A promising area of research for people for colorectal cancer prevention

1. Pre and Probiotics in the prevention of
colon-rectal cancer
Dalia Khamis El-Deeb
Lecturer of Public Health
Community Medicine Department
Alexandria Faculty of Medicine
ESPEN European Diploma of clinical nutrition

2. Points to be discussed
• History of pre and probiotics
• Important definitions
• Importance of pre and probiotics
• Pre and probiotics in cancer colon prevention
• Can synbiotics have a role in colon cancer
management as well ?

4. Death sits in the bowels; a bad digestion is the
root of all evil” Hippocrates, 400 BC

5. • They were first identified and named by
Professor Marcel B Roberfroid was a director
at The Institute Of Food Research in 1995
History of Prebiotic

6. History of Probiotics
• At the start of the 20th century, Russian Nobel prize winner
and father of modern immunology, Elie Metchnikoff, a
scientist at the Pasteur Institute, was the first to
conceptualize “Probiotics”

7. What are prebiotics and probiotics ?

8. Important definitions
• Prebiotic (Pre= Before and Biotic=life) Roberfroid offered a
refined definition in the March 2007 stating "A prebiotic is a
selectively fermented ingredient that allows specific changes,
both in the composition and/or activity in the gastrointestinal
microflora that confers benefits upon host well-being and
health."

9. Important definitions
• Roberfroid stated that only two particular prebiotics then
fully met this definition:
• Trans-galacto-oligosaccharide
• Inulin

10. Probiotics (Pro= Promoting and Biotic=life)
• The Food and Agriculture Organization of the United Nation (FAO)
defines probiotics as“ live micro-organisms, which, when administered
in adequate amount produce beneficial effect to the host when taken
orally”.
Important definitions

11. Important definitions
• Synbiotic (Syn=Plus and Biotic=life a substance
containing both a prebiotic and probiotic.

15. • Limited hydrolysis and absorption in the upper GIT(gastro-intestinal
tract).
• Selective growth stimulation of beneficial bacteria in the colon.
• Immuno stimulation.
• Stimulation of beneficial flora that promotes colonization
resistance.
Prebiotics

18. Preliminary research has demonstrated potential effects
• On calcium and other mineral absorption
• Immune system effectiveness bowel acidity
• Reduction of colorectal cancer risk
and inflammatory bowel disease (Crohn's
disease or ulcerative colitis
• Hypertension and defecation frequency
• Prebiotics may be effective in decreasing the
number of infectious episodes needing antibiotics
and the total number of infections in children aged
0–24 months
Prebiotics

20. Probiotics
Probiotic microorganisms are:
• Able to survive the passage through the digestive
system
• Able to attach to the intestinal epithelia and colonize
• Able to Maintain good viability
• Able to utilize the nutrients and substrates in a
normal diet
• Non-pathogenic and non-toxic
• Capable of exerting a beneficial effect on the host

21. • "Lactic acid bacteria (LAB) and bifidobacteria are the most
common types of microbes used as probiotics; but certain
yeasts and bacilli may also be used.
• The normal human digestive tract contains about 400 types of
probiotic bacteria that reduce the growth of harmful bacteria
and promote a healthy digestive system.
Probiotics

22. Probiotics rich food

23. Probiotics rich food

24. Probiotics rich food

25. • Lactobacillus acidophilus
• Lactobacillus ramnosus
• Lactobacillus paracasei
• Lactobacillus plantarum
• Lactobacillus bulgaricus
• Bifidobacterium infantis
• Bifidobacterium longum
• Bifidobacterium breve
• Streptococcus Thermophilus
Common probiotic agents used as therapeutic options

27. Pre and probiotics in cancer colon
prevention

29. Gut microbiota contribution
• Intestine is composed of over 1000
different bacterial species and the
microbial population is
heterogeneous in nature.
• The microbial density within large
intestine is 12-fold beyond that in
the small intestine.
• So there is an estimated 12-fold
increase in cancer risk in the large
intestine compared with the small
intestine

30. Gut microbiota contribution
• It has been revealed that microflora resident in colonic region
are able to convert harmless compounds into metabolites
that causes inflammation or tumourigenisis .
• The microflora in intesitinal region can contribute to
carcinogenesis by producing enzymes like β-glucosidase, β-
glucuronidase,nitroreductase and azoreductase .

31. Gut microbiota contribution
• The most common pathogens associated with the production of β-
glucuronidase are E.coli and Clostridium perfringens .
• These faecal enzymes may hydrolyse glucuronide, a compound that
is needed to detoxify foreign compounds and produces cancer
causing substances in intestinal lumen

34. Role of Probiotics in Colon Cancer
Prevention
• Research has been conducted to explore the role of probiotics in colon cancer
prevention.
• How gut microbiota influence the development of colon cancer is unclear but the
gut micro biome contributes colon cancer through initiation of inflammation
• Researchers suggested that the prevention of colon cancer might occur through
intervention of synbiotics (prebiotic+probiotic) that allow certain substantial
changes in the gut micro biota .

35. Role of Probiotics in Colon Cancer
Prevention
• Upon fermentation of these prebiotics
by beneficial microorganisms under
anaerobic conditions they produce
Short Chain Fatty-acids (SCFA) like
butyrate, acetate, propionate of
varying quantities.
• It results in a decrease in pH and
thereby preventing overgrowth of
pathogenic bacteria, which are pH
sensitive in nature and it was based
broadly on in vitro studies.

36. Role of Probiotics in Colon Cancer
Prevention
• These short chain fatty acids usually act as a
source of carbon for colonocytes and they
carry out important metabolic activities like
• Modulation of bioactive food components,
• Vitamin synthesis by intestinal microbiota.
• Its function shapes the host intestinal
anatomy and also gut mucosal immune
system

37. Role of Probiotics in Colon Cancer
Prevention
• Among these short-chain fatty acids, butyrate is found to
play a defensive role in DNA oxidative damage induced by
H2O2.
• It may also decrease the altered cell proliferation and
induce programmed cell death process in altered cells

38. Role of Probiotics in Colon Cancer
Prevention
• Evidences have shown that some probiotic microorganisms
Lactobacillus salivarius (L.salivarius) FP25, L. salivarius FP35,
Pediococcus pentosaceus FP3 and Enterococcus faecium FP51
exhibited anti proliferative properties.
• The proposed mechanism was given to the synergic induction by
directly adhering to colon cancer cells and triggering bio production
of butyric and propionic short chain fatty acids.

41. Conclusion
• In conclusion, colon cancer, which in a high proportion of the
population is due to somatic mutations occurring during the lifetime
of an individual, could be retarded or prevented by preventing these
mutations.
• LAB and prebiotics that enhance LAB have been shown to
deactivate genotoxic carcinogens.

42. Conclusion
• In model systems in vitro they have been shown to prevent mutations. DNA
damage has been prevented and chemopreventive systems may be stimulated
in vivo in colon tissues.
• From a mechanistic point of view, LAB offer potential as chemoprotective
agents and thus further research is clearly needed to quantify the beneficial
effects for prevention of human colon cancer.

44. • The use of probiotics and prebiotics to prevent colon cancer has
gained much attention due to positive outcomes from in-vivo and
molecular studies. Various mechanisms have been proposed
including its anticarcinogenic effects, antimutagenic properties,
modification of differentiation processes in tumor cells, production
of short chain fatty acids, and alteration of tumor gene expressions.
Conclusion

45. • Despite all the positive findings, other researches have also
reported insignificant colon cancer protective effects. However, the
increased interest in these areas demonstrated the need for further
evaluation to better understand the exact mechanisms involved,
and to generate uncontroversial experimental evidence.
Conclusion

46. Can synbiotics have a role in colon cancer
management as well ?

48. Role of Probiotics in Colon Cancer
Prevention
• In one clinical trial, that underwent a 12 week double-blind placebo-controlled,
randomized test with 37 colon cancer patients and 43 polypectomized patients,
a synbiotic composition of (Lactobacillus rhamnosus GG, Bifidobacterium lactis
Bb12+oligofructose enriched inulin) resulted in an increase of Lactobacilli &
Bifidobacteria and decrease of C. perfringens in the gut microbiota.
• Further, the production of interferon (IFN) -γ was increased by peripheral blood
mononuclear cells (PBMC) and reduced colorectal proliferation was observed in
the cancer patients.

49. Still we need more evidence based research
as it maybe A new field of Hope