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Karimi F, Azadi A, Omidifar N, Najafabady NM, Mohammadi F, Kazemi R, Gholami A. Pharmacotechnical aspects of a stable probiotic formulation toward multidrug-resistance antibacterial activity: design and quality control. BMC Complement Med Ther 2023; 23:391. [PMID: 37907893 PMCID: PMC10617127 DOI: 10.1186/s12906-023-04224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
As a well-known group of the probiotic family, the Lactobacillus has increasingly contributed to hindering the growth of pathogens, particularly resistant species, in the last decades. Since antibiotic resistance has become a severe problem in global healthcare systems and considerably increased the mortality and morbidity rate in infectious diseases, we aimed to obtain a new stable formulation of Lactobacillus to overcome resistant infections. For this purpose, we designed various gel formulations containing Lactobacillus rhamnosus (L. rhamnosus) as an active pharmaceutical ingredient (API) in a water base and oil base gel, evaluated the probiotic stability in formulation to obtain an optimum formulation, and finally, investigated the antibacterial activities of that against two common hospital-associated multidrug-resistant pathogens, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Furthermore, the pharmaceutical aspects of the optimum formulation, including stability, homogeneity, spreadability, pH value, conductivity, and rheological behavior, were assessed.The results indicated that the optimum formulation based on glycerol exhibited desirable pharmaceutical properties, including long-term stability, a perfect level of homogeneity, an acceptable range of spreadability with pseudo-plastic thixotropic behavior, and a promising antibacterial potential against MRSA and VRE. Our findings indicate that this novel probiotic formulation could be an excellent candidate to cope with antibiotic-resistant species, representing a hopeful treatment potential for topical applications, particularly in incurable infections. However, further in vivo studies seem warranted to evaluate their bactericidal activity against multi-drug resistant microorganisms.
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Affiliation(s)
- Farkhonde Karimi
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Azadi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Omidifar
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Montazeri Najafabady
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Endocrine and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mohammadi
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Radmehr Kazemi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Gholami
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Jain M, Stitt G, Son L, Enioutina EY. Probiotics and Their Bioproducts: A Promising Approach for Targeting Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus. Microorganisms 2023; 11:2393. [PMID: 37894051 PMCID: PMC10608974 DOI: 10.3390/microorganisms11102393] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Antibiotic resistance is a serious global health problem that poses a threat to the successful treatment of various bacterial infections, especially those caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Conventional treatment of MRSA and VRE infections is challenging and often requires alternative or combination therapies that may have limited efficacy, higher costs, and/or more adverse effects. Therefore, there is an urgent need to find new strategies to combat antibiotic-resistant bacteria. Probiotics and antimicrobial peptides (AMPs) are two promising approaches that have shown potential benefits in various diseases. Probiotics are live microorganisms that confer health benefits to the host when administered in adequate amounts. AMPs, usually produced with probiotic bacteria, are short amino acid sequences that have broad-spectrum activity against bacteria, fungi, viruses, and parasites. Both probiotics and AMPs can modulate the host immune system, inhibit the growth and adhesion of pathogens, disrupt biofilms, and enhance intestinal barrier function. In this paper, we review the current knowledge on the role of probiotics and AMPs in targeting multi-drug-resistant bacteria, with a focus on MRSA and VRE. In addition, we discuss future directions for the clinical use of probiotics.
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Affiliation(s)
| | | | | | - Elena Y. Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84108, USA; (M.J.); (G.S.); (L.S.)
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Kohno J, Kawamura T, Kikuchi A, Akaishi T, Takayama S, Ishii T. A Japanese traditional medicine Hochuekkito promotes negative conversion of vancomycin-resistant Enterococci. Sci Rep 2021; 11:11300. [PMID: 34050227 PMCID: PMC8163788 DOI: 10.1038/s41598-021-90890-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Vancomycin-resistant enterococci (VRE) are prominent causes of nosocomial infections. Japanese traditional (Kampo) medicine promotes intestinal immunity and protects against bacterial infections. We assessed potential differences in the clinical course of VRE-positive patients, based on their characteristics and treatment with Kampo medicines. This retrospective observational study collected data from VRE-positive patients from August 2018 to July 2019 at a tertiary-care hospital in Japan. The data of 122 consecutive VRE-positive inpatients were analyzed. Sixty-nine patients were treated with probiotics, among whom, 18 were further treated with Kampo medicines. Twenty-six of the 122 patients subsequently died. In univariate analyses, subsequent VRE negative conversion significantly reduced the mortality of VRE-detected patients (p = .0003). Administration of probiotics (p = .0065) and Kampo medicines with probiotics (p = .0002), especially of the Kampo medicine hochuekkito (p = .0014), and a higher serum albumin level positively contributed to the subsequent VRE negative conversion. Multivariate analyses demonstrated that Kampo medicines and body mass index contributed to VRE negative conversion. Hochuekkito shortened the time needed for VRE negative conversion (p = 0.0485). Administration of Kampo medicines, especially of hochuekkito, in addition to probiotics in VRE patients may promote VRE negative conversion.
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Affiliation(s)
- Junko Kohno
- Department of Obstetrics and Gynecology, Hachinohe City Hospital, 1-1-3 Tamukai, Hachinohe, 031-8555, Japan
| | - Tsuyoshi Kawamura
- Department of Neurosurgery, Hachinohe City Hospital, 1-1-3 Tamukai, Hachinohe, 031-8555, Japan
| | - Akiko Kikuchi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.,Department of Kampo Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, 1-2, Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan
| | - Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shin Takayama
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan. .,Department of Kampo Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan. .,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, 1-2, Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan.
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.,Department of Kampo Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku, Sendai, 980-8574, Japan.,Department of Kampo and Integrative Medicine, Tohoku University Graduate School of Medicine, 1-2, Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan
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Borgmann S, Rieß B, Meintrup D, Klare I, Werner G. Long-Lasting Decrease of the Acquisition of Enterococcus faecium and Gram-Negative Bacteria Producing Extended Spectrum Beta-Lactamase (ESBL) by Transient Application of Probiotics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176100. [PMID: 32825711 PMCID: PMC7503522 DOI: 10.3390/ijerph17176100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022]
Abstract
Previously it was shown that application of probiotics stopped the acquisition of vancomycin-resistant Enterococcus faecium (VRE) by patients in an early rehabilitation ward. Once the application of probiotics ended, we examined whether acquisition of VRE reoccurred. Furthermore, we examined whether probiotics altered prevalence of vancomycin-susceptible E. faecium (VSE) and Gram-negative bacteria, which produce extended spectrum beta-lactamase (ESBL). Although probiotic application ceased in April 2018, VRE-colonized patients rarely presented on that ward until 2019. Probiotic treatment also resulted in a decreased number of patients with VSE and ESBL. While decreased incidence of VRE occurred immediately, decreased VSE and ESBL numbers occurred months later. A probiotic-mediated decrease of VSE and ESBL incidence cannot be explained when assuming bacterial transmission exclusively as a linear cause and effect event. The decrease is better understood by considering bacterial transmissions to be stochastic events, which depend on various driving forces similar to an electric current. We hypothesize that VRE, VSE and ESBL uptake by patients and by staff members mutually reinforced each other, leading staff members to form a bacterial reservoir, similar to a condenser that stores electrical energy. Probiotic treatment then inhibited regeneration of that store, resulting in a breakdown of the driving force.
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Affiliation(s)
- Stefan Borgmann
- Hospital of Ingolstadt, Department of Infectious Diseases and Infection Control, D-85049 Ingolstadt, Germany;
- Correspondence: ; Tel.: +49-841-880-2020
| | - Beate Rieß
- Hospital of Ingolstadt, Department of Infectious Diseases and Infection Control, D-85049 Ingolstadt, Germany;
| | - David Meintrup
- Technische Hochschule Ingolstadt, Faculty of Engineering and Management, D-85049 Ingolstadt, Germany;
| | - Ingo Klare
- National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode Branch, D-38855 Wernigerode, Germany; (I.K.); (G.W.)
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Robert Koch Institute, Wernigerode Branch, D-38855 Wernigerode, Germany; (I.K.); (G.W.)
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Fang SB. Enterococci and food safety - Are all probiotics beneficial? Pediatr Neonatol 2020; 61:359-360. [PMID: 32037186 DOI: 10.1016/j.pedneo.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/17/2019] [Accepted: 01/21/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
- Shiuh-Bin Fang
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, 291 Jhong Jheng Road, Jhong Ho District, New Taipei City, 23561, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, 250, Wu Hsing Street, Hsin Yi District, Taipei, 11031, Taiwan.
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