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. 2025 May 22:12:1546650.
doi: 10.3389/fmed.2025.1546650. eCollection 2025.

Probiotics improve intestinal ischemia-reperfusion injury: a systematic review and meta-analysis

Zicen Zhao  1 , Yuxuan Wu  2 , Yufang Leng  1   3 , Liya Chang  1 , Yu Wang  1 , Dongbin Li  1 , Yang Xing  1
Affiliations

Probiotics improve intestinal ischemia-reperfusion injury: a systematic review and meta-analysis

Zicen Zhao et al. Front Med (Lausanne). .

Abstract

Background: Intestinal ischemia-reperfusion injury (IRI) is a common complication of intestinal surgery and carries the risk of patient death. The treatment of intestinal IRI is an important direction of current research. This study aimed to analyze animal experiments and thus investigate the effects of probiotics administration on intestinal IRI and its mechanisms.

Methods: We included a total of 12 studies from 5 databases (PubMed, Web of Science, Cochrane, Embase, and Scopus), incorporating outcome metrics including Chiu's score, levels of malondialdehyde (MDA), myeloperoxidase (MPO) tumor necrosis factor-alpha (TNF-α), IL-6, IL-1β, occludin, zonula occludens-1 (ZO-1), FITC-dextran and intestinal bacteria (Lactobacillus, Bacteroides and Bifidobacteria). Statistical analysis was performed using Review Manager 5.3.

Results: We found that probiotic-added animals had less intestinal damage after IRI compared to controls, as evidenced by a more intact intestinal barrier [occludin (2.83, 95% CI: 1.46 to 4.20, p < 0.0001), ZO-1 (3.30, 95% CI: 1.58 to 5.01, p = 0.0002) and FITC-dextran (-3.83, 95% CI: -5.83 to -2.29, p < 0.0001)], lower Chiu score (-1.83, 95% CI: -2.47 to -1.20, p < 0.0001), fewer inflammatory factors [IL-6 (-2.19, 95% CI: -3.98 to -0.39, p = 0.02), TNF-α (-2.24, 95% CI: -4.15 to -0.33, p = 0.02)], and lower levels of oxidative stress [MDA (-2.46, 95% CI: -4.62 to -0.30, p = 0.03), MPO (-0.97, 95% CI: -1.77 to -0.17; p = 0.02)]. In addition, probiotic supplementation increased the relative abundance of Lactobacillus (0.90, 95% CI: 0.33 to 1.48, p = 0.002) and Bacteroides (0.81, 95% CI: 0.14 to 1.49, p = 0.02), thus maintaining the stability of the gut microbiota.

Conclusion: In conclusion, the mechanisms by which probiotic therapy attenuates intestinal IRI may be related to decreased levels of inflammation and oxidative stress, increased probiotic abundance, and increased expression of tight junction (TJ) proteins.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024577459.

Keywords: intestine; ischemia-reperfusion injury; meta-analysis; probiotics; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Article screening flowchart.
Figure 2
Figure 2
Overall quality of included studies assessed with SYRCLE risk of bias assessment tool.
Figure 3
Figure 3
Forest plot of meta-analysis of all studies testing Chiu’s score.
Figure 4
Figure 4
Forest plot of meta-analysis of all studies detecting MDA and MPO. (A) Forest plot of MDA levels in intestinal tissue. (B) Forest plot of MPO levels in intestinal tissue.
Figure 5
Figure 5
Forest plot of meta-analysis of all studies detecting occludin, ZO-1 and FITC-dextran. (A) Forest plot of occludin. (B) Forest plot of ZO-1. (C) Forest plot of FITC-dextran.
Figure 6
Figure 6
Forest plot of meta-analysis of all studies detecting Lactobacillus, Bacteroides and Bifidobacteria. (A) Forest plot of Lactobacillus. (B) Forest plot of Bacteroides. (C) Forest plot of Bifidobacteria.
Figure 7
Figure 7
Forest plot of meta-analysis of all studies detecting IL-1β, IL-6 and TNF-α. (A) Forest plot of IL-1β. (B) Forest plot of IL-6. (C) Forest plot of TNF-α.
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