The role of Western herbal medicine in the treatment of gout

In-vitro antigout potential of Alstonia scholaris flower, characterization and prospective ligand-receptor interaction of bioactive lead compound

Gout is an arthropathic and inflammatory disease. The prevalence and incidence of such disease has risen in last decades. It is associated with life style thus it could be recognize as life style diseases. In the present study, the flower extract of Alstonia scholaris Linn R.Br., Flower was initially subjected to extraction, isolation which leads to purification of pure eight compounds. All these compounds were identified using various spectroscopic techniques. In-vitro Xanthine oxidase inhibition activity was performed to determine the antigout potential of lead compounds. Compound 8 showed significant activity among all i.e. 14.7 ± 0.43 as compare to standard allopurinol 6.77 ± 0.26. Accordingly, in-silico studies using Autodock vina 4 showed the ligand-protein interaction of luteolin with 3AX7. The docking simulations showed significant binding pocket sites of respective proteins 3AX7 with the least binding energy -10.2 kcal/mol. Consequently, molecular docking simulations for 100ns indicated robust evidence with their conformational structural interaction which serve as active sites for Lead compound. Principal Component Analysis indicated first three PCs capture 23.8%, 39%, and 49% of structural variance in protein. Therefore compound 8 could be consider for potential drug design and development in gout therapy.

From Bush Medicine to Modern Phytopharmaceutical: A Bibliographic Review of Devil's Claw (Harpagophytum spp.)

Devil's claw (Harpagophytum spp., Pedaliaceae) is one of the best-documented phytomedicines. Its mode of action is largely elucidated, and its efficacy and excellent safety profile have been demonstrated in a long list of clinical investigations. The author conducted a bibliographic review which not only included peer-reviewed papers published in scientific journals but also a vast amount of grey literature, such as theses and reports initiated by governmental as well as non-governmental organizations, thus allowing for a more holistic presentation of the available evidence. Close to 700 sources published over the course of two centuries were identified, confirmed, and cataloged. The purpose of the review is three-fold: to trace the historical milestones in devil's claw becoming a modern herbal medicine, to point out gaps in the seemingly all-encompassing body of research, and to provide the reader with a reliable and comprehensive bibliography. The review covers aspects of ethnobotany, taxonomy, history of product development and commercialization, chemistry, pharmacology, toxicology, as well as clinical efficacy and safety. It is concluded that three areas stand out in need of further investigation. The taxonomical assessment of the genus is outdated and lacking. A revision is needed to account for intra- and inter-specific, geographical, and chemo-taxonomical variation, including variation in composition. Further research is needed to conclusively elucidate the active compound(s). Confounded by early substitution, intermixture, and blending, it has yet to be demonstrated beyond a reasonable doubt that both (or all) Harpagophytum spp. are equally (and interchangeably) safe and efficacious in clinical practice.

Antihyperuricemic, Anti-Inflammatory and Antihypertensive Effect of a Dry Extract from Solidago virgaurea L. (Asteraceae)

Solidago virgaurea L. is a perennial plant used in European traditional medicine as a diuretic or a remedy for inflammatory conditions of the urinary tract but also for gout, especially in the Balkans. The present study was focused on a preclinical, in vivo evaluation of antihyperuricemic, anti-inflammatory, and antihypertensive effects of a dry extract from S. virgaurea L. (ESV). Colorimetric and HPLC–MS techniques were used to identify the main chemical constituents of ESV. Antihyperuricemic effect of ESV was assessed in a rat model of hyperuricemia induced by the administration of potassium oxonate. Antihypertensive effect of ESV was evaluated in hyperuricemic rats by monitoring systolic blood pressure with a non-invasive blood-pressure recording system. The anti-inflammatory effect of ESV was tested using a rat model of paw edema. The main chemical constituents of ESV were rutin and phenolic acids represented by chlorogenic and caffeic acid. ESV demonstrated significant antihyperuricemic effects in rats due to an uricosuric mechanism. Additionally, ESV reduced the progression of arterial hypertension in hyperuricemic rats and also showed anti-inflammatory properties slightly inferior to diclofenac. The results suggest that ESV could be a natural remedy for the treatment of gout and protection against endothelial dysfunction caused by hyperuricemia.

The [DPPH●/DPPH-H]-HPLC-DAD Method on Tracking the Antioxidant Activity of Pure Antioxidants and Goutweed (Aegopodium podagraria L.) Hydroalcoholic Extracts

The 2,2-diphenyl-1-picrylhydrazyl (DPPH)-reverse phase (RP)-HPLC-diode array detector (DAD) method was tested on standard antioxidants (AOs), i.e., reduced glutathione (GSH), ascorbic acid (vitamin C), and alcoholic extracts of A. podagraria L. An elaborated HPLC procedure enabled the simultaneous measurement of the redox couple DPPH-R (2,2-diphenyl-1-picrylhydrazyl radical)/DPPH-H (2,2-diphenyl-1-picrylhydrazine). Both forms were fully separated (R_s = 2.30, α = 1.65) on a Zorbax Eclipse XDB-C18 column eluted with methanol–water (80:20, v/v) and detected at different wavelengths in the range of 200–600 nm. The absorbance increases of the DPPH-H as well as the DPPH-R peak inhibition were measured at different wavelengths in visible and UV ranges. The chromatographic method was optimized, according to reaction time (slow, fast kinetics), the linearity range of DPPH radical depending on the detection conditions as well as the kind of the investigated antioxidants (reference chemicals and the ground elder prepared from fresh and dry plants). The scavenging capacity was expressed by the use of percentage of peak inhibition and the IC₅₀ parameters. The evaluated extracts displayed antioxidant activity, higher than 20% inhibition against 350 µM DPPH free radical. The results show that extract prepared from dry plants in the ultrasonic bath exhibits the highest antioxidant potential (IC₅₀ = 64.74 ± 0.22 µL/mL).

Safety, efficacy and tolerability of a combination micronutrient and polyherbal preparation (GoutFighter TM) for gout: a single-arm open-label pilot study

BACKGROUND

To evaluate the safety, efficacy and tolerability of a combination micronutrient and polyherbal preparation (GoutFighter ^TM) for gout management.

METHODS

A single arm, open-label pilot study was conducted at the National Hospital for Traditional Medicine in Vietnam. Participants (n=35 recruited) diagnosed with chronic gout received four tablets of GoutFighter ^TM daily over a 45-day period. Efficacy was assessed by changes in pain, swelling and blood uric acid levels, with concurrent safety and tolerability assessments.

RESULTS

A total of 27 (85.2% male) participants (mean ± SD age, 54.2 ± 12.5 years; BMI, 24.2 ± 3.6 kg/m²) with gout (median [IQR], years since diagnosis 4.0 [3.0-8.0]) completed intervention. In relation to safety, there were no significant changes in vital signs, blood biochemistry or cell counts. In regard to efficacy, the degree of perceived pain and frequency of joint swelling significantly declined after 15 and 30 days of treatment, respectively, and remained so until the end of trial. Mean blood uric acid levels also declined by 25.8 μmol/L (95% CI, 3.7 to 48.0, p=0.024). Overall, the predominance of participants (96.3%) responded favorably to treatment (p<0.0001) and GoutFighter ^TM was well tolerated, with no serious adverse events.

CONCLUSION

Clinically relevant doses of GoutFighter ^TM were found to be generally safe, well-tolerated and effective for the short-term, symptomatic relief of chronic gout. GoutFighter ^TM appears to be suitable as an adjunctive treatment in lifestyle programs for gout management, and further investigation in placebo-controlled trials is therefore warranted.

The Impact of Natural Product Dietary Supplements on Patients with Gout: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Natural product dietary supplements (NPDS) are frequently used for the treatment of gout, but reliable efficacy and safety data are generally lacking or not well organized to guide clinical decision making. This review aims to explore the impacts of NPDS for patients with gout. An electronic literature search was conducted to retrieve data published in English language from databases from inception to August 14, 2019. Randomized controlled trials (RCTs) that compared NPDS with or without placebo, diet modification, conventional pharmaceutics, or the other Chinese medicine treatment for gout patients were included. Two authors screened the articles, extracted the data, and assessed the risk of bias of each included trial independently. Meta-analysis was performed using Review Manager version 5.3.5. Results. Nine RCTS were enrolled in this review. The methodological quality of the nine RCTs was poor. The study results showed that in the majority of trials, NPDS demonstrated some degree of therapeutic efficacy for joint swelling, pain, and activity limitation. In contradistinction, serum uric acid (SUA) level (SMD -1.80, 95% CI: -4.45 to 0.86) (p > 0.05) and CRP levels (N = 232; SMD, -0.26; 95% CI, -0.55 to 0.04) (p > 0.05) did not improve significantly. The incidence of adverse events (AEs) was not lower in the participants treated with NPDS (N = 750; RR, 0.47; 95% CI, 0.20-1.11) (p > 0.05). Conclusion. Current existing evidence is not sufficient to provide clinical guidance regarding the efficacy and safety of NPDS as a treatment for gout due to poor trial quality and lack of standardized evaluation criteria. Larger and more rigorously designed RCTs are needed in the future.