A Tannic Acid-Based Medical Food, Cesinex super( registered ), Exhibits Broad-Spectrum Antidiarrheal Properties: A Mechanistic and Clinical Study

Background: The purpose of this investigation was to evaluate the efficacy and tolerability of a tannic acid-based medical food, Cesinex super( registered ), in the treatment of diarrhea and to investigate the mechanisms underlying its antidiarrheal effect. Methods: Cesinex super( registered ) was prescribed to six children and four adults with diarrhea. Patient records were retrospectively reviewed for the primary outcome. Cesinex super( registered ) and its major component, tannic acid, were tested for their effects on cholera toxin-induced intestinal fluid secretion in mice. Polarized human gut epithelial cells (HT29-CL19A cells) were used to investigate the effects of tannic acid on epithelial barrier properties, transepithelial chloride secretion, and cell viability. Results: Successful resolution of diarrheal symptoms was reported in nine of ten patients receiving Cesinex super( registered ). The treatment of HT29-CL19A cells with clinically relevant concentrations of tannic acid (0.01-1 mg/ml) significantly increased transepithelial resistance (TER) and inhibited the cystic fibrosis transmembrane conductance regulator (CFTR)-dependent or the calcium-activated Cl super(-) secretion. Tannic acid could also improve the impaired epithelial barrier function induced by tumor necrosis factor alpha (TNF alpha ) and inhibited the disrupting effect of TNF alpha on the epithelial barrier function in these cells. Cholera toxin (CTX)-induced mouse intestinal fluid secretion was significantly reduced by the administration of Cesinex super( registered ) or tannic acid. Cesinex super( registered ) has high antioxidant capacity. Conclusions: Cesinex super( registered ) demonstrates efficacy and a good safety profile in the treatment of diarrhea. The broad-spectrum antidiarrheal effect of Cesinex super( registered ) can be attributed to a combination of factors: its ability to improve the epithelial barrier properties, to inhibit intestinal fluid secretion, and the high antioxidant capacity.