In a recent study, antioxidant supplementation was found to be effective in relieving pain and reducing levels of oxidative stress in patients with chronic pancreatitis. Scientist Live spoke with Pramod Kumar Garg, MD, DM, of the All India Institute of Medical Sciences, New Delhi and lead author about his research and its implications.
What prompted you to take this specific line of research with regards to chronic pancreatitis?
Chronic pancreatitis is a common clinical problem in GI practice. The major problem in patients with chronic pancreatitis is abdominal pain which may be debilitating. In earlier preliminary studies, others and we have observed that patients with chronic pancreatitis are deficient in antioxidants and as a result have high oxidative stress. There is no definite medical treatment for chronic pancreatitis and that is why we took up this line of research to find out if antioxidants would be beneficial for such patients.
Can you describe how you approached your research and what you discovered?
We adopted the most robust study design i.e. randomised controlled trial. In this study, we randomised patients into 2 groups- one group of patients received antioxidants and the other group received placebo. Both the investigators and the patients were blinded to the identity of the drug that the patients were receiving (double blinding). We discovered that supplementation with anti-oxidants resulted in significant pain relief in patients with chronic pancreatitis. The reduction in the number of painful days/month was significantly higher in the antioxidant group compared with the placebo group. Furthermore, 32% of patients became pain free in the antioxidant groups. Reduction in pain also resulted in fewer man-days lost thus providing functional employment gain to the patients.
What do your findings tell you about chronic pancreatitis?
Chronic pancreatitis is a chronic debilitating disease. Alcohol and genetic mutations are two important causative factors. There is a state of heightened oxidative stress in such patients who are generally deficient in antioxidants due to the twin effects of decreased nutritional intake because of pain and improper digestion due to pancreatitis. Supplementation with a combination of anti-oxidants decreases the oxidative stress and thus relieves the pain.
Can you speculate on how free radical mediated injury occurs and the mechanisms at work with antioxidant supplementation?
Free radical mediated injury occurs due to oxidative stress which has been implicated as one of the dominant mechanisms of pancreatic inflammation and injury in chronic pancreatitis. Oxidative stress results from exposure to xenobiotics, which are detoxified by phase I and phase II pathways. These detoxification pathways also operate in the pancreas. Xenobiotics are external compounds that are toxic to the body; the common examples include cigarette smoke, alcohol, environmental pollutants, industrial waste etc. It has been shown that oxidative stress is enhanced significantly in patients with CP. Thus patients with chronic pancreatitis must avoid alcohol, smoking and pollutants in any form.
How do antioxidants, or at least the ones discussed in this study, offer pain relief?
Antioxidants in the body detoxify these toxic substances. Patients who are deficient in such anti-oxidants are likely to have high oxidative stress and injury to the pancreas. The common anti-oxidants include vitamin A, vitamin C, vitamin E, and selenium (trace metal). We used a combination of these anti-oxidants which resulted in decreased oxidative stress and pancreatic inflammation, and thus pain relief. Thus, patients with chronic pancreatitis must increase their intake of natural antioxidants through the consumption of fresh fruits, vegetables, and in general a nutritious diet.
What is next for your laboratory?
Our group has been working on pancreatic diseases for long. We are excited about the results of our study. We are currently focusing on the study of genetic mutations and various other aspects of the
causation of chronic pancreatitis. We are exploring other therapeutic options in pancreatitis in both experimental and clinical studies.
(Reporting by Marc Landas)
