Aloe vera: A review of toxicity and adverse clinical effects

Evaluation of Fermented Extracts of Aloe vera Processing Byproducts as Potential Functional Ingredients

Aloe is widely used as a cosmetic and medicinal plant. Numerous studies have reported that aloe gel extract has antioxidant, anticancer, antidiabetic, immunity, and skin antiaging properties. However, few studies have investigated the properties of fermentation products of aloe processing byproducts. Aloe stalks and leaves remain as byproducts after the aloe beverage manufacturing process. This study evaluated whether fermentation products of blender and press extracts of aloe processing byproducts (BF and PF, respectively) that remain after beverage manufacturing were useful as functional biomaterial by investigating their effects on adipocyte differentiation, hyaluronic acid (HA) production, tyrosinase activity, and antioxidant activity. Co-fermentation of G. xylinus and S. cerevisiae was conducted for fermentation of aloe processing byproducts. The BF and PF products did not induce observable cytotoxicity effects. However, BF and PF products did inhibit a 3T3-L1 adipocyte differentiation compared with control, with the BF product displaying greater inhibition of 3T3-L1 adipocyte differentiation than the PF product. HA production increased in HaCaT cell cultures as the concentration of the MF product increased, as compared with the untreated control. The levels of tyrosinase inhibition, 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging, and superoxide dismutase (SOD)-like activity also depended on the MF product concentration. This study indicates that the fermented products of aloe processing byproducts have biological potential for applications in the manufacturing of cosmetics, pharmaceuticals, and beverages. These laboratory bench results provide the foundation for future studies of scaling and practical applications at the industrial level.

Aloe vera gel extract: Safety evaluation for acute and chronic oral administration in Sprague-Dawley rats and anticancer activity in breast and lung cancer cells

ETHNOPHARMACOLOGICAL RELEVANCE

Aloe vera (L.) Burm. f. is a typical traditional Chinese medicine (TCM) collected in the Pharmacopoeia of the People's Republic of China (version 2015). It has been traditionally used for the treatment of constipation, and its potential therapeutic activities have been widely evaluated, including anti-tumor, anti-inflammatory and immune regulatory effects. The wide application of Aloe vera in food and therapy has raised safety issues and there are multiple safety assessments with a diverse toxicity and adverse effects from clinics and animals.

AIM OF THE STUDY

This study aimed to investigate the safety of Aloe vera barbadensis extract C (AVBEC) in rats and analyze its anticancer activity in cell lines.

MATERIALS AND METHODS

We administrated AVBEC orally in an acute toxicity study and a 6-month chronic toxicity study to observe and confirm its safety in Sprague-Dawley (SD) rats. Additionally, we explored the cytotoxicity of AVBEC in cancer cells and non-cancer cells. We further investigated the anti-tumor activity of AVBEC, and in the meantime, probed the function of component from AVBEC.

RESULTS

No deaths or substance-relative toxicity were observed in the acute toxicity study or the 6-month chronic toxicity study with doses of 44.8 g·kg^-1 and 4.48 g·kg^-1, respectively. In the chronic toxicity study, AVBEC did not cause organ toxicity, including crucial organ structure and chemical function, and peripheral and central immune system damage. Additionally, we found that AVBEC could induce cancer cell apoptosis with a relatively higher apoptotic ratio than in non-cancer cells by decreasing adenosine triphosphate (ATP) concentration and enhancing reactive oxygen species (ROS) production. We also identified components in AVBEC using high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) and probed the function of malic acid. This demonstrated that under the same circumstances, malic acid induced cell necrosis in cancer cells and non-cancer cells, while AVBEC did not.

CONCLUSIONS

These results reveal a novel mechanism of aloe gel extract in regulating cancer cell apoptosis via modulating the mitochondrial metabolism and imply a possible application of AVBEC for the treatment of malignant cancer with the safety evaluation from rats and anticancer investigation from cancer cells and non-cancer cells.

Aloe vera mitigates dextran sulfate sodium-induced rat ulcerative colitis by potentiating colon mucus barrier

ETHNOPHARMACOLOGICAL RELEVANCE

Aloe vera (L.) Burm. f. (Aloe vera) is a medicinal herb that used in Traditional Chinese Medicine (TCM) practice for the treatment of gastrointestinal diseases such as constipation and colitis. Recent studies also reported its beneficial effect in mitigating ulcerative colitis (UC). Nevertheless, the underlying mechanisms of Aloe vera against UC remain largely unknown.

AIM OF THE STUDY

This study aimed to explore a relation between the therapeutical effects of Aloe vera in UC and colonic mucus secretion, and further investigate the underlying pathways through which Aloe vera regulates colon mucus as well as preliminarily studied the main active constitute of Aloe vera to alleviate UC.

MATERIALS AND METHODS

UPLC-MS/MS were employed to analyze the Aloe vera extract. The rat models of UC were induced by free subjected to fresh 3% dextran sulfate sodium (DSS) solution for 8 days and then accessed to tap water for 2 days. Aloe vera extract (18 mg/kg and 72 mg/kg) or 5-ASA (400 mg/kg) was administered orally from day 1-10. At the end of experiment, rats were sacrificed and the colon tissues were harvested for analysis. UC symptoms was evaluated by disease activity index (DAI), colon length and H&E staining. The Alcian blue stain were determined colon mucus layer. Myeloperoxidase (MPO) activity, mucin and inflammatory cytokines in colon tissues were determined by ELISA. The expression of related proteins on PI3K/AKT and PKC/ERK signaling pathway was analyzed by Western blot. We then evaluated the effects of three main components of Aloe vera (Aloe-emodin, aloin A and B) on mucin secretion and cytokine expression in vitro by ELISA.

RESULTS

Oral supplement with Aloe vera extract resulted in a significantly decreased DSS-induced UC symptoms, including decreased DAI, prevention of the colon length shortening, and alleviation of the pathological changes occurring in colon. The expression of colonic pro-inflammatory mediators, including IL-6, IL-1β and TNF-α were suppressed, yet the expression of IL-10 was up-regulated by Aloe vera treatment. Moreover, Aloe vera significantly up-regulated the expressions of mucin proteins (e.g., MUC2 and MUC5AC) and increased the thickness of mucus layer in the colon. Further, we revealed that Aloe vera significantly upregulated p-PKC and p-ERK expression and downregulated p-PI3K and p-AKT expression. Finally, we discovered that treat with aloin A markedly decreased IL-6 levels and increased MUC2 expression in LPS-stimulated LS174T cell.

CONCLUSION

These results support that Aloe vera improved UC by enhancing colon mucus barrier functions in addition to reducing inflammation. Moreover, aloin A might be a main active components of Aloe vera to ameliorate UC.

Potential protective effects of Aloe vera gel on cardiovascular diseases: A mini-review

Cardiovascular diseases (CVDs) comprise the most prevalent causes of morbidity and mortality in both men and women worldwide. CVDs are associated with several risk factors such as hyperlipidemia, diabetes mellitus, hypertension, obesity, tobacco smoking and an unhealthy diet. Currently, in addition to the use of related pharmacological treatments in the management of CVDs, the investigation of other suitable healthcare approaches for these disorders such as the identification of herbal medicines has been considered in the scientific communities. Aloe vera (L.) Burm.f. is a perennial medicinal plant. The innermost leaf layer of this plant contains transparent gel, which is used as food. Pre-clinical studies have shown several biological activities of A. vera gel (AVG), including antidiabetic, lipid-lowering, antioxidant, antiinflammatory, hepatoprotective, and immunomodulatory effects. Other pharmacological activities of AVG such as anti-fibrotic, anti-hypertensive, and anti-atherosclerotic effects have been reported. Moreover, several clinical studies have demonstrated the ameliorating effects of AVG on some markers of CVDs risk factors. Thus, this study was conducted to review clinical trials besides in vitro and in vivo studies on the cardiac beneficial effects of AVG. However, further high-quality studies are needed to firmly establish the clinical efficacy of the plant.

Advantages of Hyaluronic Acid and Its Combination with Other Bioactive Ingredients in Cosmeceuticals

This study proposes a review on hyaluronic acid (HA) known as hyaluronan or hyaluronate and its derivates and their application in cosmetic formulations. HA is a glycosaminoglycan constituted from two disaccharides (N-acetylglucosamine and D-glucuronic acid), isolated initially from the vitreous humour of the eye, and subsequently discovered in different tissues or fluids (especially in the articular cartilage and the synovial fluid). It is ubiquitous in vertebrates, including humans, and it is involved in diverse biological processes, such as cell differentiation, embryological development, inflammation, wound healing, etc. HA has many qualities that recommend it over other substances used in skin regeneration, with moisturizing and anti-ageing effects. HA molecular weight influences its penetration into the skin and its biological activity. Considering that, nowadays, hyaluronic acid has a wide use and a multitude of applications (in ophthalmology, arthrology, pneumology, rhinology, aesthetic medicine, oncology, nutrition, and cosmetics), the present study describes the main aspects related to its use in cosmetology. The biological effect of HA on the skin level and its potential adverse effects are discussed. Some available cosmetic products containing HA have been identified from the brand portfolio of most known manufacturers and their composition was evaluated. Further, additional biological effects due to the other active ingredients (plant extracts, vitamins, amino acids, peptides, proteins, saccharides, probiotics, etc.) are presented, as well as a description of their possible toxic effects.

Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox

Background

Aloe vera and Aloe ferox have over the years been among the most sought-after Aloe species in the treatment of ailments worldwide. This review provides categorized literature on the phytochemical and scientifically proven toxicological profiles of A. vera and A. ferox to facilitate their exploitation in therapy.

Main body of the abstract

Original full-text research articles were searched in PubMed, ScienceDirect, Research gate, Google Scholar, and Wiley Online Library using specific phrases. Phenolic acids, flavonoids, tannins, and anthraquinones were the main phytochemical classes present in all the two Aloe species. Most of the phytochemical investigations and toxicity studies have been done on the leaves. Aloe vera and Aloe ferox contain unique phytoconstituents including anthraquinones, flavonoids, tannins, sterols, alkaloids, and volatile oils. Aloe vera hydroalcoholic leaf extract showed a toxic effect on Kabir chicks at the highest doses. The methanolic, aqueous, and supercritical carbon dioxide extracts of A. vera leaf gel were associated with no toxic effects. The aqueous leaf extract of A. ferox is well tolerated for short-term management of ailments but long-term administration may be associated with organ toxicity. Long-term administration of the preparations from A. vera leaves and roots was associated with toxic effects.

Short conclusion

This review provides beneficial information about the phytochemistry and toxicity of A. vera and A. ferox and their potential in the treatment of COVID-19 which up to date has no definite cure. Clinical trials need to be carried out to clearly understand the toxic effects of these species.

Complementary and alternative medicine (CAM) supplements in cancer outpatients: analyses of usage and of interaction risks with cancer treatment

Purpose

The aim of our study was to analyze the use of complementary and alternative medicine (CAM) supplements, identify possible predictors, and analyze and compile potential interactions of CAM supplements with conventional cancer therapy.

Methods

We included outpatient cancer patients treated at a German university hospital in March or April 2020. Information was obtained from questionnaires and patient records. CAM–drug interactions were identified based on literature research for each active ingredient of the supplements consumed by the patients.

Results

37.4% of a total of 115 patients consumed CAM supplements. Potential interactions with conventional cancer treatment were identified in 51.2% of these patients. All types of CAM supplements were revealed to be a potential source for interactions: vitamins, minerals, food and plant extracts, and other processed CAM substances. Younger age (< 62 years) (p = 0.020, φc = 0.229) and duration of individual cancer history of more than 1 year (p = 0.006, φc = 0.264) were associated with increased likelihood of CAM supplement use. A wide range of different CAM supplement interactions were reviewed: effects of antioxidants, cytochrome (CYP) interactions, and specific agonistic or antagonistic effects with cancer treatment.

Conclusion

The interaction risks of conventional cancer therapy with over-the-counter CAM supplements seem to be underestimated. Supplements without medical indication, as well as overdoses, should be avoided, especially in cancer patients. To increase patient safety, physicians should address the risks of interactions in physician–patient communication, document the use of CAM supplements in patient records, and check for interactions.

Aloe and its Effects on Cancer: A Narrative Literature Review

Many years ago, Aloe Vera was cited to have a lot of therapeutic properties including; anti-microbial, anti-viral, anti-cancer, anti-oxidant, anti-inflammatory, skin protection, wound healing, and regulation of blood glucose and cholesterol. However, Aloe could present some side effects. This review focused on the latest discoveries regarding the therapeutic role of Aloe plant or its compounds on the acquired biological capabilities for tumour growth and progression namely; evading growth suppressor, avoiding immune destruction, enabling replicative immortality, tumour promoting inflammation, activating invasion and metastasis, inducing angiogenesis, genome instability and mutation, resisting cell death, deregulating cellular energetics and sustaining proliferating signalling. It clarified the anti-cancer activities it exerts on different types of cancer and also highlighted some pro-oncogenic pathways that can be disrupted by different compounds of Aloe.

Aloe djiboutiensis: Antioxidant Activity, Molecular Networking-Based Approach and In Vivo Toxicity of This Endemic Species in Djibouti

For the first time, the study of the antioxidant activity, the characterization of the phytoconstituants, and the evaluation of in vitro and in vivo toxicity of A. djiboutiensis leave and latex are performed. The antioxidant activity of both latex (ADL) and the methanolic extract of leaves (ADM) is determined using 1-diphenyl-2-picrylhydrazyl (DPPH), 2,2'-azino-bis 3-ethylbenzothiazoline-6-sulphonic acid (ABTS) scavenging radical methods and ferric reducing/antioxidant power (FRAP) assay. The phytochemical study of latex is done using Liquid Chromatography-Mass Spectrometry (LC-MS/MS) and a molecular networking-based approach. The evaluation of in vivo toxicity is performed on mice by oral gavage with a suspension of ADL. Our results show that weak antioxidant activity of ADL and ADM in opposition to their high polyphenol, 83.01 mg and 46.4 mg expressed in gallic acid equivalent (GAE)/g of dry weight (DW), respectively, and flavonoid contents 13.12 mg and 4.25 mg expressed in quercetin equivalent (QE)/g dry weight (DW), respectively. Using the Global Natural Products Social Molecular Networking (GNPS) website, nine (9) anthraquinones derivatives, ten (10) chromones derivatives, two (2) flavonols/ chromones isomers are annotated in the molecular network. The treated mice do not display abnormalities in their general physical appearance and biochemistry parameters, compared to the controls. Only glucose and calcium levels are slightly higher in male treated mice compared to the vehicles.

Nutraceuticals: Transformation of Conventional Foods into Health Promoters/Disease Preventers and Safety Considerations

Nutraceuticals are essential food constituents that provide nutritional benefits as well as medicinal effects. The benefits of these foods are due to the presence of active compounds such as carotenoids, collagen hydrolysate, and dietary fibers. Nutraceuticals have been found to positively affect cardiovascular and immune system health and have a role in infection and cancer prevention. Nutraceuticals can be categorized into different classes based on their nature and mode of action. In this review, different classifications of nutraceuticals and their potential therapeutic activity, such as anti-cancer, antioxidant, anti-inflammatory and anti-lipid activity in disease will be reviewed. Moreover, the different mechanisms of action of these products, applications, and safety upon consumers including current trends and future prospect of nutraceuticals will be included.

Direct ink writing of aloe vera/cellulose nanofibrils bio-hydrogels

Direct-ink-writing (DIW) of hydrogels has become an attractive research area due to its capability to fabricate intricate, complex, and highly customizable structures at ambient conditions for various applications, including biomedical purposes. In the current study, cellulose nanofibrils reinforced aloe vera bio-hydrogels were utilized to develop 3D geometries through the DIW technique. The hydrogels revealed excellent viscoelastic properties enabled extruding thin filaments through a nozzle with a diameter of 630 μm. Accordingly, the lattice structures were printed precisely with a suitable resolution. The 3D-printed structures demonstrated significant wet stability due to the high aspect ratio of the nano- and microfibrils cellulose, reinforced the hydrogels, and protected the shape from extensive shrinkage upon drying. Furthermore, all printed samples had a porosity higher than 80% and a high-water uptake capacity of up to 46 g/g. Altogether, these fully bio-based, porous, and wet stable 3D structures might have an opportunity in biomedical fields.

Efficacy Prediction of Four Pharmaceutical Formulations for Intramammary Administration Containing Aloe vera (L.) Burm. f. Combined With Ceftiofur or Cloxacillin in Lactating Cows as an Alternative Therapy to Treat Mastitis Caused by Staphylococcus aureus

Synergy or additive effect between Aloe vera (L.) Burm.f. and beta-lactam (β-lactam) antibiotics has been reported against Staphylococcus aureus, one of the most important etiological agents of cow mastitis. The goal of the present study was to predict the efficacy of intramammary formulations containing the Aloe vera gel extract in the combination with cloxacillin or ceftiofur at low concentrations in lactating cows as an alternative therapy. Each quarter of 20 healthy Holstein Friesian lactating cows were treated with a single dose of one of the following formulations, corresponding to one of these treatment groups: A1, A2, A3, and A4. A1 and A2 contained cloxacillin at 0.25 and 0.5 mg/ml, whereas A3 and A4 contained ceftiofur 0.25 and 0.5 mg/ml, respectively. In addition, all formulations contained 600 mg/ml of an alcoholic extract of Aloe vera. Milk samples were taken at predefined time points. Antibiotics and aloin (active compound of Aloe vera) concentrations were assessed by liquid chromatography mass spectrometry system (LC-MS/MS). Pharmacokinetic profiles were obtained, and the efficacy index, the fraction of dosing interval in which the antimicrobial concentration remains above the minimum inhibitory concentrations (MICs) (T > MIC) for each formulation, was calculated considering MIC values against Staphylococcus aureus ATCC 29213 as obtained for the combination Aloe vera + antibiotic and aloin concentration in the extract. Mammary gland safety assessment was performed for each combination. Values of the main efficacy index for this study, T > MIC (h) for Aloe vera were 23.29, 10.50, 27.50, and 13.89, whereas for cloxacillin or ceftiofur were 19.20, 10.9, 19.74, and 15.63, for A1, A2, A3, and A4, respectively. Only A1 and A3 reached aloin and antibiotic recommended values as predictors of clinical efficacy for cloxacillin, ceftiofur, and aloin (50, 70, and 60%, respectively), assuming a dose interval of 24 h. The efficacy index values obtained suggest that A1 and A3 might be an effective therapy to treat bovine mastitis caused by S. aureus after a single dose. Nevertheless, further trials in S. aureus mastitis clinical cases are mandatory to confirm the efficacy of Aloe vera formulations.

Absence of genotoxicity of purified Aloe vera whole leaf dry juice as assessed by an in vitro mouse lymphoma tk assay and an in vivo comet assay in male F344 rats

Hydroxyanthracene derivatives (HAD) are naturally present in the latex layer of Aloe vera leaf, predominantly as aloins A, B and aloe-emodin. HAD are typically removed from commercial ingestible aloe products through activated charcoal filtration (decolorization). Current research aimed to evaluate genotoxic potential of a purified aloe whole leaf dry juice containing 0.3 ppm of total aloins and non-detectable aloe-emodin (LOD =0.01 ppm) in the L5178Y mouse lymphoma assay (MLA; OECD 490) and in vivo comet assay (OECD 489). No marked increases in mutant frequency at the tk locus were observed in the MLA at concentrations up to 5000 μg/mL for 3 h and 24 h (-S9), and up to a precipitating concentration of 3000 μg/mL for 3 h (+S9) compared to concurrent vehicle control. Relative total growth at the highest analyzable concentrations at 3 h (±S9) and 24 h (-S9) ranged from 64 to 133 %. In the comet assay, no statistically significant increases in DNA strand breaks were detected in the colon or kidney following oral gavage of 500, 1000 or 2000 mg/kg/day in male F344 rats for 2 days compared to concurrent vehicle control. Overall, these findings demonstrated the test article containing minimal HAD is not genotoxic under the described experimental conditions.

A competitive nature-derived multilayered scaffold based on chitosan and alginate, for full-thickness wound healing

The aim of this study was to evaluate a bioactive multilayer wound dressing, based on chitosan and alginate. To enhance healing potential, Dracaena Cinnabari and Aloe Vera were loaded as separate layers into the scaffold. The bare and bioactive multilayered scaffolds were fabricated by an iterative layering freeze-drying technique. Following of topographical, chemical, and physical assessment, the performance of the scaffolds was evaluated in vitro and in vivo. The results revealed adequate attachment, and proliferation of human foreskin fibroblasts, indicating excellent biocompatibility of the bioactive scaffold. In vivo, the performance of the multi-layered scaffold loaded with the bioactive materials was comparable with Comfeel plus®. The wounds treated with the bioactive scaffold exhibited superior hypergranulation, fibroblast maturation, epithelization, and collagen deposition, with minimal inflammation, and crust formation. It is concluded that the synergism of extracellular matrix-mimicking multi-layered scaffolding with Aloe Vera and Dracaena Cinnabari could be considered as a supportive wound dressing.

Quantitative determination of aloin, antioxidant activity, and toxicity of Aloe vera leaf gel products from Greece

BACKGROUND

Aloe vera is a popular medicinal plant used widely by the cosmetic, pharmaceutical, and food industries. The A. vera leaf gel, which is used mostly for its positive effects on human health, contains over 75 different bioactive compounds, including aloin. Aloin is a toxic compound, and its content in A. vera leaf gel products depends on the different cultivation conditions and especially on leaf processing.

RESULTS

In this study, A. vera leaf gel products, varied in terms of leaf processing, were analyzed using liquid chromatography for their aloin content, their antioxidant activity by 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonate) radical cation (ABTS^·+ ) and the 2,2-diphenyl-1-picrylhydrazyl radical (DPPH^· ) antioxidant activity assays and their toxicity against Aliivibrio fisheri and SH-SY5Y cells. In the samples processed with industrial methods and in those filtered in the lab, the content of aloin was found below the limit (0.1 mg L^-1 ) of the EU legislation however, the unprocessed and unfiltered samples were found to contain more than 10 mg L^-1 . Antioxidant activity was estimated to vary from 1.64 to 9.21 μmol Trolox mL^-1 for DPPH^· and from 0.73 to 5.14 μmol Trolox mL^-1 for ABTS^·+ . Toxicity values on A. fisheri, expressed as the concentration at 50% loss of initial luminescence, ranged from 0.03 to 0.09 mg mL^-1 . The cytotoxic study indicated that aloin A at low concentrations (1 and 10 μg mL^-1 ) protects SH-SY5Y cells from toxicity induced by hydrogen peroxide.

CONCLUSIONS

Consequently, the filtration process of A. vera leaf gels, either laboratory or industrial, resulted in aloin A content below the EU legislation detection limits. © 2020 Society of Chemical Industry.

Antiviral Activity of Jamaican Medicinal Plants and Isolated Bioactive Compounds

Plants have had historical significance in medicine since the beginning of civilization. The oldest medical pharmacopeias of the African, Arabian, and Asian countries solely utilize plants and herbs to treat pain, oral diseases, skin diseases, microbial infections, multiple types of cancers, reproductive disorders among a myriad of other ailments. The World Health Organization (WHO) estimates that over 65% of the world population solely utilize botanical preparations as medicine. Due to the abundance of plants, plant-derived medicines are more readily accessible, affordable, convenient, and have safer side-effect profiles than synthetic drugs. Plant-based decoctions have been a significant part of Jamaican traditional folklore medicine. Jamaica is of particular interest because it has approximately 52% of the established medicinal plants that exist on earth. This makes the island particularly welcoming for rigorous scientific research on the medicinal value of plants and the development of phytomedicine thereof. Viral infections caused by the human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2), hepatitis virus B and C, influenza A virus, and the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) present a significant global burden. This is a review of some important Jamaican medicinal plants, with particular reference to their antiviral activity.

Differential inhibition of gelatinase activity in human colon adenocarcinoma cells by Aloe vera and Aloe arborescens extracts

BACKGROUND

Aloe's reported bioactivities (anticancer, anti-inflammatory and wound healing) suggest they might inhibit a subgroup of matrix metalloproteinases (MMPs) called gelatinases (MMP-2 and MMP-9). The goal of the present study was to compare the MMP inhibitory potential of two Aloe species, A. vera and A. arborescens.

METHODS

Different types of extraction were tested and specific bioactive compounds were quantified. Cancer cell invasion inhibitory activities were measured in vitro using the wound healing assay in human colon cancer cells (HT29). Effects on gelatinase activities were further assessed by dye-quenched gelatin and gelatin zymography.

RESULTS

Different types of extraction yielded significantly different levels of bioactivities and of bioactive compounds, which might be due to a greater amount of extractable bioactive compounds such as anthraquinones. Both A. arborescens and A. vera have potential as inhibitory agents in cancer cell proliferation via MMP-9 and MMP-2 enzymatic activity inhibition, being able to reduce colon cancer cell proliferation and migration but A. arborescens showed to be a more effective inhibitor of cancer cell migration than A. vera.

CONCLUSION

This work opens novel perspectives on the mode of action of Aloe species in cancer cell migration and may provide clues as to why there are so many conflicting results on Aloe's activities.

Fast and easily applicable LC-UV method for analysis of bioactive anthrones from Aloe leaf latex

Aloe leaf latex is a commonly used plant preparation in traditional medicine. However, quality control on the content of medicinally important constituents is often limited. Hence, establishing a reliable quality control method to identify and quantify bioactive markers is important to ensure safety and efficacy. In the present study, a novel liquid chromatographic (LC) method was developed and validated for efficient analysis of bioactive markers to evaluate the quality of aloe leaf latex. Quantification of marker compounds was possible in only 7 min on a monolithic column using gradient elution with 0.1 % formic acid in acetonitrile and water as mobile phases. The major compounds (aloins A and B) could be baseline separated together with related compounds within 10 min. The method showed excellent linearity with determination coefficients (r²) of 0.9999. Detection limits were 0.017 and 0.013 μg/mL, while quantification limits were 0.057 and 0.043 μg/mL for aloin A and aloin B, respectively. Relative standard deviation (RSD) values for intra- and inter-day precision were less than 2% and recoveries for both aloins were close to 100 %. The robustness was evaluated using an experimental design. The method was applied to some aloe leaf latex samples from Ethiopia. Aloin contents varied from 14 to 35 % and two unknown peaks were tentatively identified as aloinoside and microdontin.

Development of a microbial coating for cellulosic surface using aloe vera and silane

The highly contagious nature of SARS-CoV-2 (COVID-19) virus has created a havoc effect all over the world in a very short period. The most effective method for precaution of this virus as suggested by WHO is use of PPEs (triple layered face mask, body suits) and social distancing. However, the frontline doctors and medical staff have high risk of exposure to the virus during treatments and removal and discarding of the PPEs. Also the PPEs are of the onetime use and wearing these PPEs in hot and humid seasons is very uncomfortable. A possible solution of this problem is if clothes are anti-bacterial and anti-viral in nature, one single-layered will be sufficient and the spread of virus will also be minimized. Considering this, we have designed a facile and durable anti-wash antimicrobial coating on cloth by aloe vera and hexadecyltrimethoxysilane (HDTMS). In lab scale study, present coating shows good chemical and thermal stability making it reusable multiple times even after repeated washing. The coated cloth reveals the excellent anti-dirt and stain resistance properties leading to complete non-adherence of dirt and stain (e.g. Color, food, ink) on it. Anti-bacterial and anti-fungi properties of the coated cloth were confirmed by doing E. coli (bacteria) and A. Niger (fungus) culture studies, respectively. This coating is imbibed with well-known anti-viral agent aloe vera which inhibits the attachment of the virus on the surface. The water-repellent nature of the coating combined with the use anti-viral agent, aloe vera makes it a potential anti-COVID-19 coating.

Exposure to the natural alkaloid Berberine affects cardiovascular system morphogenesis and functionality during zebrafish development

The plant-derived natural alkaloid berberine displays therapeutic potential to treat several pathological conditions, including dyslipidemias, diabetes and cardiovascular disorders. However, data on berberine effects during embryonic development are scarce and in part controversial. In this study, using zebrafish embryos as vertebrate experimental model, we address the effects of berberine treatment on cardiovascular system development and functionality. Starting from the observation that berberine induces developmental toxicity and pericardial edema in a time- and concentration-dependent manner, we found that treated embryos display cardiac looping defects and, at later stages, present an abnormal heart characterized by a stretched morphology and atrial endocardial/myocardial detachment. Furthermore, berberine affected cardiac functionality of the embryos, promoting bradycardia and reducing the cardiac output, the atrial shortening fraction percentage and the atrial stroke volume. We also found that, during development, berberine interferes with the angiogenic process, without altering vascular permeability. These alterations are associated with increased levels of vascular endothelial growth factor aa (vegfaa) mRNA, suggesting an important role for Vegfaa as mediator of berberine-induced cardiovascular defects. Altogether, these data indicate that berberine treatment during vertebrate development leads to an impairment of cardiovascular system morphogenesis and functionality, suggesting a note of caution in its use during pregnancy and lactation.

Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs

With growing antipathy toward conventional prescription drugs due to the fear of adverse events, the general and patient populations have been increasingly using complementary and alternative medications (CAMs) for managing acute and chronic diseases. The general misconception is that natural herbal-based preparations are devoid of toxicity, and hence short- and long-term use remain justified among people as well as the CAM practitioners who prescribe these medicines. In this regard, Ayurvedic herbal medications have become one of the most utilized in the East, specifically the Indian sub-continent, with increasing use in the West. Recent well-performed observational studies have confirmed the hepatotoxic potential of Ayurvedic drugs. Toxicity stems from direct effects or from indirect effects through herbal metabolites, unknown herb-herb and herb-drug interactions, adulteration of Ayurvedic drugs with other prescription medicines, and contamination due to poor manufacturing practices. In this exhaustive review, we present details on their hepatotoxic potential, discuss the mechanisms, clinical presentation, liver histology and patient outcomes of certain commonly used Ayurvedic herbs which will serve as a knowledge bank for physicians caring for liver disease patients, to support early identification and treatment of those who present with CAM-induced liver injury.

Haematology and Serum Biochemical Indices of Lambs Supplemented with Moringa oleifera, Jatropha curcas and Aloe vera Leaf Extract as Anti-Methanogenic Additives

Medicinal plants have been found to be effective in a wide range of applications in ruminant animals. However, some plant extracts may be toxic to animals, depending on their seconday metabolite composition and dose, and therefore, animal trials are needed to validate their safety when used as anti-methanogenic additives. This study investigated the effect of three plant extracts used as anti-methanogenic dietary additives, on the haematology and serum biochemical parameters in sheep. Methanolic extracts of Moringa oleifera (MO), Jatropha curcas (JC) and Aloe vera (AV) were orally dosed as experimental treatments for 75 days to sheep, and their effect on the haematology and serum biochemical parameters of SA Mutton Merino (SAMM) lambs were compared with sheep on a control treatment without any additive treatment. Extracts of MO, JC and AV were extracted in 100% methanol, freeze-dried, and reconstituted in distilled water. A total of 40 lambs were ranked according to their body weight into a group of four and one sheep at a time was randomly allocated into four dietary treatments which include a control treatment, and treatment with either MO, JC or AV extract. Lambs were drenched twice daily with doses equivalent to 50 mg/kg dry matter intake (DMI) based on previous week feed consumption. Blood samples were collected via jugular vein puncture and analysed for haematology and serum biochemistry parameters, using standard procedures. The results of the haematological analysis showed that most haematological parameters were not affected by plant extract used as anti-methanogenic additives (p > 0.05), except for higher white blood cell (WBC) and lymphocytes counts recorded in control lambs and lambs in the AV treatment. All serum biochemical properties (except alkaline phosphatase) were not different (p > 0.05) between the control and lambs treated with plant extracts. Alkaline phosphatase was influenced by the plant extract (p < 0.05), with lambs receiving MO, JC and AV having lower alkaline phosphatase concentrations compared to lambs on the control diet without any additive. The result of the study showed that extracts of MO, JC and AV were not toxic to sheep when used as antimethanogenic additives at the recommended dose of 50 mg/kg dry matter feed which had proved previously to be effective in reducing enteric methane emission. Therefore, these plant extracts could be used safely as alternative dietary additives to reduce enteric methane emission and boost the productivity of SA Mutton Merino sheep.

Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

Topical medicines for wound healing: A systematic review of Unani literature with recent advances

ETHNOPHARMACOLOGICAL RELEVANCE

Wound healing is an important area of research in contemporary medicine. Unani is a traditional medicine system based on hundreds of years of observations and experiences. Wounds are described under the headings qarha (arabic) and jarāhat (persian) in classical Unani texts. Several drugs of herbal, mineral and animal origin are described in Unani texts as having wound healing properties. Many of these drugs have been screened on various scientific parameters but the potential of most drugs remains unexplored.

METHODOLOGY

The study was aimed at summarizing the topical wound healing drugs mentioned in classical Unani books. The topical wound healing drugs were first identified in classical texts. Then 20 drugs were selected for detailed review on the basis of clinical relevance and wide availability.

OBSERVATIONS AND RESULTS

Seventy drugs were identified in Unani texts after removal of duplicacy. Most of the drugs (85.71%) were of herbal origin, while 10% were of mineral origin and the rest 4.28% were of animal origin. Most of the herbal drugs belonged to the Fabaceae (10%) and Rosaceae (8.33%) families. Biologically active compounds such as phenols, sterols, hydrocarbons, anthocyanidins, flavonoids and tannins have been identified in almost all drugs which support classical literature.

CONCLUSION

Unani system of medicine has a rich legacy of effective wound healing drugs, which is reinforced by modern researches. Most drugs exert their action on multiple phases of wound healing. In addition, most drugs have no reported adverse effects in laboratory and clinical studies. Hence, Unani medicine may offer the much-needed affordable and effective wound care in a wide range of clinical settings.

Herbal medicine use among pregnant women attending antenatal clinics in Lusaka Province, Zambia: A cross-sectional, multicentre study

BACKGROUND AND PURPOSE: The study of herbal medicine (HM) use which is related to maternal health, a public health priority in many sub-Saharan African countries including Zambia, has been limited. Accordingly, we aimed to determine the prevalence and patterns of HM use during pregnancy in Lusaka Province, Zambia.

MATERIALS AND METHODS

A survey-based (interviewer-administered), cross-sectional, multicentre study was conducted in 446 adult pregnant women attending antenatal clinics in June/July 2019.

RESULTS

Overall, 57.8% of participants reported using HM during their current pregnancy, with a mean of 2.0 ± 1.5 remedies/woman. Logistic regression analysis showed that HM use was significantly associated with HM use in prior pregnancies (p < 0.001) and willingness to use HM in the future (p < 0.001). The most commonly used herbs were lemon for nausea/vomiting and common cold, soybean to boost energy, ginger for common cold and nausea/vomiting, and Aloe vera for skin care. The perceived safety of HM (37.6%) and its complementary action with conventional medicines (35.3%) were the main reasons for HM use.

CONCLUSION

HM use among pregnant women attending antenatal clinics in Lusaka Province, Zambia is common, and a wide range of herbs is used.

Herbal Medicine Use During Pregnancy: A Review of the Literature With a Special Focus on Sub-Saharan Africa

Herbal medicine use has grown considerably worldwide among pregnant women, and is particularly widespread in sub-Saharan Africa. However, herbal medicines used across sub-Saharan Africa are associated with important research gaps and a lack of regulatory framework. This is particularly problematic, as herbal medicine use during pregnancy raises several concerns attributed to the herbal ingredient itself, conventional drug-herbal medicine interactions, and contamination or adulteration of herbal remedies. Moreover, several local herbal remedies used by sub-Saharan African pregnant women have never been botanically identified. In this review, an overview of the practice of herbal medicine, including the regulations, challenges and overall safety, is provided. Then, we discuss the prevalence of herbal medicine use during pregnancy across different sub-Saharan African countries, as well as the indications, adverse outcomes, and effectiveness of the most commonly used herbal medicines during pregnancy in that region.

The Effect of Aloe Vera Juice on Liver Enzymes and Hepatic Structure in a Healthy Population

BACKGROUND

There have been isolated reports of Aloe vera hepatotoxicity, usually manifested by transient liver function test abnormalities. While the European Food Safety Authority has recommended that whole leaf products containing the rind of the Aloe vera plant should not be used for human oral consumption, those Aloe vera gels made of the treated plant pulp alone are considered safe for daily consumption, provided recommended quantities are not exceeded. We aimed to assess hepatic function in healthy volunteers consuming the purified plant pulp Aloe vera gel over a 60 day period.

METHODS

35 healthy volunteers consumed the maximum recommended daily dose of 2 oz (57 mL) of Aloe vera gel twice daily for a total of 60 days. The participants attended an initial baseline visit where biochemical measurements of hepatic synthetic function were obtained, and each volunteer underwent hepatic ultrasound with elastography, superb microvascular imaging and image quantification. Further visits were undertaken at days 30 and 60 to undergo the same biochemical and imaging measurements of liver function to monitor if there were any changes in the parameters measured.

RESULTS

Seven volunteers failed to complete the study, citing unspecified gastrointestinal upset and/or an inability to tolerate the taste of the Aloe vera gel. None of these individuals had disturbance of biochemical or imaging parameters of hepatic function. Of the remaining 27 healthy volunteers, none had a change in either biochemical indices of liver function, or of ultrasound markers of hepatic blood flow or liver tissue elasticity after 60 days of Aloe vera gel consumption. However, there was a non-significant reduction in serum homocysteine levels as the only detectable change in the cohort.

CONCLUSIONS

Despite reports of potential hepatotoxicity with some Aloe vera products, in this healthy cohort, extended consumption of purified plant-pulp Aloe vera gel did not have any detectable effects on hepatic function, blood flow or tissue elasticity.

Post-transcriptional regulation activity through alternative splicing involved in the effects of Aloe vera on the Wnt/β-catenin and Notch pathways in colorectal cancer cells

Aloe vera (L.) Burm.f. is widely used as laxative drugs, cosmetics, and functional food due to a variety of therapeutic effects. However, several studies indicated a colonic carcinogenic activity of Aloe vera. But the underline mechanism has not been well clarified. This study aimed to explore the potential mechanism at the post-transcriptional level. Identification of Differential Expressed Alternative Splicing (DEAS) genes and events and the corresponding functional enrichment analyses were conducted on RKO cells after treated with Aloe vera aqueous extract and its two active components, aloin and aloesin. And RT-qPCR was conducted for validation. Results indicated that they induced 2200, 2342 and 2133 DEAS events, respectively. The GO enrichment and the COG classification results of DEAS genes showed that they were associated with transcription, as well as functions like signal transduction mechanisms. Moreover, DEAS genes related to the two colorectal cancerous pathways, Wnt and Notch pathways, were annotated. In conclusion, aloe extract, aloin and aloesin significantly regulated the DEAS profile of RKO cells. The colonic carcinogenicity of Aloe vera may due to its post-transcriptional regulatory activity through Alternative Splicing (AS) on genes, especially on Wnt-related and Notch-related key genes.

Aloe/poloxamer hydrogel as an injectable β-estradiol delivery scaffold with multi-therapeutic effects to promote endometrial regeneration for intrauterine adhesion treatment

Intrauterine adhesion (IUA) is characterized by endometrial stromal replaced with fibrous tissue during the trauma or operation induced injury. Current clinic IUA management mainly involves surgical removal of the connective tissues and physical separation and often results in reoccurrence. It is of clinic interest to directly address the issue via facilitating the endometrial repair and thereby inhibiting the formation of re-adhesion. To this end, we designed a nanocomposite aloe/poloxamer hydrogel for β-estradiol (E2) intrauterine delivery to exert multi-therapeutic effects and promote endometrial regeneration for IUA treatment. Nanoparticulate decellularized uterus (uECMNPs) was prepared to encapsulate E2 (E2@uECMNPs), which improved the solubility and prolonged cargo release. Then, E2@uECMNPs were further embedded into the thermosensitive aloe-poloxamer hydrogel (E2@uECMNPs/AP). Multiple components from E2@uECMNPs/AP system could collectively promote proliferation and inhibit apoptosis of endometrial stromal cells. E2@uECMNPs/AP significantly increased morphological recovery and decreased uterine fibrosis rate compared with IUA rats in other groups in vivo. Additionally, the levels of Ki67, cytokeratin, and estrogen receptor β were all up-regulated, along with the decreased expression of TGF-β1 and TNF-α in the uterus from rats receiving E2@uECMNPs/AP therapy. Taken together, in situ administration of E2@uECMNPs/AP hydrogel could effectively promote endometrial regeneration and prevent the re-adhesion.

Public Knowledge, Attitude, and Practice on Herbal Remedies Used During Pregnancy and Lactation in West Bank Palestine

The use of herbal products by pregnant and lactating mothers without awareness of their harmful effects may expose both mother and fetus or infant to great dangers, such as abortion, premature delivery, uterine bleeding, and physical and mental retardation of the fetus. Thus, the aim of this study was to investigate the extent to which herbal product treatment is used and the reason for which such products are used and to ensure that these reasons are correct. An ethnopharmacological survey (cross-sectional observational design study) using a pre-piloted questionnaire was undertaken on herbal products used by pregnant and lactating women in the West Bank area of Palestine. A questionnaire was distributed to 350 pregnant and lactating women. The informed consent forms, ethics, and aims of the present study were reviewed and approved by the Institutional Review Board (IRB) at An-Najah National University. To identify the most important species used, the use value (UV) index was employed, while the SPSS program was used to analyze the data. Collected data revealed that 13 medicinal plants are utilized, while 12 plants are not used during pregnancy. Moreover, 15 plants are utilized and 9 plants are not used during lactation for treating and dealing with various problems. The most commonly used plants belonged to 14 families, including Lamiaceae, Apiaceae, Leguminosae, and Rubiaceae. The plants most used during pregnancy were sage (Salvia fruticosa), anise (Pimpinella anisum), and peppermint (Mentha × piperita). Castor (Ricinus communis) oil, ginger (Zingiber officinale), saffron (Crocus sativus), and senna (Senna alexandrina) mostly were not used by pregnant women. Moreover, cinnamon (Cinnamomum verum), anise (P. anisum), peppermint (M. piperita), and sage (S. fruticosa) were mostly used during lactation. Castor (R. communis) oil, ginger (Z. officinale), garlic (Allium sativum), and aloe (Aloe vera) mostly were not used during lactation. This study is of great importance in order to decrease the possibility of endangering the lives of fetuses and infants. A combined effort among researchers, scientists, lactating women, and pregnant women may help in changing wrong uses and thoughts about medicinal plants and help to improve the overall health of both mother and fetus.

Characterization of compisote edible films from aloe vera gel, beeswax and chitosan

Environmental consciousness as well as individual’s demand for ready to eat food, recently, has changed the trends in food packaging leading to the development of biodegradable and edible packaging. Emulsified edible films have better transparency, superior mechanical properties and provide barriers to water and other atmospheric gases. Edible films if not consumed, biodegrad chemically. In present study, edible films were, initially, prepared using Chitosan and Aloe vera at different concentrations. Films were then subjected to physical and mechanical testing. Films with 20% Aloe vera had low thickness as compared to films with no Aloe vera. These films also had superior mechanical properties and lower water vapor permeability. Films with 20% Aloe vera were, then, selected and beeswax was dispersed in Chitosan-Aloe vera solution at concentration upto 2.0% followed by film preparation through casting technique. Thickness and water vapor permeability were observed to be improved with increase in concentration of beeswax. Tensile strength of edible films was also improved 1.3 times when concentration of beeswax increased from 0.5 to 2.0%. Percentage elongation decreased with increase in beeswax concentration in the emulsified films. No change in particle size was observed with change in concentration of beeswax. Emulsions were also stable at room temperatures. Decrease in transparency of emulsified edible films was observed with increase in beeswax content in the emulsified films. In addition, cost analysis of the films proved them reasonable to be used as an alternate of synthetic packaging materials.

Study of the aqueous extract of Aloe vera and its two active components on the Wnt/β-catenin and Notch signaling pathways in colorectal cancer cells

ETHNOPHARMACOLOGICAL RELEVANCE

Aloe vera (L.) Burm. f. (Aloe vera) is a common Traditional Chinese Medicine (TCM) recorded in Pharmacopoeia of the People's Republic of China (version 2015). It has been traditionally used for treatment of constipation. Aloe vera requires much attention for its safety evaluation because several studies have reported the association between oral consumption of Aloe vera and the development of colorectal cancer (CRC). However the material basis and molecular mechanism are.still less well elucidated. Although Wnt/β-catenin and Notch signaling pathway have been known to be closely related to the initiation and development of CRC, the impacts of Aloe vera on these cancerous pathways have not been completely determined yet.

AIM OF THIS STUDY

Hence, this study aimed to study the impacts of Aloe vera on the Wnt/β-catenin and Notch signaling pathway, as well as proliferation of CRC cells.

MATERIALS AND METHODS

Firstly, the effects of Aloe vera aqueous extract and its two active components (aloin and aloesin) on the Wnt/β-catenin and Notch signaling pathway were studied by luciferase reporter, RT-qPCR, western blotting and immunofluorescence assays, respectively. Furthermore, RNA sequencing analysis (RNA-seq) was then performed to verify their regulatory activities on the Wnt-related and Notch-related genes expression. Finally, their impacts on RKO cell proliferation and cell cycle phase were also evaluated via MTT assay and cell cycle analysis.

RESULTS

Our results indicate that the aqueous extract of Aloe vera and its active component aloin activated the Wnt/β-catenin pathway and inhibited the Notch signaling pathway only in the presence of Wnt3a. While aloesin was characterized to directly activate the Wnt/β-catenin pathway and inhibit the Notch pathway independent of Wnt3a. Within 24h, the Aloe vera extract and its two components were failed to affect the proliferation or cell cycle phase of RKO cells. Nevertheless, in the presence of Wnt3a, the aqueous extract of Aloe vera with the concentration of 33.3 μg/ml start to promote the cell proliferation of RKO cells after 48h incubation.

CONCLUSION

In conclusion, this study showed that Aloe vera extract and its active component aloin activated the Wnt/β-catenin pathway and inhibited the Notch pathway in the presence of Wnt3a. While another active component, aloesin, activated the Wnt/β-catenin pathway and inhibited the Notch signaling pathway independent of Wnt3a. Given that Wnt/β-catenin and Notch pathway are closely associated with the progression of CRC, these findings would be helpful to better understand the colonic carcinogenicity of Aloe vera.

Aloe veraat the frontier of glycobiology and integrative medicine: Health implications of an ancient plant

Aloe vera plant extracts are ubiquitous in foods, cosmetics, and medicine. Like all plants, these extracts contain an array of potential bioactives or glycans, which may contribute to health when applied or consumed. In the Aloe vera plant, these bioactives are dominated by acemannan, a type of carbohydrate, and related complexes of saccharides, proteins, and lipids. Clinical data suggest aloe extracts may be beneficial in the management of cutaneous and some systemic conditions, such as some forms of immune dysfunction, atherogenesis, malignancy, and numerous cell functions. These extracts also contain an entourage of bioactive substances that may be allergenic and potentially toxic as well as salutary. These substances include aloin and a variety of anthracenes. The concentrations of potential allergens, aloin, and related compounds are markedly reduced through controlled decolorization processes that are utilized by leading Aloe products manufacturers. The entourage effects of contemporary Aloe vera when consumed or applied topically represent opportunities for clinical investigation which may be applied to commercial consumer products and therapeutic indications. Future research should fully explore the range of bioactive glycan components and their respective safety and efficacy. The history and ongoing popularity of Aloe vera products represent a pragmatic mandate for well-designed investigation into the diverse functional roles of glycans.

Lead bioactive compounds of Aloe vera as potential anticancer agent

Aloe vera (Aloe barbadensis Miller) is a perennial succulent medicinal plant. It has been used as a traditional or folk medicine for thousands of years and claimed that it possesses wound and burn healing activities, and anti-inflammatory as well as immunomodulatory effects. In recent years, the use of Aloe vera has been growing as a dietary supplement. The pre-clinical studies over the last couple of decades uncover the potential therapeutic activities of Aloe vera and its bioactive compounds, especially against neoplastic disease. Such investigations indicate the possible preventive as well as therapeutic effects of Aloe vera against cancer. Here, we discuss the crucial bioactive compounds of Aloe vera that have been harnessed against cancer and also address several mechanisms of action of these lead bioactive compounds compared to other standard drugs involved in cancer prevention and treatment.

Prevalence of Traditional Medicine Use during Pregnancy, at Labour and for Postpartum Care in a Rural Area in Zimbabwe

Objectives:

The aim of this study was to determine the prevalence and types of traditional medicine used during pregnancy, at labour and for postpartum care by women in rural Zimbabwe.

Research design:

A cross-sectional survey was conducted on 398 women from two rural districts in Zimbabwe. Data on socio-demography, pregnancy related information as well as traditional medicine use patterns was collected using a structured interviewer administered questionnaire. Convenient sampling was used to recruit women of childbearing age who were either pregnant at the time of the study, or had previously given birth.

Results:

The prevalence of traditional medicine used during pregnancy and at labour was 69.9% and only 17.3% used these medicines for postpartum care. During pregnancy, 27.7% used soil from a mole hill, 21.6% used elephant dung, and 13.3% used Fadogia ancylantha. These medicines were mainly used to facilitate labour (43.5%), avoid tears/stitches (19.7%), make delivery easy and safe (18.3%) and to avoid prolonged labour (5%). Only 9% of the participants however reported to have experienced adverse effects from using traditional medicines.

Conclusion:

The use of traditional remedies in different forms during pregnancy and at labour was very common as confirmed by the high prevalence rate of 69.9%. Some of the women however used more than one type of traditional medicine during pregnancy, labour and for postpartum care. The exact effects of some of these medicines on both the mother and infant however, are not known, and there is therefore a need for them to be studied in greater detail.

Oesophageal ulcer due to a herbal remedy

Herbal-induced oesophageal lesions are rare. We report the case of an 85-year-old male who presented with cough and odynophagia. An upper endoscopy showed white deposit under the proximal oesophageal sphincter. Biopsy of the lesion revealed an oesophageal ulcer with adherent plant material and ruled-out candidiasis. At this point, the patient divulged self-preparation of an herbal remedy consisting of Aloe Vera pulp, whisky, honey, ginger and turmeric. Aloe Vera, ginger and turmeric are commonly used to sooth some gastroenterological symptoms in Complementary and Alternative Medicine. Incorrect extraction of Aloe Vera pulp and adding honey to it transformed the recipe into a sticky paste that may have injured the oesophageal mucosa. Follow-up showed that the cough and odynophagia subsided after discontinuing this herbal remedy.

Treatment-related changes after short-term exposure of SD rats to Aloe vera whole-leaf freeze-dried powder

Aloe vera is a widely used natural herb from which many sorts of commercial products have been derived using different preparation technologies. Aloe whole-leaf powder is one of the most popular subtypes. The long-term impact of aloe products has already been reported; however, there have been few studies about short-term exposure, and especially about the relative impact of Aloe vera whole-leaf freeze-dried powder (AWFP). To provide more toxicological data and to document the early changes induced by AWFP, in this study 120 SD rats were divided into four groups (control and 400/1200/2000 mg/kg treatment groups) and were administered AWFP once daily by oral gavage for 28 consecutive days, followed by a two week recovery phase. The results showed that AWFP could induce soft/loose changes in faeces. Significantly decreased white blood cell (WBC) counts, associated with reduced lymphocyte counts were also noted. The relative organ weight, including both organ-to-body weight ratio and organ-to-brain weight ratio of kidneys, was significantly increased in 2000 mg/kg compared with that in controls. Histopathologically, pigmentation in the kidneys and increased mucosal thickness in colon were also noted in a dose response groups. Other changes observed in the study were not considered to be treatment related, and 400 mg/kg was considered as the no-observed-adverse-effect level. The study provided clear evidence of treatment-related changes with a short-term exposure to AWFP. This is also the first report of the early colon morphologic changes associated with stool changes noted previously in-life phase, providing additional toxicity data which will contribute to our understanding about the short-term usage of AWFP as a remedy.

Biomimetically engineered Amphotericin B nano-aggregates circumvent toxicity constraints and treat systemic fungal infection in experimental animals

Biomimetic synthesis of nanoparticles offers a convenient and bio friendly approach to fabricate complex structures with sub-nanometer precision from simple precursor components. In the present study, we have synthesized nanoparticles of Amphotericin B (AmB), a potent antifungal agent, using Aloe vera leaf extract. The synthesis of AmB nano-assemblies (AmB-NAs) was established employing spectro-photometric and electron microscopic studies, while their crystalline nature was established by X-ray diffraction. AmB-nano-formulation showed much higher stability in both phosphate buffer saline and serum and exhibit sustained release of parent drug over an extended time period. The as-synthesized AmB-NA possessed significantly less haemolysis as well as nephrotoxicity in the host at par with Ambisome®, a liposomized AmB formulation. Interestingly, the AmB-NAs were more effective in killing various fungal pathogens including Candida spp. and evoked less drug related toxic manifestations in the host as compared to free form of the drug. The data of the present study suggest that biomimetically synthesized AmB-NA circumvent toxicity issues and offer a promising approach to eliminate systemic fungal infections in Balb/C mice.

Review of Ginkgo biloba-induced toxicity, from experimental studies to human case reports

Ginkgo biloba seeds and leaves have been used as a traditional herbal remedy for thousands of years, and its leaf extract has been consumed as a botanical dietary supplement for decades. Ginkgo biloba extract is a complex mixture with numerous components, including flavonol glycosides and terpene lactones, and is one of the most widely sold botanical dietary supplements worldwide. Concerns about potential health risks for the general population have been raised because of the widespread human exposure to Ginkgo biloba and its potential toxic and carcinogenic activities in rodents. The National Toxicology Program conducted 2-year gavage studies on one Ginkgo biloba leaf extract and concluded that there was clear evidence of carcinogenic activity of this extract in mice based on an increased incidence of hepatocellular carcinoma and hepatoblastoma. Recently, Ginkgo biloba leaf extract has been classified as a possible human carcinogen (Group 2B) by the International Agency for Research on Cancer. This review presents updated information on the toxicological effects from experimental studies both in vitro and in vivo to human case reports (caused by ginkgo seeds or leaves), and also summarizes the negative results from relatively large clinical trials.