Mechanisms of action of probiotics
Open accessAbstract
Probiotics are living microorganisms that confer health benefits to the host when administered in adequate amounts; however, dead bacteria and their components can also exhibit probiotic properties. Bifidobacterium and strains of lactic acid bacteria are the most widely used bacteria that exhibit probiotic properties and are included in many functional foods and dietary supplements. Probiotics have been shown to prevent and ameliorate the course of digestive disorders such as acute, nosocomial, and antibiotic-associated diarrhea; allergic disorders such as atopic dermatitis (eczema) and allergic rhinitis in infants; and Clostridium difficile-associated diarrhea and some inflammatory bowel disorders in adults. In addition, probiotics may be of interest as coadjuvants in the treatment of metabolic disorders, including obesity, metabolic syndrome, nonalcoholic fatty liver disease, and type 2 diabetes. However, the mechanisms of action of probiotics, which are diverse, heterogeneous, and strain specific, have received little attention. Thus, the aim of the present work was to review the main mechanisms of action of probiotics, including colonization and normalization of perturbed intestinal microbial communities in children and adults; competitive exclusion of pathogens and bacteriocin production; modulation of fecal enzymatic activities associated with the metabolization of biliary salts and inactivation of carcinogens and other xenobiotics; production of short-chain and branched-chain fatty acids, which, in turn, have wide effects not only in the intestine but also in peripheral tissues via interactions with short-chain fatty acid receptors, modulating mainly tissue insulin sensitivity; cell adhesion and mucin production; modulation of the immune system, which results mainly in the differentiation of T-regulatory cells and upregulation of anti-inflammatory cytokines and growth factors, i.e., interleukin-10 and transforming growth factor; and interaction with the brain-gut axis by regulation of endocrine and neurologic functions. Further research to elucidate the precise molecular mechanisms of action of probiotics is warranted.
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Clinical outcomes of probiotics vary widely because host genetics, baseline microbiota, diet, medications, and comorbidities modulate response and susceptibility, explaining heterogeneous results across studies.
“Clinical outcomes vary widely because host genetics, baseline microbiota, diet, medications, and comorbidities modulate response and susceptibility, which explains the heterogeneous results across studies [15,114,115].”
From Current Concepts in Probiotic Safety and Efficacy (2026) · cites this paper as [114]
The 'Volatile fatty acids' section (page unavailable) reports that probiotic effects on the microbiota and short-chain fatty acids may depend on the initial intestinal microbial ecosystem, supporting a role for baseline microbiota in differing responses. It does not establish that host genetics, diet, medications, and comorbidities modulate clinical outcomes or that those factors explain heterogeneous results across studies. (LLM, conf=0.86)
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Current Concepts in Probiotic Safety and Efficacy
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- Authors
- Plaza-Diaz, J., Ruiz-Ojeda, F. J., Gil-Campos, M., & Gil, A.
- ORCID
- Gil, Angel
- Venue
- Advances in Nutrition
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 10
- Issue
- suppl_1
- Pages
- S49-S66
- ISSN
- 2156-5376 (ISSN-L)
- 2161-8313
- PMC
- PMC6363529
- OpenAlex
- W2914734699
- Cited by
- 1,423
- References
- 162
- Citations by year
- 2026: 210 · 2025: 249 · 2024: 232 · 2023: 238 · 2022: 226 · 2021: 147 · 2020: 88 · 2019: 29 · 2018: 2 · 2017: 2
- FWCI
- 62.39
- Type
- journal article
- Language
- en
- Update notices
- erratum (2020-07-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Advances in Nutrition (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Funders
- Universidad de Granada
- U.S. Food and Drug Administration
- International Union of Nutritional Sciences
- 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 › Infant Nutrition and Health
- Keywords
- probiotics, mechanism of action, Bifidobacterium, lactic acid bacteria, gut microbiota colonization, competitive exclusion, bacteriocins, short-chain fatty acids, branched-chain fatty acids, mucin production, immunomodulation, regulatory T cells, IL-10, transforming growth factor, gut-brain axis, metabolic disorders, obesity, type 2 diabetes, non-alcoholic fatty liver disease, metabolic syndrome, Clostridium difficile-associated diarrhea, antibiotic-associated diarrhea, atopic dermatitis, allergic rhinitis, functional foods
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