Review
Prebiotics and probiotics; modifying and mining the microbiota

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Abstract

A new era in medical science has dawned with the realization of the critical role of the “forgotten organ”, the enteric microbiota, in generating a variety of functions which sustain health and, when disrupted, lead to disease. Central to this beneficial interaction between the microbiota and man is the manner in which the bacteria contained within the gut “talk” to the immune system and, in particular, the immune system that is so widespread within the gut itself, the gut-associated (or mucosa-associated) lymphoid system. Into this landscape come two new players: probiotics and prebiotics. While many products have masqueraded as probiotics, only those which truly and reproducibly contain live organisms and which have been shown, in high quality human studies, to confer a health benefit can actually claim this title. Several human disease states have benefited from the use of probiotics, most notably, diarrheal illnesses, some inflammatory bowel diseases, certain infectious disorders and, most recently, irritable bowel syndrome. Prebiotics promote the growth of “good” bacteria and, while a variety of health benefits have been attributed to their use, prebiotics have been subjected to few large scale clinical trials.

Section snippets

The normal microbiota: an essential factor in health

The human gastrointestinal microflora (now more usually referred to as the microbiota) is a complex ecosystem of approximately 300–500 bacterial species comprising nearly two million genes (the “microbiome”). Indeed, the number of bacteria within the gut is about 10 times that of all of the cells in the human body. At birth, the entire intestinal tract is sterile; bacteria enter the gut with the first feed [1]. Following infancy, the composition of the intestinal microbiota remains relatively

The gut microbiota in disease

Just as we are only now beginning to understand the key role of the microbiota in health, it has only been in very recent years that the true extent of the consequences of disturbances in the microbiota, or in the interaction between the microbiota and the host, to health has been recognized [6], [8]. Some of these are relatively obvious: for example, when many components of the normal microbiota are eliminated or suppressed by a course of broad-spectrum antibiotics the stage is set for other

Probiotics

Probiotics, derived from the Greek and meaning “for life”, are defined as live organisms that, when ingested in adequate amounts, exert a health benefit to the host. There are several commercially available supplements containing viable micro-organisms with probiotic properties. The most commonly used probiotics are Lactobacilli, Bifidobacteria and nonpathogenic yeasts. Although probiotics have been proposed for use in inflammatory, infectious, neoplastic and allergic disorders, the ideal

Probiotics in digestive disorders

While experimental observations suggest potential benefits for probiotics in a variety of gastrointestinal, pancreatic and liver disorders, solid clinical data is confined to three main areas: infection, inflammatory bowel disease and irritable bowel syndrome [38], [39].

With regard to infectious diarrhea, there appear to be two main areas of efficacy for probiotics: rotavirus-associated diarrhea and Clostridium difficile-related diarrhea. Several studies have reported that probiotics may be

Safety of probiotics

Many different species and strains and preparations of probiotics have been used for decades and by millions of healthy and diseased individuals, yet definitive data on safety is scanty. In a careful and critical review in 2006, Boyle et al. concluded that although probiotics have an excellent overall safety record, they should be used with caution in certain patient groups—particularly neonates born prematurely or with immune deficiency [62]. They reviewed case reports of instances of

Prebiotics and synbiotics

Prebiotics are defined as nondigestible, but fermentable, foods that beneficially affect the host by selectively stimulating the growth and activity of one species or a limited number of species of bacteria in the colon. Compared with probiotics, which introduce exogenous bacteria into the human colon, prebiotics stimulate the preferential growth of a limited number of health-promoting species already residing in the colon and, especially, but not exclusively, lactobacilli and bifidobacteria.

Conclusion

In human biology and medicine we have entered into the era of the microbiome; it contributions to human health and disease are only just beginning to be revealed. Over the next few years studies of this complex ecology and its interaction to the human host will, not only unlock the secrets of several important human diseases, but also will lead, through successful “mining” and modulation of the microbiota, to new therapeutic approaches [75].

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