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Khidr EG, Morad NI, Hatem S, El-Dessouki AM, Mohamed AF, El-Shiekh RA, Hafeez MSAE, Ghaiad HR. Natural remedies proposed for the management of diabetic retinopathy (DR): diabetic complications. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2025:10.1007/s00210-025-03866-w. [PMID: 39954069 DOI: 10.1007/s00210-025-03866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 01/28/2025] [Indexed: 02/17/2025]
Abstract
Diabetic retinopathy (DR) represents a significant and serious complication associated with diabetes mellitus (DM), often resulting in considerable visual impairment or even blindness. The intricate pathological processes underlying DR complicate the effectiveness of current treatment modalities. Studies have highlighted the potential of natural products in the treatment of DR via several beneficial effects including anti-inflammatory, antioxidant, anti-neovascular, and anti-apoptotic properties. Flavonoids, saponins, saccharides, and alkaloids exhibited various beneficial effects in DR in in vivo and in vitro studies. However, the clinical utilization of these natural compounds is hindered by issues such as inadequate specificity, low bioavailability, and potential toxicity. Therefore, there is a pressing need for rigorous clinical studies to confirm the efficacy of natural products in preventing or mitigating the progression of DR.
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Affiliation(s)
- Emad Gamil Khidr
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, Egypt
| | - Nourhan Ibrahim Morad
- Department of Pharmacognosy and Natural Products, Faculty of Pharmacy, Menofia University, Menofia, Egypt
| | - Shymaa Hatem
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt.
| | - Ahmed M El-Dessouki
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Ahram Canadian University, 6Th of October City, Giza, 12566, Egypt
| | - Ahmed F Mohamed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
- Faculty of Pharmacy, King Salman International University (KSIU), Ras Sedr, South Sinai, 46612, Egypt
| | - Riham A El-Shiekh
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, 11562, Egypt.
| | - Mohamed S Abd El Hafeez
- Department of Pharmacy, Kut University College, Al Kut, Wasit, 52001, Iraq
- Department of Pharmacognosy, Faculty of Pharmacy, Egyptian Russian University, Cairo-Suez Road, Badr, 11829, Egypt
| | - Heba R Ghaiad
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Kasr El Ainy St., Cairo, 11562, Egypt
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Chen J, Ni Y, Yao W, Ding X. Clinical observations and mechanistic insights of traditional Chinese medicine in the management of diabetic retinopathy. PHARMACEUTICAL BIOLOGY 2024; 62:529-543. [PMID: 38921697 PMCID: PMC11210421 DOI: 10.1080/13880209.2024.2369292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024]
Abstract
CONTEXT Diabetic retinopathy (DR) is one of the leading causes of vision impairment and blindness among diabetic patients globally. Despite advancements in conventional treatments, the quest for more holistic approaches and fewer side effects persists. Traditional Chinese medicine (TCM) has been used for centuries in managing various diseases, including diabetes and its complications. OBJECTIVE This review evaluated the efficacy and underlying mechanisms of TCM in the management of DR, providing information on its potential integration with conventional treatment methods. METHODS A comprehensive literature review was conducted using PubMed, Web of Science, and the China National Knowledge Infrastructure (CNKI) with the search terms 'traditional Chinese medicine', 'diabetic retinopathy', 'clinical efficacies' and their combinations. Studies published before 2023 without language restriction were included, focusing on clinical trials and observational studies that assessed the effectiveness of TCM in DR treatment. RESULTS The review synthesized evidence of empirical traditional Chinese formulas, traditional Chinese patent medicines, and isolated phytochemicals on DR treatment. The key mechanisms identified included the reduction of oxidative stress, inflammation, and neovascularization, as well as the improvement in neurovascular functionality and integrity of the retinal blood barrier. CONCLUSIONS TCM shows promising potential to manage DR. More large-scale, randomized controlled trials are recommended to validate these findings and facilitate the integration of TCM into mainstream DR treatment protocols.
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Affiliation(s)
- Jie Chen
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yadong Ni
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Wenhui Yao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xuansheng Ding
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Precision Medicine Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
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Sun L, Apweiler M, Tirkey A, Klett D, Normann C, Dietz GPH, Lehner MD, Fiebich BL. Anti-Neuroinflammatory Effects of Ginkgo biloba Extract EGb 761 in LPS-Activated BV2 Microglial Cells. Int J Mol Sci 2024; 25:8108. [PMID: 39125680 PMCID: PMC11312056 DOI: 10.3390/ijms25158108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
Inflammatory processes in the brain can exert important neuroprotective functions. However, in neurological and psychiatric disorders, it is often detrimental due to chronic microglial over-activation and the dysregulation of cytokines and chemokines. Growing evidence indicates the emerging yet prominent pathophysiological role of neuroinflammation in the development and progression of these disorders. Despite recent advances, there is still a pressing need for effective therapies, and targeting neuroinflammation is a promising approach. Therefore, in this study, we investigated the anti-neuroinflammatory potential of a marketed and quantified proprietary herbal extract of Ginkgo biloba leaves called EGb 761 (10-500 µg/mL) in BV2 microglial cells stimulated by LPS (10 ng/mL). Our results demonstrate significant inhibition of LPS-induced expression and release of cytokines tumor necrosis factor-α (TNF-α) and Interleukin 6 (IL-6) and chemokines C-X-C motif chemokine ligand 2 (CXCL2), CXCL10, c-c motif chemokine ligand 2 (CCL2) and CCL3 in BV2 microglial cells. The observed effects are possibly mediated by the mitogen-activated protein kinases (MAPK), p38 MAPK and ERK1/2, as well as the protein kinase C (PKC) and the nuclear factor (NF)-κB signaling cascades. The findings of this in vitro study highlight the anti-inflammatory properties of EGb 761 and its therapeutic potential, making it an emerging candidate for the treatment of neuroinflammatory diseases and warranting further research in pre-clinical and clinical settings.
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Affiliation(s)
- Lu Sun
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (L.S.); (M.A.); (A.T.); (D.K.)
| | - Matthias Apweiler
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (L.S.); (M.A.); (A.T.); (D.K.)
| | - Ashwini Tirkey
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (L.S.); (M.A.); (A.T.); (D.K.)
| | - Dominik Klett
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (L.S.); (M.A.); (A.T.); (D.K.)
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Gunnar P. H. Dietz
- Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany;
| | - Martin D. Lehner
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227 Karlsruhe, Germany;
| | - Bernd L. Fiebich
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany; (L.S.); (M.A.); (A.T.); (D.K.)
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Sadikan MZ, Abdul Nasir NA. Diabetic retinopathy: emerging concepts of current and potential therapy. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:3395-3406. [PMID: 37401966 DOI: 10.1007/s00210-023-02599-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023]
Abstract
Diabetic retinopathy (DR) is one of the leading causes of permanent central blindness worldwide. Despite the complexity and inadequate understanding of DR pathogenesis, many of the underlying pathways are currently partially understood and may offer potential targets for future treatments. Anti-VEGF medications are currently the main medication for this problem. This article provides an overview of the established pharmacological treatments and those that are being developed to cure DR. We firstly reviewed the widely utilized approaches including pan-retinal photocoagulation therapy, anti-VEGF therapy, corticosteroid therapy, and surgical management of DR. Next, we discussed the mechanisms of action and prospective benefits of novel candidate medications. Current management are far from being a perfect treatment for DR, despite mild-term favorable efficiency and safety profiles. Pharmacological research should work toward developing longer-lasting treatments or new drug delivery systems, as well as on identifying new molecular targets in the pathogenetical mechanism for DR. In order to find a treatment that is specifically designed for each patient, it is also necessary to properly characterize patients, taking into account elements like hereditary factors and intraretinal neovascularization stages for effective utilization of drugs. The current and potential approaches for diabetic retinopathy. Image was constructed using Biorender.com.
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Affiliation(s)
- Muhammad Zulfiqah Sadikan
- Department of Pharmacology, Faculty of Medicine, Manipal University College Malaysia (MUCM), Bukit Baru, 75150, Malacca, Malaysia
| | - Nurul Alimah Abdul Nasir
- Department of Medical Education, Faculty of Medicine, Universiti Teknologi MARA, 47000, Sungai Buloh, Selangor, Malaysia.
- Centre for Neuroscience Research (NeuRon), Faculty of Medicine, Universiti Teknologi MARA, 47000, Sungai Buloh, Selangor, Malaysia.
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Vitiello L, Capasso L, Cembalo G, De Pascale I, Imparato R, De Bernardo M. Herbal and Natural Treatments for the Management of the Glaucoma: An Update. BIOMED RESEARCH INTERNATIONAL 2023; 2023:3105251. [PMID: 38027044 PMCID: PMC10673672 DOI: 10.1155/2023/3105251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/13/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
Glaucoma causes the degeneration of the retinal ganglion cells (RGCs) and their axons, inducing a tissue reshaping that affects both the retina and the optic nerve head. Glaucoma care especially focuses on reducing intraocular pressure, a significant risk factor for progressive damage to the optic nerve. The use of natural treatments, such as herbs, vitamins, and minerals, is becoming increasingly popular today. While plants are a rich source of novel biologically active compounds, only a small percentage of them have been phytochemically examined and evaluated for their medicinal potential. It is necessary for eye care professionals to inform their glaucoma patients about the therapy, protection, and efficacy of commonly used herbal medicines, considering the widespread use of herbal medicines. The purpose of this review is to examine evidence related to the most widely used herbal medicines for the management and treatment of glaucoma, to better understand the potential benefits of these natural compounds as supplementary therapy.
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Affiliation(s)
- Livio Vitiello
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, Polla, 84035 Salerno, Italy
| | - Luigi Capasso
- Eye Unit, “Ospedale del Mare” Hospital, Azienda Sanitaria Locale Napoli 1 Centro, Naples 80147, Italy
| | - Giovanni Cembalo
- Eye Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Ilaria De Pascale
- Eye Unit, “Ramazzini” Hospital, Azienda Unità Sanitaria Locale Modena, Carpi 41012, Italy
| | - Roberto Imparato
- Eye Unit, Azienda Unità Sanitaria Locale Valle d'Aosta, Aosta 11100, Italy
| | - Maddalena De Bernardo
- Eye Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy
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6
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Morató X, Marquié M, Tartari JP, Lafuente A, Abdelnour C, Alegret M, Jofresa S, Buendía M, Pancho A, Aguilera N, Ibarria M, Diego S, Cuevas R, Cañada L, Calvet A, Antonio EED, Pérez-Cordón A, Sanabria Á, de Rojas I, Nuñez-Llaves R, Cano A, Orellana A, Montrreal L, Cañabate P, Rosende-Roca M, Vargas L, Bojaryn U, Ricciardi M, Ariton DM, Espinosa A, Ortega G, Muñoz N, Lleonart N, Alarcón-Martín E, Moreno M, Preckler S, Tantinya N, Ramis M, Nogales AB, Seguer S, Martín E, Pytel V, Valero S, Gurruchaga M, Tárraga L, Ruiz A, Boada M. A randomized, open-label clinical trial in mild cognitive impairment with EGb 761 examining blood markers of inflammation and oxidative stress. Sci Rep 2023; 13:5406. [PMID: 37012306 PMCID: PMC10070452 DOI: 10.1038/s41598-023-32515-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Although beta-amyloid (Aβ) and phosphorylated tau remain the preferred targets for disease-modifying treatments (DMT) against Alzheimer's disease (AD), part of the pathophysiological mechanisms of cognitive impairment are related to neuroinflammation and oxidative stress. In mild cognitive impairment (MCI), a prodromal stage of AD and other neurodegenerative conditions, the joint appearance of inflammation, oxidative stress, and metabolic alterations are the common pathways of neurotoxicity and neurodegeneration. The standardized extract of Ginkgo biloba EGb 761 interferes with the pathogenic mechanisms involved in both the development of cognitive impairment due to AD and that of vascular origin. The primary objective of this study is to compare changes in the levels of blood markers of inflammation and oxidative stress after treatment with EGb 761 in a cohort of 100 patients with MCI. In addition, we aim to assess changes in these blood markers during an additional 12-month extension phase in which patients in the control group will also receive EGb 761 and patients in the active group will extend their treatment duration. Secondary objectives include comparing changes in neuropsychiatric and cognitive test scores between the baseline (v0) and 12-month visits (v2). This study is a Phase IV, single-center, randomized, open-label, parallel-group clinical trial consisting of the 12-month follow-up of a cohort of participants with MCI [Global Deterioration Scale (GDS) = 3] and an extension with an additional 12-month follow-up. During the first 12 months, participants will be randomized into two arms: in one arm, patients will receive 1 daily tablet of EGb 761 240 mg orally (study group, n = 50), while in the other arm, patients will not receive EGb 761 and will undergo the same assessments as the treated group (control group, n = 50). After the first 12 months of the study, patients in the EGb 761-treated group will continue treatment, and patients in the control group will be offered one EGb 761 240 mg tablet per day orally. All participants will be monitored for an additional 12 months. A battery of blood markers of inflammation and oxidative stress will be quantified at v0, v1, v2, v3, and v4. The Olink Proteomics panel of inflammation markers ( https://www.olink.com/products/inflammation/ ) will be used to evaluate 92 proteins associated with inflammatory diseases and related biological processes. The second panel measures 92 proteins involved in neurological processes. At v0, v2, and v4, neuropsychological and neurological evaluations will be conducted in addition to vital signs and anthropometric studies using a body composition monitor with bioimpedance technology (Tanita). Sixty percent of the 100 MCI patients recruited were women. The mean age was 73.1 years, and the mean time between symptom onset and MCI diagnosis was 2.9 years. The mean Mini-Mental State Examination (MMSE) score was 26.7. Depressive and anxiety disorders, as well as vascular risk factors, were the most frequent comorbidities among the cohort. The study is still ongoing, and results for the first year of treatment (v0, v1, v2) are expected by 2023. Individuals with MCI have an elevated risk of developing dementia. EGb 761 is used worldwide for the symptomatic treatment of cognitive disorders due to its neuroprotective effects. In experimental models and clinical observational studies, EGb 761 has shown strong antioxidant and anti-inflammatory activity. As a result, this study has been proposed to evaluate the antioxidant and anti-inflammatory effects on plasma markers and their potential clinical correlation with the progression of cognitive decline in patients with MCI.Trial registration: Registro Español de estudios clínicos (REec) number 2020-003776-41, ClinicalTrials.gov Identifier: NCT05594355.
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Affiliation(s)
- Xavier Morató
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Marta Marquié
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pablo Tartari
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Asunción Lafuente
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carla Abdelnour
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Montserrat Alegret
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Jofresa
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mar Buendía
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Pancho
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Núria Aguilera
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Ibarria
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Susana Diego
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Rosario Cuevas
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Laia Cañada
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna Calvet
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Alba Pérez-Cordón
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ángela Sanabria
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Itziar de Rojas
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Raúl Nuñez-Llaves
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Amanda Cano
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Adelina Orellana
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Montrreal
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pilar Cañabate
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Maitée Rosende-Roca
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Liliana Vargas
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Urszula Bojaryn
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mario Ricciardi
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Diana M Ariton
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Espinosa
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Ortega
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Nathalia Muñoz
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Núria Lleonart
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Emilio Alarcón-Martín
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariola Moreno
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Silvia Preckler
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Natalia Tantinya
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maribel Ramis
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana Belen Nogales
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Susanna Seguer
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elvira Martín
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Vanesa Pytel
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sergi Valero
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Miren Gurruchaga
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
| | - Lluís Tárraga
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Ruiz
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Boada
- Ace Alzheimer Center Barcelona-Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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Hort J, Duning T, Hoerr R. Ginkgo biloba Extract EGb 761 in the Treatment of Patients with Mild Neurocognitive Impairment: A Systematic Review. Neuropsychiatr Dis Treat 2023; 19:647-660. [PMID: 36994422 PMCID: PMC10041984 DOI: 10.2147/ndt.s401231] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/04/2023] [Indexed: 03/31/2023] Open
Abstract
Background Many clinical trials testing Ginkgo biloba extract EGb 761 in patients with mild forms of cognitive impairment were conducted before widely accepted terms and diagnostic criteria for such conditions were available. This makes it difficult to compare any results from earlier and more recent trials. The objective of this systematic review was to provide a descriptive overview of clinical trials of EGb 761 in patients who met the diagnostic criteria for mild neurocognitive disorder (mild NCD) according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Methods MEDLINE, PubMed and EMBASE were searched for randomized, placebo-controlled double-blind trials of EGb 761 in mild impairment of cognitive functioning. All trials involving patients who met retrospectively applied diagnostic criteria for mild NCD were included. Trials of primary prevention of dementia and trials of combinations of medical treatments were excluded. Results Among 298 records found in databases and 76 further records related to EGb 761 in references of systematic reviews, 9 reports on clinical trials involving 946 patients met the pre-specified criteria for inclusion. Beneficial effects of EGb 761 were seen in neuropsychological tests (8 of 9 studies), scales for neuropsychiatric symptoms (3 of 3 studies), geriatric rating scales (1 of 2 studies) and global ratings of change (1 of 1 study). Significant effects were found in several domains of cognition (memory, speed of processing, attention and executive functioning). Among the neuropsychiatric symptoms, depression (2 of 3 studies) and anxiety (1 of 1 study) were significantly improved. No differences between EGb 761 treatment and placebo were seen with regard to the rates of adverse events. Discussion The included studies demonstrate treatment benefits of Ginkgo biloba extract EGb 761, mainly on cognitive deficits and neuropsychiatric symptoms, in patients with mild NCD. The drug was safe and well tolerated.
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Affiliation(s)
- Jakub Hort
- Memory Clinic, Department of Neurology, Charles University, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | - Thomas Duning
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Robert Hoerr
- Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
- Correspondence: Robert Hoerr, Research and Development, Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Str. 4, Karlsruhe, 76227, Germany, Tel +49 721 4005 429, Email
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8
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Sun W, Li J, Yan X, Liao L, Li S, Wang X, Xiao C, Shang M, Chao G, Zhou J. Traditional Chinese Medicine Injections for Diabetic Retinopathy: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:927-939. [PMID: 35861710 PMCID: PMC9805861 DOI: 10.1089/jicm.2021.0392] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: The aim of this study was to compare the efficacy of different injected Traditional Chinese Medicines in the treatment of diabetic retinopathy (DR) and to provide a reference for the selection of adjuvant therapy for DR. Content: Related literature in multiple biological databases and websites was searched up to April 15, 2022, without language and publication time restrictions. A Bayesian network meta-analysis was used to analyze the included studies. Summary: Compared with conventional treatment, the combined use of injected Traditional Chinese Medicines, including astragalus, danhong, Ginkgo biloba extract powder, ginkgo leaf extract and dipyridamole (GLED), ligustrazine (LIG), mailuoning, puerarin, safflower, shuxuetong, safflower yellow sodium chloride, and xueshuantong (XST), can significantly improve the clinical effectiveness in patients with DR, while LIG, XST, and GLED can improve vision. The strength of the evidence ranged from high to very low. Outlook: In patients with DR, the combination of multiple injected Traditional Chinese Medicines is more effective than conventional treatment; some of these medicines may also improve visual acuity. This study may provide a good resource and reference for the selection of adjuvant therapy for DR.
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Affiliation(s)
- Wu Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Junnan Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoling Yan
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Liang Liao
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shimeng Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Xueyao Wang
- Retinal Department, Eye Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Caiyin Xiao
- Retinal Department, Eye Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Mengqiu Shang
- Beijing University of Chinese Medicine, Beijing, China
| | - Guojun Chao
- Retinal Department, Eye Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.,Guojun Chao, BS, Retinal Department, Eye Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100040, China
| | - Jian Zhou
- Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.,Address correspondence to: Jian Zhou, MS, Department of Ophthalmology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100029, China
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Tan W, Qi L, Hu X, Tan Z. Research progress in traditional Chinese medicine in the treatment of Alzheimer's disease and related dementias. Front Pharmacol 2022; 13:921794. [PMID: 36506569 PMCID: PMC9729772 DOI: 10.3389/fphar.2022.921794] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
Alzheimer's disease (AD) is the world's leading cause of dementia and has become a huge economic burden on nations and families. However, the exact etiology of AD is still unknown, and there are no efficient medicines or methods to prevent the deterioration of cognition. Traditional Chinese medicine (TCM) has made important contributions in the battle against AD based on the characteristics of multiple targets of TCM. This study reviewed the treatment strategies and new discoveries of traditional Chinese medicine in current research, which may be beneficial to new drug researchers.
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Affiliation(s)
- Wanying Tan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lingjun Qi
- Sichuan Academy of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoyu Hu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhenghuai Tan
- Sichuan Academy of Traditional Chinese Medicine, Chengdu, China
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10
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Li C, Jia WW, Yang JL, Cheng C, Olaleye OE. Multi-compound and drug-combination pharmacokinetic research on Chinese herbal medicines. Acta Pharmacol Sin 2022; 43:3080-3095. [PMID: 36114271 PMCID: PMC9483253 DOI: 10.1038/s41401-022-00983-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
Traditional medicine has provided a basis for health care and disease treatment to Chinese people for millennia, and herbal medicines are regulated as drug products in China. Chinese herbal medicines have two features. They normally possess very complex chemical composition. This makes the identification of the constituents that are together responsible for the therapeutic action of an herbal medicine challenging, because how to select compounds from an herbal medicine for pharmacodynamic study has been a big hurdle in such identification efforts. To this end, a multi-compound pharmacokinetic approach was established to identify potentially important compounds (bioavailable at the action loci with significant exposure levels after dosing an herbal medicine) and to characterize their pharmacokinetics and disposition. Another feature of Chinese herbal medicines is their typical use as or in combination therapies. Coadministration of complex natural products and conventional synthetic drugs is prevalent worldwide, even though it remains very controversial. Natural product–drug interactions have raised wide concerns about reduced drug efficacy or safety. However, growing evidence shows that incorporating Chinese herbal medicines into synthetic drug-based therapies delivers benefits in the treatment of many multifactorial diseases. To address this issue, a drug-combination pharmacokinetic approach was established to assess drug–drug interaction potential of herbal medicines and degree of pharmacokinetic compatibility for multi-herb combination and herbal medicine–synthetic drug combination therapies. In this review we describe the methodology, techniques, requirements, and applications of multi-compound and drug-combination pharmacokinetic research on Chinese herbal medicines and to discuss further development for these two types of pharmacokinetic research.
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The microvascular hypothesis underlying neurologic manifestations of long COVID-19 and possible therapeutic strategies. Cardiovasc Endocrinol Metab 2021; 10:193-203. [PMID: 34765889 PMCID: PMC8575441 DOI: 10.1097/xce.0000000000000253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023]
Abstract
With the ongoing distribution of the coronavirus disease (COVID) vaccines, the pandemic of our age is ending, leaving the world to deal with its well-documented aftereffects. Long COVID comprises a variety of symptoms, of which the neurological component prevails. The most permeating theory on the genesis of these symptoms builds upon the development of microvascular dysfunction similar to that seen in numerous vascular diseases such as diabetes. This can occur through the peripheral activation of angiotensin-converting enzyme 2 receptors, or through exacerbations of pro-inflammatory cytokines that can remain in circulation even after the infection diminishes. Several drugs have been identified to act on the neurovascular unit to promote repair, such as gliptins, and others. They also succeeded in improving neurologic outcome in diabetic patients. The repurposing of such drugs for treatment of long COVID-19 can possibly shorten the time to recovery of long COVID-19 syndrome.
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12
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Fan XX, Cao ZY, Liu MX, Liu WJ, Xu ZL, Tu PF, Wang ZZ, Cao L, Xiao W. Diterpene Ginkgolides Meglumine Injection inhibits apoptosis induced by optic nerve crush injury via modulating MAPKs signaling pathways in retinal ganglion cells. JOURNAL OF ETHNOPHARMACOLOGY 2021; 279:114371. [PMID: 34181957 DOI: 10.1016/j.jep.2021.114371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/02/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Diterpene Ginkgolides Meglumine Injection (DGMI) is made of extracts from Ginkgo biloba L, including Ginkgolides A, B, and K and some other contents, and has been widely used as the treatment of cerebral ischemic stroke in clinic. It can be learned from the "Compendium of Materia Medica" that Ginkgo possesses the effect of "dispersing toxin". The ancient Chinese phrase "dispersing toxin" is now explained as elimination of inflammation and oxidative state in human body. And it led to the original ideas for today's anti-oxidation studies of Ginkgo in apoptosis induced by optic nerve crush injury. AIM OF THE STUDY To investigate the underlying molecular mechanism of the DGMI in retinal ganglion cells (RGCs) apoptosis. MATERIALS AND METHODS TUNEL staining was used to observe the anti-apoptotic effects of DGMI on the adult rat optic nerve injury (ONC) model, and flow cytometry and hoechst 33,342 staining were used to observe the anti-apoptotic effects of DGMI on the oxygen glucose deprivation (OGD) induced RGC-5 cells injury model. The regulation of apoptosis and MAPKs pathways were investigated with Immunohistochemistry and Western blotting. RESULTS This study demonstrated that DGMI is able to decrease the conduction time of F-VEP and ameliorate histological features induced by optic nerve crush injury in rats. Immunohistochemistry and TUNEL staining results indicated that DGMI can also inhibit cell apoptosis via modulating MAPKs signaling pathways. In addition, treatment with DGMI markedly improved the morphological structures and decreased the apoptotic index in RGC-5 cells. Mechanistically, DGMI could significantly inhibit cell apoptosis by inhibiting p38, JNK and Erk1/2 activation. CONCLUSION The study shows that DGMI and ginkgolides inhibit RGCs apoptosis by impeding the activation of MAPKs signaling pathways in vivo and in vitro. Therefore, the present study provided scientific evidence for the underlying mechanism of DGMI and ginkgolides on optic nerve crush injury.
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Affiliation(s)
- Xiao-Xue Fan
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China
| | - Ze-Yu Cao
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China
| | - Min-Xuan Liu
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China
| | - Wen-Jun Liu
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China
| | - Zhi-Liang Xu
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China
| | - Peng-Fei Tu
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; Peking University, Beijing, 100871, China
| | - Zhen-Zhong Wang
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China
| | - Liang Cao
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China.
| | - Wei Xiao
- Jiangsu Kanion Pharmaceutical Co.Ltd., Lianyungang, 222001, China; State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, 222001, China; Modern Chinese Medicine Innovation Cluster and Digital Pharmaceutical Technology Platform, Lianyungang, 222001, China.
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Raposo A, Saraiva A, Ramos F, Carrascosa C, Raheem D, Bárbara R, Silva H. The Role of Food Supplementation in Microcirculation-A Comprehensive Review. BIOLOGY 2021; 10:616. [PMID: 34356471 PMCID: PMC8301032 DOI: 10.3390/biology10070616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022]
Abstract
(1) Background: Cardiovascular disease (CVD) is a major public health concern worldwide and a key cause of morbidity and mortality in developed countries. Accumulating evidence shows that several CVD forms are characterized by significant microcirculatory dysfunction, which may both cause and be caused by macrovascular disease, often preceding clinical manifestations by several years. Therefore, interest in exploring food supplements to prevent and restore microcirculation has grown. Given the continuous need to expand the available therapeutic arsenal for CVD, the food supplements market has recently grown and is expected to continue growing. (2) Methods: We provide an authoritative up-to-date comprehensive review of the impact of food supplementation on microcirculation by analyzing the European and American legal food supplements framework and the importance of food safety/food quality in this industry. We review the main literature about food bioactive compounds with a focus on microcirculation and some main food supplements with proven benefits. (3) Results: Despite a lack of scientific evidence, diet and microcirculatory function are clearly connected. The main food supplement examples in the literature with potential beneficial effects on microcirculation are: Ruscus aculeatus L., Centella asiatica L., Ginkgo biloba L., Salvia miltiorrhiza Bunge, Crataegus spp., Ginseng, Mangifera indica L., Aesculus hippocastanum L., Hamamelis virginiana L., and Vitis vinifera L. (4) Conclusions: Further clinical trials are necessary to better explore the effects of these food supplements.
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Affiliation(s)
- António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
| | - Ariana Saraiva
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain; (A.S.); (C.C.)
| | - Fernando Ramos
- Pharmacy Faculty, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, Rua Dom Manuel II, Apartado 55142, 4051-401 Oporto, Portugal
| | - Conrado Carrascosa
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain; (A.S.); (C.C.)
| | - Dele Raheem
- Northern Institute for Environmental and Minority Law (NIEM), Arctic Centre, University of Lapland, 96101 Rovaniemi, Finland;
| | - Rita Bárbara
- School of Sciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Av. Campo Grande 376, 1749-024 Lisbon, Portugal;
| | - Henrique Silva
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal
- Department of Pharmacy, Pharmacology and Health Technologies, Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisbon, Portugal
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Kandiah N, Chan YF, Chen C, Dasig D, Dominguez J, Han S, Jia J, Kim S, Limpawattana P, Ng L, Nguyen DT, Ong PA, Raya‐Ampil E, Saedon N, Senanarong V, Setiati S, Singh H, Suthisisang C, Trang TM, Turana Y, Venketasubramanian N, Yong FM, Youn YC, Ihl R. Strategies for the use of Ginkgo biloba extract, EGb 761 ® , in the treatment and management of mild cognitive impairment in Asia: Expert consensus. CNS Neurosci Ther 2021; 27:149-162. [PMID: 33352000 PMCID: PMC7816207 DOI: 10.1111/cns.13536] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761® , is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits. AIMS To present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761® in MCI. MATERIALS & METHODS The ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761® as a treatment option. RESULTS EGb 761® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761® may help delay progression from MCI to dementia in some individuals. DISCUSSION EGb 761® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761® may benefit MCI patients with underlying CVD. CONCLUSION As an expert group, we suggest it is clinically appropriate to incorporate EGb 761® as part of the multidomain intervention for MCI.
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Affiliation(s)
- Nagaendran Kandiah
- National Neuroscience InstituteSingaporeSingapore
- Duke‐NUSSingaporeSingapore
- Lee Kong Chian‐Imperial CollegeSingaporeSingapore
| | | | - Christopher Chen
- Departments of Pharmacology and Psychological MedicineYong Loo Lin School of MedicineMemory Aging and Cognition CentreNational University of SingaporeSingaporeSingapore
| | | | | | | | - Jianping Jia
- Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - SangYun Kim
- Department of NeurologySeoul National University College of Medicine and Seoul National University Bundang HospitalSeoulKorea
| | - Panita Limpawattana
- Srinakarind HospitalFaculty of MedicineKhon Kaen UniversityKhon KaenThailand
| | - Li‐Ling Ng
- Changi General HospitalSingaporeSingapore
| | - Dinh Toan Nguyen
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityHue CityVietnam
| | | | | | | | | | - Siti Setiati
- Department of Internal MedicineCipto Mangunkusumo HospitalJakartaIndonesia
| | - Harjot Singh
- Dr Harjot Singh's Neuropsychiatry Centre and HospitalAmritsarIndia
| | | | - Tong Mai Trang
- Department of NeurologyUniversity Medical CenterHo Chi Minh CityVietnam
| | - Yuda Turana
- School of Medicine and Health ScienceAtma Jaya Catholic University of IndonesiaJakartaIndonesia
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15
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Artemisinin-Ginkgo biloba extract combination therapy for Plasmodium yoelii. Parasitol Int 2020; 80:102226. [PMID: 33137498 DOI: 10.1016/j.parint.2020.102226] [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: 01/01/2020] [Revised: 03/02/2020] [Accepted: 10/22/2020] [Indexed: 11/21/2022]
Abstract
Malaria remains a widespread life-threatening infectious disease, leading to an estimated 219 million cases and around 435,000 deaths. After an unprecedented success, the antimalarial progress is at a standstill. Therefore, new methods are urgently needed to decrease drug resistant and enhance antimalarial efficacy. According to the alteration of erythrocyte biomechanical properties and the immune evasion mechanism of parasites, drugs, which can improve blood circulation, can be chosen to combine with antimalarial drugs for malaria treatment. Ginkgo biloba extract (GBE), one of drug for vascular disease, was used to combine with artemisinin for Plasmodium yoelii therapy. Artemisinin-GBE combination therapy (AGCT) demonstrated remarkable antimalarial efficacy by decreasing infection rate, improving blood microcirculation and modulating immune system. Besides, the expression of invasion related genes, such as AMA1, MSP1 and Py01365, can be suppressed by AGCT, hindering invasion process of merozoites. This new antimalarial strategy, combining antimalarial drugs with drugs that improve blood circulation, may enhance the antimalarial efficacy and ameliorate restoration ability, proving a potential method for finding ideal compatible drugs to improve malaria therapy.
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Update on the Effects of Antioxidants on Diabetic Retinopathy: In Vitro Experiments, Animal Studies and Clinical Trials. Antioxidants (Basel) 2020; 9:antiox9060561. [PMID: 32604941 PMCID: PMC7346101 DOI: 10.3390/antiox9060561] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022] Open
Abstract
Current therapies for diabetic retinopathy (DR) incorporate blood glucose and blood pressure control, vitrectomy, photocoagulation, and intravitreal injections of anti-vascular endothelial growth factors or corticosteroids. Nonetheless, these techniques have not been demonstrated to completely stop the evolution of this disorder. The pathophysiology of DR is not fully known, but there is more and more evidence indicating that oxidative stress is an important mechanism in the progression of DR. In this sense, antioxidants have been suggested as a possible therapy to reduce the complications of DR. In this review we aim to assemble updated information in relation to in vitro experiments, animal studies and clinical trials dealing with the effect of the antioxidants on DR.
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Labkovich M, Jacobs EB, Bhargava S, Pasquale LR, Ritch R. Ginkgo Biloba Extract in Ophthalmic and Systemic Disease, With a Focus on Normal-Tension Glaucoma. Asia Pac J Ophthalmol (Phila) 2020; 9:215-225. [PMID: 32282348 PMCID: PMC7299225 DOI: 10.1097/apo.0000000000000279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
Glaucoma is a neurodegenerative eye disease that results in retinal ganglion cell loss and ultimately loss of vision. Elevated intraocular pressure (IOP) is the most common known risk factor for retinal ganglion cell damage and visual field loss, and the only modifiable risk factor proven to reduce the development and progression of glaucoma. This has greatly influenced our approach and assessment in terms of diagnosis and treatment. However, as many as ≥50% of patients with progressive vision loss from primary open angle glaucoma without IOP elevation (≤22 mm Hg) have been reported in the United States and Canada; 90% in Japan and 80% in Korea. Extensive research is currently underway to identify the etiology of risk factors for glaucoma other than or in addition to elevated IOP (so-called "normal-tension" glaucoma; NTG) and use this knowledge to expand available treatment options. Currently, Food and Drug Administration-approved medications for glaucoma exclusively target elevated IOP, suggesting the need for additional approaches to treatment options beyond the current scope as the definition of glaucoma changes to encompass cellular and molecular mechanisms. This review focuses on alternative medical approaches, specifically Ginkgo Biloba extract, as a potential treatment option for normal-tension glaucoma.
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Affiliation(s)
- Margarita Labkovich
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Erica B. Jacobs
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Siddharth Bhargava
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Louis R. Pasquale
- Department of Ophthalmology, Eye and Vision Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
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Kandiah N, Ong PA, Yuda T, Ng LL, Mamun K, Merchant RA, Chen C, Dominguez J, Marasigan S, Ampil E, Nguyen VT, Yusoff S, Chan YF, Yong FM, Krairit O, Suthisisang C, Senanarong V, Ji Y, Thukral R, Ihl R. Treatment of dementia and mild cognitive impairment with or without cerebrovascular disease: Expert consensus on the use of Ginkgo biloba extract, EGb 761 ®. CNS Neurosci Ther 2020; 25:288-298. [PMID: 30648358 PMCID: PMC6488894 DOI: 10.1111/cns.13095] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
Background The Ginkgo biloba special extract, EGb 761® has been widely used in the treatment of neuropsychiatric disorders, including Alzheimer’s disease (AD). Methods To guide clinical practice in the Asian region, the Asian Clinical Expert Group on Neurocognitive Disorders compiled evidence‐based consensus recommendations regarding the use of EGb 761® in neurocognitive disorders with/without cerebrovascular disease. Results Key randomized trials and robust meta‐analyses have demonstrated significant improvement in cognitive function, neuropsychiatric symptoms, activities of daily living (ADL) and quality of life with EGb 761®versus placebo in patients with mild‐to‐moderate dementia. In those with mild cognitive impairment (MCI), EGb 761® has also demonstrated significant symptomatic improvement versus placebo. World Federation of Societies of Biological Psychiatry guidelines list EGb 761® with the same strength of evidence as acetylcholinesterase inhibitors and N‐methyl‐D‐aspartate (NMDA) antagonists e.g. memantine (Grade 3 recommendation; Level B evidence). Only EGb 761® had Level B evidence in improving cognition, behaviour, and ADL in both AD and vascular dementia patients. Safety analyses show EGb 761® to have a positive risk‐benefit profile. While concerns have been raised regarding a possible increased bleeding risk, several randomized trials and two meta‐analyses have not supported this association. Conclusions The Expert Group foresee an important role for EGb 761®, used alone or as an add‐on therapy, in the treatment of MCI and dementias, particularly when patients do not derive benefit from acetylcholinesterase inhibitors or NMDA antagonists. EGb 761® should be used in alignment with local clinical practice guidelines.
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Affiliation(s)
- Nagaendran Kandiah
- Duke-NUS Singapore, National Neuroscience Institute, Singapore, Singapore
| | | | - Turana Yuda
- School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Li-Ling Ng
- Changi General Hospital, Singapore, Singapore
| | - Kaysar Mamun
- Singapore General Hospital, Singapore, Singapore
| | | | - Christopher Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | | | | | | | | | | | | | | | | | | | | | - Yong Ji
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Ralf Ihl
- Alexian Hospital, Krefeld, Germany
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Wang L, Zhao X, Yang F, Wu W, Liu Y, Wang L, Wang L, Wang Z. Enhanced bioaccessibility
in vitro
and bioavailability of Ginkgo biloba extract nanoparticles prepared by liquid anti‐solvent precipitation. Int J Food Sci Technol 2019. [DOI: 10.1111/ijfs.14141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lingling Wang
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
| | - Xiuhua Zhao
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
| | - Fengjian Yang
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
| | - Weiwei Wu
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
| | - Yanjie Liu
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
| | - Li Wang
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
| | - Lu Wang
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
| | - Zijian Wang
- Key Laboratory of Forest Plant Ecology Ministry of Education Northeast Forestry University Harbin Heilongjiang 150040 China
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Onaolapo AY, Obelawo AY, Onaolapo OJ. Brain Ageing, Cognition and Diet: A Review of the Emerging Roles of Food-Based Nootropics in Mitigating Age-related Memory Decline. Curr Aging Sci 2019; 12:2-14. [PMID: 30864515 PMCID: PMC6971896 DOI: 10.2174/1874609812666190311160754] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/16/2019] [Accepted: 02/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Age-related cognitive decline has been suggested to result from an increase in the brain neuron loss, which is attributable to continued derangement of the brain's oxidant/ antioxidant balance. Increased oxidative stress and a concomitant decrease in the brain's antioxidant defense system have been associated with functional senescence and organismal ageing. However, nature has configured certain foods to be rich sources of nootropic agents, with research showing that increased consumption of such foods or food ingredients may be protective against ageing-related memory decline. This knowledge is becoming increasingly valuable in an era when the boundary that separates food from medicine is becoming blurred. In this review, we examine extant literature dealing with the impact of ageing on brain structure and function, with an emphasis on the roles of oxidative stress. Secondly, we review the benefits of food-based antioxidants with nootropic effects and/or food-based nootropic agents in mitigating memory decline; with a view to improving our understanding of likely mechanisms. We also highlight some of the limitations to the use of food-based nootropics and suggest ways in which they can be better employed in the clinical management of age-related cognitive decline. CONCLUSION While it is known that the human brain endures diverse insults in the process of ageing, food-based nootropics are likely to go a long way in mitigating the impacts of these insults. Further research is needed before we reach a point where food-based nootropics are routinely prescribed.
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Affiliation(s)
| | | | - Olakunle James Onaolapo
- Address correspondence to this author at the Behavioural Neuroscience/Neuropharmacology Unit, Department of Pharmacology, Ladoke
Akintola University of Technology, Osogbo, Osun State, Nigeria;
Tel: 2347031986101; E-mail:
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Abstract
BACKGROUND Diabetic retinopathy is one of the major causes of blindness and the number of cases has risen in recent years. Herbal medicine has been used to treat diabetes and its complications including diabetic retinopathy for thousands of years around the world. However, common practice is not always evidence-based. Evidence is needed to help people with diabetic retinopathy or doctors to make judicious judgements about using herbal medicine as treatment. OBJECTIVES To evaluate the effectiveness and harm of single herbal medicine for diabetic retinopathy. SEARCH METHODS We searched CENTRAL, which contains the Cochrane Eyes and Vision Trials Register, MEDLINE, Embase, OpenGrey, the ISRCTN registry, ClinicalTrials.gov and the ICTRP. The date of the search was 12 June 2018. We also searched the following Chinese databases in June 2013: Chinese BioMedical Literature Database (CBM), Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), Wanfang China Dissertation Database (CDDB), Wanfang China Conference Paper Database (CCPD) and the Index to Chinese Periodical Literature. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that investigated the effects of any single herb (or extracts from a single herb) as a treatment for people with diabetic retinopathy. We considered the following comparators: placebo, no treatment, non-herbal (conventional) medicine or surgical treatment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias in the studies. Our prespecified outcomes were: progression of diabetic retinopathy, visual acuity, microaneurysms and haemorrhages in the retina, blood glycated haemoglobin A1c (HbA1c) (%) and adverse effects. We performed meta-analyses using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 10 studies involving 754 participants, of which nine were conducted in China and one in Poland. In all studies, participants in both groups received conventional treatment for diabetic retinopathy which included maintaining blood glucose and lipids using medicines and keeping a stable diabetic diet. In three studies, the comparator group also received an additional potentially active comparator in the form of a vasoprotective drug. The single herbs or extracts included Ruscus extract tablet, Sanqi Tongshu capsule, tetramethylpyrazine injection, Xueshuantong injection, Puerarin injection and Xuesaitong injection. The Sanqi Tongshu capsule, Xueshuantong injection and Xuesaitong injection were all made from the extract of Radix Notoginseng (San qi) and the main ingredient was sanchinoside. The risk of bias was high in all included studies mainly due to lack of masking (blinding). None of the studies reported the primary outcome of this review, progression of retinopathy.Combined analysis of herbal interventions suggested that people who took these herbs in combination with conventional treatment may have been more likely to gain 2 or more lines of visual acuity compared to people who did not take these herbs when compared to conventional intervention alone at the end of treatment (RR 1.26, 95% CI 1.08 to 1.48; 5 trials, 541 participants; low-certainty evidence). Subgroup analyses based on the different single herbs found no evidence for different effects of different herbs, but the power of this analysis was low. One study reported Sanqi Tongshu capsule might be associated with a greater reduction in microaneurysms and haemorrhages in the retina (very low-certainty evidence). The pooled analysis of two studies on tetramethylpyrazine or Xueshuantong injection showed such herbs may have had little effect on lowering HbA1c (MD 0.00, 95% CI -0.58 to 0.58; 215 participants; low-certainty evidence).There was very low-certainty evidence on adverse events. Two studies reported minor adverse events such as uncomfortable stomach, urticaria, dizziness and headache. There was no report of observation on adverse events in the other studies. AUTHORS' CONCLUSIONS No conclusions could be drawn about the effect of any single herb or herbal extract on diabetic retinopathy from the current available evidence. It was difficult to exclude the placebo effect as a possible explanation for observed differences due to the lack of placebo control in the included studies. Further adequately designed trials are needed to establish the evidence.
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Affiliation(s)
- Hong Wei Zhang
- The Chinese University of Hong KongSchool of Chinese MedicineShatin, N.T., Hong KongChina
| | - Hongying Zhang
- Capital Medical UniversitySchool of Traditional Chinese Medicine & PharmacologyNo. 10 of the Xitoutiao outside the YouAnmenBeijingChina
| | - Suzanne J Grant
- University of Western SydneyNational Institute of Complementary MedicineLocked Bag 1797PenrithSydneyNew South WalesAustralia2751
| | - Xia Wan
- Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences & School of Basic Medicine of Peking Union Medical CollegeDepartment of Epidemiology and Statistics5 Dong Dan San TiaoBeijingChina100005
| | - Guochun Li
- Nanjing University of Chinese MedicineDepartment of Epidemiology and statisticsNo.138 Xinling Avenue, Nanjing,ChinaNanjingJiangsu ProvinceChina
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Parveen A, Kim JH, Oh BG, Subedi L, Khan Z, Kim SY. Phytochemicals: Target-Based Therapeutic Strategies for Diabetic Retinopathy. Molecules 2018; 23:E1519. [PMID: 29937497 PMCID: PMC6100391 DOI: 10.3390/molecules23071519] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023] Open
Abstract
Background: A variety of causative factors are involved in the initiation of diabetic retinopathy (DR). Current antidiabetic therapies are expensive and not easily accessible by the public. Furthermore, the use of multiple synthetic drugs leads to severe side effects, which worsen the diabetic patient’s condition. Medicinal plants and their derived phytochemicals are considered safe and effective treatment and their consumption can reduce the DR risk. In this article, we discuss a variety of medicinal plants, and their noteworthy bio-active constituents, that will be utilized as target based therapeutic strategies for DR. Methods: A broad-spectrum study was conducted using published English works in various electronic databases including Science Direct, PubMed, Scopus, and Google Scholar. Results: Targeting the multiple pathological factors including ROS, AGEs formation, hexosamine flux, PARP, PKC, and MAPK activation through variety of bioactive constituents in medicinal plants, diabetes progression can be delayed with improved loss of vision. Conclusions: Data reveals that traditional herbs and their prominent bioactive components control and normalize pathological cellular factors involved in DR progression. Therefore, studies should be carried out to explore the protective retinopathy effects of medicinal plants using experimental animal and humans models.
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Affiliation(s)
- Amna Parveen
- Department of Pharmacognosy, College of Pharmacy, Government College University Faisalabad, Faisalabad 3800, Pakistan.
- College of Pharmacy, Gachon University, Hambakmoero, Yeonsu-gu, Incheon 406-799, Korea.
| | - Jin Hyun Kim
- College of Pharmacy, Gachon University, Hambakmoero, Yeonsu-gu, Incheon 406-799, Korea.
| | - Byeong Gyu Oh
- College of Pharmacy, Gachon University, Hambakmoero, Yeonsu-gu, Incheon 406-799, Korea.
| | - Lalita Subedi
- College of Pharmacy, Gachon University, Hambakmoero, Yeonsu-gu, Incheon 406-799, Korea.
| | - Zahra Khan
- College of Pharmacy, Gachon University, Hambakmoero, Yeonsu-gu, Incheon 406-799, Korea.
| | - Sun Yeou Kim
- College of Pharmacy, Gachon University, Hambakmoero, Yeonsu-gu, Incheon 406-799, Korea.
- Gachon Institute of Pharmaceutical Science, Gachon University, Hambakmoe-ro, Yeonsu-gu, Incheon 406-799, Korea.
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23
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Abstract
PURPOSE OF REVIEW This study will review the research on the effect of ginkgo biloba extract (GBE) on patients with glaucoma. RECENT FINDINGS GBE appears to increase ocular blood flow in those with glaucoma. However, data on visual field outcomes are inconclusive. SUMMARY GBE has been shown to have antioxidant and vascular effects, making it potentially effective in treating glaucoma. Published data are limited but show an increase in ocular blood flow after GBE administration. Conclusive evidence is lacking regarding the effect of GBE on clinical outcomes in glaucoma patients such as visual field performance.
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The Role of Liuwei Dihuang Pills and Ginkgo Leaf Tablets in Treating Diabetic Complications. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:7931314. [PMID: 28077949 PMCID: PMC5204101 DOI: 10.1155/2016/7931314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/27/2016] [Indexed: 12/15/2022]
Abstract
Objective. To observe the clinical prophylactic and therapeutic efficacy of Liuwei Dihuang Pills and Ginkgo Leaf Tablets for type 2 diabetic vascular complications. Methods. It was a randomized, double-blind and placebo-controlled clinical trial. 140 outpatients with type 2 diabetes were recruited and randomly divided into the treatment group and control group. The two groups were given basic therapy (management of blood sugar, blood pressure, etc.). Additionally, the treatment group was given Liuwei Dihuang Pills and Ginkgo Leaf Tablets, while the control group was given Liuwei Dihuang Pills and Ginkgo Leaf Tablets placebos. All subjects were followed up for consecutive 36 months and observed monthly. The clinical data as urinary microalbumin to urinary creatinine ratio (Umalb/cr), carotid intima-media thickness (IMT), diabetic nephropathy (DN) and diabetic retinopathy (DR) prevalence, cardiovascular and cerebrovascular events, blood glucose, and blood pressure were collected and analyzed statistically. Results. After 36-month treatment, the Umalb/cr level and DN and DR prevalence in treatment group were all significantly lower than control group (P < 0.05). However, the IMT level and the incidence of cardiovascular and cerebrovascular events were not significantly different between the two groups (P > 0.05). Conclusions. Liuwei Dihuang Pills and Ginkgo Leaf Tablets are beneficial to diabetic microvascular complications, while the efficacy to diabetic macrovascular complications needs more observations.
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He L, Wang H, Gu C, He X, Zhao L, Tong X. Administration of Traditional Chinese Blood Circulation Activating Drugs for Microvascular Complications in Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2016; 2016:1081657. [PMID: 27830156 PMCID: PMC5088336 DOI: 10.1155/2016/1081657] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 01/13/2023] Open
Abstract
Traditional Chinese medicine (TCM) is an important complementary strategy for treating diabetes mellitus (DM) in China. Traditional Chinese blood circulation activating drugs are intended to guide an overall approach to the prevention and treatment of microvascular complications of DM. The core mechanism is related to the protection of the vascular endothelium and the basement membrane. Here, we reviewed the scientific evidence underpinning the use of blood circulation activating drugs to prevent and treat DM-induced microvascular complications, including diabetic nephropathy (DN), diabetic peripheral neuropathy (DPN), and diabetic retinopathy (DR). Furthermore, we summarized the effects and mechanism of TCM on improving blood rheology, inhibiting aggregation of platelet, forming advanced glycation end products (AGEs), regulating oxidative stress, reducing blood fat, and improving lipid metabolism. The paper provides a new theoretical basis for the clinical practice of TCM in the prevention and treatment of DM and its microvascular complications.
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Affiliation(s)
- Lisha He
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Han Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Chengjuan Gu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xinhui He
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Linhua Zhao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xiaolin Tong
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
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Zhu J, Shi R, Chen S, Dai L, Shen T, Feng Y, Gu P, Shariff M, Nguyen T, Ye Y, Rao J, Xing G. The Relieving Effects of BrainPower Advanced, a Dietary Supplement, in Older Adults with Subjective Memory Complaints: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:7898093. [PMID: 27190539 PMCID: PMC4842387 DOI: 10.1155/2016/7898093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 01/11/2023]
Abstract
Subjective memory complaints (SMCs) are common in older adults that can often predict further cognitive impairment. No proven effective agents are available for SMCs. The effect of BrainPower Advanced, a dietary supplement consisting of herbal extracts, nutrients, and vitamins, was evaluated in 98 volunteers with SMCs, averaging 67 years of age (47-88), in a randomized, double-blind, placebo-controlled trial. Subjective hypomnesis/memory loss (SML) and attention/concentration deficits (SAD) were evaluated before and after 12-week supplementation of BrainPower Advanced capsules (n = 47) or placebo (n = 51), using a 5-point memory questionnaire (1 = no/slight, 5 = severe). Objective memory function was evaluated using 3 subtests of visual/audio memory, abstraction, and memory recall that gave a combined total score. The BrainPower Advanced group had more cases of severe SML (severity ⩾ 3) (44/47) and severe SAD (43/47) than the placebo group (39/51 and 37/51, < 0.05, < 0.05, resp.) before the treatment. BrainPower Advanced intervention, however, improved a greater proportion of the severe SML (29.5%)(13/44) (P < 0.01) and SAD (34.9%)(15/43)(P < 0.01) than placebo (5.1% (2/39) and 13.5% (5/37), resp.). Thus, 3-month BrainPower Advanced supplementation appears to be beneficial to older adults with SMCs.
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Affiliation(s)
- Jingfen Zhu
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Rong Shi
- School of Public Health, Shanghai University of TCM, Shanghai 201203, China
| | - Su Chen
- Si-Tang Community Health Service Center of Shanghai, Shanghai 200431, China
| | - Lihua Dai
- Department of Emergency Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Tian Shen
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Yi Feng
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Pingping Gu
- Southern California Kaiser Sunset, 4867 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Mina Shariff
- Department of Research, DRM Resources, 1683 Sunflower Avenue, Costa Mesa, CA 92626, USA
| | - Tuong Nguyen
- Department of Research, DRM Resources, 1683 Sunflower Avenue, Costa Mesa, CA 92626, USA
| | - Yeats Ye
- Maryland Population Research Center, University of Maryland, College Park, MD 20742, USA
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Guoqiang Xing
- Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University, Nanchong Central Hospital, Nanchong 637000, China
- Lotus Biotech.com LLC, John Hopkins University-MCC, 9601 Medical Center Drive, Rockville, MD 20850, USA
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Zheng B, Xing G, Bi Y, Yan G, Wang J, Cheng Y, Liu Y, Ashraf MA, Xie J. Comparative pharmacokinetics of a proliposome formulation of Ginkgo biloba extract and Ginaton in rats by a sensitive ultra performance liquid chromatography-tandem mass spectrometry method. Saudi J Biol Sci 2015; 23:54-65. [PMID: 26858539 PMCID: PMC4705248 DOI: 10.1016/j.sjbs.2015.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/15/2015] [Accepted: 08/16/2015] [Indexed: 11/13/2022] Open
Abstract
As a novel oral drug delivery system, proliposome was applied to improve the solubility of active components of Ginkgo biloba extract (GbE). There are currently few reports focusing on the pharmacokinetic characteristics of proliposome of GbE (GbP). A rapid and sensitive ultra performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) method for the simultaneous quantification of active components of GbP and a commercial tablet product (Ginaton) in rat plasma was developed and successfully validated. The method was applied to the comparative pharmacokinetic evaluation of GbP and Ginaton in rat plasma. The results indicated that GbP has a significant effect on absorption, elimination and bioavailability of flavonoids and terpenoid lactones in comparison with Ginaton. The obtained results would be helpful for evaluating the absorption mechanism in the gastrointestinal tract in pharmacokinetic level and guiding the development of the novel oral drug delivery system.
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Affiliation(s)
- Bin Zheng
- College of Life Sciences, Jinlin University, Changchun 130012, China
| | - Gaoyang Xing
- College of Life Sciences, Jinlin University, Changchun 130012, China
| | - Ye Bi
- College of Life Sciences, Jinlin University, Changchun 130012, China
| | - Guodong Yan
- College of Life Sciences, Jinlin University, Changchun 130012, China
| | - Jing Wang
- College of Life Sciences, Jinlin University, Changchun 130012, China
| | - Yingkun Cheng
- College of Life Sciences, Jinlin University, Changchun 130012, China
| | - Yan Liu
- College of Life Sciences, Jinlin University, Changchun 130012, China
| | - Muhammad Aqeel Ashraf
- Department of Geology, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia; Faculty of Science & Natural Resources, Universiti Malaysia Sabah, 88400 Kota Kinabalu, Sabah, Malaysia
| | - Jing Xie
- College of Life Sciences, Jinlin University, Changchun 130012, China
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Wang W, Kang Q, Liu N, Zhang Q, Zhang Y, Li H, Zhao B, Chen Y, Lan Y, Ma Q, Wu Q. Enhanced dissolution rate and oral bioavailability of Ginkgo biloba extract by preparing solid dispersion via hot-melt extrusion. Fitoterapia 2015; 102:189-97. [DOI: 10.1016/j.fitote.2014.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/01/2014] [Accepted: 10/05/2014] [Indexed: 11/29/2022]
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Chen F, Li L, Xu F, Sun Y, Du F, Ma X, Zhong C, Li X, Wang F, Zhang N, Li C. Systemic and cerebral exposure to and pharmacokinetics of flavonols and terpene lactones after dosing standardized Ginkgo biloba leaf extracts to rats via different routes of administration. Br J Pharmacol 2014; 170:440-57. [PMID: 23808355 DOI: 10.1111/bph.12285] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 06/07/2013] [Accepted: 06/24/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Flavonols and terpene lactones are putatively responsible for the properties of Ginkgo biloba leaf extracts that relate to prevention and treatment of cardiovascular disease and cerebral insufficiency. Here, we characterized rat systemic and cerebral exposure to these ginkgo compounds after dosing, as well as the compounds' pharmacokinetics. EXPERIMENTAL APPROACH Rats received single or multiple doses of ShuXueNing injection (prepared from GBE50 for intravenous administration) or GBE50 (a standardized extract of G. biloba leaves for oral administration). Brain delivery of the ginkgo compounds was assessed with microdialysis. Various rat samples were analysed using liquid chromatography/mass spectrometry. KEY RESULTS Slow terminal elimination features of the flavonols counterbalanced the influence of poor oral bioavailability on their systemic exposure levels, which also resulted in significant accumulation of the compounds in plasma during the subchronic treatment with ShuXueNing injection and GBE50. Unlike the flavonols, the terpene lactones had poor enterohepatic circulation due to their rapid renal excretion and unknown metabolism. The flavonol glycosides occurred as major forms in plasma after dosing with ShuXueNing injection, while the flavonol aglycone conjugates were predominant in plasma after dosing with GBE50. Cerebral exposure was negligible for the flavonols and low for the terpene lactones. CONCLUSION AND IMPLICATIONS Unlike the significant systemic exposure levels, the levels of cerebral exposure to the flavonols and terpene lactones are low. The elimination kinetic differences between the two classes of ginkgo compounds influence their relative systemic exposure levels. The information gained is relevant to linking ginkgo administration to the medicinal effects.
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Affiliation(s)
- Feng Chen
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, Shanghai, China; Hainan Medical University, Haikou, China
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Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine. Int J Otolaryngol 2014; 2014:682439. [PMID: 25057270 PMCID: PMC4099171 DOI: 10.1155/2014/682439] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/30/2014] [Indexed: 12/19/2022] Open
Abstract
A multicenter clinical trial was performed to compare the efficacy and safety of Ginkgo biloba extract EGb 761 and betahistine at recommended doses in patients with vertigo. One hundred and sixty patients (mean age 58 years) were randomly assigned to double-blind treatment with EGb 761 (240 mg per day) or betahistine (32 mg per day) for 12 weeks. An 11-point numeric analogue scale, the Vertigo Symptom Scale—short form, the Clinical Global Impression Scales and the Sheehan Disability Scale were used as outcome measures. Both treatment groups were comparable at baseline and improved in all outcome measures during the course of treatment. There was no significant intergroup difference with regard to changes in any outcome measure. Numerically, improvements of patients receiving EGb 761 were slightly more pronounced on all scales. Clinical global impression was rated “very much improved” or “much improved” in 79% of patients treated with EGb 761 and in 70% receiving betahistine. With 27 adverse events in 19 patients, EGb 761 showed better tolerability than betahistine with 39 adverse events in 31 patients. In conclusion, the two drugs were similarly effective in the treatment of vertigo, but EGb 761 was better tolerated. This trial is registered with controlled-trials.com ISRCTN02262139.
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Ginkobiloba Extract Improves Working Memory Performance in Middle-Aged Women: Role of Asymmetry of Prefrontal Cortex Activity During a Working Memory Task. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 812:295-301. [DOI: 10.1007/978-1-4939-0620-8_39] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Ginkgo biloba Extract for Patients with Early Diabetic Nephropathy: A Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:689142. [PMID: 23533513 PMCID: PMC3595672 DOI: 10.1155/2013/689142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 09/29/2012] [Indexed: 01/01/2023]
Abstract
Objectives. To evaluate the effectiveness and safety of a Ginkgo biloba extract for patients with early diabetic nephropathy. Methods. Randomised controlled trials (RCTs) conducted on adults with early diabetic nephropathy which used Gingko biloba extract were included. The major databases were searched, and manufacturers of Gingko biloba products were contacted for information on any published or unpublished studies. Two authors independently extracted the data from the included studies. Data analysis was conducted using Review Manager 5.0 software. Results. Sixteen RCTs were included. Ginkgo biloba extract decreased the urinary albumin excretion rate (UAER), fasting blood glucose (FBG), serum creatinine (SCR), and blood urea nitrogen (BUN). The extract also improved hemorheology. The methodological quality in the included studies was low. The explicit generation of the allocation sequence was described in only 6 trials. None of the included trials were confirmed to use blinding. Three studies had observed adverse events. One study using angiotensin-converting enzyme inhibitor (ACEi) reported mild cough in both groups. No serious adverse effects were reported. Conclusions. Gingko biloba extract is a valuable drug which has prospect in treating early diabetic nephropathy, especially with high UAER baseline level. The safety for early diabetic nephropathy is uncertain. Long-term, double-blinded RCTs with large sample sizes are still needed to provide stronger evidence.
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Saito K, Odashiro K, Maruyama T, Akashi K, Mawatari S, Fujino T. Improvement of diabetic or obese patients' erythrocyte deformability by the program of the brain-oriented obesity control system (BOOCS). J Physiol Sci 2012; 62:445-51. [PMID: 22843251 PMCID: PMC10717795 DOI: 10.1007/s12576-012-0221-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
Diabetes is characterized by absolute or relative insulin deficiency complicated with microangiopathy, whereas obesity stems from insulin resistance. A psychosomatic approach to obesity and diabetes has been highlighted, including the brain-oriented obesity control system (BOOCS). Impaired deformability of erythrocytes in obese or diabetic patients is closely linked to disturbed microcirculation, and improvement of abnormal erythrocyte rheology is a prerequisite for the prevention and treatment of microangiopathy. Therefore, erythrocyte filterability, whole cell deformability defined as flow rate of erythrocyte suspension relative to that of saline, was assessed by the nickel-mesh-filtration technique. Subjects included healthy controls (group A, n = 14), diabetic, non-obese participants (group B, n = 29), and non-diabetic, obese participants (group C, n = 32) in the 6-month BOOCS program, and most patients in groups B and C (86.9 %) completed this program. Baseline mean erythrocyte filterabilities were 89.4 ± 1.7 % in group A, 82.8 ± 5.2 % in group B, and 84.1 ± 5.6 % in group C, showing significant intergroup differences (p < 0.001). This program significantly improved (p < 0.001) the impaired erythrocyte filterability in groups B (87.9 ± 4.4 %) and C (88.5 ± 3.7 %). Declines in HbA1c (p = 0.387) and body mass index (p = 0.479) were not correlated to this improvement. These findings indicate that the mechanisms of BOOCS-induced improvement of diabetic or obese patients' erythrocyte deformability are multifactorial, and that the BOOCS program for these patients is a holistic, cost-effective, and highly compliant approach possibly ameliorating microcirculation.
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Affiliation(s)
- K. Saito
- BOOCS Clinic Fukuoka, Fukuoka, 812-0025 Japan
| | - K. Odashiro
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582 Japan
| | - T. Maruyama
- Institute of Health Science, Kyushu University, Kasuga Kohen 6-1, Kasuga, 816-8580 Japan
| | - K. Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582 Japan
| | - S. Mawatari
- Institute of Rheological Function of Foods Co. Ltd., Hisayama, 811-2501 Japan
| | - T. Fujino
- BOOCS Clinic Fukuoka, Fukuoka, 812-0025 Japan
- Institute of Rheological Function of Foods Co. Ltd., Hisayama, 811-2501 Japan
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Shim SH, Kim JM, Choi CY, Kim CY, Park KH. Ginkgo biloba extract and bilberry anthocyanins improve visual function in patients with normal tension glaucoma. J Med Food 2012; 15:818-23. [PMID: 22870951 PMCID: PMC3429325 DOI: 10.1089/jmf.2012.2241] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/29/2012] [Indexed: 11/12/2022] Open
Abstract
Ginkgo biloba extract (GBE) and anthocyanins are considered beneficial for various vascular diseases. This study was performed to evaluate the effect of GBE and anthocyanins on visual function in patients with normal tension glaucoma (NTG) based on the vascular theory of mechanisms of glaucomatous optic nerve damage. Retrospective analysis was carried out by a chart review of 332 subjects (209 men and 123 women) who were treated with anthocyanins (n=132), GBE (n=103), or no medication (control, n=97). Humphrey Visual Field (HVF) test, logarithm of the minimal angle of resolution best-corrected visual acuity (logMAR BCVA), intraocular pressure, blood pressure, and fasting blood glucose were determined before and after treatment. Complete ocular and systemic examinations were performed. The mean follow-up duration was 23.82±9.84 (range, 12-59) months; the mean anthocyanin treatment duration was 24.32±10.43 (range, 6-53) months, and the mean GBE treatment duration was 23.81±10.36 months (range, 6-59) months. After anthocyanin treatment, the mean BCVA for all eyes improved from 0.16 (±0.34) to 0.11 (±0.18) logMAR units (P=.008), and HVF mean deviation improved from -6.44 (±7.05) to -5.34 (±6.42) (P=.001). After GBE treatment, HVF mean deviation improved from -5.25 (±6.13) to -4.31 (±5.60) (P=.002). A generalized linear model demonstrated that the final BCVA was not affected by demographic differences among the groups. These results suggest that anthocyanins and GBE may be helpful in improving visual function in some individuals with NTG.
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Affiliation(s)
- Seong Hee Shim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Mo Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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Jang SH, Lee EK, Lim MJ, Hong NJ, Oh IS, Jin YW, Jeong HS, Jeong YS, Lee JC, Jang YS. Suppression of lipopolysaccharide-induced expression of inflammatory indicators in RAW 264.7 macrophage cells by extract prepared from Ginkgo biloba cambial meristematic cells. PHARMACEUTICAL BIOLOGY 2012; 50:420-428. [PMID: 22129367 DOI: 10.3109/13880209.2011.610805] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Ginkgo biloba L. (Ginkgoaceae) leaves have been used as an herbal medicine that has a complex range of biological activities. However, when we consider that biological activity of plant extracts is highly variable according to the source, location, and harvest season, technology to obtain the natural products with homogeneity is extremely important. OBJECTIVE We established the technology to obtain the cambial meristematic cells (CMCs) of Ginkgo biloba, which were expanded in vitro with homogeneity through a suspension culture and then determined the anti-inflammatory activity of fractionated samples prepared from the ethanol extract of CMCs. MATERIALS AND METHODS We determined the anti-inflammatory activity of samples using lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophage cells. Especially, influence of sample treatment on the expression of various indicators, such as nitric oxide (NO), inducible nitric oxide synthase (iNOS), cyclooxygenase (COX)-2, mitogen-activated protein (MAP) kinases, transcription factor, and cytokines, involved in inflammatory activity was assessed. RESULTS A fractionated sample demonstrated 53.4% inhibition of LPS-induced NO production from the cells. Additionally, when fractionated samples were treated, iNOS and COX-2 expressions were almost completely suppressed. Fractionated samples also inhibited the phosphorylation of LPS-induced extracellular signal-regulated (ERK) and p38 MAP kinases more than 60%. IκB phosphorylation and subsequent nuclear factor (NF)-κB activation were also suppressed by fractionated samples. The expression of pro-inflammatory cytokines, IL-6 and tumor necrosis factor (TNF)-α, was significantly inhibited by the sample treatment. DISCUSSION AND CONCLUSION Fractionated samples from the ethanol extract of Ginkgo biloba CMCs could potentially be the source of a powerful anti-inflammatory substance.
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Affiliation(s)
- Sun-Hee Jang
- Department of Molecular Biology and the Institute for Molecular Biology and Genetics, Chonbuk National University, Jeonju, Korea
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Wilkinson JT, Fraunfelder FW. Use of Herbal Medicines and Nutritional Supplements in Ocular Disorders. Drugs 2011; 71:2421-34. [DOI: 10.2165/11596840-000000000-00000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Cong WN, Tao RY, Tian JY, Zhao J, Liu Q, Ye F. EGb761, an extract of Ginkgo biloba leaves, reduces insulin resistance in a high-fat-fed mouse model. Acta Pharm Sin B 2011. [DOI: 10.1016/j.apsb.2011.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Cheng HC, Chan CM, Yeh SI, Yu JH, Liu DZ. The Hemorheological Mechanisms in Normal Tension Glaucoma. Curr Eye Res 2011; 36:647-53. [DOI: 10.3109/02713683.2010.521876] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chung TW, Liu DZ, Yang JS. Effects of interpenetration of thermo-sensitive gels by crosslinking of chitosan on nasal delivery of insulin: In vitro characterization and in vivo study. Carbohydr Polym 2010. [DOI: 10.1016/j.carbpol.2010.04.068] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Snitz BE, O'Meara ES, Carlson MC, Arnold AM, Ives DG, Rapp SR, Saxton J, Lopez OL, Dunn LO, Sink KM, DeKosky ST. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA 2009; 302:2663-70. [PMID: 20040554 PMCID: PMC2832285 DOI: 10.1001/jama.2009.1913] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning. OBJECTIVE To determine whether G. biloba slows the rates of global or domain-specific cognitive decline in older adults. DESIGN, SETTING, AND PARTICIPANTS The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years. INTERVENTION Twice-daily dose of 120-mg extract of G. biloba (n = 1545) or identical-appearing placebo (n = 1524). MAIN OUTCOME MEASURES Rates of change over time in the Modified Mini-Mental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores of individual tests. RESULTS Annual rates of decline in z scores did not differ between G. biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.032-0.050), attention (0.043; 95% CI, 0.037-0.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.097-0.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment), but there were no differences in rates of change between treatment groups (for 3MSE, P = .71; for ADAS-Cog, P = .97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education, APOE*E4 allele, or baseline mild cognitive impairment (P > .05). CONCLUSION Compared with placebo, the use of G. biloba, 120 mg twice daily, did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00010803.
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Affiliation(s)
- Beth E Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- Hong Wei Zhang
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Hongying Zhang
- Capital Medical University; School of Chinese Medicine; Beijing China
| | - Xia Wan
- Institute of Basic Medical Sciences of Chinese Academy of Medical Sciences & School of Basic Medicine of Peking Union Medical College; Department of Epidemiology and Statistics; 5 Dong Dan San Tiao Beijing China 100005
| | - Guochun Li
- Nanjing University of Chinese Medicine; 282 Hanzhong Road Nanjing China
| | - Suzanne J Grant
- University of Western Sydney; Locked Bag 1797 Penrith South DC Australia NWS 1797
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Petropoulos IK, Margetis PI, Antonelou MH, Koliopoulos JX, Gartaganis SP, Margaritis LH, Papassideri IS. Structural alterations of the erythrocyte membrane proteins in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2008; 245:1179-88. [PMID: 17219119 DOI: 10.1007/s00417-006-0500-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 11/12/2006] [Accepted: 11/13/2006] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Several rheological disorders of the erythrocytes, such as increased aggregation and decreased deformability, have been observed in diabetes mellitus and have been implicated in the development of diabetic microangiopathy. Structural alterations of the erythrocyte membrane proteins caused by the diabetic process may be at the origin of those observations. In the present study, we searched for erythrocyte membrane protein alterations in diabetic retinopathy. METHODS We examined peripheral blood samples from 40 type-2 diabetic patients with diabetic retinopathy of variable severity (19 males and 21 females, mean age 66.8 years, Group A) and we compared them with samples from 19 type-2 diabetic patients without diabetic retinopathy (13 males and six females, mean age 66.5 years, Group B) and 16 healthy volunteers (eight males and eight females, mean age 65.6 years, Group C). Erythrocyte membrane ghosts from all samples were subjected to SDS-PAGE, and the electrophoretic pattern of transmembrane and cytoskeletal proteins was analysed for each sample. The protein quantification of each electrophoretic band was accomplished through scanning densitometry. RESULTS No significant deviations from normal electrophoresis were observed in Groups B and C, apart from an increase in band 8 in two samples from Group B (11%). In contrast, in 14 samples from Group A (35%) we detected increases in protein band 8 and/or membrane-bound haemoglobin along with a decrease in spectrin. Moreover, increased mobility of band 3, an aberrant high molecular weight (MW) (> 255 kDa) band and a low MW (42 kDa) band were evident in ten samples from Group A (25%). Glycophorins were altered in 46% of Group-A patients versus 38% of Group-B patients. Females and patients with long duration of diabetes presented more electrophoretic abnormalities. CONCLUSIONS Structural alterations of the erythrocyte membrane proteins are shown for the first time in association with diabetic retinopathy. Their detection may serve as a blood marker for the development of diabetic microangiopathy. Further studies are needed to assess whether pharmaceutical intervention to the rheology of erythrocytes can prevent or alleviate microvascular diabetic complications.
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Affiliation(s)
- Ioannis K Petropoulos
- Department of Ophthalmology, University Hospitals of Geneva, 22 Alcide-Jentzer Street, 1211 Geneva 14, Switzerland.
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Williamson JD, Vellas B, Furberg C, Nahin R, Dekosky ST. Comparison of the design differences between the Ginkgo Evaluation of Memory study and the GuidAge study. J Nutr Health Aging 2008; 12:73S-9S. [PMID: 18165850 DOI: 10.1007/bf02982591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The epidemic of late life dementia, prominence of use of alternative medications and supplements, and initiation of efforts to determine how to prevent dementia have led to efforts to conduct studies aimed at prevention of dementia. The GEM (Ginkgo Evaluation of Memory) and GuidAge studies are ongoing randomized double-blind, placebo-controlled trials of Ginkgo biloba, administered in a dose of 120 mg twice per day as EGb761, to test whether Ginkgo biloba is effective in the prevention of dementia (and especially Alzheimer's disease) in normal elderly or those early cognitive impairment. Both GEM and GuidAge will also add substantial knowledge to the growing need for expertise in designing and implementing clinical trials to test the efficacy of putative disease-modifying agents for the dementias. While there are many similarities between GEM and Guidage, there are also significant differences. We present here the first comparative design and baseline data fromGEM and Guidage, two of the largest dementia primary prevention trials to date.
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Affiliation(s)
- J D Williamson
- Section on Gerontology and Geriatric Medicine, Roena Kulynych Center for Memory and Cognition Research, Sticht Center on Aging, Wake Forest University Health Sciences, Medical Center Blvd, Winston-Salem, NC 27151, USA.
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Hou WC, Tsay HS, Liang HJ, Lee TY, Wang GJ, Liu DZ. Improving abnormal hemorheological parameters in aging guinea pigs by water-soluble extracts of Salvia miltiorrhiza Bunge. JOURNAL OF ETHNOPHARMACOLOGY 2007; 111:483-9. [PMID: 17223298 DOI: 10.1016/j.jep.2006.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Revised: 12/12/2006] [Accepted: 12/14/2006] [Indexed: 05/13/2023]
Abstract
Salvia miltiorrhiza Bunge, known as Danshen in Chinese traditional medicine is effective at promoting blood circulation and removing (or decreasing) blood stasis. In the present study, we selected aging, 24-month-old guinea pigs as the animal experimental models and fed them a diet containing 75, 100 or 150 mg/(kg day) of water-soluble extract components of Salvia miltiorrhiza Bunge (WSm) for 28 days, respectively, in order to evaluate the effects of WSm on their abnormal hemorheological parameters. The results showed that the blood biochemical parameters of the aging guinea pigs remained unaffected by orally given WSm compared to the controls, except that the fibrinogen levels of the group fed the high dose of WSm (150 mg/(kg day)) decreased. Aging guinea pigs fed a low dose of WSm (75 mg/(kg day)) showed no significant difference in hemorheological parameters. However, feeding of WSm at 100 mg/(kg day) (medium dose), significantly reduced erythrocyte membrane MDA levels, which probably increased erythrocyte deformability and decreased erythrocyte flow resistance, though no improvement in erythrocyte aggregation, blood viscosity, and blood viscoelasticity could be observed. Furthermore, when the dose reached 150 mg/(kg day) of WSm (high dose), a significant decrease in whole blood viscosity was observed at high, medium and low shear rates. Blood viscosity and viscoelasticity exhibited significant improvement in oscillatory measurements. Also, we found that the oxygen transport efficiency of whole blood increased.
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Affiliation(s)
- Wen-Chi Hou
- Graduate Institute of Pharmacognosy, Taipei Medical University, Taipei, Taiwan
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Cheng HC, Chan CM, Tsay HS, Liang HJ, Liang YC, Liu DZ. Improving Effects of Epigallocatechin-3-Gallate on Hemorheological Abnormalities of Aging Guinea Pigs. Circ J 2007; 71:597-603. [PMID: 17384465 DOI: 10.1253/circj.71.597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epigallocatechin-3-gallate (EGCG) is the most potent antioxidant of all the green tea catechins. The objective of the present study was to find out whether it improved the age-induced hemorheological abnormalities or not. METHODS AND RESULTS Twenty-four-month-old aging guinea pigs were used to test the effects of EGCG on hemorheological properties. Orally feeding EGCG at 30 mg x kg(-1) x day (-1) for 28 days resulted in a decrease in erythrocyte membrane malondialdehyde, and further improved erythrocyte deformability and blood viscosity at high and middle shear rates. In addition, it also significantly reduced erythrocyte aggregation, and improved blood viscosity at low shear rates and viscoelasticity at oscillatory flow. Consequently, efficiency of blood oxygen transport in aged guinea pigs increased after administration with EGCG. CONCLUSIONS Orally feeding EGCG 30 mg x kg(-1) x day(-1) for 28 days significantly improves the abnormal hemorheological parameters. These results suggest that EGCG has considerable potential as a substantial component for the development of new drugs or functional foods in improving the age-induced hemorheological abnormalities.
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Affiliation(s)
- Huey-Chuan Cheng
- Department of Ophthalmology, Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taichung, Taiwan
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Xiang ZX, Huang C, Peng XJ, Qin Y. [Progress in treatment of diabetes mellitus and complications by Chinese herbal drugs]. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2006; 4:321-5. [PMID: 16696927 DOI: 10.3736/jcim20060323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Zhi-Xiong Xiang
- Institute for Nutritional Sciences, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
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DeKosky ST, Fitzpatrick A, Ives DG, Saxton J, Williamson J, Lopez OL, Burke G, Fried L, Kuller LH, Robbins J, Tracy R, Woolard N, Dunn L, Kronmal R, Nahin R, Furberg C. The Ginkgo Evaluation of Memory (GEM) study: design and baseline data of a randomized trial of Ginkgo biloba extract in prevention of dementia. Contemp Clin Trials 2006; 27:238-53. [PMID: 16627007 DOI: 10.1016/j.cct.2006.02.007] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Revised: 01/16/2006] [Accepted: 02/24/2006] [Indexed: 11/22/2022]
Abstract
The epidemic of late life dementia, prominence of use of alternative medications and supplements, and initiation of efforts to determine how to prevent dementia have led to efforts to conduct studies aimed at prevention of dementia. The GEM (Ginkgo Evaluation of Memory) study was initially designed as a 5-year, randomized double-blind, placebo-controlled trial of Ginkgo biloba, administered in a dose of 120 mg twice per day as EGb761, in the prevention of dementia (and especially Alzheimer's disease) in normal elderly or those with mild cognitive impairment. The study anticipates 8.5 years of participant follow-up. Initial power calculations based on estimates of incidence rates of dementia in the target population (age 75+) led to a 3000-person study, which was successfully recruited at four clinical sites around the United States from September 2000 to June 2002. Primary outcome is incidence of all-cause dementia; secondary outcomes include rate of cognitive and functional decline, the incidence of cardiovascular and cerebrovascular events, and mortality. Following screening to exclude participants with incident dementia at baseline, an extensive neuropsychological assessment was performed and participants were randomly assigned to treatment groups. All participants are required to have a proxy who agreed to provide an independent assessment of the functional and cognitive abilities of the participant. Assessments are repeated every 6 months. Significant decline at any visit, defined by specific changes in cognitive screening scores, leads to a repeat detailed neuropsychological battery, neurological and medical evaluation and MRI scan of the brain. The final diagnosis of dementia is achieved by a consensus panel of experts. Side effects and adverse events are tracked by computer at the central data coordinating center and unblinded data are reviewed by an independent safety monitoring board. Studies such as these are necessary for this and a variety of other potential protective agents to evaluate their effectiveness in preventing or slowing the emergence of dementia in the elderly population.
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Affiliation(s)
- Steven T DeKosky
- Department of Neurology, University of Pittsburgh, 3471 Fifth Avenue, Suite 811, Pittsburgh, PA 15213, USA.
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