Lead poisoning caused by contaminated Cordyceps, a Chinese herbal medicine: two case reports

Cordyceps: Alleviating ischemic cardiovascular and cerebrovascular injury - A comprehensive review

ETHNOPHARMACOLOGICAL RELEVANCE

Cordyceps has a long medicinal history as a nourishing herb in traditional Chinese medicine (TCM). Ischemic cardio-cerebrovascular diseases (CCVDs), including cerebral ischemic/reperfusion injury (CI/RI) and myocardial ischemic/reperfusion injury (MI/RI), are major contributors to mortality and disability in humans. Numerous studies have indicated that Cordyceps or its artificial substitutes have significant bioactivity on ischemic CCVDs, however, there is a lack of relevant reviews.

AIM OF THE STUDY

This review was conducted to investigate the chemical elements, pharmacological effects, clinical application and drug safety of Cordycepson ischemic CCVDs.

MATERIALS AND METHODS

A comprehensive search was conducted on the Web of Science, PubMed, Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases using the keywords "Cordyceps", "Cerebral ischemic/reperfusion injury", and "Myocardial ischemic/reperfusion injury" or their synonyms. The retrieved literature was then categorized and summarized.

RESULTS

The study findings indicated that Cordyceps and its bioactive components, including adenosine, cordycepin, mannitol, polysaccharide, and protein, have the potential to protect against CI/RI and MI/RI by improving blood perfusion, mitigating damage from reactive oxygen species, suppressing inflammation, preventing cellular apoptosis, and promoting tissue regeneration. Individually, Cordyceps could reduce neuronal excitatory toxicity and blood-brain barrier damage caused by cerebral ischemia. It can also significantly improve cardiac energy metabolism disorders and inhibit calcium overload caused by myocardial ischemia. Additionally, Cordyceps exerts a significant preventive or curative influence on the factors responsible for heart/brain ischemia, including hypertension, thrombosis, atherosclerosis, and arrhythmia.

CONCLUSION

This study demonstrates Cordyceps' prospective efficacy and safety in the prevention or treatment of CI/RI and MI/RI, providing novel insights for managing ischemic CCVDs.

Lead and arsenic intoxications by traditional and alternative medicine: men are more sensitive than women

Traditional and alternative medicines are widely used around the world and include for example herbal medicine, Ayurveda, traditional Chinese medicine, and indigenous therapies. Due to the long history and the mostly natural origin of traditional remedies, it is often assumed that they are harmless, but in recent decades more and more case reports have been published in which traditional medicine has caused metal poisoning. This paper provides an analysis of published cases in which patients have suffered metal poisoning due to traditional or alternative medicines. A systematic literature search was performed on PubMed, whereby 210 patient cases from a total of 102 case reports and 30 case series were identified and then analyzed about various aspects. Most of the traditional medicines involved come from Asia and are mainly contaminated with lead and arsenic. The analyzed patient cases show a high degree of heterogeneity with regard to age, sex, intake reason, symptoms, and severity of intoxication. The metal intoxication itself and the cause of the poisoning often remained unrecognized for a long time, which resulted in many patients undergoing unnecessary diagnostic methods and ineffective therapeutic approaches before the correct diagnosis was made. The evaluation of the available patient cases revealed a higher sensitivity to metal poisoning in children compared to adults and a higher sensitivity in men compared to women. Anemia and basophilic stippling were frequently observed and became more common as the metal content in the blood increased. Hopefully, this paper raises awareness of the potential dangers of traditional and alternative medicines, both from the patient's and the doctor's perspective, so that in case of intoxication, treatment can be initiated quickly using the correct diagnostic methods. As ingested metals do not only circulate in the blood but also accumulate in soft tissues and bones, long-term monitoring is necessary to ensure that patients make a full recovery. Doctors should be aware that, in contrast to common belief, men are more sensitive to this type of intoxication than women, necessitating particular attention for diagnosis and treatment.

Investigation of toxic heavy metals content and estimation of potential health risks in Chinese herbal medicine

The content of toxic heavy metals (THMs), including lead (Pb), arsenic (As), cadmium (Cd), and mercury (Hg), was determined in a total of 10,245 samples for 279 types of Chinese herbal medicine (CHM) using a validated inductively coupled plasma mass spectrometry method. The exceeding rate (ER) for the four THMs were calculated based on diverse permissible limits (PLs) established by different organizations and national pharmacopeias. Cluster analysis was used to classify the degree risk of THMs contamination according to the calculated ER. Results revealed that Cibotii rhizome, Selaginellae herba, Morindae officinalis radix, Asprellae ilicis radix, and Toxicodendri resina exhibited high-degree risk of Pb contamination. Eckloniae/Laminariae thallus, Spirodelae herba, and Naturalis indigo possessed high-degree risk of As contamination. Tetrapanacis medulla, Centipedae herba, Cyathulae radix, Linderae radix, Meretricis/Cyclinae concha, and Tabanus displayed high-degree risk of Cd contamination. Toxicodendri resina has high-degree risk of Hg contamination. In addition, six types of CHM, including Asprellae ilicis radix, Toxicodendri resina, Eckloniae/Laminariae thallus, Fossilia Ossis Mastodi, Haematitum, and Hedyotidis diffusae herba, may have non-carcinogenic health risk after consumption of raw materials because the calculated hazard quotient and hazard index were over 1.0. In summary, these data provide useful information about THMs contamination in CHM.

Multi-element Characteristics of Chinese Medical Baishao (Paeoniae Radix Alba) and Their Decoctions

Adopting ICP-AES and ICP-MS to determine the content of 53 elements (6 macro-elements, 47 trace elements), which used HNO₃ (5 mL) and H₂O₂ (2 mL) to digest Baishao (Paeoniae Radix Alba) by microwave. These herbs obtained from six producing areas in China, namely Xuanwu (Henan province), Shihezi (Xinjiang province), Zhongjiang (Sichuan province), Panan (Zhejiang province), Bozhou (Anhui province), and Heze (Shandong province). A certified reference material of Astragalus (GBW 10028, GSB-19) was used to assess the accuracy of the method. Except the slight change of Na and S in Xuanwu, the content of other producing areas followed the order of Ca > K > P > Mg > S > Na. The herbs of Shihezi (22,658 mg/kg) got the highest concentration of total elements, while the herbs of Panan (1.006 mg/kg) got the highest concentration of rare earth elements. The multi-element fingerprint map of Baishao was established, which was obviously different from other herbs. Meanwhile, the same method was adopted to determine the content of 50 elements in Baishao decoctions from three main producing areas. Compared with the herbs, each element was significantly reduced, and K was the highest concentration. The transfer rates of elements in Baishao decoctions followed the order (mean): As (55.79%) > Ni (55.19%) > Na (51.48%) > Mo (44.13%) > Ce (43.82%) > V (40.52%). The decoctions of Panan (0.122 mg/kg) got the highest content of rare earth elements. In all Baishao herbs and their corresponding decoctions, the levels of Cu, Cd, As, Pb, and Hg did not exceed the limits of the Green Trade Standards of Importing & Exporting Medicinal Plants & Preparations (WM2-2001) and Chinese Pharmacopoeia (2015).

Glycyrrhizic-Acid-Based Carbon Dots with High Antiviral Activity by Multisite Inhibition Mechanisms

With the gradual usage of carbon dots (CDs) in the area of antiviral research, attempts have been stepped up to develop new antiviral CDs with high biocompatibility and antiviral effects. In this study, a kind of highly biocompatible CDs (Gly-CDs) is synthesized from active ingredient (glycyrrhizic acid) of Chinese herbal medicine by a hydrothermal method. Using the porcine reproductive and respiratory syndrome virus (PRRSV) as a model, it is found that the Gly-CDs inhibit PRRSV proliferation by up to 5 orders of viral titers. Detailed investigations reveal that Gly-CDs can inhibit PRRSV invasion and replication, stimulate antiviral innate immune responses, and inhibit the accumulation of intracellular reactive oxygen species (ROS) caused by PRRSV infection. Proteomics analysis demonstrates that Gly-CDs can stimulate cells to regulate the expression of some host restriction factors, including DDX53 and NOS3, which are directly related to PRRSV proliferation. Moreover, it is found that Gly-CDs also remarkably suppress the propagation of other viruses, such as pseudorabies virus (PRV) and porcine epidemic diarrhea virus (PEDV), suggesting the broad antiviral activity of Gly-CDs. The integrated results demonstrate that Gly-CDs possess extraordinary antiviral activity with multisite inhibition mechanisms, providing a promising candidate for alternative therapy for PRRSV infection.

Heavy metal pollution and potential health risks of commercially available Chinese herbal medicines

A survey was conducted to investigate the pollution and health risks of copper (Cu), cadmium (Cd), lead (Pb), arsenic (As), mercury (Hg) and zinc (Zn) in 60 Chinese herbal medicines (CHMs) collected from a market in Kunming City, Yunnan Province, China. Furthermore, eight CHMs (Cyathulae radix, Drynariae rhizoma, Peucedani radix, Homalomenae rhizoma, Dryopteris setosa, Polygonati rhizoma, Lilii bulbus, and Linderae radix) containing high Cd concentrations were selected to further analyse their Cd chemical forms. Additionally, the dissolution rates of six heavy metals in decoction liquid were also analysed for four CHMs (Typhonii rhizoma, Linderae radix, Homalomenae rhizoma, and Cyathulae radix), and the health risks of heavy metals in CHMs were evaluated. The results showed that the Cd, Hg and Cu concentrations in the 60 CHMs exceeded the limiting values of the "Green Trade Standards of Importing & Exporting Medicinal Plants & Preparations" (WM2-2001), with exceedance ratios of 38.8%, 8.3% and 1.7%, respectively. The majority of Cd was integrated with pectates and protein in CHMs, and the other five Cd chemical forms followed the order of water-soluble > insoluble heavy metal phosphates > oxalate > residual > inorganic form, indicating that Cd had relatively low bioactivity and toxicity. The average dissolution rates of Zn, Cu, Cd, Hg, As and Pb in the four CHMs were 47.4%, 33.8%, 20.5%, 6.1%, 5.4% and 4.8%, respectively. The calculation results of hazard quotients (HQs) for Cd and Hg showed that the CHMs did not pose a threat to human health.

Linking resource supplies and price drivers: Lessons from Traditional Chinese Medicine (TCM) price volatility and change, 2002-2017

ETHNOPHARMACOLOGICAL RELEVANCE

Worldwide, one of the drivers of substitution and adulteration is the cost of the natural resources (plants, animals, fungi) that are ingredients of traditional medicines. Relatively few studies have been done that link prices of traditional medicine ingredients to what drives changes in price, yet this is an important topic. Theoretically, prices have been widely considered as an economic indicator of resource scarcity. Rare, slow growing medicinal plants sell for high prices and common, less popular species for low prices. Price levels also influence the viability of farming vs. wild harvest (and incentives to overharvest high value species when tenure is weak). Prices can also influence the harvesting or buying behaviour of harvesters, traders or manufacturers. When prices are high, then there is a greater incentive to use cheaper substitute species or adulterants. As previous studies on herbal medicine ingredients have shown, adulteration applies in a wide variety of cases, including to some Traditional Chinese Medicine (TCM) species.

AIM OF THE STUDY

The aim of this study was to gain a better understanding of which factors influenced changes in the market prices of document prices for four popular, but very different traditional Chinese medicine (TCM) species (2002 - 2017).

MATERIALS AND METHODS

Fluctuations in market prices were followed over a 15-year period (2002-2017) for four very different TCM ingredients: two plant species (one wild harvested for fruits (Schisandra sphenanthera Rehder & E.H. Wilson) the other in a transition from wild harvest to cultivation (Paris polyphylla Smith), an animal species (the Tokay gecko (Gekko gecko L.)) and the entomophagous "caterpillar fungus" (Ophiocordyceps sinensis (Berk). G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora).

RESULTS

High prices of medicinal plants are widely considered to reflect resource scarcity. Real-time market prices for three of the four very different TCM species we studied all showed major price fluctuations. The exception was P. polyphylla, whose wild populations are widely known to be increasingly scarce, where there was a steady increase in price, with few fluctuations in the upward price trend. The three other species showed significant price fluctuations. These were driven by multiple factors. Ecological and biogeographic factors that influence abundance or scarcity of supply certainly played a role. But other factors were also influential. These included both national and global economic factors (the influence of the Global Financial Crisis (GFC)), national policy changes that in turn influenced businessmen giving expensive gifts (that included O. sinensis)), climate change (influencing fruiting success of S. sphenanthera), price speculation by traders and lack of information (e.g: reduction in G. gecko prices due to traders incorrectly believing that domestication would increase supplies).

CONCLUSIONS

Price fluctuations in the four TCM species we examined are influenced by many factors and not just resource scarcity. And the situation is more complex than the trajectory based on Homma's (1992) model, where he predicted that higher prices would result in a shift to cultivation, thus replacing wild harvest. In case of both O. sinensis and P. polyphylla, Homma (1992, 1996) was right in terms of scarcity and high prices stimulating a major investment in cultivation (P. polyphylla) and artificial production (O. sinensis). But in both cases, intensive production through cultivation or artificial propagation do not yet occur on a large enough scale to reduce harvest of wild stocks. Substitution and adulteration occur with all four species. Improving information to medicinal plant traders on the supply status of TCM stocks, whether from wild harvest or from cultivation could benefit product quality, cultivation initiatives and conservation efforts.

Introduction to the special issue: Saving plants, saving lives: Trade, sustainable harvest and conservation of traditional medicinals in Asia

This "geographic and thematic" issue of the Journal of Ethnopharmacology focuses on the traditional medicines in trade in Asia on the 30th anniversary of the 1988 Chiang-Mai Declaration, an output of an historic meeting organized by WHO, IUCN and WWF. The emphasis on the Asian countries that represent the highest volume and value of medicinal plants trade in the world is deliberate. Not only because of the scale and speed of changes in traditional medicines trade in Asia, but also to highlight the conservation and sustainable use issues being faced today. In 1988, few studies had been done on the informal sector trade or on medicinal plant value-chains and even fewer studies on cross-border trade in medicinal plants or fungi. At that time, e-commerce in Traditional and Complementary Medicine (T&CM), so common today, did not even exist. And no comparitive, repeat studies of traditional medicines markets had been done at all. Thirty years later, this special issue illustrates how the traditional medicines trade has grown and changed. Links between medicinal plant conservation, scarcity and price on one hand and quality, safety and adulteration on the other are better understood. E-commerce in T&CM has grown exponentially, due to 51% of the world's population having internet access by 2017. Yet despite global policy goals for conservation and sustainable use, the challenges facing medicinal plants conservation are greater than ever before. Consequently, the need for co-operation between the health-care and conservation sectors recognised in 1988 is even greater today. And this is recognised in WHO's 2014-2023 strategy for traditional medicines, which identifies the need to raise awareness about issues of biodiversity and conservation as an important strategic action (WHO, 2013). This Special Issue is a small contribution towards that goal.

Nutritional evaluation on Lignosus cameronensis C. S. Tan, a medicinal Polyporaceae

Sclerotial powder of a cultivated species of the Tiger Milk Mushroom, Lignosus cameronensis was analysed for its nutritional components and compared against species of the same genus, Lignosus rhinocerus and Lignosus tigris. All three species have been used by indigenous tribes in Peninsular Malaysia as medicinal mushrooms. Content of carbohydrate, fibre, mineral, amino acid, palatable index, fat, ash and moisture were determined. L. cameronensis sclerotial material consists of carbohydrate (79.7%), protein (12.4%) and dietary fibre (5.4%) with low fat (1.7%) and no free sugar. It has the highest content of total carbohydrate (791 g kg^-1 ), energy value (3,700 kcal kg^-1 ) and calcium (0.85 g kg^-1 ). The crude protein content (123 g kg^-1 ) is comparable to that of L. rhinocerus with its main amino acids consisting of glutamic acid, aspartic acid and leucine. The umami index is determined to be 0.27. The total essential amino acid (45 g kg^-1 ) is comparable to that of L. tigris. The main mineral is potassium (1.51 g kg^-1 ) and the Na/K ratio was <0.6. Heavy metals such as mercury, cadmium, lead and arsenic were absent. L. cameronensis has the highest amount of food energy, total carbohydrate and calcium compared to those of both L. rhinocerus and L. tigris. The essential amino acids comprised almost 40% of the total amino acid content, slightly more than that reported from sclerotial powder of the L. tigris. © 2019 IUBMB Life, 9999(9999):1-6, 2019.

Safety assessment of cultivated fruiting body of Ophiocordyceps sinensis evaluated through subacute toxicity in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Ophiocordyceps sinensis (Berk.) G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora is one of the most renowned traditional Chinese medicine used as tonic, renal, respiratory and reproductive health, promote longevity and overall improvement in quality of life. Natural production of O. sinensis is limited due to its extreme specificity in host range and confined geographic distribution. Therefore, cultivation of the fungus was developed to meet high demand for commercialization as nutraceutical. O. sinensis fruiting body has recently been successfully cultivated in large scale using rice based solid medium, providing wider source options for consumers and scientific researchers.

AIMS OF THE STUDY

The present study aims to establish safety profile for the consumption of cultivated fruiting body of O. sinensis (FBOS) by 28-days sub-acute toxicity study in Sprague Dawley rats.

MATERIALS AND METHODS

Rats were orally administered with cultivated FBOS at three graded doses (250, 500 and 1000mg/kg), once daily for 28 consecutive days. Control group received distilled water. General observations (gross behavioral changes and toxic symptoms) and body weight of each animal were monitored daily. Haematological, serum biochemical and histopathological analysis were carried out at the end of the experiment (Day 29).

RESULTS

No behavioral changes, toxic symptoms or death was observed in rats throughout the dosing period. Cultivated FBOS treatment up to 1000mg/kg did not cause any adverse effect on the growth of the animals. Results from haematology and serum biochemistry revealed no toxic effect following cultivated FBOS treatment at three graded doses for 28 days. In addition, no treatment related histopathological changes were noted in heart, spleen, kidney, lung and liver of the animals.

CONCLUSION

The present study revealed that oral administration of cultivated FBOS for 28 days, at dosage up to 1000mg/kg did not pose toxicological concern in rats. Therefore, the no-observed-adverse-effect level (NOAEL) dose of cultivated FBOS in 28-days subacute toxicity study is higher than 1000mg/kg.

Profiling metals in Cordyceps sinensis by using inductively coupled plasma mass spectrometry

Cordyceps sinensis (C. sinensis) is a natural product that has diverse nutritional and medicinal values. Since the availability of natural C. sinensis becomes limited its authentication and quality control is of high significance. Herein we report on profiling of metals in C. sinensis by using inductively coupled plasma mass spectrometry (ICP-MS). The analysis reveals that C. sinensis contains a wide array of essential elements, including P, Mg, Zn, Cu, Fe, etc. Toxic metals detected are Cd, Pb, and As. In all five samples analyzed Pb contents are below 2.0 ppm. Arsenic level in C. sinensis caterpillar is significantly higher than that in its mycelium and varies from 3.0 to 32 ppm likely due to soil contamination. It's for the first time demonstrated in this work that clustering analysis on the proposed metal profiles consisting of 24 elements is very useful to identify "abnormal" C. sinensis samples, thus adding another dimension to the effective means for authentication and quality assessment of this highly demanded previous natural product.

Isolation, Culture and Characterization of Hirsutella sinensis Mycelium from Caterpillar Fungus Fruiting Body

The caterpillar fungus Ophiocordyceps sinensis (previously called Cordyceps sinensis) has been used for centuries in Asia as a tonic to improve health and longevity. Recent studies show that O. sinensis produces a wide range of biological effects on cells, laboratory animals and humans, including anti-fatigue, anti-infection, anti-inflammatory, antioxidant, and anti-tumor activities. In view of the rarity of O. sinensis fruiting bodies in nature, cultivation of its anamorph mycelium represents a useful alternative for large-scale production. However, O. sinensis fruiting bodies harvested in nature harbor several fungal contaminants, a phenomenon that led to the isolation and characterization of a large number of incorrect mycelium strains. We report here the isolation of a mycelium from a fruiting body of O. sinensis and we identify the isolate as O. sinensis’ anamorph (also called Hirsutella sinensis) based on multi-locus sequence typing of several fungal genes (ITS, nrSSU, nrLSU, RPB1, RPB2, MCM7, β-tubulin, TEF-1α, and ATP6). The main characteristics of the isolated mycelium, including its optimal growth at low temperature (16°C) and its biochemical composition, are similar to that of O. sinensis fruiting bodies, indicating that the mycelium strain characterized here may be used as a substitute for the rare and expensive O. sinensis fruiting bodies found in nature.

Relationship between risk factors for infertility in women and lead, cadmium, and arsenic blood levels: a cross-sectional study from Taiwan

Background

The World Health Organization reported that more than 10 % of women are severely affected by infertility, making the condition a major worldwide public health problem. Lead (Pb), cadmium (Cd), and arsenic (As) are environmental pollutants that may contribute to reproductive disorders. This cross-sectional study investigated the association between blood concentrations of Pb, Cd, and As and risk factors for infertility in women.

Methods

Women who were infertile (N = 310) or pregnant (N = 57) were recruited from the gynecology and obstetrics department of a hospital. The participants were interviewed to obtain their sociodemographic, reproductive, and lifestyle information. The concentrations of Pb, Cd, and As in their blood samples were measured using inductively coupled plasma mass spectrometry.

Results

Our findings suggested that the concentrations of Pb and As, but not Cd, were significantly higher in the blood of infertile women than in that of pregnant women. A higher percentage of the infertile women consumed more alcohol, used Chinese herbal medicine more frequently, and lacked physical activity compared with the pregnant women. After accounting for potentially relevant predictors, we observed that blood Pb levels might be elevated by using Chinese herbal medicine 1–6 times per week (aOR = 2.82, p = 0.05). In addition, engaging in physical activity 1–2 times per week (aOR = 0.37, p = 0.05) might assist in reducing Pb accumulation in infertile women, though the p value was borderline.

Conclusions

Lack of physical activity and frequent use of Chinese herbal medicine may be associated with elevated blood Pb levels in infertile women. Chinese herbal medicine use was observed to increase the Pb body burden of both infertile and pregnant women in this study. The risk–benefit for Chinese herbal medicine intake should be evaluated by women of childbearing age.

Paecilomycies japonica reduces repeated nicotine-induced neuronal and behavioral activation in rats

Background

Many studies have demonstrated that repeated injections of nicotine can produce progressive increases in locomotor activity and enhanced expression of c-fos and tyrosine hydroxylase (TH) in brain dopaminergic areas. Paecilomyces japonica (PJ) is a herbal medicine that is commonly used to treat opiate and other addictions in Eastern Asia. However, its influence on nicotine addiction has not been examined. This study was carried out to investigate the effects of PJ on repeated nicotine-induced behavioral sensitization of locomotor activity and c-Fos and TH expression in the rat brain using immunohistochemistry.

Methods

Rats were pretreated with PJ (10, 25, 50, 100, and 200 mg/kg, intraperitoneally) 30 min before repeated injections of nicotine (0.4 mg/kg, subcutaneously, twice daily for 7 days). Locomotor activity was measured in rats during 7-day nicotine treatments. On the seventh day, c-Fos and TH expression were assessed.

Results

Pretreatment with PJ decreased the development of nicotine-induced sensitization, c-Fos expression in the nucleus accumbens and striatum, and TH expression in the ventral tegmental area. PJ decreased nicotine-induced locomotor activity by modulating brain dopaminergic systems.

Conclusion

The results of the present study suggest that PJ may be a useful agent for preventing and treating nicotine addiction.

Retrospective Investigation of a Lead Poisoning Outbreak from the Consumption of an Ayurvedic Medicine: Durban, South Africa

Ayurvedic medicines have been gaining in popularity around the world in recent decades, but have also been associated with lead contamination and poisoning. In 2012 in Durban, South Africa, a lead poisoning outbreak among adolescents was associated with the consumption of an Ayurvedic medicine for the treatment of skin conditions. In 2014 eight individuals (out of 12 affected) were traced and interviewed. Questionnaires were administered; blood samples were taken for lead content analysis; and medical records were reviewed. Samples of the implicated medicines were analyzed to determine lead levels. Blood lead levels during the acute phase ranged from 34 to 116 µg/dL; and during the current study (two years later) from 13 to 34 µg/dL. The implicated lead capsules had a lead content of 125,235 µg/g. Participants suffered a wide range of non-specific ill health symptoms; and there was a significant delay in the diagnosis of lead poisoning. This study highlights the potential for lead poisoning outbreaks from the consumption of Ayurvedic medicines in African settings. There were weaknesses with regard to the diagnosis of and response to the outbreak, for which measures need to be put in place to ensure greater awareness of the role of Ayurvedic medicine in lead poisoning, and prompt diagnosis and treatment of future cases.

Safety surveillance of traditional Chinese medicine: current and future

Herbal medicine, including traditional Chinese medicine, has been used for the prevention, treatment, and cure of disorders or diseases for centuries. In addition to being used directly as therapeutic agents, medicinal plants are also important sources for pharmacological drug research and development. With the increasing consumption of herbal products intended to promote better health, it is extremely important to assure the safety and quality of herbal preparations. However, under current regulation surveillance, herbal preparations may not meet expectations in safety, quality, and efficacy. The challenge is how to assure the safety and quality of herbal products for consumers. It is the responsibility of producers to minimize hazardous contamination and additives during cultivation, harvesting, handling, processing, storage, and distribution. This article reviews the current safety obstacles that have been involved in traditional Chinese herbal medicine preparations with examples of popular herbs. Approaches to improve the safety of traditional Chinese medicine are proposed.

Pharmacological and therapeutic potential of Cordyceps with special reference to Cordycepin

An entomopathogenic fungus, Cordyceps sp. has been known to have numerous pharmacological and therapeutic implications, especially, in terms of human health making it a suitable candidate for ethno-pharmacological use. Main constituent of the extract derived from this fungus comprises a novel bio-metabolite called as Cordycepin (3′deoxyadenosine) which has a very potent anti-cancer, anti-oxidant and anti-inflammatory activities. The current review discusses about the broad spectrum potential of Cordycepin including biological and pharmacological actions in immunological, hepatic, renal, cardiovascular systems as well as an anti-cancer agent. The article also reviews the current efforts to delineate the mechanism of action of Cordycepin in various bio-molecular processes. The study will certainly draw the attention of scientific community to improve the bioactivity and production of Cordycepin for its commercial use in pharmacological and medical fields.

Properties of Cordyceps Sinensis: A review

A great mystique and aura surrounds Cordyceps sinensis (syn.: Cephalosporium sinensis), an endoparasitic fungus which has claims of anti-cancer and anti-aging properties. Much research has been conducted over the years on crude extracts and its bioactivity. More research is now focused on culturing C. sinensis and on isolating and identifying pure compounds novel to C. sinensis in an attempt to alleviate strain on demand for the natural fungi. Several polysaccharides, nucleosides and sterols all have had reports of promoting health both in vitro and in vivo. Specific and novel compounds which are characteristic to C. sinensis are emerging with reports of two new epipolythiodioxopiperazines, gliocladicillins A and B capable of inhibiting growth of HeLa, HepG2 and MCF-7 tumor cells. Exclusive to natural C. sinensis, five constituents of cordysinin (A-E) has also been reported for the first time and has been linked to anti-inflammatory properties. Although it may still be premature to believe these results should translate into pharmaceutical use, there is sufficient evidence to warrant further research.

Occupational neurotoxic diseases in taiwan

Occupational neurotoxic diseases have become increasingly common in Taiwan due to industrialization. Over the past 40 years, Taiwan has transformed from an agricultural society to an industrial society. The most common neurotoxic diseases also changed from organophosphate poisoning to heavy metal intoxication, and then to organic solvent and semiconductor agent poisoning. The nervous system is particularly vulnerable to toxic agents because of its high metabolic rate. Neurological manifestations may be transient or permanent, and may range from cognitive dysfunction, cerebellar ataxia, Parkinsonism, sensorimotor neuropathy and autonomic dysfunction to neuromuscular junction disorders. This study attempts to provide a review of the major outbreaks of occupational neurotoxins from 1968 to 2012. A total of 16 occupational neurotoxins, including organophosphates, toxic gases, heavy metals, organic solvents, and other toxic chemicals, were reviewed. Peer-reviewed articles related to the electrophysiology, neuroimaging, treatment and long-term follow up of these neurotoxic diseases were also obtained. The heavy metals involved consisted of lead, manganese, organic tin, mercury, arsenic, and thallium. The organic solvents included n-hexane, toluene, mixed solvents and carbon disulfide. Toxic gases such as carbon monoxide, and hydrogen sulfide were also included, along with toxic chemicals including polychlorinated biphenyls, tetramethylammonium hydroxide, organophosphates, and dimethylamine borane. In addition we attempted to correlate these events to the timeline of industrial development in Taiwan. By researching this topic, the hope is that it may help other developing countries to improve industrial hygiene and promote occupational safety and health care during the process of industrialization.

Increased risks of upper tract urothelial carcinoma in male and female chinese herbalists

BACKGROUND/PURPOSE

It has been shown that herbs that contain aristolochic acid induce urological cancer. Chinese herbalists have easy access to such herbs. Our previous mortality study has shown a significantly increased risk of urological cancer in female but not male herbalists. To re-examine this risk in male herbalists, the incidence of urological cancer was analyzed.

METHODS

We enrolled all 6550 Chinese herbalists in Taiwan registered during 1985-2000, and we retrospectively followed the development of cancer until 2001 by analysis of data collected from the Taiwan Cancer Registry. Standardized incidence ratios (SIRs) were calculated for urological cancers in herbalists and compared with those for the general population in Taiwan.

RESULTS

There were 30 newly diagnosed cases of urological cancer and most of them were transitional cell carcinoma (93.1%). The mean age at diagnosis for urothelial carcinoma was 51.6 years, and 51.9% were in the upper urinary tract. After adjustment for age and sex, the SIR for all urological cancers was 3.51 [(95% confidence interval (CI): 2.37-5.01]. When stratified by location, the SIRs for kidney and upper urinary tract cancers and bladder cancer were 4.24 (95% CI: 2.47-6.80) and 2.86 (95% CI: 1.52-4.89), respectively. When analyzed by sex, the SIRs for all urological cancers, kidney and upper urinary tract cancers, and bladder cancer were also significantly increased in male herbalists.

CONCLUSION

The significant risk of urothelial carcinoma noted in male herbalists increases our suspicion that this is an occupational disease that renders regular health assessment of herbalists an urgent necessity.

Increased mortality risk for cancers of the kidney and other urinary organs among Chinese herbalists

BACKGROUND

A national survey in Taiwan has shown that Chinese herbal therapy increases the risk of chronic kidney disease. However, it is unknown whether herbal therapy will increase the risk of urological cancers. The purpose of this study was to determine whether Chinese herbalists are at higher risk for urological cancers.

METHODS

We studied all Chinese herbalists in Taiwan that were registered in the Chinese Herbalist Labor Union between 1985 and 2000. We retrospectively followed their survival status and causes of death using the National Mortality Registry Database from 1985 to 2004. Standardized mortality ratios (SMRs) for urological cancers in herbalists were calculated and compared with those of the general population of Taiwan.

RESULTS

A total of 6548 Chinese herbalists were enrolled and 88,289 person-years were accrued during the observation period. After adjustment for age and sex, the SMR for urological cancers was significantly higher for Chinese herbalists than for the general population (SMR = 3.10; 95% CI: 1.41-5.87). When further stratified by location, the SMR for kidney cancer and other urinary organ cancers (SMR = 3.81; 95% CI: 1.39-8.28) except bladder cancer (SMR = 2.26; 95% CI: 0.47-6.59) were significantly higher for the Chinese herbalists. The SMR for chronic and unspecified nephritis, renal failure, and renal sclerosis were also significantly higher for herbalists (SMR = 2.40; 95% CI: 1.40-3.84).

CONCLUSIONS

Chinese herbalists have a significantly higher risk for urological cancers. This increased risk among herbalists highlights the urgent need for safety assessments of Chinese herbs.

Cordyceps: a traditional Chinese medicine and another fungal therapeutic biofactory?

Traditional Chinese medicines (TCM) are growing in popularity. However, are they effective? Cordyceps is not studied as systematically for bioactivity as another TCM, Ganoderma. Cordyceps is fascinating per se, especially because of the pathogenic lifestyle on Lepidopteron insects. The combination of the fungus and dead insect has been used as a TCM for centuries. However, the natural fungus has been harvested to the extent that it is an endangered species. The effectiveness has been attributed to the Chinese philosophical concept of Yin and Yang and can this be compatible with scientific philosophy? A vast literature exists, some of which is scientific, although others are popular myth, and even hype. Cordyceps sinensis is the most explored species followed by Cordyceps militaris. However, taxonomic concepts were confused until a recent revision, with undefined material being used that cannot be verified. Holomorphism is relevant and contamination might account for some of the activity. The role of the insect has been ignored. Some of the analytical methodologies are poor. Data on the "old" compound cordycepin are still being published: ergosterol and related compounds are reported despite being universal to fungi. There is too much work on crude extracts rather than pure compounds with water and methanol solvents being over-represented in this respect (although methanol is an effective solvent). Excessive speculation exists as to the curative properties. However, there are some excellent pharmacological data and relating to apoptosis. For example, some preparations are active against cancers or diabetes which should be fully investigated. Polysaccharides and secondary metabolites are of particular interest. The use of genuine anamorphic forms in bioreactors is encouraged.

Low blood lead concentration in association with infertility in women

This study investigated the relationship between low-level lead exposure and risk of infertility in women. Study participants consisted of 64 cases recruited at a private infertility clinic and 83 control women from the postpartum clinic unit at a medical center in Kaohsiung, Taiwan. With informed consent, venous blood samples were obtained from subjects, during their early follicular phases (the 1st to 5th days of the menstrual cycle), for measuring concentrations of lead and hormones. Information on other potential risk factors associated with infertility, including reproductive history, Chinese herbal Medicine use, dairy product consumption, residential environment, and sociodemographic status, was obtained during an in-person interview. The mean blood lead level (BLL) in infertile women was significantly higher than that in controls (3.55 vs 2.78 microg/dL, P=0.007). Compared to women with BLL < or = 2.5 microg/dL, women with BLL>2.5 microg/dL were associated with a threefold increased risk for infertility (adjusted odds ratio=2.94, 95% confidence interval 1.18-7.34), after controlling for age, body mass index, smoking, Chinese herbal Medicine use, and irregular menstruation. Women's BLL was a significant predictor of the serum estradiol concentration also. These findings suggest an important role of very low BLL in the risk of infertility in women.

COEXPOSURE OF LEAD- AND LIPOPOLYSACCHARIDE-INDUCED LIVER INJURY IN RATS: INVOLVEMENT OF NITRIC OXIDE-INITIATED OXIDATIVE STRESS AND TNF-??

In this study, we investigated the interaction between lipopolysaccharide (LPS) and lead (Pb) and the involvement of tumor necrosis factor-alpha (TNF-alpha) and oxidative stress in Pb-plus-LPS (Pb/LPS)-induced liver damage in rats. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), TNF-alpha, nitric oxide (NO), and lipid peroxidation (LPO) were determined in rats treated with Pb and/or LPS. Pb ranging from 0 to 15 mg/kg dose dependently increased AST, ALT, NO, or LPO in LPS-treated rats. Pretreatment with iNOS inhibitor 1400W reduced NO, LPO, TNF-alpha, AST, and ALT in Pb/LPS-treated rats. Thus, Pb increased LPS-induced liver damage, which might be associated with increased NO-initiated oxidative stress and TNF-alpha in rats.

Risks of herbal medicinal products

PURPOSE

Herbal medicinal products (HMPs) are again highly popular. Their current popularity renders the assessment of their safety an urgent necessity.

METHOD

Narrative review using examples only.

RESULTS

Constituents of HMPs can be toxic and numerous examples of liver, kidney or other organ damage are on record. All HMPs contain a range of pharmacologically active constituents, and users of HMPs often combine HMPs with prescribed drugs. Thus herb-drug interactions are a real possibility. In most countries, HMPs are not submitted to stringent regulation and control. Thus unreliable quality can be a problem. In particular, this poses a risk when HMPs are contaminated (e.g. with heavy metals) or adulterated (e.g. with prescription drugs). The medical literature holds numerous examples for all of these scenarios and some are used in this article to illustrate the above points. As this area is grossly under-researched, it is rarely possible to define the size of the problem.

CONCLUSIONS

It is concluded that the widespread notion of HMPs being inherently safe is naive at best and dangerous at worst. More research is required to minimise the risk HMPs may pose to consumers' health.

Determination of lead in Smilax myosotiflora herbal preparations obtained in Malaysia

The DCA (Drug Control Authority), Malaysia implemented the phase 3 registration of traditional medicines on 1 January 1992 with special emphasis on the quality, efficacy and safety (including the presence of heavy metals) in all pharmaceutical dosage forms of traditional medicinal preparations. As such, a total of 100 traditional medicinal preparations, containing Smilax myosotiflora, in various pharmaceutical dosage forms, which were bought in the Malaysian market, were analysed for lead content using atomic absorption spectrophotometry. Results showed that 15% of the products analysed possessed 10.23-23.05 ppm of lead, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is that they should not exceed 10 ppm of lead. Out of these 15 products, five products exhibited 10.23-23.05 ppm of lead, in fact they have already been registered with the DCA Malaysia. However, the rest of the products, which possessed 12.24-20.72 ppm of lead, have still not been registered with the DCA Malaysia. Although this study successfully showed that only 85% of the products complied with the quality requirement for traditional medicines in Malaysia pertaining to lead, they cannot, however, be assumed to be safe from lead contamination because of batch-to-batch inconsistency.

High frequency of skin reactions in patients with leishmaniasis treated with meglumine antimoniate contaminated with heavy metals: a comparative approach using historical controls

We analyzed data from historical controls treated with meglumine antimoniate to compare the frequency of adverse events observed in patients with cutaneous leishmaniasis treated with the same dose of meglumine antimoniate contaminated with heavy metals in an endemic area of the State of Bahia, Brazil. Group A patients were treated in 2000 with the drug produced by Eurofarma Laborat rios Ltda., S o Paulo, Brazil (lot A) and group B patients were treated in 1996 with the reference drug produced by Rhodia Farma Ltda., S o Paulo, Brazil (lot B). We observed an unusual higher frequency of skin reactions in group A patients. However, all type of adverse events observed in group A were also observed in group B. The physico-chemical analysis of these lots revealed that lot A had lower pH and higher concentration of total and trivalent antimony, lead, cadmium, and arsenic. Our findings suggest that the skin reactions could be attributed to heavy metal contamination of lot A.

Relationship between blood lead concentrations and learning achievement among primary school children in Taiwan

Over the past 20 years lead has been proven to exert an influence on the intelligence of children. Especially for children exposed to environmental lead, average blood lead was often lower than the officially recognized intoxication level. Because Kaohsiung is an industrial area in Taiwan and lead exposure is an important environmental issue, we attempted to ascertain the extent to which environmental lead influences the achievement of primary school children. We randomly selected 934 children from 32 primary schools in 11 districts of Kaohsiung City. Blood lead levels of the children were checked, and they were administered a questionnaire about their family information. Scores of several courses were used in this study on the relationship between a child's blood lead and his or her academic performance (Ranking with his or her classmates), including Chinese (reading and writing short Chinese articles), Mathematics, History and Society, and Natural Science. Multiple regression models were done with adjustments for the confounding effects of their parents' socioeconomic levels. The mean (SD) of 934 blood lead level was 5.50 (1.86) microg/dL. Spearman's coefficient showed that class rankings in Chinese, Mathematics, Natural Science, and History and Society were all strongly associated with blood lead levels (P<0.01). The multiple regression models revealed that blood lead level exerts a stronger influence on children's language ability (Chinese) than on their ability to calculate (Mathematics). Our results suggest that environmental lead exposure adversely affects a child's academic achievement, making a direct link between exposure to lead and academic attainment.

Adverse effects of unconventional therapies in the elderly: A systematic review of the recent literature

Unconventional therapies are increasingly popular, not least in populations of elderly individuals. This review summarizes the evidence regarding the risk unconventional therapies may entail for the elderly. Computerized literature searches were performed to locate all reports with original data on this topic. Most of the evidence found was anecdotal by nature and thus has obvious limitations. The results show that elderly patients can suffer harm from unconventional therapies. Herbal treatments are associated most frequently with adverse events. They can cause both direct toxicity and unwanted herb-drug interactions. Acupuncture, spinal manipulation and even massage therapy have also been implicated. Indirect risks exist if unconventional therapies are employed as a substitute for conventional treatments. It is concluded that unconventional therapies are not risk-free for elderly patients. All parties involved ought to be educated with a view of minimizing this risk, and more research is needed to increase our understanding of this area.

Gelatin potentiates lead toxicity due to improper preparation of a Chinese tea drug, choreito. A study based on our previously published case report of long-term choreito use

A woman who had used a Chinese tea drug, choreito, for treatment of chronic renal diseases over years, experienced lead poisoning with blood lead concentration over 600 μg/l on admission to the hospital. We found that one of the ingredients in choreito, kasseki, was commonly contaminated by lead (30-50 μg/g of kasseki), but this level of lead contamination in the drug had never caused poisoning previously. Our experiment indicates that another ingredient, gelatin, has lead-extracting ability and an adhesive quality on the walls of teapots. Thus, the possible causes of the toxicity seemed to be: (1) the lead in the kasseki, which was extracted by gelatin that had adhered to the wall of the pot, accumulated in large quantities for a long period of time (the patient used the same pot for more than a year without washing); and (2) a large quantity of the accumulated lead was released into the decoted drug day by day and induced the intoxication. In all, 37.2 mg of lead was extracted by 10 extractions of 4% acetic acid from the patient's pot. Repeated extraction (four times) of lead from the pot which was made by the same manufacturer in the same lot of the patient's pot with acetic acid, only totally 18.5 μg of lead was detected.Also, it is evident that the intoxication was due to an improper method of decoction, that is, the patient did not prepare the tea according to Japanese pharmsacopoedia. The patient decocted all of the ingredients at the same time.

Hepatotoxicity of botanicals

OBJECTIVE

Hepatic impairment resulting from the use of conventional drugs is widely acknowledged, but there is less awareness of the potential hepatotoxicity of herbal preparations and other botanicals, many of which are believed to be harmless and are commonly used for self-medication without supervision. The aim of this paper is to examine the evidence for hepatotoxicity of botanicals and draw conclusions regarding their pathology, safety and applications.

DESIGN

Current literature on the hepatotoxicity of herbal drugs and other botanicals is reviewed. The aetiology, clinical picture and treatment of mushroom (Amanita) poisoning are described.

RESULTS

Hepatotoxic effects have been reported for some Chinese herbal medicines (such as Jin Bu Huan, Ma-Huang and Sho-saiko-to), pyrrolizidine alkaloid-containing plants, germander (Teucrium chamaedrys), chaparral (Larrea tridentata), Atractylis gummifera, Callilepsis laureola, and others. The frequency with which botanicals cause hepatic damage is unclear. There is a lack of controlled treatment trials and the few studies published to date do not clarify the incidence of adverse effects. Many plant products do not seem to lead to toxic effects in everyone taking them, and they commonly lack a strict dose-dependency. For some products, such as Sho-saiko-to, the picture is confused further by demonstrations of hepatoprotective properties for some components. Mushroom poisoning is mostly due to the accidental consumption of Amanita species. Treatment with silymarin, thioctic acid, penicillin and liver transplantation have been shown to be effective but require early diagnosis.

CONCLUSIONS

Severe liver injury, including acute and chronic abnormalities and even cirrhotic transformation and liver failure, has been described after the ingestion of a wide range of herbal products and other botanical ingredients, such as mushrooms. It is concluded that in certain situations herbal products may be just as harmful as conventional drugs.

Lead induced anaemia due to traditional Indian medicine: a case report

Lead intoxication in adults without occupational exposure is a rare and unexpected event. The case of a western European is reported who had severe anaemia after ingestion of several ayurvedic drugs, obtained during a trip to India. Laboratory findings showed high blood lead concentrations, an increased urinary lead concentration, and an increased urinary excretion of delta-aminolaevulinic acid. Also, slightly increased urinary concentrations of arsenic and silver were found. Physicians should be aware that with growing international travel and rising self medication with drugs from uncontrolled sources the risk of drug induced poisoning could increase in the future.