Probiotics improve depression in IBS affected

Cover Pinto-Sanchez Mi, Hall GB, Ghajar K, et al. Prediotic Bifidobacterium Longum NCC3001 reduces depression values and changes brain activity: a pilot study in patients with irritable bowel syndrome [published online Ahead of print May 5, 2017]. Gastroenterology. Design randomized, placebo-controlled, double-blind pilot study participant forty-four adults (age 26 to 58; 54 % female) with irritable bowel syndrome (IBS) -d (diarrhea-sabype) or IBS-M (mixed subtype), diagnosed according to the ROM III criteria, with simultaneous to moderate depression and/or fear. Study parameters evaluated fear and depression values; IBS symptoms; Brain activation pattern; Inflammatory markers in the serum; Neurotransmitter and neurotrophic; Urine metabolom profiles; and chair microbiota profiles. Intervention Bifidobacterium Longum NCC3001 powder, 1 g (10 billion KBE) in 100 to 200 ml lactose-freeer ...

28. Oktober 2022

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Pinto-Sanchez Mi, Hall GB, Ghajar K, et al. Prediotic bifidobacterium longum ncC3001 reduces depression values and changes brain activity: a pilot study in patients with irritable bowel syndrome [published online ahead of print may 5, 2017]. gastroenterology .

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randomized, placebo -controlled, double -blind pilot study

participant

forty-four adults (age 26 to 58; 54 % female) with irritable bowel syndrome (IBS) -d (diarrhoe-sabype) or IBS-M (mixed subtype), diagnosed according to the ROM-III criteria, with simultaneous to medium-heavy depression and/or fear.

study parameters evaluated

fear and depression values; IBS symptoms; Brain activation pattern; Inflammatory markers in the serum; Neurotransmitter and neurotrophic; Urine metabolom profiles; and chair-microbiota profiles.

Intervention

Bifidobacterium Longum NCC3001 powder, 1 g (10 billion KBE) in 100 to 200 ml of lactose-free milk, soy milk or rice milk once a day for 6 weeks. The study started with a 1-month run-in phase, followed by 6 weeks of intervention/placebo and 4 more weeks follow-up.

Primary result measurement

A waste of 2 or more points at the fear of hospital and depression.

Secondary result measurements

Improvement in fear and depression (Had-scores)
Improvement of fear (State-Trait Anxiety Inventory)
ibs global adequate relief
ibs symptoms
somatization
quality of life
Changes in the activation patterns of the brain (functional magnetic resonance imaging). [fmri])
inflammatory marker in the serum
neurotransmitter and neurotropher factor
metabolomical profile of the urine
profile of the chair microbiota

important knowledge

The researchers found no statistically significant difference in the had scores of fear (relative risk [RR]: 1.31; 95 % confidence interval [CI]: 0.72-2,42; p = 0.54), but they did it with evaluations of depression (RR: 1.98; 95 % CI: 1.16-3.38; p = 0.04); 64 % of the probiotic group reached the primary result threshold (drop in at least 2 points in the depression size) compared to 32 % in the placebo group.

There were not statistically significant improvements in fear and depression scores (as a continuous result, vs > 2 threshold). With a 60 % probability of an "appropriate relief" of its IBS symptoms (RR: 1.6; 95 % KI: 0.86-2.91), the probiotic group was not significant in the intention-to-treat analysis was not statistically significant (although it was in the Per Protocol analysis).

The effect is clinically significant and lasts up to 4 weeks after the treatment.

Interestingly, the researchers were able to show that participants who rehearsed probiotics, in areas of the brain that are connected to emotional processing, as the Amygdala, showed a reduced fear reaction in FMRT.

The researchers also included many potential mechanisms of action that on secondary results such as inflammatory markers in the serum (C-reactive protein [CRP] tumor necrosis factor [tnf] -α, interferon [ifn]- γ interleukin [IL] -1β, IL-8, IL-10, IL12 and IL-10/12-ratio), neurotransmitter (serotonin, substance P and calcitonin-gene-related peptide [CGRP]), from the brain neurotropher factor and microbiom profiles. Surprisingly, they did not find statistically significant differences between the two groups in any of these results.

However, there was a reduction in methylamines and metabolites of aromatic amino acids in the urine, including 4-cresolsulfate, those who take probiotics, and the depression values of the participants correlated with the 4-cresolsulfate.

practice implications

This was a fascinating study for numerous reasons. The combination of patient symptoms and objective biomarkers as a result is of particular interest. The use of biomarkers could suggest an impact mechanism that obviously did not related to significant microbiomal changes or inflammation, but rather with changes of important host/bacteria metabolites.

While the microbiom profiles in the probiotic intervention do not differ, this was the case with the metabolomics. The connection between the reduction of the 4-cresol sulfate mirror and the depression score in the probiotic group is particularly interesting. We know that 4-cresolsulfate inhibits dopamine β-hydroxylase and a reduced activity of dopamine-β-hydroxylase is associated with depression. Mechanism of action for this probioticast stem, because it is related to depression.

For the most part, this was a well -performed study. Previous studies had shown that a decline in fear or depression in the area from 1 to 2 on the Had-Skala was the minimum improvement that would consider patients to be important. ^{4 This study was designed to identify a difference above this level (> 2 points difference). However, the study is limited by its size. It is not surprising that some of the secondary results did not achieve statistical significance - the power may not be sufficient to recognize them.
The greatest concern is the potential for financing distortions. This study was financed by Nestle, and 4 of the authors are Nestle or Nestec employees (a subsidiary of Nestle). Nestec thinks a patent for the tribe used in the study (US 8916145 B2). ^{5 The study design was solid, and although we know that the studies sponsored by industry are a risk factor for distorted effect estimates, the downgrading of the quality of a specific study is only a bit controversial.}
summarized 10 billion KBE per day b long ncC3001 for 6 weeks seems to improve depression, but not anxiety in IBS-D/M patients, with twice as many patients in the intervention group achieving an increase in threshold (64 % compared to 32 %). The effect is clinically significant and lasts up to 4 weeks after the treatment. Interestingly, the mechanism seems to be independent of changes in microbiota diversity, but could be related to the bacterial metabolom of the host. Of course, larger follow-up studies are justified, and the results of this study can only be specific for IBS-D/M patients.}

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