An expert panel was convened in October 2013 by the International Scientific Association for Probiotics and Prebiotics (ISAPP) to discuss the field of probiotics. It is now 13 years since the definition of probiotics and 12 years after guidelines were published for regulators, scientists and industry by the Food and Agriculture Organization of the United Nations and the WHO (FAO/WHO). The FAO/WHO definition of a probiotic--"live microorganisms which when administered in adequate amounts confer a health benefit on the host"--was reinforced as relevant and sufficiently accommodating for current and anticipated applications. However, inconsistencies between the FAO/WHO Expert Consultation Report and the FAO/WHO Guidelines were clarified to take into account advances in science and applications. A more precise use of the term 'probiotic' will be useful to guide clinicians and consumers in differentiating the diverse products on the market. This document represents the conclusions of the ISAPP consensus meeting on the appropriate use and scope of the term probiotic.

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Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)71142-9.pdf

Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders.

http://envismadrasuniv.org/Physiology/pdf/Gut%20flora%20in%20health%20and%20disease.pdf

Gut flora in health and disease

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

Gut microbiota is an assortment of microorganisms inhabiting the length and width of the mammalian gastrointestinal tract. The composition of this microbial community is host specific, evolving throughout an individual's lifetime and susceptible to both exogenous and endogenous modifications. Recent renewed interest in the structure and function of this "organ" has illuminated its central position in health and disease. The microbiota is intimately involved in numerous aspects of normal host physiology, from nutritional status to behavior and stress response. Additionally, they can be a central or a contributing cause of many diseases, affecting both near and far organ systems. The overall balance in the composition of the gut microbial community, as well as the presence or absence of key species capable of effecting specific responses, is important in ensuring homeostasis or lack thereof at the intestinal mucosa and beyond. The mechanisms through which microbiota exerts its beneficial or detrimental influences remain largely undefined, but include elaboration of signaling molecules and recognition of bacterial epitopes by both intestinal epithelial and mucosal immune cells. The advances in modeling and analysis of gut microbiota will further our knowledge of their role in health and disease, allowing customization of existing and future therapeutic and prophylactic modalities.

Gut Microbiota in Health and Disease

The market for functional products, such as probiotics, is undoubtedly the fastest growing area of new food product development. This market introduces a new paradigm for food safety professionals: beneficial physiological effects beyond those of good nutrition without adverse effects. This specificity generates a need for new approaches in food safety evaluation. Conventional toxicology and safety evaluation alone is of limited value in the safety evaluation of probiotic microorganisms. Instead, a multidisciplinary approach is necessary, involving the contributions of pathologists, geneticists, toxicologists, immunologists, gastroenterologists, and microbiologists. In the case of new products, the objective is to produce products that are at least as safe as conventional counterparts regardless of potential health benefits. In the case of existing strains, the history of safe use criterion is very much associated with being able to detect, enumerate and characterize strains to ensure consumers have been ingesting the same organism throughout the claimed exposure period.

Safety evaluation of probiotics

Traditionally probiotics are defined as viable microorganisms (bacteria or yeasts) that have a beneficial effect on the health of the host. Probiotics are used in fermented dairy products, but also in other foods, clinical foods and pharmaceutical preparations and they are also increasingly used as added functional ingredients in non-fermented foods. The selection of new probiotic organisms targets on new strains and even genera that are more beneficial or specific. When totally novel microbes and genetically modified organisms are introduced, their safety and the risk-to-benefit ratio have to be carefully studied and assessed. Also, new probiotics should be of genera and strains commonly found in the healthy human intestinal microflora. Lactic acid bacteria in foods have a long history of safe use. Members of the genera Lactococcus and Lactobacillus are most commonly regarded as having the generally recognised safe status. Members of the genera Streptococcus and Enterococcus and also other genera of lactic acid bacteria include some opportunistic pathogens. The theoretical adverse effects of probiotics including potential acute effects, strain-dependent properties, intrinsic factors and the potential virulence are discussed. The available information supports the safety of currently used probiotics, but recommendations for the safety assessment of new probiotics are needed and proposed.

Current Probiotics - Safety Assured?

Fermented dairy products, especially those containing probiotics, have many proposed health benefits. The current review provides an overview of these benefits for many of the strains used by the dairy industry. Relief of lactose maldigestion symptoms and shortening of rotavirus diarrhoea are health benefits provided by many probiotic strains. Other health benefits, like reduction of allergy and superficial bladder cancer, have been well investigated for selected strains. However, for many other proposed health benefits, scientific information remains fragmentary or inconclusive and requires further thorough investigation. In particular the benefits for the healthy consumer should receive more attention. The body of scientific evidence on the positive health effects of selected probiotics and starters is substantial and can be expected to continue to grow. This will further improve the acceptance of fermented probiotic dairy products by the consumer.

Health effects of probiotics and culture-containing dairy products in humans

Human intestinal microflora is a complex ecosystem with hundreds of bacterial species. Its metabolic functions and interactions with the host probably affect the human health and well being, but these effects are extremely difficult to study. However, for about 100 years, the idea of modifying the composition of colonic flora by consuming viable bacteria in order to improve the quality of life and to prevent and treat intestinal disorders has had some popularity. Solid clinical data have usually been lacking to support the health claims associated with these so-called probiotics. The situation, however, is rapidly changing. Competent clinical studies are accumulating, showing that specific probiotic microbes, mainly lactic acid bacteria and bifidobacteria, can alleviate or prevent diverse intestinal disorders and reduce the risk of some intestinal diseases. Some indication of the mechanisms of action can also be deduced from the data available, while rapidly developing molecular biological methods offer new tools to verify the survival of the probiotics in the gut and the subsequent adhesion to mucosae. While development of foods containing probiotic bacteria has a great potential for the food industry and can be expected to positively affect the general health of the population, safety considerations have to be taken into account while introducing new species or strains without a previous history of safe food use.

Probiotics: established effects and open questions.

https://www.gastro.theclinics.com/article/S0889-8553(05)00056-7/pdf

Seppo Salminen

Papers

Safety evaluation of probiotics

Current Probiotics - Safety Assured?

Health effects of probiotics and culture-containing dairy products in humans

Probiotics: established effects and open questions.

Probiotics, gut inflammation and barrier function.