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Clinical nutrition, enteral and parenteral nutrition

The influence of probiotic supplementation on gut permeability in patients with metabolic syndrome: an open label, randomized pilot study



Obesity and metabolic disorders are linked to inflammation via gut microbiota and/or gut permeability. Gut-derived endotoxin triggers inflammation leading to metabolic syndrome (MetS) and contributing to oxidative stress. We intended to investigate the effect of Lactobacillus casei Shirota on gut permeability, presence of endotoxin and neutrophil function in MetS.


Patients with MetS were randomized to receive 3 × 6.5 × 109 CFU L. casei Shirota (probiotic group) or not for 3 months. Gut permeability was assessed by a differential sugar absorption method and by determination of diaminooxidase serum levels, endotoxin by an adapted limulus amoebocyte lysate assay, neutrophil function and toll-like receptor (TLR) expression by flow cytometry and ELISA was used to detect lipopolysaccharide-binding protein (LBP) and soluble CD14 (sCD14) levels.


Twenty-eight patients and 10 healthy controls were included. Gut permeability was significantly increased in MetS compared with controls but did not differ between patient groups. None of the patients were positive for endotoxin. LBP and sCD14 levels were not significantly different from healthy controls. High-sensitive C-reactive protein and LBP levels slightly but significantly increased after 3 months within the probiotics group. Neutrophil function and TLR expression did not differ from healthy controls or within the patient groups.


Gut permeability of MetS patients was increased significantly compared with healthy controls. L. casei Shirota administration in the MetS patients did not have any influence on any parameter tested possibly due to too-short study duration or underdosing of L. casei Shirota.

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This work was supported in part by Yakult Europe. BL, ME and NJT are supported by funds of the Oesterreichische Nationalbank (Anniversary Fund, project numbers: 12930 to VS and 13699 to HS), the Austrian Science Fund (project P24362 to VS) and the Styrian Government (project A3-16.M-1/2011-25 to HS). We thank the team of the ‘Centre for medical Research’ (ZMF) of the Medical University of Graz for technical support.

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Correspondence to H Sourij.

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Leber, B., Tripolt, N., Blattl, D. et al. The influence of probiotic supplementation on gut permeability in patients with metabolic syndrome: an open label, randomized pilot study. Eur J Clin Nutr 66, 1110–1115 (2012).

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  • endotoxin
  • gut permeability
  • metabolic syndrome
  • Lactobacillus casei Shirota

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