Oral serum-derived bovine immunoglobulin improves duodenal immune reconstitution and absorption function in patients with HIV enteropathy.

Abstract

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.

• Authors: David M Asmuth, Zhong-Min Ma, Anthony Albanese, Netanya G Sandler, Sridevi Devaraj, Thomas H Knight, Neil M Flynn, Tammy Yotter, Juan-Carlos Garcia, Emily Tsuchida, Tsung-Teh Wu, Daniel C Douek, Christopher J Miller
• Journal: AIDS (London, England) (AIDS) Vol. 27 Issue 14 Pg. 2207-17 (Sep 10 2013) ISSN: 1473-5571 [Electronic] England
• PMID: 23660579 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Immunoglobulins
• Serum Globulins

Topics

• Administration, Oral
• Adsorption
• Adult
• Animals
• CD4 Lymphocyte Count
• Cattle
• Diet (methods)
• Duodenum (immunology, pathology, physiopathology)
• HIV Enteropathy (immunology, therapy)
• Humans
• Immunity, Mucosal
• Immunoglobulins (administration & dosage, isolation & purification)
• Male
• Pilot Projects
• Serum Globulins (administration & dosage, isolation & purification)
• Treatment Outcome