such as xylooligosaccharides, inulin, pectin, and chitosan. Sterile supernatants containing different metabolic products have been used for direct treatment of cell cultures prepared from CII-immunized mice and non-immunized (control mice). Our results showed that metabolic products from XOS decreased levels of IFN-γ, IL-6, IL-17, and TNF-α in both cultures from immunized and non-immunized mice. In contrast, metabolic products from inulin, pectin, and chitosan increased concentrations of these cytokines with highest values for pectin. Neither of investigated prebiotics influenced the secretion of IL-10. In addition, we found changes in the percentage of macrophages, which were different for the tested prebiotics. Also, metabolic products from pectin and chitosan caused loss of T-cells (CD3+) and increased percentages of CD4⁺CD25⁺ regulatory T cells and CD8⁺CD279⁺ anergic T cells. Hence, our data indicate that immunomodulating properties of probiotics are strain-specific and prebiotic-dependent.

Kluyveromyces marxianus as a Probiotic Yeast: A Mini-review

Background:

Yeasts play diverse roles in human life. Since ancient times, these micro organisms have been used to produce food products and beverages including bread and beer. Nowadays, the biotechnological products of yeast are some of the main components of commercial products.

Objective:

Some species of yeast such as Saccharomyces cerevisiae and Saccharomyces boulardii are recognized as probiotic yeast with extensive applications in the food and drug industries. However, certain species like Kluyveromyces marxianus are still not recognized as probiotic micro organisms despite their widespread industrial usage. In this study, the application of K. marxianus in preparing food and the medicinal product was reviewed in terms of its beneficial or harmful effects.

Methods:

Pub Med, Google Scholar, Scopus, and Science Direct databases were searched by using “Probiotics”, “Yeast”, and “Kluyveromyces marxianus”.

Results:

The findings suggest that K. marxianus can be recognized as a probiotic yeast species.

Conclusion:

It can be concluded that K. marxianus may be considered as a probiotic micro organism with a variety of commercial and medical applications.

Do Interventions with Diet or Dietary Supplements Reduce the Disease Activity Score in Rheumatoid Arthritis? A Systematic Review of Randomized Controlled Trials

The aim was to compile the evidence from Randomized Controlled Trials (RCTs) of diet or dietary supplements used to reduce disease activity in adults with Rheumatoid Arthritis (RA). Searches were performed in the databases PubMed, Scopus and Cochrane. Only RCT studies of diets, foods or dietary supplements, looking at effects on the Disease Activity Score in 28 joints (DAS28) among adults with RA, published in peer-reviewed journals, were included. A total of 27 articles were included-three of whole diets (Mediterranean diet, raw food and anti-inflammatory diet), five of food items, five of n-3 fatty acids, five of single micronutrient supplements, four of single antioxidant supplements and five of pre-, pro- or synbiotics. Studies that showed moderate strength evidence for positive effects on disease activity in RA included interventions with a Mediterranean diet, spices (ginger powder, cinnamon powder, saffron), antioxidants (quercetin and ubiquinone), and probiotics containing Lactobacillus Casei. Other diets or supplements had either no effects or low to very low strength of evidence. In conclusion, RCT studies on diet or dietary supplements are limited in patients with RA, but based on the results in this review there is evidence that some interventions might have positive effects on DAS28.

Complementary and Alternative Medicine Use in Rheumatoid Arthritis

PURPOSE OF REVIEW

Despite advances in pharmacologic management of rheumatoid arthritis (RA), complementary and alternative medicine (CAM) remains popular adjuncts to therapy among patients for ongoing symptomatology.

RECENT FINDINGS

Mind-body interventions are becoming increasingly popular, including yoga and meditation. Randomized controlled trials have found these interventions to be helpful regarding pain, mood, and energy in RA patients. Other CAM modalities, such as natural products, special diets, acupuncture, and body-based therapies, also continue to be used by RA patients with limited evidence for efficacy and safety. While there are numerous CAM interventions available, the data is very limited at this time with only low-quality evidence supporting various therapies. Medical providers are more open to the addition of CAM in their patients and require increased education on the topic. Additional research needs to be conducted in order to provide evidence-based recommendations to our patients.

A systematic review of the effects of probiotic administration in inflammatory arthritis

OBJECTIVE

To systematically identify and appraise evidence of the formulation specific effects and population specific responses of probiotics in inflammatory arthritis.

METHODS

MEDLINE (PubMed), CINAHL, EMBASE, and SCOPUS databases were searched for studies utilising probiotics in populations with inflammatory arthritis. The Joanna Briggs Institute (JBI) method was used to conduct the systematic review. A single reviewer undertook screening and data extraction. Two independent reviewers assessed the quality of evidence using JBI tools.

RESULTS

The search identified 5876 unique articles, with 154 potentially relevant full text articles retrieved. Twelve studies met the inclusion criteria and were included in the review, of which ten (83%) were randomised control trials (RCT) and two (17%) were quasi-experimental studies. Four studies included a variety of spondyloarthopathies (SpAs) and eight studies focused on rheumatoid arthritis (RA). Probiotics were supplied for a median of 60 days and mode of 56 days across all included studies (range 7-365 days). Overall, 17 different probiotics were supplied in colony forming units (CFU) per 24 hrs ranging from 1 × 10⁸ to 2.25 × 10¹¹. The order of probiotics supplied to the most participants and across the most studies was Lactobacillales. There was no statistical difference in the relative risk (RR) of minor adverse events between probiotic and control groups (RR 1.02, 95% CI 0.69 to 1.51) when including nil event studies. Meta-analysis identified a statistically significant benefit of probiotics on quality of life with a standard mean difference (SMD) of -0.37 (95% CI -0.59,-0.15) with subgroup analysis favouring Lactobacillales-only formulations. Small but statistically significant reductions in pain were identified, with a mean difference (MD) of -8.97 (95% CI-15.38, -2.56) on a 100mm visual analogue scale, independent of formulation. Meta-analysis confirmed the known statistically significant benefit of probiotics on the inflammatory marker C-reactive protein (CRP) concentration MD (mg/L) -2.33 (95% CI -4.26, -0.41), with subgroup analysis demonstrating a greater effect in RA and from combined Bifidobacteriales and Lactobacillales formulations.

CONCLUSION

This review indicates there may be differential benefits to combined formulations of Bifidobacteriales and Lactobacillales compared to purely Lactobacillales formulations, with respect to reducing pain, lowering CRP and improving quality of life. It also suggests variable benefits associated with the type of inflammatory arthritis. Relatively less benefit for lowering CRP was attributed to individuals with SpA compared to individuals with RA. Generalisability of results to clinical practice is limited by the dominant demographic of older individuals with established disease beyond the 'therapeutic window of intervention'. Small but statistically significant benefits require confirmation in clinical studies with greater consideration to potentially confounding factors of age, gender, diet and individual microbial signature.

Effect of Various Bulk Sweeteners on the Survivability of <i>Lactobacillus casei</i> 431 in Milk Chocolate: Rheological and Sensory Properties Analysis

BACKGROUND

Probiotics are the most widely consumed functional food. Consumers demand the production of foods also in low-calorie forms.

OBJECTIVE

In this study, Lactobacillus casei 431 and various sweeteners were used in milk chocolate as probiotic and bulking agents, respectively.

METHODS

Samples were prepared by using sucrose or optimum polyols combination. Chocolate samples were stored at two temperatures (4°C and 20°C) for 180 days and the viability of probiotic cells was controlled with the purpose of specifying the presented storage temperature.

RESULTS

The highest probiotic viability was determined in the samples produced with sucrose and stored at 4°C. The cell counts were retained at the functional amount after maintenance for 6 months. Probiotic sucrose-free chocolate was more viscous than control chocolate, although displayed satisfactory sensory attributes.

CONCLUSION

As a result, the sugared and sugar-free probiotic milk chocolates could be stored at room temperature. Due to the acceptable number of probiotic cells, the sucrose-free chocolates containing probiotics were considered as functional foods.

Formulation of Stable Frying Oil for Food Industry by Using Various Edible Oils and Antioxidants

Background:

Frying oils are important nutrition due to their significant changes during the frying process. These changes can cause serious health problems in consumers.

Methods:

The aims of this 3-stage study were to investigate chemical changes of Total Polar Compounds (TPC), Peroxide Value (PV), Free Fatty Acid (FFA), Anisidine Value (AV) and TOTOX Value (TV) during heating of four improved frying oil formulations including super palm olein, sunflower, rapeseed and corn oil and to assess their frying quality, blends and subsequent changes using various antioxidant compounds, including ter-butyl Hydroquinone (TBHQ) and its mixture with Ascorbyl Palmitate (ASCP).

Results:

Results showed that the best formulation at the end of frying time was FO5 including 1:1 super palm olein and corn oil containing 120 ppm of TBHQ, 120 ppm of ASCP and 0.01% of Citric Acid (CA). This formulation showed the minimum TPC, PV, TV and FFA, compared to those other formulations.

Conclusion:

Furthermore, AP was demonstrated to include synergistic effects on TBHQ in preventing thermal deterioration of the frying oils.

The gut-brain relationship: Investigating the effect of multispecies probiotics on anxiety in a randomized placebo-controlled trial of healthy young adults

INTRO

There has been an increased interest in understanding the therapeutic effect of gut-microbiota on health, particularly in mental health. However, limited research into the connection between gut-microbiota and mental health makes this study an important endeavor in exploring the effect of gut-microbiota, through probiotics intervention, on mental health like anxiety and factors related to anxiety (e.g., anxiety control, affect, negative mood regulation, and worry).

METHOD

Healthy college students (N = 86; 75.6% female), average age of 20.59, participated in a double-blind, placebo-control, and randomization-control study. Eligible participants completed a baseline survey before being assigned to a condition, which consisted of four probiotics conditions and one placebo condition. After 28 days of daily intake, the participants returned to complete their exit survey.

RESULT

Probiotics were observed to improve panic anxiety, neurophysiological anxiety, negative affect, worry, and increase negative mood regulation. Furthermore, post hoc analyses revealed that the CFU (colony-forming unit) level was more effective than species counts in accounting for the number of significant improvements. A ceiling effect was detected in the study, participants with high distress reported higher number of improvements than those with normative distress.

CONCLUSION

Overall, this study is the first to examine the effect of CFU and species count on probiotics' efficacy. The study's finding suggested that probiotics may have the therapeutic potential to treat anxiety, however, further research is necessary to make that determination.

Effects of Probiotic Supplement in Pregnant Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Previous studies showed that probiotics could improve glycemic control and attenuate some of the adverse effects of type 2 diabetes. However, whether the effects are generalizable to gestational diabetes mellitus (GDM) remains uncertain.

OBJECTIVE

We conducted a systematic review and meta-analysis to evaluate the effects of probiotic supplement in GDM.

METHOD

PubMed, EMBASE, the Cochrane Library, and EBSCO were systematically searched for relevant literature published through January 2019. Randomized controlled trials (RCTs) assessing the effects of probiotic supplement on one or more of the following in GDM were included: pregnancy outcome (the primary outcome), glycemic control, blood lipid profile, and inflammation and oxidative stress. Two reviewers independently extracted data and assessed the risk of bias in studies. Meta-analysis was conducted by using the fixed effects model unless substantial heterogeneity was found among studies.

RESULTS

Eleven randomized trials involving 719 participants were included for analysis. Eight of the trials were from Iran. Probiotics were given alone in eight trials and synbiotics in three trials. Though the components of probiotics varied, Lactobacillus was included in all trials and Bifidobacterium in all except one. The duration of intervention ranged from 4 to 8 weeks. Almost all trials (10/11) had a low risk of bias. Probiotic supplementation reduced the risk of a newborn's hyperbilirubinemia by 74% and improved four biomarkers for glycemic control (fasting blood glucose, fasting serum insulin, homeostasis model assessment insulin resistance, and quantitative insulin sensitivity check index), two biomarkers for lipid profile (triglycerides and HDL-cholesterol), and four biomarkers for inflammation and oxidative stress (total glutathione, malondialdehyde, nitric oxide, and total antioxidant capacity). But significant heterogeneity was observed in the meta-analyses on the four biomarkers related to glycemic control and on triglycerides, which could not be explained by prespecified subgroup analyses according to the mean age of participants and intervention type (i.e., probiotics or synbiotics). The effects on the risk of preterm delivery, macrosomia and a newborns' hypoglycemia, gestational age, total cholesterol, and LDL-cholesterol were not statistically significant.

CONCLUSION

Probiotic supplementation seemed to be able to reduce the risk of a newborn's hyperbilirubinemia and improve glycemic control, blood lipid profiles and inflammation and oxidative stress in pregnant women with GDM. However, due to the heterogeneity among existing studies, the surrogate nature of outcomes, and/or the fact that most studies were from Iran, the clinical significance and generalizability of the above findings remain uncertain. Further studies are warranted to address the limitations of existing evidence and better inform the management of GDM.

Do probiotics effectively ameliorate glycemic control during gestational diabetes? A systematic review

BACKGROUND

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The aim of this work was to systematically review all studies in which probiotic supplements were used during pregnancy and analyse the effects on GDM.

METHODS

The data were collected using the medical subheading (MeSH) terms: ("diabetes, gestational"[MeSH Terms] OR ("diabetes"[All Fields] AND "gestational"[All Fields]) OR "gestational diabetes"[All Fields] OR ("gestational"[All Fields] AND "diabetes"[All Fields])) AND ("probiotics"[MeSH Terms] OR "probiotics"[All Fields]). The search included original articles written in English/Portuguese and published between 2012 and 2017.

RESULTS

Of the 31 articles identified, seven met the inclusion criteria and were included in this review. In these studies, the sample size ranged from 60 to 373 women with GDM, which was between 24 and 40 weeks of pregnancy (second and third trimesters). Results demonstrated that probiotics used during pregnancy in women with GDM may improve glycaemic control and reduce VDL cholesterol, triglycerides, and inflammatory markers.

CONCLUSIONS

The present systematic review highlights the importance of probiotics for glycemic control and decrease of inflammatory markers in GDM. Further long-term studies should be conducted to elucidate this interaction.

The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials

Rheumatoid arthritis is an autoimmune disease in which probiotics appears to have an immune modulating action along with decreased inflammatory process. Therefore, we aim to investigate the efficacy of probiotics as an adjuvant therapy for rheumatoid arthritis. A comprehensive literature search was performed using nine databases including PubMed and Web of Science. Interesting data was extracted and meta-analyzed. We assessed the risk of bias using Cochrane Collaboration's tool. The protocol was registered in PROSPERO (CRD 42016036769). We found nine studies involving 361 patients who met our eligibility criteria. Our meta-analysis indicated that pro-inflammatory cytokine IL-6 was significantly lower in the probiotics compared with the placebo group (standardized mean difference = - 0.708; 95% confidence interval (CI) - 1.370 to 0.047, P = 0.036). However, there was no difference between probiotics and placebo in disease activity score (mean difference 0.023; 95% CI - 0.584 to 0.631, P = 0.940). Probiotics lowered pro-inflammatory cytokines IL-6 in RA; however, its clinical effect is still unclear. Hence, many high-quality randomized controlled trials (RCTs) are still needed to prove this effect.

Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial

AIM

Colorectal cancer patients on chemotherapy usually have elevated levels of inflammatory markers and experience numerous side effects from chemotherapy thereby leading to poor quality of life. Omega-3 fatty acid and microbial cell preparation (MCP) have been known to provide significant benefits in patients on chemotherapy. The aim of this study was to determine the effect of supplementation of omega-3 fatty acid and MCP in quality of life, chemotherapy side effects and inflammatory markers in colorectal cancer patients on chemotherapy.

METHODS

A double-blind randomized study was carried out with 140 colorectal cancer patients on chemotherapy. Subjects were separated into two groups to receive either placebo or MCP [30 billion colony-forming unit (CFUs) per sachet] at a dose of two sachets daily for 4 weeks, and omega-3 fatty acid at a dose of 2 g daily for 8 weeks. Outcomes measured were quality of life, side effects of chemotherapy and levels of inflammatory markers such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein.

RESULTS

The supplementation with MCP and omega-3 fatty acid improved the overall quality of life and alleviated certain side effects of chemotherapy. The supplementation with MCP and omega-3 fatty acid also managed to reduce the level of IL-6 (P = 0.002). There was a significant rise in the placebo group's serum TNF-α (P = 0.048) and IL-6 (P = 0.004).

CONCLUSION

The combined supplementation with MCP and omega-3 fatty acid may improve quality of life, reduce certain inflammatory biomarkers and relieve certain side effects of chemotherapy in colorectal patients on chemotherapy.

Clinical and metabolic response to probiotic supplementation in patients with rheumatoid arthritis: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

This study was performed to determine the effects of probiotic supplementation on clinical and metabolic status of patients with rheumatoid arthritis (RA).

METHODS

Sixty patients with RA aged 25-70 years were assigned into two groups to receive either probiotic capsules (n = 30) or placebo (n = 30) in this randomized, double-blind, placebo-controlled trial. The patients in the probiotic group received a daily capsule that contained three viable and freeze-dried strains: Lactobacillus acidophilus (2 × 10(9) colony-forming units [CFU]/g), Lactobacillus casei (2 × 10(9) CFU/g) and Bifidobacterium bifidum (2 × 10(9) CFU/g) for 8 weeks. The placebo group took capsules filled with cellulose for the same time period. Fasting blood samples were taken at the beginning and the end of the study to quantify related markers.

RESULTS

After 8 weeks of intervention, compared with the placebo, probiotic supplementation resulted in improved Disease Activity Score of 28 joints (DAS-28) (-0.3 ± 0.4 vs. -0.1 ± 0.4, P = 0.01). In addition, a significant decrease in serum insulin levels (-2.0 ± 4.3 vs. +0.5 ± 4.9 μIU/mL, P = 0.03), homeostatic model assessment-B cell function (HOMA-B) (-7.5 ± 18.0 vs. +4.3 ± 25.0, P = 0.03) and serum high-sensitivity C-reactive protein (hs-CRP) concentrations (-6.66 ± 2.56 vs. +3.07 ± 5.53 mg/L, P < 0.001) following the supplementation of probiotics compared with the placebo. Subjects who received probiotic capsules experienced borderline statistically significant improvement in total- (P = 0.09) and low-density lipoprotein-cholesterol levels (P = 0.07) compared with the placebo.

CONCLUSION

Overall, the results of this study indicated that taking probiotic supplements for 8 weeks among patients with RA had beneficial effects on DAS-28, insulin levels, HOMA-B and hs-CRP levels.

Probiotic bacteria: a viable adjuvant therapy for relieving symptoms of rheumatoid arthritis

The burgeoning use of probiotics has proliferated during the past two decades. However, the effect of probiotic administration for either the prevention or treatment of rheumatoid arthritis (RA) has been investigated in a limited number of studies. Randomized controlled clinical trials have provided evidences that specific probiotics supplementation exhibit anti-inflammatory effects, help to increase daily activities and alleviate symptoms in patients with RA. Therefore, using probiotic bacteria as an adjuvant therapy may be considered as a promising treatment option for RA. This review summarizes the available data about the therapeutic and preventive effect of probiotics in RA, together with probiotic supplement as a possible therapy in clinical treatment.

Oral treatment with Bifidobacterium longum 51A reduced inflammation in a murine experimental model of gout

Gout is an acute inflammatory disease characterised by the presence of uric acid crystals in the joint. This event promotes neutrophil infiltration and activation that leads to tissue damage. We investigated here whether the oral administration of the probiotic strain Bifidobacterium longum 5(1A) (BL) could ameliorate monosodium urate crystal (MSU)-induced inflammation in a murine model of gout. Mice received oral administration of BL or saline daily for 7 days and then were injected with MSU in the knee cavity. Treatment with BL significantly alleviated the inflammatory parameters, as seen by reduced hypernociception, reduced neutrophil accumulation in the joint and myeloperoxidase activity in periarticular tissue. There was inhibition of the production of CXCL1 and interleukin(IL)-1β in joints. Levels of the anti-inflammatory cytokine IL-10 were significantly higher in the knee tissue of mice treated with than control mice injected with MSU. In conclusion, oral BL treatment reduced the inflammatory response in an experimental murine model of gout, suggesting it may be useful as an adjuvant treatment in patients with gout.

Effects of Lactobacillus casei supplementation on disease activity and inflammatory cytokines in rheumatoid arthritis patients: a randomized double-blind clinical trial

AIM

The present study aimed at investigating the effects of Lactobacillus casei 01 supplementation on symptoms and inflammatory biomarkers of rheumatoid arthritis (RA) in women.

METHOD

In this randomized double-blind clinical trial, female patients with established RA for more than 1 year, 20-80 years of age and body mass index (BMI) lower than 40, who followed stable medication for 3 months prior to the supplementation, were randomly allocated to receive either one capsule containing 10(8) colony forming units (CFU) of L. casei 01, or a placebo for 8 weeks; allocation was stratified by BMI and menopausal status. Disease activity score-28 (DAS28) was calculated, European League Against Rheumatism (EULAR) response was evaluated and the cytokines, interleukin (IL)-1β, IL-6, IL-10, IL-12 and tumor necrosis factor (TNF)-α were measured.

RESULTS

Thirty patients were recruited in each group; 22 and 24 patients were analyzed in the probiotic and placebo groups, respectively. L. casei 01 supplementation decreased serum high-sensitivity C-reactive protein (hs-CRP) levels, tender and swollen joint counts, global health (GH) score and DAS28 (P < 0.05). More patients in the L. casei 01 group had moderate response to the treatment, based on the EULAR criteria, at the end of the study (P < 0.01). At the end of the study, a significant difference was observed between the two groups for IL-10, IL-12 and TNF-α changes through the study course (P < 0.05), in favor of the probiotic group. No adverse effects were reported for the intervention.

CONCLUSION

Probiotic supplementation may be an appropriate adjunct therapy for RA patients and help alleviate symptoms and improve inflammatory cytokines.

Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis

OBJECTIVES

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease in which the gut microbiota is altered. Probiotics are microorganisms that can normalize gut microbiota; thus, they may help to alleviate RA symptoms. The objective of the present clinical trial was to assess the effects of probiotic supplementation on disease activity and inflammatory cytokines in patients with RA.

METHODS

Forty-six patients with RA were assigned into two groups in this randomized, double-blind, placebo-controlled clinical trial. The patients in the probiotic group received a daily capsule that contained a minimum of 10(8) colony-forming units of Lactobacillus casei 01 for 8 wk. The placebo group took capsules filled with maltodextrin for the same time period. Questionnaires, anthropometric measurements, and fasting blood samples were collected, and the participants were assessed by a rheumatologist at baseline and at the end of the trial.

RESULTS

Disease activity score was significantly decreased by the intervention, and there was a significant difference between the two groups at the end of the study (P < 0.01). Three of the assessed serum proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-12) significantly decreased in the probiotic group (P < 0.05); however, serum levels of interleukin-1 β were not significantly affected by the probiotic (P = 0.22). The serum level of regulatory cytokine (interleukin-10) was increased by the supplementation (P < 0.05). The proportion of interleukin-10 to interleukin-12 was significantly increased in the probiotic group as well.

CONCLUSIONS

L. casei 01 supplementation improved the disease activity and inflammatory status of patients with RA. Further studies are warranted to confirm these results, and such confirmation may lead to the introduction of probiotics as adjunctive therapy for this population.