The past, the present and the perspectives for the use of probiotics

Piotr Kochan, Magdalena Strus, Piotr B. Heczko

Polish Society for Probiotics and Prebiotics, Cracow, Poland &
Chair of Microbiology, Jagiellonian University Medical College, Cracow, Poland

Abstract
Bacteria are studied for their beneficial influence for many years now. In the 21st century, the researchers are becoming more and more familiar with the mechanisms by which these bacteria interact with the environment and it is now becoming a widely accepted standard that one needs to select specific strains for the given application. This short article will summarize a few facts relating to the use of these bacteria in order to observe their potential in bringing a health benefit to the host.

The past
Already in the beginning of the 20th century, a Nobel Prize laureate – Elie Metchnikoff (1845-1916), Russian zoologist and microbiologist, may have come across the field of what is today known as probiotics. In his studies on aging and prolongation of life he concentrated on the G.I. tract flora as the source of “autointoxication” by many “harmful” bacteria and postulated that supplementing the diet with sugar fermenting, lactic acid producing bacteria with little proteolytic activity may in fact substitute these harmful bacteria. At the same time a French paediatrician – Henry Tissier observed that children with diarrhoea had less typically Y-shaped bacteria in their stools. These “bifid” bacteria were on the other hand more numerous in healthy children. He suggested that such bacteria may be beneficial when given to children with diarrhoea. Japan was the first country to introduce a commercial drink containing Lactobacillus casei Shirota into its market in 1935.

Present definition
Since its founding, the Polish Society for Probiotics and Prebiotics is strongly advocating the FAO/WHO [1] definition of probiotics: “Probiotics are live microorganisms, which when administered in adequate amount confer a health benefit on the host”. In other words, this definition restricts the use of the word to living, most commonly – bacteria or fungi, that are consumed or administered in a known number and one may observe a given health benefit for the organism. This definition also excludes the residues/supernatants to be termed with another name, possibly postbiotics.

In order for a microorganism to be called a probiotic, it should follow the FAO/WHO guidelines for evaluation [1]. One should also remember that most probiotics are sold as food supplements, not drugs.

Present studies
The studies that were done on candidate probiotic strains or probiotics up to date show many potential applications. For example, one of the most frequently investigated areas is probiotic use in paediatric diarrhoea, both infectious and antibiotic-associated. Numerous authors investigated this field and many found promising effects [2, 3], although a recently published review on antibiotic-associated diarrhoea points to the need for further hard-evidence studies [4]. There are also studies investigating the potential benefit of probiotics in inflammatory bowel diseases (IBDs) like ulcerative colitis and Crohn’s disease. Yet another well known field of investigations is the infections of the female genitourinary tract. Here the spectrum extends over the use of beneficial bacteria in counteracting the pathogens of bacterial vaginosis (BV) or yeasts causing vulvovaginal candidiasis (VVC). There are studies that show benefits of probiotic use in these infections in women, although more studies are needed here, too [5, 6].

Future perspectives
Studies on prophylaxis and treatment using probiotics will be continued in many fields of medicine and nutrition, namely gastroenterology and paediatrics (diarrhoeas, including antibiotic-associated; IBD; irritable bowel syndrome; H. pylori infections; necrotizing enterocolitis), allergology and immunology, gynaecology (BV; VVC and HIV infections), oncology (esp. colon cancer). There are also many other interesting fields with potential of probiotics to be established, e.g. radiation induced diarrhoea [7] or prevention of bacterial translocation owing to the augmentation of the intestinal barrier. The field will definitely expand when more sophisticated mechanisms of probiotic action will be elucidated. References

1. World Health Organization, Food and Agriculture Organization of the United Nations. Probiotics in food. Health and nutritional properties and guidelines for evaluation. FAO Food and Nutrition Paper 85; Rome 2006. Online access valid on July 3, 2007: ftp://ftp.fao.org/docrep/fao/009/a0512e/a0512e00.pdf
2. Szajewska H, Skorka A, Ruszczynski M, Gieruszczak-Bialek D. Meta-analysis: Lactobacillus GG for treating acute diarrhoea in children. Aliment Pharmacol Ther 2007; 25:871–881.
3. Szajewska H, Skorka A, Dylag M. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther 2007; 25:257–264.
4. Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2007; 2:CD004827.
5. Falagas ME, Betsi GI, Athanasiou S. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. J Antimicrob Chemother 2006; 58:266–272.
6. Onderdonk AB. Probiotics for women's health. J Clin Gastroenterol 2006:256–259.
7. Delia P, Sansotta G, Donato V, Frosina P, Messina G, De Renzis C, Famularo G. Use of probiotics for prevention of radiation-induced diarrhea. World J Gastroenterol 2007; 13:912–915.

If you want to contact this author:

Dr Piotr Kochan, M.D.
Chair of Microbiology
Jagiellonian University Medical College
18 Czysta Street
31-121 Cracow
Poland
Telephone: +4812 633 25 67
Fax: +4812 423 39 24
E-mail: pkochan@cm-uj.krakow.pl