Effect of pre- and probiotics on liver regeneration after resection: a randomised, double-blind pilot study. Probiotics for patients with compensated liver cirrhosis: a double-blind placebo-controlled study. The Consumption of Synbiotic Bread Containing Lactobacillus sporogenes and Inulin Affects Nitric Oxide and Malondialdehyde in Patients with Type 2 Diabetes Mellitus: Randomized, Double-Blind, Placebo-Controlled Trial Synbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis. Randomised clinical trial of synbiotic therapy in elective surgical patients Daily Consumption of Synbiotic Yogurt Decreases Liver Steatosis in Patients with Nonalcoholic Fatty Liver Disease: A Randomized Controlled Clinical Trial. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Beneficial Effect of Synbiotic Supplementation on Hepatic Steatosis and Anthropometric Parameters, But Not on Gut Permeability in a Population with Nonalcoholic Steatohepatitis Dietary Changes Involving Bifidobacterium longum and Other Nutrients Delays Chronic Kidney Disease Progression Supplementation with probiotics modifies gut flora and attenuates liver fat accumulation in rat nonalcoholic fatty liver disease model Consumption of Bifidobacterium lactis Bi-07 by healthy elderly adults enhances phagocytic activity of monocytes and granulocytes Supply of Pre‐ and Probiotics Reduces Bacterial Infection Rates After Liver Transplantation—A Randomized, Double‐Blind Trial Dietary synbiotics reduce cancer risk factors in polypectomized and colon cancer patients. Effects of perioperative synbiotic treatment on infectious complications, intestinal integrity, and fecal flora and organic acids in hepatic surgery with or without cirrhosis. Effect of Probiotic Bacteria on Microbial Host Defense, Growth, and Immune Function in Human Immunodeficiency Virus Type-1 Infection Formula fortified with live probiotic culture reduces pulmonary and gastrointestinal bacterial colonization and translocation in a newborn animal model. Preoperative synbiotic bowel conditioning for elective colorectal surgery SYNbiotics Easing Renal failure by improving Gut microbiologY (SYNERGY): a protocol of placebo-controlled randomised cross-over trial Fighting Fatty Liver Diseases with Nutritional Interventions, Probiotics, Symbiotics, and Fecal Microbiota Transplantation (FMT). Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY): A Randomized Trial. Supplementation of Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032 in Diet-Induced Obese Mice Is Associated with Gut Microbial Changes and Reduction in Obesity Effects of Synbiotic Food Consumption on Serum Minerals, Liver Enzymes, and Blood Pressure in Patients with Type 2 Diabetes: A Double-blind Randomized Cross-over Controlled Clinical Trial Early Low Volume Oral Synbiotic/Prebiotic Supplemented Enteral Stimulation of the Gut in Patients with Severe Acute Pancreatitis: A Prospective Feasibility Study
Liver regeneration is a prerequisite for extended liver surgery . Several studies have shown that the bacterial gut flora is able to modulate liver function . Previously we observed that synbiotics could partly reverse the impaired mitosis rate of hepatocytes in a rat model of synchronous liver resection and colon anastomosis . The effect of synbiotics on liver function after hepatic resection has not been analysed yet . A prospect i ve r and omised double-blind pilot trial was undertaken in 19 patients scheduled for right hepatectomy . All patients received enteral nutrition immediately post-operatively . Comparison was made between a group receiving a combination of four probiotics and four fibres and a placebo group receiving the fibres only starting the day before surgery and continuing for 10 days . Primary study endpoint was the liver function capacity measured by 13C-methacetin breath test and indocyanine green plasma disappearance rate . Portal vein flow , liver volumetry , laboratory parameters for liver function , length of hospital stay , post-operative complications and side effects of synbiotic therapy  were recorded . Liver function capacity was comparable in both groups . Complications had a negative impact on liver function . Because complications were more severe in the verum group , a sub- analysis was performed . In case of an uncomplicated course , liver function capacity was better in the patients with synbiotics . No severe side effects occurred . Synbiotics might be able to increase liver function capacity in patients after liver resection , but patient numbers were too small and the clinical courses too heterogeneous to draw any definite conclusions BACKGROUND Gut flora is related to the major complications of liver cirrhosis including hepatic encephalopathy , spontaneous bacterial peritonitis , and variceal bleeding . Prior studies have reported a beneficial effect of gut flora modification with probiotic bacteria in patients with minimal hepatic encephalopathy . We aim ed to study the effect of probiotics on clinical and laboratory parameters of patients with compensated cirrhosis . METHODS A double-blind placebo-controlled study that included patients with liver cirrhosis and at least one major complication of cirrhosis in the past , clinical evidence of portal hypertension , or decreased hepatic synthetic function . Participants were r and omly assigned to receive probiotic capsules containing Lactobacillus acidophilus , Lactobacillus bulgaricus , Bifidobacterium lactis , and Streptococcus thermophiles or placebo for a period of 6 mo . RESULTS A total of 36 patients were available for final analysis ( distributed equally between the probiotic and placebo groups ) . The administration of probiotics was not associated with significant differences in either clinical or laboratory parameters between the two groups . Because the lack of a beneficial effect may be related to the compensated liver disease of patients , we conducted a sub analysis of patients with baseline ammonia levels > 50 mmol/L. In this subgroup , the administration of probiotics appeared to significantly reduce the ammonia levels starting after 1 mo of treatment . However , this effect diminished and lost its significance following comparison to the placebo group . CONCLUSIONS Our study did not show a significant beneficial effect of probiotic supplementation in patients with compensated liver cirrhosis . Nevertheless , it points toward a possible positive effect of probiotics in patients with above normal baseline ammonia levels . This issue requires further investigation in larger cohorts Objectives : To our knowledge , no reports are available indicating the effects of synbiotic bread consumption on nitric oxide ( NO ) , biomarkers of oxidative stress , and liver enzymes among patients with type 2 diabetes mellitus ( T2DM ) . This study was performed to determine the effects of the daily consumption of synbiotic bread on NO , biomarkers of oxidative stress , and liver enzymes in patients with T2DM . Methods : This r and omized , double-blind , placebo-controlled trial was performed among 81 patients with diabetes , aged 35–70 years old . After a 2-week run-in period , patients were r and omly divided into 3 groups : group A ( n = 27 ) received synbiotic bread containing viable and the heat-resistant probiotic Lactobacillus sporogenes ( 1 × 108 CFU ) and 0.07 g inulin per 1 g , group B ( n = 27 ) received probiotic bread containing Lactobacillus sporogenes ( 1 × 108 CFU ) , and group C ( n = 27 ) received control bread for 8 weeks . Patients were asked to consume the synbiotic , probiotic , or control breads 3 times a day in 40 g packages for a total of 120 g/day . Fasting blood sample s were taken at baseline and after an 8-week intervention for quantificationof related markers . Results : After 8 weeks , the consumption of synbiotic bread compared to the probiotic and control breads result ed in a significant rise in plasma NO ( 40.6 ± 34.4 vs 18.5 ± 36.2 and −0.8 ± 24.5 µmol/L , respectively , p < 0.001 ) and a significant reduction in malondialdehyde ( MDA ) levels ( −0.7 ± 0.7 vs 0.6 ± 1.7 and 0.5 ± 1.5 µmol/L , respectively , p = 0.001 ) . We did not find any significant effect of the synbiotic bread consumption on plasma total antioxidant capacity ( TAC ) , plasma glutathione ( GSH ) , catalase , serum liver enzymes , calcium , iron , magnesium levels , and blood pressure compared to the probiotic and control breads . Conclusion : In conclusion , consumption of the synbiotic bread for 8 weeks among patients with T2DM had beneficial effects on plasma NO and MDA levels ; however , it did not affect plasma TAC , GSH , catalase levels , serum liver enzymes , calcium , iron , magnesium levels , and blood pressure Minimal hepatic encephalopathy ( MHE ) is an important disorder that may seriously impair daily functioning and quality of life in patients with cirrhosis . Treatment with lactulose is of benefit . The possible role of synbiotics ( probiotics and fermentable fiber ) has not been assessed . We screened 97 consecutive cirrhotic patients without overt hepatic encephalopathy for MHE using the number connection test and measurement of brainstem auditory evoked potentials . MHE , defined by abnormality on at least one test modality , was present in 58 ( 60 % ) patients . Fifty-five of these patients with MHE were r and omized to receive a synbiotic preparation ( n = 20 ) , fermentable fiber alone ( n = 20 ) , or placebo ( n = 15 ) for 30 days . Cirrhotic patients with MHE were found to have substantial derangements in the gut microecology , with significant fecal overgrowth of potentially pathogenic Escherichia coli and Staphylococcal species . Synbiotic treatment significantly increased the fecal content of non-urease-producing Lactobacillus species at the expense of these other bacterial species . Such modulation of the gut flora was associated with a significant reduction in blood ammonia levels and reversal of MHE in 50 % of patients . Synbiotic treatment was also associated with a significant reduction in endotoxemia . The Child-Turcotte-Pugh functional class improved in nearly 50 % of cases . Treatment with fermentable fiber alone was also of benefit in a substantial proportion of patients . In conclusion , treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis Background : It is possible to manipulate the composition of the gastrointestinal microflora by administration of pre- and probiotics . This may help to preserve gut barrier function and reduce the incidence of septic morbidity . Aims : To assess the effects of a combination of pre- and probiotics ( synbiotic ) on bacterial translocation , gastric colonisation , systemic inflammation , and septic morbidity in elective surgical patients . Patients : Patients were enrolled two weeks prior to elective abdominal surgery . Seventy two patients were r and omised to the synbiotic group and 65 to the placebo group . Patients were well matched regarding age and sex distribution , diagnoses , and POSSUM scores . Methods : Patients in the synbiotic group received a two week preoperative course of Lactobacillus acidophilus La5 , Bifidobacterium lactis Bb-12 , Streptococcus thermophilus , and Lactobacillus bulgaricus , together with the prebiotic oligofructose . Patients in the placebo group received placebo capsules and sucrose powder . At surgery , a nasogastric aspirate , mesenteric lymph node , and scrapings of the terminal ileum were harvested for microbiological analysis . Serum was collected preoperatively and on postoperative days 1 and 7 for measurement of C reactive protein , interleukin 6 , and antiendotoxin antibodies . Septic morbidity and mortality were recorded . Results : There were no significant differences between the synbiotic and control groups in bacterial translocation ( 12.1 % v 10.7 % ; p = 0.808 , χ2 ) , gastric colonisation ( 41 % v 44 % ; p = 0.719 ) , systemic inflammation , or septic complications ( 32 % v 31 % ; p = 0.882 ) . Conclusions : In this study , synbiotics had no measurable effect on gut barrier function in elective surgical patients . Further studies investigating the place of pre- and probiotics in clinical practice are required Background Nonalcoholic fatty liver disease ( NAFLD ) is the most common chronic liver disease in developed and developing countries . The use of synbiotics has been proposed as a probable management strategy for patients with NAFLD . Objective We investigated the effects of synbiotic yogurt on hepatic steatosis and liver enzymes as primary outcomes and on oxidative stress markers , adipokine concentration , and gut peptide concentration as secondary outcomes in patients with NAFLD . Methods In this 24-wk , open-label , r and omized controlled clinical trial , 102 patients [ 50 men and 52 women ; mean age : 40 y ; body mass index ( in kg/m2 ) ( mean ± SD ) : 31.2 ± 4.9 ] were r and omly assigned to 3 groups , including 2 intervention groups and 1 control group . The intervention groups consumed 300 g synbiotic yogurt containing 108 colony-forming units Bifidobacterium animalis/mL and 1.5 g inulin or conventional yogurt daily and were advised to follow a healthy lifestyle ( i.e. , diet and exercise ) . The control group was advised to follow a healthy lifestyle alone . We evaluated differences between groups in liver function measures by using repeated- measures ANOVA , ANCOVA , and logistic regression . Results At the end of the study , the grade s of NAFLD , as determined by ultrasonography , showed a significant decrease in the synbiotic group compared with the conventional and control groups ( P < 0.001 ) . The following significant mean ± SD decreases were seen in the synbiotic , conventional , and control groups , respectively : serum concentration of alanine aminotransferase ( -14.5 ± 15.6 compared with 4.6 ± 15.4 and 3.1 ± 14.4 IU/L ; P = 0.008 ) , aspartate aminotransferase ( -7.5 ± 6.1 compared with 3.0 ± 8.2 and 3.1 ± 5.7 IU/L ; P < 0.001 ) , alkaline phosphatase ( -26.2 ± 16.8 compared with 3.4 ± 30.1 and 1.5 ± 31.9 IU/L ; P = 0.024 ) , and γ-glutamyltransferase ( -6.0 ± 6.0 compared with 1.0 ± 6.4 and 7.6 ± 11.4 IU/L ; P < 0.001 ) . Conclusion Synbiotic yogurt consumption improved hepatic steatosis and liver enzyme concentrations in patients with NAFLD . This trial was registered at the Iranian Registry of Clinical Trials website ( www.i rct .ir ) as I RCT 2017020932417N2 BACKGROUND Nonalcoholic fatty liver disease ( NAFLD ) is the most common chronic liver disease in the world . Oral administration of synbiotic has been proposed as an effective treatment of NAFLD because of its modulating effect on the gut flora , which can influence the gut-liver axis . OBJECTIVE The objective was to evaluate the effects of supplementation with synbiotic on hepatic fibrosis , liver enzymes , and inflammatory markers in patients with NAFLD . DESIGN In a r and omized , double-blind , placebo-controlled clinical trial conducted as a pilot study , 52 patients with NAFLD were supplemented twice daily for 28 wk with either a synbiotic or a placebo capsule . Both groups were advised to follow an energy-balanced diet and physical activity recommendations . RESULTS At the end of the study , the alanine aminotransferase ( ALT ) concentration decreased in both groups ; this reduction was significantly greater in the synbiotic group . At the end of the study , the following significant differences [ means ( 95 % CIs ) ] were seen between the synbiotic and placebo groups , respectively : ALT [ -25.1 ( -26.2 , -24 ) compared with -7.29 ( -9.5 , -5.1 ) IU/L ; P < 0.001 ] , aspartate aminotransferase [ -31.33 ( -32.1 , -30.5 ) compared with -7.94 ( -11.1 , -4.8 ) IU/L ; P < 0.001 ] , γ-glutamyltransferase [ -15.08 ( -15.5 , -14.7 ) compared with -5.21 ( -6.6 , -3.9 ) IU/L ; P < 0.001 ] , high-sensitivity C-reactive protein [ -2.3 ( -3 , -1.5 ) compared with -1.04 ( -1.5 , -0.6 ) mmol/L ; P < 0.05 ] , tumor necrosis factor-α [ -1.4 ( -1.7 , -1.1 ) compared with -0.59 ( -0.8 , -0.3 ) mmol/L ; P < 0.001 ] , total nuclear factor κ-B p65 [ -0.016 ( -0.022 , -0.011 ) compared with 0.001 ( -0.004 , -0.007 ) mmol/L ; P < 0.001 ] , and fibrosis score as determined by transient elastography [ - 2.98 ( -3.6 , -2.37 ) compared with -0.77 ( -1.32 , -0.22 ) kPa ; P < 0.001 ] . CONCLUSIONS Synbiotic supplementation in addition to lifestyle modification is superior to lifestyle modification alone for the treatment of NAFLD , at least partially through attenuation of inflammatory markers in the body . Whether these effects will be sustained with longer treatment duration s remains to be determined Nonalcoholic fatty liver disease is the most prevalent chronic liver disease in Western countries ; it can progress to nonalcoholic steatohepatitis ( NASH ) , cirrhosis and hepatocarcinoma . The importance of gut-liver-adipose tissue axis has become evident and treatments targeting gut microbiota may improve inflammatory and metabolic parameters in NASH patients . In a r and omized , controlled clinical trial , involving 50 biopsy-proven NASH patients , we investigated the effects of synbiotic supplementation on metabolic parameters , hepatic steatosis , intestinal permeability , small intestinal bacterial overgrowth ( SIBO ) and lipopolysaccharide ( LPS ) serum levels . Patients were separated into two groups receiving Lactobacillus reuteri with guar gum and inulin for three months and healthy balanced nutritional counseling versus nutritional counseling alone . Before and after the intervention we assessed steatosis by magnetic resonance imaging , intestinal permeability by lactulose/mannitol urinary excretion and SIBO by glucose breath testing .  NASH patients presented high gut permeability , but low prevalence of SIBO . After the intervention , only the synbiotic group presented a reduction in steatosis , lost weight , diminished BMI and waist circumference measurement . Synbiotic did not improve intestinal permeability or LPS levels . We concluded that synbiotic supplementation associated with nutritional counseling seems superior to nutritional counseling alone for NASH treatment as it attenuates steatosis and may help to achieve weight loss Background : Recent studies suggest that prebiotic and /or probiotic treatments ameliorate kidney function in humans and animals by improving the gut environment . However , the gut microbiota and kidney disease interactions remain to be determined . This study investigated whether synbiotics modulate the gut microbiota and ameliorate kidney function using a rat model of chronic kidney disease ( CKD ) . As uremic toxins are associated with CKD-related mineral and bone disorder , the secondary aim was to evaluate the relationship between synbiotics and secondary hyperparathyroidism ( SHPT ) . Methods : 5/6 nephrectomy ( Nx ) rats were developed as the CKD model . Sham-operated ( sham ) rats were used as the control . To investigate the effectiveness of prebiotics ( glutamine , dietary fiber , and oligosaccharide ) and probiotics ( Bifidobacterium longum strain ; GFOB diet ) , rats were r and omly assigned to 4 groups : Nx group fed the GFOB diet ( n = 10 ) ; Nx group fed the control ( CON ) diet ( n = 10 ) ; sham group fed the GFOB diet ( n = 5 ) ; and sham group fed the control diet ( n = 5 ) . Blood , feces , and kidney sample s were collected and analyzed . Results : Serum creatinine ( Cre ) and blood urea nitrogen in the Nx GFOB group were significantly lower than those in the Nx CON group . Serum indoxyl sulfate in the Nx GFOB group was lower than that in the Nx CON group , and significantly correlated with serum Cre . Inorganic phosphorus and intact parathyroid hormone in the Nx GFOB group were significantly lower than those in the Nx CON group . Conclusion : Improving the gut environment using synbiotics ameliorated kidney function and might be a pharmacological treatment for SHPT without any serious adverse events This study aim ed to evaluate the relationship between gut probiotic flora and nonalcoholic fatty liver disease in a diet-induced rat model , and to compare the effects of two different probiotic strains on nonalcoholic fatty liver disease . Forty male Sprague-Dawley rats were r and omized into 4 groups for 12 weeks : control ( st and ard rat chow ) , model ( fat-rich diet ) , Lactobacillus ( fat-rich diet plus Lactobacillus acidophilus ) , and Bifidobacterium ( fat-rich diet plus Bifidobacterium longum ) groups . Probiotics were provided to rats in drinking water ( 1010/ml ) . Gut bifidobacteria and lactobacilli were obviously lower at weeks 8 and 10 , respectively , in the model group compared with the control group . Supplementation with Bifidobacterium significantly attenuated hepatic fat accumulation ( 0.10 ± 0.03 g/g liver tissue ) compared with the model group ( 0.16 ± 0.03 g/g liver tissue ) . However , there was no improvement in intestinal permeability in either the Lactobacillus or the Bifidobacterium group compared with the model group . In all 40 rats  , the hepatic total lipid content was negatively correlated with gut Lactobacillus ( r = −0.623 , p = 0.004 ) and Bifidobacterium ( r = −0.591 , p = 0.008 ) . Oral supplementation with probiotics attenuates hepatic fat accumulation . Further , Bifidobacterium longum is superior in terms of attenuating liver fat accumulation than is Lactobacillus acidophilus Elderly adults have alterations in their gut microbiota and immune functions that are associated with higher susceptibility to infections and metabolic disorders . Probiotics and prebiotics , and their synbiotic combinations are food supplements that have been shown to improve both gut and immune function . The objective of this r and omised , double-blind , placebo-controlled , cross-over human clinical trial was to study immune function and the gut microbiota in healthy elderly adults . Volunteers ( n 37 ) consumed prebiotic galacto-oligosaccharides ( GOS ; 8 g/d ) , probiotic Bifidobacterium lactis Bi-07 ( Bi-07 ; 109 colony-forming units/d ) , their combination ( Bi-07 + GOS ) and maltodextrin control ( 8 g/d ) in four 3-week periods separated by 4-week wash-out periods . Immune function was analysed by determining the phagocytic and oxidative burst activity of monocytes and granulocytes , whole-blood response to lipopolysaccharide , plasma chemokine concentrations and salivary IgA levels . Gut microbiota composition and faecal SCFA content were determined using 16S ribosomal RNA fluorescence in situ hybridisation and HPLC , respectively . Primary statistical analyses indicated the presence of carry-over effects and thus measurements from only the first supplementation period were considered valid . Subsequent statistical analysis showed that consumption of Bi-07 improved the phagocytic activity of monocytes ( P < 0·001 ) and granulocytes ( P = 0·02 ) . Other parameters were unchanged . We have for the first time shown that the probiotic Bi-07 may provide health benefits to elderly individuals by improving the phagocytic activity of monocytes and granulocytes . The present results also suggest that in the elderly , the effects of some probiotics and prebiotics may last longer than in adults Bacterial infections frequently occur early after liver transplantation . We recently reported significant progress with a synbiotic composition , consisting of one lactic acid bacteria ( LAB ) and one fiber , which reduced the infection rate from 48 % ( with selective bowel decontamination ) to 13 % . Now , our aim is to study if a combination of different LAB and fibers would further improve outcome BACKGROUND Animal studies suggest that prebiotics and probiotics exert protective effects against tumor development in the colon , but human data supporting this suggestion are weak . OBJECTIVE The objective was to verify whether the prebiotic concept ( selective interaction with colonic flora of nondigested carbohydrates ) as induced by a synbiotic preparation-oligofructose-enriched inulin ( SYN1 ) + Lactobacillus rhamnosus GG ( LGG ) and Bifidobacterium lactis Bb12 (BB12)-is able to reduce the risk of colon cancer in humans . DESIGN The 12-wk r and omized , double-blind , placebo-controlled trial of a synbiotic food composed of the prebiotic SYN1 and probiotics LGG and BB12 was conducted in 37 colon cancer patients and 43 polypectomized patients . Fecal and blood sample s were obtained before , during , and after the intervention , and colorectal biopsy sample s were obtained before and after the intervention . The effect of synbiotic consumption on a battery of intermediate bio-markers for colon cancer was examined . RESULTS Synbiotic intervention result ed in significant changes in fecal flora : Bifidobacterium and Lactobacillus increased and Clostridium perfringens decreased . The intervention significantly reduced colorectal proliferation and the capacity of fecal water to induce necrosis in colonic cells and improve epithelial barrier function in polypectomized patients . Genotoxicity assays of colonic biopsy sample s indicated a decreased exposure to genotoxins in polypectomized patients at the end of the intervention period . Synbiotic consumption prevented an increased secretion of interleukin 2 by peripheral blood mononuclear cells in the polypectomized patients and increased the production of interferon gamma in the cancer patients . CONCLUSIONS Several colorectal cancer biomarkers can be altered favorably by synbiotic intervention BACKGROUND The aim of this study was to assess the effect of preoperative and postoperative synbiotic treatment in hepatectomy patients with or without liver cirrhosis . METHODS Sixty-one patients with hepatic cancer were assigned r and omly to receive either oral synbiotics that consisted of Bifidobacterium , Lactobacillus , and galactooligosaccharides or no synbiotics ( control ) preoperatively for 14 days and postoperatively for 11 days . Infectious complications , intestinal mucosal integrity as measured by serum diamine oxidase ( DAO ) activity , and fecal flora and organic acid concentrations were compared between synbiotic treatment ( n = 32 ) and control ( n = 29 ) groups . RESULTS Fecal flora culture and organic acid concentrations were changed after hepatectomy in both groups . The postsurgery decrease in DAO activity was less profound in the synbiotic-treated group ( P < .01 ) and was correlated negatively with serum interleukin 6 and C-reactive protein concentrations ( P < .001 ) . Infectious complications occurred in 5 ( 17.2 % ) patients in the control group and no patients in the synbiotic-treated group ( P < .05 ) . CONCLUSION Perioperative synbiotic treatment attenuated the decrease in intestinal integrity and reduced the rate of infectious complications in patients with or without liver cirrhosis who underwent hepatic surgery The hypothesis that probiotic administration protects the gut surface and could delay progression of Human Immunodeficiency Virus type1 ( HIV-1 ) infection to the Acquired Immunodeficiency Syndrome ( AIDS ) was proposed in 1995 . Over the last five years , new studies have clarified the significance of HIV-1 infection of the gut associated lymphoid tissue ( GALT ) for subsequent alterations in the microflora and breakdown of the gut mucosal barrier leading to pathogenesis and development of AIDS . Current studies show that loss of gut CD4 + Th17 cells , which differentiate in response to normal microflora , occurs early in HIV-1 disease . Microbial translocation and suppression of the T regulatory ( Treg ) cell response is associated with chronic immune activation and inflammation . Combinations of probiotic bacteria which upregulate Treg activation have shown promise in suppressing pro inflammatory immune response in models of autoimmunity including inflammatory bowel disease and provide a rationale for use of probiotics in HIV-1/AIDS . Disturbance of the microbiota early in HIV-1 infection leads to greater dominance of potential pathogens , reducing levels of bifidobacteria and lactobacillus species and increasing mucosal inflammation . The interaction of chronic or recurrent infections , and immune activation contributes to nutritional deficiencies that have lasting consequences especially in the HIV-1 infected child . While effective anti-retroviral therapy ( ART ) has enhanced survival , wasting is still an independent predictor of survival and a major presenting symptom . Congenital exposure to HIV-1 is a risk factor for growth delay in both infected and non-infected infants . Nutritional intervention after 6 months of age appears to be largely ineffective . A meta analysis of r and omized , controlled clinical trials of infant formulae supplemented with Bifidobacterium lactis showed that weight gain was significantly greater in infants who received B. lactis compared to formula alone . Pilot studies have shown that probiotic bacteria given as a supplement have improved growth and protected against loss of CD4 + T cells . The recognition that normal bacterial flora prime neonatal immune response and that abnormal flora have a profound impact on metabolism has generated insight into potential mechanisms of gut dysfunction in many setting s including HIV-1 infection . As discussed here , current and emerging studies support the concept that probiotic bacteria can provide specific benefit in HIV-1 infection . Probiotic bacteria have proven active against bacterial vaginosis in HIV-1 positive women and have enhanced growth in infants with congenital HIV-1 infection . Probiotic bacteria may stabilize CD4 + T cell numbers in HIV-1 infected children and are likely to have protective effects against inflammation and chronic immune activation of the gastrointestinal immune system BACKGROUND / PURPOSE Acidified diets are protective against intestinal bacterial colonization and translocation .  Probiotic diets are design ed to modulate the intestinal flora to enhance mucosal immunity . This study was design ed to determine if formula acidified with live probiotic decreases bacterial gut colonization and translocation , and is equally tolerated as other acidified diets . METHODS One hundred twenty-eight rabbit pups delivered via cesarean section [ cesarean delivery , cesarean birth , abdominal delivery ] were r and omly assigned to 4 feeding groups :  NAN Nestle ( control , pH 7.0 ) ,  NAN acidified with citric acid ( pH 4.55 ) , biologically acidified Pelargon ( pH 4.55 ) , and  NAN with live Lactococcus lactis culture ( pH 4.2 ) . Pups were gavage fed every 12 hours with Enterobacter cloacae challenges of 10 colony-forming units/mL per feed and killed on day of life 3 . Lungs , liver , spleen , mesenteric lymph nodes ( MLNs ) , stomach , and cecum were cultured and quantitatively analyzed for target organism growth . Results were analyzed using chi(2 ) tests . RESULTS NAN with live probiotic culture , when compared with Pelargon , acidified NAN , and NAN , significantly reduced the incidence of Enterobacter pulmonary colonization ( P < .01 ) , bacterial translocation ( liver , P < .025 ; spleen and MLN , P < .05 ) , and gastric and intestinal colonization ( P < .001 for both ) . CONCLUSION Probiotic-fortified formula provides superior protection against pulmonary and gastrointestinal bacterial colonization and translocation compared with neutral and acidified formulas , and is equally tolerated Summary BACKGROUND : Preoperative bowel cleaning for elective colorectal surgery is a routine procedure . Synbiotics ( probiotics plus prebiotics ) are known for their beneficial effects on gut immune function and maintenance of the gut barrier . The main purpose of this study was to replace preoperative mechanical bowel cleaning with synbiotics and to assess the systemic inflammatory response and clinical outcome in patients undergoing colorectal surgery . PATIENTS AND METHODS : A prospect i ve double-blind r and omized placebo-controlled trial was conducted in 68 patients . The first group of 20 patients received synbiotics , the second group of 28 patients prebiotics and heat-deactivated probiotics , and the third ( control ) group of 20 patients mechanical bowel cleaning prior to the operation . RESULTS : Significantly higher values of interleukin 6 ( IL-6 ) were detected 72 h after the operation in the synbiotic group ( P = 0.025 ) , as well as an increase of fibrinogen at 24 h postoperatively ( P = 0.030 ) . No statistical differences were found in leukocytes count , C-reactive protein or the lymphocyte/granulocyte ratio . There were no differences in postoperative complications between the groups . Mean hospital stay was 9.2 days in the prebiotic group , 9.5 days in the control group , and 10.95 days in the synbiotic group . CONCLUSIONS : Preoperative administration of prebiotics in elective colorectal surgery appears to have the same protective effect in preventing a postoperative inflammatory response as mechanical bowel cleaning . Further prospect i ve studies are needed to verify the effects of synbiotics Background Emerging evidence suggests modulating the microbiota in the large bowel of patients with chronic kidney disease ( CKD ) through pre- and /probiotic supplementation may inhibit the development of key nephrovascular toxins . To date , quality intervention trials investigating this novel treatment in CKD are lacking . The aim of SYNERGY is to assess the effectiveness of synbiotics ( co-administration of pre- and probiotics ) as a potential treatment targeting the synthesis of uremic toxins , specifically , indoxyl sulphate ( IS ) and p-cresyl sulphate ( PCS ) . Methods / design Thirty-seven patients with moderate to severe CKD ( Stage IV and V , pre-dialysis ) will be recruited to a double-blind , placebo-controlled , r and omised cross-over trial . Patients will be provided with synbiotic therapy or placebo for 6 weeks , with a 4 week washout before cross-over . The primary outcome is serum IS , total and free ( unbound ) concentrations , measured using ultra-performance liquid chromatography . Secondary outcomes include serum PCS , total and free ( unbound ) concentrations ; cardiovascular risk , measured by serum lipopolysaccharides , serum trimethylamine-N-oxide ( TMAO ) and inflammation and oxidative stress markers ; kidney damage , measured by 24 hour proteinuria and albuminuria , estimated glomerular filtration rate and renal tubule damage ( urinary kidney injury molecule-1 ) ; patients ’ self assessed quality of life ; and gastrointestinal symptoms . In addition , the effects on the community structure of the stool microbiota will be explored in a subset of patients to vali date the mechanistic rationale underpinning the synbiotic therapy . Discussion IS and PCS are two novel uremic toxins implicated in both cardiovascular disease ( CVD ) and progression of CKD . Preliminary studies indicate that synbiotic therapy maybe a promising strategy when considering a targeted , tolerable and cost-efficient therapy for lowering serum IS and PCS concentrations . This trial will provide high quality ‘ proof-of-concept ’ data to eluci date both the efficacy of synbiotic therapy for lowering the toxins and whether reductions in serum IS and PCS translate into clinical benefits . Considering the potential of pre- and probiotics to not only shift toxin levels , but to also impede CVD and CKD progression , SYNERGY will provide vital insight into the effectiveness of this innocuous nutritional therapy . Trial Registration Universal Trial Number : U1111 - 1142 - 4363 . Australian New Zeal and Clinical Trials Registry Number : ACTRN12613000493741 , date registered : 2nd May 2013 Pediatric obesity is rising worldwide leading the worrying phenomenon of nonalcoholic fatty liver disease ( NAFLD ) to shift into one of the most frequent causes of chronic liver illness in childhood . Occurrence of NAFLD depends on several factors such as the geographical area and the diagnostic modalities used ; overall it ranges between 3 % and 10 % of pediatric population , increasing up to 70 % in patients with metabolic comorbidities ( Manco M , Bottazzo G , DeVito R et al , J Am Coll Nutr 27:667 - 676 , 2008).Recent findings have related the intestinal microbiota to a plethora of pathological conditions , including type 2 diabetes ( T2D ) , obesity , and nonalcoholic steatohepatitis ( NASH ) . One of the emerging areas of the study is the link between liver diseases and gut microbiome , which has added new information to the underst and ing of the so-called gut-liver axis . In order to address the role of gut microbiome in NAFLD onset and progression , it is necessary to " decipher " operational codes for microbiome investigation within the context of advanced laboratory medicine to capture microbiome features and , hence , to address the function of the intestinal microbiome within the gut microbiota-liver axis . Results of these investigations have allowed the beginning of implementing the usage of probiotics and symbiotics in the medical approach of  obesity and NAFLD in adults and children . Several r and omized clinical trials ( RCTs ) have been already published on  fecal microbiota transplantation  ( FMT ) , T2D , NASH , and inflammatory bowel disease (IBD).This review proposes to describe the current state of knowledge on the ways fatty liver diseases can be addressed with nutritional interventions , probiotics , symbiotics , and FMT BACKGROUND AND OBJECTIVES The generation of key uremic nephrovascular toxins , indoxyl sulfate ( IS ) , and p-cresyl sulfate ( PCS ) , is attributed to the dysbiotic gut microbiota in CKD . The aim of our study was to evaluate whether synbiotic ( pre- and probiotic ) therapy alters the gut microbiota and reduces serum concentrations of microbiome-generated uremic toxins , IS and PCS , in patients with CKD . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS Predialysis adult participants with CKD ( eGFR=10 - 30 ml/min per 1.73 m(2 ) ) were recruited between January 5 , 2013 and November 12 , 2013 to a r and omized , double-blind , placebo-controlled , crossover trial of synbiotic therapy over 6 weeks ( 4-week washout ) . The primary outcome was serum IS . Secondary outcomes included serum PCS , stool microbiota profile , eGFR , proteinuria-albuminuria , urinary kidney injury molecule-1 , serum inflammatory biomarkers ( IL-1β , IL-6 , IL-10 , and TNF-α ) , serum oxidative stress biomarkers ( F2-isoprostanes and glutathione peroxidase ) , serum LPS , patient-reported health , Gastrointestinal Symptom Score , and dietary intake . A prespecified subgroup analysis explored the effect of antibiotic use on treatment effect . RESULTS Of 37 individuals r and omized ( age = 69±10 years old ; 57 % men ; eGFR=24±8 ml/min per 1.73 m(2 ) ) , 31 completed the study .  Synbiotic therapy did not significantly reduce serum IS ( -2 μmol/L ; 95 % confidence interval [ 95 % CI ] , -5 to 1 μmol/L ) but did significantly reduce serum PCS ( -14 μmol/L ; 95 % CI , -27 to -2 μmol/L ) . Decreases in both PCS and IS concentrations were more pronounced in patients who did not receive antibiotics during the study ( n=21 ; serum PCS , -25 μmol/L ; 95 % CI , -38 to -12 μmol/L ; serum IS , -5 μmol/L ; 95 % CI , -8 to -1 μmol/L ) . Synbiotics also altered the stool microbiome , particularly with enrichment of Bifidobacterium and depletion of Ruminococcaceae . Except for an increase in albuminuria of 38 mg/24 h ( P=0.03 ) in the synbiotic arm , no changes were observed in the other secondary outcomes . CONCLUSION In patients with CKD , synbiotics did not significantly reduce serum IS but did decrease serum PCS and favorably modified the stool microbiome . Large-scale clinical trials are justified Objective To investigate the functional effects of probiotic treatment on the gut microbiota , as well as liver and adipose gene expression in diet-induced obese mice . Design Male C57BL/6J mice were fed a high-fat diet ( HFD ) for 8 weeks to induce obesity , and then r and omized to receive HFD+probiotic ( Lactobacillus curvatus HY7601 and Lactobacillus plantarum KY1032 , n = 9 ) or HFD+placebo ( n = 9 ) for another 10 weeks . Normal diet ( ND ) fed mice ( n = 9 ) served as non-obese controls . Results Diet-induced obese mice treated with probiotics showed reduced body weight gain and fat accumulation as well as lowered plasma insulin , leptin , total-cholesterol and liver toxicity biomarkers . A total of 151,061 pyrosequencing reads for fecal microbiota were analyzed with a mean of 6,564 , 5,274 and 4,464 reads for the ND , HFD+placebo and HFD+probiotic groups , respectively . Gut microbiota species were shared among the experimental groups despite the different diets and treatments . The diversity of the gut microbiota and its composition were significantly altered in the diet-induced obese mice and after probiotic treatment . We observed concurrent transcriptional changes in adipose tissue and the liver . In adipose tissue , pro-inflammatory genes ( TNFα , IL6 , IL1β and MCP1 ) were down-regulated in mice receiving probiotic treatment . In the liver , fatty acid oxidation-related genes ( PGC1α , CPT1 , CPT2 and ACOX1 ) were up-regulated in mice receiving probiotic treatment . Conclusions The gut microbiota of diet-induced obese mice appears to be modulated in mice  receiving probiotic treatment . Probiotic treatment might reduce diet-induced obesity and modulate genes associated with metabolism and inflammation in the liver and adipose tissue Background : This research was to examine the effects of synbiotic intake on minerals , liver enzymes , and blood pressure in patients with type 2 diabetes ( T2D ) . Methods : This r and omized , cross-over clinical trial was performed among 62 diabetic patients . Persons were r and omly assigned to intake either a synbiotic ( n = 62 ) or a control food ( n = 62 ) for 6 weeks . A 3-week washout period was applied following which persons were crossed over to the alternate intervention arm for an additional 6 weeks . The synbiotic was consisted of Lactobacillus sporogenes ( 1 × 107 CFU ) , 0.04 g inulin ( HPX ) as prebiotic . Persons were asked to consume the synbiotic and control foods 27 g a day . Blood pressure was measured , and blood sample s were taken at baseline and after 6-week intervention to assess calcium , magnesium , iron , alkaline phosphatase , aspartate aminotransferase , alanine aminotransferase , and total bilirubin . Results : The consumption of a synbiotic food , compared to the control food , result ed in a significant rise of calcium ( 0.66 vs. −0.14 mg/dL , P = 0.03 ) and iron ( 5.06 vs. −9.98 mg/dL , P = 0.03 ) . The decrease of total bilirubin ( 0.08 vs. −0.04 mg/dL ; P = 0.009 ) was also seen in the synbiotic group compared with the control group . Conclusions : Overall , synbiotic in T2D patients had beneficial effects on calcium , iron , and total bilirubin concentrations Abstract Background : Experience with administration of synbiotics ( prebiotics/probiotics ) in patients with severe acute pancreatitis ( SAP ) has demonstrated immunomodulatory capacity . The aim of this trial was evaluation of the feasibility and perspective of early clinical application of oral synbiotic/prebiotic supplements in patients with SAP . Methods : 90 SAP patients were enrolled during the period from 2005–2008 . Patients were stratified according to the feeding mode . CONTROL ( n = 32 ) group received st and ard whole protein feeding formula . SYNBIO ( n = 30 ) and FIBRE groups ( n = 28 ) received early ( within first 24–48 hours ) synbiotic or prebiotic supplements . Oral administration of synbiotics or prebiotics was commenced when patients were able to sip water . Results : Daily provided average volume and calories of synbiotic/prebiotic blends were smaller compared to the CONTROL , p = 0.001 . Oral administration of synbiotic/prebiotic supplements was associated with lower infection rate ( pancreatic and peripancreatic necrosis ) compared to the CONTROL , ( p = 0.03 ; p = 0.001 ) , lower rate of surgical interventions , p = 0.005 , shorter ICU ( p = 0.05 ) and hospital stay ( p = 0.03 ) . Synbiotic supplemented enteral stimulation of the gut result ed in reduced mortality rate compared to the CONTROL , p = 0.02 . Conclusion : Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut seems to be a potentially valuable complement to the routine treatment protocol of SAP
Subgroup analysis suggested the existence of liver disease at baseline , synbiotics supplementation and duration of supplementation ≥ 8 weeks result ed in more pronounced improvement in liver function enzymes than their counterparts .
Conclusions Probiotics and synbiotics may be suggested as supplements to improve serum concentration of liver enzymes , especially when synbiotics administered for a period ≥ 8 weeks and in individuals with liver disease
Purpose The gut – liver interaction suggests that modification of gut bacterial flora using probiotics and synbiotics may improve liver function .
This systematic review and meta- analysis aim ed to clarify the effect of probiotics and synbiotics consumption on the serum concentration of liver function enzymes .