Use of probiotics to correct dysbiosis of normal microbiota following disease or disruptive events: a systematic review

Abstract

ObjectiveTo assess the evidence for the claim probiotics can correct dysbiosis of the normal microbiota resulting from disease or disruptive events.SettingSystematic review of published clinical trials of patients receiving a probiotic intervention for the prevention or treatment of various diseases.Data sourcesSources searched (1985–2013): PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL, AMED and ISI Web of Science. Three on-line clinical trial registries were searched: Cochrane Central Register of Controlled trials, MetaRegister of Controlled Trials and National Institutes of Health.Review methodsIncluded studies were randomised clinical trials of probiotic interventions having microbiological assays. Studies were evaluated following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for specific probiotic strains. A standard data extraction form was used to collect the raw data.Outcome measuresThe primary outcome is the degree of microbiota correction by specific probiotic strains. Secondary outcome was the association between the degree of dysbiosis correction and clinical efficacy.ResultsThe review of the literature found three distinct study designs: model A (restoration) assayed patients enrolled with a healthy, undisturbed microbiota and then assayed postdisruptive event and probiotic therapy; model B (alteration) assayed patients with pre-existing disrupted microbiota and then postprobiotic therapy; model C (no dysbiosis) assayed volunteers with no disruptive event prebiotic and postprobiotic. From a total of 63 trials, 83% of the probiotic products using model A restored the microbiota, 56% using model B improved the microbiota and only 21% using model C had any effect on microbiota. Clinical efficacy was more commonly associated with strains capable of restoration of the normal microbiota.ConclusionsThe ability to assess the degree of dysbiosis improvement is dependent on the enrolled population and the timing of microbiological assays. The functional claim for correcting dysbiosis is poorly supported for most probiotic strains and requires further research.Trial registration numberPROSPERO (CRD42014007224).

How the microbiota shapes rheumatic diseases

“…A systematic review of the data available on the use of probiotics in a clinical context showed that the probiotics with the greatest ability to restore the microbiota have the strongest clinical efficacy 174 . As the gut microbiota is a complex network of species interacting with the host, such a restoration could be accomplished by acting on single or multiple nodes of the network, at a compositional and/or at a functional level 175 .…”

Current evidence on the use of probiotics in liver diseases

“…Moreover, probiotics are used as adjuvant treatment for many diseases that affect the GI tract, such as diarrhea, inflammatory bowel disease (IBD), cancer, Helicobacter pylori infection, vaginosis, allergy, and lactose intolerance (Hill et al, 2014;McFarland, 2014;Narbona Lopez et al, 2014;Williams, 2010). The mechanisms through which probiotic bacteria alter the progression of liver diseases are thought to relate to modifications in the composition of the natural intestinal microbiota and its activity.…”

Emerging Technologies for Gut Microbiome Research

“…Likewise, it is accepted that probiotic s generally have a short-term beneficial effect on the gut microbiota [88, 89], promoting growth of other beneficial microbes, and facilitating host immune response. Members of the lactic acid bacteria (LAB) group including several species of lactobacilli are commonly regarded as probiotics.…”

“…L. rhamnosus also has an effect on host gene expression and immune response, activating nuclear factor-κB (NF-κB), protein kinase C, and phosphoinositide 3-kinase (PI3K) pathways [91, 92]. Probiotics including species of Bifidobacterium, Lactobacillus, and Saccharomyces are regularly administered as interventions to correct dysbioses caused by disease, chemotherapy or other drug treatments [89]. By understanding the molecular mechanisms by which probiotic microbes modulate the gut microbiota through a combination of NGS and microbiology approaches, it becomes possible to develop tailored microbial interventions to treat or prevent specific chronic and acute gastrointestinal diseases.…”