Saccharomyces cerevisiae var.
boulardii (
Sb) was obtained from tea made with peels of tropical fruits and described by Henri Boulard in 1920.
Sb is recognized as nonpathogenic, is generally regarded as safe (GRAS), and has been employed for managing various gastrointestinal disorders [
1]. Recent molecular typing technologies and phylogenetic analyses categorized
Sb into the same species sharing very similar karyotypes with brewer’s yeast
S. cerevisiae (
Sc) but a different strain [
2]. Early studies have reported
Sb as a distinct yeast species from
Sc, considering the differences between the two yeasts on a number of key physiologic and metabolic traits [
3,
4]. First of all, better thermotolerance and acid tolerance have been considered to represent the phenotypic distinction of
Sb as a probiotic yeast strain because they permit better viability through the host digestive tract, while the bile salt tolerance of
Sb is weaker than
Sc [
5,
6]. In addition, galactose utilization by
Sb is significantly inefficient compared to
Sc [
3,
7], albeit the culture pattern on galactose is slightly varied among
Sb strains [
8]. The truncation of
PGM2 encoding phosphoglucomutase, which likely led to its loss of function, was the major cause of impaired galactose utilization by
Sb. Intriguingly, recovery of the full length of
PGM2 resulted in a detriment to the growth rate on glucose, the universal carbon source for
Saccharomyces, at human body temperature, connoting that phosphoglucomutase could play a pivotal role in the thermotolerance of
Sb [
7]. It is also known that
Sb cannot produce ascospores, which wild-type
Sc produces [
3]. In addition, the
Sb cell wall composition has more mannan but less glucan compared to that of
Sc. Transmission electron microscopy also demonstrated that
Sb carries a thicker and coarser mannan layer and thinner glucan layer on its cell wall than
Sc [
9,
10].
2. Health Benefits of Sb and Sc, and Their Modes of Action
Previous studies have identified diverse functionalities of
Sb against the host and pathogens including control of the balance of intestinal microbes, disruption of the colonization and infection of pathogens on the mucosa, local and systemic immune response adjustment, and stabilization of the gastrointestinal barrier function. It has been reported that lyophilized
Sb products carry a higher number of viable cells and outperform heat-killed
Sb products regarding the pharmacokinetics and probiotic stability at room temperature [
1], but the efficacy difference between the two product types may vary depending on whether the mechanism of action is probiotic or parabiotic. In the case of
Sc, a few health benefits of its intake have been reported but mostly from a nutritional perspective [
19]. Despite the considerable genetic similarity, the efficacies of
Sc as a prophylactic or therapeutic avenue against gastrointestinal disorders have not been studied as thoroughly as those of
Sb. Considering their genotypic and phenotypic similarities, however,
Sc may also provide some of the reported benefits of
Sb. The following subsections introduce detailed examples of the probiotic and non-probiotic mechanisms of the health benefits of the
Saccharomyces yeasts (described in
Figure 1 and
Table 1).
Figure 1. Overview of innate health benefits of Sb and Sc. Up-pointing triangle, benefits demonstrated only in Sb to date; down-pointing triangle, benefits demonstrated only in Sc to date; pentagon, benefits demonstrated in both Sc and Sb. Blue, benefits associated with secreted proteins; green, benefits associated with small molecules; pink, benefits associated with cell wall polysaccharides.
Table 1. Studies demonstrating key health benefits of Sb and Sc and their mechanisms.
2.1. Innate Probiotic Benefits
The inhibitory activity against the pathogenic mechanisms of varied bacterial toxins has been thoroughly investigated as a representative probiotic capability of
Sb. For instance, colitis associated with
C. difficile infection has been a major target ailment of the probiotic application of
Sb; the protective effect of
Sb administration against
Clostridioides difficile infection has been proven not only in animal models but also in placebo-controlled clinical trials [
20,
21,
22,
36,
37,
38]. A gnotobiotic murine model demonstrated that the protective effect was associated with the viability of administered
Sb as well as its dose [
22]. In vivo investigation using a rat model and in vitro assessment employing human colonic cells substantiated that a 54 kDa serine protease secreted by
Sb possesses the capacity to attenuate the pathogenicity of
C. difficile by proteolyzing its two exotoxins, toxins A and B (TcdA and TcdB) [
23,
24]. In addition, the serine protease inhibited the binding of TcdA to its receptor on the brush border epithelium in rats [
39]. Similarly,
Sb exhibits a prophylactic effect on gastrointestinal anthrax by inactivating the lethal toxin from
Bacillus anthracis, the causative pathogen of anthrax [
40]. As its major virulence factor,
B. anthracis synthesizes the lethal toxin consisting of protective antigens and the lethal factor. In vitro tests using human intestinal epithelial cells determined two mechanisms of
Sb inactivating the lethal toxin, namely absorbing the protective antigens on its cell wall and inducing its cleavage [
25]. However, the molecules exerting the binding and proteolytic actions against the
B. anthracis lethal toxin have not been demonstrated from
Sb yet.
In addition, the inhibition of bacterial endotoxin by
Sb was also demonstrated with
Escherichia coli O55:B5 as a model pathogen in a rat model. The key element of the inhibitory activity was a 63 kDa protein phosphatase catalyzing the dephosphorylation of two phosphorylation sites of the lipopolysaccharide of
E. coli O55:B5. In vivo tests revealed that the intraperitoneal injection of intact
E. coli O55:B5 lipopolysaccharide into rats resulted in 100 ng/mL of circulating tumor necrosis factor-α, along with inflammatory lesions and apoptotic bodies in the liver and heart after 9 h. In contrast, rats injected with dephosphorylated lipopolysaccharide had 40 ng/mL of tumor necrosis factor-α without any observable organic lesions [
26].
Sb also attenuates the morphological damage caused by
Vibrio cholerae. It was demonstrated in multiple rat model studies that
Sb decreased cholera toxin-induced fluid and sodium secretion [
41]. Cholera toxin increases cyclic adenosine monophosphate levels by activating adenylate cyclase. The elevation of cyclic adenosine monophosphate levels prompts the secretion of chloride and bicarbonate in crypt cells while inhibiting chloride absorption in villi [
42]. In a rat intestinal cell model, the inhibitory effect of
Sb on cyclic adenosine monophosphate was abolished when
Sb was heat-inactivated. A 120 kDa protein identified from an
Sb-conditioned medium has been proposed as the factor mediating the protective efficacy of
Sb toward
V. cholerae. The 120 kDa protein neutralized the cholera toxin-induced secretion by not exerting proteolytic or protein modification activities on cholera toxin but reducing cyclic adenosine monophosphate levels [
27].
While these specific 54 kDa, 63 kDa, and 120 kDa proteins have been proposed to play pivotal roles in the probiotic activities of
Sb, genes encoding those proteins have not been identified in the
Sb genome [
2,
43]. Accordingly, their existence in genomes of
Sc or other
Saccharomyces species has also not been confirmed yet.
Another probiotic capability of
Sb is the in situ delivery of advantageous small molecules. In a simulated gastrointestinal tract environment,
Sb and
Sc showed different transcriptional patterns of genes encoding enzymes involved in the production and secretion of polyamines, such as spermidine and spermine. Specifically,
Sb exhibited higher expression levels of the synthetic pathway of ornithine, the precursor of spermidine and spermine, and the polyamine exporter Tpo2p compared to
Sc. On the other hand,
Sb down-regulated the expression of the ornithine catabolic pathway, the polyamine importer Tpo1p, and the positive regulator of spermine uptake Ptk1p [
2,
44]. In a rat model featuring a 60% proximal small bowel resection, an elevation in mucosal polyamine concentrations attributable to the influence of
Sb was discerned [
28]. Polyamines promote the expression of digestive enzymes and nutrient transporters in gut epithelial cells, maintain the integrity of the gut epithelium, and regulate macrophage differentiation for anti-inflammatory effects [
2,
28,
45,
46].
2.2. Innate Non-Probiotic Benefits
Saccharomyces yeast cell biomass is reported to interact with the host via cell wall oligosaccharides, such as mannan and glucan, regardless of cell viability. The administration of cell wall polysaccharide fractions of
Sb or its whole cells triggers the gut mucosal immune system by stimulating enterocytes and gastrointestinal-associated immune cells via β-glucan and mannose receptors in various animal models [
29,
47,
48,
49,
50]. In vivo (mice) and in vitro (human colonic cells) assays demonstrated that the induction by
Sb cell wall components leads to immunomodulatory responses including the secretion of immunoglobulins, which protects intestinal epithelium from pathogenic bacteria and their toxins [
20,
51,
52]. In addition, the cell wall mannoprotein and β-glucan of
Sc were also documented as nonspecific immune stimulators demonstrating interactions with macrophages, neutrophils, and eosinophils in an in vitro evaluation employing murine cell lines [
30].
Also, in vitro assays have demonstrated that the mannan oligosaccharide on the surface of both
Sc and
Sb is a biomaterial that traps enteric pathogens carrying mannose-specific adhesins or receptors, such as
Salmonella enterica Typhimurium and
Escherichia coli O157, and form yeast–bacteria clusters [
9,
31,
32,
53]. Importantly, the binding affinity between representative
Saccharomyces strains and gut commensal bacteria has not been reported except for the
Sc UFMG 905 strain and
Bacteroides fragilis [
32]. The trapping capability of
Sc and
Sb is independent of their viability but prominent in the stationary phase compared to other growth phases [
31,
32,
53]. As the adhesive interaction is dependent on the mannan and mannan-specific adhesion factors, the presence of other sugars and bile salts can interfere with the trapping mechanism [
32,
54]. The adhesive interaction between the pathogenic bacteria and the
Saccharomyces yeast surface can contribute to the therapeutic efficacy of
Sb against enteric diseases, as the rivalry between yeast cell wall mannan and oligomannoside chains on enterocytes reduces the colonization and infection chances of the pathogenic bacteria [
32,
55,
56]. Because
Saccharomyces yeasts stay in the host gut transiently, yeast cells pass through the host gut, capturing pathogenic bacteria and ultimately diminishing the intestinal population of the pathogens [
12,
50]. Nevertheless, the in vivo substantiation of the parabiotic protective efficacy of
Sb predicated on adhesive interactions with pathogens remains unestablished.
Yeast cell wall polysaccharides absorb not only pathogenic bacteria but also mycotoxins. Aflatoxin B1 is a representative mycotoxin, demonstrating a binding affinity with the majority of
Sc strains. In poultry farming,
Sc has therefore been utilized as a performance-promoting ingredient with an ameliorating effect against aflatoxin B1 [
33]. An in vitro binding test manifested the dose-dependent binding of the
Sc cell wall fraction and aflatoxin B1, and the binding affinity was affected by the cell wall mannan condition [
57]. On the other hand, thermolyzed
Sc and pure mannan oligosaccharide could not successfully attenuate liver damage by aflatoxins, while dehydrated active
Sc maintained efficacy against aflatoxins during an in vivo bioassay with rats [
34]. Together, these results suggest that the aflatoxin-absorbing capacity of
Sc is a parabiotic property but thermosensitive and probably requires all cell wall components [
58]. The in vitro binding assay utilizing
Sc cell wall materials indicated a notable binding affinity between zearalenone and fumonisin B1 with
Sc cell wall polysaccharides, while deoxynivalenol did not exhibit a noticeable binding affinity [
57]. However, there is currently no substantiation of the mycotoxin-absorbing www in human subjects.
Furthermore, the administration of cell wall mannan can reshape the architecture of gut microbiota as a selective carbon source.
Sb administration increased relative abundances of
Bacteroidetes but decreased those of
Firmicutes in the mouse gut at the phylum level, and the genus
Bacteroides was one of the major momenta of the increase in the
Bacteroidetes phylum [
35,
59]. This taxonomic reconstruction of gut microbiota is connected to the efficacy of
Sb administration in multiple disorders including obesity, inflammation, skin dryness, and infectious diseases [
9,
35,
59]. In vitro competition between
Bacteroides thetaiotaomicron and
C. difficile for quenched
Saccharomyces yeast cells demonstrated that the selective nurturing effect is a non-probiotic characteristic of yeast biomass [
9].
Bacteroides is a representative genus that efficiently metabolizes various polysaccharides, including yeast cell wall mannan, via a large number of carbohydrate-active enzymes [
60]. In particular,
B. thetaiotaomicron, one of the dominant members of the commensal gut microbiota, is well known for its capacity to utilize
Saccharomyces cell wall mannan through a selfish mechanism.
B. thetaiotaomicron does not break down extracellular mannan into small oligosaccharides or mannose monomers. Instead, it produces complex mannan chunks that are not readily usable by many bacteria in the gut [
60,
61].
B. thetaiotaomicron imports the complex mannan chunks into its periplasmic space through the sus-like transport system and then digests them further to mannan monomers. The selfish mechanism has also been overserved in
Bacteroides ovatus, another example of commensal
Bacteroides [
60,
62]. The administration of
Saccharomyces cell wall mannan enhanced the relative abundances of both
B. thetaiotaomicron and
B. ovatus in a human feces fermentation system, and a positive correlation was noted in the relative ratio of
B. thetaiotaomicron and
B. ovatus. This indicates a coordinated utilization of
Saccharomyces cell wall mannan by the two
Bacteroides species [
62].