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Table of Contents
Vol. 27, No. 3, 2009
Issue release date: September 2009
Dig Dis 2009;27:412–417
(DOI:10.1159/000228582)

Prebiotics, Probiotics and Helminths: The ‘Natural’ Solution?

Guarner F.
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Abstract

Background: The pathophysiological mechanisms that generate chronic inflammatory lesions in inflammatory bowel disease (IBD) have, at least in part, been unveiled. Abnormal communication between gut microbial communities and the mucosal immune system is being incriminated as the core defect leading to intestinal injury in genetically susceptible individuals. The therapeutic manipulation of gut microecology has attracted high expectation as a strategic area for the control and prevention of IBD. Method: Literature review. Results: The gut is the major site for induction of regulatory T cells, which secrete immunoregulatory cytokines such as IL-10 and TGF-β and can regulate both Th1 and Th2 responses. Recent findings suggest that some gut commensals, including lactobacilli, bifidobacteria and helminths, play a major role in the induction of regulatory T cells in gut lymphoid follicles. Such T cell-mediated regulatory pathways are essential homeostatic mechanisms by which the host can tolerate the massive burden of innocuous antigens within the gut without responding through inflammation. In clinical practice, the evidence for the use of probiotics or prebiotics is strongest in the case of pouchitis. In addition, one probiotic strain appears to be equivalent to mesalazine in maintaining remission of ulcerative colitis. However, studies of probiotics in Crohn’s disease have been disappointing. Conclusions: Further research is needed to optimize the use of probiotics, prebiotics or helminths for these indications.



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References

  1. O’Hara AM, Shanahan F: Gut microbiota: mining for therapeutic potential. Clin Gastroenterol Hepatol 2007;5:274–284.
  2. Strober W, Fuss I, Mannon P: The fundamental basis of inflammatory bowel disease. J Clin Invest 2007;117:514–521.
  3. D’Haens GR, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P: Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 1998;114:262–267.
  4. Casellas F, Borruel N, Papo M, Guarner F, Antolín M, Videla S, Malagelada JR: Antiinflammatory effects of enterically coated amoxicillin-clavulanic acid in active ulcerative colitis. Inflamm Bowel Dis 1998;4:1–5.
  5. García-Lafuente A, Antolín M, Guarner F, Crespo E, Salas A, Forcada P, Laguarda M, Gavaldá J, Baena JA, Vilaseca J, Malagelada JR: Incrimination of anaerobic bacteria in the induction of experimental colitis. Am J Physiol 1997;272:G10–G15

    External Resources

  6. Borruel N, Casellas F, Antolín M, Carol M, Llopis M, Espín E, Naval J, Guarner F, Malagelada JR: Effects of nonpathogenic bacteria on cytokine secretion by human intestinal mucosa. Am J Gastroenterol 2003;98:865–870.
  7. O’Hara AM, O’Regan P, Fanning A, O’Mahony C, Macsharry J, Lyons A, Bienenstock J, O’Mahony L, Shanahan F: Functional modulation of human intestinal epithelial cell responses by Bifidobacterium infantis and Lactobacillus salivarius. Immunology 2006;118:202–215.
  8. Guarner F, Malagelada JR: Gut flora in health and disease. Lancet 2003;361:512–519.
  9. Suau A, Bonnet R, Sutren M, Godon JJ, Gibson G, Collins MD, Dore J: Direct analysis of genes encoding 16S rRNA from complex communities reveals many novel molecular species within the human gut. Appl Environ Microbiol 1999;65:4799–4807.
  10. Eckburg PB, Bik EM, Bernstein CN, Purdom E, Dethlefsen L, Sargent M, Gill SR, Nelson KE, Relman DA: Diversity of the human intestinal microbial flora. Science 2005;308:1635–1638.
  11. Zoetendal E, Akkermans A, Akkermans-van Vliet W, Visser J, de Vos W: The host genotype affects the bacterial community in the human gastrointestinal tract. Microb Ecol Health Dis 2001;13:129–134.

    External Resources

  12. Zoetendal EG, von Wright A, Vilpponen-Salmela T, Ben-Amor K, Akkermans AD, de Vos WM: Mucosa-associated bacteria in the human gastrointestinal tract are uniformly distributed along the colon and differ from the community recovered from feces. Appl Environ Microbiol 2002;68:3401–3407.
  13. Bouskra D, Brézillon C, Bérard M, Werts C, Varona R, Boneca IG, Eberl G: Lymphoid tissue genesis induced by commensals through NOD1 regulates intestinal homeostasis. Nature 2008;456:507–510.
  14. Guarner F, Bourdet-Sicard R, Brandtzaeg P, Gill HS, McGuirk P, van Eden W, Versalovic J, Weinstock JV, Rook GA: Mechanisms of disease: the hygiene hypothesis revisited. Nat Clin Pract Gastroenterol Hepatol 2006;3:275–284.
  15. Guarner F: The intestinal flora in inflammatory bowel disease: normal or abnormal? Curr Opin Gastroenterol 2005;21:414–418.
  16. Ott SJ, Musfeldt M, Wenderoth DF, Hampe J, Brant O, Folsch UR, Timmis KN, Schreiber S: Reduction in diversity of the colonic mucosa associated bacterial microflora in patients with active inflammatory bowel disease. Gut 2004;53:685–693.
  17. Manichanh C, Rigottier-Gois L, Bonnaud E, Gloux K, Pelletier E, Frangeul L, Nalin R, Jarrin C, Chardon P, Marteau P, Roca J, Dore J: Reduced diversity of faecal microbiota in Crohn’s disease revealed by a metagenomic approach. Gut 2006;55:205–211.
  18. Martinez C, Antolin M, Santos J, Torrejon A, Casellas F, Borruel N, Guarner F, Malagelada JR: Unstable composition of the fecal microbiota in ulcerative colitis during clinical remission. Am J Gastroenterol 2008;103:643–648.
  19. Macfarlane S, Macfarlane GT, Cummings JH: Review article: prebiotics in the gastrointestinal tract. Aliment Pharmacol Ther 2006;24:701–714.
  20. Videla S, Vilaseca J, Antolín M, García-Lafuente A, Guarner F, Crespo E, Casalots J, Salas A, Malagelada JR: Dietary inulin improves distal colitis induced by dextran sodium sulfate in the rat. Am J Gastroenterol 2001;96:1486–1493.
  21. Osman N, Adawi D, Molin G, Ahrne S, Berggren A, Jeppsson B: Bifidobacterium infantis strains with and without a combination of oligofructose and inulin (OFI) attenuate inflammation in DSS-induced colitis in rats. BMC Gastroenterol 2006;6:31.
  22. Cherbut C, Michel C, Lecannu G: The prebiotic characteristics of fructooligosaccharides are necessary for reduction of TNBS-induced colitis in rats. J Nutr 2003;133:21–27.
  23. Schultz M, Munro K, Tannock GW, Melchner I, Gottl C, Schwietz H, Scholmerich J, Rath HC: Effects of feeding a probiotic preparation (SIM) containing inulin on the severity of colitis and on the composition of the intestinal microflora in HLA-B27 transgenic rats. Clin Diagn Lab Immunol 2004;11:581–587.
  24. Hoentjen F, Welling GW, Harmsen HJM, Zhang XY, Snart J, Tannock GW, Lien K, Churchill TA, Lupicki M, Dieleman LA: Reduction of colitis by prebiotics in HLA-B27 transgenic rats is associated with microflora changes and immunomodulation. Inflamm Bowel Dis 2005;11:977–985.
  25. Rumi G, Tsubouchi R, Okayama M, Kato S, Mozsik G, Takeuchi K: Protective effect of lactulose on dextran sulphate sodium-induced colonic inflammation in rats. Dig Dis Sci 2004;49:1466–1472.
  26. Camuesco D, Peran L, Comalada M, Nieto A, Di Stasi LC, Rodriguez-Cabezas ME, Concha A, Zarzuelo A, Galvez J: Preventative effects of lactulose in the trinitrobenzenesulphonic acid model of rat colitis. Inflamm Bowel Dis 2005;11:265–271.
  27. Welters CFM, Heineman E, Thunnissen BJM, van den Bogaard AEJM, Soeters PB, Baeten CGMI: Effect of dietary inulin supplementation on inflammation of pouch mucosa in patients with an ileal pouch-anal anastomosis. Dis Colon Rectum 2002;45:621–627.
  28. Furrie E, Macfarlane S, Kennedy A, Cummings JH, Walsh SV, O’Neil DA, Macfarlane GT: Synbiotic therapy (Bifidobacterium longum/Synergy 1) initiates resolution of inflammation in patients with active ulcerative colitis: a randomized controlled pilot trial. Gut 2005;54:242–249.
  29. Casellas F, Borruel N, Torrejon A, Varela E, Antolin M, Guarner F, Malagelada JR: Oral oligofructose-enriched inulin supplementation in acute ulcerative colitis is well tolerated and associated with lowered faecal calprotectin. Aliment Pharmacol Ther 2007;25:1061–1067.
  30. Lindsay JO, Whelan K, Stagg AJ, Gobin P, Al-Hassi HO, Rayment N, Kamm MA, Knight SC, Forbes A: Clinical, microbiological, and immunological effects of fructo-oligosaccharide in patients with Crohn’s disease. Gut 2006;55:348–355.
  31. Sartor RB: Probiotic therapy of intestinal inflammation and infections. Curr Opin Gastroenterol 2005;21:44–50.
  32. Isaacs K, Herfarth H: Role of probiotic therapy in IBD. Inflamm Bowel Dis 2008;14:1597–1605.
  33. World Gastroenterology Organisation Practice Guideline: Probiotics and prebiotics. http://www.worldgastroenterology.org/probiotics-prebiotics.html.
  34. Weinstock JV, Elliott DE: Helminths and the IBD hygiene hypothesis. Inflamm Bowel Dis 2009;15:128–133.


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