Probiotics and prebiotics in intestinal health and disease: from biology to the clinic

Sanders, Mary Ellen; Merenstein, Daniel J.; Reid, Gregor; Gibson, Glenn R.; Rastall, Robert A.

doi:10.1038/s41575-019-0173-3

Cited by 2,059Probiotics and Fermented FoodsGut microbiota and healthMicrobial Metabolites in Food Biotechnology

Probiotics and prebiotics in intestinal health and disease: from biology to the clinic

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Sanders, Mary Ellen, Merenstein, Daniel J., Reid, Gregor, Gibson, Glenn R., Rastall, Robert A.·2019·Nature Reviews Gastroenterology & Hepatology

DOI 10.1038/s41575-019-0173-3

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Abstract

Probiotics and prebiotics are microbiota-management tools for improving host health. They target gastrointestinal effects via the gut, although direct application to other sites such as the oral cavity, vaginal tract and skin is being explored. Here, we describe gut-derived effects in humans. In the past decade, research on the gut microbiome has rapidly accumulated and has been accompanied by increased interest in probiotics and prebiotics as a means to modulate the gut microbiota. Given the importance of these approaches for public health, it is timely to reiterate factual and supporting information on their clinical application and use. In this Review, we discuss scientific evidence on probiotics and prebiotics, including mechanistic insights into health effects. Strains of Lactobacillus, Bifidobacterium and Saccharomyces have a long history of safe and effective use as probiotics, but Roseburia spp., Akkermansia spp., Propionibacterium spp. and Faecalibacterium spp. show promise for the future. For prebiotics, glucans and fructans are well proven, and evidence is building on the prebiotic effects of other substances (for example, oligomers of mannose, glucose, xylose, pectin, starches, human milk and polyphenols).

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Pre- and pro-biotics offer a route to manipulate the microbiome in prodromal PD.
“Alongside antibiotics, pre- and pro-biotics offer a route to manipulate the microbiome in prodromal PD [174–176], as assessed in Table 1.”
From The gut–brain axis in early Parkinson’s disease: from prodrome to prevention (2025) · cites this paper as [176]
The Introduction says prebiotics have been used to manipulate host microbes, and 'The future' says both probiotics and prebiotics can increase beneficial microorganisms. Those passages support the general route to microbiome manipulation, but the cited paper does not establish its use specifically in prodromal Parkinson’s disease (searched: Parkinson, prodromal, constipation). (LLM, conf=0.84)
Experimental — accuracy not yet measured
The antimicrobial efficacy of probiotics is highly strain-specific.
“However, the antimicrobial efficacy of probiotics is highly strain-specific, reflecting inherent differences and underscoring the importance of systematic screening and mechanistic characterization [12].”
From Comparative Genomics-Based Evaluation of Lacticaseibacillus rhamnosus KFOM 0134 as a Probiotic against Staphylococcus aureus (2026) · cites this paper as [12]
Pre- and pro-biotic interventions are shown to reverse PD pathology and symptoms in animal models.
“These interventions are shown to reverse PD pathology and symptoms in animal models, but these findings have not been reliably replicated in human studies, particularly for motor symptoms.”
From The gut–brain axis in early Parkinson’s disease: from prodrome to prevention (2025) · cites this paper as [176]
The paper’s section on probiotic mechanisms discusses animal-model findings and cautions that they do not always translate to humans. Neither that section nor the passages returned for searches on Parkinson’s disease and motor symptoms address reversal of PD pathology or symptoms in animal models. (LLM, conf=0.74)
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Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome: A Randomized Pilot Study
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Oligofructose Provides Laxation for Irregularity Associated with Low Fiber Intake
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Lack of Efficacy of Lactobacillus reuteri DSM 17938 for the Treatment of Acute Gastroenteritis: A Randomized Controlled Trial
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AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders
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“Alongside antibiotics, pre-and pro-biotics offer a route to manipulate the microbiome in prodromal PD [174–176], as assessed in Table 1.”
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“…experimental and must undergo rigorous external validation and biological confirmation before they can be considered by regulators, highlighting that computational methods complement existing safety assessments based on standardized phenotypic testing and strain-level documentation [151,153,167].”
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Authors: Sanders, M. E., Merenstein, D. J., Reid, G., Gibson, G. R., & Rastall, R. A.
Affiliations: Georgetown University Medical Center (US)
Western University (CA)
University of Reading (GB)
ORCID: Sanders, Mary Ellen
Merenstein, Daniel J.
Reid, Gregor
Gibson, Glenn R.
Rastall, Robert A.
Venue: Nature Reviews Gastroenterology & Hepatology
Publisher: Springer Science and Business Media LLC
Published: 2019-07-11
Volume: 16
Issue: 10
Pages: 605-616
ISSN: 1759-5045 (ISSN-L)
1759-5053
DOI: 10.1038/s41575-019-0173-3
OpenAlex: W2956175090
Cited by: 2,059
References: 208
Citations by year: 2026: 297 · 2025: 365 · 2024: 360 · 2023: 304 · 2022: 318 · 2021: 244 · 2020: 149 · 2019: 18 · 2017: 1
FWCI: 16.49
Type: journal article
Language: en
Update notices: correction (2019-08-09)
Open access: green
centaur.reading.ac.uk
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Nature Reviews Gastroenterology & Hepatology (publishedVersion)
PubMed (publishedVersion)
CentAUR (University of Reading) (acceptedVersion)
Scholarship@Western (Western University) (submittedVersion)
Topics: Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Health Sciences › Nursing › Nutrition and Dietetics › Microbial Metabolites in Food Biotechnology
Keywords: probiotics, prebiotics, gut microbiota, gut health, intestinal diseases, Lactobacillus, Bifidobacterium, Saccharomyces, Roseburia, Akkermansia, Propionibacterium, Faecalibacterium, glucan, fructans, oligosaccharides, pectin, breast milk, polyphenols, clinical application
MeSH terms: Gastrointestinal Microbiome, Gastrointestinal Diseases, Humans, Probiotics, Prebiotics

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Probiotics and prebiotics in intestinal health and disease: from biology to the clinic

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