Could paraprobiotics be a safer alternative to probiotics for managing cancer chemotherapy-induced gastrointestinal toxicities?

Abstract

Clinical oncology has shown outstanding progress improving patient survival due to the incorporation of new drugs. However, treatment success may be reduced by the emergency of dose-limiting side effects, such as intestinal mucositis and diarrhea. Mucositis and diarrhea management is symptomatic, and there is no preventive therapy. Bacterial and fungal-based compounds have been suggested as an alternative for preventing the development of diarrhea in cancer patients. Using probiotics is safe and effective in immunocompetent individuals, but concerns remain during immunosuppressive conditions. Paraprobiotics, formulations composed of non-viable microorganisms, have been proposed to overcome such limitation. The present literature review discusses current evidence regarding the possible use of paraprobiotics as an alternative to probiotics to prevent gastrointestinal toxicity of cancer chemotherapy.

Dietary Lactobacillus rhamnosus GG extracellular vesicles enhance antiprogrammed cell death 1 (anti-PD-1) immunotherapy efficacy against colorectal cancer

“…33 However, despite the proven positive regulatory effects of LGG on intestinal microecology, clinical trials have also found that long-term consumption of live LGG in immunocompromised populations may lead to adverse reactions, such as bacteremia. 50,51 In this study, we identified that oral administration of LGG-EV can synergistically improve the therapeutic effect of anti-PD-1 inhibitors. We demonstrated that oral LGG-EV enhanced lymphocyte infiltration in tumor tissues, including antigen-presenting dendritic cells and CD4 + and CD8 + T cells.…”

Dysgeusia increases the risk for death and other side effects during antineoplastic systemic treatment for solid tumors: a cross-sectional study

“…Other adverse effects, such as oral mucositis, constipation, and diarrhea, are also associated with dysgeusia. The painful lesions of oral mucositis, in addition to interfering with food intake, are often secondarily colonized by bacteria and fungi ( 28 ) leading to dysbiosis in addition to interfering with the taste of food ( 29 ) modifies the microbiota of the rest of the gastrointestinal tract leading to changes in motility (constipation and diarrhea) ( 30 ).…”

Probiotics and Probiotic-like Agents against Chemotherapy-Induced Intestinal Mucositis: A Narrative Review

“…These concerns would apply also to synbiotics and probiotic mixtures. In contrast, postbiotics or paraprobiotics, which are not live bacteria, would be less likely to cause harm to immunocompromised patients [23].…”

“…Table 1. Definitions of the different relevant terms related to the use of probiotics and probiotic-related derivatives [19][20][21][22][23].…”