Selected organisms that are used as probiotic agents (Gareau et al., 2010).
As it was reported by Chow (2002), the notion that food could serve as medicine was first conceived thousands of years ago by the Greek philosopher and father of medicine, Hippocrates, who once wrote: 'Let food be thy medicine, and let medicine be thy food'. However, during recent times, the concept of food having medicinal value has been reborn as 'functional foods'. The list of health benefits accredited to functional food continues to increase, and the gut is an obvious target for the development of functional foods, because it acts as an interface between the diet and all other body functions. One of the most promising areas for the development of functional food components lies in the use of probiotics and prebiotics which scientific researches have demonstrated therapeutic evidence. Nowadays, consumers are aware of the link among lifestyle, diet and good health, which explains the emerging demand for products that are able to enhance health beyond providing basic nutrition. Besides the nutritional valaes, ingestion of lactic acid bacteria (LAB) and their fermented foods has been suggested to confer a range of health benefits including immune system modulation, increased resistance to malignancy, and infectious illness (Soccol, et al., 2010).. LAB were first isolated from milk. They can be found in fermented products as meat, milk products, vegetables, beverages and bakery products. LAB occur naturally in soil, water, manure, sewage, silage and plants. They are part of the microbiota on mucous membranes, such as the intestines, mouth, skin, urinary and genital organs of both humans and animals, and may have a beneficial influence on these ecosystems. LAB that grow as the adventitious microflora of foods or that are added to foods as cultures are generally considered to be harmless or even an advantage for human health. Since their discovery, LAB has been gained mush interest in various applications, as starter cultures in food and feed fermentations, pharmaceuticals, probiotics and as biological control agents. In food industry, LAB are widely used as starters to achieve favorable changes in texture, aroma, flavor and acidity (Leory and De Vuyst, 2004). However, there has been an important interest in using bacteriocin and/or other inhibitory substance producing LAB for non-fermentative biopreservation applications. Du to their antimicrobial and antioxidant activities some LAB strains are used in food biopreservation. However, LAB are generally regarded as safe (GRAS) to the consumer and during storage, they naturally dominate the microflora of many foods (Osmanağaoğlu and Beyatli, 1999; Parada et al., 2007). Many of the indications for probiotic activity have been obtained from effects observed in various clinical situations. Even, there are few strains that have officially gained the status of pharmaceutical preparation; each of these effects is gradually being supported by a number of clinical studies or human intervention trials, performed in a way that resembles the traditional pharmacological approach (placebo-controlled, double blind, randomized trials) and the strains used in these studies belong to different microbial species, but are mostly lactic acid bacteria (Mercenier et al, 2003).
2. LAB as probiotic agents
2.1.. Overview of probiotics
The most tried and tested manner in which the gut microbiota composition may be influenced is through the use of live microbial dietary additions, as probiotics. In fact, the concept dates back as far as prebiblical ages. The first records of ingestion of live bacteria by humans are over 2,000 years old. However, at the beginning of this century probiotics were first put onto a scientific basis by the work of Metchnikoff (1908). He hypothesised that the normal gut microflora could exert adverse effects on the host and that consumption of ‘soured milks’ reversed this effect. The word ‘‘probiotics’’ was initially used as an anonym of the word ‘‘antibiotic’’. It is derived from Greek words pro and biotos and translated as ‘‘for life’’. The origin of the first use can be traced back to Kollath (1953), who used it to describe the restoration of the health of malnourished patients by different organic and inorganic supplements. Later, Vergin (1954) proposed that the microbial imbalance in the body caused by antibiotic treatment could have been restored by a probiotic rich diet; a suggestion cited by many as the first reference to probiotics as they are defined nowadays. Similarly, Kolb recognized detrimental effects of antibiotic therapy and proposed the prevention by probiotics (Vasiljevic and Shah, 2008) Later on, Lilly and Stillwell (1965) defined probiotics as “…microorganisms promoting the growth of other microorganisms”. Following recommendations of a FAO/WHO (2002) working group on the evaluation of probiotics in food, probiotics, are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (Sanders, 2008; Schrezenmeir and De Vrese, 2001). The idea of health-promoting effects of LAB is by no means new, as Metchnikoff proposed that lactobacilli may fight against intestinal putrefaction and contribute to long life. Such microorganisms may not necessarily be constant inhabitants of the gut, but they should have a “…beneficial effect on the general and health status of man and animal”
|NA||Rat model of necrotizing enterocolitis|
|Lactobacillus rhamnosus GG|
(used with lactoferrin)
|Sepsis in very low birth weight infants||NA|
produce IL-10 or trefoil factors)
|Crohn's disease||DSS-induced colitis and IL-10−/− mice (spontaneous IBD)|
|Antibiotic-associated diarrhea||IL-10−/− mice (spontaneous IBD)|
|NA||Visceral hyperalgesia 40 and |
|Pediatric antibiotic-associated diarrhea||–|
|NA||DSS-induced colitis and TNBS-induced colitis|
|VSL#3 (||Pouchitis and pediatric ulcerative colitis||DSS-induced colitis, IL-10−/− mice (spontaneous IBD; DNA only), and SAMP mouse model of spontaneous IBD|
(Holzapfel et al., 2001; Belhadj et al., 2010). Other definitions advanced through the years have been restrictive by specification of mechanisms, site of action, delivery format, method, or host. Probiotics have been shown to exert a wide range of effects. The mechanism of action of probiotics (e.g, having an impact on the intestinal microbiota or enhancing immune function) was dropped from the definition to encompass health effects due to novel mechanisms and to allow application of the term before the mechanism is confirmed. Physiologic benefits have been attributed to dead microorganisms. Furthermore, certain mechanisms of action (such as delivery of certain enzymes to the intestine) may not require live cells. However, regardless of functionality, dead microbes are not probiotics (Sanders, 2008). In relation to food, probiotics are considered as “viable preparations in foods or dietary supplements to improve the health of humans and animals”. According to these definitions, an impressive number of microbial species are considered as probiotics. (Holzapfel et al., 2001). For gastrointestinal ecosysteme, however, the most important microbial species that are used as probiotics are lactic acid bacteria (LAB) (Table 1).
2.2. Selection of probiotics
Many in vitro tests are performed when screening for potential probiotic strains. The first step in the selection of a probiotic LAB strain is the determination of its taxonomic classification, which may give an indication of the origin, habitat and physiology of the strain. All these characteristics have important consequences on the selection of the novel strains (Morelli, 2007). An FAO/WHO (2002) expert panel suggested that the specificity of probiotic action is more important than the source of microorganism. This conclusion was brought forward due to uncertainty of the origin of the human intestinal microflora since the infants are borne with virtually sterile intestine. However, the panel also underlined a need for improvement of in vitro tests to predict the performance of probiotics in humans. While many probiotics meet criteria such as acid and bile resistance and survival during gastrointestinal transit, an ideal probiotic strain remains to be identified for any given indication. Furthermore, it seems unlikely that a single probiotic will be equally suited to all indications; selection of strains for disease-specific indications will be required (Shanahan, 2003).
The initial screening and selection of probiotics includes testing of the following important criteria: phenotype and genotype stability, including plasmid stability; carbohydrate and protein utilization patterns; acid and bile tolerance and survival and growth; intestinal epithelial adhesion properties; production of antimicrobial substances; antibiotic resistance patterns; ability to inhibit known pathogens, spoilage organisms, or both; and immunogenicity. The ability to adhere to the intestinal mucosa is one of the more important selection criteria for probiotics because adhesion to the intestinal mucosa is considered to be a prerequisite for colonization (Tuomola et al., 2001). The table below (Table 2) indicates key creteria for sellecting probiotic candidat for commercial application, and figure 1 presents major and cardinal steps for sellecting probiotic candidats.
It is of high importance that the probiotic strain can survive the location where it is presumed to be active. For a longer and perhaps higher activity, it is necessary that the strain can proliferate and colonise at this specific location. Probably only host-specific microbial strains are able to compete with the indigenous microflora and to colonise the niches. Besides, the probiotic strain must be tolerated by the immune system and not provoke the formation of antibodies against the probiotic strain. So, the host must be immuno-tolerant to the probiotic. On the other hand, the probiotic strain can act as an adjuvant and stimulate the immune system against pathogenic microorganisms. It goes without saying that a probiotic has to be harmless to the host: there must be no local or general pathogenic, allergic or mutagenic/carcinogenic reactions provoked by the microorganism itself, its fermentation products or its cell components after decrease of the bacteria (Desai, 2008).
Pathogenicity and infectivity
Virulence factors—toxicity, metabolic activity and intrinsic properties, i.e., antibiotic resistance
|Technological criteria||Genetically stable strains|
Desired viability during processing and storage
Good sensory properties
|Functional criteria||Tolerance to gastric acid and juices|
Adhesion to mucosal surface
Validated and documented health effects
Antagonistic activity towards gastrointestinal
pathogens, i.e., Helicobacter pylori, Candida albicans
Antimutagenic and anticarcinogenic properties
When probiotic strains are selected, attributes important for efﬁcacy and technological function must be assessed and a list of characteristics required for all probiotic functions is required. Basic initial characterization of strain identity and taxonomy should be conducted, followed by evaluation with validated assays both in studies of animal models and in controlled studies in the target host. In vitro assays are frequently conducted that have not been proved to be predictive of in vivo function. Technological robustness must also be determined, such as the strain’s ability to be grown to high numbers, concentrated, stabilized, and incorporated into a ﬁnal product with good sensory properties, if applicable, and to be stable, both physiologically and genetically, through the end of the shelf life of the product and at the active site in the host. Assessment of stability can also be a challenge, since factors such as chain length and injury may challenge the typical assessment of colony-forming units, as well as in vivo function (Sanders, 2008). Dose levels of probiotics should be based on levels found to be efﬁcacious in human studies. One dose level cannot be assumed to be effective for all strains. Furthermore, the impact of product format on
probiotic function has yet to be explored in depth. The common quality-control parameter of colony-forming units per gram may not be the only parameter indicative of the efﬁcacy of the ﬁnal product. Other factors, such as probiotic growth during product manufacture, coating, preservation technology, metabolic state of the probiotic, and the presence of other functional ingredients in the ﬁnal product, may play a role in the effectiveness of a product. More research is needed to understand how much inﬂuence such factors have on in vivo efﬁcacy (Sanders, 2008).
2.3. Potential mechanisms of action of probiotics
A wide variety of potential beneficial health effects have been attributed to probiotics (Table 3). Claimed effects range from the alleviation of constipation to the prevention of major life-threatening diseases such as inflammatory bowel disease, cancer, and cardiovascular incidents. Some of these claims, such as the effects of probiotics on the shortening of intestinal transit time or the relief from lactose maldigestion, are considered well-established, while others, such as cancer prevention or the effect on blood cholesterol levels, need further scientific backup (Leroy et al., 2008). The mechanisms of action may vary from one probiotic strain to another and are, in most cases, probably a combination of activities, thus making the investigation of the responsible mechanisms a very difficult and complex task. In general, three levels of action can be distinguished: probiotics can influence human
|Health benefit||Proposed mechanism(s)|
|Cancer prevention||Inhibition of the transformation of pro-carcinogens into active carcinogens, binding/inactivation of mutagenic compounds, production of anti-mutagenic compounds, suppression of growth of pro-carcinogenic bacteria, reduction of the absorption of carcinogens, enhancment of immune function, influence on bile salt concentrations|
|Control of irritable bowel|
|Modulation of gut microbiota, reduction of intestinal gas production|
|Management and prevention of|
|Modulation of immune response|
|Management of inflammatory|
bowel diseases (Crohn’s disease, ulcerative colitis, pouchitis)
|Modulation of immune response, modulation of gut|
|Prevention of heart diseases/influence on blood cholesterol levels||Assimilation of cholesterol by bacterial cells, deconjugation of bile acids by bacterial acid hydrolases,|
cholesterol-binding to bacterial cell walls, reduction of hepatic cholesterol synthesis and/or redistribution of cholesterol from plasma to liver through influence of the bacterial production of short-chain fatty acids
|Prevention of urogenital tract|
|Production of antimicrobial substances, competition for adhesion sites, competitive exclusion of pathogens|
|Prevention/alleviation of diarrhoea|
caused by bacteria/viruses
|Modulation of gut microbiota, production of antimicrobial substances, competition for adhesion sites, stimulation of mucus secretion, modulation of immune response|
|Prevention/treatment of||Production of antimicrobial substances, stimulation of the mucus secretion, competition for adhesion sites, stimulation of specific and non-specific immune responses|
|Relief of lactose indigestion||Action of bacterial β-galactosidase(s) on lactose|
|Shortening of colonic transit time||Influence on peristalsis through bacterial metabolite production|
health by interacting with other microorganisms present on the site of action, by strengthening mucosal barriers, and by affecting the immune system of the host (Leroy et al., 2008), and the figure 2 shows the most important mechanisms by whiche probiotics exerce their action inside the gut.
3. Probiotics and gut health
3.1. Gut microbiota
The human gastrointestinal tract is inhabited by a complex and dynamic population of around 500-1000 of different microbial species which remain in a complex equilibrium. It has been estimated that bacteria account for 35–50% of the volume content of the human colon. These include
The intestinal microbiota is not homogeneous. The number of bacterial cells present in the mammalian gut shows a continuum that goes from 101 to 103 bacteria per gram of contents in the stomach and duodenum, progressing to 104 to 107 bacteria per gram in the jejunum and ileum and culminating in 1011 to 1012 cells per gram in the colon (Figure 3a). Additionally, the microbial composition varies between these sites. In addition to the longitudinal heterogeneity displayed by the intestinal microbiota, there is also a great deal of latitudinal variation in the microbiota composition (Figure 3b). The intestinal epithelium is separated from the lumen by a thick and physicochemically complex mucus layer. The microbiota present in the intestinal lumen differs significantly from the microbiota attached and embedded in this mucus layer as well as the microbiota present in the immediate
proximity of the epithelium. For instance,
3.2. Survival and antagonism effects of probiotics in the gut
The intestinal epithelium is the largest mucosal surface in the human body, provides an interface between the external environment and the host. The gut epithelium is constantly exposed to foreign microbes and antigens derived from digested foods. Thus, the gut epithelium acts as a physical barrier against microbial invaders and is equipped with various elements of the innate defense system. In the gut, two key elements govern the interplay between environmental triggers and the host: intestinal permeability and intestinal mucosal defense. Resident bacteria can interact with pathogenic microorganisms and external antigens to protect the gut using various strategies.
According to the generally accepted deﬁnition of a probiotic, the probiotic microorganism should be viable at the time of ingestion to confer a health beneﬁt. Although not explicitly stated, this deﬁnition implies that a probiotic should survive GI tract passage and, colonize the host epithelium. A variety of traits are believed to be relevant for surviving GI tract passage, the most important of which is tolerance both to the highly acidic conditions present in the stomach and to concentrations of bile salts found in the small intestine. These properties have consequently become important selection criteria for new probiotic functionality. In addition to tolerating the harsh physical-chemical environment of the GI tract, adherence to intestinal mucosal cells would be necessary for colonization and any direct interactions between the probiotic and host cells leading to the competitive exclusion of pathogens and/or modulation of host cell responses. Moreover, As enteropathogenic Escherichia coli are known to bind to epithelial cells via mannose receptors, probiotic strains with similar adherence capabilities could inhibit pathogen attachment and colonization at these binding sites and thereby protect the host against infection (Marco et al., 2006).
Probiotic bacteria can antagonize pathogenic bacteria by reducing luminal pH, inhibiting bacterial adherence and translocation, or producing antibacterial substances and defensins. One of the mechanisms by which the gut ﬂora resists colonization by pathogenic bacteria is by the production of a physiologically restrictive environment, with respect to pH, redox potential, and hydrogen sulﬁde production. Probiotic bacteria decrease the luminal pH, as has been demonstrated in patients with ulcerative colitis (UC) following ingestion of the probiotic preparation VSL#3. In a fatal mouse Shiga toxin-producing
Production of antimicrobial compounds, termed bacteriocins, by probiotic bacteria is also likely to contribute to their beneﬁcial activity. Several bacteriocins produced by different species from the genus
4. Probiotics and the mucous layer
Most mucosal surfaces are covered by a hydrated gel formed by mucins. Mucins are secreted by specialized epithelial cells, such as gastric foveolar mucous cells and intestinal goblet cells, Goblet cells are found along the entire length of the intestinal tract, as well as other mucosal surfaces. Mucins, are abundantly core glycosylated (up to 80% wt/wt) and either localized to the cell membrane or secreted into the lumen to form the mucous layer (Turner, 2009). Of the 18 mucin-type glycoproteins expressed by humans, MUC2 is the predominant glycoprotein found in the small and large bowel mucus. The NH2- and COOH-termini are not glycosylated to the same extent, but are rich in cysteine residues that form intra- and inter-molecular disulﬁde bonds. These glycan groups confer proteolytic resistance and hydrophilicity to the mucins, whereas the disulﬁde linkages form a matrix of glycoproteins that is the backbone of the mucous layer (Ohland and MacNaughton, 2010). Although small molecules pass through the heavily glycosylated mucus layer with relative ease, bulk fluid flow is limited and thereby contributes to the development of an unstirred layer of fluid at the epithelial cell surface. As the unstirred layer is protected from convective mixing forces, the diffusion of ions and small solutes is slowed (Turner, 2009). This gel layer provides protection by shielding the epithelium from potentially harmful antigens and molecules including bacteria from directly contacting the epithelial cell layer, while acting as a lubricant for intestinal motility. Mucins can also bind the epithelial cell surface carbohydrates and form the bottom layer, which is ﬁrmly attached to the mucosa, whereas the upper layer is loosely adherent. The mucus is the ﬁrst barrier that intestinal bacteria meet, and pathogens must penetrate it to reach the epithelial cells during infection (Ohland and MacNaughton, 2010).
Probiotics may promote mucus secretion as one mechanism to improve barrier function and exclusion of pathogens. In support of this concept, probiotics have been shown to increase mucin expression in vitro, contributing to barrier function and exclusion of pathogens. Several studies showed that increased mucin expression in the human intestinal cell lines Caco-2 (MUC2) and HT29 (MUC2 and 3), thus blocking pathogenic
5. Interaction of probiotic bacteria with gut epithelium
The composition of the commensal gut microbiota is probably influenced by the combination of food practices and other factors like the geographical localization, various levels of hygiene or various climates. The host-microbe interaction is of primary importance during neonatal period. The establishment of a normal microbiota provides the most substantial antigenic challenge to the immune system, thus helping the gut associated lymphoid tissus (GALT) maturation. The intestinal microbiota contributes to the anti-inflammatory character of the intestinal immune system. Several immunoregulatory mechanisms, including regulatory cells, cytokines, apoptosis among others, participate in the control of immune responses by preventing the pathological processes associated with excessive reactivity. An interesting premise for probiotic physiological action is their capacity to modulate the immune system. Consequently, many studies have focused on the effects of probiotics on diverse aspects of the immune response. Following consumption of probiotic products, the interaction of these bacteria with intestinal enterocytes initiates a host response, since intestinal cells produce various immunomodulatory molecules when stimulated by bacteria (Delcenseri et al., 2009). Furthermore, The indigenous microbiota is a natural resistance factor against potential pathogenic microorganisms and provides colonization resistance, also known as gut barrier, by controlling the growth of opportunistic microorganisms. It has been suggested that commensal bacteria protect their host against microbial pathogens by interfering with their adhesion and toxic effects (Myllyluoma, 2007).
The tight epithelial cell barrier forms the another line of defence between the gut luminal contents and the host. Epithelial cells lining the gastrointestinal tract are able to respond to infection by initiating either nonspecific or specific host-defence response (Kagnoff and Eckmann 1997, Strober 1998). Bacterial adhesion to the host cell or recognition by the host cell is often an essential first stage in the disease process. A wide range of gastrointestinal cell surface constituents, such as several glygoconjucates, can serve as receptors for bacterial adherence (Servin and Coconnier 2003, Pretzer et al., 2005). Furthermore, epithelial cells express constitutively host pattern recognition receptors (PRRS), such as Toll-like receptors (TLR). These are a family of transmembrane receptors that recognize repetitive patterns, i.e. the pathogen-associated molecular patterns present in diverse microbes, including gram-positive and gram-negative bacteria (Bäckhed and Hornef 2003, Takeda et al., 2003). TLRs are also found on innate immune cells, such as dendritic cells and macrophages (Vinderola et al., 2005). TLR4 recognizes lipopolysaccharide and gram-negative bacteria, while TLR2 recognizes a variety of microbial components, such as peptidoglycan and lipoteichoic acids, from gram-positive bacteria (Abreu 2003, Matsuguchi et al., 2003, Takeda et al., 2003). Also, several other TLRs with specific actions are known, such as TLR5, which responds to the bacterial flagella (Rhee et al., 2005), and TLR9, which is activated by bacterially derived short DNA fragments containing CpG sequences (Pedersen et al., 2005). Other known recognition receptors are nucleotide-binding oligomerization domain proteins, which recognize both gram-positive and gram-negative bacteria. They are located in cell cytoplasm and are implicated in the induction of defensins. Increased epithelial barrier permeability is frequently associated with gastrointestinal disorders contributing to both disease onset and persistence (Lu and Walker 2001, Berkes 2003). The gatekeeper of the paracellular pathway is the tight junction, which is an apically located cell-cell junction between epithelial cells. The tight junction permits the passage of small molecules, such as ions, while restricting the movement of large molecules, such as antigens and microorganisms, which can cause inflammation. The integral membrane protein family, which are mainly claudins, occluding and zonula occludens 1, are implicated in the formation of the paracellular channels (Berkes et al., 2003).
6. Origine and safety of probiotics
An old dogma of probiotic selection has been that the probiotic strains should be of “human origin”. One may argue that from evolutionary point of view, describing bacteria to be of human origin does not make much sense at all. The requirement for probiotics to be of human origin relates actually to the isolation of the strain rather than the “origin” itself. Usually, the strains claimed to be “of human origin” have been isolated from faecal samples of healthy human subjects, and have therefore been considered to be “part of normal healthy human gut microbiota”. In reality the recovery of a strain from a faecal sample does not necessarily mean that this strain is part of the normal microbiota of this individual, since microbes passing the GI tract transiently can also be recovered from the faecal samples (Forssten et al., 2011). In practice it is impossible to know the actual origin of the probiotic strains, regardless of whether they have been isolated from faecal samples, fermented dairy products or any other source for that matter. Isolation of a strain from faeces of a healthy individual is also not a guarantee of the safety of the strain—such a sample will also always contain commensal microbes which can act as opportunistic pathogens, or even low levels of true pathogens, which are present in the individual at sub-clinical levels. Therefore, it has been recommend that instead of concentrating on the first point of isolation, the selection processes for new potential probiotic strains should mainly focus on the functional properties of the probiotic strains rather than the “origin” (Forssten et al., 2011; Ouwehand and Lahtinen 2008).
As viable, probiotic bacteria have to be consumed in large quantities, over an extended period of time, to exert beneficial effects; the issue of the safety of these microorganisms is of primary concern (Leroy et al., 2008). Until now, reports of a harmful effect of these microbes to the host are rare. However, many species of the genera Lactobacillus, Leuconostoc, Pediococcus, Enterococcus, and Bifidobacterium were isolated frequently from various types of infective lesions. According to Gasser (1994), L. rhamnosus, L. acidophilus, L. plantarum, L. casei, Lactobacillus paracasei, Lactobacillus salivarius, Lactobacillus lactis, and Leuconostoc mesenteroides are some examples of probiotic bacteria isolated from bacterial endocarditis; L. rhamnosus, L. plantarum, Leuconostoc. mesenteroides, Pediococcus acidilactici, Bifidobacterium eriksonii, and Bifidobacterium adolescentis have been isolated from bloodstream infections and many have been isolated from local infections. Although minor side effects of the use of probiotics have been reported, infections with probiotic bacteria occur and invariably only in immunocompromised patients or those with intestinal bleeding (Leroy et al., 2008).
An issue of concern regarding the use of probiotics is the presence of chromosomal, transposon, or plasmid-located antibiotic resistance genes amongst the probiotic microorganisms. At this moment, insufficient information is available on situations in which these genetic elements could be mobilised, and it is not known if situations could arise where this would become a clinical problem (Leroy et al., 2008). When dealing with the selection of probiotic strains, the FAO/WHO Consultancy recommends that probiotic microorganisms should not harbor transmissible drug resistance genes encoding resistance to clinically used drugs (FAO/WHO, 2002). For the assessment of the safety of probiotic microorganisms and products, FAO/WHO has formulated guidelines, recommending that probiotic strains should be evaluated for a number of parameters, including antibiotic susceptibility patterns, toxin production, metabolic and haemolytic activities, and infectivity in immunocompromised animals (FAO/WHO, 2002). In vitro safety screenings of probiotics may include, among others, antibiotic resistance assays, screenings for virulence factors, resistance to host defence mechanisms and induction of haemolysis. Several different animal models have been utilized in the safety assessment of probiotics. These include models of immunodeficiency, endocarditis, colitis and liver injury. In some cases even acute toxicity of probiotics has been assessed. Last but not least, also clinical intervention trials have yielded evidence on the safety of probiotics for human consumption (Forssten et al., 2011).
The individual diversity of the intestinal microflora underscores the difficulty of identifying the entire human microbiota and poses barriers to this ﬁeld of research. In addition, it is apparent that the actions of probiotics are species and strain speciﬁc. It is also apparent that even a single strain of probiotic may exert its actions via multiple, concomitant pathways. Probiotics have long been used as an alternative to traditional medicine with the goal of maintaining enteric homeostasis and preventing disease. However, the actual efﬁcacy of this treatment in still debated. Clinical trials have shown that probiotic treatment can reduce the risk of some diseases, especially antibiotic-associated diarrhea, but conclusive evidence is impeded owing to the wide range of doses and strains of bacteria used. The mechanism of action is also an area of interest (Ohland and MacNaughton, 2010). Many studies, as discussed above, have shown that probiotics increase barrier function in terms of increased mucus, antimicrobial peptides, and sIgA production, competitive adherence for pathogens, and increased TJ integrity of epithelial cells. Current investigation into the mechanism of action of speciﬁc probiotics has focused on probiotic-induced changes in the innate immune functions involvingTLRs and its downstream systems Like NF-κB, and other pathways (Yoon and Sun, 2011). Although the immunomodulatory effects of probiotics have been demonstrated in experimental animal models of allergy, autoimmunity, and IBD, information from clinical trials in humans is scarce. Furthermore, some studies suggest that probiotics could induce detrimental effects. Therefore, more research, especially in the form of well-designed clinical trials, is needed to evaluate the efﬁcacy and safety of probiotics (Ezendam and Van Loveren, 2008). With evolving knowledge, efective probiotic therapy will be possible in the future.