1. Background
Asthma constitutes a significant health problem both in Hong Kong and worldwide (1). Different risk factors for asthma have been identified. These include atopy (2), family history of asthma, exposure to indoor aeroallergens (3) air pollution (4) and exposure to environmental tobacco smoke (5).
Asthma is associated with a chronic inflammatory state in the airway. The inflammatory component is thought to result from an imbalance between an increased free radical formation (oxidative stress) and a reduction of antioxidative defenses. Reactive oxygen species (ROS) such as superoxide radicals and hydrogen peroxide were found to be increased in patients with asthma indicating the presence of oxidative stress, and the increased level of ROS has also been found to correlate with asthma severity (6).
The airway displays a wide range of enzymatic and non-enzymatic antioxidant defenses, including reduced glutathione (GSH), superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx). There is evidence of reduced antioxidant defenses, namely GPx and SOD activity, in asthma patients (6). Furthermore, the measurement of the oxidized form of glutathione, (glutathione disulfide, GSSG) could be used as an index to reflect the degree of oxidative stress in asthma and the level of GSSG has been reported to be high in the bronchial washings of asthma patients (7). We have reported that patients with asthma showed significantly increased erythrocyte GSSG, SOD and catalase activities with concomitant reduction of erythrocyte GPx (8). These results indicate a state of increased oxidative stress accompanied by an altered state of systemic antioxidant status in asthma patients.
Green tea represents one of the common beverages consumed by people from all walks of life. Epigallocatechin gallate (EGCG) is the major polyphenol (catechin) in green tea. Green tea extract (GTE) demonstrates anti-inflammatory and immunomodulatory activities. GTE has been shown to damp down neutrophil chemotaxis and attenuates interleukin-mediated inflammatory reaction cascades (9). It has also been shown to attenuate lung injury in experimental mouse model (10).
This proposal is to investigate the effects of GTE on systemic oxidative and antioxidative status, and whether these changes are associated with changes in clinical status in local Chinese patients with stable asthma.
2. Research plan and methodology
Aims of the study
1. To determine and compare erythrocyte levels of GSSG, SOD, CAT and GPx in patients with asthma after 3 months of treatment with GTE and after GTE has been stopped for an equivalent period.
2. To determine and compare plasma levels of inflammatory marker C-reactive protein (CRP) and inflammatory mediators, interleukin-6 (IL-6) and IL-8 in these patients.
Study design This is an intervention study with patients serving as their own control
Material and Methods Patients
The investigators propose to recruit out-patients with asthma in stable clinical condition and have no acute asthmatic attack in the recent 3 months prior to recruitment. After initial assessment, recruited patients will be given GTE to be taken three times a day for 3 months. They will be reassessed at 3 months when GTE will be stopped and again at the end of 6 months. The clinical status and biochemical parameters when they are on GTE will be compared with similar parameters when they are not on GTE.
