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영어에서 한국어: Translation of an abstract from a clinical trial
원어 - 영어 Improvements to postprandial glucose control in subjects with type 2 diabetes: a multicenter, double blind, randomized placebo-controlled trial of a novel probiotic formulation
A growing body of evidence suggests that specific, naturally occurring gut bacteria are underrepresented in the intestinal tracts of subjects with type 2 diabetes (T2D) and that their functions, like gut barrier stability and butyrate production, are important to glucose and insulin homeostasis. The objective of this study was to test the hypothesis that enteral exposure to microbes with these proposed functions can safely improve clinical measures of glycemic control and thereby play a role in the overall dietary management of diabetes.
Research design and methods. We evaluated whether a probiotic comprised of these anaerobic bacteria would enhance dietary management by (1) manufacturing row novel probiotic formulations containing three (WBF-010) or five (WBF-011) distinct strains in a Current Good Manufacturing Practice (cGMP) facility, (2) establishing consistent live-cell concentrations, 93) confirming safety at target concentrations dispensed in both animal and human studies and (4) conducting a 120week parallel, double-blind, placebo-controlled, proof-of-concept study in which subjects previously diagnosed with T2D (n-76) were randomly assigned to a two times a day regimen of placebo, WBF-0101, or WBF-011.
Results. No safety or tolerability issues were observed. Compared with the placebo group, subjects administered WBF-011 (which contains inulin, Akkermansia muciniphila, Clostridiium beijerinckii, Clostriduim butyricum, Bifidobacterium infantis and Anaerobutyricum hallii) significantly improved in the primary outcome, glucose total area under the curve (AUC): -36.1 mg/dL/180 min, p=0.00500 and also improve in secondary outcomes, glycated hemoglobin (A1c): -0.6, glucose incremental-AUC: -28.3 mg/dL/180 min.
Conclusions. To our knowledge, this is the first randomized controlled trial to administer four of the five strains to human subjects with T2D. This proof-of-concept study (clinical trial number NCT03893422) shows that the intervention was safe and well tolerated and that supplementation with WBF-011 improves postprandial glucose control. The limited sample size and intersubject variability justifies future studies designed to confirm and expand on these observations.
번역어 - 한국어 제2형 당뇨 대상자의 식후혈당조절을 위한 개선제: 신규한 프로바이오틱스 제제의 다기관, 이중눈가림, 무작위, 위약대조 시험
Perraudeau et al (2020) BMJ Open Diab Res Care 8: e001319
서언. 제2형 당뇨 (T2D) 환자의 장내는 자연적으로 존재해야 할 특정 장내 세균의 수가 적다는 것이 보고되고 있고, 또한 장 내막의 안정성 유지 및 부티르산 생산과 같은 기능을 담당하는 이들 세균이 포도당과 인슐린 항상성에 중요하다는 증거도 다수 보고되고 있다. 이 연구의 목적은, 이런 기능성을 가진 미생물에 장을 노출시킴으로써 혈당 조절과 같은 임상적 수치를 안전하게 개선하여 전반적인 식단 관리에 역할을 할 수 있다는 가설을 시험해 보고자 함이다.
연구디자인과 방법론. 혐기성 미생물로 구성된 프로바이오틱스가 식단 관리에 도움을 줄 수 있는지 다음에 나열한 과정을 통해 평가하였다; (1) cGMP 시설에서 3~5가지 서로 다른 미생물 균주를 2가지 프로바이오틱스 (균주 3가지, WBF-010; 균주 5가지, WBF-011)로 제제화 한다 (2) 일정한 생균수 확보 한다 (3) 동물과 인체 시험에서 사용한 표적농도의 안전성 확인 한다 (4) 이 전에 T2D 진단을 받은 사람들 (n=76)을 위약구, WBF-010구, WBF-011구에 무작위 배열하여 12주간 하루 2번 투여하는 처치를 이중 눈가림 위약 대조 개념 증명 시험으로 진행한다.
결과. 안전성과 순응도에 관한 문제는 없었다. 위약구와 대비하여 WBF-011 투여구 (inulin, Akkermansia muciniphila, Clostridium beijerinckii, Clostridium butyricum, Bifidobacterium infantis and Anaerobutyricum hallii를 포함) 는 1차 유효성 평가변수에서 포도당 AUC (area under the curve) 수치가 -36.1 mg/dL/180min (p=0.00500) 개선되었고, 2차 유효성 평가변수에서도 당화혈색소 (A1c) 가 -0.6, 포도당 증가율인 AUC 가 -28.6 mg/dL/180min 개선 되었다.
결론. 우리가 아는 한, 본 연구가 T2D 환자에서 4가지 또는 5가지 균주를 투여한 최초의 무작위 대조시험이다. 본 개념 증명 연구 (임상 시험 번호 NCT03893422)에서, 처치가 안전하고 순응도에 문제가 없었으며, 식후 혈당 조절 능력이 WBF-011 섭취로 개선됨을 알 수 있었다. 대상자의 수가 한정적이라는 것과 대상자 간 결과 값의 편차가 있었으므로 본 연구에서 밝혀진 사항을 점검하고 확장할 수 있는 후속 연구가 필요하다.
영어: A writing in Instagram General field: Medical Detailed field: 영양
원어 - 영어 • Many recent studies have pointed out the disturbance of gut health could be the underline cause of metabolic syndrome, obesity, and some brain disorders.
• Respiratory disease and autoimmune disorders such as atopic dermatitis and inflammatory bowel disease can become worse with deterioration of gut health. Increased weight is also seen even without over-eating and the weight that have recently been lost could easily bounce back.
• Moreover, secondary metabolites produced by microbes in the gut are known to transfer directly to brain to cause depression, sleep disorders, ADHD, and dementia. This tells us gut health is deeply related to overall human metal health as well.
• Thus, gut health is something needs to be looked into along with therapeutic options when treating certain diseases.
• Then, what is a healthy gut?
• First, the epithelial lining has to be healthy. Epithelial lining surrounds the internal tissue of the intestine and is covered with mucus produced by specific cells in the epithelia. Hence, we call, “mucus epithelial membrane”.
• Mucus acts as lubricant for food materials to move smoothly in the intestine. Mucus also encloses the feces so that it can be passed through with ease. In the process of digestion, gastric acid, digestive enzymes, bile acid, and also toxic substances are produced. These will not only affect food matters but also the gut tissue. Here, the mucus in the epithelial membrane comes to the rescue to protect you.
• Thus, healthy gut equals to healthy epithelial membrane with proper amount of mucus.
• Second, microbes inside the gut should be balanced between the good ones and the bad ones. In other words, the total microbiome should be in balance.
• The original meaning of microbiome was the total genome that microbes exhibit, but the terminology has expanded to include the total microbial flora of specific human organ. For example, the gut microbiome is understood as all the microbes in the gut, usually bacteria.
• In the mucus of epithelial membrane, there resides the beneficial microbes.
• Besides the fact that good bacteria provide direct health benefits, they can support indirect advantages by suppressing the growth of bad ones.
• So, if you have balanced good and bad bacteria, it can be said to have good gut health.
• The most popular supplement for gut health is probiotics which claim to increase beneficial microbes in the gut.
• Everyone might have taken this at least one time, but:
• Are your probiotics effective?
• Are they doing the expected job in your gut?
• The literal meaning of Pro-biotics is “supporting life”.
• Probiotics are defined by WHO as, “Live bacteria that can give health benefits when taken properly”.
• Lactic acid bacteria (LAB), including famous Lactobacillus and Bifidobacterium sp., are one class of probiotics. So, if LAB are to exert beneficial effect, they must be alive and effectively colonize the mucus membrane to proliferate.
• Can they really do this?
• Let’s take a look into the journey of the ingested LAB.
• Orally ingested LAB go into stomach where they face gastric acid.
• Gastric acid is a strong acid that will even dissolve your skin, let alone bacteria; 99% of them instantly dies. This is to protect you from any food-borne pathogens and your body does not discriminate between pathogens and LAB.
• The remaining 1% continues the journey, arriving at duodenum. Here, the bacteria are exposed to bile acid and all sorts of digestive enzymes.
• Digestive enzymes will disintegrate carbohydrate, proteins, and lipids. Bacterial cells being composed of these materials, cannot escape from being attacked. Just with bile acid alone would make the environment so toxic for the survival of LAB; many will be killed again.
• Only an insignificant number arrives at the large intestine.
• Here, they are confronted and overwhelmed by a large number of indigenous members that resist newcomers.
• Human gut microbiome contains anywhere between 38 to 100 trillion bacteria. Then, what is the likelihood for a small number of foreign LAB to penetrate the large community, find a place in the mucus, colonize, and multiply thereafter?
• As we saw, the ingested LAB face a hurdle one after another, becoming bigger as the journey continues.
• My thinking is that all the ingested LAB will end up in stools.
• Some people say, orally taken LAB survives in gut because they can be detected in stools.
• Nonsense……
• When we analyze LAB in stools, we are not detecting live bacteria but the bacterial DNA.
• “While man leaves his name, bacteria leave DNA, upon death”.
• That is, bacteria killed by gastric acid can also be detected in stools.
• You can easily imagine, live bacteria would colonize the mucus membrane, live and multiply, and continuously be detected in the assay, even if you stop taking orally.
• But the truth is that if you stop taking LAB, stools would soon stop showing their existence.
• As mentioned before, it is very hard for orally taken LAB to colonize the mucus membrane. Then, how could you procure the good bacteria to your gut?
• Upon birth, each one is given with various beneficial bacteria by his mother. About 3 years of age, the ones with the right chemistry will colonize the host and become endogenous microbiome.
• This is to say, we are already equipped with good bacteria, but just not efficient in numbers for various reasons.
• Wouldn’t it be better to grow your own bacteria rather than to bring in from outside?
• There are other scientific reasons as to why internal source is better:
• 1. Healthy microbiome is the result of variety of beneficial bacteria working together, not that of one or two species.
• 2. Outgrowth of certain species is positively related to specific disease occurrence.
• 3. Lactobacillus and Bifidobacterium are not the only beneficial bacteria in the gut and increase in one or two beneficial bacteria will not change the overall profile of the microbiome.
• 4. Specific LAB intake prevents the normalization of the microbiome after the disruption by antibiotics.
• 5. Lactobacillus sp. is one of the Firmicutes noted for “obese bacteria”. Some reports have indicated weight increase with orally taken Lactobacillus sp., although others might have found otherwise.
• 6. Inconsistencies have shown for blood sugar level with Lactobacillus sp. intake; some say it went down, some show increase in Lactobacillus sp. in gut is positively related with blood sugar increase.
• What we already have is very efficient in colonization and proliferation, experts that can tune into our gut’s need.
• That is, they are very easy to form a healthy microbiome.
• On one condition though…..
• An appropriate food source in the gut.
• The food source for beneficial bacteria is called prebiotics. The word literally means, “prerequisite for life”.
• Prebiotics are complex carbohydrates that are not digested by the host and are delivered directly to good bacteria in the gut.
• Examples are the indigestible polysaccharides found in some whole grains, plant roots, and seaweeds.
• Scientific studies have proved that prebiotics grow many different kinds of good bacteria, not just one or two.
• Just by taking prebiotics, you can establish a balanced microbiome diversified with various beneficial bacteria.
• It’s that simple!
번역어 - 영어 • Many recent studies have pointed out the disturbance of gut health could be the underline cause of metabolic syndrome, obesity, and some brain disorders.
• Respiratory disease and autoimmune disorders such as atopic dermatitis and inflammatory bowel disease can become worse with deterioration of gut health. Increased weight is also seen even without over-eating and the weight that have recently been lost could easily bounce back.
• Moreover, secondary metabolites produced by microbes in the gut are known to transfer directly to brain to cause depression, sleep disorders, ADHD, and dementia. This tells us gut health is deeply related to overall human metal health as well.
• Thus, gut health is something needs to be looked into along with therapeutic options when treating certain diseases.
• Then, what is a healthy gut?
• First, the epithelial lining has to be healthy. Epithelial lining surrounds the internal tissue of the intestine and is covered with mucus produced by specific cells in the epithelia. Hence, we call, “mucus epithelial membrane”.
• Mucus acts as lubricant for food materials to move smoothly in the intestine. Mucus also encloses the feces so that it can be passed through with ease. In the process of digestion, gastric acid, digestive enzymes, bile acid, and also toxic substances are produced. These will not only affect food matters but also the gut tissue. Here, the mucus in the epithelial membrane comes to the rescue to protect you.
• Thus, healthy gut equals to healthy epithelial membrane with proper amount of mucus.
• Second, microbes inside the gut should be balanced between the good ones and the bad ones. In other words, the total microbiome should be in balance.
• The original meaning of microbiome was the total genome that microbes exhibit, but the terminology has expanded to include the total microbial flora of specific human organ. For example, the gut microbiome is understood as all the microbes in the gut, usually bacteria.
• In the mucus of epithelial membrane, there resides the beneficial microbes.
• Besides the fact that good bacteria provide direct health benefits, they can support indirect advantages by suppressing the growth of bad ones.
• So, if you have balanced good and bad bacteria, it can be said to have good gut health.
• The most popular supplement for gut health is probiotics which claim to increase beneficial microbes in the gut.
• Everyone might have taken this at least one time, but:
• Are your probiotics effective?
• Are they doing the expected job in your gut?
• The literal meaning of Pro-biotics is “supporting life”.
• Probiotics are defined by WHO as, “Live bacteria that can give health benefits when taken properly”.
• Lactic acid bacteria (LAB), including famous Lactobacillus and Bifidobacterium sp., are one class of probiotics. So, if LAB are to exert beneficial effect, they must be alive and effectively colonize the mucus membrane to proliferate.
• Can they really do this?
• Let’s take a look into the journey of the ingested LAB.
• Orally ingested LAB go into stomach where they face gastric acid.
• Gastric acid is a strong acid that will even dissolve your skin, let alone bacteria; 99% of them instantly dies. This is to protect you from any food-borne pathogens and your body does not discriminate between pathogens and LAB.
• The remaining 1% continues the journey, arriving at duodenum. Here, the bacteria are exposed to bile acid and all sorts of digestive enzymes.
• Digestive enzymes will disintegrate carbohydrate, proteins, and lipids. Bacterial cells being composed of these materials, cannot escape from being attacked. Just with bile acid alone would make the environment so toxic for the survival of LAB; many will be killed again.
• Only an insignificant number arrives at the large intestine.
• Here, they are confronted and overwhelmed by a large number of indigenous members that resist newcomers.
• Human gut microbiome contains anywhere between 38 to 100 trillion bacteria. Then, what is the likelihood for a small number of foreign LAB to penetrate the large community, find a place in the mucus, colonize, and multiply thereafter?
• As we saw, the ingested LAB face a hurdle one after another, becoming bigger as the journey continues.
• My thinking is that all the ingested LAB will end up in stools.
• Some people say, orally taken LAB survives in gut because they can be detected in stools.
• Nonsense……
• When we analyze LAB in stools, we are not detecting live bacteria but the bacterial DNA.
• “While man leaves his name, bacteria leave DNA, upon death”.
• That is, bacteria killed by gastric acid can also be detected in stools.
• You can easily imagine, live bacteria would colonize the mucus membrane, live and multiply, and continuously be detected in the assay, even if you stop taking orally.
• But the truth is that if you stop taking LAB, stools would soon stop showing their existence.
• As mentioned before, it is very hard for orally taken LAB to colonize the mucus membrane. Then, how could you procure the good bacteria to your gut?
• Upon birth, each one is given with various beneficial bacteria by his mother. About 3 years of age, the ones with the right chemistry will colonize the host and become endogenous microbiome.
• This is to say, we are already equipped with good bacteria, but just not efficient in numbers for various reasons.
• Wouldn’t it be better to grow your own bacteria rather than to bring in from outside?
• There are other scientific reasons as to why internal source is better:
• 1. Healthy microbiome is the result of variety of beneficial bacteria working together, not that of one or two species.
• 2. Outgrowth of certain species is positively related to specific disease occurrence.
• 3. Lactobacillus and Bifidobacterium are not the only beneficial bacteria in the gut and increase in one or two beneficial bacteria will not change the overall profile of the microbiome.
• 4. Specific LAB intake prevents the normalization of the microbiome after the disruption by antibiotics.
• 5. Lactobacillus sp. is one of the Firmicutes noted for “obese bacteria”. Some reports have indicated weight increase with orally taken Lactobacillus sp., although others might have found otherwise.
• 6. Inconsistencies have shown for blood sugar level with Lactobacillus sp. intake; some say it went down, some show increase in Lactobacillus sp. in gut is positively related with blood sugar increase.
• What we already have is very efficient in colonization and proliferation, experts that can tune into our gut’s need.
• That is, they are very easy to form a healthy microbiome.
• On one condition though…..
• An appropriate food source in the gut.
• The food source for beneficial bacteria is called prebiotics. The word literally means, “prerequisite for life”.
• Prebiotics are complex carbohydrates that are not digested by the host and are delivered directly to good bacteria in the gut.
• Examples are the indigestible polysaccharides found in some whole grains, plant roots, and seaweeds.
• Scientific studies have proved that prebiotics grow many different kinds of good bacteria, not just one or two.
• Just by taking prebiotics, you can establish a balanced microbiome diversified with various beneficial bacteria.
• It’s that simple!
전문 지식