Probiotics fortify intestinal barrier function: a systematic review and meta-analysis of randomized trials

Yanfei Zheng; Zengliang Zhang; Ping Tang; Yuqi Wu; Anqi Zhang; Delong Li; Chong-Zhi Wang; Jin-Yi Wan; Haiqiang Yao; Chun-Su Yuan

doi:10.3389/fimmu.2023.1143548

Probiotics fortify intestinal barrier function: a systematic review and meta-analysis of randomized trials

Front Immunol. 2023 Apr 24:14:1143548. doi: 10.3389/fimmu.2023.1143548. eCollection 2023.

Authors

Yanfei Zheng^{1

2}, Zengliang Zhang³, Ping Tang^{1

2}, Yuqi Wu^{1

2}, Anqi Zhang², Delong Li^{1

2}, Chong-Zhi Wang^{4

5}, Jin-Yi Wan^{1

2}, Haiqiang Yao^{1

2}, Chun-Su Yuan^{4

5}

Affiliations

¹ School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
² National Institute of Traditional Chinese Medicine (TCM) Constitution and Preventive Medicine, Beijing University of Chinese Medicine, Beijing, China.
³ Traditional Chinese Medicine College, Inner Mongolia Medical University, Inner Mongolia, China.
⁴ Tang Center for Herbal Medicine Research, The University of Chicago, Chicago, IL, United States.
⁵ Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL, United States.

Abstract

Background: Probiotics play a vital role in treating immune and inflammatory diseases by improving intestinal barrier function; however, a comprehensive evaluation is missing. The present study aimed to explore the impact of probiotics on the intestinal barrier and related immune function, inflammation, and microbiota composition. A systematic review and meta-analyses were conducted.

Methods: Four major databases (PubMed, Science Citation Index Expanded, CENTRAL, and Embase) were thoroughly searched. Weighted mean differences were calculated for continuous outcomes with corresponding 95% confidence intervals (CIs), heterogeneity among studies was evaluated utilizing I2 statistic (Chi-Square test), and data were pooled using random effects meta-analyses.

Results: Meta-analysis of data from a total of 26 RCTs (n = 1891) indicated that probiotics significantly improved gut barrier function measured by levels of TER (MD, 5.27, 95% CI, 3.82 to 6.72, P < 0.00001), serum zonulin (SMD, -1.58, 95% CI, -2.49 to -0.66, P = 0.0007), endotoxin (SMD, -3.20, 95% CI, -5.41 to -0.98, P = 0.005), and LPS (SMD, -0.47, 95% CI, -0.85 to -0.09, P = 0.02). Furthermore, probiotic groups demonstrated better efficacy over control groups in reducing inflammatory factors, including CRP, TNF-α, and IL-6. Probiotics can also modulate the gut microbiota structure by boosting the enrichment of Bifidobacterium and Lactobacillus.

Conclusion: The present work revealed that probiotics could improve intestinal barrier function, and alleviate inflammation and microbial dysbiosis. Further high-quality RCTs are warranted to achieve a more definitive conclusion.

Clinical trial registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=281822, identifier CRD42021281822.

Keywords: immune function; inflammation; intestinal barrier function; probiotics; randomized controlled trial.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Bifidobacterium
Gastrointestinal Microbiome*
Humans
Inflammation
Probiotics* / therapeutic use
Randomized Controlled Trials as Topic

Grants and funding

This work was supported in part by the National Natural Science Foundation of China (81973714, 82274379); Fundamental Research Funds for the Central Universities (2022-JYB-JBZR-009); Beijing University of Chinese Medicine High-level Talent Start-up Research Project (2021-XJ-KYQD-004).