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PROBIOTICS IN INFECTIONS

AnkitaM. Pharmacy, Pharmacology

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INTRODUCTION• The human intestine is home to an estimated 100

trillion bacteria• These tiny trillion tenants constitute the gut flora

Human GIT and Gut flora

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Where does gut flora come from?

• Role of environmentBacteria are first established during the birth

of a baby– External environment– Method of delivery

• Role of diet“We are what we eat”

applies to infants too– Type of proteins– Availability of iron

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Maintenance of gut flora

• Mouth and throat– Saliva

• Stomach– pH and mucus

• Small intestine, pancreas & liver– Digestive juices and enzymes

• Mucosal barrier– Intestinal epithelial cells, tight junctions and

mucus layer

Mucosal barrier

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Importance of gut flora

• Fermentation of carbohydrates

• Source of energy and nutrients

• Prevention of growth of pathogenic organisms

• Metabolism of dietary carcinogens

• Absorption of water and ions

These beneficial effects of gut flora can be exploited by administering them as PROBIOTICS

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PROBIOTICS

The word Probiotics originates from the Greeklanguage, ‘Pro’ means ‘for’ and ‘Bios’ means‘Life’, that is ‘for life’The evolution of the concept of Probiotics iscredited to the Nobel Prize winning Russianscientist Elie Metchnikoff

Elie Metchnikoff

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The Food and Agriculture Organization of UnitedNations (FAO) and World Health Organization(WHO) defined Probiotics as “Live organisms which when administered indefinite amounts confer a health benefit on thehost”

The friendly critters in our gut known as Probiotics

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Lactobacillus speciesL. acidophilusL. plantarumL. casei subspecies rhamnosusL. brevisL. delbreuckii subspecies bulgaricus

Probiotic strains

Lactobacillus

Bifidobacterium

Bifidobacterium species B. adolescentisB. bifidumB. longum B. InfantisB. breve

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Other Species:

Streptococcus salivarius ssp. thermophilusLactococcus lactis ssp. lactisLactococcus lactis ssp. cremorisEnterococcus faeciumLeuconostoc mesenteroides ssp. dextranicumPropionibacterium freudenreichiiPediococcus acidilacticiSaccharomyces boulardii Escherichia coli

Escherichia coli Nissle

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PREBIOTICS & SYNBIOTICS Prebiotics

Prebiotics are non-digestible but fermentable oligosaccharides that are specifically designed to change the composition and activity of the intestinal microbiota with prospect to promote the health of the host

Examples- insulin, garlic, onions, chicory root, asparagus, whole wheat, rye, barley

SynbioticsA synbiotic is a combination of one or

more probiotics and prebioticsExamples- Bacilac sachet, Ecosyn capsules

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Mechanism of Action of Probiotics

Antimicrobial Activity• Decrease luminal pH• Secrete antimicrobial peptides• Block bacterial adhesion to epithelial cells• Inhibit bacterial invasion

Enhancement of Barrier Function• Increase mucus production• Enhance barrier integrity

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Inhibition of enteric bacteria and enhancement of barrier function by probiotic bacteria.

Immunomodulation

• Effects on epithelial cells

• Effects on dendritic cells

• Effects on monocytes/macrophage

• Effects on lymphocytes - B lymphocytes - NK cells - T cells - T cell redistribution

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Mechanism of Action of Probiotics

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Modulation of mucosal immune response by Probiotic bacteria

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Factors affecting viability of Probiotics

• Temperature

• pH

• Water activity

• Oxygen

• Freeze-thawing

• Sheer forces

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Administration of Probiotics

• Time of administration reasonably between meals

• Frequency of administration organisms which do not adhere well are given more frequently

• Dosage 50 million - 1 trillion CFU/day

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Incorporation of Probiotics into foodsProbiotics can be incorporated into foods and beverages in a variety of ways-

Dry blended into foods and powders - infant formulas Dispersed into liquid or semi liquid products - juices Inoculated into fermented products - fermented

milks

Infant formula Juices Fermented milks

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APPLICATIONS

KEEPING HEALTHYPEOPLE

HEALTHY

LACTOSEMAL-DIGESTION

BOWELTRANSIT

IRRITABLE BOWEL SYNDROME

ALLERGY

COLON CANCER

HYPER-CHOLESTROLEMIA

HYPER-TENSION

INFECTIONS

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Probiotics in Infections

• Gastrointestinal infections– Helicobacter pylori– Enteropathogenic microorganisms– Rotavirus– Antibiotic- and Clostridium difficile -associated

diarrhoea– Inflammatory bowel disease

• Systemic infections

• Vaginal infections

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Current Probiotics Problem in India

• Extravagant claims• Lack of knowledge about clinical recommendations• Incomplete species and strain specificity• No clear mechanism and sites of action• Dose and safety related issues• Lack of good manufacturing practices• Poor availability of validated biomarkers

Efforts should be made to conduct clinical trials in Indian population for comprehensive evaluation of the efficacy of the Indian probiotic cultures

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ICMR-DBT GUIDELINES

• Genus, species and strain identification • In vitro tests to screen potential probiotic strains • In vivo safety and efficacy studies in animal models • Evaluation of safety of probiotics for human use• Evaluation of efficacy studies in humans• Effective dosage of probiotic strain / strains• Labeling Requirements • Manufacturing and handling procedures

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Indian perspectives ahead• Rigorous scientific research backs probiotics to be of

remarkable therapeutic efficacy• Probiotics may provide a natural way of controlling serious

health issues• Development of probiotics may expand due to – Identification of a myriad of probiotic organisms– Advanced molecular biology techniques and genetic

engineering– Advanced delivery techniques

It will not be an exaggeration to say that probiotics in the future will be the reigning therapeutic agents

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PROBIOTICS WORLDWIDEBRAND NAME GENERIC NAME COMPANY NAME

Florastor Saccharomyces boulardii Biocide

Bacid Lactobacillus acidophillus

Insight Pharmaceuticals

Culturelle DS Lactobacillus rhamnosus

Culturelle

Flora-Q Lactobacillus acidophillus

Fougera Pharmaceuticals

Risa Quad Lactobacillus acidophillus

Rising Pharmaceuticals

BD Lactinex Lactobacillus acidophillus, Lactobacillus bulgaricus

Becton, Dickinson & Company

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Probiotic Research Institutes at India

Central Food Technology and Research Institute, Mysore, India

National Dairy Research Institute, Karnal, Haryana, India

Institute of Microbial Technology, Chandigarh, India

National Dairy Development Board, Anand, Gujarat, India

Nestle Pvt Ltd, Panipat, Haryana, India

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Eat Probiotics, live healthy life

So…. Eat the “good bugs” every day.…

Make them part of your daily diet.... You will find they make very friendly

houseguests….!!

Let’s begin the Probiotics revolution…!!

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REFERENCES• Barun Bhattacharya K. Emergence of Probiotics in Therapeutic

Applications. International Journal of Pharmaceutical Sciences and Nanotechnology. 2009;2(1);383-389

• Hart Al, Knight SC. Mechanisms of Probiotics: Recent Advances, Inflamm Bowel Dis,2009;15(2);300-310

• Maity TK, Misra AK. Probiotics and Human Health:Synoptic Review African Journal of Food, Agriculture, Nutrition and Development. 2009;9(8);1778-1796

• Schrezenmeir J. Probiotics, Prebiotics and Symbiotics. Advances in Biochemical Engineering/Biotechnology. 2008;111;1-66

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• Benedict Jose C, Sharanya G. A Review on Nutritional Impact of Pre and Probiotics. The Pharma Review. 2009;13(3);89-92

• Gibson G, Sanders ME. Probiotics:Their Potential to Impact Human Health, Cast Issue Paper. 2007;36

• Sanders ME. How Do We know When Something called “Probiotic” Is Really a Probiotic?A Guideline for Consumers and Health care Professionals. 2009; 1(1);3-12

• Sharma Ak, Mohan P, Nayak BB. Probiotics:Making a come back. Indian Journal of Pharmacology. 2005;37(6);358-365

• www.wikipedia.com

REFERENCES

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