Current level of consensus on probiotic science--report of an expert meeting--London, 23 November 2009

L. plantarum and L. lactis as a promising agent in treatment of inflammatory bowel disease and colorectal cancer

It has been understood for nearly a century that patients with intestinal inflammatory disease (IBD) have a higher risk of developing colorectal cancer (CRC). Recently, two species of lactic acid bacteria, Lactobacillus plantarum and Lactococcus lactis, have been investigated as therapeutic agents for IBD. These bacteria have been shown to survive gastric transit, to adhere and colonize in the intestinal tract of humans and modulate the intestinal microbiota and immune response. L. plantarum and L. lactis might be used as multifunctional drugs for the treatment of IBD and the prevention or treatment of CRC. This article summarizes current knowledge of L. plantarum and L. lactis as therapeutic and preventative agents for IBD and CRC, respectively.

Probiotic Lactobacillus and the potential risk of spreading antibiotic resistance: a systematic review

Background and purpose

Lactobacillus, the most popular probiotic, has recently gained more attention because it is a potential reservoir of antibiotic resistance. This review summarized and discussed the phenotypic-genotypic characteristics of antibiotic resistance.

Experimental approach

Google Scholar, PubMed, Web of Science, and Scopus were searched up to February 2022. The inclusion criteria were all studies testing antibiotic resistance of probiotic Lactobacillus strains present in human food supplementation and all human/animal model studies in which transferring antibiotic-resistant genes from Lactobacillus strains to another bacterium were investigated.

Findings/Results

Phenotypic and genotypic characterization of Lactobacillus probiotics showed that the most antibiotic resistance was against protein synthesis inhibitors (fourteen studies, 87.5%) and cell wall synthesis inhibitors (ten studies, 62.5%). Nine of these studies reported the transfer of antibiotic resistance from Lactobacillus probiotic as donor species to pathogenic bacteria and mostly used in vitro methods for resistance gene transfer.

Conclusion and implications

The transferability of resistance genes such as tet and erm in Lactobacillus increases the risk of spreading antibiotic resistance. Further studies need to be conducted to evaluate the potential spread of antibiotic resistance traits via probiotics, especially in elderly people and newborns.

Assessment of a Multispecies Probiotic Supplement for Relief of Seasonal Allergic Rhinitis: A Randomized Double-Blind Placebo-Controlled Trial

Background: Early phase clinical research provided initial support for the use of a multispecies probiotic supplement to improve quality of life (QoL) in adults with seasonal allergic rhinitis (AR) and reduce the use of AR symptom relieving medication. This study aimed to confirm these early phase findings in a double-blind randomized placebo-controlled trial. Methods: Individuals, aged 18-65 years, with a minimum 2-year history of AR, moderate-to-severe AR symptoms, and a positive radio-allergosorbent test to Bermuda (Couch) Grass were randomized to receive either a multispecies probiotic supplement (total colony-forming units 4 × 10⁹/day) or placebo twice daily for 8 weeks. A mini-rhinoconjunctivitis quality of life questionnaire (mRQLQ) scale was administered at screening, days 0, 28, and 56. The proportion of participants with a >0.7 improvement in mRQLQ was the primary outcome. Participants also completed a daily symptom and medication diary during the supplementation period. Results: There were 165 participants randomized, with 142 included in the primary outcome analysis. The percentage of participants meeting the threshold for a clinically meaningful reduction in the mRQLQ from days 0 to 56 was not significantly different between groups (61% vs. 62%, p = 0.90). However, 76 participants had a clinically meaningful improvement in QoL (decrease in mRQLQ >0.7) prior to the start of supplementation (screening to day 0). Conclusion: Changes in self-reported QoL and other disease severity metrics between screening and the start of supplementation limited the ability to discern an effect of supplementation and highlight the need for adaptive clinical trial designs in allergy research. Clinical Trial Registration: The trial was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12619001319167).

Psycho-Microbiology, a New Frontier for Probiotics: An Exploratory Overview

Probiotics are gradually gaining importance in the field of psychiatry in the form of psychobiotics. Psychobiotics' studies examine the existing relationship between gut microbiota and mental phenomena; the intake of certain strains of probiotics, such as Bifidobacterium and Lactobacillus, for example, allow the gut microbial system to be modified in order to provide benefits at the psychic, immune, hormonal, and mental levels. Those who suffer from forms of depression, anxiety disorders, chronic stress, low mood, but also people who do not suffer from such disorders, can therefore benefit from the use of psychobiotics. Thanks to probiotics, neurochemicals can in fact be produced within the gut microbiota and interact with receptors of the enteric nervous system that innervate the entire gastrointestinal tract. Once they enter the portal circulation, these substances go on to influence components of the nervous system and ultimately the brain, through what is called the gut-brain axis. This article proposes an exploratory overview of the proven effects of probiotics on brain activity and psycho-related diseases, focusing on clinical studies and measurable outcomes. The search was conducted using two different online tools: ClinicalTrials.gov and PubMed.

The role of probiotic supplementation on insulin resistance in obesity associated diabetes: A mini review

Obesity and diabetes are two metabolic disorders linked by an inflammatory process named insulin resistance (IR). Various research on the role of gut microbiota in developing obesity and its associated disorders has led to the growing interest in probiotic supplementation. Considering the life-threatening complications of diabesity this mini review explored the effects of probiotic supplementation on IR in obesity associated diabetes. This review is based on recent articles from 2005-2020, studying the role of probiotic supplementation on glucose and insulin parameters in healthy and diabetic mouse model. Probiotic supplementation altered the gut microbiota composition, increased short chain fatty acid production, and decreased pro inflammatory cytokines. Additionally, they decreased intestinal permeability, circulating lipopolysaccharides and metabolic endotoxemia, hence improved insulin sensitivity and reduced obesity. Although multi-strain probiotic supplementation showed greater benefits than single strain interventions, variations in the concentration of probiotics used and the duration of treatment also influenced the results.  Probiotic supplementation could manipulate the gut microbiota by reducing intestinal permeability, inflammation and ameliorate IR and obesity associated diabetes in animal models which requires further long-term clinical studies in humans. 

An Upper-Division, Remote Microbiology Laboratory That Blends Virtual and Hands-on Components to Promote Student Success during the COVID-19 Pandemic

The COVID-19 shutdown forced many institutions of higher education to shift in-person teaching to emergency remote teaching. This was particularly challenging for laboratory courses, where students are expected to learn hands-on skills needed for their career goals. Here, we describe the transformation of an upper-division microbiology laboratory to a course that seamlessly integrates online simulations with safe, hands-on experiences that can be done from home. This blended lab course helped students attain learning outcomes similar to those achieved in the in-person class. We illustrate the implementation of Unknown Portfolios to help students gain the data analysis and critical thinking skills needed to identify an unknown microorganism. Our data show that students who took these online courses mastered material as well as students who took the lab in person, demonstrating proficiency in laboratory safety skills, hands-on techniques, and theoretical class content. Last, we explore online adaptations to enhance in-person lab classes, aiming at reducing the accessibility and equity gaps inherited in many courses, as well as discussing challenges that instructors might experience in this process.

Probiotic and Antifungal Attributes of Lactic Acid Bacteria Isolates from Naturally Fermented Brazilian Table Olives

Research with fermented olives as a source of wild Lactic Acid Bacteria (LAB) strains with probiotic and biotechnological characteristics constitutes a promising field of work. The present study evaluated in vitro probiotic, antifungal, and antimycotoxigenic potential of LAB isolates from naturally fermented Brazilian table olives. Among fourteen LAB isolates, the Levilactobacillus brevis CCMA 1762, Lactiplantibacillus pentosus CCMA 1768, and Lacticaseibacillus paracasei subsp. paracasei CCMA 1770 showed potential probiotic and antifungal properties. The isolates showed resistance to pH 2.0 (survival ≥ 84.55), bile salts (survival ≥ 99.44), and gastrointestinal tract conditions (survival ≥ 57.84%); hydrophobic cell surface (≥27%); auto-aggregation (≥81.38%); coaggregation with Escherichia coli INCQS 00181 (≥33.97%) and Salmonella Enteritidis ATCC 564 (≥53.84%); adhesion to the epithelial cell line Caco-2 (≥5.04%); antimicrobial activity against the bacteria S. Enteritidis ATCC 564 (≥6 mm), Listeria monocytogenes ATCC 19117 (≥6 mm), Staphylococcus aureus ATCC 8702 (≥3 mm), and the fungi Penicillium nordicum MUM 08.16 (inhibition ≥ 64.8%). In addition, the strains showed the ability to adsorb the mycotoxins aflatoxin B1 (≥40%) and ochratoxin A (≥34%). These results indicate that LAB strains from naturally fermented Brazilian table olives are potentially probiotic and antifungal candidates that can be used for food biopreservation.

Health Benefits of Probiotics in Sport and Exercise - Non-existent or a Matter of Heterogeneity? A Systematic Review

Background

The use of probiotics in sports has been growing in recent years, as up to 50% of athletes suffer from training- and performance-limiting gastrointestinal (GI) problems. Moreover, repeated exhaustive exercise and high training loads may lead to a transiently depressed immune function, associated with an increased risk of upper respiratory tract infection (URTI).

Aim

To provide a qualitative analysis of probiotic effects on URTI, GI symptoms and the immune system in healthy individuals under consideration of performance level as main classifier.

Methods

A systematic review of the literature was conducted (PubMed, SPORTDiscus with Full Text, Web of Science) to analyze the effects of probiotics in athletes and healthy active individuals on GI problems, URTI, and the immune system. A qualitative synthesis with performance level and treatment duration as main classifiers was performed.

Results

Of 41 eligible studies, 24 evaluated the effects of probiotic supplements in athletes, 10 in recreationally active individuals and 7 in healthy untrained adults. Large heterogeneity was observed in terms of probiotic strains, mode of delivery, performance level, treatment duration and outcome assessment. Overall, studies provided inconsistent observations.

Conclusion

The effects of probiotics on immune system, URTI, and GI symptoms in athletes, healthy adults and recreationally active individuals remain inconclusive. Based on the analyzed studies and identified parameters, this article provides suggestions to align future research on the effects of probiotics in exercise.

Systematic Review Registration

PROSPERO, identifier: CRD42021245840.

A Randomized, Placebo-Controlled Trial Assessing the Effect of VISBIOME ES Probiotic in People With HIV on Antiretroviral Therapy

BACKGROUND

A5350, a phase II, randomized, double-blind study, evaluated the safety and tolerability of the probiotic Visbiome Extra Strength (ES) over 24 weeks and measured effects on inflammation and intestinal barrier function.

METHODS

The primary outcome was change in soluble CD14 (sCD14) levels; secondary outcomes included safety and tolerability, markers of inflammation and cellular activation, and microbiome. In a substudy, gut permeability was assessed by paired colonic biopsies measuring the area of lamina propria occupied by CD4+ cells, interleukin (IL)-17+ cells, and myeloperoxidase (MPO). Changes between arms were compared with the 2-sample t test with equal variance or the Wilcoxon rank-sum test. For safety, the highest graded adverse events (AEs) were compared between arms using the Fisher exact test.

RESULTS

Overall, 93 participants enrolled: 86% male, median age 51 years, median CD4 count 712 cells/mm3. Visbiome ES was safe and well tolerated. There was no difference in mean change in sCD14 from baseline to week 25/26 between placebo (mean change, 92.3 µg/L; 95% CI, -48.5 to 233 µg/L) and Visbiome ES (mean change, 41.0 µg/L; 95% CI, -94.1 to 176.2 µg/L; P=.60). Similarly, no statistically significant differences between arms in inflammatory marker changes were identified. In substudy participants, no statistical differences between arms for change in cellular marker expression or gut permeability were observed (P>.05 for all). The microbiome demonstrated increased probiotic species and a significant decrease in Gammaproteobacteria (P=.044) in the Visbiome ES arm.

CONCLUSIONS

Visbiome ES was safe and altered the microbiome but demonstrated no effect on systemic inflammatory markers, pathology, or gut permeability in antiretroviral therapy-treated people with HIV.

Development and evaluation of probiotic delivery systems using the rennet-induced gelation of milk proteins

The aims of this study were to develop a milk protein-based probiotic delivery system using a modified rennet-induced gelation method and to determine how the skim milk powder concentration level and pH, which can affect the rennet-induced intra- and inter-molecular association of milk proteins, affect the physicochemical properties of the probiotic delivery systems, such as the particle size, size distribution, encapsulation efficiency, and viability of probiotics in simulated gastrointestinal tract. To prepare a milk protein-based delivery system, skim milk powder was used as a source of milk proteins with various concentration levels from 3 to 10% (w/w) and rennet was added to skim milk solutions followed by adjustment of pH from 5.4 or 6.2. Lactobacillus rhamnosus GG was used as a probiotic culture. In confocal laser scanning microscopic images, globular particles with a size ranging from 10 μm to 20 μm were observed, indicating that milk protein-based probiotic delivery systems were successfully created. When the skim milk powder concentration was increased from 3 to 10% (w/w), the size of the delivery system was significantly (p < 0.05) increased from 27.5 to 44.4 μm, while a significant (p < 0.05) increase in size from 26.3 to 34.5 μm was observed as the pH was increased from 5.4 to 6.4. An increase in skim milk powder concentration level and a decrease in pH led to a significant (p < 0.05) increase in the encapsulation efficiency of probiotics. The viability of probiotics in a simulated stomach condition was increased when probiotics were encapsulated in milk protein-based delivery systems. An increase in the skim milk powder concentration and a decrease in pH resulted in an increase in the viability of probiotics in simulated stomach conditions. It was concluded that the protein content by modulating skim milk powder concentration level and pH were the key manufacturing variables affecting the physicochemical properties of milk protein-based probiotic delivery systems.

Development of a Probiotics Practice E-Reference Database for Health Care Professionals

PURPOSE

Currently available references provide evidence on the efficacy of probiotics strains but exclude product-specific information, making it challenging for health care professionals (HCPs) to provide consumers with suitable recommendations on probiotics. An online probiotics e-reference database was developed to assist HCPs in delivering evidence-based recommendations on probiotics to consumers. The usability and applicability of the database in health care practice were evaluated.

METHODS

Information on the efficacy of probiotics and probiotic products was collated using a PubMed literature search, and from local pharmacies and online supplement stores. A web database was compiled using various programming scripts and uploaded onto a web server. The database was beta-tested using an online self-administered questionnaire for community-based pharmacists, and responses were analyzed using descriptive statistics.

FINDINGS

The database comprised 584 clinical study excerpts, 449 probiotic products, and 1879 unique product-study links. Users can search for suitable probiotics based on their indication profile or for a specific probiotic product. Information provided includes the probiotic constituents, dosage regimen, and indications of the product, with supporting clinical evidence. Overall, all participants of the beta-test indicated that they were satisfied with the database and were willing to use it again (both, 13 participants [100%]). In addition, all participants indicated that they found the database intuitive to use and smooth functioning, without inconsistencies (both, 13 [100%]). The majority also indicated that they found the information provided to be clear, comprehensive, and useful in health care practice (12 [92.3%] each).

IMPLICATIONS

The probiotics e-reference database is an integrated resource that is user-friendly, and provides HCPs with ready access to clear and comprehensive information on probiotic products and clinical studies, so that HCPs can provide consumers with relevant and evidence-based recommendations on probiotics.

Probiotics combined with rifaximin influence the neurometabolic changes in a rat model of type C HE

Type C hepatic encephalopathy (HE) is a neuropsychiatric disease caused by chronic liver disease. Management of type C HE remains an important challenge because treatment options are limited. Both the antibiotic rifaximin and probiotics have been reported to reduce the symptoms of HE, but longitudinal studies assessing their effects on brain metabolism are lacking and the molecular mechanisms underpinning their effects are not fully understood. Therefore, we evaluated in detail the effects of these different treatments on the neurometabolic changes associated with type C HE using a multimodal approach including ultra-high field in vivo ¹H MRS. We analyzed longitudinally the effect of rifaximin alone or in combination with the probiotic Vivomixx on the brain metabolic profile in the hippocampus and cerebellum of bile duct ligated (BDL) rats, an established model of type C HE. Overall, while rifaximin alone appeared to induce no significant effect on the neurometabolic profile of BDL rats, its association with the probiotic resulted in more attenuated neurometabolic alterations in BDL rats followed longitudinally (i.e. a smaller increase in Gln and milder decrease in Glu and Cr levels). Given that both rifaximin and some probiotics are used in the treatment of HE, the implications of these findings may be clinically relevant.

Interplay Between Exercise and Gut Microbiome in the Context of Human Health and Performance

Gut microbiota and exercise have recently been shown to be interconnected. Both moderate and intense exercise are typically part of the training regimen of endurance athletes, but they exert different effects on health. Moderate exercise has positive effects on the health of average athletes, such as a reduction in inflammation and intestinal permeability and an improvement in body composition. It also induces positive changes in the gut microbiota composition and in the microbial metabolites produced in the gastrointestinal tract. Conversely, intense exercise can increase gastrointestinal epithelial wall permeability and diminish gut mucus thickness, potentially enabling pathogens to enter the bloodstream. This, in turn, may contribute to the increase in inflammation levels. However, elite athletes seem to have a higher gut microbial diversity, shifted toward bacterial species involved in amino acid biosynthesis and carbohydrate/fiber metabolism, consequently producing key metabolites such as short-chain fatty acids. Moreover, rodent studies have highlighted a bidirectional relationship, with exercise impacting the gut microbiota composition while the microbiota may influence performance. The present review focuses on gut microbiota and endurance sports and how this interconnection depends upon exercise intensity and training. After pointing out the limits of the studies so far available, we suggest that taking into account the microbiota composition and its metabolic contribution to human host health could help in monitoring and modulating athletes' health and performance. Such an integrated approach should help in the design of microbiome-based solutions for health or performance.

Evaluation of graded levels of Bacillus coagulans GBI-30, 6086 on apparent nutrient digestibility, stool quality, and intestinal health indicators in healthy adult dogs

Bacillus coagulans GBI-30, 6086 is a commercially available spore-forming non-toxigenic microorganism approved for use in dog foods with high resiliency to stresses associated with commercial manufacturing. The objectives of this research were to examine the effect of B. coagulans on stool quality, nutrient digestibility, and intestinal health markers in healthy adult dogs. Extruded diets containing graded levels of B. coagulans applied either to the base ration before extrusion or to the exterior of the kibble as a topical coating after extrusion were randomly assigned to 10 individually housed adult beagle dogs (7 castrated males and 3 spayed females) of similar age (5.75 ± 0.23 yr) and body weight (12.3 ± 1.5 kg). The study was designed as a 5 × 5 replicated Latin square with 16-d adaptation followed by 5-d total fecal collection for each period. Five dietary treatments were formulated to deliver a dose of 0-, 6-, 7-, 8-, and 9-log10 colony-forming units (CFU) per dog per day for the control (CON), extruded B. coagulans (PEX), and low, moderate, and high B. coagulans coating levels (PCL, PCM, and PCH), respectively. Food-grade TiO2 was added to all diets at a level of 0.4% to serve as an indigestible dietary marker for digestibility calculations. Data were analyzed using a mixed model through SAS (version 9.4, SAS Institute, Inc., Cary, NC) with treatment as a fixed effect and room (i.e., replicate), period, and dog(room) as random effects. Apparent total tract digestibility of organic matter, crude protein, crude fat, and gross energy calculated by the marker method were numerically greatest for dogs fed the 9-log10 dose treatment with increases (P < 0.05) observed in gross energy and organic matter digestibility compared with the negative control. No significant differences were observed in food intake, stool quality, fecal pH, fecal ammonia, fecal short-chain fatty acids, or branched-chain fatty acids for the extruded B. coagulans treatment (PEX) or the coated B. coagulans treatments (PCL, PCM, and PCH) compared with CON. These results suggest that B. coagulans has a favorable impact on nutrient digestibility and no apparent adverse effects when added to extruded diets at a daily intake level of up to 9-log10 CFU in healthy adult dogs.

Microencapsulation of probiotic lactobacilli with shellac as moisture barrier and to allow controlled release

BACKGROUND

Rapid dissolution in digestive tract and moisture sorption during ambient storage are the two challenges of dry probiotic preparations. To solve these problems, microcapsules with shellac (LAC) addition containing Limosilactobacillus reuteri TMW 1.656 were designed in this work to provide a good moisture barrier and to provide controlled release in digestive tract, based on the hydrophobicity and acid-resistance of LAC. Four microcapsules were prepared using the method of emulsification/external gelation based on the crosslinking reaction between alginate or LAC with calcium ion, including alginate/sucrose (ALG), alginate/shellac/sucrose (ALG/LAC), alginate/whey protein isolate/sucrose (ALG/WPI) and alginate/whey protein isolate/shellac/sucrose (ALG/WPI/LAC).

RESULTS

Measurements of physical properties showed that microcapsules with LAC addition (ALG/WPI/LAC and ALG/LAC) had larger particle size, much denser structure, lower hygroscopicity and slower solubilization in water, which agreed with the primary microcapsule design. Probiotic survivals in digestive juices followed the order of ALG/WPI/LAC ≥ ALG/WPI ≥ ALG/LAC > ALG. Probiotic stability after heating and ambient storage both exhibited the order of ALG/WPI/LAC > ALG/LAC ≈ ALG/WPI > ALG, which can be explained by the decreased hygroscopicity with adding LAC.

CONCLUSION

LAC addition contributed to better probiotic survivals after freeze drying, simulated digestion, heating and ambient storage, and whey protein isolate (WPI) addition had a synergistic effect. Microcapsule hygroscopicity was closely related with probiotic survivals after heating and ambient storage, while microcapsule solubilization was closely related with probiotic survivals in simulated juices. Within our knowledge, this is the first report to improve probiotic stability during ambient storage based on LAC hydrophobicity. © 2020 Society of Chemical Industry.

Probiotics improve the neurometabolic profile of rats with chronic cholestatic liver disease

Chronic liver disease leads to neuropsychiatric complications called hepatic encephalopathy (HE). Current treatments have some limitations in their efficacy and tolerability, emphasizing the need for alternative therapies. Modulation of gut bacterial flora using probiotics is emerging as a therapeutic alternative. However, knowledge about how probiotics influence brain metabolite changes during HE is missing. In the present study, we combined the advantages of ultra-high field in vivo 1H MRS with behavioural tests to analyse whether a long-term treatment with a multistrain probiotic mixture (VIVOMIXX) in a rat model of type C HE had a positive effect on behaviour and neurometabolic changes. We showed that the prophylactic administration of this probiotic formulation led to an increase in gut Bifidobacteria and attenuated changes in locomotor activity and neurometabolic profile in a rat model of type C HE. Both the performance in behavioural tests and the neurometabolic profile of BDL + probiotic rats were improved compared to the BDL group at week 8 post-BDL. They displayed a significantly lesser increase in brain Gln, a milder decrease in brain mIns and a smaller decrease in neurotransmitter Glu than untreated animals. The clinical implications of these findings are potentially far-reaching given that probiotics are generally safe and well-tolerated by patients.

Antimicrobial Resistance of Lactobacillus johnsonii and Lactobacillus zeae in Raw Milk

Lactobacillus johnsonii and Lactobacillus zeae are among the lactobacilli with probiotic properties, which occur in sour milk products, cheeses, and to a lesser extent in raw milk. Recently, resistant strains have been detected in various species of lactobacilli. The aim of the study was to determine the incidence of resistant Lactobacillus johnsonii and Lactobacillus zeae strains in various types of raw milk. A total of 245 isolates were identified by matrix-assisted laser desorption/ionization mass spectrometry and polymerase chain reaction methods as Lactobacillus sp., of which 23 isolates of Lactobacillus johnsonii and 18 isolates of Lactobacillus zeae were confirmed. Determination of susceptibility to selected antibiotics was performed using the E-test and broth dilution method, where 7.3% of lactobacilli strains were evaluated as ampicillin-resistant, 14.7% of isolates as erythromycin-resistant, and 4.9% of isolates as clindamycin-resistant. The genus Lactobacillus johnsonii had the highest resistance to erythromycin (34.8%), similar to Lactobacillus zeae (33.3%). Of the 41 isolates, the presence of the gene was confirmed in five Lactobacillus johnsonii strains and in two strains of Lactobacillus zeae. The presence of resistant strains of Lactobacillus johnsonii and Lactobacillus zeae is a potential risk in terms of spreading antimicrobial resistance through the food chain.

Difficulties in developmental follow-up of preterm neonates in a randomised-controlled trial of Bifidobacterium breve M16-V - Experience from Western Australia

BACKGROUND

Probiotics may be neuroprotective for preterm neonates due to their anti-inflammatory effects and ability to facilitate nutrition.

AIM

To assess long-term effects of early probiotic supplementation on neuropsychological development in preterm infants.

STUDY DESIGN

Follow up study.

SUBJECTS

Children at age 3 to 5 years who had participated as preterm infants (<33 week) in the randomised controlled trial.

OUTCOMES

Primary: Continuous early learning composite measure derived from the Mullen's Scale of Early Learning (MSEL). Other outcomes were assessed by the Developmental, Dimensional and Diagnostic Interview, Developmental NEuroPSYchological assessment-2nd Edition, Parental questionnaires using children's communication checklist-2nd edition, social responsiveness scale, and Vineland Adaptive Behavioural Scales-2nd edition.

MEASURES

Continuous scores derived from all the measures.

RESULTS

67 children of the 159 participants (42%) (Probiotic: 36/79, Placebo: 31/80) were followed-up for at least one neuropsychological assessment. All six assessments were completed in 18/31 (58.1%) of the control vs. 11/36 (30.6%) probiotic group children. Multivariable analysis of MSEL composite score showed no evidence of probiotic effect univariately, or after adjustment for gestation, intrauterine growth restriction, Apgar <7 at 5 min and age at assessment (adjusted mean effect in probiotic group: -2.7, 95% CI -8.5-3.0, p = 0.349).

CONCLUSION

There was no significant effect on neurodevelopment of children assessed at the age of 3 to 5 years who participated as preterm neonates in the RCT of B. breve M-16V. The validity of these results is limited by the reduced sample size due to high rate of loss to follow up.

Probiotic characteristics of Lactobacillus strains isolated from cheese and their antibacterial properties against gastrointestinal tract pathogens

In the present study, four Lactobacillus strains from the cheese were analyzed for its probiotic potential against enteropathogenic bacteria. The probiotic properties of the selected strains were also analyzed and the selected bacterial strains showed high tolerance in bile salts and organic acid. The strain L. plantarum LP049 showed maximum survival rate (92 ± 4.2% and 93.3 ± 2%) after 3 h of treatment at 0.25% (w/v) bile salts and 0.25% (w/v) organic acid concentrations. The ability of the Lactobacillus strains to adhere to human epithelial cells (HT-29 cell lines) was evaluated and L. plantarum LP049 showed maximum adhesion property (19.2 ± 1.1%) than other tested strains. The Lactobacillus strains produced lactic acid at various concentrations. Compared with other strains, maximum level of lactic acid (3.1 g/L), hydrogen peroxide (4.31 mM) and bacteriocin (31 AU/mg) was detected in LB049. The inhibitory activity of culture supernatant against various bacterial pathogens was observed. The zone of inhibition ranged between 6 ± 2 mm and 23 ± 2 mm. The cell free extract showed activity against, Escherichia coli (ATCC 10536), Salmonella enteritidis (ATCC 13076), Shigella flexneri (ATCC 29903), and Enterococcus faecium (ATCC 8459). Consequently, L. plantarum LP049 may be considered as a potential candidate for the production of novel bioactive metabolites for therapeutic and bio-protective applications.

Probiotic Potential of Lactobacillus paracasei CT12 Isolated from Water Kefir Grains (Tibicos)

The water kefir grains are a multi-species starter culture used to produce fermented beverages of sucrose solution with or without fruit extracts. The water kefir grains are known in Mexico as Tibicos, which are mainly used to produce Tepache, a traditional Mexican drink made by fermenting pineapple peel. The microbiota of Tibicos mainly include lactic acid bacteria (LAB) and since most probiotics belong to this group, Tibicos may represent a potential source of probiotic bacteria. Moreover, several bacteria isolated from kefir samples have been recognized as probiotics. Hence, the aim of this study was to assess the probiotic properties of a Lactobacillus strain isolated from Tibicos. The isolated, designed as CT12, was identified as Lactobacillus paracasei by sequencing 16S RNA gene. L. paracasei CT12 showed a survival rate of ca. 57% and 40% following simulated gastric and intestinal digestion, respectively. Besides, the strain was sensitive to ampicillin and erythromycin, and exhibited hydrophobicity (97-99%), autoaggregation (ca. 70%) and mucin adhesion properties (up to 90%), while no possessed haemolytic capacity. Furthermore, its cell-free supernatant displayed relevant antimicrobial, antifungal and antioxidant capacity. Hence, L. paracasei CT12 appears to possess a potential probiotic value.

Beyond Heat Stress: Intestinal Integrity Disruption and Mechanism-Based Intervention Strategies

The current climate changes have increased the prevalence and intensity of heat stress (HS) conditions. One of the initial consequences of HS is the impairment of the intestinal epithelial barrier integrity due to hyperthermia and hypoxia following blood repartition, which often results in a leaky gut followed by penetration and transfer of luminal antigens, endotoxins, and pathogenic bacteria. Under extreme conditions, HS may culminate in the onset of “heat stroke”, a potential lethal condition if remaining untreated. HS-induced alterations of the gastrointestinal epithelium, which is associated with a leaky gut, are due to cellular oxidative stress, disruption of intestinal integrity, and increased production of pro-inflammatory cytokines. This review summarizes the possible resilience mechanisms based on in vitro and in vivo data and the potential interventions with a group of nutritional supplements, which may increase the resilience to HS-induced intestinal integrity disruption and maintain intestinal homeostasis.

Efficacy of prebiotics and probiotics for functional dyspepsia: A systematic review and meta-analysis

BACKGROUND

Functional dyspepsia (FD) is a functional gastrointestinal disorder. Evidence suggests that disturbance of the gastrointestinal microbiota may be implicated in FD. We performed a systematic review and meta-analysis to examine the efficacy of prebiotics and probiotics for FD.

METHODS

MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (through September 2018). Randomized controlled trials (RCTs) that recruited adults with FD and that compared prebiotics, probiotics, or synbiotics with placebo or no therapy were eligible. Eligibility assessment and data extraction were performed by two independent researchers. Dichotomous symptom data were pooled to obtain a relative risk (RR) with a 95% confidence interval (CI) of remaining symptomatic after therapy. Continuous data were pooled using a standardized or weighted mean difference with a 95% CI.

RESULTS

The search strategy identified 1062 citations. Five RCTs were eligible for inclusion. The RR of FD symptoms improving with probiotics or probiotics vs placebo was 1.15 (95% CI 1.01-1.30). Probiotics and prebiotics had beneficial effects on symptom scores of FD. Data for synbiotics in the context of FD were sparse, and no definite conclusions could be drawn.

ETHICS AND DISSEMINATION

This study belongs to the category of systematic reviews, not clinical trials. Therefore, it does not require ethical approval. The results of this study will be published in influential international academic journals related to this topic.

CONCLUSION

Probiotics and prebiotics seemed to be effective treatments for FD, although the individual species and strains that are the most beneficial remain unclear. Using only probiotics failed to improve the symptoms of FD. Further evidence is required before the role of probiotics, prebiotics, and synbiotics in FD can be fully understood.

Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity

Poor maternal mental health has been associated with a myriad of pregnancy and child health complications. Obesity in pregnancy is known to increase one’s risk of experiencing poor maternal mental health and associated physical and mental health complications. Probiotics may represent a novel approach to intervene in poor mental health and obesity. We conducted this pre-specified secondary analysis of the Healthy Mums and Babies (HUMBA) randomised controlled trial to investigate whether probiotics would improve maternal mental health outcomes up to 36 weeks of pregnancy. Two-hundred-and-thirty pregnant women with obesity (BMI ≥ 30.0 kg/m²) were recruited and randomised to receive probiotic (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, minimum 6.5 × 10⁹ CFU) or placebo capsules. Depression, anxiety, and functional health and well-being were assessed at baseline (12⁰−17⁶ weeks’ gestation) and 36 weeks of pregnancy. Depression scores remained stable and did not differ between the probiotic (M = 7.18, SD = 3.80) and placebo groups (M = 6.76, SD = 4.65) at 36 weeks (p-values > 0.05). Anxiety and physical well-being scores worsened over time irrespective of group allocation, and mental well-being scores did not differ between the two groups at 36 weeks. Probiotics did not improve mental health outcomes in this multi-ethnic cohort of pregnant women with obesity.

International Society of Sports Nutrition Position Stand: Probiotics

Position statement: The International Society of Sports Nutrition (ISSN) provides an objective and critical review of the mechanisms and use of probiotic supplementation to optimize the health, performance, and recovery of athletes. Based on the current available literature, the conclusions of the ISSN are as follows: 1)Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (FAO/WHO).2)Probiotic administration has been linked to a multitude of health benefits, with gut and immune health being the most researched applications.3)Despite the existence of shared, core mechanisms for probiotic function, health benefits of probiotics are strain- and dose-dependent.4)Athletes have varying gut microbiota compositions that appear to reflect the activity level of the host in comparison to sedentary people, with the differences linked primarily to the volume of exercise and amount of protein consumption. Whether differences in gut microbiota composition affect probiotic efficacy is unknown.5)The main function of the gut is to digest food and absorb nutrients. In athletic populations, certain probiotics strains can increase absorption of key nutrients such as amino acids from protein, and affect the pharmacology and physiological properties of multiple food components.6)Immune depression in athletes worsens with excessive training load, psychological stress, disturbed sleep, and environmental extremes, all of which can contribute to an increased risk of respiratory tract infections. In certain situations, including exposure to crowds, foreign travel and poor hygiene at home, and training or competition venues, athletes' exposure to pathogens may be elevated leading to increased rates of infections. Approximately 70% of the immune system is located in the gut and probiotic supplementation has been shown to promote a healthy immune response. In an athletic population, specific probiotic strains can reduce the number of episodes, severity and duration of upper respiratory tract infections.7)Intense, prolonged exercise, especially in the heat, has been shown to increase gut permeability which potentially can result in systemic toxemia. Specific probiotic strains can improve the integrity of the gut-barrier function in athletes.8)Administration of selected anti-inflammatory probiotic strains have been linked to improved recovery from muscle-damaging exercise.9)The minimal effective dose and method of administration (potency per serving, single vs. split dose, delivery form) of a specific probiotic strain depends on validation studies for this particular strain. Products that contain probiotics must include the genus, species, and strain of each live microorganism on its label as well as the total estimated quantity of each probiotic strain at the end of the product's shelf life, as measured by colony forming units (CFU) or live cells.10)Preclinical and early human research has shown potential probiotic benefits relevant to an athletic population that include improved body composition and lean body mass, normalizing age-related declines in testosterone levels, reductions in cortisol levels indicating improved responses to a physical or mental stressor, reduction of exercise-induced lactate, and increased neurotransmitter synthesis, cognition and mood. However, these potential benefits require validation in more rigorous human studies and in an athletic population.

Effects of Probiotics on Intestinal Failure-Associated Liver Disease in Adult Patients Receiving Prolonged Parenteral Support: A Tertiary Care Center Experience

BACKGROUND

It has been hypothesized that dysbiosis plays a significant role in the pathogenesis of intestinal failure-associated liver disease (IFALD). Therefore, we aimed to investigate the effect of probiotics on IFALD in patients receiving parenteral support, namely home parenteral nutrition (HPN) and home intravenous fluids (HIVFs).

METHODS

We retrospectively reviewed charts of patients with intestinal failure who received HPN or HIVF for >2 weeks at our tertiary center between January 2005 and August 2016. We excluded patients <18 years of age, patients with other causes of liver disease, patients who used probiotics for <30 days, patients with <6 months' follow-up, and those who had long-term antibiotic use (>30 days). Bivariable and multivariable logistic regression analyses were used in this study.

RESULTS

A total of 282 patients who received parenteral support were included. Eighty-five percent of our sample received PN. A total of 78 (27.7%) patients used probiotics. The prevalence of IFALD in patients who used probiotics was 35.9% vs 54.4% in patients who did not use probiotics, P = .005. In multivariable analysis, only small-bowel length of 10-90 cm and HPN use showed a significant impact on IFALD, odds ratio (OR) = 4.394 (95% confidence interval [CI], 1.635-11.814; P = .003) and OR = 4.502 (95% CI 1.412-14.351; P = .011), respectively.

CONCLUSION

Our study revealed that the prevalence of IFALD was comparable among the probiotic users and nonusers. Only small bowel length of 1090 cm and HPN use showed a significant impact on IFALD.

Critical insights into antibiotic resistance transferability in probiotic Lactobacillus

Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, with respect to metabolism, immune function, and nutrition. Any perturbation of these beneficial microbes leads to gut dysbiosis, which triggers the development of various disorders in the gastrointestinal system. Probiotics play a key role in resolving the dysbiosis posed by external factors such as antibiotics, other substances, or interventions. Supplementing probiotics with antibiotics is favorable in reducing the harmful effects of antibiotics on gut flora. These microbes also possess specific intrinsic drug resistance mechanisms that aid their survival in the internal environment. According to US Food and Drug Administration reports, species belonging to Lactobacillus and Bifidobacterium genera are the most common probiotics consumed by humans through commercial products. However, various studies have reported the tendency of microbes to acquire specific drug resistance, in recent years, through various mechanisms. The reports on transferable resistance among probiotics are of major concern, of which minimal information is available to date. The aim of this review was to describe the pros and cons of drug resistance among these beneficial microorganisms with emphasis on the recommended selection criteria for specific probiotics, devoid of transferable drug resistance genes, suitable for human consumption.

Characterization of antimicrobial activity of three Lactobacillus plantarum strains isolated from Chinese traditional dairy food

Many Lactobacillus plantarum strains can secrete some antimicrobial substances and be added to food as antimicrobial agents and preservatives. In this study, three L. plantarum strains (P1, S11, and M7) with strong antimicrobial activity against three pathogenic bacteria were isolated from Xinjiang traditional dairy products. Five common organic acids produced by fermentation of strains play a key role in inhibiting three pathogenic bacteria. At the same pH, the antimicrobial activity of the fermentation broth against Escherichia coli and Salmonella is stronger than that of the organic acid alone. Thus, three kinds of antimicrobial agents (P1-1, M7-1, and S11-1) mixed with five common organic acids were produced. Moreover, the antimicrobial activity against Salmonella ASI.1174 of the antimicrobial agents was about 30% higher than that of the fermentation broth. In addition, organic acid antimicrobial agents combined in different proportions can inhibit different pathogenic bacteria. According to this result, it is a potential approach to develop novel antimicrobial agents used in food preservation by mixing different organic acids.

Design and implementation of novel nutraceuticals and derivatives for treating intestinal disorders

Gastrointestinal illnesses pose a significant worldwide disease burden and are associated with an array of medicinal and surgical therapies. Standard pharmaceutical options have adverse effects, prompting the rise of nutraceutical or food-derivative therapies. Here, we present an overview of the current nutraceutical therapies in gastrointestinal disease. We then introduce the calcium-sensing receptor (CaSR) as a novel therapeutic target. A G-protein-coupled receptor found in apical and basal intestinal cells, the CaSR modulates intestinal fluid secretion and mucosal integrity. Applying nutraceuticals that upregulate the CaSR may alleviate symptoms seen across a spectrum of illnesses. At last, we discuss how nanoparticle technology can be implemented to effectively deliver nutraceuticals to diseased regions of the intestine, thereby minimizing systemic side effects.

Effects of a 6-month multi-strain probiotics supplementation in endotoxemic, inflammatory and cardiometabolic status of T2DM patients: A randomized, double-blind, placebo-controlled trial

OBJECTIVE

The aim of this trial was to characterize the beneficial effects of probiotics on decreasing endotoxin levels and other cardiometabolic parameters in Arab patients with type 2 diabetes mellitus (T2DM).

METHODS

Saudi adults with naïve T2DM (n = 30; 12 males and 18 females) were randomly allocated to receive twice daily placebo or 2.5 × 10⁹ cfu/g of Ecologic^®Barrier (multi-strain probiotics; n = 31; 14 males and 17 females) in a double-blind manner over a 6 month period, respectively. Anthropometrics were measured and fasting blood samples were collected to analyze endotoxin, glycemic parameters [glucose, insulin, c-peptide and homeostasis model assessment for insulin resistance (HOMA-IR)], lipids [triglycerides, total cholesterol, low and high-density lipoprotein (LDL and HDL, respectively) cholesterol and total/HDL-cholesterol ratio], inflammatory markers [tumor-necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP)] and adipocytokines [leptin, adiponectin and resistin] at baseline and after 3 and 6 months of intervention.

RESULTS

Multi-strain probiotics supplementation for 6 months caused a significant decrease in circulating levels of endotoxin by almost 70% over 6 months, as well as glucose (38%), insulin (38%), HOMA-IR (64%), triglycerides (48%), total cholesterol (19%), total/HDL-cholesterol ratio (19%), TNF-α (67%), IL-6 (77%), CRP (53%), resistin (53%), and a significant increase in adiponectin (72%) as compared with baseline. Only HOMA-IR had a clinically significant reduction (-3.4, 64.2%) in the probiotics group as compared to placebo group at all time points. No other clinically significant changes were observed between the probiotic or placebo group at 3 and 6 months in other markers.

CONCLUSION

Multi-strain probiotic supplementation over 6 months as a monotherapy significantly decreased HOMA-IR in T2DM patients, with the probiotic treatment group highlighting reduced inflammation and improved cardiometabolic profile. As such, multi-strain probiotics is a promising adjuvant anti-diabetes therapy.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01765517.

Bacillus subtilis strain specificity affects performance improvement in broilers

The study reports the effects on broiler performance of a newly isolated Bacillus subtilis strain, which is phylogenetically not closely related to already well-described strains of B. subtilis. In the first experiment, birds were reared in battery cages and exposed to C. perfringens. An increase in growth performance was observed with the strain when compared to the challenged animals. Three additional growth trials were conducted to 35 d of age, in different rearing conditions (genetic breeds, corn-soybean meal-based diet with or without animal proteins, in presence or absence of phytase, on fresh or used litter) to investigate the efficacy and the specificity of this new B. subtilis strain on the improvement of BWG and FCR of broilers in comparison with a B. subtilis-based DFM already used in the field. Whatever the rearing conditions tested, the new B. subtilis strain led to an average 3.2% improvement in feed conversion ratio or bodyweight. Comparatively, the commercial Bacillus strain significantly improved broiler performance in only one trial out of 3 with an average improvement reaching 2%. All these results indicate that this new B. subtilis strain consistently improves broiler performances.

Dietary Alteration of the Gut Microbiome and Its Impact on Weight and Fat Mass: A Systematic Review and Meta-Analysis

Dietary alteration of the gut microbiome is an important target in the treatment of obesity. Animal and human studies have shown bidirectional weight modulation based on the probiotic formulation used. In this study, we systematically reviewed the literature and performed a meta-analysis to assess the impact of prebiotics, probiotics and synbiotics on body weight, body mass index (BMI) and fat mass in adult human subjects. We searched Medline (PubMed), Embase, the Cochrane Library and the Web of Science to identify 4721 articles, of which 41 were subjected to full-text screening, yielding 21 included studies with 33 study arms. Probiotic use was associated with significant decreases in BMI, weight and fat mass. Studies of subjects consuming prebiotics demonstrated a significant reduction in body weight, whereas synbiotics did not show an effect. Overall, when the utilization of gut microbiome-modulating dietary agents (prebiotic/probiotic/synbiotic) was compared to placebo, there were significant decreases in BMI, weight and fat mass. In summary, dietary agents for the modulation of the gut microbiome are essential tools in the treatment of obesity and can lead to significant decreases in BMI, weight and fat mass. Further studies are needed to identify the ideal dose and duration of supplementation and to assess the durability of this effect.

The role of the microbiome and the use of probiotics in gastrointestinal disorders in adults in the Asia-Pacific region - background and recommendations of a regional consensus meeting

The Asia-Pacific region is diverse, with regard to ethnicity, culture, and economic development incorporating some of the world's least and most developed nations. Gastrointestinal diseases are common in the Asia-Pacific region, and their prevalence, presentation, and management vary considerably within the region. There is growing evidence for an important role for the human gut microbiota in gastrointestinal health. As a consequence, geographic variations in the composition of the gut microbiota may contribute to variations in both the prevalence and response to therapy of specific diseases. Probiotics have been proposed as a valuable option in the prevention and treatment of a number of gastrointestinal illnesses, but the quality of available evidence to support their efficacy is variable. A meeting of international experts in adult and pediatric gastroenterology was held at the Sorbonne University, Paris, France, on April 11 and 12, 2016, to discuss current evidence supporting the use of probiotics in gastrointestinal disorders in the Asia-Pacific region. This article provides an overview of the discussions held at this meeting and recommends the formation of an Asia-Pacific Consortium on Gut Microbiota similar to those established in Europe and North America.

Genome-scale modeling and transcriptome analysis of Leuconostoc mesenteroides unravel the redox governed metabolic states in obligate heterofermentative lactic acid bacteria

Obligate heterofermentative lactic acid bacteria (LAB) are well-known for their beneficial health effects in humans. To delineate the incompletely characterized metabolism that currently limits their exploitation, at systems-level, we developed a genome-scale metabolic model of the representative obligate heterofermenting LAB, Leuconostoc mesenteroides (iLME620). Constraint-based flux analysis was then used to simulate several qualitative and quantitative phenotypes of L. mesenteroides, thereby evaluating the model validity. With established predictive capabilities, we subsequently employed iLME620 to elucidate unique metabolic characteristics of L. mesenteroides, such as the limited ability to utilize amino acids as energy source, and to substantiate the role of malolactic fermentation (MLF) in the reduction of pH-homeostatic burden on F0F1-ATPase. We also reported new hypothesis on the MLF mechanism that could be explained via a substrate channelling-like phenomenon mainly influenced by intracellular redox state rather than the intermediary reactions. Model simulations further revealed possible proton-symporter dependent activity of the energy efficient glucose-phosphotransferase system in obligate heterofermentative LAB. Moreover, integrated transcriptomic analysis allowed us to hypothesize transcriptional regulatory bias affecting the intracellular redox state. The insights gained here about the low ATP-yielding metabolism of L. mesenteroides, dominantly controlled by the cellular redox state, could potentially aid strain design for probiotic and cell factory applications.

Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature

Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for ‘general bowel health’ or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

The Gut Microbiome and Obesity

The gut microbiome consists of trillions of bacteria which play an important role in human metabolism. Animal and human studies have implicated distortion of the normal microbial balance in obesity and metabolic syndrome. Bacteria causing weight gain are thought to induce the expression of genes related to lipid and carbohydrate metabolism thereby leading to greater energy harvest from the diet. There is a large body of evidence demonstrating that alteration in the proportion of Bacteroidetes and Firmicutes leads to the development of obesity, but this has been recently challenged. It is likely that the influence of gut microbiome on obesity is much more complex than simply an imbalance in the proportion of these phyla of bacteria. Modulation of the gut microbiome through diet, pre- and probiotics, antibiotics, surgery, and fecal transplantation has the potential to majorly impact the obesity epidemic.

Obesity and microbiota: an example of an intricate relationship

It is widely accepted that metabolic disorders, such as obesity, are closely linked to lifestyle and diet. Recently, the central role played by the intestinal microbiota in human metabolism and in progression of metabolic disorders has become evident. In this context, animal studies and human trials have demonstrated that alterations of the intestinal microbiota towards enhanced energy harvest is a characteristic of the obese phenotype. Many publications, involving both animal studies and clinical trials, have reported on the successful exploitation of probiotics and prebiotics to treat obesity. However, the molecular mechanisms underlying these observed anti-obesity effects of probiotics and prebiotic therapies are still obscure. The aim of this mini-review is to discuss the intricate relationship of various factors, including diet, gut microbiota, and host genetics, that are believed to impact on the development of obesity, and to understand how modulation of the gut microbiota with dietary intervention may alleviate obesity-associated symptoms.

Systematic review and meta-analysis: the effects of fermented milk with Bifidobacterium lactis CNCM I-2494 and lactic acid bacteria on gastrointestinal discomfort in the general adult population

BACKGROUND

It has been suggested that probiotics may improve gastrointestinal discomfort. Not all probiotics exhibit the same effects and consequently meta-analyses on probiotics should be confined to well-defined strains or strain combinations. The aim of this study was to evaluate the effectiveness of a probiotic fermented milk (PFM) that includes Bifidobacterium lactis (B. lactis) CNCM I-2494 and lactic acid bacteria on gastrointestinal discomfort in the general adult population.

METHODS

Double-blind randomized controlled trials in the general adult population comparing PFM with a control dairy product for at least 4 weeks were searched from multiple literature databases (up to February 2015). Meta-analyses using random-effects models, with individual participant data were undertaken to calculate an odds ratio (OR) or standard mean difference (SMD), with a 95% confidence interval (CI).

RESULTS

The search strategy identified 12,439 documents. Overall, three trials with a total of 598 adults (female = 96.5%) met the inclusion criteria. Consumption of the PFM product was associated with a significant improvement in overall gastrointestinal discomfort compared with the control product (OR = 1.48; 95% CI 1.07-2.05), with a number needed to treat (NNT) of 10.24 (95% CI 5.64-55.93). PFM was also superior to the control in reducing digestive symptoms, as measured using a composite score (SMD = -0.21; 95% CI -0.37 to -0.05). Sensitivity analyses produced similar results, and the heterogeneity between studies was minimal.

CONCLUSIONS

This meta-analysis shows that the consumption of PFM with B. lactis CNCM I-2494 and lactic acid bacteria is associated with a modest but consistent and significant improvement of outcomes related to gastrointestinal discomfort in healthy adults.

Lactobacillus casei strain C1 attenuates vascular changes in spontaneously hypertensive rats

Hypertension can be caused by various factors while the predominant causes include increase in body fluid volume and resistance in the circulatory system that elevate the blood pressure. Consumption of probiotics has been proven to attenuate hypertension; however, the effect is much strain-dependent. In this study, a newly isolated Lactobacillus casei (Lb. casei) strain C1 was investigated for its antihypertensive properties in spontaneously hypertensive rats (SHR). Lactic acid bacteria (LAB) suspension of 11 log colony-forming unit (CFU) was given to SHR (SHR+LAB, n=8), and phosphate buffer saline (PBS) was given as a control in SHR (SHR, n=8) and in Wistar rats as sham (WIS, n=8). The treatment was given via oral gavage for 8 weeks. The results showed that the weekly systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and aortic reactivity function were remarkably improved after 8 weeks of bacterial administration in SHR+LAB. These effects were mostly attributed by restoration of wall tension and tensile stress following the bacterial treatment. Although not statistically significant, the level of malondialdehye (MDA) in SHR+LAB serum was found declining. Increased levels of glutathione (GSH) and nitric oxide (NO) in SHR+LAB serum suggested that the bacterium exerted vascular protection through antioxidative functions and relatively high NO level that induced vasodilation. Collectively, Lb. casei strain C1 is a promising alternative for hypertension improvement.

Probiotics are helpful in hepatic encephalopathy: a meta-analysis of randomized trials

BACKGROUND

Hepatic encephalopathy (HE) is a major complication of cirrhosis and is associated with decreased survival and increased health care utilization.

AIM

The aim of this study was to evaluate the efficacy of probiotics in the management minimal hepatic encephalopathy HE (MHE) and overt HE (OHE) in comparison to no treatment/placebo and lactulose.

METHODS

The main outcomes measured were mortality, improvement in MHE, progression to OHE in patients with MHE and hospitalization. We calculated odds ratios (OR) with 95% confidence intervals (CI). Study heterogeneity was assessed using the I(2) statistic.

RESULTS

Fourteen studies totalling 1152 patients were included in the analysis. The use of probiotics had no impact on the overall mortality when compared to either lactulose (OR: 1.07, 95% CI: 0.47-2.44, P = 0.88) or no treatment/placebo (OR: 0.69, 95% CI: 0.42-1.14, P = 0.15). When probiotics was compared to no treatment/placebo, it was associated with a significant improvement in MHE (OR: 3.91, 95% CI: 2.25-6.80, P < 0.00001), decreased hospitalization rates (OR: 0.53, 95% CI: 0.33-0.86, P = 0.01) and decreased progression to overt hepatic encephalopathy (OR: 0.40, 95% CI: 0.26-0.60, P < 0.0001). However when compared to lactulose, probiotics did not show a significant difference in improvement of MHE (OR: 0.81, 95% CI: 0.52-1.27, P = 0.35), hospitalization rates (OR: 1.02, 95% CI: 0.52-1.99, P = 0.96) or progression to overt hepatic encephalopathy (OR: 1.24, 95% CI 0.73-2.10, P = 0.42).

CONCLUSIONS

Overall the use of probiotics was more effective in decreasing hospitalization rates, improving MHE and preventing progression to OHE in patients with underlying MHE than placebo, but similar to that seen with lactulose. The use of probiotics did not affect mortality rates.

Benefits of Bifidobacterium breve M-16V Supplementation in Preterm Neonates - A Retrospective Cohort Study

Background

Systematic reviews of randomised controlled trials report that probiotics reduce the risk of necrotising enterocolitis (NEC) in preterm neonates.

Aim

To determine whether routine probiotic supplementation (RPS) to preterm neonates would reduce the incidence of NEC.

Methods

The incidence of NEC ≥ Stage II and all-cause mortality was compared for an equal period of 24 months ‘before’ (Epoch 1) and ‘after’ (Epoch 2) RPS with Bifidobacterium breve M-16V in neonates <34 weeks. Multivariate logistic regression analysis was conducted to adjust for relevant confounders.

Results

A total of 1755 neonates (Epoch I vs. II: 835 vs. 920) with comparable gestation and birth weights were admitted. There was a significant reduction in NEC ≥ Stage II: 3% vs. 1%, adjusted odds ratio (aOR) = 0.43 (95%CI: 0.21–0.87); ‘NEC ≥ Stage II or all-cause mortality’: 9% vs. 5%, aOR = 0.53 (95%CI: 0.32–0.88); but not all-cause mortality alone: 7% vs. 4%, aOR = 0.58 (95% CI: 0.31–1.06) in Epoch II. The benefits in neonates <28 weeks did not reach statistical significance: NEC ≥ Stage II: 6% vs. 3%, aOR 0.51 (95%CI: 0.20–1.27), ‘NEC ≥ Stage II or all-cause mortality’, 21% vs. 14%, aOR = 0.59 (95%CI: 0.29–1.18); all-cause mortality: 17% vs. 11%, aOR = 0.63 (95%CI: 0.28–1.41). There was no probiotic sepsis.

Conclusion

RPS with Bifidobacterium breve M-16V was associated with decreased NEC≥ Stage II and ‘NEC≥ Stage II or all-cause mortality’ in neonates <34 weeks. Large sample size is required to assess the potential benefits of RPS in neonates <28 weeks.

The Role of Probiotics on the Microbiota: Effect on Obesity

The microbiota and the human host maintain a symbiotic association. Nowadays, metagenomic analyses are providing valuable knowledge on the diversity and functionality of the gut microbiota. However, with regard to the definition of a "healthy microbiota" and the characterization of the dysbiosis linked to obesity, there is still not a clear answer. Despite this fact, attempts have been made to counteract obesity through probiotic supplementation. A literature search of experimental studies relevant to the topic was performed in PubMed database with the keywords "probiotic" and "obesity" and restricted to those with "Lactobacillus" or "Bifidobacterium" in the title. So far, evidence of an antiobesity effect of different lactobacilli and bifidobacteria has been mainly obtained from animal models of dietary-induced obesity. Using these experimental models, a substantial number of studies have reported reductions in weight gain and, in particular, fat tissue mass at different locations following administration of bacteria, as compared with controls. Antiatherogenic and anti-inflammatory effects-including regulation of expression of lipogenic and lipolytic genes in the liver, reduction in liver steatosis, improvement of blood lipid profile and glucose tolerance, decreased endotoxemia, and regulation of inflammatory pathways-are also reported in many of them. The number of human studies focused on probiotic administration for obesity management is still very scarce, and it is too soon to judge their potential efficacy, especially when considering the fact that the actions of probiotics are always strain specific and the individual response varies according to intrinsic factors, the overall composition of diet, and their interactions.

In vitro assessment of the antimicrobial potentials of Lactobacillus helveticus strains isolated from traditional cheese in Sinkiang China against food-borne pathogens

KLDS 1.8701 showed a wide antimicrobial spectrum resulting from organic acids and contact dependent inhibition.

Can We Prevent Obesity-Related Metabolic Diseases by Dietary Modulation of the Gut Microbiota?

Obesity increases the risk of type 2 diabetes, cardiovascular diseases, and certain cancers, which are among the leading causes of death worldwide. Obesity and obesity-related metabolic diseases are characterized by specific alterations in the human gut microbiota. Experimental studies with gut microbiota transplantations in mice and in humans indicate that a specific gut microbiota composition can be the cause and not just the consequence of the obese state and metabolic disease, which suggests a potential for gut microbiota modulation in prevention and treatment of obesity-related metabolic diseases. In addition, dietary intervention studies have suggested that modulation of the gut microbiota can improve metabolic risk markers in humans, but a causal role of the gut microbiota in such studies has not yet been established. Here, we review and discuss the role of the gut microbiota in obesity-related metabolic diseases and the potential of dietary modulation of the gut microbiota in metabolic disease prevention and treatment.