Abstract:
We aimed to evaluate the effect of a combination of natural products on parameters related
to inflammation, endothelial dysfunction, and oxidative stress in a cohort of familial Mediterranean
fever (FMF) patients with Serum Amyloid A amyloidosis, in a non-randomized, 24-week open-label
interventional study. Morinda citrifolia (anti-atherosclerotic-AAL), omega-3 (anti-inflammatory-AIC),
and extract with Alaskan blueberry (antioxidant-AOL) were given to patients with FMF-related
biopsy-proven AA amyloidosis. Patients were >18 years and had proteinuria (>3500 mg/day) but a
normal estimated glomerular filtration rate (eGFR). Arterial flow-mediated dilatation (FMD), carotid
intima media thickness (CIMT), and serum biomarkers asymmetric dimethylarginine (ADMA),
high sensitivity C-reactive protein (hs-CRP), pentraxin (PTX3), malondialdehyde (MDA), Cu/Znsuperoxide
dismutase (Cu/Zn-SOD), and glutathione peroxidase (GSH-Px) were studied at baseline
and after 24 weeks of treatment. A total of 67 FMF-related amyloidosis patients (52 male (77.6%);
median age 36 years (range 21–66)) were enrolled. At the end of a 24-week treatment period with AAL, AIC, and AOL combination therapy, ADMA, MDA, PTX3, hsCRP, cholesterol, and proteinuria
were significantly decreased compared to baseline, while CuZn-SOD, GSH-Px, and FMD levels
were significantly increased. Changes in inflammatory markers PTX3, and hsCRP were negatively
correlated with FMD change, and positively correlated with decreases in proteinuria, ADMA, MDA,
cholesterol, and CIMT. Treatment with AAL, AIC and AOL combination for 24 weeks were significantly
associated with reduction in inflammatory markers, improved endothelial functions, and
oxidative state. Efficient control of these three mechanisms can have long term cardiovascular and
renal benefits for patients with AA amyloidosis.