Role of probiotics in colorectal surgery: A prospective randomized double-blind pilot study

L. Gianotti, M. Braga, L. Morelli, F. Galbiati, S. Rocchetti, S. Coppola, A. Beneduce, C. Gilardini, D. Zonenschain, A. Nespoli

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To investigate whether probiotic bacteria given perioperatively may adhere to the colonic mucosa, reduce concentration of pathogens in stools, and modulate local immunefunction. Design: Prospective, randomized, double-blind, clinical trial Methods: Thirty-one patients undergoing elective colorectal resection for cancer were allocated to receive either placebo (group A, n = 10), or a dose of 107 of a mixture of Bifidobacterium longum (BB536) and Lactobacillus jonhsonii (La1) (group B, n = 11), or the same mixture at a concentration of 109 (group C, n = 10). Probiotics or placebo were given orally in 2 doses/day for 3 days before operation. The same treatment continued postoperatively from day 2 to 4. Stools were collected before treatment (day -4), during surgery (day 0), and 5 days after operation. During the operation, colonic mucosa samples were harvested to evaluate bacterial adherence and to phenotype dendritic cell subsets by surface antigen expression (flow cytometry). Presence of BB536 and La1 was evaluated by the random amplified polymorphism DNA method. Results: The 3 groups were balanced for baseline and surgical parameters. BB536 was never found at any time point studied. At day 0, La1 was present in 60% of patients in group C in either stools or biopsy, in 27.2% in B, and none in the placebo group (p = 0.02, group C vs. A). There was a linear correlation between dose given and number of adherent La1 (p = 0.01). The rate of mucosal colonization by Enterobacteriaceae was 30% in group C, 82% in group B, and 70% in group A (p = 0.03, C vs. B). Enterobacteriaceae count in stools was 2.4 (log10 scale) in C, 4.2 in B, and 4.5 in A (p = 0.07). The same trend was observed for colonizing enterococci. La1 was not found at day +5. After ex vivo stimulation with lipopolysaccharides, groups C and B had a lower proliferation rate compared with group A. Moreover, dendritic phenotypes CD83-123, CD83-HLADR, and CD83-11c (markers of activation) were significantly less expressed in patients colonized with LA1 (p 0.05). Conclusions: La1, but not BB536, adhere to the colonic mucosa, affect intestinal microbiota by reducing the concentration of pathogens, and modulate local immunity.

Original languageEnglish
Pages (from-to)190-198
Number of pages9
JournalNutritional Therapy and Metabolism
Volume26
Issue number4
Publication statusPublished - Oct 2008

Keywords

  • BB536
  • Colorectal surgery
  • Dendritic cells
  • Intestinal flora
  • Intestinal immunity
  • La1
  • Probiotics

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nutrition and Dietetics

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