Possible mechanism of action of chickpea on gastrointestinal manifestation in cystic fibrosis patients

Shahpar Kaveh, Saeed Sadr, Hanieh Tahermohammadi

1Shahid Beheshti University of Medical Sciences, Traditional Medicine and Materia Medical Research Center, Iran; 2Shahid Beheshti University of Medical Sciences, Department of Pediatrics Pulmonary Diseases, Mofid Children’s HospitalShahid Beheshti University of Medical Sciences, Iran; 3Shahid Beheshti University of Medical Sciences, Department of Traditional Medicine, School of Traditional Medicine, Iran.

Cystic fibrosis (CF) as the commonest inherited disorder in Caucasians can affect around 1 in every 2,500 live births.Which is due to the CF transmembrane conductance regulator (CFTR)dysfunction, located mainly at the apical surfaces of epithelial cells in the airways, pancreas, intestine,kidneys, sweat gland, and male reproductive tract,in which CFTR is vital for the transepithelial fluid homeostasis.CFTR malfunction may result in lifethreatening disorders [1].The digestive problems are resulted in the forming abnormally thick mucus because of failure in chloride and water transport.In the gastrointestinal tract, such thick and sticky mucus can clog the ducts preventing digestive enzymes to enter the intestine.Nutritional insufficiency remains a big concern in CF patients and it accrues owing to the CFTR mutation which leads to the production of abnormally thick and sticky mucus affecting the food digestion and absorption, especially, fat and fatsoluble vitamins, and prohibiting digestive enzymes to be entered the intestine.Accordingly, foods are not digested or absorbed in good order, resulting in maldigestion and malabsorption.Related complications are consist of exocrine pancreatic dysfunction, intestinal inflammation, enteric circular muscle impairment,bacterial overgrowth, and impaired bicarbonate and bile acid release [2].

Iranian Traditional Medicine (ITM), which has been developed by the attempts made by the Iranian Muslim physicians, such as Avicenna (980–1037AD)and others in ancient and medieval time.The Canon of Avicenna is one of the manuscripts by these physicians that have been used as reference books in international Universities until the 17th century AD.Their significant manuscripts has been written and applied in Iran till the 18th century.Thus, the concepts or agents introduced in them have been applied between the 10th and the 18th century and passed trials and tests by different Iranian physicians [3].

There is no CF disorder in ITM sources, but due to the production of thickened secretions in the body ducts, it is classified in the group of diseases caused by the production of thick and sticky secretions.Due to the nutritional status importance in CF management besides the ITM recommendation about the food effects in diseases with thick and sticky secretions in body ducts such as gastrointestinal tract, chickpea is one the best food that helps to eliminat the thick gastrointestinal tract secretions [4].Chickpea (Cicer arietinum) belongs to Fabaceae family [5].India has been the largest producer of chickpea, followed by Pakistan, Turkey, Australia, Myanmar, Ethiopia, Iran,Mexico, Canada and the United States [6].According to the main theories regarding CF, chickpea possibly is a hypothesis to develop a natural medicinal or functional food for the treatment of CF gastrointestinal disorders, because of the following reasons: Chickpeas contain phenolic compounds, isoflavonoids, and flavonoids, such as kaempferol, genistein, myricetin,and quercetin [5].Genistein is a natural isoflavone and its biological effect was first reported in the 1940s and early 1950s.Quercetin as a flavone in the 1980s was revealed capable of inhibiting PKC, phosphorylase kinase, casein kinase, and the tyrosine kinase activity associated with pp60src [7].It has been approved that genistein and other associated flavones and isoflvones influence epithelial ion transport.Nguyen et al.were the first to report these impacts of flavones on the ion transport mediated by CFTR.They indicated that quercetin and kaempferol activated Cl release across T84 cell monolayers [7, 8].Also in one study, total polyphenol content and total flavonoid content were examined in 17 chickpea categories, which showed that the shells of these plants contained more than 95%of these compounds [9], and Chickpea has various vitamins, minerals and many bioactive compounds,such as phytates, oligosaccharides, enzyme inhibitors can reduce the risk of chronic disorders.It has also nutritive value making it accepted as a functional food[6].

According to the mentioned studies, chickpea can be hypothesized as a functional food for CF patients just as it has some ingredients that affect CFTR in previous studies, also gain consumer acceptance as a functional food.So chickpea is suggested as a functional food for next experimental and clinical research in CF.