title: A tannic acid-based medical food, Cesinex(®), exhibits broad-spectrum antidiarrheal properties: a mechanistic and clinical study.
abstract: BACKGROUND
  The purpose of this investigation was to evaluate the efficacy and tolerability of a tannic acid-based medical food, Cesinex(®), in the treatment of diarrhea and to investigate the mechanisms underlying its antidiarrheal effect.
  
  
  METHODS
  Cesinex(®) was prescribed to six children and four adults with diarrhea. Patient records were retrospectively reviewed for the primary outcome. Cesinex(®) and its major component, tannic acid, were tested for their effects on cholera toxin-induced intestinal fluid secretion in mice. Polarized human gut epithelial cells (HT29-CL19A cells) were used to investigate the effects of tannic acid on epithelial barrier properties, transepithelial chloride secretion, and cell viability.
  
  
  RESULTS
  Successful resolution of diarrheal symptoms was reported in nine of ten patients receiving Cesinex(®). The treatment of HT29-CL19A cells with clinically relevant concentrations of tannic acid (0.01-1 mg/ml) significantly increased transepithelial resistance (TER) and inhibited the cystic fibrosis transmembrane conductance regulator (CFTR)-dependent or the calcium-activated Cl(-) secretion. Tannic acid could also improve the impaired epithelial barrier function induced by tumor necrosis factor alpha (TNFα) and inhibited the disrupting effect of TNFα on the epithelial barrier function in these cells. Cholera toxin (CTX)-induced mouse intestinal fluid secretion was significantly reduced by the administration of Cesinex(®) or tannic acid. Cesinex(®) has high antioxidant capacity.
  
  
  CONCLUSIONS
  Cesinex(®) demonstrates efficacy and a good safety profile in the treatment of diarrhea. The broad-spectrum antidiarrheal effect of Cesinex(®) can be attributed to a combination of factors: its ability to improve the epithelial barrier properties, to inhibit intestinal fluid secretion, and the high antioxidant capacity.
authors: Department of Physiology, University of Tennessee Health Science Center, 894 Union Avenue, 415 Nash Research Building, Memphis, TN 38163, USA. aren@uthsc.edu
authors: Aixia
authors: A
authors: Ren
authors: Weiqiang
authors: W
authors: Zhang
authors: Hugh Greg
authors: HG
authors: Thomas
authors: Amy
authors: A
authors: Barish
authors: Stephen
authors: S
authors: Berry
authors: Jeffrey S
authors: JS
authors: Kiel
authors: Anjaparavanda P
authors: AP
authors: Naren
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000818:Animals; D000930:Antidiarrheals / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D002460:Cell Line; D002463:Cell Membrane Permeability / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D002712:Chlorides / Q000378:metabolism; D002772:Cholera Toxin / Q000009:adverse effects; D003967:Diarrhea / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004847:Epithelial Cells / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D019073:HT29 Cells; D006801:Humans; D007223:Infant; D007419:Intestinal Secretions / Q000187:drug effects; D051379:Mice; D008810:Mice, Inbred C57BL; D008875:Middle Aged; D012189:Retrospective Studies; D013634:Tannins / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000930:Antidiarrheals; D002712:Chlorides; D013634:Tannins; D002772:Cholera Toxin