Potential of Spirulina Platensis as a Nutritional Supplement in Malnourished HIV-Infected Adults in Sub-Saharan Africa: A Randomised, Single-Blind Study

BACKGROUND

Malnutrition is a major global public health issue and its impact on communities and individuals is more dramatic in Sub-Saharan Africa, where it is compounded by widespread poverty and generalized high prevalence of human immunodeficiency virus (HIV). Therefore, malnutrition should be addressed through a multisectorial approach, and malnourished individuals should have access to nutritional rehabilitation molecules that are affordable, accessible, rich in nutrient and efficient. We thus assessed the efficacy of two affordable and accessible nutritional supplements, spirulina platensis versus soya beans among malnourished HIV-infected adults.

METHODS

Undernourished patients, naïve of, but eligible to antiretroviral treatment (ART), aged 18 to 35 years were enrolled and randomly assigned to two groups. The first group received spirulina (Group A) as food supplement and the second received soya beans (Group B). Patients were initiated ART simultaneously with supplements. Food supplements were auto-administered daily, the quantity being calculated according to weight to provide 1.5 g/kg body weight of proteins with 25% from supplements (spirulina and soya beans). Patients were monitored at baseline and followed-up during twelve weeks for anthropometric parameters, body composition, haemoglobin and serum albumin, CD4 count and viral load.

RESULTS

Fifty-two patients were enrolled (Group A: 26 and Group B: 26). The mean age was 26.4 ± 4.9 years (Group A) and 28.7 ± 4.8 (Group B) with no significant difference between groups (P = 0.10). After 12 weeks, weight and BMI significantly improved in both groups (P < 0.001 within each group). The mean gain in weight and BMI in Group A and B were 4.8 vs. 6.5 kg, (P = 0.68) and 1.3 vs. 1.90 Kg/m(2), (P = 0.82) respectively. In terms of body composition, fat free mass (FFM) did not significantly increase within each group (40.5 vs. 42.2 Kg, P = 0.56 for Group A; 39.2 vs. 39.0 Kg, P = 0.22 for Group B). But when compared between the two groups at the end of the trial, FFM was significantly higher in the spirulina group (42.2 vs. 39.0 Kg, P = 0.01). The haemoglobin level rose significantly within groups (P < 0.001 for each group) with no difference between groups (P = 0.77). Serum albumin level did not increase significantly within groups (P < 0.90 vs. P < 0.82) with no difference between groups (P = 0.39). The increase in CD4 cell count within groups was significant (P < 0.01 in both groups), with a significantly higher CD4 count in the spirulina group compared to subjects on soya beans at the end of the study (P = 0.02). Within each group, HIV viral load significantly reduced at the end of the study (P < 0.001 and P = 0.04 for spirulina and soya beans groups respectively). Between the groups, the viral load was similar at baseline but significantly reduced in the spirulina group at the end of the study (P = 0.02).

CONCLUSION

We therefore conclude in this preliminary study, firstly, that both spirulina and soja improve on nutritional status of malnourished HIV-infected patients but in terms of quality of nutritional improvement, subjects on spirulina were better off than subjects on soya beans. Secondly, nutritional rehabilitation improves on immune status with a consequent drop in viral load but further investigations on the antiviral effects of this alga and its clinical implications are strongly needed.

Traditional medicine: past, present and future research and development prospects and integration in the National Health System of Cameroon

Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being. In the last decade traditional medicine has become very popular in Cameroon, partly due to the long unsustainable economic situation in the country. The high cost of drugs and increase in drug resistance to common diseases like malaria, bacteria infections and other sexually transmitted diseases has caused the therapeutic approach to alternative traditional medicine as an option for concerted search for new chemical entities (NCE). The World Health Organisation (WHO) in collaboration with the Cameroon Government has put in place a strategic platform for the practice and development of TM in Cameroon. This platform aims at harmonizing the traditional medicine practice in the country, create a synergy between TM and modern medicine and to institutionalize a more harmonized integrated TM practices by the year 2012 in Cameroon. An overview of the practice of TM past, present and future perspectives that underpins the role in sustainable poverty alleviation has been discussed. This study gives an insight into the strategic plan and road map set up by the Government of Cameroon for the organisational framework and research platform for the practice and development of TM, and the global partnership involving the management of TM in the country.

In vitro cytotoxicity and antioxidant activities of five medicinal plants of Malvaceae family from Cameroon

The potential antiproliferative and antioxidant activities of extracts from five medicinal plants from Cameroon were evaluated in vitro on HepG-2 cells. The results showed the significant decrease of the viability of the cells in a concentration-dependent manner. According to the IC(50) obtained, the extracts of S. acuta (461.53±0.23) and U. lobata (454.93±0.12) showed significant antiproliferative activity. At fixed concentration (250μgmL(-1)), extracts demonstrated higher antiproliferative activity (67.05%; 65.42%), (52.62%; 56.64%) and (32.98%; 36.85%) respectively during 24, 48 and 72h. Extracts of S. cordifolia and V. album demonstrated significant antiproliferative property after 48h while S. rhombifolia exhibited weak cytotoxicity. The results of the antioxidant properties showed that theses extracts induced significantly increase of SOD, CAT and GsT activity after 48h. Taken together, the results extracts showed that of S. acuta and U. lobata may be a promising alternative to synthetic substances as natural compound with high antiproliferative and antioxidant activities.

Analgesic and antiinflammatory activities of Erigeron floribundus

This study was intended to evaluate the analgesic and antiinflammatory activities of an aqueous extract of Erigeron floribundus (H.B. & K) or (syn": Conyza sumatrensis (Retz) E.K. Walker) (Asteraceae). Phytochemical analysis was carried out using standard methodologies. The analgesic investigations were carried out against two types of noxious stimuli, chemical (formalin-induced pain and acetic acid-induced writhing) and thermal (hotplate and tail immersion tests). The effects following aspirin and naloxone pretreatments were also studied. For the antiinflammatory activities, the carrageenan-induced oedema of the hindpaw of rats was used and the paw volume measured plethysmometrically from 0 to 24 h after injection. This was compared to a standard drug indomethacin (10 mg/kg). The results were subjected to statistical analysis. The plant had saponins, flavonoids, glycosides, alkaloids, oils, phenols and tannins and significantly increased the reaction time of hotplate and immersion tests. It decreased the writhings of acetic acid-induced abdominal contractions and lickings of formalin-induced pain. Aspirin had no effect on hotplate and tail immersion tests but showed an effect on writhing test. These results showed that the plant had both central and peripheral acting effects and this was confirmed by its effect on both phases of formalin-induced pain. The extract also significantly decreased the rat paw oedema volume at 50 mg/kg and above. In conclusion, Erigeron floribundus has central and peripheral analgesic properties as well as antiinflammatory activities.

Reduced insulin secretion in offspring of African type 2 diabetic parents

OBJECTIVE

To determine the early biochemical predictors of increased susceptibility to develop diabetes in offspring of African type 2 diabetic parents.

RESEARCH DESIGN AND METHODS

A total of 69 offspring (case subjects) of 26 families in Cameroon with at least one type 2 diabetic parent were studied, and 62 offspring (control subjects) from 25 families in Cameroon with no parent with type 2 diabetes underwent an oral glucose tolerance test. Early insulin secretion was calculated using the ratio of the 0- to 30-min incremental insulin values to the 0- to 30-min incremental glucose. Anthropometric parameters were also measured.

RESULTS

Of the case subjects, 23% were glucose intolerant (4% with diabetes and 19% with impaired glucose tolerance [IGT]) compared with 6.5% (all with IGT) of control subjects (P = 0.02). There was also an increasing prevalence of glucose intolerance, especially IGT with increasing number of glucose-intolerant parents. Fasting serum insulin levels were not different in the two groups; however, at 30 min, the case subjects had lower insulin levels than the control subjects (P < 0.006). Case subjects with IGT had lower 30-min insulin concentration, early insulin secretion, and 2-h insulin levels than those with normal glucose tolerance (NGT) (F = 4.1, P < 0.05; F = 4.1, P < 0.04; and F = 5.1, P < 0.03, respectively). Furthermore, case subjects with NGT and IGT had lower early insulin secretion than control subjects (F = 4. 1, P < 0.03). These differences remained after adjustment for BMI and regardless of the status of parental diabetes. Two-hour insulin concentration showed a positive association (odds ratio = 0.95 CI 0.90-0.99, P = 0.039) with IGT in the case subjects.

CONCLUSIONS

Diabetes and IGT are more prevalent in the offspring of African type 2 diabetic parents, and this may be due to an underlying degree of beta-cell impairment marked by reduced early-phase insulin secretion.

Interaction of HLA and age on levels of antibody to Plasmodium falciparum rhoptry-associated proteins 1 and 2

The Plasmodium falciparum rhoptry-associated proteins 1 and 2 (RAP1 and RAP2) are candidate antigens for a subunit malaria vaccine. The design of the study, which looks at the acquisition of immunity to malaria from childhood to old age, has allowed us to document the interaction of HLA and age on levels of antibody to specific malarial antigens. Antibodies reach maximum levels to RAP1 after the age of 15 but to RAP2 only after the age of 30. The effect of HLA-DRB1 and -DQB1 and age on levels of antibody to rRAP1 and rRAP2 was analyzed with a multiple regression model in which all HLA alleles and age were independent variables. DQB1*0301 and -*03032 showed an age-dependent association with levels of antibody to rRAP1, being significant in children 5 to 15 years (P < 0.001) but not in individuals over 15 years of age. DRB1*03011 showed an age-dependent association with antibody levels to rRAP2; however, this association was in adults over the age of 30 years (P < 0.01) but not in individuals under the age of 30 years. No associations were detected between DRB1 alleles and RAP1 antibody levels or between DQB1 alleles and RAP2 antibody levels. Thus, not only the HLA allele but also the age at which an interaction is manifested varies for different malarial antigens. The interaction may influence either the rate of acquisition of antibody or the final level of antibody acquired by adults.

[Blood lipid and apolipoprotein concentrations in a healthy urban population of Northern Cameroon: variation with age and sex]

We determined plasma lipids and apolipoproteins A-I and B in 142 subjects from Ngaoundere, in the north of Cameroon, as a means of evaluating atherosclerotic risks. The mean triglyceride concentration was 0.836 +/- 0.174 g/l; mean total cholesterol concentration was 1.276 +/- 0.251; mean HDL cholesterol concentration was 0.162 +/- 0.222; mean apolipoprotein A-I concentration was 0.577 +/- 0.096 and mean apolipoprotein B concentration was 0.836 +/- 0.174. These values differ from those reported for Caucasian populations but are similar to those reported in other studies in Cameroon. All lipid factors except HDL cholesterol concentration increased significantly with age (p < 0. 05). There were also differences between the sexes, with mean triglyceride, LDL cholesterol, HDL cholesterol and apolipoprotein B concentrations significantly higher (p < 0.01) in men than in women. There was no significant difference between the sexes, however, in total cholesterol and apolipoprotein A-I concentrations. Thus advanced age and being male are risk factors for atherosclerosis in this population.

Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon

The adoption of Western lifestyles is known to lead to increasing prevalence of non-insulin-dependent diabetes mellitus in Africa, yet epidemiological studies using standardised methods are rare. The prevalence of diabetes and impaired glucose tolerance was determined in a rural and an urban community in Cameroon using the 75-g oral glucose tolerance test and the World Health Organization diagnostic criteria in 719 rural (292 men, 427 women) and 1048 urban (458 men, 590 women) subjects aged 24-74 years. The response rate was 95 and 91% for the rural and urban population, respectively. The age-standardized prevalence of diabetes in the rural and urban population was respectively 0.9% (95% confidence interval (0.2-2.7)) and 0.8% (0.2-1.8) for men and 0.5% (0.1-1.6) and 1.6% (0.7-3.1) for women, and that of impaired glucose tolerance was 5.8% (3.3-9.4) and 1.8% (0.9-3.2) for men, and for women, 2.2% (1.0-4.0) and 2.0% (0.6-4.5). Although for both men and women the body mass index was higher at all ages in the urban than in the rural area, the 2-h plasma glucose, even after adjustment for age and body mass index, was significantly higher in the rural than in the urban area (p < 0.005, p < 0.002 for men and women, respectively). There was a female excess of diabetes in the urban area and an equal sex distribution in the rural area. In the rural area 67% (4 of 6) of diabetic subjects were unknown before the survey, compared with 57% (8 of 14) in the urban area. These data indicate a low prevalence of diabetes in Cameroon; however, the prevalence of impaired glucose tolerance suggests an early stage of a diabetes epidemic.

[Cerebral malaria in children in Yaounde, Cameroon. Clinical, paraclinical and developmental aspects]

Cerebral malaria is one of the major and deadly complications of malaria. In Cameroon, recent reports indicate that severe cases of malaria are increasingly more prevalent, particularly in children. The present study aims at describing the clinical presentation and laboratory findings of cerebral malaria in children in Yaounde. All patients admitted in the paediatric ward of Yaounde Central Hospital with malaria, who presented neurological signs and were tested positive for Plasmodium in their peripheral blood were recruited into the study. 36 cases were enrolled in all, making up 2.7% of all admissions. The patients' median age was 4.5 years. 52.8% were on malaria prophylaxis. Convulsions and coma with preceding hyperthermia were present in more than 90% of the patients. Blood parasites level median was 1.3% on admission. One patient had hypoglycaemia on admission and two others had it later on after admission; 16.7% had neurological sequels at discharge and two children died (5.6%). Delay in diagnosis and initiation of treatment with quinine adversely affected the prognosis of cerebral malaria in the study group.

Glycolipid antigens of adult O. volvulus reactive with patients sera from onchocerciasis endemic areas in Cameroon

Lipid extraction of adult O. volvulus worms using a chloroform/methanol/water mixture yielded 10 lipid fractions of which 8 were demonstrated by the orcinol reagent to be glycolipids. In TLC, two of these lipid fractions had mobilities similar to cholesterol and cholesterol ester (Rf.: 0.95, 0.86) whereas two others migrated as sphingomyelin and lecithin (Rf.: 0.40, 0.35) respectively. Other components migrated at intermediate positions. The glycolipids were immunologically active and reacted with sera from onchocerciasis patients. The highest reaction was obtained with the IgG antibody class, followed by IgM while no appreciable reactivity was observed with IgE. Sera from patients infected with other filariae such as Loa-loa and Dipetalonema perstans did not show any significant reaction with these antigens. The significance of these results is discussed.

Erythrocyte and plasma cholesterol exchange in sickle cell anemia

The effects of sickling on cholesterol exchange between red cell membranes and serum lipoproteins were studied by following the movement of tritiated cholesterol incorporated into erythrocytes. The initial rate of this exchange was greater in sickled cells than in normal cells. One quarter of the cholesterol in the sickled cells is quickly exchanged with plasma lipoproteins. After 15 minutes, the rate becomes identical for these two types of cells, reaching similar equilibrium at end. The sickling of red cells would explain the observed differences, although conditions of hypoxia and the saturation of the incubation medium with oxygen tend respectively to accentuate and to cancel this phenomenon.

[Salivary, urinary and plasma thiocyanate in smokers and non-smokers]

Thiocyanate is a major metabolic product of hydrocyanic acid. Its concentration in the serum, urine and saliva of individuals with little exposure to hydrocyanic acid (i.e. non smokers) is very low. But about three fold higher concentrations of thiocyanate are found in the sera, urine and saliva of smokers as compared to non smokers, because of cyanide provided by cigarette smoke. The concentrations of thiocyanate in the three biological fluids studied were different and it appeared to be no correlation in the distribution of thiocyanate concentrations in these fluids when individual subjects were compared. Urinary and salivary concentration power showed decreased kidney excretion of thiocyanate in smokers. The appearance or the disappearance of thiocyanates in the saliva and the urine takes place slowly. The salivary or urinary levels of thiocyanates are therefore good indicators of chronic intoxication from tobacco because it is not very sensitive to daily variations in tobacco smoking; it reflects the slow transformation of cyanide as well as the final elimination of this ion from urine which is slowed down in smokers.

The effects of alloxan diabetes, insulin and epinephrine on glucose-6-phosphate dehydrogenase from rat liver and brain

The control of glucose-6-phosphate dehydrogenase (G6PD) activity of the liver and brain were studied in normal and alloxan diabetic rats. Fasting decreased G6PD activity in brains and livers of normal rats significantly, but these decreases were reversed by placing the rats on a sucrose-rich diet. Injection of insulin were reversed by placing the rats on the sucrose-rich diet. Injection of insulin into normal 48h fasted rats had no significant effect on G6PD activity after 15 min. However, epinephrine significantly decreased liver G6PD activity by 17%, 7.5 min, after injection. Epinephrine had no effect on brain G6PD activity. In fed alloxan diabetic animals, the G6PD activity was found to be about 50% of that found in normal rats. Treatment of diabetic rats with protamine insulin partially reversed the decrease in G6PD activity caused by alloxan diabetes. It is concluded that insulin and epinephrine are important for the regulation of G6PD activity in vivo.