Complementary inhalation of bicarbonate and thiocyanate in addition to the normal inhalation with Sodium Chloride

Question

Dear ladies and gentlemen,
our little son is 18 months old and has been diagnosed as a CF child 6 weeks ago. Of course, we as parents are constantly reflecting how we could further develop or improve the therapy of our child. As an employee of a university I have online-access on many scientific medical data pools and journals. I have to admit, that I am looking to these very often....
Many a time I have read that the CFTR gates in addition to chloride ions also bicarbonate and thiocyanate (and lately: hyaluronic acid). The effects of this on a defective CFTR are discussed.
So, the absence of bicarbonate is expected to impede the folding of the mucines in the lung as well as the absence of thiocyanate is expected to weaken the immune-system of the lung, as hypothiocyanate as a "mild" oxidant is not produced anymore.
I ask myself for quite a time, why the daily inhalation with iso- or hypertonic saline is not completed with these salts, in order to achieve a therapeutic effect?
Finally the normal saline inhalation is not more than "only" the complementation of something that is missing. The GSH-inhalation would for me also aim in the direction of this approach...
Are there any attempts in this direction respectively are there any planned?
I would be very thankful for an answer.
Yours sincerely,

Answer

Dear questioner,
your questions are right and therefore I have difficulty in only answering them with the comment that there are up to now not enough study data. I would nevertheless like to do it in such a way. I am working at a CF-center with a research group in which the topic "rehydration of the mucus and improvement of the muco-ciliaric clearance (as far as possible)" plays a very important role.
Also that you are thinking about this in a time, when your child is still so young, is absolutely right. We also follow therapeutic approaches here, that achieve the greatest effect when used preventively. In spite of this I have to put you off, as each of these components has to be checked sufficiently and until now they are not. Even if it seems theoretically very logical, many things can not be confirmed in the end or are overlaid in vivo by other physiological and pathophysiological effects or even neutralized. Therefore one should wait until the group around P.M. Quinton provides first data concerning inhalation of bicarbonate (?), which show that the theory is correct. As I occupied myself some years ago with oxidants and antioxidants, I know, that here one has to take into account the wole "antioxidative network". The supplementation of a one single substance as savior did not bring the hoped effect in other illnesses with a deficiency of antioxidants, as the anti-oxidative capacity of a single substance is also dependent on other anti-oxidants (enzymatic, non-enzymatic). There are some anti-oxidants, which could react as an oxidant after their reaction, if they are not recycled fast enough.
In how far this is so for the by you mentioned substances, is at the moment not known to me and probably also not known to many other CF-treaters. Therefore studies are absolutely needed, in which effects and side-effects of the single substance have to be checked. Unfortunately one does not like to hear the calling for patience, especially then, if one runs out of time. But I can only ask for this.
For me as somebody who worked for years on carotinoides, the most difficult experience was the CARET-study. In this study smokers were treated with carotin and vitamin A, because one was of the opinion that there was enough evidence for its positive effect and that was really so at this point in time. In 1996 the study was stopped as there were more deaths in the verum-group than in the placebo-group and else there were no positive effects in comparison for the verum-group. Also here it came up that a vitamin resp. a carotinoid (until then always seen as an anti-oxidant) given in high dosage to an organism with a generally depleted "anitoxidative system" can lead very fast to negative effects. In this case both substances oxidated fast to high reagible peroxidative products, which can especially damage enzymes and protein structures. For sure this result does not have to be true for the by you mentioned substances, but such results prohibit an unexamined usage. On the other hand, in case of CF every straw has to be caught and no promising possibility (this is what it is about here) should be left unexamined. I hope to have helped you with my answer.
Yours sincerely.
Olaf Sommerburg

22.11.2010