Abstract
Necrotizing enterocolitis (NEC) is a devastating disease predominately found in premature infants that is associated with significant morbidity and mortality. Despite decades of research, medical management with broad spectrum antibiotics and bowel rest has remained relatively unchanged, with no significant improvement in patient outcomes. The etiology of NEC is multi-factorial; however, gastrointestinal dysbiosis plays a prominent role in a neonate’s vulnerability to and development of NEC. Probiotics have recently emerged as a new avenue for NEC therapy. However, current delivery methods are associated with potential limitations, including the need for at least daily administration in order to obtain any improvement in outcomes. We present a novel formulation of enterally delivered probiotics that addresses the current limitations. A single enteral dose of Lactobacillus reuteri delivered in a biofilm formulation increases probiotic survival in acidic gastric conditions, increases probiotic adherence to gastrointestinal epithelial cells, and reduces the incidence, severity, and neurocognitive sequelae of NEC in experimental models.
Highlights
Necrotizing enterocolitis (NEC) is a disease that has been a major source of morbidity and mortality for premature neonates for decades
The etiology of NEC is multi-factorial with prematurity, low birth weight, administration of enteral feeds, and antibiotic exposure associated with development of the disease [2,5]
Ofof a biocompatible dextranomer microsphere (DM; red); (B) magnified scanningelectron electronmicroscopy microscopy (SEM) image demonstrating the production of biofilm by L. reuteri adhered to a sucrose-loaded dextranomer microspheres (DMs)
Summary
Necrotizing enterocolitis (NEC) is a disease that has been a major source of morbidity and mortality for premature neonates for decades. To counter the altered intestinal microbiome and to reduce the pathogenic bacterial colonization frequently seen in premature infants, administration of probiotics, or live microorganisms that confer a health benefit on the host, emerged as a means of NEC prevention in the late 1990s [21,22]. Repeated administration of oral probiotic bacteria to premature infants with compromised gut barrier function can be problematic, given the risk of inducing bacteremia or sepsis from the probiotic administered [36,37,38,39] To overcome these concerns and limitations, we introduced a novel probiotic delivery system that delivers beneficial health-promoting Lactobacillus reuteri (ATCC 23272) in a biofilm state rather than in a free-living planktonic state [40,41]. This review describes our findings from multiple publications using our novel probiotic delivery system, as well as the potential future applications it may bring to neonatal care
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