What Does Research Say about Saccharomyces Boulardii

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07 Apr What Does Research Say about Saccharomyces Boulardii

Posted at 00:31h in Gut Health, Probiotics by

Saccharomyces boulardii has been extensively studied and used in clinical practice. It has been shown to exert various actions in our gastrointestinal tract, as well as our immune function. The following brief summary presents what research has shown so far of S. boulardii‘s therapeutic capabilities.

Antibiotic-Associated, Acute Traveler’s Diarrhea

Saccharomyces boulardii has been extensively studied and found to be effective for the treatment of various forms of diarrhea.

In a review of two randomized controlled trials testing S. boulardii for antibiotic-associated diarrhea (AAD), it showed a 30% risk reduction in the disease [10].

Another RCT looked at the efficacy of S. boulardii in the treatment of acute diarrhea caused by Entamoeba histolytica, and found that at the end of 4 weeks, amebic cysts were detected in 19% of control cases compared to none in the S. boulardii group [11].

Inflammatory Bowel Disease (IBD), Crohn’s and IBS

S. boulardii has a unique action on IBD by a specific alteration of the migratory behavior of T cells, causing them to accumulate in the mesenteric lymph nodes. Consequently, it limits the infiltration of T-helper 1 cells in the inflamed colon and the amplification of inflammation induced by pro-inflammatory cytokines production. [5]

S. boulardii added to conventional therapy was able to decrease the relapse rate in patients with Crohn’s disease over a 6-month period (6% in adjunct S. boulardii group vs. 38% in conventional treatment alone) [6]. This could be partly due to the ability of S. boulardii to improve the integrity of the intestinal mucosal barrier [9].

S. boualrdii has also been shown to improve quality of life in IBS patients. In one trial 67 patients with IBS were randomized to receive S. boulardii or a placebo for 4 weeks. The overall improvement in quality of life was more than twice as high in the S. boulardii group as that in the placebo-treated group (15.4% vs. 7.0%) [7].

C. difficile Infection

In a double blind RCT, three antibiotic regimens were used over a 10-day period (either a high or low-dose of vancomycin or metronidazole) combined with S. boulardii or placebo. After a 2-month follow-up, a significant decrease of CDI recurrences was observed only in patients treated with a high-dose of vancomycin and S. boulardii compared with antibiotic and placebo-treated patients [4].

The protective effects of S. boulardii on C. difficile infection in humans are mainly due to the release of a serine protease that degrades toxin A and B of C. difficile. The protease also disrupts the binding of toxin A to its receptor and the brush border membrane receptor itself [3].

*Honorable Mention: Anti-Candida Action

Research has shown that S. boulardii decreases colonization of the intestine by the C. albicans infection [13], and also inhibits the translocation of C. albicans from the gastrointestinal tract in immunosuppressed rats [12].

Another study demonstrated that S. boulardii reduces the virulence of C. albicans by secreting active compounds such as capric acid that reduce candidal adhesion and biofilm formation and inhibit hyphae formation [14].

Mechanisms of Action

Anti-Microbial Action

S. boulardii exerts anti-microbial activities via two main mechanisms, namely direct anti-toxin activity and inhibition of growth and invasion of pathogens.

In vitro, S. boulardii directly inhibits the growth of several pathogens (Candida albicans, E. coli, Shigella, Pseudomonas aeruginosa, Staphylococcus aureus, Entamoeba hystolitica), and cell invasion by Salmonella typhimurium and Yersinia enterocolitica.

S. boulardii also secretes a enzymatic protein – phosphatase that is able to dephosphorylate and inactivate the endotoxin of E coli. [2]

Trophic Action

There is evidence to suggest that S. boulardii acts partly by enhancing the integrity of the tight junction between enterocytes, thus preserving intestinal integrity and function.

Studies have also shown that when S. boulardii is given to antibiotic-shocked animals or patients with diarrhea, normal microbiota is re-established more rapidly. This effect is tightly linked to a stimulation of short chain fatty acid (SCFA) production, especially butyrate. The production of SCFAs is significantly decreased in patients receiving antibiotics, so these effects may be especially relevant in the management of antibiotic-associated diarrhea (AAD).

Immuno-regulation and Anti-inflammatory Activity

S. boulardii has been shown to exert anti-inflammatory effects in the GI tract via different mechanisms.

S. boulardii inhibits MAP kinase and NF- κB signal transduction pathways and decreases the secretion of IL-8, thereby reducing inflammatory diarrhea.

S. boulardii also activates the expression of peroxisome proliferator-activated receptor-G, which protects from GI inflammation in the host [1].

References:

  1. Pothoulakis C. Review article: anti-inflammatory mechanisms of action of Saccharomyces boulardii. Aliment Pharmacol Ther 2009;30: 826 – 33.
  2. Buts JP, DeKeyser N, Stilmant C, et al. Saccharomyces boulardii produces in rat small intestine a novel protein phosphatase that inhibits Echerichia coli endotoxin by dephosphorylation. Pediatr Res 2006; 60:24 – 9.
  3. Castagluolo I, Riegler MF, Valenick L, et al. Saccharomyces boulardii protease inhibits effects of Clostridium difficile toxins A and B in human colonic mucosa. Infect Immun 1999;67:302-7.
  4. McFarland et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA 1994; 271: 1913-1918.
  5. Dalmasso et al. Saccharomyces boulardii inhibits inflammatory bowel disease by trapping T cells in mesenteric lymph nodes. Gastroenterology (2006). Vol 131: 1812-1825.
  6. Guslandim et al. Saccharomyces boulardii in maintenance treatment of Crohn’s disease. Dig Dis Sci 2000; 45: 1462- 1464.
  7. Choi et al. A Randomized, Double-blind, Placebo-controlled Multicenter Trial of Saccharomyces boulardii in Irritable Bowel Syndrome: Effect on Quality of Life. J Clin Gastroenterol 2011.
  8. Saint-Marc et al. AIDS related diarrhea: a double-blind trial of Saccharomyces boulardii. Sem Hôp Paris 1995; 71: 735-741.
  9. Vilela et al. Influence of Saccharomyces boulardii on the intestinal permeability of patients with Crohn’s disease in remission. Scandinavian Journal of Gastroenterology, 2008; 43: 842-848.
  10. Canani et al. Saccharomyces boulardii: a summary of the evidence for gastroenterology clinical practice in adults and children. European Review for Medical and Pharmacological Sciences. 2011; 15: 809-822.
  11. Mansour-Ghanaei et al. Efficacy of Saccharomyces boulardii with antibiotics in acute amoebiasis. World J Gastroenterol 2003; 9: 1832-1833.
  12. Berg R, Bernasconi P, Fowler D, Gautreaux M (1993) Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces boulardii. J Infect Dis 168: 1314- 1318.
  13. Jawhara S, Poulain D (2007) Saccharomyces boulardii decreases inflammation and intestinal colonization by Candida albicans in a mouse model of chemically-induced colitis. Med Mycol 45: 691-700.
  14. Murzyn et al. Capric Acid Secreted by S. boulardii Inhibits C. albicans Filamentous Growth, Adhesion and Biofilm Formation. PLoS ONE;2010, Vol. 5 Issue 8, p1.
  15. Guslandi, Giollo, Testoni. A pilot trial of Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol. 2003 Jun;15(6):697-8.