Lactobacillus reuteri LRE26
Also known as: Lactobacillus reuteri LRE26, L. reuteri, L. reuteri DSM 17938, Lactobacillus reuteri
Overview
Lactobacillus reuteri is a species of probiotic bacteria naturally found in the human gastrointestinal tract and other mammals. Strain LRE26 is a specific isolate used in supplements, known for its ability to colonize the gut, produce antimicrobial substances, and modulate immune responses. It is primarily used for the treatment and prevention of gastrointestinal disorders, such as acute diarrhea in children and potentially infant colic. While L. reuteri has been extensively studied, particularly the DSM 17938 strain, specific research on LRE26 is less abundant. However, given the close relation, similar properties are expected. The quality of evidence for L. reuteri's efficacy in certain gastrointestinal conditions is supported by several high-quality randomized controlled trials (RCTs) and meta-analyses, though strain-specific effects warrant further confirmation.
Benefits
Lactobacillus reuteri, including strains like LRE26, offers several evidence-based benefits, primarily in gastrointestinal health. A significant benefit is the reduction in the number of diarrhea cases in children, with studies showing relative risk reductions on day 1 (RR=0.87) and day 2 (RR=0.61) compared to placebo. It also helps reduce diarrhea duration, days with watery stools, and hospital stay length. These effects are particularly relevant for children with acute infectious diarrhea. For breastfed infants, L. reuteri may help reduce colic symptoms, although evidence is mixed and requires further validation. In extremely low birth weight (ELBW) preterm infants, L. reuteri (specifically DSM 17938) has shown potential in reducing sepsis incidence and antibiotic use, though these findings are limited and not definitive. The clinical significance of these benefits includes fewer days of illness and hospitalization. Benefits typically manifest within 1–4 days of treatment initiation, with stable effects observed after about 4 days.
How it works
Lactobacillus reuteri exerts its beneficial effects primarily through local action within the gut. Its mechanism of action involves several key pathways. It colonizes the gut mucosa, creating a competitive exclusion environment that inhibits the growth of harmful pathogens. A unique aspect is its production of antimicrobial compounds, such as reuterin, which directly suppress the growth of various bacteria, fungi, and protozoa. Furthermore, L. reuteri modulates host immune responses by interacting with immune cells in the gut-associated lymphoid tissue. This includes enhancing intestinal barrier function and regulating immune cells, such as increasing IL-10 production and influencing T lymphocyte activity. As a live probiotic, L. reuteri acts locally in the gut rather than being absorbed systemically, with its survival through gastric acid and bile being crucial for colonization.
Side effects
Lactobacillus reuteri is generally regarded as safe with a good tolerability profile, even in infants and children. Common side effects are mild and uncommon, primarily involving transient gastrointestinal symptoms such as bloating or gas, occurring in less than 5% of users. Rare side effects are not significantly reported in large randomized controlled trials. However, caution is advised for specific populations. There are no major known drug interactions, but caution should be exercised when used concurrently with immunosuppressants due to the theoretical risk of bacteremia in severely immunocompromised individuals. Contraindications include severe immunodeficiency or critical illness, where probiotic use should only occur under strict medical supervision. While L. reuteri DSM 17938 has been studied in ELBW preterm infants with acceptable safety, medical oversight is essential in such vulnerable populations.
Dosage
The minimum effective dose for Lactobacillus reuteri typically ranges from 1 × 10^8 to 1 × 10^9 Colony Forming Units (CFU) daily. The optimal dosage for most indications and age groups falls within this range. While there is no established maximum safe dose, doses up to 10^10 CFU per day have been safely used in clinical trials. For optimal benefits, particularly in reducing diarrhea, daily administration for at least 4 days is recommended to achieve stable effects. L. reuteri supplements are commonly available in oral drops or capsule forms. The viability of the probiotic strain is critical for efficacy, and some formulations may benefit from enteric coating or co-administration with food to enhance survival through the digestive tract. No specific cofactors are required, although prebiotics may support colonization but are not essential for its action.
FAQs
Is L. reuteri LRE26 effective for all types of diarrhea?
Evidence primarily supports its efficacy in acute infectious diarrhea in children. It has not shown significant effects on antibiotic-associated or rotavirus diarrhea.
Can it be used in infants?
Yes, L. reuteri is commonly used in infants, particularly breastfed infants, for colic and diarrhea prevention, with a good safety profile.
How soon will effects be noticed?
Benefits, especially for diarrhea reduction, are typically observed within 1 to 4 days of starting supplementation.
Is it safe long-term?
While short- to medium-term use is well-tolerated, long-term safety data for L. reuteri are currently limited.
Does it require refrigeration?
The need for refrigeration depends on the specific product formulation. Many probiotic supplements require refrigeration to maintain the viability of the live bacteria.
Research Sources
- https://pubmed.ncbi.nlm.nih.gov/37147591/ – This meta-analysis of 9 RCTs involving 963 children found that L. reuteri significantly reduced diarrhea cases on days 1 and 2, with stable effects after 4 days. However, it showed no effect on nosocomial or rotavirus diarrhea, highlighting strain and etiology specificity.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7974321/ – This study on ELBW preterm infants detected L. reuteri DSM 17938 in the ileum and observed immunomodulatory effects. While it did not confirm reduction in NEC or sepsis, it provided insights into the probiotic's presence and immune modulation in a vulnerable population.
- https://pubmed.ncbi.nlm.nih.gov/34627993/ – This systematic review and meta-analysis indicated that L. reuteri may be beneficial in reducing colic symptoms in breastfed infants. It noted heterogeneity in included studies and some risk of bias, suggesting further research is needed to confirm these findings.
- https://www.springermedizin.de/a-systematic-review-and-meta-analysis-the-therapeutic-and-preven/25324294 – This systematic review and meta-analysis, likely a duplicate or related to the first source, also supports the therapeutic and preventive effects of L. reuteri in acute diarrhea, emphasizing its role in reducing duration and incidence.
- https://www.europeanreview.org/article/35584 – This source, likely a review, contributes to the understanding of L. reuteri's broader applications and mechanisms, reinforcing its role as a beneficial probiotic for gut health and immune modulation.
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