tissue-protective and immune potentiating effects in thalassemic children: a pilot clinical trial

Thalassemia is a major health problem in affected children due to iron overload, increased oxidative stress, atherogenic lipid profile and tissue-damage. This study aims at investigating the cardioprotective and tissueprotective benefits of Al-hijamah and their impact on cell-mediated immunity for treating thalassemic children. This study aimed also at investigating the tissue-clearance principle of Taibah mechanism: whenever pathological substances are to be cleared from the human body, Al-hijamah is indicated. Al-hijamah was done to thalassemic children (15 males and 5 females having a mean age of 9.07 ± 4.26 years) using sterile disposable sets in a complete aseptic hospital environment. Prior ethical committee agreement (in addition to written patient’s consents) was obtained from Tanta Faculty of Medicine, Egypt. Twenty thalassemic children received iron chelation therapy plus Al-hijamah for one session (30-60 minutes) versus an age and sex-matched thalassemic control group treated with iron chelation therapy only. Al-hijamah is a quite safe outpatient hematological procedure that significantly decreased serum cholesterol (from 129.75 ± 3.67 to 103.5 ± 4.18 mg/dl) and decreased serum triglycerides (from 109.25 ± 8.96 to 91.95 ± 7.22 mg/dl). Interestingly, Al-hijamah exerted significant tissue-protective effects (it decreased serum GPT from 98.65 ± 12.27 to 71.65 ± 32.78 U/L and serum GOT from 96.35 ± 14.33 to 69.35 ± 34.37 U/L). Al-hijamah-induced ferritin excretion caused decreased serum ferritin (high serum ferritin negatively Al-hijamah is cardio-protective and tissue-protective in thalassemia 448 Am J Blood Res 2020;10(6):447-458 Introduction Children with β-thalassemia major exhibit increased endogenous oxidative stress-induced tissue damage evidenced by increased serum malondialdehyde (MDA), and MDA/low density lipoprotein-cholesterol (LDL-C) ratio and decreased plasma vitamin E levels [1-3]. Tissue damage in thalassemia involves many organs e.g. the liver and is characterized by raised serum hepatic transaminases (ALT and AST) in addition to elevated serum levels of cell death circulating biomarkers, M30 and M65 in patients with β-thalassemia major [4]. Thalassemia causes an atherogenic lipid profile (high serum cholesterol and LDL-C) where subclinical atherosclerosis started prematurely in children with beta-thalassemia than can be radiologically diagnosed through estimating the carotid artery intima to media thickness [5]. Currently, there is no single available treatment modality for thalassemia that exerts tissue-protective effects and improves patients’ immunity. Cupping therapy is a medical term that describes applying sucking cups to the skin for therapeutic purposes and includes both dry cupping therapy (DCT) and wet cupping therapy (WCT). Traditional WCT is currently practiced in Chinese hospitals (less frequently than DCT) and many other parts of the world for treating different medical conditions e.g. shoulder and neck pain [6]. Suction applied to cups is an external factor that can be controlled according to the therapeutic indications [7-12]. DCT is a one-suction step technique (single S technique) while wet cupping includes traditional Chinese WCT and prophetic medicine WCT (Alhijamah). Al-hijamah is not practiced in Chinese medicine but is highly recommended in so many prophetic ahadith (sayings). Traditional Chinese WCT is a two-step technique (skin scarification and suction, double S technique). Al-hijamah is Arabic WCT of prophetic medicine and is a three-step technique (skin suction, scarification and suction, triple S technique) practiced in Arabic countries. Al-hijamah is a promising excretory treatment to clear blood of causative pathological substances (CPS) according to the evidence-based Taibah mechanism (Taibah theory). Taibah mechanism states that Al-hijamah uses a physiological excretory mechanism (pressure-dependent filtration and excretion) through the fenestrated capillaries of the skin dermis (acting as a filter) that resemble the fenestrated capillaries of the renal glomeruli. In Taibah mechanism, Al-hijamah also acts as a super kidney that can excrete all causative pathological substances (CPS) collectively and simultaneously outside the human body. This clears the tissues, serum and intercellular fluids from CPS and enhances the immunity. In a previous report, Al-hijamah was reported to reduce serum ferritin (circulating iron stores) in healthy people (in one session) significantly by about 22.25% [13]. Excessive traditional Chinese WCT decreased serum iron significantly causing iron deficiency (in multiple sessions) [14]. Al-hijamah is an alternative treatment to phlebotomy for treating thalassemia with the advantage of minimal blood loss. We previously suggested Al-hijamah as a possible treatment for thalassemia [9, 10]. In this study, we aimed at investigating the two principles of Taibah mechanism: “whenever pathological substances are to be cleared from the human body, Al-hijamah is indicated. Al-hijamah enhances immunity”. Moreover, in this study, we investigated Al-hijamah as a promising treatment for thalassemic children. Materials and methods