Effects of Curcuminoids-Piperine Combination on Systemic Oxidative Stress, Clinical Symptoms and Quality of Life in Subjects with Chronic Pulmonary Complications Due to Sulfur Mustard: A Randomized Controlled Trial
J Diet Suppl. 2016;13(1):93-105
Exposure to Sulphur Mustard (SM) during Iraq-Iran war (1980-88), not only affected the skin but also caused chronic complications in the respiratory system of civilian and army personnel. Depending upon dose and duration of exposure, chronic respiratory problems due to SM could be manifested as: chronic obstructive pulmonary disease (COPD), bronchiolitis obliterans, bronchiectasis and pulmonary fibrosis. All of these are accompanied by histopathological changes in lung tissue, known as “mustard lung”.
Oxidative stress plays an important role in pathophysiology of SM-induced complications. Previous published studies on chronic respiratory diseases have shown that they are accompanied by over production of reactive oxygen species (ROS) and concomitant depletion of antioxidants. Curcuminoids are known for their potent anti-oxidant properties, which could be correlated to their chemical structure. Therefore Curcuminoids should be considered as potent natural supplement in managing oxidative stress and may play important role in managing SM-induced complications of which oxidative stress is one of the main factor. Before this study, the efficacy of Curcuminoids in treatment of chronic respiratory complications in SM-intoxicated patients have never been assessed.
To investigate the efficacy of short-term supplementation with Curcuminoids (plus Piperine for enhanced bioavailability) in alleviating systemic oxidative stress, clinical symptoms and improvement in health related quality of life (HRQoL), in patients suffering from SM-induced chronic pulmonary complications and on standard respiratory treatments.
A randomized double-blind placebo-controlled trial with 89 male patients was planned. Patients were randomly allocated to receive either Curcuminoids (Curcumin C3 Complex®) + Piperine (BioPerine®) combination (n=45, 1500 mg/day + 15 mg/day) or placebo (n=44) for 4 weeks. The patients continued their standard treatment of salmeterol (bronchodilator), N-acetylcysteine (anti-oxidant and mucolytic agent) and omeprazole [for gastroesophageal reflux diseases (GERD)] during the study. All patients were examined by board certified pulmonologist at baseline and at the end of the trial. Fasting blood samples were collected at the baseline and at the end of the trial and were analyzed for reduced glutathione (GSH) and malonedialdehyde (MDA) concentrations. High-resolution computed tomography (HRCT) suggested the diagnosis of bronchiolitis obliterans in all patients. The effects of Curcuminoids on health status of patients (symptoms and HRQoL) were evaluated using St. George respiratory Questionnaire (SGRQ) and COPD assessment test (CAT) indices.
The parameters evaluated during the trial (i.e. at baseline and at the end of the study) included fasting glucose level and lipid profile (total cholesterol, LDL-C, HDL-C and Triglycerides) along with liver and kidney function tests.
- Out of 89 patients, 78 completed the study (Curcuminoids group n=39, placebo group n=39).
- The serum MDA levels were reduced at the end of trial in both groups, but more decrease was observed in Curcuminoids group (P<0.001).
- In case of serum GSH, the levels were increased at the end of trial in both groups. However, more increase was observed in Curcuminoids group (P<0.001).
- Both CAT and SGRQ (total and subscale) scores were reduced at the end of trial, but magnitude of reduction was more for Curcuminoids group. This showed greater improvement in health status and respiratory system with Curcuminoids supplementation.
The use of Curcuminoids supplementation in SM-intoxicated patients was found to be safe and well tolerated, which is beneficial for SM patients as they may require long term treatments. The findings of the current study also showed that Curcumin supplementation was found to mitigate oxidative stress, decreasing symptoms and improving HRQoL of SM-induced pulmonary complications.
Since the current treatment options for mustard lung are very limited and symptomatic, the beneficial effects of these Curcuminoids suggest them as “safe adjuvants” in patients with SM-induced pulmonary complications, receiving standard therapy for the treatment.