Academic journal article Journal of Health Population and Nutrition

Salovum Egg Yolk Containing Antisecretory Factor as an Adjunct Therapy in Severe Cholera in Adult Males: A Pilot Study

Academic journal article Journal of Health Population and Nutrition

Salovum Egg Yolk Containing Antisecretory Factor as an Adjunct Therapy in Severe Cholera in Adult Males: A Pilot Study

Article excerpt

INTRODUCTION

Vibrio cholerae is the enteric bacterial pathogen that causes cholera. The disease can often be very severe characterized by frequent passage of voluminous watery stools and vomiting leading to severe dehydration and, if not efficiently treated, might result in death; the rates can be as high as 50-80% (1). Prevention of dehydration, rehydration using appropriate oral or intravenous fluids, and the use of an effective antimicrobial agent, along with continued feeding, are important in the case-management strategy of cholera (2,3). Since cholera involves stimulation of secretory process in response to cholera toxin produced by V. cholerae, efforts to identify and test potential antisecretory agents to reduce the severity of diarrhoea are ongoing. Most of these agents assessed so far have no or minimal effect (4-15). Until now, none of the antisecretory agents has been recommended for the clinical management of cholera patients.

As possible antisecretory agents, some endogenous factors have recently drawn the attention of researchers. Antisecretory factor (AF), a naturally-occurring protein, is produced in the brain and in the secretory organs, such as gallbladder, lungs, kidneys, and the intestine, in response to infection (16-20). AF is also secreted in blood, bile, and breastmilk in response to intestinal enterotoxin challenge (21), and the content in sows' milk is probably crucial for protection against neonatal diarrhoea in suckling piglets (22). It has also been found that carbohydrates and amino acids of specially-processed cereals are also able to induce secretion of AF or AF-like proteins (23,24), which might be useful for therapeutic applications. Preclinical animal studies have shown that AF can have both prophylactic and therapeutic applications in the treatment of various types of diarrhoea (25-29). Results of human studies also demonstrated that AF possesses strong anti-inflammatory properties (30-32).

The Salovum egg yolk powder contains antisecretory-like proteins in a much higher (500 times) concentration than found in normal hen eggs. This is achieved by feeding hens with specially-processed cereals, capable of inducing production of antisecretory-like proteins in the yolk, from which an egg powder is produced (33,34). In view of its apparent antisecretory and anti-inflammatory effects, AF could be therapeutically useful in diarrhoeal diseases of various aetiologies. Therefore, we evaluated the effect of salovum egg yolk powder containing AF in the management of adult male cholera patients

MATERIALS AND METHODS

This open, controlled (pilot study) clinical trial was conducted among 40 adult patients to evaluate the effect of AF-rich Salovum egg yolk powder as an adjunct therapy in the management of severe cholera. The study patients were selected from among those attending the Dhaka Hospital of icddr,b from June to December 2005. The Ethics Review Committee of icddr,b approved the protocol. Adult male patients who attended the Dhaka Hospital for treatment were screened for eligibility. All patients aged 18-55 years with a history of watery diarrhoea of <24 hours and signs of severe dehydration and initial stool dark-field microscopy positive for V. cholerae were eligible for participation in the study. Patients with a history of chronic diarrhoea, dysentery, receiving antimicrobial or antidiarrhoeal drugs within one week before admission, renal or hepatic dysfunction, known allergies to eggs, and refusal of written informed consent were excluded from the study. Upon initial screening, patients were brought to the research ward of the hospital, weighed, and placed on a cholera cot. A standard medical history, thorough physical examinations, including assessment of dehydration using the modified guidelines of the World Health Organization (WHO) (35), and vital signs were recorded in pre-designed forms. Before randomization in the study, all the patients were rehydrated with intravenous (IV) fluids containing polyelectrolytes (Na 133, Cl 98, K 13, and acetate equivalent to 48 mmol/L of bicarbonate) at a rate of 100 mL/kg of body-weight over 4-6 hours, in addition to replacement of ongoing losses in stool and vomit. …

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