Department of Surgery, Milano-Bicocca University, San Gerardo Hopsital, Via Pergolesi 33, 20052 Monza, Italy.
World J Gastroenterol. 2010 Jan 14;16(2):167-75. doi: 10.3748/wjg.v16.i2.167.
To investigate whether probiotic bacteria, given perioperatively, might adhere to the colonic mucosa, reduce concentration of pathogens in stools, and modulate the local immune function.
A randomized, double-blind clinical trial was carried out in 31 subjects undergoing elective colorectal resection for cancer. Patients were allocated to receive either a placebo (group A, n = 10), or a dose of 10(7) of a mixture of Bifidobacterium longum (BB536) and Lactobacillus johnsonii (La1) (group B, n = 11), or the same mixture at a concentration of 10(9) (group C, n = 10). Probiotics, or a placebo, were given orally 2 doses/d for 3 d before operation. The same treatment continued postoperatively from day two to day four. Stools were collected before treatment, during surgery (day 0) and 5 d after operation. During the operation, colonic mucosa samples were harvested to evaluate bacterial adherence and to assess the phenotype of dendritic cells (DCs) and lymphocyte subsets by surface antigen expression (flow cytometry). The presence of BB536 and La1 was evaluated by the random amplified polymorphism DNA method with specific polymerase chain reaction probes.
The three groups were balanced for baseline and surgical parameters. BB536 was never found at any time-points studied. At day 0, La1 was present in 6/10 (60%) patients in either stools or by biopsy in group C, in 3/11 (27.2%) in group B, and none in the placebo group (P = 0.02, 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 enterobacteriacae was 30% (3/10) in C, 81.8% (9/11) in B and 70% (7/10) in A (P = 0.03, C vs B). The Enterobacteriacae count in stools was 2.4 (log10 scale) in C, 4.6 in B, and 4.5 in A (P = 0.07, C vs A and B). The same trend was observed for colonizing enterococci. La1 was not found at day +5. We observed greater expression of CD3, CD4, CD8, and naive and memory lymphocyte subsets in group C than in group A with a dose response trend (C > B > A). Treatment did not affect DC phenotype or activation, but after ex vivo stimulation with lipopolysaccharides, groups C and B had a lower proliferation rate compared to group A (P = 0.04). Moreover, dendritic phenotypes CD83-123, CD83-HLADR, and CD83-11c (markers of activation) were significantly less expressed in patients colonized with La1 (P = 0.03 vs not colonized).
La1, but not BB536, adheres to the colonic mucosa, and affects intestinal microbiota by reducing the concentration of pathogens and modulates local immunity.
研究围手术期给予益生菌是否可以黏附在结肠黏膜上，减少粪便中病原体的浓度，并调节局部免疫功能。
对 31 例因癌症行择期结直肠切除术的患者进行了一项随机、双盲临床试验。患者被分配接受安慰剂（A 组，n=10）、长双歧杆菌（BB536）和嗜酸乳杆菌（La1）混合物剂量为 10(7)（B 组，n=11）或相同浓度 10(9)的混合物（C 组，n=10）。益生菌或安慰剂在术前 3 天每天口服 2 次。术后第 2 天至第 4 天继续进行相同的治疗。在治疗前、手术期间（第 0 天）和术后 5 天收集粪便。在手术过程中，采集结肠黏膜样本，通过表面抗原表达（流式细胞术）评估细菌黏附情况，并评估树突状细胞（DC）和淋巴细胞亚群的表型。通过随机扩增多态性 DNA 方法和特定的聚合酶链反应探针评估 BB536 和 La1 的存在。
三组在基线和手术参数方面均平衡。任何时间点均未发现 BB536。在第 0 天，C 组中 6/10（60%）患者的粪便或活检中存在 La1，B 组中 3/11（27.2%）患者存在 La1，而安慰剂组中则不存在（P=0.02，C 与 A 相比）。给予的剂量与黏附的 La1 数量呈线性相关（P=0.01）。肠杆菌定植率 C 组为 30%（3/10），B 组为 81.8%（9/11），A 组为 70%（7/10）（P=0.03，C 与 B 相比）。C 组粪便中肠杆菌计数为 2.4（对数 10 刻度），B 组为 4.6，A 组为 4.5（P=0.07，C 与 A 和 B 相比）。定植肠球菌也观察到了同样的趋势。第 5 天未发现 La1。与 A 组相比，C 组的 CD3、CD4、CD8、幼稚和记忆淋巴细胞亚群的表达更高，且呈剂量反应趋势（C>B>A）。治疗并未影响 DC 表型或激活，但与 A 组相比，C 组和 B 组在 LPS 体外刺激后增殖率较低（P=0.04）。此外，在与 La1 定植的患者中，树突状细胞表型 CD83-123、CD83-HLADR 和 CD83-11c（激活标志物）的表达明显较低（P=0.03 与未定植相比）。
La1 但不是 BB536 可以黏附在结肠黏膜上，并通过减少病原体浓度和调节局部免疫来影响肠道微生物群。
