The increase in the prevalence of obesity over the past 20 years has been alarming worldwide (
1). Obesity, as a complex and major metabolic disease, is caused by adipose tissue expansion due to an imbalance between energy intake and expenditure. The excess fat is stored in adipocytes, resulting in hypertrophy and hyperplasia, which has been associated with type II diabetes mellitus, fatty liver disease, insulin resistance, and chronic inflammation (
2-
4). In obesity, hypertrophied adipocytes overproduce various inflammatory cytokines, disrupting the cross-talk between the adipose tissue and important organs involved in metabolic processes, such as the liver and skeletal muscle (
5,
6). Skeletal muscles, as one of the main metabolic tissues, have a prominent role in regulating glucose and lipid metabolism (
7). Inflammatory mediators affect muscles’ sensitivity to insulin (
8), among which tumor necrosis factor α (TNF-α), as well as other pro-inflammatory cytokines produced by macrophages within the adipose tissue, seems to play a key role in insulin resistance pathogenesis in obese individuals (
9,
10). Obesity and a high-fat diet (HFD) can change macrophages’ phenotype from M2 (anti-inflammatory) to M1 (pro-inflammatory) (
11). M1 macrophages highly express inducible nitric oxide synthase (iNOS) and pro-inflammatory cytokines (e.g., TNF-α, IL-1, IL-6), while M2 macrophages mainly express arginase1 (ARG1) and/or anti-inflammatory cytokines (e.g., IL-10) (
12).
On the other hand, it has been shown that in addition to inflammation, HFD leads to oxidative stress by inducing the production of reactive oxygen species (ROS) and reducing the expression of antioxidant factors such as superoxide dismutase (SOD). The production of ROS and inflammatory factors leads to insulin resistance and diabetes (
13). Recently, the role of gut microbiota has been suggested in regulating caloric intake and energy expenditure, thereby contributing to obesity and its metabolic complications (
14). There is evidence that genetically obese animal models and patients with obesity have fewer
Bacteroidetes and more
Firmicutes in comparison with controls, boosting the energy yield from the host’s diet (
14-
16). Gut dysbiosis impairs the gut barrier and enhances the circulatory levels of gut-derived endotoxins like lipopolysaccharides (LPS). Lipopolysaccharides can penetrate into various organs, activating the immune system after being recognized by toll-like receptor (TLR)-4, nurturing low-grade inflammation in the gut and other organs (
17,
18). Gut dysbiosis and chronic low-grade inflammation are pertinent to obesity and insulin resistance (
17,
19-
21).
Recent investigations have proposed that the manipulation of gut microbiota and the use of probiotics (microorganisms with beneficial biological functions) can be novel approaches to treating obesity and its related complication (
20,
22). Probiotics are living microorganisms that, when administered in adequate amounts, have shown beneficial physiologic or therapeutic effects on the host (
23). Probiotics have been documented to promote anti-inflammatory effects and modulate hyperphagia, weight gain, fat mass loss, and glucose tolerance (
24-
27).
Bifidobacterium and
Lactobacillus are well-studied probiotics with beneficial effects on the health status and the ability to survive in various delivery formats during gastric transit (
28,
29).
Bacillus species have received attention in research as their spores enable them to survive in severe processing and storage conditions, as well as in the harsh environment of the gastrointestinal tract (GIT) (
30).
Among
Bacillus species,
Bacillus coagulans was first isolated from spoiled canned milk by Hammer in 1915, attracting increasing attention since then (
31).
Bacillus coagulans is a spore-forming, gram-positive, lactic-producing, catalase-positive, and facultative anaerobic bacterium with a GRAS (generally recognized as safe) status affirmed by the US Food and Drug Administration (FDA). Animal and preclinical studies on
B. coagulans have been focused on its beneficial effects on diverse diseases and conditions, including irritable bowel syndrome, colitis, rheumatoid arthritis, and obesity (
31,
32). The results of one study showed that drinking apple vinegar in combination with
B. coagulans improved serum lipid profile and insulin resistance and prevented hepatic steatosis induced by HFD in mice (
32).
Lactobacillus (Lactic acid bacteria (LAB)), a main component of human GIT microbial flora, is usually used as probiotics, either alone or in combination with other agents, for fermentation in the food and dairy industries.
Lactobacillus species are non-spore-forming, gram-positive, anaerobic bacteria that have been noted to promote immunostimulatory effects, maintain the intestinal microbial balance, prevent GI infections, and nurture hypocholesterolemic effects (
33-
36).
Different
Lactobacillus species have been investigated for their potential beneficial effects on obesity. For instance,
L. reuteri has been associated with weight gain, while
L. casei and
L. paracasei were associated with weight loss (
33). Moreover,
L. plantarum was reported to correct plasma lipid profiles and body weight and attenuate systemic inflammation in rats with HFD-induced obesity (
37).
There is evidence that the ingestion of
L. paracasei in the long term reduces HFD-induced obesity by decreasing body weight and abdominal fat in rats (
38). Another investigation on school-aged children documented that
L. paracasei had a protective role against obesity induced by an unhealthy diet (
33). In another study, data have shown that the consumption of
L. paracasei prebiotics and synbiotics for 12 weeks reduced abdominal dysbiosis and inflammation in insulin-resistant obese male Wistar rats (
39).