Current Clinical Pharmacology

The gut microbiota and their metabolites play a central role in modulating gut health and disease in all age groups. The administration of beneficial microbes (probiotics) confer several health benefits on the host. The administration of some indigestible dietary fibre/carbohydrate (prebiotics) alone or in combination with probiotics (symbiotics) can also alter the composition and/or activity of the intestinal microbiota and bring possible benefits to the individual’s health. The use of prebiotics, probiotics, and symbiotics formulations has been appreciated for health benefits in "topping up your good bacteria" or indeed in an attempt to normalise the dysbiotic microbiota associated with several disorders. Prebiotics, probiotics and symbiotics are widely used to mantain a proper gut immune function and promote healthy digestive system and treat several gastro-intestinal disorders however, new therapeutic uses are emerging in several disorders and pathologies not only affecting the digestive system but also other organs and systems. The thematic issue is intended to provide updated reviews about clinical y preclinical evidence of uses of prebiotics, probiotics, and synbiotics. We hope that this special issue will help attract the interest of different medical specialties, nursing care and other communities, such as public, health-related academics and industry, on this group of bioactive compounds. This issue of Current Clinical Pharmacology, ‘‘New effects of prebiotics, probiotics, and symbiotics” reflects the interplay between different health sciences at the leading edge of this growing research field which intensively suggest new opportunities for improving the care or to prevent adverse outcomes in several disorders. Roselli and Finamore [1] reviewed the use of synbiotics in the treatment of ulcerative colitis, a chronic inflammation of the colon caused by a dysregulated immune response to host intestinal microbiota in genetically susceptible subjects. The mechanism of actions of synbiotics appears to be mediated by the modulation of the inflammatory response through cytokine expression and immune cell modulation induced by probiotic bacteria, and stimulating on production of certain short-chain fatty acid by prebiotics. Jayanama and Theou [2] review the benificial effects of probiotics and prebiotics on frailty and ageing because in older people the inappropriate intake of prebiotics and probiotics, sarcopenia, physical inactivity, polypharmacy, and social vulnerability can lead to a gut dysbiosis. The use of probiotics and prebiotics may improve the homeostasis of gut microflora and prevent frailty and unhealthy aging, although their effects vary based on the features of individual populations. Chronic wounds are commonly associated with polymicrobial biofilm infections. In the previous years, the extensive use of antibiotics has generated several antibiotic-resistant variants. To overcome this issue, alternative natural treatments have been proposed, including the use of microorganisms like probiotics. Brognara et al. [3] reviewed the scientific evidence for the use of probiotics in the treatment of infected chronic wounds. Lactobacillus plantarum currently represents the most studied strain, showing a positive application in burns compared to guideline treatments, and an additional mean in chronic wound infections. Naseer et al. [4] reviewed the available literature on the utility of different commercially available prebiotics in patients with functional and chronic idiopathic constipation, a highly prevalent functional gastrointestinal disorder that may significantly affect the quality of life and health care costs. The authors conclude after the analysis of clinical trials that the administration of prebiotics is an effective treatment for chronic idiopathic constipation as it improves the stool consistency, number of bowel moments and bloating. Naseer et al. [5] reviewed the use of prebiotics and probiotic in inflammatory bowel diseases. They found most of the studies evaluating the effects of probiotics used administration of lactobacillus, VSL#3 or Escherichia coli nissle 1917 and there is also evidence supporting these agents for induction and maintenance of remission in ulcerative colitis and prevention of pouchitis relapse with minimal adverse effects. The efficacy of prebiotics such as fructooligosaccharides and Plantago ovata seeds in ulcerative colitis are inconclusive and the data regarding the utility of prebiotics in pouchitis is limited. In contrast, the results of the clinical trials for remission induction and maintenance in active Crohn's disease or post-operative relapse with probiotics and prebiotics are inadequate and not very convincing. Prebiotics and probiotics are safe, effective and have great therapeutic potential. However, better designed clinical trials in the multicenter setting with a large sample and long duration of intervention are needed to identify the specific strain or combination of probiotics and prebiotics which will be more beneficial and effective in patients with inflammatory bowel disease. Vlachoud et al. [5] in their systematic review evaluated randomized controlled trials and experimental studies assessing the effect of probiotic supplements on diabetic nephropathy. Most of the microorganisms used in the studies belonged to the Lactobacillus and Bifidobacterium genus although they did not follow a specific dosage. The majority of the studies demonstrated the benefits of probiotic supplementation on the reduction of inflammation, oxidative stress and on the amelioration of renal function biomarkers in subjects with diabetic nephropathy [6].