The Effects of Probiotic/Synbiotic on Serum Level of Zonulin as a Biomarker of Intestinal Permeability: A Systematic Review and Meta-Analysis
-
Amirhossein RAMEZANI AHMADI
,
Mehdi SADEGHIAN
,
Meysam ALIPOUR
,
Samira AHMADI TAHERI
,
Sepideh RAHMANI
,
Amir ABBASNEZHAD
Abstract
Background: This systematic review and meta-analysis was conducted to obtain a conclusive result on the influence of probiotics/synbiotic on serum levels of zonulin. Data related to serum levels of zonulin were extracted to determine the effects of probiotic/synbiotic on intestinal permeability.
Methods: The literature search was conducted across the Cochrane Central Register of Controlled Trials, PubMed, Scopus and ISI Web of Science, Search up to Nov 2018. Clinical trials evaluating the effect of probiotic/synbiotic on serum zonulin levels of all human subjects were included.
Results: Nine studies (including 496 intervention and 443 control subjects) met the inclusion criteria for the meta-analysis. According to the meta-analysis, probiotic/synbiotic has a significant effect on serum zonulin reduction (WMD=-10.55 [95% CI: -17.76, -3.34]; P=0.004). However, the high level of heterogeneity was observed among the studies (I2=97.8, P<0.001). The subgroup analysis suggested study quality, blinding, study duration, Participants age, subject's health status and supplement type as sources of heterogeneity.
Conclusion: Probiotic/synbiotic have favorable effects on serum levels of zonulin as a measure of intestinal permeability. However, the results should be interpreted with caution due to the high heterogeneity and further evidence is required before definitive recommendations can be made.
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33. Agrawal AS, Garron T, Tao X, et al (2015).Generation of a transgenic mouse model of Middle East respiratory syndrome coronavirus infection and disease. J Virol, 89(7):3659-70.
34. Mertz D, Kim TH, Johnstone J, et al (2013). Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ, 347:f5061.
35. Lippi G, Henry BM (2020). Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med, 75: 107–108.
36. Wan Y, Shang J, Graham R, et al (2020). Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol, 94(7):e00127-20.
37. Oakes JM, Fuchs RM, Gardner JD , et al (2018). Nicotine and the renin-angiotensin system. Am J Physiol Regul Integr Comp Physiol, 315(5):R895-R906.
38. Zhang J-j, Dong X, Cao Y-y, et al (2020). Clinical characteristics of 140 patients infected with SARSCoV2 in Wuhan, China. Allergy, doi: 10.1111/all.14238. [Epub ahead of print]
39. Weinkove R, McQuilten ZK, Adler J, et al (2020). Managing haematology and oncology patients during the COVID‐19 pandemic: interim consensus guidance. Med J Australia, doi:https://doi.org/10.5694/mja2.50607
40. Wu Z, McGoogan JM (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323(13):1239-42.
41. Liang W, Guan W, Chen R, et al (2020). Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol, 21(3):335-7.
42. Huang C, Wang Y, Li X, et al (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet,395(10223):497-506.
43. Chen N, Zhou M, Dong X, et al (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet,395(10223):507-13.
44. Cao Z, Zhang Q, Lu X, et al (2020). Estimating the effective reproduction number of the 2019-nCoV in China. MedRxiv, doi: 10.1101/2020.01.27.20018952.
45. Zhao S, Lin Q, Ran J, et al ( 2020). Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Int J Infect Dis, 92:214-7.
46. Cheng Y, Luo R, Wang K, et al (2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int, 97(5):829-838.
47. Chen M, Fan Y, Wu X, et al (2020). Clinical characteristics and risk factors for fatal outcome in patients with 2019-coronavirus infected disease (COVID-19) in Wuhan, China. Available at SSRN: https://ssrn.com/abstract=3546069
48. Yang Y, Shi J, Ge S, et al (2020). Effect of continuous renal replacement therapy on all-cause mortality in COVID-19 patients undergoing invasive mechanical ventila-tion: a retrospective cohort study. MedRxiv, doi: 10.1101/2020.03.16.20036780
49. Deng X, Yang J, Wang W, et al (2020). Case fatality risk of novel coronavirus diseases 2019 in China. medRxiv. doi: MedRxiv, 2020. doi: 10.1101/2020.03.04.20031005
50. Caramelo F, Ferreira N, Oliveiros B. (2020). Estimation of risk factors for COVID-19 mortality-preliminary results. MedRxiv, 2020. doi: 10.1101/2020.02.24.20027268
51. Zhou F, Yu T, Du R, et al (2020).Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 395(10229) :1054-62.
52. Yuan M, Yin W, Tao Z, Tan W, et al (2019). Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One,15(3):e0230548.
53. Yang X, Yu Y, Xu J, et al (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med, 8(5): 475-81.
2. Bonilla-Aldana DK, Dhama K, Rodriguez-Morales AJ(2020). Revisiting the one health approach in the context of COVID-19: a look into the ecology of this emerging disease. Adv Anim Vet Sci, 8(3):234-7.
3. Anderson RM, Heesterbeek H, Klinkenberg D, et al (2020). How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet, 395(10228):931-4
4. Guo Y-R, Cao Q-D, Hong Z-S, et al (2020). The origin, transmission and clinical ther-apies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil Med Res, 7(1):1-10.
5. Organization WH (2020). Report of the WHO-China Joint Mission on Corona-virus Disease 2019 (COVID-19). Availa-ble from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
6. Stroup DF, Berlin JA, Morton SC, et al (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA, 283(15):2008-12.
7. Wells G, Shea B, O’Connell D, et al (2014). Newcastle-Ottawa quality assessment scale cohort studies. Ontario, Canada: University of Ottawa. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
8. Wells G, Shea B, O’Connell D, et al (2017). Newcastle–Ottawa quality assessment scale—case control studies. 2017. Availa-ble from: http://www.ohri.ca/programs/clinical_epidemiology/nosgen.pdf
9. Wu F, Zhao S, Yu B, et al (2020). A new coronavirus associated with human res-piratory disease in China. Nature, 579(7798):265-9.
10. Adhikari SP, Meng S, Wu Y-J, et al (2020). Epidemiology, causes, clinical manifesta-tion and diagnosis, prevention and con-trol of coronavirus disease (COVID-19) during the early outbreak period: a scop-ing review. Infect Dis Poverty, 9(1):1-12.
11. worldometers 2020. Available from: https://www.worldometers.info/coronavirus/#countries.
12. Wu C, Chen X, Cai Y, et al (2020).Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA In-tern Med, doi: 10.1001/jamainternmed.2020.0994
13. Hong K-H, Choi J-P, Hong S-H, et al ( 2018). Predictors of mortality in Middle East respiratory syndrome (MERS). Thorax,73(3):286-9.
14. Choi KW, Chau TN, Tsang O, et al (2003). Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med, 139(9):715-23.
15. Opal SM, Girard TD, Ely EW (2005). The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis.41(Supplement_7):S504-S12.
16. Novel CPERE (2020).The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi, 41(2):145. [Article in Chinese; Abstract available in Chinese from the publisher]
17. Guan W-j, Ni Z-y, Hu Y, Liang W-h, et al (2020). Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 382(18):1708-20.
18. Jaillon S, Berthenet K, Garlanda C. (2019). Sexual dimorphism in innate immunity. Clinic Rev Allerg Immunol, 56:308–321.
19. Badawi A, Ryoo SG (2016).Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. Int J Infect Dis, 49:129-33.
20. Yang J, Zheng Y, Gou X, et al (2020). Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis, 94:91-5.
21. Carey IM, Critchley JA, DeWilde S, et al (2018). Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care,41(3):513-21.
22. van Crevel R, van de Vijver S, Moore DA (2017). The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol, 5(6):457-68.
23. Shah BR, Hux JE (2003). Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care,26(2):510-3.
24. Shi Q, Zhang X, Jiang F, et al (2020). Dia-betic Patients with COVID-19, Charac-teristics and Outcome: A Two Centre, Retrospective, Case Control Study. SSRN Electronic Journal, DOI: 10.2139/ssrn.3551369.
25. Allard R, Leclerc P, Tremblay C et al (2010). Diabetes and the severity of pandemic in-fluenza A (H1N1) infection. Diabetes Care, 33(7):1491-3.
26. Odegaard JI, Chawla A ( 2012).Connecting type 1 and type 2 diabetes through innate immunity. Cold Spring Harb Perspect Med,2(3):a007724.
27. Dooley KE, Chaisson RE.( 2009). Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis.9(12):737-46.
28. Guo L, Wei D, WU Y, et al (2019). Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol,10:2752.
29. Shi Q, Zhao K, Yu J, et al (2020) Clinical characteristics of 101 non-surviving hospitalized patients with COVID-19: A single center, retrospective study. MedRxiv, 2020. doi: 10.1101/2020.03.04.20031039
30. Chu KH, Tsang WK, Tang CS, et al ( 2005). Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int, 67(2):698-705.
31. Zhao X, Zhang B, Li P, et al ( 2020). Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis. MedRxiv, doi: 10.1101/2020.03.17.20037572
32. Alraddadi BM, Watson JT, Almarashi A, et al (2014). Risk factors for primary Middle East respiratory syndrome coronavirus illness in humans, Saudi Arabia 2014. Emerg Infect Dis,22(1):49.
33. Agrawal AS, Garron T, Tao X, et al (2015).Generation of a transgenic mouse model of Middle East respiratory syndrome coronavirus infection and disease. J Virol, 89(7):3659-70.
34. Mertz D, Kim TH, Johnstone J, et al (2013). Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ, 347:f5061.
35. Lippi G, Henry BM (2020). Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med, 75: 107–108.
36. Wan Y, Shang J, Graham R, et al (2020). Receptor recognition by the novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS coronavirus. J Virol, 94(7):e00127-20.
37. Oakes JM, Fuchs RM, Gardner JD , et al (2018). Nicotine and the renin-angiotensin system. Am J Physiol Regul Integr Comp Physiol, 315(5):R895-R906.
38. Zhang J-j, Dong X, Cao Y-y, et al (2020). Clinical characteristics of 140 patients infected with SARSCoV2 in Wuhan, China. Allergy, doi: 10.1111/all.14238. [Epub ahead of print]
39. Weinkove R, McQuilten ZK, Adler J, et al (2020). Managing haematology and oncology patients during the COVID‐19 pandemic: interim consensus guidance. Med J Australia, doi:https://doi.org/10.5694/mja2.50607
40. Wu Z, McGoogan JM (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323(13):1239-42.
41. Liang W, Guan W, Chen R, et al (2020). Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol, 21(3):335-7.
42. Huang C, Wang Y, Li X, et al (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet,395(10223):497-506.
43. Chen N, Zhou M, Dong X, et al (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet,395(10223):507-13.
44. Cao Z, Zhang Q, Lu X, et al (2020). Estimating the effective reproduction number of the 2019-nCoV in China. MedRxiv, doi: 10.1101/2020.01.27.20018952.
45. Zhao S, Lin Q, Ran J, et al ( 2020). Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Int J Infect Dis, 92:214-7.
46. Cheng Y, Luo R, Wang K, et al (2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int, 97(5):829-838.
47. Chen M, Fan Y, Wu X, et al (2020). Clinical characteristics and risk factors for fatal outcome in patients with 2019-coronavirus infected disease (COVID-19) in Wuhan, China. Available at SSRN: https://ssrn.com/abstract=3546069
48. Yang Y, Shi J, Ge S, et al (2020). Effect of continuous renal replacement therapy on all-cause mortality in COVID-19 patients undergoing invasive mechanical ventila-tion: a retrospective cohort study. MedRxiv, doi: 10.1101/2020.03.16.20036780
49. Deng X, Yang J, Wang W, et al (2020). Case fatality risk of novel coronavirus diseases 2019 in China. medRxiv. doi: MedRxiv, 2020. doi: 10.1101/2020.03.04.20031005
50. Caramelo F, Ferreira N, Oliveiros B. (2020). Estimation of risk factors for COVID-19 mortality-preliminary results. MedRxiv, 2020. doi: 10.1101/2020.02.24.20027268
51. Zhou F, Yu T, Du R, et al (2020).Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 395(10229) :1054-62.
52. Yuan M, Yin W, Tao Z, Tan W, et al (2019). Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One,15(3):e0230548.
53. Yang X, Yu Y, Xu J, et al (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med, 8(5): 475-81.
| Files | ||
| Issue | Vol 49 No 7 (2020) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v49i7.3575 | |
| PMCID | PMC7548501 | |
| PMID | 33083288 | |
| Keywords | ||
| Probiotic Symbiotic Intestinal permeability Zonulin Gut barrier; | ||
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How to Cite
1.
RAMEZANI AHMADI A, SADEGHIAN M, ALIPOUR M, AHMADI TAHERI S, RAHMANI S, ABBASNEZHAD A. The Effects of Probiotic/Synbiotic on Serum Level of Zonulin as a Biomarker of Intestinal Permeability: A Systematic Review and Meta-Analysis. Iran J Public Health. 2020;49(7):1222-1231.
