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The effect of pyridostigmine on small intestinal bacterial overgrowth (SIBO) and plasma inflammatory biomarkers in HIV-associated autonomic neuropathies

التفاصيل البيبلوغرافية
العنوان: The effect of pyridostigmine on small intestinal bacterial overgrowth (SIBO) and plasma inflammatory biomarkers in HIV-associated autonomic neuropathies
المؤلفون: Sandeep Sharma, Bani Chander Roland, Seunghee Kim-Schulze, Steven Lawrence, Elizabeth Pedowitz, Sherif Heiba, Emma K. T. Benn, Mary Catherine George, Alexandra Nmashie, Jacinta Murray, Jessica Robinson-Papp, Josef Machac, Allison Navis, Susan Morgello
المصدر: J Neurovirol
سنة النشر: 2019
مصطلحات موضوعية: 0301 basic medicine, Male, medicine.medical_specialty, medicine.drug_class, Lipopolysaccharide Receptors, Gene Expression, Inflammation, HIV Infections, Systemic inflammation, Gastroenterology, Drug Administration Schedule, Article, Proinflammatory cytokine, 03 medical and health sciences, Cellular and Molecular Neuroscience, 0302 clinical medicine, Virology, Internal medicine, Small intestinal bacterial overgrowth, Intestine, Small, medicine, Humans, Autonomic Pathways, Gastroparesis, Gastric emptying, business.industry, Interleukin-6, Tumor Necrosis Factor-alpha, Macrophages, Macrophage Activation, Middle Aged, medicine.disease, 030104 developmental biology, Neuroprotective Agents, Treatment Outcome, Neurology, Pyridostigmine, Acetylcholinesterase inhibitor, Bacterial Translocation, Female, Neurology (clinical), Cholinesterase Inhibitors, medicine.symptom, business, Gastrointestinal Motility, 030217 neurology & neurosurgery, medicine.drug, Pyridostigmine Bromide
الوصف: BACKGROUND. Small intestinal bacterial overgrowth (SIBO) is common among patients with HIV-associated autonomic neuropathies (HIV-AN), and may be associated with increased bacterial translocation and elevated plasma inflammatory biomarkers. Pyridostigmine is an acetylcholinesterase inhibitor which has been used to augment autonomic signaling. We sought preliminary evidence as to whether pyridostigmine could improve proximal gastrointestinal motility, reduce SIBO, reduce plasma sCD14 (a marker of macrophage activation and indirect measure of translocation), and reduce the inflammatory cytokines IL-6 and TNFα in patients with HIV-AN. METHODS. Fifteen participants with well-controlled HIV, HIV-AN, and SIBO, were treated with 8 weeks of pyridostigmine (30mg PO TID). Glucose breath testing for SIBO, gastric emptying studies (GES) to assess motility, plasma sCD14, IL-6 and TNFα, and gastrointestinal autonomic symptoms were compared before and after treatment. RESULTS. Thirteen participants (87%) experienced an improvement in SIBO following pyridostigmine treatment; with an average improvement of 50% (p=0.016). There was no change in gastrointestinal motility, however only two participants met GES criteria for gastroparesis at baseline. TNFα and sCD14 levels declined by 12% (p=0.004) and 19% (p=0.015) respectively; there was no significant change in IL-6 or gastrointestinal symptoms. CONCLUSION. Pyridostigmine may ameliorate SIBO and reduce levels of sCD14 and TNFα in patients with HIV-AN. Larger placebo-controlled studies are needed to definitively delineate how HIV-AN affects gastrointestinal motility, SIBO, and systemic inflammation in HIV, and whether treatment improves clinical outcomes.
تدمد: 1538-2443
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9adac0634f02523fed65eb4091a4ad41
https://pubmed.ncbi.nlm.nih.gov/31098925
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....9adac0634f02523fed65eb4091a4ad41
قاعدة البيانات: OpenAIRE
الوصف
تدمد:15382443