The role of adjuvant probiotics to attenuate intestinal inflammatory responses due to cancer treatments

Abstract

Chemotherapy and radiotherapy treatment regimens for gastrointestinal, peritoneal and pelvic tumours can disrupt the intestinal microbiome and intestinal epithelia. Such disturbances can provoke symptoms such as diarrhoea, nausea and vomiting. Chemotherapy and radiotherapy induced gastrointestinal toxicity aggravating intestinal microbiome dysbiosis is postulated to adversely alter the intestinal microbiome, with a consequent induced pro-inflammatory effect that disrupts the intestinal microbiome-epithelia-mucosal immunity axis. Although not widely recognised, the intestinal mucosa is the largest and most densely and dynamically populated immune-environment. Cancer treatment adverse effects that affect intestinal and mucosal cells inadvertently target and disrupt resident intestinal macrophages, the cells that marshal immune activity in the intestinal mucosa by shaping pro-inflammatory and anti-inflammatory activities to control and eradicate infectious insults and maintain local homeostasis. Pathobionts (bacteria capable of pathogenic pro-inflammatory activity) and noxious environmental and bacterial antigens use the intestinal epithelia and gap junctions as a point of entry into the systemic circulation. This translocation movement promotes toxic sequelae that obstruct intestinal macrophage functions resulting in uncontrolled local and systemic pro-inflammatory activity, loss of phagocytic function and loss of expression of tight junction proteins. Probiotic bacteria as an adjunctive treatment shows efficacy in ameliorating enteropathies such as mucositis/diarrhoea resulting from chemotherapy or radiotherapy regimens. As such we posit that an important benefit that warrants a further focused research effort is the administration of adjuvant probiotics to help reduce the incidence of febrile neutropenia.

Dietary restriction increases protective gut bacteria to rescue lethal methotrexate-induced intestinal toxicity

“…53 Multiple studies have proved that the application of probiotics can attenuate abnormalities of inflammatory cells induced by chemotherapies. 34,54,55 In line with that, our study revealed that DR attenuated the infiltration of CD11b + cells. It is possible that DR-mediated modulation of gut microbiota ameliorates changes in inflammatory cells upon MTX treatment, which requires further future investigation.…”

Microbial-Based Therapies in the Treatment of Inflammatory Bowel Disease – An Overview of Human Studies

“…Although not mandatory, studies should also evaluate the adverse effects and drug interactions of probiotics since they have been used as adjuvant therapy in various diseases (Thomsen et al, 2018). For instance, the probiotic E. coli strain Nissle 1917 influences the pharmacokinetics of concomitantly taken antiarrhythmic drug amiodarone by increasing the drug bioavailability (Matuskova et al, 2014).…”

The Effects of Ionizing Radiation on Gut Microbiota, a Systematic Review

“…Of these, 2854 were excluded based on title and abstract (415 were conference abstracts, 2 were book chapters, 48 were reviews, 2 were commentaries, 2 were articles in different languages unreadable by authors, 1 was a case report, and 2384 were not focused on gut microbiota and/or ionizing radiation). Full texts of the remaining 77 studies were carefully assessed, and further 66 were excluded (31 concerned animal studies, 25 did not report the effect of ionizing radiation in microbiota [ 30 , 31 , 32 ], 5 were reviews [ 33 ], 4 were commentaries [ 34 ], 1 was in a different language unreadable by authors [ 35 ], and the authors could not access to the full text of 1 article). Thus, finally, a total of 11 studies were included in this review.…”