“Lactobacillus rhamnosus L34”: A Native Probiotic That Reduces Inflammation in Patients with Chronic Kidney Disease 

Researchers from the Faculty of Medicine, Chulalongkorn University have discovered a native probiotic strain, Lactobacillus rhamnosus L34, that helps reduce uremic toxins and inflammation-related cytokines in patients with chronic kidney disease (CKD) before dialysis. The research team is currently collaborating with a pharmaceutical company to develop a Thai-made probiotic dietary supplement tailored for Thai patients.   

In recent years, probiotic dietary supplements have gained popularity among health-conscious consumers due to their role in promoting digestive health. Common products include yogurt and fermented milk drinks, which contain beneficial microorganisms that support intestinal function. 

However, probiotics offer benefits beyond gut health alone. Modern medical science has revealed more amazing properties of many intestinal microorganisms that can help alleviate disease conditions and slow bodily degeneration, including chronic kidney disease. Recently, Prof. Dr.  Somying Tumwasorn and Assoc. Prof. Dr. Asada Leelahavanichkul, from the Division of Bacteriology and Division of Immunology, respectively, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, developed a powdered probiotic product of Lactobacillus rhamnosus L34 specifically for patients with chronic kidney failure.

“Clinical trials showed that after patients with chronic kidney disease consumed Lactobacillus rhamnosus L34 for one month, levels of uremic toxins and inflammation-related cytokines decreased significantly,” said Assoc. Prof. Dr. Asada.

He added that “Lactobacillus rhamnosus L34 is a probiotic strain native to Thai people, making it particularly suitable as a dietary supplement for Thai patients”. 

Probiotics and Health 

Assoc. Prof. Dr. Asada further illustrated that “Probiotics are beneficial microorganisms that can be bacteria, fungi, or yeast. However, we normally mean the intestinal bacteria. 

“The human body contains both good and bad bacteria. Good bacteria produce certain nutrients that cannot be synthesized by the body, such as short-chain fatty acids and certain vitamins. Probiotics help break down fiber and foods that the body cannot digest, and compete with harmful bacteria for nutrients, thus reducing the number of harmful bacteria and increase the good bacteria.” 

Currently, Thailand’s Food and Drug Administration recognizes 23–24 probiotic strains permitted for use in food products, including Bifidobacterium, Lactobacillus, Staphylococcus sciuri, and Propionibacterium arabinosum. Among these, Lactobacillus is the most widely recognized by consumers.

“Lactobacillus is a group of bacteria known for its strong ability to produce lactic acid, which is why it is commonly used in the production of drinking and regular yogurt,” explained Assoc. Prof. Dr. Asada.

“Within the Lactobacillus group, there are different subgroups known as species, such as rhamnosus and casei. These two species belong to the same group and are very similar—for example, they share the same staining characteristics and are both anaerobic bacteria. However, they differ slightly in certain biochemical properties, which is why they are classified as separate species.” 

Lactobacillus  rhamnosus L34 Probiotics 

Lactobacillus rhamnosus L34 was first identified approximately ten years ago by Prof. Dr. Somying Tumwasorn of Chula’s Department of Microbiology,  

“Through DNA sequencing analysis of probiotic strains isolated from infant stool samples, Prof. Dr. Somying found some interesting strains.” Assoc. Prof. Dr. Asada further explained, “We isolate the bacteria from the feces and feed the food that the bacteria like until they grow. Once we have successfully cultured the bacterial, we analyze to see if this bacterium has been found or if it is unique.  We did DNA sequencing analysis and learned that the intestinal bacteria called probiotics, Lactobacillus rhamnosus, L 34 have a unique sequence.”  

Reducing Inflammation in Chronic Kidney Disease 

Assoc. Prof. Dr. Asada subsequently conducted studies using the probiotic Lactobacillus rhamnosus L34 in animals, including intestinal infection models, sepsis models, and renal disease models. The findings showed that in the kidney disease model, animals receiving the probiotic exhibited reduced inflammation-related factors compared with those that did not receive the probiotic.

“We began by conducting studies in animal models. Animals with only one-sixth of normal kidney function showed a buildup of waste products normally excreted in urine, similar to what occurs in humans. The animals were given the probiotic once daily for three months, and the results showed a reduction in gut-derived uremic toxins (GDUTs).” 

 Assoc. Prof. Dr. Asada further explained that “kidney diseases” lead to changes in certain waste products because they can no longer be excreted efficiently through urine. These waste products are instead eliminated via the intestine, where they are metabolized by certain gut bacteria into several substances. Some of these substances are known as gut-derived uremic toxins (GDUTs). These toxins increase inflammation, cause arterial stiffness, raise the risk of stroke and cardiovascular disease, and further accelerate the progression of kidney deterioration.”

“However, when we administered the probiotic Lactobacillus rhamnosus L34, a beneficial bacterium, it helped suppress harmful bacteria, resulting in a reduction in uremic toxins.” 

Following promising results in animal studies, Assoc.  Prof. Dr. Asada proceeded to the next phase of research involving patients with chronic kidney disease in 2024.

“We asked patients to take Lactobacillus rhamnosus L34 in a powdered form for approximately one month. Blood tests showed reductions in gut-derived uremic toxins and cytokines—key markers of inflammation—while kidney function itself remained unchanged.”  

Assoc. Prof. Dr. Asada told us that Lactobacillus rhamnosus L34 is suitable for patients with chronic kidney disease stages 3–5, during the pre-dialysis period (see the boxed section for more information on stages of chronic kidney disease).

“For patients with chronic kidney disease who do not yet require dialysis, taking Lactobacillus rhamnosus L34 may help reduce inflammation. However, for patients at stage five who require dialysis, probiotics may need to be used in combination with dialysis, and whether this approach is effective will require further study. Patients who need renal replacement therapy (RRT), but have not received it may experience severe, life-threatening complications due to the accumulation of uremic toxins. These complications include altered mental status, fluid overload in the lungs leading to shortness of breath, generalized swelling, and bleeding into the pericardium that disrupts cardiac function and may result in death. It is therefore important to emphasize that probiotic supplementation is intended only as an adjunct to standard treatment and cannot replace current standard therapies.”

Powdered Probiotic Supplement for Patients with Chronic Kidney Disease 

The probiotic Lactobacillus rhamnosus L34 product has now been patented. The research team from Chulalongkorn University has appointed Greater Pharma Co., Ltd. as its manufacturer. 

“We store Lactobacillus rhamnosus L34 in a lyophilized (freeze-dried) form in the laboratory. When needed, it is re-cultured in test tubes, where the bacteria grow and can then be used for further applications.” 

“However, for commercial production, the most cost-effective way to cultivate the bacteria is through industrial-scale processes. We have therefore partnered with a pharmaceutical company to develop a dietary supplement that meets standards suitable for patient use, with good taste, and affordable price to Thais. Further advances in manufacturing techniques may help reduce costs even more in the future, and these technologies could become an important body of knowledge for the country going forward.” 

Regarding the design of the powdered probiotic product, Assoc. Prof. Dr. Asada said “some patients with chronic kidney disease cannot take probiotics in yogurt due to its high phosphate content. This is particularly true for patients with advanced kidney failure who produce little urine and must restrict fluid intake. Probiotic products that require large volumes of liquid or contain high phosphate dairy products are therefore impractical. A powdered form allows patients who prefer not to drink much fluid to mix the probiotic with food, such as rice, or dissolve it in a small amount of water to drink.”

The Future of Microbiome Research in Healthcare 

Although a dietary supplement product has already been developed, the research is far from complete.  Assoc. Prof. Dr. Asada explained that “future studies will focus on whether longer-term probiotic consumption can help reduce complications associated with chronic kidney disease, as a one-month of probiotics consumption may be too short to observe additional benefits. He also noted the need to explore ways to help the probiotic persist longer in the gut. Ideally, specific probiotics administered over a period of time that be able to colonize and grow independently in the intestine may provide sustained benefits and reducing the cost of continuous supplementation. More research is therefore needed to determine appropriate strategies for modifying the gut microbiome in different disease conditions.

Assoc. Prof. Dr. Asada further explained that products which serve as food for probiotic microorganisms—known as prebiotics—as well as formulations that combine probiotics with their nutritional substrates, referred to as symbiotic, are also of great interest. If feasible, the development of so-called “super probiotics” could offer benefits across a wide range of diseases. In addition, studying bioactive molecules produced by probiotics, such as short-chain fatty acids, is particularly promising, as these compounds could be more easily developed into pharmaceutical products and stored more conveniently than probiotics composed of live microorganisms.

As a microbiology researcher, Assoc. Prof. Dr. Asada hopes to see health products based on gut microbiome modulation developed by Thai researchers, for the benefit of Thai people, at prices that are affordable and within reach.

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