Lactobacillus Rhamnosus GG

Probiotics Symposium Nov 2008

Probiotics Symposium, Nov 14-15, 2008

Hosted by University of Nevada School of Medicine, Las Vegas, NV, USA

I attended an extremely informative symposium on probiotics in November, 2008. The Second Annual Symposium on Probiotics, Prebiotics, and Enzymes: Clinical Applications in Human Health was hosted by the University of Nevada School of Medicine. The conference was organized and sponsored by Klaire Labs, a division of ProThera Inc.

An international faculty presented the most recent research and hypotheses on the mechanisms of action and use of probiotics, prebiotics, and digestive enzymes to maintain and improve both physical and mental health.

There were several international specialists who presented their views, research and information as well as clinical experience in the practical application of probiotics.

Dr. Charalabos Pothoulakis, professor of medicine at the David Geffen School of Medicine at UCLA and director of the UCLA Inflammatory Bowel Disease Center, presented two lectures. On the first day, he focused on probiotic mechanisms of action. He discuseed the research performed in his laboratory showing that Saccharomyces boulardii�s beneficial effect in C. difficile and the associated diseases, is due in part to prevention of inhibitory kBa degradation. This effect prevents C. difficile�s toxin A from activating nuclear factor- kB (NF-kB), which is how toxin A causes colonocyte death.

Dr Pothoulakis also reported that supernatant from S. boulardii culture inhibits inflammatory interleukin-8 production and blocks NF-kB-mediated gene transcription. He reviewed evidence that supernatant from a multispecies probiotic formulation inhibits tumor necrosis factor-a (TNF-a) stimulation of NF-kB.

He also presented evidence that Lactobacilllus rhamnosus GG produces two proteins that rescue colonocytes from TNF-k induced damage and apoptosis.

On the second day Dr Pothoulakis reviewed the evidence for the role of probiotics in Inflammatory Bowel Disease, i.e. Crohns Disease and Ulcerative Colitis. He concluded that a multi-species preparation has clear benefit in pouchitis, a complication often seen in ulcerative colitis. He also state that S. boulardii has benefit by reducing production of proinflammatory cytokines.

Dr. Maria Oliva-Hemker, chief of the Division of Pediatric Gastroenterology and Nutrition at Johns Hopkins University School of Medicine, offered us in depth information about neonatals and their potential lack of normal gastrointestinal microflora. She outlined factors that may disrupt an infant’s microbiota and the health consequences of such disruptions, which include gastrointestinal disturbances and immune dysfunction. Dr Oliva-Hemker reviewed the research supporting the use of probiotics to reduce the incidence of necrotizing enterocolitis (NEC) in preterm, low-birth weight infants and concluded that L. rhamnosus GG, Bifidobacterium infantis, B. bifidum, and S. boulardii have all shown benefit and, most importantly, proven to be safe in this highly vulnerable patient group.

Dr Martin Katzman and Dr Richard Lord also presented on the first day of the symposium. Dr Martin Katzman is Assistant Professor of Psychiatry at the University of Toronto and director of the Stress, Trauma, Anxiety, Rehabilitation and Treatment Clinic. He presented the intriguing hypothesis that probiotics may have a role in the treatment of patients with depression and anxiety.

Richard Lord, Chief Science Officer of the Metametrix Institute, reviewed the clinical laboratory use of DNA amplification of microbial genetic material isolated from stool samples to assess the composition of the gastrointestinal microflora and to detect pathogenic organisms and parasites. This technique avoids the well-known limitations of traditional stool cultures.

Another presenter, Dr. Gary Elmer, is Professor Emeritus of Medicinal Chemistry at the University of Washington. He regarded as an authority on the use of probiotics to prevent and manage antibiotic-associated diarrhea and Clostridium difficile disease. He gave us an excellent overview of probiotics and he dispelled the common myths that probiotics are not well studied and are only effective for diarrheal illnesses. He did stress that adequate probiotic doses are essential to ensure good clinical outcomes, and noted that recovery of organisms from stool cultures does not always correlate with benefit.

We also had international representation. Dr. Sandra Macfarlane, Senior research scientist for the Division of Pathology and Neuroscience at the University of Dundee was there. She presented cutting-edge research on the use of prebiotics used alone or in combination with probiotics (symbiotics) to modify gastrointestinal ‘biofilms’. Biofilms are communities of microorganisms that live within a self-produced matrix of exopolymers. Microbes prefer living within biofilms, which protect them from dislodgement, host immune responses, and antimicrobial agents. Pathogens living within biofilms are highly resistant to efforts to eradicate them, and pathogenic biofilms may be a source of recurrent disease.

Dr Macfarlane shared data that showed microbial gastrointestinal biofilm communities in patients with ulcerative colitis contain significantly fewer bifidobacteria and higher numbers of anaerobic gram-positive cocci, peptostreptococci, enterococci, and enterobacteria.

Dr Macfarlane also reviewed both in vivo and in vitro evidence that prebiotic inulin can significantly increase intestinal biofilm bifidobacterial populations while simultaneously decreasing biofilm populations of Clostridium, Bacteroides, Fusobacterium, and Enterobacteraceae species, and at the same time inhibit pathogen activity and reduce C. difficiie toxin concentrations.

This evidence led to her hypothesis that treating ulcerative colitis patients with a combination of prebiotics and probiotics could be beneficial. She concluded by presenting data from her recent study on the use of B. longum and oligofructose-enriched inulin in patients with ulcerative colitis. The synbiotic caused a marked increase in bifidobacteria populations, a striking reduction mucosal human f3-defensin levels, and significant improvements in colonic mucosal inflammation seen on colonoscopy.

Dr. Gary Gray, professor emeritus of medicine at Stanford University School of Medicine and director of the Stanford Celiac Sprue Clinic, reviewed the pathophysiology of celiac disease and presented his research on the peptidase treatment of dietary gluten. He found that an endopeptidase isolated from barley reduced fat malabsorption in patients with celiac disease in remission.

Dr. Andrew Bruce, professor emeritus of urology at the University of Toronto, lectured on the use of a probiotic formulation containing L. reuteri RC14 and L. rhamnosus GR-1 to treat vaginal dysbiosis and reduce the incidence of recurrent urinary tract infections in women. He told us that oral probiotic use provides benefit and the organisms do not have to be administered vaginally.

Then there was Dr. John Morton, who is associate professor of surgery and director of the bariatric surgery program at Stanford University. His fascinating data told about the potential role of the gastrointestinal microbiota in the growing worldwide epidemic of obesity. He said that the rapid spread of obesity in the US since 1997 has led many investigators to question whether an infectious agent or agents could be involved.

He said that it has been established that obesity spreads within networks of friends and families, and that treating obese parents with bariatric surgery can result in weight loss in their children. The gut microflora generates 30% of a person’s daily caloric intake. He hypothesized that the presence of pathogenic microbes extracting energy from the diet may contribute to overweight and obesity.

Dr Morton told us about the exciting results of a study he recently conducted in which L. acidophilus was administered to patients following Roux-en-Y bariatric surgery. The study was undertaken to assess whether a probiotic could reduce the incidence of intestinal bacterial overgrowth in these patients, which it did. However, an unexpected finding was that compared to placebo, patients receiving the probiotic experienced significantly greater weight loss following surgery. This is the first clinical trial to suggest that probiotics may enhance weight loss. Dr Morton is planning a large multi-center trial as a follow up to this potentially highly important outcome.