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Clinical usefulness of probiotics in inflammatory bowel diseases

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Probiotics are live nonpathogenic bacteria or bacterial components that may be helpful in the prevention and treatment of acute diarrhoea in adults and children and have some effects on the course of inflammatory bowel diseases (IBD). Many experimental and clinical studies suggest that intestinal bacterial flora plays an important role in the pathogenesis of IBD, and manipulation of the luminal contents with antibiotics or probiotics represents a potentially effective therapeutic option. The beneficial effect of probiotics was demonstrated mainly in the prevention and treatment of pouchitis and in maintaining remission of mild to moderate ulcerative colitis. Probiotics seems to be less effective in patients with Crohn’s disease. Randomized clinical trials are still required to further define the role of probiotics as preventive and therapeutic agents. This review summarizes the current data about probiotics in IBD.
The influence of fungal colonization and probiotic treatment on the course of gastric ulcer (GU) and ulcerative colitis (UC) was not explored. Our studies included: 1) clinical investigation of 293 patients with dyspeptic and ulcer complaints and 72 patients with lower gastrointestinal (GI) tract: 60 patients with UC, 12 with irritable bowel syndrome (IBS) - the control group. Significant fungal colonization (SFC), over 105 CFU/ml was evaluated. Mycological investigation was performed, including qualitative and quantitative examination, according to Muller method, 2) experimental studies in rats included estimation of the influence of inoculation of Candida isolated from human GI tract on the healing process of GU, induced by acetic acid with or without probiotic Lactobacillus acidophilus (106 CFU/ml) introduced intragastrically (i.g.). At 0, 4, 15 and 25 day after ulcer induction. Weight, damage area, gastric blood flow (GBF) (H2 clearance), expression of mRNA for cytokines IL-ß, TNF-alpha (ELISA) were evaluated. Mycology: qualitative and quantitative examination was performed. MPO serum activity was measured. Results of clinical studies: 1) SFC was more frequent in patients with GU: 54.2% of cases and patients with over 5 years history of UC: 33.3% cases. 2) SFC delayed GU healing and influenced the maintenance of clinical symptoms in both diseases. Results of animal studies: 3) In Candida inoculated rats, the GBF was significantly lower than in the vehicle controls (saline administered group). Upregulation of TNF-alpha, IL-1ß was recorded. The GUs were still present till 25 day in all rats inoculated with Candida, in contrast to vehicle group (reduction of ulcer in 92% at day 25). Conclusions: 1) Fungal colonization delays process of ulcer and inflammation healing of GI tract mucosa. That effect was attenuated by probiotic therapy. 2) Probiotic therapy seems to be effective in treatment of fungal colonization of GI tract. 3) Lactobacillus acidophilus therapy shortens the duration of fungal colonization of mucosa (enhanced Candida clearance is associated with IL-4, INF- response).
AIM. We investigated effects of pulsating electromagnetic field (PEMF-50 Hz, 45 ± 5 mT) on viability and cytokine production by human peripheral blood mononuclear cells (PBMC) from healthy donors and from Crohn’s disease patients (CD). METHODS. The study was performed after activation of cells with phytohaemaglutinin (PHA) and lipopolisaccharide (LPS). Exposure of PBMC cultures to PEMF from both CD patients and from healthy donors decreased cell’s viability of about 10% and 5% (p>0,05) respectively. PEMF influence was most effective after threefold application. Susceptibility of PBMCs to magnetic field exposure differs among the stimulated (PHA, LPS) and not stimulated (NS) cells. Mitogen activated cells during cell division are most susceptible to induction of the cell death as a result of magnetic interaction, contrary PEMF exposure has minimal effect on non-diving PBMCs from CD patients and from controls. Decreased viability of the Crohn derived cells upon magnetic stimulation was accompanied by altered cytokines profile. Exposed and stimulated PBMCs from Crohn patients decreased IFN- proinflammatory and increased IL-10 anti-inflammatory cytokine production. The electromagnetically induced cell death could be an important step for non-invasive PEMF treatment in chronic inflammatory diseases.
The influence of fungal colonization on the course of ulcerative colitis (UC) has not been thoroughly studied. We determined the activity of the disease using clinical, endoscopic and histological index (IACH) criteria in UC patients with fungal colonization and the healing process of UC induced by an intrarectal administration of trinitrobenzene sulfonic acid (TNBS) in rats infected with Candida, without and with antifungal (fluconazole) or probiotic (lacidofil) treatment. The intensity of the healing of the colonic lesions was assessed by macro- and microscopic criteria as well as functional alterations in colonic blood flow (CBF). Myeloperoxidase (MPO) content and plasma proinflammatory cytokines IL-1ß and TNF- levels were evaluated. Candida more frequently colonized patients with a history of UC within a 5-year period, when compared with those of shorter duration of IBS. Among Candida strains colonizing intestinal mucosa, Candida albicans was identified in 91% of cases. Significant inhibition of the UC activity index as reflected by clinical, endoscopical and histological criteria was observed in the Candida group treated with fluconazole, when compared to that without antifungal treatment. In the animal model, Candida infection significantly delayed the healing of TNBS-induced UC, decreased the CBF and raised the plasma IL-1ß and TNF- levels, with these effects reversed by fluconazole or lacidofil treatment. We conclude that 1) Candida delays healing of UC in both humans and that induced by TNBS in rats, and 2) antifungal therapy and probiotic treatment during Candida infection could be beneficial in the restoration and healing of colonic damage in UC.
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