Cytokine responses to symbiotic and lactoferrin combination in very low birth weight neonates: a randomized control trial

Abstract

Introduction. Probiotics and prebiotics, which are multifunctional agents, have potential benefits in chronic mucosal inflammation, including the prevention of necrotizing enterocolitis. However, the mechanisms and the results of these immunomodulatory effects are not clear. This study aimed to investigate the cytokine response to the combination of Lactobacillus and Bifidobacterium together with fructo-and galactooligosaccharides (symbiotic) and lactoferrin in very low birth weight neonates. Population and Methods. Infants ≤ 32 GWs and ≤ 1,500 g were randomly assigned to receive a symbiotic combination or 1 ml distilled water as placebo starting with the first feed until discharge. Blood samples were obtained at postnatal 0 ± 2, 14 ± 2, and 28 ± 2 days, and the serum levels of interferon-γ, interleukin (IL)-5, IL-10, and IL-17A were measured. Results. In the study group (n = 25), the IL-10 levels decreased throughout the study period (p = 0.011) but did not change in the control group. The IL-5 levels remained steady in the first 14 days and decreased significantly thereafter (p = 0.042) in the study group, whereas they increased in the first 14 days (p = 0.019), and then decreased in 28 days (p = 0.011) in the control group (n = 25). The levels of the other cytokines did not change throughout the study period. Conclusion. The combined use of probiotics with oligosaccharides and lactoferrin was associated with a decrease in IL-10 levels, but no change was observed in the other cytokines.

Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies

“…Enteral administration of a mixture of probiotics, prebiotics and lactoferrin slightly increased systemic IFNγ protein levels at 28 days of life, but did not affect several other cytokines (IL5, IL10 and IL17) in a RCT in premature infants [249].…”

“…Serum IL5 (protein) at 0, 14 and 28 days = [249] Serum IL10 (protein) at 0, 14 and 28 days (protein) = [249] Serum IL17 (protein) at 0, 14 and 28 days = [249] Serum IFNγ (protein) 0, 14 days = [249] Serum IFNγ (protein) 28 days ↑ [249] ↑ depicts an increase, ↓ depicts a decrease; SC-GOS, short chain galacto-oligosaccharides; LC-FOS, long chain fructo-oligosaccharides.…”

Current therapy option for necrotizing enterocolitis: Practicalities and challenge

“…In addition to maintaining the barrier function of the gut, lactoferrin influences intestinal epithelial cell proliferation and apoptosis ( 16 ). Lactoferrin’s effectiveness in preventing and treating NEC has been demonstrated in several preclinical studies and clinical trials ( 17 , 18 ). Up to now, a phase III clinical trial ( ClinicalTrials.gov Identifier: NCT03431558) is currently underway to determine the health effects of lactoferrin with gradient concentration in neonates with low birth weight at the Aga Khan University Hospital, Pakistan.…”