Inhibition of Helicobacter pylori Infection in Humans by Lactobacillus reuteri ATCC 55730 and Effect on Eradication Therapy: A Pilot Study

Background:  Several studies report an inhibitory effect of probiotics on Helicobacter pylori .
Aim:  To test whether Lactobacillus reuteri ATCC 55730 reduces H. pylori intragastric load in vivo, decreases dyspeptic symptoms, and affects eradication rates after conventional treatment.
Materials and Methods:  In a double-blind placebo-controlled study, 40 H. pylori -positive subjects were given L. reuteri once a day for 4 weeks or placebo. All underwent upper endoscopy, ¹³C-urea breath test, and H. pylori stool antigen determination at entry and ¹³C-urea breath test and H. pylori stool antigen (used as both qualitative and semiquantitative markers) after 4 weeks of treatment. Sequential treatment was administered subsequently to all.
Results:  In vivo, L. reuteri reduces H. pylori load as semiquantitatively assessed by both ¹³C-urea breath test δ -value and H. pylori stool antigen quantification after 4 weeks of treatment ( p <  .05). No change was shown in patients receiving placebo. L. reuteri administration was followed by a significant decrease in the Gastrointestinal Symptom Rating Scale as compared to pretreatment value ( p <  .05) that was not present in those receiving placebo ( p =  not significant). No difference in eradication rates was observed.
Conclusions:  L. reuteri effectively suppresses H. pylori infection in humans and decreases the occurrence of dyspeptic symptoms. Nevertheless, it does not seem to affect antibiotic therapy outcome.     

罗伊乳杆菌LE16益生特性的研究

目的研究罗伊乳杆菌LE16的益生特性。方法通过体外和动物实验,评价罗伊乳杆菌LE16的益生特性。结果该菌株对p H 2.5的强酸和0.3%高胆盐环境均有良好的耐受性。对引起肠道感染的几种病原菌均有不同程度的拮抗,尤其对枯草芽胞杆菌、伤寒沙门菌、单核细胞增生李斯特菌及蜡样芽胞杆菌的抑制作用最强。对肠道菌群正常和失调的小鼠均具有调节功能。结论罗伊乳杆菌LE16具有良好的益生性能,可作为益生菌菌株开发应用于食品和保健食品中。     

Probiotic containing Lactobacillus reuteri DSM 17648 as an adjunct treatment for Helicobacter pylori infection: A randomized,double-blind,placebo-controlled trial

Background

Despite multiple therapy regimens, the decline in the Helicobacter pylori eradication rate poses a significant challenge to the medical community. Adding Lactobacillus reuteri probiotic as an adjunct treatment has shown some promising results. This study aims to investigate the efficacy of Lactobacillus reuteri DSM 17648 in H. pylori eradication and its effect in ameliorating gastrointestinal symptoms and adverse treatment effects.

Materials and Methods

This randomized, double-blinded, placebo-controlled trial involved treatment-naïve H. pylori-positive patients. Ninety patients received standard triple therapy for 2 weeks before receiving either a probiotic or placebo for 4 weeks. The posttreatment eradication rate was assessed via a ¹⁴C urea breath test in Week 8. The Gastrointestinal Symptom Rating Scale (GSRS) questionnaire and an interview on treatment adverse effects were conducted during this study.

Results

The eradication rate was higher in the probiotic group than in the placebo group, with a 22.2% difference in the intention-to-treat analysis (91.1% vs. 68.9%; p = 0.007) and 24.3% difference in the per-protocol analysis (93.2% vs. 68.9%; p = 0.007). The probiotic group showed significant pre- to post-treatment reductions in indigestion, constipation, abdominal pain, and total GSRS scores. The probiotic group showed significantly greater reductions in GSRS scores than the placebo group: indigestion (4.34 ± 5.00 vs. 1.78 ± 5.64; p = 0.026), abdominal pain (2.64 ± 2.88 vs. 0.89 ± 3.11; p = 0.007), constipation (2.34 ± 3.91 vs. 0.64 ± 2.92; p = 0.023), and total score (12.41 ± 12.19 vs. 4.24 ± 13.72; p = 0.004). The probiotic group reported significantly fewer adverse headache (0% vs. 15.6%; p = 0.012) and abdominal pain (0% vs. 13.3%; p = 0.026) effects.

Conclusions

There was a significant increase in H. pylori eradication rate and attenuation of symptoms and adverse treatment effects when L. reuteri was given as an adjunct treatment.     

Inhibition of growth of Trichophyton tonsurans by Lactobacillus reuteri

Aim: The aims of this study were to identify antifungal lactic acid bacteria (LAB) and characterize their activity against the dermatophyte Trichophyton tonsurans. Methods and Results: A total of 165 different LAB were isolated and initially screened for anti‐Penicillium expansum activity. Five strains, which exhibited strong inhibitory activity, were then tested against the dermatophyte T. tonsurans DSM12285, where they also caused inhibition as observed by large fungal clearing on agar surface. The strongest inhibition was seen with Lactobacillus reuteri R2. When freeze‐dried cell‐free supernatant powder from this strain was incorporated in culture medium at concentrations >1%, growth of fungal colony was inhibited. Conidia germination was also inhibited under these conditions as determined by microscopy. The anti‐T. tonsurans activity of Lact. reuteri R2 was not affected neither by heat treatment nor by proteolytic treatment using pronase E and proteinase K, indicating that the responsible agent(s) were nonproteinaceous in nature. Conclusions: Lactobacillus reuteri R2 was identified as having strong inhibitory activity against the dermatophyte T. tonsurans DSMZ12285. Significance and Impact of the Study: LAB are naturally associated with many foods and are well recognized for their biopreservative properties. The use of these and/or their products may well provide alternative safe approaches for the inhibition of dermatophytic fungi.     

人胃粘膜乳酸杆菌与幽门螺杆菌感染的相关性

目的:探讨胃内正常菌群乳酸杆菌对幽门螺杆菌(Helicobacter pylori,HP)的影响。方法:51例胃粘膜活检标本均取自于行胃镜检查的胃炎患者,分离培养乳酸杆菌,通过扩增其16S rRNA基因并测序来鉴定乳酸杆菌的种类;胃炎程度及活动度的分类依据悉尼分类系统,运用改良Gimesa染色鉴定HP感染。结果:胃粘膜中共分离出9种乳酸杆菌,分离阳性率为49.0%;乳酸杆菌阳性病人与阴性病人的HP感染率、胃炎程度的差异及胃炎活动度的差异均无统计学意义(P>0.05);HP阳性病人的胃炎程度较HP阴性病人更严重(P<0.05);有益生菌作用的乳酸杆菌与非益生菌类乳酸杆菌的HP感染率差异无统计学意义(P>0.05)。结论:胃内乳酸杆菌的存在对HP感染无影响。     

Investigation of the immunomodulatory effects of Lactobacillus casei and Bifidobacterium lactis on Helicobacter pylori infection

Background: Lactobacillus and Bifidobacterium species have shown beneficial effects in the treatment of Helicobacter pylori infection; however, the mechanisms behind such effects are not fully understood. In this study, we have investigated the immunomodulatory effects of probiotics in a mouse model of H. pylori infection. Materials and methods: H. pylori‐infected C57BL/6 mice were treated with L. casei L26, B. lactis B94, or no probiotics for 5 weeks, respectively. Mice not infected with H. pylori were included as normal controls. Gastric histology, protein levels of interleukin (IL)‐1β, IL‐10, IL‐12/23p40, and H. pylori colonization density in the gastric tissues, as well as H. pylori‐specific antibodies were examined. Results: In mice receiving L. casei L26 and B. lactis B94, gastric neutrophil infiltration and IL‐1β were significantly decreased and IL‐10 was significantly increased as compared with mice receiving no probiotics. In mice receiving B. lactis B94, IL‐12/23p40 was significantly increased and H. pylori IgG was significantly reduced as compared with mice receiving no probiotics. No significant difference of H. pylori colonization was observed among the three groups of mice. Conclusion: The reduced level of IL‐1β and neutrophil infiltration observed in mice infected with H. pylori following treatment with L. casei L26 and B. lactis B94 resulted from a modulation of immune response rather than a decrease of H. pylori colonization. Furthermore, B. lactis B94 has the intrinsic ability to promote a Th1 immune response through an increase in IL‐12/IL‐23.     

罗伊氏乳杆菌的益生功能

罗伊氏乳杆菌是目前已报道的几乎可存在于所有脊椎动物和哺乳动物肠道内的乳酸杆菌,是具有益生功效的肠道益生菌.通过对罗伊氏乳杆菌良好的肠道定植能力和其产生的罗伊氏菌素的介绍,阐明其可能的益生作用机理.重点论述了罗伊氏乳杆菌促进人类和动物健康功能的研究进展,并探讨了今后罗伊乳杆菌益生菌制剂的工业化发展趋势.     

Strain-dependent proliferation in response to human gastric mucin and adhesion properties of Helicobacter pylori are not affected by co-isolated Lactobacillus sp

Background: Helicobacter pylori colonize the mucus layer that covers the gastric epithelium and can cause gastritis, ulcers, and gastric cancer. Recently, Lactobacillus sp. have also been found to reside in this niche permanently. This study compares adhesive properties and proliferation of co‐isolated lactobacilli and H. pylori in the presence of mucins and investigates possibilities for lactobacilli‐mediated inhibition of H. pylori. Materials and methods: Binding and proliferation of four H. pylori and four Lactobacillus strains, simultaneously isolated after residing in the stomachs of four patients for >4 years, to human gastric mucins were investigated using microtiter‐based methods. Results: The H. pylori strains co‐isolated with lactobacilli exhibited the same mucin binding properties as demonstrated for H. pylori strains previously. In contrast, no binding to mucins was detected with the Lactobacillus strains. Proliferation of mucin‐binding H. pylori strains was stimulated by the presence of mucins, whereas proliferation of non‐binding H. pylori and Lactobacillus strains was unaffected. Associative cultures of co‐isolated H. pylori and Lactobacillus strains showed no inhibition of H. pylori proliferation because of the presence of whole bacteria or supernatant of lactobacilli. Conclusions: The presence of lactobacilli in the stomach did not select for different mucin binding properties of H. pylori, and Lactobacillus sp. did neither compete for binding sites nor inhibit the growth of co‐isolated H. pylori. The effects of human gastric mucins on H. pylori proliferation vary between strains, and the host–bacteria interaction in the mucus niche thus depends on both the H. pylori strain and the microenvironment provided by the host mucins.     

Inhibition of Helicobacter pylori haemogglutination activity by human salivary mucins

Abstract Thirty isolates of Helicobacter pylori from gastric biopsies agglutinated human erthyrocyte suspensions. Crude mucin preparation derived from saliva of 20 different donors were examined for their ability to inhibit haemagglutination. All mucin preparations exhibited strong inhibitory activity. Removal of sialic residues from mucin preparations by treatment with neuraminidase resulted in a substantial reduction of their inhibitory activity. The mucin prepations had no bactericidal or aggregation activity for H. pylori . These results are discussed in the context of the role of mucins in colonization of the gastric mucosa by H. pylori     

pH-dependent binding of Helicobacter pylori to pig gastric mucins

A microtiter-based assay was developed to study the binding of Helicobacter pylori to pig gastric mucins purified by density-gradient centrifugation in CsCl/4 M guanidinium chloride. Binding of H. pylori was observed over the 'mucin' band as well as with 'low-density' components in the gradients, and binding to the latter was more pronounced when incubations were performed at 37 degrees C as compared to 20 degrees C. At a lower pH, binding of H. pylori (strain SVA 40) to the 'high-density' mucins from pig antrum was increased but binding to the 'low-density' ones was decreased. Binding of the P466 strain (Le(b)-specific) was mainly associated with the 'mucin' band, whereas the MO19 strain reacted preferentially with the 'low-density' components. In summary, H. pylori may bind to gastric mucins and the binding is influenced by temperature, pH and the repertoire of bacterial adhesins.     

Inhibition of heparan sulphate and other glycosaminoglycans binding to Helicobacter pylori by various polysulphated carbohydrates

Abstract Heparan sulphate binding to Helicobacter pylori at pH 4 to 5 was inhibited with various sulphated polysaccharides (heparin and chondroitin sulphates, fucoidan, carrageenans and some others), but not by carboxylated or nonsulphated compounds. Heparin binding proteins are exposed on the cell surface.     

乳杆菌治疗幽门螺杆菌感染疗效的Meta分析

目的 系统评价乳杆菌治疗幽门螺杆菌（H. pylori）感染的有效性。方法 计算机检索PubMed、Cochrane Central Register of Controlled Trials、Clinicatrials.gov、中国临床试验注册中心（http://www.chictr.org.cn/）、中国知网（CNKI）、万方数据库。检索时间从建库至2016年6月30日。此外追索已纳入文献和综述的参考文献。经两位研究者独立筛选文献、提取资料和评价质量,交叉核对后,采用Stata 12.0进行Meta分析。结果 最终纳入17个RCT,共1 758例患者。Meta分析结果：乳杆菌联合常规三联疗法能提高H. pylori根除率[OR=2.762,95%CI(2.163,3.526),P<0.001],降低不良反应发生率[OR=0.334,95%CI(0.242,0.461),P<0.001],但乳杆菌单独应用对H. pylori根除率结果与对照组比较差异无统计学意义。根据乳杆菌给药疗程的亚组分析结果,0~14（含14）d乳杆菌联合给药方案显著提高了H. pylori根除率[OR=2.893,95%CI(2.187,3.827),P<0.05],14~28（含28）d给药疗程也显著提高了H. pylori根除率[OR=2.619,95%CI(1.652,4.153),P<0.05]。乳杆菌联合三联疗法在欧洲人群及亚洲人群的亚组分析中,均提高了H. pylori根除率。结论 乳杆菌联合三联疗法有利于提高H. pylori根除率,并能降低总不良反应的发生,在H. pylori感染相关疾病的治疗中具有一定意义。     

In vitro growth inhibition of Helicobacter pylori by lactobacilli belonging to the Lactobacillus plantarum group

AIMS: The aim of this study was to test and locate the in vitro anti-Helicobacter activity of seven Lactobacillus strains belonging to Lactobacillus plantarum group. METHODS AND RESULTS: Growth inhibition of H. pylori was tested using a well-plate assay. Of the strains displaying the strongest growth inhibition, a L. plantarum isolated from sauerkraut (MLBPL1) was chosen for further studies. The detected anti-Helicobacter activity of MLBPL1 was mainly associated with cell wall, and to a minor extent with the culture supernatant. The active component, which was determined to be between 3 and 10 kDa in size, retained its activity after 10 min treatment at 100 degrees C. The activity was present when MLBPL1 was cultivated in rich laboratory cultivation medium MRS and in different food matrices. CONCLUSIONS: The strains belonging to L. plantarum group showed anti-Helicobacter activity in vitro. The main activity seemed to be associated with cell wall rather than culture supernatant or intracellular fraction. SIGNIFICANCE AND IMPACT OF THE STUDY: In view of the rapid spread of resistant H. pylori strains caused by antibiotic therapy, addition of a fermented food containing L. plantarum to the conventional antibiotic treatment of Helicobacter infection could establish a potential complementary means to suppress the infection.     

Identification and characterization of antibiotic resistance genes in Lactobacillus reuteri and Lactobacillus plantarum

Aims:  The study aimed to identify the resistance genes mediating atypical minimum inhibitory concentrations (MICs) for tetracycline, erythromycin, clindamycin and chloramphenicol within two sets of representative strains of the species Lactobacillus reuteri and Lactobacillus plantarum and to characterize identified genes by means of gene location and sequencing of flanking regions.
Methods and Results:  A tet (W) gene was found in 24 of the 28 Lact. reuteri strains with atypical MIC for tetracycline, whereas four of the six strains with atypical MIC for erythromycin were positive for erm (B) and one strain each was positive for erm (C) and erm (T). The two Lact. plantarum strains with atypical MIC for tetracycline harboured a plasmid-encoded tet (M) gene. The majority of the tet (W)-positive Lact. reuteri strains and all erm -positive Lact. reuteri strains carried the genes on plasmids, as determined by Southern blot and a real-time PCR method developed in this study.
Conclusions:  Most of the antibiotic-resistant strains of Lact. reuteri and Lact. plantarum harboured known plasmid-encoded resistance genes. Examples of putative transfer machineries adjacent to both plasmid- and chromosome-located resistance genes were also demonstrated.
Significance and Impact of the Study:  These data provide some of the knowledge required for assessing the possible risk of using Lact. reuteri and Lact. plantarum strains carrying antibiotic resistance genes as starter cultures and probiotics.     

复方嗜酸乳杆菌片联合三联方案根除幽门螺杆菌的临床研究

目的探讨复方嗜酸乳杆菌片联合三联方案根除幽门螺杆菌(Helicobacter pylori,H.pylori)的疗效及不良反应。方法将143例H.pylori检测阳性的患者随机分为A1组(48例)、A2组(46例)和B组(49例)。B组给予三联方案(埃索美拉唑、阿莫西林、克拉霉素)根除H.pylori治疗,疗程10d。A1组、A2组分别在上述三联方案的基础上同时加用10d、20d的复方嗜酸乳杆菌片。治疗过程中观察并记录上述三组的不良反应发生情况,停药4周后查13 C呼气试验判别H.pylori根除是否成功。结果共133例患者完成治疗和随访,A1组、A2组、B组根除率按方案(PP)分析分别为65.9%、69.8%、63.0%,按意向性(ITT)分析分别为60.4%、65.2%、59.2%,无论按方案分析还是意向性分析三组根除率差异均无统计学意义(P0.05)。纳入三组的共143例患者均完成不良反应的随访,A1组、A2组、B组不良反应发生率分别为10.4%、8.7%、30.6%,三组相比差异有统计学意义(P0.05),其中A1组、A2组分别与B组相比差异有统计学意义(P0.05),A1组与A2组相比差异无统计学意义(P0.05)。结论三联方案加用10d、20d的复方嗜酸乳杆菌片未能提高H.pylori根除率,但可降低不良反应发生率。     

罗伊乳杆菌对致龋变形链球菌拮抗作用的研究

目的研究罗伊乳杆菌对变形链球菌的拮抗作用,初步了解产生拮抗作用的原因。方法利用罗伊乳杆菌无菌上清液,应用双层平板打孔法测定其抑菌效果,再通过滤纸片抑菌法对罗伊乳杆菌发酵的酸乳制品与普通酸乳制品对变形链球菌的抑菌作用进行比较,用饱和硫酸铵沉淀法分析产生拮抗作用的原因。结果罗伊乳杆菌有显著抑菌活性（P〈0.05）,仅罗伊乳杆菌的发酵乳样品对变性链球菌产生直径为6.3mm抑菌圈,80%饱和硫酸铵沉淀的细菌素抑菌活力最强,蛋白酶K处理后无明显抑菌圈。结论本研究证明了罗伊乳杆菌的代谢产物以及罗伊乳杆菌发酵的酸奶制品对致龋菌变形链球菌有着明显的拮抗作用。     

含米诺环素和奥硝唑的四联疗法联合双歧杆菌乳杆菌三联活菌片根除幽门螺杆菌的效果

目的研究含米诺环素及奥硝唑的四联疗法的有效性和安全性,并分析双歧杆菌乳杆菌三联活菌片(金双歧)在幽门螺杆菌根除治疗中的效果,指导临床实践。方法回顾性分析2018年5月至2019年5月福建省立医院收治的101例幽门螺杆菌阳性患者,所有患者均采用艾司奥美拉唑+米诺环素+奥硝唑+铋剂四联方案,其中51例患者联合金双歧治疗,比较各类患者治疗效果及不良反应。通过13C尿素呼气试验评估幽门螺杆菌根除情况。不良反应及临床症状缓解情况通过访谈进行评估。结果 101例患者幽门螺杆菌总根除率为94.06%(95%CI:87.01%~97.56%),共出现不良反应19例,不良反应率为18.81%(95%CI:11.98%~28.07%)。90.10%的患者依从性良好。联合和不联合金双歧的患者其幽门螺杆菌根除率差异无统计学意义(92.2%vs 96.0%,P=0.678 0),临床症状缓解情况差异也无统计学意义(P=0.444 0),但联合金双歧可减少治疗不良反应发生率(P=0.005 0)。结论含米诺环素和奥硝唑的四联疗法是根除幽门螺杆菌有效且耐受性良好的方案。补充金双歧不能提高患者根除率,但可以减少治疗时的不良反应。     

数学模型法研究L．casei LC2W对H.pylori SS1黏附MKN-45细胞的抑制作用

目的研究干酪乳杆菌LC2W对幽门螺杆菌（H.pylori）SS1黏附MKN-45的抑制作用,探讨益生菌对致病菌拈抗的机制。方法体外培养人胃癌细胞MKN-45,采用平板计数的方法研究2株细菌的黏附性质;引入数学模型,比较LC2W与H.pylori SS1的竞争、排除和替代作用。结果运用模型可以估算出LC2W和H.pylori SS1对MKN-45最大黏附数和亲和力的大小,并可以预测在混合体系中2种菌黏附的比例;实验发现LC2W对H.pylori SS1的黏附具有很强的竞争作用和排除作用,且这2种作用存在明显的量效关系。LC2W对H.pylori SS1的黏附的替代作用不明显或过程非常缓慢。结论所采用的数学模型能较好的模拟LC2W和H.pylori SS1黏附及LC2W对H.pylori SS1黏附抑制作用,这种抑制作用主要是通过竞争性占位形成的。