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Limosilactobacillus reuteri DSM-17938 for preventing cough in adults with mild allergic asthma: A double-blind
Imran Satia1,2, Ruth Cusack1, Catie Stevens1
1Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Background:
Cough is a common troublesome symptom in asthma which is neuronally mediated. Limosilactobacillus reuteri DSM-17938 (L. reuteri DSM-17938) is a probiotic shown to be effective in pre-clinical models at suppressing neuronal responses to capsaicin, a transient receptor potential vanilloid agonist (TRPV1).
Objective:
Investigate the effects of DSM-17938 versus matched placebo on capsaicin-evoked coughs in mild allergic asthmatics.
Methods:
We performed a 4-visit, randomized, double-blind, placebo-controlled, two-way cross-over study comparing full dose cough responses with inhaled capsaicin in mild allergic asthmatics after 1 month of treatment with DSM-17938 compared with matched placebo. Randomization and allocation to trial group were carried out by a central computer system. Histamine skin prick testing, airway hyper-responsiveness and inflammatory cells in induced sputum were measured at every visit. Blood was collected to extract PBMCs and stimulated with CD3/CD28 to ascertain the effects of DSM-17938 /placebo on T-cell cytokine responses.
Results:
Seventeen subjects were recruited and 15 completed the study (8 females, mean age 27.3 years). There was no difference in the change in maximum capsaicin-evoked coughs (Emax) after treatment with L. reuteri DSM-17938 compared with placebo [mean difference 2.07 coughs (95% CI -2.77 to 6.91, p = .38) or relative changes in geometric mean ratios for the dose evoking at least half the Emax (ED50) [1.05 (95% CI 0.31-3.58, p = .94)], concentration evoking 2 coughs (C2) [0.63 (0.26-1.53), p = .28] and 5 coughs (C5) [0.79 (0.25-2.50), p = .67]. There was no effect on histamine skin prick wheal size, intensity of itch sensation, methacholine PC20, airway inflammation or T-cell responses after stimulation with CD3/CD28. There were no serious adverse events. One subject developed a mild upper respiratory tract infection and another mild transient nausea whilst on DSM-17938.
Conclusion:
In this small study in adults with mild allergic asthma, we found no evidence that L. reuteri DSM-17938 has any systemic effects on airway nerves, smooth muscle, sputum inflammatory cells, skin responses or T-cell responses after oral consumption.
Trial Registration:
Clinicaltrials.gov Identifier: NCT03603522.
Insights
Limosilactobacillus reuteri DSM-17938 did not significantly reduce cough responses in mild allergic asthmatics. This probiotic showed no systemic effects on airway nerves, inflammation, or immune responses in the study.
Area of Science:
- Immunology
- Gastroenterology
- Respiratory Medicine
Background:
- Cough is a common asthma symptom mediated by neuronal pathways.
- Limosilactobacillus reuteri DSM-17938 (L. reuteri DSM-17938) is a probiotic with pre-clinical efficacy in suppressing neuronal responses.
- Capsaicin, a TRPV1 agonist, is used to model cough responses.
Purpose of the Study:
- To investigate the effects of L. reuteri DSM-17938 versus placebo on capsaicin-evoked coughs in mild allergic asthmatics.
- To assess the impact of L. reuteri DSM-17938 on airway nerve sensitivity and inflammatory markers.
Main Methods:
- A randomized, double-blind, placebo-controlled, cross-over study design was employed.
- Participants received either L. reuteri DSM-17938 or placebo for one month.
- Cough responses to inhaled capsaicin, histamine skin prick tests, airway hyper-responsiveness, and induced sputum inflammatory cells were measured.
Main Results:
- No significant difference was observed in capsaicin-evoked coughs (Emax, ED50, C2, C5) between L. reuteri DSM-17938 and placebo groups.
- L. reuteri DSM-17938 did not affect histamine skin prick responses, methacholine PC20, or airway inflammation.
- No significant impact on T-cell cytokine responses after ex vivo stimulation was detected.
Conclusions:
- Oral consumption of L. reuteri DSM-17938 did not demonstrate systemic effects on airway nerves, smooth muscle, or inflammatory/immune cells in mild allergic asthmatics.
- The study found no evidence supporting the use of L. reuteri DSM-17938 for managing cough in this patient population.
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