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Applied and Environmental Microbiology, September 2002, p. 4689-4693, Vol. 68, No. 9
0099-2240/02/$04.00+0 DOI: 10.1128/AEM.68.9.4689-4693.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Cholesterol Assimilation by Lactic Acid Bacteria and Bifidobacteria Isolated from the Human Gut
Dora I. A. Pereira* and Glenn R. Gibson
Food Microbial Sciences Unit, School of Food Biosciences, The University of Reading, Reading RG6 6BZ, United Kingdom
Received 27 March 2002/
Accepted 25 June 2002

ABSTRACT
The objective of this study was to evaluate the effect of human
gut-derived lactic acid bacteria and bifidobacteria on cholesterol
levels in vitro. Continuous cultures inoculated with fecal material
from healthy human volunteers with media supplemented with cholesterol
and bile acids were used to enrich for potential cholesterol
assimilators among the indigenous bacterial populations. Seven
potential probiotics were found:
Lactobacillus fermentum strains
F53 and KC5b,
Bifidobacterium infantis ATCC 15697,
Streptococcus bovis ATCC 43143,
Enterococcus durans DSM 20633,
Enterococcus gallinarum, and
Enterococcus faecalis. A comparative evaluation
regarding the in vitro cholesterol reduction abilities of these
strains along with commercial probiotics was undertaken. The
degree of acid and bile tolerance of strains was also evaluated.
The human isolate
L. fermentum KC5b was able to maintain viability
for 2 h at pH 2 and to grow in a medium with 4,000 mg of bile
acids per liter. This strain was also able to remove a maximum
of 14.8 mg of cholesterol per g (dry weight) of cells from the
culture medium and therefore was regarded as a candidate probiotic.

INTRODUCTION
Since Shaper et al. (
18) and later Mann (
12) observed that men
from the tribes of Samburu and Masai warriors in Africa showed
a reduction in serum cholesterol levels after consumption of
large amounts of milk fermented with a wild
Lactobacillus strain,
there has been considerable interest in the beneficial effects
of fermented milk products containing lactobacilli and/or bifidobacteria
on human lipid metabolism. Several human studies have suggested
a moderate cholesterol-lowering action of dairy products fermented
with a certain strain(s) of probiotic bacteria (
1,
2,
10,
17;
G. Schaarmann, J. Schneider, A. Zorn, C. Vilser, and G. Jahreis,
Am. J. Clin. Nutr.
73[Suppl.]
:496S, 2001). However, the role
of fermented milk products as hypocholesterolemic agents in
humans is still equivocal, as the clinical studies performed
have given variable data and no firm conclusions can be drawn
(
6,
23). From several in vitro studies a number of mechanisms
have been proposed for the purported cholesterol-lowering action
of probiotic bacteria (
7,
9,
11,
13,
21,
22,
24). These include
physiological actions of the end products of short-chain fatty
acid fermentation (especially propionate), cholesterol assimilation
by the bacteria, cholesterol binding to the bacterial cell wall,
and enzymatic deconjugation of bile acids. These hypotheses
need to be confirmed in animal and human studies, and the exact
mechanism(s) of action of probiotic bacteria on cholesterol
reduction remains unclear.
In this study, we evaluated the in vitro cholesterol-lowering effects of strains of lactic acid bacteria and bifidobacteria of human origin and compared them to those of commercial probiotic strains. Further, we have investigated the ability of the cultures to tolerate acid and bile concentrations typically found in the upper gastrointestinal tract of humans. We hope this study provides further background and new, improved strains for the understanding of the purported action of probiotic bacteria on cholesterol levels.

Source and maintenance of bacterial strains.
The origins of the strains used in this study are shown in Table
1. The human isolates of
Lactobacillus fermentum (F53 and KC5b),
Enterococcus gallinarum,
Enterococcus faecalis, and
Lactobacillus brevis (NR1C1684) have not been deposited in a culture collection
and will be provided upon request. Stock cultures were maintained
at -70°C on Microbank cryovials (Pro-Lab Diagnostics). Working
cultures were maintained and subcultured in MRS-THIO broth (MRS
broth [Oxoid] supplemented with 0.2% [wt/vol] sodium thioglycolate
[Sigma]). Prior to assay, strains were serially transferred
three times in broth and incubated anaerobically (10% H
2, 10%
CO
2, and 80% N
2) at 37°C for 24 h. Seed cultures of each
strain were taken at the end of the exponential phase of growth
at cell densities of ca. 10
9 CFU/ml. All the bacterial strains
used in this study were identified by PCR techniques (34 cycles
of amplification of DNA by PCR) followed by sequencing of the
bacterial 16S rRNA gene (data not shown). Approximately 500
nucleotides proximal to the 5' end of the rRNA were sequenced
with an ABI PRISM dRhodamine terminator cycle sequencing kit
with AmpliTaq DNA polymerase FS (PE Applied Biosystems, Inc.)
and an automatic DNA sequencer (model 373A; PE Applied Biosystems,
Inc.). Screening of the isolates was carried out using the reverse
primers pD* (GTATTACCGCGGCTGCTG) and

(ACTGCTGCCTCCCGTAGGAG).
Generated sequences were compared to those available in the
GenBank/EMBL (European Bioinformatics Institute) database by
using the program WU-Blast2 (Washington University), in order
to ascertain their closest phylogenetic relatives (Table
1).

Assimilation of cholesterol.
The ability of cultures to assimilate cholesterol was determined
by a modification of the method described by Danielson et al.
(
5). The test medium used for screening cultures for cholesterol
uptake was sterile modified MRS broth (mMRS) supplemented with
oxgall and a water-soluble form of cholesterol (polyoxyethanyl-cholesteryl
sebacate; Sigma). The composition of the mMRS broth was (grams
per liter unless otherwise indicated): peptone (Oxoid), 10.0;
Lab-Lemco powder (Oxoid), 8.0; yeast extract (Oxoid), 4.0; Tween
80, 1 ml liter
-1; K
2HPO
4, 2.0; triammonium citrate, 2.0; sodium
acetate, 3.0; MgSO
4 · 7H
2O, 0.2; MnSO
4 · H
2O,
0.04; sodium thioglycolate, 2.0; and glucose, 10.0. Two different
bile concentrations were used, 0.2 and 0.4% (wt/vol) oxgall
(OXOID), to mimic approximate levels in the intestinal tract
(
19). The final cholesterol concentration in the medium was
ca. 100 mg liter
-1. All chemicals were obtained from Merck unless
otherwise stated. The seed culture was added at a 1% (vol/vol)
inoculum size to Hungate tubes containing 9.9-ml aliquots of
the test medium. The cultures were statically fermented for
12 h at 37°C under anaerobic conditions. Bacterial growth
was monitored hourly by measuring the optical density of the
culture broth at 650 nm. Each strain was tested in three different
runs and each time in triplicate. Uninoculated sterile broth
was used as the control. Following incubation, bacterial cells
were removed by centrifugation (2000
x g, 10 min, 4°C),
and the spent broth and uninoculated control broths were then
assayed for their cholesterol content. The dry weight of the
cultures was determined after drying the centrifuged cells to
a constant weight in an 80°C oven. Strains were compared
for cholesterol assimilation in terms of their specific cholesterol
uptake after the 12-h incubation period, according to the following
equation:
 | (1) |
where
B is cholesterol
content in the uninoculated control (milligrams liter
-1),
T is cholesterol in the culture medium (milligrams liter
-1), and
W is cells (dry weight [grams]) after 12 h of incubation.

Cholesterol assay.
The cholesterol in the spent broths was first extracted by the
procedure described by Gilliland et al. (
7). The total cholesterol
content of the evaporated residues was then determined by the
enzymatic assay described by Salè et al. (
15).

Bile tolerance.
All strains were evaluated for rapidity of growth in a broth
medium with and without bile acids. Overnight cultures were
inoculated (1% [vol/vol]) into mMRS broth and mMRS broth containing
0.2 and 0.4% (wt/vol) oxgall and incubated anaerobically at
37°C for 12 h. Cultures were monitored hourly for growth
spectrophotometrically at 650 nm. Comparison of cultures was
based on their growth rates in each broth. The experiments were
repeated three times in triplicate.

Acid tolerance.
Overnight cultures of strains were inoculated (10% [vol/vol])
into MRS broth (Oxoid) previously adjusted to pH 2.0 with HCl.
The mixtures were incubated anaerobically at 37
oC for 2 h. One-milliliter
samples were taken at various times (0, 15, 30, 45, 60, and
120 min), serially 10-fold diluted in anaerobic diluent (half-strength
peptone water plus 0.5 g of
L-cysteine HCl liter
-1, pH 7.0),
and plated in triplicate onto MRS agar (Oxoid). The plates were
incubated at 37°C for 24 h under anaerobic conditions before
enumeration. The experiments were repeated three times.

Statistical analysis.
Cholesterol assimilation and acid and bile tolerance were analyzed
by the one-way analysis of variance procedure of SPSS to determine
whether significant (
P < 0.05) variation occurred among means
in each experiment (
8). The least significant difference (Bonferroni
t test) was used to determine which means differed significantly.
The standard deviation on the specific cholesterol uptake was estimated from the standard deviations on the cholesterol assimilations and the standard error of the dry weight determinations by the law of error propagation in arithmetic operations.

Cholesterol reduction from the culture media.
The amount of cholesterol assimilated during 12 h of anaerobic
growth at 37°C (Table
2) revealed a wide variation among
strains as well as between trials for the same strain. All strains
examined were able to assimilate cholesterol to some extent
with the exception of
Lactobacillus crispatus ATCC 33820 and
Enterococcus durans ATCC 59607, which did not grow well in the
media used. The amounts of cholesterol assimilated by the cultures
ranged from 0.09 to 29.73 mg/g of cells (0.4 to 47% of the cholesterol
in the media). No statistically significant differences were
found between the cultures tested with regard to their specific
cholesterol uptake rate (
P > 0.05), due to the high variability
of data. In the majority of cases, uptake of cholesterol was
higher in the medium with 0.4% (wt/vol) oxgall, although this
was significant only (
P < 0.05) for
Lactobacillus casei Shirota.
Cultures of
L. brevis NR1C1684 and
E. faecalis assimilated more
than 1.5 times the average of the other strains in the media
with 0.2 and 0.4% (wt/vol) oxgall, respectively. However, this
effect was not statistically significant (
P > 0.05).
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TABLE 2. Cholesterol specific uptake during 12 h of anaerobic growth in mMRS broth supplemented with bile acids and 100 mg of cholesterol per litera
|

Growth in the presence of bile salts.
Table
3 shows the effect of bile salts on the growth of the
strains arranged in order of decreasing bile tolerance, as determined
by a lowering of the growth rate in the medium with 0.4% bile
acids. Significant variations existed among the cultures with
regard to their ability to grow in mMRS broth and in mMRS broth
supplemented with bile acids (
P < 0.01).
L. crispatus ATCC
33820 was less bile tolerant than all the other strains tested,
not being able to grow in the presence of 0.2% bile acids. In
a comparison of all the other strains,
L. casei Shirota and
Bifidobacterium infantis ATCC 15697 were the most sensitive
to bile acid, with significantly lower growth rates in the medium
with 0.4% (wt/vol) bile acids than in the absence of bile (
P < 0.05).
Lactobacillus delbrueckii JCM 1002,
E. gallinarum,
and
L. fermentum strains F53 and KC5b showed some sensibility
to bile acids; however, the differences found in the growth
rate were not significant (
P > 0.05). The remaining strains
showed no significant differences in their growth in the media
with and without bile acids.

Acid tolerance of cultures.
The effects of acidity on the viability of strains are presented
in Table
4 arranged in order of decreasing acid tolerance.
Lactobacillus pentosus (B) and
Streptococcus thermophilus DSM 20617 were the
most acid sensitive of all strains tested, losing viability
in less than 15 min at pH 2.0. The total CFU of
L. casei Shirota,
E. gallinarum,
L. brevis NR1C1684,
B. infantis ATCC 15697, and
Streptococcus bovis ATCC 43143 significantly decreased (
P <
0.01) after 15 min in medium at pH 2.0. This decrease ranged
from 1.7 to 4.5 log cycles. The viability of
L. casei and
L. crispatus ATCC 33820 at pH 2.0 significantly decreased (ca.
1 log cycle,
P < 0.01) after 30 min, and after 60 min these
strains showed a 3- to 4-log-cycle decrease in counts.
L. fermentum KC5b,
L. delbrueckii JCM 1002, and
Lactobacillus acidophilus johnsonii were the most acid-tolerant strains, retaining around
100% viability for up to 2 h at pH 2.0. No significant differences
were found between the viability after 2 h for
L. fermentum KC5b and
L. acidophilus johnsonii (
P > 0.05). Although the
latter showed a small but significant decrease in viability
after 30 min at pH 2.0 (0.4 log cycles,
P = 0.042), this was
transient, and the viable counts recovered after that time.
The maintenance of viability of
L. delbrueckii JCM 1002 after
2 h at pH 2.0 was significantly lower than that of
L. fermentum KC5b (
P = 0.037) but not than that of
L. acidophilus johnsonii
(
P > 0.05).
The data from in vitro studies show that some strains of
L. acidophilus and
Bifidobacterium longum are able to take up cholesterol
into their cellular membrane (
4,
7,
11,
13,
14). However, controversy
still exists as to whether these and other strains of probiotic
bacteria can exert any cholesterol-lowering action in vivo.
In this study, we have examined the cholesterol assimilation
abilities of nine strains of lactic acid bacteria and bifidobacteria
of human origin together with 11 commercial probiotics. We assessed
the survival abilities of these cultures after passage through
conditions set to simulate the upper intestinal tract, i.e.,
by comparison of their acid and bile tolerance. Both of these
traits are required for efficacious probiotics, and variability
in survival rates may help to explain controversy about their
beneficial aspects, including cholesterol reduction. Considering
the purported mechanisms behind this phenomenon, it is rational
to assume that probiotic survival in the gut is a prerequisite.
The results presented here partly confirm the data of Gilliland
et al. (
7), Ra

i

et al. (
14), and Tahri et al. (
21) in that some
strains of lactic acid bacteria and bifidobacteria are able
to remove cholesterol from culture medium during anaerobic growth
in the presence of bile acids. However, great variability was
found between strains and even for the same strain during different
experimental runs. On the other hand, small differences were
observed in the growth and the specific cholesterol uptake rate
of each culture among the three replicates of the same run,
as indicated by small associated standard deviations (Table
2). This suggests that the cholesterol assimilation ability
of the bacteria is highly dependent on their growth in each
run, perhaps reflecting the growth stage of the inoculum used.
Indeed, Tahri et al. (
20,
21) demonstrated that the ability
of some strains of bifidobacteria to take up cholesterol into
their cellular membrane was growth associated, since resting
cells did not interact with cholesterol. Although in the experiments
carried out here the seed cultures were always grown till the
end of the exponential phase, under the same conditions, and
after at least three subculturings from the stock frozen cultures,
differences were still observed in the growth of each strain
between runs. This was particularly significant for
L. brevis,
L. pentosus,
L. casei,
Lactobacillus reuteri DSM 20016T, and
S. bovis. Also, significant variation (
P < 0.05) was found
between strains in their growth in the test media used, and
therefore, the direct comparison of their cholesterol reduction
data may give misleading impressions. In order to take this
into account, we determined the specific cholesterol uptake
rate of each strain, which was standardized with the final dry
weight of the culture. However, considerable variation with
regard to the cholesterol assimilation in the different runs
for the same strain was still observed in some cases. This could
be partly explained by a coprecipitation of cholesterol with
deconjugated bile acids, which is observed at pH values below
5.5 (
9). Since the study was performed without pH control, it
is probable that part of the cholesterol present in the growth
medium precipitated when the pH had dropped below 5.5, due to
bacterial fermentation and short-chain fatty acid formation.
The amount of cholesterol coprecipitated with bile acids in
each culture may differ between trials due to variations in
bacterial growth and therefore the final pH of the medium. However,
this phenomenon would be relevant for only those strains that
were able to deconjugate bile acids. For the majority of strains
tested, cholesterol reduction from the culture medium was higher
(although not significantly so) in the presence of more bile
acids. This is in agreement with the work of Tahri et al. (
22),
who reported higher cholesterol assimilation with increased
oxgall concentrations in the growth medium. Cultures of
L. pentosus (A),
Lactobacillus plantarum NDV,
L. fermentum F53,
L. reuteri DSM 20016T,
E. durans DSM 20633, and
E. gallinarum all assimilated
below 1 mg of cholesterol per g of cells with 0.2% (wt/vol)
bile acids in the medium in at least two of the runs. Although
the amount of cholesterol assimilated by these strains increased
with 0.4% (wt/vol) oxgall, this concentration is unlikely to
occur in vivo since the bile acid content of the small intestine
is normally below this level (
24). Alternatively, cultures of
L. brevis NR1C1684,
L. casei Shirota, and
E. faecalis all assimilated
more than 5 mg/g with 0.2% (wt/vol) oxgall in two of the runs.
However, the variability found does not allow the conclusion
that such strains were better cholesterol assimilators. Previous
studies have shown that, in order to assimilate cholesterol,
the organisms must be able to grow in the presence of bile (
4,
7,
20,
21,
25). With the exception of
L. crispatus ATCC 33820,
all the cultures tested exhibited some degree of bile tolerance,
being able to grow in medium containing up to a concentration
of 4,000 mg/liter, four times the considered standard for bile
tolerance (
24). However, the strains with high bile tolerance
did not necessarily assimilate more cholesterol than those with
a lower tolerance. For example,
L. acidophilus johnsonii was
significantly more bile tolerant than
L. casei Shirota but did
not assimilate more cholesterol. In this study, intrinsic resistance
to gastric acid was observed to be a rare property among the
commercial probiotic cultures examined. With the exception of
L. acidophilus johnsonii and
Lactobacillus delbrueckii subsp.
bulgaricus JCM 1002, the latter previously reported as poorly
tolerant (
3), all other commercial strains lost viability after
2 h in a medium at pH 2.0. From all the strains tested, only
L. fermentum KC5b,
L. delbrueckii JCM 1002, and
L. acidophilus johnsonii retained good viability for up to 2 h at pH 2.0 and
were therefore considered intrinsically tolerant to acid. In
order to exert a beneficial effect in the gut, probiotic cultures
must survive passage through the stomach and be tolerant to
the bile concentrations in the small intestine (
16). Survival
at pH 3.0 for 2 h and growth in medium containing 1,000 mg of
bile acids per liter are considered standards for acid and bile
tolerance of probiotic cultures (
24).
Results from the present study showed that the human strain L. fermentum KC5b isolated from the steady state of chemostats with media enriched with bile acids and cholesterol was comparable to the commercial probiotics L. delbrueckii subsp. bulgaricus JCM 1002 and L. acidophilus johnsonii in its ability to tolerate acid and bile. Furthermore, this strain is of human origin, which could be of advantage in its ability to compete with the indigenous microflora. Additional in vitro studies are needed, focused on determining the cholesterol reduction ability of this strain in a variety of media and growth conditions in pH-controlled experiments, as well as the mechanism(s) behind the purported assimilation process. Also, the influence of this strain on the indigenous microflora and overall metabolic activity of the gut should be further assessed in vitro in mixed-culture and mixed-substrate environments prior to the design of any clinical intervention trials.

ACKNOWLEDGMENTS
D. Pereira gratefully acknowledges the Portuguese Ministry of
Science and Technology (FCT) for a Ph.D. scholarship (PRAXISXXI/BD/19520/99)
during the course of this work.

FOOTNOTES
* Corresponding author. Mailing address: Food Microbial Sciences Unit, School of Food Biosciences, The University of Reading, Whiteknights Road, Reading RG6 6BZ, United Kingdom. Phone: 44-118-9357213. Fax: 44-118-9357222. E-mail:
D.I.A.Pereira{at}reading.ac.uk.


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Applied and Environmental Microbiology, September 2002, p. 4689-4693, Vol. 68, No. 9
0099-2240/02/$04.00+0 DOI: 10.1128/AEM.68.9.4689-4693.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
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