Effect of synbiotic supplementation on matrix metalloproteinase enzymes, quality of life and dietary intake and weight changes in rectal cancer patients undergoing neoadjuvant chemoradiotherapy

Abstract

BACKGROUND: Probiotic/synbiotic has the important role of in altering intestinal bacteria, reducing inflammation and improvement of intestinal diseases. OBJECTIVE: We aimed to investigate the effect of synbiotic supplementation on matrix metalloproteinase (MMP) enzymes, hs-CRP, quality of life, dietary intake and weight changes in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (CRT). METHODS: In this study, 46 rectal cancer patients were recruited. Patients were allocated to the synbiotic (n = 23) group or placebo groups (n = 23) receiving 2 synbiotic or placebo capsules for six weeks. Anthropometric measurements, quality of life, dietary intakes, and serum levels of MMP-2, MMP-9, and hs-CRP were compared before and after intervention with the use of statistical tests. RESULTS: The mean energy, carbohydrate, and protein intake of patients increased in the synbiotic group, while in the placebo group, post intervention, significant reduction was noticed in these parameters (P < 0.05). Synbiotic supplementation caused improvement in global health status, symptom scale scores and scores of functional scale. At the end of intervention, the elevation in hs-CRP, MMP-2, and MMP-9 levels in the placebo group was approximately two and four times higher than the synbiotic group respectively. CONCLUSION: According to our results, synbiotic supplementation may be helpful in cancer patients undergoing CRT. However, further studies must consider synbiotic as a new complementary treatment.

Oral Administration of Probiotics Reduces Chemotherapy-Induced Diarrhea and Oral Mucositis: A Systematic Review and Meta-Analysis

“…Following the above inclusion and exclusion criteria, 507 articles (ongoing studies, unexpectedly terminated trials, noncancer patients, not oral probiotic use, in vitro studies, nonchemotherapy studies, and reviews) and 38 duplicate articles were removed after carefully reading their titles and abstract, leaving only 51 articles. After reading the remaining articles, 39 additional studies were further excluded because of that 12 studies did not include cancer patients or they were not receiving chemotherapy (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), two did not include oral probiotic use (38,39), 20 had no record of diarrhea or oral mucositis in patients (40-59) (18 of them did not include diarrhea or oral mucositis indicators (40)(41)(42)(43)(44)(45)(46)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), and the other two studies only recorded the frequency of diarrhea or oral mucositis rather than the number of patients who had the adverse reactions (47, 48)), and five were not randomized controlled trials (60)(61)(62)(63)(64). Finally, 12 articles were selected for the meta-analysis.…”

The impact of pre-, pro- and synbiotics supplementation in colorectal cancer treatment: a systematic review

“…The year of publication ranged from 2007 to 2023, where approximately 70% of the studies were published in the last 10 years. In terms of geographic localization the included studies are from China (n=6) ( 34 – 39 ), Turkey (n=2) ( 40 , 41 ), Slovenia (n=2) ( 42 , 43 ), Japan (n=2) ( 44 , 45 ), Greece (n=2) ( 46 , 47 ), Brazil (n=2) ( 48 , 49 ), Iran (n=2) ( 50 , 51 ), Malaysia (n=1) ( 52 ), Finland (n=1) ( 53 ), Sweden (n=1) ( 54 ), Slovakia (n=1) ( 55 ), Republic of Korea (n=1) ( 56 ) and Bosnia and Herzegovina (n=1) ( 57 ). There were a total of 2204 participants, 1139 in the intervention groups and 1065 in the control groups.…”

“…Species of the Lactobacillus, Bifidobacterium and Enterococcus genera were the most commonly used for the probiotics or synbiotics intervention. Placebo was used for the control group in 18 of the studies ( 34 – 42 , 46 – 50 , 52 , 54 – 56 ) while the other 6 used standard care treatment ( 43 – 45 , 51 , 53 , 57 ). Characterization of these studies is shown in Table 2 .…”

“…Out of the 24 included studies, 17 evaluated the impact of probiotics or synbiotics supplementation in colorectal cancer surgery ( 34 – 38 , 42 – 49 , 52 , 54 , 56 , 57 ) while the remaining 7 studied the impact on treatment with chemotherapy ( 39 – 41 , 50 , 51 , 53 , 55 ). One study selected patients undergoing chemoradiotherapy so outcomes on the impact of this approach in treatment with radiotherapy was also assessed ( 50 ). None of the studies evaluated the impact of probiotics or synbiotics supplementation in CRC patients undergoing immunotherapy.…”

Synbiotics as Supplemental Therapy for the Alleviation of Chemotherapy-Associated Symptoms in Patients with Solid Tumours

“…In 2020, another clinical study demonstrated the effect of synbiotic supplementation on colorectal cancer patients ( n = 46) undergoing chemotherapy. The study reported a slight decrease in the mean symptom score for diarrhoea in the synbiotic group when compared to the placebo group where it increased significantly [ 134 ]. More recently, a randomised clinical trial found that the administration of synbiotics prevented bacteremia and reduced gastrointestinal toxicities, including diarrhoea in oesophageal cancer patients ( n = 42), for those receiving chemotherapy [ 135 ].…”