From Bible to bedside medicine: Designer probiotics

Some of the biggest news from the American College of Gastroenterology (ACS) annual meeting was 4000 years old. Science may be just unlocking the secrets of probiotics, but man first discovered these microorganisms in biblical times. The Talmud says that Abraham drank “sour milk” every day, most likely a form of yogurt, possibly contributing to his living many years. And about a hundred years ago, a Russian Nobel Prize winner microbiologist formulated his scientific concept, focusing on Lactobacilli. By 1935, they had perfected a strain of Lactobacillus casei that could resist stomach acid and bile and then pass into, and colonize, the intestines.

According to the WHO, probiotics are live microorganisms that when administered in adequate amounts confer a health benefit on the host.

At an ACG symposium, speakers discussed the focus of current probiotic science, which involves biochemical, genetic, and physiologic techniques.

A consultant to the probiotics and food supplement industries said that not all live cultures are probiotics, and each must be evaluated for its health effects. Target sites for probiotics range from the mouth to the stomach, duodenum, jejunum, ileum, and colon. They may help prevent dental caries, have anti-inflammatory effects in the colon, be antidiarrheic, and help regulate vaginal microflora. These microorganisms can have benefits at any colonized areas of the body and probably systemic effects as well. Effects are dose- and strain-specific, so no one probiotic would do all of these things.

There is good evidence for use of probiotics for:

• Infectious diarrhea in children

• Antibiotic-associated diarrhea

• Pouchitis

And more evidence is emerging about potential benefits in relation to:

• Colic

• Traveler’s diarrhea

• Cancer

• Allergy symptoms

• Duration of colds/respiratory infections.

For example, the probiotic Lactobacillus fermentum CECT5716 has been found to improve the immune system by increasing flu vaccine efficacy. In this study, compared with placebo, the group taking this strain for 28 days (plus vaccine on day 14) had a significant increase in helper T cell type 1 cytokines, and higher antigen-specific immunoglobulin A levels.

In another study of 262 adults, fewer patients taking Lactobacillus reuteri protectis missed work because of illness versus controls (11% vs. 26%).

The medical doctor of the University of Chicago said that giving probiotics to people who are taking antibiotics would cost about $100 to $130 for each case of diarrhea prevented, including cases of Clostridium difficile-associated diarrhea.

President of the World Gastroenterology Organization, and president-elect of the American College of Gastroenterology, told that the field of probiotics is now beyond the threshold in terms of a major breakthrough.

He noted that the old displacement theory of good bugs forcing out the bad ones has gone by the wayside, and current research is focusing on bacteria-host interactions, looking at dendritic antigen-presenting cells and the host’s ability to sense whether flora is friend or foe.

Probiotic research has implications for clinical diagnosis of several diseases by testing the flora, sampling the intestinal mucosa, and measuring the systemic immune response to see if the host-flora interaction is appropriate or disturbed. Therapeutic efficacy depends on the ability to modulate disturbed flora or the immune response with probiotics. “Will we see designer probiotics designed for specific diseases?” The answer is absolutely.

He suggested that one of the best things about probiotics is their safety. Even in patients with active inflammatory bowel disease, probiotic treatment for up to 1 year has had no ill effects. And if anyone would have a leaky gut, it is these patients.

He warned that quality control is still lacking, in terms of shelf life and number and type of organisms. Some of them working on this area and this may surprise them to hear this would welcome more regulation. But they observed that judging by this year’s ACG meeting, the fields of gastroenterology shows much greater enthusiasm for probiotics than in the past and more acceptance of this area as for medicine in the future.

Probiotics are commercially available as supplements, foods, and medical foods. Eventually, pharmaceutical probiotics may be developed for specific conditions. It now recommends that probiotic labels contain the following information:

• The probiotic used — genus, species, and strain

• The levels present at the end of the product’s shelf life

• Truthful statements about nutritional support, based on human studies.