- Email: [email protected]
Might patients with immune-related diseases benefit from probiotics?
Nutrition 29 (2013) 583–586
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
Editorial
Might patients with immune-related diseases benefit from probiotics?
Probiotics The Food and Agriculture Organization/World Health Organization (FAO/WHO) defines probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” [1]. Probiotics have been used for many years to support restoring and maintaining a healthy intestinal balance in favor of beneficial bacteria. Scientific attention to the health benefits of yogurt was commenced by Elie Metchnikoff in the beginning of 1900s. Lactic acid bacteria and bifidobacteria are the most common types of microbes used as probiotics, but certain yeasts and bacilli may also be classified as probiotics [2]. A main consideration in the selection of probiotics is to choose a strain that can stay alive and establish itself under the situation encountered in the intestinal environment [3,4]. The human intestinal microbiota, complex with total counts of 1011 to 1012 bacteria per gram of stool [4], is the largest source of microbial stimulation that exerts both harmful and helpful effects on human health [5]. The microbiota acquired during early life play an important role in the regulation and improvement of the host immune system [6,7]. Probiotics prevent colonization by pathogen bacteria through competition for nutrients, degradation of the toxin receptors in the mucosa membrane, production of inhibitory compounds, upregulation of gut mucin genes, and stimulating immune system [8,9].
Immune-related diseases The physiologic role of the immune response is protection against infectious microbes; however, even non-harmful foreign substances can stimulate the immune system [10]. The host defense system consists of a complex array of cells and molecules, which include innate and acquired mechanisms. The innate immune system mediates the initial protection against infections that are nonspecific to a given pathogen; the main mechanism of native immunity is phagocytosis. In contrast to innate immunity, the adaptive immune system shows a high level of specificity and memory. There are two key components of adaptive immunitydhumoral and cellular immunity [11]. Two extremities of the variety of immunerelated diseases are immune deficiency and immune hypersensitivity, which have been extensively studied in connection with probiotics. 0899-9007/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nut.2012.10.008
Disarrays caused by imperfection immunity are called immunodeficiency diseases. When defects in one or more mechanisms of the immune system occur as a result of genetic problems, they are called primary immunodeficiency. Other imperfection in the immune response may result from pollutions, diet, or microbes, which is called acquired immunodeficiency [10]. Acquired immunodeficiency syndrome (AIDS) is among the most important acquired diseases. AIDS is a human immunity disorder caused by the human immunodeficiency virus (HIV) [12]. At the beginning of infection with HIV, several million viruses may exist per milliliter of blood [13]. These viruses reduce numbers of circulating CD4þ T-cells; consequently, infections with a variety of opportunistic microbes result. This acute viremia is linked to almost all patients with the activation of CD8þ T-cells, which kill HIV-infected cells, therefore producing an antibody, or seroconversion. The symptoms of AIDS patients include weight loss, respiratory tract infections, prostatitis, and skin rashes. Diarrhea is a common complication in patients with HIV infection [14]. The adaptive immune reaction provides particular resistance against infection with microorganisms, but some immune responses increase excessively and unsuitably in response to the stimulations. This is usually called hypersensitivity. There are four important types of hypersensitivity. Type I, allergic reactions occur when a person’s immune system answers to normally benign substances in the environment and particular mediators are released. Type II hypersensitive reactions are mediated by antibodies binding to specific cells or tissues. In type III, immune complements are placed in the tissue causing local tissue damage and swelling; autoimmune disorders such as inflammatory bowel disease, rheumatoid arthritis, and type 1 diabetes mellitus are classified in this category. In type IV hypersensitive answers, T-cells effectors secrete lymphokines when encountering the same antigen for the second time which ends in inflammatory responses [10,15]. This review emphasizes the beneficial effects of probiotics on alleviating the symptoms of autoimmune diseases, allergies, and AIDS, as well as on enhancing the quality of patients’ lives.
Effect of probiotics on immune-related disease Numerous in vivo and in vitro investigations have shown that particular strains of probiotics are able to modulate the
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Editorial / Nutrition 29 (2013) 583–586
performance of the immune system, stimulate the immune function to defend against infectious disorders and cancers, and regulate overexpressed immune responses connected with immuno-inflammatory diseases, such as allergy and inflammatory bowel disease (IBD) [16]. Probiotic and AIDS HIV/AIDS is a prominent problem in the human race, which revolutionizes the human landscape in the world. Comparatively, a minority of patients obtains antiretroviral therapy, and acute diarrhea influences their quality of life dramatically. Use of probiotics improves immune response and feature of AIDS patients’ life [17]. Advantages of probiotic bacteria on the immune system have been confirmed in recent studies. L. plantarum 299v supplementation in HIV-positive children could shorten acute diarrhea [18]. 2.5 1010 CFU of the B. bifidum and S. thermophilus in formula showed an increase in the CD4þ count in children with HIV infections [19]. A study by Anukam et al. [20] reported rises in the mean CD4þ count in the AIDS female by L. rhamnosus and L. reuteri at a dose of 2.5 1012 CFU. A recent study in Mwanza (Tanzania) recommended that consuming yogurt supplemented with 1010 CFU of the probiotic strain L. rhamnosus may successfully improve gastrointestinal symptoms and alleviate tolerance to antiretroviral treatment [21]. Probiotic and autoimmune diseases There are two significant categories of autoimmune diseases: immune system attack to particular organs, such as the stomach, pancreas, adrenal, and thyroid, and non–organ-specific diseases, including the rheumatological disorders. Regulation of enteric flora composition by probiotics may alleviate the symptoms of some autoimmune disorders. Superlative studies have been performed to investigate the effect of probiotic supplementation in IBD, rheumatoid arthritis, and type 1 diabetes mellitus [15]. IBD comprises two discrete disorders: Crohn’s disease (CD) and ulcerative colitis (UC). Pouchitis is another disease that consequences from complex ileal pouch-anal anastomosis (IPAA) surgery for UC. Some studies showed the potential of probiotic supplementation in the debarment and/or treatment of various inflammatory bowel disorders [11,22]. Some strains of lactobacilli, bifidobacteria, and Streptococcus salivarius ssp. thermophilus (VSL #3) deferred the first onset of acute pouchitis and improved life quality of people with ileal pouch-anal anastomosis [23,24]. Supplementation with 1-2 1010 CFU L. rhamnosus GG for 3 mo changed the intestinal microbiota, but endoscopic or clinical response was not improved [25]. L. rhamnosus GG at the dose of 1.4 1010 CFU in the fermented food product delayed episodes of pouchitis [26]. A dose of 6 1011 CFU of (VSL #3) maintained antibiotic introduced remission [27]. The roles of beneficial microbes in active UC have also been reported in literature. The probiotic E. coli Nissle at a dose of 5–50 109 CFU was shown to have a clinical impact similar to that obtained by Mesalazine [28]. 1.8 1010 CFU of L. rhamnosus GG in the form of tablets seemed to be beneficial and harmless for maintaining remission in patients suffering from UC [29]. In people with moderate UC, using VSL # 3 supplementation was safe and effective in achieving clinical responses and remissions [30–32]. In a double-blind clinical study, the efficiency of rectal E. coli Nissle at the dose of 1–4 109 CFU was significant in per protocol analysis in moderate distal UC [33]. In pediatric patients with active distal UC, rectal infusion of L. reuteri in the form of
enema solution with 1010 CFU/d was effective in altering mucosal expression levels of some cytokines, which improved mucosal inflammation [34]. Decline in disease activity has been attained in children with CD by probiotic intervention [35]. One gram of the yeast Saccharomyces boulardii, when administered three times a day with Mesalamine in the form of a capsule, attained remission in CD patients [36]. L. rhamnosus GG supplementation was unable to reduce the risk of postoperative recurrence in CD [37–39]. Controlled studies of probiotics found no efficacy for L. johnsonii as maintenance therapies for CD [40,41]. Evidence has revealed that there is a correlation between the gastrointestinal flora and the development of rheumatoid arthritis. Using capsules containing 1010 CFU of L. rhamnosus GG did not show considerable difference in the activity of rheumatoid arthritis, although improvement in subjective well-being was reported [42]. Two mo of supplementation with 2 109 CFU Bacillus coagulans appeared to be safe and effective for patients with rheumatoid arthritis [43]. After 3 mo of consuming capsules containing 4 109 CFU of L. rhamnosus and L. reuteri, although no clinical improvement were observed, functional improvement was reported by rheumatoid arthritis patients [44]. Probiotic and allergy The incidence of allergic diseases is growing dramatically in both developing and industrialized countries. This increase is particularly problematic in children. Atopic dermatitis (AD), asthma, and allergic rhinitis represent the most common chronic diseases of this type [45]. Alteration of the intestinal microbiota or lack of beneficial microbes during childhood is the most important reason among the factors in the increased prevalence of allergic diseases [46]. Beneficial bacteria were shown to competently down-regulate inflammation related with hypersensitivity responses in patients with atopic eczema and food allergy [47,48]. The application of 5 109 CFU/d of the probiotic strains L. rhamnosus and L. reuteri significantly altered the production of the cytokines IL-2, IL-4, IL-10, or IFN-g, thereupon they improved clinical symptoms in children with AD [49]. In another study, Taylor et al. [50] explained that supplementation with 3 109 CFU of L. acidophilus did not decrease the risk of AD in high-risk infants. In a clinical study in children with cow’s milk allergy and AD, it was illustrated that the use of L. rhamnosus GG at a dose of 5 109 CFU for 4 wk increased production of IL-10 and IFN-g [51]. L. gasseri and L. coryniformis at a dose of 2 108 CFU for each strain in yogurt decreased IgE in plasma and increased regulatory T-cells (CD4þ/CD25þ) in children suffering from allergy [52]. Conclusion Probiotics have been shown to stimulate and regulate immune system function. Our literature review showed that patients with immune-related diseases, resulting from either deficiency or oversensitivity of this system, may benefit from probiotics. It is noteworthy that this effect is largely dependent on the strain and dosage of probiotics, as well as the investigated conditions. References [1] Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, AsghariJafarabadi M, Mofid V. Probiotic yogurt improves antioxidant status in type 2 diabetic patients. Nutrition 2012;28(5):539–43.
Editorial / Nutrition 29 (2013) 583–586 [2] Water JV, Naiyanetr P. Yogurt and immunity: The health benefits of fermented milk products that contain lactic acid bacteria. In: Farnworth ER, editor. Handbook of fermented functional foods. London: CRC Press; 2003. p. 130–55. [3] Homayouni A. Letter to the editor. Food Chemistry 2009;114:1073. [4] Percival M. Choosing a probiotic supplement. Clinic Nutrition Insights 1997;6:1–4. [5] Delcenserie V, Martel D, Lamoureux M, Amiot J, Boutin Y, Roy D. Immunomodulatory effects of probiotics in the intestinal tract. Current Issues in Molecular Biology 2008;10(1–2):37–54. [6] Roach S, Tannock GW. Indigenous bacteria that influence the number of Salmonella typhimurium in the spleen of intravenously challenged mice. Can J Microbiol 1980;26:408–11. [7] Yamazaki S, Kamimura H, Momose H, Kawashima T, Ueda K. Protective effect of bifidobacterium-monoassociation against lethal activity of Escherichia coli. Bifidobacteria Microflora 1982;1:55. [8] Parracho H, McCartney AL, Gibson GR. Probiotics and prebiotics in infant nutrition. Pro Nutr Soc 2007;66:405–11. [9] Rattanachaikunsopon P, Phumkhachorn P. Lactic acid bacteria: Their antimicrobial compounds and their uses in food production. Annals of Biological Research 2010;1:218–28. [10] Abbas AK, Lichtman AH. Functions and disorders of the immune system. Basic immunology. 2nd ed. Philadelphia: Elsevier; 2006. [11] Gill HS, Grover S, Batish VK, Gill P. Immunological effects of probiotics and their significance to human health. In: Charalampopoulos D, Rastall RA, editors. Prebiotics and probiotics science and technology. Berlin: Springer; 2009. p. 901–48. [12] Sepkowitz KA. AIDSdthe first 20 years. N Engl J Med 2001;344: 1764–72. [13] Piatak M Jr, Saag MS, Yang LC, Clark SJ, Kappes JC, Luk KC, et al. High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR. Science 1993;259:1749–54. [14] Pantaleo G, Demarest JF, Schacker T, Vaccarezza M, Cohen OJ, Daucher M, et al. The qualitative nature of the primary immune response to HIV infection is a prognosticator of disease progression independent of the initial level of plasma viremia. Proc Natl Acad Sci USA 1997;94:254–8. [15] Brostoff J, Male D, Roth DB, Roitt I. Immunology. 7th ed. London: Mosby Elsevier; 2006. [16] Gill HS, Guarner F. Probiotics and human health: A clinical perspective. Postgrad Med J 2004;80:516–26. [17] Suttajit M. Advances in nutrition support for quality of life in HIVþ/AIDS. Asia Pac J Clin Nutr 2007;16(Suppl 1):318–22. S, Bengmark S, Johann-Liang R, Marshall F, [18] Cunningham-Rundles S, Ahrne Metakis L, et al. Probiotics and immune response. Am J Gastroenterol 2000; 95(Suppl 1):S22–5. [19] Trois L, Cardoso EM, Miura E. Use of probiotics in HIV-infected children: A randomized double-blind controlled study. J Trop Pediatr 2008;54:19–24. [20] Anukam KC, Osazuwa EO, Osadolor HB, Bruce AW, Reid G. Yogurt containing probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 helps resolve moderate diarrhea and increases CD4 count in HIV/AIDS patients. J Clin Gastroenterol 2008;42:239–43. [21] Irvine SL, Hummelen R, Hekmat S. Probiotic yogurt consumption may improve gastrointestinal symptoms, productivity, and nutritional intake of people living with human immunodeficiency virus in Mwanza, Tanzania. Nutrition Research 2011;31:875–81. [22] Matsumoto S, Hara T, Hori T, Mitsuyama K, Nagaoka M, Tomiyasu N, et al. Probiotic Lactobacillus-induced improvement in murine chronic inflammatory bowel disease is associated with the down-regulation of proinflammatory cytokines in lamina propria mononuclear cells. Clin Exp Immunol 2005;140:417–26. [23] Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, et al. Prophylaxis of pouchitis onset with probiotic therapy: A double-blind, placebo-controlled trial. Gastroenterology 2003;124: 1202–9. [24] Gionchetti P, Rizzello F, Venturi A, Campieri M. Probiotics in infective diarrhoea and inflammatory bowel diseases. J Gastroenterol Hepatol 2000;15: 489–93. [25] Kuisma J, Mentula S, Jarvinen H, Kahri A, Saxelin M, Farkkila M. Effect of Lactobacillus rhamnosus GG on ileal pouch inflammation and microbial flora. Aliment Pharmacol Ther 2003;17:509–15. [26] Gosselink MP, Schouten WR, van Lieshout LM, Hop WC, Laman JD, Ruselervan Embden JG. Delay of the first onset of pouchitis by oral intake of the probiotic strain Lactobacillus rhamnosus GG. Dis Colon Rectum 2004;47: 876–84. [27] Mimura T, Rizzello F, Helwig U, Poggioli G, Schreiber S, Talbot IC, et al. Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut 2004;53:108–14. k M, et al. Maintain[28] Kruis W, Fric P, Pokrotnieks J, Luk as M, Fixa B, Kasca ing remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 2004;53: 1617–23.
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[29] Zocco MA, dal Verme LZ, Cremonini F, Piscaglia AC, Nista EC, Candelli M, et al. Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 2006;23:1567–74. [30] Sood A, Midha V, Makharia GK, Ahuja V, Singal D, Goswami P, et al. The probiotic preparation, VSL#3 induces remission in patients with mild-tomoderately active ulcerative colitis. Clin Gastroenterol Hepatolo 2009;7: 1202–9. [31] Miele E, Pascarella F, Giannetti E, Quaglietta L, Baldassano RN, Staiano A. Effect of a probiotic preparation (VSL#3) on induction and maintenance of remission in children with ulcerative colitis. AmJ Gastroenterol 2009; 104:437–43. [32] Tursi A, Brandimarte G, Papa A, Giglio A, Elisei W, Giorgetti GM, et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: A doubleblind, randomized, placebo-controlled study. Am J Gastroenterol 2010; 105:2218–27. [33] Matthes H, Krummenerl T, Giensch M, Wolff C, Schulze J. Clinical trial: Probiotic treatment of acute distal ulcerative colitis with rectally administered Escherichia coli Nissle 1917 (EcN). BMC Complement Altern Med 2010;10: 1–8. [34] Oliva S, Di Nardo G, Ferrari F, Mallardo S, Rossi P, Patrizi G, et al. Randomised clinical trial: The effectiveness of Lactobacillus reuteri ATCC 55730 rectal enema in children with active distal ulcerative colitis. Aliment Pharmacol Ther 2012;35:327–34. [35] Gupta P, Andrew H, Kirschner BS, Guandalini S. Is lactobacillus GG helpful in children with Crohn’s disease? Results of a preliminary, open-label study. J Pediatr Gastroenterol Nutr 2000;31:453–7. [36] Guslandi M, Mezzi G, Sorghi M, Testoni PA. Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci 2000;45:1462–4. [37] Prantera C, Scribano ML, Falasco G, Andreoli A, Luzi C. Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: A randomised controlled trial with Lactobacillus GG. Gut 2002; 51:405–9. [38] Schultz M, Timmer A, Herfarth HH, Sartor RB, Vanderhoof JA, Rath HC. Lactobacillus GG in inducing and maintaining remission of Crohn’s disease. BMC Gastroenterol 2004;4:5. [39] Bousvaros A, Guandalini S, Baldassano RN, Botelho C, Evans J, Ferry GD, et al. A Randomized, Double-blind trial of Lactobacillus GG versus placebo in addition to standard maintenance therapy for children with Crohn’s disease. Inflamm Bowel Dis 2005;11:833–9. mann M, Seksik P, Laharie D, Colombel JF, Bouhnik Y, et al. [40] Marteau P, Le Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn’s disease: A randomised, double blind, placebo controlled GETAID trial. Gut 2006;55:842–7. [41] Van Gossum A, Dewit O, Louis E, de Hertogh G, Baert F, Fontaine F, et al. Multicenter randomized-controlled clinical trial of probiotics (Lactobacillus johnsonii, LA1) on early endoscopic recurrence of Crohn’s disease after ileo-caecal resection. Inflamma Bowel Dis 2007;13:135–42. [42] Hatakka K, Martio J, Korpela M, Herranen M, Poussa T, Leasanen T, et al. Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritisdA pilot study. Scand J Rheumatol 2003;32:211–5. [43] Mandel DR, Eichas K, Holmes J. Bacillus coagulans: A viable adjunct therapy for relieving symptoms of rheumatoid arthritis according to a randomized, controlled trial. BMC Complement Altern Med 2010;10:1–7. [44] Pineda Mde L, Thompson SF, Summers K, de Leon F, Pope J, Reid G. A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis. Med Sci Monit 2011;17:CR347–54. [45] Pawankar R, Canonica GW, Holgate ST, Lockey RF. WAO white book on allergy 2011–2012: Executive Summary. http://www.worldallergy.org/ publications/wao_white_book.pdf. Accessed August 2, 2012. [46] Ghadimi D, lster-Holst RF, de Vrese M, Winkler P, Heller KJ, Schrezenmeir J. Effects of probiotic bacteria and their genomic DNA on TH1/TH2-cytokine production by peripheral blood mononuclear cells (PBMCs) of healthy and allergic subjects. Immunology 2008;213:677–92. [47] Dugas B, Mercenier A, Lenoir-Wijnkoop I, Arnaud C, Dugas N, Postaire E. Immunity and probiotics. Immunol Today 1999;20:387–90. [48] Majamaa H, Isolauri E, Saxelin M, Vesikari T. Lactic acid bacteria in the treatment of acute rotavirus gastroenteritis. J Pediatr Gastroenterol Nutr 1995;20:333–8. [49] Rosenfeldt V, Benfeldt E, Nielsen SD, Michaelsen KF, Jeppesen DL, Valerius NH, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol 2003;111:389–95. [50] Taylor AL, Dunstan JA, Prescott SL. Probiotic supplementation for the first 6 mo of life fails to reduce the risk of atopic dermatitis and increases the risk of allergen sensitization in high-risk children: A randomized controlled trial. J Allergy Clin Immunol 2007;119:184–91. [51] Pohjavuori E, Viljanen M, Korpela R, Kuitunen M, Tiittanen M, Vaarala O, et al. Lactobacillus GG effect in increasing IFN-gamma production in infants with cow’s milk allergy. J Allergy Clin Immunol 2004;114:131–6. ~ avate A, Sierra S, Lara-Villoslada F, Romero J, Maldonado J, [52] Martınez-Can Boza J, et al. A probiotic dairy product containing L. gasseri CECT5714 and L. coryniformis CECT5711 induces immunological changes in children suffering from allergy. Pediatr Allergy Immunol 2009;20:592–600.
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Editorial / Nutrition 29 (2013) 583–586
Aziz Homayouni Rad, Ph.D. Department of Food Science and Technology Faculty of Health and Nutrition Tabriz University of Medical Sciences Tabriz, Iran E-mail address: [email protected] (A. Homayouni Rad) Reza Torab, M.D. Faculty of Medicine Tabriz University of Medical Sciences Tabriz, Iran Morad Ghalibaf, M.D. Assistant professor Faculty of Medicine
Islamic Azad University of Tabriz Tabriz, Iran Sharareh Norouzi, M.Sc. Department of Food Science and Technology and Faculty of Nutrition Faculty of Health and Nutrition Tabriz University of Medical Sciences Tabriz, Iran Elnaz Vaghef Mehrabany, M.Sc. Department of Nutrition Faculty of Nutrition Tabriz University of Medical Sciences Tabriz, Iran
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
Editorial
Might patients with immune-related diseases benefit from probiotics?
Probiotics The Food and Agriculture Organization/World Health Organization (FAO/WHO) defines probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” [1]. Probiotics have been used for many years to support restoring and maintaining a healthy intestinal balance in favor of beneficial bacteria. Scientific attention to the health benefits of yogurt was commenced by Elie Metchnikoff in the beginning of 1900s. Lactic acid bacteria and bifidobacteria are the most common types of microbes used as probiotics, but certain yeasts and bacilli may also be classified as probiotics [2]. A main consideration in the selection of probiotics is to choose a strain that can stay alive and establish itself under the situation encountered in the intestinal environment [3,4]. The human intestinal microbiota, complex with total counts of 1011 to 1012 bacteria per gram of stool [4], is the largest source of microbial stimulation that exerts both harmful and helpful effects on human health [5]. The microbiota acquired during early life play an important role in the regulation and improvement of the host immune system [6,7]. Probiotics prevent colonization by pathogen bacteria through competition for nutrients, degradation of the toxin receptors in the mucosa membrane, production of inhibitory compounds, upregulation of gut mucin genes, and stimulating immune system [8,9].
Immune-related diseases The physiologic role of the immune response is protection against infectious microbes; however, even non-harmful foreign substances can stimulate the immune system [10]. The host defense system consists of a complex array of cells and molecules, which include innate and acquired mechanisms. The innate immune system mediates the initial protection against infections that are nonspecific to a given pathogen; the main mechanism of native immunity is phagocytosis. In contrast to innate immunity, the adaptive immune system shows a high level of specificity and memory. There are two key components of adaptive immunitydhumoral and cellular immunity [11]. Two extremities of the variety of immunerelated diseases are immune deficiency and immune hypersensitivity, which have been extensively studied in connection with probiotics. 0899-9007/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nut.2012.10.008
Disarrays caused by imperfection immunity are called immunodeficiency diseases. When defects in one or more mechanisms of the immune system occur as a result of genetic problems, they are called primary immunodeficiency. Other imperfection in the immune response may result from pollutions, diet, or microbes, which is called acquired immunodeficiency [10]. Acquired immunodeficiency syndrome (AIDS) is among the most important acquired diseases. AIDS is a human immunity disorder caused by the human immunodeficiency virus (HIV) [12]. At the beginning of infection with HIV, several million viruses may exist per milliliter of blood [13]. These viruses reduce numbers of circulating CD4þ T-cells; consequently, infections with a variety of opportunistic microbes result. This acute viremia is linked to almost all patients with the activation of CD8þ T-cells, which kill HIV-infected cells, therefore producing an antibody, or seroconversion. The symptoms of AIDS patients include weight loss, respiratory tract infections, prostatitis, and skin rashes. Diarrhea is a common complication in patients with HIV infection [14]. The adaptive immune reaction provides particular resistance against infection with microorganisms, but some immune responses increase excessively and unsuitably in response to the stimulations. This is usually called hypersensitivity. There are four important types of hypersensitivity. Type I, allergic reactions occur when a person’s immune system answers to normally benign substances in the environment and particular mediators are released. Type II hypersensitive reactions are mediated by antibodies binding to specific cells or tissues. In type III, immune complements are placed in the tissue causing local tissue damage and swelling; autoimmune disorders such as inflammatory bowel disease, rheumatoid arthritis, and type 1 diabetes mellitus are classified in this category. In type IV hypersensitive answers, T-cells effectors secrete lymphokines when encountering the same antigen for the second time which ends in inflammatory responses [10,15]. This review emphasizes the beneficial effects of probiotics on alleviating the symptoms of autoimmune diseases, allergies, and AIDS, as well as on enhancing the quality of patients’ lives.
Effect of probiotics on immune-related disease Numerous in vivo and in vitro investigations have shown that particular strains of probiotics are able to modulate the
584
Editorial / Nutrition 29 (2013) 583–586
performance of the immune system, stimulate the immune function to defend against infectious disorders and cancers, and regulate overexpressed immune responses connected with immuno-inflammatory diseases, such as allergy and inflammatory bowel disease (IBD) [16]. Probiotic and AIDS HIV/AIDS is a prominent problem in the human race, which revolutionizes the human landscape in the world. Comparatively, a minority of patients obtains antiretroviral therapy, and acute diarrhea influences their quality of life dramatically. Use of probiotics improves immune response and feature of AIDS patients’ life [17]. Advantages of probiotic bacteria on the immune system have been confirmed in recent studies. L. plantarum 299v supplementation in HIV-positive children could shorten acute diarrhea [18]. 2.5 1010 CFU of the B. bifidum and S. thermophilus in formula showed an increase in the CD4þ count in children with HIV infections [19]. A study by Anukam et al. [20] reported rises in the mean CD4þ count in the AIDS female by L. rhamnosus and L. reuteri at a dose of 2.5 1012 CFU. A recent study in Mwanza (Tanzania) recommended that consuming yogurt supplemented with 1010 CFU of the probiotic strain L. rhamnosus may successfully improve gastrointestinal symptoms and alleviate tolerance to antiretroviral treatment [21]. Probiotic and autoimmune diseases There are two significant categories of autoimmune diseases: immune system attack to particular organs, such as the stomach, pancreas, adrenal, and thyroid, and non–organ-specific diseases, including the rheumatological disorders. Regulation of enteric flora composition by probiotics may alleviate the symptoms of some autoimmune disorders. Superlative studies have been performed to investigate the effect of probiotic supplementation in IBD, rheumatoid arthritis, and type 1 diabetes mellitus [15]. IBD comprises two discrete disorders: Crohn’s disease (CD) and ulcerative colitis (UC). Pouchitis is another disease that consequences from complex ileal pouch-anal anastomosis (IPAA) surgery for UC. Some studies showed the potential of probiotic supplementation in the debarment and/or treatment of various inflammatory bowel disorders [11,22]. Some strains of lactobacilli, bifidobacteria, and Streptococcus salivarius ssp. thermophilus (VSL #3) deferred the first onset of acute pouchitis and improved life quality of people with ileal pouch-anal anastomosis [23,24]. Supplementation with 1-2 1010 CFU L. rhamnosus GG for 3 mo changed the intestinal microbiota, but endoscopic or clinical response was not improved [25]. L. rhamnosus GG at the dose of 1.4 1010 CFU in the fermented food product delayed episodes of pouchitis [26]. A dose of 6 1011 CFU of (VSL #3) maintained antibiotic introduced remission [27]. The roles of beneficial microbes in active UC have also been reported in literature. The probiotic E. coli Nissle at a dose of 5–50 109 CFU was shown to have a clinical impact similar to that obtained by Mesalazine [28]. 1.8 1010 CFU of L. rhamnosus GG in the form of tablets seemed to be beneficial and harmless for maintaining remission in patients suffering from UC [29]. In people with moderate UC, using VSL # 3 supplementation was safe and effective in achieving clinical responses and remissions [30–32]. In a double-blind clinical study, the efficiency of rectal E. coli Nissle at the dose of 1–4 109 CFU was significant in per protocol analysis in moderate distal UC [33]. In pediatric patients with active distal UC, rectal infusion of L. reuteri in the form of
enema solution with 1010 CFU/d was effective in altering mucosal expression levels of some cytokines, which improved mucosal inflammation [34]. Decline in disease activity has been attained in children with CD by probiotic intervention [35]. One gram of the yeast Saccharomyces boulardii, when administered three times a day with Mesalamine in the form of a capsule, attained remission in CD patients [36]. L. rhamnosus GG supplementation was unable to reduce the risk of postoperative recurrence in CD [37–39]. Controlled studies of probiotics found no efficacy for L. johnsonii as maintenance therapies for CD [40,41]. Evidence has revealed that there is a correlation between the gastrointestinal flora and the development of rheumatoid arthritis. Using capsules containing 1010 CFU of L. rhamnosus GG did not show considerable difference in the activity of rheumatoid arthritis, although improvement in subjective well-being was reported [42]. Two mo of supplementation with 2 109 CFU Bacillus coagulans appeared to be safe and effective for patients with rheumatoid arthritis [43]. After 3 mo of consuming capsules containing 4 109 CFU of L. rhamnosus and L. reuteri, although no clinical improvement were observed, functional improvement was reported by rheumatoid arthritis patients [44]. Probiotic and allergy The incidence of allergic diseases is growing dramatically in both developing and industrialized countries. This increase is particularly problematic in children. Atopic dermatitis (AD), asthma, and allergic rhinitis represent the most common chronic diseases of this type [45]. Alteration of the intestinal microbiota or lack of beneficial microbes during childhood is the most important reason among the factors in the increased prevalence of allergic diseases [46]. Beneficial bacteria were shown to competently down-regulate inflammation related with hypersensitivity responses in patients with atopic eczema and food allergy [47,48]. The application of 5 109 CFU/d of the probiotic strains L. rhamnosus and L. reuteri significantly altered the production of the cytokines IL-2, IL-4, IL-10, or IFN-g, thereupon they improved clinical symptoms in children with AD [49]. In another study, Taylor et al. [50] explained that supplementation with 3 109 CFU of L. acidophilus did not decrease the risk of AD in high-risk infants. In a clinical study in children with cow’s milk allergy and AD, it was illustrated that the use of L. rhamnosus GG at a dose of 5 109 CFU for 4 wk increased production of IL-10 and IFN-g [51]. L. gasseri and L. coryniformis at a dose of 2 108 CFU for each strain in yogurt decreased IgE in plasma and increased regulatory T-cells (CD4þ/CD25þ) in children suffering from allergy [52]. Conclusion Probiotics have been shown to stimulate and regulate immune system function. Our literature review showed that patients with immune-related diseases, resulting from either deficiency or oversensitivity of this system, may benefit from probiotics. It is noteworthy that this effect is largely dependent on the strain and dosage of probiotics, as well as the investigated conditions. References [1] Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, AsghariJafarabadi M, Mofid V. Probiotic yogurt improves antioxidant status in type 2 diabetic patients. Nutrition 2012;28(5):539–43.
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Aziz Homayouni Rad, Ph.D. Department of Food Science and Technology Faculty of Health and Nutrition Tabriz University of Medical Sciences Tabriz, Iran E-mail address: [email protected] (A. Homayouni Rad) Reza Torab, M.D. Faculty of Medicine Tabriz University of Medical Sciences Tabriz, Iran Morad Ghalibaf, M.D. Assistant professor Faculty of Medicine
Islamic Azad University of Tabriz Tabriz, Iran Sharareh Norouzi, M.Sc. Department of Food Science and Technology and Faculty of Nutrition Faculty of Health and Nutrition Tabriz University of Medical Sciences Tabriz, Iran Elnaz Vaghef Mehrabany, M.Sc. Department of Nutrition Faculty of Nutrition Tabriz University of Medical Sciences Tabriz, Iran