Safety and Efficacy Study of PEA and Polydatin on Intestinal Inflammation and Visceral Hyperalgesia in IBS Patients

Study Overview
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Brief Summary
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Despite the pathophysiology of IBS remains largely unsettled, several mechanisms have been proposed to explain symptom generation. These include psychosocial factors, altered gastrointestinal motor function and altered perception of visceral stimuli because of chronic low-grade inflammation and increased nociceptive mediator release by inflammatory cells, particularly mast cells. The aim of this pilot study is to provide evidence of: intestinal mast cell (MC) infiltration and activation in IBS patients; down-modulation of MC activation by the oral administration of the association of palmitoylethanolamide (PEA) and polydatin in IBS patients.

Detailed Description
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The number of inflammatory cells in the gut wall of IBS patients is increased in comparison to asymptomatic controls. A significant increase in the number of both mast cells and T-lymphocytes in the mucosa of IBS patients have been reported. Electron microscopic studies demonstrated that mast cells were more frequently degranulated in IBS, suggesting their increased state of activation. Accordingly, an increased mucosal release of preformed mediators, such as histamine and tryptase, as well as de novo synthesis and secretion of arachidonic acid end products (e.g. prostaglandin E2) have been demonstrated. These mediators are known to target sensory nerve pathways, including those innervating the gastrointestinal tract, leading to visceral hyperalgesia. Electron microscopic studies showed that the mean distance between inflammatory cells and enteric nerves is significantly reduced in IBS patients, thus providing a conceptual basis for a putative pathogenetic role of low-grade inflammation on sensory-motor dysfunction in IBS. Activated mast cells in close proximity to mucosal colonic innervation correlated with the frequency and severity of abdominal pain. Evidence that mast cell mediators of IBS patients, but not controls, evoked activation of nociceptive sensory afferent neurons are available, thus providing a possible mechanism through which mast cells can evoke pain in IBS patients. Similar results has been recently reported following the administration into the rat colon of supernatants collected from human IBS colonic biopsy samples in culture. This nociceptive effect on murine sensory neurons was inhibited by serine protease inhibitors and a Protease Activating Receptor-2 antagonist.

Official Title
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Effect of the Oral Administration in IBS Patients of the Association of 200 mg Micronised Palmitoylethanolamide (PEA) and 20 mg Polydatin, on Parameters of Intestinal Inflammation and Visceral Hyperalgesia.

Conditions
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Irritable Bowel Syndrome

Intervention / Treatment
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* Dietary Supplement: Recoclix
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: IBS patients (both males and females) with positive diagnosis based on Rome III criteria (all IBS subtypes will be included) Age in the range 18-70 years Subjects capable of conforming to the study protocol Subjects who have given their free and informed consent Exclusion Criteria: Any relevant organic, systemic or metabolic disease, such as celiac disease, IDDM (Insulin-Dependant Diabetes Mellitus), Insulin-Independent Diabetes Mellitus, metabolic syndrome, pelvic organ prolapse, and urinary incontinence. Subjects with ascertained intestinal organic diseases (ulcerative colitis, Crohn's disease, microscopic colitis, infectious colitis, ischemic colitis, complicated diverticular disease). Subjects with untreated food intolerance, i.e. remaining symptomatic despite the withdrawal of the suspected food Previous major abdominal surgeries Females of childbearing potential, in the absence of effective contraceptive methods Subjects who become unable to conform to protocol Subjects who are continuously taking contact laxatives Subjects who have been continuously administered glucocorticoids, anti-histaminergic and mast cell stabilizer drugs within the previous 30 days Subjects who have been continuously administered trimebutine within the previous 30 days Treatment with any investigational drug within the previous 30 days Recent history or suspicion of alcohol abuse or drug addiction

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Recoclix (CM&D Pharma Limited)<br>Recoclix: two tablets per day for 12 weeks | Dietary Supplement: Recoclix<br>* tablets; 200 mg PEA+20 mg polydatin; 2 tablets/day; 12 weeks<br>|
| Placebo Comparator: Placebo<br>IBS patients | Other: Placebo<br>* tablets, 2tablets/day, 12 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes from screening visit of mast cell infiltration and activation in biopsy samples of colon mucosa from IBS patients, following 12 weeks of dietary supplementation with palmitoylethanolamide (PEA) and polydatin | Comparison between healthy volunteers and IBS patients (screening visit) on the following parameters: number of infiltrating mast cells (ICH) mast cell activation, as per histamine and tryptase release in the surnatant of cultured colon biopsy samples Comparison between active and placebo supplemented IBS patients (after 12 weeks from randomization) on the following parameters: number of infiltrating mast cells (ICH) mast cell activation, as per histamine and tryptase release in the surnatant of cultured colon biopsy samples | screening visit and after 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in biomarkers related to the endocannabinoid system | Comparison between active and placebo supplemented IBS patients (after 12 weeks from randomization) on the level of anandamide, 2-AG, PEA, CB1, CB2, FAAH (LC-APCI-MS; immunoblotting) | 12 weeks after randomization | 
| Changes from screening visit of other inflammatory cell subsets in biopsy samples of colon mucosa from IBS patients, following 12 weeks of dietary supplementation with palmitoylethanolamide (PEA) and polydatin | Comparison between active and placebo supplemented IBS patients (after 12 weeks from randomization) of the number of other inflammatory cell subsets (ICH) | screening visit and after 12 weeks | 
| Safety assessment by no changes in laboratory parameters and vital signs | Laboratory test (blood cell count, AST, ALT, creatinine, gamma-GT, alkaline phosphatase, total bilirubin, glucose, N, Na, K, Ca) Physical examination and vital signs (systolyc and diastolic blood pressure, heart rate, respiratory rate) | 4, 8, 12 weeks after randomization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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IBS, mast cell activation, low grade inflammation, visceral hyperalgesia