Each year globally, more than 600,000 infants die of sepsis, a condition of bacterial infection that spreads fast and leads to organ failure. But a therapy developed by a team led by an American professor of Indian origin Pinaki Panigrahi over the last 20 years and details of which were published in Nature this week could do wonders. The therapy has been found to reduce the risk of infection by 40 per cent in trials and it can be inexpensive - less than one dollar for a course- Dr. Panigrahi told The Hindu by phone.
Dr. Panigrahi is a professor of epidemiology and pediatrics at the Child Health Research Institute and Center for Global Health at the University of Nebraska Medical Centre’s College of Public Health.
The therapy is to feed the infant with good bacteria that will populate his/her gut and block harmful bacteria. The probiotic bacterial strain is aided with a non-absorbable sugar to enhance its ability to effectively colonize the gut - researchers call the probiotic-sugar combination, a synbiotic. The oral therapy starts during day 2-4 of life, as a preventive measure, much like a vaccine.
More than a quarter of neonatal deaths in India are due to sepsis, which is one of the two most common causes of neonatal deaths globally, according to a study published in the Lancet Global Health in 2016. In a significant number of cases, the infection probably begins in the gut.
Dr. Panigrahi is happy about the outcome of the trials that began in 2008 in Odisha, where he grew up. But he is equally excited about the prospects of some unexpected and surprising collateral benefits that the therapy appears to provide. This includes a reduction in lower respiratory tract and other infections among the infants who were administered the synbiotic, indicating an overall improvement in immunity status.
“Apart from saving babies from sepsis and respiratory tract infection, this type of intervention has much bigger and wider ramifications. The most relevant is its impact on stunting,” said Dr. Panigrahi, explaining the wide prevalence of stunting in India, which is due to gut dysfunction that starts early in a child’s life.
“Early infections and continued exposure to a large bacterial load during the first two years of life results in tropical enteropathy (an intestinal disorder that affects the ability to absorb nutrients), which did not exist when I went to medical school in India 30 years ago. It was something we read about in our textbooks. Such tropical enteropathy and gut dysfunction is rampant in India now and 40% of children under the age of two are stunted,” he said, adding that stunted children end up with low cognitive development. When coupled with intrauterine stress and fast accumulation of fat during early infancy, stunting leads to chronic disease such as hypertension and diabetes in adulthood. Dr. Panigrahi hopes to expand the therapy’s dose and duration to combat the prevalence of childhood stunting, which stunts the country's economy and development too.
The probiotic study in neonates, largest in medical history covered 4,556 babies, and stopped short of the initial plan to cover 8000 of them. “The ethics of medical trials require that once it is found to be definitively good or bad, it must stop. In this case, the results were clear and undeniably good according to an independent data safety monitoring board.
Dr. Panigrahi’s team screened over 280 strains of probiotic bacteria before hitting upon a specific strain of Lactobacillus plantarum, abundantly found in curd, and fermented fruits and vegetables. - such as Indian pickles. These bacteria populate the healthy infant stool rather quickly and the strain used in the experiment was isolated from the diaper of a 11 month-old healthy baby.
The indiscriminate use of wide-spectrum antibiotics is causing resistance to many drugs and a probiotic solution such as this could avert a health crisis in the making, Dr. Panigrahi said. A graduate from MKCG Medical College, and a US-based physician, Professor Panigrahi’s heart remains in India, as he travels to Delhi, Mumbai, Puducherry and various sites in Odisha multiple times a year. He says the results of the trial are also an indicator of the unexplored potential of ancient Ayurvedic discoveries made thousands of years ago in India “The concept of consuming probiotics in the form of curd and the importance of gut health dates back to the originating days of Ayurveda that dates back to 6,000 BC. ” he said, adding that the current national interest in Ayurveda should expand to support modern clinical trials of traditional medicines.
“This study is a testament to the world-class research done by my colleagues at the Asian Institute of Public Health in Bhubaneswar, as well as US collaborators at the Emerging Pathogens Institute in Florida and the Medical Center at Michigan State University. What’s more, it demonstrates India’s ability to find its own solutions with overseas collaboration. India has the largest patient population, the best clinicians, statisticians, laboratories, and IT experts – all the ingredients needed to conduct successful clinical trials and translational research.” he said, Population-based surveillance of infection, finding the root cause, and other preparatory work completed over 5-6 years, and the actual trial done over another five years cost over $10 million, and was funded by the U.S National Institutes of Health (NIH). Dr. Panigrahi says India must commit more government funding for such research and also give more attention to public health issues. “Every dollar spent in public health gets 17-18 dollars in return,” he said.
Dr. Panigrahi believes that traditional curd making technique can be refined to make it therapeutic. "That will be a leap in public health intervention," he said.