VSL#3 Probiotic Mixture

Abstract

VSL#3 (VSL#3) is a high-concentration probiotic preparation of eight live freeze-dried bacterial species that are normal components of the human gastrointestinal microflora, including four strains of lactobacilli (Lactobacillus casei, L. plantarum, L. acidophilus and L. delbrueckii subsp. bulgaricus), three strains of bifidobacteria (Bifidobacterium longum, B. breve and B. infantis) and Streptococcus salivarius subsp. thermophilus. Data from noncomparative trials suggest that VSL#3 has clinical potential in the treatment of active mild to moderate ulcerative colitis and as maintenance therapy for patients with ulcerative colitis in remission. In addition, a randomised, open-label, multicentre trial showed that VSL#3 in combination with low-dose balsalazide (a prodrug of mesalazine [mesalamine; 5-aminosalicylic acid]) was more effective than standard doses of basalazide or mesalazine monotherapy in the treatment of acute mild to moderate ulcerative colitis. Randomised, double-blind, placebo-controlled studies have shown VSL#3 is effective in preventing the onset of acute pouchitis in patients with newly formed surgical pouches, and in maintaining remission following antibacterial treatment of acute pouchitis in patients with a history of refractory or recurrent pouchitis. Treatment guidelines from the US and the UK include VSL#3 as a therapeutic option for the prevention of pouchitis relapse in patients with chronic pouchitis. In general, VSL#3 was well tolerated in clinical trials. Large, well designed, controlled confirmatory clinical trials will further determine the place of VSL#3 in the treatment of ulcerative colitis.

Post-Translational Inhibition of IP-10 Secretion in IEC by Probiotic Bacteria: Impact on Chronic Inflammation

“…Apart from that, one could raise the hypothesis that probiotic therapy is generally less effective in the ileum than in the colon due to high luminal content passage rates in this intestinal segment. The failure of VSL#3 in the context of ileitis together with the observed reduction of cecal inflammation in IL-10 −/− mice is consistent with clinical data showing effective probiotic treatment mostly in the context of UC [9] and pouchitis patients [51]. The finding that VSL#3 has protective effects on cecal but not on colonic inflammation clearly reveals intestinal segment specific effects of the probiotic mixture.…”

Potential role of nutraceutical compounds in inflammatory bowel disease

“…A third study with S. boulardii showed a reduction in the intestinal permeability in the probiotic group, however some concerns arose due to wide variability of intestinal permeability in CD patients and lack of correlation with CD activity index (CDAI) or endoscopic remission[23]. The largest probiotic trials in UC assessed the role of VSL#3, a multibacterial culture for oral use, consisting of the following species of bacteria: B. breve , B. longum , B. infantis , L. acidophilus , L. plantarum , L. paracasei , L. bulgaricus , and S. thermophiles [24]. An Indian multicenter trial showed a 42.9% of VSL#3 patients remission, compared with 15.7% of placebo patients[25], as well as an Italian 8 wk study which showed that VSL#3 was significantly superior to placebo in reducing the disease activity of mild-to-moderate UC.…”

Host-probiotic interaction: new insight into the role of the endocannabinoid system by in vivo and ex vivo approaches

“…Data from several trials (reviewed by Chapman et al . 13 ) suggested that VSL#3 has clinical potential in the treatment of many gut inflammatory diseases, but the mechanisms by which it exerts its beneficial role are not fully elucidated.…”

“…The probiotic formulation selected for this study was VSL#3 containing 450 billion of a mixture of Lactobacilli , Bifidobacteria , and Streptococcus thermophilus (commercialized in EU as Vivomixx® and in USA as Visbiome®). This probiotic mixture was selected for this study because of its recognized clinical potential in the treatment of several gastrointestinal inflammatory diseases 13–15 . Although the mechanism of action of VSL#3 is not fully understood several studies performed on animal models have shown that VSL#3 modulates the host immune response.…”