No evidence of harms of probiotic Lactobacillus rhamnosus GG ATCC 53103 in healthy elderly-a phase I open label study to assess safety, tolerability and cytokine responses

Patricia L Hibberd, Lauren Kleimola, Anne-Maria Fiorino, Christine Botelho, Miriam Haverkamp, Irina Andreyeva, Debra Poutsiaka, Claire Fraser, Gloria Solano-Aguilar, David R Snydman, Patricia L Hibberd, Lauren Kleimola, Anne-Maria Fiorino, Christine Botelho, Miriam Haverkamp, Irina Andreyeva, Debra Poutsiaka, Claire Fraser, Gloria Solano-Aguilar, David R Snydman

Abstract

Background: Although Lactobacillus rhamnosus GG ATCC 53103 (LGG) has been consumed by 2 to 5 million people daily since the mid 1990s, there are few clinical trials describing potential harms of LGG, particularly in the elderly.

Objectives: The primary objective of this open label clinical trial is to assess the safety and tolerability of 1×1010 colony forming units (CFU) of LGG administered orally twice daily to elderly volunteers for 28 days. The secondary objectives were to evaluate the effects of LGG on the gastrointestinal microbiome, host immune response and plasma cytokines.

Methods: Fifteen elderly volunteers, aged 66-80 years received LGG capsules containing 1×1010 CFU, twice daily for 28 days and were followed through day 56. Volunteers completed a daily diary, a telephone call on study days 3, 7 and 14 and study visits in the Clinical Research Center at baseline, day 28 and day 56 to determine whether adverse events had occurred. Assessments included prompted and open-ended questions.

Results: There were no serious adverse events. The 15 volunteers had a total of 47 events (range 1-7 per volunteer), 39 (83%) of which were rated as mild and 40% of which were considered related to consuming LGG. Thirty-one (70%) of the events were expected, prompted symptoms while 16 were unexpected events. The most common adverse events were gastrointestinal (bloating, gas, and nausea), 27 rated as mild and 3 rated as moderate. In the exploratory analysis, the pro-inflammatory cytokine interleukin 8 decreased during LGG consumption, returning towards baseline one month after discontinuing LGG (p = 0.038) while there was no difference in other pro- or anti-inflammatory plasma cytokines.

Conclusions: Lactobacillus rhamnosus GG ATCC 53103 is safe and well tolerated in healthy adults aged 65 years and older.

Trial registration: ClinicalTrials.gov NCT 01274598.

Trial registration: ClinicalTrials.gov NCT01274598.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participant flow diagram.
Figure 1. Participant flow diagram.

References

    1. Joint Food and Agriculture Organization of the United Nations and World Health Organization Working Group (2002) Guidelines for the Evaluation of Probiotics in Food.
    1. NIH NCCAM (2014) Oral Probiotics: An Introduction.
    1. Nandhini Rajagopal (2014) The North American Probioics Market.
    1. Human Microbiome Project Consortium (2012) Structure, function and diversity of the healthy human microbiome. Nature 486: 207–214. nature11234 [pii]. doi: 10.1038/nature11234
    1. Human Microbiome Project Consortium (2012) A framework for human microbiome research. Nature 486: 215–221. nature11209 [pii]. doi: 10.1038/nature11209
    1. Aagaard K, Petrosino J, Keitel W, Watson M, Katancik J, et al. (2013) The Human Microbiome Project strategy for comprehensive sampling of the human microbiome and why it matters. FASEB J 27: 1012–1022. fj.12-220806 [pii]. doi: 10.1096/fj.12-220806
    1. Gevers D, Knight R, Petrosino JF, Huang K, McGuire AL, et al. (2012) The Human Microbiome Project: a community resource for the healthy human microbiome. PLoS Biol 10: e1001377. PBIOLOGY-D-12-01967 [pii]. doi: 10.1371/journal.pbio.1001377
    1. Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, et al. (2009) A core gut microbiome in obese and lean twins. Nature 457: 480–484. nature07540 [pii]. doi: 10.1038/nature07540
    1. Madan JC, Farzan SF, Hibberd PL, Karagas MR (2012) Normal neonatal microbiome variation in relation to environmental factors, infection and allergy. Curr Opin Pediatr 24:753–759 10.1097/MOP.0b013e32835a1ac8
    1. Madan JC, Salari RC, Saxena D, Davidson L, O'Toole GA, et al. (2012) Gut microbial colonisation in premature neonates predicts neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 97: F456–F462. fetalneonatal-2011-301373 [pii]. doi: 10.1136/fetalneonatal-2011-301373
    1. Petschow B, Dore J, Hibberd P, Dinan T, Reid G, et al. (2013) Probiotics, prebiotics, and the host microbiome: the science of translation. Ann N Y Acad Sci 1306:1–17 10.1111/nyas.12303
    1. Food and Drug Administration (2013) FDA Guidance for Clinical Investigators, Sponsors and IRBs. Investigational New Drug Applications (INDs) - Determining whether human research studies can be conducted without an IND.
    1. Hempel S, Newberry S, Ruelaz A, Wang Z, Miles JN, et al. (2011) Safety of probiotics used to reduce risk and prevent or treat disease. Evid Rep Technol Assess (Full Rep) 1–645.
    1. Gorbach SL (1996) The discovery of Lactobacillus GG. Nutrition Today 31:25–45.
    1. Wong SS, Quan TZ, Dunne EM, Mulholland EK, Tang ML, et al. (2013) Inhibition of Streptococcus pneumoniae adherence to human epithelial cells in vitro by the probiotic Lactobacillus rhamnosus GG. BMC Res Notes 6: 135. 1756-0500-6-135 [pii]. doi: 10.1186/1756-0500-6-135
    1. Hudault S, Lievin V, Bernet-Camard MF, Servin AL (1997) Antagonistic activity exerted in vitro and in vivo by Lactobacillus casei (strain GG) against Salmonella typhimurium C5 infection. Appl Environ Microbiol 63:513–518.
    1. Miettinen M, Matikainen S, Vuopio-Varkila J, Pirhonen J, Varkila K, et al. (1998) Lactobacilli and streptococci induce interleukin-12 (IL-12), IL-18, and gamma interferon production in human peripheral blood mononuclear cells. Infection & Immunity 66:6058–6062.
    1. Veckman V, Miettinen M, Pirhonen J, Siren J, Matikainen S, et al. (2004) Streptococcus pyogenes and Lactobacillus rhamnosus differentially induce maturation and production of Th1-type cytokines and chemokines in human monocyte-derived dendritic cells. J Leukoc Biol 75: 764–771. jlb.1003461 [pii]. doi: 10.1189/jlb.1003461
    1. Fang H, Elina T, Heikki A, Seppo S (2000) Modulation of humoral immune response through probiotic intake. FEMS Immunol Med Microbiol 29:47–52.
    1. Ocana VS, Ruiz Holgado AA, Nader-Macias ME (1999) Growth inhibition of Staphylococcus aureus by H2O2-producing Lactobacillus paracasei subsp. paracasei isolated from the human vagina. FEMS Immunology & Medical Microbiology 23:87–92.
    1. Fang W, Shi M, Huang L, Chen J, Wang Y (1996) Antagonism of lactic acid bacteria towards Staphylococcus aureus and Escherichia coli on agar plates and in milk. Veterinary Research 27:3–12.
    1. Forestier C, De CC, Vatoux C, Joly B (2001) Probiotic activities of Lactobacillus casei rhamnosus: in vitro adherence to intestinal cells and antimicrobial properties. Res Microbiol 152: 167–173. S0923250801011883 [pii].
    1. Lievin-Le MV, Servin AL (2014) Anti-infective activities of lactobacillus strains in the human intestinal microbiota: from probiotics to gastrointestinal anti-infectious biotherapeutic agents. Clin Microbiol Rev 27: 167–199. 27/2/167 [pii]. doi: 10.1128/CMR.00080-13
    1. Floch MH, Walker WA, Madsen K, Sanders ME, Macfarlane GT, et al. (2011) Recommendations for probiotic use-2011 update. J Clin Gastroenterol 45 Suppl S168–S171. 00004836-201111001-00015 [pii]. doi: 10.1097/MCG.0b013e318230928b
    1. Floch MH, Walker WA, Guandalini S, Hibberd P, Gorbach S, et al. (2008) Recommendations for probiotic use–2008. J Clin Gastroenterol 42 Suppl 2S104–S108 10.1097/MCG.0b013e31816b903f
    1. King S, Glanville J, Sanders ME, Fitzgerald A, Varley D (2014) Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis. Br J Nutr 1–14. S0007114514000075 [pii]. doi: 10.1017/S0007114514000075
    1. Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, et al. (2005) Lactobacillus sepsis associated with probiotic therapy. Pediatrics 115: 178–181. 115/1/178 [pii]. doi: 10.1542/peds.2004-2137
    1. Vahabnezhad E, Mochon AB, Wozniak LJ, Ziring DA (2013) Lactobacillus bacteremia associated with probiotic use in a pediatric patient with ulcerative colitis. J Clin Gastroenterol 47:437–439 10.1097/MCG.0b013e318279abf0
    1. Rautio M, Jousimies-Somer H, Kauma H, Pietarinen I, Saxelin M, et al. (1999) Liver abscess due to a Lactobacillus rhamnosus strain indistinguishable from L. rhamnosus strain GG. Clin Infect Dis 28:1159–1160.
    1. MacKay AD, Taylor MB, Kibbler CC, Hamilton-Miller JM (1999) Lactobacillus endocarditis caused by a probiotic organism. Clin Microbiol Infect 5:290–292.
    1. Kunz AN, Noel JM, Fairchok MP (2004) Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome. J Pediatr Gastroenterol Nutr 38: 457–458. 00005176-200404000-00017 [pii].
    1. De Groote MA, Frank DN, Dowell E, Glode MP, Pace NR (2005) Lactobacillus rhamnosus GG bacteremia associated with probiotic use in a child with short gut syndrome. Pediatr Infect Dis J 24: 278–280. 00006454-200503000-00022 [pii].
    1. Zein EF, Karaa S, Chemaly A, Saidi I, Daou-Chahine W, et al.. (2008) [Lactobacillus rhamnosus septicemia in a diabetic patient associated with probiotic use: a case report]. Ann Biol Clin (Paris) 66: 195–198. abc.2008.0210 [pii]. doi: 10.1684/abc.2008.0210
    1. Licciardi PV, Tang ML (2011) Vaccine adjuvant properties of probiotic bacteria. Discov Med 12:525–533.
    1. Isolauri E, Joensuu J, Suomalainen H, Luomala M, Vesikari T (1995) Improved immunogenicity of oral D × RRV reassortant rotavirus vaccine by Lactobacillus casei GG. Vaccine 13:310–312.
    1. Davidson LE, Fiorino AM, Snydman DR, Hibberd PL (2011) Lactobacillus GG as an immune adjuvant for live-attenuated influenza vaccine in healthy adults: a randomized double-blind placebo-controlled trial. Eur J Clin Nutr 65: 501–507. ejcn2010289 [pii]. doi: 10.1038/ejcn.2010.289
    1. Jefferson T, Di PC, Al-Ansary LA, Ferroni E, Thorning S, et al. (2010) Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev CD004876. doi: 10.1002/14651858.CD004876.pub3
    1. Ioannidis JP, Evans SJ, Gotzsche PC, O'Neill RT, Altman DG, et al. (2004) Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med 141: 781–788. 141/10/781 [pii].
    1. Hodkinson A, Kirkham JJ, Tudur-Smith C, Gamble C (2013) Reporting of harms data in RCTs: a systematic review of empirical assessments against the CONSORT harms extension. BMJ Open 3: e003436. bmjopen-2013-003436 [pii]. doi: 10.1136/bmjopen-2013-003436
    1. Maggi CB, Griebeler IH, Dal Pizzol TS (2014) Information on adverse events in randomised clinical trials assessing drug interventions published in four medical journals with high impact factors. Int J Risk Saf Med 26:: 9–22. L561PV6418665472 [pii]; doi: 10.3233/JRS-140609
    1. Mirpuri J, Sotnikov I, Myers L, Denning TL, Yarovinsky F, et al. (2012) Lactobacillus rhamnosus (LGG) regulates IL-10 signaling in the developing murine colon through upregulation of the IL-10R2 receptor subunit. PLoS One 7: e51955. PONE-D-12-24800 [pii]. doi: 10.1371/journal.pone.0051955
    1. Arvola T, Laiho K, Torkkeli S, Mykkanen H, Salminen S, et al. (1999) Prophylactic Lactobacillus GG reduces antibiotic-associated diarrhea in children with respiratory infections: a randomized study. Pediatrics 104:e64.
    1. Clinical Laboratory Standards Institute (2009) Methods for dilution antimicrobial susceptibilty tests for bacteriathat gro aerobically - approved standard. CLIS publication number M07-A8 Clinical and Laboratory Standards Institute.
    1. Clinical Laboratory Standards Institute (2009) Methods for dilution antimicrobial susceptibilty tests for bacteria that grow\ aerobically - approved standard. CLIS publication number M07-A8 Clinical and Laboratory Standards Institute.
    1. Mangalat N, Liu Y, Fatheree NY, Ferris MJ, Van Arsdall MR, et al. (2012) Safety and tolerability of Lactobacillus reuteri DSM 17938 and effects on biomarkers in healthy adults: results from a randomized masked trial. PLoS One 7: e43910. PONE-D-12-14097 [pii]. doi: 10.1371/journal.pone.0043910
    1. Kaser S, Kaser A, Sandhofer A, Ebenbichler CF, Tilg H, et al. (2003) Resistin messenger-RNA expression is increased by proinflammatory cytokines in vitro. Biochem Biophys Res Commun 309:286–290.
    1. Oberhelman RA, Kosek MN, Penataro-Yori P, Paredes-Olortegui M, Connolly E (2014) A phase one safety study of Lactobacillus reuteri conducted in the Peruvian Amazon: Observations from the field. Am J Trop Med Hyg 90: 777–780. ajtmh.13-0639 [pii]. doi: 10.4269/ajtmh.13-0639
    1. Bousvaros A, Guandalini S, Baldassano RN, Botelho C, Evans J, et al. (2005) A randomized, double-blind trial of Lactobacillus GG versus placebo in addition to standard maintenance therapy for children with Crohn's disease. Inflamm Bowel Dis 11:833–839.
    1. Saxelin M, Lassig A, Karjalainen H, Tynkkynen S, Surakka A, et al.. (2010) Persistence of probiotic strains in the gastrointestinal tract when administered as capsules, yoghurt, or cheese. Int J Food Microbiol 144: 293–300. S0168-1605(10)00561-1 [pii]. doi: 10.1016/j.ijfoodmicro.2010.10.009
    1. Donato KA, Gareau MG, Wang YJ, Sherman PM (2010) Lactobacillus rhamnosus GG attenuates interferon-{gamma} and tumour necrosis factor-alpha-induced barrier dysfunction and pro-inflammatory signalling. Microbiology 156: 3288–3297. mic.0.040139-0 [pii]. doi: 10.1099/mic.0.040139-0
    1. Lopez M, Li N, Kataria J, Russell M, Neu J (2008) Live and ultraviolet-inactivated Lactobacillus rhamnosus GG decrease flagellin-induced interleukin-8 production in Caco-2 cells. J Nutr 138: 2264–2268. 138/11/2264 [pii]. doi: 10.3945/jn.108.093658
    1. Breen EC, Reynolds SM, Cox C, Jacobson LP, Magpantay L, et al.. (2011) Multisite comparison of high-sensitivity multiplex cytokine assays. Clin Vaccine Immunol 18: 1229–1242. CVI.05032-11 [pii]. doi: 10.1128/CVI.05032-11

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