The effects of synbiotic supplementation on blood pressure and other maternal outcomes in pregnant mothers with mild preeclampsia: a triple-blinded randomized controlled trial

Preeclampsia (PE) is a condition affecting pregnant women, involving protein presence in the urine and high blood pressure, and leading to short- and long-term complications for the mother and fetus, such as kidney failure, low platelet count, impaired liver function, and pulmonary edema. Reliable prevention and treatment methods for PE are currently lacking, leading to extreme management measures, including parturition and expeditious placenta removal. When PE develops in the early stages of pregnancy, the pregnancy is usually terminated to prevent maternal morbidity, causing newborn morbidity and mortality, particularly in newborns delivered before 33 weeks. This study implemented a randomized, placebo-controlled, triple-blinded phase III design to investigate the effectiveness of an oral synbiotic preparation to treat PE and prevent complications. One-hundred and twenty-eight pregnant women with mild preeclampsia and gestational age exceeding 24 weeks randomly received either one capsule/day of the oral synbiotic, which contained fructooligosaccharides (FOS) as the prebiotic and lactobacilli, bifidobacteria, and streptococci as the probiotics, or the placebo up until the time of delivery. The primary outcomes included the systolic and diastolic blood pressures and the pregnancy duration. Post-intervention, the synbiotic group experienced significantly lower systolic and diastolic blood pressure than the placebo group. The incidence of severe PE, proteinuria, and mean serum creatinine levels significantly declined in the synbiotic-supplemented group compared to the placebo group. Therefore, these findings unveil the beneficial effects of synbiotics on some PE-related pregnancy outcomes. Further studies remain necessary to verify the advantages of extended intake and higher doses of synbiotic supplementation in high-risk pregnancies for PE.

Key takeaways:

• Preeclampsia (PE) is a condition affecting pregnant women, constituting high blood pressure and protein in the urine.
• The study investigated the effects of synbiotic supplementation on blood pressure and pregnancy outcomes in pregnant women with mild PE.
• The administration of synbiotic supplements showed potential in ameliorating indicators associated with PE, such as lowering systolic and diastolic blood pressure, proteinuria, and serum creatinine, consequently preventing the progression toward severe PE. 
• Larger and longer studies to verify these advantages of synbiotic supplementation are warranted. 

Access to the study: https://pubmed.ncbi.nlm.nih.gov/38297273/ 

Reference: Movaghar, R., Abbasalizadeh, S., Vazifekhah, S., Farshbaf-Khalili, A., & Shahnazi, M. (2024). The effects of synbiotic supplementation on blood pressure and other maternal outcomes in pregnant mothers with mild preeclampsia: a triple-blinded randomized controlled trial. BMC women’s health, 24(1), 80. https://doi.org/10.1186/s12905-024-02922-6

Gut enterotype-dependent modulation of gut microbiota and their metabolism in response to xanthohumol supplementation in healthy adults

Xanthohumol (XN) is a primary polyphenol found in the hop plant (Humulus lupulus) that has traditionally been a key ingredient in beer production. XN exhibits antioxidant, anti-inflammatory, anti-hyperlipidemic, and prebiotic activity, which has made it an emerging candidate dietary supplement for various applications in biomedical syndromes. While XN and its metabolites have shown robust anti-bacterial properties in vitro against anaerobic pathogens, including Bacteroides fragilis, Clostridium perfringens, and Clostridioides difficile, how XN affects the gut ecology of healthy human adults in vivo is yet to be studied. This randomized, triple-blinded, placebo-controlled clinical trial investigated the safety and tolerability of XN. Thirty healthy adults randomly received either one capsule daily containing 24 mg/day of XN or the placebo for eight weeks. Despite minimal changes in alpha- or beta-diversity measures of the gut microbiota, the results indicated that XN supplementation reshaped individual taxa in an enterotype-dependent manner. Specifically, high inter-individual variation in metabolic profiles and bioavailability of XN metabolites were observed in the study, highlighting the personalized nature of the effects of XN. For example, microbiota-derived bile acid metabolism reductions were noted, specifically in the Prevotella and Ruminococcus enterotypes. As such, this study provides valuable insights into the personalized effects of XN on the gut microbiota and host physiology in human adults, highlighting the potential of XN use in personalized nutritional interventions. 

Key takeaways:

• XN is one of the primary polyphenols in the hop plant that has demonstrated pronounced antioxidant, anti-inflammatory, anti-hyperlipidemic, and prebiotic activities. 
• The study indicated that XN supplementation may not significantly affect the overall composition of the gut microbiota but does lead to alterations in the relative abundance of specific taxa in an enterotype-dependent manner. 
• XN has potential in precision medicine approaches and nutritional interventions for elucidating personalized effects on the gut microbiota and human physiology. 

Access to the study: https://pubmed.ncbi.nlm.nih.gov/38358253/ 

Reference: Jamieson, P. E., Smart, E. B., Bouranis, J. A., Choi, J., Danczak, R. E., Wong, C. P., Paraiso, I. L., Maier, C. S., Ho, E., Sharpton, T. J., Metz, T. O., Bradley, R., & Stevens, J. F. (2024). Gut enterotype-dependent modulation of gut microbiota and their metabolism in response to xanthohumol supplementation in healthy adults. Gut microbes, 16(1), 2315633. https://doi.org/10.1080/19490976.2024.2315633 

A synbiotic preparation (SIM01) for post-acute COVID-19 syndrome in Hong Kong (RECOVERY): a randomised, double-blind, placebo-controlled trial

Post-acute COVID-19 syndrome (PACS) is a multi-system condition that follows the acute infection with SARS-CoV-2 and affects over 65 million individuals worldwide. PACS comprises debilitating symptoms, including fatigue, memory loss, difficulty in concentration, insomnia, mood disturbances, hair loss, shortness of breath, coughing, inability to exercise, chest pain, muscle pain, joint pain, gastrointestinal upset, and general unwellness. This condition usually extends beyond four weeks after the acute viral infection and lasts up to several years in some cases. While numerous bodily systems are affected by PACS, including respiratory, gastrointestinal, and neuropsychiatric systems, increasing studies are revealing distinct alterations to the gut microbiota with PACS. With an unclear pathogenesis for PACS, effective treatment options are currently scarce. This randomized, double-blinded, placebo-controlled trial aimed to assess the effects of a synbiotic preparation SIM01 for PACS symptom alleviation. Four-hundred and sixty-three individuals previously diagnosed with COVID-19 with one or more remaining PACS symptoms four weeks or more after confirmed SARS-CoV-2 were randomly assigned to orally receive either the synbiotic preparation, SIM01 (n=232) or the placebo (n=231) for six months. SIM01 is comprised of three prebiotics (GOS, xylooligosaccharides, and resistant dextrin) and 10 billion colony-forming units of three bacterial strains, including Bifidobacterium adolescentis, B. bifidum, and B. longum, in sachets given twice daily. After six months, the SIM01 group had a significantly higher proportion of individuals experiencing alleviated fatigue, memory loss, difficulty in concentration, gastrointestinal upset, and general unwellness compared to placebo. As such, synbiotic supplementation may be utilized to manage PACS symptoms via a microbiome-modulatory mechanism. More studies in the future are needed to validate these findings.

Key takeaways:

• PACS is a common syndrome that follows an acute SARS-CoV-2 infection, lasting between 4 weeks to several years and affecting over 65 million individuals globally.
• Studies have shown significant changes in the intestinal microbiota composition in PACS patients.
• The synbiotic preparation group showed significant alleviation in numerous PACS symptoms, including fatigue, memory loss, difficulty concentrating, gastrointestinal upset, and general unwellness. 
• Further studies are warranted to validate this study’s findings. 

Access the study: https://pubmed.ncbi.nlm.nih.gov/38071990/ 

Reference: Lau, R. I., Su, Q., Lau, I. S. F., Ching, J. Y. L., Wong, M. C. S., Lau, L. H. S., Tun, H. M., Mok, C. K. P., Chau, S. W. H., Tse, Y. K., Cheung, C. P., Li, M. K. T., Yeung, G. T. Y., Cheong, P. K., Chan, F. K. L., & Ng, S. C. (2024). A synbiotic preparation (SIM01) for post-acute COVID-19 syndrome in Hong Kong (RECOVERY): a randomised, double-blind, placebo-controlled trial. The Lancet. Infectious diseases, 24(3), 256–265. https://doi.org/10.1016/S1473-3099(23)00685-0 

The effects of inulin-type fructans on cardiovascular disease risk factors: systematic review and meta-analysis of randomized controlled trials

Inulin-type fructans (ITF) are the leading prebiotics in the market; however, current evidence remains inconclusive regarding ITF’s beneficial effects on cardiovascular diseases. This systemic review and meta-analysis aimed to evaluate ITF supplementation effects on the risk factors of cardiovascular diseases in adult subjects. Six databases, including MEDLINE, EMBASE, Emcare, AMED, CINAHL, and the Cochrane Library, were searched for randomized controlled trials (RCTs) from inception through May 15, 2022. Eligible RCTs used ITF or a placebo (such as control, foods, diets) in adults for at least two weeks, with effects studied on one or more of the following risk factors: low, very-low, or high-density lipoprotein cholesterol (LDL-C, VLDL-C, HDL-C), total cholesterol, apolipoprotein A1 or B, triglycerides, fasting blood glucose, body mass index, body weight, waist circumference, waist-to-hip ratio, systolic or diastolic blood pressure, or hemoglobin A1c. The extracted data was assessed for bias and certainty of evidence (CoE). In total, this meta-analysis included fifty-five RCTs with 2,518 participants. While the pooled estimate showed that ITF supplementation reduced LDL-C, triglycerides, and body weight, the CoE was low for all results. In addition, little to no significant effect was observed on other cardiovascular disease risk factors. Nonetheless, the observed effects were higher when the study extended beyond six weeks or was performed in pre-obese and obese participants. Overall, this systemic review and meta-analysis revealed that ITF may reduce several cardiovascular disease risk factors such as LDL-C, triglycerides, and body weight despite the current evidence having a low CoE and requiring further well-designed studies to validate these effects. 

Key takeaways:

• ITFs are popular prebiotic options despite the inconclusiveness of the current evidence regarding their benefits in cardiovascular disease risk factors.
• This meta-analysis systemically assessed the effects of ITF supplementation on cardiovascular disease risk factors in adult patients, aiming to aid clinical decision-making. 
• ITF may reduce LDL-C, TG, and body weight and might be particularly beneficial to patients with obesity when taken for at least six weeks. 

Access the study: https://pubmed.ncbi.nlm.nih.gov/38309832/ 

Reference: Talukdar, J. R., Cooper, M., Lyutvyn, L., Zeraatkar, D., Ali, R., Berbrier, R., Janes, S., Ha, V., Darling, P. B., Xue, M., Chu, A., Chowdhury, F., Harnack, H. E., Huang, L., Malik, M., Powless, J., Lavergne, F. V., Zhang, X., Ehrlich, S., Jenkins, D. J., … de Souza, R. J. (2024). The effects of inulin-type fructans on cardiovascular disease risk factors: systematic review and meta-analysis of randomized controlled trials. The American journal of clinical nutrition, 119(2), 496–510. https://doi.org/10.1016/j.ajcnut.2023.10.030