a review synbiotic: the impact on health · 2014. 4. 4. · therefore, the current short review...

Synbiotic is used when a product containsboth probiotics and prebiotics Jürgen andMichael, 2001. Because the word alludes

to synergism, this term should be reserved forproducts in which the prebiotic compoundselectively favors the probiotic compound. Inthis strict sense, a product containingoligofructose and probiotic bifidobacteriawould fulfill the definition, whereas a productcontaining oligofructose and a probioticLactobacillus casei strain would not. However,one might argue that synergism is attained invivo by ingestion of lactobacilli on the one handand promotion of indigenous bifidobacteria.Synbiotics refer to nutritional supplementscombining probiotics and prebiotics and in aform of synergism. The main reason for using a

synbiotic is that a true probiotic, without itsprebiotic food, does not survive well in thedigestive system. Without the necessary foodsource for the probiotic, it will have a greaterintolerance for oxygen, low pH, andtemperature. As prebiotics provides a greatplace for probiotics to thrive, the population ofthese good bacteria is known to preserve.Studies have shown that by harnessing both thebenefits of these prebiotics and probiotics intosynergy, the number of good bacteria in thedigestive systems increased many folds for thebetterment of our health (http://hubpages.com/hub/synbiotics). Typically, a synbiotic productcontains one to ten billion active cells. Forinstance, yogurts containing live and activecultures produce a synbiotic effect with inulin.

Key Words :

Synbiotic,Probiotics

Paper History :Received : 04.02.2013;Accepted : 06.04.2013

HIND MEDICAL RESEARCH INSTITUTE

A REVIEW

International Journal of Medical SciencesVolume 6 | Issue 1 | April, 2013 | 23-30

See end of the paper forauthors’ affiliationCorrespondence to :

MADHUDepartment of Food andNutrition College of HomeScience Punjab AgriculturalUniversity, LUDHIANA(PUNJAB) INDIA

Synbiotic: The Impact on Health

MADHU, ANITA KOCHHAR AND NEETU

ABSTRACT : Synbiotics is the term used for a mixture of probiotics (live microbial feed additives that beneficiallyaffects the host animal) and prebiotics (non-digestible food ingredients that beneficially affect the organism). Themanipulation of composition of the gut microbiota in infants and adults through dietary supplementation is possibleby probiotic/prebiotic/synbiotic therapies. Probiotic products (dietary supplements containing potentially beneficialbacteria or friendly bacteria) and prebiotics (mainly oligosaccharides and disaccharides) make up an important partof maintaining intestinal health. The probiotics use the prebiotics as a food source, which enables them to survivefor a longer period of time inside the human digestive system than would otherwise be possible. Synbiotics (probiotics+ prebiotics) enable to improve the viability of probiotics and to deliver specific health benefits. Probiotic/prebiotic/synbiotic characteristics include antimicrobial, anticarcinogenic, antidiarrheal and antiallergenic qualities, osteoporosisprevention, ulcerative colitis, reduction in serum fats and blood sugars, regulation of the immune system and treatingliver-related brain dysfunction. Age-related changes in gut physiology, microbiota and mucosal immune responseare well established. Moreover, exposure to different challenges during life such as early encounter of environmentalinsults in the newborn, infant formula feeding, antibiotic treatment, gastrointestinal diseases and stress, also interfereswith the normal development and balance of the healthy gut microbiota. Therefore, the current short review givesan overview of today’s main aspects of the effect of fibres, probiotics and synbiotics on the health and immunesystem in different life-stages.

How to cite this paper : Madhu, Kochhar, Anita and Neetu (2013). Synbiotic: The Impact on Health. Internat. J. Med. Sci.,6(1) : 23-30.

HIND MEDICAL RESEARCH INSTITUTEInternat. J. Med. Sci., 6(1) Apr., 2013 :24

Synbiotics work in two ways i) by improving the viability ofprobiotics and ii) by delivering specific health benefits. (http://www.scribd.com/doc/36894148/Prebiotik-DanProbiotik-Nestle). In the last few years, studies on synbiotics have startedto emerge, with the main focus being applications againstdisease (Kolida and Gibson, 2011). The intake of a synbioticfood leads to a modulation of the gut metabolic activitieswith a maintenance of the gut biostructure. In particular, thesignificant increase of short chain fatty acids, ketones, carbondisulfide and methyl acetate following the feeding periodsuggested potential health promoting effects of the synbioticfood (Vitali et al., 2010).

Definition of probiotics :The term probiotic, meaning “for life,” is derived from

the Greek language. It was first used by Lilly and Stillwell in1965 to describe “substances secreted by one microorganismwhich stimulates the growth of another” and thus, wascontrasted with the term antibiotic. It may be because of thispositive and general claim of definition that the term probioticwas subsequently applied to other subjects and gained a moregeneral meaning. Parker (1974) was the first to use the termprobiotic in the sense that it is used today. He definedprobiotics as “organisms and substances which contribute tointestinal microbial balance.” Retaining the word ‘substances’in Parker’s definition of probiotics resulted in a wideconnotation that included antibiotics. In 1989 Fuller attemptedto improve Parker’s definition of probiotic with the followingdistinction: “A live microbial feed supplement whichbeneficially affects the host animal by improving its intestinalmicrobial balance.” This revised definition emphasizes therequirement of viability for probiotics and introduces theaspect of a beneficial effect on the host, which was, accordingto his definition, an animal. In 1992 Havenaar et al broadenedthe definition of probiotics with respect to host and habitatof the microflora as follows: “A viable mono- or mixedculture of microorganisms which applied to animal or man,beneficially affects the host by improving the properties ofthe indigenous microflora.”

Revision of the definition probiotic :Considering the various arguments, particularly the

discrimination of usual yogurt cultures and products derivedfrom probiotic cultures and products, we propose thefollowing definition as the one that is closest to the definitionof the term probiotic given by Havenaar and Huis In’t Veld1992: “A preparation of or a product containing viable, definedmicroorganisms in sufficient numbers, which alter the microflora(by implantation or colonization) in a compartment of the hostand by that exert beneficial health effects in this host.”Reasons for the revision of Havenaar and Huis In’t Velddefinition are as follows:

–The need to include products in addition to micro-

organisms, or preparations of micro-organisms.–The requirement of sufficient microbial numbers to exerthealth effects.

–Preference for the phrase “alteration of the microflora”over “improving the properties of the…microflora,”because the optimal properties of the indigenousmicroflora were not defined until now and the evidenceof benefit can be shown only by health effects.

–Definition of the term indigenous microflora refers to“the usually complex mixture of bacterial population thatcolonizes a given area in the host that has not been affectedby medical or experimental intervention, or by disease”and use of ‘to colonize’ to describe a bacterial populationthat establishes in size over time without the need forperiodic reintroduction of the bacteria by repeated oraldoses or other means.

The health effects attributed to the use of probioticsare numerous. The following outcomes are well documented)lower frequency and duration of diarrhea associated withantibiotics (Clostridium difficile), rotavirus infection,chemotherapy, and, to a lesser extent, traveler’s diarrhea)stimulation of humoral and cellular immunity) and decreasein unfavorable metabolites, e.g., ammonium andprocancerogenic enzymes in the colon. There is some evidenceof health effects through the use of probiotics for thefollowing:

– Reduction of Helicobacter pylori infection;– Reduction of allergic symptoms;– Relief from constipation;– Relief from irritable bowel syndrome;– Beneficial effects on mineral metabolism, particularly

bone density and stability;– Cancer prevention and– Reduction of cholesterol and triacylglycerol plasma

concentrations (weak evidence).

Definition of prebiotic :The term prebiotic was introduced by Gibson and

Roberfroid (1995) who exchanged “pro” for “pre,” whichmeans “before” or “for.” They defined prebiotics as “a non-digestible food ingredient that beneficially affects the hostby selectively stimulating the growth and/or activity of oneor a limited number of bacteria in the colon.” This definitionmore or less overlaps with the definition of dietary fiber,with the exception of its selectivity for certain species. Thisselectivity was shown for bifidobacteria, which may bepromoted by the ingestion of substances such asfructooligosaccharides and inulin (Gibson and Roberfroid,1995 and Hidaka et al., 1986), transgalactosylatedoligosaccharides (Ito et al., 1993, Rowland and Tanaka 1993),and soybean oligosaccharides (Hayakawa et al., 1990 andSaito et al., 1992).


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Internat. J. Med. Sci., 6(1) Apr., 2013 : 25

Symbiotic immune protection in infants and children :Romeo et al. (2010) prebiotics target indigenous

beneficial bacteria already established in the gut and havebecome relevant in infant nutrition, as formula-fed infantsusually have lower numbers of bifidobacteria compared tothe breastfed infants. Bruck et al. (2006) and Pendres et al.(2006). taking breast-feeding as the natural example of infantnutrition, the prebiotics approach should be considered as aphysiological approach to influence intestinal microbiotaearly in life. In this regard, Bruzzese et al. (2006) suggestedthat the addition of non-digestible oligosaccharides and inulinto infant food may exert a comparable effect to human milk.Moreover, prebiotics can simulate the bifidogenic effects ofbreast milk oligosaccharides and have been shown to exertlong-term effects (up to two years) for protecting againstinfection, lowering the incidence of allergy and also exertingpositive consequences for the postnatal development of theimmune system. The prebiotic fibres inulin andoligosaccharides have been extensively studied in infants andchildren. Scholten et al. (2006), the addition of the inulin/galactooligosaccharides (GOS) mixture in weaning foods of4- to 6-month-old infants in a daily dose of 4,5 g during 6 wksucceeded in increasing of the faecal percentage ofBifidobacteria population (form 43 to 57%) of the fecal flora.Other intervention study in infants receiving an inulin/GOSmixture during 12 months, significantly decreased theepisodes of gastrointestinal and respiratory tract infections,Bakker-Zierikzee et al. (2006) also enhancing faecalimmunoglobulin (Ig) A levels. Bruzzese et al. (2006),moreover, inulin and oligofructose have also been reportedas promoting positive effects as indicated by a lowerincidence of febrile episodes in infants.

Synbiotic : an overview :The modulation of the intestinal microbiota by dietary

fibre has been established to serve as a useful adjunct in thetreatment of gastrointestinal and inflammatory disease inadults. Romeo et al (2010) recent evidence even suggeststhat inhibition of inflammatory processes may be an importantmediator in the association between dietary fibre consumptionand cardiovascular diseases (CVD). In fact, cross-sectionaland randomized crossover intervention trials havedemonstrated an association between dietary fibre and clinicalinflammation biomarkers, such as C-reactive protein (CRP). Inexperimental models, prebiotics such as inulin and oligofructosehave been associated with reduced mucosal inflammation andmay offer an opportunity to prevent inflammatory boweldisease and other mucosal inflammatory disorders. Otherhealth effects of prebiotics (prevention of diarrhoea,modulation of the intestinal microbiota metabolism, cancerprevention, positive effects on lipid metabolism, stimulationof mineral adsorption) are indirect, i.e. mediated by theintestinal microbiota, and,therefore, less-well proven. On the

other hand, recent studies have shown the potentially extensiveimpact of prebiotics on gut microbiota composition,stimulating directly or indirectly putative beneficial gutcommensals other than lactic acid bacteria, opening excitingareas of research for the discovery of new probiotic strainsand synbiotic combinations. When it was observed that themain health promoting actions of prebiotics is because oftheir capacity to increase the growth and metabolic activityof probiotic microorganisms, it was thought to administerboth of them simultaneously. Such a product is a food or foodsupplement which contains live cells of the beneficial bacteria(probiotic) and a selective substrate (prebiotic). When sucha combined product is administered, the bacterial cells whichsurvive their transit through the stomach grow quickly andcompetitively because of the presence of the selectivesubstrate (prebiotic) and establish their predominance byPatel and Patel (2010). Since the word ‘synbiotics’ refers tosynergism, this term should be used for products in whichthe prebiotic compound selectively favours the probioticmicrobe, e.g., FOS in combination with strains such as Bif.infantis, Bif. longum, etc. As the prebiotic component of thesynbiotics improve the survival of the probiotic bacteriacrossing the upper part of the GIT, their effects are enhancedin the large bowel by Patel and Patel (2010). While probioticsact in the small intestine, prebiotics are specifically targetedto act on the flora in the large intestine by Patel and patel(2010), Burns and Rowland (2000) and de Verese et al.(2001). The two thus work synergistically. The combinationof suitable prebiotics with probiotic/s has been found (fromboth in vitro and in vivo experiments) to stimulate the survivaland activity of the organism, for example a FOS in conjunctionwith a Bifidobacterium strain or lactitol in conjunction withLactobacillus. Besides the synergistic effect in which thegrowth of beneficial bacteria (existing strains) in the colonis promoted, synbiotics also act to improve the survival,implantation and growth of newly added probiotic strains. Thecombination of Bifidobacterium and oligofructose has beenfound to act synergistically and retard colon carcinogenesisin rats compared to either given individually by Liong (2008).Rowland et al. (1998) in a study, administered inulin and Bif.longum (6x109CFU/d) to AOM-treated Sprague Dawley rats,found a significant (26%) decrease in total ACF that is morethan either agent given alone. Another investigationdemonstrated that the consumption of Bif. lactis and resistantstarch was able to enhance the apoptotic response to AOM inrats, which was suggested to be due to the resistant starchacting as a metabolic substrate to provide optimal activity ofthe probiotic species. Roller et al. (2004) have demonstratedthat synbiotic (combination of oligofructose-enriched inulin,L. rhamnose and Bif. lactis) use prevented AOM-inducedsuppression of NK-cell activity in Peyer’s patches, an effectnot noted in the individual pro- and prebiotic treatments. Thesestudies indicate that synbiotics may have a role in CRC

SYNBIOTIC: THE IMPACT ON HEALTH

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treatment by Fotiadis et al. (2008). Prebiotics alone appearto give inconsistent results on carcinogen-induced ACFinduction which may be partly due to differences in the typeof carcinogen and treatment regimes used. While inulin (10%in diet) had no significant effect on total ACF in the colon ortheir multiplicity in F344 rats, a significant decrease in ACF/cm2 of colon was observed by Rao et al. (1998). BothRowland et al. (1998) and Challa et al. (1997) investigatedthe effect of combined treatment of Bif. longum and lactulose.The combination produced a 48 per cent inhibition of colonicACF, which was significantly greater than either agent usedalone (synergistic effect). Similarly in another experiment,Rowland et al. (1998) found a reduction in total ACF of 74per cent in rats given Bif. longum plus inulin (by comparisonto a 29 per cent and 21 per cent decrease achieved by Bif.longum or inulin alone). Rowland et al. (1998) again found areduction of large ACF by 59 per cent when synbiotic wasused, whereas the individual treatments had no effect. Lionget al. (2008) has mentioned a lesser number of tumours inrats treated with carcinogens when they were given cerealbran. He also concluded that synbiotics produced increasedbenefits compared to the administration of either probioticor prebiotic alone. Rafter et al. (2007) evaluated the effectof synbiotic on reducing cancer risk factors in 37 coloncancer patients and 43 polypectomized patients in a 12-wkrandomized, double-blind and placebo-controlled trial. Theyused the synbiotic containing L. rhamnosus GG and Bif.lactisBb12 as probiotics and oligofructose-enriched inulin asprebiotic. They observed that such an administration alteredthe composition of the faecal bacterial composition whenthe populations of protective (beneficial) bacteria were foundto be increased and the numbers of cancer promoting(harmful) bacteria were reduced by Daniells et al. (2010).They also found that certain CRC intermediate biomarkerswere modified via such synbiotic intervention, wherecolorectal proliferation and the capacity of faecal water toinduce necrosis in colonic cells were decreased. Moreover,they observed improved epithelial barrier functions inpolypectomized patients. Conducting genotoxicity assaysusing the colonic biopsy samples, the authors found that theexposure of polypectomized patients to genotoxins wasreduced at the end of the intervention period. Although theexact mechanisms of these effects remain unknown, theauthors postulated that the synbiotic use had contributed tothe modifications of the composition of the colonic bacterialecosystem with subsequent altered metabolic activity of thecolon. These authors also observed that synbiotic useprevented the increased secretion of interleukin-2 byperipheral blood mononuclear cells in the polypectomizedpatients along with an increase in the production of interferonin the cancer patients.

Moroti et al. (2012) studied a randomized, double-blind, placebo-controlled study was conducted on twenty

volunteers (ten for placebo group and ten for symbioticgroup), aged 50 to 60 years. The criteria for inclusion in thestudy were: total cholesterol > 200 mg/dL; triglycerides >200 mg/dL and glycemia > 110 mg/dL. Over a total test periodof 30 days, 10 individuals (the symbiotic group) consumed adaily dose of 200 mL of a symbiotic shake containing 108UFC/mL Lactobacillus acidophilus, 108 UFC/mLBifidobacterium bifidum and 2 g oligofructose, while 10other volunteers (the placebo group) drank daily the sameamount of a shake that did not contain any symbiotic bacteria.Blood samples were collected 15 days prior to the start ofthe experiment and at 10-day intervals after the beginning ofthe shake intake. The standard lipid profile (total cholesterol,triglycerides and HDL cholesterol) and glycemia, or bloodsugar levels, were evaluated by an enzyme colorimetric assay.The results of the symbiotic group showed a non-significantreduction (P > 0.05) in total cholesterol and triglycerides, asignificant increase (P < 0.05) in HDL cholesterol and asignificant reduction (P < 0.05) in fasting glycemia. Nosignificant changes were observed in the placebo group.

Khodadad and Sabbaghian (2010) in a double-blindrandomized placebo controlled study 102 children aged 4–12 years with functional constipation were assessedaccording to Rome III criteria for 4 weeks. They were dividedinto 3 groups: Group A, received 1.5 ml/kg/day oral liquidparaffin plus placebo, group B, 1 sachet synbiotic per dayplus placebo and group C, 1.5 ml/kg/day oral liquid paraffinplus 1 sachet synbiotic per day. Frequency of bowelmovements (BMs), stool consistency, number of fecalincontinence episodes, abdominal pain, painful defecation perweek, success of treatment and side effects were determinedin each group before and after treatment. The frequency ofBMs per week increased in all groups (P<0.001), but itdiffered between groups and was higher in group C (P=0.03).Stool consistency increased and number of fecalincontinence episodes, abdominal pain and painful defecationper week decreased in all groups similarly and there wasstatistically no difference between them. No side effects werereported in group B; the main side effect in group A and Cwas seepage of oil (P<0.001). Treatment success was similarin all groups without any significant difference between them(P=0.6).This study showed that synbiotics have positiveeffects on symptoms of childhood constipation without anyside effects.

Vitali et al. (2010) studied the human gut harbors adiverse community of microorganisms which servenumerous important functions for the host wellbeing.Functional foods are commonly used to modulate thecomposition of the gut microbiota contributing to themaintenance of the host health or prevention of disease. Inthe present study, we characterized the impact of one monthintake of a synbiotic food, containing fructooligosaccharidesand the probiotic strains Lactobacillus helveticus Bar13 and


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Fig 1 : Main effects of fibres, probiotics and synbiotics on the immunesystem in different life-stages in humans

Bifidobacterium longum Bar33, on the gut microbiotacomposition and metabolic profiles of 20 healthy subjects.The synbiotic food did not modify the overall structure ofthe gut microbiome, as indicated by polymerase chainreaction-denaturing gradient gel electrophoresis (PCR-DGGE). The ability of the probiotic L. helveticus and B.longum strains to pass through the gastrointestinal tract washypothesized on the basis of real-time PCR data. In spite of astable microbiota, the intake of the synbiotic food resultedin a shift of the fecal metabolic profiles, highlighted by thegas chromatography mass spectrometry solid phase micro-extraction (GC-MS/SPME) analysis. The extent of short chainfatty acids (SCFA), ketones, carbon disulfide and methylacetate was significantly affected by the synbiotic foodconsumption. Furthermore, the canonical discriminantanalysis of principal coordinates (CAP) of GC-MS/SPMEprofiles allowed a separation of the stool samples recoveredbefore and after the consumption of the functional food. Inthis study we investigated the global impact of a dietaryintervention on the gut ecology and metabolism in healthyhumans. It was demonstrated that the intake of a synbioticfood leads to a modulation of the gut metabolic activitieswith a maintenance of the gut biostructure. In particular, thesignificant increase of SCFA, ketones, carbon disulfide andmethyl acetate following the feeding period suggests potentialhealth promoting effects of the synbiotic food.

A group of 26 healthy subjects, aged 22–47 years,participated in a 6-week placebo-controlled dietary interventionstudy. After a 2- week baseline period, in which all volunteersconsumed 500 ml day)1 of 2 per cent skimmed milk(Placebo), the study was designed as a randomized,doubleblind, two-armed parallel study in which 4-weekconsumption of 500 ml day portions of synbiotic or placebowere compared. Faecal microbial counts, pH, l-lactic acidand bile acid concentrations were assessed before and afterthe intervention. Synbiotic consumption significantlydecreased faecal dry weight (P < 0Æ01) and l-lactic acid (P


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oligosaccharide, resistant starches, sugaralcohols, difructoseanhydride) have shown positive effect on mineral absorption,metabolism, bone composition and architecture in animalsand humans.

Conclusion :The concept of synbiotics is not new. What is new is

the appreciation of its integral role in health and disease.Research in the food and nutrition sciences is central tounderstanding underlying mechanisms that form the basisfor practical applications. Probiotics/prebiotics/synbiotics aregaining importance because of the innumerable benefits,especially treating lactose intolerance, hypercholesterolproblem, cardiac diseases and managing cardiac problems likeatherosclerosis and arteriosclerosis effects. Benefits ofprobiotics also include: strengthening of the immune system,anti-cancer effect - especially in reducing the risk of coloncancer, reduction in levels of faecal enzymes associated withcancer, prevention and treatment of diarrhea, prevention andreduction of constipation and enhancement of resistanceagainst pathogens. Synbiotics are thought to prevent certainallergic symptoms and aid in the alleviation of diarrhea; theyalso have anticarcinogenic qualities, certain antimicrobialproperties and help regulate the immune system. Areas offuture interest for the application of probiotics/prebiotics/synbiotics include colon and bladder cancers, diabetes andrheumatoid arthritis. However, poor reputation of probiotics/prebiotics/synbiotics appears to be due to lack of meaningfulclinical endpoints (Lewis and Atkinson, 2009). Since theearly immune development in infants and the markedlydeclining immune function (immunosenescence) in theelderly have extensively been studied, prebiotic fibres,probiotics and synbiotics may be targeted for these specificage groups. Although the development of synbiotics toimprove prevention and/or treatment of immune-relateddiseases have emerged as a new strategy for nutritionistsand other health professionals, further intervention studiesare needed to prove any added benefits or health effects ofthis combination of ingredients and scientific verificationwill be critical to the success of this concept. Moreover,further studies to ascertain the mechanisms, the optimaldose/duration and the long-term safety forthe interventionin different age groups are also needed.

Authors’ affiliations :ANITA KOCHHAR AND NEETU, Department of Food and Nutrition, Collegeof Home Science Punjab Agricultural University, LUDHIANA (PUNJAB)

INDIA

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< 0Æ05) concentration, while significantly increased faecalbifidobacteria (P < 0Æ05) and lactobacilli (P < 0Æ01)counts.The tested synbiotic milk showed its synbiotic natureby enhancing the growth of bifidobacteria and lactobacilli.Significance and impact of the study: Scientific support tofunctional effect of a synbiotic milk.

Furrie et al. (2005) recent clinical trial reported thatsynbiotic therapy resulted in improvements in inflammatorymarkers, reduced inflammation in the rectal mucosa andregeneration of colonic epithelial tissue in patients with activeUC. The probiotic Bifidobacterium longum (2.0 ×1011cfu/d) and a prebiotic (synergy 1), made up of inulinoligofructose(12 g/d), were administered to 16 patients with active UC fora period of 1 month in a double-blind, randomized-controlledtrial. Patients were assessed using the clinical activity index,and sigmoidoscopic appearance was scored on study entry.Patients were asked to keep a daily bowel habit diary thatrecorded the amount and consistency of each stool, thepresence of blood or mucus in the stool, and whether thesubject experienced any abdominal pain. Rectal biopsies werealso taken for histological scoring. Transcription levels ofepithelial related immune markers were also measured: humanbeta defensins (hBD), tumor necrosis factor-alpha (TNF-alpha) and interleukin 1-alpha (IL-1). At the end of the study,each patient was reassessed in the same manner as thepretreatment visit. Conventional therapy (i.e. steroids,immunosuppressants, or 5-ASA) was not altered during thestudy. The synbiotic-treated group had lower sigmoidoscopyscores compared with placebo (P = 0.06). Expression ofmarkers used to assess inflammatory response of theepithelia was significantly reduced in the symbiotic patientgroup (hBD2: P =0.0156; hBD3: P = 0.0379; hBD4: P =0.0078). A significant reduction in expression of TNF-alphaand IL-1, which drive inflammation, was reported aftertreatment with synbiotic therapy (P =0.0175 and 0.0379,respectively). There was also concurrent reduction in colitisat the macroscopic and microscopic level. This short-termpilot trial is the first evidence demonstrating that synbiotictherapy may be a promising new therapy in the managementof UC. The combination of pro- and prebiotics is referred toas a synbiotic. Successful synbiotic combinations have asynergistic effect, greater than that of either the pro- orprebiotic administered individually. In recent times, severalstudies have demonstrated the capacity for synbiotics toreduce CRC. Rowland and Tanaka (1993) reported that thecombination of inulin and Bifidobacterium longum was moresuccessful at decreasing azoxymethane-induced ACF thaneither treatment alone.

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