The role of probiotics in the immune response and intestinal microbiota of children with celiac disease: a systematic review

Camila Fernanda Jedwab, Bruna Cardoso de Mattos Boccalini Roston, Ana Beatriz Ferreira de Souza Toge, Isadora Fagundes Echeverria, Guilherme Ojea Gomes Tavares, Matheus Alves Alvares, Vera Esteves Vagnozzi Rullo, Marcella Rocha Machado de Oliveira, Camila Fernanda Jedwab, Bruna Cardoso de Mattos Boccalini Roston, Ana Beatriz Ferreira de Souza Toge, Isadora Fagundes Echeverria, Guilherme Ojea Gomes Tavares, Matheus Alves Alvares, Vera Esteves Vagnozzi Rullo, Marcella Rocha Machado de Oliveira

Abstract

Objective: To evaluate changes in peripheral immunological response (decrease in blood proinflammatory cytokines) and fecal microbiota (especially Bacteroidetes and Firmicutes) after administration of probiotics in children with celiac disease on a gluten-free diet.

Data source: The databases MEDLINE, LILACS, Springer and SciELO were used for this review, with the descriptors "celiac disease AND probiotics". At the end of the search, 168 articles were retrieved, four of which were included in the final qualitative synthesis, having as inclusion criteria randomized clinical trials and pediatric population (1-19 years) and, as exclusion criteria, interventions other than probiotics, studies with patients with other diseases associated with celiac disease, or patients who did not meet the diagnostic criteria. All elected studies were published until September 2020, without language restriction, with patients receiving strains of Bifidobacterium breve or B. longum and on a gluten-free diet.

Data synthesis: The studies show that the administration of probiotics along with a gluten-free diet, can approximate the fecal microbiota of celiac patients to typical conditions of healthy individuals, by restoring the abundance of some microbial communities that characterize the typical physiological condition. In addition, the administration of probiotics can reduce serum proinflammatory cytokines (mainly TNF-alpha).

Conclusions: Despite the positive correlation between probiotics and fecal microbiota/serological markers in pediatric patients with celiac disease, we emphasize the need for future multicentric studies that should include a larger number of patients and a longer follow up period.

Conflict of interest statement

Conflict of interests

The authors declare there is no conflict of interests.

Figures

Figure 1. Flowchart of inclusion of studies…
Figure 1. Flowchart of inclusion of studies in the analysis.

References

    1. Gasbarrini GB, Mangiola F, Gerardi V, Ianiro G, Corazza GR, Gasbarrini A. Coeliac disease: an old or a new disease? History of a pathology. Intern Emerg Med. 2014;9:249–256. doi: 10.1007/s11739-013-1044-5.
    1. Brown JR, Singh P. Coeliac disease. Paediatr Int Child Health. 2019;39:23–31. doi: 10.1080/20469047.2018.1504431.
    1. Schuppan D, Junker Y, Barisani D. Celiac disease: from pathogenesis to novel therapies. Gastroenterology. 2009;137:1912–1933. doi: 10.1053/j.gastro.2009.09.008.
    1. Paul SP, McVeigh L, Gil-Zaragozano E, Basude D. Diagnosis and nursing management of coeliac disease in children. Nurs Child Young People. 2016;28:18–24. doi: 10.7748/ncyp.28.1.18.s28.
    1. Vivas S, De Morales JM, Fernandez M, Hernando M, Herrero B, Casqueiro J, et al. Age-related clinical, serological, and histopathological features of celiac disease. Am J Gastroenterol. 2008;103:2360–2365. doi: 10.1111/j.1572-0241.2008.01977.x.
    1. Kurppa K, Ashorn M, Iltanen S, Koskinen LL, Saavalainen P, Koskinen O, et al. Celiac disease without villous atrophy in children: a prospective study. J Pediatr. 2010;157:373–380. doi: 10.1016/j.jpeds.2010.02.070.
    1. Chibbar R, Dieleman LA. The gut microbiota in celiac disease and probiotics. Nutrients. 2019;11:2375–2375. doi: 10.3390/nu11102375.
    1. Losurdo G, Principi M, Iannone A, Ierardi E, Di Leo A. The interaction between celiac disease and intestinal microbiota. J Clin Gastroenterol. 2016;50:S145–S147. doi: 10.1097/mcg.0000000000000682.
    1. Marchand V. Using probiotics in the paediatric population. Paediatr Child Health. 2012;17:575–575. doi: 10.1093/pch/17.10.575.
    1. Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol. 2012;18:6036–6059. doi: 10.3748/wjg.v18.i42.6036.
    1. Tursi A, Elisei W, Giorgetti GM, Brandimarte G, Aiello F. Complications in celiac disease under gluten-free diet. Dig Dis Sci. 2009;54:2175–2182. doi: 10.1007/s10620-008-0595-1.
    1. Tratado de Pediatria: Sociedade Brasileira de Pediatria. 4. ed. Barueri, SP: Manole; 2017.
    1. Laparra JM, Sanz Y. Bifidobacteria inhibit the inflammatory response induced by gliadins in intestinal epithelial cells via modifications of toxic peptide generation during digestion. J Cell Biochem. 2010;109:801–807. doi: 10.1002/jcb.22459.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–269. doi: 10.7326/0003-4819-151-4-200908180-00135.
    1. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–160. doi: 10.1097/mpg.0b013e31821a23d0.
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane handbook for systematic reviews of interventions. New Jersy: John Wiley & Sons; 2019.
    1. Quagliariello A, Aloisio I, Cionci N, Luiselli D, D’Auria G, Martinez-Priego L, et al. Effect of Bifidobacterium breve on the intestinal microbiota of coeliac children on a gluten free diet: a pilot study. Nutrients. 2016;8:660–660. doi: 10.3390/nu8100660.
    1. Klemenak M, Dolinšek J, Langerholc T, Di Gioia D, Mičetić-Turk D. Administration of Bifidobacterium breve decreases the production of TNF-α in children with celiac disease. Dig Dis Sci. 2015;60:3386–3392. doi: 10.1007/s10620-015-3769-7.
    1. Olivares M, Castillejo G, Varea V, Sanz Y. Double-blind, randomised, placebo-controlled intervention trial to evaluate the effects of Bifidobacterium longum CECT 7347 in children with newly diagnosed coeliac disease. Br J Nutr. 2014;112:30–40. doi: 10.1017/s0007114514000609.
    1. Primec M, Klemenak M, Di Gioia D, Aloisio I, Cionci NB, Quagliariello A, et al. Clinical intervention using Bifidobacterium strains in celiac disease children reveals novel microbial modulators of TNF-α and short-chain fatty acids. Clin Nutr. 2019;38:1373–1381. doi: 10.1016/j.clnu.2018.06.931.
    1. Cheng J, Kalliomäki M, Heilig HG, Palva A, Lähteenoja H, Vos WM, et al. Duodenal microbiota composition and mucosal homeostasis in pediatric celiac disease. BMC Gastroenterology. 2013;13:113–113. doi: 10.1186/1471-230x-13-113.
    1. Verdu EF, Galipeau HJ, Jabri B. Novel players in coeliac disease pathogenesis: role of the gut microbiota. Nat Rev Gastroenterol Hepatol. 2015;12:497–506. doi: 10.1038/nrgastro.2015.90.
    1. Nadal I, Donant E, Ribes-Koninckx C, Calabuig M, Sanz Y. Imbalance in the composition of the duodenal microbiota of children with coeliac disease. Journal of medical microbiology. 2007;56:1669–1674. doi: 10.1099/jmm.0.47410-0.
    1. Sanz Y. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans. Gut Microbes. 2010;1:135–137. doi: 10.4161/gmic.1.3.11868.
    1. Zheng B, Bergenhenegouwen J, Overbeek S, Kant HJ, Garssen J, Folkerts G, et al. Bifidobacterium breve attenuates murine dextran sodium sulfate-induced colitis and increases regulatory T cell responses. PloS One. 2014;9:e95441. doi: 10.1371/journal.pone.0095441.
    1. Francavilla R, Angelis M, Rizzello CG, Cavallo N, Dal Bello F, Gobbetti M. Selected probiotic lactobacilli have the capacity to hydrolyze gluten peptides during simulated gastrointestinal digestion. Appl Environ Microbiol. 2017;83:e00376–e00417. doi: 10.1128/aem.00376-17.
    1. Håkansson Å, Aronsson C, Brundin C, Oscarsson E, Molin G, Agardh D. Effects of Lactobacillus plantarum and Lactobacillus paracasei on the peripheral immune response in children with celiac disease autoimmunity: a randomized, double-blind, placebo-controlled clinical trial. Nutrients. 2019;11:1925–1925. doi: 10.3390/nu11081925.
    1. Martinello F, Roman CF, Souza PA. Effects of probiotic intake on intestinal bifidobacteria of celiac patients. Arq Gastroenterol. 2017;54:85–90. doi: 10.1590/s0004-2803.201700000-07.
    1. World Gastroenterology Organization [homepage on the Internet] WGO Practice Guideline - Celiac Disease. 2016. [[cited 2020 Aug 20]]. Available from:

Source: PubMed

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