Aportes de la biotecnología al diagnóstico y tratamiento de la enfermedad renal crónica y comorbilidades frecuentes / Biotechnology contribution to the diagnosis and treatment of chronic kidney disease and frequent comorbidities

Este trabajo tiene como objetivo revisar las contribuciones de la biotecnología, en relación con el tratamiento, diagnóstico y la monitorización de la enfermedad renal crónica (ERC) y sus comorbilidades más frecuentes, especialmente la anemia. En relación con los tratamientos, enfocamos el desarrollo de productos biofarmacéuticos como los agentes estimulantes de la eritropoyesis (ESA), que fueron los primeros biofármacos utilizados para el tratamiento de la anemia asociada a la ERC; analizamos sus características y utilización actual después de varios años de experiencia clínica, así como también otras alternativas en desarrollo. Revisamos distintos tipos de bioterapias, la utilización de las células estromales mesenquimales de médula ósea (MSC) y tratamientos alternativos con modificaciones dietarias, que se basan en la asociación entre la microbiota intestinal de los pacientes renales crónicos y sus condiciones fisiopatológicas. Finalmente, en relación con el diagnóstico y monitorización, nos referimos al estudio y validación de biomarcadores diagnósticos, predictivos y terapéuticos que han permitido optimizar los resultados clínicos en este tipo de pacientes. (AU)

The aim of this work is to review the contributions of biotechnology, in relation to the treatment, diagnosis and monitoring of chronic kidney disease (CKD) and its most frequent comorbidities, especially anemia. Regarding the treatment, we focus on the development of biopharmaceutical products such as erythropoiesis stimulating agents (ESA), which were the first biopharmaceuticals used to treat anemia associated with chronic kidney disease (CKD). We analyzed their characteristics and their current use after several years of clinical experience, as well as other alternatives in development. We also review different types of biotherapies, the use of bone marrow mesenchymal stromal cells (MSC) and alternative treatments with dietary modifications, which are based on the association between the intestinal microbiota of chronic kidney patients and their pathophysiological conditions. Finally, in relation to diagnosis and monitoring, we refer to the study and validation of diagnostic, predictive and therapeutic biomarkers that have made clinical results possible to be optimized in this type of patient. (AU)

[Prebiotics as functional food ingredients: terminology, choice and comparative evaluation criteria, classification].

The purpose of this review is to analyze current concepts of prebiotics as one of the most promising groups of functional food ingredients, identify problems and trends in the investigations in this area. The background for the emergence and development stages of the concept of «prebiotics¼ as non-digestible food substances that selectively stimulate the growth and (or) the biological activity of one or a limited number of representatives of the protective microflora of the human intestine, contributing to the maintenance of its normal structure and biological activity is shown. The criteria for selecting prebiotics and the formula for prebiotic index determining are presented. Methods for determining the bifidogenic properties of functional foods enriched with probiotic microorganisms or prebiotic substances are described. Prebiotics are classified according to several factors: nature and structure, origin and sources of raw materials, the method of production, the field of application. It is shown that most researchers consider prebiotics only as substances of carbohydrate nature, primarily indigestible oligosaccharides. A brief description of the most studied prebiotics (fructans, galactans and lactulose) is given. The information on technological properties of oligosaccharide-prebiotics is generalized. It is shown that prebiotics belong to the fast growing segments in the world market of functional ingredients, however their production and use in Russia is still at the initial stage of development. The main tasks in the field of prebiotics researches are defined: clarifying the definition, improving the methods for analyzing their chemical composition, study of the effectiveness and mechanisms of influence on the intestinal microbiota, especially on the interaction in the «macroorganism-microbiota¼ system using modern molecular genetic methods; scientific substantiation of the possibility of prebiotics using for the prevention and treatment of alimentary-dependent diseases. For the practical implementation of these tasks, it is necessary to develop new cost-effective methods for the production of prebiotics and synbiotics, as well as food technology with their use.

Comparative effect of different dietary inulin sources and probiotics on growth performance and blood characteristics in growing-finishing pigs.

The study was focused on assessment of the effect of an extract of long-chain inulin (LCI) and dried tubers of Jerusalem artichoke (JA) and a multispecies probiotic preparation as well as a combination thereof on growth performance and blood parameters of fattening pigs. In total, 144 pigs (initial body weight 30.0 ± 0.5 kg) were used in a 98-d experiment. The six dietary treatments consisted of the control diet (Con), diet Con supplemented with probiotics (ConP) and four diets supplemented with LCI or JA alone or with probiotics (diets LCIP and JAP). Throughout the fattening period, there was a beneficial effect of the probiotic supplementation to the inulin-containing diets and the average daily gain (ADG) was increased by supplementation of probiotics in combination with inulin sources (p < 0.05). At the end of the fattening period, ADG and feed conversion ratio (FCR) were higher after supplementation of LCI only (p < 0.05). Compared with group ConP, in groups LCI and JA, the ADG and FCR were improved (p < 0.05). Only in the first fattening stage, the addition of the prebiotics and/or probiotics had an impact on the level of white blood cells and some biochemical indices in pigs. In younger animals, probiotic or LCI supplementation increased the IgG level (p < 0.05). There was also an interaction between the probiotics and JA resulting in increased IgG and IgA concentrations (p < 0.05). In the finishing period, LCI addition increased the IgM level (p < 0.05), whereas JA addition increased IgG and IgM levels as well (p < 0.05). In conclusion, both dietary sources of inulin and probiotic supplementation can improve the fattening performance and health status of growing pigs.

Impact of the incorporation of probiotic strains and fruit by-products in fermented synbiotic soy product and on the composition and metabolic activity of the gut microbiota in vitro / Impacto da incorporação de cepas probióticas e de subprodutos de frutas em um produto fermentado de soja simbiótico e sobre a composição e a atividade metabólica da microbiota intestinal humana in vitro

The present study aimed to develop a fermented soy beverage containing fruit by-products and probiotics and to evaluate the impact of this product on the composition and metabolic activity of the human intestinal microbiota using an in vitro simulation model of the intestinal conditions (TIM-2). Therefore, the present study was divided into three stages. Stage I was based on obtaining, processing and physical-chemical, microbiological and functional characterization of fruit by-products (acerola, orange, mango, and passion fruit) and soybean (okara), as well as amaranth flour. Additionally, the ability to use these vegetable by-products and amaranth flour by probiotic and non-probiotic strains was evaluated. The results showed that the acerola byproduct presented the highest dietary fibre content (48.46 g/100 g) among the by-products tested, as well as amaranth flour. Orange and passion fruit by-products were the substrates that most promoted the growth of bacterial populations, including strains of Escherichia coli and Clostridium perfringens. On the other hand, the acerola by-product was the substrate that showed the highest selectivity for beneficial bacteria. Also, in this stage, ten probiotic strains (seven lactobacilli and three bifidobacteria) and three starter strains (Streptococcus thermophilus) were tested for their ability to deconjugate bile salts and for proteolytic activity against milk and soy proteins. The results showed that none of the tested strain showed proteolytic ability against milk and soybean proteins. In addition, the probiotic strains Lactobacillus acidophilus LA-5 and Bifidobacterium longum BB-46 deconjugated more types of bile acids tested, and the strains of S. thermophilus tested showed no ability to deconjugate bile salts. Next, the acerola by-product (ABP) and the probiotic strains LA-5 and BB-46 were selected to continue stage II of the study (development of a fermented soy beverage). For this purpose, a 23 factorial design was used, in a total of 8 trials with three replicates of each one, and the effects of the probiotic strains and the acerola by-product on the physical-chemical, microbiological, and sensory characteristics of these fermented soy beverages were evaluated. At the same time, probiotic viability and survival under in vitro gastrointestinal (GI) simulated conditions were evaluated in fermented soy beverage (FSB). The results showed that the presence of BB-46 and ABP affected the sensory acceptability of FSB negatively. ABP also led to significant differences in the texture profile of the FSB (P<0.05). Populations of probiotic strains ranged from 7.0 to 8.2 log CFU equivalent/mL during 28 days of refrigerated storage (4° C) of FBS, and the co-culture (LA-5+BB-46) and the ABP did not affect the viability of both microorganisms significantly (P> 0.05). However, ABP increased the survival of BB-46 under in vitro simulated GI conditions significantly. For stage III, a 22 experimental design was performed. To evaluate the impact of these FBS on the composition and metabolic activity of the intestinal microbiota of lean and obese humans, a validated in vitro model called TIM-2 was used, available at the Maastricht University (Venlo, The Netherlands), which simulates normal conditions of the lumen of the proximal colon, with all parameters controlled by a computer. Samples were collected from TIM-2 to quantify probiotic microorganisms (LA-5 and BB-46), Lactobacillus spp., Bifidobacterium spp., and total bacteria, using the quantitative PCR method (qPCR) and the intestinal microbiota profile was determined using an Illumina Mysec Next Generation Sequencing (NGS) method. Concentrations of shortchain fatty acids and branched-chain fatty acids and lactate produced by the different microbiotas during fermentation in TIM-2 were also determined. The results showed that the lean microbiota presented the high production of acetate and lactate than the microbiota of obese individuals. Significant reductions in Bifidobacterium populations in the lean microbiota were observed at 0 and 48 h of an assay for all experimental meals, except for the meal that had the probiotic combination (LA-5 and BB-46) and the ABP supplementation, which showed an increased total Bifidobacterium and Lactobacillus populations throughout the experimental period for both microbiotas tested. The FSB supplemented with ABP presented the best characteristics regarding the modulation of the obese microbiota, with an increase in Bifidobacterium spp. and Lactobacillus spp. Additionally, after 48 hours of intervention in TIM-2, the obese microbiota was apparently similar to the lean microbiota, showing a beneficial modulation of this microbiota. The results suggest that the fermented soy beverage supplemented with the acerola by-product and the probiotic strains may present beneficial health effects. However, clinical studies are required to complement and confirm the results observed in the in vitro assays

O presente trabalho visou desenvolver uma bebida fermentada de soja adicionada de resíduos de frutas e suplementada com cepas probióticas e avaliar o impacto desse produto sobre a composição e a atividade metabólica da microbiota intestinal humana, utilizando um modelo de simulação in vitro das condições intestinais (TIM-2). Para tanto, o presente trabalho foi dividido em três etapas. A etapa I foi baseada na obtenção, processamento e caracterização físico-química, microbiológica e funcional de subprodutos de frutas (acerola, laranja, manga e maracujá) e soja (okara), bem como da farinha de amaranto. Adicionalmente, a capacidade de utilização desses subprodutos vegetais e da farinha de amaranto por cepas probióticas e não probióticas foi avaliada. Os resultados mostraram que o subproduto de acerola apresentou o maior conteúdo de fibras alimentares totais (48,46 g/100 g) dentre os subprodutos testados, bem como a farinha de amaranto. Os subprodutos de laranja e maracujá foram os substratos que mais promoveram a multiplicação das populações bacterianas, incluindo das cepas de Escherichia coli e Clostridium perfringens. Por outro lado, o subproduto de acerola foi o substrato que apresentou a maior seletividade para bactérias benéficas. Ainda nessa etapa, dez cepas probióticas (sete lactobacilos e três bifidobacterias) e três cepas starter (Streptococcus thermophilus) foram testadas quanto à sua capacidade de desconjugação de sais biliares e atividade proteolítica frente às proteínas do leite e da soja. Os resultados revelaram que nenhuma cepa testada apresentou capacidade de proteólise das proteínas do leite e da soja. Adicionalmente, as cepas probióticas Lactobacillus acidophilus LA-5 e Bifidobacterium longum BB-46 desconjugaram a maior quantidade de ácidos biliares testados e as cepas de S. thermophilus testadas não apresentaram capacidade de desconjugação de sais biliares. Após a análise dos resultados da etapa I, o resíduo de acerola (ABP) e as cepas probióticas LA-5 e BB-46 foram selecionadas para dar continuidade à etapa II do estudo(desenvolvimento de uma bebida fermentada a base de soja). Para esse fim, foi utilizado um delineamento experimental do tipo fatorial 23, totalizando 8 ensaios com três repetições de cada, e foram avaliados os efeitos das cepas probióticas e do subproduto de acerola sobre as características físico-químicas, microbiológicas e sensoriais dessas bebidas fermentadas de soja. Paralelamente, foram realizadas análises da sobrevivência das cepas probióticas frente às condições gastrintestinais simuladas in vitro nas bebidas fermentadas de soja (FSB). Os resultados mostraram que a presença de BB-46 e ABP afetaram negativamente a aceitabilidade sensorial das FSB. O ABP também levou a diferenças significativas no perfil de textura das FSB (P<0,05). As populações das cepas probióticas nas diferentes formulações de FSB variaram de 7,0 a 8,2 log de UFC equivalente/mL durante os 28 dias de armazenamento (4 ºC) e a co-cultura (LA-5+BB-46) e o ABP não afetaram (P>0,05) a viabilidade de ambos os microrganismos. No entanto, ABP aumentou significativamente a sobrevivência de BB-46 frente às condições gastrintestinais sumuladas in vitro. Para a etapa III do presente estudo, um delineamento experimental fatorial 22 foi realizado. Para a avaliação do impacto dessas FSB sobre a composição e atividade metabólica da microbiota intestinal de humanos eutróficos e obesos, foi utilizado um modelo in vitro TIM-2 na Maastricht University (Venlo, Holanda), que simula as condições normais do lúmen do cólon proximal, com todos os parâmetros controlados por um computador. Amostras foram coletadas do TIM-2 para a quantificação dos microrganismos probióticos (LA-5 e BB-46), Lactobacillus spp., Bifidobacterium spp. e bactérias totais, utilizando o método de PCR quantitativo (qPCR), e o perfil da microbiota intestinal foi determinado utilizando Next-Generation Sequencing (NGS) Illumina Mysec. A concentração de ácidos graxos de cadeia curta e de cadeia ramificada e lactato produzidos pelas diferentes microbiotas durante a fermentação no TIM-2 também foi determinada. Os resultados mostraram que a microbiota de humanos eutróficos apresentou uma alta produção de acetato e lactato em comparação com a microbiota de obesos. Reduções significativas das populações de Bifidobacterium na microbiota de eutróficos foram observadas entre 0 e 48 h de ensaio para todas as refeições experimentais, exceto para a refeição que apresentou a combinação probiótica (LA-5 e BB-46) e a suplementação com ABP, que apresentou aumento de Bifidobacterium e Lactobacillus totais durante todo o período de análise para ambas as microbiotas testadas. As FSB suplementadas com ABP apresentaram os melhores resultados em relação à modulação da microbiota de humanos obesos, com o aumento Bifidobacterium spp. e Lactobacillus spp. Adicionalmente, após 48 horas de intervenção no TIM-2, a microbiota de obesos foi aparentemente similar à microbiota de eutróficos, mostrando uma modulação benéfica dessa microbiota. Os resultados sugerem que as bebidas fermentadas de soja suplementadas com o subproduto de acerola e cepas probióticas podem apresentar efeitos benéficos à saúde. No entanto, estudos clínicos são necessários para complementar e confirmar os resultados observados nos ensaios in vitro

Probióticos e prebióticos na prevenção e no tratamento de doenças em lactentes e crianças / Probiotics and prebiotics in prevention and treatment of diseases in infants and children

OBJETIVO: Avaliar o impacto do uso de probióticos e prebióticos na saúde das crianças. FONTES DOS DADOS: Foram pesquisados os bancos de dados MEDLINE e LILACS, selecionando-se artigos relevantes em inglês e francês. SÍNTESE DOS DADOS: O leite humano é rico em oligossacarídeos prebióticos e pode conter probióticos. Não existem dados sugerindo que a adição de probióticos a fórmulas para lactentes possa ser prejudicial, mas as evidências de sua eficácia são insuficientes para que seja recomendada. Visto que dados sugerem que a adição de oligossacarídeos prebióticos específicos pode reduzir infecções e atopia em lactentes saudáveis, sua adição parece razoável. Os benefícios a longo prazo dos pro e prebióticos para o sistema imunológico em desenvolvimento ainda precisam ser comprovados. Probióticos selecionados reduzem a duração da diarreia infecciosa em 1 dia, mas faltam evidências quanto à prevenção, exceto na diarreia associada a antibióticos. Alguns probióticos específicos previnem a enterocolite necrosante, e outros micro-organismos podem ser benéficos nos casos de gastrite por Helicobacter pylori e de cólica do lactente. Não há evidências suficientes para recomendar o uso de probióticos na prevenção e no tratamento da dermatite atópica. A utilização de probióticos nos casos de constipação, síndrome do intestino irritável, doença inflamatória intestinal e infecções extraintestinais requer mais estudos. CONCLUSÕES: A duração da administração, a dosagem microbiana e as espécies utilizadas necessitam de maior validação, tanto para probióticos quanto para prebióticos. Alegações de saúde injustificadas são uma grande ameaça ao conceito de pro e prebióticos.

OBJECTIVE: To evaluate the impact of probiotics and prebiotics on the health of children. SOURCES: MEDLINE and LILACS were searched for relevant English and French-language articles. SUMMARY OF THE FINDINGS: Human milk is rich in prebiotic oligosaccharides and may contain some probiotics. No data suggest that addition of probiotics to infant formula may be harmful, but evidence of its efficacy is insufficient for its recommendation. Since data suggest that addition of specific prebiotic oligosaccharides may reduce infections and atopy in healthy infants, their addition to infant formula seems reasonable. Long-term health benefits of pro- and prebiotics on the developing immune system remain to be proven. Selected probiotics reduce the duration of infectious diarrhea by 1 day, but evidence in prevention is lacking, except in antibiotic-associated diarrhea. Some specific probiotics prevent necrotizing enterocolitis, and other microorganisms may be beneficial in Helicobacter pylori gastritis and in infantile colic. Evidence is insufficient to recommend probiotics in prevention and treatment of atopic dermatitis. The use of probiotics in constipation, irritable bowel syndrome, inflammatory bowel disease, and extra-intestinal infections requires more studies. CONCLUSIONS: Duration of administration, microbial dosage, and species used need further validation for both pro- and prebiotics. Unjustified health claims are a major threat for the pro- and prebiotic concept.

Probiotics and prebiotics in prevention and treatment of diseases in infants and children.

OBJECTIVE: To evaluate the impact of probiotics and prebiotics on the health of children. SOURCES: MEDLINE and LILACS were searched for relevant English and French-language articles. SUMMARY OF THE FINDINGS: Human milk is rich in prebiotic oligosaccharides and may contain some probiotics. No data suggest that addition of probiotics to infant formula may be harmful, but evidence of its efficacy is insufficient for its recommendation. Since data suggest that addition of specific prebiotic oligosaccharides may reduce infections and atopy in healthy infants, their addition to infant formula seems reasonable. Long-term health benefits of pro- and prebiotics on the developing immune system remain to be proven. Selected probiotics reduce the duration of infectious diarrhea by 1 day, but evidence in prevention is lacking, except in antibiotic-associated diarrhea. Some specific probiotics prevent necrotizing enterocolitis, and other microorganisms may be beneficial in Helicobacter pylori gastritis and in infantile colic. Evidence is insufficient to recommend probiotics in prevention and treatment of atopic dermatitis. The use of probiotics in constipation, irritable bowel syndrome, inflammatory bowel disease, and extra-intestinal infections requires more studies. CONCLUSIONS: Duration of administration, microbial dosage, and species used need further validation for both pro- and prebiotics. Unjustified health claims are a major threat for the pro- and prebiotic concept.

Inmunonutrición: segunda parte / Immunonutrition: second part

El concepto de inmunonutrición se refiere a la adición de nutrimentos específicos a los regímenes de nutrición enteral o parenteral, en concentraciones mayores a las habitualmente contenidas en las dietas normales, para lograr un efecto farmacológico determinado que mejore la función inmunitaria. Todos los conceptos mencionados indican que el eje intestinoneuroendocrino tiene un papel significativo al influir en la vulnerabilidad del hospedero a infecciones. Entre los inmunonutrimentos se encuentran: arginina, glutamina, ácidos grasos ù-3, prebióticos, zinc, y vitamina A.

The concept of immunonutrition concerns the addition of specific nutrients to the regimes of enteral or parenteral nutrition, at concentrations greater than those usually contained in normal diets to achieve a given pharmacological effect to improve immune function. All the concepts above indicate that gutneuroendocrine axis plays a significant role in influencing host vulnerability to infection. Among inmunonutriments are: arginine, glutamine, ù-3 fatty acids, prebiotics, zinc, and vitamin A.