Individuals with cirrhosis have been reported to show a duodenal bacterial dysbiosis that might be related to the composition of the oral microbiota. Although the relationship between cirrhosis and gut microbiota is only observational and causality cannot be inferred yet, studying the effects of probiotics in patients with cirrhosis is promising.
A recent study, led by Vanessa Stadlbauer from the Department of Gastroenterology and Hepatology, Medical University of Graz, in Graz (Austria), has found that a multispecies probiotic may have beneficial effects on immune function in patients with cirrhosis.
The researchers performed a randomised, double blind, placebo-controlled study in which out-patients with stable cirrhosis (alcoholic cirrhosis, hepatitis C virus-associated cirrhosis and other cirrhoses) received either a daily dose of a multispecies probiotic containing 8 different bacterial strains (Bifidobacterium bifidum W23, Bifidobacterium lactis W52, Lactobacillus acidophilus W37, Lactobacillus brevis W63, Lactobacillus casei W56, Lactobacillus salivarius W24, Lactococcus lactis W19 and Lactococcus lactis W58) (6 g, 2.5 x 109 colony forming units/g; n = 44) or a placebo (n = 36) for 6 months and were followed up for another 6 months. In addition, healthy controls (n = 51) who received no intervention were included in the study to control for laboratory parameters. Detailed assessments were performed after 3 months of intervention, after 6 months of intervention, and after a further 6 months of observation.
Neutrophil resting burst (a measure of neutrophil activation) and levels of neopterin (produced by activated monocytes, macrophages, and dendritic cells upon stimulation by T-lymphocytes; induces the production of reactive species in neutrophils) increased after 6 months of intervention in the probiotic group, but not in the placebo group. These data show that probiotic intervention improved anti-microbial activity during the intervention period.
Infection rates were exceptionally low in both intervention and placebo groups, though a numerical trend toward lower frequency of mild infections in the probiotic group compared to the placebo group was reported.
Probiotic intervention did not have a significant influence on neutrophil phagocytosis, endotoxin load, endotoxin-related proteins, gut permeability, or inflammatory markers in this context.
Finally, liver function showed some improvement with probiotics but not with placebo. Of the 16 patients in the probiotic group with a Child-Pugh score (CPS; used to assess the prognosis of chronic liver cirrhosis) of 7 or higher, 6 improved after initiation of probiotics. These results were corroborated by a slight improvement in the model of end-stage liver disease (MELD) score in the probiotic group. No change in liver function was found in the placebo group.
In conclusion, supplementation with a multispecies probiotic for 6 months may benefit immune function in some patients with cirrhosis. As probiotics were very well tolerated by the patients, without side effects, these data suggest a possible role for probiotics in managing liver cirrhosis.
Chen Y, Ji F, Guo J, Shi D, Fang D, Li L. Dysbiosis of small intestinal microbiota in liver cirrhosis and its association with etiology. Sci Rep. 2016; 6:34055. doi: 10.1038/srep34055.
Horvath A, Leber B, Schmerboeck B, et al. Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis. Aliment Pharmacol Ther. 2016; 44(9):926-35. doi: 10.1111/apt.13788.