Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, 143005, Punjab, India.
Department of Microbiology, Government Medical College, Amritsar, 143005, Punjab, India.
Res Social Adm Pharm. 2024 Aug;20(8):760-767. doi: 10.1016/j.sapharm.2024.04.015. Epub 2024 May 3.
Acute respiratory distress syndrome (ARDS) is a lung complication of COVID-19 that requires intensive care and ventilation. Beta-hydroxybutyrate (BHB) is a ketone body that can modulate metabolism and inflammation in immune cells and lung tissues. We hypothesized that oral BHB could alleviate COVID-19 related ARDS by reducing pro-inflammatory cytokines and increasing anti-inflammatory cytokines.
We randomized 75 patients with mild (as per Berlin criteria) ARDS symptoms to receive oral 25 g twice daily or placebo for five days. The primary outcome was the change in pro-inflammatory cytokines (Interleukin-1β, Interleukin-6, interleukin-18, tumour necrosis factor-alpha) and anti-inflammatory cytokine (interleukin-10) from baseline to day 5. The secondary outcomes were the change in BHB levels from baseline to day 5, the number of hospitalization days, and the occurrence of adverse events.
Treatment with formulated BHB resulted in a significant decrease in pro-inflammatory cytokines; Interleukin-1β (p = 0.0204), Interleukin-6 (p = 0.0309), interleukin-18 (p = 0.0116), tumour necrosis factor-alpha (p = 0.0489) and increase in interleukin-10 (p = 0.0246) compared treatment with placebo. Importantly, higher BHB levels (p = 0.0001) were observed after supplementation; additionally, patients who underwent this approach were hospitalized for fewer days. No serious adverse events were reported.
Beta-hydroxybutyrate, an oral adjunct therapy, has shown promising results in ameliorating symptoms of ARDS. This includes reduced inflammation, oxidative stress, and decreased patient fatigue levels. Further study with a large sample size is warranted to assess the potential of BHB therapy's effectiveness in reducing the development of severe illness.
急性呼吸窘迫综合征（ARDS）是 COVID-19 的一种肺部并发症，需要重症监护和通气。β-羟丁酸（BHB）是一种酮体，可以调节免疫细胞和肺组织中的代谢和炎症。我们假设口服 BHB 可以通过减少促炎细胞因子和增加抗炎细胞因子来减轻 COVID-19 相关的 ARDS。
我们将 75 名符合柏林标准的轻度 ARDS 症状患者随机分为两组，分别接受口服 25g 每日两次或安慰剂治疗五天。主要结局是从基线到第 5 天促炎细胞因子（白细胞介素-1β、白细胞介素-6、白细胞介素-18、肿瘤坏死因子-α）和抗炎细胞因子（白细胞介素-10）的变化。次要结局是从基线到第 5 天 BHB 水平的变化、住院天数和不良事件的发生。
用配方 BHB 治疗可显著降低促炎细胞因子；白细胞介素-1β（p=0.0204）、白细胞介素-6（p=0.0309）、白细胞介素-18（p=0.0116）、肿瘤坏死因子-α（p=0.0489）和白细胞介素-10 增加（p=0.0246）与安慰剂治疗相比。重要的是，补充后观察到更高的 BHB 水平（p=0.0001）；此外，接受这种方法的患者住院时间更短。没有报告严重不良事件。
口服补充剂β-羟丁酸在改善 ARDS 症状方面显示出了有希望的结果。这包括减少炎症、氧化应激和降低患者疲劳水平。需要更大样本量的进一步研究来评估 BHB 治疗在降低严重疾病发展方面的潜力。
