Role of the gut microbiome and probiotics for prevention and management of tuberculosis

The use of probiotics in modulating the gut microbiome to confer clinical benefits in various disease conditions is increasing. Probiotics are defined as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.” The challenges in treating tuberculosis (TB) in the present era are the multidrug-resistant, extensively drug-resistant, and latent strains of TB; patient noncompliance resulting from anti-TB-related adverse effects; and undesirable treatment outcomes due to treatment discontinuation. The application of probiotics in TB is promising to combat these challenges. Preclinical study data have established the antimycobacterial characteristics of the probiotics by simulating the phagocytic action via release of antipathogenic substances. The mode of action of probiotics includes remodeling of the microbial ecosystem, which leads to inhibition of pathogens by adherence and production of antipathogenic byproducts such as bacteriocins and indole propionic acid. The additional mechanisms involve immunomodulation by balancing the proinflammatory and antiinflammatory mediators, promoting intestinal barrier function, and the biosynthesis of short-chain fatty acids, vitamin K and vitamin B. This chapter briefly discusses the gut-axis and its role in immune homeostasis, the role of the gut microbiome, and probiotics in tuberculosis prevention and treatment.