FIBRONECTIN AS POSSIBLE ADJUNCT IN TREATMENT OF SEVERE MALNUTRITION

John Fredell; Yvonne Takyi; Walter Gwenigale; David Van Reken; David Troko; Mark Monson; Aloysius Hanson; Marilyn Horowitz; Bernard Horowitz; Lawrence Sandberg; Joyce Sandberg

doi:10.1016/S0140-6736(87)91437-1

FIBRONECTIN AS POSSIBLE ADJUNCT IN TREATMENT OF SEVERE MALNUTRITION

John Fredell
, Yvonne Takyi
, Walter Gwenigale
, David Van Reken
, David Troko
, Mark Monson
, Aloysius Hanson
, Marilyn Horowitz
, Bernard Horowitz
, Lawrence Sandberg
, Joyce Sandberg

Pathology Division

Research output: Contribution to journal › Letter › peer-review

Original language	English
Pages (from-to)	962
Number of pages	1
Journal	The Lancet
Volume	330
Issue number	8565
DOIs	https://doi.org/10.1016/S0140-6736(87)91437-1
State	Published - Oct 24 1987

ASJC Scopus Subject Areas

General Medicine

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@article{375eca0cc4f24b0c93f344ba9a6b713f,

title = "FIBRONECTIN AS POSSIBLE ADJUNCT IN TREATMENT OF SEVERE MALNUTRITION",

author = "John Fredell and Yvonne Takyi and Walter Gwenigale and \{Van Reken\}, David and David Troko and Mark Monson and Aloysius Hanson and Marilyn Horowitz and Bernard Horowitz and Lawrence Sandberg and Joyce Sandberg",

note = "Funding Information: TREATMENT OF SEVERE MALNUTRITION StR,\—Three years ago we tested plasma fibronectin levels in 58 malnourished Liberian children with marasmus or kwashiorkor. Low levels of fibronectin correlated with poor survival, and children destined to recover had rapidly increasing fibronectin levels before there were other overt signs of recovery whereas non-recovering children did not. A high initial fibronectin level was a better predictor (92\%) of recovery than was mid-arm circumference (77\%), total plasma solids (80\%), weight deficit (82 \%) or haematocrit (78\%). Yoder et aF have also reported rapid rises in fibronectin in successfully treated infants with protein- calorie malnutrition. We have given pure fibronectin or albumin (placebo) to 66 severely ill children of mean age 19 months with kwashiorkor (34), marasmus (28), or kwashiorkor/marasmus (4) who were admitted to three Liberian hospitals, from September, 1986, to March, 1987. The fibronectin was prepared by the New York Blood Center and treated with a solvent/detergent combination to inactivate viruses.3 The protein was administered intravenously on the first 4 days in hospital in a double-blind randomised study of three fibronectin doses (7-5, 15, and 21 mg/kg) or albumin (control) with approximately twice as many treated as non-treated. All groups received the same total protein dosage because albumin was added to the fibronectin to the same final protein content. All children received conventional nutritional support, together with antihelminthic drugs, antimalarials, and antibiotics where necessary. 14 children were given blood transfusions, but fibronectin, increases resulting from these were transient. The average length of hospital stay was 14 days. The 66 children had plasma fibronectin levels below 150 Ilg/ml on admission (normal above 250 ug/ml). A further 12 patients did not qualify for trial analysis because of initial plasma fibronectin levels above 150 ig/ml; they survived whether they were treated or not. 38 (84\%) of the 45 treated children but only 11 (52\%) of 21 controls survived (X2 test; p < 002). Treatment was effective regardless of dosage level. Weight, activity level, affect, facial and peripheral oedema, stool pattern, and appetite were recorded over the first 14 days in hospital. One-way analysis of variance revealed no significant differentes in improvement rate in respect of these variables between treated and non-treated children. The mechanism of action of fibronectin is unknown. This trial suggests that treatment with fibronectin can improve the chance of survival in severely malnourished children. Supported by grants from the Veterans{\textquoteright} Administration, Loma Linda Medical Center, Beckman Instruments Inc, and World Vision International and by private gifts. Chris Lace, Becky Minton, and Lynn Stell gave expert nursing and technical assistance.",

year = "1987",

month = oct,

day = "24",

doi = "10.1016/S0140-6736(87)91437-1",

language = "English",

volume = "330",

pages = "962",

journal = "The Lancet",

issn = "0140-6736",

number = "8565",

}

TY - JOUR

T1 - FIBRONECTIN AS POSSIBLE ADJUNCT IN TREATMENT OF SEVERE MALNUTRITION

AU - Fredell, John

AU - Takyi, Yvonne

AU - Gwenigale, Walter

AU - Van Reken, David

AU - Troko, David

AU - Monson, Mark

AU - Hanson, Aloysius

AU - Horowitz, Marilyn

AU - Horowitz, Bernard

AU - Sandberg, Lawrence

AU - Sandberg, Joyce

N1 - Funding Information: TREATMENT OF SEVERE MALNUTRITION StR,—Three years ago we tested plasma fibronectin levels in 58 malnourished Liberian children with marasmus or kwashiorkor. Low levels of fibronectin correlated with poor survival, and children destined to recover had rapidly increasing fibronectin levels before there were other overt signs of recovery whereas non-recovering children did not. A high initial fibronectin level was a better predictor (92%) of recovery than was mid-arm circumference (77%), total plasma solids (80%), weight deficit (82 %) or haematocrit (78%). Yoder et aF have also reported rapid rises in fibronectin in successfully treated infants with protein- calorie malnutrition. We have given pure fibronectin or albumin (placebo) to 66 severely ill children of mean age 19 months with kwashiorkor (34), marasmus (28), or kwashiorkor/marasmus (4) who were admitted to three Liberian hospitals, from September, 1986, to March, 1987. The fibronectin was prepared by the New York Blood Center and treated with a solvent/detergent combination to inactivate viruses.3 The protein was administered intravenously on the first 4 days in hospital in a double-blind randomised study of three fibronectin doses (7-5, 15, and 21 mg/kg) or albumin (control) with approximately twice as many treated as non-treated. All groups received the same total protein dosage because albumin was added to the fibronectin to the same final protein content. All children received conventional nutritional support, together with antihelminthic drugs, antimalarials, and antibiotics where necessary. 14 children were given blood transfusions, but fibronectin, increases resulting from these were transient. The average length of hospital stay was 14 days. The 66 children had plasma fibronectin levels below 150 Ilg/ml on admission (normal above 250 ug/ml). A further 12 patients did not qualify for trial analysis because of initial plasma fibronectin levels above 150 ig/ml; they survived whether they were treated or not. 38 (84%) of the 45 treated children but only 11 (52%) of 21 controls survived (X2 test; p < 002). Treatment was effective regardless of dosage level. Weight, activity level, affect, facial and peripheral oedema, stool pattern, and appetite were recorded over the first 14 days in hospital. One-way analysis of variance revealed no significant differentes in improvement rate in respect of these variables between treated and non-treated children. The mechanism of action of fibronectin is unknown. This trial suggests that treatment with fibronectin can improve the chance of survival in severely malnourished children. Supported by grants from the Veterans’ Administration, Loma Linda Medical Center, Beckman Instruments Inc, and World Vision International and by private gifts. Chris Lace, Becky Minton, and Lynn Stell gave expert nursing and technical assistance.

PY - 1987/10/24

Y1 - 1987/10/24

UR - https://www.scopus.com/pages/publications/0023239654

UR - https://www.scopus.com/pages/publications/0023239654#tab=citedBy

U2 - 10.1016/S0140-6736(87)91437-1

DO - 10.1016/S0140-6736(87)91437-1

M3 - Letter

C2 - 2889873

SN - 0140-6736

VL - 330

SP - 962

JO - The Lancet

JF - The Lancet

IS - 8565

ER -

FIBRONECTIN AS POSSIBLE ADJUNCT IN TREATMENT OF SEVERE MALNUTRITION

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