Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis.
Probiotics may correct intestinal dysbiosis and proinflammatory conditions in patients with liver cirrhosis.



To test the effects of a multispecies probiotic on innate immune function, bacterial translocation and gut permeability.



In a randomised, double blind, placebo-controlled study, stable cirrhotic out-patients either received a daily dose of a probiotic powder containing eight different bacterial strains (Ecologic Barrier, Winclove, Amsterdam, The Netherlands) (n = 44) or a placebo (n = 36) for 6 months and were followed up for another 6 months.



We found a significant but subclinical increase in neutrophil resting burst (2.6-3.2%, P = 0.0134) and neopterin levels (7.7-8.4 nmol/L, P = 0.001) with probiotics but not with placebo. Probiotic supplementation did not have a significant influence on neutrophil phagocytosis, endotoxin load, gut permeability or inflammatory markers. Ten severe infections occurred in total; one during intervention in the placebo group, and five and four after the intervention has ended in the probiotic and placebo group, respectively. Liver function showed some improvement with probiotics but not with placebo.



Probiotic supplementation significantly increased serum neopterin levels and the production of reactive oxygen species by neutrophils. These findings might explain the beneficial effects of probiotics on immune function. Furthermore, probiotic supplementation may be a well-tolerated method to maintain or even improve liver function in stable cirrhosis. However, its influence on gut barrier function and bacterial translocation in cirrhotic patients is minimal.
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Horvath
Department of Transplantation Surgery, Medical University of Graz, Graz, Austria. bettina.leber@medunigraz.at.|Centre for Biomarker Research in Medicine (CBmed), Graz, Austria. bettina.leber@medunigraz.at.
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Leber
Department of Transplantation Surgery, Medical University of Graz, Graz, Austria.
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Schmerboeck
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Tawdrous
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Zettel
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Hartl
Institute of Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria.
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Madl
Institute of Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria.
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Stryeck
Division of Biological Chemistry, Biocentre, Medical University of Innsbruck, Innsbruck, Austria.
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Fuchs
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Lemesch
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Douschan
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Krones
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Spindelboeck
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Durchschein
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Rainer
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Zollner
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Stauber
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Fickert
Department of Transplantation Surgery, Medical University of Graz, Graz, Austria.
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Stiegler
Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
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Stadlbauer
D000328:Adult; D018988:Bacterial Translocation / Q000187:drug effects / Q000502:physiology*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D065569:Gastrointestinal Absorption / Q000187:drug effects / Q000502:physiology*; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007113:Immunity, Innate / Q000187:drug effects / Q000502:physiology*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000276:immunology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010539:Permeability / Q000187:drug effects; D019936:Probiotics / Q000008:administration & dosage*; D016896:Treatment Outcome