Probiotics May Effectively Treat Autoimmune Diseases

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Gut microbiota-based therapies may be able to improve a variety of autoimmune diseases, including fibromyalgia, psoriasis, juvenile idiopathic arthritis (JIA), lupus nephritis, systematic lupus erythematosus, ulcerative colitis, and Crohn’s disease, according to a study published in BMC Medicine.¹

Previous data has shown a link between autoimmune diseases and genetic, environmental, intestinal flora, among other factors. In addition, “fecal transplantation” has formerly been used in the treatment of ulcerative colitis as it can change the diversity and composition of intestinal flora, although this treatment option is still in its early stages.²

“Probiotics are a general term for a class of active microorganisms that can colonize the host intestine and have beneficial effects on the body,” wrote a group of Chinese investigators. “By interacting with host cells, they affect the composition and structural integrity of the intestinal flora, thereby affecting their metabolism and immunity.”

Although prior research has indicated gut microbiota-based treatment may be a potentially effective method to treat autoimmune disease, systematic summary is lacking. Therefore, in the systemic review and meta-analysis, investigators searched PubMed, Embase, Sinomed, China National Knowledge Infrastructure (CNKI), and other databases to identify eligible trials related to the treatment of autoimmune diseases with probiotics from inception through June 2022.

The outcomes were the efficacy indicators of the disease, such as Disease activity score at 28 joints (DAS28), Psoriasis Area and Severity Index (PASI), and Systemic Lupus Erythematosus Disease Activity Measure (SLEDAI).

The risk of bias was assessed by 2 investigators and RevMan 5.4 software was used for meta-analysis.

Of a total of 5799 studies, 80 randomized controlled trials and 14 types of autoimmune disease were identified. Among these groups, some randomized controlled trials contained experimental groups and were subsequently divided into “a” and “b.” These trials originated from 27 different countries and regions, including Sweden, Italy, China, Canada, New Zealand, Brazil, India, the United Kingdom, Ireland, Spain, Poland, and the United States.

Gut microbiota-based treatment relieved pain for patients with fibromyalgia, although the fibromyalgia impact questionnaire score was not significant.

Of these trials, only 1 reported adverse events, which showed no significant difference in the incidence of abnormal liver function, infection, diarrhea, tachycardia, and other adverse drug reactions between patients receiving probiotics and the control group.

Regarding DAS28, there were no significant differences in scores between the probiotic cohort and the control group. Additionally, there were no significant differences in tender joint count and swollen joint count across cohorts. Interestingly, PASI scores improved among the probiotic group when compared with controls.

Treatment may improve hemoglobin A1C (HbA1c) in type 1 diabetes mellitus (T1Dm); however, its effect on total insulin requirement does not appear to be significant.

Probiotic therapy did not increase the incidence of adverse events among this patient population.

Investigators noted potential sources of bias arising from the sample itself or from improper experimental methods. Because of this, investigators categorized data as 1) high risk, 2) inability to judge, and 3) low risk.

“This meta-analysis also showed that probiotics can improve the endoscopic score of ulcerative colitis patients, improve the overall response rate (reduce inefficiency), reduce disease activity, and reduce C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, and there are no obvious adverse events,” investigators concluded. “However, due to the small number of randomized controlled trials, no firm conclusions can be drawn, and more randomized controlled trials are needed to confirm or revise the results.”

References

1. ^{Zeng L, Yang K, He Q, et al. Efficacy and safety of gut microbiota-based therapies in autoimmune and rheumatic diseases: a systematic review and meta-analysis of 80 randomized controlled trials. BMC Med. 2024;22(1):110. Published 2024 Mar 13. doi:10.1186/s12916-024-03303-4}
2. ^{Atzeni F, Gerardi MC, Barilaro G, et al. Interstitial lung disease in systemic autoimmune rheumatic diseases: a comprehensive review. Expert Rev Clin Immunol. 2018;14(1):69–82. https://doi.org/10.1080/1744666X.2018.1411190.}