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Randomized pilot trial of a synbiotic dietary supplement in chronic HIV-1 infection.

Abstract

BACKGROUND

Infection with HIV-1 results in marked immunologic insults and structural damage to the intestinal mucosa, including compromised barrier function. While the development of highly active antiretroviral therapy (HAART) has been a major advancement in the treatment of HIV-1 infection, the need for novel complementary interventions to help restore intestinal structural and functional integrity remains unmet. Known properties of pre-, pro-, and synbiotics suggest that they may be useful tools in achieving this goal.

METHODS

This was a 4-week parallel, placebo-controlled, randomized pilot trial in HIV-infected women on antiretroviral therapy. A synbiotic formulation (Synbiotic 2000®) containing 4 strains of probiotic bacteria (10(10) each) plus 4 nondigestible, fermentable dietary fibers (2.5 g each) was provided each day, versus a fiber-only placebo formulation. The primary outcome was bacterial translocation. Secondary outcomes included the levels of supplemented bacteria in stool, the activation phenotype of peripheral T-cells and monocytes, and plasma levels of C-reactive protein and soluble CD14.

RESULTS

Microbial translocation, as measured by plasma bacterial 16S ribosomal DNA concentration, was not altered by synbiotic treatment. In contrast, the synbiotic formulation resulted in significantly elevated levels of supplemented probiotic bacterial strains in stool, including L. plantarum and P. pentosaceus, with the colonization of these two species being positively correlated with each other. T-cell activation phenotype of peripheral blood lymphocytes showed modest changes in response to synbiotic exposure, with HLA-DR expression slightly elevated on a minor population of CD4+ T-cells which lack expression of HLA-DR or PD-1. In addition, CD38 expression on CD8+ T-cells was slightly lower in the fiber-only group. Plasma levels of soluble CD14 and C-reactive protein were unaffected by synbiotic treatment in this study.

CONCLUSIONS

Synbiotic treatment for 4 weeks can successfully augment the levels of probiotic species in the gut during chronic HIV-1 infection. Associated changes in microbial translocation appear to be absent, and markers of systemic immune activation appear largely unchanged. These findings may help inform future studies aimed at testing pre- and probiotic approaches to improve gut function and mucosal immunity in chronic HIV-1 infection.

TRIAL REGISTRATION

Clinical Trials.gov: NCT00688311.

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  • Authors+Show Affiliations

    ,

    Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA.

    , , , , , , , , , ,

    Source

    MeSH

    ADP-ribosyl Cyclase 1
    Adult
    Anti-HIV Agents
    Bacteria
    Bacterial Translocation
    C-Reactive Protein
    CD4-Positive T-Lymphocytes
    CD8-Positive T-Lymphocytes
    Chronic Disease
    Colon
    Dietary Fiber
    Feces
    Female
    Fermentation
    HIV Infections
    HIV-1
    HLA-DR Antigens
    Humans
    Intestinal Mucosa
    Lipopolysaccharide Receptors
    Lymphocyte Activation
    Male
    Middle Aged
    Phenotype
    Pilot Projects
    Prebiotics
    Probiotics
    Programmed Cell Death 1 Receptor
    RNA, Ribosomal, 16S
    Synbiotics

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22747752

    Citation

    Schunter, Marco, et al. "Randomized Pilot Trial of a Synbiotic Dietary Supplement in Chronic HIV-1 Infection." BMC Complementary and Alternative Medicine, vol. 12, 2012, p. 84.
    Schunter M, Chu H, Hayes TL, et al. Randomized pilot trial of a synbiotic dietary supplement in chronic HIV-1 infection. BMC Complement Altern Med. 2012;12:84.
    Schunter, M., Chu, H., Hayes, T. L., McConnell, D., Crawford, S. S., Luciw, P. A., ... Critchfield, J. W. (2012). Randomized pilot trial of a synbiotic dietary supplement in chronic HIV-1 infection. BMC Complementary and Alternative Medicine, 12, p. 84. doi:10.1186/1472-6882-12-84.
    Schunter M, et al. Randomized Pilot Trial of a Synbiotic Dietary Supplement in Chronic HIV-1 Infection. BMC Complement Altern Med. 2012 Jun 29;12:84. PubMed PMID: 22747752.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Randomized pilot trial of a synbiotic dietary supplement in chronic HIV-1 infection. AU - Schunter,Marco, AU - Chu,Hiutung, AU - Hayes,Timothy L, AU - McConnell,Delandy, AU - Crawford,Sean S, AU - Luciw,Paul A, AU - Bengmark,Stig, AU - Asmuth,David M, AU - Brown,Jennifer, AU - Bevins,Charles L, AU - Shacklett,Barbara L, AU - Critchfield,J William, Y1 - 2012/06/29/ PY - 2012/03/07/received PY - 2012/06/29/accepted PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2012/12/10/medline SP - 84 EP - 84 JF - BMC complementary and alternative medicine JO - BMC Complement Altern Med VL - 12 N2 - BACKGROUND: Infection with HIV-1 results in marked immunologic insults and structural damage to the intestinal mucosa, including compromised barrier function. While the development of highly active antiretroviral therapy (HAART) has been a major advancement in the treatment of HIV-1 infection, the need for novel complementary interventions to help restore intestinal structural and functional integrity remains unmet. Known properties of pre-, pro-, and synbiotics suggest that they may be useful tools in achieving this goal. METHODS: This was a 4-week parallel, placebo-controlled, randomized pilot trial in HIV-infected women on antiretroviral therapy. A synbiotic formulation (Synbiotic 2000®) containing 4 strains of probiotic bacteria (10(10) each) plus 4 nondigestible, fermentable dietary fibers (2.5 g each) was provided each day, versus a fiber-only placebo formulation. The primary outcome was bacterial translocation. Secondary outcomes included the levels of supplemented bacteria in stool, the activation phenotype of peripheral T-cells and monocytes, and plasma levels of C-reactive protein and soluble CD14. RESULTS: Microbial translocation, as measured by plasma bacterial 16S ribosomal DNA concentration, was not altered by synbiotic treatment. In contrast, the synbiotic formulation resulted in significantly elevated levels of supplemented probiotic bacterial strains in stool, including L. plantarum and P. pentosaceus, with the colonization of these two species being positively correlated with each other. T-cell activation phenotype of peripheral blood lymphocytes showed modest changes in response to synbiotic exposure, with HLA-DR expression slightly elevated on a minor population of CD4+ T-cells which lack expression of HLA-DR or PD-1. In addition, CD38 expression on CD8+ T-cells was slightly lower in the fiber-only group. Plasma levels of soluble CD14 and C-reactive protein were unaffected by synbiotic treatment in this study. CONCLUSIONS: Synbiotic treatment for 4 weeks can successfully augment the levels of probiotic species in the gut during chronic HIV-1 infection. Associated changes in microbial translocation appear to be absent, and markers of systemic immune activation appear largely unchanged. These findings may help inform future studies aimed at testing pre- and probiotic approaches to improve gut function and mucosal immunity in chronic HIV-1 infection. TRIAL REGISTRATION: Clinical Trials.gov: NCT00688311. SN - 1472-6882 UR - https://www.unboundmedicine.com/medline/citation/22747752/full_citation L2 - https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-12-84 DB - PRIME DP - Unbound Medicine ER -