title: Probiotics promote rapid-turnover protein production by restoring gut flora in patients with alcoholic liver cirrhosis.
abstract: OBJECTIVE
  Accumulating evidence suggests that deterioration of the gut flora contributes to the pathogenesis of alcoholic liver cirrhosis (ALC). However, the ALC flora profile and its response to probiotic treatment have not been fully examined. This double-blind placebo-controlled study aimed to evaluate whether the probiotic beverage Yakult 400 (Y400), which contains Lactobacillus casei strain Shirota, improves liver function in ALC patients, and to analyze the precise gut flora profile by real-time quantitative PCR (qPCR).
  
  
  METHODS
  A total of 37 hospitalized ALC patients were randomly allocated to Y400 (n = 18) and placebo (n = 19) groups. Y400 or placebo was served twice a day during the first half of the four-week study. Serum concentrations of rapid-turnover proteins (i.e., transthyretin and transferrin), hypersensitive C-reactive protein, and interleukin-6 were measured weekly. qPCR analysis of fecal bacteria was performed biweekly; stocked fecal samples from 46 healthy subjects were used as references.
  
  
  RESULTS
  Serum transthyretin levels significantly increased in the Y400 group in week 3; similar-although statistically insignificant-increases were seen for transferrin and albumin. Levels of hypersensitive C-reactive protein, but not interleukin-6, significantly decreased in week 4. Before treatment, populations of obligate anerobic bacteria were significantly smaller and those of Enterobacteriaceae were larger in patients than in healthy subjects examined in a previous study. Y400 corrected this imbalance.
  
  
  CONCLUSIONS
  This is the first report describing the unique gut flora of ALC patients. Y400 treatment normalized the gut flora and improved liver function. These promising findings warrant further investigation in larger, multicenter studies.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan. hirokoga@med.kurume-u.ac.jp.
authors.forename: Hironori
authors.initials: H
authors.lastname: Koga
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tamiya
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Mitsuyama
authors.affiliation: Orin Hospital, Onojo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ishibashi
authors.affiliation: Yakult Central Institute for Microbiological Research, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Yakult Central Institute for Microbiological Research, Tokyo, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Imaoka
authors.affiliation: Yakult Central Institute for Microbiological Research, Tokyo, Japan.
authors.forename: Taeko
authors.initials: T
authors.lastname: Hara
authors.affiliation: Yakult Central Institute for Microbiological Research, Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Yakult Central Institute for Microbiological Research, Tokyo, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Ooeda
authors.affiliation: Yakult Central Institute for Microbiological Research, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Umezaki
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Sata
keywords: Lactobacillus; Randomized placebo-controlled study; Real-time quantitative PCR (qPCR); Transthyretin