Condition
Blood Health
Blood health is how well your blood carries oxygen, helps defend against infection and keeps circulating, which depends on healthy red and white cells. The strongest evidence is for pegcetacoplan, which improved hemoglobin more than the standard drug eculizumab in a large trial in paroxysmal nocturnal hemoglobinuria. Beyond that, evidence is limited: chlorophyllin improved white blood cell counts in one trial of 105 people, but most other work is small or in animals.
Sources: PMID 35441351
- Updated
- How we grade
- 26 studies cited
- Supplements studied
- 4
- Medicines and peptides
- 2
- Graded outcomes
- 11
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| White Blood Cell Count An RCT of 105 patients with leukopenia found sodium copper chlorophyllin tablets (60 patients) improved peripheral white blood cell counts over 1 month compared to leucogen and placebo controls. A separate animal study in aplastic anemia mice showed effects on mesenchymal stem cell function. Limited to a single human RCT. | Improves (the measure goes up) | Small effect | 3 studies | 105 people | ||
Studies that measured white blood cell count | ||||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Erythrocyte Membrane Integrity Human studies showed L-cysteine supplementation preserved erythrocyte membrane acetylcholinesterase and Na+,K+-ATPase activities and protected G6PD activity from reduction during exercise-induced oxidative stress. | Improves (the measure goes up) | Small effect | 2 studies | 40 people | ||
Studies that measured erythrocyte membrane integrity | ||||||
Essential fatty acid (EFA)
- Red Blood Cell Rheology: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Red Blood Cell Rheology A small human trial found that combined omega-3 and omega-6 EFA supplementation improved red blood cell deformability and rheological properties, which may support microcirculation. | Improves (the measure goes up) | Small effect | 3 studies | 20 people | ||
Histidine
- Iron Status: improves
- Hemoglobin Synthesis: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Iron Status Limited human research suggests histidine supplementation may improve iron status and enhance iron absorption in iron-deficiency anemia. Biochemically, histidine is critical for hemoglobin structure and oxygen binding, and animal studies confirm its importance in hemoglobin synthesis. Evidence remains preliminary with no large controlled trials. | Improves (the measure goes up) | Small effect | ||||
| Hemoglobin Synthesis Animal studies demonstrate histidine is essential for hemoglobin synthesis, and histidine deficiency causes growth retardation. The imidazole side chain of histidine plays a critical structural role in hemoglobin's oxygen-binding capacity. Human supplementation data supporting improved hemoglobin levels is very limited. | Improves (the measure goes up) | Small effect |
Prescription medicines and peptides studied, for context
Pegcetacoplan (Empaveli)
- Hemoglobin Improvement vs Eculizumab: improves
- Extravascular Hemolysis Control: improves
- Transfusion Independence: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Hemoglobin Improvement vs Eculizumab PEGASUS Phase III trial: Pegcetacoplan significantly superior to eculizumab for hemoglobin improvement (p<0.001). First therapy to demonstrate superiority over standard C5 inhibitor treatment in PNH. | Improves (the measure goes up) | Large effect | 12 studies | |||
| Extravascular Hemolysis Control Unique mechanism: C3 inhibition prevents C3b opsonization, controlling extravascular hemolysis that C5 inhibitors cannot address. Addresses key limitation of prior PNH treatments. | Improves (the measure goes up) | Large effect | 11 studies | |||
| Transfusion Independence PEGASUS trial: 85% of pegcetacoplan patients transfusion-free at 16 weeks vs 15% on eculizumab (p<0.001). Dramatic reduction in transfusion requirements. | Improves (the measure goes up) | Large effect | 8 studies | |||
| Complement-Inhibitor-Naive PNH PRINCE Phase III trial: Superior to supportive care in treatment-naive PNH patients. Achieved hemoglobin stabilization and LDH reduction. Approved for both naive and C5i-experienced patients. | Improves (the measure goes up) | Large effect | 8 studies | |||
| Safety Profile Well-tolerated in clinical trials. Most common AEs: injection site reactions, infections. Requires vaccination against encapsulated bacteria (meningococcal, pneumococcal). Self-administered subcutaneously. | Improves (the measure goes up) | Moderate effect | 8 studies |
Gramicidin
- Hemolytic Toxicity: worsens
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Hemolytic Toxicity SAFETY CONCERN: Highly hemolytic - cannot be administered systemically. Internal use contraindicated. Topical absorption negligible. Limits use to topical applications only. | Worsens (the measure goes up) | Large effect | 6 studies |
Key findings
- White Blood Cell CountImproves (the measure goes up)
- Erythrocyte Membrane IntegrityImproves (the measure goes up)
- Red Blood Cell RheologyImproves (the measure goes up)
Studies cited
26 studies from PubMed
- Breakthrough hemolysis in paroxysmal nocturnal hemoglobinuria throughout clinical trials: from definition to clinical practice.
- Hemolysis events in the phase 3 PEGASUS study of pegcetacoplan in patients with paroxysmal nocturnal hemoglobinuria.
- Treatment of dry age-related macular degeneration: A review.
- Correction to: Pegcetacoplan: A Review in Paroxysmal Nocturnal Haemoglobinuria.
- Pegcetacoplan for Treating Paroxysmal Nocturnal Haemoglobinuria: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.
- Pegcetacoplan: A New Opportunity for Complement Inhibition in PNH
- Pegcetacoplan versus eculizumab in patients with paroxysmal nocturnal haemoglobinuria (PEGASUS): 48-week follow-up of a randomised, open-label, phase 3, active-comparator, controlled trial.
- Pegcetacoplan: A Review in Paroxysmal Nocturnal Haemoglobinuria
- Novel targeted C3 inhibitor pegcetacoplan for paroxysmal nocturnal hemoglobinuria
- From discovery to approval: A brief history of the compstatin family of complement C3 inhibitors
- Efficacy of topical drugs in the treatment of patients with acute inflammatory diseases of the pharynx
- The Multifaceted Antibacterial Mechanisms of the Pioneering Peptide Antibiotics Tyrocidine and Gramicidin S
- Effects of sodium copper chlorophyllin on mesenchymal stem cell function in aplastic anemia mice
- Perinatal programming of murine immune responses by polyunsaturated fatty acids.
- Gramicidin S and polymyxins: the revival of cationic cyclic peptide antibiotics
- L-cysteine supplementation prevents exercise-induced alterations in human erythrocyte membrane acetylcholinesterase and Na+,K+-ATPase activities.
- L-cysteine supplementation protects the erythrocyte glucose-6-phosphate dehydrogenase activity from reduction induced by forced training.
- Essential fatty acids, DHA and human brain.
- Analysis of the therapeutic effect of sodium copper chlorophyllin tablet in treating 60 cases of leukopenia
- Structure-activity relationships of de novo designed cyclic antimicrobial peptides based on gramicidin S
- The beneficial effects of omega-3 and omega-6 essential fatty acid supplementation on red blood cell rheology.
- The interaction of the antimicrobial peptide gramicidin S with lipid bilayer model and biological membranes
- Effect of sodium copper chlorophyllin on the formation of calcium oxalate crystals in rat kidney
- Utilization of gramicidin dragee in throat inflammation and tonsillitis
- Medium-chain triglycerides (8:0 and 10:0) are promising nutrients for sarcopenia: a randomized controlled trial
- The effects of β-hydroxy-β-methylbutyrate or HMB-rich nutritional supplements on sarcopenia patients: a systematic review and meta-analysis.