For both immunostimulatory and immunoregulatory roles, contemporary research has already identified a few promising strains of immunoactive probi-otics (predominantly LAB) and these strains either are currently being commercialized or are near commercialization. An on-going need for research in this area is for continued safety monitoring, particularly among individuals with pre-existing health conditions. For example, among patients with active autoimmune conditions, probiotic strains that stimulate cellular immune function must receive particular and thorough attention to avoid the potential for disease exacerbation; moreover, the safety of probiotics in subjects with deficient immune systems (e.g. acquired immune deficiency syndrome (AIDS) patients) should be considered. That aside, the essential requirement in all of these cases is not only that the probiotic under consideration is effective at influencing immunity but that it influences the immune system in the appropriate manner and, moreover, that this action contributes in a meaningful way to health improvement. In the former case, this suggests that well-designed and appro priate clinical trials are conducted to determine the impact of any probiotic on the immune system and that this research is conducted on the target population (with regard to demographics, etc.) (Meydani and Ha, 2000). In the latter case, where an effect of probiotics on the immune system has already been demonstrated, there remains the need to correlate immunoactivity with health improvement. In many cases (e.g. boosting of anti-tumour immunity) such evidence will only come from longitudinal/cross-sectional studies of significant duration (Macfarlane and Cummings, 1999). Nevertheless, major progress in the use of defined probiotics for health improvement is likely to become apparent in the coming decade.
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