Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis

Year: 2016

Journal: Alimentary Pharmacology and Therapeutics

Authors: A. Horvath B. Leber B. Schmerboeck M. Tawdrous G. Zettel et al.

Abstract

Background
Probiotics may correct intestinal dysbiosis and proinflammatory conditions
in patients with liver cirrhosis.


Aim
To test the effects of a multispecies probiotic on innate immune function,
bacterial translocation and gut permeability.


Methods
In a randomised, double blind, placebo-controlled study, stable cirrhotic
out-patients either received a daily dose of a probiotic powder containing
eight different bacterial strains (Ecologic Barrier, Winclove, Amsterdam,
The Netherlands) (n = 44) or a placebo (n = 36) for 6 months and were
followed up for another 6 months.


Results
We found a significant but subclinical increase in neutrophil resting burst
(2.6–3.2%, P = 0.0134) and neopterin levels (7.7–8.4 nmol/L, P = 0.001)
with probiotics but not with placebo. Probiotic supplementation did not have
a significant influence on neutrophil phagocytosis, endotoxin load, gut permeability
or inflammatory markers. Ten severe infections occurred in total;
one during intervention in the placebo group, and five and four after the
intervention has ended in the probiotic and placebo group, respectively. Liver
function showed some improvement with probiotics but not with placebo.


Conclusions
Probiotic supplementation significantly increased serum neopterin levels and
the production of reactive oxygen species by neutrophils. These findings might
explain the beneficial effects of probiotics on immune function. Furthermore,
probiotic supplementation may be a well-tolerated method to maintain or
even improve liver function in stable cirrhosis. However, its influence on gut
barrier function and bacterial translocation in cirrhotic patients is minimal.