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Strain-Specificity and Disease-Specificity of Probiotic Efficacy: A Systematic Review and Meta-Analysis
Lynne V McFarland1, Charlesnika T Evans2,3, Ellie J C Goldstein4
1Department of Medicinal Chemistry, School of Pharmacy, University of Washington Medical Center, Seattle, WA, United States.
Background:
As the use and diversity of probiotic products expands, the choice of an appropriate type of probiotic is challenging for both medical care professionals and the public alike. Two vital factors in choosing the appropriate probiotic are often ignored, namely, the probiotic strain-specificity and disease-specificity for efficacy. Reviews and meta-analyses often pool together different types of probiotics, resulting in misleading conclusions of efficacy.
Methods:
A systematic review of the literature (1970-2017) assessing strain-specific and disease-specific probiotic efficacy was conducted. Trials were included for probiotics with an identifiable strain (either single strain or mixtures of strains) that had at least two randomized, controlled trials for each type of disease indication. The goal was to determine if probiotic strains have strain and/or disease-specific efficacy.
Results:
We included 228 trials and found evidence for both strain specificity and disease specificity for the efficacy of specific probiotic strains. Significant efficacy evidence was found for 7 (70%) of probiotic strain(s) among four preventive indications and 11 (65%) probiotic strain(s) among five treatment indications. Strain-specific efficacy for preventing adult antibiotic-associated diarrhea was clearly demonstrated within the Lactobacillus species [e.g., by the mixture of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R, and Lactobacillus rhamnosus CLR2 (Bio-K+®), by L. casei DN114001 (Actimel®) and by Lactobacillus reuteri 55730], while other Lactobacillus strains did not show efficacy. Significant disease-specific variations in efficacy was demonstrated by L. rhamnosus GG and Saccharomyces boulardii CNCM I-745, as well as other probiotic strains.
Conclusion:
Strong evidence was found supporting the hypothesis that the efficacy of probiotics is both strain-specific and disease-specific. Clinical guidelines and meta-analyses need to recognize the importance of reporting outcomes by both specific strain(s) of probiotics and the type of disease. The clinical relevance of these findings indicates that health-care providers need to take these two factors into consideration when recommending the appropriate probiotic for their patient.
Insights
Probiotic effectiveness depends on specific strains and the conditions they treat. Healthcare providers should consider both strain and disease specificity when recommending probiotics for patients.
Area of Science:
- Microbiology
- Gastroenterology
- Clinical Nutrition
Background:
- The expanding market of probiotic products presents challenges in selecting appropriate strains.
- Strain-specificity and disease-specificity are critical factors often overlooked in probiotic efficacy assessments.
- Existing reviews and meta-analyses may pool diverse probiotics, leading to potentially misleading conclusions.
Purpose of the Study:
- To systematically review and assess the strain-specific and disease-specific efficacy of probiotics.
- To determine if specific probiotic strains demonstrate efficacy tailored to particular health indications.
- To provide evidence-based guidance for selecting effective probiotic interventions.
Main Methods:
- Conducted a systematic literature review from 1970 to 2017.
- Included trials with identifiable probiotic strains (single or mixed) and at least two randomized controlled trials per indication.
- Focused on evaluating strain and disease-specific efficacy.
Main Results:
- Evidence supports both strain-specific and disease-specific efficacy for probiotics.
- Significant efficacy was found for 70% of strains in preventive indications and 65% in treatment indications.
- Specific Lactobacillus strains showed efficacy for antibiotic-associated diarrhea, while others did not; efficacy varied by disease for L. rhamnosus GG and S. boulardii.
Conclusions:
- Probiotic efficacy is demonstrably strain-specific and disease-specific.
- Clinical guidelines and meta-analyses should report outcomes stratified by specific probiotic strains and disease types.
- Healthcare providers must consider strain and disease specificity when recommending probiotics to patients.
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