Invasive giardiasis is the most common gastro-intestinal infection caused by the protozoal parasite-Giardia lamblia. The Incidence of infection is as high as in 50% or more in the regions of world with inadequate hygienic conditions, especially in populations of lower socio-economic levels. A high prevalence of this infection is noticed in infants and children. A large proportion of patients remain asymptomatic. The modern chemotherapy, though has better response on acute infection, but it is associated with several side effects, such as drug-resistance, disturbance of microflora of bowel, nausea, abdominal cramps, furry tongue, metallic sharp and unpleasant taste etc. Therefore, preference is converging on herbal drugs, especially on Rasayana Therapy as these drugs not only help to eradicate the parasite but also rejuvenate the ‘Bala’ or immunity of the host. In the present study efforts are directd to unravel the immunomodulatory anti-protozoal/anti-giardial activity of the herbal preparation; Pippalli Rasayana (PR), a product developed from two herbs, viz., Pippalli (Piper longum) and Palash (Butea monosperma).
1. Preparation of drug
Palash \Butea monosperma) Panchang (40 Kg stem, bark and leaves + 10 Kg roots + 10 Kg flowers and fruits) were dried. Contents were burnt to ashes (4.5 Kg) and dissolved in 8-10 times weight of water. The mixture was thoroughly stirred and left for 24 hr. Contents were then filtered through a folded fine cloth. The filtrate (Palash Kshara-Jal) was subjected to Bhawana to Pippalli as under; Pippalli {Piper longum) fruit was dried and powdered after removing the foreign particles. Powder (15 Kg) was thoroughly mixed with Palash-Kshara-Jal and dried under the sun. The contents were well ground and fried in butter. The finished product was called as Pippali Rasayana (PR).
2. Immuno-modulation tests
Balb-C mice, weighing 18-20 gm, were orally administered with varying doses of PR. Drug was given daily for seven days. The subsequent day was termed as zero-day for further tests.
(a) Macrophage migration index (MMI)
The assay was carried out according to the standard method of Saxena et. al. Briefly; on day zero, peritoneal exudate cells (PEC) were collected from mice by administering RPMI-1 640 medium containing 10 lU/ml heparin and withdrawing exudate aseptically. The PEC were washed and suspended in the same medium to a concentration of 40-50 X 106 cells/ml. The suspension was filled in microhaematocrit capillaries. One end of the capillary was sealed and centrifuged at 600 X g for 3 min. The capillaries were cut at cell-liquid interphase, placed in a migration chamber filled with complete RPMI-1640 containing 10% fetal calf serum. PEC from normal (Untreated control) mice were simultaneously run in a similar manner. The ratio of the area of migration of the cells from treated animal to that of the control was termed as MMI.
(b) Haemagglutination (HA) titre
It was done according to the method of Puri et al. Briefly; the drug-treated and untreated (control) mice were injected with 1 X 1Q8 sheep-RBC (SRBC) intraperitoneally. After four days of immunization, serum was collected by retino-orbital puncture. Antibody levels were determined by two fold dilution of sera, prepared in 0.15 M PBS, pH 7.2 in ‘V’ bottom micro-titer plates. Into each well 25 ml of 1 % SRBC suspension was dispensed and contents were mixed thoroughly. After 1.5-2.0 hr. of incubation at room temperature the reciprocal of the highest dilution of the test sample giving 50% agglutination was expressed as the HA-titre.
(c) Plaque forming cell (PLC) assay
PFC test was carried out according to the method of Jerne and Nordin (1963). Briefly; the spleen cells were separated, from the drug treated and untreated (control) mice, in RPMI-1640 medium. Cells were washed and suspended in the same, medium to a density of 1X106 cells/ml. Petri dishes (2.5 cm diam.) were layered with 1.2% agaraose in RPMI-1640, 0.1 ml suspension of 20% (v/v) SRBC and 1X105 spleen cells in 0.1 ml was poured over the base layer. The petri dishes were incubated at 37°C for 90 min. Two ml. of 1:10 diluted fresh guinea pig serum was added in each petri dish as a source of complement. Incubation was further followed for 45 min. Plaques formed on the agarose surface were counted immediately and the values were expressed as counts per 105 spleen cells.
3. In vivo Antigiardial test
Swiss mice, weighing 18-20 gm, free from G. muris infection were used. Axenic-strain of G. lamblia (Portland-1), grown for 48 hr. in TYI-S-33 medium, was centrifuged. Supernatant was discarded and pellet was dispensed with fresh medium. An aliquot of 0.25 ml medium, containing 0.5-1.0 X 106 trophozoites were injected intra-jejunally in mice. After 48 hr of infection the animals were divided into two groups of six each. One group served as control and other was administered with varying doses of drug orally. The drug was given daily for 5 successive days, after which the control and the treated animals were sacrificed. Jejunum was surgically removed and flushed with PBS pH 7.2. Flushings were examined microscopically for trophozoites. Relative recovery (%) was assessed in experimental sets by comparing against the control (infected + drug un-treated) sets.
4. Clinical study on giardiasis-patients
(a) Selection of patients
Patients were selected from the out patient (OPD) and Indoor patient department (IPD) of State Ayurvedic College and Hospital, Lucknow. Patients, with typical symptoms of giardiasis especially those showing recurrence of infection, were included in the study.
(b) Pathological investigations
(i) Stool examination
Small portion of stool samples was suspended in 1-2 ml. of normal saline (0.85% w/v sodium chloride). Allowed to stand at room temperature. Cysts of G. lamblia, floating over the surface, were carefully with-drawn with a Pasture pipette and dispensed over the glass slide. On microscopic examination, Giardia-cysts appeared double walled body with a faint median line and four nuclei.
(ii) Haematological examination
Blood smear, prepared from a single drop of patient’s blood, was stained with Leishmania’s stain and examined in a light microscope. Total (TLC) and differential (DLC) were recorded. RBC counts were determined in Neubauer’s chamber. Erythrocyte sedimentation rate was assessed in Wintrobe’s tube and Packed Cell Volume (PCV) by the haematocrit tube. Haemoglobin estimation was carried out by Sahil’s method.
(iii) Serum examination
Serum protein and serum albumin was estimated by standard kit (Mitra total protein reagent and albumin kit, New-Delhi). Subsequently from the values, Albumin: Globulin (A:G) ratio was extrapolated. Cell mediated immune (CMI) status of giardiasis patients was determined from serum samples by LMI-test, briefly: macrophages were collected from mice after administration of 8-10 ml tissue culture medium (RPMI-1640) with 10 Ill/ml heparin. Peritoneal exudate (PE), so collected, was centrifuged at 250 X g for 3 min. PE containing peritoneal macrophages (PM) was washed with RPMI-1640 with 20% v/v foetal calff serum. 1 ml medium with 2 X 106 PM were dispensed into a test tube with 0.2 ml test serum and incubated the contents for 2 ha. at 37°C. Washed the cells with RPMI-1640. PM were filled into a microhaematocrit capillary, sealed at one end with plasticine and centrifuged at 250 X g for 3 min. capillaries were cut at cell/liquid interphase with diamond pencil and the closed end was fixed on the bottom of migration chamber with the help of non-toxic paraffin wax. Chamber was filled with complete RPMI-1640 medium, covered with a glass coverslip and sealed with paraffin wax.. Chamber was incubated under humidity at 37°C for 18 h. Following incubation the area of migration of macrophage was drawn on Whatman No. 1 filter paper with the help of Camera Lucida attached to a light microscope.
5. Administration of drug and follow-up
The patients were given PA in the doses of 2.5 gm, twice a day with jeggury, honey or milk. Patients were advised to take light and easily digestible diet. The outdoor patients were asked to attend OPD weekly for the clinical examination, whereas IPD patients were examined daily. Their stool samples were collected weekly to examine for the cysts of G. lamblia. Patients were examined clinically and pathologically for the progress of the clinical features for another 2 months.
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