Hms Chandra Kusuma

The Effect of House Dust Mite Immunotherapy, Probiotic and Nigella sativa in The Number of Th17 Cell and Asthma Control Test Score

The Role of Th17 cells in the pathogenesis of asthma and immunotherapy is being a new concept and paradigm. Immunotherapy on asthma requires long periods of time, so administration of an adjuvant had been considered to improve its efficacy. The aims of this study was to evaluate the therapeutic efficacy of immunotherapy combined with probiotics and Nigella sativa in the number of Th17 cells and the improvement of clinical symptoms of asthma. A total of 31 children with mild asthma were evaluated and then randomized to receive immunotherapy or immunotherapy plus Nigella sativa or immunotherapy plus probiotic or immunotherapy plus Nigella sativa plus probiotic openly for 14 weeks. Statistical analysis found no significant difference in the mean number of Th17 cells pre and post test in all four treatment groups, however we found a significant differences asthma control test (ACT) score before and after the immunotherapy + Nigella sativa treatment (p = 0.001), before and after immunotherapy + probiotic treatment (p = 0.004), as well as before and after immunotherapy plus Nigella sativa plus probiotic treatment (p = 0.000). Correlation test found a significant association between the number of Th17 cells and ACT score in all groups. The combination immunotherapy with Nigella sativa and probiotics did not reduce the number of peripheral blood Th17 cells mild asthmatic children, but can improve the clinical symptom. Keywords - Immunotherapy, House dust mite, Probiotics, Nigella sativa, Th17 cell, Asthma Control test

Improvement of Th17/Treg balance and Asthma Control Test score by Nigella sativa supplementation in asthmatic children: a new approach to managing asthma

Introduction: Th17 and Treg cells have important roles in the development and progression of the allergic diseases, such as asthma. Several studies reported that Nigella sativa could improve chronic airway inflammation, and inhibit airway remodeling by regulating the immune system. To examine the effect of Nigella sativa supplementation on Th17/ Treg cells, and asthma control test score in asthmatic children. Materials and Methods: Twenty-eight children with asthma meeting the inclusion criteria in Saiful Anwar Hospital, Indonesia, participated in this study. All subjects took the standard treatment based on asthma guidelines. Nigella sativa oil (NSO) is given as additional treatment at the dose of 15–30 mg/kg/day for eight weeks in a randomized, singleblind-controlled trial. Th17 and Treg in peripheral blood mononuclear cells were analyzed by flow cytometry tool. Improvement of asthma control was accessed by ACT (Asthma Control Test) Score. Results: There was a significant decrease of Th17, and an increase of Treg percentages in NSO treatment group. Th17/ Treg ratio was lower in NSO group compared to the standard treatment group (1.06±0.33 vs. 2.30±1.08, p=0.001). The ACT score improvement was significantly higher in NSO compared to that in the standard treatment group (3.71±1.634 vs. 1.86±0.864, p=0.033). However, there was no significant correlation between Th17/Treg ratio and ACT score in preand post-treatment (p=0.552, p=0.344 respectively). Conclusion: NSO supplementation improves Th17/Treg balance and clinical symptoms in asthmatic children.

Perbedaan Skor ACT, CD4+CD25+Foxp3treg, CD4+IFN-γ pada Pemberian Imunoterapi, Probiotik dan Nigella Sativa

Probiotik dan Nigella sativa memiliki efek imunomodulator dan telah banyak banyak dikaji penggunaannya dalam kombinasi dengan imunoterapi asma. Imunoterapi dapat merubah perjalanan alamiah asma yang melibatkan perubahan respon imun Th2 menjadi Th1 dengan peningkatan IFN-γ. Proses tersebut juga berhubungan dengan pembentukan Tregulator, tetapi belum jelas mekanisme mana yang lebih dominan. Penelitian dilakukan untuk mengetahui perbedaan skor ACT serta jumlah sel CD4+CD25+FoxP3Treg dan CD4+IFN-γ pada anak asma ringan yang mendapat imunoterapi, probiotik dan Nigella sativa. Penelitian dilakukan dengan desain randomized clinical trial posttest only with control pada 32 subjek penelitian yang memenuhi kriteria inklusi dalam 4 kelompok yaitu kelompok A (imunoterapi+plasebo), kelompok B (imunoterapi+Nigella sativa), kelompok C (imunoterapi+probiotik), dan kelompok D (imunoterapi+Nigella sativa+probiotik). Perlakuan diberikan selama 56 minggu (imunoterapi fase induksi 14 minggu dan fase rumatan 42 minggu). Imunoterapi berupa ekstrak house dust mite diberikan subkutan, probiotik berupa Lactobacillus acidophilus dan Bifidobacterium lactis, dengan penilaian skoring asma menggunakan Asthma Control Test (ACT). Jumlah sel CD4+CD25+FoxP3+Treg dan CD4+IFN-γ diukur menggunakan flowcytometry. Hasil menunjukkan skor ACT kelompok C lebih tinggi bermakna dibandingkan kelompok A (p=0,04). Jumlah CD4+CD25+FoxP3+Treg paling tinggi pada kelompok D (15,966±9,720) , sedangkan jumlah CD4+IFN-γ paling tinggi pada kelompok C (17,506±11,576), tetapi tidak didapatkan perbedaan bermakna pada jumlah CD4+CD25+FoxP3+Treg (p=0,278) dan CD4+IFN-γ (p=0,367) antar semua kelompok. Dapat disimpulkan bahwa Imunoterapi+probiotik dapat meningkatkan skor ACT lebih baik dibandingkan imunoterapi saja. Imunoterapi, Nigella sativa, dan probiotik tidak memberikan perbedaan bermakna pada jumlah CD4+CD25+FoxP3 Treg dan CD4+IFN-γ.Kata Kunci: Asthma Control Test, CD4+CD25+FoxP3+Treg, CD4+IFN-γ, imunoterapi, Nigella sativa, probiotik