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PROBIOTICS IN HEALTH & DISEASE

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• What are Probiotics?

• Potential Mechanisms of Action

• Therapeutic Targets of Probiotics

• Strain Specificity

• Quality Control

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PROBIOTICS

“Live microorganisms which when administered in adequate amounts confer a health benefit on the host”

Probiotic microorganisms can be found in both supplement form and as components of foods and beverages.

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TYPES OF PROBIOTIC

• Lactobacillus - Most available are species are,

- L.acidophilus - L.casei - L.reuterii - L.rhamnosus - L.bulgaricus - L.plantarum Bifidobacteria - Most available are species are,

- B.infantis - B.longum - B.bifidum - B.lactis• Saccharomyces boulardii – Widely studied probiotic yeast• Saccharomyces cerevisiae- Most used probiotic strain for varied

applications

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MECHANISM OF ACTION

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THERAPEUTIC TARGETS OF PROBIOTICS

Gut Function

Acute Diarrhea AAD, Travelers diarrhea C. difficile Inf Lactose IndigestionIBS symptoms Gut pain sensationInflammatory bowel

Oral CareDental caries

ColdsRespiratory Infections

Skin Microbiology, Inflammation

Metabolic SyndromeObesity, Diabetes

AllergyAtopic dermatitisAsthma

Vaginal Infection

S. boulardii Is Effective in Patients with Recurrent C. difficile Disease

CDD=Clostridium difficile-associated diseaseMcFarland L, et al. JAMA. 1994;271:1913-1918.

Initial CDD

CD

D r

ecu

rren

ce,

%

S. boulardii(n=31)

Placebo(n=33)

P=NS

Recurrent CDD

Control(n=34)

P=0.04

Patients received standard antibiotics (vancomycin or metronidazole) and S. boulardii 1 g/day or placebo for 4 weeks.

CD

D r

ecu

rren

ce,

% S. boulardii

(n=26)

Mixtures included: Lactinex = L. acidophilus and L. bulgaricus; Lactobacillus acidophilus and Bifidobacterium lactis; Lactobacillus acidophilus and Bifidobacterium infantis.

McFarland, Am J Gastroenterol 2006; 101(4): 812-822.

PROBIOTICS FOR PREVENTION OF ANTIBIOTIC ASSOCIATED DIARRHEA

Probiotics are live active cultures

More is not better

Dose (1 billion vs 10 billion vs 450 billion)Number of strains

The effect of probiotics is genus specific

MISCONCEPTIONS ABOUT PROBIOTICS

DOSAGE & STRAINS OF PROBIOTICS

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• The dose of probiotics is usually expressed as the number of colony forming units (CFUs)

• The required dose of probiotics may vary greatly for different strains and the specific health effect under investigation

• Probiotic effects should be considered dose-specific

• Dose listed on the label must be based on studies that show a health effect in humans

• Different strains of the same species can be different

• Clinical support to substantiate claims must be for each probiotic strain

PROBIOTICS -QUALITY CONTROL

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• Source (Animal vs Human; Normal vs Diseased)

• Safety (in at risk populations)

• Characterization (strain purity)

• Viability (Cfu Delivered)

• Dose (Dose-response studies)

• Combinations/cocktails (Different effects of different Bacterial,yeast

strains)

AWARENESS OF PROBIOTICS

PROBIOTICS IN THE CURRENT MARKET PLACE

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ADVANTAGES OF YEAST PROBIOTIC COMPARE TO BACTERIAL PROBIOTICS

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Probiotic Characteristics Yeast

ProbioticBacterial Probiotic

Unique Advantage

Viable at a lower pH to survive gastric digestion

Yes Limited

Resistance to Antibiotics Yes No

Reaches colon in an active state Yes Limited

SafetyDoes not lead to permanent intestinal colonization

Yes Yes

Appropriate for ages 2 months and up Yes Limited

Toxin neutralization

Neutralization of Enterotoxin Yes No

Temperature stability

Required Refrigeration No Yes

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