Gum Arabic Fibers Decreased Inflammatory Markers and Disease Severity Score among Rheumatoid Arthritis Patients, Phase II Trial

Abstract

Background Rheumatoid arthritis (RA) is autoimmune inflammatory disease that attacks the synovium of the joints. Both TNFa and interleukin-1 play crucial roles in the pathogenesis of RA. Gum Arabic (GA) is gummy exudates from Acacia senegal tree. Gum Arabic fermentation by colonic bacteria increases serum butyrate concentrations, so it is considered as prebiotic agent. Gum Arabic (GA) has anti-inflammatory activity through its derivative butyrate. To the best of our knowledge, this is the first study conducted to investigate GA intake on inflammatory markers among RA patients. Patients and Methods This is clinical trial phase II in which 40 patients were enrolled aged 18 to 70 years. Patients received 30g/day GA for 12 weeks. TNF α, ESR, and complete blood count were measured and DAS-28 was calculated before and after regular GA consumption. Study was approved by the Ethical committee of National Medicines and Poisons Board. Results This study showed significant decrease in level of serum TNF α (p value 0.05) [95% CI, 0.65 -16.5], ESR (p value 0.011) [95% CI, 2.6 -18.89], and number of swollen and tender joints in RA patients after 12 weeks of GA intake which reflected as significant decrease in disease severity score DAS 28 P.V:0.00 [95% CI, 1.25 -1.99]. On the other hand, GA had trivial change in blood indices. Conclusion Gum Arabic has favorable immune modulator effect on rheumatoid arthritis. It can be utilized in clinical practice as adjuvant therapy. Trial Registration This trial was registered with ClinicalTrials.gov Identifier: NCT02804581 Registered at 19 June 2016, prospective registration.

Effect of Gum Arabic (Acacia senegal) on C-reactive protein level among sickle cell anemia patients

“…Earlier studies reveled GA anti-inflammatory effects as it decreased several inflammatory markers as TNFα, ESR and CRP [19,20]. Reduction of CRP level could be accredited to GA prebiotics properties.…”

“…It decreases the proinflammatory cytokine expression through inhibition of NFκB [16,17].Oral intake of GA has been shown to provide several health benefits [18], such as prebiotic effects [12]. GA has immune-modulatory [13,19], anti-inflammatory [20], and antioxidant properties [11,12,21,22].…”

Role of L. plantarum KX519413 as Probiotic and Acacia Gum as Prebiotic in Gastrointestinal Tract Strengthening

“…The fermentation of acacia gum by colonic bacteria releases butyrate. Butyrate serves as a potent anti-inflammatory agent by inhibiting NF K B (it mediates the transcription of inflammatory cytokines) [50]. The improved anti-inflammatory activity of the synbiotic may be due to the combinatory use of acacia gum, and the TNF-α-level-lowering effect of acacia gum make it significant in patients with Crohn's disease and rheumatoid arthritis.…”

Clinical effects of Arabic gum (Acacia): A mini review

“…Tumor necrosis factor-α (TNF-α) is a main pro-inflammatory mediator involved in the development of RA (51) . Ebtihal et al (2018) demonstrated that the anti-inflammatory effect of GA through reduction TNF-α, erythrocyte sedimentation rate (ESR) level and improvement in clinical symptoms in RA patients when given (30 gm/day) of GA during the study period (52) .…”