A Tannic Acid-Based Medical Food, Cesinex, 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, in the treatment of diarrhea and to investigate the mechanisms underlying its antidiarrheal effect. Methods Cesinex was prescribed to six children and four adults with diarrhea. Patient records were retrospectively reviewed for the primary outcome. Cesinex 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. 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- secretion. Tannic acid could also improve the impaired epithelial barrier function induced by tumor necrosis factor alpha (TNFa) and inhibited the disrupting effect of TNFa on the epithelial barrier function in these cells. Cholera toxin (CTX)-induced mouse intestinal fluid secretion was significantly reduced by the administration of Cesinex or tannic acid. Cesinex has high antioxidant capacity. Conclusions Cesinex demonstrates efficacy and a good safety profile in the treatment of diarrhea. The broadspectrum antidiarrheal effect of Cesinex 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.