Hajela et al.

Gut Pathogens 2012, 4:1

http://www.gutpathogens.com/content/4/1/1

MEETING REPORT Open Access

Health impact of probiotics - vision and

opportunities
Neerja Hajela1, G Balakrish Nair2, Philip Abraham3 and Nirmal K Ganguly4*

Abstract
Our understanding of the role of the microbiota in our gut and other sites in our body is rapidly emerging and
could lead to many new and innovative approaches for health care. The promise of the potential role of probiotics
for the prevention and treatment of enteric and other infections as an effective solution needs to be realized. The
meeting report summarizes the insights and learning from a recent symposium, “Health Impact of Probiotics -
Vision and Opportunities” conducted in Mumbai by the Yakult India Microbiota and Probiotic Science Foundation
and P.D. Hinduja National Hospital, Mumbai. The symposium reflected its objective of unraveling the potential role
of probiotics for health benefits through presentations and discussions. Experts clearly highlighted the role of
probiotics in improving various aspects of health and in immune modulation. The report also captures the debate
and discussions on the challenges that are likely to be encountered for the use of probiotics in the country.

Introduction stated that of the many proposed interventions, probio-

The recent advent of high throughput sequencing tech- tics offer immense potential for the prevention of a vari-
nologies has provided new insights into the composition ety of diseases. It is therefore not surprising that the
and metabolic activities of the intestinal biome. Today it past decade has witnessed tremendous progress in the
is recognized that this complex ecosystem is an assem- area of probiotic research with scientific evidence
blage of more than 1000 species of microorganisms that quickly accumulating to validate their possible role as
exist in harmony (symbiosis) with the host and exert important therapeutic and preventive strategy for gastro-
metabolic activities that virtually parallels an organ intestinal diseases, treatment and prevention of allergic
within an organ. While most of these activities are bene- disorders, chronic inflammatory diseases, prevention of
ficial for the host some may be deleterious, the nature of cancers and reduction of respiratory diseases.
effect, being determined by the composition of the flora. Dr. R.A. Badwe, Director, Tata Memorial Cancer Hos-
Thus a mutualistic relationship between the beneficial pital, Mumbai, the Chief Guest reemphasized the signifi-
symbionts and commensals is paramount for the main- cant role of the gut flora in maintaining health and
tenance of health and wellbeing with dysbiosis resulting stated that although most of the claims and benefits
in clinical disease. It follows that the gut flora can be associated with probiotic usage are being established,
manipulated to enhance the beneficial components they mainly represent the findings from the West and
which represent a promising strategy for the prevention therefore probiotics have found greater acceptance in
and management of various infective and non - infective that part of the world. The potential for their use in the
disorders. developing world has not been adequately investigated.
The symposium started with the welcome address by With the realization that infectious and non-infectious
Prof. N.K. Ganguly, Distinguished Biotechnology diseases account for a large majority of deaths annually
Research Professor, Department of Biotechnology, in resource limited settings there is optimism about the
National Institute of Immunology, New Delhi. He gave a ability of interventions such as probiotics to prevent
broad introduction to the topic, emphasizing the central health disparities. However, since colonization with a
role of the gut flora in the improvement of health. He probiotic is dependent on the interplay of multiple fac-
tors in the intestinal mileu, inherent differences in gut
* Correspondence: [email protected] microbial ecology may significantly impact the function-
4
National Institute of Immunology, New Delhi, India
Full list of author information is available at the end of the article
ing of the probiotic strain and therefore requires a

© 2012 Hajela et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
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thorough understanding and much more evidence needs Multiple meta-analyses indicate effectiveness in reducing
to be generated in these settings. the duration of acute enteritis in pre-schoolers and in
reducing the frequency of necrotizing enterocolitis in
Yakult India Microbiota and Probiotic Science Foundation pre-term babies [1,2]. There is some evidence support-
Recognizing this need, a group of eminent scientists ing the use of selected probiotic agents to either prevent
formed the Yakult India Microbiota and Probiotic or treat antibiotic-associated diarrhea and Clostridium
Science Foundation. This foundation was registered as a difficile infection. In Prof. Sherman’s opinion, more data
society on 9th November 2011 under the Societies is, however, necessary to confirm the efficacy of probio-
Registration Act XXI of 1860. The Foundation will aim tic agents, either solely or in combination, in the man-
at providing a common scientific platform for basic agement of various chronic inflammatory bowel diseases
scientists and clinicians to share and exchange knowl- and in allergic enterocolitis. According to him, in future,
edge and views and to expand into newer areas of pro- probiotic strains are likely to be chosen for use in speci-
biotic research. While the foundation will channelize fic clinical settings based on their underlying mechan-
International knowledge and expertise in the field of ism(s) of action. There is also the possibility of
probiotics it will also promote collaborative research in developing specific disease targeted designer probiotics,
the development of probiotics as well as foster and he added. Elaborating further, he opined that issues
maintain research links with scientists of similar interest. related to optimal dosages, time of ingestion, single ver-
The foundation endeavors to do this through an Annual sus combination formulations, maintenance of viability,
Probiotic Symposium, which will blend fundamental and and the merits of employing probiotic-derived products
applied research related to the use of probiotics for the would only be answered by undertaking additional
enhancement of human health. With this in mind, the research in the field.
first symposium of the Foundation with the theme Presenting the evidence for their use in adults, Dr.
“Health Impact of Probiotics - Vision and Opportu- Philip Abraham, Consultant Gastroenterologist, P.D.
nities” was convened on December 10 and 11, 2011 in Hinduja National Hospital, Mumbai, India, stated that
Mumbai. probiotics may be useful in preventing antibiotic-asso-
This report summarizes the discussions and delibera- ciated diarrhoea, including those caused by Clostridium
tions that ensued over the two days of the symposium. difficile. They are also efficacious in reducing the sever-
We hope this will prompt basic scientists, microbiolo- ity and duration of other adult and pediatric diarrhoeas
gists and nutritionists to bring new perspectives to the especially those caused by rotavirus. However, their role
science of probiotics and clarify some of the major in prevention of traveler’s diarrhoea is equivocal and
issues such as efficacy and acceptable outcomes that hence limits their use in this condition.
surrounds implementation of probiotic usage in the Dr. Abraham further elaborated on the evidence for
country. The challenge of designing randomized con- their use in chronic and acute conditions specifying that
trolled trials for understanding and targeting particular there is increasing evidence indicating that probiotics
biomarkers and end points for the disease and identify- are an effective adjunct to triple therapy in the eradica-
ing strain specific health benefits to mark a road map tion of Helicobacter pylori infection, exhibiting enhanced
that may be followed to allow for probiotic usage in the eradication rates and reductions in adverse events. He
country needs to be addressed. added that although probiotics have shown benefit in
improving symptoms of Irritable Bowel Syndrome, cur-
Unraveling the effects of probiotics in Gastrointestinal rent clinical practice guidelines do not recommend their
(GI) disorders use in treatment regimens. In Inflammatory Bowel Dis-
Evidence for the utility of probiotics in the prevention eases, results are variable although positive benefit has
and treatment of GI disorders in the pediatric population been shown, in preventing relapses in Ulcerative Colitis
and in adults was presented by Prof. Philip Sherman, Pro- and Crohn’s disease, the most consistent and favourable
fessor of Pediatrics, Microbiology and Dentistry, Research result being in the prevention and treatment of the pou-
Institute, University for Sick Children, University of Tor- chitis. Data for the prevention of colon cancer in high-
onto, Canada and Dr. Philip Abraham, Senior Consultant risk individuals however, requires long-term intervention
Gastroenterologist and Hepatologist at P.D. Hinduja and is therefore hard to come by. There is favourable
National Hospital, Mumbai. evidence in animal studies and some evidence in
Presenting global evidence for their utility in children, humans, that probiotics can reduce cell proliferation in
Prof. Sherman illustrated that evidence through rando- patients with colonic adenoma [1]. Previous studies sug-
mized controlled trails have demonstrated that certain gest that clinical improvement may occur in patients
probiotic strains are more effective than placebo in a with hepatic encephalopathy due to reduction of fecal
variety of conditions affecting the gastrointestinal tract. urease activity and blood ammonia concentration.
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Why probiotics in diarrhoea in low and middle income role in prevention of acute diarrhoea in young children
countries? in a community setting. These results show a significant
India continues to face disproportionate morbidity and protective effect (14%, 95% CI: 4-23%) of the probiotic
mortality due to diarrhoeal diseases. The 2008 statistics on acute diarrhea in children during the 24 week period
indicate that 18% of the global child diarrhoeal deaths with only 608 children in the Probiotic group (0.88 no.
and 77% of diarrhoeal deaths of children in Southeast of cases/child/year) developing diarrhoea as compared
Asia were from India [3]. Using both culture dependent to 674 children in the Nutrient group (1.029 no. of
and culture independent methods for 26 different cases/child/year) during the 24 week study period [6].
enteric pathogens, Dr. G.Balakrish Nair, Executive Elaborating on the same study Dr. Koji Nomoto,
Director of the Translational Health Science and Tech- Associate Director, Yakult Central Institute for Micro-
nology Institute, Gurgaon, Haryana, provided evidence biological Research, Tokyo, presented details of the var-
that more than two thirds of the patients with diarrhoea iation in the composition of the gut flora in the
admitted to the Infectious Diseases Hospital in Kolkata diarrhoeal samples from the children in the probiotic
excreted more than one enteric pathogen and, some of and nutrient groups. Analysis of the composition was
them excreted as many as six pathogens. Several com- done using Yakult Intestinal Flora - SCAN (YIF-
munity-based diarrhoeal surveillance studies conducted SCAN®) which is based on reverse transcription quanti-
in the urban slums of Kolkata, have also shown that tative PCR (RT- qPCR) using specific primers that target
enteric pathogens found amongst cases with varied age bacterialr RNA molecules [7-9]. Dr. Nomoto shared
and socio economic status, matched healthy children results which revealed that the gut flora was disrupted
sampled as controls thereby substantiating that the in the diarrhoeal samples in comparison to the non
extent of exposure to fecal bacteria and enteric patho- diarrhoeal samples and how these aberrations in the gut
gens in impoverished settings is huge. This results in flora could be restored by including a probiotic
tropical enteropathy, increased permeability and modest intervention.
malabsorption [4]. The consequence of these conditions According to Dr. Shinjini Bhatnagar, Professor, Pedia-
include impaired nutrient utilization because of altered tric Biology Centre at the Translational Health Science
microbiota, poor oral vaccine uptake, diminished protec- Technology Institute, Gurgaon, Haryana, at present,
tive efficacy of these vaccines as compared to that in there is a lack of sufficient evidence for the use of pro-
developed countries and requirement of higher oral vac- biotics in the treatment of acute diarrhoea in the devel-
cine dose in the impoverished settings [5]. Available oping world and large randomized controlled studies
data from developed countries suggest that probiotics using specific probiotic regimes in defined groups of
are effective against diarrhoea of diverse causes and fur- children with uniform definitions for clinical outcomes
nish the evidence for the use of probiotics in prevention would definitely pave the way forward. She stated that
and treatment of diarrhoea. In stark contrast, in devel- this would help to advance the understanding of specific
oping countries, probiotics need to be effective against a probiotics in Indian settings where breast feeding rates
complex backdrop of child undernutrition, ingestion of are higher and microbial colonization of the gut is dif-
high concentration of fecal bacteria because of poor ferent. In her opinion, these studies should focus on
sanitary conditions, tropical enteropathy, hyperperme- evaluating possible interactions when probiotics are
able gut, reduced nutrient absorption and growth falter- used as combinations or with other antimicrobials/
ing. Using this as the background, Dr. Nair opined that drugs/zinc.
probiotics may serve as an ideal intervention strategy to
improve gut microbiota and counter enteric pathogens Probiotics in mucosal immunology by which mechanisms
present in such disease endemic areas. Appropriately can probiotics be clinically effective?
conducted randomized trials would decide the future As a key physical interface to the external environment,
significance of probiotics in impoverished settings and the gut epithelium is a highly dynamic and multi func-
would also help to furnish information on the mechan- tional barrier. In health, a delicate homeostasis is main-
ism of action of probiotics in settings quite different tained at intestinal surfaces between the micro
from the sanitized West. organisms present and the host tissues to finely tune
Dr. Nair shared the findings of a recent study on 3758 responses appropriate to native commensals versus
children aged 1-5 years in an urban slum in Kolkata potential pathogens. The protective mucus layer in the
which evaluated the occurrence of first episodes of diar- intestine controls unchecked bacterial proliferation and
rhoea as primary outcome and composition of fecal also serves as a feedback system to regulate both innate
microbiota as the secondary outcome. The results of the and adaptive immune responses [10]. Dr. S.V. Chiplun-
study revealed that daily intake of a probiotic strain, kar, Principal Investigator, ACTREC, Tata Memorial
Lactobacillus casei strain Shirota played an important Centre, Mumbai discussed the various in vitro and in
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vivo studies which have shown that specific strains of Service Institution. Data presented by him evidenced
probiotics are able to modulate the immune system to that investigation of faecal bacteria disclosed significant
protect against infectious diseases and cancer. increment in numbers of faecal Bifidobacterium. Methi-
She stated that probiotic supplementation leads to a cillin-resistant Staphylococcus aureus and methicillin-
significant increase in phagocytic activity of blood resistant coagulase-negative Staphylococci were detected
monocytes, granulocytes and augments NK cell activity from 1 case and from 5 cases, respectively, out of 42
though a variety of mechanisms. Major gaps, she said, cases before the clinical study, were not isolated after
exist in our knowledge about the mechanisms by which the administration of LcS [15]. Professor Yamashiro also
probiotics modulate antitumor immunity. Further, dif- illustrated that B. breve was very effective in the treat-
ferent probiotic strains vary in their ability to modulate ment of mucositis (also referred to as mucosal barrier
the immune system and therefore efficacy of each strain injury), one of the most debilitating side effects of che-
needs to be carefully demonstrated through rigorously motherapy treatment and was also very effective in pre-
designed randomized, double-blind, placebo-controlled venting NEC and infection in preterm infants [16].
studies. In conclusion, she emphasized that probiotics
play an important role in potentiating innate and Bacterial vaginosis and probiotics
acquired immune responsiveness which can be further Dr. P. Hemalatha of the National Institute of Nutrition
exploited for modulating anti-cancer immunity [11]. (NIN), Hyderabad presented information on the use of
Extending these deliberations further Dr. Masanobu probiotics in Bacterial Vaginosis (BV), one of the most
Nanno, Associate Director at the Yakult Central Insti- common vaginal syndrome afflicting premenopausal and
tute for Microbiological research, Tokyo presented the pregnant women. Dr. Hemalatha indicated that since
significant role of Lactobacillus casei strain Shirota reduction of lactobacilli and increase in pH are the
(LcS) as an important immune modulator that has the main pathogenesis of BV, probiotics are being explored
ability to prevent recurrence of cancers. This strain of for their role in restoring the vaginal flora. Meta-analysis
bacteria, he shared, has more than 75 years of research of several trials with antibiotics have shown a cure rate
to back its scientific efficacy and has demonstrated a of 60% but oral lactobacilli treatment followed by anti-
beneficial role in the prevention of recurrence of super- biotics for treatment of BV have shown more than 80%
ficial bladder cancer following transurethral resection cure rate after one month. Further, a Cochrane meta-
[12]. The same strain of bacteria according to him was analysis on efficacy of lactobacilli for the treatment of
also effective in preventing the recurrence of colorectal BV showed beneficial outcome with oral probiotics
cancer with moderate or severe atypia in subjects who combined with metronidazole or estriol preparation sug-
had undergone surgical resection of colon polyps [13]. gesting the need to combine antibiotics with lactobacilli
He elaborated that for understanding the mechanism of while aiming to treat BV. Sharing findings of a double-
action of LcS especially in the prevention of colon can- blind, randomized, placebo-controlled study conducted
cer, the effect of LcS on colitis associated cancer models by NIN on 67 healthy, non pregnant, married women
was examined where it was observed that administration aged 20 to 40 years from urban slum with BV (Nugents’
of LcS prevented the reccurrence of colon cancer by score > 7) where a vaginal tablet containing at least 10
down-regulating IL - 6 production in the colonic [9] viable Lactobacilli (L. brevis, L. salivarius subsp. Sali-
mucosa [14]. NK cell activity was also restored in cinius, L. plantarum) inserted into the vagina daily at
HTLV-I-associated myelopathy patients and the cyto- bedtime for 8 days demonstrated a cure rate of nearly
toxic activity increased significantly in healthy subjects 80%. Cervico-vaginal lavage (CVL) was collected to mea-
who consumed LcS for a period of three weeks. In vitro sure the concentrations of tumor necrosis factor (TNF)-
analysis revealed that LcS-induced activation of NK cells a, interleukin (IL)-1 b and IL-6 by Quantitative Milli-
is mediated by IL-12 produced by phagocytic cells. plex ELISA kit. It was interesting to note significant
Therefore, establishing the fact that LcS plays a signifi- reduction in IL-1b and IL-6 proinflammatory cytokines
cant role in immune modulation which may be the with lactobacilli treatment, while an increase in IL-6
mechanism for the prevention of recurrence of cancers. cytokine was observed with pH adjustment tablet. This
Professor Yuichiro Yamashiro from the Probiotics is the first study demonstrating the effect of lactobacilli
Research Laboratory of Juntendo University Graduate treatment on local proinflammatory cytokines [15].
School of Medicine, Tokyo, Japan elaborating two stu- Merits of this study include control on time of sam-
dies of LcS supplementation shared how the administra- pling and initiation of treatment, which was during the
tion of LcS, decreased febrile episodes (> 37°C) and the same phase of the menstrual cycle in all the subjects.
duration of such episodes, reduced constipation fre- Therefore, hormonal influence could be ruled out on
quency and decreased development of diarrhoea thereby the effectiveness of the lactobacilli treatment. Attrition
bestowing health benefits to elderly people at a Health rate was also minimum all through. The major
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drawbacks of the study include non-use of antibiotics to be done in an individual case [17]. Given that meta-
for the treatment of BV and using a pH adjustment genomic studies and metabolomic profiling of the
tablet instead of a placebo. The vaginal tablet containing microbiota and the human host have provided major
three strains of lactobacilli used in the study discussed advances in the ability to characterize the molecular
was well tolerated and no side effects were reported, aspects of the intestinal microbiota and understand the
which was similar to the earlier findings. The strains of human-microbiota interaction, it can be hoped that
lactobacilli used in the study were however, chosen not these will eventually translate to more robust in vitro
so much for their ability to adhere and colonize at high and animal testing procedures that can precede human
levels but primarily because, the preparation when used trials and provide the additional evidence for health
in Italy showed 100% efficacy. However, as suggested benefits. In addition, he emphasized that the health sys-
earlier, longer and repeated treatments could be sug- tem would need to be harnessed in a way that would
gested for better out come and must be treated with allow the reporting and capture of any adverse events
antibiotics prior to lactobacilli instillation. that can be potentially related to use of probiotic foods
or drugs and provide post-market surveillance of the
Which is the best carrier matrix for a probiotic? kind available in the developed world.
A question that often comes up in most deliberations is Dr. Gianfranco Grompone, Senior Scientist, Danone
about the choice of the carrier matrix for the delivery of Research, Institute Pasteur, Montevideo extended the
the probiotic strain. Dr. A.K. Srivastava, Director, discussion further and illustrated in a very exciting pre-
National Dairy Research Institute, Karnal, India stated sentation entitled “Reshaping In Vitro Tests for Probio-
that dairy based foods, particularly traditional fermented tics: Increasing Predictability by a Multi-Dimensional
milks like dahi, yoghurts and dairy beverages which are Approach” how predictability can be improved from in
already an integral part of the traditional Indian diet vitro tests for better selection and characterization of
and are considered functional foods can be explored as potential anti-infectious probiotic strains [1]. Presenting
the most appropriate carriers of probiotics to optimally a multi-dimensional integrative approach applied by him
express their health promoting functions in the gut. and his team to screen 100 LAB strains in vitro, they
Dairy based probiotic foods represent the largest seg- developed novel host-bacteria heterotypic co-culture
ment accounting for nearly 65% of the total world func- systems with Intestinal Epithelial Cells, Peripheral Bone
tional food market. Presently, dairy based probiotic food Monocyte Cells and Dendritic cells that were incubated
industry is firmly placed at the global level completely with strains of Lactobacillus, Bifidobacterium or Strepto-
dominated by Europe, Japan and USA. Although, India coccus and cytokine secretion profiles determined. In
is yet to make a mark in the probiotic product develop- addition mannose adhesion and direct pathogen-inhibi-
ment in a big way, major global leaders like Yakult and tion on agar plates were tested. All the results were
Nestle, and National player: Mother Dairy have underta- compiled and analyzed by Principal Component Analysis
ken the formidable task of introducing a new market for in order to rank and compare the strains [18]. Two
probiotics in India having covered much ground in a strains displayed distinct activity profiles of great inter-
short span. He emphasized that to launch Indian pro- est for probiotic application, one for anti-inflammatory
biotic products in the country, vital issues such as devel- effect and the other one for anti-infectious purpose. Pre-
oping novel indigenous probiotic strains with proven liminary results, he shared, show anti-infectious effect in
functional efficacy both in vitro and in vivo, their inter- vivo using mice infection models.
compatibility, effective dosage and colonization in the
human gut, technological parameters during processing Conclusion
of the product, encapsulation and their impact on stabi- It is perhaps most appropriate to conclude with the
lity, survival and viability of probiotic strains along with statement made by Professor Yamashiro who stated that
validation of health claims and safety using different ani- according to World Population Prospects of the UN, we
mal models as well as in human subjects through clini- are currently witnessing a transition from high fertility
cal studies would need to be worked out. Future success and mortality rates to low birth rate and death. This
of probiotic formulations, in his opinion, will depend on trend reflects the size and structure of regional popula-
consumer’s acceptance. tions leading to longevity and shrinking of child popula-
Dr. B.S. Ramakrishna, Professor and Head, Depart- tion. The results of studies conducted by Professor
ment of Medical Gastroenterology, Christian Medical Yamashiro and his colleagues highlight the role that
College, Vellore stated that although the FAO/WHO probiotics will play in the future and the benefits that it
criteria provide excellent general principles for the char- will bring for changing structure of world population.
acterization and evaluation of probiotics in food, they Health decision makers have an opportunity to make
fall short of prescribing the specific tests that may need important strides in the area of probiotic research. A
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robust pipeline of strain specific benefits that probiotics 10. Borchers AT, Selmi C, Meyers FJ, Keen CL, Gershwin ME: Probiotics and
immunity. J Gastroenterol 2009, 44(1):26-46.
accrue at a local level is needed to ensure that they are 11. Shida K, Nanno M: Probiotics and immunology: separating the wheat
safely, swiftly and successfully delivered to everyone who from the chaff. Trends Immunol 2008, 29:565-573.
needs them. 12. Aso Y, Akaza H, Kotake T, Tsukamoto T, Imai K, Naito S: Preventive effect of
a Lactobacillus case preparation on the recurrence of superficial bladder
cancer in a double-blind trial. Eur Urol 1995, 27:104-109.
13. Ishikawa H, Akedo I, Otani T, Suzuki T, Nakamura T, Takeyama I, Ishiguro S,
Author details
1 Miyaoka E, Sobue T, Kakizoe T: Randomized trial of dietary fiber and
Yakult India Microbiota and Probiotic Science Foundation, New Delhi, India.
2 Lactobacillus case administration for prevention of colorectal tumors. Int
Translational Health Science and Technology Institute, Gurgaon, Haryana,
J Cancer 2005, 116:762-767.
India. 3P.D. Hinduja National Hospital, Mumbai, India. 4National Institute of
14. Matsumoto S, Hara T, Nagaoka M, Mike A, Mitsuyama K, Sako T,
Immunology, New Delhi, India.
Yamamoto M, Kado S, Takada T: A component of polysaccharide
peptidoglycan complex on Lactobacillu induced an improvement of
Authors’ contributions
murine model of inflammatory bowel disease and colitis-associated
NH has put together the report on proceedings of the symposium, “Health
cancer. Immunology 2009, 128(1 Suppl):e170-e180.
Impact of Probiotics - Vision and Opportunities.” GBN conceptualized the
15. Chiba Y, Shida K, Nagata S, Wada M, Bian L, Wang C, Shimizu T,
report and gave critical inputs related to the proceedings of the symposium.
Yamashiro Y, Kiyoshima-Shibata J, Nanno M, Nomoto K: Well-controlled
PA has reviewed the report to verify the factual details of the proceedings
proinflammatory cytokine responses of Peyer’s patch cells to probiotic
of the symposium. NKG was the chairperson of the symposium and critically
Lactobacillus casei. Immunology 2009, 130(3):352-62.
reviewed the report of the proceedings of the symposium, “Health Impact
16. Satoh Y, Shinohara K, Umezaki H, Shoji H, Satoh H, Ohtsuka Y, Shiga S,
of Probiotics - Vision and Opportunities”. All authors read and approved the
Nagata S, Shimizu T, Yamashiro Y: Bifidobacteria prevents NEC and
final manuscript.
infection in preterm infants. Inter J Probio and Prebio 2007, 2:149-54.
17. Joint Food and Agriculture Organization/World Health Organization:
Competing interests
Guidelines for the evaluation of probiotics in foods. London, Ontario,
GBN, PA and NKG are governing body members of the Yakult India
Canada; 2002, 1-11.
Microbiota and Probiotic Science Foundation and declare that they have no
18. Ng SC, Hart AL, Kamm MA, Stagg AJ, Knight SC: Mechanism of action of
competing interest. GBN is the Executive Director of the Translational Health
probiotics: recent advances. Inflamm Bowel Dis 2009, 15:300-310.
Science and Technology Institute, Gurgaon, Haryana. PA is a Senior
Consultant Gastroenterologist and Hepatologist at P.D. Hinduja National doi:10.1186/1757-4749-4-1
Hospital, Mumbai, India. NKG is Distinguished Biotechnology Research Cite this article as: Hajela et al.: Health impact of probiotics - vision and
Professor, Department of Biotechnology, National Institute of Immunology, opportunities. Gut Pathogens 2012 4:1.
New Delhi, India. NH is a Biotechnologist, Secretary and Treasurer of Yakult
India Microbiota and Probiotic Science Foundation and the Head of Science,
Yakult Danone India Pvt. Limited, a probiotic food company. The report is a
reflection of the proceedings of the symposium and not her own views or
that of the company.

Received: 7 February 2012 Accepted: 12 March 2012

Published: 12 March 2012

References
1. Gareau MG, Sherman PM, Walker A: Probiotics and the gut microbiota in
intestinal health and disease. Nat Rev Gastroenterol Hepatol 2010,
7:503-514.
2. Michail S, Sherman P: Nutrition and Human Health: Probiotics in Pediatric
Medicine Totawa: Humana/Springer Press; 2009.
3. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P,
Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C: Global,
regional, and national causes of child mortality in 2008: a systematic
analysis. Lancet 2010, 375:1969-87.
4. Humphrey JH: Child undernutrition, tropical enteropathy, toilets and
handwashing. Lancet 2009, 874:1032-35.
5. Serazin AC, Shackelton LA, Wilson C, Bhan MK: Improving the performance
of enteric vaccines in the developing world. Nature Immunol 2010,
11:769-73.
6. Sur D, Manna B, Niyogi SK, Ramamurthy T, Palit A, Nomoto K, Takahashi T,
Shima T, Tsuji H, Kurakawa T, Takeda Y, Nair GB, Bhattacharya SK: Role of
probiotic in preventing acute diarrhoea in children: a community-based, Submit your next manuscript to BioMed Central
randomized, double-blind placebo-controlled field trial in an urban
and take full advantage of:
slum. Epidemiol Infect 2011, 139:919-926.
7. Kubota H, Tsuji H, Matsuda K, Kurakawa T, Asahara T, Nomoto K: Detection
of human intestinal catalase-negative, Gram-positive cocci by rRNA- • Convenient online submission
targeted reverse transcription-PCR. Appl Environ Microbiol 2010, • Thorough peer review
76:5440-5451.
• No space constraints or color figure charges
8. Matsuda K, Tsuji H, Asahara T, Kado Y, Nomoto K: Sensitive quantitative
detection of commensal bacteria by rRNA-targeted reverse transcription- • Immediate publication on acceptance
PCR. Appl Environ Microbiol 2007, 73:32-39. • Inclusion in PubMed, CAS, Scopus and Google Scholar
9. Sakaguchi S, Saito M, Tsuji H, Asahara T, Takata O, Fujimura J, Nagata S,
Nomoto K, Shimizu T: Bacterial rRNA-targeted reverse transcription-PCR • Research which is freely available for redistribution
used to identify pathogens responsible for fever with neutropenia. J Clin
Microbiol 2010, 48:1624-1628. Submit your manuscript at
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