Although the primary site of immunological signalling is at the gut mucosal interface, there is evidence that the immunomodulatory effects of probiotics can be expressed systemically. Typically, this is manifested by changes in leucocyte or humoral function, which can be assessed by ex vivo assays. To date, several compartments of the immune system have been identified as affected by probiotic delivery, including lymphocyte function (proliferation, cytokine secretion and cellular cytotoxicity); innate cell defences (e.g. phagocytosis, oxidative radical production, lysosomal enzyme secretion); natural cytocidal function of macrophages and natural killer (NK) cells, and antibody responses (both in terms of total immunoglobulin (Ig) levels and antigen-specific responses) (Table 13.1). In addition, there is evidence that oral delivery of probiotics can influence cellular phenotype expression, both at the mucosal interface and systemically, to reflect a state of activation.
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