Lung-Directed Bacteriotherapy in Cystic Fibrosis: Could It Be an Option?

Abstract

Due to the alarming spread of bacterial resistance to conventional drugs, the sole use of antibiotics to fight lung infections in cystic fibrosis (CF) is not resolutive, and novel strategies to replace or complement the use of antibiotics are highly desirable. Among these strategies, the use of probiotics is emerging as a particularly attractive approach. Probiotic administration via the oral route has demonstrated an ability to improve lung function and to reduce infection and exacerbation rates in CF patients through mechanisms mainly attributable to the gut–lung axis. Nevertheless, some studies reported no beneficial effect of probiotic intake suggesting that there is margin for improvement of such innovative intervention in CF. The present review aims to address the rationale behind probiotic use in CF and discuss the hypothesis that nasal/aerosol administration of appropriate probiotic strains may help to exert a direct beneficial effect on the respiratory tract, increasing the effectiveness of probiotic interventions in CF patients.

Emerging Multiscale Biofabrication Approaches for Bacteriotherapy

“…The identification and implementation of alternative antimicrobial strategies that can replace or complement the use of antibiotics represent a widely recognized priority in the era of antimicrobial resistance. Hence, the identification of alternative therapeutic strategies that can replace or support the use of antibiotics has widely emerged as a priority in research [ 1 ]. Among different approaches, bacteriotherapy has emerged as an intriguing option.…”

“…Among different approaches, bacteriotherapy has emerged as an intriguing option. Bacteriotherapy relies on the use of harmless bacteria (e.g., probiotics) to compete with pathogens to displace them, suppress the expression of their virulence factors, and contrast the microbial ability to induce tissue injury and chronic inflammation [ 1 , 2 , 3 ]. The interest in bacteriotherapy to prevent or cure infectious diseases has recently been raised due to the rapid progression in molecular technologies.…”

“…There are pathologic conditions in which patients are constantly prone to develop infections, like cystic fibrosis (CF), or are not eligible or not responsive to antibiotic treatments, which could greatly benefit from innovative antimicrobial strategies to substitute or complement antibiotic use [ 15 ]. Probiotic administration to CF patients via the oral route was able to partially restore gut dysbiosis, reduce intestinal inflammation, and lower lung through mechanisms that could be related by some studies to the gut–lung axis [ 1 , 16 ]. Administering probiotics through the respiratory, i.e., via nasal spray or aerosol, instead of through the GI route represents an expectant approach.…”

“…Administering probiotics through the respiratory, i.e., via nasal spray or aerosol, instead of through the GI route represents an expectant approach. It is believed that probiotic efficacy could be enhanced by their direct delivery at the infectious site, where they would compete with pathogens for adhering to lung mucosa, interfere with pathogen growth and virulence, improve the integrity of the lung mucosal barrier, and provide an immune-modulatory response [ 1 ]. Such a strategy was successful in mice and is under evaluation in humans [ 17 , 18 , 19 , 20 ].…”

Probiotics Administration in Cystic Fibrosis: What Is the Evidence?

“…Even more important is the finding that CF patients themselves had dysbiosis and that this could explain at least in part not only the intestinal disorders but also the respiratory ones. The acquisition of previously unknown information about the importance of some bacteria, i.e., those partially or totally disappeared in the gut of CF patients, in the regulation of the activity and function of both the gut and the lung was the base to suggest the use of these microorganisms, the so-called probiotics, in CF patients [ 18 , 19 ]. Main aim of this paper is to discuss which are the biological basis for probiotic administration to CF patients and which results could be expected.…”