Anatabine supplementation decreases thyroglobulin antibodies in patients with chronic lymphocytic autoimmune (Hashimoto's) thyroiditis: a randomized controlled clinical trial

Lowell R Schmeltz, Thomas C Blevins, Stephen L Aronoff, Kerem Ozer, Jonathan D Leffert, Marc A Goldberg, Barry S Horowitz, Richard H Bertenshaw, Pedro Troya, Amy E Cohen, Ryan K Lanier, Curtis Wright 4th, Lowell R Schmeltz, Thomas C Blevins, Stephen L Aronoff, Kerem Ozer, Jonathan D Leffert, Marc A Goldberg, Barry S Horowitz, Richard H Bertenshaw, Pedro Troya, Amy E Cohen, Ryan K Lanier, Curtis Wright 4th

Abstract

Context: Hashimoto's thyroiditis is less prevalent in tobacco smokers. Anatabine, an alkaloid found in Solanaceae plants including tobacco, has been reported to ameliorate a mouse model of Hashimoto's thyroiditis.

Objective: The effects of anatabine in patients with Hashimoto's thyroiditis were studied.

Design, setting, patients, and intervention: This was a double-blind, randomized, placebo-controlled multisite study. A total of 146 patients (70 treated with anatabine and 76 with placebo) completed the study. Approximately 50% of patients in each group were taking levothyroxine. Anatabine lozenges (9-24 mg/d) or placebo, each containing vitamins A and D3, were administered orally 3 times a day for 3 months.

Main outcome measures: Serum thyroperoxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) levels were assessed. Safety was assessed through adverse events, clinical laboratory evaluations, and vital sign measurements.

Results: Anatabine-treated patients had a significant reduction in absolute serum TgAb levels from baseline by study end relative to those receiving placebo (P=.027); however, there were no significant changes or differences in treatment group means for TPOAb or TgAb levels. Mean±SD TgAb values decreased by 46.2±101.1 and 3.9±83.9 World Health Organization units for the anatabine and placebo groups, respectively. Significantly more patients had a >20% drop in TgAb levels in the anatabine than placebo group (P=.023). Overall, the anatabine supplement was safe and well tolerated, although significantly (P<.05) more patients in the anatabine group reported adverse events.

Conclusions: These results demonstrate an immunological effect of anatabine on TgAb levels. Further studies are warranted to determine the longer-term effects and possible actions of anatabine on the course of Hashimoto's thyroiditis.

Trial registration: ClinicalTrials.gov NCT01551498.

Figures

Figure 1.
Figure 1.
TgAbs and TPOAbs in patients treated with anatabine (○) or placebo (●). A and B, means ± SEM over time for TgAbs and TPOAbs. C, Absolute change in TgAbs between subsequent visits and baseline. D, Percentage of patients with a >20% decrease in TgAbs.

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