An Oral Formulation of the Probiotic, Bacillus subtilis HU58, Was Safe and Well Tolerated in a Pilot Study of Patients with Hepatic Encephalopathy. (30th June 2020)

• Record Type: Journal Article
• Authors: Yossef, Sayed; Clark, Frances; Bubeck, Sarah S.; Abernethy, John; Bayne, Thomas; Krishnan, Kiran; Young, Aicacia
• Other Names: Bastos Jairo Kenupp Academic Editor.
• Is Part Of: Evidence-based complementary and alternative medicine. Volume 2020(2020)
• Publication Date: 2020-06-30
• Subjects: Alternative medicine -- Periodicals; 615.505
• DOI: 10.1155/2020/1463108
• Languages: English
• ISSNs: 1741-427X

Abstract

Abstract : Background . Hepatic encephalopathy often results in high blood ammonia levels because of inefficient ammonia processing by the liver. Lactulose treatment promotes the growth of urease-producing gut bacteria and a reduced colon pH, thus reducing blood ammonia absorption. It is thought that probiotics as an add-on therapy may be beneficial. Patients and Methods . Bacillus subtilis HU58 was tested for safety and tolerability in patients with hepatic encephalopathy taking lactulose in this double-bind, placebo-controlled, 4-week pilot study. Study participants received one dose of B . subtilis HU58 or placebo (orally) for the first five days and two daily doses thereafter. Participants were monitored for safety and blood ammonia levels. Results . Forty patients participated (placebo, 11; probiotic, 29). Baseline characteristics were generally comparable; the mean baseline blood ammonia level was somewhat higher in the probiotic group. Mild or moderate treatment-emergent adverse events (TEAEs) were reported in 27.3% and 17.2% of patients in the placebo and probiotic groups, respectively; no severe TEAEs were reported. One patient (9.1%) taking placebo and two (6.9%) taking the probiotic experienced serious TEAEs (SAEs); none resulted in study discontinuation and all were considered to have no/unlikely relationship to the study product. There were no significant differences in the mean percent change (MPC) of blood ammonia levels between groups, though the probiotic group exhibited a trend toward a milder increase. Stratification of the probiotic group by baseline blood ammonia level (>60 μ g/dL and ≤60 μ g/dL) resulted in a significantly reduced MPC in the >60 μ g/dL subgroup (MPC (SD); ≤60 μ g/dL ( n = 14), 35.3% (73.3); >60 μ g/dL ( n = 14), −26.5% (24.4); p = 0.0087 ). Conclusions . Daily treatment with oral B . subtilis HU58 was safe and well tolerated over a 4-week period in patients with hepatic encephalopathy, and a significantly reduced MPC of blood ammonia level was observed in patients with a baseline level >60 µ g/dL.