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Synbiotic therapy decreases microbial translocation and inflammation and improves immunological status in HIV-infected patients: a double-blind randomized controlled pilot trial.
González-Hernández, LA, Jave-Suarez, LF, Fafutis-Morris, M, Montes-Salcedo, KE, Valle-Gutierrez, LG, Campos-Loza, AE, Enciso-Gómez, LF, Andrade-Villanueva, JF
Nutrition journal. 2012;11:90
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Plain language summary
HIV causes gastrointestinal dysfunction and microbial translocation that can provoke local and systemic inflammation that may lead to disease progression. Inflammation and intestinal permeability increase and the reduction in immune defences creates the opportunity for microbial overgrowth and raised lipopolysaccharides levels, which may lead to disease progression. HIV-infected patients also tend to have low levels of beneficial bacteria. Probiotics have the potential to stimulate the immune system through IgA secretion and reduce inflammation. Prebiotics selectively stimulate the growth of some bacteria, altering the composition and metabolic activity of gut microbiota. This randomized, prospective, double-blind controlled pilot study evaluates use of probiotics and prebiotic to expand beneficial microbiota that help decrease bacterial translocation and pro-inflammatory cytokine production, thereby improving immune functions in HIV-infected subjects. 20 HIV-infected adult patients were divided into four groups (n=5 per group) to receive probiotics, synbiotic, a prebiotic, or placebo once daily for 16 weeks. Probiotics used were Lactobacillus rhamnosus plus Bifidobacterium lactis. From baseline to week 16, the synbiotic group showed a reduction in bacterial DNA concentrations in plasma. The probiotic and synbiotic groups demonstrated a decrease in total bacterial load in feces. The probiotic group showed a significant increase in beneficial bacteria load (such as Bifidobacterium and a decrease in harmful bacteria load (such as Clostridium). The synbiotic group had greater increases in CD4+ T-cell count and cytokine levels (IL-6) decreased significantly. Serious adverse effects previously reported with the use of probiotics in immunocompromised patients were not reported in this study. The authors found no decrease in HIV-1 plasma viral load so the use of a synbiotic for maintaining an undetectable viral load as part of the primary prevention of HIV transmission is not justified.
Abstract
BACKGROUND HIV-infection results in damage and dysfunction of the gastrointestinal system. HIV enteropathy includes pronounced CD4+ T-cell loss, increased intestinal permeability, and microbial translocation that promotes systemic immune activation, which is implicated in disease progression. A synbiotic is the combination of probiotics and prebiotics that could improve gut barrier function. Our study goal was to determine whether the use of a synbiotic, probiotics or a prebiotic can recover immunological parameters in HIV-infected subjects through of a reduction of microbial translocation and pro-inflammatory cytokine production. METHODS A randomized, double-blind controlled study was performed; twenty Antiretroviral treatment-naïve HIV-infected subjects were subgrouped and assigned to receive a synbiotic, probiotics, a prebiotic, or a placebo throughout 16 weeks. RESULTS We had no reports of serious adverse-events. From baseline to week 16, the synbiotic group showed a reduction in bacterial DNA concentrations in plasma (p = 0.048). Moreover, the probiotic and synbiotic groups demonstrated a decrease in total bacterial load in feces (p = 0.05). The probiotic group exhibited a significant increment of beneficial bacteria load (such as Bifidobacterium; p = 0.05) and a decrease in harmful bacteria load (such as Clostridium; p = 0.063). In the synbiotic group, the CD4+ T-cells count increased (median: +102 cells/μL; p = 0.05) and the level of Interleukin 6 cytokine decreased significantly (p = 0.016). CONCLUSIONS Our study showed a significant increase in CD4+ T lymphocyte levels in the synbiotic group, which could delay the initiation of antiretroviral therapy and decrease costs in countries with limited resources.
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Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double-blind cross-over diet intervention study.
Bentz, S, Hausmann, M, Piberger, H, Kellermeier, S, Paul, S, Held, L, Falk, W, Obermeier, F, Fried, M, Schölmerich, J, et al
Digestion. 2010;81(4):252-64
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Environmental factors are thought to play a part in the development of or exacerbation of symptoms in Crohn's disease (CD), and patients often implicate food as a contributing factor. Immunoglobulin E (IgE) food reactions can be rare in IBD and immunoglobulin G (IgG) testing can be controversial, this study set out to compare IgG antibody reactions in 79 CD patients and 20 healthy individuals. The pilot study measured IgG levels against 271 foods in the blood. It then went on to measure stool frequency, abdominal pain and general well-being following a 6 week specific elimination diet (based on foods identified by the IgG testing) or a 6 week sham diet. 23 participants were included in the follow on 12 week, cross-over double blinded study. Eosinophil-derived neurotoxin (EDN) in stool was also measured to evaluate disease activity. The pilot study showed a significantly higher IgG reaction in the CD patients. In the follow-up study there was a decrease in stool frequency, abdominal pain and general well-being during the specific diet compared to the sham diet. EDN was found to decrease in both the specific and sham diet. It was concluded that IgG antibodies may contribute to CD but the mechanism is still not clear.
Abstract
BACKGROUND Environmental factors are thought to play an important role in the development of Crohn's disease (CD). Immune responses against auto-antigens or food antigens may be a reason for the perpetuation of inflammation. METHODS In a pilot study, 79 CD patients and 20 healthy controls were examined for food immunoglobulin G (IgG). Thereafter, the clinical relevance of these food IgG antibodies was assessed in a double-blind cross-over study with 40 patients. Based on the IgG antibodies, a nutritional intervention was planned. The interferon (IFN)gamma secretion of T cells was measured. Eosinophil-derived neurotoxin was quantified in stool. RESULTS The pilot study resulted in a significant difference of IgG antibodies in serum between CD patients and healthy controls. In 84 and 83% of the patients, respectively, IgG antibodies against processed cheese and yeast were detected. The daily stool frequency significantly decreased by 11% during a specific diet compared with a sham diet. Abdominal pain reduced and general well-being improved. IFNgamma secretion of T cells increased. No difference for eosinophil-derived neurotoxin in stool was detected. CONCLUSION A nutritional intervention based on circulating IgG antibodies against food antigens showed effects with respect to stool frequency. The mechanisms by which IgG antibodies might contribute to disease activity remain to be elucidated.