Chinese Expert Consensus on Clinical Application of Oral Ginkgo biloba Preparations (2020)

Yiwei Xiaoyu granules for treatment of chronic atrophic gastritis with deficiency syndrome of the spleen and stomach

BACKGROUND

The Correa sequence, initiated by Helicobacter pylori (H. pylori), commonly progresses to gastric cancer through the stage of chronic atrophic gastritis (CAG). Although eradication of H. pylori only reduces the risk of gastric cancer, it does not eliminate the risk for neoplastic progression. Yiwei Xiaoyu granules (YWXY) are a commonly used composite preparation in Chinese clinics. However, the pursuit of excellence in clinical trials and the establishment of standardized animal experiments are still needed to contribute to full understanding and application of traditional Chinese medicine in the treatment of CAG.

AIM

To demonstrate the effectiveness of YWXY in patients with CAG and spleen-stomach deficiency syndrome (DSSS), by alleviating histological scores, improving response rates for pathological lesions, and achieving clinical efficacy in relieving DSSS symptoms.

METHODS

We designed a double-blind, randomized, controlled trial. The study enrolled seventy-two H. pylori-negative patients (mean age, 52.3 years; 38 men) who were randomly allocated to either the treatment group or control group in a 1:1 ratio, and treated with 15 g YWXY or 0.36 g Weifuchun (WFC) tablet combined with the respective dummy for 24 wk. The pre-randomization phase resulted in the exclusion of 72 patients: 50 participants did not meet the inclusion criteria, 12 participants declined to participate, and 10 participants were excluded for various other reasons. Seven visits were conducted during the study, and histopathological examination with target endoscopic biopsy of narrow-band imaging was requested before the first and seventh visits. We also evaluated endoscopic performance scores, total symptom scores, serum pepsinogen and gastrin-17.

RESULTS

Six patients did not complete the trial procedures. Treatment with YWXY improved the Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stage, compared with WFC (P < 0.05). YWXY provided better relief from symptoms of DSSS and better improvement in serum gastric function, compared with WFC (P < 0.05).

CONCLUSION

YWXY compared with WFC significantly reduced the risk of mild or moderate atrophic disease, according to OLGIM stage, significantly relieved symptoms of DSSS, and improved serum gastric function.

Ginkgo biloba and Its Chemical Components in the Management of Alzheimer's Disease

The pathogenesis of Alzheimer's disease (AD), a degenerative disease of the central nervous system, remains unclear. The main manifestations of AD include cognitive and behavioral disorders, neuropsychiatric symptoms, neuroinflammation, amyloid plaques, and neurofibrillary tangles. However, current drugs for AD once the dementia stage has been reached only treat symptoms and do not delay progression, and the research and development of targeted drugs for AD have reached a bottleneck. Thus, other treatment options are needed. Bioactive ingredients derived from plants are promising therapeutic agents. Specifically, Ginkgo biloba (Gb) extracts exert anti-oxidant, anticancer, neuroplastic, neurotransmitter-modulating, blood fluidity, and anti-inflammatory effects, offering alternative options in the treatment of cardiovascular, metabolic, and neurodegenerative diseases. The main chemical components of Gb include flavonoids, terpene lactones, proanthocyanidins, organic acids, polysaccharides, and amino acids. Gb and its extracts have shown remarkable therapeutic effects on various neurodegenerative diseases, including AD, with few adverse reactions. Thus, high-quality Gb extracts are a well-established treatment option for AD. In this review, we summarize the insights derived from traditional Chinese medicine, experimental models, and emerging clinical trials on the role of Gb and its chemical components in the treatment of the main clinical manifestations of AD.

UV-B promotes flavonoid biosynthesis in Ginkgo biloba by inducing the GbHY5-GbMYB1-GbFLS module

Ginkgo biloba (ginkgo) leaves have medicinal value due to their high levels of secondary metabolites, such as flavonoids. We found that the flavonoid content in ginkgo leaves increases significantly at high altitudes (Qinghai-Tibet Plateau). Considering that high UV-B radiation is among the key environmental characteristics of the Qinghai-Tibet Plateau, we carried out simulated UV-B treatments on ginkgo seedlings and found that the flavonoid content of the leaves increased significantly following the treatments. Combined with results from our previous studies, we determined that the transcription factor GbHY5 may play a key role in responses to UV-B radiation. Overexpression of GbHY5 significantly promoted the accumulation of flavonoids in both ginkgo callus and Arabidopsis thaliana. Furthermore, yeast two-hybrid and real-time quantitative PCR showed that GbHY5 promoted the expression of GbMYB1 by interacting with GbMYB1 protein. Overexpression of GbMYB1 in ginkgo callus and A. thaliana also significantly promoted flavonoid biosynthesis. GbFLS encodes a key enzyme in flavonoid biosynthesis, and its promoter has binding elements of GbHY5 and GbMYB1. A dual-luciferase reporter assay indicated that while GbHY5 and GbMYB1 activated the expression of GbFLS individually, their co-expression achieved greater activation. Our analyses reveal the molecular mechanisms by which the UV-B-induced GbHY5-GbMYB1-GbFLS module promotes flavonoid biosynthesis in ginkgo, and they provide insight into the use of UV-B radiation to enhance the flavonoid content of ginkgo leaves.

Phytochemical Compounds, Antioxidant, and Digestive Enzymes Inhibitory Activities of Different Fractions from Ginkgo biloba L. Nut Shells

This study was designed to investigate the phytochemical compounds, antioxidant, and digestive enzymes inhibitory activities of the free (F), esterified (E), and insoluble-bound (IB) fractions from Ginkgo biloba L. nut shells. Results showed that a total of twelve compounds were detected in G. biloba nut shells by using UHPLC-ESI-HRMS/MS, including two kinds of organic acids, three kinds of phenolic acids, three kinds of flavonoids, and four kinds of terpene lactones. The F fraction contained all identified compounds and had the highest contents of the total phenolics and total flavonoids. All of the three different fractions exhibited good DPPH radical and ABTS radical cation scavenging activities and strong inhibitory effects on the generation of intracellular reactive oxygen species (ROS). Moreover, these three fractions also had good inhibitory effects towards α-glucosidase and pancreatic lipase. Among the three fractions, the F fraction possessed the strongest bioactivities. The findings obtained in the current study may provide some insights and bases for the further investigation and application of G. biloba nut shells in clinical medicine or the nutraceutical industry.

Neurotoxic effects of environmental contaminants-measurements, mechanistic insight, and environmental relevance

Pollution is a significant and growing concern for any population regardless of age because these environmental contaminants exhibit different neurodegenerative effects on persons of different ages. These environmental contaminants are the products of human welfare projects like industry, automobile exhaust, clinical and research laboratory extrudes, and agricultural chemicals. These contaminants are found in various forms in environmental matrices like nanoparticles, particulate matter, lipophilic vaporized toxicants, and ultrafine particulate matter. Because of their small size, they can easily cross blood-brain barriers or use different cellular mechanisms for assistance. Other than this, these contaminants cause an innate immune response in different cells of the central nervous system and cause neurotoxicity. Considering the above critiques and current needs, this review summarizes different protective strategies based on bioactive compounds present in plants. Various bioactive compounds from medicinal plants with neuroprotective capacities are discussed with relevant examples. Many in vitro studies on clinical trials have shown promising outcomes using plant-based bioactive compounds against neurological disorders.

Potentialities of Ginkgo extract on toxicants, toxins, and radiation: a critical review

Exposure to toxins is a severe threat to human health and life in today's developing and industrialized world. Therefore, identifying a protective chemical could be valuable and fascinating in this case. The purpose of this article was to bring together thorough review of studies on Ginkgo biloba to aid in the creation of ways for delivering its phytoconstituents to treat toxicants and radiation. This review gathered and evaluated studies on the defensive impact of Ginkgo biloba extract (GBE) against toxicities caused by toxic chemical agents (such as lead, cadmium, and aluminum), natural toxins (for example, lipopolysaccharide-induced toxicity and damage, gossypol, latadenes, and lotaustralin), and radiation (for example, gamma, ultra-violet, and radio-frequency radiation). According to this review, GBE has a considerable therapeutic effect by influencing specific pathophysiological targets. Furthermore, GBE has antioxidant, anti-inflammatory, anti-apoptotic, and antigenotoxicity properties against various toxicities. These are due to flavone glycosides (primarily isorhamnetin, kaempferol, and quercetin) and terpene trilactones (ginkgolides A, B, C, and bilobalide) that aid GBEs' neutralizing effect against radiation and toxins by acting independently or synergistically. This will serve as a reference for the functional food, cosmetic, and pharmaceutical industries worldwide.

A critical review of current technologies used to reduce ginkgotoxin, ginkgotoxin-5'-glucoside, ginkgolic acid, allergic glycoprotein, and cyanide in Ginkgo biloba L. seed

The Ginkgo biloba has astonished scholars globally with enormous bioactives, with sales exceeding $10 billion since 2017. The Ginkgo biloba seed (GBS) is an essential part of culinary culture. Nevertheless, toxins in fresh Ginkgo biloba seed (GBS) have limited GBSs' daily consumption. Ginkgotoxin and ginkgotoxin-5-glucoside cause poisoning, tonic-clonic convulsions, and neurotoxic effects. Ginkgolic acid causes cytotoxicity and allergies. Allergic glycoprotein in GBS causes nausea, seizures, dyspnea, mydriasis, vomiting, and bellyache. The amygdalin-derived hydrocyanic acid cause dizziness, vomiting, cramping, and sleeping disorders. Food products are frequently exposed to various processing techniques to increase food safety and functionality. As a result, this review focused on the technologies that have been used to minimize toxins in GBS. In addition, a comparison of these techniques was made based on their benefits, drawbacks, feasibility, pharmacological activities, and future direction or opportunities to improve current ones were provided.

A critical review of Ginkgolic acid in Ginkgo biloba leaves extract (EGb). Toxicity, technologies to remove the ginkgolic acids and its promising bioactivities

Ginkgo biloba leaves extract (EGb) is high in bioactive components (over 170), which are used in food additives, medicine, cosmetics, health products, and other sectors. Nonetheless, ginkgolic acids (GAs) in...