Modulating the microbial landscape: A probiotic odyssey from ancient wisdom to modern medicine

The historical journey of probiotics is fascinating, from their ancient roots in fermented foods to their potential as personalized medicine. This paper honors the pioneers who paved the path to current advancements. Significant progress has been made in understanding probiotics, including their mechanisms of action, such as competitive exclusion and immune modulation. For example, Lactobacillus plantarum has been shown to improve eczema and the common cold, whereas Bifidobacterium longum aids in nutrient absorption and fights off harmful organisms. In addition, Saccharomyces boulardii has been demonstrated to be effective in preventing antibiotic-associated diarrhea. Probiotics are applied in various fields, including digestive health, immunity enhancement, and chronic condition management. This review discusses the applications of probiotics and addresses challenges such as strain specificity, safety considerations, and regulatory oversights. The future of probiotics lies in precision medicine, with personalized interventions combined with prebiotics (food for probiotics) to unlock their full potential for enhancing human health and well-being. The paper serves as a valuable resource and a gateway for further research.
- Stahl U. Traditional fermented foods. J Appl Bacteriol. 1987;63(6):465-75.
- Hill C, Guarner F, Reid G, et al. Expert consensus document. The international scientific association for probiotics and prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. doi: 10.1038/nrgastro.2014.66
- Gasbarrini G, Bonvicini F, Gramenzi A. Probiotics history. J Clin Gastroenterol. 2016;50(Suppl 1):S116-S119. doi: 10.1097/MCG.0000000000000697
- Ozen M, Dinleyici EC. The history of probiotics: The untold story. Benef Microbes. 2015;6(2):159-166. doi: 10.3920/BM2014.0103
- Shade A, Peter H, Allison SD, et al. Fundamentals of microbial community resistance and resilience. Front Microbiol. 2012;3:417. doi: 10.3389/fmicb.2012.00417
- Kamble NS, Bera S, Bhedase SA, Gaur V, Chowdhury D. Review on applied applications of microbiome on human lives. Bacteria. 2024;3(3):141-159. doi: 10.3390/bacteria3030010
- Fierer N, Lauber CL, Zhou N, McDonald D, Costello EK, Knight R. Forensic identification using skin bacterial communities. Proc Natl Acad Sci U S A. 2010;107(14):6477-6481. doi: 10.1073/pnas.1000162107
- Sender R, Fuchs S, Milo R. Revised estimates for the number of human and bacteria cells in the body. PLoS Biol. 2016;14(7):e1002533. doi: 10.1371/journal.pbio.1002533
- Cryan JF, O’Riordan KJ, Cowan CSM, et al. The microbiota-gut-brain axis. Physiol Rev. 2019;99(4):1877-2013. doi: 10.1152/physrev.00018.2018
- Fuller R. Probiotics in man and animals. J Appl Bacteriol. 1989;66(5):365-378.
- Royal Society of Chemistry. Lactobacillus plantarum Gram Stained CC 3.0 BYNC. United Kingdom: Royal Society of Chemistry. doi: 10.1039/C9RA10446A
- Julie6301. Lactobacillus plantarum. CC 3.0 BYSA Wikimedia Commons. Available from: https://commons.wikimedia. org/w/index.php?curid=15311964 [Last accessed on 2025 May 08].
- Craver C, Tabery J, Illari P. Mechanisms in Science. United Kingdom: Cambridge University Press; 2015.
- Mechanisms of Probiotics. Biology Notes Online. Available from: https://biologynotesonline.com/ probiotics/?form=mg0av3#mechanisms_of_probiotics [Last accessed on 2025 May 08].
- Hemaiswarya S, Raja R, Ravikumar R, Carvalho IS. Mechanism of action of probiotics. Braz Arch Biol Technol. 2013;56:113-119. doi: 10.1590/S1516-89132013000100015
- Slykerman RF, Davies N, Vlckova K, et al. Precision psychobiotics for gut-brain axis health: Advancing the discovery pipelines to deliver mechanistic pathways and proven health efficacy. Microb Biotechnol. 2025;18(1):e70079. doi: 10.1111/1751-7915.70079
- Perdigón G, Fuller R, Raya R. Lactic acid bacteria and their effect on the immune system. Curr Issues Intest Microbiol. 2001;2(1):27-42.
- Den Besten G, Van Eunen K, Groen AK, et al. Short-chain fatty acids and their role in human health. Adv Nutr. 2014;5(1):5-17. doi: 10.1194/jlr.R036012
- Petrut SM, Bragaru AM, Munteanu AE, Moldovan AD, Moldovan CA, Rusu E. Gut over mind: Exploring the powerful gut-brain Axis. Nutrients. 2025;17(5):842. doi: 10.3390/nu17050842
- Liou MJ, Miller BM, Litvak Y, et al. Host cells subdivide nutrient niches into discrete biogeographical microhabitats for gut microbes. Cell Host Microbe. 2022;30(6):836-847.e6. doi: 10.1016/j.chom.2022.04.012
- Aghamohammad S, Hafezi A, Rohani M. Probiotics as functional foods: How probiotics can alleviate the symptoms of neurological disabilities. Biomed Pharmacother. 2023;163:114816. doi: 10.1016/j.biopha.2023.114816
- Consumer Reports. The Problem with Expired Medication. Available from: https://www.consumerreports.org/drug-safety/the-problem-with-expired-medication [Last accessed on 2025 May 08].
- Wilcox H, Carr C, Seney S, Reid G, Burton JP. Expired probiotics: What is really in your cabinet? FEMS Microbes. 2020;1(1):xtaa007. doi: 10.1093/femsmc/xtaa007
- Alnahas F, Yeboah P, Fliedel L, Abdin AY, Alhareth K. Expired medication: Societal, regulatory and ethical aspects of a wasted opportunity. Int J Environ Res Public Health. 2020;17(3):787. doi: 10.3390/ijerph17030787
- Han BZ, Rombouts FM, Nout MJ. A Chinese fermented soybean food. Int J Food Microbiol. 2001;65(1-2):1-10. doi: 10.1016/s0168-1605(00)00523-7
- Steinkraus K. Handbook of Indigenous Fermented Foods, Revised and Expanded. United States: CRC Press; 2018.
- Metchnikoff E. Immunity in Infective Diseases. Oxford: University Press; 1907.
- Anukam KC, Reid G. Probiotics: 100 years (1907-007) after Elie Metchnikoff’s observation. In: Communicating Current Research and Educational Topics and Trends in Applied Microbiology. Vol. 1. Mumbai: Formatex; 2007. p. 466-474.
- Gordon S. Elie Metchnikoff, the man and the myth. J Innate Immun. 2016;8(3):223-227. doi: 10.1159/000443331
- Leeuwenhoek. Available from: https://commons.wikimedia.org/wiki/File:Anthonie_van_Leeuwenhoek_(1632-1723)._Natuurkundige_te_Delft_ Rijksmuseum_SK-A-957.jpeg [Last accessed on 2025 May 21].
- Pasteur. Available from: http://resource.nlm.nih. gov/101425953 [Last accessed on 2025 May 21].
- Gram. Available from: https://commons.wikimedia.org/wiki/ File:hans_christian_gram_ portrait_by_hansen_weller.jpg [Last accessed on 2025 May 21].
- Metchnikoff. Available from: https://www.loc.gov/pictures/ item/2014694764 [Last accessed on 2025 May 21].
- Fleming. Available from: https://www.nobelprize.org/prizes/medicine/1945/fleming/ photo-gallery [Last accessed on 2025 May 21].
- Woese. Available from: https://en.wikipedia.org/wiki/ file: carl_woese.jpg [Last accessed on 2025 May 21].
- Reid G. Probiotics: A Story About Hope. Available from: https://www.amazon.com.au [Last accessed on 2025 May 21].
- Sanders ME, Merenstein DJ, Reid G, Gibson GR, Rastall RA. Probiotics and prebiotics in intestinal health and disease: From biology to the clinic. Nat Rev Gastroenterol Hepatol. 2019;16(10):605-616. doi: 10.1038/s41575-019-0173-3
- Guarner F. The Enteric Microbiota. San Rafael: Morgan and Claypool Publishers; 2012.
- Morelli L. Probiotics: Definition and Taxonomy 10 Years after the FAO/WHO Guidelines. In: Probiotic Bacteria and Their Effect on Human Health and Well-Being. Basel: Karger Medical and Scientific Publishers; 2013. p. 1-8.
- Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486(7402):207-214. doi: 10.1038/nature11234
- Goodrich JK, Davenport ER, Beaumont M, et al. Genetic determinants of the gut microbiome in UK twins. Cell Host Microbe. 2016;19(5):731-743. doi: 10.1016/j.chom.2016.04.017
- Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Efficacy of probiotics in prevention of acute diarrhoea: A meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis. 2006;6(6):374-382. doi: 10.1016/S1473-3099(06)70495-9
- Allen SJ, Wareham K, Wang D, et al. Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): A randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2013;382(9900):1249-1257.
- Szajewska H, Konarska Z, Kołodziej M. Probiotic bacterial and fungal strains: Claims with evidence. Dig Dis. 2016;34(3):251-259. doi: 10.1159/000443359
- Loftus EV Jr., Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North Am. 2002;31(1):1-20. doi: 10.1016/s0889-8553(01)00002-4
- Gupta V, Garg R. Probiotics. Indian J Med Microbiol. 2009;27(3):202-209. doi: 10.4103/0255-0857.53201
- Collado MC, Isolauri E, Laitinen K, Salminen S. Distinct composition of gut microbiota during pregnancy in overweight and normal-weight women. Am J Clin Nutr. 2008;88(4):894-899. doi: 10.1093/ajcn/88.4.894
- Shen YL, Zhang LQ, Yang Y, Yin BC, Ye BC, Zhou Y. Advances in the role and mechanism of lactic acid bacteria in treating obesity. Food Bioeng. 2022;1(1):101-115. doi: 10.1002/fbe2.12002
- Ducrotté P, Sawant P, Jayanthi V. Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome. World J Gastroenterol. 2012;18(30):4012-4018.
- Im E, Pothoulakis C. Recent advances in Saccharomyces boulardii research. Gastroenterol Clin Biol. 2010;34(Suppl 1):S62-S70. doi: 10.1016/S0399-8320(10)70023-3
- Horvat IB, Gobin I, Kresović A, Hauser G. How can probiotic improve irritable bowel syndrome symptoms? World J Gastrointest Surg. 2021;13(9):923-931. doi: 10.4240/wjgs.v13.i9.923
- Khailova L, Baird CH, Rush AA, Barnes C, Wischmeyer PE. Lactobacillus rhamnosus GG treatment improves intestinal permeability and modulates inflammatory response and homeostasis of spleen and colon in experimental model of Pseudomonas aeruginosa pneumonia. Clin Nutr. 2017;36(6):1549-1557. doi: 10.1016/j.clnu.2016.09.025
- Available from: https://www.medicalnewstoday.com/articles/microbiome-testing# considerations [Last accessed on 2025 May 21].
- Available from: https://www.choice.com.au/health-and-body/conditions/general-health/ articles /diy-gut-flora-testing-kits [Last accessed on 2025 May 21].
- McFarland LV, Evans CT, Goldstein EJ. Strain-specificity and disease-specificity of probiotic efficacy: A systematic review and meta-analysis. Front Med (Lausanne). 2018;5:124. doi: 10.3389/fmed.2018.00124
- Douillard FP, Ribbera A, Kant R, et al. Comparative genomic and functional analysis of 100 Lactobacillus rhamnosus strains and their comparison with strain GG. PLoS Genet. 2013;9(8):e1003683. doi: 10.1371/journal.pgen.1003683
- LastMojojomo. How Probiotics Destroyed My Health (Long STORY/Rant); 2020. Available https://www.reddit.com/r/ibs/comments/jpkol3/how_probiotics_destroyed_my_health_ long_storyrant [Last accessed on 2025 May 21].
- Gueniche A, Philippe D, Bastien P, et al. Randomised double-blind placebo-controlled study of the effect of Lactobacillus paracasei NCC 2461 on skin reactivity. Benef Microbes. 2014;5(2):137-145. doi: 10.3920/BM2013.0001
- Sutema IAMP, Latarissa IR, Widowati IGAR, Sartika CR. Topical probiotics in acne vulgaris treatment: A systematic review and meta-analysis. J Dermatol Treat. 2023;34(1):2208123.
- Levin J, Momin A. How robust is the evidence for probiotics in the management of rosacea? Dermatol Ther. 2010;23(6):680-689.
- Valdez JC, Ramos AN, Fernández D, et al. Probiotics and their potential use in wound treatment. In: Probiotics: Immunobiotics and Immunogenics. United States: CRC Press; 2013:298-335.
- Nobile V, Hajat C, Cestone E, Cascella F, Santus G. Skin Antiaging and Skin Health Benefits of Probiotics Intake Combined with Topical Ectoin and Sodium Hyaluronate: A Randomized, Double-Blind, Placebo-Controlled Trial. Available from: https://www.mdpi.com/2079-9284/12/2/34 [Last accessed on 2025 May 21].
- Falagas ME, Betsi GI, Athanasiou S. Probiotics for the treatment of women with bacterial vaginosis. Clin Microbiol Infect. 2007;13(7):657-664. doi: 10.1111/j.1469-0691.2007.01688.x
- Pendharkar S, Brandsborg E, Hammarström L, Marcotte H, Larsson PG. Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection. BMC Infect Dis. 2015;15:255. doi: 10.1186/s12879-015-0971-3
- Chatterjee A, Bhattacharya H, Kandwal A. Probiotics in periodontal health and disease. J Indian Soc Periodontol. 2011;15(1):23-28. doi: 10.4103/0972-124X.82260
- Chinnappa A, Konde H, Konde S, Raj S, Beena JP. Probiotics for future caries control: A short-term clinical study. Indian J Dent Res. 2013;24(5):547-549. doi: 10.4103/0970-9290.123363
- Karbalaei M, Keikha M, Kobyliak NM, et al. Alleviation of halitosis by use of probiotics and their protective mechanisms in the oral cavity. New Microbes New Infect. 2021;42:100887. doi: 10.1016/j.nmni.2021.100887
- CN103520216A - Probiotic Human Injection. Available from: https://patents.google.com/ patent/CN103520216A/en [Last accessed on 2025 May 08].
- Monnerat N, Lambert AC, Genné D. What happens after an accidental intravenous probiotic injection? Clin Microbiol Infect. 2020;26(4):517-518. doi: 10.1016/j.cmi.2019.11.027
- Morishita M, Kida M, Motomura T, et al. Elucidation of the tissue distribution and host immunostimulatory activity of exogenously administered probiotic-derived extracellular vesicles for immunoadjuvant. Mol Pharm. 2023;20(12):6104-6113. doi: 10.1021/acs.molpharmaceut.3c00460
- Extracellular Vesicles: An Introduction. Abcam. Available from: https://www.abcam.cn/primary-antibodies/extracellular-vesicles-an-introduction [Last accessed on 2025 May 08].
- Yáñez-Mó M, Siljander PR, Andreu Z, et al. Biological properties of extracellular vesicles and their physiological functions. J Extracell Vesicles. 2015;4(1):27066. doi: 10.3402/jev.v4.27066
- Song Y, Zhang C, Zhang J, et al. Localized injection of miRNA-21-enriched extracellular vesicles effectively restores cardiac function after myocardial infarction. Theranostics. 2019;9(8):2346-2360. doi: 10.7150/thno.29945
- Jokicevic K, Kiekens S, Byl E, et al. Probiotic nasal spray development by spray drying. Eur J Pharm Biopharm. 2021;159:211-220. doi: 10.1016/j.ejpb.2020.11.008
- Tran TT, Cheow WS, Pu S, Park JW, Hadinoto K. Dry powder inhaler formulation of Lactobacillus rhamnosus GG targeting Pseudomonas aeruginosa infection in bronchiectasis maintenance therapy. Pharmaceutics. 2024;16(8):980. doi: 10.3390/pharmaceutics16080980
- Gazerani P, Papetti L, Dalkara T, et al. The brain, the eating plate, and the gut microbiome: Partners in migraine pathogenesis. Nutrients. 2024;16(14):2222. doi: 10.3390/nu16142222
- Snydman DR. The safety of probiotics. Clin Infect Dis. 2008;46(Suppl 2):S104-S111, discussion S144-S151.
- Vogel L, Van den Abeele E. Better Regulation: A Critical Assessment. Belgium: ETUI; 2010.
- Wong CB, Odamaki T, Xiao JZ. Beneficial effects of Bifidobacterium longum subsp. longum BB536 on human health: Modulation of gut microbiome as the principal action. J Funct Foods. 2019;54:506-519. doi: 10.1016/j.jff.2019.02.002
- Mugwanda K, Hamese S, Van Zyl WF, et al. Recent advances in genetic tools for engineering probiotic lactic acid bacteria. Biosci Rep. 2023;43(1):BSR202112. doi: 10.1042/BSR20211299