ReviewLactic acid bacteria in the prevention of pneumococcal respiratory infection: Future opportunities and challenges
Highlights
► Lactic acid bacteria (LAB) are able to improve respiratory immunity. ► Mechanisms involved in the protective activity of LAB are suggested in this review. ► Selection of immunobiotic LAB should be based on innate immunity activation. ► LAB modulate the inflammatory response via the induction of IL-10 production. ► LAB's ability to regulate the inflammatory response is clue to avoid tissue damage.
Introduction
Acute lower respiratory tract infections are a persistent public health problem. They cause a greater burden of disease worldwide than human immunodeficiency virus infection, malaria, cancer, or heart attacks [1]. Streptococcus pneumoniae is one of the microorganisms that cause severe respiratory infections. It is a common inhabitant of the upper respiratory tract, existing mainly as a commensal bacterium along with other co-resident microorganisms on the respiratory epithelium. Defects in host defenses can alter this host–pathogen interaction and allow strains to invade the host [2]. Pneumococcus is one of the principal aetiological agents of pneumonia, bacterial meningitis and otitis media and children, the elderly and immunocompromised hosts are particularly at high risk [2]. Despite appropriate therapies, mortality due to the different pneumococcal pathologies remains high: around 1 million children die every year from pneumococcal diseases, mainly in developing countries [3], [4]. The rapid emergence of multidrug-resistant S. pneumoniae strains throughout the world has led to increased emphasis on the prevention of pneumococcal infections by vaccination. However, available vaccines present disadvantages associated with their low immunogenicity in populations at risk (i.e., the pneumococcal 23-valent polysaccharide vaccine) or with their high cost as a public health strategy in developing countries (i.e., conjugated vaccines) [5], [6].
Two of the most important strategies for the prevention of infectious diseases are healthy nutrition and the use of effective vaccines. Historically, deaths from infections have been reduced by improvements in nutrition. Besides, during the last few decades, a large body of literature has established strong links between nutrition, immune function and infectious diseases. Moreover, the development of vaccines and their massive use have enabled the eradication of numerous infectious diseases in various parts of the world. Lactic acid bacteria (LAB) can be used for both strategies.
They have been used for the development of probiotic foods with the ability to stimulate the immune system, which would increase resistance to infections, even in immunocompromised hosts [7], [8]. On the other hand, the advances in the molecular biology of LAB have enabled the development of recombinant strains expressing antigens from various pathogens that have proved effective to induce protective immunity. In this review we examine the current scientific literature dealing with the use of LAB strains to prevent respiratory infections. In particular, we have focused on the works that deal with the capacity of probiotic and recombinant LAB to improve the immune response against S. pneumoniae.
Section snippets
Effect on immunocompetent hosts
Several studies have demonstrated that certain probiotic LAB strains can exert their beneficial effect on the host through their immunomudulatory activity [7], [8], [9], [10], [11]. Although most research concerning LAB-mediated enhanced immune protection is focused on gastrointestinal tract pathogens, a few recent studies have centered on whether immunobiotics might sufficiently stimulate the common mucosal immune system to provide protection to other mucosal sites as well [7], [8], [11], [12]
Expression of pneumococcal antigens in lactic acid bacteria
The beneficial effects of LAB against pneumococcal respiratory infections encouraged researchers to develop vaccines that would combine the immunomodulatory properties of such bacteria with antigen delivery [56], [57], [58]. During the last decade, the expression of different pneumococcal antigens was achieved in diverse LAB strains, using diverse expression vectors (Table 1).
The first pneumococcal antigen expressed in LAB was type 3 capsular polysaccharide (CPS) [59]. In this work, fragments
Probiotic effector molecules
The post-genomics era has strongly stimulated the identification of candidate effector molecules from probiotic microorganisms that are could confer a health benefit to the host via the intestinal immunity, including direct interactions with host epithelial or immune cells. However, there is very limited knowledge on the molecular mechanisms by which probiotics exert their health beneficial effects on the host. To date, only few candidate probiotic effector molecules have been discovered, and
Conclusions
In this review we describe several research works dealing with the possibility of using LAB for the prevention of S. pneumoniae respiratory infection. The results discussed here and the ones described by different groups using LAB for the prevention of other respiratory infections show some important coincidences. In general, LAB strains with immunomodulatory properties are able to stimulate the innate immune system. Then, when an infectious stimulus occurs, adaptive immunity is activated
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