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The use of antioxidant supplemented multivitamin supplementation may reduce respiratory exacerbations in patients with cystic fibrosis. These are the findings of an essay published in the American Journal of Respiratory and Critical Care Medicine
. The use of multivitamin supplementation enriched with antioxidants could reduce respiratory exacerbations in patients with cystic fibrosis.
Published in American Journal of Respiratory and Critical Care Medicine
More specifically, the antioxidant supplementation tested was safe and well tolerated, resulting in an increase in systemic antioxidant concentrations and a modest reduction in anti-oxidant levels. Systolic inflammation after 4 weeks. In addition, antioxidant treatment was also badociated with a lower risk of early pulmonary exacerbation
Rationale and Study Design
"People with CF often face chronic bacterial infections responsible for the inflammation and release of large amounts of reactive oxygen species (ROI) on the respiratory tract – the researchers recall in the introduction to work. "
Under normal conditions, the body should be able to put in place an antioxidant defense mechanism capable of neutralizing oxidative stress, but the CF is also characterized by the presence of dietary deficiencies of antioxidants. contributes to the occurrence of an imbalance between oxidizing and antioxidant substances and increased inflammation, resulting in lung injury and a progressive loss of lung function.
"The improvement of the Antioxidant status in the presence of cystic fibrosis is an important clinical factor.This could have a positive effect on health – the researchers continue – Several formulations of oral antioxidants have been tested in patients with cystic fibrosis with conflicting results.
However, until now, there was no well-designed randomized controlled trial on the use of a cocaine. Antioxidant product that included several antioxidants in a single formulation. "
From where the new study, a Phase 2 multicenter clinical trial, conducted in 15 US centers linked to the CF Therapeutics Foundation Development Network, which recruited patients over 10 years of age mean 22 years) also suffering from pancreatic insufficiency, a condition leading to malabsorption of antioxidants. 19659006] Study participants had a FEV1 value of between 40% and 100% predicted value, based on age, bad belonging to stature and a set of other characteristics.
randomized for 16 weeks treatment with antioxidant supplemented multivitamin supplementation or multivitamin supplementation alone (control group [196] 59006] Among the parameters included in the study were systemic concentrations of antioxidants, the evaluation of certain markers of inflammation and stress ox ydatif, as well as some clinical results (pulmonary exacerbations, anthropometric measurements, lung function), as well as examination of safety and tolerability
Main results
The study did not satisfy The achievement of the primary endpoint, represented by the change in concentrations of myeloperoxidase (MPO) in sputum 16 weeks. In this regard, the researchers said that they chose DFO in the sputum "rather than another marker of airway inflammation – such as neutrophil elastase – As DFO generates reactive oxygen species (ROI) as part of their function in innate defense mechanisms of the host, and is therefore considered by many as a marker of oxidative stress.
That said, however, in patients supplemented with antioxidants, compared to the control group, a halving risk occurred in the first episode of exacerbation requiring the use of antibiotics (aHR = 0.50, p = 0.04)
During the 16 weeks of the study, of 73 patients (36 of whom were supplemented with antioxidants), 53% of the group treated with antioxidants experienced 28 exacerbations, compared to 68% of the control group who experienced 39.
Finally, It has also been observed that supplemented ioxidants have increased circulating concentrations of antioxidants such as beta-carotene, coenzyme Q10, gamma-tocopherol (a form of vitamin E) and lutein and, at the same time, have reduces transient inflammation (at 4 weeks, but not at 16) measured by two inflammatory blood markers such as calprotectin and MPO
In summary
Supplementation for 4 months of a formula-enriched multivitamin antioxidant has been shown to be a safe and well-tolerated intervention in patients with cystic fibrosis, leading to an increase in systemic concentrations of antioxidant substances and a transient reduction in systemic inflammation
Although the primary endpoint of the study (MPO variation in sputum) was not achieved, a clinically significant time increase at first exacerbation n in patients supplemented with antioxidants
According to the authors of the study the only improvement in antioxidant status would be sufficient to suggest the use of antioxidant supplementation alone
"Of course – they conclude – the development of safe and effective anti-inflammatory therapies remains a key priority to be pursued by the CF expert community ".
NC
Bibliography
Sagel SD et al. Effects of an antioxidant-enriched multivitamin in cystic fibrosis: a randomized, controlled and multicenter trial. American Journal of Respiratory and Critical Care Medicine 2018; ePub-ahead-of-print.
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