Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14

Aims:  To determine the ability of probiotic lactobacilli to improve the treatment of vulvovaginal candidiasis (VVC) using a randomized, double-blind and placebo-controlled trial.
Methods and Results:  Fifty-five women diagnosed with VVC by vaginal discharge positive for Candida spp. (according to culture method) associated with at least one of the symptoms (itching and burning vaginal feeling, dyspareunia and dysuria), were treated with single dose of fluconazole (150 mg) supplemented every morning for the following 4 weeks with two placebo or two probiotic capsules (containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14). At 4 weeks, the probiotic treated group showed significantly less vaginal discharge associated with any of the above mentioned symptoms (10·3% vs 34·6%; P  =   0·03) and lower presence of yeast detected by culture (10·3% vs 38·5%; P  =   0·014).
Conclusion:  This study has shown that probiotic lactobacilli can increase the effectiveness of an anti-fungal pharmaceutical agent in curing disease.
Significance and Impact of the Study:  This novel finding of probiotic lactobacilli augmenting the cure rate of yeast vaginitis, not only offers an alternative approach to a highly prevalent condition that adversely affects the quality of life of women around the world, but also raises the question of how this combination works.     

乳杆菌代谢物脂肪酸组分对白假丝酵母菌的抑制及临床疗效观察

目的观察乳杆菌DM9811代谢物中脂肪酸组分（以下称抑菌液）在体内外对白假丝酵母菌的抑制效果,探索外阴阴道假丝酵母菌病（VVC）的安全、有效、无副作用的生态制剂疗法。方法不同浓度抑菌液对白假丝酵母菌的作用及作用不同时间的抑菌效果;对2003年9月～2004年1月57例VVC患者分别给予抑菌液（试验组）及达克宁栓（对照组）进行治疗,并做相关细菌培养及疗效判定。结果（1）体外试验中抑菌液对白假丝酵母菌的抑制作用随着浓度的降低而降低;在1：2浓度（乙酸含量0．8mg／ml）抑制作用随着时闻的延长而增强,12h达100％;对乳杆菌无抑制作用。（2）体内试验中抑菌液使阴道白假丝酵母菌数量明显减少（P〈0．05）,使阴道pH明显降低（P〈0．05）,阴道内乳杆菌数量差异无显著性（P〉0．05）;达克宁栓使阴道内白假丝酵母菌数量明显减少,乳酸杆菌数量明显下降（P〈0．05）,而阴道pH无变化。（3）2组1疗程治愈率及1个月复查治愈率均差异无显著性。（4）副反应：两者比较差异有显著性（P〈0．05）。结论抑菌液在体内外对白假丝酵母茵均有明显的抑杀作用;降低阴道pH;对阴道乳杆菌数量无影响;无副作用;可用于VVC的治疗。     

定菌生调整实验小鼠念珠菌性阴道炎的菌群失调的研究

目的 应用阴道细菌培养与光镜细胞学检查相结合的方法,研究定菌生对阴道念珠菌感染的菌群失调的调整作用。方法 以小鼠为实验对象,用盐酸林可霉素造成阴道菌群失调,并将分离的念珠菌接种到小鼠阴道内,造成小鼠阴道念珠菌感染模型,分别采用定菌生、抗真菌＋定菌生及抗真菌（制霉菌素）治疗1疗程后,取其阴道分泌物进行念珠菌及乳杆菌的菌群分析,并同时进行分泌物镜检,取阴道组织标本做病理组织学检查。结果 模型组小鼠阴道内主要细菌数量乳杆菌显著下降（P〈0．01）．出现阴道红肿、分泌物多呈块状和阴道黏膜充血等念珠菌阴道炎的典型症状,分泌物涂片镜检查到白细胞及念珠菌,而定菌生组和定菌生＋制霉菌素组治疗的小鼠,阴道黏膜与健康对照组的阴道黏膜基本相同,阴道内主要菌群——乳杆菌的数量恢复正常,阴道内念珠菌显著降低,与自然恢复组相比差异有极显著性（P〈0．01）,与制霉菌素处理比差异也有显著性,治疗效果明显好于制霉菌素。结论 定菌生能阻止念珠菌对阴道上皮的粘附作用,能调整阴道的菌群,对阴道黏膜有一定的修复功能,是治疗念珠菌性阴道炎有效的微生态调节剂。     

Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized,placebo-controlled trial in 64 healthy women

Urogenital infections afflict an estimated one billion people each year. The size of this problem and the increased prevalence of multi-drug resistant pathogens make it imperative that alternative remedies be found. A randomized, placebo-controlled trial of 64 healthy women given daily oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 for 60 days showed no adverse effects. Microscopy analysis showed restoration from asymptomatic bacterial vaginosis microflora to a normal lactobacilli colonized microflora in 37% women during lactobacilli treatment compared to 13% on placebo (P=0.02). Lactobacilli were detected in more women in the lactobacilli-treated group than in the placebo group at 28 day (P=0.08) and 60 day (P=0.05) test points. Culture findings confirmed a significant increase in vaginal lactobacilli at day 28 and 60, a significant depletion in yeast at day 28 and a significant reduction in coliforms at day 28, 60 and 90 for lactobacilli-treated subjects versus controls. The combination of probiotic L. rhamnosus GR-1 and L. fermentum RC-14 is not only safe for daily use in healthy women, but it can reduce colonization of the vagina by potential pathogenic bacteria and yeast.     

Augmentation of antimicrobial metronidazole therapy of bacterial vaginosis with oral probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14: randomized, double-blind, placebo controlled trial

This study enrolled 125 premenopausal women diagnosed with bacterial vaginosis (BV) by presence of vaginal irritation, discharge and 'fishy' odor, and Nugent criteria and detection of sialidase enzyme. The subjects were treated with oral metronidazole (500 mg) twice daily from days 1 to 7, and randomized to receive oral Lactobacillus rhamnosus GR-1 (1 x 10(9)) and Lactobacillus reuteri RC-14 (1 x 10(9)) or placebo twice daily from days 1 to 30. Primary outcome was cure of BV as determined by normal Nugent score, negative sialidase test and no symptoms or signs of BV at day 30. A total of 106 subjects returned for 30-day follow-up, of which 88% were cured in the antibiotic/probiotic group compared to 40% in the antibiotic/placebo group (p<0.001). Of the remaining subjects, 30% subjects in the placebo group and none in the probiotic group had BV, while 30% in the placebo and 12% in the probiotic group fell into the intermediate category based upon Nugent score, sialidase result and clinical findings. High counts of Lactobacillus sp. (>10(5) CFU/ml) were recovered from the vagina of 96% probiotic-treated subjects compared to 53% controls at day 30. In summary, this study showed efficacious use of lactobacilli and antibiotic in the eradication of BV in black African women.     

乳杆菌发酵上清对耐药白假丝酵母生物膜的作用

目的 研究德氏乳杆菌(Lactobacillus delbrueckii,L.delbrueckii)和发酵乳杆菌(Lactobacillus fermentum,L.fermentum)发酵上清液对3株耐氟康唑白假丝酵母临床分离株CA3、CA6、CA8生物膜形成和分散的作用。 方法 通过MIC试验,确认3株白假丝酵母临床分离株对氟康唑耐药;用96孔板构建体外白假丝酵母生物膜;用棋盘法分别检测L.delbrueckii、L.fermentum发酵上清液与氟康唑联用对3株白假丝酵母的作用;用XTT法对生物膜形成量进行定量分析;检测L.delbrueckii、L.fermentum发酵上清液与氟康唑联用对白假丝酵母时间-生长曲线的影响;显微镜拍照检测L.delbrueckii、L.fermentum发酵上清液单独和氟康唑联用对白假丝酵母生物膜形态的影响;平板培养法检测L.fermentum发酵上清液对白假丝酵母黏附作用的影响。 结果 CA3、CA6、CA8三株临床分离菌株对氟康唑耐药,MIC浓度均为8 μg/mL。L.delbrueckii与L.fermentum发酵上清液与氟康唑联用对3株耐药型白假丝酵母的生物膜形成与分散均未表现出协同作用,且发酵上清液与氟康唑联用效果不如发酵上清液单独处理效果好,L.fermentum发酵上清液对生物膜的分散作用较L.delbrueckii发酵上清液强。L.fermentum发酵上清液抑制白假丝酵母的初始黏附。 结论 L.delbrueckii、L.fermentum发酵上清液单独应用时均对耐氟康唑白假丝酵母生物膜的形成与分散有干预作用,与氟康唑联用时未表现出协同作用,抑制耐药白假丝酵母生物膜的作用可能与抑制菌丝形成和起始黏附有关。     

Immunomodulatory and protective effect of probiotic Lactobacillus casei against Candida albicans infection in malnourished mice

The effect of Lactobacillus casei CRL 431 (Lc), when administered as a supplement to a repletion diet, on the resistance of malnourished mice to Candida albicans infection was studied. Weaned mice were malnourished by being given a protein-free diet (PFD) for 21 days. The malnourished mice were then fed a balanced conventional diet (BCD) for 7 days or BCD for 7 days with supplemental Lc on days 6 and 7 (BCD+Lc). Malnourished (MNC) and well-nourished (WNC) mice were used as controls. At the end of the treatments the mice were infected intraperitoneally with C. albicans. Animals that had received probiotics had improved survival and resistance against this infection compared to those in the BCD and MNC groups. The number and fungicidal activity of phagocytes, and the concentrations of tumor necrosis factor-α, interferon-γ and interleukin-6 (IL-6), increased in blood and infected tissues in all experimental groups, but MNC mice showed lower concentrations than those in the WNC group. BCD and BCD+Lc mice showed higher concentrations of these variables than those in the MNC group, but only the BCD+Lc group presented values similar to the WNC mice. Malnutrition also impaired the production of IL-17 and IL-10 in response to infection. Both repletion treatments normalized IL-17 concentrations, but IL-10 in the BCD+Lc group was significantly higher than in WNC mice. The addition of L. casei to the repletion diet normalized the immune response against C. albicans, allowing efficient recruitment and activation of phagocytes, as well as effective release of pro-inflammatory cytokines. In addition, probiotic treatment induced an increase in IL-10 concentrations, which would have helped to prevent damage caused by the inflammatory response.     

克霉唑阴道片与乳杆菌制剂联合及序贯治疗重度外阴阴道假丝酵母菌病疗效

目的探讨克霉唑阴道片与阴道乳杆菌活菌制剂定君生联合及序贯应用治疗重度外阴阴道假丝酵母菌病(SVVC)的有效性及复发情况。方法选取中国人民解放军中部战区总医院2017年3月至2019年6月收治的240例SVVC患者,采用简单随机化分组方法(随机数字表法以及随机数余数分组法),分为序贯组(采用克霉唑阴道片先行治疗随后序贯应用乳杆菌制剂)、联合组(克霉唑阴道片与乳杆菌制剂同时联合用药)及单纯用药组(仅应用克霉唑阴道片治疗)各80例。3组患者均在治疗开始后第14~21天进行第1次复查,第28~35天进行第2次复查,观察2次复查后的乳杆菌分级、有效率及复发率。结果第1次复查时,序贯组及联合组患者阴道内乳杆菌数量较单纯用药组均显著增加(P=0.001);序贯组、联合组、单纯用药组有效率分别为78.8%、85.0%、63.8%,序贯组与联合组差异无统计学意义(P=0.305),该2组与单纯用药组比较差异均有统计学意义(P=0.036,P=0.002)。第2次复查时3组患者阴道内乳杆菌数量差异无统计学意义(P=0.895),序贯组、联合组、单纯用药组有效率分别为67.5%、66.3%、48.8%,序贯组与联合组差异无统计学意义(P=0.867),该2组与单纯用药组比较差异均有统计学意义(P=0.016,P=0.025)。序贯组、联合组、单纯用药组复发率分别为14.3%、22.1%、23.5%,序贯组明显低于联合组及单纯用药组(P=0.033)。结论克霉唑阴道片与乳杆菌制剂联合及序贯用药治疗SVVC均可达到更高的有效率,序贯用药在降低复发率方面效果更佳。     

乳酸菌阴道胶囊联合克霉唑治疗复发性外阴阴道假丝酵母菌病的疗效与安全性分析

目的 探讨乳酸菌阴道胶囊联合克霉唑治疗复发性外阴阴道假丝酵母菌病的效果及安全性。 方法 随机选择我院妇科于2017年7月-2018年12月收治的102例复发性外阴阴道假丝酵母菌病患者作为研究对象,共分为两组:单一克霉唑组和乳酸菌阴道胶囊与克霉唑联合组,每组各有51例患者,单一克霉唑组仅予以克霉唑阴道片治疗,而乳酸菌阴道胶囊与克霉唑联合组同时予以克霉唑及乳酸菌阴道胶囊治疗。比较两组患者症状好转率、临床治愈率、复发率和不良反应发生率。 结果 乳酸菌阴道胶囊与克霉唑联合组的症状好转率、临床治愈率高于单一克霉唑组,其疾病复发率低于单一克霉唑组(均P0.05)。 结论 乳酸菌阴道胶囊联合克霉唑治疗外阴阴道假丝酵母菌病的效果优于单一克霉唑组,并且两组患者不良反应发生率相当,即用药安全性相当,值得推广。     

Antifungal activity of clinical Lactobacillus strains against Candida albicans biofilms: identification of potential probiotic candidates to prevent oral candidiasis

This study isolated Lactobacillus strains from caries-free subjects and evaluated the inhibitory effects directly on three strains of C. albicans, two clinical strains and one reference strain. Thirty Lactobacillus strains were isolated and evaluated for antimicrobial activity against in vitro C. albicans biofilms. L. paracasei 28.4, L. rhamnosus 5.2 and L. fermentum 20.4 isolates exhibited the most significant inhibitory activity against C. albicans. Co-incubation between these microorganisms resulted in deterrence of biofilm development and retardation of hyphal formation. The hindrance of biofilm development was characterized by the downregulated expression of C. albicans biofilm-specific genes (ALS3, HWP1, EFG1 and CPH1). L. paracasei 28.4, L. rhamnosus 5.2 and L. fermentum 20.4 demonstrated the ability to exert antifungal activity through the inhibition of C. albicans biofilms.     

乳杆菌优良菌株的筛选及对小鼠阴道白假丝酵母菌过度增殖干预

目的探讨乳杆菌优良菌株的筛选及其对小鼠阴道白假丝酵母菌过度增殖干预作用。方法对德氏乳杆菌DM8909菌株进行诱变筛选,得到耐抗生素突变株208,以ICR小鼠为实验对象,用甲硝唑进行小鼠阴道菌群脱污染,将白假丝酵母菌接种到小鼠阴道内,构建小鼠阴道白假丝酵母菌过度增殖模型。采用阴道接种德氏乳杆菌DM8909突变株208菌液（2×108CFU/mL）处理,取其阴道冲洗液进行阴道菌群分析,并进行阴道上皮细胞的电镜检查。结果乳杆菌干预后显著清除阴道内的假丝酵母菌,肠杆菌恢复正常水平,与模型组比较,差异有统计学意义（P〈0.05）。结论德氏乳杆菌DM8909抗性菌株208能调整白假丝酵母菌在小鼠阴道内定植,对小鼠阴道上皮细胞有恢复作用。     

Lasioglossins LLIII affect the morphogenesis of Candida albicans and reduces the duration of experimental vaginal candidiasis in mice

Lasioglossins are a group of peptides with identified antimicrobial activity. The inhibitory effects of two synthetic lasioglossin derivatives, LLIII and D‐isomeric variant LLIII‐D, on morphological changes in Candida albicans in vitro and the effect of local administration of LLIII during experimental murine candidiasis were investigated. C. albicans blastoconidia were grown in the presence of lasioglossin LLIII or LLIII‐D at concentrations of 11.5 μM and 21 μM, respectively, for 1, 2 and 3 days and their viability determined by flow cytometry using eosin Y staining. Morphological changes were examined by light and fluorescent microscopy. The Candida‐inhibitory effect of daily intravaginal administration of 0.7 or 1.4 μg of LLIII was assessed in mice with experimentally‐induced vaginal candidiasis. LLIII and LLIII‐D lasioglossins exhibited candidacidal activity in vitro (>76% after 24 hr and >84% after 48 hr of incubation). After 72 hr incubation of Candida with low concentration of lasioglossins, an increase in viability was detected, probably due to a Candida antimicrobial peptides evasion strategy. Furthermore, lasioglossins inhibited temperature‐induced morphotype changes toward hyphae and pseudohyphae with sporadic occurrence of atypical cells with two or enlarged nuclei, suggesting interference with mitosis or cytokinesis. Local application of LLIII reduced the duration of experimental candidiasis with no evidence of adverse effects. Lasioglossin LLIII is a promising candidate for development as an antimicrobial drug for treating the vaginal candidiasis.

     

乳杆菌代谢物对白色念珠菌影响的体外试验研究

目的从阴道微生态平衡角度出发,观察乳杆菌(DM9811)代谢物对白色念珠菌的抑杀效果,并行组份分析,探索CV(candidal vaginitis,CV)的生态疗法.方法取CV患者阴道分泌物30例,分离培养,鉴定,保留白色念珠菌菌株.1.以提取液(以下简称提取液)Ⅰ和Ⅱ分别代替蒸馏水配制培养基SⅠ和SⅡ,将保留的白色念珠菌株传代5次后,配制菌液,接种于S、SⅠ和SⅡ中,培养后活菌计数.2.对提取液Ⅰ和Ⅱ倍比稀释,并代替蒸馏水配制多个培养基SⅠ和SⅡ,测定SⅠ和SⅡ中没有菌落生长的最低有效浓度(MIC).3.气相色谱测定提取液中挥发酸类成分并定量.4.选择提取液最低浓度加1的方法配制培养基,比较提取液和乙酸水溶液对白色念珠菌的抑制效果.结果1.白色念珠菌生长24 h后计活菌数,将SⅠ与S,SⅡ与S中活菌数相比较,非参数配对T检验P＜0.01.2.提取液Ⅰ最低有效浓度为1:4,提取液Ⅱ最低有效浓度为1:2.3.气相色谱测定提取液Ⅱ中挥发酸类主要成分为乙酸,浓度为0.235 9 S/100ml.4.提取液和乙酸对白色念珠菌的生长都有抑制作用,但提取液的抑制作用明显强于乙酸.结论乳酸杆菌DM9811代谢物对白色念珠菌有明显的抑菌和杀菌作用,可作为一种新型的生态制剂进行开发,用于治疗念珠菌阴道炎.     

A subpopulation of Candida albicans and Candida tropicalis biofilm cells are highly tolerant to chelating agents

Many Candida spp. produce surface-adherent biofilm populations that are resistant to antifungal compounds and other environmental stresses. Recently, certain chelating agents have been recognized as having strong antimicrobial activity against biofilms of Candida species. This study investigated and characterized the concentration- and time-dependent killing of Candida biofilms by the chelators tetrasodium EDTA and sodium diethyldithiocarbamate. Here, Candida albicans and Candida tropicalis biofilms were cultivated in the Calgary Biofilm Device and then exposed to gradient arrays of these agents. Population survival was evaluated by viable cell counting and by confocal laser scanning microscopy (CLSM) in conjunction with fluorescent viability staining. At concentrations of > or =2 mM, both EDTA and diethyldithiocarbamate killed c. 90-99.5% of the biofilm cell populations. Notably, a small fraction (c. 0.5-10%) of biofilm cells were able to withstand the highest concentrations of these antifungals that were tested (16 and 32 mM for EDTA and diethyldithiocarbamate, respectively). Interestingly, CLSM revealed that these surviving cells were irregularly distributed throughout the biofilm community. These data suggest that the use of chelating agents against biofilms of Candida spp. may be limited by the refractory nature of a variant cell subpopulation in the surface-adherent community.     

乳杆菌DM9811代谢产物脂肪酸组分对义齿性口炎患者口腔中白假丝酵母菌的抑制

目的从调整口腔菌群平衡的角度出发,观察乳杆菌DM9811代谢产物脂肪酸组分对义齿性口炎患者口腔菌群的影响。方法（1）体外试验：配制不同浓度乳杆菌DM9811代谢产物脂肪酸组分的沙包液体培养基,分别接种10^8CFU／ml白假丝酵母菌菌液,用CFU活菌记数法计数。（2）临床试验：符合义齿性口炎病例40例,随机分为试验组20例和对照组20例（阴性对照组和阳性对照组各10例）。分别给予乳杆菌DM9811代谢产物脂肪酸组分、纯净水、洗必泰含漱液。观察菌群变化。结果（1）体外试验：乳杆菌DM9811代谢产物脂肪酸组分在浓度为1．6、0．8和0．4mg／ml时对白假丝酵母菌的抑制作用分别为100％、98．11％和62．72％。（2）临床试验：试验组在治疗后口腔黏膜白假丝酵母菌数量明显降低,口腔链球菌数量升高,较治疗前差异均有显著性（P〈0．01）;停药后第21天较治疗7d差异无显著性（P〉0.05）。结论乳杆菌DM9811代谢产物脂肪酸组分对口腔白假丝酵母菌有明显的抑杀作用;对口腔链球菌有促进作用,可能有调整口腔菌群平衡的作用。     

pH及氧气对白念珠菌菌丝形成的影响

目的探讨pH值和氧气对白念珠菌菌丝形成的影响。方法通过调节Muller—Hinton液体培养基的pH值和去除培养基中的氧气来观察白念珠菌的生长曲线、倍增时间和菌丝形成率的变化。结果在无氧气的液体培养基中,白念珠菌生长缓慢,不能产生菌丝结构,只有酵母细胞形成。生长曲线的延缓期内各组没有明显差异,而在生长的对数期pH3和pH4的条件下念珠菌生长速度明显慢于pH5、pH6、pH7、pH8和pH9。菌丝形成率在pH3、pH4和pH5条件下〈20％,而在pH6、pH7、pH8和pH9条件下可高达70％。结论厌氧条件抑制白念珠菌的菌丝形成,只形成酵母细胞。白念珠菌在pH3—9的范围内均能生长,偏酸性环境有利于白念珠菌酵母形成,偏碱性的环境有助于菌丝的形成。     

地衣芽胞杆菌对白色念珠菌等的拮抗作用

目的了解地衣芽胞杆菌在试管内与阴道正常菌群共生关系的情况。方法将地衣芽胞杆菌菌液分别与葡萄球菌、大肠埃希菌、白色念珠菌、德氏乳杆菌混合培养,定量计数各菌在不同时间内单独培养和混合培养时各菌的活菌数。结果地衣芽胞杆菌生长不受金黄色葡萄球菌、白色念珠菌和大肠埃希菌的影响,金黄色葡萄球菌和白色念珠菌在有地衣芽胞杆菌存在的情况下,其生长受到明显的抑制（P〈0.05）;乳杆菌在12-48 h内,有显著的抑制地衣芽胞杆菌生长的作用,而乳杆菌的生长不受地衣芽胞杆菌的存在与否而正常生长。结论地衣芽胞杆菌对金黄色葡萄球菌及白色念珠菌在体外具有明显的拮抗作用,地衣芽胞杆菌对大肠埃希菌、乳杆菌无明显的体外拮抗作用。     

Effect of growth time on the surface and adhesion properties of Lactobacillus rhamnosus GG

Aims:  To investigate the changes in the surface properties of Lactobacillus rhamnosus GG during growth, and relate them with the ability of the Lactobacillus cells to adhere to Caco-2 cells.
Methods and Results:  Lactobacillus rhamnosus GG was grown in complex medium, and cell samples taken at four time points and freeze dried. Untreated and trypsin treated freeze dried samples were analysed for their composition using SDS-PAGE analysis and Fourier transform infrared spectroscopy (FTIR), hydrophobicity and zeta potential, and for their ability to adhere to Caco-2 cells. The results suggested that in the case of early exponential phase samples (4 and 8 h), the net surface properties, i.e. hydrophobicity and charge, were determined to a large extent by anionic hydrophilic components, whereas in the case of stationary phase samples (13 and 26 h), hydrophobic proteins seemed to play the biggest role. Considerable differences were also observed between the ability of the different samples to adhere to Caco-2 cells; maximum adhesion was observed for the early stationary phase sample (13 h). The results suggested that the adhesion to Caco-2 cells was influenced by both proteins and non-proteinaceous compounds present on the surface of the Lactobacillus cells.
Conclusion:  The surface properties of Lact. rhamnosus GG changed during growth, which in return affected the ability of the Lactobacillus cells to adhere to Caco-2 cells.
Significance and Impact of the Study:  The levels of adhesion of Lactobacillus cells to Caco-2 cells were influenced by the growth time and reflected changes on the bacterial surface. This study provides critical information on the physicochemical factors that influence bacterial adhesion to intestinal cells.