Abstract

Functional gastrointestinal disorders (FGIDs) are a common concern during the first year of life. Recognized as gut-brain axis disorders by Rome IV criteria, FGIDs etiology is linked to altered gut-brain interaction, intestinal physiology, and microbiota. In this regard, probiotics have emerged as a promising therapy for infant FGIDs. In this study, we have investigated the probiotic potential of the strains Bifidobacterium longum KABP042 and Pediococcus pentosaceus KABP041—isolated from healthy children’s feces—in the treatment of FGIDs. To this scope, genome sequences of both strains were obtained and subjected to in silico analyses. No virulence factors were detected for any strain and only the non-transferable erm(49) gene, which confers resistance to erythromycin and clindamycin, was identified in the genome of B. longum KABP042. Safety of both strains was confirmed by acute oral toxicity in rats. In vitro characterization revealed that the strains tolerate gastric and bile challenges and display a great adhesion capacity to human intestinal cells. The two strains mediate adhesion by different mechanisms and, when combined, synergically induce the expression of Caco-2 tight junction proteins. Moreover, growth inhibition experiments demonstrated the ability of the two strains alone and in combination to antagonize diverse Gram-negative and Gram-positive bacterial pathogens during sessile and planktonic growth. Pathogens’ inhibition was mostly mediated by the production of organic acids, but neutralization experiments strongly suggested the presence of additional antimicrobial compounds in probiotic culture supernatants such as the bacteriocin Lantibiotic B, whose gene was detected in the genome of B. longum KABP042. Finally, an exploratory, observational, pilot study involving 36 infants diagnosed with at least one FGID (infant colic and/or functional constipation) showed the probiotic formula was well tolerated and FGID severity was significantly reduced after 14 days of treatment with the 2 strains. Overall, this work provides evidence of the probiotic and synergic properties of strains B. longum KABP042 and P. pentosaceus KABP041, and of their potential to treat pediatric FGIDs.Clinical Trial Registration: [www.ClinicalTrials.gov], [identifier NCT04944628].

Highlights

  • Infants commonly suffer from gastrointestinal symptoms that do not have an organic explanation and are diagnosed as having a functional gastrointestinal disorder (FGID)

  • According to EFSA criteria (EFSA, 2018, 2021), P. pentosaceus KABP041 and B. longum KABP042 do not pose any concern in relation to potential antimicrobial resistance (AMR) dissemination

  • We investigated the probiotic properties and the functionality of the two strains B. longum KABP042 and P. pentosaceus KABP041 through in vitro tests, genomic analysis, and in vivo assays, including an exploratory, observational trial to test the safety, tolerability and efficacy of the probiotic combination in infants diagnosed with FGIDs involving infant colic and functional constipation

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Summary

Introduction

Infants commonly suffer from gastrointestinal symptoms that do not have an organic explanation and are diagnosed as having a functional gastrointestinal disorder (FGID). One in two infants develop FGIDs during the first 6 months of life and up to 75% of these children suffer two or more at the same time (Vandenplas et al, 2015). FGIDs reduce quality of life of pediatric patients (Robin et al, 2018), cause distress to caregivers impairing family function and lead to repetitive visits to pediatricians impacting healthcare costs (Vandenplas et al, 2015). Infant colic and functional constipation are among the most prevalent pediatric FGIDs, with an aggregated prevalence of 35% in infants younger than 12 months (Vandenplas et al, 2015). Functional constipation involves infrequent and/or painful defecation, fecal incontinence, and abdominal pain, causing physical suffering to infants and emotional suffering to infants and parents (Levy et al, 2017)

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