Patent Abstract:
the present invention relates to probiotic compositions and kits thereof , comprising live bacteria belonging to the natural flora of the human body cavity such as intestine and vaginal tract , in particular , strains of lactobacillus or bifidobacterium species , and low molecular - weight non - proteinaceous iron chelators capable of lowering the iron concentration over the whole physiological ph - range of relevance to levels that inhibit growth of pathogens , but which allow for the growth of the bacteria of the composition .

Detailed Description:
it is therefore a first aspect of the present invention a pharmaceutical or probiotic composition comprising : ( a ) at least one lactobacillus species and strain or at least one bifidobacterium species and strain , or any mixtures thereof ; and the compositions of the invention are particularly advantageous as they may be used in the prevention and / or treatment of pathologies or pathological states due to infections of the human body cavities . in the present description , and unless otherwise provided , with the term lactobacillus species and strain and bifidobacterium species and strain we intend those species and strains having a good tolerability in humans and a high affinity for human mucosa . preferably , the lactobacillus strain belongs to the species selected from lactobacillus johnsonii , lactobacillus reuterii , lactobacillus paracasei , lactobacillus casei , lactobacillus animalis , lactobacillus ruminis , lactobacillus acidophilus , lactobacillus rhamnosus , lactobacillus fermentum , and lactobacillus delbrueckii subsp . lactis . even more preferably , lactobacillus strains are those selected from the group consisting of lactobacillus johnsonii la1 ncc 2461 (= cncm i - 2116 ), lactobacillus reuterii strains 4000 and 4020 ( from biogaia biologics inc ., raleigh , n . c . ), lactobacillus paracasei strains cncm i - 1390 , cncm i - 1391 , cncm i - 1392 , lactobacillus casei strain shirota , lactobacillus acidophilus strain cncm i - 1447 , lactobacillus acidophilus lat 11 / 83 , lactobacillus acidophilus ncc 2463 (= cncm i - 2623 ), lactobacillus rhamnosus gg ( atcc 53103 ), lactobacillus rhamnosus 271 ( dsmz 6594 ) and lactobacillus rhamnosus vtt e - 800 . as far as the bifidobacterium strain is concerned , it preferably belongs to the species selected from : bifidobacterium spp ., bifidobacterium bifidum , bifidobacterium longum , bifidobacterium pseudolongum , bifidobacterium infantis , bifidobacterium adolescentis , and bifidobacterium lactis . even more preferably , bifidobacterium strains are selected from the group consisting of : bifidobacterium bifidum ncc 189 (= cncm i - 2333 ), bifidobacterium adolescentis ncc 251 (= cncm i - 2168 ), bifidobacterium lactis ( atcc 27536 ), bifidobacterium breve cncm i - 1226 , bifidobacterium infantis cncm i - 1227 , and bifidobacterium longum cncm i - 1228 . all the mentioned lactobacilli and bifidobacteria are well known to the skilled person and they may be isolated according to known methods or , in case , they may be obtained directly from the referred bacterial collections . unless otherwise provided , the pharmaceutical or probiotic compositions of the invention may comprise one or more lactobacillus species and strain , or one or more bifidobacterium species and strain , or even any mixture thereof , selected from the aforementioned lactobacilli and bifidobacteria . preferably , however , the compositions comprise at least one lactobacillus species and strain or at least one bifidobacterium species and strain . even more preferably , the pharmaceutical or probiotic compositions of the invention comprise at least one lactobacillus species and strain . in the present description , unless stated otherwise , with the term chelator we intend chemical moieties , agents , compounds or molecules , either as such or in the form of pharmaceutically acceptable salts , characterized by the presence of functional groups which are able to form a complex by more than one coordination bond with a transition metal or another metal entity . in the specific case , the chelator , otherwise known as chelating agent , according to the invention , is a physiologically acceptable derivative enabling for the formation of an iron coordination complex , acting by that as an iron sequestring agent . most preferred iron chelators are those with a conditional formation constant for iron ( iii ) ions over the ph range of 4 . 6 to 8 . 2 , of at least 10 15 l / mol , and preferably above 10 17 l / mol . with the term physiologically acceptable we intend any chelator suitable for the administration to humans for the intended therapeutic use , in combination with the above lactobacilli and / or bifidobacteria , in any suitable administration routes . with the term non - proteinaceous chelator or chelating agent we intend any chelators not having the characterizing structures of proteins , being the definition of protein widely known to the skilled person . typically , the non - proteinaceous chelator of the invention has an average molecular weight ( mw ) lower than 10 kda , more preferably lower than 5 kda and even more preferably lower than 1 kda , that is well below the average mw of the protein structures ( e . g . lactoferrin mw = 80 kda ). suitable chelating agents are , for instance , selected from the group consisting of : pyridinone derivatives such as deferiprone ( see the merck index , xiii ed . 2001 , no . 2878 ), hydroxamates such as desferroxamine b or acetohydroxamic acid ; cathecols such as 1 , 8 - dihydroxynaphthalene - 3 , 6 - sulfonic acid , mecams , 4 - licams , 3 , 4 - licams , 8 - hydroxyquinoline or disulfocathecol ; polyaminopolycarboxylic acids and derivatives thereof comprising , inter alia , ethylenediamine - n , n ′- bis ( 2 - hydroxyphenylacetic acid ) ( eddha ), n -( hydroxyethyl )- ethylenediaminetriacetic acid ( hedta ), n , n ′- bis ( 2 - hydroxybenzyl )- ethylenediamine - n , n ′- diacetic acid ( hbed ), n , n ′- ethylenebis - 2 -( o - hydroxyphenyl ) glycine ( ehpg ), triethylene - tetraaminehexaacetic acid ( ttha ), diethylenetriamine pentaacetic acid ( dtpa ), dtpa - bismethylamide , benzo - dtpa , dibenzo - dtpa , phenyl - dtpa , diphenyl - dtpa , benzyl - dtpa , dibenzyl - dtpa , n , n - bis [ 2 -[( carboxymethyl )[( methylcarbamoyl ) methyl ] ethyl ]- glycine ( dtpa - bma ), n -[ 2 -[ bis ( carboxymethyl ) amino ]- 3 -( 4 - ethoxyphenyl ) propyl )]- n -[ 2 -[ bis ( carboxymethyl ) amino ] ethyl ] glycine ( eob - dtpa ), 4 - carboxy - 5 , 8 , 11 - tris ( carboxymethyl )- 1 - phenyl - 2 - oxa - 5 , 8 , 11 - triazatridecan - 13 - oic acid ( bopta ), n , n - bis [ 2 -[ bis ( carboxymethyl ) amino ] ethyl ] l - glutamic acid ( dtpa - glu ) and dtpa - lys ; ethylenediaminotetraacetic acid ( edta ), trans - 1 , 2 - diaminocyclohexane ; n , n , n ′, n ′- tetraacetic acid ( cdta ), nta , pdta , 1 , 4 , 7 , 10 - teraazacyclododecane - 1 , 4 , 7 ,- triacetic acid ( do3a ) and derivatives thereof including , for example , [ 10 -( 2 - hydroxypropyl )- 1 , 4 , 7 , 10 - teraazacyclododecane - 1 , 4 , 7 ,- triacetic acid ( hpdo3a ) and corresponding [ 10 -( 2 - hydroxypropyl )- 1 , 4 , 7 , 10 - tetraazado decane - 1 , 4 , 7 - triacetato ( 3 -)- n 1 , n 4 , n 7 n 10 , o 1 , o 4 , o 7 , o 10 ] calcinate ( 1 -), calcium ( 2 : 1 ), better known as calteridol or ca 3 ( hpdo3a ) 2 , 1 , 4 , 7 - triazacyclononane - n , n ′, n ″- triacetic acid ( nota ), 6 -[ bis ( carboxymethyl ) amino ] tetrahydro - 6 - methyl - 1h - 1 , 4 - diazepine - 1 , 4 ( 5h )- diacetic acid ( aazta ) and derivative thereof , 1 , 4 , 7 , 10 - tetraazacyclotetradecane - 1 , 4 , 7 , 10 - tetraacetic acid ( dota ) and derivatives thereof including , among others , benzo - dota , dibenzo - dota , ( α , α ′, α ″, α ′″)- tetramethyl - 1 , 4 , 7 , 10 - tetraazacyclo - tetradecane - 1 , 4 , 7 , 10 - tetraacetic acid ( dotma ), and 1 , 4 , 8 , 11 - tetraazacyclotetradecane - n , n ′, n ″, n ′″- tetraacetic acid ( teta ), or corresponding compounds wherein one or more carboxylic group is replaced by a phosphonic and / or phosphinic group including , for instance , n , n ′- bis -( pyridoxal - 5 - phosphate )- ethylenediamine - n . n ′- diacetic acid ( dpdp ), ethylenedinitrilotetrakis ( methylphosphonic ) acid ( edtp ), 1 , 4 , 7 , 10 - tetraazacyclotetradecane - 1 , 4 , 7 , 10 - tetra ( methylenepho sphonic ) acid ( dotp ); as well as texaphyrins , porphyrins and phthalocyanines . preferred chelating agents according to the present invention include deferiprone , hpdo3a and derivatives thereof such as , inter alia , calteridol , dtpa and derivatives thereof comprising , for instance , dtpa - glu and dtpa - lys ; dota and derivatives thereof ; bopta ; aazta and derivatives thereof ; edta and derivatives thereof ; teta and derivatives thereof . the above listed chelating agents are widely known in the art and may be in case prepared according to known methods . for most of them , in addition , there already exists experience with human use . for a general reference to iron chelators see , for instance , zu d . liu , robert c . hider ; design of iron chelators with therapeutic application ; coordination chemistry reviews volume 232 , issues 1 - 2 , october 2002 , pages 151 - 171 . as an example , the iron chelator dtpa in the form of calcium trisodium pentetate ( ditripentat ®, heyl & amp ; co ., berlin , germany ) is used subcutaneously , at daily doses of 0 . 5 to 1 g for 5 days a week , for the treatment of thalassemia in patients with high - tone deafness caused by deferoxamine ( ref . 32 ). additionally , although in the form of a salified gadolinium complex , gadopentetate dimeglumine ( magnevist ®, schering ag , berlin , germany ) is used as a contrast agent for magnetic resonance imaging . its enteral form contains trisodium pentetate as excipient at a level of 455 mg / l of administrable drink . as the maximal recommended dose is 1 l , an oral dose of 455 mg ( 0 . 99 mmol ) of trisodium pentetate is already being used and proven to be safe , at least for a single administration . the acute oral semilethal dose ( ld 50 ) of dtpa in mice is 3500 mg / kg . thus , dtpa is a safe oral drug , representing a preferred iron chelator for the compositions of the present invention . likewise , the compound 4 - carboxy - 5 , 8 , 11 - tris ( carboxymethyl )- 1 - phenyl - 2 - oxa - 5 , 8 , 11 - triazatridecan - 13 - oic acid ( bopta ) has been found to have an acute oral ld 50 in mice of 8 . 4 mmol / kg . it is therefore a further preferred iron chelator for the compositions of the invention . for the pharmaceutical use , these chelators may also be formulated as complexes in the form of a pharmaceutical acceptable salt , including neutral salts , such as in particular , calcium complexes . in this direction , in fact , the calcium binding affinity is weak enough to not substantially interfere with the iron binding of pharmacological interest . in this respect , another preferred iron chelator in the form of a calcium complex , is calteridol also known as ca 3 ( hpdo3a ) 2 and corresponding to [ 10 -( 2 - hydroxypropyl )- 1 , 4 , 7 , 10 - tetraazadodecane - 1 , 4 , 7 - triacetato ( 3 -)- n 1 , n 4 , n 7 , n 10 , o 1 , o 4 , o 7 , o 10 ] calcinate ( 1 -), calcium ( 2 : 1 ), which is used in the intravenous contrast agent formulations of gadoteridol ( see the merck index , xiii ed ., 2001 , no . 4353 ). the preferred therapeutic or probiotic compositions of the invention can be formulated in different ways , depending on the desired route of administration , according to methods adopted in the pharmaceutical field . preferably , the compositions of the invention may be administered either orally or topically , as reported in more details herein below . as an example , said compositions can be formulated as a mixture of components or , alternatively , they can equally be offered as separate pharmaceutical formulations in a single kit , for example for the simultaneous or sequential oral or vaginal administration . therefore , it is an additional embodiment of the invention a kit of parts wherein a first part comprises at least one lactobacillus species and strain or at least one bifidobacterium species and strain , or mixtures thereof , and a second part comprises at least one low molecular - weight non - proteinaceous iron chelator . non limitative examples of particularly preferred compositions of the invention are disclosed below . a first embodiment of the invention is represented by the compositions generally intended for gastrointestinal use , to be preferably administered as a drink , a capsule , an infant formula or a dairy product . to this extent , the selected bacterial strains may be suitably employed so that the amount of bacteria available to the individual corresponds to about 10 3 to about 10 14 cfu per day , preferably from about 10 7 to about 10 12 cfu per day , and even more preferably from about 10 9 to about 10 12 cfu per day . the corresponding amount of iron chelator may range from about 10 − 3 to about 10 − 9 mol , and preferably from 10 − 4 to about 10 − 7 mol . in case the compositions of the invention should be intended in the form of an oral formulation , they might be offered in any proper form , such as , among others , a milk drink , a yoghurt - similar milk product , a cheese , an ice - cream , a fermented cereal - based product , a milk - based powder , an infant formula , a tablet , a capsule , a liquid suspension , a dried oral grit or powder , a wet oral paste or jelly , a grit or powder for dry tube feeding or a fluid for wet tube feeding . alternatively , the drink may be prepared before use from a dissolvable capsule containing the active ingredients . preferably , the drink may be prepared before use by reconstituting a dry powder containing the lyophilized bacteria and the iron chelator or , alternatively , by reconstituting a dry powder containing the lyophilized bacteria with a physiological solution already comprising the chelator . the dry powder is preferably packaged in such a way that the stability of the solid may be retained along the time , such as for instance , into airtight and light - tight sachets , under air or nitrogen , under a noble gas or under vacuum . as far as the capsules are concerned , they may be properly manufactured according to conventional methods . from all of the above , it is clear to the skilled person that the compositions of the invention may further comprise any additional excipients among those commonly employed in pharmaceutical formulations , in order , for instance , to stabilize the compositions themselves , or to render them easily dispersible or to give them an agreeable taste . among said excipients inulin , fructose , starch , xylo - oligosaccharides , silicon oxide , buffering agents as well as flavors , are suitable examples . furthermore , optional active ingredients may be also present in the compositions of the invention such as , for instance , vitamins , amino acids , polypeptides and the like . an example of an optional active ingredient may be represented by glutamine ( ref . 33 ) which may help intestinal cells to defend themselves under stress conditions due to pathogenic organisms ( ref . 34 and 35 ). alanyl - glutamine ( ref . 36 ) as well as a variety of vitamins may also represent additional ingredients within the compositions . the presence of transition metals should be preferably avoided so to not impair the binding and / or sequestration of the naturally occurring iron ions by the chelator . however , by considering that the preferred chelators according to the invention bind iron ions much stronger than other physiological transition - metal ions , for instance zinc or copper , the presence of these latter substantially does not affect the efficacy of the present compositions . according to an additional embodiment , the present invention also provides for a composition intended for the vaginal use , for instance as a compressed vaginal suppository or insert , preferably as a rapidly dissolving type , such as a tampon or a douche . vaginal suppositories and capsules are well - known pharmaceutical formulations . during their manufacturing process , however , special cares should be taken to operate at temperature conditions at which the bacteria may survive , according to methods known in the art ( ref . 4 ). vaginal inserts are also known in the art and may be manufactured , for instance , by powder compression of maltodextrin beads including the components of the invention ( ref . 4 ). standard catameneal tampons , and their production methods , can be well adapted for obtaining vaginal tampons bearing the ingredients of the invention on their surface ; preferably , the final tampon is packaged in a way suitable for the protection from moisture . vaginal douches are commercially known and generally consist of a product to be locally applied by a proper applicator , hence suitable for the vaginal delivery of the compositions of the invention . clearly , unlike otherwise provided , also the compositions intended for vaginal use may comprise additional excipients among those known in the art ( e . g ., buffering agents ) and / or active ingredients known for formulations of this type . the compositions of the invention resulted to be particularly effective in the colonization of the gastrointestinal tract or the vaginal tract and , hence , allow for the restoration of a well functioning microflora , particularly in the case of a previous use of antibiotics . it will be self evident to the skilled person , that said compositions may find a wide range of applications either in the maintenance of probiotic bacteria adhering to healthy mucosal surfaces or in the treatment of the infections of the human body cavities such as , e . g ., the vaginal tract , the male urethra , the intestine and the buccal cavity . vaginal infections wherein the compositions of the invention may be advantageously used may comprise , as non limiting examples , bacterial vaginosis , symptomatic yeast vaginitis , gonorrhea , chlamydia , trichomoniasis , human immunodeficiency virus infection , urinary tract infection or pelvic inflammatory disease . further , among the pathological conditions of the gastrointestinal tract , the compositions of the invention may be used for the treatment of acute diarrhea in adults and infants , rotavirus - related , travel &# 39 ; s or antibiotic - associated diarrhea , and recurrent clostridium difficile colitis . with the aim of illustrating the present invention , without posing any limitation to it , the following examples are now given . a powder containing lactobacilli and at least one small molecular weight non - proteinaceous iron chelator , suitable for preparing a drink , was formulated to have the following composition : portions of 7 g of this powder were filled into sachets under low humidity conditions and sealed . a single dose of the drink consisted in the content of a sachet suspended in a glass of water . analogously to example 1 , a powder containing the selected strain of lactobacilli and the small molecular weight non - proteinaceous iron chelator was formulated , wherein the chelator was calteridol , which is [ 10 -( 2 - hydroxypropyl )- 1 , 4 , 7 , 10 - tetraazadodecane - 1 , 4 , 7 - triacetato ( 3 -)- n 1 , n 4 , n 7 , n 10 , o 1 , o 4 , o 7 , o 10 ] calcinate ( 1 -), calcium ( 2 : 1 ), abbreviated ca 3 ( hp - do3a ) 2 , in the same amount . a powder containing the selected lactobacilli strain and at least one small molecular weight non - proteinaceous iron chelator suitable for preparing a drink was formulated to have the following composition : portions of 7 g of this powder were filled into sachets under low humidity conditions and sealed . a single dose of the drink consisted in the content of a sachet suspended in a glass of water . a therapeutic infant formulation was obtained by mixing from 0 . 5 % to 5 %, preferably 2 %, of polypeptides ; from 0 . 2 % to 10 %, preferably 4 %, of fat ; from 1 % to 25 %, preferably 8 %, of non - levan carbohydrates ( including lactose 65 %, maltodextrin 20 % and starch 15 %); a proper amount of an iron chelator , and at least 10 6 cfu / ml of the following strain : lactobacillus acidophilus cncm i - 1447 , in combination with traces of vitamins to meet the daily requirements ; from 0 . 01 % to 2 %, preferably 0 . 3 %, of minerals , and from 50 % to 75 % of water . a yoghurt - like milk product was prepared by the following procedure . one liter of a milk product containing 2 . 8 % of fats and supplemented with 2 % of skimmed milk powder and 6 % of sucrose was prepared . then , the product was pasteurized at 96 ° c . for 30 min according to known methods . a proper amount of calteridol was then added . a preculture of lactobacillus paracasei cncm i - 1390 was reactivated in a medium containing 10 % of reconstituted milk powder and 0 . 1 % of commercial yeast extract with 1 % sucrose . the pasteurized milk product was then inoculated with 1 % of the reactivated preculture and this milk product was then allowed to ferment until the ph reaches a value of 4 . 5 . the resulting therapeutic yoghurt - like milk - product was stored at 4 ° c . in a sterilized blender , 0 . 12 kg finely ground calteridol was blended with 1 . 33 kg of polyethylene glycol 1000 ( peg 1000 ) under nitrogen , during which the polyethylene glycol melts . under continued mild mixing the calteridol - peg 1000 mixture was cooled until returned to a semi - solid consistency . by intensive mechanical mixing and under vacuum in a cooled container , the following ingredients were admixed : the resulting mixture was formed into 5 g suppositories by a cooled compression molding technique . the procedure substantially follows the one of example 3 of ref . 4 , with the difference that the maltodextrin beads was first sprayed with an aqueous solution of calteridol sodium and dried in a fluid bed drier , and then sprayed with the bacterial cell matrix suspension . 2 parts gelatin ( e . g ., 137 . 5 g per 500 ml reagent water ) and 4 parts skim milk ( e . g ., 15 g per 250 ml reagent water ) were autoclaved at about 121 ° c . for about 15 min . 4 parts xylitol ( e . g ., 59 g per 250 ml reagent water ) and 4 parts dextrose ( 25 g per 250 ml reagent water ) were mixed together , the mixture was adjusted to ph 7 . 2 - 7 . 4 and filter sterilized with a 0 . 22 μm filter . the sterile components were therefore combined into a single solution ( gelatin base ) and stored at 2 - 8 ° c . ascorbic acid was prepared as a 5 % ( w / w ) solution , filter - sterilized with a 0 . 22 μm filter and stored at − 20 ° c . at the time of the production of the vaginal medicant , the gelatin base was melted and tempered to about 35 ° c . then , the 5 % ( w / w ) ascorbic acid was added to the gelatin base at a ratio of 1 : 10 to form the preservation matrix solution . a solution of calteridol ( 462 mg / ml reagent water ) was prepared and sterilized at 121 ° c . for 20 min . lactobacillus paracasei cncm i - 1390 is grown as described in ref . 30 at a cell density of about 5 × 10 9 cells / ml and a cell pellet was prepared by centrifugation for 5 min at 1400 - 1600 rpm . the cell pellet was resuspended in a phosphate - buffered saline and pelleted again by centrifugation . the cell pellet was resuspended in 1 part of phosphate - buffered saline and 10 parts of preservation matrix solution . the cell matrix suspension was gently mixed and maintained under continuous mixing at 35 ° c . to form the complete vaginal medicant , a fluid bed dryer having sterilized components was assembled for use . maltodextrin beads ( maltrin ® qd m510 , grain processing corporation , muscatine , iowa ) were placed into the fluid bed dryer and dried at 33 ° c . until a sufficient dryness was achieved . the air pressure was then set to 14 psi , and the solution of calteridol sodium [ ca 3 ( hp - do3a ) 2 ] ( 50 ml per kg of maltodextrin beads ) was sprayed onto the beads using a peristaltic pump . the beads were allowed to dry for 30 min at about 38 ° c . the temperature was decreased to 33 ° c . and the cell matrix suspension ( 50 ml per kg of maltodextrin beads ) was sprayed onto the beads with the aid of the peristaltic pump . after 50 % of the cell matrix suspension was sprayed onto the beads , the temperature was increased to 38 ° c . after all the cell matrix suspension was sprayed onto the beads , the coated beads were allowed to dry at about 38 ° c . for about 30 min . in case , the coated maltodextrin beads may be frozen and stored as a powder . the powder was filled into gelatin capsules type 00 to a level of about 500 mg per capsule . one capsule contains about 5 × 10 8 cfu of lactobacilli . the capsules may be packaged , optionally under nitrogen or vacuum , into air and vapor - tight primary packaging material . the procedure substantially follows the one of the preceding example 7 , with the difference that the phosphate - buffered saline used in the preparation of the cell matrix suspension was modified to contain 10 mm of a small molecular weight non - proteinaceous iron chelator , preferably calteridol sodium [ ca 3 ( hp - do3a ) 2 ], under reduction of the sodium chloride concentration to achieve isotonicity , i . e ., about 290 mosmol / kg . vaginal capsules were prepared essentially as described in present example 8 , except that lactobacullus paracasei cncm i - 1390 was replaced by the lactobacullus crispatus ctv - 05 described in ref . 4 . the maltodextrin beads coated with lactobacullus paracasei cncm i - 1390 were prepared as described in example 14 . vaginal inserts were prepared by compression . a lyophilized powder containing lactic acid bacteria , the chelator and the excipients was prepared . a vaginal tampon was prepared composed of an absorbent compressed , cylindrical core of tissue pulp and short rayon fibers . maximal dryness of the core was assured by placing it in a high vacuum overnight and working in a low humidity environment . the tailing one - third was temporarily wrapped with plastic and the leading two - thirds were covered with the described powder by turning and rubbing it by hand on a flat glass surface . a non - woven cover was wrapped around the core and a withdrawal string was knotted around the core at its trailing end . the finished tampon was packaged under dry nitrogen into airtight and light - tight pharmaceutical sachet . 1 . gorbach s . l ., menda k . b ., thadepalli h . & amp ; keith l . : anaerobic microflora of the cervix in healthy women . am . j . obstet . gynecol . 117 , 1053 - 1055 , 1973 . 2 . redondo - lopez v ., cook r . l . & amp ; sobel j . g . : emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora . rev . infect . dis . 12 , 856 - 872 , 1990 . 3 . reid g ., bruce a . w . & amp ; taylor m . : influence of three - day antimicrobial therapy and lactobacillus vaginal suppositories on recurrence of urinary tract infection . clin . ther . 14 , 11 - 16 , 1992 . 4 . chrisope g . l . : vaginal lactobacillus medicant . u . s . pat . no . 6 , 468 , 526 b2 . 5 . bin l . x . : controlled clinical trial of lacteol fort sachets versus furazolidone or berberine in the treatment of acute diarrhea in children . ann . pédiatr . [ paris ], 42 , 396 - 401 , 1995 . 6 . boulloche j ., mouterde o . & amp ; mallet e . : management of acute diarrhea in infants and young children . ann . pédiatr . [ paris ], 41 , 1 - 7 , 1994 . 7 . biller j . a ., katz a . j ., flores a . f ., buie t . m . & amp ; gorbach s . l . : treatment of recurrent clostridium difficile colitis with lactobacillus gg . j . pediatr . gastroenterol . nutr . 21 , 224 - 226 , 1995 8 . isolauri e ., kaila m ., mykänen h ., ling w . h . & amp ; salminen s . : oral bacteriotherapy for viral gastroenteritis . dig . dis . sci . 39 , 2595 - 2600 , 1994 . 9 . raza s ., graham s . m ., allen s . j ., sultana s ., cuevas l . & amp ; hart c . a . : lactobacillus gg promotes recovery from acute nonbloody diarrhea in pakistan . pedatr . inf . dis . j . 14 , 107 - 111 , 1995 . 10 . 11 . saavedra j . m ., bauman n . a ., oung i ., perman j . a . & amp ; yolken r . h . : feeding of bifidobacterium bifidum and streptococcus thermophilus to infants in hospital for prevention of diarrhea and shedding of rotavirus . lancet 344 , 1046 - 1049 , 1994 . 11 . hallen a ., jarstrand c . & amp ; pahlson c . : treatment of bacterial vaginosis with lactobacilli . sex . trasm . dis . 19 , 146 - 148 , 1992 . 12 . sarkinov s . e ., krymshokalova z . s ., kafarskaia l . i . & amp ; korshunoov v . m . : [ the use of the biotherapeutic agent zhlemik for correcting the microflora in bacterial vaginosis ] zhur . mikrobiol . epidemiol . immunobiol . [ moscow ] ( 1 ), 88 - 90 , 2000 . 13 . wooldridge k . g . & amp ; williams p . h . : iron uptake mechanisms of pathogenic bacteria . fems microbiol . rev . 12 , 325 - 348 , 1993 . 14 . gohlke m . b . & amp ; cockrum r . h . : dietary supplement combining colostrums and lactoferrin in a mucosal delivery format . u . s . pat . no . 6 , 258 , 383 b1 . 15 . trümpler u ., straub p . w . & amp ; rosenmund a . : antibacterial prophylaxis with lactoferrin in neutropenic patients . eur . j . clin . microbiol . infect . dis . 8 , 310 - 313 , 1989 . 16 . tanaka k ., ikeda m ., nozaki a ., kato n ., tsuda h ., saito s . & amp ; sekihara h . : lactoferrin inhibits hepatitis c virus viremia in patients with chronic hepatitis c : a pilot study . jpn . j . cancer res . 90 , 367 - 371 , 1999 . 17 . machnicki m ., zimecki m . & amp ; zagulski t . : lactoferrin regulates the release of tumour necrosis factor alpha and interleukin 6 in vivo . int . j . exp . pathol . 74 , 433 - 439 , 1993 . 18 . mickelsen p . a ., blackman e . & amp ; 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