Disease-modifying immune-modulatory effects of the N-163 strain of Aureobasidium pullulans-produced 1,3-1,6 Beta glucans in young boys with Duchenne muscular dystrophy: Results of an open-label, prospective, randomized, comparative clinical study

Abstract

AbstractBackgroundDuchenne muscular dystrophy (DMD) is an inherited neuromuscular disorder causing progressive muscle weakness and premature death. Steroids remain the mainstream approach for supportive care but have side effects; other targeted therapies and gene therapies are also being developed. As there is limited evidence on the use of disease-modifying nutritional supplement adjuncts in DMD, this pilot trial is to evaluate the effects of supplementation of Aureobasidium pullulans-derived 1,3-1,-6 beta glucan from the N-163 strain in young patients with DMD.MethodsTwenty-seven patients with Duchenne muscular dystrophy (DMD)—nine in the control arm (undergoing conventional therapies)—participated. The patients were divided into groups: those not administered steroids (Steroid -ve) (n = 5), those administered steroids (Steroid +ve) (n = 4), and 18 in the treatment arm (N-163 beta glucan supplement along with conventional therapies; N-163 Steroid –ve and N-163 Steroid +ve); they participated in the study for 45 days. Assessments of muscle function, disease status, and levels of IL-6, IL-13, TGF-β, creatinine kinase (CK), titin, TNF-α, haptoglobin, and dystrophin in the blood and myoglobin in the urine were performed at baseline and at the end of the study.ResultsIL-6 showed a significant decrease in the N-163 Steroid -ve group, from a baseline value of 7.2 ± 1.2 pg/ml to 2.7 ± 0.03 pg/ml. IL-13 decreased in both treatment groups—from 157.76 ± 148.68 pg/ml to 114.08 ± 81.5 pg/ml (N-163 Steroid -ve) and from 289.56 ± 232.88 pg/ml to 255.56 ± 214.13 pg/ml (N-163 Steroid +ve). TGF-β levels showed a significant decrease in the N-163 Steroid –ve group, from a baseline value of 3302 ± 1895 ng/ml to 1325.66 ± 517 ng/ml post intervention. Dystrophin levels increased by up to 32% in both Steroid +ve and -ve groups. Medical research council (MRC) grading showed muscle strength improvement in 12 out of 18 patients (67%) in the treatment group and four out of nine (44%) subjects in the control group.ConclusionSupplementation with the N-163 beta glucan food supplement produced disease-modifying beneficial effects: a significant decrease in inflammation and fibrosis markers, increase in dystrophin and improvement in muscle strength in DMD subjects over 45 days, thus making this a potential adjunct treatment for DMD after validation. A longer duration of follow-up and further research on the mechanism of action and commonalities with other diseases provoked by hyperactive inflammation and/or fibrosis may pave the way for their extended applications in other dystrophinopathies and neuroinflammatory diseases.Trial registrationClinical trials registry of India, CTRI/2021/05/033346. Registered on 5 May, 2021.