P-009 Use of Serum-Derived Bovine Immunoglobulin/Protein Isolate (SBI) in Patients With Crohn’s Disease

Abstract

BACKGROUND: Serum-derived bovine immunoglobulin/protein isolate (SBI) is a specially- formulated oral protein source with. 50% immunoglobulins with a multifaceted mechanism of action of SBI: microbial component binding, maintaining gastrointestinal immune balance, managing gut barrier function and improving nutrient utilization (Petschow et al., 2014). SBI has been shown to address gastrointestinal symptoms in patients with Irritable Bowel Syndrome (Wilson et al., 2013) and HIV-associated enteropathy (Asmuth et al., 2013). Given this information, patients with Crohn's diseasemay also benefit from the clinical nutritional management of SBI therapy. METHODS: This is a retrospective case study of 4 patients with Crohn's disease and an investigation of their response with the use of SBI therapy. RESULTS: The first case involved a 53 year old Caucasian male with 30+ year history of Crohn's disease. The patient has an established ileostomy, chronic dehydration, short gut syndrome, and hypomagnesium. He was started on SBI 5 g/day and his symptoms have improved with a reduction in the ileostomy output 3.5 down to 1.2 liter/day and creatinine levels from 3.2 to 2.9 mg/dL. The patient continues on SBI therapy. A second case involved a 54 year old Caucasian male, who had a history of Crohn's disease and 20 year right hemicolectomy. The patient was given SBI at 5 g/day and has since reported no significant symptoms and has reduced infusion of adalimumab from every 7 days to every 14 days. The patient continues on SBI therapy. A third case involved a 21 year old Caucasian male with a 7 year history of Crohn's disease. The patient has had mild flares, cramps, diarrhea and a loss of weight. Treatment has included adalimumab and mesalamine. SBI at 5 g/day was initiated approximately 6 months ago and he has since gained approximately 10 pounds with no reports of diarrhea. The patient continues SBI therapy. The fourth case involved a 49 year old Caucasian male with Crohn's disease and a right hemicolectomy for nearly 20 years. The patient failed to respond to infliximab or adalimumab therapy resulting in intermittent steroid use to manage his symptoms. SBI at 5 g BID was incorporated into the patient's therapy resulting in a resolution of his cramps and abdominal pain allowing for a successful taper off of steroid therapy without the return of symptoms. The patient continues on a maintenance dose of SBI 5 g BID to manage his condition. CONCLUSIONS: Since SBI has been shown to normalize bowel function, gastrointestinal microbiota, and enhance tight junction protein expression between intestinal epithelial cells as well as enhance nutritional utilization, this may serve as a valuable addition to current therapeutic options in Crohn's disease. Although this is a retrospective assessment of a small number of cases, the evidence suggests that SBI has an impact on the gastrointestinal symptomatology associated with the nutritional management of Crohn's disease. As such, this prescription medical food should be investigated for its potential use in this difficult to manage disease state.