Effect of a Probiotic Preparation (VSL#3) on Induction and Maintenance of Remission in Children With Ulcerative Colitis

Miele, Erasmo; Pascarella, Filomena; Giannetti, Eleonora; Quaglietta, Lucia; Baldassano, Robert N.; Staiano, Annamaria

doi:10.1038/ajg.2008.118

Cited by 441 publications

(255 citation statements)

References 35 publications

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“…Evidence has shown that the administration of probiotics to patients suffering from IBD can restore the microbiota composition and induce beneficial effects (Ringel et al, 2012;Vanderpool et al, 2008). In patients suffering from UC, the clinical efficacy of probiotics was demonstrated by administration of VSL#3 that resulted in a remission in adult patients with active UC (Sood et al, 2009;Tursi et al, 2010) and in children (Miele et al, 2009). In addition, treatment with L. rhamnosus GG was effective in maintaining remission in patients suffering from UC (Zocco et al, 2006).…”

Section: Discussionmentioning

confidence: 98%

Specific probiotic dietary supplementation leads to different effects during remission and relapse in murine chronic colitis

Zheng

Bergenhenegouwen

Kant

et al. 2016

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Although interest in using probiotics to prevent and treat intestinal diseases is increasing, the effects of specific probiotic strains still remain unclear. Here, we assess the therapeutic effects of two probiotic strains, Lactobacillus rhamnosus NutRes 1 and Bifidobacterium breve NutRes 204 on a dextran sodium sulphate (DSS)-induced chronic murine colitis model. The chronic colitis was induced by two DSS treatment cycles with a rest period of 10 days (the remission or resolution phase). The probiotic supplementation was started during the resolution phase, after the first DSS treatment cycle, and continued until the end of the experiment. In addition to clinical observations made during the experiment, cellular infiltration was measured along with mRNA expression of pro-inflammatory cytokines, T cell-associated cytokines, and Toll like receptors (TLR) in the inflamed colon after second DSS treatment cycle. L. rhamnosus, but not B. breve, rapidly and effectively improved the DSS-induced bloody diarrhoea during the resolution phase. However, a contradictory effect by both probiotic strains on the faecal condition was found after re-induction of colitis. The worsening of the faecal condition was accompanied by a reduced number of neutrophils and increased expression of interferon-γ in the colons of DSS-treated mice. Furthermore, an increased expression of TLR2, TLR6 and pro-inflammatory markers including chemokine (C-C motif ) ligand 2, interleukin (IL)-1β, tumour necrosis factor α and IL-6 was found in DSS-treated mice with L. rhamnosus supplementation. These results indicate that therapeutic administration of specific probiotics might be beneficial during the resolution phase of colitis. However, caution should be taken as specific probiotic treatments reduce neutrophil influx, which may be the reason of exacerbation of chronic colitis.

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Section: Discussionmentioning

confidence: 98%

Specific probiotic dietary supplementation leads to different effects during remission and relapse in murine chronic colitis

Zheng

Bergenhenegouwen

Kant

et al. 2016

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“…Probiotics have shown more promise in the treatment of ulcerative colitis. Two preparations in particular, E. coli Nissle 1917 and VSL#3 (a combination of 8 different probiotic strains) have been shown to induce and maintain remission in mild to moderate disease (Kruis et al, 2004;Miele et al, 2009;Sood et al, 2009). Despite the lack of clinical evidence for efficacy of many probiotic strains, in a recent study, 40% of IBD patients regularly used non-prescribed probiotics, and use was more common in Crohn's disease patients than ulcerative colitis patients (Agathou and Beales, 2013).…”

Section: Introductionmentioning

confidence: 99%

Streptococcus thermophilus NCIMB 41856 ameliorates signs of colitis in an animal model of inflammatory bowel disease

Bailey

Vince²,

Williams³

et al. 2017

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Treatment of inflammatory bowel disease (IBD) is mainly based on suppression of symptoms, often with numerous side effects. Trials of probiotics in IBD have frequently produced disappointing results. The majority of probiotics are unusual, since they do not require iron for growth, unlike many bacteria resident in the intestine. The IBD intestine is iron-rich due to bleeding and use of oral iron supplements; conventional probiotics would be rapidly outcompeted. We have evaluated an iron-responsive Streptococcus thermophilus strain for its potential to reduce signs of colitis. Efficacy of S. thermophilus was evaluated in the dextran sodium sulphate mouse model of colitis. Treated animals were given 1×108 cfu S. thermophilus per day and clinical observations were taken daily. At termination, gross and histopathological signs of disease, cellular infiltration, location of bacteria, and cytokine expression in the intestine were determined. S. thermophilus delayed onset of colitis and reduced clinical signs of disease, including bodyweight loss and gastrointestinal bleeding. It reduced bacterial translocation into the colonic tissue. Increased numbers of CD8+ intraepithelial lymphocytes were seen in control animals treated with S. thermophilus. S. thermophilus had no effect on gross pathology, histopathology or cytokine production in either colitic or control animals. We propose that S. thermophilus promotes maintenance of mucosal barrier function which reduces bacterial translocation, thereby reducing immune stimulation and associated inflammation. This allows mucosal healing, reducing gastrointestinal bleeding and weight loss. This could be studied as a locally-acting adjunct or alternative to current IBD treatments.

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“…However, two recent meta-analyses that performed subgroup analyses per probiotic, indicated a significant benefit of VSL#3 over control in inducing remission in UC (relative risk 1·69 (95 % CI 1·17, 2·43) (46) and relative risk 1·74 (95 % CI 1·19, 2·55) (47) ). The trial conducted by Miele (34) also suggested a benefit for VSL#3 in maintaining remission in UC in children, whereas meta-analysis of three trials (41)(42)(43) suggested that VSL#3 significantly prevented relapse in patients with pouchitis (relative risk 0·18 (95 % CI 0·10, 0·34) (47) ). Lactobacillus rhamnosus GG was evaluated in a large randomised controlled trial including 187 patients with inactive UC.…”

Section: Proceedings Of the Nutrition Societymentioning

confidence: 99%

“…thermophilus). In several trials, the potential of VSL#3 was evaluated to induce remission in patients with active UC (31)(32)(33)(34)(35)(36)(37) , to maintain remission in patients with UC (34,38) , to maintain remission or prevent postoperative relapse in patients with CD (39,40) or to prevent or treat pouchitis (41)(42)(43)(44) . As the functional properties and benefits of probiotic strains are strain-dependent and cannot be extrapolated to other strains (45) , not even strains of the same genus, meta-analysis of trials using different probiotic products should be interpreted very cautiously.…”

Section: Proceedings Of the Nutrition Societymentioning

confidence: 99%

Modulating the microbiota in inflammatory bowel diseases: prebiotics, probiotics or faecal transplantation?

2014

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Crohn's disease (CD) and ulcerative colitis (UC) are the two major phenotypes of inflammatory bowel diseases (IBD) which constitute a spectrum of chronic, debilitating diseases characterised by a relapsing inflammation of the intestinal mucosal lining. Evidence from a variety of disciplines implicates the intestinal microbiota in the pathogenesis of idiopathic IBD and their complications, including pouchitis. Many studies have reported a dysbiosis in IBD, characterised by a decrease in diversity, a decreased abundance of some dominant commensal members (such as Clostridium IV and XIVa) and an increase in detrimental bacteria (such as sulphate reducing bacteria and Escherichia coli). Therapies such as prebiotics and probiotics aim to selectively manipulate the intestinal microbiota and have been evaluated as an attractive therapeutic option with few side effects. The multispecies product VSL#3 was found effective in preventing and maintaining remission in pouchitis, whereas both VSL#3 and E. coli Nissle were effective in maintaining remission in UC. A more drastic approach to restore the composition of the microbiota and correct the underlying imbalance is a faecal microbiota transplantation (FMT). FMT has been successfully applied to treat patients with even recalcitrant Clostridium difficile infection. Particularly in UC, the majority of studies suggest that FMT may be an effective treatment option although the evidence is still limited. It is anticipated that our increasing knowledge on the composition and function of the intestinal microbiota components will allow in the future for a better selection of highly performing bacteria with specific functions required for specific benefits.

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Effect of a Probiotic Preparation (VSL#3) on Induction and Maintenance of Remission in Children With Ulcerative Colitis

Abstract: This is the first pediatric, randomized, placebo-controlled trial that suggests the efficacy and safety of a highly concentrated mixture of probiotic bacterial strains (VSL#3) in active UC and demonstrates its role in maintenance of remission.

Cited by 441 publications

References 35 publications

Specific probiotic dietary supplementation leads to different effects during remission and relapse in murine chronic colitis

Specific probiotic dietary supplementation leads to different effects during remission and relapse in murine chronic colitis

Streptococcus thermophilus NCIMB 41856 ameliorates signs of colitis in an animal model of inflammatory bowel disease

Modulating the microbiota in inflammatory bowel diseases: prebiotics, probiotics or faecal transplantation?

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