The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract

Intestinal microbiota, probiotics and their interactions with drugs: knowledge, attitudes and practices of health science students in Serbia

BACKGROUND

Acquiring sufficient knowledge and understanding the importance of intestinal microbiota and probiotics in health and disease, as well as their potential for interactions with concurrently administered drugs, can significantly influence future pharmacotherapeutic practices among health science students.

OBJECTIVE

This study aimed to assess the knowledge, factors influencing knowledge, attitudes, and practices regarding intestinal microbiota and probiotics and their interactions with drugs among students of the Faculty of Medicine in Novi Sad.

MATERIALS AND METHODS

This cross-sectional study was conducted in the form of an anonymous questionnaire among first- and final-year medical and pharmacy students. Predictors of knowledge scores were analyzed using a negative binomial regression model.

RESULTS

The questionnaire was completed by 263 medical and pharmacy students (44.58% first-year and 55.5% final-year students). Approximately half of the students (53.2%) demonstrated fair knowledge, 34.2% had poor knowledge, and only 12.5% had good knowledge about the intestinal microbiota and probiotics. Study year and self-assessment of knowledge were statistically significant predictors of knowledge scores, while the presence of chronic diseases, previous education, and lifestyle were not. The most common indications for probiotic use among respondents were antibiotic use (75.4%) and gastrointestinal symptoms (69.9%). A large number of respondents reported not paying attention to the concurrent use of probiotics with drugs or food, nor to the choice of specific probiotic strains. Most students expressed that they receive insufficient information on this topic at the university.

CONCLUSION

Most students demonstrate inadequate knowledge about the gut microbiota and probiotics, which affects their practical use of these supplements. The primary reasons for this are insufficient information and unreliable sources of information. Therefore, enhancing education on this topic could significantly improve the knowledge and pharmacotherapeutic practices of future healthcare professionals.

Wheat Flour Pasta Combining Bacillus coagulans and Arthrospira platensis as a Novel Probiotic Food with Antioxidants

Arthrospira platensis (Ap) and Bacillus coagulans (Bc) have been successfully used to develop functional foods, but a combination of both regarding functional implications in nutritional value and antioxidant capacity has not been explored. This work aimed to develop an artisanal wheat flour pasta with egg using 5% A. platensis and 1% B. coagulans GBI 6068 (labeled as Bc+Ap). Uncooked pasta was characterized regarding nutritional value; furthermore, total phenolic content, antioxidant capacity by 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS), and ferric reducing antioxidant power (FRAP), pigment content, colorimetry assay, textural profile analysis, buffering capacity, and probiotic viability were carried out on uncooked and cooked pasta to assess the changes induced by cooking. The Bc+Ap pasta showed enhanced nutritional value with a significant increase in protein content (30.61%). After cooking, the pasta showed increased phenolic content (14.22% mg GAE/g) and antioxidant capacity (55.59% µmol Trolox equivalents/g and 10.88% µmol Fe+2/g) for ABTS and FRAP, respectively, as well as pigment content (6.72 and 1.17 mg/100 g) for chlorophyll a+b and total carotenoids, respectively, but relative impacts on colorimetric parameters in contrast to control (wheat flour pasta). Furthermore, Bc+Ap showed improved firmness (59%, measured in g), buffer capacity (87.80% μmol H+(g × ΔpH)-1), and good probiotic viability (7.2 ± 0.17 log CFU/g) after the cooking process.

Pharmacists' Knowledge, Perception, and Prescribing Practice of Probiotics in the UAE: A Cross-Sectional Study

BACKGROUND

The human body is a complex and interconnected system where trillions of microorganisms, collectively known as the gut microbiota, coexist with these cells. Besides maintaining digestive health, this relationship also impacts well-being, including immune function, metabolism, and mental health. As frontline healthcare providers, pharmacists are pivotal in promoting the benefits of probiotics for immune support. This study explored pharmacists' knowledge, perception, and practice behavior in the UAE towards the implication of probiotic application beyond digestive health, such as cardiovascular and mental health impacts and their diverse dosage forms.

METHOD

An online self-administered survey was distributed among pharmacists in the UAE. Data were collected through personal visits to pharmacies, where pharmacists were approached and asked to complete the questionnaire. The sample size included 407 pharmacists, determined using the formula for proportions with a 95% confidence level and a 5% margin of error. Statistical analysis was performed using SPSS version 29. Descriptive statistics were used to summarize demographic characteristics and survey responses. The knowledge levels were categorized into poor, moderate, and good. Chi-square analysis was employed to investigate associations between demographic factors and knowledge levels, with a significance level set at p < 0.05, enhancing the robustness of the study's findings.

RESULTS

This study included 407 completed eligible responses. About 63.56% of participants were female, with 52.1% employed in pharmacy chains. While 91.2% of pharmacists recognized probiotics' role in immune support, only 30% were aware of their cardiovascular benefits. Moreover, chewing gum was the least known dosage form of probiotics, recognized by only 16.7% of respondents. Additionally, only 57% of the participants recognized liposomes as a dosage form. In practice, most pharmacists recommended storing probiotics at room temperature, accounting for 66.6%. The most prevalent misconception encountered in the pharmacy setting was the belief that probiotics are primarily intended for gastrointestinal tract problems, at 79.1% of the respondents. Regarding perception, the agreement was observed regarding the safety of probiotics for all ages. Perceived barriers included the high cost of probiotics, with the majority (86.5%) indicating this as a significant obstacle, while lack of demand was identified as the minor barrier by 64.6%. Additionally, an association was found at a significance level of p < 0.05 with knowledge, gender, educational level, type and location of pharmacy, and source of information.

CONCLUSIONS

The study highlights knowledge gaps in pharmacists' understanding of probiotic applications beyond digestive health, particularly cardiovascular health and depression. Targeted educational interventions are necessary to address these gaps. The findings underscore the importance of ongoing professional development for pharmacists, enhancing their role in patient education and the promotion of probiotics for overall health.

The Effect of Food Matrix Taken with Probiotics on the Survival of Commercial Probiotics in Simulation of Gastrointestinal Digestion

The adequate survival of probiotics in the harsh environment of the gastrointestinal (GI) tract plays a crucial role in the expression of their functional properties. The aim of the present study was to evaluate the survival of commercial probiotics during digestion using a standardised INFOGEST 2.0 model extended with three food matrices simulating three scenarios for the consumption of probiotics: on an empty stomach, with juice, or with food (porridge). All eight products matched the bacterial content stated on the label. After simulated digestion, we observed an average decrease in viability of 1.6 log10 colony forming units (CFU) when the product was co-digested with water, a 2.5 log10 CFU decrease in the presence of juice, and a 1.2 log10 CFU decrease in the presence of porridge. The survival rate of the probiotics was statistically higher in the test samples with porridge (91.8%) than in those with juice (79.0%). For two products, the number of lactobacilli and bifidobacteria strains after digestion was less than <3 × 105 CFU, which can be considered insufficient. The present study has shown that the survival of probiotic strains during GI passage depends not only on their ability to withstand these harsh conditions but may also be influenced by the manufacturing process and by the foods consumed together with the probiotics.

Effect of Probiotic Fermented Milk Supplementation on Glucose and Lipid Metabolism Parameters and Inflammatory Markers in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Modulating gut microbiota composition through probiotic administration has been proposed as a novel therapy for type 2 diabetes mellitus (T2DM), and fermented milk is arguably the most common and ideal probiotic carrier. The present meta-analysis was performed to assess the effects of probiotic fermented milk supplementation on glucose and lipid metabolism parameters and inflammatory markers in patients with T2DM using published data from randomized controlled trials (RCTs). The PubMed, Web of Science, and Cochrane Library databases were searched for relevant RCTs. A random-effects model was used to generate the weighted mean difference (WMD) and 95% confidence interval (95% CI). Probiotic fermented milk supplementation reduced the levels of fasting plasma glucose (MD = -17.01, 95% CI -26.43, -7.58 mg/dL; n = 7), hemoglobin A1c (MD = -0.47, 95% CI -0.74, -0.21%; n = 7), total cholesterol (MD = -5.15, 95% CI -9.52, -0.78 mg/dL; n = 7), and C-reactive protein (MD = -0.25, 95% CI -0.43, -0.08; n = 3) but did not significantly affect the levels of HOMA-IR (MD = -0.89, 95% CI -2.55, 0.78; n = 3), triglyceride (MD = -4.69, 95% CI -14.67, 5.30 mg/dL; n = 6), low-density lipoprotein cholesterol (MD = -4.25, 95% CI -8.63, 0.13 mg/dL; n = 7), high-density lipoprotein cholesterol (MD = 1.20, 95% CI -0.96, 3.36 mg/dL; n = 7), and tumor necrosis factor-alpha (MD: -0.58, 95% CI -1.47, 0.32 pg/mL; n = 2). In summary, the present findings provide a crude indication of the potential benefits of probiotic fermented milk supplementation in improving glucose and lipid metabolism and inflammation in patients with T2DM. However, more robust evidence is needed to determine the clinical significance of probiotic fermented milk in the management of T2DM.

Multi-species synbiotic supplementation increased fecal short chain fatty acids and anti-inflammatory cytokine interleukin-10 in adult men with dyslipidemia; A randomized, double-blind, clinical trial

BACKGROUND

Mounting evidence revealed that an imbalance of Gut Microbiota (GM) leads to metabolic disorders. Synbiotics through regulation of GM composition can be an effective intervention in the management of metabolic diseases. This study aimed to investigate the effects of multi-species synbiotic supplementation on serum interleukin10 (IL-10) and fecal Short Chain Fatty Acids (SCFAs) in patients with dyslipidemia.

METHODS

In this double-blind, randomized, placebo-controlled clinical trial, fifty-six adult men with dyslipidemia were randomly allocated to intervention and control groups and received either synbiotic or placebo powder twice a day for 12 weeks. Each synbiotic sachet contained 6 species of probiotic microorganisms with a total dose of 3 × 1010 Colony Forming Unit (CFU) and 5 gr inulin and Fructooligosaccharide (FOS) as prebiotics. Blood and stool samples were collected at the baseline and end of the study. Dietary intake, physical activity, anthropometric measurements, serum IL-10, and fecal SCFAs were assessed before and after the intervention.

RESULT

There were no significant differences between the baseline characteristics of patients in the two groups. Serum IL-10 was increased in the synbiotic group (p < 0.0001). Moreover, synbiotic supplementation increased fecal concentration of acetate (p < 0.0001), butyrate (p = 0.043), propionate (p < 0.0001), and valerate (p < 0.026). A significant positive correlation was observed between the changes in fecal butyrate level and serum IL-10 concentration in the control group (r = 0.48, p = 0.01).

CONCLUSIONS

A Twelve-week synbiotic supplementation increased fecal SCFAs and improved inflammation in adult men with dyslipidemia.

Gut Microbiome Integration in Drug Discovery and Development of Small Molecules

Human microbiomes, particularly in the gut, could have a major impact on the efficacy and toxicity of drugs. However, gut microbial metabolism is often neglected in the drug discovery and development process. Medicen, a Paris-based human health innovation cluster, has gathered more than 30 international leading experts from pharma, academia, biotech, clinical research organizations, and regulatory science to develop proposals to facilitate the integration of microbiome science into drug discovery and development. Seven subteams were formed to cover the complementary expertise areas of 1) pharma experience and case studies, 2) in silico microbiome-drug interaction, 3) in vitro microbial stability screening, 4) gut fermentation models, 5) animal models, 6) microbiome integration in clinical and regulatory aspects, and 7) microbiome ecosystems and models. Each expert team produced a state-of-the-art report of their respective field highlighting existing microbiome-related tools at every stage of drug discovery and development. The most critical limitations are the growing, but still limited, drug-microbiome interaction data to produce predictive models and the lack of agreed-upon standards despite recent progress. In this paper we will report on and share proposals covering 1) how microbiome tools can support moving a compound from drug discovery to clinical proof-of-concept studies and alert early on potential undesired properties stemming from microbiome-induced drug metabolism and 2) how microbiome data can be generated and integrated in pharmacokinetic models that are predictive of the human situation. Examples of drugs metabolized by the microbiome will be discussed in detail to support recommendations from the working group. SIGNIFICANCE STATEMENT: Gut microbial metabolism is often neglected in the drug discovery and development process despite growing evidence of drugs' efficacy and safety impacted by their interaction with the microbiome. This paper will detail existing microbiome-related tools covering every stage of drug discovery and development, current progress, and limitations, as well as recommendations to integrate them into the drug discovery and development process.

Unravelling the Gastroprotective Potential of Kefir: Exploring Antioxidant Effects in Preventing Gastric Ulcers

The present study was conducted to evaluate the protective effect of milk kefir against NSAID-induced gastric ulcers. Male Swiss mice were divided into three groups: control (Vehicle; UHT milk at a dose of 0.3 mL/100 g), proton pump inhibitor (PPI; lansoprazole 30 mg/kg), and 4% milk kefir (Kefir; 0.3 mL/100 g). After 14 days of treatment, gastric ulcer was induced by oral administration of indomethacin (40 mg/kg). Reactive oxygen species (ROS), nitric oxide (NO), DNA content, cellular apoptosis, IL-10 and TNF-α levels, and myeloperoxidase (MPO) enzyme activity were determined. The interaction networks between NADPH oxidase 2 and kefir peptides 1-35 were determined using the Residue Interaction Network Generator (RING) webserver. Pretreatment with kefir for 14 days prevented gastric lesions. In addition, kefir administration reduced ROS production, DNA fragmentation, apoptosis, and TNF-α systemic levels. Simultaneously, kefir increased NO bioavailability in gastric cells and IL-10 systemic levels. A total of 35 kefir peptides showed affinity with NADPH oxidase 2. These findings suggest that the gastroprotective effect of kefir is due to its antioxidant and anti-inflammatory properties. Kefir could be a promising natural therapy for gastric ulcers, opening new perspectives for future research.

Effect of esomeprazole with and without a probiotic on fecal dysbiosis, intestinal inflammation, and fecal short-chain fatty acid concentrations in healthy dogs

BACKGROUND

Proton pump inhibitors can cause diarrhea and a transient increase in fecal dysbiosis index in dogs. It is unknown if concurrent probiotic administration mitigates these effects.

OBJECTIVE/HYPOTHESIS

To assess the fecal Canine Microbial Dysbiosis Index (CMDI), fecal short chain fatty acid (SCFA), and fecal calprotectin concentrations in dogs administered esomeprazole with and without a probiotic.

ANIMALS

Eleven healthy dogs.

METHODS

Prospective, within-subjects before and after study. All dogs received 7-day courses of esomeprazole (1 mg/kg PO q 24h) alone followed by esomeprazole with a probiotic (15 billion CFU/kg), separated by a 4-week washout period. Data were compared between phases using mixed effects ANOVA or generalized estimating equations with post-hoc Holm adjustment for 2-way comparisons.

RESULTS

Compared to baseline (mean CMDI -2.66, SD 3.04), fecal CMDI was not different with esomeprazole administration alone (mean CMDI -1.48, SD 3.32, P = .08), but there was a significant increase (Diff 3.05, 95% CI [1.37, 4.74], P < .001, Effect size 2.02) when esomeprazole and a probiotic were administered concurrently (mean CMDI 0.39, SD 2.83). CMDI was significantly higher when esomeprazole was administered with a probiotic than alone (Diff 1.87, 95% CI [0.19, 1.87], P = .02, Effect size 1.24). Fecal calprotectin and SCFA concentrations did not differ between phases. The occurrence of vomiting and diarrhea was not different from baseline when esomeprazole was administered alone (36%/27%) or with a probiotic (46%/9%).

CONCLUSIONS AND CLINICAL IMPORTANCE

In healthy dogs, concurrent administration of a probiotic is unlikely to lessen adverse effects associated with esomeprazole administration.

Gut Microbiome and Dietar Considerations

The gut microbiome represents a complex microbial ecosystem that exerts direct and indirect effects on other organ systems and contributes to both health and disease. It is sensitive to various stimuli such as childhood immunity, medications, diet, stressors, and sleep. Modulating the gut microbiome can prevent and even treat certain disease states. Although no definitive guidelines exist to support a healthy microbiome, there are several evidence-based interventions proved to improve gut health and reduce the risk for numerous chronic diseases.

A short-term bioreactor assay to assess the effect of essential oils on a microbiota derived from piglet's intestinal content

BACKGROUND

Modulating the microbiota is an emerging way to improve pig health. In-vitro bioreactor systems can be used to reproduce intestinal microbiota to study modulating avenues. In this study, a continuous feeding system to support a microbiota derived from piglet colonic contents, over 72 h, was developed. The microbiota from piglets was collected and used as inoculum. The culture media was derived from an artificial digestion of piglet feed. The microbiota diversity in time, the reproducibility between replicates and the diversity of the bioreactor microbiota compared to the inoculum was assessed. Essential oils were used as a proof of concept to assess the in vitro microbiota modulation. The microbiota diversity was assessed by 16S rRNA amplicon sequencing. Quantitative PCR was also used for total bacteria, lactobacilli and Enterobacteria.

RESULTS

At the start of the assay, the bioreactor microbiota diversity was similar to the inoculum. Time and replication affected the bioreactor microbiota diversity. Between 48 and 72 h, no statistical variation of the microbiota diversity was observable. After a 48 h running period, thymol and carvacrol were added at 200 ppm or 1000 ppm for 24 h. No microbiota modification was observed by sequencing. Quantitative PCR results showed a significant growth of lactobacilli when thymol was used at 1000 ppm, where only a trend was observed with the 16S analysis.

CONCLUSIONS

This study presents a bioreactor assay that can be used as a tool for rapid screening of additives and suggests that the effects of essential oils on the microbiota are subtle, acting against a few bacterial genera.

Knowledge and Attitude towards Probiotics among Dental Students and Teachers: A Cross-Sectional Survey

This cross-sectional survey assessed the knowledge of and the attitude towards probiotics of dental students and academics at Sechenov University, Moscow, Russia. Our questionnaire consisted of 15 questions divided into 3 sections: respondents' sociodemographic data, knowledge on probiotics, and attitude towards probiotics. The data were analyzed using the Mann-Whitney U test, Fisher's exact test, and Spearman's rank correlation coefficient. Out of the 658 questionnaires distributed, a total of 239 questionnaires were completed by the undergraduates, yielding a response rate of 39.6%, and 54 by the teaching staff (response rate = 100%). Most students (53.6%) and teachers (55.5%) had a fair knowledge of probiotics (p = 0.3135). A vast majority of dental students (97.9%) and all teachers had a positive attitude towards probiotics, with higher mean scores among academics (p < 0.001). A positive weak correlation was found between knowledge and attitude (Spearman r = 0.17, p = 0.0027). The results obtained reveal the need for more evidence-based educational trainings for university teachers and a course on probiotics to be included in the curriculum for dental students.

Probiotics, prebiotics, and synbiotics in chronic constipation: Outstanding aspects to be considered for the current evidence

This integrative aimed to evaluate the effects and the potential mechanism of action of prebiotics, probiotics, and synbiotics on constipation-associated gastrointestinal symptoms and to identify issues that still need to be answered. A literature search was performed in the PubMed database. Animal models (n = 23) and clinical trials (n = 39) were included. In animal studies, prebiotic, probiotic, and synbiotic supplementation showed a decreased colonic transit time (CTT) and an increase in the number and water content of feces. In humans, inulin is shown to be the most promising prebiotic, while B. lactis and L. casei Shirota probiotics were shown to increase defecation frequency, the latter strain being more effective in improving stool consistency and constipation symptoms. Overall, synbiotics seem to reduce CTT, increase defecation frequency, and improve stool consistency with a controversial effect on the improvement of constipation symptoms. Moreover, some aspects of probiotic use in constipation-related outcomes remain unanswered, such as the best dose, duration, time of consumption (before, during, or after meals), and matrices, as well as their effect and mechanisms on the regulation of inflammation in patients with constipation, on polymorphisms associated with constipation, and on the management of constipation via 5-HT. Thus, more high-quality randomized control trials (RCTs) evaluating these lacking aspects are necessary to provide safe conclusions about their effectiveness in managing intestinal constipation.

From fecal microbiota transplantation toward next-generation beneficial microbes: The case of Anaerobutyricum soehngenii

The commensal gut microbiota is important for human health and well-being whereas deviations of the gut microbiota have been associated with a multitude of diseases. Restoration of a balanced and diverse microbiota by fecal microbiota transplantation (FMT) has emerged as a potential treatment strategy and promising tool to study causality of the microbiota in disease pathogenesis. However, FMT comes with logistical challenges and potential safety risks, such as the transfer of pathogenic microorganisms, undesired phenotypes or an increased risk of developing disease later in life. Therefore, a more controlled, personalized mixture of cultured beneficial microbes might prove a better alternative. Most of these beneficial microbes will be endogenous commensals to the host without a long history of safe and beneficial use and are therefore commonly referred to as next-generation probiotics (NGP) or live biotherapeutic products (LBP). Following a previous FMT study within our group, the commensal butyrate producer Anaerobutyricum spp. (previously named Eubacterium hallii) was found to be associated with improved insulin-sensitivity in subjects with the metabolic syndrome. After the preclinical testing with Anaerobutyricum soehngenii in mice models was completed, the strain was produced under controlled conditions and several clinical studies evaluating its safety and efficacy in humans were performed. Here, we describe and reflect on the development of A. soehngenii for clinical use, providing practical guidance for the development and testing of NGPs and reflecting on the current regulatory framework.

Diet and Pre-Intervention Washout Modifies the Effects of Probiotics on Gestational Diabetes Mellitus: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials

Dynamic interactions among gestational diabetes mellitus (GDM), gut microbiota, inflammation, oxidative stress, and probiotics are increasingly acknowledged. This meta-analysis aimed to summarize the effects of probiotics in GDM, focusing on lifestyle intervention and pre-intervention washout, in addition to metabolic, inflammation, oxidative stress, and pregnancy outcomes. Three electronic databases (i.e., PubMed, Scopus, and CENTRAL) were searched from inception until October 2020. A meta-analysis was performed, and the effect sizes were reported as either mean differences or odds ratios with 95% confidence intervals. Altogether, 10 randomized controlled trials enrolling 594 participants were included. The meta-analysis indicated that probiotics supplementation effectively reduced fasting plasma glucose by 3.10 mg/dL, and subgroup analyses suggested that the duration of intervention, number of species, pre-intervention washout period, and dietary intervention may determine the effects of probiotics. Probiotics also reduced the level of inflammatory markers (high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-α, and malondialdehyde), incidence of macrosomia, and newborn hospitalization. In conclusion, this meta-analysis suggests that probiotics may have positive effects on metabolic, inflammation, oxidative stress, and neonatal outcomes in women with GDM. Additionally, diet and pre-intervention washout may modify the effects of probiotics. Future studies are warranted on a larger scale to ascertain the clinical significance.

Targeted Delivery of Probiotics: Perspectives on Research and Commercialization

Considering the significance of the gut microbiota on human health, there has been ever-growing research and commercial interest in various aspects of probiotic functional foods and drugs. A probiotic food requires cautious consideration in terms of strain selection, appropriate process and storage conditions, cell viability and functionality, and effective delivery at the targeted site. To address these challenges, several technologies have been explored and some of them have been adopted for industrial applicability. Encapsulation of probiotics has been recognized as an effective way to stabilize them in their dried form. By conferring a physical barrier to protect them from adverse conditions, the encapsulation approach renders direct benefits on stability, delivery, and functionality. Various techniques have been explored to encapsulate probiotics, but it is noteworthy that the encapsulation method itself influences surface morphology, viability, and survivability of probiotics. This review focuses on the need to encapsulate probiotics, trends in various encapsulation techniques, current research and challenges in targeted delivery, the market status of encapsulated probiotics, and future directions. Specific focus has been given on various in vitro methods that have been explored to better understand their delivery and performance.

The issue of the correct use of probiotics in the absence of recommendations

Antibiotics are important for saving both human health and life. Antibiotics destroy all bacteria within their spectrum, because they do not distinguish between good and bad bacteria. Even if an antibiotic therapy lasts only a few days, it may cause diarrhoea and mycosis. Antibiotics destroy most bacterial species in the intestines. These changes may affect one’s whole life. Today it is a challenge for medicine to be able to manipulate the microbiome so as to restore normal relations between microorganisms. At present, when antibiotics are abused, probiotics are very often applied. However, as there are no recommendations, a lot of mistakes can be made when using them. Both drugs and dietary supplements can be classified as probiotics. Medicinal probiotics are subject to very strict registration requirements and their use is associated with a specific disease or ailment. Probiotic microorganisms must be classified according to their genus, species and strain. These preparations may contain one or more probiotic strains depending on its application. At present there are no established schemes or rules concerning the dosage of probiotic preparations. This issue arouses numerous controversies. It is assumed that the probiotic should be applied at a dose which proved to have a beneficial effect in tests conducted on humans. Patients usually make decisions on the choice and dosage of preparations themselves. Individualised probiotic therapy is the key to success. There is no universal preparation – a specific probiotic should be used in a particular clinical case.

Knowledge, attitudes, and understanding of probiotics among pediatricians in different regions of Saudi Arabia

BACKGROUND

Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit upon the host. Knowledge and attitudes of health professionals have been reported to be at a medium level for probiotics. The objective was to evaluate the knowledge and practice styles about probiotics among pediatricians working in different regions of Saudi Arabia.

METHODS

This cross-sectional study was conducted at pediatric hospitals in Saudi Arabia. A national survey of 550 pediatric providers (PPs) was conducted between January and March 2020 anonymously on their knowledge and practice styles regarding probiotics, and it was completed by pediatric residents (PRs), pediatric specialist (PSs), pediatric consultants (PCs), and pediatric gastroenterologists (PGs).

RESULTS

The survey had a response rate of 82%. Among the respondents, 57.7% were aware of the probiotic's definition. There were significant differences in the percentage of participants who had little knowledge of probiotics (P < 0.05), with the highest being PRs and the lowest being PGs. The most common probiotic used by all participants was Lactobacillus acidophilus (63.3%), and Mycobacterium avium was prescribed the least often (8.6%). Most PRs and PSs correctly reported that probiotics reduce the risk of antibiotic-induced diarrhea (74.9 and 80.2%, respectively), but there were no significant differences among them.

CONCLUSIONS

Significant differences in knowledge and practice patterns exist for probiotics. Identification of knowledge gaps may be useful to develop educational materials to improve the proper definition, knowledge, and use of probiotics.

Effect of the carrier material, drying technology and dissolution media on the viability of Lactobacillus fermentum K73 during simulated gastrointestinal transit

The goal of this study was to determine the effect of the carrier material, drying technology and dissolution media during the passage of L. fermentum K73 through a dynamic in vitro digestion system (IViDiS). The carrier materials were (i) culture medium with growing micro-organisms and (ii) culture medium with maltodextrin : sweet whey [0.6 : 0.4]. The carrier materials were dried by spray-drying and freeze-drying to obtain four types of powders. The dissolution media consisted of water and 1% fat milk. The powders were tested using an in vitro dynamic digestion system (IViDiS). The results showed that powders derived from culture medium had the highest protective effect on the viability of L. fermentum K73 in both dissolution media and that survival increased when the powders were tested in milk. The modified Gompertz model was used to model L. fermentum K73 behaviour during the digestion process. The model showed that cells entrapped in culture medium had the longest lag phase and the slowest inactivation rate when evaluated in milk.

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.

Lactobacillus rhamnosus GG and Saccharomyces cerevisiae boulardii exert synergistic antipathogenic activity in vitro against enterotoxigenic Escherichia coli

Short-term colonic in vitro batch incubations were performed to elucidate the possible synergistic effects of Lactobacillus rhamnosus GG (CNCM-I-4798) and Saccharomyces cerevisiae boulardii (CNCM-I-1079) (associated in Smebiocta/Smectaflora Protect®) on the colonic microbial fermentation process, as well as their antipathogenic activity against enterotoxigenic Escherichia coli (LMG2092) (ETEC). These incubations adequately simulate the native microbiota and environmental conditions of the proximal colon of both adult and toddler donors, including the colonic mucosal layer. Results indicated that both strains were capable of growing together without showing antagonistic effects. Co-cultivation of both strains resulted in increased butyrate (stimulated by L. rhamnosus GG), propionate (stimulated by S. boulardii), and ethanol (produced by S. boulardii) production compared to the control incubations, revealing the additive effect of both strains. After inoculation of ETEC under simulated dysbiotic conditions, a 40 and 46% reduction in the concentration of ETEC was observed upon addition of both strains during the experiments with the adult and toddler donor, respectively. Furthermore, ETEC toxin levels decreased upon S. boulardii inoculation, probably due to proteolytic activity of this strain, with a synergistic effect being observed upon co-cultivation of L. rhamnosus GG and S. boulardii resulting in a reduction of 57 and 46% for the adult and toddler donor, respectively. Altogether, the results suggest that both probiotics together may help microbiota functionality, in both adults and toddlers and under healthy or impaired conditions, which could be of great interest when the colonic microbiota is dysbiotic and therefore sensitive to pathogenic invasion such as during antibiotic treatment.

Health Professionals' Knowledge of Probiotics: An International Survey

The objective of this study was to survey health professionals to investigate their knowledge of probiotics. An online survey was conducted to gather data on the knowledge of health professionals. The online survey was distributed via email and social media platforms using snowball sampling. A total of 1066 health professionals (859; 80.6% female) from 30 countries responded to the survey. Most of the respondents evaluated their knowledge of probiotics as medium (36.4%) or good (36.2%). Only 8.9% of the respondents rated it as excellent. No statistical difference in knowledge was found between male and female health professionals. Over 80% of pharmacists, allied health professionals, medical doctors and dentists, and other health professionals knew the correct definition of probiotics as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”, whereas three quarters of registered nurses and midwives and less than two thirds of psychologists identified the correct definition. Statistically, more female than male health professionals knew the correct definition of probiotics. The most frequently recognized species of bacteria containing probiotic strains were Lactobacillus acidophilus (92%), Bifidobacterium bifidum (82%), and Lactobacillus rhamnosus (62%). The opinions on when it is best to take probiotics were different (χ² = 28.375; p < 0.001), with 90.2% of respondents identifying that probiotics have beneficial effects if taken during antibiotic therapy, 83.5% for diarrhea, 70.6% for constipation, 63.3% before traveling abroad, and 60.4% for treating allergies. Almost 79% of health professionals involved in this study have advised their patients to use probiotics and 57.5% of the respondents wanted to learn more about probiotics. All things considered, health professionals have a medium level of knowledge of probiotics, which could be improved by the implementation of targeted learning programs. As probiotics have many beneficial effects in a wide range of health areas, health professionals need to adopt the use of probiotics in clinical practice.

Effect of synbiotic and probiotic supplementation on serum brain-derived neurotrophic factor level, depression and anxiety symptoms in hemodialysis patients: a randomized, double-blinded, clinical trial

BACKGROUND

The aim of this study was to investigate the effects of probiotic and synbiotic supplementation on the depression and anxiety symptoms and serum brain-derived neurotrophic factor (BDNF) level.

METHODS

Seventy-five HD patients were randomly assigned to receive the synbiotic (15 g of prebiotics, 5 g of probiotic containing Lactobacillus acidophilus T16, Bifidobacterium bifidum BIA-6, Bifidobacterium lactis BIA-7, and Bifidobacterium longum BIA-8 (2.7 × 10⁷ CFU/g each)) or probiotics (5 g probiotics as in synbiotic group with 15 g of maltodextrin as placebo) or placebo (20 g of maltodextrin) for 12 weeks. Serum BDNF was measured by ELISA kit. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of depression (HADS-DEP) and anxiety (HADS-ANX).

RESULTS

From baseline to 12 weeks, synbiotic supplementation resulted in a significant decrease in HADS-DEP score in a subgroup of patients with depressive symptom (HADS-DEP ≥ 8) compared to the placebo and probiotic supplementation (p = .001, p = .002, respectively) and in all patients compared to the placebo (p = .004). There was no significant difference among the groups in terms of HADS-ANX scores. However, the HADS-ANX scores decreased significantly in the synbiotic group compared to the baseline in all patients (p = .047) and also patients with depressive symptom (p = .03). In addition, in a subgroup of HD patients with depressive symptom, the serum BDNF increased significantly in the synbiotic group when compared to the placebo (p < .001) and probiotic group (p = .011).

CONCLUSION

Overall, 12 weeks of synbiotic supplementation resulted in greater improvement in depression symptoms and serum BDNF level compared to the probiotic supplementation in HD patients especially in the subgroup of patients with depression symptoms.

Advances and Current Challenges in Intestinal in vitro Model Engineering: A Digest

The physiological environment of the intestine is characterized by its variegated composition, numerous functions and unique dynamic conditions, making it challenging to recreate the organ in vitro. This review outlines the requirements for engineering physiologically relevant intestinal in vitro models, mainly focusing on the importance of the mechano-structural cues that are often neglected in classic cell culture systems. More precisely: the topography, motility and flow present in the intestinal epithelium. After defining quantitative descriptors for these features, we describe the current state of the art, citing relevant approaches used to address one (or more) of the elements in question, pursuing a progressive conceptual construction of an "ideal" biomimetic intestinal model. The review concludes with a critical assessment of the currently available methods to summarize the important features of the intestinal tissue in the light of their different applications.

Probiotic assisted weight management as a main factor for glycemic control in patients with type 2 diabetes: a randomized controlled trial

OBJECTIVES

To evaluate the effect of Lactobacillus casei 01 on dietary intake, body weight, and glycemic control in patients with T2DM.

METHOD

Forty patients with T2DM (n = 20 for each group) were assigned into two groups in present trial. The patients in the probiotic group received a daily capsule containing a minimum of 108 CFU of L. casei 01 for 8 week. The placebo group took capsules filled with maltodextrin for the same time period. Dietary intake questionnaires and anthropometric measurements were collected, and the participants were assessed by an endocrinologist at baseline and at the end of the trial.

RESULTS

Lactobacillus casei 01 supplementation significantly decreased total energy, carbohydrate, fat, and protein intake compared with placebo (p = 0.001, p = 0.002, p = 0.009, p = 0.001; respectively). Moreover weight, BMI, and waist circumference were significantly decreased in intervention group compared with placebo group (p < 0.001; p < 0.001; p = 0.029; respectively). In comparison with placebo group serum fetuin-A level, fasting blood sugar, insulin concentration, and insulin resistance were significantly decreased (p = 0.023, p =0.013, p = 0.028; p = 0.007; respectively), and serum SIRT1 level was significantly increased (p = 0.040) in intervention group.

CONCLUSIONS

Lactobacillus casei 01 supplementation affected dietary intake and body weight in a way that improved fetuin-A and SIRT1 levels and glycemic response in subjects with T2DM. Affecting the fetuin-A and SIRT1 levels introduces a new known mechanism of probiotic action in diabetes management.

Multifunctional Role of the Whey Culture Medium in the Spray Drying Microencapsulation of Lactic Acid Bacteria

This study aims to evaluate the multifunctional role of whey culture medium during the spray drying microencapsulation of Lactobacillus fermentum K73. Whey culture medium containing growing microorganisms served to hydrate different mixtures (gum arabic, maltodextrin and whey). We evaluated the use of these mixtures as carbon sources and their protective effects on simulated gastrointestinal conditions. The optimal mixture was spray-dried while varying the outlet temperature and atomizing pressure using a response surface design. These conditions served to evaluate microorganism survival, tolerance to gastrointestinal conditions in vitro, physicochemical properties, morphometric features and stability at 4, 25 and 37 °C. Lactobacillus fermentum K73 replicated in the carrier material. Bacterial change cycles were (-1.97±0.16) log CFU/g after the drying process and 
(-0.61±0.08) and (-0.23±0.00) log CFU/g after exposure of the capsules to simulated gastric pH and bile salt content, respectively. The physicochemical properties and morphometric features were within the normal ranges for a powder product. The powder was stable at a storage temperature of 4 °C. The spray drying of the whey culture medium with growing microorganisms using the optimized drying conditions was successful. This study demonstrates the use of whey culture medium as a component of carrier material or as the carrier material itself, as well as its protective effects during drying, under simulated gastrointestinal conditions, and at varied storage temperatures.

The Effects of Lactobacillus casei on Glycemic Response, Serum Sirtuin1 and Fetuin-A Levels in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

Background:

Type 2 diabetes mellitus (T2DM) is related to the gut microbiota with numerous molecular mechanisms. Modulating the gut microbiota by probiotics could be effective in management of T2DM. The aim of the present trial was to evaluate the effect of Lactobacillus casei on glycemic control and serum sirtuin1 (SIRT1) and fetuin-A in patients with T2DM.

Methods:

Forty patients with T2DM (n = 20 for each group) were divided into intervention (probiotic) and placebo groups. The intervention group received a daily capsule containing 10⁸ cfu of L. casei for eight weeks. The patients in placebo group took capsules containing maltodextrin for the same time duration. Anthropometric measurements, dietary intake questionnaires, and blood samples were collected, and the patients were assessed by an endocrinologist at the beginning and at the end of the trial.

Results:

Fasting blood sugar, insulin concentration, and insulin resistance significantly decreased in probiotic group compared with placebo group (-28.32 [-50.23 to -6.41], 0.013; -3.12 [-5.90 to -0.35], 0.028; -32.31 [-55.09 to -9.54], 0.007, respectively). Moreover, HbA1c reduced after intervention, but the reduction was not significant (-0.45 [-0.96 to 0.05], 0.077). In comparison with placebo, the L. casei supplementation significantly increased SIRT1 and decreased fetuin-A levels at the end of the trial (0.52 [0.026 to 1.02], 0.040; -17.56 [-32.54 to -2.58], 0.023, respectively).

Conclusion:

L. casei supplementation affected SIRT1 and fetuin-A levels in a way that improved glycemic response in subjects with T2DM. Affecting the SIRT1 and fetuin-A levels introduces a new known mechanism of probiotic action in diabetes management.

In vitro digestion models suitable for foods: Opportunities for new fields of application and challenges

In vitro digestion assays simulate the physiological conditions of digestion in vivo and are useful tools for studying and understanding changes, interactions, as well as the bioaccessibility of nutrients, drugs and non-nutritive compounds. The technique is widely used in fields such as nutrition, pharmacology and food chemistry. Over the last 40 years, more than 2500 research articles have been published using in vitro digestion assays (85% of which have been published in the last two decades) to elucidate multiple aspects such as protein digestibility, nutrient interactions or the viability of encapsulated microorganisms. The most recent trend in the use of this technique involves the determination of the antioxidant activity of bioactive compounds after digestion. However, the inability to reproduce certain in vivo digestion events, as well as the multiple models of in vitro digestion, point to a need to optimize and validate the method with in vivo assays to determine its limitations and uses. The purpose of this paper is to provide an overview of the current state of the art of in vitro digestion models through an analysis of how they have evolved in terms of the development of digestion models (parameters, protocols, guidance) and taking into consideration the boom in new fields of application.

Probiotics and the Microbiome in Celiac Disease: A Randomised Controlled Trial

Background. There is limited research investigating the composition of the gastrointestinal microbiota in individuals with celiac disease (CoeD) reporting only partial symptom improvement despite adherence to a strict gluten-free diet (GFD). The aim of this research was to determine if the gastrointestinal microbiota could be altered by probiotic bacteria and provide a potential new therapy for this subgroup. Methods. A multicentre RCT was conducted between January and August 2011 in Australia. Participants included 45 people with CoeD reporting only partial symptom improvement despite adherence to a strict GFD for a minimum of 12 months. Participants took 5 g of VSL#™ probiotic formulation (n = 23) or 5 g placebo (n = 22) orally twice daily for 12 weeks. The main outcome measured was the efficacy of the probiotic formula in altering faecal microbiota counts between baseline and week 12. Safety was determined by safety blood and monitoring adverse events. Results. SPSS™ multivariate repeated measures analysis (95th confidence level) revealed no statistically significant changes between the groups in the faecal microbiota counts or blood safety measures over the course of the study. Conclusion. The probiotic formula when taken orally over the 12-week period did not significantly alter the microbiota measured in this population. The trial was registered with Australian and New Zealand Clinical Trials Register ACTRN12610000630011.

Impact of a yogurt matrix and cell microencapsulation on the survival of Lactobacillus reuteri in three in vitro gastric digestion procedures

The goal of this study was to assess the interaction between microencapsulation and a yogurt food matrix on the survival of Lactobacillus reuteri NCIMB 30242 in four different in vitro systems that simulate a gastric environment. The four systems were: United States Pharmacopeia (USP) solutions, a static two-step (STS) procedure which included simulated food ingredients, a constantly dynamic digestion procedure (IViDiS), as well a multi-step dynamic digestion scheme (S’IViDiS). The pH profiles of the various procedures varied between systems with acidity levels being: USP > STS > IViDiS = S’IVIDiS. Addition of a food matrix increased the pH in all systems except for the USP methodology. Microencapsulation in alginate-based gels was effective in protecting the cells in model solutions when no food ingredients were present. The stability of the probiotic culture in the in vitro gastric environments was enhanced when (1) yoghurt or simulated food ingredient were present in the medium in sufficient quantity, (2) pH was higher. The procedure-comparison data of this study will be helpful in interpreting the literature with respect to viable counts of probiotics obtained from different static or dynamic in vitro gastric systems.

Dissolution of Lipid-Based Matrices in Simulated Gastrointestinal Solutions to Evaluate Their Potential for the Encapsulation of Bioactive Ingredients for Foods

The goal of the study was to compare the dissolution of chocolate to other lipid-based matrices suitable for the microencapsulation of bioactive ingredients in simulated gastrointestinal solutions. Particles having approximately 750 μm or 2.5 mm were prepared from the following lipid-based matrices: cocoa butter, fractionated palm kernel oil (FPKO), chocolate, beeswax, carnauba wax, and paraffin. They were added to solutions designed to simulate gastric secretions (GS) or duodenum secretions (DS) at 37°C. Paraffin, carnauba wax, and bees wax did not dissolve in either the GS or DS media. Cocoa butter, FPKO, and chocolate dissolved in the DS medium. Cocoa butter, and to a lesser extent chocolate, also dissolved in the GS medium. With chocolate, dissolution was twice as fast as that with small particles (750 μm) as compared to the larger (2.5 mm) ones. With 750 μm particle sizes, 90% dissolution of chocolate beads was attained after only 60 minutes in the DS medium, while it took 120 minutes for 70% of FPKO beads to dissolve in the same conditions. The data are discussed from the perspective of controlled release in the gastrointestinal tract of encapsulated ingredients (minerals, oils, probiotic bacteria, enzymes, vitamins, and peptides) used in the development of functional foods.