| ironjustice@aol.com 2006-08-14, 2:30 am |
| Letters to the Editor
Indian Pediatrics 2005; 42:618-620
Natural Antioxidant Therapy for Patients with Hemolytic Anemia
We read with interest the article by Marwaha, et al.(1) on the use of
wheat grass juice (WGJ) to reduce transfusion requirements in patients
with thalassemia major. We applaud the authors for their efforts in
this innovative pilot study, and wish to speculate on possible
mechanisms of action that may be considered in the event the authors or
others wish to pursue this line of investigation.
TABLE I
Effect of WGJ Therapy on Blood Transfusion Requirements.
Pre-WGJ therapy * Post-WGJ therapy * p value =A7
Interval between transfusions (days)
22.4 (22.4, 17.5 - 27.5)
26.35 (28.7, 20.7 - 42.2)
0.001
Blood Transfusion (g/kg/year)
255 (242.6, 156 - 306)
188 (187.5, 91 - 291)
0.001
(N =3D 16, * Median, Mean, Minimum - Maximum; =A7 Wilcoxon signed-rank
test).
First, likely recognizing that all statistically significant results
may not be clinically significant, the authors chose a clinical albeit
arbitrary endpoint to evaluate the success of the WGJ therapy to
decrease transfusion requirements in the study patients. Using their
definition of success (>25% reduction of blood transfused compared to
the pre-WGJ period), they reasoned that 50% of the patients responded
to the WGJ therapy. Using the data they provided in the table in the
paper, we performed relevant statistical analyses on the entire cohort
to evaluate the effects of WGJ on the total amount of blood transfused
and the mean interval between transfusions. We found that WGJ therapy
decreased the total volume of blood transfused and increased the
intervals between blood transfusions of the entire study cohort (Table
I). More importantly, the blood transfusion requirements and intervals
between transfusions of the post-WGJ therapy period demonstrated
negative and positive relation-ships respectively to the duration of
WGJ therapy (Pearson's correlation co-efficient of 0.560, P <0.05 and
0=2E627, P <0.01, respectively). These analyses suggest that not only is
WGJ therapy effective, but also that the benefit is related to the
duration of WGJ therapy. Second, as the authors chose not to speculate
on the mechanism of the beneficial action of the WGJ therapy on their
transfusion dependent patients, we would like to propose a testable
hypothesis for consideration to facilitate future studies in this area.
Historically, the beneficial effects of WGJ therapy have been
attributed to its rich nutritional content that include antioxidant
vitamins (C&E) and bio-flavenoids(2). We speculate that the effects of
the WGJ therapy may be due to the action of natural antioxidants on red
blood cell (RBC) antioxidant function, and corresponding effects on
cellular enzyme function and membrane integrity. This thought is
supported by studies that show decreased antioxidant capacities of RBCs
of patients with thalassemia(3) as well as beneficial effects on RBC
life-span by supplementation of antioxidants in vivo in other hemolytic
disorders(4). Although, in this study, the authors did not measure RBC
life-span, the greater interval between blood transfusions following
institution of WGJ therapy suggests that RBC life-span was increased.
Interestingly, the authors noted that the response to WGJ therapy took
some months (the "neutral period"); this may suggest that the natural
antioxidants contained in the WGJ are better able to prevent cellular
injury than to repair RBC enzymes/membranes once damaged. Hence, RBCs,
once damaged, would be cleared from the circulation by the
reticulo-endothelial system as they would prior to the onset of the WGJ
therapy, but newly formed RBCs would not be damaged and have a longer
life-span. This antioxidant hypothesis can be easily tested by
measuring indices of RBC antioxidant capacity previously noted to be
abnormal in patients with thalassemia(3) in study subjects currently on
WGJ therapy and matched control patients not consuming WGJ. Studies of
RBC life-span may be attempted, but are more complex and are not likely
to yield more information than the interval between blood transfusions
already noted. Such an antioxidant mechanism of action of WGJ was also
cited by Ben-Arye et al to explain the beneficial effects of WGJ
therapy in patients with ulcerative colitis(2). While clinical trials
are currently underway to find suitable blood substitutes for patients
needing blood transfusions, they may not be readily available in
developing countries nor would they be preferable to natural therapies
aimed at preserving a patient's own RBCs. Indeed, WGJ and other
nutritional therapies may be considered as adjuvants to drug therapy.
Using nutritional therapy to augment a patient's antioxidant defenses
in an effort to decrease morbidity and mortality has similarly been
advocated in other more dreaded diseases such as cancer(5).
Caraciolo J. Fernandes,
Section of Neonatology,
Department of Pediatrics,
Texas Children Hospital,
Baylor college of Medicine,
Houston, Tx 77030,
E-mail: fernande@bcm.edu
Donough J. O'Donovan,
Department of Pediatrics,
University college Hospital,
Galway, Ireland.
References
1=2E Marawaha RK, Bansal D, Kaur S, Trehan A. Wheat grass juice reduces
transfusion requirement in patients with thalassemia major: a pilot
study. Indian Pediatr 2004; 41: 716-720.
2=2E Ben-Arye E, Goldin E, Wengrower D, Stamper A, Kohn R, Berry E. Wheat
grass juice in the treatment of active distal ulcerative colitis: a
randomized double-blind placebo-controlled trial. Scand J Gastroenterol
2002; 37: 444-449.
3=2E Chan AC, Chow CK, Chiu D. Interaction of antioxidants and their
implication in Genetic Anemia. Proc Soc Exp Biol Med 1999; 222:
274-282.
4=2E Hafez M, Amar ES, Zedan M, Hammad H, Sorour AH, el-Desouky ES, Gamil
N=2E Improved erythrocyte survival with combined vitamin E and selenium
therapy in children with glucose-6-phosphate dehydrogenase deficiency
and mild chronic hemolysis. J Pediatr 1986; 108: 558-561.
5=2E Donaldson M. Nutrition and cancer: A review of the evidence for an
anti-cancer diet. Nutrition Journal 2004; 3: 19.
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