Transcript Probiotics - khaledhemida

Prebiotics &Probiotics :
Does it realy works ?
By
Prof DR KHALED HEMIDA
Ain Shams University
‫عــن أبى هريرة رضى هللا عنــه أن‬
‫رســـول هللا صــلى هللا عليــه و سـلــم‬
‫قـــال ‪:‬‬
‫‪ ...‬و مــن ســـلك طــريقـــا يلتمــــس فيــه‬
‫عـلـمــــا ســهـــل هللا لـــه طـــر يقــــا الــى‬
‫الجنـــــة ‪.‬‬
‫‪2‬‬
‫رواه مســـــــلم‬
‫‪2004‬‬
Objectives
• Introduce the concept of probiotics, prebiotics, and
synbiotics
• Give a brief history of probiotics
• List some of the potential uses
• Give some insight to the practical considerations
when using them
Some Definitions
• Antibiotic
• Probiotic
• Prebiotic
• Symbiotic
Antibiotic
Definition
• A drug used to treat infections caused by bacteria
and other microorganisms.
• Originally, an antibiotic was a substance produced by
one microorganism that selectively inhibits the
growth of another.
Functional Foods
• Prebiotics & probiotics are example of Functional
foods :
- substances or supplements administered to obtain
a specific result .
• Also called “nutriceuticals” or “biotherapeutics”
Probiotics
• Non-pathogenic live microbial food supplements.
• Organisms that, when administered in adequate
amounts, exert a positive influence on health .
• Live organisms that benefit the host animal by
improving intestinal microbial balance.
• Usually administered in yogurt or capsules.
Probiotics
Candidates
• Lactobacillus (anerobic, gram (+) rods)
– acidophilus, reuteri, casei, planatarum, rhamnosus “GG”
• Bifidobacteria (anerobic, gram (+) rods)
– bifidum, breve, infantis, longum
• Streptococcus
– thermophilus
• Saccharomyces
• Several combinations on the market:
- VSL #3 :
(8 separate organisms:
3 Bifidobacteria, 1 Streptococcus, 4 Lactobacilli)
Lactobacillus GG
Acidophilus with E faecium –
Essential Formulas - Ohhira
Probiotic 12 plus OMX
Prebiotics
Definition
• Nondigestible food ingredients
• Not absorbed or degraded
• Positively affect the endogenous flora
• Stimulate the growth of one or a limited number
of bacterial species
– FOS  Bifidobacteria
– Lactulose  Lactobacilli
Prebiotics
Candidates
•
•
•
•
•
•
•
•
•
Fructooligosaccharide (aka oligofructose)
Isomaltooligosaccharide
Xylooligosaccharide
Inulin
Fiber
Oligomate
Palatinose
Pyrodextrin
Raftiline
Prebiotic Benefits
• Increase in levels of good bacteria
• Reduction in levels of bad bacteria
• Increase in mineral absorption (for example,
calcium)
• Control or prevention of occasional diarrhoea
• Relief from occasional constipation, in the elderly
• Increase in bioavailability of minerals (for
example, calcium and magnesium).
Synbiotics
Definition
• A probiotic organism + its prebiotic food .
• Providing both the organism and substrate at the
time of ingestion may offer improved chance of
survival in GI tract
Microbiology of GI tract
• More Bacteria than tissue cells in the body
• We do not know how many kinds are in the gut, very
little knowledge.
• Vaginal delivered babies have nearly sterile GI tract ,
soon it is populated with microbes
• Breast fed – Lactobacillus and Bifidobaterium
• Bottle fed – E. Coli and Bacteroides
• Anaerobic 1000 : Aerobic 1
Intestinal Flora
• 1012 viable bacteria/gram
of large bowel content
– More than total cells in the
human body
– More than total humans
who have ever lived
• At least 17 families
• At least 50 genera
• 400-500 species in any
single person
• 80-90% unculturable
Intestinal Microflora:
Location & Prevalence
• Rare in the esophagus
• Uncommon in the stomach
– primarily gram (+)
– 102 - 104
• 105 in the jejunum – primarily aerobes
• 1010 – 1012 in the colon
– primarily anerobes
– 1000x more anerobes than aerobes
Factors that affect how the intestinal flora works
Stress and fatigue
Overall diet
Alcohol &
tobacco use
Medicine
(Antibiotics)
Aging
Poor
hygiene
Intestinal
infection
Imbalanced Intestinal Flora
Harmful bacteria dominant
Unhealthy state
Dysbiosis
An altered balance of
Aggressive microbial
species
E. coli, Bacteroides,
Enterococcus and
Klebsiella
species.
Versus
Beneficial microbial
species
Lactobacillus and
Bifidobacterium species.
Swidsinski A et al. Gastroenterology(2002)
History of Probiotics
History
• Metchnikoff – 1907 :
- Ingesting yogurt with Lactobacilli reduces toxic
bacteria of the gut and prolongs life
• Kipeloff 1926 :
- Stressed importance of Lactobacillus acidophilus for
good health
History
• Rettger 1930’s :
- Early clinical application of Lactobacillus
• Parker 1974 :
- 1st to use the term probiotics
• Fuller 1989 :
- Defined probiotics
General Principles of Probiotic Therapeutic Activity
1- Regulation of intestinal microbial homeostasis,
2- Interference with the ability of pathogens to colonize and
infect the mucosa,
3- Modulation of local and systemic immune responses,
4- Stabilization or maintenance of the gastrointestinal barrier
function,
5- Inhibition of procarcinogenic enzymatic activity
6- Induction of enzymatic activity that favors good nutrition.
Marco ML, et al,. Curr Opin Biotechnol 2006;
SO,,,
Probiotics create an unfavorable environment for
pathogens by
Promotion of the
integrity of the
gut's defense
barrier by
normalizing
intestinal
permeability
Modulation of intestinal
secretory Ig function &
control of
Intestinal inflammatory
responses by
balancing the release
of cytokines.
Maintenance
of the normal
Gastrointestinal
flora
microecology.
Clancy R: FEMS Immunol Med Microbiol 2003 .
Chronic Inflammation:
Imbalance Between Mediators
TNFa
IL-1b
IFNg
IL-12
IL-8
IL-1Ra
IL-4/IL-13
TGFb
IL-10
Probiotics can lead to inhibition
of the growth of conventional organisms
or potential pathogens
through a variety of mechanisms:
1- Their
capacity to
decrease
luminal pH
2- Secrete
bactericidal
proteins
(bacteriocins)
3- Inhibit bacterial
adhesion to
epithelial cells
4- Interfere with the
production of
defensins which
have antibacterial
properties
So,,,Probiotics
• Helps to restore the balance of “good”
bacteria and “bad” bacteria
• Facilitates the growth of healthy bacteria –
i.e., Bifidobacterium and Lactobacillus
(O’Mahony 2004; Gastro)
How do they work?
• Probiotics may have:
1- antibacterial,
2- immunomodulatory,
3- anticarcinogenic,
4- antidiarrhoeal,
5- antiallergenic and
6- antioxidant activities
• The antibacterial ability may partially be due to the
ability to colonize the colon and reinforce the barrier
function of the intestinal mucosa
‫الكعبـــة المشـــرفة‬
Clinical Therapeutic Effects of Probiotics
Many Potential Uses
1-Helicobacter Pylori Infection
2-Cancer
3- Irritable Bowel Syndrome
4- Postoperative Complications
5- Pancreatitis
6- Infectious diarrhea
7-Clostridium Difficile Diarrhea
8- Antibiotic-Associated Diarrhea
9- Radiation-induced Diarrhea
10- Nonalcoholic Fatty Liver Disease
11- Inflammatory Bowel Disease
Agarwal R, et al.: J Pediatr Gastroenterol Nutr 2003 .
Prbiotics for Treatment of diarrhea
Probiotics in prevention and treatment of diarrhea
Role on IBD
Normal Intestine Versus Intestine
with IBD
Chronic uncontrolled
Trigger Factors
= inflammation
-Infection
-Bacterial products
Probiotics
Normal Gut
Probiotics
Moderately
infammed
Normal gut
Controlled
inflammation
Therapy of IBD
Decreased
Immunomodulatory
Luminal Antigens
Interventions
Antibiotcs
Anti-TNF- @
Gut Lavage
Anti-IL-12
Lactobacillus
Anti-IL-4
Anti-IL-1ß
IL-10
ISIS-2302
Probiotics
??
76 patients,
randomized to either VSL#3 or placebo after 1
month of antibiotic therapy
to achieve full endoscopic and clinical remission.
The trial conducted lasted 9 months
85% of patients on VSL#3
had remained in
remission
whereas all placebo-treated
patients had relapsed
After completion of therapy, all patients who had remained in
remission on therapy relapsed after the probiotic was withdrawn
Gionchetti P, et al.: Gastroenterology 2003,
Mimura T, U, et al. Gut. 2004.
• Therefore, probiotics are acting to correct the imbalance between
effector and regulatory mechanisms that are the hallmark of IBD.
• Probiotics have no proven use in therapy or maintenance of
remission in Crohn's disease.
• VSL#3 has promising results in induction & maintainence of
remission I UC.
• EcN (E coli Nissle 1917) is equivalent to mesalasin in treatment
and maintenance of remission in ulcerative colitis .
Probiotics in IBS& SIBO
• Commercially available probiotics such as
VSL#3 or Flora-Q have been used for treating
small intestinal bacterial overgrowth and IBS,
but their effectiveness is not known.
• Bifidobacterium infantis 35624 is the only
probiotic that has been demonstrated to be
effective for treating patients with IBS.
Probiotics
Summary
• Probiotics are an old concept, with a new
attitude
• Potential therapy for many GI related diseases
• Largely unproven, but growing body scientific
evidence
• Patients will need guidance as to :
- which ones to use,
- when to use them,
- how to use them
Probiotics:
Questions to answer
• Which species is the best?
• Are combination agents better?
• What is the appropriate dose?
• What is the appropriate duration of treatment?
Probiotics:
What’s needed
• Standardized protocols
• Larger studies
• Defined outcomes
• Correlation with :
- Symptoms? Or
- Cytokine levels? Or
‫جـــــزاكــــم اللــــه خــــــيرا‬
‫علـــى‬
‫حســـن استمــــاعكــــم‬
‫‪41‬‬
‫‪2004‬‬