Efficacy of daily intake of Lactobacillus casei Shirota on respiratory symptoms and influenza vaccination immune response: A randomized, double-blind, placebo-controlled trial in healthy elderly nursing home residents

Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 03/2012; 95(5):1165-71. DOI: 10.3945/ajcn.111.026831
Source: PubMed


Age is associated with immune dysregulation, which results in an increased infection rate and reduced effectiveness of vaccination.
We assessed whether an intervention with Lactobacillus casei Shirota (LcS) in elderly nursing home residents reduced their susceptibility to respiratory symptoms and improved their immune response to influenza vaccination.
Between October 2007 and April 2008, a randomized, double-blind, placebo-controlled trial was conducted in 737 healthy people aged ≥ 65 y in 53 nursing homes in Antwerp, Belgium. Volunteers were randomly assigned to receive a probiotic (n = 375; 2 bottles of fermented milk that contained ≥ 6.5 × 10(9) live LcS/bottle) or a placebo (n = 362; similar drink with no bacteria) for 176 d. After 21 d, all subjects received an influenza vaccination. Primary outcome parameters were the number of days with respiratory symptoms, the probability of respiratory symptoms, and antiinfluenza antibody titer by hemagglutination inhibition after vaccination.
Univariate and multivariate modeling showed no effect of the probiotic on clinical outcome parameters. Generalized linear mixed modeling showed no effect of the probiotic itself on the probability of respiratory symptoms [OR of probiotic: 0.8715; 95% CI: 0.6168, 1.2887). No significant difference regarding the influenza-vaccination immune response was shown.
The results of this study show that daily consumption of a fermented milk drink that contains LcS has no statistically or clinically significant effect on the protection against respiratory symptoms. This trial was registered at as NCT00849277.

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    • "Mañé et al. [23] showed significant trends in reducing infection incidence and mortality due to pneumonia in institutionalized elderly subjects treated with two Lactobacillus plantarum strains. Some trials showed that Lactobacillus and Bifidobacterium probiotics could increase influenza vaccination immune responses in the elderly24252627. Endospore formers such as Bacillus species are interesting because their spores resist the acid barrier of the stomach and are stable for long periods in commercial food products [28]. "
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    • "This is connected to the fact that the gut (or its associated lymphoid system, GALT) is the largest immunologically competent organ in the human body (de Vrese & Marteau, 2007;Eizaguirre et al., 2002). Probiotics are believed to positively influence the immune function (Ashraf, Vasiljevic, Day, Smith, & Donkor, 2014;Herrera, Salva, Villena, Barbieri, & Alvarez, 2013;Kim et al., 2015), and several studies reported immunomodulatory activity associated with LcS (Hori, Kiyoshima, Shida, & Yasui, 2001Matsuzaki, 1998;Nagao, Nakayama, Muto, & Okumura, 2000;Van Puyenbroeck et al., 2012). LcS is able to promote the innate immunity by increasing NK cell activity, and improves inflammatory status by an increasing IL-10/IL-12 ratio. "
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