Lactobacillus acidophilus LB: a useful pharmabiotic for the treatment of digestive disorders

José María Remes Troche, Enrique Coss Adame, Miguel Ángel Valdovinos Díaz, Octavio Gómez Escudero, María Eugenia Icaza Chávez, José Antonio Chávez-Barrera, Flora Zárate Mondragón, José Antonio Ruíz Velarde Velasco, Guillermo Rafael Aceves Tavares, Marco Antonio Lira Pedrín, Eduardo Cerda Contreras, Ramón Isaías Carmona Sánchez, Héctor Guerra López, Rodolfo Solana Ortiz, José María Remes Troche, Enrique Coss Adame, Miguel Ángel Valdovinos Díaz, Octavio Gómez Escudero, María Eugenia Icaza Chávez, José Antonio Chávez-Barrera, Flora Zárate Mondragón, José Antonio Ruíz Velarde Velasco, Guillermo Rafael Aceves Tavares, Marco Antonio Lira Pedrín, Eduardo Cerda Contreras, Ramón Isaías Carmona Sánchez, Héctor Guerra López, Rodolfo Solana Ortiz

Abstract

Dysbiosis, a loss of balance between resident bacterial communities and their host, is associated with multiple diseases, including inflammatory bowel diseases (nonspecific chronic ulcerative colitis and Crohn's disease), and digestive functional disorders. Probiotics, prebiotics, synbiotic organisms and, more recently, pharmabiotics, have been shown to modulate the human microbiota. In this review, we provide an overview of the key concepts relating to probiotics, prebiotics, synbiotic organisms, and pharmabiotics, with a focus on available clinical evidence regarding the specific use of a unique pharmabiotic, the strain Lactobacillus acidophilus LB (Lactobacillus boucardii), for the management of gastrointestinal disorders. Since it does not contain living organisms, the administration of L. acidophilus LB is effective and safe as an adjuvant in the treatment of acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea, even in the presence of immunosuppression.

Keywords: L. acidophilus LB; acute diarrhea; antibiotic-associated diarrhea; pharmabiotics; probiotics.

Conflict of interest statement

Conflict of interest statement: José María Remes Troche is a member of advisory boards for Asofarma, Takeda and Laboratorios Carnot and has given lectures for Asofarma, Takeda, Alfa Sigma, Sanfer, Menarini, and Laboratorios Carnot. Enrique Coss Adame declares being a member of advisory boards for Takeda Mexico, Asofarma Mexico, and Grünenthal Mexico, and a speaker for Takeda, Asofarma, Grünenthal, and Alfa Sigma. Miguel Ángel Valdovinos Díaz declares no conflicts of interest associated with this manuscript. Octavio Gómez Escudero declares no conflicts of interest associated with this manuscript María Eugenia Icaza Chávez declares no conflicts of interest associated with this manuscript José Antonio Chávez-Barrera declares no conflicts of interest associated with this manuscript. Flora Zárate Mondragón declares no conflicts of interest associated with this manuscript. José Antonio Ruíz Velarde Velasco declares no conflicts of interest associated with this manuscript Guillermo Rafael Aceves Tavares declares being a speaker for Laboratorios Carnot. Marco Antonio Lira Pedrín declares no conflicts of interest associated with this manuscript. Eduardo Cerda Contreras declares no conflicts of interest associated with this manuscript. Ramón Isaías declares no conflicts of interest associated with this manuscript. Héctor Guerra López and Rodolfo Solana Ortiz are employees of Laboratorios Carnot.

© The Author(s), 2020.

Figures

Figure 1.
Figure 1.
The distinction of a prebiotic based on the proposed definition. Reproduced with permission from Macmilllan/Springer Nature. Prebiotics must be selectively utilized and have adequate evidence of health benefit for the target host. Dietary prebiotics must not be degraded by the target host enzymes. *The figure shows candidate as well as accepted prebiotics in that levels of evidence currently vary, with FOS and GOS being the most researched prebiotics. CLA, conjugated linoleic acid; FOS, fructooligosaccharides; GOS, galactooligosaccharides; MOS, mannanoligosaccharides; PUFA, polyunsaturated fatty acid; XOS, xylooligosaccharides.
Figure 2.
Figure 2.
Mechanisms of gut microbiota modulation. Reproduced with permission from Wiley–Blackwell.
Figure 3.
Figure 3.
Probiotics’ action mechanisms in homeostasis maintenance. Modified, with permission from Wageningen Publishers.
Figure 4.
Figure 4.
Summary of the mechanisms of action of Lactobacillus acidophilus LB. Reproduced with permission from SAGE. The drawing on the left summarizes the activities of Lactobacillus LB cells and secreted molecules against luminally localized bacterial pathogens, and bacterial pathogens attached at the brush border or internalized in polarized intestinal epithelial cells. The drawing on the right summarizes the antagonistic activities of L. acidophilus-LB-secreted molecules against the pathogen-induced, signaling-dependent structural and functional lesions in the intestinal epithelial cells.

References

    1. Petersen C, Round JL. Defining dysbiosis and its influence on host immunity and disease. Cell Microbiol 2014; 16: 1024–1033.
    1. Chang C, Lin H. Dysbiosis in gastrointestinal disorders. Best Pract Res Clin Gastroenterol 2016; 30: 3–15.
    1. Vemuri RC, Gundamaraju R, Shinde T, et al. Therapeutic interventions for gut dysbiosis and related disorders in the elderly: antibiotics, probiotics or faecal microbiota transplantation? Benef Microbes 2017; 8: 179–192.
    1. Ursell LK, Metcalf JL, Parfrey LW, et al. Defining the human microbiome. Nutr Rev 2012; 70(Suppl. 1): S38–S44.
    1. Libertucci J, Young VB. The role of the microbiota in infectious diseases. Nat Microbiol 2019; 4: 35–45.
    1. Dieterich W, Schink M, Zopf Y. Microbiota in the gastrointestinal tract. Med Sci 2018; 6: 116–124.
    1. Sánchez B, Delgado S, Blanco-Míguez A, et al. Probiotics, gut microbiota, and their influence on host health and disease. Mol Nutr Food Res. Epub ahead of print 10 October 2017. DOI: 10.1002/mnfr.201600240.
    1. MedicalNewsToday. What are the gut microbiota and human microbiome?, . (2018, accessed 5 February 2020).
    1. Vieira AT, Fukumori C, Ferreira CM. New insights into therapeutic strategies for gut microbiota modulation in inflammatory diseases. Clin Transl Immunology 2016; 5: e87.
    1. Gibson GR, Hutkins R, Sanders ME, et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol 2017; 14: 491–502.
    1. World Gastroenterology Organization. Practice guideline. Probiotics and prebiotics, . (2017, accessed 5 February 2020).
    1. Markowiak P, Śliżewska K. Effects of probiotics, prebiotics, and synbiotics on human health. Nutrients 2017; 9: 1021.
    1. Patel R, DuPont HL. New approaches for bacteriotherapy: prebiotics, new-generation probiotics, and synbiotics. Clin Infect Dis 2015; 60(Suppl. 2): S108–S121.
    1. Van den Nieuwboer M, Brummer RJ, Guarner F, et al. The administration of probiotics and synbiotics in immune compromised adults: is it safe? Benef Microbes 2015; 6: 3–17.
    1. Giron F, Quigley EM. Pharmabiotic manipulation of the microbiota in gastrointestinal disorders: a clinical perspective. J Neurogastroenterol Motil 2018; 24: 355–366.
    1. Lee ES, Song EJ, Nam YD, et al. Probiotics in human health and disease: from nutribiotics to pharmabiotics. J Microbiol 2018; 56: 773–782.
    1. Weiss GA, Hennet T. Mechanisms and consequences of intestinal dysbiosis. Cell Mol Life Sci 2017; 74: 2959–2977.
    1. Valdes AM, Walter J, Segal E, et al. Role of the gut microbiota in nutrition and health. BMJ 2018; 361: k2179.
    1. Sebastián-Domingo JJ, Sánchez-Sánchez C. From the intestinal flora to the microbiome. Rev Esp Enferm Dig 2018; 110: 51–56.
    1. Passos MDCF, Moraes-Filho JP. Intestinal microbiota in digestive diseases. Arq Gastroenterol 2017; 54: 255–262.
    1. Goldstein EJ, Tyrrell KL, Citron DM. Lactobacillus species: taxonomic complexity and controversial susceptibilities. Clin Infect Dis 2015; 60(Suppl. 2): S98–S107.
    1. Ljungh A, Wadström T. Lactic acid bacteria as probiotics. Curr Issues Intest Microbiol 2006; 7: 73–89.
    1. Fernández MF, Boris S, Barbés C. Probiotic properties of human lactobacilli strains to be used in the gastrointestinal tract. J Appl Microbiol 2003; 94: 449–455.
    1. Dunne C, O’Mahony L, Murphy L, et al. In vitro selection criteria for probiotic bacteria of human origin: correlation with in vivo findings. Am J Clin Nutr 2001; 73(Suppl. 2): 386S–392S.
    1. Valdovinos MA, Montijo E, Abreu AT, et al. The Mexican consensus on probiotics in gastroenterology. Consenso mexicano sobre probióticos en gastroenterología. Rev Gastroenterol Mex 2017; 82: 156–178.
    1. Simkins J, Kaltsas A, Currie BP. Investigation of inpatient probiotic use at an academic medical center. Int J Infect Dis 2013; 17: e321–e324.
    1. Bull M, Plummer S, Marchesi J, et al. The life history of Lactobacillus acidophilus as a probiotic: a tale of revisionary taxonomy, misidentification and commercial success. FEMS Microbiol Lett 2013; 349: 77–87.
    1. Axcan Pharma SA. Declaración acerca del nombre de la cepa de la especialidad farmacéutica Lacteol. France: Axcan Pharma, 2006.
    1. Liévin-Le Moal V. A gastrointestinal anti-infectious biotherapeutic agent: the heat-treated Lactobacillus LB. Therap Adv Gastroenterol 2016; 9: 57–75.
    1. Szajewska H, Guarino A, Hojsak I, et al. Use of probiotics for management of acute gastroenteritis: a position paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr 2014; 58: 531–539.
    1. Adams CA. The probiotic paradox: live and dead cells are biological response modifiers. Nutr Res Rev 2010; 23: 37–46.
    1. Salazar-Lindo E, Figueroa-Quintanilla D, Caciano MI, et al. Effectiveness and safety of Lactobacillus LB in the treatment of mild acute diarrhea in children. J Pediatr Gastroenterol Nutr 2007; 44: 571–576.
    1. Liévin-Le Moal V, Sarrazin-Davila LE, Servin AL. An experimental study and a randomized, double-blind, placebo-controlled clinical trial to evaluate the antisecretory activity of Lactobacillus acidophilus strain LB against nonrotavirus diarrhea. Pediatrics 2007; 120: e795–e803.
    1. Simakachorn N, Pichaipat V, Rithipornpaisarn P, et al. Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children. J Pediatr Gastroenterol Nutr 2000; 30: 68–72.
    1. Xiao SD, Zhang DZ, Lu H, et al. Multicenter, randomized, controlled trial of heat-killed Lactobacillus acidophilus LB in patients with chronic diarrhea. Adv Ther 2003; 20: 253–260.
    1. Boulloche J, Mouterde O, Mallet E. Management of acute diarrhoea in infants and young children: controlled study of the anti-diarrhoeal efficacy of killed L. acidophilus (LB Strain) versus a placebo and a reference drug (loperamide). Ann Pediatr 1994; 41: 457–463.
    1. Bin LX. Controlled clinical trial in infants and children comparing Lactéol Fort sachets with two antidiarrhoeal reference drugs. Ann Pediatr 1995; 42: 396–401.
    1. Liévin-Le Moal V, Amsellem R, Servin AL. Impairment of swimming motility by antidiarrheic Lactobacillus acidophilus strain LB retards internalization of Salmonella enterica serovar typhimurium within human enterocyte-like cells. Antimicrob Agents Chemother 2011; 55: 4810–4820.
    1. Jason YSK, Ann GK, Zhaojin C, et al. Lactéol Fort reduces antibiotic-associated diarrhea. Singapore Fam Physician 2010; 36: 46–49.
    1. Grandy G, Medina M, Soria R, et al. Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children. BMC Infect Dis 2010; 10: 253.
    1. Szajewska H, Ruszczyński M, Kolaček S. Meta-analysis shows limited evidence for using Lactobacillus acidophilus LB to treat acute gastroenteritis in children. Acta Paediatr 2014; 103: 249–255.
    1. Sniffen JC, McFarland LV, Evans CT, et al. Choosing an appropriate probiotic product for your patient: an evidence-based practical guide. PLoS One 2018; 13: e0209205.
    1. Su GL, Ko CW, Bercik P, et al. AGA clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders. Gastroenterology 2020; 159: 697–705.
    1. Malagón-Rojas JN, Mantziari A, Salminen S, et al. Postbiotics for preventing and treating common infectious diseases in children: a systematic review. Nutrients 2020; 12: 389–403.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe