New Scientific Paradigms for Probiotics and Prebiotics Gregor Reid, PhD, M.E. Sanders, PhD, H. Rex Gaskins, PhD, Glenn R. Gibson, PhD, Annick Mercenier, PhD, Robert Rastall, PhD, Marcel Roberfroid, PhD, Ian Rowland, PhD, Christine Cherbut, PhD, and Todd R. Klaenhammer, PhD Abstract The inaugural meeting of the International Scientific Association for Probiotics and Prebiotics (ISAPP) was held May 3 to May 5 2002 in London, Ontario, Canada. A group of 63 academic and industrial scientists from around the world convened to discuss current issues in the science of probiotics and prebiotics. ISAPP is a non-profit organization comprised of international scientists whose intent is to strongly support and improve the levels of scientific integrity and due diligence associated with the study, use, and application of probiotics and prebiotics. In addition, ISAPP values its role in facilitating communication with the public and healthcare providers and among scientists in related fields on all topics pertinent to probiotics and prebiotics. It is anticipated that such efforts will lead to development of approaches and prod- ucts that are optimally designed for the improvement of human and animal health and well being. This article is a summary of the discussions, conclusions, and recommendations made by 8 work- ing groups convened during the first ISAPP workshop focusing on the topics of: definitions, intestinal flora, extra-intestinal sites, im- mune function, intestinal disease, cancer, genetics and genomics, and second generation prebiotics. Key Words: probiotics, prebiotics, guidelines, intestine, urogeni- tal immunity, genetics H umans have evolved in symbiosis with an estimated 10 14 resident microorganisms. However, as medicine has widely defined and explored the perpetrators of disease, including those of microbial origin, it has paid relatively little attention to the microbial cells that constitute the most abundant life forms associated with our body. Microbial metabolism in humans and animals constitutes an intense biochemical activity in the body, with profound repercus- sions for health and disease. As understanding of the human genome constantly expands, an important opportunity will arise to better determine the relationship between microbial populations within the body and host factors (including gen- der, genetic background, and nutrition) and the concomitant implications for health and improved quality of life. Com- bined human and microbial genetic studies will determine how such interactions can affect human health and longev- ity, which communication systems are used, and how they can be influenced to benefit the host. Probiotics are defined as “live microorganisms which, when administered in adequate amounts confer a health benefit on the host.” 1 The probiotic concept dates back over 100 years, but only in recent times have the scientific knowledge and tools become available to properly evaluate their effects on normal health and well being, and their potential in preventing and treating disease. A similar situ- ation exists for prebiotics, defined by this group as “non- digestible substances that provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bac- teria.” Prebiotics function complementary to, and possibly synergistically with, probiotics. Numerous studies are pro- viding insights into the growth and metabolic influence of these microbial nutrients on health. Today, the science be- hind the function of probiotics and prebiotics still requires more stringent deciphering both scientifically and mecha- nistically. The explosion of publications and interest in pro- biotics and prebiotics has resulted in a body of collective research that points toward great promise. However, this research is spread among such a diversity of organisms, delivery vehicles (foods, pills, and supplements), and po- tential health targets such that general conclusions cannot easily be made. Nevertheless, this situation is rapidly chang- ing on a number of important fronts. With progress over the past decade on the genetics of lactic acid bacteria and the recent, 2,3 and pending, 4 release of complete genome sequences for major probiotic species, Submitted February 19, 2003. Accepted March 25, 2003 From the Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute (G.R.); University of Western Ontario, London, Canada (G.R.); Dairy and Food Culture Technologies, Centennial, CO (M.E.S.); University of Illinois, Urbana, IL (H.R.G.); University of Reading, UK (G.R.G., R.R.); Institut Pasteur de Lille, Lille, France (A.M.); Universite Catholique Louvain, Belgium (M.R.); University of Ulster, Northern Ireland (I.R.); National Institute for Agricultural Research, Nantes, France (C.C.); and North Carolina State University, Raleigh, NC. (T.R.K.) Dr. Sanders is a consultant for companies interested in probiotics and prebiotics; Drs. Rowland and Roberfroid also work with industries in this field; Dr. Reid owns patents on probiotic strains; Dr. Mercenier is em- ployed by Nestle ´ who produce probiotics. Address correspondence and reprint requests to Dr. Gregor Reid, Ca- nadian Research and Development Centre for Probiotics, Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada. E-mail: gregor@uwo.ca J Clin Gastroenterol 2003;37(2):105–118. © 2003 Lippincott Williams & Wilkins, Inc. 105