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Kiiza D, Rostami-Hochaghan D, Alhassan Y, Seden K, Reynolds H, Kaboggoza JP, Taegtmeyer M, Chen T, Challenger E, Malaba T, Wang D, Else L, Hern F, Sharp J, Neary M, Dilly Penchala S, Waitt C, Orrell C, Colbers A, Myer L, Owen A, Rannard S, Khoo S, Lamorde M. Clinical, pharmacological, and qualitative characterization of drug-drug interactions in pregnant women initiating HIV therapy in Sub-Saharan Africa. J Antimicrob Chemother 2024; 79:2334-2342. [PMID: 38997229 DOI: 10.1093/jac/dkae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/22/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND We investigated the impact of Drug-Drug Interactions (DDIs) on virologic control among HIV-positive pregnant women initiating antiretroviral therapy while identifying drivers for Traditional Medicine (TM) use and exploring the nature and extent of TM-related DDIs. METHODS Employing a three-pronged approach, we examined DDIs arising from comedication, including TM, in ART. The DolPHIN-2 trial (NCT03249181) randomized 268 HIV-positive pregnant women in Uganda and South Africa to dolutegravir (DTG)-based (135) or efavirenz-based (133) regimens while systematically recording comedications and screening for DDIs. We used Cox regression models to compare time-to-virologic control between participants with and without DDIs. We conducted in-depth interviews and focus group discussions among 37 and 67 women with and without HIV, respectively, to explore reasons for TM use during pregnancy. Additionally, in-vitro and in-vivo studies evaluated the composition and impact of clay-based TM, mumbwa, on DTG plasma exposure. RESULTS The baseline prevalence of DDIs was 67.2%, with TM use prevalent in 34% of participants, with mumbwa being the most frequent (76%, 69/91). There was no difference in virologic response between participants with and without DDIs. Fetal health and cultural norms were among the reasons cited for TM use. Analysis of mumbwa rods confirmed significant amounts of aluminium (8.4%-13.9%) and iron (4%-6%). In Balb-C mice, coadministration of mumbwa led to a reduction in DTG exposure observed in the AUC0-24 (-21%; P = 0.0271) and C24 (-53%; P = 0.0028). CONCLUSIONS The widespread use of clay-based TM may compromise HIV treatment, necessitating medication screening and counselling to manage DDIs in pregnant women.
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Affiliation(s)
- Daniel Kiiza
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kay Seden
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Helen Reynolds
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Julian P Kaboggoza
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elizabeth Challenger
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Thokozile Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Duolao Wang
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Laura Else
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Faye Hern
- Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Jo Sharp
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Megan Neary
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Sujan Dilly Penchala
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Catriona Waitt
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Medical Innovations (RIMI), Radboud University Medical Center, Nijmegen, Netherlands
| | - Landon Myer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Steve Rannard
- Department of Chemistry, University of Liverpool, Liverpool, UK
| | - Saye Khoo
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Royal Liverpool University Hospital, NHS Trust, UK
| | - Mohammed Lamorde
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Enyang D, Sonibare MA, Tchamgoue AD, Tchokouaha LRY, Yadang FS, Nfor GN, Kom CW, Betote PDH, Tchinda CF, Tiogo SSK, Agbor GA. Protective and Ameliorative Effects of Hydroethanolic Extract of Piper nigrum (L.) Stem against Antiretroviral Therapy-Induced Hepatotoxicity and Dyslipidemia in Wistar Rats. J Toxicol 2024; 2024:5811080. [PMID: 38357682 PMCID: PMC10866638 DOI: 10.1155/2024/5811080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 12/05/2023] [Accepted: 12/30/2023] [Indexed: 02/16/2024] Open
Abstract
Antiretroviral therapy (ART) has revolutionized the lives of people living with HIV/AIDS by overall improving their quality of life and increasing life expectancy. However, ART-associated hepatotoxicity and metabolic disorders in HIV/AIDS patients are growing concerns to clinicians, especially due to the long-term use of the drugs. This study reported on the phytochemical and pharmacological profile of hydroethanolic extracts of Piper nigrum stem (PNS) and evaluated its protective effect against tenofovir/lamivudine/efavirenz (TLE)-induced hepatotoxicity and dyslipidemia in Wistar rats. Cytotoxic, antioxidant, and anti-inflammatory assays were performed on PNS. Thirty-six rats divided into 6 groups of 6 animals/group were administered: distilled water, 17 mg/kg TLE, 17 mg/kg TLE and 100 mg/kg silymarin, 17 mg/kg TLE, and Piper extract (200 mg/kg, 400 mg/kg, or 800 mg/kg) orally for 28 days. The body weight of animals was recorded every 7 days. On Day 29, the rats were sacrificed, and blood samples were collected for hematological and biochemical tests. Portions of the liver and kidneys were collected for histological evaluation, while liver homogenates were prepared from the rest to measure antioxidant enzymes. PNS possessed in vitro cytotoxic, antioxidant, and anti-inflammatory activities. A significant decrease (p < 0.05) in the body weight of rats treated with PNS was observed. A significant high platelet count (p < 0.05) was observed in the PNS800 mg/kg group. A considerable decrease in alkaline phosphatase and triglycerides was observed in the silymarin and PNS group compared to the TLE-only group. The findings also show a significant increase in catalase and glutathione in the TLE-only group compared to the normal group, while SOD decreased. Histological observations revealed normal hepatic and renal tissues in the silymarin, and PNS-treated groups compared to the normal control, while leucocyte infiltration was observed in the TLE-only group. These results suggest that PNS extract possessed antioxidant activity that alleviated TLE-induced toxicity. Further studies are necessary to understand the pharmacokinetic interactions between ART and PNS.
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Affiliation(s)
- Doreen Enyang
- Medicinal Plant Research and Drug Development Program, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan, Nigeria
| | - Mubo A. Sonibare
- Department of Pharmacognosy, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Armelle D. Tchamgoue
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
| | - Lauve R. Y. Tchokouaha
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
| | - Fanta S. Yadang
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
| | - Gael N. Nfor
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
| | - Christelle W. Kom
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
| | - Patrick D. H. Betote
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
| | - Cedric F. Tchinda
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
| | | | - Gabriel A. Agbor
- Centre for Research on Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Ministry of Scientific Research and Innovations, P.O. Box 6163, Yaoundé, Cameroon
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Mosavat SH, Pasalar M, Joulaei H, Ameli V, Heydari ST, Mirzazadeh A, Hashempur MH. Complementary and alternative medicine use among people living with HIV in Shiraz, Southern Iran. Front Public Health 2023; 11:1206665. [PMID: 37869188 PMCID: PMC10585019 DOI: 10.3389/fpubh.2023.1206665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background Living with HIV requires lifelong care to support engagement with and adherence to antiretroviral therapy. The Middle East and North Africa region provides access to ART, but research is lacking on the lived-experiences of people living with HIV. Globally, complementary and alternative medicine (CAM) is increasingly used by patients who need support alongside receiving medical treatment for chronic conditions. This study aims to examine the frequency and reasons behind the use of CAM, as well as identify its associated factors among people living with HIV in Shiraz, Iran. Methods In this cross-sectional study, a total of 320 patients (aged 18-70 years) with a confirmed diagnosis of HIV residing in Fars province and diagnosed between 1999 and 2019 were recruited randomly through their clinical record numbers from five HIV treatment centers. They were surveyed on their quality of life and CAM use via the Short-Form Health Survey questionnaire (SF-36) and a semi-structured survey of "CAM use." The data analysis for this study involved the use of Chi-squared test, independent t-test, and multiple logistic regression model. Results Of 287 patients, 89.22% reported using CAM in the previous year. CAM use was more prevalent among those with a family history of CAM use (94.3% vs. 81.8%, p = 0.023). Frequent reasons for using CAM were reported to be sexual dysfunction (32.4%), depression (28.3%), thirstiness (23.3%), and nausea (17.5%). Quality of life, as measured via the SF-36 questionnaire in all its 8 sub-domains, did not differ among those who used CAM versus those who did not (61.5 ± 27.6 vs. 58.1 ± 30.9, p = 0.626). Conclusion CAM was used among a majority of people living with HIV in Shiraz, Iran. People who used CAM appeared to experience a similar quality of life relative to those who did not use CAM. Future studies on the modalities of engagement with CAM can improve patient-physician shared decision-making and increase lifelong care options for people living with HIV.
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Affiliation(s)
- Seyed Hamdollah Mosavat
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vira Ameli
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Mohammad Hashem Hashempur
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Yao G, Miao X, Wu M, Lv Z, Bai Y, Chang Y, Ouyang H, He J. Pharmacokinetics of active compounds of a Terminalia chebula Retz. Ethanolic extract after oral administration rats using UPLC-MS/MS. Front Pharmacol 2023; 14:1067089. [PMID: 36713843 PMCID: PMC9880438 DOI: 10.3389/fphar.2023.1067089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
Terminalia chebula Retz. (TC) is a well-known Chinese herbal medicine and rich in chemical components with multiple pharmacological effects. In this study, an ultra-performance liquid chromatography-tandem mass spectroscopy (UPLC-MS/MS) method was developed and used to determine the blood concentrations of nine active compounds (chebulic acid, gallic acid, protocatechuic acid, corilagin, chebulagic acid, chebulinic acid, 1,2,3,4,6-O-pentagalloylglucose, ellagic acid and ethyl gallate) after oral administration of TC extracts in rats. Pretreatment of plasma samples with protein precipitate with methanol was carried out, and caffeic acid was used as the internal standard (IS). Compounds precisions of intra- and inter-day were less than 14.6%, and the accuracy ranged from -11.7% to 13.5%. The extraction recoveries of compounds were between 84.9% and 108.4%, while matrix effects occurred between 86.4% and 115.9%. Stability tests showed that all nine analytes had been stable under four storage conditions, and statistically significant the relative standard deviations were under 13.7%. The validated UPLC-MS/MS method was applied with great success to plasma pharmacokinetics analysis of the TC extracts, and the pharmacokinetic results showed that among the nine components, the area under the concentration-time curve (AUC(0-tn), 231112.38 ± 64555.20 h ng/mL) and maximum concentration (Cmax, 4,983.57 ± 1721.53 ng/mL) of chebulagic acid were relatively large, which indicated that it had a higher level of plasma exposure. The half-life of elimination (T1/2) of chebulinic acid, corilagin and chebulagic acid were 43.30, 26.39 and 19.98 h, respectively, suggesting that these analytes showed prolonged retention and metabolize more slowly in vivo. This study would deliver a theoretical foundation for the further application of TC in clinical practice.
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Affiliation(s)
- Guangzhe Yao
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China,Haihe Laboratory of Modern Chinese Medicine, Tianjin, China
| | - Xinxin Miao
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mengxuan Wu
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhenguo Lv
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yu Bai
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanxu Chang
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Huizi Ouyang
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jun He
- Tianjin State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China,Haihe Laboratory of Modern Chinese Medicine, Tianjin, China,*Correspondence: Jun He,
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Bertuccioli A, Cardinali M, Di Pierro F, Magi S, Zonzini G. A Practical Perspective on the Use of Botanicals During the COVID-19 Pandemic: From Proven to Potential Interactions. J Med Food 2022; 25:1-11. [PMID: 34788575 PMCID: PMC8787711 DOI: 10.1089/jmf.2021.0062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022] Open
Abstract
In this review, we examined the top 10 nutraceutical products sold in Italian pharmacies and parapharmacies as well as hypermarkets and supermarkets; in the first, three product categories saw the greatest increase in sales (vitamins and minerals, immunostimulants, and sleep products) for the 12-month period between October 2019 and October 2020 (including first pandemic wave of SARS-CoV-2). We are investigating their respective formulas and isolating the botanicals that are used to make them. Many of these products have undergone preclinical and clinical studies. We performed a systematic literature search in the MEDLINE database using PubMed and Google Scholar from November 15, 2020 to December 15, 2020 (including studies carried out between 1980 and 2020). The search terms that were used included the complete name of the medicinal plant in English or Latin and the terms "cytochrome" or "drug interactions," crossing, respectively, the Latin name and English common names with "cytochrome" and "drug interactions." The search included in vitro and in vivo studies describing the effects of interaction between the plant (extract or botanical medicine) and human cytochromes. Despite their great complexity, there is decidedly limited clinical data on botanical medicine. In fact, of the 28 botanicals that were examined, only 2 (Citrus paradisi and Rhodiola rosea) show in vivo pharmacological interactions in human subjects. On the contrary, for the other botanicals, there is only weak evidence of dubious clinical significance or potential interactions shown in animal models or in vitro without clinical confirmation. This study provides a rational assessment of the most widely used products, including those used in self-medication, to simplify patient management during the COVID-19 health emergency.
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Affiliation(s)
| | - Marco Cardinali
- Department of Internal Medicine, Infermi Hospital, AUSL Romagna, Rimini, Italy
| | - Francesco Di Pierro
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
- Scientific & Research Department, Velleja Research, Milano, Italy
| | - Simone Magi
- Italian Association of Fitness e Medicine (AIFeM), Ravenna, Italy
| | - Giordano Zonzini
- Italian Association of Fitness e Medicine (AIFeM), Ravenna, Italy
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Del Rayo Camacho-Corona M, Camacho-Morales A, Góngora-Rivera F, Escamilla-García E, Morales-Landa JL, Andrade-Medina M, Herrera-Rodulfo AF, García-Juárez M, García-Espinosa P, Stefani T, González-Barranco P, Carrillo-Tripp M. Immunomodulatory effects of Allium Sativum L. and its constituents against viral infections and metabolic diseases. Curr Top Med Chem 2021; 22:109-131. [PMID: 34809549 DOI: 10.2174/1568026621666211122163156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/24/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Allium sativum L., or garlic, is one of the most studied plants worldwide within the field of traditional medicine. Current interests lie in the potential use of garlic as a preventive measure and adjuvant treatment for viral infections, e.g., SARS-CoV-2. Even though it cannot be presented as a single treatment, its beneficial effects are beyond doubt. The World Health Organization has deemed it an essential part of any balanced diet with immunomodulatory properties. OBJECTIVE The aim of the study was to review the literature on the effects of garlic compounds and preparations on immunomodulation and viral infection management, with emphasis on SARS-CoV-2. METHOD Exhaustive literature search has been carried out on electronic databases. CONCLUSION Garlic is a fundamental part of a well-balanced diet which helps maintain general good health. The reported information regarding garlic's ability to beneficially modulate inflammation and the immune system is encouraging. Nonetheless, more efforts must be made to understand the actual medicinal properties and mechanisms of action of the compounds found in this plant to inhibit or diminish viral infections, particularly SARS-CoV-2. Based on our findings, we propose a series of innovative strategies to achieve such a challenge in the near future.
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Affiliation(s)
| | | | - Fernando Góngora-Rivera
- Stroke Unit and Neurology Department, University Hospital Jose Eleuterio Gonzalez, Universidad Autónoma de Nuevo León, Monterrey, N.L. Mexico
| | - Erandi Escamilla-García
- Centro de Investigación y Desarrollo en Ciencias de la Salud (CIDICS), Universidad Autónoma de Nuevo León, Monterrey, N.L. Mexico
| | - Juan Luis Morales-Landa
- Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, A.C. Subsede Noreste, Apodaca, N.L. Mexico
| | - Mariana Andrade-Medina
- Biomolecular Diversity Laboratory, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Monterrey, Apodaca, N.L. Mexico
| | - Aldo Fernando Herrera-Rodulfo
- Biomolecular Diversity Laboratory, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Monterrey, Apodaca, N.L. Mexico
| | - Martín García-Juárez
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, N.L. Mexico
| | | | - Tommaso Stefani
- Laboratory for Biology of Secondary Metabolism, Institute of Microbiology, Czech Acad Sci, Prague. Czech Republic
| | - Patricia González-Barranco
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León. San Nicolás de los Garza, N.L. Mexico
| | - Mauricio Carrillo-Tripp
- Biomolecular Diversity Laboratory, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Monterrey, Apodaca, N.L. Mexico
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Sánchez-Cid P, Jiménez-Rosado M, Alonso-González M, Romero A, Perez-Puyana V. Applied Rheology as Tool for the Assessment of Chitosan Hydrogels for Regenerative Medicine. Polymers (Basel) 2021; 13:2189. [PMID: 34209385 PMCID: PMC8271898 DOI: 10.3390/polym13132189] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
The regeneration of soft tissues that connect, support or surround other tissues is of great interest. In this sense, hydrogels have great potential as scaffolds for their regeneration. Among the different raw materials, chitosan stands out for being highly biocompatible, which, together with its biodegradability and structure, makes it a great alternative for the manufacture of hydrogels. Therefore, the aim of this work was to develop and characterize chitosan hydrogels. To this end, the most important parameters of their processing, i.e., agitation time, pH, gelation temperature and concentration of the biopolymer used were rheologically evaluated. The results show that the agitation time does not have a significant influence on hydrogels, whereas a change in pH (from 3.2 to 7) is a key factor for their formation. Furthermore, a low gelation temperature (4 °C) favors the formation of the hydrogel, showing better mechanical properties. Finally, there is a percentage of biopolymer saturation, from which the properties of the hydrogels are not further improved (1.5 wt.%). This work addresses the development of hydrogels with high thermal resistance, which allows their use as scaffolds without damaging their mechanical properties.
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Affiliation(s)
- Pablo Sánchez-Cid
- Department of Chemical Engineering, Faculty of Chemistry, Universidad de Sevilla, 41012 Sevilla, Spain; (P.S.-C.); (A.R.); (V.P.-P.)
| | - Mercedes Jiménez-Rosado
- Department of Chemical Engineering, Higher Polytechnic School, Universidad de Sevilla, 41012 Sevilla, Spain;
| | - María Alonso-González
- Department of Chemical Engineering, Higher Polytechnic School, Universidad de Sevilla, 41012 Sevilla, Spain;
| | - Alberto Romero
- Department of Chemical Engineering, Faculty of Chemistry, Universidad de Sevilla, 41012 Sevilla, Spain; (P.S.-C.); (A.R.); (V.P.-P.)
| | - Victor Perez-Puyana
- Department of Chemical Engineering, Faculty of Chemistry, Universidad de Sevilla, 41012 Sevilla, Spain; (P.S.-C.); (A.R.); (V.P.-P.)
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Bessong PO, Matume ND, Tebit DM. Potential challenges to sustained viral load suppression in the HIV treatment programme in South Africa: a narrative overview. AIDS Res Ther 2021; 18:1. [PMID: 33407664 PMCID: PMC7788882 DOI: 10.1186/s12981-020-00324-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background South Africa, with one of the highest HIV prevalences in the world, introduced the universal test and treat (UTT) programme in September 2016. Barriers to sustained viral suppression may include drug resistance in the pre-treated population, non-adherence, acquired resistance; pharmacokinetics and pharmacodynamics, and concurrent use of alternative treatments. Objective The purpose of this review is to highlight potential challenges to achieving sustained viral load suppression in South Africa (SA), a major expectation of the UTT initiative. Methodology Through the PRISMA approach, published articles from South Africa on transmitted drug resistance; adherence to ARV; host genetic factors in drug pharmacokinetics and pharmacodynamics, and interactions between ARV and herbal medicine were searched and reviewed. Results The level of drug resistance in the pre-treated population in South Africa has increased over the years, although it is heterogeneous across and within Provinces. At least one study has documented a pre-treated population with moderate (> 5%) or high (> 15%) levels of drug resistance in eight of the nine Provinces. The concurrent use of ARV and medicinal herbal preparation is fairly common in SA, and may be impacting negatively on adherence to ARV. Only few studies have investigated the association between the genetically diverse South African population and pharmacokinetics and pharmacodynamics of ARVs. Conclusion The increasing levels of drug resistant viruses in the pre-treated population poses a threat to viral load suppression and the sustainability of first line regimens. Drug resistance surveillance systems to track the emergence of resistant viruses, study the burden of prior exposure to ARV and the parallel use of alternative medicines, with the goal of minimizing resistance development and virologic failure are proposed for all the Provinces of South Africa. Optimal management of the different drivers of drug resistance in the pre-treated population, non-adherence, and acquired drug resistance will be beneficial in ensuring sustained viral suppression in at least 90% of those on treatment, a key component of the 90-90-90 strategy.
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Clinical Evaluation of Acetaminophen-Galgeuntang Interaction Based on Population Approaches. Pharmaceutics 2020; 12:pharmaceutics12121182. [PMID: 33291732 PMCID: PMC7761965 DOI: 10.3390/pharmaceutics12121182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 01/10/2023] Open
Abstract
Galgeuntang (GGT), a traditional herbal medicine, is widely co-administered with acetaminophen (AAP) for treatment of the common cold, but this combination has not been the subject of investigation. Therefore, we investigated the herb–drug interaction between GGT and AAP by population pharmacokinetics (PKs) modeling and simulation studies. To quantify PK parameters and identify drug interactions, an open label, three-treatment, three-period, one-sequence (AAP alone, GGT alone, and AAP and GGT in combination) clinical trial involving 12 male healthy volunteers was conducted. Ephedrine (EPD), the only GGT component detected, was identified using a one-compartment model. The PKs of AAP were described well by a one-compartment model and exhibited two-phase absorption (rapid followed by slow) and first-order elimination. The model showed that EPD significantly influenced the PKs of AAP. The simulation results showed that at an AAP dose of 1000 mg × 4 times daily, the area under the concentration versus time curve of AAP increased by 16.4% in the presence of GGT compared to AAP only. In conclusion, the PKs of AAP were affected by co-administration of GGT. Therefore, when AAP is combined with GGT, adverse effects related to overdose of AAP could be induced possibly.
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Targeting ESKAPE pathogens with anti-infective medicinal plants from the Greater Mpigi region in Uganda. Sci Rep 2020; 10:11935. [PMID: 32686689 PMCID: PMC7371678 DOI: 10.1038/s41598-020-67572-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
Antibiotic resistance poses one of the greatest threats to global health today; conventional drug therapies are becoming increasingly inefficacious and limited. We identified 16 medicinal plant species used by traditional healers for the treatment of infectious and inflammatory diseases in the Greater Mpigi region of Uganda. Extracts were evaluated for their ability to inhibit growth of clinical isolates of multidrug-resistant ESKAPE pathogens. Extracts were also screened for quorum quenching activity against S. aureus, including direct protein output assessment (δ-toxin), and cytotoxicity against human keratinocytes (HaCaT). Putative matches of compounds were elucidated via LC–FTMS for the best-performing extracts. These were extracts of Zanthoxylum chalybeum (Staphylococcus aureus: MIC: 16 μg/mL; Enterococcus faecium: MIC: 32 μg/mL) and Harungana madagascariensis (S. aureus: MIC: 32 μg/mL; E. faecium: MIC: 32 μg/mL) stem bark. Extracts of Solanum aculeastrum root bark and Sesamum calycinum subsp. angustifolium leaves exhibited strong quorum sensing inhibition activity against all S. aureus accessory gene regulator (agr) alleles in absence of growth inhibition (IC50 values: 1–64 μg/mL). The study provided scientific evidence for the potential therapeutic efficacy of these medicinal plants in the Greater Mpigi region used for infections and wounds, with 13 out of 16 species tested being validated with in vitro studies.
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Stanifer JW, Kilonzo K, Wang D, Su G, Mao W, Zhang L, Zhang L, Nayak-Rao S, Miranda JJ. Traditional Medicines and Kidney Disease in Low- and Middle-Income Countries: Opportunities and Challenges. Semin Nephrol 2018; 37:245-259. [PMID: 28532554 DOI: 10.1016/j.semnephrol.2017.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Traditional medicines are a principal form of health care for many populations, particularly in low- and middle-income countries, and they have gained attention as an important means of health care coverage globally. In the context of kidney diseases, the challenges and opportunities presented by traditional medicine practices are among the most important considerations for developing effective and sustainable public health strategies. However, little is known about the practices of traditional medicines in relation to kidney diseases, especially concerning benefits and harms. Kidney diseases may be caused, treated, prevented, improved, or worsened by traditional medicines depending on the setting, the person, and the types, modes, and frequencies of traditional medicine use. Given the profound knowledge gaps, nephrology practitioners and researchers may be uniquely positioned to facilitate more optimal public health strategies through recognition and careful investigation of traditional medicine practices. Effective implementation of such strategies also will require local partnerships, including engaging practitioners and users of traditional medicines. As such, practitioners and researchers investigating kidney diseases may be uniquely positioned to bridge the cultural, social, historical, and biologic differences between biomedicine and traditional medicine, and they have opportunities to lead efforts in developing public health strategies that are sensitive to these differences.
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Affiliation(s)
- John W Stanifer
- Division of Nephrology, Department of Medicine, Duke University, Durham, NC; Duke Global Health Institute, Duke University, Durham, NC; Duke Clinical Research Institute, Duke University, Durham, NC.
| | | | - Daphne Wang
- Duke Global Health Institute, Duke University, Durham, NC
| | - Guobin Su
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Traditional Chinese Medicine, Guangzhou, China; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; National Clinical Research Base for Chronic Kidney Disease and Traditional Chinese Medicine, Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wei Mao
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Traditional Chinese Medicine, Guangzhou, China; National Clinical Research Base for Chronic Kidney Disease and Traditional Chinese Medicine, Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Lei Zhang
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Traditional Chinese Medicine, Guangzhou, China; National Clinical Research Base for Chronic Kidney Disease and Traditional Chinese Medicine, Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - La Zhang
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Traditional Chinese Medicine, Guangzhou, China; National Clinical Research Base for Chronic Kidney Disease and Traditional Chinese Medicine, Nephrology Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; School of Health and Biomedical Science, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Shobhana Nayak-Rao
- KS Hedge Medical Academy, Medical Sciences Complex, Derlakatte Mangalore, Karnataka, India
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Monera-Penduka TG, Maponga CC, Wolfe AR, Wiesner L, Morse GD, Nhachi CFB. Effect of Moringa oleifera Lam. leaf powder on the pharmacokinetics of nevirapine in HIV-infected adults: a one sequence cross-over study. AIDS Res Ther 2017; 14:12. [PMID: 28293270 PMCID: PMC5348890 DOI: 10.1186/s12981-017-0140-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/23/2017] [Indexed: 01/03/2023] Open
Abstract
Background Moringa oleifera Lam., an herb commonly consumed by HIV-infected people on antiretroviral therapy, inhibits cytochrome P450 3A4, 1A2 and 2D6 activity in vitro; and may alter the pharmacokinetics (PK) of antiretroviral drugs metabolized via the same pathways. However, in vitro drug interaction activity may not translate to a clinically significant effect. Therefore, the effect of moringa leaf powder on the PK of nevirapine in HIV-infected people was investigated. Methods Adult patients at steady-state dosing with nevirapine were admitted for 12-h intensive PK sampling following a 21-day herbal medicine washout. Blood sampling was repeated after 14 days of nevirapine and moringa (1.85 g leaf powder/day) co-administration. Nevirapine plasma concentrations were determined by liquid chromatography-tandem mass spectrometry. To assess the effect of moringa on nevirapine PK, the change in nevirapine area under the plasma concentration–time curve (AUC) was determined. The mean difference in pre- and post-moringa nevirapine, maximum concentration (Cmax) and concentration at 12 h (C12h) were also calculated. The PK parameters were compared by assessing the post/pre geometric mean ratios (GMRs) and associated 90% confidence intervals (CIs). Results Pharmacokinetics analyses were performed on the results from 11 participants for whom complete data were obtained. The post/pre GMRs and associated 90% CIs for nevirapine were 1.07 (1.00–1.14) for the AUC; 1.06 (0.98–1.16) for Cmax and 1.03 (0.92–1.16) for C12h. Conclusion Co-administration of Moringa oleifera Lam. leaf powder at the traditional dose did not significantly alter the steady-state PK of nevirapine. Trial registration number NCT01410058 (ClinicalTrials.gov)
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Pharmacokinetic Herb-Drug Interactions: Insight into Mechanisms and Consequences. Eur J Drug Metab Pharmacokinet 2016; 41:93-108. [PMID: 26311243 DOI: 10.1007/s13318-015-0296-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Herbal medicines are currently in high demand, and their popularity is steadily increasing. Because of their perceived effectiveness, fewer side effects and relatively low cost, they are being used for the management of numerous medical conditions. However, they are capable of affecting the pharmacokinetics and pharmacodynamics of coadministered conventional drugs. These interactions are particularly of clinically relevance when metabolizing enzymes and xenobiotic transporters, which are responsible for the fate of many drugs, are induced or inhibited, sometimes resulting in unexpected outcomes. This article discusses the general use of herbal medicines in the management of several ailments, their concurrent use with conventional therapy, mechanisms underlying herb-drug interactions (HDIs) as well as the drawbacks of herbal remedy use. The authors also suggest means of surveillance and safety monitoring of herbal medicines. Contrary to popular belief that "herbal medicines are totally safe," we are of the view that they are capable of causing significant toxic effects and altered pharmaceutical outcomes when coadministered with conventional medicines. Due to the paucity of information as well as sometimes conflicting reports on HDIs, much more research in this field is needed. The authors further suggest the need to standardize and better regulate herbal medicines in order to ensure their safety and efficacy when used alone or in combination with conventional drugs.
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Mncengeli S, Manimbulu NM, Panjasaram N. Concurrent use of Antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini Metropolitan area of KwaZulu Natal. Afr Health Sci 2016; 16:1118-1130. [PMID: 28479905 PMCID: PMC5398459 DOI: 10.4314/ahs.v16i4.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People living with HIV/AIDS (PLWA) often use African Traditional Medicines (ATM) either alone or in combination with Western medicines including Antiretrovirals (ARV). OBJECTIVES To explore the prevalence of concurrent Antiretrovirals (ARV) and African Traditional medicines (ATM) use and determine the effects of any concurrent use on the CD4+ Lymphocyte count and Viral Load (VL) of PLWA in the eThekwini Metropolitan area. METHODS A descriptive and exploratory study was carried out on 360 patients. Information was gathered on patients socioeconomic characteristics, ATM usage, outcome measures of HIV disease progression (CD4+ Count, VL). The data was analysed using descriptive statistics, univariate and multivariate analyses. RESULTS 4.98% (14/281) of the patients used ATM and ARV concurrently during the study period. Over 65% (185/281) reported ATM use before diagnosis with HIV whilst 77.6% (218/281) reported previous ATM use after their HIV diagnosis but before initiation with ARV. Place of residence (p=0.004), age (p<0.001) and education level (P=0.041) were found to be significantly and positively correlated with ATM use. There were no statistically significant changes in mean plasma CD4+ Count and inconclusive effects on VL during the period of the study in the group taking ARV alone when compared with the group using ARV and ATM concomitantly. CONCLUSION Concurrent ARV and ATM use is quite low (4.98%) when compared to ATM use before HIV diagnosis and after HIV diagnosis but before initiation with ARV. This may point to efficient pre-counselling efforts before ARV initiation by health care professionals. This study also demonstrated that there were no significant differences in the CD4+ and inconclusive effects on VL, between patients taking both ARV and ATM concomitantly and those using ARV alone.
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Affiliation(s)
- Sibanda Mncengeli
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
| | - Nlooto M Manimbulu
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
| | - Naidoo Panjasaram
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal (Westville Campus), Private Bag X54001, Durban 4000. South Africa
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Pharmacokinetic, Pharmacogenetic, and Other Factors Influencing CNS Penetration of Antiretrovirals. AIDS Res Treat 2016; 2016:2587094. [PMID: 27777797 PMCID: PMC5061948 DOI: 10.1155/2016/2587094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/21/2016] [Indexed: 12/22/2022] Open
Abstract
Neurological complications associated with the human immunodeficiency virus (HIV) are a matter of great concern. While antiretroviral (ARV) drugs are the cornerstone of HIV treatment and typically produce neurological benefit, some ARV drugs have limited CNS penetration while others have been associated with neurotoxicity. CNS penetration is a function of several factors including sieving role of blood-brain and blood-CSF barriers and activity of innate drug transporters. Other factors are related to pharmacokinetics and pharmacogenetics of the specific ARV agent or mediated by drug interactions, local inflammation, and blood flow. In this review, we provide an overview of the various factors influencing CNS penetration of ARV drugs with an emphasis on those commonly used in sub-Saharan Africa. We also summarize some key associations between ARV drug penetration, CNS efficacy, and neurotoxicity.
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Jalloh MA, Gregory PJ, Hein D, Risoldi Cochrane Z, Rodriguez A. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS 2016; 28:4-15. [PMID: 27655839 DOI: 10.1177/0956462416671087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many patients who take antiretroviral drugs also take alternative therapies including dietary supplements. Some drug-supplement combinations may result in clinically meaningful interactions. We aimed to investigate the evidence for dietary supplement interactions with antiretrovirals. A systematic review was conducted using multiple resources including PubMed, Natural Medicine Comprehensive Database, The Review of Natural Products, and Google Scholar. All human studies or case reports evaluating an interaction between a dietary supplement and an antiretroviral were selected for inclusion. Twenty-eight pharmacokinetic studies and case-series/case reports were selected for inclusion. Calcium carbonate, ferrous fumarate, some forms of ginkgo, some forms of garlic, some forms of milk thistle, St. John's wort, vitamin C, zinc sulfate, and multivitamins were all found to significantly decrease the levels of selected antiretrovirals and should be avoided in patients taking these antiretrovirals. Cat's claw and evening primrose oil were found to significantly increase the levels of antiretrovirals and patients should be monitored for adverse effects while taking these dietary supplements with antiretrovirals. This systematic review shows the importance of screening all human immunodeficiency virus patients for dietary supplement use to prevent treatment failure or adverse effects related to an interaction.
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Affiliation(s)
- Mohamed A Jalloh
- 1 Department of Clinical Sciences, College of Pharmacy Touro University California, Vallejo, CA 94592, USA
| | - Philip J Gregory
- 2 Department of Pharmacy Practice, Center for Drug Information & Evidence-Based Practice, School of Pharmacy & Health Professions, Creighton University, Omaha, NE, USA
| | - Darren Hein
- 2 Department of Pharmacy Practice, Center for Drug Information & Evidence-Based Practice, School of Pharmacy & Health Professions, Creighton University, Omaha, NE, USA
| | - Zara Risoldi Cochrane
- 2 Department of Pharmacy Practice, Center for Drug Information & Evidence-Based Practice, School of Pharmacy & Health Professions, Creighton University, Omaha, NE, USA
| | - Aleah Rodriguez
- 2 Department of Pharmacy Practice, Center for Drug Information & Evidence-Based Practice, School of Pharmacy & Health Professions, Creighton University, Omaha, NE, USA
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Mugomeri E, Chatanga P, Chakane N. MEDICINAL HERBS USED BY HIV-POSITIVE PEOPLE IN LESOTHO. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES : AJTCAM 2016; 13:123-131. [PMID: 28852728 PMCID: PMC5566135 DOI: 10.21010/ajtcam.v13i4.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of medicinal herbs whose efficacy and toxicities are not known by HIV-positive people in Lesotho is a threat to the effectiveness of antiretroviral treatment. This study explored some medicinal herbs used by HIV-positive people in Lesotho and the reasons for their use. METHODS This was a cross sectional study based on a questionnaire distributed to purposively-sampled HIV-positive people in Leribe and Maseru districts of Lesotho. The participants' socio-demographic and clinical variables were summarized using frequency tables in Stata version 13 statistical software. Data variables for medicinal herbs used, frequency of use, uses by the participants and in the literature, parts of plants used and the method of preparation were also explored. RESULTS Out of 400 questionnaires distributed to the participants, 389 were returned with data acceptable for analysis. Ages of the participants ranged from 18 to 75 years (Mean=43 + 11.6). Out of the 272 (69.9%) participants who conceded that they had used medicinal herbs at least once, 30 (7.7%) participants used medicinal herbs frequently while 242 (62.2 %) rarely used the herbs. At least 20 plant species belonging to 16 families were reportedly used by the participants. Asteraceae was the most common plant family reportedly used by the participants. Allium sativum and Dicoma anomala, reportedly used by 21.0% and 14.3% respectively, were the most commonly used medicinal herbs in this population. In addition, boosting the immune system and treating gastrointestinal ailments, apparently cited by 32% and 28% participants respectively, were the most commonly reported reasons for using medicinal herbs. CONCLUSION A considerable proportion (69.9%) of HIV-positive people use medicinal herbs in this population, and 7.7% use them frequently. At least 20 plant species belonging to 16 families were reportedly used by the participants. HIV counselling protocols in Lesotho should emphasize the dangers of using medicinal herbs whose safety and compatibility with antiretroviral drugs is not known. The efficacy and toxicity profiles of the medicinal plants identified in this study need to be investigated. Furthermore, the effects of these plants on antiretroviral treatment outcomes including herb-drug interactions need to be explored.
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Affiliation(s)
- Eltony Mugomeri
- Eltony Mugomeri (MTech. Biomedical Technology) Department of Pharmacy, National University of Lesotho, Faculty of Health Sciences, Roma Campus, P.O. Roma 180, Maseru, Lesotho
| | - Peter Chatanga
- Peter Chatanga (MSc. Tropical Resource Ecology) Department of Biology, National University of Lesotho, Faculty of Science and Technology, Roma Campus, P.O. Roma 180, Maseru, Lesotho
| | - Ntema Chakane
- Ntema Chakane (BSc. Nursing and Midwifery)Department of Nursing, National University of Lesotho, Faculty of Health Sciences, Roma Campus, P.O. Roma 180, Maseru, Lesotho
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Nethathe GD, Matamba T, Malumalu J, Dladla N, Bayibayi T, Russell SL. Traditional medicine use in surgical patients in a South African tertiary hospital. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1187497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nlooto M, Naidoo P. Traditional, complementary and alternative medicine use by HIV patients a decade after public sector antiretroviral therapy roll out in South Africa: a cross sectional study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:128. [PMID: 27189225 PMCID: PMC4869398 DOI: 10.1186/s12906-016-1101-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
Abstract
Background The roll out of antiretroviral therapy in the South African public health sector in 2004 was preceded by the politicisation of HIV-infection which was used to promote traditional medicine for the management of HIV/AIDS. One decade has passed since; however, questions remain on the extent of the use of traditional, complementary and alternative medicine (TCAM) by HIV-infected patients. This study therefore aimed at investigating the prevalence of the use of African traditional medicine (ATM), complementary and alternative medicines (CAM) by adult patients in the eThekwini and UThukela Health Districts, South Africa. Methods A cross- sectional study was carried out at 8 public health sector antiretroviral clinics using interviewer-administered semi-structured questionnaires. These were completed from April to October 2014 by adult patients who had been on antiretroviral therapy (ART) for at least three months. Use of TCAM by patients was analysed by descriptive statistics using frequency and percentages with standard error. Where the associated relative error was equal or greater to 0.50, the percentage was rejected as unstable. A p-value <0.05 was estimated as statistically significant. Results The majority of the 1748 participants were Black Africans (1685/1748, 96.40 %, SE: 0.00045), followed by Coloured (39/1748, 2.23 %, SE: 0.02364), Indian (17/1748, 0.97 %, SE: 0.02377), and Whites (4/1748, 0.23 %, SE: 0.02324), p < 0.05. The prevalence of ATM use varied prior to (382/1748, 21.85 %) and after ART initiation (142/1748, 8.12 %), p <0.05, specifically by Black African females both before (14.41 %) and after uptake (5.49 %), p < 0.05. Overall, 35 Black Africans, one Coloured and one Indian (37/1748, 2.12 %) reported visiting CAM practitioners for their HIV condition and related symptoms post ART. Conclusion Despite a progressive implementation of a successful antiretroviral programme over the first decade of free antiretroviral therapy in the South African public health sector, the use of TCAM is still prevalent amongst a small percentage of HIV infected patients attending public healthcare sector antiretroviral clinics. Further research is needed to explore reasons for use and health benefits or risks experienced by the minority that uses both conventional antiretroviral therapy with TCAM.
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Montserrat-de la Paz S, Fernandez-Arche A, de la Puerta R, Quilez AM, Muriana FJG, Garcia-Gimenez MD, Bermudez B. Mitraphylline inhibits lipopolysaccharide-mediated activation of primary human neutrophils. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:141-148. [PMID: 26926175 DOI: 10.1016/j.phymed.2015.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/17/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Mitraphylline (MTP) is the major pentacyclic oxindolic alkaloid presented in Uncaria tomentosa. It has traditionally been used to treat disorders including arthritis, heart disease, cancer, and other inflammatory diseases. However, the specific role of MTP is still not clear, with more comprehensivestudies, our understanding of this ancient herbal medicine will continue growing. HYPOTHESIS/PURPOSE Some studies provided its ability to inhibit proinflamatory cytokines, such as TNF-α, through NF-κB-dependent mechanism. TNF-α primes neutrophils and modulates phagocytic and oxidative burst activities in inflammatory processes. Since, neutrophils represent the most abundant pool of leukocytes in human blood and play a crucial role in inflammation, we aimed to determine the ability of MTP to modulate neutrophil activation and differentially regulate inflammatory-related cytokines. METHODS To determine the mechanism of action of MTP, we investigated the effects on LPS-activated human primary neutrophils responses including activation surface markers by FACS and the expression of inflammatory cytokines, measured by real time PCR and ELISA. RESULTS Treatment with MTP reduced the LPS-dependent activation effects. Activated neutrophils (CD16(+)CD62L(-)) diminished after MTP administration. Moreover, proinflamatory cytokines (TNF-α, IL-6 or IL-8) expression and secretion were concomitantly reduced, similar to basal control conditions. CONCLUSION Taken together, our results demonstrate that MTP is able to elicit an anti-inflammatory response that modulates neutrophil activation contributing to the attenuation of inflammatory episodes. Further studies are need to characterize the mechanism by which MTP can affect this pathway that could provide a means to develop MTP as new candidate for inflammatory disease therapies.
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Affiliation(s)
- Sergio Montserrat-de la Paz
- Department of Pharmacology, School of Pharmacy, University of Seville, 41012, Seville, Spain ; Laboratory of Cellular and Molecular Nutrition, Instituto de la Grasa, CSIC, Seville, Spain
| | - Angeles Fernandez-Arche
- Department of Pharmacology, School of Pharmacy, University of Seville, 41012, Seville, Spain
| | - Rocío de la Puerta
- Department of Pharmacology, School of Pharmacy, University of Seville, 41012, Seville, Spain
| | - Ana M Quilez
- Department of Pharmacology, School of Pharmacy, University of Seville, 41012, Seville, Spain
| | - Francisco J G Muriana
- Laboratory of Cellular and Molecular Nutrition, Instituto de la Grasa, CSIC, Seville, Spain
| | | | - Beatriz Bermudez
- Department of Pharmacology, School of Pharmacy, University of Seville, 41012, Seville, Spain .
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Montserrat-de la Paz S, de la Puerta R, Fernandez-Arche A, Quilez AM, Muriana FJG, Garcia-Gimenez MD, Bermudez B. Pharmacological effects of mitraphylline from Uncaria tomentosa in primary human monocytes: Skew toward M2 macrophages. JOURNAL OF ETHNOPHARMACOLOGY 2015; 170:128-135. [PMID: 25975515 DOI: 10.1016/j.jep.2015.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/02/2015] [Accepted: 05/03/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Uncaria tomentosa (Willdenow ex Roemer & Schultes) DC. (Rubiaceae) is a Peruvian thorny liana, commonly known as "cat׳s claw", and traditionally used in folk medicine to deal with several inflammatory diseases. Mitraphylline (MTP) is the most abundant pentacyclic oxindolic alkaloid (POA) from U. Tomentosa and has been reported to modify the inflammatory response. Herein, we have sought to identify the mechanisms underlying this modulatory effect of MTP on primary human monocytes and its ability to regulate differentiation processes on human primary monocyte and monocyte-derived macrophages. MATERIAL AND METHODS In vitro studies with human primary monocytes and monocyte-derived macrophages were performed. Monocytes and M0 macrophages were exposed to MTP (25μM) and LPS (100ng/mL). M0 macrophages were polarized to M1 and M2 phenotypes in the absence or presence of MTP. The activation state of monocytes/macrophages was assessed by flow cytometry, gene expression and protein analysis of different specific markers. RESULTS In human primary monocytes, the incubation of MTP for 24h reduced the number of classical (CD14(++)CD16(-)) and intermediate (CD14(++)CD16(+)) subsets when compared to untreated or LPS-treated cells. MTP also reduced the chemotactic capacity of human primary monocytes. In addition, MTP promoted the polarization of M0 macrophages toward an anti-inflammatory M2 phenotype, the abrogation of the release of pro-inflammatory cytokines such as TNFα, IL-6 or IL-1β, as well as the restoration of markers for M2 macrophages in LPS-treated M1 macrophages. CONCLUSIONS Our results suggest that MTP may be a key modulator for regulating the plasticity of monocytes/macrophages and the attenuation of the inflammatory response.
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Affiliation(s)
- S Montserrat-de la Paz
- Department of Pharmacology. School of Pharmacy. University of Seville, Spain; Laboratory of Cellular and Molecular Nutrition. Instituto de la Grasa, CSIC, Seville, Spain
| | - R de la Puerta
- Department of Pharmacology. School of Pharmacy. University of Seville, Spain
| | - A Fernandez-Arche
- Department of Pharmacology. School of Pharmacy. University of Seville, Spain
| | - A M Quilez
- Department of Pharmacology. School of Pharmacy. University of Seville, Spain
| | - F J G Muriana
- Laboratory of Cellular and Molecular Nutrition. Instituto de la Grasa, CSIC, Seville, Spain
| | - M D Garcia-Gimenez
- Department of Pharmacology. School of Pharmacy. University of Seville, Spain
| | - B Bermudez
- Department of Pharmacology. School of Pharmacy. University of Seville, Spain.
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Mee P, Wagner RG, Gómez-Olivé FX, Kabudula C, Kahn K, Madhavan S, Collinson M, Byass P, Tollman SM. Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study. Altern Ther Health Med 2014; 14:504. [PMID: 25515165 PMCID: PMC4325963 DOI: 10.1186/1472-6882-14-504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period. METHODS Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use. RESULTS There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated. CONCLUSIONS There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.
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Cho YY, Jeong HU, Kim JH, Lee HS. Effect of honokiol on the induction of drug-metabolizing enzymes in human hepatocytes. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2137-45. [PMID: 25395831 PMCID: PMC4224024 DOI: 10.2147/dddt.s72305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Honokiol, 2-(4-hydroxy-3-prop-2-enyl-phenyl)-4-prop-2-enyl-phenol, an active component of Magnolia officinalis and Magnolia grandiflora, exerts various pharmacological activities such as antitumorigenic, antioxidative, anti-inflammatory, neurotrophic, and antithrombotic effects. To investigate whether honokiol acts as a perpetrator in drug interactions, messenger ribonucleic acid (mRNA) levels of phase I and II drug-metabolizing enzymes, including cytochrome P450 (CYP), UDP-glucuronosyltransferase (UGT), and sulfotransferase 2A1 (SULT2A1), were analyzed by real-time reverse transcription polymerase chain reaction following 48-hour honokiol exposure in three independent cryopreserved human hepatocyte cultures. Honokiol treatment at the highest concentration tested (50 μM) increased the CYP2B6 mRNA level and CYP2B6-catalyzed bupropion hydroxylase activity more than two-fold in three different hepatocyte cultures, indicating that honokiol induces CYP2B6 at higher concentrations. However, honokiol treatment (0.5–50 μM) did not significantly alter the mRNA levels of phase I enzymes (CYP1A2, CYP3A4, CYP2C8, CYP2C9, and CYP2C19) or phase II enzymes (UGT1A1, UGT1A4, UGT1A9, UGT2B7, and SULT2A1) in cryopreserved human hepatocyte cultures. CYP1A2-catalyzed phenacetin O-deethylase and CYP3A4-catalyzed midazolam 1′-hydroxylase activities were not affected by 48-hour honokiol treatment in cryopreserved human hepatocytes. These results indicate that honokiol is a weak CYP2B6 inducer and is unlikely to increase the metabolism of concomitant CYP2B6 substrates and cause pharmacokinetic-based drug interactions in humans.
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Affiliation(s)
- Yong-Yeon Cho
- College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
| | - Hyeon-Uk Jeong
- College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
| | - Jeong-Han Kim
- Department of Agricultural Biotechnology, Seoul National University, Seoul, Korea
| | - Hye Suk Lee
- College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
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Acharya D, Enslin G, Chen W, Sandasi M, Mavimbela T, Viljoen A. A chemometric approach to the quality control of Sutherlandia (cancer bush). BIOCHEM SYST ECOL 2014. [DOI: 10.1016/j.bse.2014.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Larson EC, Hathaway LB, Lamb JG, Pond CD, Rai PP, Matainaho TK, Piskaut P, Barrows LR, Franklin MR. Interactions of Papua New Guinea medicinal plant extracts with antiretroviral therapy. JOURNAL OF ETHNOPHARMACOLOGY 2014; 155:1433-40. [PMID: 25138353 PMCID: PMC4247785 DOI: 10.1016/j.jep.2014.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/19/2014] [Accepted: 07/10/2014] [Indexed: 05/20/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE A substantial proportion of the population in Papua New Guinea (PNG) lives with human immunodeficiency virus (HIV). Treatment requires lifelong use of antiretroviral therapy (ART). The majority of people in PNG use traditional medicines (TM) derived from plants for all types of health promotions. Consequently, there is a concern that herb-drug interactions may impact the efficacy of ART. Herb-drug, or drug-drug, interactions occur at the level of metabolism through two major mechanisms: enzyme induction or enzyme inhibition. In this study, extracts of commonly-used medicinal plants from PNG were screened for herb-drug interactions related to cytochrome P450s (CYPs). MATERIALS AND METHODS Sixty nine methanol extracts of TM plants were screened for their ability to induce CYPs by human aryl hydrocarbon receptor- (hAhR-) and human pregnane X receptor- (hPXR-) dependent mechanisms, utilizing a commercially available cell-based luciferase reporter system. Inhibition of three major CYPs, CYP1A2, CYP3A4, and CYP2D6, was determined using human liver microsomes and enzyme-selective model substrates. RESULTS Almost one third of the TM plant extracts induced the hAhR-dependent expression of CYP1A2, the hPXR-dependent expression of CYP3A4, or both. Almost two thirds inhibited CYP1A2, CYP3A4, or CYP2D6, or combinations thereof. Many plant extracts exhibited both induction and inhibition properties. CONCLUSIONS We demonstrated that the potent and selective ability of extracts from PNG medicinal plants to affect drug metabolizing enzymes through induction and/or inhibition is a common phenomenon. Use of traditional medicines concomitantly with ART could dramatically alter the concentrations of antiretroviral drugs in the body; and their efficacy. PNG healthcare providers should counsel HIV patients because of this consequence.
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Affiliation(s)
- Erica C Larson
- Department of Pharmacology and Toxicology, University of Utah, 30 S. 2000 E., Salt Lake City, Utah 84112, USA.
| | - Laura B Hathaway
- Department of Pharmacology and Toxicology, University of Utah, 30 S. 2000 E., Salt Lake City, Utah 84112, USA.
| | - John G Lamb
- Department of Pharmacology and Toxicology, University of Utah, 30 S. 2000 E., Salt Lake City, Utah 84112, USA.
| | - Chris D Pond
- Department of Pharmacology and Toxicology, University of Utah, 30 S. 2000 E., Salt Lake City, Utah 84112, USA.
| | - Prem P Rai
- School of Medicine and Health Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, NCD, Papua New Guinea.
| | - Teatulohi K Matainaho
- School of Medicine and Health Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, NCD, Papua New Guinea; School of Natural and Physical Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, NCD, Papua New Guinea.
| | - Pius Piskaut
- School of Natural and Physical Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, NCD, Papua New Guinea.
| | - Louis R Barrows
- Department of Pharmacology and Toxicology, University of Utah, 30 S. 2000 E., Salt Lake City, Utah 84112, USA; School of Medicine and Health Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, NCD, Papua New Guinea; School of Natural and Physical Sciences, University of Papua New Guinea, P.O. Box 5623, Boroko, NCD, Papua New Guinea.
| | - Michael R Franklin
- Department of Pharmacology and Toxicology, University of Utah, 30 S. 2000 E., Salt Lake City, Utah 84112, USA.
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Awortwe C, Bouic PJ, Masimirembwa CM, Rosenkranz B. Inhibition of major drug metabolizing CYPs by common herbal medicines used by HIV/AIDS patients in Africa-- implications for herb-drug interactions. Drug Metab Lett 2014; 7:83-95. [PMID: 24475926 PMCID: PMC4354708 DOI: 10.2174/1872312808666140129123210] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/03/2013] [Accepted: 01/25/2014] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate the potential risk of common herbal medicines used by HIV-infected patients in Africa for herb-drug interactions (HDI). High throughput screening assays consisting of recombinant Cytochrome P450 enzymes (CYPs) and fluorescent probes, and parallel artificial membrane permeability assays (PAMPA) were used. The potential of herbal medicines to cause HDI was ranked according to FDA guidelines for reversible inhibition and categorization of time dependent inhibition was based on the normalized ratio. CYPs 1A2 and 3A4 were most inhibited by the herbal extracts. H. hemerocallidea (IC50 = 0.63 µg/mL and 58 µg/mL) and E. purpurea (IC50 = 20 µg/mL and 12 µg/mL) were the potent inhibitors of CYPs 1A2 and 3A4 respectively. L. frutescens and H. hemerocallidea showed clear time dependent inhibition on CYP3A4. Furthermore, the inhibitory effect of both H. hemerocallidea and L. frutescens before and after PAMPA were identical. The results indicate potential HDI of H. hemerocallidea, L. frutescens and E. purpurea with substrates of the affected enzymes if maximum in vivo concentration is achieved.
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Affiliation(s)
| | | | | | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Department of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg, Cape Town, 7505, South Africa.
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Al-Jenoobi FI, Al-Thukair AA, Alam MA, Abbas FA, Al-Mohizea AM, Alkharfy KM, Al-Suwayeh SA. Modulation of CYP2D6 and CYP3A4 metabolic activities by Ferula asafetida resin. Saudi Pharm J 2014; 22:564-9. [PMID: 25561870 PMCID: PMC4281599 DOI: 10.1016/j.jsps.2014.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/26/2014] [Indexed: 11/30/2022] Open
Abstract
Present study investigated the potential effects of Ferula asafetida resin on metabolic activities of human drug metabolizing enzymes: CYP2D6 and CYP3A4. Dextromethorphan (DEX) was used as a marker to assess metabolic activities of these enzymes, based on its CYP2D6 and CYP3A4 mediated metabolism to dextrorphan (DOR) and 3-methoxymorphinan (3-MM), respectively. In vitro study was conducted by incubating DEX with human liver microsomes and NADPH in the presence or absence of Asafetida alcoholic extract. For clinical study, healthy human volunteers received a single dose of DEX alone (phase-I) and repeated the same dose after a washout period and four-day Asafetida treatment (phase-II). Asafetida showed a concentration dependent inhibition on DOR formation (in vitro) and a 33% increase in DEX/DOR urinary metabolic ratio in clinical study. For CYP3A4, formation of 3-MM in microsomes was increased at low Asafetida concentrations (10, 25 and 50 μg/ml) but slightly inhibited at the concentration of 100 μg/ml. On the other hand, in vivo observations revealed that Asafetida significantly increased DEX/3-MM urinary metabolic ratio. The findings of this study suggest that Asafetida may have a significant effect on CYP3A4 metabolic activity. Therefore, using Ferula asafetida with CYP3A4 drug substrates should be cautioned especially those with narrow therapeutic index such as cyclosporine, tacrolimus and carbamazepine.
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Affiliation(s)
- Fahad I. Al-Jenoobi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Corresponding author. Address: Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh-11451, Saudi Arabia. Tel.: +966 504187374.
| | - Areej A. Al-Thukair
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohd Aftab Alam
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fawkeya A. Abbas
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M. Al-Mohizea
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M. Alkharfy
- Department of Clinical Pharmacy, College of Pharmacy and Biomarkers Research Program, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saleh A. Al-Suwayeh
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Koffuor GA, Dickson R, Gbedema SY, Ekuadzi E, Dapaah G, Otoo LF. The immunostimulatory and antimicrobial property of two herbal decoctions used in the management of HIV/AIDS in Ghana. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2014; 11:166-72. [PMID: 25371579 DOI: 10.4314/ajtcam.v11i3.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND HIV/AIDS is a pandemic retarding economic growth and destroying human capital globally. This study therefore investigated the perceived efficacy of Betula alba (BA) and Sutherlandia frutescens (SF) decoctions used in the management of HIV/AIDS in Ghana. MATERIALS AND METHODS A study on the records of HIV/AIDS patients attending Habibi Herbal Clinic, Kumasi, Ghana, was conducted to obtain information on the initial viral load presented during their maiden visit and results after treatment with the herbal decoctions. The decoctions were assessed for immunostimulatory property in cyclophosphamide-induced immunosuppressed ICR mice. Total white blood cell count, as well as lymphocyte and neutrophil counts were determined and their effects compared with Levamisole. The decoctions were also screened for antimicrobial activity by the micro dilution method. RESULTS The two herbal decoctions used significantly reduced (P ≤ 0.001) the patients' viral loads (47.42 ± 17.28 % to 13.69 ± 12.42 %; n=16). BA (1, 2, and 4 mg/kg) and SF (0.4, 0.8, and 1.6 mg/kg) caused significant increment (P ≤ 0.001) in total WBC and lymphocyte count in mice comparable to that produced by 2.5 mg/kg Levamisole. The decoctions also exhibited antimicrobial activity against gram negative and gram positive bacteria as well as Candida albicans (MIC 0.607 to 3.062 mg/ml). Phytochemicals present in both plants include saponins, terpenoids and coumarins. CONCLUSION The Betula alba and Sutherlandia frutescens decoctions have interesting immunostimulatory and antimicrobial properties and hence could be useful in the management of HIV/AIDS and associated opportunistic infections.
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Affiliation(s)
- George Asumeng Koffuor
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rita Dickson
- Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Yao Gbedema
- Department of Pharmaceutics; Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edmund Ekuadzi
- Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gabriel Dapaah
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lydia Francisca Otoo
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Zhang B, Leung WK, Zou Y, Mabusela W, Johnson Q, Michaelsen TE, Paulsen BS. Immunomodulating polysaccharides from Lessertia frutescens leaves: isolation, characterization and structure activity relationship. JOURNAL OF ETHNOPHARMACOLOGY 2014; 152:340-348. [PMID: 24480566 DOI: 10.1016/j.jep.2014.01.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sutherlandia frutescens (syn. Lessertia frutescens) is an indigenous plant in Southern Africa and has been extensively studied from the ethnobotanical point of view. Amongst the various traditional uses, several illnesses involving the immune system have been reported. Due to some of the therapeutic effects observed, in relation to the traditional uses reported by the "khoi san" and "nama" people on cancer related illnesses, the plant has been given the local name kankerbos (cancerbush). Recently the plant has also been used amongst HIV/AIDS patients to stimulate the immune system. MATERIALS AND METHODS Leaves of Sutherlandia frutescens were extracted sequentially with ethanol, 50% ethanol/water, and water at 50 and 100°C. The polysaccharides were extracted with water and fractionated by ion exchange chromatography and gel filtration to obtain enriched polysaccharide fractions. The bioactivities of the fractions were tested in the complement assay. Some of the fractions were treated with the enzyme pectinase, and the fragments thus produced were separated by gel filtration and their activities tested. Monosaccharide compositions and linkage analyses were determined for the relevant fractions. RESULTS The leaves of Sutherlandia frutescens contain polysaccharides of the pectin type. Fractions from both the water extracts of 50 and 100°C were bioactive. Fractions chosen for further studies showed that the fragment with the highest M(W) after the pectinase treatment had a substantially higher biological effect than the parent molecules. Based on a comparison of the different fractions it was concluded that galactose-rich regions were important for the bioactivity, these being of the AGII and AGI type, with the latter probably being more important than the former. Fragments rich in xylose also gave higher activity than those without it. CONCLUSIONS Our theory that the polysaccharides present in the leaves of Sutherlandia frutescens could be of importance as immunomodulating agents was confirmed. It was also shown that certain types of polysaccharides had a higher effect in the complement system than others. Thus both the water extracts obtained at 50 and 100°C contain interesting biologically active polysaccharides.
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Affiliation(s)
- Bingzhao Zhang
- School of Pharmacy, University of Oslo, Oslo, Norway; GIAT-HKU joint Center for Synthetic Biology Engineering Research (CSynBER), Guangzhou Institute of Advanced Technology, Chinese Academy of Sciences, 511458 Nansha, Guangzhou, PR China
| | - Wei Kee Leung
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Yuanfeng Zou
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Wilfred Mabusela
- South African Herbal Science and Medicine Institute (SAHSMI), University of Western Cape, Bellville, South Africa
| | - Quinton Johnson
- Nelson Mandela Metropolitan University, George, Southern Cape, South Africa
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Effect of Garden Cress Seeds Powder and Its Alcoholic Extract on the Metabolic Activity of CYP2D6 and CYP3A4. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:634592. [PMID: 24711855 PMCID: PMC3966352 DOI: 10.1155/2014/634592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/21/2014] [Indexed: 11/18/2022]
Abstract
The powder and alcoholic extract of dried seeds of garden cress were investigated for their effect on metabolic activity of CYP2D6 and CYP3A4 enzymes. In vitro and clinical studies were conducted on human liver microsomes and healthy human subjects, respectively. Dextromethorphan was used as a common marker for measuring metabolic activity of CYP2D6 and CYP3A4 enzymes. In in vitro studies, microsomes were incubated with NADPH in presence and absence of different concentrations of seeds extract. Clinical investigations were performed in two phases. In phase I, six healthy female volunteers were administered a single dose of dextromethorphan and in phase II volunteers were treated with seeds powder for seven days and dextromethorphan was administered with last dose. The O-demethylated and N-demethylated metabolites of dextromethorphan were measured as dextrorphan (DOR) and 3-methoxymorphinan (3-MM), respectively. Observations suggested that garden cress inhibits the formation of DOR and 3-MM metabolites. This inhibition of metabolite level was attributed to the inhibition of CYP2D6 and CYP3A4 activity. Garden cress decreases the level of DOR and 3-MM in urine and significantly increases the urinary metabolic ratio of DEX/DOR and DEX/3-MM. The findings suggested that garden cress seeds powder and ethanolic extract have the potential to interact with CYP2D6 and CYP3A4 substrates.
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Hu M, Fan L, Zhou HH, Tomlinson B. Theranostics meets traditional Chinese medicine: rational prediction of drug–herb interactions. Expert Rev Mol Diagn 2014; 12:815-30. [DOI: 10.1586/erm.12.126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abad Martínez MJ, del Olmo LMB, Benito PB. Interactions Between Natural Health Products and Antiretroviral Drugs. STUDIES IN NATURAL PRODUCTS CHEMISTRY 2014. [DOI: 10.1016/b978-0-444-63430-6.00006-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Bains RK. African variation at Cytochrome P450 genes: Evolutionary aspects and the implications for the treatment of infectious diseases. EVOLUTION MEDICINE AND PUBLIC HEALTH 2013; 2013:118-34. [PMID: 24481193 PMCID: PMC3868406 DOI: 10.1093/emph/eot010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The genomics revolution has provided a plethora of data from many previously uncharacterized populations. The increase in the amount of genetic data has improved our understanding of why individuals and populations differ in their susceptibility to multiple diseases. It has also enabled researchers to identify how genomic variation, including at the Cytochrome P450 (CYP450) super-family, affects the safety and efficacy of therapeutic drugs. CYP450 metabolize ∼90% of clinically administered drugs. Variability in CYP450 expression is known to affect the safety and efficacy of therapeutic drugs, including many used in the treatment and control of infectious diseases. There are inter-ethnic differences in the frequencies of clinically relevant CYP450 variants which affect CYP450 expression. Comparative studies of African populations have identified population structuring at CYP450 genes. This is associated with intra-African differences in the success of drug therapies used in the treatment of infectious diseases. Therapeutic drugs dominate control strategies for infectious diseases and are widely administered through mass drug administration campaigns. However, resistance to chemotherapy is spreading across endemic regions. The most common response has been to increase chemotherapeutic dosages, and administer combination therapies. However, there are few pharmacovigilance data examining how these changes influence adverse drug reactions. This review provides an overview of current knowledge of intra-Africa CYP450 variation, and the known associations with sub-optimal clinical outcomes in the treatment of infectious diseases. In addition, the potential for evolutionary approaches in the study of CYP450 variation is discussed to examine their potential in preventative medicine and intervention strategies within Africa.
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Affiliation(s)
- Ripudaman K Bains
- Research Department of Genetics, Evolution and Environment, Darwin Building, University College London, London WC1E 6BT, UK
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