Manipulation of Intestinal Microbial Flora for Therapeutic Benefit in Inflammatory Bowel Diseases: Review of Clinical Trials of Probiotics, Prebiotics and Synbiotics

Abstract

Pathogenesis of Inflammatory Bowel Diseases(Ulcerative Colitis, Crohn's disease and Pouchitis) includes an abnormal immunological response to disturbed intestinal microflora. Therapeutic strategies are designed to intervene in these abnormal host microbial communications. A novel approach in the last decade has been to use other bacteria or selective foods to induce beneficial bacteria to normalize inflammation. In this review we discuss rationale for such use and describe 46 clinical trials gleaned from the literature. Reports are divided into type, indications, and agents used. The search revealed 15 nonrandomized and 31 randomized trials. Of the latter 23 were double-blind and 8 were open-label randomized controlled. In 32 of the total, different probiotics were used, while 10 and 4 used different prebiotics or synbiotics respectively. In 14 nonrandomized trials, outcome was successful. In the randomized controlled trials 12 of 16 ulcerative colitis but only 2 of Crohn's disease trials of biotic therapy were successful. No superiority of any probiotic was clearly evident, but a multi-agent mixture, VSL3# may be better suited in ulcerative colitis and pouchitis while the probiotic Lactobacillus rhamnosus GG appears less useful in inflammatory bowel disease, especially Crohn's disease. Further studies with uniform stringent criteria are needed to provide proof of this therapy in inflammatory bowel disease.

Probiotic/prebiotic supplementation of antiretrovirals improves gastrointestinal immunity in SIV-infected macaques

“…These PP were chosen based on previous studies showing improved GI tract physiology and/or decreased inflammation (5,6,10). PP treatment alone did not affect plasma viral loads or CD4 + T cell numbers in blood or the GI tract (Supplemental Figure 2).…”

“…The increased mortality in ARV-treated, HIV-infected individuals is associated with inflammation and cardiovascular disease, which are in turn associated with GI mucosal damage and microbial translocation that do not resolve completely with ARV treatment (1,3). Probiotic and prebiotic supplements have improved outcomes in several diseases characterized by GI tract inflammation (4)(5)(6), and probiotics have safely been administered to HIV-infected individuals resulting in modest improvements in CD4 + T cell counts and clinical GI symptoms even without ARV treatment (7)(8)(9). We therefore studied potential benefits of synbiotic supplementation of ARVs in SIV-infected Asian macaques.…”

Aberrant response to commensal Bacteroides thetaiotaomicron in Crohnʼs disease

“…However, this suppression was limited to the ileum in CD. Probiotics including LGG have general been less effective in CD than UC 42 and adverse responses have been reported. [43][44][45][46] Given the immunoregulatory potential of bacteroides species 36 the question arises whether B. theta might be a potentially useful probiotic agent in CD.…”

The bifidogenic effect of inulin and oligofructose and its consequences for gut health

“…The effects of these prebiotics in people with gut diseases (for example, see MacFarlane et al, 2008;Hedin et al, 2007;Heilpern and Szilagyi, 2008) are beyond the scope of this review.…”