Representative microbe commonly considered as probiotics.
Abstract
Probiotics are live microorganisms, which confer health benefits on host when administered in adequate amounts. Probiotics exert their beneficial effects by maintenance flora healthy, enhancement of mucosal barrier integrity and modulation of immune responses. Antimicrobial substances including bacteriocins, hydrogen peroxide, organic acids, and short-chain fatty acids (SCFAs) produced by probiotics allow them to inhibit mucosal and epithelial adherence of pathogens and compete for limiting resources, thus suppress the growth of bacterial and fungal pathogens. Probiotics effect the colonization of fungal pathogen Candida to host surfaces, suppress Candida growth and biofilm development in vitro. Clinical results have shown that some probiotics can reduce oral, vaginal, and enteric colonization of Candida, alleviate clinical signs and symptoms, and potentially reduce the incidence of invasive fungal infection. Therefore, probiotics may be potential antifungals for prevention and treatment of candidiasis.
Keywords
- probiotics
- mechanism of action
- antimicrobial activity
- candidiasis
- safety
1. Introduction
Probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host,” which was defined by the Food and Drug Organization of the United Nations (FAO) and World Health Organization (WHO) [1, 2, 3]. Probiotics should have some fundamental characteristics, such as human origin, nonpathogenic in nature, resistance to destruction by technical processing, acid and bile tolerances, adequate adherence and colonization on epithelial surfaces, antagonistic activity against pathogens, regulation of immune response, and influence human metabolic activities [4, 5, 6, 7].
Bacteria belonging to the genera
Genera | Species |
---|---|
Others |
It is noteworthy that health benefits of probiotic bacteria are strain specific, which cannot be generalized to other strains, not even the same species, although some properties may be common for different strains because of the similarities in the metabolism of ecological functionality [5, 6]. Thus, the selection of certain probiotics for therapeutic purposes should be targeted for specific pathogens. Probiotics effects are dose specific [5, 6]. It has been suggested that a daily intake of 106–109 colony-forming units (CFUs) of probiotic microorganisms is the minimum effective dose for therapeutic purposes [5, 6, 8].
A number of probiotics are currently commercially available, and they have been categorized into single-strain or multi-strain/multispecies products [7, 23, 24]. Multi-strain/multispecies probiotics exhibited better effects than single-strain probiotics. The multispecies probiotic consortium VSL#3 (
Among the most frequently used probiotics, the genera
In this chapter, we briefly review the mechanisms of action of probiotics, the safety concern of probiotics, and their potentials for prevention and treatment of diseases. Here, we discuss the application of probiotics in the fungal
2. Probiotics mechanism of action
Probiotics mechanism of action is with important differences among different species and strain, examples are listed in Table 2.
Mechanism of action | Probiotics | Study outcomes | References |
---|---|---|---|
Maintenance flora healthy by reduction the growth and colonization of pathogens | [26] | ||
Increased survival of mice infected by multidrug resistant | [27] | ||
Levels of beneficial organic acids significantly increased in the gut, and the incidences of infectious (pneumonia and bacteremia) complications were significantly lower in the probiotic group | [32] | ||
Synbiotic ( | Acetic acid concentration significantly increased (100 times), pH value decreased, Gram-negative rod (1/10) in the gut decreased, and | [33] | |
Multi-strain synbiotic for 7 days (RCT) | Synbiotic group had lower pathogenic bacteria (43% versus 75%) and multiple organisms (39% versus 75%) in nasogastric aspirates than controls | [34] | |
Probiotic group had great higher counts of | [35] | ||
Colonization of | [28] | ||
Enhancement of mucosal barrier integrity | Bacterial translocation in mesenteric lymph nodes and liver was reduced to 0 and 12%, respectively | [29] | |
Microencapsulated | Bacterial translocation to mesenteric lymph nodes was reduced by encapsulated | [30] | |
VSL#3 (RCT) | Decreased incidence of bacterial translocation in VSL#3 group than in water group (8% versus 50%; P = 0.03) | [31] | |
Immune modulation | VSL#3 ( | Reduced acute physiology and chronic health evaluation II score; reduced sequential organ failure assessment, IL-6, procalcitonin, and protein | [36] |
Late attenuating effect (after 15 days), serum IL-6 levels reduced | [37] |
2.1. Maintenance flora healthy by reduction the growth and colonization of pathogens
The ability of probiotics to establish in the gastrointestinal (GI) tract, maintain flora healthy, and reduce the growth of pathogens and colonization is enhanced by their ability to eliminate competitors. Probiotic strains release different antimicrobial molecules such as organic acids, hydrogen peroxide (Н2О2), and antimicrobial peptide bacteriocins into the intestinal environment to limit the growth of bacterial and fungal pathogens [6, 39, 40, 41, 42, 43].
Lactic acid and acetic acid are the main metabolites formed by lactic acid bacteria (LAB). Both lactic acid and acetic acid could result in acidity environment and thus inhibit the growth of various microorganisms. Acetic acid has a broader spectrum of antimicrobial activity when compared to lactic acid. Moreover, it is known that a synergistic effect exists between the two acids: mixtures of acetic and lactic acids suppress the growth of the pathogenic enteric bacterium
LAB can also produce Н2О2, the antimicrobial activity of which is linked to the strong oxidizing effect. Hydrogen peroxide showed a bactericidal effect on most pathogens when in combination with lactoperoxidase-thiocyanate milk system [45].
Bacteriocins are ribosomally synthesized antimicrobial peptides, which have broad spectrum of inhibitory effect against Gram-positive and Gram-negative bacteria, viruses, and fungi [47, 48, 49, 50].
2.2. Enhancement of mucosal barrier integrity
Probiotics have been shown to improve barrier function and the mechanisms of barrier function including alteration of tight junction protein expression and/or localization, induction of mucus secretion, increased production of cytoprotective molecules such as heat-shock proteins, inhibition of apoptosis of epithelial cells, and promoting cell survival [29, 55, 56]. They compete with pathogens and prevent their invasion through the epithelium by the ability of adherence to the intestinal epithelium and mucus.
Furthermore, butyrate, a short-chain fatty acid (SCFA), could reduce bacterial translocation, improve the organization of tight junctions, modulate intestinal motility in addition to being an energy source for colonocytes, and maintain the integrity of the intestinal epithelium [29, 30, 31, 58, 59, 60].
2.3. Immune modulation
Probiotics are reported to enhance phagocytic activity of granulocytes and cytokine excretion in lymphocytes, increase immunoglobulin-secreting cells, and attenuate inflammasome activation. They are able to affect cells involved in immune responses, including epithelial cells, dendritic cells (DCs), T cells, regulatory T (Treg) cells, monocytes/macrophages, immunoglobulin A (IgA)-producing B cells, and natural killer cells [62, 63].
Probiotic bacteria have an effect on intestinal DCs, which have the ability to recognize and respond to different bacteria by linking the innate immune system to the adaptive immune response and to develop T- and B-cell responses. Badia et al. found that the immunomodulatory role of
Probiotics also influence intestinal epithelial cells through interaction with Toll-like receptors (TLRs) and downregulate the expression of NF-κB and proinflammatory cytokines [67, 68]. This effect is supported by the following studies: the supernatant of probiotic
3. Probiotic as antifungals for prevention and treatment of candidiasis
3.1. In vitro evidences: probiotics in prevention/treatment of Candida infections
Several
Probiotics | Target pathogen | Study outcome | References |
---|---|---|---|
14 strains: | All probiotics inhibited the growth of | [81] | |
[87] | |||
High activity toward | [79] | ||
Strong inhibition of | [86] | ||
Significant inhibitory effect on biofilm formation and reduce viability of | [80] | ||
Visible inhibition zones of fungal | [77] | ||
Reduce growth of | [78] | ||
80 preterm neonates with a very low birth weight: probiotic reduced incidence and intensity of enteric colonization by | [28] | ||
276 elderly people: probiotic intervention reduced the risk of high yeast counts by 75% and the prevalence of hyposalivation (RCT) | [76] | ||
55 women: probiotics significant reduced vaginal discharge, itching, and/or burning vaginal feeling, dyspareunia, and/or dysuria, and reduced the presence of | [82] | ||
150 children (aged 3 month to 12 year) on broad-spectrum antibiotics for at least 48 h: probiotic therapy avoided a significant increase in the number of patients colonized by | [83] | ||
65 patients with | [84] | ||
112 preterm neonates (gestational age < 37 wk and birth weight < 2500 g): probiotics may reduce enteral fungal colonization and invasive fungal sepsis in low-birth-weight neonates (RCT) | [75] | ||
215 elderly people (aged 60–102 y): significant reduction of | [85] |
However, the mechanisms involved in antifungal activity of probiotics against
3.2. In vivo evidences: probiotics in prevention/treatment of Candida infections
The elderly are a group particularly susceptible to oral candidiasis, because of frequent usage of dentures, hyposalivation, and their weakened immune status. Researches by Hatakka et al. and Kraft-Bodi et al. have shown that the daily consumption of food with
For the urogenital tract, chronic vulvovaginal candidiasis (VVC) is the most common candidiasis disease and impacts the life quality of thousands of women around the world. Researches on the effect of probiotics in the treatment and prophylaxis of VVC have been performed [82]. Martinez et al., in an RCT involving 55 women, demonstrated that the administration of
For the GI tract,
Together, both the laboratory studies and clinical studies showed that probiotics could prevent
4. Safety of probiotics
Although most commercially available probiotic strains are generally regarded as safe and none of the clinical studies mentioned above were reported to have adverse effects directly related to probiotics, there are some concerns regarding the safety of probiotics, including potential of bacteremia and/or endocarditis occurrence, toxicity to the gastrointestinal tract, and transfer of antibiotic resistance [4].
4.1. Potential of bacteremia and/or endocarditis occurrence
Lactic acid bacteria, including
4.2. Toxicity to the gastrointestinal tract
The role of probiotics on gastrointestinal physiology suggests a theoretical possibility that the production of metabolites might be undesirable and also might lead to malabsorption due to deconjugation of bile salts. These might increase the risk of colon cancer; however, there is no epidemiologic or clinical evidence to support this hypothesis [94, 95].
4.3. Transfer of antibiotic resistance
Another major safety concern of theoretical importance is genetic transfer of antibiotic resistance from probiotic strains to pathogenic cells in the gastrointestinal tract [96, 97]. Plasmids with antibiotic-resistance genes, including genes encoding resistance to tetracycline, erythromycin, chloramphenicol, and macrolide-lincosamide-streptogramin, have been found in
With respect to the potential risks of probiotics, it is important to conduct population-based surveillance for safety concern.
5. Conclusions
Probiotics have the ability to restore the imbalance of intestinal microbiota and could act as both prophylactic and adjunctive therapy against candidiasis. Antifungal effect of probiotics is likely due to their interference with
Acknowledgments
This project was funded by the National Key Research and Development Program of China (2016YFD0400400), the National Science Foundation of China (31601449), the International Science and Technology Cooperation Program of China (2013DFA32330), the Natural Science Foundation of Zhejiang Province (LY16C200002), and the Food Science and Engineering—the most important discipline of Zhejiang Province (2017SIAR202).
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