Article

Probiotics to young children with atopic dermatitis: A randomized placebo-controlled trial

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Abstract

Impairment of the intestinal mucosal barrier is involved in the pathogenesis of atopic dermatitis (AD), and studies suggest that probiotics stabilize the intestinal barrier function and decrease gastrointestinal symptoms in children with AD. The purpose of this study was to evaluate the clinical and immunobgical changes of AD after consumption of the probiotic strains Lactobacillus acidophilus NCFM and Bifidobacterium animalis subsp. lactis Bi-07. Double-blind randomized placebo-controlled intervention study. Fifty children (mean age 18 months) with AD received NCFM (10 10 CFU/day), Bi-07 (10 10 CFU/day) or placebo for 8 weeks. The immunological activity and clinical effect was evaluated by IgE, ECP, IL-10, IFN-γ, IL-31, faecal calprotectin and SCORAD index. There were no overall beneficial effects of the probiotic strains on the degree of AD measured by SCORAD index. However, a post hoc analysis showed a significant reduction in severity of AD in the Bi-07 group and together with the decreasing leveh of IFN-γ and IL-10 possible beneficial effects of this probiotic strain could be of interest. There was no effect on inflammatory markers or faecal calprotectin. The significant correlation between ECP and SCORAD index suggest the use of ECP as a measure of the degree of AD in children.

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... All 18 interventional studies were randomized (39-56), 10 were double-blinded (39,42,44,45,47,48,50,53,54,56), and one study was open-label (41) ( Table II). ...
... There was a total of 2,802 participants, of whom 2,560 were children (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) and 242 adults (50)(51)(52)(53)(54)(55)(56). The study populations varied with regard to the baseline severity of eczema (mild-to-severe), age (newborns, children and adults), age at faecal sampling, and duration of follow-up (4-16 weeks). ...
... A total of 15 studies, which included both children and adults with AD, aimed to investigate the efficacy of probiotics on the severity of AD compared with placebo (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56). In 8 studies, oral probiotic supplement was superior to placebo and resulted in a significant reduction in the severity of AD (45-47, 49, 53-56). ...
Article
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The immune mechanisms involved in atopic dermatitis (AD) are complex and little is known about the possible role of the gut microbiota in the aetiopathogenesis of AD. A systematic review of the literature was performed according to PRISMA guidelines, and included 44 of 2,199 studies (26 observational and 18 interventional studies). Detection of gut microbiota was performed by either 16s rRNA PCR, or by culture. Observational studies were diverse regarding the age of study participants and the bacterial species investigated. Overall, the results were conflicting with regard to diversity of the gut microbiota, specific bacterial colonization, and subsequent risk of AD. Nearly half of the included interventional studies showed that an altered gut microbial colonization due to use of probiotics had a positive effect on the severity of AD. The remaining studies did not show an effect of probiotics on the severity of AD despite an alteration in the gut microbial composition. The role of the gut microbiome for the onset and severity of pre-existing AD remains controversial.
... Previous studies have demonstrated that L. acidophilus NCFM and B. lactis HN019 improved metabolic health in patients with diabetes and metabolic syndrome [29,30]. Besides, intake of B. lactis Bi-07 alone could reduce the severity of atopic dermatitis [31]; when combined with L. acidophilus NCFM, the mixture helped relieving bloating symptoms [12]. Nevertheless, studies demonstrating their potential applicability in supporting hair and skin health are very limited. ...
... Eligible subjects included males and females aged [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] years, self-reported of hair loss and oily scalp, had impaired fasting blood glucose (6.1-6.9 mmol/L) [32] and borderline total cholesterol (5.2-6.1 mmol/L) [33], and experienced moderate or higher stress (score≥29) evaluated by the Perceived Stress Scale (PSS) [34]. ...
Article
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Objective: We conducted this study to explore the effect of oral probiotic supplementation on hair density as a primary outcome in subjects with hair loss and at high risk of metabolic syndrome. The secondary objectives were to assess probiotic effects on skin barrier function,metabolic health and stress responses.Methods: We supplemented the diets of Chinese adults presenting with hair loss and high risk of metabolic syndrome (n = 26, male gender 38.5%, age = 33.6 ± 4.5 years) with a multi-strain probiotic formula at a dosage of 18.1 billion colony forming units (CFU) twice daily for 12 weeks. We compared the hair density, hair loss, anthropometrics measures, blood biochemistry markers, skin biophysical characteristics and stress-associated responses between baseline and the end of the trial.Results: After 12 weeks of probiotic supplementation, 96.2% of the study participants had improvement in hair density (median density level increased: 1; interquartile range: 1-2). Participants reported reduced hair loss both quantitatively and qualitatively. The majority (73.1%) of the participants reported apparent relief of scalp itching. Stratum corneum hydration and pH increased, while transepidermal water loss and sebum decreased on both scalp and facial skin. Body weight and body mass index decreased following probiotic consumption. Most components of glucose metabolism and the lipid profile were significantly better, with increases in high-density lipoprotein cholesterol and reductions in glucose, homeostasis model assessment-estimated insulin resistance, total cholesterol, non-high-density lipoprotein cholesterol and triglycerides. Inflammation and oxidative stress markers improved with increases in interferon-γ and superoxide dismutase, and reductions in high-sensitivity C-reactive protein, interleukin-6, interleukin-31 and malondialdehyde. No changes were observed in glycated hemoglobin, insulin, immunoglobulin E and interleukin-10 levels. Besides, perceived stress relieved in participants accompanied with improved sleep quality as well as better overall perception of life quality and health.Conclusion: Twice-daily supplementation with the test probiotic formula over a 12-weeks period may exert profound beneficial effects on hair growth, skin condition, glucose and lipid metabolism, and stress-associated psychological and physiological responses in participants presenting with hair loss and high risk of metabolic syndrome. This study has been registered at Chinese Clinical Trial Registry (ChiCTR2100050498).Keywords: hair density, hair loss, metabolic syndrome, oral probiotic supplementation
... Three trials studied using different types of bacterial strain probiotics on either of the subjects' arms. 24,29,36 The different types of probiotic strain groups were analyzed separately in this subgroup analysis. The mixture of different bacterial species showed the greatest effect on decreasing the SCORAD value (WMD À6.60, 95% CI À10.42 to À2.79, P < .001). ...
... However, the amount of topical agent used was different in each study. For example, several studies included subjects who were allowed to use emolients, 14,16,28,30,32,36,38 topical steroids, 14,16,23e25,31,35,38 or even topical calcineurins 15 during their intervention with probiotics. 15,21,22,30,31,35,38 Ten trials reported the use of topical steroids in subjects during the intervention period. ...
Article
Background The effects of probiotics on the treatment of atopic dermatitis (AD) are inconclusive. Objective To determine the clinical effect of probiotics in the management of AD overall and in different age groups. Methods A comprehensive search of databases through December 2013 was performed. For this meta-analysis, randomized controlled trials measuring the treatment effects of probiotics or synbiotics in patients diagnosed with AD were included. The primary outcome was a difference in Scoring of Atopic Dermatitis (SCORAD) values between the treatment and placebo groups overall and in different age populations. Results Twenty-five randomized controlled trials (n = 1,599) were available for this meta-analysis. Significant differences in SCORAD values favoring probiotics over the control were observed overall (mean −4.51, 95% confidence interval −6.78 to −2.24), in children 1 to 18 years old (−5.74, 95% confidence interval −7.27 to −4.20), and in adults (−8.26, 95% confidence interval −13.28 to −3.25). However, the effectiveness of probiotics in infants (<1 year old) with AD was not proved. The effect of synbiotic use was not significantly different from that of probiotic use. Treatment with a mixture of different bacterial species or of Lactobacillus species showed greater benefit than did treatment with Bifidobacterium species alone. Conclusion The overall result of this meta-analysis suggests that probiotics could be an option for the treatment of AD, especially for moderate to severe AD in children and adults. However, no evidence was found supporting the beneficial role of probiotics in infants.
... Bb-12, Lactobacillus strain GG 8 semanas Se produjo una mejora significativa en la condición de la piel en pacientes que recibieron fórmulas suplementadas con probióticos, en comparación con el grupo no suplementado 20 Viljanen et al. 23 dosis de probióticos, la duración distinta de los tratamientos y la subjetividad de la escala SCORAD para evaluar la gravedad de la DA. Dada la heterogeneidad de las características de las poblaciones entre los diferentes estudios, el análisis por subgrupos no refleja resultados potencialmente reales, salvo por el seguimiento, en cuyo caso se estableció que la eficacia del uso de probióticos se observa tras su administración por más de 12 semanas. ...
Article
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Background and objective Probiotics, defined as live microbial dietary supplements that provide health benefits for the host, have been suggested as a treatment for atopic dermatitis based on a variety of proposed mechanisms of action. We analyzed evidence for the efficacy of probiotics to attenuate the severity of atopic dermatitis in pediatric patients younger than the age of 18 years. Material and methods Systematic review of trials of probiotics that included patients under the age of 18 years with a confirmed diagnosis of atopic dermatitis scored for severity using the Scoring Atopic Dermatitis SCORAD) tool. We performed a meta-analysis of the randomized placebo controlled trials. The following databases were searched: MEDLINE, Web of Science, Scopus, ClinicalTrials.gov, Epistemonikos, Trip Medical Database, and the Spanish Virtual Health Library. Results Twenty trials were retrieved and included in the systematic review. Sixteen supported the use of probiotics to attenuate SCORAD-evaluated severity. Meta-analysis found an overall mean difference in effect between probiotics and placebo of −0.38 (95% CI, −0.63 to −0.14) in favor of probiotics. However, trial heterogeneity was high (I² statistic, 76%) due to clinical and methodological variability. Conclusion In spite of clinical heterogeneity in trials attributable to different types of probiotic products and doses, and to the subjective variability of the SCORAD scale, we conclude that probiotics are beneficial for reducing the severity of atopic dermatitis as reflected by the SCORAD index.
... The results of the study by Gøbel et al. study on L. acidophilus and B. lactis Bi-07 (Bi-07) were that there was no benefit for the probiotics on the severity of AD. However, a post hoc analysis showed a significant reduction in severity of AD in the Bi-07 group and possible positive effects of this probiotic strain could be of further interest [68]. Gore et al. in their trial compared the effects of using B. lactis and L. paracasei. ...
Article
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There is a growing quantity of evidence on how skin and gut microbiome composition impacts the course of various dermatological diseases. The strategies involving the modulation of bacterial composition are increasingly in the focus of research attention. The aim of the present review was to analyze the literature available in PubMed (MEDLINE) and EMBASE databases on the topic of microbiome modulation in skin diseases. The effects and possible mechanisms of action of probiotics, prebiotics and synbiotics in dermatological conditions including atopic dermatitis (AD), psoriasis, chronic ulcers, seborrheic dermatitis, burns and acne were analyzed. Due to the very limited number of studies available regarding the topic of microbiome modulation in all skin diseases except for AD, the authors decided to also include case reports and original studies concerning oral administration and topical application of the pro-, pre- and synbiotics in the final analysis. The evaluated studies mostly reported significant health benefits to the patients or show promising results in animal or ex vivo studies. However, due to a limited amount of research and unambiguous results, the topic of microbiome modulation as a therapeutic approach in skin diseases still warrants further investigation.
... 247 Gøbel et al expressed that the consumption of probiotics decreased the levels of IFN-γ and IL-10 leading to the beneficial effects of probiotics in young children experiencing atopic dermatitis. 248 A metaanalysis suggests that probiotics may be an option for the treatment of atopic dermatitis including moderate to severe atopic dermatitis in the children and adults. 249 Another meta-analysis also exhibits that probiotics have a protective role in the pre and postnatal period in all risky population. ...
Article
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Probiotics are beneficial bacteria living in the microbiota ecosystem of the human body playing particular important roles in human health. The increasing rate of various diseases and the studies about the balance of gut microbiome made scientists trying to find novel therapies in this regard and hypothesize the relationships between the imbalance of gut microbiome and spread of various diseases especially in the immune system. Previous studies have indicated that when administrated in specific amounts, probiotics exert beneficial properties for human health such as antibacterial effects, cytotoxic effects, Hypocholesterolemic effects, immunomodulatory effects, wound healing effects etc. Probiotics also are known to produce nourishing healthy supplements for the human body such as vitamin K and B as well as healthy fatty acids. In this regard summarization of scientific evidence may help to familiarize the scientists with this novel area of research helping to find effective therapies for various disease. In this study, we used published literature in scientific databases such as Web of Science, Cochrane Library, Medline, PubMed, Science Direct, Scopus, as well as Google Scholar for data collection. So, the present review describes scientific-based evidence about probiotics and some of their beneficial effects to highlight the path for further researches about these beneficial bacteria.
... (Reprinted) JAMA Dermatology Published online November 8, 2017 E5 mented in the probiotic group was greater than that obtained with other probiotics tested in a previous placebo-controlled clinical trial. [32][33][34][35][36][37][38][39][40][41][42][43] This study showed better response in SCO- RAD (83% relative reduction) than previously communicated results by Farid et al 44 (68% of response), Iemoli et al 45 (63%), or Yeşilova et al (64%). 46 Several factors may influence the re- sponse to probiotic treatment in AD, and they were taken into account when the protocol of this clinical study was de- signed: treatment longer than 8 weeks might condition the positive effect of probiotic use, 47 patients older than 1 year have a greater response to probiotics, 35,36,38,47 patients with mod- erate to severe AD have a better response, 20 and a mixture of probiotics has better beneficial effects than a single probi- otic, especially when lactobacilli and bifidobacteria are in- cluded in the mixture. ...
Conference Paper
El tratamiento oral con una mezcla de probióticos reduce el índice SCORAD y el uso de corticoides tópicos en pacientes jóvenes con dermatitis atópica. Ensayo clínico randomizado (Accesit: mejor comunicación oral en investigación biomedical) Vicente Navarro-López MD1,2*; Ana Ramírez-Boscá MD2,3; Daniel Ramón-Vidal PhD4,5; Beatriz Ruzafa-Costas MD2; Salvador Genovés-Martínez BTech5; Empar Chenoll-Cuadros PhD5; Miguel Carrión-Gutiérrez PhD6; José Manuel Pérez-Orquín MD7; José Horga de la Parte MD8 ; Francisco M. Codoñer-Cortés PhD4. 1Clinical Microbiology and Infectious Disease and Microbiology Unit, Hospital Universitario Vinalopó, Elche, Spain. 2Department of Clinical Medicine, Universidad Católica San Antonio de Murcia (UCAM), Spain. 3Department of Dermatology, Hospital Universitario Vinalopó, Elche, Spain. 4Lifesequencing S.L., Catedrático Agustín Escardino Benlloch 9 Edif 2, 46980 Paterna, Valencia, Spain. 5Biopolis S.L., Catedrático Agustín Escardino Benlloch 9 Edif 2, 46980 Paterna, Valencia, Spain. 6Especialidades Farmacéuticas Centrum, Alicante, Spain. 7Korott S.L., Carrer Filà Benimerines, 61, 03801 Alcoi, Alicante, Spain. 8Department of Pharmacology, Pediatrics and Organic Chemistry, Universidad Miguel Hernández de Elche, Alicante, Spain. Objetivo: Determinar la eficacia y seguridad del tratamiento sistémico con un probiótico en la evolución de la dermatitis atópica y su influencia en el uso de corticoides tópicos. Método: Ensayo clínico randomizado doble ciego controlado con placebo de 12 semanas de duración. Criterios de inclusión: diagnóstico de dermatitis atópica, edad entre 4-17 años y actividad moderada de la enfermedad. Criterios de exclusión: tratamiento con inmunosupresores los tres meses previos, antibióticos en dos semanas previas, enfermedad inflamatoria intestinal o signos infección activa. Pacientes estratificados por bloques de acuerdo a las variables edad, el género y la edad de debut de la dermatitis atópica y randomizados para asignar tratamiento (placebo vs probiótico). La intervención consistió en la administración de una cápsula diaria que contenía 109 cfu de los probióticos Bifidobacterium lactis CECT 8145, Bifidobacterium longum CECT 7347 and Lactobacillus casei CECT 9104. El grupo placebo se trató con una cápsula de la misma apariencia conteniendo maltodextrina. La variable principal fue el índice SCORAD y la secundaria el número de días de uso de corticoides. Se analizó mediante secuenciación masiva la microbiota intestinal y los marcadores de inflamación sistémica sanguínea. Resultados: El SCORAD disminuyó un 75% en el grupo probiótico y 22.70% en el grupo placebo (p<0.001). Las tres variables del SCORAD (intensidad, extensión del eccema y síntomas subjetivos) mejoraron con significación estadística en el grupo probiótico. El uso tópico de esteroides fue menor en el grupo probiótico (2.88±6.5 vs 0.42± 2.04; p=0.03). La microbiota en heces en el grupo probiótico tras tratamiento mostró aumento de Bacteroides, Ruminococcus y Bifidobacterium y disminución de la concentración de Faecalibacterium al comparar con el grupo placebo. Conclusiones: El probiótico estudiado mejoró el indice de SCORAD y redujo el consumo de corticoides tópicos en pacientes jóvenes con dermatitis atópica moderada.
... (Reprinted) JAMA Dermatology Published online November 8, 2017 E5 mented in the probiotic group was greater than that obtained with other probiotics tested in a previous placebo-controlled clinical trial. [32][33][34][35][36][37][38][39][40][41][42][43] This study showed better response in SCO- RAD (83% relative reduction) than previously communicated results by Farid et al 44 (68% of response), Iemoli et al 45 (63%), or Yeşilova et al (64%). 46 Several factors may influence the re- sponse to probiotic treatment in AD, and they were taken into account when the protocol of this clinical study was de- signed: treatment longer than 8 weeks might condition the positive effect of probiotic use, 47 patients older than 1 year have a greater response to probiotics, 35,36,38,47 patients with mod- erate to severe AD have a better response, 20 and a mixture of probiotics has better beneficial effects than a single probi- otic, especially when lactobacilli and bifidobacteria are in- cluded in the mixture. ...
Article
Importance Oral intake of new probiotic formulations may improve the course of atopic dermatitis (AD) in a young population. Objective To determine whether a mixture of oral probiotics is safe and effective in the treatment of AD symptoms and to evaluate its influence on the use of topical steroids in a young population. Design, Setting, and Participants A 12-week randomized, double-blind, placebo-controlled intervention trial, from March to June 2016, at the outpatient hospital Centro Dermatológico Estético de Alicante, Alicante, Spain. Observers were blinded to patient groupings. Participants were children aged 4 to 17 years with moderate atopic dermatitis. The groups were stratified and block randomized according to sex, age, and age of onset. Patients were ineligible if they had used systemic immunosuppressive drugs in the previous 3 months or antibiotics in the previous 2 weeks or had a concomitant diagnosis of intestinal bowel disease or signs of bacterial infection. Interventions Twelve weeks with a daily capsule containing freeze-dried powder with 10⁹ total colony-forming units of the probiotic strains Bifidobacterium lactis CECT 8145, B longum CECT 7347, and Lactobacillus casei CECT 9104 and maltodextrin as a carrier, or placebo (maltodextrin-only capsules). Main Outcomes and Measures SCORAD index score and days of topical steroid use were analyzed. Results Fifty children (26 [50%] female; mean [SD] age, 9.2 [3.7] years) participated. After 12 weeks of follow-up, the mean reduction in the SCORAD index in the probiotic group was 19.2 points greater than in the control group (mean difference, −19.2; 95% CI, −15.0 to −23.4). In relative terms, we observed a change of −83% (95% CI, −95% to −70%) in the probiotic group and −24% (95% CI, −36% to −11%) in the placebo group (P < .001). We found a significant reduction in the use of topical steroids to treat flares in the probiotic arm (161 of 2084 patient-days [7.7%]) compared with the control arm (220 of 2032 patient-days [10.8%]; odds ratio, 0.63; 95% CI, 0.51 to 0.78). Conclusions and Relevance The mixture of probiotics was effective in reducing SCORAD index and reducing the use of topical steroids in patients with moderate AD. Trial Registration clinicaltrials.gov Identifier: NCT02585986
... Significantly reduction eczema in high-risk for a minimum of 2 years provided that the probiotic was administered to the infant within 3 months of birth. [123] 50 children with AD B. animalis subsp lactis 8 weeks Significant reduction in the severity of AD with an improved ration of IFN-γ and IL-10. ...
Article
Full-text available
The human gastrointestinal tract is colonised by a complex ecosystem of microorganisms. Intestinal bacteria are not only commensal, but they also undergo a synbiotic co-evolution along with their host. Beneficial intestinal bacteria have numerous and important functions, e.g., they produce various nutrients for their host, prevent infections caused by intestinal pathogens, and modulate a normal immunological response. Therefore, modification of the intestinal microbiota in order to achieve, restore, and maintain favourable balance in the ecosystem, and the activity of microorganisms present in the gastrointestinal tract is necessary for the improved health condition of the host. The introduction of probiotics, prebiotics, or synbiotics into human diet is favourable for the intestinal microbiota. They may be consumed in the form of raw vegetables and fruit, fermented pickles, or dairy products. Another source may be pharmaceutical formulas and functional food. This paper provides a review of available information and summarises the current knowledge on the effects of probiotics, prebiotics, and synbiotics on human health. The mechanism of beneficial action of those substances is discussed, and verified study results proving their efficacy in human nutrition are presented.
... A double blind, randomized, placebo-controlled intervention in children with atopic dermatitis (AD) using Danisco's probiotic strain Bifidobacterium animalis subsp lactis. Bi-07 showed that there was a significant reduction in the severity of AD with an improved ration of IFN-γ and IL-10 [38]. d) Hypocholesterolemic and Hypotensive Effects-In vitro studies conducted previously have evaluated a number of mechanisms proposed for the cholesterol-lowering effects of probiotics and prebiotics. ...
... The probiotic strains Lactobacillus acidophilus [11] and Bifidobacterium animalis subsp. Lactis Bi-07 stabilize the intestinal barrier function and decreased gastrointestinal symptoms in children [39]. Lactobacillus casei DN-114 001 is another probiotic strain that survives and reinforced the intestinal barrier function by inhibiting the increase in enteropathogenic Escherichia coli-induced paracellular permeability [40] [41]. ...
Article
The objective of the present work is to test the effectiveness of probiotic potency of regular yoghurt, synbiotic yoghurt and traditional fermented Egyptian sobya containing endogenous probiotic strains compared to unfermented rice milk porridge. Methods: The study consisted of 28 male subjects with mean age of 13.9 ± 0.1 years. The subjects were divided into four groups, three groups consumed one of three fermented supplements, while the fourth group served as a control group. Stool and urinary samples were carried out prefeeding and after 3-week nutritional intervention for assessing five indicators of revelance to colonic metabolic activities. The fermented supplements used for evaluation were regular yoghurt, synbiotic yoghurt and traditional fermented sobya; while the fourth group was given unfermented rice milk and served as control. Intestinal permeability was assessed by the urinary lactulose mannitol ratio. Results: The mean fecal total lactobacilli counts increased (P < 0.05) three weeks after daily consumption of the three fermented supplements (P < 0.05), when compared to the pre-intervention levels. Similar trends were observed for genus bifidobacterium. On the contrary, enterobacteraceae counts were reduced in all the three groups consuming fermented supplements. The three-week dietary interventions with regular yogurt or sobya significantly reduced the lactulose/manitol (L/M) ratios (P < 0.05). The mean urinary anti-oxidative activities increased only among subjects consuming synbiotic yogurt for three weeks, compared to pre-intervention period (P < 0.05). Similar trend was found after consumption of fermented sobya, but the increase didn’t attain significant level (P > 0.05). Mean fecal short chain fatty acids concentrations (acetic; propionic and butyric) tended to increase following the intervention with synbiotic yogurt or sobya compared to respective pre-intervention values; but the difference didn’t attain significance (0.1 > P > 0.05). The 3-week nutritional intervention didn’t impact the activities of the fecal hydrolytic enzymes. Conclusion: Nutritional intervention with regular yoghurt, synbiotic yoghurt or traditional fermented sobya improved the balance of human resident microbiota and other GI tract-associated health parameters to variable degrees.
... The genome of NCFM contains genes involved in acid and bile tolerance as well as adhesion (Altermann et al., 2005) and in vitro investigations confirm survival of NCFM during passage of the gastrointestinal tract and that duodenal digestion upregulates genes involved in adhesion (Weiss & Jespersen, 2010). NCFM has been shown to adhere to intestinal cells (Sanders & Klaenhammer, 2001) and several human studies report intake of NCFM to increase L. acidophilus cell numbers in fecal samples (Ouwehand et al., 2009;Gøbel et al., 2010;Larsen et al., 2011). However, in the present study, intake of synbiotic resulted in increase in NCFM numbers in only three of the 16 volunteers (data not shown). ...
Article
Probiotics, prebiotics, and combinations thereof, that is synbiotics, have been reported to modulate gut microbiota of humans. In this study, effects of a novel synbiotic on the composition and metabolic activity of human gut microbiota were investigated. Healthy volunteers (n = 18) were enrolled in a double-blinded, randomized, and placebo-controlled cross-over study and received synbiotic [Lactobacillus acidophilus NCFM (10⁹ CFU) and cellobiose (5 g)] or placebo daily for 3 weeks. Fecal samples were collected and lactobacilli numbers were quantified by qPCR. Furthermore, 454 tag-encoded amplicon pyrosequencing was used to monitor the effect of synbiotic on the composition of the microbiota. The synbiotic increased levels of Lactobacillus spp. and relative abundances of the genera Bifidobacterium, Collinsella, and Eubacterium while the genus Dialister was decreased (P < 0.05). No other effects were found on microbiota composition. Remarkably, however, the synbiotic increased concentrations of branched-chain fatty acids, measured by gas chromatography, while short-chain fatty acids were not affected. Synbiotic effect on human gut microbiota diversity and metabolic activity. Synbiotic effect on human gut microbiota diversity and metabolic activity.
... Moreover the probiotic strain Bifidobacterium animalis subsp. lactis Bi-07 has been reported to reduce the severity of atopic dermatitis as compared to before probiotic treatment, however no difference was observed between probiotic and placebo treatment [21]. Perinatal exposure to L. rhamnosus GG showed a tendency of restraining excessive weight gain during the first years of life [22] and L. acidophilus NCFM preserved insulin sensitivity in type 2 diabetics as compared to placebo, however inflammatory markers and systemic inflammatory response were unaffected [23]. ...
Article
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Prebiotics, probiotics and synbiotics can be used to modulate both the composition and activity of the gut microbiota and thereby potentially affecting host health beneficially. The aim of this study was to investigate the effects of eight synbiotic combinations on the composition and activity of human fecal microbiota using a four-stage semicontinuous model system of the human colon. Carbohydrates were selected by their ability to enhance growth of the probiotic bacteria Lactobacillus acidophilus NCFM (NCFM) and Bifidobacterium animalis subsp. lactis Bl-04 (Bl-04) under laboratory conditions. The most effective carbohydrates for each probiotic were further investigated, using the colonic model, for the ability to support growth of the probiotic bacteria, influence the composition of the microbiota and stimulate formation of short-chain fatty acids (SCFA).The following combinations were studied: NCFM with isomaltulose, cellobiose, raffinose and an oat β-glucan hydrolysate (OBGH) and Bl-04 with melibiose, xylobiose, raffinose and maltotriose. All carbohydrates showed capable of increasing levels of NCFM and Bl-04 during fermentations in the colonic model by 10(3)-10(4) fold and 10-10(2) fold, respectively. Also the synbiotic combinations decreased the modified ratio of Bacteroidetes/Firmicutes (calculated using qPCR results for Bacteroides-Prevotella-Porphyromonas group, Clostridium perfringens cluster I, Clostridium coccoides - Eubacterium rectale group and Clostridial cluster XIV) as well as significantly increasing SCFA levels, especially acetic and butyric acid, by three to eight fold, as compared to the controls. The decreases in the modified ratio of Bacteroidetes/Firmicutes were found to be correlated to increases in acetic and butyric acid (p = 0.04 and p = 0.03, respectively). The results of this study show that all synbiotic combinations investigated are able to shift the predominant bacteria and the production of SCFA of fecal microbiota in a model system of the human colon, thereby potentially being able to manipulate the microbiota in a way connected to human health.
... A double blind, randomized, and placebo-controlled intervention in children with atopic dermatitis (AD) using Danisco's probiotic strain Bifidobacterium animalis subsp lactis. Bi-07 showed that there was a significant reduction in the severity of AD with an improved ration of IFN-γ and IL-10 [72]. Other studies also indicate that the consumption of dietary supplements or foods containing probiotics can stabilize the intestinal barrier function and decrease gastrointestinal inflammation in children with AD [73]. ...
Article
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The human intestinal tract has been colonized by thousands of species of bacteria during the coevolution of man and microbes. Gut-borne microbes outnumber the total number of body tissue cells by a factor of ten. Recent metagenomic analysis of the human gut microbiota has revealed the presence of some 3.3 million genes, as compared to the mere 23 thousand genes present in the cells of the tissues in the entire human body. Evidence for various beneficial roles of the intestinal microbiota in human health and disease is expanding rapidly. Perturbation of the intestinal microbiota may lead to chronic diseases such as autoimmune diseases, colon cancers, gastric ulcers, cardiovascular disease, functional bowel diseases, and obesity. Restoration of the gut microbiota may be difficult to accomplish, but the use of probiotics has led to promising results in a large number of well-designed (clinical) studies. Microbiomics has spurred a dramatic increase in scientific, industrial, and public interest in probiotics and prebiotics as possible agents for gut microbiota management and control. Genomics and bioinformatics tools may allow us to establish mechanistic relationships among gut microbiota, health status, and the effects of drugs in the individual. This will hopefully provide perspectives for personalized gut microbiota management.
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Resumen Introducción y objetivo Los probióticos, definidos como microorganismos vivos que proveen un beneficio para la salud del huésped, se han propuesto como una opción terapéutica para la dermatitis atópica (DA), habiéndose identificado varios mecanismos de acción. Se evaluó la eficacia del uso de probióticos para disminuir la gravedad de dermatitis atópica en pacientes pediátricos menores de 18 años. Material y métodos Se realizó una revisión sistemática y metaanálisis que incluyó ensayos clínicos aleatorizados en pacientes menores de 18 años con diagnóstico establecido de dermatitis atópica, cuya gravedad estuvo medida por el Scoring Atopic Dermatitis (SCORAD) comparando el efecto de probióticos con el placebo, mediante la investigación en bases de datos MEDLINE, Web Of Science (WOS), Scopus, ClinicalTrials.gov, Epistemonikos, Trip medical database, Biblioteca virtual en salud (BVS). Resultados Se obtuvieron 20 estudios que fueron incluidos en la revisión sistemática, de los cuales 16 apoyan el uso de probióticos para reducir la gravedad del SCORAD en la dermatitis atópica. En el metaanálisis se obtuvo como resultado global una diferencia de medias de −0,38, con un IC 95% de −0,63 a −0,14, a favor del uso de probióticos; sin embargo, se encontró una alta heterogeneidad en los estudios debido a la variabilidad clínica y metodológica, con un I² = 76%. Conclusiones El uso de probióticos es beneficioso para reducir la gravedad de la DA medida según SCORAD, a pesar de la presencia de una alta heterogeneidad clínica, derivada de sus diferentes tipos, dosis y variabilidad de una escala subjetiva como es el SCORAD.
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Lactic acid bacteria (LAB) are known for their biotechnological potential. Moreover, LAB are distinguished by amazing criteria: Adjusting the intestinal environment, inhibiting pathogenic microbes in the gastrointestinal tract, ability to reduce pathogen adhesion activity, improving the balance of the microbiota inside the intestine, capabilities of regulating intestinal mucosal immunity, and maintaining intestinal barrier function. The escalating number of research and studies about beneficial microorganisms and their impact on promoting health has attracted a big interest in the last decades. Since antiquity, various based fermented products of different kinds have been utilized as potential probiotic products. Nevertheless, the current upsurge in consumers' interest in bioalternatives has opened new horizons for the probiotic field in terms of research and development. The present review aims at shedding light on the world of probiotics, a continuous story of astonishing success in various fields, in particular, the biomedical sector and pharmaceutical industry, as well as to display the importance of probiotics and their therapeutic potential in purpose to compete for sturdy pathogens and to struggle against diseases and acute infections. Shadows and future trends of probiotics use are also discussed.
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The effect of bacteria (Bacillus clausii) addition on the culturability and antioxidant activity of resveratrol prepared by spray drying was studied in this work. Inulin and lactose were employed as carrying agents and their performance compared. Resveratrol microencapsulated in inulin showed the highest antioxidant activity (26%) against free radicals. The co-encapsulated materials (bacteria and resveratrol) in inulin and lactose showed similar activities (21%, and 23%, respectively) suggesting that part of resveratrol was absorbed by the bacteria. Particles showed a regular spherical morphology with smooth surfaces, and size in the micrometer range (2–25 μm). The absence of bacteria in the SEM micrographs and the culturability activity suggested the preservation of the organisms within the micro and co-microencapsulated particles. The present work proposes the preparation of a functional food with probiotic and antioxidant properties.
Article
Background The current evidence on the use of probiotics in treating atopic dermatitis is inconclusive. This study determined the comparative effectiveness of the different types of probiotic strains in treating pediatric atopic dermatitis. Methodology Systematic and manual search for all randomized controlled trials available from inception until January 31, 2020 were done. Two independent authors conducted the search, screening, appraisal, and data abstraction. Network meta‐analysis was conducted using STATA 14 software. Results Twenty‐two studies involving 28 different probiotic strains were included. The top three ranked probiotic strains in terms of efficacy are Mix1 (Bifidobacterium animalis subsp. lactis CECT 8145, Bifidobacterium longum CECT 7347, and Lactobacillus casei CECT 9104); Lactobacillus casei DN‐114001; and Mix6 (Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius ). Compared to placebo, Mix1 reduces atopic dermatitis symptoms with high certainty evidence (SMD ‐1.94, 95% CI ‐2.65 to ‐1.24; 47 participants). Mix6 compared to placebo probably reduces atopic dermatitis symptoms based on moderate certainty evidence (SMD ‐0.85, 95% CI ‐1.50 to ‐0.20; 40 participants). Lactobacillus casei DN‐114001 compared to placebo may reduce atopic dermatitis symptoms based on low certainty evidence (SMD ‐1.35, 95% CI ‐2.04 to ‐0.65). In terms of safety, the highest ranked strain is Lactobacillus fermentum VRI‐003, while the lowest ranked strain is Lactobacillus rhamnosus GG. Conclusion Certain probiotic preparations show benefit in reducing allergic symptoms in pediatric atopic dermatitis.
Article
Background: Eczema is a common chronic skin condition. Probiotics have been proposed as an effective treatment for eczema; their use is increasing, as numerous clinical trials are under way. This is an update of a Cochrane Review first published in 2008, which suggested that probiotics may not be an effective treatment for eczema but identified areas in which evidence was lacking. Objectives: To assess the effects of probiotics for treating patients of all ages with eczema. Search methods: We updated our searches of the following databases to January 2017: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, the Global Resource of Eczema Trials (GREAT) database, MEDLINE, Embase, PsycINFO, the Allied and Complementary Medicine Database (AMED), and Latin American Caribbean Health Sciences Literature (LILACS). We searched five trials registers and checked the reference lists of included studies and relevant reviews for further references to relevant randomised controlled trials (RCTs). We also handsearched a number of conference proceedings. We updated the searches of the main databases in January 2018 and of trials registries in March 2018, but we have not yet incorporated these results into the review. Selection criteria: Randomised controlled trials of probiotics (live orally ingested micro-organisms) compared with no treatment, placebo, or other active intervention with no probiotics for the treatment of eczema diagnosed by a doctor. Data collection and analysis: We used standard methodological procedures as expected by Cochrane. We recorded adverse events from the included studies and from a separate adverse events search conducted for the first review. We formally assessed reporting bias by preparing funnel plots, and we performed trial sequential analysis for the first primary outcome - eczema symptoms at the end of active treatment.We used GRADE to assess the quality of the evidence for each outcome (in italic font). Main results: We included 39 randomised controlled trials involving 2599 randomised participants. We included participants of either gender, aged from the first year of life through to 55 years (only six studies assessed adults), who had mild to severe eczema. Trials were undertaken in primary and secondary healthcare settings, mainly in Europe or Asia. Duration of treatment ranged from four weeks to six months, and duration of follow-up after end of treatment ranged from zero to 36 months. We selected no standard dose: researchers used a variety of doses and concentrations of probiotics. The probiotics used were bacteria of the Lactobacillus and Bifidobacteria species, which were taken alone or combined with other probiotics, and were given with or without prebiotics. Comparators were no treatment, placebo, and other treatments with no probiotics.For all results described in this abstract, the comparator was no probiotics. Active treatment ranged from six weeks to three months for all of the following results, apart from the investigator-rated eczema severity outcome, for which the upper limit of active treatment was 16 weeks. With regard to score, the higher the score, the more severe were the symptoms. All key results reported in this abstract were measured at the end of active treatment, except for adverse events, which were measured during the active treatment period.Probiotics probably make little or no difference in participant- or parent-rated symptoms of eczema (13 trials; 754 participants): symptom severity on a scale from 0 to 20 was 0.44 points lower after probiotic treatment (95% confidence interval (CI) -1.22 to 0.33; moderate-quality evidence). Trial sequential analysis shows that target sample sizes of 258 and 456, which are necessary to demonstrate a minimum mean difference of -2 and -1.5, respectively, with 90% power, have been exceeded, suggesting that further trials with similar probiotic strains for this outcome at the end of active treatment may be futile.We found no evidence suggesting that probiotics make a difference in QoL for patients with eczema (six studies; 552 participants; standardised mean difference (SMD) 0.03, 95% CI -0.36 to 0.42; low-quality evidence) when measured by the participant or the parent using validated disease-specific QoL instruments.Probiotics may slightly reduce investigator-rated eczema severity scores (24 trials; 1596 participants). On a scale of 0 to 103 for total Severity Scoring of Atopic Dermatitis (SCORAD), a score combining investigator-rated eczema severity score and participant scoring for eczema symptoms of itch and sleep loss was 3.91 points lower after probiotic treatment than after no probiotic treatment (95% CI -5.86 to -1.96; low-quality evidence). The minimum clinically important difference for SCORAD has been estimated to be 8.7 points.We noted significant to extreme levels of unexplainable heterogeneity between the results of individual studies. We judged most studies to be at unclear risk of bias; six studies had high attrition bias, and nine were at low risk of bias overall.We found no evidence to show that probiotics make a difference in the risk of adverse events during active treatment (risk ratio (RR) 1.54, 95% CI 0.90 to 2.63; seven trials; 402 participants; low-quality evidence). Studies in our review that reported adverse effects described gastrointestinal symptoms. Authors' conclusions: Evidence suggests that, compared with no probiotic, currently available probiotic strains probably make little or no difference in improving patient-rated eczema symptoms. Probiotics may make little or no difference in QoL for people with eczema nor in investigator-rated eczema severity score (combined with participant scoring for eczema symptoms of itch and sleep loss); for the latter, the observed effect was small and of uncertain clinical significance. Therefore, use of probiotics for the treatment of eczema is currently not evidence-based. This update found no evidence of increased adverse effects with probiotic use during studies, but a separate adverse events search from the first review revealed that probiotic treatment carries a small risk of adverse events.Results show significant, unexplainable heterogeneity between individual trial results. Only a small number of studies measured some outcomes.Future studies should better measure QoL scores and adverse events, and should report on new probiotics. Researchers should also consider studying subgroups of patients (e.g. patients with atopy or food allergies, adults) and standardising doses/concentrations of probiotics given.
Article
Atopic eczema (AE) is a common chronic inflammatory skin condition. Whilst many AE treatment options are available, the evidence to support their efficacy varies in depth and quality. In 2000, an NIHR HTA systematic review identified and evaluated existing randomised controlled trials (RCTs) of AE treatments. To ensure continuing utility, the NIHR commissioned an update to the review. Here, we present an overview of the updated report and key findings. Systematic reviews and RCTs of AE treatments that included participants with AE (criteria based or diagnosed) were identified using: MEDLINE, EMBASE, CENTRAL, LILACS, AMED, CINAHL and Cochrane Skin Group Specialised Register (searched to August 31st 2013 (RCTs) and 31st December 2015 (systematic reviews)). Outcome measures included: symptoms, AE severity, quality-of-life, and adverse effects. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Of the 287 new RCTs identified, only 22 (8%) were judged to be low risk of bias. When combined with RCTs from the previous review (n= 254), we found ‘reasonable evidence of benefit’ for corticosteroids, calcineurin inhibitors, Atopiclair™, ciclosporin, azathioprine, ultraviolet light and education programmes. Interventions with reasonable evidence of ‘no benefit’ included some dietary interventions, ion exchange water softeners, multiple daily applications of topical corticosteroids and antibiotic-containing corticosteroids for non-infected AE. Many common treatments lack evidence of efficacy and warrant further evaluation. The evidence base for AE is still hampered by poor trial design and reporting. The trials included in this review were used to establish the Global Resource of Eczema Trials (GREAT) Database. This article is protected by copyright. All rights reserved.
Article
Eczema is a very common chronic inflammatory skin condition. Objectives To update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps. Data sources Electronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs). Review methods Studies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings. Results Of 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; and Mycobacterium vaccae vaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing. Limitations The large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies. Conclusions Although the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease. Funding The National Institute for Health Research Programme Grants for Applied Research programme.
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Atopic dermatitis (AD) is a common, recurrent, chronic inflammatory skin disease that is a cause of considerable economic and social burden. Its prevalence varies substantially among different countries with an incidence rate proclaimed to reach up to 20% of children in developed countries and continues to escalate in developing nations. This increased rate of incidence has changed the focus of research on AD toward epidemiology, prevention, and treatment. The effects of probiotics in the prevention and treatment of AD remain elusive. However, evidence from different research groups show that probiotics could have positive effect on AD treatment, if any, that depend on multiple factors, such as specific probiotic strains, time of administration (onset time), duration of exposure, and dosage. However, till date we still lack strong evidence to advocate the use of probiotics in the treatment of AD, and questions remain to be answered considering its clinical use in future. Based on updated information, the processes that facilitate the development of AD and the topic of the administration of probiotics are addressed in this review.
Chapter
This chapter discusses the evidence base for treating atopic eczema (atopic dermatitis) by means of three common clinical scenarios: a child with moderately severe atopic eczema, a person with clinically infected atopic eczema and an adult with severe atopic eczema. Allergic factors such as exposure to house dust mite may be important, but nonallergic factors such as exposure to irritants, bacteria, and hard water may be equally important. Topical tacrolimus has been licensed in the USA and UK for the treatment of people with moderate to severe atopic eczema that is not adequately responsive, or who are intolerant of conventional therapies. The chapter also deals with probiotics used to help reduce symptoms of atopic eczema. The trials of lactobacilli strains of probiotics mostly do not show any significant benefits compared with placebo or in addition to standard treatments.
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The effect of probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 on the composition of the Lactobacillus group, Bifidobacterium and the total bacterial population in feces from young children with atopic dermatitis was investigated. The study included 50 children randomized to intake of one of the probiotic strain or placebo. Microbial composition was characterized by denaturing gradient gel electrophoresis, quantitative PCR and, in a subset of subjects, by pyrosequencing of the 16S rRNA gene. The core population of the Lactobacillus group was identified as Lactobacillus gasseri, Lactobacillus fermentum, Lactobacillus oris, Leuconostoc mesenteroides, while the bifidobacterial community included Bifidobacterium adolescentis, Bifidobacterium bifidum, Bifidobacterium longum and Bifidobacterium catenulatum. The fecal numbers of L. acidophilus and B. lactis increased significantly after intervention, indicating survival of the ingested bacteria. The levels of Bifidobacterium correlated positively (P=0.03), while the levels of the Lactobacillus group negatively (P=0.01) with improvement of atopic eczema evaluated by the Severity Scoring of Atopic Dermatitis index. This correlation was observed across the whole study cohort and not attributed to the probiotic intake. The main conclusion of the study is that administration of L. acidophilus NCFM and B. lactis Bi-07 does not affect the composition and diversity of the main bacterial populations in feces.
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Calprotectin is a calcium binding protein present predominantly in neutrophils with antimicrobial and antiprolipherative activities. Calprotectin concentration is higher in feces than in plasma and significantly increased levels of fecal calprotectin (FC) were found in patients with bowel inflammation disease (IBD). Nineteen out-patients with IBD, comprising 14 Crohn's disease (CD) individuals and 5 ulcerative colitis (UC) patients, and 5 healthy volunteers were investigated. Fecal calprotectin was analyzed by ELISA. We found that patients with IBD had significantly higher concentration of FC than in healthy children (FC median 1076.7 vs 19.5 microg/g of stool, p = 0.0053). We determined higher level of FC in patients with CD than in UC (1132.4 vs 490.98 microg/g of stool), but not statistically significant. It has been proved that FC represents a surrogate marker of neutrophils influx into the bowel lumen; hence it can be regarded as a simple and non-invasive marker of intestinal inflammation (Tab. 2, Fig. 1, Ref. 38). Full Text (Free, PDF) www.bmj.sk.
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Acute glomerulonephritis is a common cause of renal dysfunction and ultimately renal failure. The inflammation involved is a tightly regulated response with pro- and anti-inflammatory cytokines playing key roles. Interleukin-1 (IL-1) and tumor necrosis factor (TNF) are the principal pro-inflammatory cytokines produced by intrinsic cells and infiltrating leukocytes. IL-1 and TNF can be directly antagonized using IL-1 receptor antagonist (IL-1ra) or binding proteins such as soluble receptors or antibodies. Alternatively, cytokines with anti-inflammatory properties can be used to decrease IL-1 and TNF synthesis, increase the production of their natural antagonists and deactivate inflammatory cells such as macrophages. This review will focus on these anti-inflammatory cytokines, principally IL-4, IL-6, IL-10 and IL-13, and highlight recent research of their activities in existing models of renal disease. The results of these experiments offer a promising new avenue of treatment.
Article
The aims of this study were to analyze the peculiarities of allergies to food; to determine gastrointestinal disorders, endoscopic signs of mucosal damage and histological lesions of the mucosa and to establish their relation to the extent of atopic dermatitis and its degree of severity. A total of 164 children (86 boys and 78 girls) suffering only from atopic dermatitis were examined. Atopic dermatitis was diagnosed using standard diagnostic criteria; extent of disease (the Basic Clinical Scoring System (BCSS)) and the severity (Scoring Atopic Dermatitis (SCORAD) index), total serum IgE levels were determined; skin prick and patch tests with the main food allergens were performed. Using questionnaire gastrointestinal disorders with the symptoms of atopic dermatitis were ascertained. In children with atopic dermatitis suffering from chronic dyspepsia esophagealgastroduodenoscopy was performed and biopsy samples from the antrum of the stomach and duodenum were taken. The age of patients ranged from 6 months to 18 years. According to extent of atopic dermatitis and degree of severity localized, mild atopic dermatitis prevailed. Analysis of the changes in total Ig E levels showed different degree of sensitization of the children examined. Considering the type of allergic reaction, immediate-type allergic reactions dominated only in 11.6% of children with atopic dermatitis, whereas delayed-type allergic reactions manifested in 44.5% of children. No food allergy was present in one-fifth of children with atopic dermatitis. One hundred four (63.4%) children complained of gastrointestinal disorders. Of these 104 patients, 17 children (mean age 6.9 years) who underwent esophagealgastroduodenoscopy with biopsy had no pathology; however, histological examination of mucosa revealed eosinophilic infiltration in the gastric antrum and duodenum in three children. The most common gastrointestinal disorders are: abdominal pain vomiting, diarrhea, abdominal distention, and constipation. The incidence of gastrointestinal disorders does not depend on the extent and severity of atopic dermatitis. Gastrointestinal disorders manifest independent of the type of allergic reactions inducing atopic dermatitis. The most common food allergens, such as soy, milk, peanuts, corn, carrots, rye, wheat, white of the egg, cod, and chicken were determined by skin patch test. According to our data, no pathology was found in children with atopic dermatitis during endoscopic examination. Our data showed that allergic-like changes in gastric and duodenal mucosa were present only in older (7-10-year-old) children.
Article
Background Eosinophil cationic protein (ECP) is a cytotoxic agent secreted by activated eosinophils during allergic and inflammatory processes. The aim of the study was to determine the ECP level, absolute and relative eosinophil count and IgE antibodies in children with atopic dermatitis (AD) compared with those of nonatopic children, and to assess the correlation of these laboratory parameters with the clinical severity of AD. Methods This prospective study comprised 70 children. There were 49 children with AD aged 3–36 months, and the control group comprised 21 children with a negative personal and family history for atopic diseases. Detailed history, serum ECP levels (UniCAP FEIA), relative and absolute eosinophil counts and total serum IgE antibodies were determined in both groups. In the children with AD, skin involvement was measured by the SCORAD index. Results The calculated SCORAD index was between 16 and 83. IgE antibodies, relative and absolute eosinophil counts showed a significantly wider range of values and a statistically higher median (P < 0.001) in the patients with AD compared with the control group. These laboratory parameters did not correlate with the severity of AD. The serum ECP median level, in the children with AD, was 16.2 µg/L (range 3.01–65.30) compared with 5.92 µg/L (range 2.76–21.90) in the control group. Correlation of the total SCORAD index and the serum ECP levels was negative, weak (r = –0.065) and statistically not significant (P > 0.05). The same was found for the correlation of serum ECP and intensity of skin changes (r = –0.095) and serum ECP and subjective symptoms (r = –0.045). The correlation was positive, but weak and statistically not significant for the serum ECP and extent of the skin lesions (r = 0.079, P > 0.05). Conclusion Elevated levels of ECP, relative and absolute eosinophil counts, as well as IgE antibodies were determined in the patients with AD. As these laboratory findings did not correlate with the severity of AD, they can be considered only as additional methods in the evaluation of patients with AD.
Article
Nerve growth factor (NGF) is known to act as a potent mediator in neuroinflammatory processes. Recent studies point to a role of NGF in the skin pathophysiology of atopic dermatitis (AD) and psoriasis. Hereby, NGF was found to interact with the major cellular components (mast cells and eosinophils) of both skin diseases. In order to investigate NGF serum levels as a possible clinical marker of disease activity and immunological status, we determined serum NGF, eosinophil cationic protein (ECP), total IgE and score of AD (SCORAD) in 57 patients with AD as well as NGF and the psoriasis area and severity index (PASI) in 17 patients with psoriasis. Fifty healthy subjects served as controls. We used a highly sensitive improved fluorometric two-site ELISA system for serum NGF detection. IgE and ECP were measured by CAP-FEIA and radioimmunoassay. We did not find a significant correlation between NGF and either ECP, total IgE, or severity of disease assessed by SCORAD. Also in patients with psoriasis, there was no significant correlation with disease activity determined by PASI. Even though there is increasing evidence showing NGF to be involved in the local inflammatory pathophysiology of AD within skin lesions, our findings suggest that NGF systemic serum concentration is not a suitable parameter to estimate the clinical or immunological status of AD or psoriasis patients. This result is inconsistent with some previous studies showing a positive correlation of serum NGF with AD severity, which might be, for example, due to the fact that the present results are corrected for unspecific binding.
Article
Atopic dermatitis (AD) is a common, chronic, inflammatory skin disease that can significantly reduce the quality of life of not only patients but also entire families. This review will focus on the currently available non-pharmacologic and pharmacologic treatments for the control and management of AD. A review of English-language articles from January 1953 to May 2006 was performed within the MEDLINE database. Search terms included, but were not limited to, atopic dermatitis, topical corticosteroids, and topical calcineurin inhibitors. Studies evaluating the diagnosis, physical and psychological burden, and underlying pathophysiology of AD were included. Particular focus was placed on literature presenting key safety and efficacy data from clinical trials involving AD treatment. Although good skin care and trigger avoidance are fundamental to AD management, most patients also require pharmacologic intervention. Topical therapies comprise the foundation of AD treatment. In particular, topical corticosteroids have been a mainstay in AD treatment for several decades and the newer topical calcineurin inhibitors have become a valuable addition to the therapeutic armamentarium. TCIs are a safe and effective AD treatment; they limit the number of disease flares, extend the time between flares, and provide a steroid-sparing option that may be of particular benefit in the pediatric population. The use of more potent therapies, such as systemic (oral/injected) agents or phototherapy, is typically limited to the treatment of severe, refractory disease. Additionally, owing to the increased risk for bacterial, viral, and fungal infections in patients with AD, topical or systemic antimicrobials are an important component of treatment. Case reports and small-scale studies were typically not included in this analysis and owing to the limited number of trials evaluating TCSs, consensus statements and comprehensive review articles were used to obtain information pertaining to the use of this treatment in AD. AD is a common, chronic disease requiring a long-term management strategy that incorporates preventive measures and a multipronged treatment approach.