Probiotic intervention on the microbiome regarding inflammatory gut disease: Crohn's disease and ulcerative
colitis Ally Biernat, Sarah Haynes, Jana Horn
Department of Food Science and Human Nutrition December 2015
Abstract Probio'cs are classified as live bacterial microorganisms that have the capability to posi'vely alter the bacteria popula'on in the human intes'ne, that aids in diges'on of food and nutrients.1 These bacteria species have been classified as the gut microbiome. In pa'ents with inflammatory bowel disease (IBD), there is an overgrowth in the popula'on of harmful bacteria which cause the gut to produce an inflammatory response against itself.2 This autoimmune response leads to 'ssue damage which causes severe diarrhea, cons'pa'on, cramping, pain and malabsorp'on. 3 Current research has been geared towards the varying mechanisms of which probio'cs can be used as complementary, therapeu'c treatments for IBD in addi'on to other medica'ons.
Objec+ves 1. Describe the e'ology and pathogenesis of inflammatory bowel diseases,
Crohn’s disease, and ulcera've coli's. 2. Discuss the microbiome and probio'cs as it relates to Crohn’s disease and
ulcera've coli's. 3. Iden'fy probio'cs as treatment for Crohn’s disease and ulcera've coli's.
Introduc+on and Background It is currently es'mated that 1 million individuals in America have inflammatory bowel disease.4 Inflammatory bowel disease (IBD) is a chronic, immune-‐mediated illness, characterized by periods of remission and flare-‐ups. The two most commonly diagnosed clinical subgroups of IBD include Crohn’s disease (CD) and ulcera've coli's. Crohn’s disease is characterized by discon'nuous and transmural lesions of the intes'nal wall, which lead to malfunc'on of the intes'ne. Ulcera've coli's is characterized by the presence of localized inflamma'on and superficial lesions in the colon, usually in the lower colon.5 The e'ology of IBD is currently unknown and there is no known cure for this debilita'ng gut disease. Recent treatments include cor'costeroids, aminosalicylates and immunomodulators, and an'-‐TNF-‐α humanized an'bodies. Although these treatments induce and maintain clinical remission, the adverse side effects of the drugs on other areas of the body outweigh the ability to use them long-‐term. 5 Since these treatments are not effec've long-‐term, research is being developed regarding the func'on of microorganisms that u'lize the gut to aid in diges'on. It was discovered that aUer birth, bacteria, which encompass the microbiome, densely colonize the gastrointes'nal tract. There are over 100 trillion microorganisms that reside in the average adult large intes'ne.5 IBD pa'ents have been found to experience dysbiosis in the microbiome, meaning there is a imbalance of the host’s gut bacteria which allows pathogenic bacteria to cul'vate in the GI tract.6
Physiological Aspects Probio'cs func'on through different mechanisms that include the ability to increase short chain faZy acid produc'on and butyrate produc'on, produce an'bacterial substances, improve the 'ght junc'ons of the gut epithelial cells, and displace pathogenic or pro-‐inflammatory bacteria.2 Through these mechanisms, probio'cs can advance the healing process of damaged intes'nal cells. Probio'cs also aide in immune system improvement by increasing the produc'on rate of an'gen-‐detec'ng dendri'c cells, T-‐cells, and an'-‐inflammatory cytokines such as TGF and IL-‐10.2 Increasing these immune responses will also trigger secretory IgA, which helps to maintain the intes'nal mucosa from further damage. In a study involving the yeast, Saccharomyces boulardii in conjunc'on with mesalamine (a drug used to prevent intes'nal flare-‐ups) resulted in fewer relapses of diarrhea caused by an'bio'cs and Clostridium difficle, an oUen overgrown, harmful bacterium in pa'ents with IBD.7
Related Nutrients Pa'ents with Crohn’s disease or ulcera've coli's exhibit signs of decreased gut func'on including a decrease in the ability of the gut to absorb nutrients. Many that are diagnosed with IBD also report decreased food intake due to the fear of later symptoms and consequently the majority of pa'ents with IBD are malnourished.3 Studies have shown pa'ents with IBD are commonly deficient in vitamin A, vitamin E, thiamin, riboflavin, folic acid, iron, calcium and zinc.3 There is no correla'on between the severity of deficiencies and dura'on of disease; all IBD pa'ents exhibit deficiencies. 3,8 It is important for pa'ents with IBD to eat a well-‐balanced, healthful diet to receive as many vital nutrients as possible. It is also recommended for those suffering with IBD to take supplements of vitamin A, E, and C. A study has shown that with supplementa'on of vitamin A in the diet, diarrhea in pa'ents nearly subsided. Vitamin E and C were given to pa'ents with high oxida've stress and it helped to improve their status and decrease the stress.3,6
Applica+ons In order for a microorganism to be classified as a probio'c, it must undergo strict and specific func'onal tes'ng to ensure the beneficial effects and promote increased health, treatment, or preven'on of specific diseases including Crohn's and ulcera've coli's. 2 Probio'cs such as Lactobacillus helve7cus, and Escherichia coli strain Nissle 1917, have the poten'al to minimize signs and symptoms in
those suffering with IBD, because the gut microbiome has been proven to be one of the most adaptable and modifiable organs of the body. 9, 10
Conclusion Inflammatory Bowel Disease can be a very debilita'ng disease that affects a large amount of the popula'on. While medica'ons have been developed to help control the signs and symptoms of IBD, probio'cs have been proven to aid in the healing process of the gut. Probio'cs help limit future onsets of inflamma'on and painful effects of the disease such as cons'pa'on, diarrhea and malabsorp'on.
Acknowledgments A special thanks to Dr. Tiffany Weir and Graduate Mentor Tessa Komine.
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