Serum-derived bovine immunoglobulin/protein isolate should be considered in patients with HIV gut barrier dysfunction

Excerpt

We read the paper by Assimakopoulos et al. [1] with great interest and agree with their arguments in favor of the importance of intestinal barrier dysfunction in HIV infection even after the reconstitution of CD4 lymphocyte numbers and function with antiretroviral therapy. In fact, a recent paper by Hunt et al. [2] has demonstrated increased mortality in two cohorts of HIV patients with persistent small intestinal barrier dysfunction despite systemic CD4 recovery following antiretroviral therapy. We also agree that the time has come to consider other therapeutic interventions for HIV enteropathy in addition to anti-retroviral drugs. To the possible interventions mentioned by the authors, another therapy should be added to the list: serum-derived bovine immunoglobulin/protein isolate (SBI), the primary dietary ingredient in a physician supervised medical food. In a pilot study, SBI was shown to reduce the gastrointestinal symptoms associated with HIV enteropathy and to lower the markers of enterocyte damage (i.e., intestinal fatty acid-binding protein) as well as to significantly increase intestinal mucosal lymphocyte counts [3]. Furthermore, HIV patients administered SBI over an 8-week period demonstrated an increase in D-xylose uptake. The specially formulated protein preparation in SBI contains >50 % IgG, 5 % IgM, 1 % IgA and other proteins found in colostrum and milk, but has no lactose, casein, or whey. It is also gluten-, dye-, and soy-free. The oral formulation is administered by mixing in water, juices, yogurt or other soft foods. The primary rationale for the inclusion of SBI as a nutritional therapeutic for patients with HIV and intestinal dysfunction is the multi-faceted mechanism of action. The mechanism of action for SBI begins with the immunoglobulins, which survive past the stomach, binding to various microbial components, followed by the maintenance of GI immune balance, and management of gut barrier function thereby leading to improvement in nutrient uptake and utilization (for review see [4]). A version of SBI has been studied for the past 20 years in various animal models because of its veterinary and feed additive applications. A meta-analysis of 75 different studies which summarized 43 independent publications in over 12,000 piglets on plasma preparations from which SBI is derived demonstrated improved nutrient uptake, metabolism, and utilization compared to multiple animal and vegetable protein sources [5]. These pre-clinical data suggest that the oral administration of immunoglobulins, particularly those present in SBI, are able to manage gut barrier function to allow for better nutrient uptake supporting the findings of the previously mentioned pilot study in patients with HIV-associated enteropathy [3]. SBI is generally recognized as safe (GRAS), an FDA safety requirement for all foods including medical foods. The preparation has very few side-effects and no significant drug or food interactions. SBI provides unique nutrient needs distinctively required for HIV enteropathy patients who experience barrier dysfunction. We support the conclusion by Assimakopoulos et al. for new modalities which restore barrier function and suggest that SBI, a specially formulated medical food, must be considered by clinicians for the management of HIV-associated enteropathy. …