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World J Gastroenterol. Jul 21, 2022; 28(27): 3370-3382
Published online Jul 21, 2022. doi: 10.3748/wjg.v28.i27.3370
Probiotics and postbiotics in colorectal cancer: Prevention and complementary therapy
Monika Kvakova, Anna Kamlarova, Jana Stofilova, Veronika Benetinova, Izabela Bertkova
Monika Kvakova, Anna Kamlarova, Jana Stofilova, Veronika Benetinova, Izabela Bertkova, Center of Clinical and Preclinical Research MEDIPARK, Faculty of Medicine, P.J. Safarik University in Kosice, Kosice 04011, Slovakia
Author contributions: All authors contributed equally to the conceptualization and design of the manuscript; Kvakova M prepared and finalized the manuscript; Kamlarova A, Stofilova J, and Benetinova V reviewed the literature, and prepared the tables and figure; Bertkova I as senior author revised the manuscript; all authors approved the final manuscript.
Supported by Scientific Grant Agency of the Ministry of Education of Slovak Republic and Academy of Sciences VEGA, No. 1/0393/20; and the Operational Program Integrated Infrastructure Within the Project: Demand-Driven Research for the Sustainable and Innovative Food, Co-financed by the European Regional Development Fund, No. Drive4SIFood 313011V336.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Monika Kvakova, PhD, Research Fellow, Research Scientist, Center of Clinical and Preclinical Research MEDIPARK, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, Kosice 04011, Slovakia.
Received: January 18, 2022
Peer-review started: January 18, 2022
First decision: March 8, 2022
Revised: March 22, 2022
Accepted: June 16, 2022
Article in press: June 16, 2022
Published online: July 21, 2022

Colorectal cancer (CRC) is a leading cause of human mortality worldwide. As conventional anticancer therapy not always being effective, there is growing interest in innovative “drug-free” cancer treatments or interventions that improve the efficacy of established therapy. CRC is associated with microbiome alterations, a process known as dysbiosis that involves depletion and/or enrichment of particular gut bacterial species and their metabolic functions. Supplementing patient treatment with traditional probiotics (with or without prebiotics), next-generation probiotics (NGP), or postbiotics represents a potentially effective and accessible complementary anticancer strategy by restoring gut microbiota composition and/or by signaling to the host. In this capacity, restoration of the gut microbiota in cancer patients can stabilize and enhance intestinal barrier function, as well as promote anticarcinogenic, anti-inflammatory, antimutagenic or other biologically important biochemical pathways that show high specificity towards tumor cells. Potential benefits of traditional probiotics, NGP, and postbiotics include modulating gut microbiota composition and function, as well as the host inflammatory response. Their application in CRC prevention is highlighted in this review, where we consider supportive in vitro, animal, and clinical studies. Based on emerging research, NGP and postbiotics hold promise in establishing innovative treatments for CRC by conferring physiological functions via the production of dominant natural products and metabolites that provide new host-microbiota signals to combat CRC. Although favorable results have been reported, further investigations focusing on strain and dose specificity are required to ensure the efficacy and safety of traditional probiotics, NGP, and postbiotics in CRC prevention and treatment.

Keywords: Colorectal cancer, Traditional probiotics, Next-generation probiotics, Postbiotics, Gut microbiota

Core Tip: The effects of traditional probiotics, next-generation probiotics (NGP), or postbiotics in colorectal cancer (CRC) prevention and complementary therapy can be associated independently or in mutual cooperation with several mechanisms, including suppression of inflammation, enhancing apoptosis of tumor cells, restoring intestinal barrier function, competition with pathogens and by promoting healthy gut microbiota composition and function. Traditional probiotics, NGP, or postbiotics supplementation is also a potential strategy to boost the effectiveness of chemotherapy and immunotherapy, reduce the rate of postoperative complications, and improve the quality of lives of CRC patients.