بسم الله الرحمن الرحيم

1. 32 البقرة: من الآية بسم الله الرحمن الرحيم قالوا سبحانك لا علم لنا إلا ما علمتنا إنك أنت العليم الحكيم صدق الله العظيم

2. Probiotics and the Skin Nagwa M. Elwan, M.D Prof. of Dermatology, Tanta – Egypt AzzaEl.Toukhy, ShereenGheida & Wallaa Abdel-Azeem, Tanta

3. The concept of functional foods was introduced long time ago with Hippocrateand his motto: (let food be your medicine). • Increasing evidence started to support the concept that diet may play an important role in modulation of many important physiological functions in the body ( Functional foods)

4. Among a number of functional foods, fermented foods and probiotics take the center stage due to their long traditional safe use, established and postulated beneficial effects.

5. WHAT’S PROBIOTICS? Definition

6. The term probiotics meaning (for life), is derived from Greek language. • FAW/WHO working group, suggested a definition for probiotics : “Live micro-organisms that when administrated in adequate amounts confer a health benefits for the host".

7. Gastrointestinal microbiota and probiotics • The definition of probiotics has evolved from a live active culture, which improves the balance of the gut microbiota composition . • Intestinal microbiota meaning intestinal microflora but the term microbiota (small life) has been recommended.

8. Growing scientific evidence supporting the concept that maintenance of healthy gut microbiotamay provide protection against: * GIT disorders * IBD (inflam.bowel dis.) * Allergy * Cancer

9. Gastrointestinal microbiota and probiotics • The metabolic activity of the intestinal microbiota is involved in the fermentation of exogenous & endogenous carbon & energy sources. • Moreover, it provides an important stimulus for the maturation of the immune system.

10. Dominant microbial genera in the adult human gastrointestinal tract. * CFU: colony forming unit.

11. Probiotic Bacteria Why Probiotics? The theoretical basis for the selection of probiotic micro-organisms :

12. Probiotic Bacteria The main probiotic bactaria used in dairy products are: Lactobacilli

13. Probiotic Bacteria Bifidobacteria and Probionibacteria

14. Immunity and Probiotics

15. Immunity and probiotics • Modulation of host immunity is one of the most commonly presented benefits of the consumption of probiotics. • It is commonly suggested that probiotics must "persist and multiply" in the target ecosystem to be effective.

16. Good evidence that lactobacilli & bifidobacteria can affect : * Antigen presenting cells ( DCs & monocytes ) * Regulatory T cells * T & B cells * Enterocytes

17. Immunity and probiotics Schematic representation of the multiple consequences of the cross-talk between the probiotic bacteria and the intestinal mucosa

18. Probiotics as theraputic tools

19. Probiotics as theraputic tools Probiotics are under study for a variety of pathophysiological states including: • Urogenital infections. • Infectious diarrheas. • Allergy. • Hypertension. • Hypercholesterolemia. • Kidney stones.

20. Risks associated with probiotics as treatment The main risks associated with probiotic use are: A- Infection: All cases of probiotics bacteremia or fungemia have occurred in immune compromised patients, chronic disease, or debilitation, but no reports of sepsis related to probiotics use in healthy persons.

21. Risks associated with probiotics as treatment B- Immune deviation or excessive immune stimulation: Probiotics have been shown to suppress Th2 cytokine and increase production of Th1 cytokine. These effects may be detrimental to pregnancy viability.

22. Risks associated with probiotics as treatment C- Deleterious metabolic activities: The intestinal microbiota play an important role in many metabolic activities, including complex carbohydrate digestion, lipid metabolism, and glucose homeostasis. Therefore there is a theoretical risk of adverse metabolic effects from manipulation of the microbiota with the use of probiotics, even if such manipulation is only temporary.

23. D- Microbial resistance: Many probiotic strains are naturally resistant to vancomycin, which raises concerns about possible transfer of such resistance to more pathogenic organism. Risks associated with probiotics as treatment

24. Prebiotics and Synbiotics

25. Prebiotics and Synbiotics Prebiotics: Defined as ‘‘nondigestible - food ingredient (s) that beneficially affects host health by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon’’.

26. Prebiotics and Synbiotics Synbiotics: Is a product containing prebiotics and probiotics and in which the prebiotics compound selectively favors the probiotics.

27. Probiotics and Prebiotics for Skin • Probiotics, in contrast to prebiotics, are based on the use of living organisms which upon ingestion in certain numbers exert health beneficial effects beyond inherent general nutrition.

28. The concept of modulation of micro-flora originally developed for gut • but, can be applied to modulate the composition of any microbial community including the skin micro-flora to achieve beneficial effects • Selective inhibition of detrimental & stimulation of beneficial bacteria of the skin, in contrast to antibiotics .

29. Probiotics in prevention of atopic diseases

30. Probiotics for prevention of atopic diseases • Atopic dermatitis is a highly pruritic chronic inflammatory skin disease that commonly presents during early infancy and childhood but can persist or start in adulthood. • AD has two types: an extrinsic type associated with IgE-sensitization and an intrinsic type without IgE mediated sensitization.

31. Probiotics for prevention of atopic diseases • Basis for using probiotics in allergic disease: • Epidemiologic links between less exposure to microbes and allergic disease. • Intestinal microbiotica are the largest source of microbial exposure through early immune development.

32. Probiotics for prevention of atopic diseases • Intestinal microbiotica appear to be essential for normal immune development. • Differences in prenatal colonization noted in children who go on to develop allergic disease.

33. Probiotics for prevention of atopic diseases • Prenatal administration of probiotics associated with anti-inflammatory and immunoregulatory effects on immune function. • Initial studies on probioticsare promis-ingin the prevention and early treatment of allergic disease.

34. Probiotics in prevention of atopic diseases • Clinical implication of probiotics in pediatric atopic dermatitis: • Clinical trials on the efficacy of probiotics for pediatric atopic dermatitis (PAD). • A prenatal and postnatal regimen of probiotics for pregnant women with risk factors for atopic disease is an effective option to help preventing persistent PAD in their children.

35. Probiotics Marketing: • A Nutrition Business Journal projects a saturation market value is expected of approximately $1.2 billion for probiotics supplements in the united states. • In Egypt probiotics is found in some types of yoghurt.

36. Conclusions

37. Conclusions • Probiotics are “Live microorganisms that when administrated in adequate amounts confer a health benefits for the host”. • Probioticsevolved from a live active culture, improving the balance of gut microbiota composition to beneficial effects.

38. Conclusions • The main probiotic bacteria used in dairy products are: Lactobacilli, Bifidobacteria and Probionibacteria. • Modulation of host immunity is one of the most commonly presented benefits of the consumption of probiotics.

39. Conclusions • Probiotics can be used in many pathological conditions including: Hypertension, GIT disorders, allergy and even cancer.

40. Conclusions • A prenatal and postnatal regimen of probiotics is an effective option for pregnant women with risk factors for atopic disease to help prevention of PAD in their children.

41. Thank You NagwaElwan