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Sedighi M, Zahedi Bialvaei A, Hamblin MR, Ohadi E, Asadi A, Halajzadeh M, Lohrasbi V, Mohammadzadeh N, Amiriani T, Krutova M, Amini A, Kouhsari E. Therapeutic bacteria to combat cancer; current advances, challenges, and opportunities. Cancer Med 2019; 8:3167-3181. [PMID: 30950210 PMCID: PMC6558487 DOI: 10.1002/cam4.2148] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 12/26/2022] Open
Abstract
Successful treatment of cancer remains a challenge, due to the unique pathophysiology of solid tumors, and the predictable emergence of resistance. Traditional methods for cancer therapy including radiotherapy, chemotherapy, and immunotherapy all have their own limitations. A novel approach is bacteriotherapy, either used alone, or in combination with conventional methods, has shown a positive effect on regression of tumors and inhibition of metastasis. Bacteria-assisted tumor-targeted therapy used as therapeutic/gene/drug delivery vehicles has great promise in the treatment of tumors. The use of bacteria only, or in combination with conventional methods was found to be effective in some experimental models of cancer (tumor regression and increased survival rate). In this article, we reviewed the major advantages, challenges, and prospective directions for combinations of bacteria with conventional methods for tumor therapy.
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Affiliation(s)
- Mansour Sedighi
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Abed Zahedi Bialvaei
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Michael R. Hamblin
- Wellman Center for PhotomedicineMassachusetts General HospitalBostonMassachusetts
- Department of DermatologyHarvard Medical SchoolBostonMassachusetts
- Harvard‐MIT Division of Health Sciences and TechnologyCambridgeMassachusetts
| | - Elnaz Ohadi
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Arezoo Asadi
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Masoumeh Halajzadeh
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Vahid Lohrasbi
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Nima Mohammadzadeh
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and HepatologyGolestan University of Medical SciencesGorganIran
| | - Marcela Krutova
- 2nd Faculty of Medicine, Department of Medical MicrobiologyCharles University and Motol University HospitalPragueCzech Republic
| | - Abolfazl Amini
- Laboratory Sciences Research CenterGolestan University of Medical SciencesGorganIran
| | - Ebrahim Kouhsari
- Department of Microbiology, School of MedicineIran University of Medical SciencesTehranIran
- Laboratory Sciences Research CenterGolestan University of Medical SciencesGorganIran
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Cook DJ, Johnstone J, Marshall JC, Lauzier F, Thabane L, Mehta S, Dodek PM, McIntyre L, Pagliarello J, Henderson W, Taylor RW, Cartin-Ceba R, Golan E, Herridge M, Wood G, Ovakim D, Karachi T, Surette MG, Bowdish DME, Lamarche D, Verschoor CP, Duan EH, Heels-Ansdell D, Arabi Y, Meade M. Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial-PROSPECT: a pilot trial. Trials 2016; 17:377. [PMID: 27480757 PMCID: PMC4970233 DOI: 10.1186/s13063-016-1495-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 07/09/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Probiotics are live microorganisms that may confer health benefits when ingested. Randomized trials suggest that probiotics significantly decrease the incidence of ventilator-associated pneumonia (VAP) and the overall incidence of infection in critically ill patients. However, these studies are small, largely single-center, and at risk of bias. The aim of the PROSPECT pilot trial was to determine the feasibility of conducting a larger trial of probiotics to prevent VAP in mechanically ventilated patients in the intensive care unit (ICU). METHODS In a randomized blinded trial, patients expected to be mechanically ventilated for ≥72 hours were allocated to receive either 1 × 10(10) colony-forming units of Lactobacillus rhamnosus GG or placebo, twice daily. Patients were excluded if they were at increased risk of L. rhamnosus GG infection or had contraindications to enteral medication. Feasibility objectives were: (1) timely recruitment; (2) maximal protocol adherence; (3) minimal contamination; and (4) estimated VAP rate ≥10 %. We also measured other infections, diarrhea, ICU and hospital length of stay, and mortality. RESULTS Overall, in 14 centers in Canada and the USA, all feasibility goals were met: (1) 150 patients were randomized in 1 year; (2) protocol adherence was 97 %; (3) no patients received open-label probiotics; and (4) the VAP rate was 19 %. Other infections included: bloodstream infection (19.3 %), urinary tract infections (12.7 %), and skin and soft tissue infections (4.0 %). Diarrhea, defined as Bristol type 6 or 7 stools, occurred in 133 (88.7 %) of patients, the median length of stay in ICU was 12 days (quartile 1 to quartile 3, 7-18 days), and in hospital was 26 days (quartile 1 to quartile 3, 14-44 days); 23 patients (15.3 %) died in the ICU. CONCLUSIONS The PROSPECT pilot trial supports the feasibility of a larger trial to investigate the effect of L. rhamnosus GG on VAP and other nosocomial infections in critically ill patients. TRIAL REGISTRATION Clinicaltrials.gov NCT01782755 . Registered on 29 January 2013.
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MESH Headings
- Adult
- Aged
- Canada
- Feasibility Studies
- Female
- Hospital Mortality
- Humans
- Intensive Care Units
- Intubation, Intratracheal/adverse effects
- Intubation, Intratracheal/mortality
- Lacticaseibacillus rhamnosus/growth & development
- Length of Stay
- Male
- Middle Aged
- Pilot Projects
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/mortality
- Pneumonia, Bacterial/prevention & control
- Pneumonia, Ventilator-Associated/diagnosis
- Pneumonia, Ventilator-Associated/microbiology
- Pneumonia, Ventilator-Associated/mortality
- Pneumonia, Ventilator-Associated/prevention & control
- Probiotics/administration & dosage
- Probiotics/adverse effects
- Severity of Illness Index
- Time Factors
- Trachea/microbiology
- Treatment Outcome
- United States
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Affiliation(s)
- Deborah J. Cook
- Department of Medicine, McMaster University, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, ON Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Jennie Johnstone
- Public Health Ontario, Toronto, ON Canada
- St. Joseph’s Health Center, Toronto, ON Canada
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | - John C. Marshall
- Department of Surgery, University of Toronto, Toronto, ON Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON Canada
| | - Francois Lauzier
- Research Center of the CHU de Québec – Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC Canada
- Department of Medicine, Université Laval, Quebec City, QC Canada
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Sangeeta Mehta
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON Canada
| | - Peter M. Dodek
- Division of Critical Care Medicine, St. Paul’s Hospital and University of British Columbia, Vancouver, BC Canada
- Center for Health Evaluation and Outcome Sciences, St. Paul’s Hospital and University of British Columbia, Vancouver, BC Canada
| | | | - Joe Pagliarello
- Division of Critical Care, University of Ottawa, Ottawa, ON Canada
| | - William Henderson
- Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC Canada
| | - Robert W. Taylor
- Department of Critical Care Medicine, Mercy Hospital, St Louis, MO USA
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN USA
| | - Eyal Golan
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON Canada
| | - Margaret Herridge
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON Canada
| | - Gordon Wood
- Department of Anesthesia & Critical Care, Vancouver Island Health Authority, Victoria, BC Canada
| | - Daniel Ovakim
- Department of Anesthesia & Critical Care, Vancouver Island Health Authority, Victoria, BC Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, ON Canada
| | - Michael G. Surette
- Department of Medicine, McMaster University, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, ON Canada
| | - Dawn M. E. Bowdish
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON Canada
| | - Daphnee Lamarche
- Biochemistry and Biomedical Sciences Department, McMaster University, Hamilton, ON Canada
| | - Chris P. Verschoor
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON Canada
| | - Erick H. Duan
- Department of Medicine, McMaster University, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, ON Canada
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Yaseen Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maureen Meade
- Department of Medicine, McMaster University, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, ON Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - For the PROSPECT Investigators and the Canadian Critical Care Trials Group
- Department of Medicine, McMaster University, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, ON Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
- Public Health Ontario, Toronto, ON Canada
- St. Joseph’s Health Center, Toronto, ON Canada
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Department of Surgery, University of Toronto, Toronto, ON Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON Canada
- Research Center of the CHU de Québec – Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC Canada
- Department of Medicine, Université Laval, Quebec City, QC Canada
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, QC Canada
- Division of Critical Care Medicine, St. Paul’s Hospital and University of British Columbia, Vancouver, BC Canada
- Center for Health Evaluation and Outcome Sciences, St. Paul’s Hospital and University of British Columbia, Vancouver, BC Canada
- Division of Critical Care, University of Ottawa, Ottawa, ON Canada
- Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC Canada
- Department of Critical Care Medicine, Mercy Hospital, St Louis, MO USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN USA
- Department of Anesthesia & Critical Care, Vancouver Island Health Authority, Victoria, BC Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON Canada
- Biochemistry and Biomedical Sciences Department, McMaster University, Hamilton, ON Canada
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Johnstone J, Meade M, Marshall J, Heyland DK, Surette MG, Bowdish DME, Lauzier F, Thebane L, Cook DJ. Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial-PROSPECT: protocol for a feasibility randomized pilot trial. Pilot Feasibility Stud 2015; 1:19. [PMID: 27965798 PMCID: PMC5154039 DOI: 10.1186/s40814-015-0013-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/13/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Probiotics are defined as live microorganisms that may confer health benefits when ingested. Meta-analysis of probiotic trials suggests a 25 % lower ventilator-associated pneumonia (VAP) and 18 % lower infection rates overall when administered to patients in the intensive care unit (ICU). However, prior trials are small, largely single center, and at high risk of bias. Before a large rigorous trial is launched, testing whether probiotics confer benefit, harm, or have no impact, a pilot trial is needed. The aim of the PROSPECT Pilot Trial is to determine the feasibility of performing a larger trial in mechanically ventilated critically ill patients investigating Lactobacillus rhamnosus GG. A priori, we determined that the feasibility of the larger trial would be based on timely recruitment, high protocol adherence, minimal contamination, and an acceptable VAP rate. METHODS/DESIGN Patients ≥18 years old in the ICU who are anticipated to receive mechanical ventilation for ≥72 hours will be included. Patients are excluded if they are at increased risk of probiotic-associated infection, have strict enteral medication contraindications, are pregnant, previously enrolled in a related trial, or are receiving palliative care. Following informed consent, patients are randomized in variable unspecified block sizes in a fixed 1:1 ratio, stratified by ICU, and medical, surgical, or trauma admitting diagnosis. Patients receive 1 × 1010 colony forming units of L. rhamnosus GG (Culturelle, Locin Industries Ltd) or an identical placebo suspended in tap water administered twice daily via nasogastric tube in the ICU. Clinical and research staff, patients, and families are blinded. DISCUSSION The primary outcomes for this pilot trial are the following: (1) recruitment success, (2) ≥90 % protocol adherence, (3) ≤5 % contamination, and (4) ~10 % VAP rate. Additional clinical outcomes are VAP, other infections, diarrhea (total, antibiotic associated, and Clostridium difficile), ICU and hospital length of stay, and mortality. The morbidity, mortality, and cost of VAP underscore the need for cost-effective prophylactic interventions. The PROSPECT Pilot Trial is the initial step toward rigorously evaluating whether probiotics decrease nosocomial infections, have no effect, or actually cause infections in critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov. NCT01782755.
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Affiliation(s)
- Jennie Johnstone
- Public Health Ontario, Toronto, Ontario Canada
- St. Joseph’s Health Center, Toronto, Ontario Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Maureen Meade
- Department of Medicine, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, Ontario Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - John Marshall
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Daren K Heyland
- Department of Medicine, Queen’s University, Kingston, Canada
| | - Michael G Surette
- Department of Medicine, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, Ontario Canada
| | - Dawn ME Bowdish
- Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Francois Lauzier
- Department of Medicine, Research Center of the CHU de Québec, Population Health and Optimal Health Practices Research Unit, Québec, Canada
| | - Lehana Thebane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
- Biostatistics Unit, St Joseph’s Healthcare—Hamilton, Hamilton, Ontario Canada
| | - Deborah J Cook
- Department of Medicine, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, Ontario Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - For the PROSPECT Investigators and the Canadian Critical Care Trials Group
- Public Health Ontario, Toronto, Ontario Canada
- St. Joseph’s Health Center, Toronto, Ontario Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, McMaster Health Sciences Center, Room 2C11, 1200 Main Street W, Hamilton, Ontario Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
- Department of Medicine, Queen’s University, Kingston, Canada
- Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- Department of Medicine, Research Center of the CHU de Québec, Population Health and Optimal Health Practices Research Unit, Québec, Canada
- Biostatistics Unit, St Joseph’s Healthcare—Hamilton, Hamilton, Ontario Canada
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