The world of synbiotics: a review of literature and clinical evidence in diarrhoea from the lens of a paediatrician

The use of synbiotics in the management of acute diarrhoea in children is becoming a common practice in India. However, since this is an upcoming modality of treatment, it is essential to review the scientific rationale and evidence on clinical efficacy and safety in the context of paediatric diarrhoea. In addition, most synbiotics contain a combination of multiple probiotics along with a prebiotic. Thus arises, a parallel need to understand whether a combination of probiotics performs better than single probiotics, hence justifying the rationale for such combinations. A review of available evidence suggests that synbiotics are indeed safe and superior in efficacy to single probiotics (like Bacillus clausii, Lactobacillus rhamnosus GG etc) and that there is a good body of evidence to support the efficacy and tolerability of synbiotics in the management of paediatric acute gastroenteritis. There is also evidence to suggest that combination probiotics have superior benefits compared to single probiotics, thus justifying their use as part of synbiotics. The overall benefits of synbiotics reported in various clinical trials on paediatric diarrhoea include, a rapid normalization of the gastrointestinal flora, a reduction in the duration of diarrhoea, quicker improvement in stool consistency, lesser administration of additional medications like antibiotics, antiemetics and antipyretics, higher physician reported treatment satisfaction scores and enhanced overall efficacy against gastrointestinal pathogens, including diarrhoea of rota virus origin. Hence, synbiotics put up a strong case to look beyond probiotics and single probiotic formulations in paediatric diarrhoea.

Study of B cell epitope conserved region of the Zika virus envelope glycoprotein to develop multi-strain vaccine

A Zika virus (ZIKV) infection causes severe clinical manifestations, both in newborn baby and adult. It was consideredas the public health emergency by the World Health Organization in 2016. Until now, there is no approved drug orvaccine for the treatment or prevention of multi-strain ZIKV infection. The present work attempts to identify theB cell epitope conserved region of ZIKV envelope glycoprotein through an intensive in silico study. A total of 363ZIKV strains was retrieved from the National Center of Biotechnology Information (NCBI) database, then aligned toobtain the conserved region of ZIKV glycoprotein. The interaction between the conserved region with Axl receptortyrosine kinase, a ZIKV receptor on the host cell, has been evaluated through molecular docking approach. TheB cell epitope was identified using the immune epitope database (IEDB) web server. This study revealed that theconserved region of ZIKV envelope glycoprotein interacts with Asp9, Glu12, Glu40, Asp177, Glu243, and Glu245of Axl receptor. Two sequences in ZIKV envelope glycoprotein, “ISDSDSRCPTQGEALKQSDTQY” (22-mer) and“SQHSGMGETDERAKVETPNSPRAEATL” (27-mer), are identified as B cell epitopes. Further studies are necessaryto confirm their possibility as the potential ZIKV multi-strain vaccine in the future.