Probiotics improve intestinal ischemia-reperfusion injury: a systematic review and meta-analysis.

2025-05-22
Frontiers in medicine 12

PubMed: 40486191
DOI: 10.3389/fmed.2025.1546650

Study Design

Type: Systematic Review
Sample size: n = 12
Population: animal experiments
Methods: Included a total of 12 studies from 5 databases (PubMed, Web of Science, Cochrane, Embase, and Scopus); statistical analysis was performed using Review Manager 5.3.

Background

Intestinal ischemia-reperfusion injury (IRI) is a common complication of intestinal surgery and carries the risk of patient death. The treatment of intestinal IRI is an important direction of current research. This study aimed to analyze animal experiments and thus investigate the effects of probiotics administration on intestinal IRI and its mechanisms.

Methods

We included a total of 12 studies from 5 databases (PubMed, Web of Science, Cochrane, Embase, and Scopus), incorporating outcome metrics including Chiu's score, levels of malondialdehyde (MDA), myeloperoxidase (MPO) tumor necrosis factor-alpha (TNF-α), IL-6, IL-1β, occludin, zonula occludens-1 (ZO-1), FITC-dextran and intestinal bacteria (Lactobacillus, Bacteroides and Bifidobacteria). Statistical analysis was performed using Review Manager 5.3.

Results

We found that probiotic-added animals had less intestinal damage after IRI compared to controls, as evidenced by a more intact intestinal barrier [occludin (2.83, 95% CI: 1.46 to 4.20, p < 0.0001), ZO-1 (3.30, 95% CI: 1.58 to 5.01, p = 0.0002) and FITC-dextran (-3.83, 95% CI: -5.83 to -2.29, p < 0.0001)], lower Chiu score (-1.83, 95% CI: -2.47 to -1.20, p < 0.0001), fewer inflammatory factors [IL-6 (-2.19, 95% CI: -3.98 to -0.39, p = 0.02), TNF-α (-2.24, 95% CI: -4.15 to -0.33, p = 0.02)], and lower levels of oxidative stress [MDA (-2.46, 95% CI: -4.62 to -0.30, p = 0.03), MPO (-0.97, 95% CI: -1.77 to -0.17; p = 0.02)]. In addition, probiotic supplementation increased the relative abundance of Lactobacillus (0.90, 95% CI: 0.33 to 1.48, p = 0.002) and Bacteroides (0.81, 95% CI: 0.14 to 1.49, p = 0.02), thus maintaining the stability of the gut microbiota.

Conclusion

In conclusion, the mechanisms by which probiotic therapy attenuates intestinal IRI may be related to decreased levels of inflammation and oxidative stress, increased probiotic abundance, and increased expression of tight junction (TJ) proteins.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024577459.

Research Insights

Supplement	Dose	Health Outcome	Effect Type	Effect Size	Source
Lactobacillus plantarum 14D	—	Improved Intestinal Barrier Function	Beneficial	Large	View source a more intact intestinal barrier [occludin (2.83, 95% CI: 1.46 to 4.20 ...), ZO-1 (3.30, 95% CI: 1.58 to 5.01 ... ) and FITC-dextran (-3.83, 95% CI: -5.83 to -2.29 ...)]
Lactobacillus plantarum 14D	—	Reduced Inflammation	Beneficial	Moderate	View source fewer inflammatory factors [IL-6 (-2.19, 95% CI: -3.98 to -0.39 ...), TNF-α (-2.24, 95% CI: -4.15 to -0.33 ...)]
Lactobacillus plantarum 14D	—	Reduced Intestinal Ischemia-Reperfusion Injury	Beneficial	Large	View source probiotic-added animals had less intestinal damage after IRI compared to controls, as evidenced by a more intact intestinal barrier ... lower Chiu score ... fewer inflammatory factors ... and lower levels of oxidative stress
Lactobacillus plantarum 14D	—	Reduced Oxidative Stress	Beneficial	Moderate	View source lower levels of oxidative stress [MDA (-2.46, 95% CI: -4.62 to -0.30 ...), MPO (-0.97, 95% CI: -1.77 to -0.17 ...)]