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Probiotics for Oral Candidiasis: Critical Appraisal of the Evidence and a Path Forward
Linda S Archambault1,2, Anna Dongari-Bagtzoglou1
1Department of Craniofacial Sciences, University of Connecticut Health Center, Farmington, CT, United States.
Abstract:
Oropharyngeal Candidiasis (OPC) is a mucosal fungal infection that is prevalent among patients with compromised immunity. The success of probiotics in treating chronic diseases with a microbial etiology component at other mucosal sites (i.e., gastro-intestinal, genitourinary and alveolar mucosae) has inspired research into the use of probiotics in the treatment of OPC. A growing body of research in vitro and in animal models indicates that some probiotic species and strains have inhibitory activities against Candida albicans growth, morphological switching, and biofilm formation. However, recent review and meta-analysis studies reveal a dearth of human randomized, controlled clinical trials on the efficacy of probiotics to treat or prevent OPC, while the majority of these have not based their selection of probiotic strains or the type of administration on sound pre-clinical evidence. In this mini-review, we assess the state of the field, outline some of the difficulties in translating lab results to clinical efficacy, and make recommendations for future research needed in order to move the field forward.
Insights
Probiotics show promise for treating oropharyngeal candidiasis (OPC) in lab studies, but more high-quality human trials are needed. Future research should focus on evidence-based probiotic selection for effective OPC treatment.
Area of Science:
- Microbiology
- Immunology
- Medical Mycology
Background:
- Oropharyngeal candidiasis (OPC) is a common fungal infection in immunocompromised individuals.
- Probiotics have shown success in other mucosal infections, prompting investigation for OPC.
- In vitro and animal studies suggest probiotics can inhibit Candida albicans.
Purpose of the Study:
- To review the current evidence on probiotics for OPC treatment and prevention.
- To identify challenges in translating preclinical findings to clinical practice.
- To provide recommendations for future research directions.
Main Methods:
- Review of in vitro studies and animal models.
- Analysis of existing human clinical trials and meta-analyses.
- Assessment of preclinical evidence supporting probiotic selection.
Main Results:
- Preclinical data indicate potential efficacy of certain probiotic strains against Candida albicans.
- A significant lack of robust human randomized controlled trials (RCTs) for probiotic use in OPC.
- Existing human trials often lack a basis in sound preclinical evidence for strain selection or administration.
Conclusions:
- While promising in vitro and animal models, robust clinical evidence for probiotics in OPC is limited.
- Translating laboratory findings to clinical efficacy faces significant hurdles.
- Future research must prioritize well-designed human RCTs based on strong preclinical data to advance probiotic therapy for OPC.
