AB0607 Effect of probiotic lactobacillus casei shirota on clinical manifestations and serum cytokines in patients with rheumatoid arthritis
Authors: S.L. Ruiz-Quezada, G.E. Martínez-Bonilla, A.A. De la Cruz-Castro, K.P. Estrada-Martínez, V. González-Diaz, M. Castañeda Ureña, V. Rodríguez-Orozco, A. Lόpez-Rodríguez, A.G. Bernard-Medina, S. Cerpa-Cruz, S. Gutiérrez-Ureña, J.F. Muñoz-Valle, M.R. Torres-Vitela
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Probiotics are live microorganisms administered primarily in fermented milk products that increase the viability of the microbiota, allow the physiological processes of the intestine and modulate the immune system.The probiotic <i>L. casei</i> Shirota has decreased the inflammatory response in mice with collagen-induced arthritis. <h3>Objectives</h3> To determine the effect of <i>Lactobacillus casei</i> Shirota on the clinical manifestations, gastrointestinal symptoms and serum levels of pro and anti-inflammatory cytokines: TNF-α, IL-1 b and IL-10 in patients with active RA. <h3>Methods</h3> We performed a controlled single blinded clinical trial that included 19 female patients with active RA (DAS &gt;3.2), ≥18 years of age, with no other inflammatory rheumatic o infectious disease and on stable treatment (DMARDs and prednisone &lt;10 mg/d) in the last 3 months. They were randomized to two groups: the study group was given fermented milk at a dose of 4×10<sup>10</sup> CFU of <i>L. casei</i> Shirota per day for 6 weeks and a placebo group. Cutoffs were made at 0, 6 and 9 weeks, the latter as a washout period to see if the effect remained. DAS28-ESR, HAQ-DI, gastrointestinal symptoms with the validated Gastrointestinal Symptom Rating Scale questionnaire (GSRS) and serum levels of cytokines: TNFα, IL-1β and IL-10 (ELISA) were evaluated. Statistical analysis was performed with SPSS using nonparametric tests Kruskal Wallis and Mann-Whitney test. <h3>Results</h3> We included 11 patients in the study group (51±12 years of age) and 8 patients in the placebo group (54±20 years of age). No statistical significance in clinical findings was observed between both groups, but patients in the study group did improvein HAQ DI values that decreased from 1.03±0.4 at week 0 to 0.58±0.4 and 0.51±0.5 at week 6 and 9 respectively (p&lt;0.05). A favorable trend was observed in DAS28, 5.5±0.8, 5.2±0.9 and 4.9±1.1 at week 0, 6 and 9 respectively. An improvement in gastrointestinal symptoms was seen with a GSRS score of 8.4±4.8 at baseline that decreased to 3.8±2.3 at week 9 (p&lt;0.05). Proinflammatory cytokine levels also tended to decrease and an increase in anti-inflammatory cytokines was seen but without statistical significance between baseline and end of study results, but neither when compared with the placebo group. No patient experienced side effects. <h3>Conclusions</h3> These results suggest that probiotic <i>L. casei</i> Shirota may have beneficial additive effect when used to treat RA. However more studies are needed with a higher dose, longer period of time and a larger amount of patients to determine effects of <i>L. casei</i> Shirota. <h3>References</h3> So JS, Kwon HK, Lee CG, Yi HJ, Park JA, Lim SY, et al. Lactobacillus casei suppresses experimental arthritis by down-regulating T helper 1 effector functions. Mol Immunol. 2008 May;45(9):2690-9. <h3>Disclosure of Interest</h3> None Declared