Skip to main content Accessibility help

New insights into the impact of the intestinal microbiota on health and disease: a symposium report

  • Linda V. Thomas (a1) and Theo Ockhuizen (a2)


The present report summarises key insights from a recent symposium focusing on the impact of the intestinal microbiota on health and disease. A more appropriate definition of health was proposed since health maintenance is a dynamic process better assessed in terms of ability to adapt to stress and maintain physiological homeostasis. Biomarkers specifically for health are needed; use of challenge models and subjects with suboptimal health or specific disease risk were advised. The complexity of interactions between external factors, the intestinal epithelium, intestinal microbiota, the immune system and health was exemplified by describing the effects of antibiotics, the Western diet and non-digestible carbohydrates on the microbiota. The association of certain bacteria with different states of health or disease was acknowledged but also that is not always clear whether this is a cause or effect. Recent identification of three robust faecal metagenome clusters may advance this understanding. It was speculated that knowledge of the intestinal microbiota profile may eventually help in the diagnosis of health risks and choice of therapy. It was agreed that beneficial manipulation of the commensal microbiota can improve health outcome. For this purpose, three areas were reviewed. Firstly, research into probiotics as vaccine adjuvants was considered useful for substantiation of immune function claims. Secondly, positive results with certain probiotics and synbiotics for colorectal cancer are emerging, mostly from in vitro and animal studies. Finally, studies in endurance athletes have shown strain-specific probiotic benefit in terms of maintenance of immune function and, for certain strains, reduction of episodes of respiratory and/or gastrointestinal tract infections.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      New insights into the impact of the intestinal microbiota on health and disease: a symposium report
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      New insights into the impact of the intestinal microbiota on health and disease: a symposium report
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      New insights into the impact of the intestinal microbiota on health and disease: a symposium report
      Available formats


Corresponding author

*Corresponding author: L. V. Thomas, fax +44 20 8839 3250, email


Hide All
1Frank, DN, St Amand, AL, Feldman, RA, et al. (2007) Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. PNAS 104, 1378013785.
2World Health Organization (1946) WHO definition of Health, Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
3World Health Organization (2006) Constitution of the World Health Organization – Basic Documents, Forty-fifth edition, Supplement, October 2006.
4Volponi, AJ, Broteron, T & Luppold, R (2004) Development of an information fusion system for engine diagnostics and health management. AIAA 1st Intelligent Systems Technical Conference 20–24 September. Chicago, IL, USA.
5Zhao, L & Shen, J (2010) Whole-body systems approaches for gut-microbiota-targeted, preventive healthcare. J Biotechnol 149, 183190.
6Zeissig, S, Bojarski, C, Buergel, N, et al. (2004) Downregulation of epithelial apoptosis and barrier repair in active Crohn's disease by tumour necrosis factor α antibody treatment. Gut 53, 12951302.
7Hering, NA, Fromm, A, van Tol, EA, et al. (2010) Transforming growth factor-α, a whey protein component, strengthens the intestinal barrier by upregulating claudin-4 in HT/29/B6 cells. J Nutr 141, 783789.
8Amasheh, M, Schlicter, S, Amasheh, S, et al. (2008) Quercetin enhances epithelial barrier function and increases claudin-4 expression in Caco-2 cells. J Nutr 138, 10671073.
9Amasheh, M, Fromm, A, Krug, SM, et al. (2010) TNF-α induced and berberine-antagonized tight junction barrier impairment via tyrosine kinas, Akt and NFκB signalling. J Cell Science 123, 41454155.
10Raes, J & Bork, P (2008) Molecular eco-systems biology: towards a better understanding of community function. Nat Rev Microbiol 6, 693699.
11Turnbaugh, PJ, Ley, RE, Hamady, M, et al. (2007) The human microbiome project. Nature 449, 804810.
12Qin, J, Li, R, Raes, J, et al. (2010) A human gut microbial gene catalogue established by metagenomic sequencing. Nature 464, 5965.
13Arumugam, M, Raes, J, Pelletier, E, et al. (2011) Enterotypes of the human gut microbiome. Nature 473, 174180, Erratum in Nature 474, 666.
14Zwielehner, J, Liszt, K, Handschur, M, et al. (2009) Combined PCR-DGGE fingerprinting and quantitative-PCR indicates shifts in fecal population sizes and diversity of Bacteroides, bifidobacteria and Clostridium cluster IV in institutionalized elderly. Exp Gerontol 44, 440446.
15Liszt, K, Zwielehner, J, Handschur, M, et al. (2009) Characterization of bacteria, clostridia and Bacteroides in faeces of vegetarians using qPCR and PCR-DGGE fingerprinting. Ann Nutr Metab 54, 253257.
16Greer, JB & O'Keefe, SJ (2011) Microbial induction of immunity, inflammation, and cancer. Front Physiol 1, 168.
17Zoetendal, EG, Akkermans, ADL & de Vos, WM (1998) Temperature gradient gel electrophoresis analysis of 16S rRNA from human fecal samples reveals stable and host-specific communities of active bacteria. Appl Environ Microbiol 64, 38543859.
18Walker, AW, Ince, J, Duncan, SH, et al. (2011) Dominant and diet-responsive groups of bacteria within the human colonic microbiota. ISME J 5, 220230.
19Duncan, SH, Belenguer, A, Holtrop, G, et al. (2007) Reduced dietary intake of carbohydrates by obese subjects results in decreased concentrations of butyrate and butyrate-producing bacteria in feces. Appl Environ Microbiol 73, 10731078.
20Russell, WR, Gratz, S, Duncan, SH, et al. (2011) High protein, reduced carbohydrate diets promote metabolite profiles likely to be detrimental to colonic health. Am J Clin Nutr 93, 10621072.
21Louis, P, Young, P, Holtri, G, et al. (2010) Diversity of human colonic butyrate-producing bacteria revealed by analysis of the butyryl-CoA:acetate CoA-transferase gene. Environ Microbiol 12, 304314.
22Hippe, B, Zwielehner, J, Liszt, K, et al. (2011) Quantification of butyryl CoA-transferase genes reveals different butyrate production capacity in individuals according to diet and age. FEMS Microbiol Lett 316, 130135.
23Sandler, RH, Finegold, SM, Bolte, ER, et al. (2000) Short-term benefit from oral vancomycin treatment of regressive-onset autism. J Child Neurol 15, 429435.
24Klinder, A, Forster, A, Caderni, G, et al. (2004) Fecal water genotoxicity is predictive of tumor-preventive activities by inulin-like oligofructoses, probiotics (Lactobacillus rhamnosus and Bifidobacterium lactis) and their synbiotic combination. Nutr Cancer 49, 144155.
25Cani, PD, Amar, J, Iglesias, MA, et al. (2007) Metabolic endotoxaemia initiates obesity and insulin-resistance. Diabetes 56, 17611772.
26Li, M, Wang, B, Zhang, M, et al. (2008) Symbiotic gut microbes modulate human metabolic phenotypes. PNAS 105, 21172122.
27Cani, PD & Delzenne, NM (2009) Interplay between obesity and associated metabolic disorders: new insights in the gut microbiota. Curr Opin Pharmacol 9, 737743.
28Zhang, C, Zhang, M, Wang, S, et al. (2010) Interactions between gut microbiota, host genetics and diet relevant to development of metabolic syndrome in mice. ISME J 4, 232241.
29Atarashi, K, Nishimura, J, Shima, T, et al. (2008) ATP drives lamina propria TH17 cell differentiation. Nature 455, 808814.
30Ivanov, At II, arashi, K, Manel, N, et al. (2009) Induction of intestinal Th17 cells by segmented filamentous bacteria. Cell 139, 485498.
31Atarashi, K, Tanoue, T, Shima, T, et al. (2011) Induction of colonic regulatory T cells by indigenous Clostridium species. Science 331, 337341.
32Sokol, H, Pigneur, B, Watterlot, L, et al. (2008) Faecalibacterium prausnitzii is an anti-inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. PNAS 105, 1673116736.
33Collins, SM & Bercic, P (2009) The relationship between intestinal microbiota and the central nervous system in normal gastrointestinal function and disease. Gastroenterology 136, 20032014.
34Spiller, R & Garsed, K (2009) Postinfectious irritable bowel syndrome. Gastroenterology 136, 19791988.
35Barbara, G, Stanghellini, V, Brandi, G, et al. (2005) Interactions between commensal bacteria and gut sensorimotor function in health and disease. Am J Gastroenterol 100, 25602568.
36Sudo, N, Chida, Y, Aiba, Y, et al. (2004) Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J Physiol 1, 263275.
37O'Mahony, SM, Marchesi, JR, Scully, P, et al. (2008) Early life stress alters behavior, immunity, and microbiota in rats: implications for irritable bowel syndrome and psychiatric illnesses. Biol Psychiatry 65, 263267.
38Schoepfer, AM, Schaffer, T, Seibold-Schmid, B, et al. (2008) Antibodies to flagellin indicate reactivity to bacterial antigens in IBS patients. Neurogastroenterol Motil 20, 11101118.
39Preidis, GA & Versalovic, J (2009) Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era. Gastroenterology 136, 20152031.
40Moayyedi, P, Ford, AC, Talley, NJ, et al. (2010) The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review. Gut 59, 325332.
41Pimentel, M, Park, S, Mirocha, J, et al. (2006) The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 145, 557563.
42Malinen, E, Rinttilä, T, Kajander, K, et al. (2005) Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR. Am J Gastroenterol 100, 373382.
43Kassinen, A, Krogius-Kurikka, L, Mäkivuokko, H, et al. (2007) The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology 133, 2433.
44Lyra, A, Rinttilä, T, Nikkilä, J, et al. (2009) Diarrhoea-predominant irritable bowel syndrome distinguishable by 16S rRNA gene phylotype quantification. World J Gastroenterol 15, 59365945.
45Malinen, E, Rintatilä, T, Kajander, K, et al. (2005) Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR. Am J Gastroenterol 100, 373382.
46Simrén, M & Stotzer, PO (2006) Use and abuse of hydrogen breath tests. Gut 55, 297303.
47Lee, H-R & Pimentel, M (2006) Bacteria and irritable bowel syndrome: the evidence for small intestinal bacterial overgrowth. Curr Gastroenterol Rep 8, 305311.
48Salzman, NH, Underwood, MA & Bevins, CL (2007) Paneth cells, defensins, and the commensal microbiota: a hypothesis on intimate interplay at the intestinal mucosa. Semin Immunol 19, 7083.
49Langhorst, J, Junge, A, Rueffer, A, et al. (2009) Elevated human beta-defensin-2 levels indicate an activation of the innate immune system in patients with irritable bowel syndrome. Am J Gastroenterol 104, 404410.
50Turner, JR (2009) Intestinal mucosal barrier function in health and disease. Nat Rev Immunol 9, 799809.
51Piche, T, Barbara, G, Aubert, P, et al. (2009) Impaired intestinal barrier integrity in the colon of patients with irritable bowel syndrome: involvement of soluble mediators. Gut 58, 196201.
52Barbara, G, Stanghellini, V, De Giorgio, R, et al. (2004) Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 126, 693702.
53Barbara, G, Wang, B, Stanghellini, V, et al. (2007) Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology 132, 2637.
54Spor, A, Koren, O & Ley, R (2011) Unravelling the effects of the environment and host genotype on the gut microbiome. Nat Rev Microbiol 9, 279289.
55Lebeer, S, Vanderleyden, J & De Keersmaecker, SC (2010) Host interactions of probiotic bacterial surface molecules: comparison with commensals and pathogens. Nat Rev Microbiol 8, 171184.
56Abreu, M (2010) Toll-like receptor signalling in the intestinal epithelium: how bacterial recognition shapes intestinal function. Nat Rev Immunol 10, 131444.
57Haller, D, Russo, MP, Sartor, RB, et al. (2002) IKKβ and phosphatidylinositol 3-kinase/Akt participate in non-pathogenic Gram-negative enteric bacteria-induced ReIA phosphorylation and NF-κB activation in both primary and intestinal epithelial cells. J Biol Chem 277, 3816838178.
58Ruiz, PA, Shkoda, A, Kim, SC, et al. (2005) IL-10 gene-deficient mice lack TGF-β/Smad signalling and fail to inhibit proinflammatory gene expression in intestinal epithelial cells after the colonisation with colitogenic Enterococcus faecalis. J Immunol 174, 29902999.
59Hoffmann, M, Rath, E, Holzwimmer, G, et al. (2008) Lactobacillus reuteri 100-23 transiently activates intestinal epithelial cells of mice that have a complex microbiota during early stages of colonization. J Nutr 138, 16841691.
60Kaser, A, Zeissig, S & Blumberg, RS (2010) Inflammatory bowel disease. Ann Rev Immunol 28, 573621.
61Steck, N, Hoffmann, M, Sava, IG, et al. (2011) Enterococcus faecalis metalloprotease compromises epithelial barrier and contributes to intestinal inflammation. Gastroenterology 141, 959971.
62Lebeer, S, Vanderleyden, J & De Keersmaecker, SCJ (2010) Host interactions of probiotic bacterial surface molecules: comparison with commensals and pathogens. Nat Rev Microbiol 8, 171184.
63Clavel, T & Haller, D (2007) Bacteria- and host-derived mechanisms to control intestinal cell homeostasis: implications for chronic inflammation. Inflamm Bowel Dis 13, 11531164.
64Werner, T, Wagner, SJ, Martinez, I, et al. (2011) Depletion of luminal iron alters the gut microbiota and prevents Crohn's disease-like ileitis. Gut 60, 325333.
65Schiffrin, EJ, Rochat, F, Link-Amster, H, et al. (1995) Immunomodulation of human blood cells following the ingestion of lactic acid bacteria. J Dairy Sci 78, 491497.
66European Food Safety Authority (2011) Guidance on the scientific requirements for health claims related to gut and immune function. EFSA J 9, 1984.
67Bunout, D, Barrera, G, Hirsch, S, et al. (2004) Effects of a nutritional supplement on the immune response and cytokine production in free-living Chilean elderly. JPEN J Parenter Enteral Nutr 28, 348354.
68Boge, T, Rémigy, M, Vaudaine, S, et al. (2009) A probiotic fermented dairy drink improves antibody response to influenza vaccination in the elderly in two randomised controlled trials. Vaccine 27, 56775684.
69Olivares, M, Díaz-Ropero, MP, Sierra, S, et al. (2007) Oral intake of Lactobacillus fermentum CECT5716 enhances the effects of influenza vaccination. Nutrition 23, 254260.
70Davidson, LE, Fiorino, AM, Snydman, DR, et al. (2011) Lactobacillus GG as an immuneadjuvant for live-attenuated influenza vaccine in healthy adults: a randomized double-blind placebo-controlled trial. Eur J Clin Nutr 65, 501507.
71Van Overtvelt, L, Moussu, H, Horiot, S, et al. (2010) Lactic acid bacteria as adjuvants for sublingual allergy vaccines. Vaccine 28, 29862992.
72Callegari, ML, Riboli, B, Sanders, JW, et al. (1998) The S-layer gene of Lactobacillus helveticus CNRZ 892: cloning, sequence and heterologous expression. Microbiology 144, 719726.
73Konstantinov, SR, Smidt, H, de Vos, WM, et al. (2008) S layer protein A of Lactobacillus acidophilus NCFM regulates immature dendritic cell and T cell functions. PNAS 105, 1947419479.
74Voltan, S, Martines, D, Elli, M, et al. (2008) Lactobacillus crispatus M247-derived H2O2 acts as a signal transducing molecule activating peroxisome proliferator activated receptor-gamma in the intestinal mucosa. Gastroenterology 135, 12161227.
75Boyle, F & Ferlay, J (2005) Cancer incidence and mortality in Europe, 2004. Annals Oncol 16, 481488.
76World Cancer Research Fund/American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington DC: AICR.
77Commane, D, Hughes, R, Shortt, C, et al. (2005) The potential mechanisms involved in the anti-carcinogenic action of probiotics. Mutat Res 591, 276289.
78Reddy, BS (1998) Prevention of colon cancer by pre- and probiotics: evidence from laboratory studies. Br J Nutr 80, S219S223.
79Kawano, A, Ishikawa, H, Nakamura, T, et al. (2010) Evaluation of epidemiological studies of intestinal bacteria that affected occurrence of colorectal cancer: studies on prevention of colorectal tumours by dairy products and lactic acid bacteria. Nippon Eiseigaku Zasshi 65, 422446.
80Oberreuther-Moschner, DL, Jahreis, G, Rechkemmer, G, et al. (2004) Dietary intervention with the probiotics Lactobacillus acidophilus 145 and Bifidobacterium longum 913 modulates the potential of human faecal water to induce damage in HT29clone19A cells. Br J Nutr 91, 925932.
81Ishikawa, H, Akedo, I, Otani, T, et al. (2005) Randomized trial of dietary fiber and Lactobacillus casei administration for prevention of colorectal tumours. Int J Cancer 116, 762767.
82Femia, AP, Luceri, C, Dolara, P, et al. (2002) Antitumorigenic activity of the prebiotic inulin enriched with oligofructose in combination with the probiotics Lactobacillus rhamnosus and Bifidobacterium lactis on azoxymethane-induced colon carcinogenesis in rats. Carcinogenesis 23, 19531960.
83Rafter, J, Bennett, M, Caderni, G, et al. (2007) Dietary synbiotics reduce cancer risk factors in polypectomized and colon cancer patients. Am J Clin Nutr 85, 488496.
84Neville, V, Gleeson, M & Folland, JP (2008) Salivary IgA as a risk factor for upper respiratory infections in elite professional athletes. Med Sci Sports Exerc 40, 12281236.
85Gleeson, M (2007) Exercise and immune function. J Appl Physiol 103, 693699.
86Nieman, DC, Johanssen, LM, Lee, JW, et al. (1990) Infectious episodes in runners before and after the Los Angeles Marathon. J Sports Med Phys Fitness 30, 316328.
87Simons, SM & Kennedy, RG (2004) Gastrointestinal problems in runners. Curr Sports Med Rep 3, 112116.
88Jeukendrup, AE, Vet-Joop, K, Sturk, A, et al. (2000) Relationship between gastro-intestinal complaints and endotoxaemia, cytokine release and the acute-phase reaction during and after long-distance triathlon in highly trained men. Clin Sci 98, 4755.
89Kekkonen, RA, Vasankari, TJ, Vuorimaa, T, et al. (2007) The effect of probiotics on respiratory infections and gastrointestinal symptoms during training in marathon runners. Int J Sport Nutr Exerc Metab 7, 352363.
90Tiollier, E, Chennaoui, M, Gomez-Merino, D, et al. (2007) Effect of a probiotic supplementation on respiratory infections and immune and hormonal parameters during intense military training. Mil Med 172, 10061011.
91Cox, AJ, Pyne, DB, Saunders, PU, et al. (2010) Oral administration of the probiotic Lactobacillus fermentum VRI-003 and mucosal immunity in endurance athletes. Br J Sports Med 44, 222226.
92Gleeson, M, Bishop, NC, Oliveira, M, et al. (2011) Daily probiotic's (Lactobacillus casei Shirota) reduction of infection incidence in athletes. Int J Sport Nutr Exerc Metab 21, 5564.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed