title: L-isoleucine-supplemented oral rehydration solution in the treatment of acute diarrhoea in children: a randomized controlled trial.
abstract: Antimicrobial peptides represent an important component of the innate immune defenses of living organisms, including humans. They are broad-spectrum surface-acting agents secreted by the epithelial cells of the body in response to infection. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides. The objectives of the study were to examine if addition of L-isoleucine to oral rehydration salts (ORS) solution would reduce stool output and/or duration of acute diarrhoea in children and induce antimicrobial peptides in intestine. This double-blind randomized controlled trial was conducted at the Dhaka Hospital of ICDDR,B. Fifty male children, aged 6-36 months, with acute diarrhoea and some dehydration, attending the hospital, were included in the study. Twenty-five children received L-isoleucine (2 g/L)-added ORS (study), and 25 received ORS without L-isoleucine (control). Stool weight, ORS intake, and duration of diarrhoea were the primary outcomes. There was a trend in reduction in mean +/- standard deviation (SD) daily stool output (g) of children in the L-isoleucine group from day 2 but it was significant on day 3 (388 +/- 261 vs. 653 +/- 446; the difference between mean [95% confidence interval (CI) (-)265 (-509, -20); p = 0.035]. Although the cumulative stool output from day 1 to day 3 reduced by 26% in the isoleucine group, it was not significant. Also, there was a trend in reduction in the mean +/- SD intake of ORS solution (mL) in the L-isoleucine group but it was significant only on day 1 (410 +/- 169 vs. 564 +/- 301), the difference between mean (95% CI) (-)154 (-288, -18); p = 0.04. The duration (hours) of diarrhoea was similar in both the groups. A gradual increase in stool concentrations of beta-defensin 2 and 3 was noted but they were not significantly different between the groups. L-isoleucine-supplemented ORS might be beneficial in reducing stool output and ORS intake in children with acute watery diarrhoea. A further study is warranted to substantiate the therapeutic effect of L-isoleucine.
authors.affiliation: Clinical Sciences Division, ICDDR,B GPO Box 128, Dhaka 1000, Bangladesh. nhalam@icddrb.org
authors.forename: N H
authors.initials: NH
authors.lastname: Alam
authors.forename: R
authors.initials: R
authors.lastname: Raqib
authors.forename: H
authors.initials: H
authors.lastname: Ashraf
authors.forename: F
authors.initials: F
authors.lastname: Qadri
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.forename: M
authors.initials: M
authors.lastname: Zasloff
authors.forename: B
authors.initials: B
authors.lastname: Agerberth
authors.forename: M A
authors.initials: MA
authors.lastname: Salam
authors.forename: N
authors.initials: N
authors.lastname: Gyr
authors.forename: R
authors.initials: R
authors.lastname: Meier
mesh_terms: D000704:Analysis of Variance; D001459:Bangladesh; D002675:Child, Preschool; D003967:Diarrhea / Q000628:therapy*; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D007532:Isoleucine / Q000008:administration & dosage*; D008297:Male; D010865:Pilot Projects; D016896:Treatment Outcome; D023083:beta-Defensins / Q000032:analysis
chemical_list: D023083:beta-Defensins; D007532:Isoleucine