Treatment Of Children’s Asthma With A Lipid Extract Of The New Zealand Green Lipped Mussel (Perna Canaliculus) (Lyprinol?) - A Double Blind, Randomised Controlled Trial In Children With Moderate To Severe Chronic Obstructive Asthma.

摘要

The efficacy and safety of an oral standardised lipid extract of New Zealand green lipped mussel (Perna canaliculus) marketed as Lyprinol ? was assessed as maintenance therapy for children with moderate asthma. A total of 71 children aged 6 to 13 years were enrolled in a 16-week, single centre, double-masked, placebo-controlled, parallel-group trial and randomly assigned to receive either Lyprinol or placebo (2 capsules twice daily). Patients were maintained on as-needed beta-agonist therapy and inhaled corticosteroid (ICS) throughout the study. Results. Lyprinol improved the percentage of children reporting little or no trouble with their asthma at three months of treatment (97% vs. 76% p=0.057). Both groups were able to tolerate a dose reduction of ICS. There were fewer mild and moderate asthma exacerbations overall in the Lyprinol group. Lyprinol was well tolerated. It appears from this study that Lyprinol is a safe nutritional supplement for children with moderate asthma and that larger prospective controlled studies should explore its potential use as a nutraceutical in asthma as an addition to conventional treatment. Introduction Inflammatory cellular infiltrates, including lymphocytes, eosinophils, and mast cells, are found in the airways of patients with asthma, even during periods of clinical stability1. These cells produce multiple inflammatory mediators, such as histamine, cytokines, and the cysteinyl leukotrienes (leukotrienes C4, D4, and E4). Compelling evidence exists for the role of the cysteinyl leukotrienes in the pathophysiology of asthma1,2,3,4. These mediators are potent bronchoconstricting agents and induce other features typical of asthma, including airway-wall edema and mucus hypersecretion5.Interest in the possible health benefits of dietary marine n-3 fatty acids (fish oil) developed following observations that those populations with a high dietary intake of fish also have a low incidence of asthma6. The potential anti-inflammatory effect of fish oil may relate to its constituent eicosapentaenoic acid (EPA), being a competitive substrate with arachidonic acid in generating metabolites. EPA is a substrate for the generation of less active prostanoids and leukotrienes than arachidonic acid, thereby potentially acting to reduce airway inflammation and bronchoconstriction7.The influence of a diet rich in EPA and DHA in the role of airway inflammation in asthma has been the subject of interest of several small trials8,9,10. To date, the evidence for beneficial effects of a dietary intake which is high in marine n-3 fatty acids is controversial. Whilst some support for this hypothesis has occurred in epidemiological studies, the data from intervention studies has been conflicting. Black11 hypothesized that dietary fatty acid intake may influence the development of allergic sensitization by increasing the formation of prostaglandin E2; which in turn promotes T helper lymphocyte Th2 responses and stimulates the formulation of immunoglobulin E. As dietary fat intake patterns have changed over the past few decades, with an increase in saturated and omega-6 fat consumption, and a reduction in polyunsaturated omega-3 fat intake, this may be an important factor in the increasing prevalence of asthma and possibly other allergic diseases. Although used for asthma, the efficacy of dietary marine fatty acids (fish oil) is controversial and a review12 of the clinical trials of asthma and fish oils by Monteleone et al. concluded that there was no evidence of clinical improvement in people with asthma using fish oil supplementation, despite some changes seen in inflammatory cell functions. In a review Woods et al.13 analyzed nine trials of fish oil supplementation in asthma without finding any consistent effect on all analyzable outcomes. More recently an experimental clinical study in mild asthma suggests bronchial allergic inflammation is related to a diet deficient in polyunsaturated fatty acids14. Oily fish and shellf