title: Lactobacillus reuteri ATCC55730 in cystic fibrosis.
abstract: OBJECTIVE
  The aim of this study was to evaluate in patients with cystic fibrosis (CF) the effect of Lactobacillus reuteri (LR) on the rate of respiratory exacerbations and of the infections of both upper respiratory and gastrointestinal tracts.
  
  
  METHODS
  Prospective randomized, double-blind, placebo-controlled study enrolling 61 patients with CF with mild-to-moderate lung disease at the Regional Center for CF of the Department of Pediatrics, University of Rome "La Sapienza." All of the patients were not hospital inpatients at the time of the enrollment. Inclusion criteria were forced expiratory volume in the first second (FEV1) >70% predicted; no inhaled or systemic steroids, no anti-inflammatory drugs, antileukotrienes, and mast cell membrane stabilizers; and no serious organ involvement. Exclusion criteria were a history of pulmonary exacerbation or upper respiratory infection in the previous 2 months; changes in medications in the last 2 months; a history of hemoptysis in the last 2 months; and colonization with Burkholderia cepacia or mycobacteria. Patients were randomly assigned to receive LR (30 patients) in 5 drops per day (10(10) colony-forming units) or placebo (31 patients) for 6 months. Main outcomes were number of episodes of pulmonary exacerbations and hospital admissions for pulmonary exacerbations, number of gastrointestinal and upper respiratory tract infections. FEV1, fecal calprotectin, and cytokine profile in induced sputum and plasma were assessed at baseline and at the end of the trial.
  
  
  RESULTS
  Pulmonary exacerbations were significantly reduced in the LR group compared with the placebo group (P<0.01; odds ratio 0.06 [95% confidence interval {CI} 0-0.40]; number needed to treat 3 [95% CI 2-7]). Similarly, the number of upper respiratory tract infections (in our series only otitis) was significantly reduced in the LR group compared with the placebo group (P<0.05; odds ratio 0.14 [95% CI 0-0.96]; number needed to treat 6 [95% CI 3-102]). The 2 groups did not differ statistically in the mean number and duration of hospitalizations for pulmonary exacerbations and gastrointestinal infections. There was no significant statistical difference in the mean delta value of FEV1, fecal calprotectin concentration, and tested cytokines (tumor necrosis factor-α and interleukin-8) between the 2 groups.
  
  
  CONCLUSIONS
  LR reduces pulmonary exacerbations and upper respiratory tract infections in patients with CF with mild-to-moderate lung disease. LR administration may have a beneficial effect on the disease course of CF.
authors.affiliation: *Department of Pediatrics, Pediatric Gastroenterology and Liver Unit †Regional Center for Cystic Fibrosis, University of Rome "La Sapienza," ‡Department of Internal Medicine and Geriatrics, Catholic University of "Sacro Cuore," §ENEA, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Oliva
authors.forename: Alessandra
authors.initials: A
authors.lastname: Menichella
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pistelli
authors.forename: Riccardo Valerio
authors.initials: RV
authors.lastname: De Biase
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarchi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Laura
authors.initials: L
authors.lastname: Stronati
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D004268:DNA-Binding Proteins / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D005767:Gastrointestinal Diseases / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D016209:Interleukin-8 / Q000378:metabolism; D052200:Limosilactobacillus reuteri / Q000145:classification; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D008168:Lung / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D008171:Lung Diseases / Q000517:prevention & control; D008297:Male; D009687:Nuclear Proteins / Q000378:metabolism; D061366:Numbers Needed To Treat; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D014157:Transcription Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D055815:Young Adult
chemical_list: D004268:DNA-Binding Proteins; C474280:FEV protein, human; D016209:Interleukin-8; D039841:Leukocyte L1 Antigen Complex; D009687:Nuclear Proteins; D014157:Transcription Factors; D014409:Tumor Necrosis Factor-alpha