April 2009

Physicians’ Roundtable Presentation Synopsis

On February 26, 2009, Dr. Stephen Olmstead, Chief Science Officer for ProThera® and Klaire Labs™, gave a lecture to the Physicians’ Roundtable meeting in Greenville, North Carolina on gastrointestinal biofilm. The presentation was entitled Life on the Edge: The Clinical Implications of Gastrointestinal Biofilm. Dr. Olmstead observed that microbes prefer life within biofilm. Biofilm is defined as a collaborative community of sessile microorganisms metabolically and genetically distinct from their free-living, planktonic kindred. Biofilms are ubiquitous and may be beneficial or harmful. A self-produced hydrated matrix largely composed of exopolysaccharides encases biofilm populations. Biofilms protect microorganisms from predation and provide significant resistance to antimicrobials.

Dr. Olmstead noted that the medical community is increasingly recognizing pathogenic biofilm as a major factor in chronic, persistent diseases. The presence of biofilm explains why many chronic infections resist treatment with antimicrobial agents and are distinguished by recurrent relapses. Persistent pathogenic biofilm may lead to chronic symptoms as the body’s immune responses are repelled and inflammation damages tissue. He discussed biofilm formed by Helicobacter pylori, Clostridium difficile, and Candida albicans as examples. Alternatively, healthy biofilm formed by the gastrointestinal microflora may protect against disease.

The evidence for the ability of biofilm to be disrupted by enzymes such as cellulase and Serratia peptidase and by metal chelating agents such as disodium EDTA and lactoferrin was reviewed. Dr. Olmstead proposed a protocol to treat pathogenic gastrointestinal biofilm with nutraceuticals that centered on an enzymatic formulation designed to disrupt pathogenic biofilm. This enzyme formulation may be augmented with a chelating agent such as disodium EDTA and/or lactoferrin. He stressed it is essential to begin at a low dose and slowly titrate up carefully assessing the patient for symptoms of “die off” and felt it is prudent to begin with the enzyme formulation alone and only add a chelator after the patient’s response has been noted. Antimicrobial agents must be combined with the enzymatic formulation and chelators in order to eliminate pathogens. These agents should be taken on an empty stomach at the same time as the hydrolytic enzymes. Antimicrobials administered may be natural agents such as berberine and undecylenic acid. The antibiofilm enzymes and chelators may be combined with prescription antimicrobials if need be. Probiotics and prebiotics should be used to restore a healthy gastrointestinal microflora biofilm. They should be taken with meals to maximize probiotic survival and at a different time of day than the antibiofilm enzymes, chelators, and antimicrobials. This minimizes the effect of these agents on the probiotic organisms. Dr. Olmstead concluded by emphasizing that pathogenic gastrointestinal biofilms may be responsible for a variety of intestinal dysbiosis and may be eliminated with nutraceuticals.

Dr. Olmstead is lead author on the technical article Life on the Edge: The Clinical Implications of Gastrointestinal Biofilm. Please log in to view the article.