Saudi Pharmaceutical Journal (2015) 23, 107–114

King Saud University

Saudi Pharmaceutical Journal

www.ksu.edu.sa
www.sciencedirect.com

REVIEW

Role of Probiotics in health improvement,

infection control and disease treatment and
management
a,b,* b
A.A. Amara , A. Shibl

a
Protein Research Department, Genetic Engineering and Biotechnology Research Institute, Mubarak City for Scientific Research
and Technology Applications, Alexandria, Egypt
b
Division of Microbiology, Pharmaceutics Department, College of Pharmacy, KSU, Riyadh, Saudi Arabia

Received 16 May 2013; accepted 7 July 2013

Available online 18 July 2013

KEYWORDS Abstract Research which concerns the usefulness of Probiotics show increasing interest based on
Probiotics; the rise of their publications, products and the awareness of the public of their benefits. There is
Health; increasing interest concerning Probiotics from the public, researchers, governmental organizations
Infections; (such as the WHO/FAO) and medicinal and food companies. Probiotics means ‘‘let good microbes
Disease management work for you in different fields get their benefits and take a rest’’. Such work will include, food
digestion, production of useful products to destroy the bad microbes, complement the functions
of the missed digestive enzymes (due to missed or defective genes), and to maintain the digestive
system’s pH, and so on. Probiotics will augment the efficiency of our biological fermentors, the
digestive system. Many authors have described the history and the progress of Probiotics and their
different applications. In this review, we will focus mainly on three points, health improvement,
infection control and disease management, which could be eliminated by the use of different types
of direct uses of Probiotics or by the use of foods containing Probiotics.
ª 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University.

* Corresponding author. Address: Division of Microbiology, Phar-

maceutics Department, College of Pharmacy, Faculty of Pharmacy at
King Saud University (KSU) Riyadh, P.O. Box 2457, Riyadh 11451,
Saudi Arabia. Tel.: +966 4677730; fax: +966 4676383.
E-mail addresses: amroamara@web.de, aamara@ksu.edu.sa (A.A.
Amara), amshibl@ksu.edu.sa (A. Shibl).
URLs: http://pharmacy.ksu.edu.sa/en/pages/departments/pharma-
ceutics/, http://faculty.ksu.edu.sa/78443/Pages/AmroAmara.aspx
(A.A. Amara), http://pharmacy.ksu.edu.sa/en/pages/departments/
pharmaceutics/ (A. Shibl).
Peer review under responsibility of King Saud University.

Production and hosting by Elsevier

1319-0164 ª 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University.
http://dx.doi.org/10.1016/j.jsps.2013.07.001
108 A.A. Amara, A. Shibl

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
1.1. Common microbes used as Probiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
1.2. Probiotic for health improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
1.3. Good and bad microbes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
1.4. Probiotic, the good against the bad microbes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
1.5. The relation of Probiotics to our health could be summarized in the following points and facts. . . . . . . . . . . . . 110
1.6. Infection control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2. Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2.1. Diarrheal diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2.2. Helicobacter pylori infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
2.3. The role of Probiotics in disease treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
3. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

1. Introduction Koumiss, Leben and Dahi as claimed by Hosono (1992). Pub-

lic distribute stories about the origin of some types of Probio-
It became clear that intestinal microflora had metabolic func- tics and that some have religious origin, such as the origin of
tions, such as fermenting indigestible dietary residues and Kefier. Amara, 2012, describe some of the Probiotics used by
endogenous mucus, saving of energy, production of vitamin the Pharaonic civilization, which the Egyptians still use nowa-
K, and absorption of ions (O’Sullivan et al., 1992). Probiotics days. They include milk, seeds, fish and some other products.
have roles in epithelial cell proliferation and differentiation, However, it might be that Ilya Ilyich Metchnikoff, the Nobel
and the development and the homeostasis of the immune sys- Prize winner in Medicine in 1908, at the Pasteur Institute
tem (Cammarota et al., 2009). Probiotics are not an invention was the first who spotted the effect of what is called now Pro-
but existed in our traditional foods such as beverages, salty biotic. He linked the health and longevity to the ingestion of
fishes, yogurt, different types of cheeses and so on since olden bacteria present in yogurt (Metchnikoff and Mitchell, 1910;
times (Amara, 2012). Such food structures contain different Metchnikoff, 2004). In 1907, he postulated that bacteria were
types of useful bacteria. It might be that the first real use of food involved in yogurt fermentation, Lactobacillus bulgaricus and
containing Probiotics was fermented milk (Hosono, 1992). Hu- Streptococcus thermophilus, suppress the putrefactive-type fer-
mans learned that fermented milk has a good taste. Later they mentations of the intestinal flora and that consumption of
learned how to convert it into cheese, yogurt and so on (Metch- these yogurts was important in maintaining health. He corre-
nikoff and Mitchell, 1910; Metchnikoff, 2004; Amara, 2012). lated the long life of Bulgarian peasants and their good health
Before the discovery of the microscope, humans knew how to to yogurt intake which contained the Lactobacillus species and
prepare different types of milk products with different tastes he simplified his conclusions to the public that, Probiotics
and structures (Amara, 2012). This is a result of the action of could do an extra-job by digesting unusual components exactly
different microbial reactions induced by different microbes like what happens in the ruminant animals which eat rough
(Bourdichon et al., 2012). The public, globally transfer such food composed of bulky vegetables. In Japan, in the early
information for producing such foods from generation to gen- 1930s, Shirota succeeded in isolating strains existing in healthy
eration till today. We really did not know the starting point for individuals’ intestinal bacteria. Such strains are able to survive
the first use of food containing Probiotics particularly for and to passage through the gut. He has used such strains to de-
medicinal applications. However, by one way or the other Pro- velop fermented milk and test such milk effects on patients. He
biotics collectively are a part of the fermented food if the active introduced his first products into the market, which have been
microbes are useful and able to colonize the digestive system. given the name Shirota (later named Lactobacillus casei Shiro-
Fermentation using microbes is known from ancient times. ta). The producer company’s name was the Yakult Honsha
One could see the fungi growing in the food by the naked Company. Probiotics can be defined as living microorganisms
eye. The public knew how to produce Bakery and alcoholic administered in an adequate number that continue to exist in
products from times immemorial. They knew how to maintain the intestinal bionetwork, to perform a health positive effect
the product quality and testing by maintaining a seed culture (Gismondo et al., 1999). Probiotics as a term was first used
from the most successful fermentation processes to use in the by Lilly and Stillwell (1965) to describe the ‘substances secreted
next process (Amara, 2012). However, scientists were interested by one microorganism that stimulate the growth of another’.
to give such honor to Van Leeuwenhoek and Hooke in 1665 Parker (1974), proposed that Probiotics are ‘organisms and
(Gest, 2004). For more details about the fermented foods, refer substances which contribute to intestinal microbial balance’.
to Bourdichon et al. (2012) and the references within. Food and Agriculture Organization of the United Nations/
It might be that Probiotics have been discovered by the first World Health Organization (FAO/WHO, 2001) endorsed by
human who used milk products, or, might be with substances the International Scientific Association for Probiotics and
other than milk! such as the other different types of the fer- Prebiotics (Reid et al., 2003), defined Probiotics as ‘Live
mented foods. However, climatic conditions, for sure, favored microorganisms which, when administered in adequate
traditional sour milk or cultured dairy products such as Kefir, amounts, confer a health benefit on the host’.
Role of Probiotics in health improvement, infection control and disease treatment and management 109

1.1. Common microbes used as Probiotics 1.4. Probiotic, the good against the bad microbes

The microbes used as Probiotics represent different types If harmful microbes colonized our digestive system they will
such as bacteria, yeast or mold. However, there are more ferment food in incorrect ways and toxins, which will affect
common species of each such as: 1 – Bacteria: (i) Lactobacil- our health, might be produced. What could Probiotics do? Pro-
lus: acidophilus, sporogenes, plantarum, rhamnosum, del- biotics are able to regenerate our digestive system with good
brueck, reuteri, fermentum, lactus, cellobiosus, brevis, casei, microbes that will neutralize the harmful ones. Useful mi-
farciminis, paracasei, gasseri, crispatus; (ii) Bifidobacterium: crobes will ferment our food correctly and improve our health.
bifidum, infantis, adolescentis, longum, thermophilum, breve, Why must we use Probiotics? During our lives, we are exposed
lactis, animalis; (iii) Streptococcus: lactis, cremoris, alivarius, to different types of microbes, which are unsuitable for our
intermedius, thermophilis, diacetylactis; (iv) Leuconostoc mes- health. Antibiotic treatment could destroy our useful micro-
enteroides; (v) Pediococcus; (vi) Propionibacterium; (vii) flora. In such cases, Probiotics should be used to regenerate
Bacillus; (viii) Enterococcus; (ix) Enterococcus faecium; 2 – our microflora. If our daily food contains Probiotics, that will
Yeast and molds: Saccharomyces cerevisiae, Saccharomyces be the best and the cheapest way to recover any losses in our
bourlardii, Aspergillus niger, Aspergillus oryzue, Candida pin- digestive system microflora and to improve our health. In old-
tolopesii, Sacaromyces boulardii. en civilizations, the public used to include food-containing
The type of the microbes used as Probiotics increased due Probiotics in their daily food (Amara, 2012). However, when
to the increase in the research concerning the subject as well our microflora has been affected severely due to any reasons,
as by the increase of the newly discovered and identified mi- Probiotics should be given in large dosage as tablets or in
crobes, which could be used as Probiotics. One should update any other suitable forms (Reid et al., 2003). A healthy intestine
his microbial flora from time to time and follow the research is one that maintains a significant balance of bacteria such as
and the published data about Probiotics to gain more knowl- lactobacilli, streptococci, clostridia, coliform, and bacteroides.
edge and ideas. Conditions such as stress, excessive alcohol use, high fat diets,
meat, sugar, genetic disorders, chlorine and fluoride in drink-
1.2. Probiotic for health improvement ing water, antibiotics, inadequate food, exposure to environ-
mental toxins and many others factors could change the
One of the points described in this review about Probiotics is balance of our intestinal flora (Hosono, 1992). In fact, our
their role in health improvement. In fact, this is the most health is affected by many exogenous and endogenous factors
important point, where we expected that healthy persons will that could change our microflora position. Useful microflora
be the first in need to use Probiotics which will lead to improve guarantees good health. One cannot hear the sound of the dai-
their general health and as a result will protect them from dif- ly battles between the good and the bad microbes in our bodies
ferent kinds of illness. Improving health will be an intelligent or see how they enter our bodies with each breath, talk and
step for protecting us from different types of illness. Neverthe- with each food consumed. Actually, they are essential for
less, how could Probiotics do that? The following paragraphs our health. They build our immune system slowly to be ready
will highlight the concept of how Probiotics could improve for the pathogens (Bandyopadhyay and Das Mohapatra, 2009;
our health directly or indirectly. Cammarota et al., 2009). Those that live far away from such a
lifestyle are more susceptible to infections and diseases
1.3. Good and bad microbes (Amara, 2012). Another side of the story, that such microbes
and mainly those which are non-pathogenic, are like workers
working in a big firm (our body), they do various jobs to sup-
Our bodies have groups of microbes each working collec-
port and assist us all the times. Mainly, they do that spontane-
tively to perform different functions. The most important
ously. By doing such work, they save for us energy and power,
ones are those existing in our digestive system (Gismondo
or they even do what we could not do. Complementing the
et al., 1999; Fioramonti et al., 2003). They improve food
Lactose digestion deficiency is such an example (Hawrelak,
digestion and consumption. They are able to complement
2003). The existence of harmful bacteria could finding resis-
many deficiencies in our digestive system. They decrease
tance in the body, so their negative effects might not appear di-
the steps needed in our bodies to change complicated food
rectly, but after a considerable time. Alternatively, they are not
structures to simpler ones. Alternatively, many bad variants
few in number but produced in considerable amounts, at this
of different microbes will take their positions and will digest
point they will be really harmful (Amara, 2012). Bad microbes,
our food incorrectly. They will even add some toxins to our
even though apparently non existant in a healthy person, actu-
food during the digestive process. Hence, each food cycle
ally, exist, but cannot do a lot of harm because of the existence
will lead to a real deterioration to our health (Amara,
of good bacteria. They are under continuous pressure from
2012). Many diseases are diagnosed incorrectly while their
good bacteria. Good bacteria, fill in the spaces existing in
main actual elevating purpose is due to the existence of
our body, and prevent bad ones from taking their chances.
bad microbes in the digestive system, mainly due to the
However, because of our misuse and misunderstanding of their
leakage in the feeding processes, the life style or even dis-
behavior, we change the conditions usually towards the benefit
eases which will direct the balance toward the bad microbes.
of bad bacteria. By changing the balance toward the bad mi-
The affected ones are humans because they did not follow
crobes, we will start to suffer, and our health will start to de-
the correct steps to protect themselves from losing the useful
grade. To prevent that, the bad microbes should be kept
strains and gaining harmful ones. In such cases, Probiotics
under control (Amara, 2012). Therefore, there is no better
are needed to be given in higher dosages (Amara, 2012; Reid
solution other than, letting good ones compete with them, take
et al., 2003).
110 A.A. Amara, A. Shibl

their places and in some cases omit them or decrease them to Here we should highlight that, Probiotics or anything in
the minimum safe amount. The intestinal tract is home to our lives should not exceed a certain limit and should be
one hundred trillion (1014) different types of microbe (Gis- used wisely to give the best expected results (Salminen
mondo et al., 1999). Many of the bad microbes like to live in et al., 1998).
alkaline or natural environment, that is why our stomach is
acidic to kill most of them before they pass into the long intes- 1.6. Infection control
tine. Bad microbes produce ammonia that change the intesti-
nal tract pH to becoming more alkaline (Metchnikoff and
The mechanisms by which Probiotics exert their effects are lar-
Mitchell, 1910; Metchnikoff, 2004; Marteau et al., 2001).
gely unknown, and there are still many open research points.
One might observe that upon drinking fermented milk, which
However, Probiotics are involved in modifying gut pH, antag-
is weakly acidic, he feels good and relaxed. This is because of
onizing pathogens through the production of antimicrobial
two factors, that fermented milk contains acids, which kill
compounds, competing for pathogen binding and receptor
pathogenic bacteria, and at the same time contains good bac-
sites as well as for available nutrients and growth factors, stim-
teria, which will directly fill the space of the just killed bacteria
ulating immunomodulatory cells, and producing lactase (Ta-
(Fernandes et al., 1987; Hilton et al., 1977). Additionally, it
ble 1). The most important point of Probiotics is that they
still contains proteins that are able to reduce any extra-acidity.
are proven to be safe, cost effective, and could interfere with
One of the most important strains existing naturally in milk
the microbial infection. In 1994, the World Health Organiza-
products is Lactobacillus. The microflora in our digestive sys-
tion deemed Probiotics to be the next-most important immune
tem do crucial jobs, such as filling in digestive system spaces,
defense system when commonly prescribed antibiotics are ren-
food digestion, killing of pathogens, and secreting vitamins
dered useless by antibiotic resistance (Kailasapathy and Chin,
(e.g. vitamin B) and some essential amino acids, enzymes help
2000; Levy, 2000). The use of Probiotics in antibiotic resistance
in digesting complicated fibers in the food, acid (e.g. lactic
is termed as microbial interference therapy (Botes et al., 2008;
acid) helps to prevent pathogenic microflora from exceeding
Fukao et al., 2009; Zhou et al., 2005).
their number limit, and to perform many other vital activities.
As well, Probiotic strains found in the colon help in digesting
2. Examples
some forms of fiber. One should highlight that Probiotics are
also able to some extent activate the immune system (Camma-
rota et al., 2009). 2.1. Diarrheal diseases

1.5. The relation of Probiotics to our health could be summarized Probiotics are proving to have roles in diarrhea prevention and
in the following points and facts control after antibiotic treatment. Lactobacillus GG, Lactoba-
cillus reuteri, and S. boulardii, Bifidobacteria spp., are used
for curing diarrhea (Hilton et al., 1977; Isolauri, 2004; Benchi-
1 – Probiotics are useful and friendly microbes. mol and Mack, 2004). Also Probiotics are able to suppress
2 – They are able to compete with the bad microbes and col- travelers’ diarrhea (Hilton et al., 1977) and diarrheal diseases
onize our digestive system. in young children caused by rotaviruses (Saavedra et al.,
3 – They are able to ferment our food to simpler byproducts 1994; Vanderhoof, 2000). The Probiotic species used with chil-
and could promote our health by many different dren include Lactobacillus spp., L. reuteri, Lactobacillus casei,
mechanisms. S. boulardii, Bifidobacterium bifidum and S. thermophilus (Hil-
4 – Their amount could be deteriorated due to many fac- ton et al., 1977; Tomas et al., 2004). Probiotics might prevent
tors, such as incorrect diet, alcohol, age and so on. This microbes that carry diarrhea by competing with pathogenic
is why they should be taken through our regular diet. viruses or bacteria by preventing them from binding to epithe-
5 – In particular cases such as after antibiotic treatments, lial cells (DeSimone, 1986; O’Sullivan et al., 1992), or by pro-
where they are expected to be affected severely, they ducing bacteriocins such as nisin (del Miraglia and De Luca,
should be taken orally in considerable amounts or with 2004).
food.
6 – Probiotics promote health while they: 2.2. Helicobacter pylori infections
a. Remove the side effect of the pathogens or the harmful
microbes. Aiba et al. (1998) showed Lactobacillus salivarius capable of
b. Supply the body with useful byproducts. producing high amounts of lactic acid, which can inhibit
c. Reduce the jobs of our digestive system. the growth of H. pylori in vitro. There is some preliminary
d. Reduce the effect of the first attack of harmful com- evidence that Probiotic bacteria may inhibit the gastric colo-
pounds, instead of our cells, by their biofilm, which pro- nization and activity of H. pylori, which is associated with
tects our digestive system. gastritis, peptic ulcers and gastric cancer. L. salivarius was
e. Reduce the amount of food needed by our bodies due to found to inhibit H. pylori colonization in the in vitro studies
the correct digestion and metabolism of any amount of as well as in mice (Aiba et al., 1998; MacFarlane and Cum-
food. mings, 2002). The use of Probiotics in the field of H. pylori
f. Probiotics in some cases could complement the defi- infection has been proposed for improving the eradication
ciency in our genetic materials by helping us to borrow rate and tolerability and for the compliance of multiple anti-
the products of their genes (such as in case of the lactose biotic regimens used for the infection (Bazzoli et al., 1992; Fi-
fermentation deficiency). lippo et al., 2001).
Role of Probiotics in health improvement, infection control and disease treatment and management 111

Table 1 Different types of Probiotic microbial strains, and their usage.

Disease name Strain References
Eczema Escherichia coli Niers et al. (2009), Soh et al. (2009),
Bifidobacterium bifidum Viljanen et al. (2005a and 2005b)
Bifidobacterium lactis
Lactococcus lactis
Food allergies Escherichia coli Lodinova-Zadnikova et al. (2003)
Immunity Bacillus circulans PB7 Bandyopadhyay and Das Mohapatra
Lactobacillus plantarum (2009) and Cammarota et al. (2009)
DSMZ 12028
Antibiotic effect removal Enterococcus mundtii ST4SA Botes et al. (2008), Fukao et al. (2009) and
Lactobacillus plantarum 423 Zhou et al. (2005)
Lactobacillus brevis KB290
Lactobacillus strains
Bifidobacterium strains
Gastroenteritis Lactobacillus casei Yamada et al. (2009)
Therapeutics
Intestinal Lactobacillus plantarum species Kennedy et al. (2000), Strowski and
hyperpermeability 299 (LP299) Wiedenmann (2009) and White et al. (2006)
Vaginal candidiasis Lactobacillus rhamnosus GR-1 Martinez et al. (2009)
(thrush) Lactobacillus reuteri RC-14
Urinary tract infection Lactobacillus rhamnosus GR-1 Anukam et al. (2009)
Lactobacillus reuteri RC-14
Lactose intolerance Lactobacillus acidophulus Hawrelak (2003)
Non-steroidal anti- Escherichia coli strain Nissle Ukena et al. (2005)
inflammatory drug 1917
Intestinal dysbiosis Lactobacillus johnsonii La1 Hawrelak (2003), Silva et al. (1987), and
Lactobacillus strain Bennett et al. (1996)
Lactobacillus GG
Irritable bowel syndrome Bifidobacterium infantis 35624 Brenner and Chey (2009), Enck et al.
Escherichia coli DSM17252 (2009), Whorwell et al. (2006)
Bifidobacterium infantis 35624
Traveler’s diarrhea Lactobacillus GG Hawrelak (2003), and Michail and
Lactobacillus plantarum Abernathy (2002)
Radiation-induced Lactobacillus casei DN-114 001 Giralt et al. (2008)
diarrhea
Crohn’s disease Escherichia coli strain Nissle Boudeau et al. (2003)
1917
Prevention of colon cancer Enterococcus faecium M-74 Mego et al. (2005) and Thirabunyanon
lactic acid bacteria et al. (2009).
Ulcerative colitis Lactobacillus acidophilus Abdin and Saeid (2008), Adam et al.
Escherichia coli Nissle 1917 (2006), and Imaoka et al. (2008)
Bifidobacterium
Peptic ulcer disease Lactobacillus acidophulus Iarovenko et al. (2007)
Prevention of atopy Lactobacillus rhamnosus GG Huurre et al. (2008) and van der Aa et al.
(2008)
Hypercholesterolemia and Enterococcus faecium M-74 Hlivak et al. (2005), Kiatpapan et al. (2001)
cardiovascular diseases Lactobacillus plantarum and Nguyen et al. (2007)
Propionibacterium
freudenreichii
Lactobacillus plantarum PH04

2.3. The role of Probiotics in disease treatment of deficiencies like lactose intolerance. The role of Probiotics
in such types of cases will be in removing such deficiencies
Probiotics could not only improve our health or control path- by different mechanisms such as (i) supplying our bodies with
ogenic infections but could also help in real disease treatment the products of the missed gene products, (ii) supplying our
and management (Table 1). Part of the basis for doing such bodies with suitable alternative products, (iii) supplying our
tasks is based on the same concepts about Probiotic functions, bodies with the final products of a complete pathway which
which are described in the above sections. But, how could will be the best choice and in the case that none of the defective
Probiotics help in real disease treatment and management. pathway metabolic intermediates will be accumulated in our
The most critical points are in understanding of the disease cells in the case of a single or multiple gene deficiency which
behavior and its causative agents. For examples, diseases could block a certain pathway, (for more details refer to
which are related to genetic disorders, will cause certain sort Amara, 2013 and the references within), (iv) Probiotics could
112 A.A. Amara, A. Shibl

support a weak (rather than a completely defected pathway) researchers and the different applications for Probiotics in
pathway which might be due to a defect in a single allele rather their different forms highlight how much such wonderful mi-
than the defect in both alleles. Exactly like in the case of those crobes could do to promote our health, protect us and ensure
who have retinoblastoma. In such a case the critical basis for treatment or management of diseases. Perhaps the most critical
the Knudson hypnosis’s will be completely interfered with point of Probiotics, is that they come in natural forms and per-
while a single gene will not be a subject to excessive stress that form natural safe activities. This review, gives a compact col-
could lead to a mutation (Amara, 2013), (v) Probiotics will be lection of the different strains of probiotics, types,
the best support for us when we become old. It will reduce the applications and some of the involved companies in such fields
load on our biological system and will enable us to do extra as well as the names of the same types of foods rich in Probi-
activity, particularly those related to improving our ability to otics. The future will show increasing interest in Probiotics, the
utilize food. Here are some roles for Probiotics in maintaining promising microbes.
our health, in disease treatment and management:
References
1 – Suppression of the putrefactive-type fermentation which
was one of the Ilya Ilyich Metchinkoff postulations Abdin, A.A., Saeid, E.M., 2008. An experimental study on ulcerative
about the usefulness of Probiotics (Metchnikoff, 2004). colitis as a potential target for probiotic therapy by Lactobacillus
2 – Used to reduce the antibiotic destructive effect and to acidophilus with or without ‘‘olsalazine’’. J. Crohns. Colitis. 2, 296–
regenerate any type of loss in beneficial microflora. 303.
Some Bacillus species are recommended for use with Adam, B., Liebregts, T., Holtmann, G., 2006. Maintaining remission
antibiotics while they are resistant to them (Bandyopad- of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is
as effective as with standard mesalazine. Z. Gastroenterol. 44, 267–
hyay and Das Mohapatra, 2009; Cammarota et al.,
269.
2009). Aiba, Y., Suzuki, N., Kabir, A.M., Takagi, A., Koga, Y., 1998. Lactic
3 – Treating of the diarrheal disorder. Saccharomyces cere- acid-mediated suppression of Helicobacter pylori by the oral
visiae var boulardii was used widely for treating various administration of Lactobacillus salivarius as a Probiotic in a
diarrheal disorders (Hawrelak 2003; Michail and Abern- gnotobiotic murine model. Am. J. Gastroenterol. 93, 2097–2101.
athy, 2002). Amara, A., 2012. In: Amara, A. (Ed.), Toward Healthy Genes.
4 – Improving intestinal tract health (Vanderhoof, 2000). Schüling Verlage, Germany.
5 – Enhancing the immune system, synthesis and enhancing Amara, A.A., 2013. The inevitability of balanced lives: genes–foods –
the bioavailability of nutrients (MacFarlane and Cum- action-interactions. IIOBJ 4 (2), 1–27.
mings, 2002). Anukam, K.C., Hayes, K., Summers, K., Reid, G., 2009. Probiotic
Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14
6 – Reducing symptoms of lactose intolerance and decreas-
may help downregulate TNF-Alpha, IL-6, IL-8, IL-10 and IL-12
ing the prevalence of allergy in susceptible individuals (p70) in the neurogenic bladder of spinal cord injured patient
(Hawrelak, 2003). with urinary tract infections: a two-case study. Adv. Urol.,
7 – Reducing the risk of certain cancers (Mego et al., 2005; 680363.
Thirabunyanon et al., 2009). Bandyopadhyay, P., Das Mohapatra, P.K., 2009. Effect of a Probiotic
8 – Control of serum cholesterol levels (Hlivak et al., 2005). bacterium Bacillus circulans PB7 in the formulated diets: on
9 – Improved digestion of lactose against foods containing growth, nutritional quality and immunity of Catla catla (Ham.).
lactose. Fish Physiol. Biochem. 35, 467–478.
10 – Probiotics may also influence the protective functions of Bazzoli, F., Zagari, R.M., Fossi, S., 1992. In vivo Helicobacter
the intestinal mucosa including the synthesis and secre- pyloriclearance failure with Lactobacillus acidophilus. Gastroenter-
ology 102, A38.
tion of antibacterial peptides (Cammarota et al., 2009).
Benchimol, E.I., Mack, D.R., 2004. Probiotics in relapsing and chronic
11 – Hypertension (Blood pressure control) (Hlivak et al., diarrhea. J. Pediatr. Hematol. Oncol. 26, 515–517.
2005). Bennett, R.G., Gorbach, S.L., Goldin, B.R., Chang, T., Laughon,
12 – Condition of the genitourinary tract (Martinez et al., B.E., Greenough, W.B., Bartlett, J.G., 1996. Treatment of relapsing
2009). Clostridium difficile diarrhea with Lactobacillus GG. Nutr. Today
31, 35S–39S.
Botes, M., Loos, B., van Reenen, C.A., Dicks, L.M., 2008. Adhesion
3. Conclusion of the probiotic strains Enterococcus mundtii ST4SA and Lactoba-
cillus plantarum 423 to Caco-2 cells under conditions simulating the
intestinal tract, and in the presence of antibiotics and anti-
The health condition of the mother and the environment where inflammatory medicaments. Arch. Microbiol. 190, 573–584.
the child is born determines the first species which colonizes his Boudeau, J., Glasser, A.L., Julien, S., Colombel, J.F., Darfeuille-
body and which affects his health during his life. Good micro- Michaud, A., 2003. Inhibitory effect of probiotic Escherichia coli
bial strain colonies of microflora will lead to good health and strain Nissle 1917 on adhesion to and invasion of intestinal
will give us different types of benefit. In our life, there are epithelial cells by adherent-invasive E. coli strains isolated from
many factors that disturb our useful microflora, in these con- patients with Crohn’s disease. Aliment. Pharmacol. Ther. 18, 45–
ditions exo-sources should be used. Such exo-sources which 56.
Bourdichon, F., Casaregola, S., Farrokh, C., Frisvad, J.C., Gerds,
contain such useful microbes or what is named Probiotics
M.L., Hammesf, W.P., Harnett, J., Huys, G., Laulund, S.,
could exist in many types of foods, fermented foods, milk Ouwehand, A., Powell, I.B., Prajapati, J.B., Seto, Y., Schure,
and milk products. Also, science, the scientist and the modern E.T., Van Boven, A., Vankerckhoven, V., Zgoda, A., Tuijtelaars,
companies provide us with different forms of Probiotics for S., Hansen, E.B., 2012. Food fermentations: microorganisms with
different types of illness. The early human observations, the technological beneficial use. Int. J. Food Microbiol. 154, 87–97.
Role of Probiotics in health improvement, infection control and disease treatment and management 113

Brenner, D.M., Chey, W.D., 2009. Bifidobacterium infantis 35624: a Iarovenko, I.I., Golofeevskii, V., Sitkin, S.I., 2007. The new possibil-
novel probiotic for the treatment of irritable bowel syndrome. Rev. ities for improving peptic ulcer therapy with the use of probiotic
Gastroenterol. Disord. 9, 7–15. drugs. Voen. Med. Zh. 328, 17–22.
Cammarota, M., De Rosa, M., Stellavato, A., Lamberti, M., Marza- Imaoka, A., Shima, T., Kato, K., Mizuno, S., Uehara, T., Matsumoto,
ioli, I., Giuliano, M., 2009. In vitro evaluation of Lactobacillus S., Setoyama, H., Hara, T., Umesaki, Y., 2008. Anti-inflammatory
plantarum DSMZ 12028 as a probiotic: emphasis on innate activity of probiotic Bifidobacterium: enhancement of IL-10
immunity. Int. J. Food Microbiol. 135, 90–98. production in peripheral blood mononuclear cells from ulcerative
del Miraglia, G.M., De Luca, M.G., 2004. The role of Probiotics in the colitis patients and inhibition of IL-8 secretion in HT-29 cells.
clinical management of food allergy and atopic dermatitis. J. Clin. World J. Gastroenterol. 14, 2511–2516.
Gastroenterol. 38, S84–S85. Isolauri, E., 2004. Dietary modification of atopic disease: Use of
DeSimone, C., 1986. The adjuvant effect of yogurt on gamma Probiotics in the prevention of atopic dermatitis. Curr. Allergy
interferon by Con-A stimulated human lymphocytes. Nutr. Rep. Asthma Rep. 4, 270–275.
Int. 33, 419–433. Kailasapathy, K., Chin, J., 2000. Survival and therapeutic potential of
Enck, P., Zimmermann, K., Menke, G., Klosterhalfen, S., 2009. Probiotic organisms with reference to Lactobacillus acidophilus and
Randomized controlled treatment trial of irritable bowel syndrome Bifidobacterium spp. Immunol. Cell Biol. 78, 80–88.
with a probiotic E. coli preparation (DSM17252) compared to Kennedy, R.J., Hoper, M., Deodhar, K., Kirk, S.J., Gardiner,
placebo. Z. Gastroenterol. 47, 209–214. K.R., 2000. Probiotic therapy fails to improve gut permeability
Fernandes, C.F., Shahani, K.M., Amer, M.A., 1987. Therapeutic role in a hapten model of colitis. Scand. J. Gastroenterol. 35, 1266–
of dietary lactobacilli and lactobacillic fermented dairy products. 1271.
FEMS Microbiol. Rev. 46, 343–356. Kiatpapan, P., Yamashita, M., Kawaraichi, N., Yasuda, T., Murooka,
Filippo, C., Filippo, C., Di Caro, S., Santarelli, L., Armuzzi, A., Y., 2001. Heterologous expression of a gene encoding cholesterol
Gasbarrini, G., Gasbarrini, A., 2001. Helicobacter pylori treatment: oxidase in probiotic strains of Lactobacillus plantarum and Propi-
a role for Probiotics. Dig. Dis. 19, 144–147. onibacterium freudenreichii under the control of native promoters.
Fioramonti, J., Theodorou, V., Bueno, L., 2003. Probiotics: what are J. Biosci. Bioeng. 92, 459–465.
they? What are their effects on gut physiology? Best Pract. Res. Levy, J., 2000. The effects of antibiotic use on gastrointestinal
Clin. Gastroenterol. 17, 711–724. function. Am. J. Gastroenterol. 95, S8–S10.
Food and Agriculture Organization/World Health Organization Lilly, D.M., Stillwell, R.H., 1965. Probiotics: Growth-promoting
(FAO/WHO), 2001. Health and nutritional properties of Probiotics factors produced by microorganisms. Science 147, 747–748.
in food including powder milk with live lactic acid bacteria, Report Lodinova-Zadnikova, R., Cukrowska, B., Tlaskalova-Hogenova, H.,
of a Joint FAO/WHO Expert Consultation on Evaluation of 2003. Oral administration of Probiotic Escherichia coli after birth
Health and Nutritional Properties of Probiotics in Food including reduces frequency of allergies and repeated infections later in life
Powder Milk with Live lactic acid bacteria, Córdoba, Argentina. (after 10 and 20 years). Int. Arch. Allergy Immunol. 131,
Available at: http://www.who.int/foodsafety/publications/fs_man- 209–211.
agement/en/probiotics.pdf. MacFarlane, G.T., Cummings, J.H., 2002. Probiotics, infection and
Fukao, M., Tomita, H., Yakabe, T., Nomura, T., Ike, Y., Yajima, N., immunity. Curr. Opin. Infect. Dis. 15, 501–506.
2009. Assessment of antibiotic resistance in probiotic strain Marteau, P.R., de Vrese, M., Cellier, C.J., Schrezenmeir, J., 2001.
Lactobacillus brevis KB290. J. Food Prot. 72, 1923–1929. Protection from gastrointestinal diseases with the use of Probiotics.
Gest, H., 2004. The discovery of microorganisms by Robert Hooke Am. J. Clin. Nutr. (Suppl.) 73, 430–436.
and Antoni van Leeuwenhoek, Fellows of The Royal Society. Martinez, R.C., Franceschini, S.A., Patta, M.C., Quintana, S.M.,
Notes Records R. Soc. Lond. 58, 187–201. Candido, R.C., Ferreira, J.C., De Martinis, E.C., Reid, G., 2009.
Giralt, J., Regadera, J.P., Verges, R., Romero, J., de la Fuente, I., Improved treatment of vulvovaginal candidiasis with fluconazole
Biete, A., Villoria, J., Cobo, J.M., Guarner, F., 2008. Effects of plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus
probiotic Lactobacillus casei DN-114 001 in prevention of radia- reuteri RC-14. Lett. Appl. Microbiol. 48, 269–274.
tion-induced diarrhea: results from multicenter, randomized, pla- Mego, M., Majek, J., Koncekova, R., Ebringer, L., Ciernikova, S.,
cebo-controlled nutritional trial. Int. J. Radiat. Oncol. Biol. Phys. Rauko, P., Kovac, M., Trupl, J., Slezak, P., Zajac, V., 2005.
71, 1213–1219. Intramucosal bacteria in colon cancer and their elimination by
Gismondo, M.R., Drago, L., Lombardi, A., 1999. Review of Probi- probiotic strain Enterococcus faecium M-74 with organic selenium.
otics available to modify gastrointestinal flora. Int. J. Antimicrob. Folia Microbiol. (Praha) 50, 443–447.
Agents 12, 287–292. Metchnikoff, I.I., 2004. The Prolongation of Life: Optimistic Studies.
Hawrelak, J., 2003. Probiotics: choosing the right one for your needs. Springer Publishing Company, New York, NY, USA.
J. Aust. Traditional-Med. Soc. 9 (2), 67–75. Metchnikoff, I.I., Mitchell, P.C., 1910. Nature of Man or Studies in
Hilton, E., Kolakawaki, P., Singer, C., Smith, M., 1977. Efficacy of Optimistic Philosophy. Kessinger Publishing, Whitefish, MT, USA.
Lactobacillus GG as a diarrheal preventive in travelers. J. Travel Michail, S., Abernathy, F., 2002. Lactobacillus plantarum reduces the
Med. 4, 41–43. in vitrosecretory response of intestinal epithelial cells to entero-
Hlivak, P., Odraska, J., Ferencik, M., Ebringer, L., Jahnova, E., patho-genic Escherichia coli infection. J. Pediatr. Gastroenterol.
Mikes, Z., 2005. One-year application of probiotic strain Entero- Nutr. 35 (3), 350–355.
coccus faecium M-74 decreases serum cholesterol levels. Bratisl. Nguyen, T.D., Kang, J.H., Lee, M.S., 2007. Characterization of
Lek. Listy 106, 67–72. Lactobacillus plantarum PH04, a potential probiotic bacterium with
Hosono, A., 1992. Fermented milk in the orient. In: Naga sawa, Y., cholesterol-lowering effects. Int. J. Food Microbiol. 113, 358–361.
Hosono, A. (Eds.), Functions of Fermented Milk: Challenges for Niers, L., Martin, R., Rijkers, G., Sengers, F., Timmerman, H., van
the Health Sciences. Elsevier Applied Science, London, UK, pp. Uden, N., Smidt, H., Kimpen, J., Hoekstra, M., 2009. The effects
61–78. of selected Probiotic strains on the development of eczema (the P
Huurre, A., Laitinen, K., Rautava, S., Korkeamaki, M., Isolauri, E., and A study). Allergy 64, 1349–1358.
2008. Impact of maternal atopy and probiotic supplementation O’Sullivan, M.G., Thornton, G., O’Sullivan, G.C., Collins, J.K., 1992.
during pregnancy on infant sensitization: a double-blind placebo- Probiotic bacteria: myth or reality. Trends Food Sci. Technol. 3,
controlled study. Clin. Exp. Allergy 38, 1342–1348. 309–314.
114 A.A. Amara, A. Shibl

Parker, R.B., 1974. Probiotics, the other half of the antibiotic story. up-regulation of the proinflammatory chemokine MCP-1. BMC
Anim. Nutr. Health 29, 4–8. Med. Genet. 6, 43.
Reid, G., Sanders, M.E., Gaskins, H.R., Gibson, G.R., Mercenier, A., van der Aa, L.B., Sprikkelman, A.B., van Aalderen, W.M., 2008.
Rastall, R., Roberfroid, M., Rowland, I., Cherbut, C., Klaenham- Impact of maternal atopy and probiotic supplementation during
mer, T.R., 2003. New scientific paradigms for Probiotics and pregnancy on infant sensitization. Clin. Exp. Allergy 38, 1698,
prebiotics. J. Clin. Gastroenterol. 37, 105–118. author reply 1698-9.
Saavedra, J.M., Bauman, N.A., Oung, I., Perman, J.A., Yolken, R.H., Vanderhoof, J.A., 2000. Probiotics and intestinal inflammatory
1994. Feeding of Bifidobacterium bifidum and Streptococcus ther- disorders in infants and children. J. Pediatr. Gastroenterol. Nutr.
mophilusto infants in hospital for prevention of diarrhea and 30, S34–S38.
shedding of rotavirus. Lancet 344, 1046–1049. Viljanen, M., Kuitunen, M., Haahtela, T., Juntunen-Backman, K.,
Salminen, S., von Wright, A., Morelli, L., Marteau, P., Brassart, D., de Korpela, R., Savilahti, E., 2005a. Probiotic effects on faecal
Vos, W.M., Fondén, R., Saxelin, M., Collins, K., Mogensen, G., inflammatory markers and on faecal IgA in food allergic atopic
Birkeland, S.E., Mattila-Sandholm, T., 1998. Demonstration of eczema/dermatitis syndrome infants. Pediatr. Allergy Immunol. 16,
safety of Probiotics – a review. Int. J. Food Micro biol. 44, 93–106. 65–71.
Silva, M., Jacobs, N.V., Deneke, C., Gorbach, S.L., 1987. Antimicro- Viljanen, M., Pohjavuori, E., Haahtela, T., Korpela, R., Kuitunen, M.,
bial substance from a human Lactobacillus strain. Antimicrob. Sarnesto, A., Vaarala, O., Savilahti, E., 2005b. Induction of
Agents Chemother. 31, 1231–1233. inflammation as a possible mechanism of Probiotic effect in atopic
Soh, S.E., Aw, M., Gerez, I., Chong, Y.S., Rauff, M., Ng, Y.P., Wong, eczema-dermatitis syndrome. J. Allergy Clin. Immunol. 115, 1254–
H.B., Pai, N., Lee, B.W., Shek, L.P., 2009. Probiotic supplemen- 1259.
tation in the first 6 months of life in at risk Asian infants-effects on White, J.S., Hoper, M., Parks, R.W., Clements, W.D., Diamond, T.,
eczema and atopic sensitization at the age of 1 year. Clin. Exp. Bengmark, S., 2006. The probiotic bacterium Lactobacillus planta-
Allergy 39, 571–578. rum species 299 reduces intestinal permeability in experimental
Strowski, M.Z., Wiedenmann, B., 2009. Probiotic carbohydrates biliary obstruction. Lett. Appl. Microbiol. 42, 19–23.
reduce intestinal permeability and inflammation in metabolic Whorwell, P.J., Altringer, L., Morel, J., Bond, Y., Charbonneau, D.,
diseases. Gut 58, 1044–1045. O’Mahony, L., Kiely, B., Shanahan, F., Quigley, E.M., 2006.
Thirabunyanon, M., Boonprasom, P., Niamsup, P., 2009. Probiotic Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624
potential of lactic acid bacteria isolated from fermented dairy milks in women with irritable bowel syndrome. Am. J. Gastroenterol.
on antiproliferation of colon cancer cells. Biotechnol. Lett. 31, 571– 101, 1581–1590.
576. Yamada, T., Nagata, S., Kondo, S., Bian, L., Wang, C., Asahara, T.,
Tomas, M.S., Claudia Oter, M., Ocana, V., Elena Nader-Macias, M., Ohta, T., Nomoto, K., Yamashiro, Y., 2009. Effect of continuous
2004. Production of antimicrobial substances by lactic acid bacteria probiotic fermented milk intake containing Lactobacillus casei
I: determination of hydrogen peroxide. Methods Mol. Biol. 268, strain Shirota on fever in mass infectious gastroenteritis rest home
337–346. outbreak. Kansenshogaku Zasshi 83, 31–35.
Ukena, S.N., Westendorf, A.M., Hansen, W., Rohde, M., Geffers, R., Zhou, J.S., Pillidge, C.J., Gopal, P.K., Gill, H.S., 2005. Antibiotic
Coldewey, S., Suerbaum, S., Buer, J., Gunzer, F., 2005. The host susceptibility profiles of new probiotic Lactobacillus and Bifido-
response to the probiotic Escherichia coli strain Nissle 1917: specific bacterium strains. Int. J. Food Microbiol. 98, 211–217.