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Zhang X, Zhang L, Zhang B, Liu K, Sun J, Li Q, Zhao L. Herbal tea, a novel adjuvant therapy for treating type 2 diabetes mellitus: A review. Front Pharmacol 2022; 13:982387. [PMID: 36249806 PMCID: PMC9561533 DOI: 10.3389/fphar.2022.982387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic, endocrine disease characterized by persistent hyperglycemia. Several studies have shown that herbal tea improves glucose metabolism disorders in patients with T2DM. This study summarizes the published randomized controlled trials (RCTs) on herbal tea as a adjuvant therapy for treating T2DM and found that herbal teas have potential add-on effects in lowering blood glucose levels. In addition, we discussed the polyphenol contents in common herbal teas and their possible adverse effects. To better guide the application of herbal teas, we further summarized the hypoglycemic mechanisms of common herbal teas, which mainly involve: 1) improving insulin resistance, 2) protecting islet β-cells, 3) anti-inflammation and anti-oxidation, 4) inhibition of glucose absorption, and 5) suppression of gluconeogenesis. In conclusion, herbal tea, as a novel adjuvant therapy for treating T2DM, has the potential for further in-depth research and product development.
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Affiliation(s)
- Xiangyuan Zhang
- Department of Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate College, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Lili Zhang
- Department of Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Boxun Zhang
- Department of Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ke Liu
- Department of Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jun Sun
- Graduate College, Changchun University of Traditional Chinese Medicine, Jilin, China
| | - Qingwei Li
- Department of Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Qingwei Li, ; Linhua Zhao,
| | - Linhua Zhao
- Department of Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Qingwei Li, ; Linhua Zhao,
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Dai Z, Liao X, Wieland LS, Hu J, Wang Y, Kim TH, Liu JP, Zhan S, Robinson N. Cochrane systematic reviews on traditional Chinese medicine: What matters-the quantity or quality of evidence? PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 98:153921. [PMID: 35104758 PMCID: PMC9741948 DOI: 10.1016/j.phymed.2021.153921] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Systematic reviews on traditional Chinese medicine (TCM) are constantly increasing. However, if these reviews are to be of practical value, the evidence needs to be relevant, valid, and adequately reported. Cochrane Systematic Reviews (CSRs) are considered as high-quality systematic reviews that can inform health care decision making. Our aim was to provide an overview of the scope, findings, quality and impact of CSRs on the benefits and harms associated with TCM interventions for the treatment and prevention of disease to provide new information for clinical practice and future research. METHODS The Cochrane Database of Systematic Reviews was searched up to May 2021, and descriptive characteristics were extracted. The correspondence between the questions asked in the CSRs and the available evidence, conclusions and certainty of findings (according to GRADE assessment), methodological quality (AMSTAR 2), and impact (Altmetric Attention Score [AAS], total citations by guideline, and total citations in Web of Science [WoS]) of CSRs were extracted. Tabular and graphical summaries of these descriptive characteristics were constructed. RESULTS Of 104 CSRs on TCM identified, 70 diseases belonged to 16 disease systems and contained 1642 primary studies with 157,943 participants. Interventions included Chinese herbal medicine (n = 70), acupuncture (n = 28), TCM exercises (n = 4), and moxibustion (n = 2). Among 1642 primary studies, 662 studies included an intervention group treated with at least one TCM therapy and 980 studies included a combination of therapies. Promising outcomes from the 104 CSRs were divided into endpoint outcomes (34 diseases), doctor- or patient-reported outcomes (27 diseases), and surrogate outcomes (37 diseases). Despite the presence of promising outcomes, only 5/104 CSRs drew overall positive conclusions, 42 CSRs concluded the evidence was insufficient, and 54 failed to draw firm conclusions. GRADE assessments were reported in 41.3% of the CSRs, and the ratings were mostly low or very low. Comparing the questions asked and results obtained, there was frequently a lack of information about specific outcomes. Only 16 CSRs obtained results for all outcomes listed in the methods section. According to AMSTAR 2, 51 CSRs (49.0%) were of low quality. The total number of citations in the WoS was 2135 (mean ± SD: 20.8 ± 21.2), and 38.5% of the CSRs had been cited in guidelines 95 times. CONCLUSION Although TCM is commonly used, evidence of its effectiveness remains largely inconclusive. Rigorous high-quality trials are needed to support the performance of high-quality reviews and to increase the evidence base. It is critical to emphasize quality over quantity in future TCM research.
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Affiliation(s)
- Zeqi Dai
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China; China Center for Evidence Based Traditional Chinese Medicine, Beijing 100700, China
| | - Xing Liao
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - L Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore MD 21201, USA
| | - Jing Hu
- Evidence-based Medicine Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China
| | - Yongyan Wang
- Center for Evidence Based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, #23 Kyungheedae-ro, Dondaemun-gu, Seoul 02447, South Korea
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China.
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.5 Yiheyuan Road, Haidian District, Beijing 100191, China.
| | - Nicola Robinson
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing 100029, China; Institute of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK.
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Interventions for preventing influenza: An overview of Cochrane systematic reviews and a Bayesian network meta-analysis. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 19:503-514. [PMID: 34544670 DOI: 10.1016/j.joim.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Influenza places a heavy public health burden in numerous countries every year. In addition to vaccines, there are some interventions that are effective in preventing influenza. OBJECTIVE This overview of systematic reviews (SRs) aimed to evaluate the efficacy and safety of interventions for influenza prevention. SEARCH STRATEGY We searched the Cochrane Database of Systematic Reviews, 2020, Issue 1 for relevant Cochrane SRs using the keywords "common cold," "influenza," and "flu." INCLUSION CRITERIA Cochrane SRs that investigated the prevention of influenza were included. Participants included the general population without influenza or influenza-like symptoms, who were treated with preventative interventions and compared to individuals receiving no treatment or placebo. DATA EXTRACTION AND ANALYSIS Two reviewers independently screened citations against pre-defined inclusion criteria and extracted data. The methodological quality of these SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews-II (AMSTAR-II) guidelines. The primary outcome of our analysis was the incidence of influenza, and the secondary outcomes were the incidence of influenza-like illness and hospitalization. In addition to the narrative summary of SR findings, we also pooled data from homogeneous trials among these SRs and produced evidence mapping. We conducted a network meta-analysis to compare the effect across interventions and used the Cochrane approach to grading of recommendations, assessment, development, and evaluation (GRADE) to assess the quality of evidence. RESULTS Eleven Cochrane SRs were included, covering five medications, eleven vaccinations and four complementary therapies. Among these SRs, 73% scored "high" quality on AMSTAR-II rating. We found that eight interventions, including amantadine, garlic, and six different vaccines, were beneficial for reducing the incidence of influenza compared to placebo, while oseltamivir, zanamivir, Ganmao capsule, Echinacea, and another three types of vaccine were probably beneficial. Ganmao capsule ranked highest for influenza prevention in the network meta-analysis, followed by amantadine, garlic, and vaccines of all types. Monovalent inactivated parenteral vaccine was found to be beneficial in reducing the incidence of influenza-like illness. None of the interventions reduced the hospitalization rate. CONCLUSION High-quality evidence showed that garlic or vaccine had advantages in preventing influenza, and that vitamin C is not effective. The effect of other interventions needs to be further verified with high-quality evidence.
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Yoshino T, Arita R, Horiba Y, Watanabe K. The use of maoto (Ma-Huang-Tang), a traditional Japanese Kampo medicine, to alleviate flu symptoms: a systematic review and meta-analysis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:68. [PMID: 30885188 PMCID: PMC6421694 DOI: 10.1186/s12906-019-2474-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/06/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Influenza is a common viral infection worldwide. Maoto (ma-huang-tang) was developed in ancient China and is used to alleviate flu symptoms. Currently, no meta-analyses have evaluated the efficacy and safety of maoto for alleviating flu symptoms. METHODS In the present study, we searched MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, a Japanese database (Ichushi), two Chinese databases (China National Knowledge Infrastructure and VIP), and two Korean databases (Korean Medical database and Korean Association of Medical Journal Editors) for studies published in or before October 2017. Clinical studies that compared maoto plus neuraminidase inhibitors (NAIs) vs. NAIs alone, or maoto alone vs. NAIs alone, were included in the present analysis. The primary outcome measure (efficacy) was the length of time from the start of medication to resolution of influenza symptoms (fever, headache, malaise, myalgia, and chills) and virus isolation. The secondary outcome measures (safety) were as follows: (1) side effects and adverse reactions, such as nausea, abnormal behaviour, or discontinuation of symptomatic treatment; (2) morbidity (complications caused by influenza infection) or mortality; and (3) hospitalisation for any reason. RESULTS Twelve relevant studies were identified, including two randomised controlled trials (RCTs, N = 60) and ten non-randomised studies (NRSs, N = 1110). We found that maoto plus NAIs was superior to NAIs alone in terms of the duration of fever in one RCT (P < 0.05, median difference = - 6 h) and four NRSs (P = 0.003, weighted mean difference = - 5.34 h). The duration of symptoms or virus isolation did not differ between maoto and NAIs. No severe side effects or adverse reactions were reported related to maoto or NAIs. CONCLUSIONS Although we could not reach a definitive conclusion because of the small sample sizes and high risk of bias in the analysed studies, maoto may lower the duration of fever when it is used alone or in combination with NAIs and may be a well-tolerated treatment. More RCTs are needed to determine the efficacy and safety of maoto.
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Affiliation(s)
- Tetsuhiro Yoshino
- Center for Kampo Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
- Linus Pauling Institute, Oregon State University, Linus Pauling Science Center, Corvallis, OR USA
| | - Ryutaro Arita
- Center for Kampo Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
- Department of Education and Support for Regional Medicine, Department of Kampo Medicine, Tohoku University School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, Miyagi Japan
| | - Yuko Horiba
- Center for Kampo Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Kenji Watanabe
- Center for Kampo Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
- Faculty of Environment and Information Studies, Keio University, 5322 Endo, Fujisawa, Kanagawa Japan
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Hui DS, Lee N, Chan PK, Beigel JH. The role of adjuvant immunomodulatory agents for treatment of severe influenza. Antiviral Res 2018; 150:202-216. [PMID: 29325970 PMCID: PMC5801167 DOI: 10.1016/j.antiviral.2018.01.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/31/2017] [Accepted: 01/05/2018] [Indexed: 12/18/2022]
Abstract
A severe inflammatory immune response with hypercytokinemia occurs in patients hospitalized with severe influenza, such as avian influenza A(H5N1), A(H7N9), and seasonal A(H1N1)pdm09 virus infections. The role of immunomodulatory therapy is unclear as there have been limited published data based on randomized controlled trials (RCTs). Passive immunotherapy such as convalescent plasma and hyperimmune globulin have some studies demonstrating benefit when administered as an adjunctive therapy for severe influenza. Triple combination of oseltamivir, clarithromycin, and naproxen for severe influenza has one study supporting its use, and confirmatory studies would be of great interest. Likewise, confirmatory studies of sirolimus without concomitant corticosteroid therapy should be explored as a research priority. Other agents with potential immunomodulating effects, including non-immune intravenous immunoglobulin, N-acetylcysteine, acute use of statins, macrolides, pamidronate, nitazoxanide, chloroquine, antiC5a antibody, interferons, human mesenchymal stromal cells, mycophenolic acid, peroxisome proliferator-activated receptors agonists, non-steroidal anti-inflammatory agents, mesalazine, herbal medicine, and the role of plasmapheresis and hemoperfusion as rescue therapy have supportive preclinical or observational clinical data, and deserve more investigation preferably by RCTs. Systemic corticosteroids administered in high dose may increase the risk of mortality and morbidity in patients with severe influenza and should not be used, while the clinical utility of low dose systemic corticosteroids requires further investigation.
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Affiliation(s)
- David S Hui
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Nelson Lee
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; Division of Infectious Diseases, University of Alberta, Edmonton, Canada
| | - Paul K Chan
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - John H Beigel
- Leidos Biomedical Research Inc, Support to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Hu XY, Wu RH, Logue M, Blondel C, Lai LYW, Stuart B, Flower A, Fei YT, Moore M, Shepherd J, Liu JP, Lewith G. Andrographis paniculata (Chuān Xīn Lián) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One 2017; 12:e0181780. [PMID: 28783743 PMCID: PMC5544222 DOI: 10.1371/journal.pone.0181780] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/06/2017] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a substantial threat to public health. Safe and effective alternatives are required to reduce unnecessary antibiotic prescribing. Andrographis Paniculata (A. Paniculata, Chuān Xīn Lián) has traditionally been used in Indian and Chinese herbal medicine for cough, cold and influenza, suggesting a role in respiratory tract infections (RTIs). This systematic review aimed to evaluate the clinical effectiveness and safety of A. Paniculata for symptoms of acute RTIs (ARTIs). MATERIALS AND METHODS English and Chinese databases were searched from their inception to March 2016 for randomised controlled trials (RCTs) evaluating oral A. Paniculata without language barriers (Protocol ID: CRD42016035679). The primary outcomes were improvement in ARTI symptoms and adverse events (AEs). A random effects model was used to pool the mean differences and risk ratio with 95% CI reported. Methodological quality was evaluated using the Cochrane risk of bias tool; two reviewers independently screened eligibility and extracted data. RESULTS Thirty-three RCTs (7175 patients) were included. Most trials evaluated A. Paniculata (as a monotherapy and as a herbal mixture) provided commercially but seldom reported manufacturing or quality control details. A. Paniculata improved cough (n = 596, standardised mean difference SMD: -0.39, 95% confidence interval CI [-0.67, -0.10]) and sore throat (n = 314, SMD: -1.13, 95% CI [-1.37, -0.89]) when compared with placebo. A. Paniculata (alone or plus usual care) has a statistically significant effect in improving overall symptoms of ARTIs when compared to placebo, usual care, and other herbal therapies. Evidence also suggested that A. Paniculata (alone or plus usual care) shortened the duration of cough, sore throat and sick leave/time to resolution when compared versus usual care. No major AEs were reported and minor AEs were mainly gastrointestinal. The methodological quality of included trials was overall poor. CONCLUSIONS A. Paniculata appears beneficial and safe for relieving ARTI symptoms and shortening time to symptom resolution. However, these findings should be interpreted cautiously owing to poor study quality and heterogeneity. Well-designed trials evaluating the effectiveness and potential to reduce antibiotic use of A. Paniculata are warranted.
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Affiliation(s)
- Xiao-Yang Hu
- Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom
| | - Ruo-Han Wu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Martin Logue
- Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom
| | - Clara Blondel
- AgroParisTech, Paris Institute of Technology for Life, Food and Environmental Sciences, Paris, France
| | - Lily Yuen Wan Lai
- Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom
| | - Andrew Flower
- Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom
| | - Yu-Tong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Michael Moore
- Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - George Lewith
- Primary Care and Population Sciences, Aldermoor Health Centre, Southampton, United Kingdom
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Chao J, Dai Y, Verpoorte R, Lam W, Cheng YC, Pao LH, Zhang W, Chen S. Major achievements of evidence-based traditional Chinese medicine in treating major diseases. Biochem Pharmacol 2017. [PMID: 28636884 DOI: 10.1016/j.bcp.2017.06.123] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A long history of use and extensive documentation of the clinical practices of traditional Chinese medicine resulted in a considerable number of classical preparations, which are still widely used. This heritage of our ancestors provides a unique resource for drug discovery. Already, a number of important drugs have been developed from traditional medicines, which in fact form the core of Western pharmacotherapy. Therefore, this article discusses the differences in drug development between traditional medicine and Western medicine. Moreover, the article uses the discovery of artemisinin as an example that illustrates the "bedside-bench-bedside" approach to drug discovery to explain that the middle way for drug development is to take advantage of the best features of these two distinct systems and compensate for certain weaknesses in each. This article also summarizes evidence-based traditional medicines and discusses quality control and quality assessment, the crucial steps in botanical drug development. Herbgenomics may provide effective tools to clarify the molecular mechanism of traditional medicines in the botanical drug development. The totality-of-the-evidence approach used by the U.S. Food and Drug Administration for botanical products provides the directions on how to perform quality control from the field throughout the entire production process.
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Affiliation(s)
- Jung Chao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing; Graduate Institute of Health-Industry Technology, Research Center for Food and Cosmetic Safety, and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City; Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, China Medical University, Taichung
| | - Yuntao Dai
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing
| | - Robert Verpoorte
- Natural Products Laboratory, Institute of Biology, Leiden University, Leiden
| | - Wing Lam
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT
| | - Yung-Chi Cheng
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT
| | - Li-Heng Pao
- Graduate Institute of Health-Industry Technology, Research Center for Food and Cosmetic Safety, and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City
| | - Wei Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing
| | - Shilin Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing.
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Huang L, Zhang L, Liu Y, Luo R, Zeng L, Telegina I, Vlassov VV. Arbidol for preventing and treating influenza in adults and children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd011489.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Liang Huang
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
- Ministry of Education; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University; Chengdu Sichuan China 610041
- West China Second University Hospital, Sichuan University; Evidence-Based Pharmacy Center; Chengdu China
| | - Lingli Zhang
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
| | - Yantao Liu
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
- Ministry of Education; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University; Chengdu Sichuan China 610041
- West China Second University Hospital, Sichuan University; Evidence-Based Pharmacy Center; Chengdu China
| | - Rong Luo
- West China Second University Hospital, Sichuan University; Department of Pediatrics; Chengdu Sichuan China
| | - Linan Zeng
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
- Ministry of Education; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University; Chengdu Sichuan China 610041
- West China Second University Hospital, Sichuan University; Evidence-Based Pharmacy Center; Chengdu China
| | - Irina Telegina
- Stavropol State Medical Academy; Department of Obstetrics and Gynaecology, Faculty of Post-Graduate Education; Marshala Zhukova street 42, flat 40 Stavropol Russian Federation 355035
| | - Vasiliy V Vlassov
- State Research University Higher School of Economics; Health Policy Institute; PO Box 13 Moscow Russian Federation 109451
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Su G, Chen X, Liu Z, Yang L, Zhang L, Stålsby Lundborg C, Wen Z, Guo X, Qin X, Liang J, Liu X. Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children. Cochrane Database Syst Rev 2016; 12:CD011958. [PMID: 27905672 PMCID: PMC6463872 DOI: 10.1002/14651858.cd011958.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acute respiratory tract infections (ARTIs) are common in children and can involve both upper and lower airways. Many children experience frequent ARTI episodes or recurrent respiratory tract infections (RRTIs) in early life, which creates challenges for paediatricians, primary care physicians, parents and carers of children.In China, Astragalus (Huang qi), alone or in combination with other herbs, is used by Traditional Chinese Medicine (TCM) practitioners in the form of a water extract, to reduce the risk of ARTIs; it is believed to stimulate the immune system. Better understanding of the therapeutic mechanisms of Astragalus may provide insights into ARTI prevention, and consequently reduced antibiotic use. OBJECTIVES To assess the effectiveness and safety of oral Astragalus for preventing frequent episodes of acute respiratory tract infections (ARTIs) in children in community settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 12, 2015), MEDLINE (Ovid) (1946 to 31 December 2015), Embase (Elsevier) (1974 to 31 December 2015), AMED (Ovid) (1985 to 31 December 2015), Chinese National Knowledge Infrastructure (CNKI) (1979 to 31 December 2015) and Chinese Scientific Journals full text database (CQVIP) (1989 to 31 December 2015), China Biology Medicine disc (CBM 1976 to 31 December 2015) and Wanfang Data Knowledge Service Platform (WanFang) (1998 to 31 December 2015). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing oral Astragalus as a sole Chinese herbal preparation with placebo to prevent frequent episodes of ARTIs in children. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures for this review. We assessed search results to identify relevant studies. We planned to extract data using standardised forms. Disagreements were to be resolved through discussion. Risk of bias was to be assessed using the Cochrane 'Risk of bias' tool. We planned to use mean difference (MD) or standardised mean difference (SMD) for continuous data and risk ratio (RR) or odds ratio (OR) to analyse dichotomous data, both with 95% confidence intervals (CIs). MAIN RESULTS We identified 6080 records: 3352 from English language databases, 2724 from Chinese databases, and four from other sources. Following initial screening and deduplication, we obtained 120 full-text papers for assessment. Of these, 21 were not RCTs; 55 did not meet the inclusion criteria because: participants were aged over 14 years; definition was not included for recurrent or frequent episodes;Astragalus preparation was not an intervention; Astragalus preparation was in the formula but was not the sole agent; the Astragalus preparation was not administered orally; or Astragalus was used for treatment rather than prevention of ARTI. A further 44 studies were excluded because they were not placebo-controlled, although other inclusion criteria were fulfilled.No RCTs met our inclusion criteria. AUTHORS' CONCLUSIONS We found insufficient evidence to enable assessment of the effectiveness and safety of oral Astragalus as a sole intervention to prevent frequent ARTIs in children aged up to 14 years.
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Affiliation(s)
- Guobin Su
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
- Karolinska InstitutetGlobal Health ‐ Health Systems and Policy: Medicines, focusing antibiotics, Department of Public Health SciencesTomtebodavägen 18a, Widerströmska HusetStockholmStockholmSweden171 77
| | - Xiankun Chen
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineKey Unit of Methodology in Clinical ResearchGuangzhouGuangdongChina
| | - Zhuangzhu Liu
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
- Guangdong Provincial Hospital of Chinese MedicineEmergency DepartmentNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Lihong Yang
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineEvidence‐Based Medicine and Clinical Research Service GroupNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - La Zhang
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
| | - Cecilia Stålsby Lundborg
- Karolinska InstitutetGlobal Health ‐ Health Systems and Policy: Medicines, focusing antibiotics, Department of Public Health SciencesTomtebodavägen 18a, Widerströmska HusetStockholmStockholmSweden171 77
| | - Zehuai Wen
- Guangdong Provincial Hospital of Chinese MedicineKey Unit of Methodology in Clinical ResearchNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineEvidence‐Based Medicine and Clinical Research Service GroupNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Xindong Qin
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
| | - Jueyao Liang
- Guangzhou University of Chinese MedicineThe Second Clinical CollegeNo 12 Jichang RoadGuangzhouGuangdongChina510120
| | - Xusheng Liu
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
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Mc Mahon A, Martin-Loeches I. The pharmacological management of severe influenza infection - 'existing and emerging therapies'. Expert Rev Clin Pharmacol 2016; 10:81-95. [PMID: 27797595 DOI: 10.1080/17512433.2017.1255550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over the last century several influenza outbreaks have traversed the globe, most recently the influenza A(H1N1) 2009 pandemic. On each occasion, a highly contagious, virulent pathogen has emerged, leading to significant morbidity and mortality amongst those affected. Areas covered: Early antiviral therapy and supportive care is the mainstay of treatment. Treatment should be started as soon as possible and not delayed for the results of diagnostic testing. Whilst oseltamivir is still the first choice, in case of treatment failure, oseltamivir resistance should be considered, particularly in immunosuppressed patients. Here we review the antivirals currently used for management of influenza and explore a number of investigational agents that may emerge as effective antivirals including parenteral agents, combination antiviral therapy and novel agents in order to adequately target influenza virulence. Expert Commentary: New tools for rapid diagnosis and susceptible strains will help if a patient is not improving because of a resistant strain or an inadequate immune response. Further randomized control trials will be conducted to investigate the use of new antivirals and co-adjuvant therapies that will help to elucidate the process of immune modulation, particularly in immunocompetent patients.
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Affiliation(s)
- Aisling Mc Mahon
- a Multidisciplinary Intensive Care Research Organization (MICRO) , St James's University Hospital , Dublin , Ireland
| | - Ignacio Martin-Loeches
- a Multidisciplinary Intensive Care Research Organization (MICRO) , St James's University Hospital , Dublin , Ireland.,b Department of Clinical Medicine , Trinity College, Welcome Trust-HRB Clinical Research Facility, St Jame's Hospital , Dublin , Ireland
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11
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Hartling L, Featherstone R, Nuspl M, Shave K, Dryden DM, Vandermeer B. The contribution of databases to the results of systematic reviews: a cross-sectional study. BMC Med Res Methodol 2016; 16:127. [PMID: 27670136 PMCID: PMC5037618 DOI: 10.1186/s12874-016-0232-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One of the best sources for high quality information about healthcare interventions is a systematic review. A well-conducted systematic review includes a comprehensive literature search. There is limited empiric evidence to guide the extent of searching, in particular the number of electronic databases that should be searched. We conducted a cross-sectional quantitative analysis to examine the potential impact of selective database searching on results of meta-analyses. METHODS Our sample included systematic reviews (SRs) with at least one meta-analysis from three Cochrane Review Groups: Acute Respiratory Infections (ARI), Infectious Diseases (ID), Developmental Psychosocial and Learning Problems (DPLP) (n = 129). Outcomes included: 1) proportion of relevant studies indexed in each of 10 databases; and 2) changes in results and statistical significance of primary meta-analysis for studies identified in Medline only and in Medline plus each of the other databases. RESULTS Due to variation across topics, we present results by group (ARI n = 57, ID n = 38, DPLP n = 34). For ARI, identification of relevant studies was highest for Medline (85 %) and Embase (80 %). Restricting meta-analyses to trials that appeared in Medline + Embase yielded fewest changes in statistical significance: 53/55 meta-analyses showed no change. Point estimates changed in 12 cases; in 7 the change was less than 20 %. For ID, yield was highest for Medline (92 %), Embase (81 %), and BIOSIS (67 %). Restricting meta-analyses to trials that appeared in Medline + BIOSIS yielded fewest changes with 1 meta-analysis changing in statistical significance. Point estimates changed in 8 of 31 meta-analyses; change less than 20 % in all cases. For DPLP, identification of relevant studies was highest for Medline (75 %) and Embase (62 %). Restricting meta-analyses to trials that appeared in Medline + PsycINFO resulted in only one change in significance. Point estimates changed for 13 of 33 meta-analyses; less than 20 % in 9 cases. CONCLUSIONS Majority of relevant studies can be found within a limited number of databases. Results of meta-analyses based on the majority of studies did not differ in most cases. There were very few cases of changes in statistical significance. Effect estimates changed in a minority of meta-analyses but in most the change was small. Results did not change in a systematic manner (i.e., regularly over- or underestimating treatment effects), suggesting that selective searching may not introduce bias in terms of effect estimates.
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Affiliation(s)
- Lisa Hartling
- Cochrane Child Health, University of Alberta, ECHA4-472, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
- Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Robin Featherstone
- Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Megan Nuspl
- Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kassi Shave
- Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Donna M. Dryden
- Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Ben Vandermeer
- Alberta Research Center for Health Evidence (ARCHE), University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
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Su G, Chen X, Liu Z, Yang L, Zhang L, Stålsby Lundborg C, Wen Z, Guo X, Qin X, Liang J, Liu X. Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Huang L, Zhang L, Liu Y, Luo R, Zeng L, Telegina I, Vlassov VV. Arbidol for preventing and treating influenza in adults and children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Alves Galvão MG, Rocha Crispino Santos MA, Alves da Cunha AJL. Amantadine and rimantadine for influenza A in children and the elderly. Cochrane Database Syst Rev 2014; 2014:CD002745. [PMID: 25415374 PMCID: PMC7093890 DOI: 10.1002/14651858.cd002745.pub4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Influenza is an acute respiratory illness caused by influenza A and B viruses. Complications may occur, especially among children and the elderly. OBJECTIVES To assess the effectiveness and safety of amantadine and rimantadine in preventing, treating and shortening the duration of influenza A in children and the elderly. SEARCH METHODS We searched CENTRAL (2014, Issue 9), MEDLINE (1966 to September week 4, 2014) and EMBASE (1980 to October 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs comparing amantadine and/or rimantadine with no intervention, placebo, other antivirals or different doses or schedules of amantadine or rimantadine in children and the elderly with influenza A. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the search results. We extracted and analysed data using the standard Cochrane methodology. MAIN RESULTS We identified 12 studies (2494 participants: 1586 children and 908 elderly) comparing amantadine and rimantadine with placebo, paracetamol (one trial: 69 children) or zanamivir (two trials: 545 elderly) to treat influenza A.Amantadine was effective in preventing influenza A in children (773 participants, risk ratio (RR) 0.11; 95% confidence interval (CI) 0.04 to 0.30). The assumed risk of influenza A in the control group was 10 per 100. The corresponding risk in the rimantadine group was one per 100 (95% CI 0 to 3). Nevertheless, the quality of the evidence was low and the safety of the drug was not well established.For treatment, rimantadine was beneficial in abating fever on day three of treatment in children: one selected study with low risk of bias, moderate evidence quality and 69 participants (RR 0.36; 95% CI 0.14 to 0.91). The assumed risk was 38 per 100. The corresponding risk in the rimantadine group was 14 per 100 (95% CI 5 to 34).Rimantadine did not show any prophylactic effect in the elderly. The quality of evidence was very low: 103 participants (RR 0.45; 95% CI 0.14 to 1.41). The assumed risk was 17 per 100. The corresponding risk in the rimantadine group was 7 per 100 (95% CI 2 to 23).There was no evidence of adverse effects caused by treatment with amantadine or rimantadine.We found no studies assessing amantadine in the elderly. AUTHORS' CONCLUSIONS The quality of the evidence combined with a lack of knowledge about the safety of amantadine and the limited benefits of rimantadine, do not indicate that amantadine and rimantadine compared to control (placebo or paracetamol) could be useful in preventing, treating and shortening the duration of influenza A in children and the elderly.
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Affiliation(s)
- Márcia G Alves Galvão
- Municipal Secretariat of HealthAvenida Ayrton Senna, 250/ 205Barra da Tijuca. Alfa Barra 1Rio de JaneiroRJBrazil22793‐000
| | | | - Antonio JL Alves da Cunha
- School of Medicine, Federal University of Rio de JaneiroDepartment of PediatricsAv. Carlos Chagas Filho, 373Edificio do CCS ‐ Bloco K ‐ 2o. andar, Sala K49Rio de JaneiroRio de JaneiroBrazil21941‐902
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Yang CH, Tan DH, Hsu WL, Jong TT, Wen CL, Hsu SL, Chang PC. Anti-influenza virus activity of the ethanolic extract from Peperomia sui. JOURNAL OF ETHNOPHARMACOLOGY 2014; 155:320-325. [PMID: 24882727 PMCID: PMC7127046 DOI: 10.1016/j.jep.2014.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 05/13/2014] [Accepted: 05/21/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Peperomia sui Lin and Lu (Peperomia sui), a well-known Taiwanese folk medicine, has a broad range of biological effects, especially in treatment of upper respiratory tract diseases. However, no previous study has explored the activity of Peperomia sui against influenza virus infections. This study was carried out to evaluate the anti-influenza virus activity and the potential virucidal effect of the ethanolic extract of Peperomia sui (PSE). METHODS The anti-H6N1 avian influenza viral activity of PSE against the influenza virus A/Chicken/TW/0518/2011 (H6N1) in chicken fibroblast DF-1 cells was evaluated by cell viability assay, hemagglutination assay, neuraminidase activity assay, indirect immunofluorescence assay and quantitative RT-PCR assay. RESULTS PSE significantly increased the viability of cells that were infected by the H6N1 virus. PSE also suppressed the synthesis of viral nucleoprotein (NP), and inhibited the growth of the virus in DF-1 cells. Further, PSE inhibited the neuraminidase activity of H6N1 virus. CONCLUSIONS The findings of this study provide important information for the exploitation and utilization of Peperomia sui in treatment of influenza infection.
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Affiliation(s)
- Chih-Hsueh Yang
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung 402, Taiwan, Republic of China; Department of Education and Research, Taichung Veterans General Hospital, Taichung 407, Taiwan, Republic of China
| | - Duen-Huey Tan
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung 402, Taiwan, Republic of China
| | - Wei-Li Hsu
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung 402, Taiwan, Republic of China
| | - Ting-Ting Jong
- Department of Chemistry, National Chung Hsing University, Taichung 402, Taiwan, Republic of China
| | - Chi-Luan Wen
- Taiwan Seed Improvement and Propagation Station, Council of Agriculture, Taichung 426, Taiwan, Republic of China
| | - Shih-Lan Hsu
- Department of Education and Research, Taichung Veterans General Hospital, Taichung 407, Taiwan, Republic of China.
| | - Poa-Chun Chang
- Graduate Institute of Microbiology and Public Health, National Chung Hsing University, Taichung 402, Taiwan, Republic of China.
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Jamal S, Scaria V. Data-mining of potential antitubercular activities from molecular ingredients of traditional Chinese medicines. PeerJ 2014; 2:e476. [PMID: 25081126 PMCID: PMC4106188 DOI: 10.7717/peerj.476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 06/16/2014] [Indexed: 11/20/2022] Open
Abstract
Background. Traditional Chinese medicine encompasses a well established alternate system of medicine based on a broad range of herbal formulations and is practiced extensively in the region for the treatment of a wide variety of diseases. In recent years, several reports describe in depth studies of the molecular ingredients of traditional Chinese medicines on the biological activities including anti-bacterial activities. The availability of a well-curated dataset of molecular ingredients of traditional Chinese medicines and accurate in-silico cheminformatics models for data mining for antitubercular agents and computational filters to prioritize molecules has prompted us to search for potential hits from these datasets. Results. We used a consensus approach to predict molecules with potential antitubercular activities from a large dataset of molecular ingredients of traditional Chinese medicines available in the public domain. We further prioritized 160 molecules based on five computational filters (SMARTSfilter) so as to avoid potentially undesirable molecules. We further examined the molecules for permeability across Mycobacterial cell wall and for potential activities against non-replicating and drug tolerant Mycobacteria. Additional in-depth literature surveys for the reported antitubercular activities of the molecular ingredients and their sources were considered for drawing support to prioritization. Conclusions. Our analysis suggests that datasets of molecular ingredients of traditional Chinese medicines offer a new opportunity to mine for potential biological activities. In this report, we suggest a proof-of-concept methodology to prioritize molecules for further experimental assays using a variety of computational tools. We also additionally suggest that a subset of prioritized molecules could be used for evaluation for tuberculosis due to their additional effect against non-replicating tuberculosis as well as the additional hepato-protection offered by the source of these ingredients.
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Affiliation(s)
- Salma Jamal
- CSIR Open Source Drug Discovery Unit , Anusandhan Bhavan, Delhi , India
| | - Vinod Scaria
- CSIR Open Source Drug Discovery Unit , Anusandhan Bhavan, Delhi , India
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