1
|
Liu X, Chai R, Xu Q, Zou M, Jiang S, Liu Y, Li R, Kong T, Chen X, Xu R, Liu S, Zhang Z, Liu N. Targeting Skp2 degradation with troxerutin decreases neointima formation. Eur J Pharmacol 2024; 982:176947. [PMID: 39209097 DOI: 10.1016/j.ejphar.2024.176947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
The proliferative and migratory abilities of vascular smooth muscle cells (VSMCs) play a crucial role in neointima formation following vascular injury. Skp2 facilitates proliferation and migration in cells through cell cycle regulation, presenting an important therapeutic target for atherosclerosis, pulmonary hypertension, and vascular restenosis. This study aimed to identify a natural product capable of inhibiting neointima formation post vascular injury. Here, we demonstrate that troxerutin, a flavonoid, significantly reduced viability and downregulated Skp2 in VSMCs. Moreover, troxerutin exhibited anti-proliferative effects on VSMCs and mitigated neointima formation. These findings collectively elucidate the intrinsic mechanism of troxerutin in treating atherosclerosis, pulmonary hypertension, and vascular restenosis by targeting the E3-linked enzyme Skp2.
Collapse
MESH Headings
- Hydroxyethylrutoside/analogs & derivatives
- Hydroxyethylrutoside/pharmacology
- S-Phase Kinase-Associated Proteins/metabolism
- S-Phase Kinase-Associated Proteins/antagonists & inhibitors
- Neointima/drug therapy
- Neointima/pathology
- Neointima/metabolism
- Animals
- Cell Proliferation/drug effects
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Proteolysis/drug effects
- Cell Survival/drug effects
- Humans
- Cell Movement/drug effects
- Down-Regulation/drug effects
- Rats
Collapse
Affiliation(s)
- Xiaolin Liu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Renjie Chai
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Qiong Xu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Min Zou
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Siqin Jiang
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Yajing Liu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Rongxue Li
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Tianyu Kong
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Xiaohua Chen
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Ruqin Xu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Shiming Liu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China
| | - Zhenhui Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China.
| | - Ningning Liu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510260, China.
| |
Collapse
|
2
|
Bai W, Tan H, Duan X, Hu J, Wang F, Wu J, Bai J, Hu J. Inhibitory effects of flavonoids on organic cation transporter 1: Implications for food/herb-drug interactions and hepatoprotective effects. Food Chem Toxicol 2024; 193:114983. [PMID: 39245401 DOI: 10.1016/j.fct.2024.114983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024]
Abstract
Organic cation transporter 1 (OCT1, gene symbol: SLC22A1) is mainly responsible for the hepatic uptake of various cationic drugs, closely associated with drug-induced liver injury (DILI). Screening and identifying potent OCT1 inhibitors with little toxicity in natural products is of great value in alleviating OCT1-mediated liver injury. Flavonoids, a group of polyphenols commonly found in foodstuffs and herbal products, have been reported to cause transporter-mediated food/herb-drug interactions (FDIs). Our objective was to investigate potential inhibitors of OCT1 from 96 flavonoids, evaluate the hepatoprotective effects on retrorsine-induced liver injury, and clarify the structure-activity relationships of flavonoids with OCT1. Thirteen flavonoids exhibited significant inhibition (>50%) on OCT1 in OCT1-HEK293 cells. Among them, the five strongest flavonoid inhibitors (IC50 < 10 μM), including α-naphthoflavone, apigenin, 6-hydroxyflavone, luteolin, and isosilybin markedly decreased oxaliplatin-induced cytotoxicity. In retrorsine-induced liver injury models, they also reduced alanine aminotransferase (ALT) and aspartate aminotransferase (AST) to different levels, the best of which was 6-hydroxyflavone. The pharmacophore model clarified that hydrogen bond acceptors at the 4,8,5' position might play a vital role in the inhibitory effect of flavonoids on OCT1. Taken together, our findings would pave the way to predicting the potential risks of flavonoid-related FDIs in humans and optimizing flavonoid structure to alleviate OCT1-mediated liver injury.
Collapse
Affiliation(s)
- Wanting Bai
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Beijing Key Laboratory of Active Substances Discovery and Drug Ability Evaluation, Department of Drug Metabolism, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Huixin Tan
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Beijing Key Laboratory of Active Substances Discovery and Drug Ability Evaluation, Department of Drug Metabolism, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Xiaoyan Duan
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Beijing Key Laboratory of Active Substances Discovery and Drug Ability Evaluation, Department of Drug Metabolism, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Jiahuan Hu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Beijing Key Laboratory of Active Substances Discovery and Drug Ability Evaluation, Department of Drug Metabolism, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Fenghe Wang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Beijing Key Laboratory of Active Substances Discovery and Drug Ability Evaluation, Department of Drug Metabolism, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Jinjin Wu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Beijing Key Laboratory of Active Substances Discovery and Drug Ability Evaluation, Department of Drug Metabolism, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Jie Bai
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Jinping Hu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Beijing Key Laboratory of Non-Clinical Drug Metabolism and PK/PD Study, Beijing Key Laboratory of Active Substances Discovery and Drug Ability Evaluation, Department of Drug Metabolism, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China.
| |
Collapse
|
3
|
Galis P, Bartosova L, Farkasova V, Bartekova M, Ferenczyova K, Rajtik T. Update on clinical and experimental management of diabetic cardiomyopathy: addressing current and future therapy. Front Endocrinol (Lausanne) 2024; 15:1451100. [PMID: 39140033 PMCID: PMC11319149 DOI: 10.3389/fendo.2024.1451100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
Diabetic cardiomyopathy (DCM) is a severe secondary complication of type 2 diabetes mellitus (T2DM) that is diagnosed as a heart disease occurring in the absence of any previous cardiovascular pathology in diabetic patients. Although it is still lacking an exact definition as it combines aspects of both pathologies - T2DM and heart failure, more evidence comes forward that declares DCM as one complex disease that should be treated separately. It is the ambiguous pathological phenotype, symptoms or biomarkers that makes DCM hard to diagnose and screen for its early onset. This re-view provides an updated look on the novel advances in DCM diagnosis and treatment in the experimental and clinical settings. Management of patients with DCM proposes a challenge by itself and we aim to help navigate and advice clinicians with early screening and pharmacotherapy of DCM.
Collapse
Affiliation(s)
- Peter Galis
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University Bratislava, Bratislava, Slovakia
| | - Linda Bartosova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University Bratislava, Bratislava, Slovakia
| | - Veronika Farkasova
- Institute for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Monika Bartekova
- Institute for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Institute of Physiology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Kristina Ferenczyova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University Bratislava, Bratislava, Slovakia
- Institute for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Tomas Rajtik
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University Bratislava, Bratislava, Slovakia
- Institute for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| |
Collapse
|
4
|
Grandi G, Feliciello L, Iaccheri M, Melotti C, Anceschi F, Facchinetti F. The effect of a flavonoid mixture containing diosmin, hesperidin and troxerutin in women with congestion syndrome associated to pelvic pain: a color Doppler ultrasonography study. Minerva Obstet Gynecol 2024; 76:250-256. [PMID: 38939979 DOI: 10.23736/s2724-606x.24.05432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Pelvic congestion syndrome (PCS) is associated with chronic pelvic pain (CPP). The efficacy of flavonoids for treating PCS symptoms is still a matter of debate, and little has been published. The aim of this study was to assess the efficacy of a mixture of diosmin, troxerutin, and hesperidin in improving symptoms of patients with PCS, observing a direct effect on circulation by specific color Doppler ultrasonography (CDU) evaluations. METHODS This was a pilot, prospective, independent, cross-over, daily-diary-based trial. Women were evaluated with CDU for 3 times (baseline, 60 days, 120 days). Data about N.=13 women who completed the study were analyzed. RESULTS During the treatment, we recorded a significant reduction of intermenstrual and menstrual pain intensity (total points) (P<0.05). The satisfaction after treatment was significantly higher than after placebo (P<0.0001). A significant reduction in the diameter of the major ovarian vein (P=0.004 compared to placebo), associated with an increase in peak systolic velocity (P=0.01) and a corresponding significant increase in the Resistivity Index (P<0.0001) were recorded during treatment. CONCLUSIONS The use of a mixture of diosmin, troxerutin and hesperidin in women with PCS can significantly help to manage typical symptoms of pelvic pain and it is associated with an evident Doppler effect on pelvic microcirculation.
Collapse
Affiliation(s)
- Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy -
| | - Lia Feliciello
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Iaccheri
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Melotti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Anceschi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
5
|
Zhou M, Ma J, Kang M, Tang W, Xia S, Yin J, Yin Y. Flavonoids, gut microbiota, and host lipid metabolism. Eng Life Sci 2024; 24:2300065. [PMID: 38708419 PMCID: PMC11065335 DOI: 10.1002/elsc.202300065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 05/07/2024] Open
Abstract
Flavonoids are widely distributed in nature and have a variety of beneficial biological effects, including antioxidant, anti-inflammatory, and anti-obesity effects. All of these are related to gut microbiota, and flavonoids also serve as a bridge between the host and gut microbiota. Flavonoids are commonly used to modify the composition of the gut microbiota by promoting or inhibiting specific microbial species within the gut, as well as modifying their metabolites. In turn, the gut microbiota extensively metabolizes flavonoids. Hence, this reciprocal relationship between flavonoids and the gut microbiota may play a crucial role in maintaining the balance and functionality of the metabolism system. In this review, we mainly highlighted the biological effects of antioxidant, anti-inflammatory and antiobesity, and discussed the interaction between flavonoids, gut microbiota and lipid metabolism, and elaborated the potential mechanisms on host lipid metabolism.
Collapse
Affiliation(s)
- Miao Zhou
- College of Animal Science and TechnologyHunan Agricultural UniversityChangshaChina
| | - Jie Ma
- College of Animal Science and TechnologyHunan Agricultural UniversityChangshaChina
| | - Meng Kang
- College of Animal Science and TechnologyHunan Agricultural UniversityChangshaChina
| | - Wenjie Tang
- Sichuan Animal Science AcademyLivestock and Poultry Biological Products Key Laboratory of Sichuan ProvinceSichuan Animtech Feed Co., LtdChengduSichuanChina
| | - Siting Xia
- College of Animal Science and TechnologyHunan Agricultural UniversityChangshaChina
| | - Jie Yin
- College of Animal Science and TechnologyHunan Agricultural UniversityChangshaChina
| | - Yulong Yin
- College of Animal Science and TechnologyHunan Agricultural UniversityChangshaChina
| |
Collapse
|
6
|
The Potential of Flavonoids and Flavonoid Metabolites in the Treatment of Neurodegenerative Pathology in Disorders of Cognitive Decline. Antioxidants (Basel) 2023; 12:antiox12030663. [PMID: 36978911 PMCID: PMC10045397 DOI: 10.3390/antiox12030663] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
Flavonoids are a biodiverse family of dietary compounds that have antioxidant, anti-inflammatory, antiviral, and antibacterial cell protective profiles. They have received considerable attention as potential therapeutic agents in biomedicine and have been widely used in traditional complimentary medicine for generations. Such complimentary medical herbal formulations are extremely complex mixtures of many pharmacologically active compounds that provide a therapeutic outcome through a network pharmacological effects of considerable complexity. Methods are emerging to determine the active components used in complimentary medicine and their therapeutic targets and to decipher the complexities of how network pharmacology provides such therapeutic effects. The gut microbiome has important roles to play in the generation of bioactive flavonoid metabolites retaining or exceeding the antioxidative and anti-inflammatory properties of the intact flavonoid and, in some cases, new antitumor and antineurodegenerative bioactivities. Certain food items have been identified with high prebiotic profiles suggesting that neutraceutical supplementation may be beneficially employed to preserve a healthy population of bacterial symbiont species and minimize the establishment of harmful pathogenic organisms. Gut health is an important consideration effecting the overall health and wellbeing of linked organ systems. Bioconversion of dietary flavonoid components in the gut generates therapeutic metabolites that can also be transported by the vagus nerve and systemic circulation to brain cell populations to exert a beneficial effect. This is particularly important in a number of neurological disorders (autism, bipolar disorder, AD, PD) characterized by effects on moods, resulting in depression and anxiety, impaired motor function, and long-term cognitive decline. Native flavonoids have many beneficial properties in the alleviation of inflammation in tissues, however, concerns have been raised that therapeutic levels of flavonoids may not be achieved, thus allowing them to display optimal therapeutic effects. Dietary manipulation and vagal stimulation have both yielded beneficial responses in the treatment of autism spectrum disorders, depression, and anxiety, establishing the vagal nerve as a route of communication in the gut-brain axis with established roles in disease intervention. While a number of native flavonoids are beneficial in the treatment of neurological disorders and are known to penetrate the blood–brain barrier, microbiome-generated flavonoid metabolites (e.g., protocatechuic acid, urolithins, γ-valerolactones), which retain the antioxidant and anti-inflammatory potency of the native flavonoid in addition to bioactive properties that promote mitochondrial health and cerebrovascular microcapillary function, should also be considered as potential biotherapeutic agents. Studies are warranted to experimentally examine the efficacy of flavonoid metabolites directly, as they emerge as novel therapeutic options.
Collapse
|
7
|
Amorphous Solid Dispersion of Hesperidin with Polymer Excipients for Enhanced Apparent Solubility as a More Effective Approach to the Treatment of Civilization Diseases. Int J Mol Sci 2022; 23:ijms232315198. [PMID: 36499518 PMCID: PMC9740072 DOI: 10.3390/ijms232315198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022] Open
Abstract
The present study reports amorphous solid dispersions (ASDs) of hesperidin (Hes) prepared by ball milling to improve its solubility and apparent solubility over the unmodified compound. The carriers were Soluplus® (Sol), alginate sodium (SA), and hydroxypropylmethylcellulose (HPMC). XRPD analysis confirmed full amorphization of all binary systems in 1:5 w/w ratio. One glass transition (Tg) observed in DSC thermograms of hesperidin:Soluplus® (Hes:Sol) and hesperidin:HPMC (Hes:HPMC) 1:5 w/w systems confirmed complete miscibility. The mathematical model (Gordon-Taylor equation) indicates that the obtained amorphous systems are characterized by weak interactions. The FT-IR results confirmed that hydrogen bonds are responsible for stabilizing the amorphous state of Hes. Stability studies indicate that the strength of these bonds is insufficient to maintain the amorphous state of Hes under stress conditions (25 °C and 60 °C 76.4% RH). HPLC analysis suggested that the absence of degradation products indicates safe hesperidin delivery systems. The solubility and apparent solubility were increased in all media (water, phosphate buffer pH 6.8 and HCl (0.1 N)) compared to the pure compound. Our study showed that all obtained ASDs are promising systems for Hes delivery, wherein Hes:Sol 1:5 w/w has the best solubility (about 300-fold in each media) and apparent solubility (about 70% in phosphate buffer pH 6.8 and 63% in HCl).
Collapse
|
8
|
Picciariello A, Rinaldi M, Grossi U, Verre L, De Fazio M, Dezi A, Tomasicchio G, Altomare DF, Gallo G. Management and Treatment of External Hemorrhoidal Thrombosis. Front Surg 2022; 9:898850. [PMID: 35592120 PMCID: PMC9110961 DOI: 10.3389/fsurg.2022.898850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background External hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades. Methods This mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered. Results Traditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48–72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique. Conclusion The management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.
Collapse
Affiliation(s)
- Arcangelo Picciariello
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Marcella Rinaldi
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Ugo Grossi
- II Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Treviso, Italy
- Correspondence: Ugo Grossi
| | - Luigi Verre
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Michele De Fazio
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Agnese Dezi
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Donato F Altomare
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Gaetano Gallo
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| |
Collapse
|
9
|
Alldinger I, Poschinski Z, Ganzera S, Helmes C. Perianal thrombosis: no need for surgery. Langenbecks Arch Surg 2022; 407:1251-1256. [PMID: 35064300 DOI: 10.1007/s00423-021-02415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
AIM There is little evidence for the best therapy for perianal thrombosis. No prospective trials exist. Even quality of retrospective data is low, due to low patient numbers or vague follow-up data. PATIENTS AND METHODS Six hundred nineteen patients with thrombosis of internal or external hemorrhoids who presented in our clinic between March 2017 and August 2018 were enrolled in the study. All patients were treated conservatively, with sitz baths and oral pain medication, if needed. No surgery was performed. Follow-up data was obtained by personal examination. Data was gathered prospectively, and data analysis was retrospective. RESULTS Five hundred four patients had perianal thrombosis (81.4%), and 115 patients had thrombosed hemorrhoids. Mean pain on a numerical rating scale (0-10) was 3.8 for perianal thrombosis and 5.2 for thrombosed hemorrhoids. Five hundred forty-eight patients (88.5%) did not need a sick leave. On follow-up, patients stated that their pain had largely resolved after 5 days and completely disappeared after 10 days. Local recurrence rate after perianal thrombosis was 6.3%. CONCLUSION Perianal thrombosis and thrombosed hemorrhoids heal well without surgery. There is no evidence for advantages surgical therapy could offer.
Collapse
Affiliation(s)
- Ingo Alldinger
- Center of Coloproctology, Schadowstr. 11b, 40212, Düsseldorf, Germany.
| | - Zoe Poschinski
- Center of Coloproctology, Schadowstr. 11b, 40212, Düsseldorf, Germany
| | - Silke Ganzera
- Center of Coloproctology, Schadowstr. 11b, 40212, Düsseldorf, Germany
| | - Christian Helmes
- Center of Coloproctology, Schadowstr. 11b, 40212, Düsseldorf, Germany
| |
Collapse
|
10
|
Sidorova AV, Yunusov BT, Groshilin VS, Arkharov AV, Aliev VA. [Modern trends in combined treatment of hemorrhoids: topical form Tribenoside + Lidocaine and phlebotonic Ginkgo biloba + Troxerutin + Heptaminol]. Khirurgiia (Mosk) 2022:90-97. [PMID: 36562679 DOI: 10.17116/hirurgia202212290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Acute hemorrhoids are the most common reason for referring to coloproctologist in people of working age. In the modern world, food culture and lifestyle are the most prominent factors leading to the risk of hemorrhoids. In the 21st century, it is hard to overestimate an importance of potential employability and active social role regarding socio-economic well-being. This thesis applies to patients suffering from proctological diseases, and those with hemorrhoids prevail among these ones. Minimally invasive treatment and pharmacotherapy defined primary needs of patients, i.e. treatment should be quick, safe and effective. Favorable treatment outcomes are possible only in pathogenetic therapy. In this review, we will define the priorities in effective combined treatment of hemorrhoids.
Collapse
Affiliation(s)
| | | | - V S Groshilin
- Rostov State Medical University, Rostov-on-Don, Russia
| | - A V Arkharov
- Zhukovsky Municipal Clinical Hospital, Zhukovsky, Russia
| | - V A Aliev
- Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
11
|
Romano L, Nervini A, Stia S, Schietroma M, Giuliani A. A combination of diosmin, hesperidin, and ruscogenin: Clinical effects in symptomatic hemorrhoidal disease. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Garmanova TN, Markaryan DR, Kazachenko EA, Lukianov АM, Agapov MA. PREOPERATIVE USE OF MICRO-FLAVONOID FRACTION (MMF) AS PART OF A MULTIMODAL ANALGESIA IN ANORECTAL SURGERY: PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND STUDY PROTOCOL. SURGICAL PRACTICE 2021. [DOI: 10.38181/2223-2427-2021-4-44-52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim: To assess the efficiency of the micro-flavonoid fraction (MMF) administration prior to anorectal surgery with spinal anesthesia on postoperative pain severity reduction.Methods: Patients of our clinic who meet the following inclusion criteria are included: they must be diagnosed with surgical treatment of anorectal diseases. All participants are randomly divided into 2 groups: the first one gets a tablet with 1000 mg MFF (Detralex®), the second one gets a tablet containing starch per os 14 days before surgery (72 participants per arm). Then patients of each group will continue MFF administration for 30 days after surgery. Patients of both arms receive spinal anesthesia and undergo surgery. Following the procedure the primary and secondary outcomes are evaluated: frequency of the opioid drugs intake, the severity of the postoperative pain syndrome, duration and frequency of other drugs intake, readmission rate, overall quality of life, time from the procedure to returning to work and the complications rate, C-reactive protein level.Discussion: the MFF intake allows reducing the severity of the hemorrhoidal disease symptoms during conservative treatment. In addition, the Detralex® efficacy has been proven in postoperative pain reduction for patients diagnosed with varicose veins of the lower extremities. We intend to evaluate the feasibility of the preoperative MFF administration for the postoperative pain reduction and the decrease of the postoperative complications in patients with hemorrhoidal disease.
Collapse
Affiliation(s)
- T. N. Garmanova
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - D. R. Markaryan
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - E. A. Kazachenko
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - А. M. Lukianov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| |
Collapse
|
13
|
Gunache (Roșca) RO, Apetrei C. Determination of Diosmin in Pharmaceutical Products with Chemically Modified Voltammetric Sensors. Int J Mol Sci 2021; 22:ijms22147315. [PMID: 34298934 PMCID: PMC8304735 DOI: 10.3390/ijms22147315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
In this paper, the electrochemical behavior of two types of sensors based on modified screen-printed electrodes (one screen-printed electrode based on carbon (SPCE) and another screen-printed electrode modified with Prussian Blue (PB/SPCE)) was studied with the aim of sensitive detection of diosmin, an active pharmaceutical compound from the class of flavonoids. The scan electron microscopy technique was used for the morphological characterization of PB/SPCE. The preliminary analysis assessed the electrochemical behavior of SPCE and PB/SPCE in KCl solution and in a double solution of potassium ferrocyanide-potassium chloride. It was shown that the active area of PB/SPCE is superior to the one of SPCE, the greater sensitivity being related with the presence of the electroactive modifier. Similarly, in the case of diosmin detection, the PB/SPCE sensor detect more sensitivity the diosmin due to the electrocatalytic effect of PB. From the study of the influence of reaction rate on the sensor's electrochemical response, it was shown that the detection process is controlled by the adsorption process, the degree of surface coverage with electroactive molecules being higher in the case of PB/SPCE. From the PB/SPCE calibration curve, it wasdetermined that it has high sensitivity and low detection and quantification limit values (limit of detection 5.22 × 10-8 M). The applicability of the PB/SPCE sensor was confirmed by sensitive analysis of diosmin in pharmaceutical products. The voltammetric method is suitable for the detection and quantification of diosmin in pharmaceutical products. The method is simple, accurate, and quick and can be used in routine analysis in the examination of the quality of pharmaceutical products and other types of samples.
Collapse
|
14
|
Orefice R, Litta F, Parello A, De Simone V, Campennì P, Marra AA, Ratto C. A Prospective Study on the Efficacy of Two Different Phlebotonic Therapies as a Bridge to Surgery in Patients with Advanced Hemorrhoidal Disease. J Clin Med 2021; 10:jcm10081549. [PMID: 33917023 PMCID: PMC8067694 DOI: 10.3390/jcm10081549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
The aims of this study were to evaluate the efficacy of two different phlebotonic therapies, preoperatively administered in advanced hemorrhoidal disease (HD) patients with recommendation for surgery, and to assess patient satisfaction after treatment. In this prospective observational study, 100 patients were preoperatively treated either with micronized purified flavonoid fraction (group A) or sublingual nano-emulsion flavonoid (group B). HD symptoms, local inflammation signs and patients' satisfaction were evaluated at baseline visit (T0), after 4 weeks of therapy (T1) and 8 weeks after its discontinuation (T2). In group A, a significant improvement for all HD symptoms and inflammation signs was observed after therapy (T1), followed by a reduction of efficacy in T2, except for itching and edema. In group B, therapy had a significant benefit on symptoms and local inflammation at T1, which persisted after its discontinuation for all symptoms, and edematous hemorrhoids. In both groups, the satisfaction rate was "good" in 60% of patients and patients were statistically significant more satisfied at T1 compared with T2 (p = 0.0001). No adverse events were recorded. Preoperative treatment was safe and useful to optimize patients' clinical condition prior to surgery.
Collapse
Affiliation(s)
- Raffaele Orefice
- Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy; (R.O.); (F.L.); (V.D.S.); (P.C.); (A.A.M.); (C.R.)
| | - Francesco Litta
- Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy; (R.O.); (F.L.); (V.D.S.); (P.C.); (A.A.M.); (C.R.)
| | - Angelo Parello
- Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy; (R.O.); (F.L.); (V.D.S.); (P.C.); (A.A.M.); (C.R.)
- Correspondence: ; Tel.: +39-339-299-9492
| | - Veronica De Simone
- Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy; (R.O.); (F.L.); (V.D.S.); (P.C.); (A.A.M.); (C.R.)
| | - Paola Campennì
- Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy; (R.O.); (F.L.); (V.D.S.); (P.C.); (A.A.M.); (C.R.)
| | - Angelo Alessandro Marra
- Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy; (R.O.); (F.L.); (V.D.S.); (P.C.); (A.A.M.); (C.R.)
| | - Carlo Ratto
- Proctology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy; (R.O.); (F.L.); (V.D.S.); (P.C.); (A.A.M.); (C.R.)
- Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy
| |
Collapse
|
15
|
Karim N, Shishir MRI, Gowd V, Chen W. Hesperidin-An Emerging Bioactive Compound against Metabolic Diseases and Its Potential Biosynthesis Pathway in Microorganism. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2020.1858312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Naymul Karim
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China
| | - Mohammad Rezaul Islam Shishir
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China
| | - Vemana Gowd
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China
| | - Wei Chen
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China
- Ningbo Research Institute, Zhejiang University, Ningbo, China
| |
Collapse
|
16
|
Al Duhaidahawi D, Hasan SA, Al Zubaidy HFS. Flavonoids in the Treatment of Diabetes: Clinical Outcomes and Mechanism to Ameliorate Blood Glucose Levels. Curr Diabetes Rev 2021; 17:e120720188794. [PMID: 33290200 DOI: 10.2174/1573399817666201207200346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND For thousands of years, natural food products have been used as a medicine for treating diseases that affect the human body, including diabetes mellitus (DM). Lately, several investigations have been performed on the flavonoid derivatives of plant origin, and their biological activity has been extensively studied. METHODS Given our need to know more mechanisms for treating DM, we performed a thorough research review on treating diabetes mellitus based on flavonoids, their therapeutic potential, and biological action. RESULTS Flavonoids reduce complications in addition to their vital role as effective supplements for preventing diabetes mellitus by regulating glucose metabolism, lipid profile, liver enzyme activity, a protein kinase inhibitor, PPAR, and AMPK with NF-κB. CONCLUSION The articles that we reviewed showed the positive role of flavonoids, which in a certain way reduce diabetes, but their side effects still need to be studied further.This review is focused on describing the different types of dietary flavonoids along with their mechanisms of reducing blood glucose and enhancing insulin sensitivity, as well as their side effects.
Collapse
Affiliation(s)
- Dunya Al Duhaidahawi
- Faculty of Pharmacy, Department of Pharmacognacy, University of Kufa, AL-Najaf, Iraq
| | - Samer A Hasan
- Pharmacognacy, Pharmacy, University of Kufa, AL-Najaf, Iraq
| | | |
Collapse
|
17
|
van Tol RR, Kleijnen J, Watson AJM, Jongen J, Altomare DF, Qvist N, Higuero T, Muris JWM, Breukink SO. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis 2020; 22:650-662. [PMID: 32067353 DOI: 10.1111/codi.14975] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/03/2020] [Indexed: 12/15/2022]
Abstract
AIM The goal of this European Society of ColoProctology project was to establish a multidisciplinary, international guideline for haemorrhoidal disease (HD) and to provide guidance on the most effective (surgical) treatment for patients with HD. METHODS The development process consisted of six phases. In phase one we defined the scope of the guideline. The patient population included patients with all stages of haemorrhoids. The target group for the guideline was all practitioners treating patients with haemorrhoids and, in addition, healthcare workers and patients who desired information regarding the treatment management of HD. The guideline needed to address both the diagnosis of and the therapeutic modalities for HD. Phase two consisted of the compilation of the guideline development group (GDG). All clinical members needed to have affinity with the diagnosis and treatment of haemorrhoids. Further, attention was paid to the geographical distribution of the clinicians. Each GDG member identified at least one patient in their country who could read English to comment on the draft guideline. In phase three review questions were formulated, using a reversed process, starting with possible recommendations based on the GDG's knowledge. In phase four a literature search was performed in MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews. The search was focused on existing systematic reviews addressing each review question, supplemented by other studies published after the time frame covered by the systematic reviews. In phase five data of the included papers were extracted by the surgical resident (RT) and checked by the methodologist (JK) and the GDG. If needed, meta-analysis of the systematic reviews was updated by the surgical resident and the methodologist using Review Manager. During phase six the GDG members decided what recommendations could be made based on the evidence found in the literature using GRADE. RESULTS There were six sections: (i) symptoms, diagnosis and classification; (ii) basic treatment; (iii) outpatient procedures; (iv) surgical interventions; (v) special situations; (vi) other surgical techniques. Thirty-four recommendations were formulated. CONCLUSION This international, multidisciplinary guideline provides an up to date and evidence based summary of the current knowledge of the management of HD and may serve as a useful guide for patients and clinicians.
Collapse
Affiliation(s)
- R R van Tol
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J Kleijnen
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A J M Watson
- Department of Surgery, Raigmore Hospital, Inverness, UK
| | - J Jongen
- Department of Surgical Proctology, Proktologische Praxis Kiel,, Kiel, Germany
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University of Aldo Moro of Bari, Bari, Italy
| | - N Qvist
- Surgical Department A, Odense University Hospital, Odense C, Denmark
| | - T Higuero
- Clinique Saint Antoine, Nice, France
| | - J W M Muris
- Department of Family Medicine/General Practice, Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
18
|
de Souza P, da Silva LM, de Andrade SF, Gasparotto Junior A. Recent Advances in the Knowledge of Naturally-derived Bioactive Compounds as Modulating Agents of the Renin-angiotensin-aldosterone System: Therapeutic Benefits in Cardiovascular Diseases. Curr Pharm Des 2020; 25:670-684. [PMID: 30931846 DOI: 10.2174/1381612825666190329122443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/25/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND One of the biggest challenges to public health worldwide is to reduce the number of events and deaths related to the cardiovascular diseases. Numerous approaches have been applied to reach this goal, and drug treatment intervention has been indispensable along with an effective strategy for reducing both cardiovascular morbidity and mortality. Renin-angiotensin-aldosterone system (RAAS) blockade is currently one of the most important targets of cardiovascular drug therapy. Many studies have proven the valuable properties of naturally-derived bioactive compounds to treat cardiovascular diseases. METHODS The goal of this review, therefore, is to discuss the recent developments related to medicinal properties about natural compounds as modulating agents of the RAAS, which have made them an attractive alternative to be available to supplement the current therapy options. RESULTS Data has shown that bioactive compounds isolated from several natural products act either by inhibiting the angiotensin-converting enzyme or directly by modulating the AT1 receptors of angiotensin II, which consequently changes the entire classical axis of this system. CONCLUSION While there are a few evidence about the positive actions of different classes of secondary metabolites for the treatment of cardiovascular and renal diseases, data is scarce about the clinical assays established to demonstrate their value in humans.
Collapse
Affiliation(s)
- Priscila de Souza
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Nucleo de Investigacoes Quimico-Farmaceuticas (NIQFAR), Universidade do Vale do Itajai (UNIVALI), Rua Uruguai, 458, 88302-901 Itajai, SC, Brazil
| | - Luisa M da Silva
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Nucleo de Investigacoes Quimico-Farmaceuticas (NIQFAR), Universidade do Vale do Itajai (UNIVALI), Rua Uruguai, 458, 88302-901 Itajai, SC, Brazil
| | - Sérgio F de Andrade
- Programa de Pos-Graduacao em Ciencias Farmaceuticas, Nucleo de Investigacoes Quimico-Farmaceuticas (NIQFAR), Universidade do Vale do Itajai (UNIVALI), Rua Uruguai, 458, 88302-901 Itajai, SC, Brazil
| | - Arquimedes Gasparotto Junior
- Laboratorio de Eletrofisiologia e Farmacologia Cardiovascular, Faculdade de Ciencias da Saude, Universidade Federal da Grande Dourados, Dourados, MS, Brazil
| |
Collapse
|
19
|
Zheng Y, Zhang R, Shi W, Li L, Liu H, Chen Z, Wu L. Metabolism and pharmacological activities of the natural health-benefiting compound diosmin. Food Funct 2020; 11:8472-8492. [DOI: 10.1039/d0fo01598a] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diosmin is a famous natural flavonoid for treating chronic venous insufficiency and varicose veins.
Collapse
Affiliation(s)
- Yizhou Zheng
- College of Pharmacy
- Gannan Medical University
- Ganzhou
- China
| | - Rui Zhang
- College of Pharmacy
- Gannan Medical University
- Ganzhou
- China
| | - Weimei Shi
- College of Pharmacy
- Gannan Medical University
- Ganzhou
- China
| | - Linfu Li
- College of Pharmacy
- Gannan Medical University
- Ganzhou
- China
| | - Hai Liu
- College of Pharmacy
- Gannan Medical University
- Ganzhou
- China
| | - Zhixi Chen
- College of Pharmacy
- Gannan Medical University
- Ganzhou
- China
| | - Longhuo Wu
- College of Pharmacy
- Gannan Medical University
- Ganzhou
- China
| |
Collapse
|
20
|
Bozdağ M, Eraslan G. The effect of diosmin against lead exposure in rats ‡. Naunyn Schmiedebergs Arch Pharmacol 2019; 393:639-649. [PMID: 31792554 DOI: 10.1007/s00210-019-01758-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/30/2019] [Indexed: 12/18/2022]
Abstract
In this study, the effect of diosmin against the adverse effects of lead exposure in rats was investigated. Wistar Albino race 40 male rats weighing 150-200 g 2-3 months were used. A total of 4 groups were assigned, one of which was control and the other 3 were trial groups. The rats in the control group were treated with dimethyl sulfoxide, which was used only as a vehicle in diosmin administration. Groups 2, 3, and 4 from the experimental group were given diosmin at a dose of 50 mg/kg.bw, lead acetate at the dose of 1000 ppm, lead acetate at the dose of 1000 ppm, and diosmin at a dose of 50 mg/kg.bw for 6 weeks, respectively. Application of lead acetate with drinking water and also diosmin was performed by oral catheter. At the end of the experimental period, blood was taken to dry and with heparin by puncture to the heart under light ether anesthesia. Following the blood samples, some organs of the rats (the liver, kidney, brain, heart, and testis) were removed. Some biochemical parameters (glucose, triglyceride, cholesterol, BUN, creatinine, uric acid, LDH, AST, ALT, ALP, total protein, albumin) were measured in serum. Some oxidative stress parameters in tissue samples and blood (MDA, NO, SOD, CAT, GSH-Px, GSH) were evaluated. Body and organ (the liver, kidney, brain, heart, and testis) weights were also evaluated at the end of the study. No significant change was observed in the parameters examined in the diosmin alone-treated group by comparison to control group. On the other hand, significant changes were found in the values of lead acetate-treated group comparing control group. It was observed that the values approached the values of the control group in the combination of lead and diosmin. Exposure to lead acetate at a dose of 1000 ppm for 6 weeks causes organ damage; however the diosmin application at a dose of 50 mg/kg.bw had a positive effect on the regression of tissue damage.
Collapse
Affiliation(s)
- Mehmet Bozdağ
- Department of Veterinary Pharmacology and Toxicology, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Gökhan Eraslan
- Faculty of Veterinary Medicine, Department of Pharmacology and Toxicology, Erciyes University, Kayseri, Turkey.
| |
Collapse
|
21
|
Kestřánek J. Hemorrhoid management in women: the role of tribenoside + lidocaine. Drugs Context 2019; 8:212602. [PMID: 31555338 PMCID: PMC6752749 DOI: 10.7573/dic.212602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
Hemorrhoids are commonly reported in women. However, despite the high prevalence of hemorrhoids in women and the major impact of this condition on quality of life, specific evidence and recommendations on the treatment of hemorrhoids in women are scant. This paper reviews various options in current therapy for hemorrhoids in women—namely, medical intervention (topical and systemic drug therapy)—and discusses the available clinical evidence for an appropriate use of over-the-counter topical formulations for the symptomatic treatment of hemorrhoids. Its focus is on a medical preparation containing tribenoside + lidocaine, available as a rectal cream (tribenoside 5%/lidocaine 2%) and a suppository (tribenoside 400 mg/lidocaine 40 mg) and marketed under the brand Procto-Glyvenol® (Recordati, SpA, Italy). Given its rapid comprehensive efficacy on all the different symptoms of hemorrhoids, the tribenoside + lidocaine combination can find a place in the treatment of this hemorrhoidal disease. Importantly, its efficacy and tolerability have been formally evaluated in several well-conducted studies, some of which were specifically conducted in women. In particular, tribenoside + lidocaine can be safely administered in postpartum women and in pregnant women after the first trimester of pregnancy. In pregnant women, the tribenoside/lidocaine combination significantly improved both subjective and objective symptoms of hemorrhoids. Fast onset of symptom relief was reported from 10 minutes after administration, lasting up to 10–12 hours. On these bases, tribenoside + lidocaine can represent a fast, effective, and safe option to treat hemorrhoids when conservative therapy is indicated, and it deserves consideration as a first-line treatment of this disease in clinical practice.
Collapse
Affiliation(s)
- Jan Kestřánek
- Department of Obstetrics and Gynaecology, University Hospital, Charles University, Hradec Kralove, Czech Republic
| |
Collapse
|
22
|
Abstract
Hemorrhoidal disease is a fairly common and debilitating clinical entity. Despite centuries’ of attempts to shed light on its pathophysiology, to cure those affected and to improve sufferers’ quality of life, many aspects of the disease remain elusive. Individual beliefs and historical legends, accompanied by undocumented theories, have established and perpetuated the confusion regarding the mechanisms leading to the development of the disease and the rules governing its treatment. Hemorrhoids are classified as internal or external and are viewed as a disease when they become symptomatic. Returning to basic medical sciences, this mini-review focuses on internal hemorrhoids and aims to define the histology and anatomy of the normal and abnormal internal hemorrhoidal plexus and to encourage clinicians to comprehend the pathophysiology of the disease. If doctors can understand the pathophysiology of hemorrhoidal disease, they will be able to clarify the nature of the associated symptoms and complications and to make the correct therapeutic decision.
Collapse
|
23
|
Corsale I, Carrieri P, Martellucci J, Piccolomini A, Verre L, Rigutini M, Panicucci S. Flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) in the treatment of I-III degree hemorroidal disease: a double-blind multicenter prospective comparative study. Int J Colorectal Dis 2018; 33:1595-1600. [PMID: 29934701 DOI: 10.1007/s00384-018-3102-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE We evaluated the efficacy of new flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) to reduce bleeding from I-III degrees hemorrhoidal disease in the short and medium time. METHODS One hundred fifty-four consecutive patients with hemorrhoidal disease recruited in four colorectal units were enrolled to the study. Exclusion criteria were allergy to the flavonoids, inflammatory bowel disease, obstructed defecation syndrome, pregnancy and puerperium, associated anal disease or hemorrhoidal thrombosis, proctologic surgical procedures within 1 year before recruitment, contemporary cancer or HIV, previous pelvic radiotherapy, patients receiving oral anticoagulant therapy, or contemporary administration of other therapy for hemorrhoids. Patients with inability to understand the study or mental disorders were also excluded. RESULTS Seventy-eight were randomized to receive the mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin (study group, SG), and 76 a mixture of diosmin in combination with hesperidin, diosmetin, isoroifolin, and linarin in purified micronized fraction (control group, CG). Bleeding, number of pathological piles, and Golligher's grade were assessed at each scheduled visit and compared using the Chi-square test. During the study period, bleeding improved after 1 and 6 months both in the SG (79.5 and 70.5%) and in the CG (80.2 and 75%) without significant differences between two groups. Satisfaction degree after 6 months was greater in the patients of the SG (4.05) towards the CG (3.25): this result was statistical significant (p 0.003). CONCLUSIONS Use of flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) is a safe and effective mean of managing bleeding from hemorrhoidal disease and minimal adverse events are reported.
Collapse
Affiliation(s)
- Italo Corsale
- General Surgery Unit, SS. Cosma e Damiano Hospital, Pescia, Italy.
| | - Paolo Carrieri
- General, Emergency and Mini-invasive surgery, Careggi University Hospital, Florence, Italy
| | - Jacopo Martellucci
- General Surgery Unit, Borgo San Lorenzo Hospital, Borgo San Lorenzo, Italy
| | | | - Luigi Verre
- Unit of General Surgery 2, Policlinico Le Scotte, Siena, Italy
| | - Marco Rigutini
- General Surgery Unit, SS. Cosma e Damiano Hospital, Pescia, Italy
| | - Sonia Panicucci
- General Surgery Unit, SS. Cosma e Damiano Hospital, Pescia, Italy
| |
Collapse
|
24
|
Bashankaev BN, Wexner SD, Arkharov AV. [Common sense of diosmin administration in combined treatment of hemorrhoids]. Khirurgiia (Mosk) 2018:83-89. [PMID: 30199057 DOI: 10.17116/hirurgia201808283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flavonoids are herbal medicines and widely used for chronic venous diseases and hemorrhoids. Flavonoid diosmin in both micronized and non-micronized form is a part of various drugs. According to literature data, flavonoids are able to reduce venous stasis, suppress local inflammation, improve venous tone and lymphatic outflow. It should be noted that biological models of in vivo trials have certain limitations while available data of different researches are contradictory. However, flavonoids were recommended for hemorrhoids in view of meta-analysis of 14 trials comparing flavonoids (diosmin, micronized purified flavonoid fraction and rutosides) with placebo in 1514 patients with hemorrhoids and Cochrane review of 24 randomized controlled trials (2,334 participants). These drugs should be administered as a part of complex therapy. At the same time, there is no conclusive evidence to prefer only one of these medicines. There are also no data confirming the benefits of daily dosage of 3000 mg per day of micronized fraction of flavonoids compared with 1800 mg of purified diosmin per day for treatment of acute hemorrhoids.
Collapse
Affiliation(s)
- B N Bashankaev
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia; GMS Clinic and Hospitals, Moscow, Russia
| | - S D Wexner
- Colorectal Surgery Department of the Cleveland Clinic Florida, Weston, USA
| | - A V Arkharov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, GMS Clinic and Hospitals, Moscow, Russia, Colorectal Surgery Department of the Cleveland Clinic Florida, Weston, USA
| |
Collapse
|
25
|
Parés D, Abcarian H. Management of Common Benign Anorectal Disease: What All Physicians Need to Know. Am J Med 2018; 131:745-751. [PMID: 29499172 DOI: 10.1016/j.amjmed.2018.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/15/2022]
Abstract
Benign anorectal conditions produce anal pain, rectal bleeding, or discharge from the perianal region, which are highly prevalent symptoms in the general population. Hemorrhoidal disease, anal fissure, perianal abscess, proctalgia syndromes, and pruritus anii are the most common clinical disorders. Well-trained physicians, irrespective of their specialty, can treat most of these disorders and refer them to a specialist in proctology only when necessary. The aim of this review is to provide a practical guide to the management of benign anorectal disorders in terms of their initial management and the criteria for specialist referral.
Collapse
Affiliation(s)
- David Parés
- Department of Colon and Rectal Surgery, Hospital Germans Trias i Pujol, School of Medicine, Universitat Autónoma de Barcelona, Badalona, Spain.
| | - Herand Abcarian
- Division of Colon and Rectal Surgery, University of Illinois at Chicago
| |
Collapse
|
26
|
Wunpathe C, Potue P, Maneesai P, Bunbupha S, Prachaney P, Kukongviriyapan U, Kukongviriyapan V, Pakdeechote P. Hesperidin Suppresses Renin-Angiotensin System Mediated NOX2 Over-Expression and Sympathoexcitation in 2K-1C Hypertensive Rats. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2018; 46:751-767. [PMID: 29754503 DOI: 10.1142/s0192415x18500398] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hesperidin, a flavonoid derived from citrus fruits, possesses several beneficial effects including anti-oxidation and anti-inflammation. The aim of this study was to investigate the effects of hesperidin on the renin-angiotensin system (RAS) cascade that mediated oxidative stress and sympathoexcitation in two-kidney, one-clipped (2K-1C) hypertensive rats. 2K-1C hypertension was induced in male Sprague-Dawley rats. Hypertensive rats were treated with hesperidin at 20[Formula: see text]mg/kg or 40[Formula: see text]mg/kg or losartan at 10[Formula: see text]mg/kg beginning at three weeks after surgery and then continued for four weeks ([Formula: see text]/group). Hesperidin reduced blood pressure in a dose-dependent manner in hypertensive rats compared to untreated rats ([Formula: see text]). Increased plasma angiotensin converting enzyme (ACE) activity and angiotensin II levels, as well as, upregulated AT1 receptor protein expression in aortic tissues were attenuated in hypertensive rats treated with hesperidin. Hesperidin suppressed oxidative stress markers and NADPH oxidase over-expression, and restored plasma nitric oxide metabolites in 2K-1C rats. This was associated with improvement of the vascular response to acetylcholine in isolated mesenteric vascular beds and aortic rings from 2K-1C rats treated with hesperidin ([Formula: see text]). Enhancement of nerve-mediated vasoconstriction related to high plasma noradrenaline in the 2K-1C group was alleviated by hesperidin treatment ([Formula: see text]). Furthermore, losartan exhibited antihypertensive effects by suppressing the RAS cascade and oxidative stress and improved vascular dysfunction observed in 2K-1C rats ([Formula: see text]). Based on these results, it can be presumed that hesperidin is an antihypertensive agent. Its antihypertensive action might be associated with reducing RAS cascade-induced NOX2 over-expression and sympathoexcitation in 2K-1C hypertensive rats.
Collapse
Affiliation(s)
- Chutamas Wunpathe
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Prapassorn Potue
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Putcharawipa Maneesai
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Sarawoot Bunbupha
- ¶ Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Parichat Prachaney
- † Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Upa Kukongviriyapan
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| | | | - Poungrat Pakdeechote
- * Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,§ Cardiovascular Research Group, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
27
|
Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C. Erratum to: Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol 2016; 20:201. [PMID: 26728606 DOI: 10.1007/s10151-015-1416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G F Cocorullo
- Unit of Emergency and General Surgery, Department of Surgical Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Barts Health, London, UK
| | - F Marino
- Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy
| | - J Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - C Ratto
- Proctology Unit, University Hospital "A Gemelli", Catholic University, Rome, Italy
| |
Collapse
|