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Synbiotic formula shows promise in reducing long COVID symptoms

In a recent study published within the journal The Lancet Infectious Diseases, researchers investigated the efficacy of a novel synbiotic preparation named SIM01 against the symptoms of post-acute COVID-19 syndrome. They tested the formulation on a Hong Kong-based study cohort comprising 463 patients over the course of six months.



Their findings highlight that SIM01 supplementation significantly alleviated fatigue, bolstered memory, and improved concentration in these cases in comparison with the controls. Moreover, general unwellness and gastrointestinal distress were significantly reduced within the cohort receiving SIM01.

This study marks one in all the primary steps in treating this hitherto prevalent yet poorly understood and untreatable condition. It will be the basis for future gut microbiota remedies for long COVID.

Study: A synbiotic preparation (SIM01) for post-acute COVID-19 syndrome in Hong Kong (RECOVERY): a randomised, double-blind, placebo-controlled trial. Image Credit: Donkeyworx / Shutterstock

What’s PACS?

The coronavirus disease 2019 (COVID-19) stays one in all the worst pandemics in human history, directly infecting greater than 772 million individuals and claiming almost 7 million lines globally. Unfortunately, surviving the infection was not the top of COVID-19-related misfortune, with between 10-30% of survivors retaining COVID-19 symptoms (and even developing latest ones) for weeks, months, and, in rare cases, even years after recovering from the first infection.

Colloquially named ‘long COVID’ the medical post-acute COVID-19 syndrome has been defined by the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) as any COVID-19 symptoms that “persist beyond 4 weeks after the acute infection and will last for as much as several years.”

Given the novelty of the condition, PACS stays poorly understood, albeit recent studies into the syndrome have identified that COVID-19 leads to significant alternations to the composition and performance of gut microbiota, which can play a critical role in PCAS.

“…metagenomic sequencing of fecal samples showed depletion of several helpful bacteria, reminiscent of Bifidobacterium adolescentis, in association with specific PACS symptoms.”

PCAS has been accountable for globally extensive socioeconomic loss and stays a highly debilitating syndrome for patients living with the condition. Discovering a cure for the greater than 65 million PCAS patients worldwide is imperative before human society can resume pre-COVID-19 stability and performance.

Concerning the study

In the current study, researchers conducted a randomized, double-masked, placebo-controlled trial to research the efficacy of SIM01, a novel synbiotic formulation designed to alleviate PACS symptoms. The study was carried out between 25 June 2021 and 12 August 2022 and included 463 patients randomly assigned to either the case (SIM01; n = 232) or control (placebo; n = 231) cohorts.

SIM01 consists of a micro-encapsulated powder (lyophilized) comprising 20 billion colony-forming units (CFUs) of Bifidobacterium bifidu, B. adolescentis, and B. longum. The formulation also comprises prebiotic compounds (n = 3) and dextrin, that are known to advertise probiotic growth. Previous data on the relative abundance of those components in healthy adult Chinese individuals was used to make a decision the relative concentrations of PACS constituents.

Study participants were COVID-19 survivors aged 18 or older with PACS symptoms. Participants lacking at the very least PACS symptoms were excluded from data analyses. The variety of PACS symptoms and their relative severities was assessed using a post-acute COVID-19 syndrome 14-item improvement questionnaire (PACSQ-14). Study treatment involved cases and controls ingesting two sachets day by day comprising either SIM01 (cases) or low-dosage vitamin C (controls).

Data collection included participant demographic information (especially sex and age), medical data (obtained from hospital records), and physical activity metrics. “quality of life and physical activity were assessed by the trained interviewers using a visible analog scale, with scores starting from 0–100, and International Physical Activity Questionnaire.”

Renal function, liver function, and inflammatory marker profiling were achieved using blood plasma samples collected during initial screening and nonetheless during follow-ups at 3 and 6 months. Fecal samples were further collected for microbiome profiling.

“An independent Data and Safety Monitoring Committee (DSMC) consisting of two physicians and a biostatistician repeatedly reviewed data on opposed events and monitored patient safety.”

Study findings

SIM01 treatment resulted in a bunch of helpful outcomes, including alleviating gastrointestinal upset, a typical symptom of PACS. The formulation was further found to lead to a greater than 2-fold reduction in fatigue when comparing case energy levels to their control counterparts. This final result is more than likely as a result of increased microbial butyrate production, a byproduct of the bacteria included within the formulation.

“The current study didn’t discover a big difference in quality of life and physical activity between the 2 groups at six months.”

Surprisingly, SIM01 supplementation was related to improvements in concentration and memory recall, two previously unexplored symptoms of Long COVID. The mechanisms underpinning these interactions remain unknown and must be the main focus of future research aimed toward alleviating this globally prevalent condition.

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