Lactobacillus reuteri is a Gram-positive bacterial species that naturally inhabits the gut of mammals and birds. Discovered in the early 1980s, some strains of L. reuteri are used as probiotics. L. reuteri is a trademark of Biogaia, Inc., a Sweden-based company devoted to the bacterium's commercial prospects.
Though the species Lactobacillus reuteri has been recognized for some time, knowledge of its probiotic properties did not come until much later.
As early as the turn of the 20th century, L. reuteri was recorded in scientific classifications of lactic acid bacteria, though at this time it was mistakenly grouped as a member of "Lactobacillus fermentum." In the 1960s, further work by German microbiologist Gerhard Reuter - for whom the species eventually would be named - began to distinguish L. reuteri from L. fermentum. Reuter re-classified the species as "Lactobacillus fermentum biotype II."
L. reuteri was eventually identified as a distinct species in 1980 by Kandler et al. This group found significant differences between L. reuteri and other biotypes of L. fermentum, and thus proposed that it be given formal species identity. They chose the species name "reuteri," after discoverer Gerhard Reuter, and L. reuteri has since been recognized as a separate species within the Lactobacillus genus.
L. reuteri as a "universal" gut organism
In the early 1980s, shortly after its recognition as a distinct species, scientists began to find L. reuteri in many natural environments. L. reuteri has been isolated from many foods, especially meat and milk products.
Interest in L. reuteri began to increase as scientists began to find it colonizing the intestines of healthy animals. Gerhard Reuter first isolated L. reuteri from human fecal and intestinal samples in the 1960s, and this work was later repeated by other researchers. The same experiments - attempting to isolate L. reuteri from feces and intestine of healthy animals - were also done for non-human species, proving that L. reuteri seems to be present almost universally throughout the animal kingdom. For example, L. reuteri was discovered to be present naturally in the intestines of healthy sheep, chickens, pigs, and rodents.
Furthermore, a study searching for 18 major species of gut flora, including ''Lactobacillus acidophilus'', in a variety of animals found that L. reuteri was the only bacterium that constituted a "major component" of the Lactobacillus species present in the gut of each of the host animals tested. L. reuteri is now well-established as one of the most ubiquitous members of the naturally-occurring gut bacteria.
A related discovery is that each animal host seems to have a host-specific strain of L. reuteri - eg. a rat strain for rats, a pig strain for pigs, etc. The universality of L. reuteri, in conjunction with this evolved host-specificity, has led scientists to make inferences about its importance in promoting the health of the host organism. As a comparison, individual genes that are found in multiple species across the phylogenetic tree are presumed to be essential to the proper function of the organism. The gene for Myosin, for example, appeared early in evolution and is present in most forms of life. Different species have slightly different versions of Myosin - as the gene has been adapted to each species' needs - but the core of Myosin gene is always identifiable. Likewise, species have adapted slightly different strains of L. reuteri to their needs, suggesting that L. reuteri is one of the most important gut bacteria, and that it has long played a role in maintaining the health of its hosts.
L. reuteri as an anti-microbial agent
In the late 1980s, Walter Dobrogosz, Ivan Casas, and their colleagues discovered that L. reuteri produced a novel broad-spectrum antibiotic substance via the organism's fermentation of glycerol. They named this substance "reuterin," also after Gerhard Reuter.
Reuterin, it was found, inhibits the growth of some harmful Gram-negative and Gram-positive bacteria, along with yeasts, fungi, and protozoa. Naturally, a gut organism capable of fighting off other, harmful gut organisms was of great interest. Researchers found that L. reuteri can indeed secrete sufficient amounts of reuterin to cause the desired anti-microbial effects. Furthermore, since about 4-5 times the amount of reuterin is needed to kill "good" gut bacteria (i.e. L. reuteri and other Lactobacillus species) as "bad," this would allow L. reuteri to remove gut invaders while keeping normal gut flora intact.
Recent studies have called into question whether or not reuterin production is essential for L. reuteri 's health-promoting activity. However, the discovery that it naturally produces an antibiotic substance was nevertheless important, as it has led to a great deal of further research on L. reuteri.
Clinical Results in Humans
Although L. reuteri occurs naturally in humans, it is not found in all individuals. Therefore, dietary supplementation is needed to introduce and maintain high levels of L. reuteri in most people. Oral intake of L. reuteri has been shown to effectively colonize the intestine of healthy people; colonization begins rapidly within days of ingestion, although the amount of the bacterium present in the body returns to low levels within several months after intake is stopped . Furthermore, L. reuteri is found in breast milk , and oral intake on the mother's part likewise increases the amount of L. reuteri present in her milk, and the likelihood that it will be transferred to the child's body .
Once present in the body, L. reuteri benefits its host in a variety of ways, particularly by fighting off harmful infections and mediating the body's immune system.
One of the most well-documented effects of L. reuteri is in the treatment of rotavirus-induced diarrhea, especially in children. Treatment of rotaviral diarrhea by consumption of L. reuteri significantly shortens the duration of the illness as compared to placebo. Furthermore, this effect is dose-dependent: the more L. reuteri consumed, the faster the diarrhea stops . L. reuteri is also effective as a prophylactic for this illness; children fed L. reuteri while healthy are less likely to fall ill with diarrhea in the first place . With regard to prevention of gut infections, comparative research has found L. reuteri to be more potent than other probiotic organisms  .
L. reuteri is also an effective treatment against infant colic. Over a period of several weeks, infants who are given L. reuteri steadily decrease the amount of time each day spent crying - the defining symptom of colic. In fact L. reuteri was much better in decreasing the infants' crying time than the standard therapy of simethicone treatment . However, colic is still poorly understood, and it is not clear why or through what mechanism L. reuteri ameliorates its symptoms.  One theory of colic, though, holds that affected infants cry because of severe gastro-intestinal discomfort; if this is indeed the case, it is quite plausible that L. reuteri somehow acts to lessen this discomfort, since its primary residence is inside the gut.
L. reuteri is capable of eradicating the gut pathogen Helicobacter pylori, which causes peptic ulcers and is endemic in parts of the developing world. In one study, none of H. pylori-infected patients treated with omeprazole were cured, while those given L. reuteri in addition to omeprazole had a cure rate of 60%.
L. reuteri may also be capable of promoting dental health, as it has been proven to kill Streptococcus mutans, a bacterium responsible for tooth decay. A screen of several probiotic bacteria found that L. reuteri was the only species of those tested able to block S. mutants. Before testing in humans was begun, another study showed that L. reuteri had no harmful effects on teeth. Clinical trials have since proven that those people whose mouths are colonized with L. reuteri (via dietary supplementation) have significantly less of the harmful S. mutans . Since these studies have been short-term, it is not yet known whether L. reuteri prevents tooth decay. However, since L. reuteri is able to reduce the numbers of an important decay-causing bacterium, this would be expected.
Gingivitis also may be ameliorated by consumption of L. reuteri. Patients afflicted with severe gingivitis showed decreased gum bleeding, plaque formation, and other gingivitis-associated symptoms compared with placebo after chewing gum containing L. reuteri.
By protecting against many common infections, L. reuteri promotes overall wellness in both children and adults. Double-blind, randomized studies in child care centers have found that L. reuteri-fed infants fall sick less often, require fewer doctor visits, and are absent fewer days from the day care center compared to placebo and to the competing probiotic Bifidobacterium lactis .
Similar results have been found in adults; adults comsuming L. reuteri daily end up falling ill less often, as measured by their decrease use of sick leave .
Results in Animal Models
Scientific studies that require harming the subjects (for example, exposing them to a dangerous virus) may obviously not be conducted in humans. Therefore, many of the benefits of L. reuteri have been studied only in different animal species, such as pigs and mice. Given the similarity of mammalian species, however, it is likely - though not scientifically proven - that these benefits hold true for humans as well.
In general, animal studies on L. reuteri are done using the species-specific strain of the bacterium (see above).
Protection Against Pathogens
L. reuteri confers a high level of resistance to the pathogen Salmonella typhimurium, halving mortality rates in mice . The same is true for chickens and turkeys; L. reuteri greatly moderates the morbidity and mortality caused by this dangerous food-bourne pathogen.
L. reuteri is also effective in stopping harmful strains of E. coli from affecting its host. A study performed in chickens showed that L. reuteri was a potent as the antibiotic gentamicin in preventing E. coli-related deaths .
The protozoal parasite Cryptosporidium parvum causes severe watery diarrhea, which can become life-threatening if the patient is immunocompromised (as in individuals infected with HIV). L. reuteri is known to lessen the symptoms of C. parvum in mice and pigs. Given that there is no known direct treatment for C. parvum (the antibiotic Paromomycin has limited effect), L. reuteri may prove valuable in protecting patients suffering from this disease.
Some protective effect against the yeast Candida albicans has been found in mice, but in this case L. reuteri did not work as well as other probiotic organisms such as L. acidophilus and L. casei .
In young commercial livestock such as turkey chicks and piglets, body weight and growth rate are good indicators of the health of the animal. Animals raised in the dirty, crowded environments of commercial farms are generally less healthy (and therefore weigh less) than their counterparts born and bred in cleaner homes. In turkeys, for example, this phenomenon is known as "poult growth depression," or PGD .
Supplementing the diets of these young farm animals with L. reuteri helps them to largely overcome the stresses imposed by their unhealthy habitats. Commercial turkeys fed L. reuteri from birth had nearly a 10% higher adult body weight than their peers raised in the same conditions . A similar study on piglets showed that L. reuteri is at least as effective as synthetic antibiotics in improving body weight under crowded conditions .
The mechanism by which L. reuteri is able to support the healthy growth of these animals is not entirely understood. It is possible that L. reuteri simply serves to protect livestock against illness caused by Salmonella typhimurium and other pathogens (see above), which are much more common in crowded commercial farms. However, other studies have revealed that L. reuteri can also help when the growth depression is caused entirely by a lack of dietary protein, and not by contageous disease . This raises the possibility that L. reuteri somehow improves the intenstines' ability to absorb and process nutrients .
Effect on Chemical and Trauma-induced Injury
Treating colonic tissue from rats with acetic acid causes an injury similar to the human condition ulcerative colitis. Treating the injured tissue with L. reuteri immediately after removing the acid almost completely reverses any ill effects , leading to the possibility that L. reuteri may be beneficial in the treatment of human colitis patients.
In addition to its role in digestion, the intestinal wall is also vital in preventing harmful bacteria, endotoxins, etc., from "leaking" into the bloodstream. This leaking, known as bacterial "translocation," is very dangerous and can lead to lethal conditions such as sepsis. In humans, translocation is more likely to occur following such events as liver injury and injestion of some poisons. In rodent studies, L. reuteri was found to greatly reduce the amount of bacterial translocation following either the surgical removal of the liver or injection with D-galactosamine , a chemical which also causes liver damage.
The anti-cancer drug methotrexate causes severe enterocolitis in high doses. L. reuteri greatly mitigates the symptoms of methotrexate-induced enterocolitis in rats, one of which is bacterial translocation .
- Orla-Jensen, S. 1919. The lactic acid Bacteria. Det Kongelige Danske Videnskasbernes Selskab. Naturvidenskabelige mathematiske Afdeling, NS 8.5.2
- Reuter G. Das vorkommen von laktobazillen in lebensmitteln und ihr verhalten im menschlichen intestinaltrakt. Zbl Bak Parasit Infec Hyg I Orig 1965; 197 S: 468–87.
- Kandler O., Stetter K., Kohl R. 1980. Lactobacillus reuteri sp. nov. a new species of heterofermentative lactobacilli. Zbl. Bakt. Hyg. Abt. Orig. C1:264-269.
- Lerche M, Reuter G. Das vorkommen aerob wachsender grampositiver stabchen des genus Lactobacuillus beijerinck im darminhalt erwachsener menchen. Zbl Bak Parasit Infec Hyg I Orig 1965; 185 S: 446–81.
- Dellaglio F, Arrizza FS, Leda A. Classification of citratefermenting lactobacilli isolated from lamb stomach, sheep milk, and pecorino romano cheese. Zbl Bakt Hyg Abt Orig 1981; C2: 349–56.
- Molin G, Jeppsson B, Johansson M-L, et al. Numerical taxonomy of Lactobacillus spp. associated to healthy and diseased mucosa of the human intestines. J Appl Microbiol 1993; 74: 314–23. Entrez PubMed 8468264
- Sarra PG, Dellaglio F, Bottazzi V. Taxonomy of lactobacilli isolated from the alimentary tract of chickens. Syst Appl Microbiol 1985; 6: 86–9.
- Naito S, Hayashidani H, Kaneko K, Ogawa M, Benno Y. Development of intestinal lactobacilli in normal piglets. J Appl Bacteriol 1995; 79: 230–6. Entrez PubMed 7592119
- Molin G, Johansson M-L, Stahl M, et al. Systematics of the Lactobacillus population on rat mucosa with special reference to Lactobacillus reuteri. Antonie Van Leeuwenhoek 1992a; 61: 175–83. Entrez PubMed 1325752
- Mitsuoka T. The human gastrointestinal tract. In: Wood BJB, ed. The lactic acid bacteria. v. 1. The lactic acid bacteria in health and disease. New York: Elsevier Applied Science, 1992: 69–114.
- Casas IA, Dobrogosz WJ. Lactobacillus reuteri: An overview of a new probiotic for humans and animals. Microecol Therap 1997; 25: 221–31.
- Ivan A. Casas, Walter J. Dobrogosz. "Validation of the Probiotic Concept: Lactobacillus reuteri Confers Broad-spectrum Protection against Disease in Humans and Animals," Microbial Ecology in Health and Disease, December 1 2000, Volume 12, Number 4. (link to article)
- Talarico TL, Casas IA, Chung TC, Dobrogosz WJ. Production and isolation of reuterin, a growth inhibitor produced by Lactobacillus reuteri. Antimicrob Agents Chemother. 1988 Dec;32(12):1854-8. Entrez PubMed 3245697
- Talarico TL, Dobrogosz WJ. Chemical characterization of an antimicrobial substance produced by Lactobacillus reuteri. Antimicrob Agents Chemother. 1989 May;33(5):674-9. Entrez PubMed 2751282
- Wolf BW, Garleb KA, Ataya DG, Casas IA. Safety and tolerance of Lactobacillus reuteri in healthy adult male subjects. Microbial Ecol Health Dis 1995; 8: 41–50.
- Sinkiewicz G, Nordström EA. Occurrence of Lactobacillus reuteri, lactobacilli and bifidobacteria in human breast milk. Pediatr Res 58:415, abstract 353.
- Abrahamsson T, Jakobsson T, Sinkiewicz G, Fredriksson M, Björkstén B. Intestinal microbiota in infants supplemented with the probiotic bacterium Lactobacillus reuteri. J Ped Gastroenterol Nutr 40(5):692, abstract PN 1-17.
- Shornikova AV, Casas IA, Mykkanen H, Salo E, Vesikari T. Bacteriotherapy with Lactobacillus reuteri in rotavirus gastroenteritis. Pediatr Infect Dis J 1997; 16: 1103-7. Entrez PubMed 9427453
- Ruiz-Palacios G, Guerrero ML, Hilty M. Feeding of a probiotic for the prevention of community-acquired diarrhea in young Mexican children. (1996) Pediatr Res 39(4) part 2:184A, abstract 1089.
- Romeo MG, Betta P, Oliveri S. (2006) Presented at the 5th Annual meeting of the Italian Society of Perinatal Medicine, Parma, Italy, 15-17 June 2006. Abstract published in J Perinat Med 34(Suppl 1): A9, abstract MSL_24.
- Guerrero M, Dohnalek M, Newton P, Kuznetsova O, Ruiz-Palacios G, Murphy T, Calva J, Hilty M, Costigan T., 1st World Congress of Pediatric Infectious Diseases, Dec. 1996, abstract no. 610:45-2.
- Savino F., Pelle E., Palumeri E., Oggero R. and Miniero R. (2007). "Lactobacillus reuteri (ATCC strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study". Pediatrics. 119 (1): 124–130. PMID 17200238.
- Saggioro A, Caroli M, Pasini M, Bortoluzzi F, Girardi L, Pilone G. Helicobacter pylori eradication with Lactobacillus reuteri. A double blind placebo-controlled study. (2005) Dig Liver Dis 37(suppl 1): S88, abstr. PO1.49.
- Nikawa H, Makihira S, Fukushima H, Nishimura H, Ozaki Y, Ishida K, Darmawan S, Hamada T, Hara K, Matsumoto A, Takemoto T, Objectivei R. Lactobacillus reuteri in fermented bovine milk decreases the oral carriage of mutans streptococci. (2004) Int J Food Microbiol 95:219-223. Entrez PubMed 15282133
- Krasse P, Carlsson B, Dahl C, Paulsson A, Nilsson Å, Sinkiewicz G. Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri. (2006) Swed Dent J 30:55-60. Entrez PubMed 16878680
- Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: Comparison of two probiotic agents. (2005) Pediatrics 115:5-9. Entrez PubMed 15629974
- Tubelius P, Stan V, Zachrisson A. Increasing work-place healthiness with the probiotic Lactobacillus reuteri: A randomised, double blind placebo-controlled study. (2005) Environmental Health 4:25. Entrez PubMed 16274475
- Carbajal N, Sriburi A, Carter P, Dobrogosz W, Casas, I. Probiotic administrations of Lactobacillus reuteri protect mice from Salmonella typhimurium infection. Proceedings of the 36th Annual Meeting of the Association for Gnotobiotics. 1998 Jun 14–16; Bethesda (MD): Association for Gnotobiotics; 1998.
- Casas IA, Edens FW, Dobrogosz WJ. Lactobacillus reuteri : an effective probiotic for poultry and other animals. Lactic acid bacteria, 2nd ed. New York: Marcel Dekker, 1998: 475–518.
- Edens FW, Parkhurst CR, Casas IA, Dobrogosz WJ. Principles of ex ovo competitive exclusion and in ovo administration of Lactobacillus reuteri. Poult Sci 1997; 76: 179–96. Entrez PubMed 9037704
- Alak JI, Wolf BW, Mdurvwa EG, Pimentel-Smith GE, Adeyemo O. Effect of Lactobacillus reuteri on intestinal resistance to Cryptosporidium parvum infection in a murine model of acquired immunodeficiency syndrome. J Infect Dis 1997; 175: 218–21. Entrez PubMed 8985225
- Cryptosporidium parvum
- Wagner RD, Pierson C, Warner T, et al. Biotherapeutic effects of probiotic bacteria on candidiasis in immunodeficient mice. Infect Immun 1997; 65: 4165–72. Entrez PubMed 9317023
- Barnes JH. Evaluating poult growth and productivity during brooding. Turkeys 1993; 41: 23–4.
- Casas IA, Edens FW, Parkhurst CR, Dobrogosz WJ. Probiotic treatment with Lactobacillus reuteri protects commercial turkeys from avian growth depression. Biosci Microflora 1998; 17: 141–7.
- Blanchard P, Gill P, Schulze H. Efficacy of Lactobacillus reuteri 1063-IA in pre and post-weaning pigs. Hertfordshire SG5 4JG (UK): MLC Stotfold Pig Development Unit; 1998. Study Reference No. FF9801.
- Dunham HJ, Casas IA, Edens FW, Parkhurst CR, Garlich JD, Dobrogosz WJ. Avian growth depression in chickens induced by environmental, microbiological, or nutritional stress is moderated by probiotic administrations of Lactobacillus reuteri. Biosci Microflora 1998; 17: 133–9.
- Fabia R, Ar’Rajab A, Johansson ML, et al. The effect of exogenous administration of Lactobacillus reuteri R2LC and oat fiber on acetic acid-induced colitis in the rat. Scandinavian J Gastroenterol 1993; 28: 155–62. Entrez PubMed 8382837
- Wang XD, Soltesz V, Molin G, Anderson R. The role of oral administration of oatmeal fermented by Lactobacillus reuteri R2LC on bacterial translocation after acute liver failure induced by subtotal liver resection in the rat. Scandinavian J Gastroenterol 1995; 30: 180–5.Entrez PubMed 7732342
- Adawi D, Kasravi B, Molin G, Jeppsson B. Effect of Lactobacillus supplementation with and without arginine on liver damage and bacterial translocation in an acute liver injury model in the rat. Hepatology 1997; 25: 642–7. Entrez PubMed 9049212
- Mao Y, Nobaek S, Kasravi B, et al. The effects of Lactobacillus strains and oat fiber on methotrexate-induced enterocolitis in rats. Gastroenterol 1996; 111: 334–44. Entrez PubMed 8690198