Yeast
Derived Beta-1,3-D-Glucan:
An Adjuvant Concept
by Leonid Ber, MD
According
to the Webster Medical Dictionary, adjuvant (from Latin ad-juvo,
to give aid to) is a substance added to a drug product formulation
which affects the action of the active ingredient in a predictable
way. This term has been widely utilized in immunology, where it means
a vehicle used to enhance antigenicity of vaccines (for example,
Freunds adjuvant). Much broader utilization of this term can
be applied today to some naturally derived substances. This adjuvant
concept closely relates to what is today referred to as a complementary/alternative
modality.
Poly-branched
beta-1,3-D-glucan is a naturally occurring polysaccharide that can
be found in a variety of fungal cells including cell walls of yeast,
Saccharomyces cerevisiae. As any other glucan (or polyglucose), it
consists of glucose units linked together. For example, most starches
are alpha-glucans. Out of different glucans, the beta-1,3-D-glucan
configuration has been shown to act as a non-specific immune-activator.
Goldman,
and later Czop, identified a specific receptor on the cells of macrophage
origin that binds to the beta-1,3-D-glucan molecule. This receptor
is a protein complex that appears to be present throughout the whole
differentiation cycle of macrophages, starting in the bone marrow.
Mature macrophages are found in virtually all the tissues including
the central nervous system. When a macrophage encounters beta-1,3-D-glucan,
it becomes activated. All the functions, including phagocytosis (ability
to engulf foreign cells and particles), release of certain cytokines
(intercellular hormones), and the processing of antigens are improved
and brought up-to-date. Macrophages are extensively involved in everyday
detoxifying processes, intestinal flora maintenance, anti-infective
and anti-tumor protection and maintenance of overall health integrity.
Although most of the research with this substance has been done in
vitro and parenterally, later research at Baylor College of Medicine,
sponsored by ImmuDyne, indicates the oral effectiveness of purified
beta-1,3-D-glucan (Wyde, 1989).
The
integrity of beta-1,3-D-glucan taken orally differs from other food
substances. This type of glucan is acid resistant so it passes the
stomach virtually unchanged. Further, in the intestine there is a
lack of a specific enzyme (beta-1,3-glucanase) that would break it
down to glucose or di-glucose so as to be absorbed through the intestinal
wall. On the other hand, there are macrophages that inhabit the intestinal
wall and are able to pick up beta-1,3-D-glucan particles through
beta-glucan receptors. Immediate activation of these cells follows
and later, they are able to travel back to the local lymph nodes
(Payers Patches) as a part of their natural antigen-presenting function,
to release cytokines (IL-1, IL-6, GM-CSF, Interferons) and induce
systemic immune activation.
The
mechanism described above is called phagocytic transport and it is
common for certain microorganisms. Studies conducted with oral application
of C13 labeled glucan also support existence of phagocytic transport
for beta-1,3-D-glucan.
An
adjuvant concept of pharmacological application for beta-1,3-D-glucan
was suggested by DiLuzio in the 70s. This article is an attempt to
overview this concept from today's perspectives utilizing modern
knowledge of oral effectiveness, and a specific transport mechanism
of beta-1,3-D-glucan.
There
is now enough data to support the use of beta-1,3-D-glucan as an
adjuvant in several important medicinal applications.
1.
Combination "glucan + anti-infective agent
Beta-1,3-D-glucan
itself can elicit broad anti-infective effects. The nature of macrophage
activation induced by this compound is non-specific. Staphylococcus
aureus, Eschericia coli, Candida albicans, Pneumocytis carinii, Listeria
monococytogenesis, Leishmania donovani, Herpes simplex, Ascaris suum
- this is an incomplete list of microorganisms, against which a protective
effect of glucan has been established. This list, as you can see,
includes bacteria, fungi, viruses and parasites. None of the anti-infective
agents possess such a broad spectrum of activity. Unlike an antibiotic
compound interfering with metabolism of a pathogen, beta-1,3-D-glucan
is a substance that modifies host response to cells genetically different
from the host.
Numerous
studies support the theory that an antibiotic and a macrophage activator
work synergistically.
Experimental
peritonitis in rats was used to show synergy between widely used
antibiotic ampicillin and glucan. A 100% survival was the result
of the combination treatment, while glucan alone gave 30% survival,
and ampicillin in the given dose elicited 65% survival (20% survival
in the control group). All the results were statistically significant
(Lahnborg 1982).
A
56% survival was achieved when subtherapeutic doses of gentamycin
was combined with intraperitoneally delivered glucan at just 0.1
mg/mice challenged with Escherichia coli. This was a very significant
increase of survival rate, considering that either no treatment or
this low dose of antibiotic alone, gave no protection from peritonitis
(0% survival), while glucan alone gave 9% increase in survival. The
difference between controls and the combination treatment was highly
statistically significant (Browder, 1987).
Anti-fungal
effect of beta-1,3-D-glucan from yeast cell wall is particularly
interesting. It is known that glucan configuration in Saccharomyces
cerevisiae resembles the one in Candida albicans . Glucan administered
orally in mice with chronic generalized Candida infection, resulted
in significant increase in the candidacidal activity of alveolar
and spleen macrophages. The resistance not only to systemic infection
with Candida albicans, but also Staphylococcus aureus increased,
significantly reducing the growth of microorganisms in the kidneys
of infected animals. Glucan also worked synergistically with the
anti-fungal drug Amphotericin B (Nicoletti, 1992).
Although
there is not enough data collected with regard to the anti-viral
effect of glucan, there is now work in progress regarding its adjuvant
anti-HIV effect.
Mortality,
associated with Herpes simplex in mice was shown to be profoundly
modified in early works and later, it was supported by oral studies
(Wyde, 1990).
Mice
treated with glucan both before and after the lethal viral hepatitis
challenge, exhibited only limited liver pathology, minimal plasma
enzyme alterations, and greatly enhanced survival versus a group
receiving no treatment (DiLuzio, 1980). Macrophage phagocyting function,
significantly impaired by hepatitis, was maintained by glucan application.
Another
study shows that virally challenged mice have a limited wound-healing
capacity that was corrected by systemic glucan application (Kenyon,
1983).
2.
Combination "glucan + anti-neoplastic agent"
Glucan
anti-tumor effect can be local or systemic. A local injection of
beta-1,3-D-glucan suspension into melanoma lesions has been shown
to successfully resolve the tumor locally (Mansell, 1978). In these
human experiments, the site of injection revealed no previously established
tumor, but plenty of macrophages filled with pigments. Obviously,
macrophages were drawn to the site where they phagocytized and destroyed
pigment-bearing tumor cells. These intralesional injections in some
cases were able to control further growth of remote metastasis of
the same tumor which resumed growth after glucan treatment withdrawal.
Unfortunately,
no clinical applications were developed out of these results until
recently (Carrow, 1996). The latest data contains very promising
information, not only in regard to human melanoma, but also to basal
cell carcinoma.
Experimental
animal data on systemic applications of beta-1,3-D-glucan anti-tumor
effects is abundant. Significant reduction in tumor growth and prolonged
survival was observed in mice with transplanted melanoma. In mice
with adenocarcinoma, there was an 85% reduction of tumor mass accompanied
by prolonged survival. An anaplastic mammary carcinoma study showed
results of 70% tumor regression and 80% survival versus 100% in the
group with no glucan treatment. Chronic administration of glucan
to aging mice with lymphocytic leukemia significantly improved their
survival (DiLuzio, 1980).
In
these and other experimental models, systemic macrophage activation
and certain cytokine releases, seem to be critical for clearing tissues
from the tumor cells (Proctor, 1980) and inhibiting metastasis (Sakurai,
1991).
A
combination of beta-1,3-D-glucan and an antineoplastic agent(s) might
have a significant potential considering its a) direct anti-tumor
effect, and b) ability to counteract chemotherapy-induced immunosuppression
resulting in higher mortality from opportunistic infections.
The
efficacy of glucan in combination with BCNU chemotherapy was measured
using the disseminated transplantable leukemia; the combination yielded
a high level (56%) of cures compared to no survival for either agent
alone (Stewart, 1978).
Glucan
application can also protect a patient from leukocytopenia (decrease
in the number of peripheral leukocytes) associated with a chemotherapeutic
agent, which is one of the major obstacles in the chemotherapy of
cancer. A decrease in the number of peripheral leukocytes by 5-fluorouracil
was prevented by the oral application of glucan in mice. Proliferative
responses of bone marrow cells to granulocyte/macrophage colony stimulating
factor (GM-CSF) or granulocyte colony stimulating factor (G-CSF)
were suppressed by 5- fluorouracil treatment, and their recoveries
were enhanced by glucan and serum level of cytokines such as IL-1
and IL-6 were increased (Miyazaki, 1992 ).
Interestingly,
that use of corticosteroid hormones, also having immunosuppressive
effect, and widely used as a part of chemotherapy programs or in
autoimmune situations, might be another indication for use of beta-1,3-D-glucan
in combination with this class of drugs. Goldman showed that the
amount of beta-1,3-D-glucan binding capacity of macrophages increases
when they are exposed to hydrocortisone. She states that this might
be a result of enhanced expression of beta-glucan receptor. A logical
interpretation of that can be that it's an attempt to compensate
the diminished phagocytic ability of macrophages exposed to this
class of hormones.
3.
Combination " glucan + radiotherapy
This
combination seems to be very logical in the light of the data mentioned
above. Radioprotective (bone marrow protective effect) of yeast glucan
is well-established and documented with the mechanism of enhancing
hemopoietic recovery and hence, by regenerating the host's ability
to resist life-threatening opportunistic infections. However, it
also has been demonstrated that host resistance to opportunistic
infection in glucan-treated irradiated animals is enhanced even prior
to the detection of significant hemopoietic regeneration. This early
enhanced resistance to microbial invasion could be correlated with
enhanced and/or prolonged macrophage (but not granulocyte) function.
These
results suggest that early post-irradiation glucan may mediate its
radioprotection by enhancing resistance to microbial invasion mechanisms
not necessarily predicated on hemopoietic recovery.
Experimental
data suggest that glucan can also function as an effective free-radical
scavenger (primarily toward hydroxyl radical). Because macrophages
have been shown to selectively phagocytize and sequester glucan,
it is possible that these specific cells may be protected by virtue
of glucan's free-radical scavenging ability (Patchen, 1987).
Oral
application of yeast beta-1,3-D-glucan for 20 consecutive days after
a single, near lethal, dose of radiation resulted in 70-90% survival
versus 30% in the control group.
4.
Combination "glucan + topical agent"
Glucan
is an excellent wound healer. In experiments glucan-treated wounds
showed a higher number of macrophages in the early, inflammatory
stage of repair, with fewer polymorphonuclear neutrophilic leukocytes
than did control wounds. Both re-epithelization and the onset of
fibroplasia commenced at an earlier stage in glucan-treated wounds
than in control wounds. Five days following the incision, glucan-treated
wounds were generally completely re-epithelialized, while control
wounds were not. The organization of fibroblasts in glucan-treated
wounds was more advanced at 5 and 7 days following injury, and the
extent of fibroplasia was also greater. By 10 days following injury,
glucan-treated wounds were completely re-epithelialized and no formation
of granulomas was observed up to one month following wounding (Leibovich,
1980).
In
humans, topical glucan treatment resulted in 73% improvement in chronic
decubitus ulcers with complete closure and epitalization in 27% of
treated ulcers. All wounds remained clean with no infections occurring
during this treatment (DiLuzio, 1984).
Considering
the data above, a topical combination of an antibiotic and beta-1,3-D-glucan
as an adjuvant for wound healing applications, seems to be appropriate.
An
interesting effect of topical application of glucan was observed
in regard to non-wounded aged skin. Revitalizing, such as reducing
the number, depth and length of wrinkles, thickening, reducing roughness
and dryness of the skin was shown in a group of female volunteers
(Smith, 1991).
Applied
topically, glucan activates epidermal macrophages (Langerhans cells).
This mechanism plus its free-radical scavenging effect makes it a
photoprotective agent. Glucan application resulted in the reduction
of after-UV erythema and preservation of the amount of Langerhans
cells in the epidermis (Elmets, 1992). A combination of a sunscreen
+ glucan is suggested.
Anti-irritant
effect of beta-1,3-D-glucan was also shown in combination with otherwise
severe irritation causing levels of lactic acid (Smith, 1991). Glucan
also has a synergistic effect with another anti-aging topical ingredient:
retinoic acid (Retin-A). Similar to corticosteroids, Retin-A significantly
increases the number of beta-glucan receptor-sites on phagocytic
cells.
5.
Combination "glucan + nutrients"
Very
recent discoveries have been made on combined use of glucan and vitamin
C derivatives.
Intracellular
ascorbate content in phagocyting cells reaches 40 times the level
of plasma ascorbates. Macrophages activated with beta-1,3-D-glucan
exhibit a significant drop in the intracellular ascorbate content.
This might lead to the exhaustion of free-radical scavenging capacity
of these cells, as well as to impaired motility and certain enzyme
production by macrophages.
There
are products on the market now that combine beta-1,3-D-glucan and
vitamin C derivatives to replenish ascobate levels in the glucan-activated
macrophages. This is not only physiological from the standpoint of
glucan pharmacological effects, but it also seems to have a great
impact on results of Vitamin C treatments.
Commercial
application of yeast derived purified beta-1,3-D-glucan, available
in a dietary supplement form and in a pure form for compounding,
started in 1995. There is obviously a lack of recent double-blind
human studies but plenty of anecdotal clinical data ranging from
tumor mass rejection to healing of chronic wounds. Hopefully, we
will see more studies with beta-1,3-D-glucan in the near future as
this substance gains acceptance within the medical community.
Clinical
directions presented in this paper are not by any means a complete
list of all possible applications and adjuvancy combinations with
this substance. I believe that a thinking physician can find more
ways to utilize this material in practice. Now, when we have a better
understanding of its mode of action, we can prognose and prove in
practice the benefits of using beta-1,3-D-Glucan by itself or by
adding it to either conventional or alternative types of therapies
that would affect such therapies in a predictable way, which in turn
is a concept of adjuvancy.
Correspondence:
Leonid
G. Ber, MD, Vice President Research & Development
ImmuDyne,
Inc., 11200 Wilcrest Green Drive, Houston, Texas 77042 USA
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