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. 2013 May;62(5):787-96.
doi: 10.1136/gutjnl-2012-302504. Epub 2013 Mar 8.

An Update on the Use and Investigation of Probiotics in Health and Disease

Free PMC article

An Update on the Use and Investigation of Probiotics in Health and Disease

Mary Ellen Sanders et al. Gut. .
Free PMC article


Probiotics are derived from traditional fermented foods, from beneficial commensals or from the environment. They act through diverse mechanisms affecting the composition or function of the commensal microbiota and by altering host epithelial and immunological responses. Certain probiotic interventions have shown promise in selected clinical conditions where aberrant microbiota have been reported, such as atopic dermatitis, necrotising enterocolitis, pouchitis and possibly irritable bowel syndrome. However, no studies have been conducted that can causally link clinical improvements to probiotic-induced microbiota changes. Whether a disease-prone microbiota pattern can be remodelled to a more robust, resilient and disease-free state by probiotic administration remains a key unanswered question. Progress in this area will be facilitated by: optimising strain, dose and product formulations, including protective commensal species; matching these formulations with selectively responsive subpopulations; and identifying ways to manipulate diet to modify bacterial profiles and metabolism.

Conflict of interest statement

Competing interests MES consults with numerous probiotic companies, but has no financial stake in any company. She is a member of the Danone Yakult US probiotics scientific board. FG is member of the Scientific Committee of Instituto Danone (Barcelona, Spain). RG is a member of the Danone Yakult US probiotics scientific board. PRH is a member of the Danone Yakult US probiotics scientific board. EMMQ has served as a consultant, advisory board member and/or speaker for Movetis, Shire, Ironwood, Almirall, Janssen, Yakult, Procter and Gamble, Rhythm and Alimentary Health and has received research funding from Procter and Gamble, Merck, Alimentary Health and Norgine. He is a non-executive board member of, and shareholder in, Alimentary Health. His research is supported in part through a grant to the Alimentary Pharmabiotic Centre from Science Foundation, Ireland. RBS has served as a consultant, advisory board member and/or speaker for Dannon, Yakult, Procter & Gamble and Salix. PMS serves on medical advisory boards for Abbott Nutrition, Mead Johnson Nutrition and Procter & Gamble, has received research grants from Institut Rosell-Lallemand, is a stockholder in Antibe Therapeutics, and has received an honorarium from ILSI North America. EM is a member of the Danone International Advisory Board for Activia and the Danone Yakult US probiotics scientific board.


Figure 1
Figure 1
Scope of probiotic products and uses. (A) Probiotics can be found in food, dietary/nutritional supplements, drugs and medical foods. Each product has country-specific legal requirements for allowed claims of efficacy, target populations, safety and risk/benefit assessment. (B) Hypothesised future uses for probiotics in modifying the composition or activities of the microbiota for improved health. (C) A range of health and clinical targets for different probiotics have been studied, encompassing intestinal and extraintestinal sites, and over a range of life stages. The evidence is strongest in the conditions shown in bold. Mechanisms for observed health effects may not be known, but probably include direct or indirect action on the activities and/or populations of gut microbiota and on the intestinal immune system. AAD, antibiotic-associated diarrhoea; CID, common infectious disease; IBS, irritable bowel syndrome; NEC, necrotising enterocolitis; RR, reduced risk; T, treatment; URTI, upper respiratory tract infections.

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