الفهرس 
T YPE 1 D IABETES M ELLITUS (Only 14 pages are availabe for public view
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Abstract
Background: The role of altered gut microbiota in metabolic disorders such as obesity, diabetes, and cardiovascular disease is well established. Gut microbiota have been proposed as a main actor in the pathogenesis of type 1 diabetes mellitus (T1DM). Interleukin (IL)-21 is a type 1 cytokine that is mainly produced by activated T lymphocytes, particularly the inflammatory Th17, subset and has been implicated in the pathogenesis of T1DM. IL-22 is produced by immune cells present beneath the epithelium and is induced by bacteria present in the intestine. It exerts essential roles in maintaining mucosal barrier integrity within the intestine. IL-22 shows diverse metabolic benefits, as it improves insulin sensitivity, preserves gut mucosal barrier and endocrine functions, decreases endotoxaemia and chronic inflammation, and regulates lipid metabolism in liver and adipose tissues. Probiotics are live micro-organisms that, when administered in adequate amounts, confer health benefits on the host. Probiotics have been shown to exert major effects on the immune system and this interaction is clearly linked to gut microbes. The efficacy of probiotics in diabetes has been shown in a preclinical setting as well as in human trials.
Objectives: Therefore, we performed a randomized-controlled trial to assess the effect of oral supplementation with probiotics on blood glucose levels and glycemic control as well as IL-21 and IL-22 levels in pediatric patients T1DM.
Methods: This study included 70 children and adolescents with T1DM. Enrolled patients aged 5-18 years with disease duration > 1 year. Patients were randomly assigned into two groups; intervention group (group A) who received oral probiotics containing Lactobacillus acidophilus La-14 (108 CFU) 0.5 mg once daily. The other group (group B) did not receive any supplementation and served as a control group. Both groups were followed-up for 6 months with assessment of fasting blood glucose (FBG), HbA1c, IL-21 and IL-22 levels.
Results: Both groups were well-matched as regards baseline clinical characteristics and laboratory parameters (p>0.05). After 6 months, probiotics supplementation for group A resulted in a significant decrease of FBG, HbA1c, total cholesterol and IL-21 levels while IL-22 was increased compared with baseline levels (p<0.001) and compared with group B (p<0.001). No adverse reactions were reported. Baseline IL-21 was positively correlated to FBG, HbA1c and total cholesterol while there were negative correlations between these variables and IL-22 levels.
Conclusions: Probiotics supplementation improved blood glucose levels and glycemic control possibly through their immune-modulatory effects on cytokines IL-21 and IL-22. Thus, probiotics could be a safe and effective adjuvant therapy in pediatric patients with T1DM.