Taraxacum officinale and related species-An ethnopharmacological review and its potential as a commercial medicinal plant

ETHNOPHARMACOLOGICAL RELEVANCE

Dandelion (Taraxacum spec) is a wild plant that has been used for centuries as a traditional medicine in the relief and treatment of several diseases. This use is due to the presence of sesquiterpenes, saponins, phenolic compounds, flavonoids, and sugars, among others, found in the organs of the plant.

AIM OF THE STUDY

The aim of this work is to provide a current review of developments and trends in research on the Taraxacum genus, with a focus on traditional uses and pharmacological properties. This should shed light on the potential of this plant as an attractive commercial herbal medicine.

MATERIALS AND METHODS

Documents were collected, analyzed, and classified for information regarding medical, agronomic, genetic, and biological aspects of the Taraxacum species. This process was based on a thorough search of documents indexed by scientific search engines.

RESULTS

Two important periods of research on Taraxacum have been identified: the first, between 1930 and 1950; and the second, from 1990 to today. During the former, agricultural and genetics research on this plant were, due to the shortage of natural rubber, the focus. In contrast, the main drive in Taraxacum research is now the recovery of bioactives and/or applications in medicine. Pharmacology is the main area in which these plants have been tested, thanks in part to its widely known traditional uses; however, there is less than enthusiastic interest in further human clinical trials. In other areas, Taraxacum sports an enormous list of compounds of industrial interest; and while it is true that only a small amount of these compounds is immediately available in Taraxacum organs and makes it relatively commercially unattractive, only scarce efforts have been made to improve yields. Compounding this issue, most studies of its growth and cultivation have been focused mainly on controlling it as a weed detrimental to certain industrial crops. To wit, in spite of all the research carried out, less than 1% of all the species identified so far (>2500) have been studied (including Taraxacum officinale, Taraxacum coreanum, Taraxacum mongolicum and Taraxacum platycarpum). This is a indication of the little knowledge that we have about this genus so far. Biotechnology (involving genetics, agriculture, and biology) is the most powerful means by which to take advantage of all the medicinal potential of Taraxacum. Great strides have been made in identifying metabolic pathways for synthesizing terpenes, one of the most important compound families in clinical applications. In order to improve yield and performance of the plant in the field, greenhouse cultivation is another aspect taken into account, deriving an increase in recovery of bioactives from Taraxacum organs. Even while considering that only a few species have been studied, their different biochemical and cultivation profiles indicate huge potential for qualitative improvements in composition through genetic engineering, thus directly impacting pharmacological properties.

CONCLUSIONS

Taraxacum is has been traditionally considered a natural remedy, well-inserted into popular knowledge, but with low commercial applicability. Only once the recovery of pure and highly reactive compounds can be pursued at (a qualitatively and quantitatively attractive) economical scale, human clinical trials would be of interest in order to prove their efficacy and safety, positioning Taraxacum as an important commercial source of natural drugs.

Associations among Depression Symptoms with Alcohol and Smoking Tobacco Use in Adult Patients with Congenital Heart Disease

BACKGROUND

Adult congenital heart disease (ACHD) patients have high rates of untreated depression and anxiety disorders. We evaluated associations among self-reported depression symptoms and alcohol/smoking tobacco use.

METHODS

From 2009 to 2013, 202 ACHD patients (45% male) completed questionnaires on depressive symptoms, anxiety symptoms, and substance use as part of routine clinical care. Data were collected by retrospective chart review.

RESULTS

Mean age was 31 ± 10 years, 21% reported often feeling depressed and 33% reported feeling nervous or anxious. Sixty-one percent of patients reported some alcohol intake; 25% reported current or previous smoking tobacco use. Patients with depressive symptoms were 3× as likely to report drinking alcohol (OR 2.89; 95% CI 1.29-6.5) and 5× more likely to report smoking tobacco use (OR 5.17; 95% CI 1.49-17.87). Fourteen percent of patients were prescribed antidepressant/antianxiety medications; 43% of patients on medication reported depressive symptoms. In patients reporting symptoms, those who consumed alcohol were less likely to be on antidepressant/antianxiety medications (21%) than those who did not consume alcohol (56%).

CONCLUSION

Self-reported depressive symptoms are associated with increased alcohol and smoking tobacco use by ACHD patients. Alcohol use may be a means of self-medicating for untreated depression, but further investigation is needed. Risk factors, including depressive symptoms and substance use, should be routinely assessed and addressed in ACHD patients.

Combination therapy in pulmonary arterial hypertension: is this the new standard of care?

Pulmonary arterial hypertension (PAH) is a rare, progressive, and potentially fatal cardiopulmonary syndrome that imposes a significant burden on patients in terms of morbidity and mortality, and on managed care organizations in terms of resource utilization. The majority of PAH-approved therapies are high-touch, high-management, high-cost treatments dispensed through specialty pharmacies. Current treatment guidelines recommend combination therapy for patients who show inadequate clinical response or who deteriorate on monotherapy. Combination therapies target 2, or sometimes 3, distinct PAH-associated signaling pathways: the endothelin, prostacyclin, and nitric oxide pathways. Registry data suggest that combination therapy is utilized in more than half of patients with PAH in the United States. Evidence supporting the use of combination therapy is provided through clinical trials, retrospective research, registry data, and expert guidelines. Managed care decision makers are charged with making population-based decisions on resource allocation. These decision makers must always consider cost, but must also be aware that clinical evidence suggests that early treatment with combination therapy can significantly reduce disease burden, may reduce hospitalizations, and should be considered when making coverage decisions.

Impaired exercise capacity following atrial septal defect closure: an invasive study of the right heart and pulmonary circulation

Patients with early repair of an isolated atrial septal defect (ASD) are expected to have unremarkable right ventricular (RV) and pulmonary circulation physiology. Some studies, however, suggest persistent functional impairment. We aimed to examine the role of abnormal RV and pulmonary vascular response to exercise in patients who had undergone ASD closure. Using a previously published data set, we reviewed invasive exercise cardiopulmonary testing with right-sided hemodynamic data for 12 asymptomatic patients who had undergone ASD closure. The 5 (42%) patients with impaired maximal oxygen uptake ([Formula: see text]) were older and exhibited a lower peak cardiac index (5.6 ± 0.8 vs. 9.0 ± 1.2 L/min/m(2); P = .005) because of abnormal stroke volume augmentation (+3.2 ± 3.9 vs. +17.4 ± 10.2 mL/m(2); P = .02). While all resting hemodynamic variables were similar, patients with low [Formula: see text] tended to have abnormal total pulmonary vascular resistance change during exercise (+11% ± 41% vs. -28% ± 26%; P = .06) and had a steeper relation between mean pulmonary arterial pressure and cardiac index (5.8 ± 0.6 vs. 2.2 ± 0.1 L/min/m(2); P = .02). The increase in peak mean RV power during exercise was also significantly lower in the impaired-[Formula: see text] patients (4.7 ± 1.6 vs. 7.6 ± 2.1 J/s; P = .04). As described in the original study, despite normal resting hemodynamics, a subset of asymptomatic patients with repaired ASD had diminished exercise capacity. Our analysis allows us to conclude that this is due to a combination of abnormal pulmonary vascular response to exercise and impaired RV function.

Data-driven decisions for reducing readmissions for heart failure: general methodology and case study

BACKGROUND

Several studies have focused on stratifying patients according to their level of readmission risk, fueled in part by incentive programs in the U.S. that link readmission rates to the annual payment update by Medicare. Patient-specific predictions about readmission have not seen widespread use because of their limited accuracy and questions about the efficacy of using measures of risk to guide clinical decisions. We construct a predictive model for readmissions for congestive heart failure (CHF) and study how its predictions can be used to perform patient-specific interventions. We assess the cost-effectiveness of a methodology that combines prediction and decision making to allocate interventions. The results highlight the importance of combining predictions with decision analysis.

METHODS

We construct a statistical classifier from a retrospective database of 793 hospital visits for heart failure that predicts the likelihood that patients will be rehospitalized within 30 days of discharge. We introduce a decision analysis that uses the predictions to guide decisions about post-discharge interventions. We perform a cost-effectiveness analysis of 379 additional hospital visits that were not included in either the formulation of the classifiers or the decision analysis. We report the performance of the methodology and show the overall expected value of employing a real-time decision system.

FINDINGS

For the cohort studied, readmissions are associated with a mean cost of $13,679 with a standard error of $1,214. Given a post-discharge plan that costs $1,300 and that reduces 30-day rehospitalizations by 35%, use of the proposed methods would provide an 18.2% reduction in rehospitalizations and save 3.8% of costs.

CONCLUSIONS

Classifiers learned automatically from patient data can be joined with decision analysis to guide the allocation of post-discharge support to CHF patients. Such analyses are especially valuable in the common situation where it is not economically feasible to provide programs to all patients.

Intravenous Epoprostenol for Management of Pulmonary Arterial Hypertension during Pregnancy

Background Pulmonary arterial hypertension carries a high risk of mortality in pregnancy. Recent advances in treatment may improve disease course and allow for successful management of the pregnancy. Case Report We present the case of a 20-year-old gravida 1, para 0 with diagnosis of severe primary pulmonary hypertension. The patient was managed with epoprostenol (prostacyclin) infusion via an indwelling catheter, which was initiated at 23 weeks' gestation. The dose was adjusted to the patient's symptoms and a successful vaginal delivery was achieved at 36 weeks' gestation. Although maternal postpartum course was uncomplicated, unexplained neonatal demise occurred at 11 days of life. Conclusion Successful management of pulmonary hypertension in pregnancy can be accomplished with a multidisciplinary approach and intensive therapy. Long-term effects of epoprostenol on fetal or neonatal well-being are unknown.

The effect of c-fos on acute myocardial infarction and the significance of metoprolol intervention in a rat model

Over-expression of c-fos may play a role in some diseases. Research pertaining to the expression of c-fos in acute myocardial ınfarction (AMI) is rare, and the detailed role of c-fos in AMI has not been reported. Therefore, the purpose of this project was to elucidate the detailed effect of c-fos on AMI rats and evaluate the effect of a metoprolol intervention. An AMI rat model was established for the purposes of this study. The expression of c-fos in AMI was evaluated via immunohistochemical analysis and in situ hybridization. Simultaneously, we investigated the effect of c-fos on AMI rats via medicinal treatment with c-fos monoclonal antibody, isoproterenol, and metoprolol. Positive c-Fos protein expression and c-fos mRNA expression in cardiomyocytes were increased at 1, 3, 7, and 10 days after ligation in AMI rats compared with a sham-operated group. Peak expression occurred at 3 days after ligation. The weight percentage fraction of infarct size was decreased in rats treated with c-fos monoclonal antibody compared with the control normal saline treatment group. The weight percentage fraction of infarction size was increased after c-fos was increased via the administration of isoproterenol. c-Fos protein expression and the infarct size in rats treated with metoprolol were also decreased compared with the control normal saline treatment group. The results showed that c-fos expression rapidly increased after coronary ligation; c-fos plays an important role in myocardial lesions and is likely to be involved in the pathogenesis of AMI as well. Metoprolol can inhibit the expression of c-fos and has a positive therapeutic effect on rats after AMI; the involvement effect of metoprolol on myocardial infarction might be correlated with its effect on the inhibition of c-fos.