In Focus - Traumeel

Transcription

In Focus - Traumeel

d 2.00 • US $ 2.00 • CAN $ 3.00
Biomedical
Therapy
J o urnal o f
Volume 3, Number 2 ) 2009
Integrating Homeopathy
and Conventional Medicine
Mucosal
Distress
• Intestinal Permeability and Its Role in Disease • Differential Treatment of Chronic Rhinosinusitis
Contents
I n Fo c u s
Intestinal Permeability and Its Role in Disease . . . . . . . . . . . .4
W h a t E l s e I s N e w ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Re f r e s h Yo u r H o m o t ox i c o l o g y
The Mucosal Immune System:
Functional Properties and Potential Clinical Implications . . 14
Specialized Applications
Immune Modulation
With Microdose Combination Products . . . . . . . . . . . . . . . . . 17
Meet the Expert
Dr. Bert Hannosset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Practical Protocols
Chronic Rhinosinusitis With and Without Polyps:
Differential Treatment With Bioregulatory Medicines . . . . .20
M a r ke t i n g Yo u r P r a c t i c e
Think About the Future! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Re s e a r c h H i g h l i g h t s
Gastrointestinal Cramps in Children:
Spascupreel Comparable to Hyoscine Butylbromide . . . . . . 24
Making of ...
Manufacturing of Traumeel Injection Solution
Part II: Sterilization, Quality Control, Labeling,
and Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Cover photograph © MedicalRF.com/Getty Images
)2
Published by/Verlegt durch: International Academy for Homotoxicology GmbH, Bahnackerstraße 16,
76532 Baden-Baden, Germany, www.iah-online.com, e-mail: journal@iah-online.com
Editor in charge/verantwortlicher Redakteur: Dr. Alta A. Smit
Print/Druck: VVA Konkordia GmbH, Dr.-Rudolf-Eberle-Straße 15, 76534 Baden-Baden, Germany
© 2009 International Academy for Homotoxicology GmbH, Baden-Baden, Germany
© H. P. Hoff/artbotanica
)
)
A Block to Bioregulation
Dr. Alta A. Smit
W
hy devote an entire issue to
mucous membranes? The
body’s mucosal surfaces have often
been compared to a sixth sense, and
as evolution progressed from unicellular organisms to complex structures, the mucosae had to adapt to
become both barriers to harmful
substances and selective sieves permitting passage of nutrients and
other beneficial substances. The mucous membranes therefore constitute
one of the body’s most sophisticated
immune organs.
The role of the epithelium itself in
the immune process is also the subject of intense research.1 The mucosal immune system in all its complexity makes up the largest part of
our immune system, and research is
increasing our knowledge not only
of how immune responses in general
are evoked, but also of how the mucosal system is linked to the systemic immune system.
Recent years have seen a major shift
in how we view disease in relation
to the mucosal immune system: Certain diseases once classified as autoimmune disorders are now understood as autoinflammatory disorders,
and conventional medical literature
is also beginning to view a lack of
acute inflammatory response as a
cause of disease, as bioregulatory
practitioners have known for decades.2
It is thus no wonder that mucosal
distress span many specialties, from
gastroenterology to gynecology;
more surprising, though, is the interest of disciplines such as neurology and rheumatology (see focus
article). Bioregulatory medicine,
moreover, sees mucosal distress as
one of the major blocks to bioregulation and therefore an essential
consideration in developing any
treatment regimen.
We begin our investigation with a
focus article on gut permeability by
Dr. David Lescheid, followed by an
overview article on mucosal immunity by Dr. Doris Ottendorfer, a recognized specialist in this field. The
rubric Specialized Applications illustrates how this knowledge can be
applied, and the column Practical
Protocols demonstrates how modern
immune research into debilitating
conditions such as chronic rhinosinusitis can aid in refining our bioregulatory microdose therapy.
Mary Kingzette summarizes a cohort study that compares Spascupreel to the reference drug hyoscine
butylbromide and concludes that
the microdose product is just as effective as the conventional drug in
treating spasms in children. The
Journal of Biomedical Therapy 2009 ) Vol. 3, No. 2
Making of … presents the second
part of ampoule manufacturing (although mucosal distress, of course,
is more likely to benefit from direct
sublingual or intranasal administration rather than injections). As usual,
marketing specialist Marc Deschler
has excellent advice for practitioners, this time writing about the importance of adequate financial planning. Last but not least, we continue
revealing our experts in a new light,
this time with Dr. Bert Hannosset,
the vice president of the International Society of Homotoxicology
and Homeopathy.
Dr. Alta A. Smit
References:
1. Schleimer RP, Kato A, Kern R, Kuperman D,
Avila PC. Epithelium: at the interface of innate and adaptive immune responses. J Allergy
Clin Immunol. 2007;120(6):1279-1284.
2. Marks DJ, Harbord MW, MacAllister R, et
al. Defective acute inflammation in Crohn’s
disease: a clinical investigation. Lancet.
2006;367(9511):668-678.
)3
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Intestinal Permeability and
Its Role in Disease
By David Lescheid, PhD, ND
Maintaining integrity in the gastrointestinal (GI) tract
is of paramount importance in our overall health. The
commonly recognized functions of the GI tract (digestion,
secretion, absorption, and motility) can occur effectively
only if there are intact epithelial membranes. These functions must occur properly to provide us with the nutrients
that we need to support our activities of daily living.
T
)4
he mucous membranes of the
GI tract also provide compartmentalization, protecting the
relatively fragile, homeodynamic
internal milieu from the relatively
harsh environment of the intestinal
lumen. Mucosal membranes include
many different structures and cells
with unique roles in maintaining
the physical, chemical, and immunological barrier functions.1
Another major function of the GI
tract is immunity. The epithelial
cells of the GI tract provide the first
line of defense, protecting us from
the potentially dangerous or foreign
substances brought into our body
via our food and drink. Furthermore,
most pathogenic microbes, including
many medically important viruses,2
must cross a mucosal barrier to cause
disease. It is estimated that up to
80% of the immune system cells are
initiated in the GI tract or spend a
good portion of their life there. The
gut-associated lymphatic system
(GALT) is part of an interdependent
mucosal immune system termed the
mucosa-associated lymphatic system
(MALT). Immunocompetent cells
that develop in the GALT are transported via the lymphatic system to
the circulatory system to be carried
to other mucous membranes, such as
the respiratory and urogenital tracts,
to provide protection. This interdependence between all mucous
membranes in the body is important
because it means that by using bioregulatory medicines to restore integrity in the GI tract, we can influence the overall immune system and
general health.
The immunological barrier function is a very dynamic and complex
one, with roles not only in protection from substances that are foreign and/or potentially dangerous
but also in tolerance to commensal
microflora and the nutrients that are
digested and absorbed to maintain
normal body functions (Figure). In
the healthy GI tract, with intact mucous membranes, tolerance is the
predominant immunological function. Therefore, we do not react to
the daily nutrients that we need to
support our physiological functions. If the GI tract barrier is compromised, there is a breakdown in
tolerance, leading to increased reactivity, chronic activation of immune
system cells, and production of cytokines that can have localized and
systemic effects.
Some of the more common diseases
associated with a breakdown in the
integrity of the GI tract include the
inflammatory bowel diseases3 and
certain autoimmune diseases, such
as ankylosing spondylitis, IgA nephropathy and multiple sclerosis,4 type
1 diabetes mellitus,5 and autism.6
Other conditions associated with
a hyperpermeable GI tract include
congestive heart failure,7 chronic venous insufficiency and the development of leg ulcers,8 major depressive
disorder,9 chronic fatigue immune
deficiency syndrome,10 gallstones,11
and progression of human immunodeficiency virus (HIV) infection.12
The documented relationship between a “leaky gut” and so many
important diseases, as described,
speaks to the importance of medical
interventions that can safely and effectively promote healing in a timely manner. This article will describe
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the scientific support for the use of
antihomotoxic medicines in treating a hyperpermeable GI tract and
restoring optimal health.
Using homotoxicology to treat
a hyperpermeable GI tract
One of the inherent strengths in
homotoxicology is that it provides
a very well thought out, logical approach to the progression of diseases
and of disease regression. The Disease Evolution Table (DET) outlines
a framework from which to position
a disease in relation to its status of
regulation and deregulation and to
which germ layer of tissue has been
affected. It also provides a relative
guide as to the prognosis of the disease and the phases that might occur during healing. On the DET, a
leaky gut is classified on the vertical
axis in the section on endodermal
tissue, just to the right of the regulation/compensation division in the
impregnation phase. It means that it
will take some time to restore gut
integrity and that all 3 pillars of homotoxicology (i.e., organ regulation
and cellular activation, immunomodulation, and detoxification) will
have to be used to provide complete
resolution.
In any disease, it is important to first
examine the broader picture and ask
what external influences might be
contributing to the disease or acting as obstacles to cure the disease.
For example, we know that many
substances (e.g., gluten, certain food
additives, heavy metals, and inhalants) affect the permeability of the
GI tract. Microbial infections and
aging also can increase permeability.
Excessive, regular consumption of
alcohol13,14 and high fructose corn
syrup15 are also associated with the
development of a leaky gut in susceptible people. It is important to
discontinue this external supply of
toxins as a first step towards resolution. Discontinuing these toxins
supports the 4-S approach to detoxification: Stop (the external supply of
Blood
stream
toxins), Support (the organs of detoxification and drainage), Stimulate
(elimination of toxins), and Sensitize
(the patient for detoxification). Other toxins that affect the permeability
of the GI tract include pharmaceutical drugs, such as proton pump
inhibitors16 and nonsteroidal antiinflammatory drugs (e.g., cyclooxy
genase [COX] 2 inhibitors).17,18 Zeel
has been shown to be as effective as
COX-2 inhibitors in a clinical trial
of patients with mild to moderate
arthritis of the knee.19 There are
numerous clinical trials demonstrating that topical Traumeel effectively manages pain in many different
musculoskeletal disorders, including
acute symptomatic treatment of tendinopathy.20 These studies suggest
that antihomotoxic medicines can
be used as anti-inflammatory agents
that will not damage the GI tract.
The permeability of the GI tract is
not only affected by physical toxins,
but also by lifestyle events or stressors on mental or emotional levels.
Blood flow to the liver
Figure. Intestinal mucosa. The mucosal
Lymph
node
barrier prevents harmful substances
(e.g., toxins, pathogenic bacteria, and in-
CRH and TRH receptor
flammatory mediators) from entering
the body. At the same time, it serves as
a highly selective filter, ensuring the
absorption of useful substances (e.g.,
food particles) through tight junctions
and epithelial cells.
Food particles
Bacteria
CRH
NSAIDs
Alcohol
Probiotic bacteria
Unstirred water
Tight
junction
Enterocyte
Abbreviations: CRH, corticotropin-reEpithelial
barrier
Mucus layer
leasing hormone; NSAID, nonsteroidal
anti-inflammatory drug; TRH, thyrotropin-releasing hormone.
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For example, it has been shown that
even a short period of sleep deprivation in mice will cause a profound
change in permeability of the GI
tract and translocation of bacteria
to normally sterile sites, such as the
mesenteric lymph nodes, spleen,
pancreas, and blood.21 Chronic insomnia in humans is also associated
with the production of proinflammatory cytokines and the reduction of
antioxidant systems and hormones
that can lead to hyperpermeability
in the GI tract.22 Neurexan is an antihomotoxic medicine that is useful
in treating insomnia and helping to
relax persons who are overstimulated by the stressors of daily living.23 Modulating stressors, such as
insomnia, can be an important part
of treating a leaky gut because it has
been shown in animal studies that
chronic psychological stress will
cause hyperpermeability in the GI
tract and predispose the animals to
hypersensitivity and illness.24,25
We have known for years that there
is a connection between the nervous,
endocrine, and immune systems via
shared signaling molecules, receptors, and anatomical locations.26,27
This field of psychoneuroimmunology has provided the scientific proof
that there is a gut-brain connection
and that physiological or pathological changes in one of these organs
profoundly influence the function of the other organ. Recently, a
parasympathetic anti-inflammatory
pathway has been described; this
pathway connects the cytokine signals in the GI tract with vagus nerve
fibers, the brain, acetylcholine and
its receptors on macrophages, and
further changes in cytokine signals.28,29 This pathway, termed the
cholinergic anti-inflammatory pathway, provides the evidence needed
to support the role that modulating parasympathetic nervous system
output from the brain can play in
healing the leaky gut. Several effective methods of modulating this
pathway include acupuncture, biofeedback, mindfulness meditation,
various forms of physical therapies,
and chiropractic techniques.28,29 Furthermore, there are a number of antihomotoxic medications that have
been shown to be very effective in
modulating the psychosomatic influences on disease states. These
include Nervoheel, for anxiousness
and irritability23,30; Neuro-Injeel/
Neuro-Heel, for deeper pathologies,
particularly for someone who has
never been well since a specific life
event; and Tonico-Injeel/TonicoHeel, for physical and mental exhaustion from overwork.23
Correcting any dysregulation in the
brain is an important component
of healing a leaky gut. This healing can occur indirectly by modulating shared signaling molecules,
such as cytokines, between the organs, as described previously. Alternately, this restoration can occur
directly because there is recent evidence that physical structures previously thought to be found only in
the central nervous system are also
found in the GI tract.31 This is the
so-called brain-gut axis. It is suggested that “cellular interactions
previously thought to be unique to
the blood-brain barrier, also regulate
gut epithelial permeability.”31 This
evidence provides further support
to the potential of using medicines
commonly considered to be nervous
system specific as adjuncts to healing the GI tract.
Once the external factors contributing to the development of a leaky
gut, or interfering with self-regulation, have been identified and
addressed, it is important to begin
treatments using the 3 pillars of homotoxicology.
Cross section of gut mucosa
1. Organ regulation and
cellular activation
There are a number of different
antihomotoxic medicines that will
support and regulate the organs of
the GI tract. One of the key structures contributing to the physical
barrier function of the GI tract is
the tight junction between the epithelial cells. These tight junctions
ensure that most of the substances
that are absorbed follow the intracellular pathway rather than the
paracellular pathway. By following the intracellular pathway, they
are carefully processed by the intracellular enzymes and biochemical pathways of the epithelial cells
before they enter the lymphatic or
circulatory systems to be carried to
the rest of the body. Two important
processes in GI epithelial cells are
the cytochrome P450 enzyme sys-
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tems,32,33 which are involved in the
phase I and phase II detoxification
of substances; and the p-glycoprotein and cation/anion transporter
systems,34,35 which act as phase III
transporters regulating the influx
and efflux of certain drugs, metals,
and toxins. The function of both of
these systems can be supported by
Mucosa compositum. Furthermore,
these intracellular processes are energy dependent and, therefore, the
use of Coenzyme compositum is indicated to help support the Krebs/
tricarboxylic acid cycle generation
of adenosine triphosphate (ATP).
The tight junctions are also complex, dynamic structures that can be
influenced by many different types
of stimuli,36 possibly including antihomotoxic medicines. A breakdown
in the integrity of tight junctions
has been associated with many different diseases.37 The tight-junctional complex consists of a number of different proteins, including
zonulins, occludins, and claudins; a
number of different kinases; and a
junctional adhesion protein, which
is a member of the immunoglobulin
superfamily.38 The claudins and the
occludins form extracellular loops
that span the gap between the cells.
The claudin proteins are water-filled
pores that carefully select substances
that enter the paracellular pathway
based on charge and size. Zonulins
act as tethering proteins linking the
claudins to the intracellular matrix
via their attachment to actin and myosin. This structural arrangement of
the tight-junctional complex means
that changes in the intracellular matrix, via actin-myosin interactions,
can affect the opening and closing
of the claudin pores and, therefore,
the integrity of the epithelial barrier.
The myosin heads have ATPase activity and, therefore, hydrolyze ATP
to provide the energy to help them
move along the actin strands.39 This
energy-dependent process can be
supported by the use of Coenzyme
compositum, an antihomotoxic
medicine that is thought to generate
ATP via its influence on the intracellular Krebs/tricarboxylic acid cycle.
2. Immunoregulation
If the tight-junctional complexes
become permeable, macromolecules,
including substances in food and
drink that have not been thoroughly
processed and microflora and their
endotoxins, cross into the supporting aerolar connective tissue and interact with the immune system cells
located there. These interactions
result in the synthesis and secretion
of inflammatory cytokines, such as
interleukin (IL) 1b, tumor necrosis
factor (TNF) α, and interferon g.
These cytokines also directly affect
the tight-junctional architecture to
further increase permeability.38,40
A positive feedback loop is set up,
with increased intestinal permeability up-regulating the synthesis
and secretion of proinflammatory
cytokines that increase permeability even further. Reversing a leaky
gut requires repairing the physical
tight-junctional structure, as described previously, in addition to
modulating the inflammatory cytokines that are further impairing
the healing process. According to a
number of animal and human observational studies, it appears that the
actual physical damage to the mucosal epithelial cell barrier occurs
prior to the induction of excessive
proinflammatory cytokines.41 This
further strengthens the importance
of structural and functional organ
support, as described previously,
as an initial strategy to treating the
leaky gut.
Once substances have crossed the
mucosal epithelial cell barriers, antigen-presenting cells (e.g., dendritic
cells) collect them, process them,
and present them to naïve T cells.
Depending on the nature of these
substances, their dose, and the extent of interaction, different types
of cytokines are synthesized and
secreted. These cytokines influence
the direction of T-cell development
towards either T-helper cell type 1
(Th1)-dominant (cell-mediated) immunity or Th2-dominant (humoral)
immunity. Other T cells, termed
Th3 and/or Treg cells, play a role
in ensuring that the immune system
shift in either direction is moderated
and not too vigorous or persistent. A
detailed description of Th1/Th2/
Th3/Treg immunity is beyond the
scope of this article and is reviewed
in detail elsewhere.42-45
An enhanced understanding of the
cytokines involved in the pathogenesis of various diseases will assist in
the development and use of safe, effective methods of modulating these
cytokines and recreating balance
in the immune system to promote
healing. Immunomodulation is an
important step in the healing of the
leaky gut.
Two of the most important cyto
kines directly contributing to increased permeability in the GI tract
are IL-1b46 and TNF-α.38 There
are a number of specific targets for
these cytokines in mainstream medicine, including the monoclonal antibodies to TNF-α, infliximab and
adalimumab; however, both of these
medicines have a substantial number of potentially severe adverse effects.47 A safer, effective way to modulate these cytokines is by using the
antihomotoxic medicine Traumeel.
Using in vitro studies, the extent of
modulation of TNF-α and IL-1b
by Traumeel is significant, ranging
from 54% to 70%, respectively.48
Echinacea compositum is an antihomotoxic medicine that has been
shown to effectively prevent postoperative infections.49 There is re-
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cent evidence that the alkylamides
from extracts of the root of Echinacea species modulate TNF-α, via
the endogenous cannabinoid receptors.50,51 The N-alkylamides of Echinacea purpurea work synergistically
to not only decrease the expression
of TNF-α but also to increase the
expression of IL-10,52 a cytokine
known for its immunosuppressive
effects on Th1-dominant diseases
such as Crohn’s disease.
Because of the ability of Echinacea
extracts to shift the immune system
towards Th2-dominant immunity, it
is important to use them with caution and only in conditions in which
they are unlikely to aggravate signs
and symptoms. For example, ulcerative colitis is considered a Th2dominant disease53 and, therefore,
any medical intervention (e.g., with
Echinacea extracts) that promotes
further development of Th2 cells
might cause an aggravation of symptoms. Furthermore, persons who are
sensitive to plants in the Asteraceae
family also might be sensitive to
Echinacea extracts. Finally, because
Echinacea species extracts, in particular the aerial parts, have immunostimulatory activity, it is suggested
that they are not administered in
full concentrations to persons with
autoimmune conditions. A homeopathic concentration of D4
(1:10,000) is considered safe for
oral use and, therefore, the use of
Echinacea compositum drinking
ampoules is safe in autoimmune and
proliferative conditions.
Even before substances in the GI
tract lumen reach the epithelial
cells or tight-junctional complexes,
they must diffuse through a mucous
layer. The mucous layer is not simply a static physical structure. It is
highly dynamic, with a meshwork
of many different interdependent
proteins and carbohydrates. Two of
the best-characterized components
of the mucous layer are trefoil factor peptides (TFFs) and mucin.54
Both of these components are synthesized and secreted by the goblet
cells interspersed throughout the
mucous membrane. They migrate
onto the luminal side of the epithelial cells to provide an extra viscous
layer of protection and selective
filtration.55,56 The synthesis and release of TFFs is diurnal, with a peak
time during the nocturnal hours.
This protective rhythm is disrupted
by aging, a Helicobacter pylori infection, sleep deprivation,57 and celiac
disease.58 Furthermore, there is evidence that modulating proinflammatory cytokines, such as TNF-α,
also helps maintain optimal levels of
TFFs,59 suggesting that this might
be another mechanism by which
Traumeel can act to help in the restoration of gut integrity.
3. Detoxification
Once the organs of the GI tract have
been supported and the proinflammatory cytokines have been modulated to the point at which they can
self-regulate, it is important to ensure that all remaining endotoxins
and exotoxins are detoxified and
drained. Clearing toxins also helps
to activate physiological systems
that protect the GI tract from further
damage. In addition to the TFFs, another important component of the
mucous layer is mucin. Mucins are
large extracellular proteins that are
heavily glycosylated with a bottle
brush-like structure. The mucins
play a number of roles, including
control of cell growth, signal transduction from the lumen to the intracellular structures, adhesion of commensal and potentially pathogenic
microbes, and protection.60 Their
protective function is due in part to
the ability of the glycoproteins to
act as a molecular sieve, carefully
regulating diffusion of substances
based on their charge and size. For
this careful, selective process to occur optimally, the mucins need to
be relatively free of toxins. Furthermore, regulating proinflammatory
cytokines also helps mucins to assemble and function appropriately.61
It can be postulated that using Lymphomyosot and Traumeel might
help to keep the mucin structures
clear and able to perform their functions optimally; this is an important
contributing factor to healing a hyperpermeable GI tract.
Many of the immune system cells of
the GALT are present in the loose
areolar connective tissue just below
the epithelial cells.1 For these immune cells to work optimally, there
must be a relatively clear pathway for
antigens to be able to be received by
them. Furthermore, these immune
system cells must have a relatively
high degree of mobility to move
to where they are needed to mount
an appropriate immune response. In
my opinion, using drainage preparations, such as Lymphomyosot, may
help keep this loose areolar connective tissue relatively free of exotoxins
and endotoxins; this is an important
part of ensuring that an appropriate
immune response occurs.
It is important to recognize that
there is a closely regulated, interdependent relationship between the
GI tract and the liver. The stomach,
intestine, spleen, and pancreas drain
to the liver via the hepatic portal
system. Therefore, many of the toxins from a leaky gut will end up in
the liver, where they need to be processed. Furthermore, if the detoxification mechanisms in the liver are
not functioning adequately, excess
or insufficiently processed toxins are
recycled back into the duodenum of
the GI tract via the bile duct. Using
Nux vomica-Homaccord or Hepar
compositum to support liver detoxification systems and Coenzyme
) I n Fo c u s
compositum to support the energy
demands of these systems is thus
important. The addition of Berberis-Homaccord reduces the toxin
burden even further by supporting the detoxification and drainage
functions of the kidneys and liver.
Animal studies14,62 have shown that
excess alcohol consumption causes
direct damage to hepatocytes and
leads to the development of a leaky
gut. The increased toxin load, subsequent to this increased GI tract permeability, further contributes to liver damage, stressing the importance
of addressing the health of the liver
and GI tract simultaneously.
Conclusions
Because of the paramount importance of the mucosa in systemic
immune responses and the connectivity between all of the mucosal
barriers in the body, repairing a
leaky gut can be an important access point in the management of
many diseases. Management begins
by discontinuing the intake of potentially damaging toxins or lifestyle
choices and replacing or repairing
them with antihomotoxic medicines
that will not cause any further damage. It is important to support the
ability of the various organs to perform their physiological functions
(using Mucosa compositum, Nux
vomica-Homaccord, and Coenzyme
compositum) and to immunomodulate cytokines, such as IL-1b and
TNF-α (using Traumeel and Echinacea compositum). This will halt
the positive feedback loop of increased permeability, production of
excess proinflammatory cytokines,
and further permeability. It is also
important to recognize that there
is a definitive gut-brain connection
and, therefore, it is essential to address any mental and/or emotional
disturbances (using Neurexan, Neuro-Heel/Neuro-Injeel, Nervoheel,
or Tonico-Heel/Tonico-Injeel) that
could be interfering with restoration
of mucosal integrity. Finally, it is important to remove toxins and to activate the organs, so that they maintain optimal detoxification pathways
even after therapy has been discontinued.
The science and art of homotoxicology provides us with a scientifically
supported, logical framework to
heal a hyperpermeable GI tract and,
therefore, support maximal health
in our patients. One of the additional strengths of antihomotoxic
medicine is that the medications can
be used synergistically with other
natural health products to support
timely and effective healing. Other
natural health products shown to be
useful in healing the leaky gut include probiotics,62-64 quercetin,65-68
L-glutamine,69-71 zinc,72-74 zinc carnosine,75 vitamin A,76 vitamin D,77,78
melatonin,79 curcumin,80-83 and licorice extracts.84|
Hans-Heinrich Reckeweg Award 2010
Join in – have your experience rewarded
Heel annually honors outstanding scientific research in
the field of a unique homeotherapeutic system (homotoxicology) with the Hans-Heinrich Reckeweg Award.
The main award (€ 10,000)
is presented for scientific work of fundamental theoretical and/or practical significance in antihomotoxic
medicine in the fields of human and veterinary medicine.
The incentive award (€ 5,000)
is presented for promising results arising from clinical,
case-based or fundamental research in antihomotoxic
medicine in the fields of human and veterinary medicine. The prize money is intended to fund further research.
Both prizes are awarded for research carried out in a
laboratory or registered practice. All results must be
new, convincing and previously unpublished, and research should not have involved animal testing.
The deadline for submissions is May 31, 2010.
For more information contact:
Biologische Heilmittel Heel GmbH,
Department of Research,
76532 Baden-Baden, Germany
Phone +49 7221 501-227,
Fax +49 7221 501-660, info@heel.de,
www.heel.com
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References:
1. Bourlioux P, Koletzko B, Guarner F, Braesco
V. The intestine and its microflora are partners for the protection of the host: report
on the Danone Symposium “The Intelligent
Intestine,” held in Paris, June 14, 2002. Am J
Clin Nutr. 2003;78(4):675-683.
2. Williams JE. Portal to the interior: viral pathogenesis and natural compounds that restore
mucosal immunity and modulate inflammation. Alt Med Rev. 2003;8(4):395-409.
3. Laukoetter MG, Nava P, Nusrat A. Role of the
intestinal barrier in inflammatory bowel disease. World J Gastroenterol. 2008;14(3):401407.
4. Fasano A, Shea-Donohue T. Mechanisms of
disease: the role of intestinal barrier function
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) 11
) What Else Is New?
Eating a poor diet when pregnant or
breastfeeding may cause long-lasting
health damage to the child.
No fast food
during pregnancy!
To slim down,
get enough sleep
A mother’s heavy consumption of
fast food during pregnancy increases
the likelihood that her child will develop unhealthy eating habits. At
least, that’s what British animal experiments suggest. During pregnancy and lactation, rats were fed either
normal lab rations or a junk-food
diet consisting of potato chips,
chocolate, and high-fat cheese. The
results indicate that offspring subjected to high levels of fat and sugar
in utero also tended to select unhealthy foods later, when given a
choice. The effects on body mass
and blood lipid and insulin levels
were predictable. There is considerable evidence that these findings
also apply to humans, so pregnant
and nursing women should pay special attention to healthy eating.
Children and adolescents who do
not get enough sleep risk becoming
overweight, according to an American study in which 335 youngsters
aged 7 to 17 years underwent three
successive nights of standard polysomnography. Overweight children
slept an average of 22 minutes less
than their normal-weight age peers
and had significantly shorter periods of REM sleep. The researchers
calculated that the risk of overweight is doubled by sleeping one
hour less each night and tripled by
losing an hour of REM sleep.
Arch Gen Psychiatry.
2008;65(8):924-932.
Musical aptitude and
social competence
are genetically linked
Musically gifted people are also
likely to be socially adept. That’s an
oversimplified statement of the findings of a recent Finnish research
study. Scientists from Helsinki discovered that social competencies
such as human bonding and attachment are encoded on the same gene
as the ability to carry a tune and
keep a beat. The study analyzed the
genetic makeup of 19 families whose
members included professional musicians and/or active amateurs. The
results demonstrated that the testconfirmed musicality of individual
family members could be traced to
two variants of the arginine-vasopressin receptor 1A, a gene also associated with human bonding and
altruism.
PLoS ONE 4(5):e5534.
doi:10.1371/journal.pone.0005534.
J Physiol. 2008;586(13):3219-3230.
F O R P RO F E S S I ONA L U S E ON LY
) 12
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articles in this journal.
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© iStockphoto.com/Armin Hinterwirth
) What Else Is New?
Latest research findings suggest that
the cells responsible for the axolotl’s
famed ability to regenerate limbs,
organs, and even parts of the brain do
not undergo dedifferentiation into a
pluripotent state.
Can French kissing
cause cancer?
The Mexican salamander:
a “miracle of regeneration”
According to an American study,
oral sex and open-mouthed kissing
are associated with the development
of oral human papillomavirus (HPV)
infection and may therefore be responsible for increases in HPV-positive oropharyngeal cancers, which
have tripled in the last 40 years and
are predicted to double in each successive decade. Formerly, most
oropharyngeal cancers were caused
by heavy smoking, but the human
papillomavirus is now the single
greatest factor. The case-control
study provides a possible explanation for this shift. Oral HPV infection was discovered in 4.8 percent
of 332 control patients in an ENT
outpatient clinic. In another study,
oral HPV infection was found in 2.9
percent of 210 male students, aged
18 to 23 years. Among the control
patients, the risk of infection increased with the lifetime number of
sex partners; the trend was significantly more pronounced with oral
sex than with vaginal contacts.
Among the college students, HPV
infection increased with the number
of oral sex partners and openmouthed kissing partners but not
with vaginal sexual contacts.
Research scientists at Dresden Technological University’s Center for
Regenerative Therapies have discovered how the axolotl (Ambystoma
mexicanum) replaces severed limbs.
Contrary to previous assumptions,
the basis of limb regeneration in the
axolotl is not pluripotent cells with
unrestricted potential, but rather
cells that can only develop into specific tissues, as in mammals. Nonetheless, the axolotl is able to regenerate complete and functional limbs,
organs, and even parts of the brain.
“Our research demonstrates for the
J Infect Dis. 2009;199(9):1263-1269.
first time that axolotl cells behave
like the cells in mammals and are
not so different from our own,” emphasizes Professor Elly Tanaka, who
headed the Dresden study. By integrating a fluorescent protein into
the axolotl’s genotype and tracking
the further development of individual cells and tissues, the Dresden
scientists were able to show that in
axolotls, different types of progenitor cells with restricted developmental potential formed at the site of an
injury. “Most cells are restricted to
their own tissue identity,” explains
Tanaka. According to the authors,
these findings open up completely
new perspectives for regenerative
medicine.
Nature. 2009;460(7251):60-65.
Now avai lable on li n e!
The International Academy for Homotoxicology is pleased to
announce that the Journal of Biomedical Therapy is now also
available online at www.iah-online.com. Visitors of the IAH
web site can download the current issue, peruse back issues, or
look for articles in the “List of published topics.”
) 13
) Re f r e s h Yo u r H o m o t ox i c o l o g y
The Mucosal Immune System
Functional Properties and Potential Clinical Implications
By Doris Ottendorfer, PhD
Introduction
Mucosa-associated organs represent
the physical interface to the environment. They are, therefore, particularly vulnerable to damage by infectious pathogens or noxious agents.
This is why all mucosae are under
constant surveillance by a specifically organized mucosa-associated
lymphoid tissue (MALT). Notably,
mucosal immune responses differ
functionally from systemic immunity against blood-borne antigens.
For example, mucosal antigen uptake and handling induce antigenspecific mucosal immune responses,
but normally suppress systemic immunity against most orally ingested
antigens. An explanation of these
differences is given in the following
sections.
) 14
Oral tolerance
The above-mentioned difference
between systemic and mucosal immune responses reflects the distinct
challenges that mucosal surfaces
face from being directly exposed to
the external environment. To protect mucosal surfaces from injury
and subsequently from organ damage and severe diseases, the mucosal
immune system must be able to discriminate efficiently between potential pathogens on one side and to
tolerate the tremendous number of
commensal microbes and harmless
food antigens on the other side.1,2
This phenomenon, called oral tolerance, has emerged as a fundamental
aspect of mucosal immunity, contributing highly to intestinal homeostasis and human health.
Structural properties of
the mucosal immune system
Oral tolerance is defined as a state of
“systemic hyporesponsiveness” to
orally administered harmless anti
gen(s) on subsequent antigen challenge. The breakdown of this delicate balance provokes uncontrolled
mucosal inflammation due to unlimited antigen contact with the MALT.3
For example, in newborns, some
regulatory pathways of mucosal immunity might not be fully matured,
allowing for greater sensitization to
harmless dietary antigens instead of
suppression. Therefore, food allergies can occur. Presumably, probiotic
bacteria, with their numerous mechanisms of action, may represent a
hopeful therapy to treat allergic disorders, as recently reviewed.4,5
The complexity of the mucosal
barrier deserves some attention,
considering the anatomical aspects
of tolerance against luminal antigens.6 Both cellular and noncellular
components cooperate to maintain
mucosal barrier function. Among
noncellular components, luminal
enzyme activities, antimicrobial factors (e.g., defensins), and secretory
IgA antibodies are present in large
amounts in the mucous layer covering the mucosal surface. These
components neutralize bacteria and
viruses.6 The proteolytic cleavage of
food antigens from egg, soy, fish, or
nuts minimizes their immunogenic
properties. Mucin glycoproteins lining the intestinal epithelium contribute substantially to mucosal barrier
function. Remarkably, intestinal epi
thelial cells and luminal commensal
bacteria closely interact to terminate
and/or limit mucosal immune responses at a complex molecular level.7 For example, it has been demonstrated that recognition by intestinal
epithelial cells of selected probiotic
bacteria strongly down-regulates an
important proinflammatory signaling cascade, the nuclear factor-κB
pathway.7 Even the composition
and functional activities of the gut
microbiota crucially affect the structure and functions of the mucosal
immune system.8
Immunological networks
The efficient recognition of potential pathogens as one task of mucosal immunity includes inductive
sites, such as Peyer’s patches, where
T-helper type 2 (Th2) cells provide
cytokine help for B lymphocytes
to switch to IgA antibody production.9,10 The lamina propria, as an
effector site of mucosal tissues, contains many mature B plasma cells
secreting secretory IgA delivered for
mucosal protection against potential
pathogens. Numerous T-helper cells
and cytotoxic T cells in the lamina
propria mediate cell-mediated immunity against microbes and viruses. For active oral tolerance to occur,
) Re f r e s h Yo u r H o m o t ox i c o l o g y
Table. Overview of T-regulatory Cells (adapted from Shevach12)
Variable
“Natural” Treg Cells
“Induced” Treg Cells
Inducing stimuli
TCR stimulation
with self-peptides
TCR stimulation with peripheral (auto)
antigens, foreign antigens, dietary
antigens, or pathogens
Type of APC, mode of antigen presentation,
and cytokine milieu are also important
Origin
Derived from the thymus
Conversion and/or expansion of
nonregulatory peripheral CD4+ naïve,
memory, or effector T cells
Phenotype
FOXP3 positive
CD25 positive
Highly variable coexpression of
FOXP3 and CD25
Mechanisms of suppression
T-cell–T-cell–contact and/or
T-cell–APC–contact dependent
Cell-contact–dependent, cell-bound
TGF-b and, in some cases, soluble TGF-b
Cytokines (IL-10 and TGF-b)
Other cytokines
(IL-2, IL-4, IL-6, IL-13, IFN-g, and TGF-b)
Accessory molecules
(e.g., CTLA-4 and GITR)
Th3 cells (soluble TGF-b and/or IL-10)
Tr1 cells (IL-10)
CD8+ Treg cells (not well defined,
cell-contact–dependent, ILT3 and ILT4)
Abbreviations: APC, antigen-presenting cell; CTLA, cytotoxic T-lymphocyte antigen; FOX, fork head box; GITR, glucocorticoidinduced tumor necrosis factor receptor; IFN, interferon; IL, interleukin; ILT, immunoglobulinlike transcript; TCR, T-cell receptor;
TGF, transforming growth factor; Th, T-helper cell; Treg, T regulatory; Tr1, T-regulatory cell type 1.
more than one mechanism presumably prevents uncontrolled mucosal
immune responses against harmless
antigens. Functionally distinct T-cell
populations interact with differently
specialized subtypes of antigen-presenting cells (APCs) in distinct mucosal compartments. In this context,
it is reasonable to assume that the
maturation and activation stage of
locally present APCs, such as dendritic cells, dictates the fate of mucosal T-cell activation.11 Additional
T cells with profound immunosuppressive functions, summarized under the term regulatory T cells, have
been identified (Table).12
These include T-regulatory 1 (Tr1)
cells and Th3 cells. From experimental models for autoimmune encephalomyelitis (EAE), Weiner and
colleagues13 coined the term Th3
cells to explain their results. In mice
orally fed myelin basic protein as an
autoantigen for multiple sclerosis
in humans, the peripheral immune
response against the same antigen
was inhibited on challenge. As responsible cell types, Th3 regulatory
cells were detected, secreting large
amounts of the cytokine transforming growth factor β. Interestingly,
higher antigen doses favored T-cell
anergy and/or depletion, whereas
lower antigen doses seemed to generate tolerance mediated by these
Th3 cells.13 Other regulatory T-cell
populations such as Tr1 cells differed from classic Th1 cells by their
secretion of larger amounts of the
immunosuppressvie cytokine interleukin 10. Interleukin 10 controls
Th1 cell activation and several macrophage functions.
Clinical implications
for oral tolerance
Altogether, oral tolerance mechanisms represent a continuous natural immunological event driven by
exogenous antigens. For therapeutic
purposes, it seems logical to assume
that some human autoimmune diseases, such as multiple sclerosis or
type 1 diabetes mellitus, may be prevented by orally given self-antigens.
However, recently reviewed work
on this topic indicated that this
immunological concept functions
well in animal disease models, but
yielded inconsistent results in human clinical trials.14 In contrast, sublingual immunotherapy (SLIT) with
oral allergen extracts for allergic
rhinitis and conjunctivitis considerably improved symptom relief of
these disorders.15 Ongoing research
efforts on the basic mechanisms of
this fascinating part of mucosal immunity hopefully will help prevent
some pitfalls, so that the use of oral
tolerance pathways may in the future become an inherent part of immune therapy.|
) 15
References:
1. Wittig BM, Zeitz M. The gut as an organ of immunology. Int J Colorectal Dis.
2003;18(3):181-187.
2. Sansonetti PJ. War and peace at mucosal
surfaces. Nat Rev Immunol. 2004;4(12):953964.
3. Sampson HA. Food allergy: when mucosal
immunity goes wrong. J Allergy Clin Immunol. 2005;115(1):139-141.
4. Sherman PM, Ossa JC, Johnson-Henry K.
Unraveling mechanisms of action of probiotics. Nutr Clin Pract. 2009;24(1):1014.
5. Kullen MJ, Bettler J. The delivery of probiotics and prebiotics to infants. Curr Pharm
Des. 2005;11(1):55-74.
6. Baumgart DC, Dignass AU. Intestinal barrier function. Curr Opin Clin Nutr Metab
Care. 2002;5(6):685-694.
7. Neish AS. The gut microflora and intestinal epithelial cells: a continuing dialogue.
Microbes Infect. 2002;4(3):309-317.
8. O’Hara AM, Shanahan F. The gut flora as a forgotten organ. EMBO Rep.
2006;7(7):688-693.
9. Mayer L. Mucosal immunity. Pediatrics.
2003;111(6, pt 3):1595-1600.
10. MacDonald TT. The mucosal immune
system. Parasite Immunol. 2003;25(5):235246.
11. Shortman K, Naik SH. Steady-state and
inflammatory dendritic-cell development.
Nat Rev Immunol. 2007;7(1):19-30.
12. Shevach EM. From vanilla to 28 flavors:
multiple varieties of T regulatory cells. Immunity. 2006;25(2):195-201.
13. Miller A, Lider O, Roberts AB, Sporn MB,
Weiner HL. Suppressor T cells generated
by oral tolerization to myelin basic protein suppress both in vitro and in vivo
immune responses by the release of transforming growth factor beta after antigenspecific triggering. Proc Natl Acad Sci USA.
1992;89(1):421-425.
14. Weiner HL. Current issues in the treatment
of human diseases by mucosal tolerance.
Ann N Y Acad Sci. 2004;1029:211-224.
15. Kuo CH, Wang WL, Chu YT, Lee MS,
Hung CH. Sublingual immunotherapy in
children: an updated review. Pediatr Neonatol. 2009;50(2):44-49.
IAH
Abbreviated
Course
An e-learning course leading to certification in
homotoxicology from the International Academy
for Homotoxicology in just 40 hours.
1 Access the IAH website at www.iah-online.com.
Select your language.
2 Click on Login and register.
3 Go to Education Program.
4 Click on The IAH abbreviated course.
5 When you have finished the course, click on
Examination. After completing it successfully,
you will receive your certificate by mail.
For MDs and licensed healthcare practitioners only
Free of charge
) 16
www.iah-online.com
) Specialized Applications
Immune Modulation With
Microdose Combination Products
By Alta A. Smit, MD
T
Three properties seem to make microdose bioregulatory products ideal
for modulation of the mucosal immune system.
he importance of the mucosal
immune system has been addressed by several authors in this
journal. The complexity of this immune system and its effects on the
systemic immune system make it an
attractive target for addressing local
immune problems, such as inflammatory bowel disease and allergy.
These properties can also be used
for systemic immune dysregulation,
such as adjuvant therapy for autoimmune diseases, in which case the
corresponding tissue extract is used
in an oral form.
sponse in the mucosa. The arrows indi-
and the dotted arrows, differentiation;
red relates to regular activation or inhi-
Plants1 and organ preparations have
a combination chemistry that can be
efficiently used to address multiple
targets. This fits the complexity of
the immune system in the mucosa.
bition, whereas orange indicates pro-
cesses that are predominantly found in
allergy.
Abbreviations: DC, dendritic cell; Ig, im-
munoglobulin; IFN, interferon; IL, inter-
leukin; TGF, transforming growth factor;
Th, T-helper cell; Treg, T-regulatory cell.
DC
Th0
Lymph node
IL-2
TGF-ß
Th2
IL-2
IFN-γ
Th1
IL-3
IL-4
Mast cell
Y
Y
IgE
Y
IgG4
Y
Y
YY
Histamine
Leukotrienes
Cytokines
Plasma cell
Y Y
Peripheral tissues
Basophil
Y
IL-3
IL-4
IL-5
Y
IL-3
IL-5
Treg
Y
Eosinophil
Histamine
Leukotrienes
Cytokines
cate secretion; the blunt lines, inhibition;
1. Multitarget regulation
Allergen/Antigen
Peptides
Leukotrienes
Cytokines
Figure. Deployment of the T-cell re-
IgA
) 17
) Specialized Applications
Table 1. Medications Used to Induce Local Tolerance
Medication
Target Tissue (Local)
Medication
Target Tissue (Systemic)
Mucosa compositum
Universal for mucosae
Traumeel
General
Euphorbium compositum
Nasal mucosa
Tonsilla compositum
Podophyllum compositum
Gut mucosa
Reticuloendothelial tissue
(including bone marrow)
Solidago compositum
Urogenital tract
Cerebrum compositum
Brain
Gynäcoheel
Female reproductive tract
Hepar compositum
Liver
Ovarium compositum
Ovarium
Thyreoidea compositum
Thyroid
2. The microdose
) 18
Table 2. Medications Used to Induce Systemic Tolerance
It also seems that microdose preparations will have an effect on the immune system, which tends toward
regulation rather than stimulation or
suppression. The mucosal immune
system is especially geared towards
tolerance, especially in the face of
microdoses of food.2 The main carriers of the antigen are in the first
instance dendritic cells.3 These cells
will carry the antigen to the mesenteric lymph node,4 where this response takes place. The mechanism
is depicted in the Figure. The main
cell involved in the tolerance reaction is the T-regulatory cell, which
plays a pivotal role in the downregulation of both T-helper cell type
1 (Th1) and Th2. The induction of
Th3 and transforming growth factor
β by microdose preparations was
shown on blood culture results.5
Furthermore, Traumeel was shown
in vitro to down-regulate proinflammatory cytokines from T cells and
colon epithelial cells.6
3. Possibility of
sublingual administration
It seems that the oral mucosa has
special features that make it ideal for
oral tolerance. Sublingual immunotherapy used in allergy is more efficient if it is given sublingually or
nasally, but not intraintestinally.7
Furthermore, the oral mucosal interface, also called the “gateway to the
gut,”8 seems to have a special relationship to tolerance because of the
number of bacterial species living
there.9
The medications listed in Table 1
and Table 2 are examples used to induce local and systemic tolerance,
respectively.|
References:
1. McChesney JD, Venkataraman SK, Henri
JT. Plant natural products: back to the future or into extinction? Phytochemistry.
2007;68(14):2015-2022.
2. Wershil BK, Furuta GT. Gastrointestinal
mucosal immunity. J Allergy Clin Immunol.
2008;121(suppl 2):380S-383S.
3. Worbs T, Bode U, Yan S, et al. Oral tolerance
originates in the intestinal immune system
and relies on antigen carriage by dendritic
cells. J Exp Med. 2006;203(3):519-527.
4. Macpherson AJ, Smith K. Mesenteric lymph
nodes at the center of immune anatomy. J Exp
Med. 2006;203(3):497-500.
5. Heine H, Schmolz M. Induction of the immunological bystander reaction by plant extracts. Biomed Ther. 1998;16(3):224-226.
Lider O, Oberbaum M. Inhibition of IL-1b
and TNF-α secretion from resting and activated human immunocytes by the homeopathic medication Traumeel S. Clin Dev Immunol. 2004;11(2):143-149.
7. Mascarell L, Van Overtvelt L, Moingeon P.
Novel ways for immune intervention in immunotherapy: mucosal allergy vaccines. Immunol Allergy Clin North Am. 2006;26(2):283306, vii-viii.
8. Pennisi E. A mouthful of microbes. Science.
2005;307(5717):1899-1901.
9. Cutler CW, Jotwani R. Dendritic cells
at the oral mucosal interface. J Dent Res.
2006;85(8):678-689.
) Meet the Expert
Dr. Bert Hannosset
By Catherine E. Creeger
B
these disciplines. Bert was so enthusiastic about his new discoveries that
he stopped practicing conventional
medicine in 1988 and quickly
learned all he could about homeopathy and phytotherapy. Having established himself in complementary
medical circles, he went on to study
neural therapy (1991-1992). These
studies in turn introduced him to
antihomotoxic medicines.
Dr. Hannosset’s connection to homotoxicology continued to develop.
Eager to spread the word and give
others a chance to learn about it, he
gladly accepted an offer to lecture
on homotoxicology. In the past five
years, he has had the opportunity to
give several courses on homotoxicology and antihomotoxic medications
and has even become
the president of both
the Belgian Homo
toxicological Society
and Belgium’s largest
school of clinical homeopathy. He truly enjoys
teaching other medical
doctors and especially
fostering knowledge of
homotoxicology and clinical homeopathy among an
ever-growing group of Belgian MDs. Since August 2008, he
has served as vice president on the
board of the International Society of
Homotoxicology and Homeopathy.
At the moment, teaching continuing-education courses is his major
ert Hannosset was born in
1960 in a village of only 600
residents in the Hesbaye (Haspen
gouw) district of Belgium, one of
the country’s most productive agricultural regions. He grew up on a
small farm, where he developed a
love of nature and learned early on
the meaning of hard physical labor.
Perhaps this is why he decided at
age ten that he wanted to become a
medical doctor rather than a veterinarian – the hard and dirty aspect of
treating animals was not terribly appealing to him!
After seven years of boarding school
education, he began his medical
studies in 1978, obtaining his MD
degree in 1985 from the University
of Leuven (Belgium). 1985 was a
particularly big year for Bert: He
also got married that year and started a private practice in conventional
medicine together with his wife,
also an MD, whom he had met during his fourth year of medical school.
Today they have three young-adult
children and still work together as a
team, but their practice has evolved
to emphasize complementary medicine (homeopathy, phytotherapy,
neural therapy, and biopuncture,
among others).
In 1986, disappointed with the failure of conventional medicine in
treating his young son, Dr. Hannosset was introduced to homeopathy
and phytotherapy by a chance encounter with another doctor who
had several years’ experience in
“hobby,” which really doesn’t leave him much
time for other recreational activities,
except for walking and bicycling
with his wife and friends out in nature on weekends. But who knows
what the future may bring?|
) 19
) Practical Protocols
Chronic Rhinosinusitis
With and Without Polyps
Differential Treatment With Bioregulatory Medicines
By Alta A. Smit, MD
C
hronic rhinosinusitis (CRS) is
one of the most commonly reported diseases. More than 24 million office visits for CRS were described as far back as 1992, and this
incidence has probably increased
rather than decreased.1 In the United States, the incidence of CRS is
more than 10% in the general population.2
The pathogenesis of CRS is poorly
understood. There is evidence for
the role of bacteria and fungi as well
as the presence of a deranged immune response in the sinuses and
upper airways.2 Deficiencies in the
epithelial immune barrier function
might compromise the interaction
between the host and external stimuli, which may lead to an increased
susceptibility to bacterial and fungal
colonization in patients with CRS.
Chronic rhinosinusitis is defined as a
group of disorders characterized by
inflammation of the mucosa of the
nose and the paranasal sinuses of at
least 12 weeks’ duration. Two classes of CRS exist, and these can be
divided according to the T-cell responses seen in the mucosa.
According to Joe and Thakkar,3 it is
best to think of these as inflammation from either a neutrophilic or an
eosinophilic origin. The eosinophilic classification refers to CRS
with nasal polyps (CRSwNP), also
associated with aspirin-exacerbated
respiratory disease, asthma, and allergic fungal rhinosinusitis. The
neutrophilic subtype refers to CRS
without nasal polyps (CRSsNP).
Children seem to experience CRSwNP more often.4 This is also reflected in the cytokine profiles: CRSwNP has an up-regulated T-helper
cell type 2 (Th2) profile and low Tregulatory cells, whereas CRSsNP
has a Th1 profile5 (see Figure). The
pathogenesis of CRSwNP is described in Table 1.
Table 1. Pathogenesis of Chronic (Eosinophilic) Rhinosinusitis With Polyps.
) 20
• Hypersensitivity immune reaction
• The initiating antigen is a fungus (non-invasive)
• Antigen-presenting cells secrete interleukin 10, recruit T cells
• Th1/Th2 imbalance
• A regulation rigidity into a Th2 profile occurs
• Eosinophilia ensues
• Eosinophils surround fungus
• Eosinophils secrete major basic protein, which chemically damages the mucosa
• Basophils and mast cells add to inflammation
Thus, it is important to adjust bioregulatory treatment in patients with
these conditions. In CRSwNP, the
immunomodulation is performed
with Engystol. Engystol is used in
this case because it has been shown
to increase interferon-γ, which will
support the Th1 profile and balance
the Th2 rigidity.6
In CRSsNP, the immunomodulation is performed with Traumeel.
Traumeel has been shown to downregulate the proinflammatory cyto
kines interleukin 1, interleukin 8,
and tumor necrosis factor a.7
The rest of the treatment stays the
same for the two types, as illustrated
with the protocol in Table 2.|
References:
1. Cherry WB, Li JT. Chronic rhinosinusitis in
adults. Am J Med. 2008;121(3):185-189.
2. Tieu DD, Kern RC, Schleimer RP. Alterations in epithelial barrier function and host
defense responses in chronic rhinosinusitis.
J Allergy Clin Immunol. 2009;124(1):37-42.
3. Joe SA, Thakkar K. Chronic rhinosinusitis and asthma. Otolaryngol Clin North Am.
2008;41(2):297-309, vi.
4. Coffinet L, Chan KH, Abzug MJ, Simões
EA, Cool C, Liu AH. Immunopathology of
chronic rhinosinusitis in young children.
J Pediatr. 2009;154(5):754-758.
5. Van Bruaene N, Pérez-Novo CA, Basinski
TM, et al. T-cell regulation in chronic paranasal sinus disease. J Allergy Clin Immunol.
2008;121(6):1435-1441,1441.e1-e3.
6. Enbergs H. Effects of the homeopathic preparation Engystol on interferon-γ production
by human T-lymphocytes. Immunol Invest.
2006;35(1):19-27.
Lider O, Oberbaum M. Inhibition of IL-1β
and TNF-α secretion from resting and activated human immunocytes by the homeopathic medication Traumeel S. Clin Dev Immunol. 2004;11(2):143-149.
) Practical Protocols
Cor
ti
A
DHE
sol
Figure. Th1/Th2 balance.
Abbreviations: DHEA, dehydroepiandrosterone; IFN,
interferon; IL, interleukin; TGF, transforming growth factor;
Th, T-helper cell; TNF, tumor necrosis factor.
IL-2
IFN-γ
TNF
Inflammation
IL-4, IL-13
IL-5
IL-10
TGF-β
Inhibition
Allergy
Table 2. Treatment for Chronic Rhinosinusitis With Nasal
Polyps (CRSwNP) and Without Nasal Polyps (CRSsNP).
DET Phase
Basic and/or Symptomatic
Orodermal
•
Degeneration
Euphorbium
compositum S/SN*
D&D
(CRSwNP and CRSsNP)
Regulation Therapya
Optional
•
• Echinacea
Advanced supportive de-
toxification and drainageb
followed by
or impregnation
(depending on
•
Basic detoxification and
•
CRSwNP:
•
CRSsNP:
the severity)
IM
compositum
(if there is
severe infection)
drainage: Detox-Kitc
Engystol N tablets
Traumeel S tablets
also as biopuncture
(using the ampoules)
OR
•
•
•
Mucosa compositum
Coenzyme compositum
Ubichinon compositum
Dosages: Euphorbium compositum: 1 spray in each nostril up to 5 times per day. Regulation therapy: tablets: 1 tablet 3 times
per day; ampoules: 1 ampoule of each medication, 1 to 3 times per week. Detox-Kit: 30 drops of each medication in 1.5 liters
of water; drink throughout the day.
a
Antihomotoxic regulation therapy consists of a three-pillar approach: detoxification and drainage (D&D), immunomodulation
(IM), and organ regulation (OR).
b
Advanced supportive detoxification and drainage consists of Hepar compositum (liver), Solidago compositum (kidney), and
Thyreoidea compositum (connective tissue).
The Detox-Kit consists of Lymphomyosot, Nux vomica-Homaccord, and Berberis-Homaccord.
c
) 21
* Marketed as Sinusin in the United States.
) M a r k e t i n g Yo u r P r a c t i c e
Think About the Future!
By Marc Deschler
Marketing specialist
Toward year’s end, we all typically reflect on the year that
is drawing to a close and begin to wonder about the next.
Being well-prepared means fewer surprises in the future,
so I’d like to suggest two topics that deserve serious
thought.
1. Do you have a plan for 2010?
For any business – including a medical practice – planning must be understood first and foremost as an attempt to shape the future. The
classical definition of planning is
systematic, future-oriented thinking
that sets goals and outlines how to
implement them. With last year’s expense statement in front of you,
you’ll need to ask the following
questions to come up with a meaningful plan for the near future (e.g.,
for the coming year):
• Does the category “other expenses” include expenditures incurred only in this particular
year, such as consultants’ fees?
• Does the statement include expenses actually belonging to an
earlier year, perhaps because a
supplier was very late in billing
you?
• Were there any costs unrelated to
the operation of the practice,
such as vandalism repairs?
• Did you acquire any durable assets that will be paid off only in
the next year or later?
This process identifies nonrecurring
expenditures and costs unrelated to
running your business. Simply carrying them over into the future
would falsify your projections.
In times of economic downturn, effective
cost containment is more important
than ever. Understanding the basics
of business administration and being
) 22
aware of your practice expenses will
allow you to react faster to changing
circumstances.
The next step is to develop a reasonable budget based on your cleanedup figures for the past year. At this
point, there are additional factors to
consider:
• Do you anticipate any salary
changes for your assistants?
• Ask your tax advisor whether
there is any advantage to switching from straight-line to declining-balance depreciation of assets.
• Consider the state of the financial market and discuss refinancing loans with your bank. Interest rates are often flexible.
• Take into account any fundamental upcoming changes in
your practice – a pregnancy, extensive renovations, etc.
• The inflation rate should also be
included in your calculations.
Prices for consumer goods rarely
go down.
At this point, you’ve already taken a
big step toward controlling costs.
During the planning year, note
whether your predictions are accurate and investigate any discrepancies.
At times when your income changes
almost daily or the economic headlines are bad, planning of this sort
may seem either unnecessary or not
worth the effort. Keep in mind,
though, that the only way to change
your income situation in the future
is through effective cost containment. First of all, this means under-
© iStockphoto.com/Zsolt Nyulaszi
Group or joint practices share expenses
for staff, office space, and equipment.
This can significantly increase the
profitability of the joint enterprise.
standing the basics and being aware
of the expenses and organization of
your practice. Having a good grasp
of them allows you to react significantly more quickly to changing circumstances.
2. Inter-practice cooperation
In times of declining revenue, many
solo practitioners begin to think
about some form of group or joint
practice. To a large extent, outer circumstances will determine whether
sharing staff and/or facilities with
others is possible or practical. A
shared practice spends less on staff
and office space than two (or more)
individual practices would. Since
each practitioner’s total expenses are
lower, his or her income is also
higher. In other words, the same
profit is possible from a lower volume of business. And sharing expensive diagnostic equipment, for
example, results in a much larger return on the investment. Several factors need to be considered to ensure
a successful partnership, but new,
creative models of cooperation are
definitely worth considering. Equipment sharing is the least binding
form of association between two or
more practitioners. The closer the
association, the more important
careful planning and weighing the
pros and cons becomes.
What are the advantages of sharing
a practice?
• The partners complement each
other, resulting in both an expansion of the practice’s expert
knowledge and competence and
in entrepreneurial synergies that
produce economic advantages
for both parties. This can be true
not only of a practice adding a
junior partner but also of longestablished practices joining
forces.
• The partners can step in for each
other. The practice is covered
during vacation times and on
sick days, reducing the burden of
expenses. In addition, the extended office hours that may be
possible with multiple partners
make the practice more interesting to patients.
• Two can accomplish more than
one, and four eyes are better than
two. Doubling the number of responsible parties cuts business
risks in half.
• Partnerships make financing easier. Two partners may mean more
owner equity, and many banks
have more confidence in partnerships than in sole proprietors.
There are several fundamental prerequisites, however, to achieving a
workable partnership. Play it safe
and take your time finding the right
person. The human factor is as important in a business partnership as
it is in a marriage. If the two partners aren’t on the same wavelength,
separation eventually becomes in-
evitable. The partnership must be
absolutely fair and based on fundamental principles of trust and openness, even if the partners are not
equally invested. Mistrust can destroy any partnership.
Discuss the future goals of the partnership and what each of you expect
from it – not just once, but repeatedly and frankly. Here, too, sharing
ideas has a stimulating effect. It’s
also important to discuss all aspects
of your future interaction – distribution of ownership, compensation
and profit sharing, division of labor,
competencies, vacation times, decision-making procedures – and set
them down in writing. Decide on a
timetable and commit to specific action steps so the partnership can
start up on time.
It is highly recommended to seek
legal advice and to carefully consi
der the following points in the contract: staff hiring; terms of severance,
including non-competition clauses
and terms of payment, the latter of
which could be drawn out in order
to ensure the liquidity of the practice. Moonlighting as a factor should
be under rules of contract to ensure
equality in the time the partners
spend in the practice. If it becomes
obvious already at an early stage
that a partnership will require greater adjustment on your part than you
are willing to make, do not simply
adopt a “wait and see” attitude; end
the association before it starts.|
) 23
) Re s e a r c h H i g h l i g h t s
Gastrointestinal Cramps in Children
Spascupreel Comparable to Hyoscine Butylbromide
By Mary A. Kingzette
Introduction
Gastrointestinal cramps and spasms
are common in children and adults.
In Germany, approximately 10 million prescriptions and an unknown
number of over-the-counter selfmedications are used annually for
these symptoms. In the United States,
$1.2 billion was spent on over-thecounter antacids, antidiarrhetics,
and antigas products in 2002.
Hyoscine butylbromide is an alkaloid medication with spasmolytic
and parasympatholytic properties;
it is frequently used to treat acute
colic. One disadvantage of this treatment is that hyoscine (scopolamine)containing treatments can be infrequently associated with dry mouth,
urinary retention, and increases in
ocular pressure.
Natural medicines are increasingly
used as suitable solutions for acute
and chronic disease. Spascupreel is
a homeopathic medication that consists of plant and mineral extracts
in microdose (10−2 to 10−6). It has
been used empirically in over 50
countries primarily for spasms of
smooth muscles of the stomach, intestines, bladder, and uterus.
In the present study, conducted in
Germany, the effects of Spascupreel
were compared with those of the
conventional medication hyoscine
butylbromide in children younger
than 12 years who had gastrointestinal or urethral spasms.
Methods
This cohort study was prospective,
observational, and non-interventional. A total of 204 children were
enrolled from 57 centers. Each child
received either Spascupreel or hyoscine butylbromide orally (both in
tablet form). The practitioner determined the treatment for each patient.
Doses were determined according to
patient age and recommendations of
the product information sheet. The
maximum study duration was 1
week.
The patients included were children
younger than 12 years who had
newly diagnosed or recurring gastrointestinal or urethral spasms. The
patients excluded were those 12
years or older, those already receiving treatment for gastrointestinal
spasms, or those for whom one of
the study treatments was contraindicated.
At the initial visit, the children
were examined and data were collected (demographics; localization,
intensity, and duration of spasms;
etiology; auscultation findings; ultrasonographic findings; possible
adjunctive diseases; possible earlier
therapies; and presence of risk factors, including adiposity, asthma, diabetes mellitus, eczema, bronchitis,
and decreased renal function).
The effectiveness of the respective
therapies was evaluated by the effect
on severity of spasms and clinical
symptoms, including pain/cramps,
sleep disturbances, distress, eating
or drinking difficulties, and frequent
crying. The scale for these variables
was from 0 to 3 (0 indicates asymptomatic; 1, mild symptoms; 2, moderate symptoms; and 3, severe symptoms).
Time to first improvement of symptoms was also recorded (after the
first administration, after 12-24
hours of treatment, after 1-3 days of
treatment, after > 3 days of treatment, and no improvement). The estimated total effect of treatment was
determined by the physician, on a
scale of 1 to 5 (1 indicates asymptomatic; 2, clear improvements; 3,
moderate improvements; 4, no improvements; and 5, worsening of
symptoms).
Compliance was evaluated on a
4-point scale (ranging from very
good to low), given by the physician, based on information from the
patient or caregiver. Tolerability was
Aconitum napellus
) 24
) Re s e a r c h H i g h l i g h t s
Monkshood or Wolfsbane (Aconitum
napellus) and the False Helleborine,
also known as White Hellebore
(Veratrum album), are two of the active
ingredients contained in Spascupreel.
Veratrum album
evaluated by the practitioner based
on a 4-point scale (very good, good,
moderate, and low). Very good tolerability indicates no tolerability
complaints, and low tolerability indicates a reaction after each administration.
Results
There were 2 groups in this study:
the Spascupreel group (n = 99) and
the control (hyoscine butylbromide)
group (n = 105). There were no statistically significant differences in
sex between the 2 groups, but patients in the Spascupreel group tended to be younger and, therefore, also
shorter and lighter than patients in
the hyoscine butylbromide group.
Patients were treated for a mean of
6.1 days in both groups. There were
15 patients in the Spascupreel group
and 31 in the control group who
discontinued treatment. In most cases, discontinuation occurred because
of the disappearance of symptoms
during therapy.
The scores for all variables improved
during treatment. The time to first
improvement of symptoms was less
than 1 day in 12% of the Spascupreel
group and 13% of the control group.
Most patients (80% in the Spascupreel group and 89% in the hyoscine
butylbromide group) experienced an
improvement in symptoms within 2
days of treatment, without significant differences between treatment
groups. No improvement during the
study period was noted for only 4%
of the Spascupreel group and 2% of
the control group.
According to the physicians, treatment was successful (“very good”)
in 75% of the Spascupreel group
and 79% of the control group. Both
groups had similar levels of overall satisfaction with treatment (P =
0.44).
During the study, the patients
shifted from having predominantly severe or medium symptoms to
mostly being asymptomatic for all
variables. The greatest effect was
seen for pain/cramps and severity of
symptoms. For total score, the mean
change from baseline was −7.9 in
the Spascupreel group versus −6.6
in the hyoscine butylbromide group
(negative values indicate symptom
improvement).
Most patients reported “very good”
tolerability with both treatments:
91% in the Spascupreel group and
93% in the hyoscine butylbromide
group (P = 0.83). There were no
adverse events reported for either
treatment. Most patients also reported “very good” compliance in both
groups: 72% in the Spascupreel
group and 68% in the hyoscine butylbromide group (P = 0.44).
Discussion
This observational study of 2 groups
of children younger than 12 years
indicates that Spascupreel (a homeopathic treatment) is comparable to
hyoscine butylbromide (a conventional treatment) for gastrointestinal
spasms.
Alternative treatments for various
conditions, including musculoskeletal conditions, vertigo, and respiratory and gastrointestinal disorders,
are being used more commonly in
the industrialized world. Reasons for
the popularity of alternative medical
practices include the generally lower rate of adverse events with these
treatments and the closer interaction
between patient and practitioner.
In the present study, both Spascupreel and hyoscine butylbromide
showed comparable improvements
in the severity of symptoms. The
tolerability of both treatments was
also very good. Finally, there were
no adverse effects with either treatment.
Overall, the study showed that patients who opt for homeopathic
therapy for gastrointestinal spasms
can be treated successfully with
Spascupreel. Spascupreel proved to
be very good for treating gastrointestinal symptoms and showed very
good tolerability and compliance as
well.|
Reference:
Müller-Krampe B, Oberbaum M, Klein P, Weiser
M. Effects of Spascupreel versus hyoscine butylbromide for gastrointestinal cramps in children.
Pediatr Int. 2007;49(3):328-334.
) 25
) Making of ...
Manufacturing of
Traumeel Injection Solution
Part II: Sterilization, Quality Control,
Labeling, and Packaging
By Larissa Wörthwein-Mack
With regard to both equipment and personnel, the production
of Traumeel ampoules is subject to more stringent regulation
than the production of non-sterile dosage forms such as ointment, tablets, or drops. Preparing the ingredients, producing
and filtering the injection solution and filling it into glass
ampoules all take place in Class C cleanrooms, which can be
entered only by specially trained personnel wearing protective
clothing.
A
fter filling, the ampoules are
marked for identification, plac
ed in stainless steel containers, and
transferred to the Sterilization department, where they are autoclaved
in accordance with the requirements
of the European Pharmacopeia (Ph.
Eur.). In this process, hot steam under pressure of 1 bar over atmospheric pressure is used to effectively
kill all microorganisms. The sterilizers used in this process are very
large, tall compartments of stainless
steel that can be vented on two sides.
The ampoules to be sterilized enter
from a Class C cleanroom on one
side and are discharged on the other.
Duration, temperature, and pressure
of the sterilization process are constantly and precisely monitored and
recorded by measuring devices built
into the sterilizer. In addition, the
ampoules are marked with an indicator stripe showing that the required temperature has been attained. Only then is the sterilizer
emptied. Samples are taken to monitor microbiological and chemical
quality.
Quality control testing
In the next step, an optical testing
procedure is used to monitor every
ampoule (100 percent control) for
) 26
Device for testing ampoules
for visible particles
Photos by Sonja Bell
) Making of ...
Manual loading of ampoules
into a sterilizer
A star wheel feeding ampoules into
the testing device for visible particles
Right:
Device for testing ampoules for leaks
mobile and visible particles such as
bits of glass that might develop
when the ampoules are sealed. The
testing device detects visible particles down to 50 µm in size. All defective ampoules are sorted out and
destroyed. All the ampoules that
pass this test are carried by a conveyor belt to the next testing site,
where they are tested for leaks. Measuring conductivity under high voltage determines whether each ampoule is intact or cracked. Here, too,
every ampoule is tested (100 percent). This machine can test up to
approximately 200,000 ampoules
per day.
All of the intact ampoules then continue on to the labeling department,
where self-adhesive labels are applied. Product-specific printing
plates are first used to hot-stamp the
required data on the blank labels.
Immediately downstream, a camera
system checks to ensure that the
printing is complete and correct.
The label is then detached from its
carrier film, applied to an ampoule,
and secured by a roller. A sensor
uses a mark on each label to guide it
into position. As each ampoule is
discharged from the labeler, it is
monitored by another sensor that
confirms the presence of a label.
This equipment can label about
330,000 ampoules per day.
After labeling, the finished Traumeel
ampoules are spot-checked for correctly applied and printed labels.
Packaging
The labeled ampoules still have to
pass through one last department,
namely, the Packaging department.
A machine inserts the ampoules into
special trays shaped out of heated
plastic film. Another machine inserts
each filled tray into a folded cardboard box along with a package insert. After a scanner confirms the
identity of the secondary packaging
(box and package insert), the batch
number and expiration date are
stamped on the box. At the end of
the assembly line, the package is
weighed to confirm that all components have been included in the box.
The finished boxes are then bundled
and packed into shipping cartons.
The production head then checks
the manufacturing report to confirm
that the ampoules were produced in
accordance with the production instructions. The head of Quality
Control also checks the report to
confirm that all testing was conducted in accordance with the test instructions to ensure the required
quality. As the very last step, the
batch of medication is released by
the Qualified Person in accordance
with §15 of the German Pharmaceuticals Act (AMG).
Now the Traumeel ampoules are
ready to be shipped out to wholesalers and pharmacies in more than 50
countries around the globe. With a
production of 100 million units per
year, Heel is the world’s leading
manufacturer of homeopathic injection medications.|
Inserting ampoules into plastic trays
on the assembly line
) 27
C a s e St u dy
Co m p e t i t i o n
Submit your case study on bioregulatory treatment for presentation at
a scientific symposium in Baden-Baden, Germany!
Authors of the two best case studies received by the International
Academy for Homotoxicology (IAH):
q will present their findings in person at the scientific symposium
of the International Society of Homotoxicology and Homeopathy
(ISOHH) during Medical Week in late October 2010 in Baden-Baden,
Germany;
q will have their studies published in a subsequent issue of the wellknown “Journal of Biomedical Therapy;”
q will receive free travel and accommodations courtesy of the IAH.
For criteria and conditions of entry, along with a sample case study
and guidelines for writing up your research, visit the IAH website at
www.iah-online.com and click on “Case study competition.”
Let the world know about your expertise in bioregulatory medicine!
www.iah-online.com

In Focus - Traumeel

Transcription

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