Regulatory issues concerning the safety, efficacy and quality of herbal remedies

Ethnobotanical survey of medicinal wild plants in the Shouf Biosphere Reserve, Lebanon

BACKGROUND

Medicinal plants and associated traditional knowledge play a vital role in supporting the livelihoods and resilience of indigenous communities. This ethnobotanical survey aims to identify medicinal plants used by the local communities of the Shouf Biosphere Reserve of Lebanon (SBR) and document the associated traditional knowledge.

METHODOLOGY

Focus groups and personal interviews with 133 informants of community members of 22 villages of SBR were performed during 2019-2022. Informants were selected using purposive sampling techniques based on their knowledge of medicinal plants and experience in traditional herbal medicine. Interviews were conducted using a semi-structured questionnaire through field visits.

RESULTS

Informants were equally represented by females and males and had different demographic characteristics, and the main source of knowledge was ancestral. A total of 184 medicinal plant species belonging to 57 families were documented. The predominant families were Asteraceae (31 spp.), Lamiaceae (14 spp.), and Rosaceae (14 spp.). Leaves (23%) were the plant part most used. Decoction (45%) was the predominant preparation method, while internal (oral) use (47%) was the most frequent administration mean. Berberis libanotica, Dittrichia viscosa, and Daucus carota achieved the highest scores of frequency of citation (FC), relative frequency of citation (RFC), use value (UV), and fidelity level (FL). Furthermore, diseases and ailments of gastrointestinal tract were the category most treated.

CONCLUSIONS

Findings revealed a rich and diverse list of medicinal plants with associated traditional knowledge still actively used to treat a wide range of diseases. Future phytochemical and pharmacological studies are recommended to determine the efficacy and safety of plant species used. The management body of the SBR and all related authorities are invited to continue their conservation efforts to protect such rich biocultural heritage.

An Intramolecular Hydroaminomethylation-Based Approach to Pyrrolizidine Alkaloids under Microwave-Assisted Heating

A general method for the synthesis of pyrrolizidine derivatives using an intramolecular hydroaminomethylation protocol (HAM) under microwave (MW) dielectric heating is reported. Starting from a 3,4-bis(benzyloxy)-2-[(benzyloxy)methyl]-5-vinylpyrrolidine, MW-assisted intramolecular HAM in the presence of gaseous H2 and CO gave the natural alkaloid hyacinthacine A2 protected as benzyl ether. The same approach gave a lentiginosine analogue starting from the corresponding vinyl N-hydroxypyrrolidine. The nature of the reaction products and the yields were strongly influenced by the relative stereochemistry of the starting pyrrolidines, as well as by the catalyst/ligand employed. The use of ethanol as a solvent provides environmentally friendly conditions, while the ligand/catalyst system can be recovered by separating the alkaloid product with an SCX column and recycling the ethanolic solution. HAM worked up to three times with the recycled catalyst solution without any significant impact on yield.

Safety, Stability, and Therapeutic Efficacy of Long-Circulating TQ-Incorporated Liposomes: Implication in the Treatment of Lung Cancer

Thymoquinone (TQ), which is one of the main bioactive constituents of Nigella sativa seeds, has demonstrated its potential against various cancer models. The poor solubility of TQ in aqueous solution limits its uses in clinical application. The present study aimed to develop a novel formulation of TQ to increase its bioavailability and therapeutic potential with minimal toxicity. Polyethylene glycol (PEG)-coated DSPC/cholesterol comprising TQ liposomes (PEG-Lip-TQ) were prepared and characterized on various aspects. A computational investigation using molecular docking was used to assess the possible binding interactions of TQ with 12 prospective anticancer drug targets. The in vitro anticancer activity was assessed in A549 and H460 lung cancer cells in a time- and dose-dependent manner, while the oral acute toxicity assay was evaluated in silico as well as in vivo in mice. TQ docked to the Hsp90 target had the lowest binding energy of −6.05 kcal/mol, whereas caspase 3 was recognized as the least likely target for TQ with a binding energy of −1.19 kcal/mol. The results showed 96% EE with 120 nm size, and −10.85 mv, ζ-potential of PEG-Lip-TQ, respectively. The cell cytotoxicity data demonstrated high sensitivity of PEG-Lip-TQ and a several fold decrease in the IC₅₀ while comparing free TQ. The cell cycle analysis showed changes in the distribution of cells with doses. The in vivo data revealed an ~9-fold increase in the LD₅₀ of PEG-Lip-TQ on free TQ as an estimated 775 and 89.5 mg/kg b.w, respectively. This study indicates that the pharmacological and efficacy profile of PEG-lip-TQ is superior to free TQ, which will pave the way for an exploration of the effect of TQ formulation in the treatment of lung cancer in clinical settings.

Medicinal plants and bioactive natural products as inhibitors of NLRP3 inflammasome

The NLR family, pyrin domain-containing 3 (NLRP3) inflammasome is a multiprotein complex that induces caspase-1 activation and the downstream substrates involved with the processing and secretion of the pro-inflammatory cytokines interleukin-1β (IL-1β) and IL-18 and tumor necrosis factor-α (TNF- α). The NLRP3 inflammasome is activated by a wide range of danger signals that derive from metabolic dysregulation. Activation of this complex often involves the adaptor ASC and upstream sensors including NLRP1, NLRP3, NLRC4, AIM2, and pyrin, which are activated by different stimuli including infectious agents and changes in cell homeostasis. It has been shown that nutraceuticals and medicinal plants have antiinflammatory properties and could be used as complementary therapy in the treatment of several chronic diseases that are related to inflammation, for example, cardiovascular diseases and diabetes mellitus. Herb-based medicine has demonstrated protective effects against NLRP3 inflammasome activation. Therefore, this review focuses on the effects of nutraceuticals and bioactive compounds derived from medicinal plants on NLRP3 inflammasome activation and the possible mechanisms of action of these natural products. Thus, herb-based, natural products/compounds can be considered novel, practical, and accessible agents in chronic inflammatory diseases by inhibiting NLRP3 inflammasome activation.

Reproductive Toxicity of Theobroma cacao: Increase in Survival Index, Nongenotoxic, and Proimplantation Potential

Unsweetened natural cocoa (UNCP) was evaluated for reproductive toxicity in rats. A preliminary genotoxic potential was evaluated by the DNA comet assay test using C57Bl/6 mice. Both therapeutic dose (TD; 900 mg/kg) and high dose (HD; 9000 mg/kg) of UNCP were used. White Wistar rats were used in two experimental groups. The females received UNCP 15 days before crossing with untreated males. The males received UNCP for 48 days before mating with untreated females. Subacute toxicity was observed during a 14-day oral administration of UNCP. Results show that a high tail DNA% was observed with methyl mesylate administration in all tissues analysed. The lowest tail DNA% value was observed in the liver (1.64 ± 0.26) and kidney (1.63 ± 0.30) during UNCP (TD) administration. UNCP did not induce observable physical congenital malformations on the pubs of treated female and male rats, lacks genotoxic potential, and did not adversely affect pregnancy index, pub weights, and survival index, but UNCP exhibited proimplantation potential (p > 0.05).

The genotoxicity of an aqueous extract of Gyejibokryeong-hwan

Background

Gyejibokryeong-hwan (Guizhi Fuling Wan in China), a mixture of five herbal plants, is a well-known treatment for renal diseases including those associated with climacteric syndrome. However, the genotoxicity of Gyejibokryeong-hwan has not yet been well established.

Methods

The present study investigated that the genotoxicity of an aqueous extract of Gyejibokryeong-hwan (GJBRHE): an in vitro chromosomal aberration test using Chinese hamster lung cells, an in vitro bacterial reverse mutation assay (Ames test) with Salmonella typhimurium and Escherichia coli strains, and an in vivo micronucleus test using ICR mouse bone marrow.

Results

GJBRHE with or without the S9 mix showed no genotoxicity in the Ames test up to 5000 μg/plate or in the in vivo MN test up to 2000 mg/kg body weight. In contrast, the chromosomal aberration test showed that GJBRHE induced an increase in the number of chromosomal aberrations compared with the control after treatment for 6 h with 4200 μg/mL GJBRHE in the presence of the S9 mix and for 22 h with 800 μg/mL GJBRHE in the absence of the S9 mix.

Conclusions

GJBRHE did not cause detectable genotoxic effects in the bacterial mutation test or the in vivo MN test, however genotoxic effect was detected in the in vitro chromosomal aberration assay. Our results suggest that GJBRHE may be associated with a low risk of carcinogenesis. Thus, further detailed experiments would be needed to clarify the compound responsible for inducing this genotoxicity of GJBRHE and to determine its mechanism.

PHARMACEUTICAL EVALUATION AND TOXICOLOGICAL QUANTIFICATION OF HEAVY METALS AND ADULTERATED ALLOPATHIC CONTENTS IN RAW AND FINISHED DOSAGE FORM OF ANTIHYPERTENSIVE HERBAL PRODUCTS

BACKGROUND

Herbal products of questionable quality create major concern for human population since their production is often not controlled and regulated.

MATERIAL AND METHODS

Antihypertensive herbal products were subjected to pharmaceutical quality control parameters specified in Pharmacopoeias, toxic quantification of heavy metals by flame atomic absorption spectrophotometer and adulterated allopathic contents were quantified using advanced HPLC techniques.

RESULTS

A lot of variations in pharmaceutical parameters like moisture contents and LOD% values were observed. Also deviations to a greater extent in weight variation, (P1, P2, P6, P12, P16, P17, P19, and P20), and hardness of the tablets of products (P1, P3, P8 and P11) were found. Friability of tablets of the Products (P3, P9 and P11) was found failed. Heavy metals i-e Fe (1597.20ppm, 1648ppm) in P5, P9, Pb (61.32ppm, 16.59 ppm) in P5, Cr (96.91ppm,108.48 ppm) in P4, P14, Cd (39.53ppm, 32.31 ppm) in P11, P12, Cu (28.22ppm, 21.04 ppm) in P15, P17, Zn (80.31ppm,76.27 ppm) in P15, P16, Ni (45.46ppm,22.18ppm) in P9, P13 in toxic concentrations were detected. Adulterated allopathic contents of Amlpdopine in higher quantities, administered according to manufacturer dose were found in P12 (20.30 mg/day), Verapamil in P2 (93.50 mg/day), Nifedipine (38.65 mg/day) in P6. Products P4, P5 and P7 were found to have a combination of Amlodipine and Hydrochlorothiazide and higher concentrations were found in P5 (10.72 mg/day, 24.75 mg/day).

CONCLUSION

The antihypertensive herbal products contained different kind of adulterants. Our findings suggest that effective regulatory measures should be put in place to address this problem. This will help to decrease the toxic effects of these remedies and increase the commercialization, internationalization and harmonization of antihypertensive herbal products.

Investigation the efficiency of various methods of volatile oil extraction from Trichodesma africanum and their impact on the antioxidant and antimicrobial activities

Background:

Currently, there is an increasing interest in developing more efficient techniques for the extraction of phytochemicals. Microwaves and ultrasonic extraction methods are promising techniques that can be used for this purpose.

Objectives:

The purpose of this study was to investigate the impact of different extraction methods on yield, antioxidant and antimicrobial activities of volatile oil extracted from Trichodesma africanum.

Materials and Methods:

Volatile oil was extracted using microwave, ultrasonic, microwave-ultrasonic, and conventional hydrodistillation methods. The extracted oil was evaluated for antioxidant and antimicrobial activities. The antioxidant activity was assessed by 2,2-Diphenyl-1-picrylhydrazyl scavenging assay, whereas the antimicrobial activity was assessed by broth microdilution method. The antimicrobial activity of the volatile oils was examined against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa American type culture collection reference strains, as well as against methicillin-resistant S. aureus (MRSA) and Candida albicans clinical isolates.

Results:

The volatile oil obtained by the four extraction methods in this study exhibited both antioxidant and antimicrobial activities. Among the four extraction methods used, the microwave-ultrasonic method yielded the largest amount (1.8% v/w) and the yield exhibited the highest antioxidant activity in terms of inhibition (91.83% ± 1.1). The minimum inhibitory concentrations for E. coli, P. aeruginosa, S. aureus, MRSA, and C. albicans were 3, 5, 6, 3, and 9, respectively.

Conclusion:

Among the extraction techniques used in this study, the microwave-ultrasonic method showed the best results. Moreover, this study suggests that T. africanum volatile oils contain active substances that could potentially be used both as natural preservatives in food and pharmaceutical industries as well as in developing new antimicrobial and antioxidant agents.

Herbal Medicine in Mexico: A Cause of Hepatotoxicity. A Critical Review

In Mexico, herbal products are commonly used as therapeutic tools. The analysis of several publications reveals that there are dozens of different herbs and herbal products used for different reasons, some of which have been implicated in causing toxic liver disease. However, methodological aspects limit the attribution of causality, and the precise incidence and clinical manifestations of herb-induced liver injury have not been well characterized. This review outlines the history of traditional herbal medicine in Mexico, critically summarizes the mechanisms and adverse effects of commonly used herbal plants, and examines the regulatory issues regarding the legal use of these products.

Herb-drug interactions: challenges and opportunities for improved predictions

Supported by a usage history that predates written records and the perception that "natural" ensures safety, herbal products have increasingly been incorporated into Western health care. Consumers often self-administer these products concomitantly with conventional medications without informing their health care provider(s). Such herb-drug combinations can produce untoward effects when the herbal product perturbs the activity of drug metabolizing enzymes and/or transporters. Despite increasing recognition of these types of herb-drug interactions, a standard system for interaction prediction and evaluation is nonexistent. Consequently, the mechanisms underlying herb-drug interactions remain an understudied area of pharmacotherapy. Evaluation of herbal product interaction liability is challenging due to variability in herbal product composition, uncertainty of the causative constituents, and often scant knowledge of causative constituent pharmacokinetics. These limitations are confounded further by the varying perspectives concerning herbal product regulation. Systematic evaluation of herbal product drug interaction liability, as is routine for new drugs under development, necessitates identifying individual constituents from herbal products and characterizing the interaction potential of such constituents. Integration of this information into in silico models that estimate the pharmacokinetics of individual constituents should facilitate prospective identification of herb-drug interactions. These concepts are highlighted with the exemplar herbal products milk thistle and resveratrol. Implementation of this methodology should help provide definitive information to both consumers and clinicians about the risk of adding herbal products to conventional pharmacotherapeutic regimens.

Effects of biochemical alteration in animal model after short-term exposure of Jatropha curcas (Linn) leaf extract

This study aims to evaluate potential toxic effect of Jatropha curcas leaves methanol extract on laboratory rats as well as determine its LD50. A total of 80 male Wistar rats were used as the experimental animals, 40 for LD50 determination and the other 40 for toxicity study. Based on the pretest that was done in order to establish a range of toxicity, 4 dosages (86.00, 58.00, 46.00, and 34.0 kg/body weight) were chosen. The rats were randomly assigned into four groups with 10 rats in each group. Rats in groups 1, 2, 3, and 4 were given 0 mg/kg, 500 mg/kg, 1000 mg/kg, and 2000 mg/kg body weight of Jatropha curcas extract, respectively, by oral intubation for 21 days. Thereafter, clinical signs, change in body weight, toxicity symptoms, and biochemical parameters were obtained. The LD50 at 95% confidence limits for rats was 46.0 mg/kg body weight (44.95-52.69 mg/kg body mass). There was no clinical and biochemical signs of toxicity when the extract was administered at 500, 1000, and 2000 mg/kg body weight, respectively (P > 0.05). Results obtained from this study suggest that liver, kidney, and haematological system of rats tolerated methanolic leave extract of Jatropha curcas at a certain concentration.

In vitro and in vivo safety evaluation of Dipteryx alata Vogel extract

Background

Dipteryx alata Vogel popularly known as "baru" is an important commercial leguminous tree species from the Brazilian Cerrado, which possess medicinal properties, besides its fruits consumption by animals and humans. The use of the "naturally occurring plants" as herbal remedies and foods mainly from leaves, seeds, flowers and roots of plants or extracts require precautions before ensuring these are safe and efficacious. The objective of this study was to evaluate the safety of D. alata barks extract.

Methods

Vegetal drugs of D. alata barks were submitted to quality control assays and further to the safety assays under 1) in vitro parameter by Salmonella (Ames) mutagenicity, and 2) in vivo parameter on the pregnancy of rats.

Results

The extract was non-mutagenic to any of the assessed strains TA97a, TA98, TA100 and TA102 even after metabolic activation (+S9). All in vivo parameters (reproductive ability evaluation, physical development of rat offsprings, and neurobehavioral development assays) showed no changes related to control group.

Conclusion

D. alata barks extract is neither mutagenic by the Ames test nor toxic in the pregnancy of rats, with no physical-neurobehavioral consequences on the rat offsprings development.

Toxicological evaluation of Gumiganghwaltang aqueous extract in Crl:CD (SD) rats: 13 weeks oral gavage studies

Gumiganghwaltang is a traditional oriental herbal medicine that has been commonly used to treat colds and inflammatory diseases. Aqueous extract of Gumiganghwaltang (GMGHT) was administrated daily by oral gavage to male and female rats for 13 weeks. A dose of 2000 mg/kg/day was selected as a maximum, and doses of 1000 and 500 mg/kg/day were determined as medium and low doses, respectively. No treatment-related clinical signs or mortality were observed in the treatment group. We observed no clear treatment-related effects with regard to body weight, food consumption, ophthalmology, hematology, or urinalysis data. The serum biochemistry values for sodium and chloride in the treated male and female groups (1000 mg/kg/day) were lower than in those treated with the vehicle control. However, these changes lacked dose dependence, and no abnormalities were found in corresponding pathological findings. Our results indicated that the no-observed-adverse-effect-level (NOAEL) for GMGHT was determined to be a dietary dose of over 2000 mg/kg/day for both sexes under the present experimental conditions.

A 4-week Repeated Dose Oral Toxicity and Cytotoxicity Study of Gumiganghwaltang in Crl:CD (SD) Rats

Gumiganghwaltang (GGT) is a traditional oriental herbal prescription commonly used to treat colds and inflammatory diseases in Korea. This study reports the first evaluation of the oral toxicity and cytotoxicity effects of repeat doses of GGT. GGT was orally administered daily at doses of 0, 500, 1000, and 2000 mg/kg for 4 weeks. Analysis of body weight gain, mortality, clinical observations, urinalysis, blood biochemistry, hematology, organ weight, and histopathological data revealed no significant differences between the V.CONTROL and GGT-treated groups. In addition, we investigated the cytotoxicity of GGT against LNCaP, RBL-1, and BEAS-2B cell lines, and splenocytes. Based on the results, we conclude that GGT orally administered to rats is safe with no drug-related toxicity, even at the highest dose, in 4-week repeated dose studies. Thus, this concentration is considered the non-observable effect dose in rats.

Stakeholders' perspectives on the regulation and integration of complementary and alternative medicine products in Lebanon: a qualitative study

Background

The regulation of the markets for Complementary and Alternative Medicine (CAM) products presents a global challenge. There is a dearth of studies that have examined or evaluated the regulatory policies of CAM products in the Eastern Mediterranean Region (EMR). We investigate the regulatory frameworks and the barriers for the proper regulation and integration of CAM products in Lebanon, as an example of an EMR country with a weak public infrastructure.

Methods

We utilized a qualitative study design involving a series of semi-structured interviews with stakeholders of the CAM market in Lebanon. Snowball sampling was used to identify interviewees; interviews continued until the "saturation" point was reached. A total of 16 interviews were carried out with decision makers, representatives of professional associations, academic researchers, CAM product importers, policy makers and a media representative. Interviews were transcribed and thematic analysis of scripts was carried out.

Results

There was a consensus among all stakeholders that the regulation of the market for CAM products in Lebanon needs to be strengthened. Thematic analysis identified a number of impediments jeopardizing the safety of public consumption and hindering the integration of CAM therapies into mainstream medicine; including: weak infrastructure, poor regulation, ineffective policies and politics, weak CAM awareness and sub-optimal coordination and cooperation among stakeholders. With respect to policy instruments, voluntary instruments (self regulation) were deemed ineffective by stakeholders due to poor awareness of both users and providers on safe use of CAM products. Stakeholders' rather recommended the adoption of a combination of mixed (enhancing public awareness and integration of CAM into medical and nursing curricula) and compulsory (stricter governmental regulation) policy instruments for the regulation of the market for CAM products.

Conclusions

The current status quo with respect to the regulation of CAM products in Lebanon is not conducive to public safety, nor does it support the integration of CAM products into the healthcare system. The Ministry of Health indeed plays a dominant role in the regulation of these products through a combination of mixed and compulsory policy instruments. Yet, the proper implementation of these regulations requires political resolve coupled with the cooperation of all CAM stakeholders.

The state of the art of traditional arab herbal medicine in the eastern region of the mediterranean: a review

Historical and current studies indicate that the Eastern region of the Mediterranean has been distinguished from other regions by a rich inventory of complementary alternative medicine (CAM), in particular herbal medicine. Data collected from several surveys and studies indicate that there is a flourishing and well-developed trade of herbs. These surveys also reveal that 200-250 herbs are used in treating human diseases and are sold or traded in market places in the Mediterranean region or internationally. In addition, some of these herbs are rare or even endangered species. In regard to the status of the know-how of herbalists, unfortunately, herbal medicine in our region is mostly prescribed by ethnopharmacologists symptomatically-based on signs and symptoms alone, rather than as a result of a full understanding of the underlying disease. In some cases, herbs used today may not even correspond to the plants described originally in the old literature, as the former are cultivated from herbs that went through different breeding procedures throughout several centuries. This article presents a systematic review of both the state of the art of traditional Arab herbal medicine and the status of the know-how of Arab herbalists.

Genotoxicity assessment of Pyungwi-san (PWS), a traditional herbal prescription

ETHNOPHARMACOLOGICAL RELEVANCE

Pyungwi-san (PWS, Heii-san in Japanese) is a mixture of six herbs and is traditionally used in Northeast Asia (especially Korea and Japan) for the treatment of gastrointestinal disorder, such as dyspepsia and inappetance induced by gastric dilatation and gastrointestinal catarrh.

AIM OF THE STUDY

Although PWS is a widely used herbal prescription in Korea and Japan, little information is available in the literature on the safety and toxicity of PWS. As part of a safety evaluation of PWS, the present study evaluated the potential genotoxicity of PWS using a standard battery of test.

MATERIALS AND METHODS

We prepared PWS using a water extraction method and simultaneously extracted three compounds from PWS using high performance liquid chromatography. The PWS extract that was obtained was assayed for genotoxicity using the standard three tests recommended by the Korea Food and Drug Administration. These tests included the bacterial reverse mutation test (Ames test), the chromosomal aberration test using China hamster lung cells, and the micronucleus test using ICR mice.

RESULTS

The Ames test showed that the PWS extract did not induce an increase in the number of revertant colonies compared with vehicle control at any dose in all of tester strains. In the micronucleus test, no significant increase was observed in micronucleated polychromatic erythrocytes (MNPCEs) at any dose of PWS extract compared with vehicle control. Conversely, chromosomal aberration test showed that the PWS extract at a dosage of 4500 μg/mL induced an increase in the number of chromosomal aberrations in the 6 h group with metabolic activation compared with the vehicle control.

CONCLUSION

PWS extract exhibits genotoxicity, based on the results of the chromosomal aberration test. Thus, further detailed experiments will be needed to identify the ingredient responsible for inducing this genotoxicity and to determine its mechanism.

Use, Attitudes and Knowledge of Complementary and Alternative Drugs (CADs) Among Pregnant Women: a Preliminary Survey in Tuscany

To explore pregnant women's use, attitudes, knowledge and beliefs of complementary and alternative drugs (CADs) defined as products manufactured from herbs or with a natural origin. A preliminary survey was conducted among 172 pregnant women in their third trimester of pregnancy, consecutively recruited in two obstetrical settings; 15 women were randomly selected to compute a test-to-retest analysis. Response rate was 87.2%. Test-to-retest analysis showed a questionnaire's reproducibility exceeding a K-value of 0.7 for all items. Mean age was 32.4 ± 0.4 years; most women were nulliparae (62.7%). The majority of subjects (68%) declared to have used one or more CADs during their lifetime; 48% of pregnant women reported taking at least one CAD previously and during the current pregnancy. Women's habitual use of CADs meant they were at higher risk of taking CADs also during pregnancy (adjusted odds ratio = 10.8; 95% confidence interval: 4.7-25.0). Moreover, 59.1% of the subjects were unable to correctly identify the type of CADs they were using. The majority of women resorted to gynecologists as the primary information source for CADs during pregnancy, while they mainly referred to herbalists when not pregnant. Habitual use of CADs seems to be a strong predictor for their ingestion also during pregnancy; in addition most subjects were unable to correctly identify the products they were taking. In the light of the scanty data concerning the safety of CADs during pregnancy, these preliminary results confirm the need to investigate thoroughly the situation of pregnant women and CADs consumption.

Safety of botanical ingredients in personal care products/cosmetics

The key issue of the safety assessment of botanical ingredients in personal care products (PCP) is the phytochemical characterisation of the plant source, data on contamination, adulteration and hazardous residues. The comparative approach used in the safety assessment of GM-plants may be applied to novel botanical PCP ingredients. Comparator(s) are the parent plant or varieties of the same species. Chemical grouping includes definition of chemical groups suitable for a read-across approach; it allows the estimation of toxicological endpoints on the basis of data from related substances (congeneric groups) with physical/chemical properties producing similar toxicities. The Threshold of Toxicological Concern (TTC) and Dermal Sensitisation Threshold (DST) are tools for the assessment of trace substances or minor ingredients. The evaluation of skin penetration of substances present in human food is unnecessary, whereas mixtures may be assessed on the basis of physical/chemical properties of individual substances. Adverse dermal effects of botanicals include irritation, sensitisation, phototoxicity and immediate-type allergy. The experience from dietary supplements or herbal medicines showed that being natural is not equivalent to being safe. Pragmatic approaches for quality and safety standards of botanical ingredients are needed; consumer safety should be the first objective of conventional and botanical PCP ingredients.

Safety assessment of personal care products/cosmetics and their ingredients

We attempt to review the safety assessment of personal care products (PCP) and ingredients that are representative and pose complex safety issues. PCP are generally applied to human skin and mainly produce local exposure, although skin penetration or use in the oral cavity, on the face, lips, eyes and mucosa may also produce human systemic exposure. In the EU, US and Japan, the safety of PCP is regulated under cosmetic and/or drug regulations. Oxidative hair dyes contain arylamines, the most chemically reactive ingredients of PCP. Although arylamines have an allergic potential, taking into account the high number of consumers exposed, the incidence and prevalence of hair dye allergy appears to be low and stable. A recent (2001) epidemiology study suggested an association of oxidative hair dye use and increased bladder cancer risk in consumers, although this was not confirmed by subsequent or previous epidemiologic investigations. The results of genetic toxicity, carcinogenicity and reproductive toxicity studies suggest that modern hair dyes and their ingredients pose no genotoxic, carcinogenic or reproductive risk. Recent reports suggest that arylamines contained in oxidative hair dyes are N-acetylated in human or mammalian skin resulting in systemic exposure to traces of detoxified, i.e. non-genotoxic, metabolites, whereas human hepatocytes were unable to transform hair dye arylamines to potentially carcinogenic metabolites. An expert panel of the International Agency on Research of Cancer (IARC) concluded that there is no evidence for a causal association of hair dye exposure with an elevated cancer risk in consumers. Ultraviolet filters have important benefits by protecting the consumer against adverse effects of UV radiation; these substances undergo a stringent safety evaluation under current international regulations prior to their marketing. Concerns were also raised about the safety of solid nanoparticles in PCP, mainly TiO(2) and ZnO in sunscreens. However, current evidence suggests that these particles are non-toxic, do not penetrate into or through normal or compromised human skin and, therefore, pose no risk to human health. The increasing use of natural plant ingredients in personal care products raised new safety issues that require novel approaches to their safety evaluation similar to those of plant-derived food ingredients. For example, the Threshold of Toxicological Concern (TTC) is a promising tool to assess the safety of substances present at trace levels as well as minor ingredients of plant-derived substances. The potential human systemic exposure to PCP ingredients is increasingly estimated on the basis of in vitro skin penetration data. However, new evidence suggests that the in vitro test may overestimate human systemic exposure to PCP ingredients due to the absence of metabolism in cadaver skin or misclassification of skin residues that, in vivo, remain in the stratum corneum or hair follicle openings, i.e. outside the living skin. Overall, today's safety assessment of PCP and their ingredients is not only based on science, but also on their respective regulatory status as well as other issues, such as the ethics of animal testing. Nevertheless, the record shows that today's PCP are safe and offer multiple benefits to quality of life and health of the consumer. In the interest of all stakeholders, consumers, regulatory bodies and producers, there is an urgent need for an international harmonization on the status and safety requirements of these products and their ingredients.

Oleandrin produces changes in intracellular calcium levels in isolated cardiomyocytes: a real-time fluorescence imaging study comparing adult to neonatal cardiomyocytes

Oleanders are common, hardy shrubs that grow throughout the southern United States. They contain cardiotonic steroids formed from cardenolides and bufadienolides, making the plant poisonous to both animals and humans. Aliquots of both commercially available oleander and fresh oleander extracts were prepared. Fresh, rod-like, calcium-tolerant adult rat cardiomyocytes and cultured neonatal cardiomyocytes were isolated and treated with 0-4 ng/ml of both preparations, challenged with verapamil and ouabain, and real-time spectrophotometric calcium transients and images were acquired. A number of effects were observed with the adult cells: (1) intracellular calcium levels were increased in a concentration-dependent manner: (2) reduced calcium transient heights and eventual cessation of beating resulted; and (3) increased sparking intensity led to subsequent beating and eventual calcium overload. In the spontaneously beating cultured neonatal myocytes increased intramyocytic calcium levels were also seen, with retention of this calcium rise leading to overload and, as in the adult myocytes, cessation of beating. These observations demonstrate that oleander extract is markedly potent with respect to the elevation of calcium concentrations in cardiomyocytes, and that the inability of the cardiomyocytes to release the accumulated calcium possibly indicates a role for oleandrin in inhibition of ryanodine receptor calcium release channels, calcium uptake via Na+,K+-ATPase inhibition [EC 3.6.1.3], and/or dysfunction of sarcolemmal calcium release channels.

Study of Aconitine toxicity in rat embryos in vitro

BACKGROUND

Aconitum is widely used in traditional medicine for its anti-inflammatory, analgesic, and cardiotonic properties. Knowledge is limited, however, on its effects on embryonic development.

METHODS

Whole embryo culture was applied to explore the effects of aconitine on rat embryos during their critical period of organogenesis. All embryos isolated on gestational day 9.5 were exposed to 0, 1, 2.5, 5, and 10 microg/ml of aconitine with and without S9 mix, and scored for their growth and differentiation at the end of the 48-hr culture period.

RESULTS

The embryonic growth and development were adversely affected at the concentration of 2.5 microg/ml aconitine without S9 mix, represented as reduced crown-rump length and head length, decreased number of somites, and lower morphologic score. When the concentration of aconitine was increased to 5 microg/ml, it induced severe dysmorphogenesis effects, including cardiac defect (undivided cardiac tube and inflated pericardial cavity), irregular somites, and brain malformation (e.g., narrow brain vesicles). In the presence of S9 mix, Aconitine toxicity to rat embryos was reduced to a certain extent.

CONCLUSIONS

Our study showed that Aconitine had direct embryotoxic effects during the rat organogenetic period. NOAEL was about 1 microg/ml and metabolism in S9 mix could induce the attenuation of Aconitine toxicity. Until more is known about the effects of Aconitine in pregnant women, we suggest its use should be treated with caution.

Toxicological study of the hepatotherapeutic herbal formula, Chunggan extract, in beagle dogs

AIM: To evaluate the pharmaceutical safety of a Chinese herbal formula, Chunggan extract (CGX), traditionally prescribed as a hepatotherapeutic drug via systemic acute and subacute toxicological study.

METHODS: Twenty male dogs and 20 female dogs were fed doses 50 times and 4 times greater than the clinically-recommended drug dosages in an acute and a subacute toxicological study, respectively. Adverse effects were examined by comparing the differences between normal and drug-administered groups using clinical signs, necropsies, histopathologic findings, haematology, urinalysis, and biochemical analysis.

RESULTS: In the acute study no change in the body weight, diarrhoea, apetite, mortality rate and histopathology of major organs was observed in male or female dogs with a single administration of CGX at 5 g/kg. No drug-induced abnormalities at analysis of histopathology, haematology, urinalysis, and biochemistry were found with any dose of this drug.

CONCLUSION: CGX is supposed to be very safe when used in a clinical application with a wide therapeutic index.

Safety of traditional arab herbal medicine

Herbal remedies are widely used for the treatment and prevention of various diseases and often contain highly active pharmacological compounds. Many medicinal herbs and pharmaceutical drugs are therapeutic at one dose and toxic at another. Toxicity related to traditional medicines is becoming more widely recognized as these remedies become popular in the Mediterranean region as well as worldwide. Most reports concerning the toxic effects of herbal medicines are associated with hepatotoxicity although reports of other toxic effects including kidney, nervous system, blood, cardiovascular and dermatologic effects, mutagenicity and carcinogenicity have also been published in the medical literature. This article presents a systematic review on safety of traditional Arab medicine and the contribution of Arab scholars to toxicology. Use of modern cell biological, biochemical, in vitro and in vivo techniques for the evaluation of medicinal plants safety is also discussed.

Herbal remedies: effects on clinical laboratory tests

CONTEXT

Complementary and alternative medicine (herbal medicines) can affect laboratory test results by several mechanisms.

OBJECTIVE

In this review, published reports on effects of herbal remedies on abnormal laboratory test results are summarized and commented on.

DATA SOURCES

All published reports between 1980 and 2005 with the key words herbal remedies or alternative medicine and clinical laboratory test, clinical chemistry test, or drug-herb interaction were searched through Medline. The authors' own publications were also included. Important results were then synthesized.

DATA SYNTHESIS

Falsely elevated or falsely lowered digoxin levels may be encountered in a patient taking digoxin and the Chinese medicine Chan Su or Dan Shen, owing to direct interference of a component of Chinese medicine with the antibody used in an immunoassay. St John's wort, a popular herbal antidepressant, increases clearance of many drugs, and abnormally low cyclosporine, digoxin, theophylline, or protease inhibitor concentrations may be observed in a patient taking any of these drugs in combination with St John's wort. Abnormal laboratory results may also be encountered owing to altered pathophysiology. Kava-kava, chaparral, and germander cause liver toxicity, and elevated alanine aminotransferase, aspartate aminotransferase, and bilirubin concentrations may be observed in a healthy individual taking such herbal products. An herbal product may be contaminated with a Western drug, and an unexpected drug level (such as phenytoin in a patient who never took phenytoin but took a Chinese herb) may confuse the laboratory staff and the clinician.

CONCLUSIONS

Use of alternative medicines may significantly alter laboratory results, and communication among pathologists, clinical laboratory scientists, and physicians providing care to the patient is important in interpreting these results.

Labor analgesia for the parturient with herbal medicines use: what does an obstetrician need to know?

The use of herbal medicines in the developed world is widespread, and increasing. Herbal medicines, which include a wide spectrum of substances ranging from home-made teas to the national regulatory bodies-approved medicinal substances, are defined as plant-derived products that are used for medicinal and/or nutritional purposes. The use of herbal self-therapy is common in pregnancy, with many parturients consuming more than one agent at a time. Despite widespread use there has been surprisingly little research into the outcomes or the potential risks of using herbal therapies during pregnancy. As epidural analgesia is the most popular form of pain relief in labor, the potential for herbal remedies-related alterations in maternal hemodynamics (e.g., hypertension, tachycardia), and increased bleeding tendencies (e.g., spinal-epidural hematoma) remain a significant concern. Obstetricians and obstetric anesthesiologists must be familiar with the effects of herbal medicines and should specifically inquire about the use of herbal medicines during prenatal/preanesthetic assessment. This review article attempts to summarize current data on special considerations for labor analgesia in parturients with herbal medicines use.

Herbal products: behaviors and beliefs among Italian women

PURPOSE

The use of phytotherapy is growing worldwide, but the popular perception is that this kind of approach is natural and therefore safer than traditional medicine; for this reason the use is frequently not communicated to the doctor. Instead, even if many herbal remedies are benign in nature, some of these therapies have potentially harmful side effects or adverse interactions with other medications. So, the purpose of our study was to analyze the behavior patterns and decision-making modalities about herbal remedy use among a sample of Italian women.

METHODS

During a 5-month period, interviews to women attending the outpatient ambulatory of an urban university general hospital were made on the basis of a pre-structured 25-item questionnaire.

RESULTS

Among a random study population of 1,044 subsequent patients, 491 women (47.03%) reported to have been taking one or more herbal products in the last year, sometimes used during pregnancy or given to their children (35.23%). The 10 most frequently used herbal products reported were propolis, aloe, valerian root, blueberry, fennel, dandelion, mallow, arnica, thyme, and Echinacea. The major purposes for using these products were to stimulate the immune system and to cure respiratory problems. 47/491 (9.57%) women reported side effects, but only 36% referred to the doctor. In most of the cases, herbal products were taken in combination with drugs (44.61%) or homeopathic treatments (11.81%). The majority of our women did not obtain information about this kind of therapy from a health care provider (72.71%).

CONCLUSIONS

The present survey highlights the general use of phytomedicines by a sample of Italian women, the potential risk of their confidence with the 'natural world,' and the lack of discussion on this argument with doctors and pharmacists. This suggests the importance of training for health care providers and the need of informational programs for consumers.

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

The purpose of this paper is to explore the possibility that adverse reactions and drug interactions arising from the use of homeopathic and herbal medicines could lead to confusion when adverse reactions to conventional medicines are reported. An extensive literature review was conducted on the occurrence of adverse reactions and drug interactions following the use of homeopathic or herbal remedies, and the potential for these to confound adverse event reporting to conventional medicines considered. The survey demonstrates the potential for herbal remedies and homeopathic products, to produce adverse drug reactions or drug interactions, and shows the scope for potential for confusion with those arising from conventional medicines. There is a need for greater awareness that adverse reactions apparently due to a conventional medicine, might in reality be due to a herbal medicine or a drug interaction between a herbal medicine and a conventional drug, particularly when a health professional is unaware of the extent of a patient's self-medication with alternative therapies.

Evaluation of contraceptive activity of a mineralo-herbal preparation in Sprague-Dawley rats

OBJECTIVE

This study was aimed to evaluate a marketed mineralo-herbal preparation containing plants known to have potent contraceptive activity, or contraindicated for use during pregnancy in folklore/ancient Indian literature and recommended for use as an appetizer and headache, hyperacidity and chronic constipation reliever for effect on spermatogenesis and implantation-cum-early postimplantation events in adult Sprague-Dawley rats.

METHODS

The preparation, suspended in distilled water with the addition of sterile gum acacia, was administered at 1 g/kg daily dose (extrapolated from human dose on surface area basis) to male rats covering one spermatogenic cycle and to female rats during the entire preimplantation and early postimplantation period by oral route. Fertility performance of male rats was tested following mating with untreated fertile females.

RESULTS

Findings of this study indicate that the mineralo-herbal preparation at this dose and schedule produced no discernible effect on weight of testis, epididymis and accessory glands, spermatogenesis, vasal sperm picture or mating rate in male rats when administered during the period covering one spermatogenic cycle, but caused significant reduction in number of implantations in females mated with these male rats as well as in female rats treated during the postcoital period.

CONCLUSIONS

Any adverse effect on fertility/reproductive health following administration over longer periods/at higher doses in humans habituated to continuous use of this preparation cannot be completely ruled out from this limited study. Findings also suggest caution in indiscriminate use of this and other such preparations containing varying amounts of plants/plant products reported to possess contraceptive property and available for other pharmacological indications over-the-counter in most countries.