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Probiotics and prebiotics in intestinal health and disease: from biology to the clinic
Open accessAbstract
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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“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]
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“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]
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“These approaches are primarily used in the early stages of discovery and safety screening to identify potential antibiotic resistance genes, virulence-associated traits, and mobile genetic elements, enabling risk assessment and regulatory evaluation, and supporting phenotypic analyses and clinical validation [31,152,153].”
From Current Concepts in Probiotic Safety and Efficacy (2026) · cites this paper as [153]
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“In contrast, AI-based predictions are currently considered 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].”
From Current Concepts in Probiotic Safety and Efficacy (2026) · cites this paper as [153]
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“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]
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“In particular, these approaches are crucial for non-traditional probiotic candidates derived from gut commensals that lack a long history of safe use—such as Akkermansia, Faecalibacterium, Bacteroides, and Clostridium species—where in silico analyses complement phenotypic testing to accelerate safe development [153,162].”
From Current Concepts in Probiotic Safety and Efficacy (2026) · cites this paper as [153]
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Metadata
- 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)
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2019-07-11
- Volume
- 16
- Issue
- 10
- Pages
- 605-616
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- 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
- FWCI
- 16.49
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-08-09)
- Open access
- 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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