The study’s authors hypothesised probiotics could help boost neutrophil dysfunction – a common problem in cirrhosis sufferers – by reducing intestinal permeability and bacterial translocation.
However, they found neutrophil resting burst - the resting rate of reactive oxygen species production - increased significantly in the probiotic group during intervention, from 2.6% to 3.2%, but not in the placebo group.
They used the probiotic Dutch Ecologic Barrier, also marketed by owner Winclove as Omnibiotic Hetox in Austria, Germany and Switzerland, which contains strains including B. bifidum, B. lactis, L. acidophilus, L. brevis, L. casei, L. salivarius and L. lactis strains W19 and W58.
Daily doses of the probiotic or a placebo were provided to 90 cirrhotic out-patients at the University Hospital Graz in Austria over six months, with another six months of follow-up. The researchers reported low drop-out rates for the probiotic group, and normal rates for the placebo group.
No effect on gut permeability
“Probiotics were very well tolerated by the patients and side effects were rare. Probiotic supplementation significantly increased serum neopterin levels and the production of reactive oxygen species by neutrophils,” the authors wrote in their study, published in the journal Alimentary Pharmacology & Therapeutics.
“Markers of gut permeability and translocation of Gram-negative bacteria assessed in this study showed no improvement and neutrophil phagocytosis worsened irrespective of the intervention over the course of one year to only 60% of the baseline value. Liver function was slightly improved during intervention and decreased without it,” they added.
As to the main aim of the study, the authors found probiotics had no effect on neutrophil phagocytosis – the ability of neutrophils to engulf bacteria.
“In both groups, phagocytic capacity decreased significantly over time (P < 0.001), while the population of inactive neutrophils stayed on a high but constant level,” the authors wrote.
However, they found neutrophil resting burst increased significantly in the probiotic group during intervention, from 2.6% to 3.2%, but not in the placebo group.
The authors were encouraged by the increased serum neopterin levels seen in the probiotic group, which significantly increased during intervention and at the end, and then decreased to baseline levels following the end of the intervention period.
The researchers tested the bactericidal properties of the serum, which was significantly impaired for both groups, but detected “no improvement… during probiotic intervention or placebo in the whole study cohort”.
Bactericidal improvement for alcoholic patients
“However, in the subgroup of alcoholic cirrhosis, six months of probiotics tended to improve serum killing capacity compared to baseline. There was no change in the placebo group,” they noted.
All the subjects showed significantly impaired gut barrier integrity, but the researchers found no significant effect on markers such as lactulose–mannitol ratio, diamine oxidase and calprotectin from the probiotics.
“In the probiotic group, mannitol recovery was stable throughout the intervention, while in the placebo group, mannitol recovery decreased significantly during intervention and further during the observation period. However, these changes did not impact on lactulose–mannitol ratio,” the authors wrote.
“We found that probiotics maintained mannitol recovery, while it gradually decreased in the placebo group. Reduced mannitol absorption might be due to reduced intestinal surface in cirrhosis. Therefore, probiotics might have a beneficial effect on the intestinal epithelium,” they added.
Source: Alimentary Pharmacology & Therapeutics
Published online ahead of print, doi: 10.1111/apt.13788
“Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis”
Authors: Horvath, A., et al.