TY - JOUR
T1 - Oral serum-derived bovine immunoglobulin improves duodenal immune reconstitution and absorption function in patients with HIV enteropathy
AU - Asmuth, David M.
AU - Ma, Zhong Min
AU - Albanese, Anthony
AU - Sandler, Netanya G.
AU - Devaraj, Sridevi
AU - Knight, Thomas H.
AU - Flynn, Neil M.
AU - Yotter, Tammy
AU - Garcia, Juan Carlos
AU - Tsuchida, Emily
AU - Wu, Tsung Teh
AU - Douek, Daniel C.
AU - Miller, Christopher J.
PY - 2013/9/10
Y1 - 2013/9/10
N2 - Objectives: To examine the impact of serum-derived bovine immunoglobulin, an oral medical food known to neutralize bacterial antigen and reduce intestinal inflammation, on restoration of mucosal immunity and gastrointestinal function in individuals with HIV enteropathy. Design: Open-label trial with intensive 8-week phase of bovine serum immunoglobulin (SBI) 2.5 g twice daily with a 4-week washout period and an optional 9-month extension study. Methods: HIV enteropathy was defined as chronic gastrointestinal symptoms including frequent loose or watery stools despite no identifiable, reversible cause. Upper endoscopy for tissue immunofluorescent antibody assay and disaccharide gut permeability/absorption studies were performed before and after 8 weeks of SBI to test mucosal immunity and gastrointestinal function. Blood was collected for markers of microbial translocation, inflammation, and collagen kinetics. A validated gastrointestinal questionnaire assessed changes in symptoms. Results: All eight participants experienced profound improvement in symptoms with reduced bowel movements/day (P=0.008) and improvements in stool consistency (P=0.008). Gut permeability was normal before and after the intervention, but D-xylose absorption increased in seven of eight participants. Mucosal CD4+ lymphocyte densities increased by a median of 139.5 cells/mm2 from 213 to 322 cells/mm2 (P=0.016). Intestinal-fatty acid binding protein (I-FABP), a marker of enterocyte damage, initially rose in seven of eight participants after 8 weeks (P=0.039), and then fell below baseline in four of five who continued receiving SBI (P=0.12). Baseline serum I-FABP levels were negatively correlated with subsequent rise in mucosal CD4+ lymphocyte densities (r= -0.74, P=0.046). Conclusion: SBI significantly increases intestinal mucosal CD4+ lymphocyte counts, improves duodenal function, and showed evidence of promoting intestinal repair in the setting of HIV enteropathy.
AB - Objectives: To examine the impact of serum-derived bovine immunoglobulin, an oral medical food known to neutralize bacterial antigen and reduce intestinal inflammation, on restoration of mucosal immunity and gastrointestinal function in individuals with HIV enteropathy. Design: Open-label trial with intensive 8-week phase of bovine serum immunoglobulin (SBI) 2.5 g twice daily with a 4-week washout period and an optional 9-month extension study. Methods: HIV enteropathy was defined as chronic gastrointestinal symptoms including frequent loose or watery stools despite no identifiable, reversible cause. Upper endoscopy for tissue immunofluorescent antibody assay and disaccharide gut permeability/absorption studies were performed before and after 8 weeks of SBI to test mucosal immunity and gastrointestinal function. Blood was collected for markers of microbial translocation, inflammation, and collagen kinetics. A validated gastrointestinal questionnaire assessed changes in symptoms. Results: All eight participants experienced profound improvement in symptoms with reduced bowel movements/day (P=0.008) and improvements in stool consistency (P=0.008). Gut permeability was normal before and after the intervention, but D-xylose absorption increased in seven of eight participants. Mucosal CD4+ lymphocyte densities increased by a median of 139.5 cells/mm2 from 213 to 322 cells/mm2 (P=0.016). Intestinal-fatty acid binding protein (I-FABP), a marker of enterocyte damage, initially rose in seven of eight participants after 8 weeks (P=0.039), and then fell below baseline in four of five who continued receiving SBI (P=0.12). Baseline serum I-FABP levels were negatively correlated with subsequent rise in mucosal CD4+ lymphocyte densities (r= -0.74, P=0.046). Conclusion: SBI significantly increases intestinal mucosal CD4+ lymphocyte counts, improves duodenal function, and showed evidence of promoting intestinal repair in the setting of HIV enteropathy.
KW - Bovine immunoglobulin
KW - D-xylose absorption
KW - Gastrointestinal associated lymphoid tissue
KW - Gut permeability
KW - HIV enteropathy
KW - Immune reconstitution
KW - Immunohistochemistry
KW - Intestinal fatty acid binding protein
KW - Monocyte chemotaxis protein-1
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UR - http://www.scopus.com/inward/citedby.url?scp=84884500301&partnerID=8YFLogxK
U2 - 10.1097/QAD.0b013e328362e54c
DO - 10.1097/QAD.0b013e328362e54c
M3 - Article
C2 - 23660579
AN - SCOPUS:84884500301
SN - 0269-9370
VL - 27
SP - 2207
EP - 2217
JO - AIDS
JF - AIDS
IS - 14
ER -