Preclinical evidence of polyherbal formulations on wound healing: A systematic review on research trends and perspectives

Analysis of quality parameters and preservative concentrations in Sahacharadi Kwatha: A comparative study of three commercial brands

BACKGROUND

Sahacharadi Kwatha is traditionally employed in Ayurvedic therapy for "vata" related conditions such as back pain, herniated disc, palsy, sciatica, and paralysis. Classical Ayurvedic texts recommend the use of freshly prepared Kwatha for optimal patient benefits. However, in response to the commercialization of Ayurveda and the demand for convenient over-the-counter (OTC) formulations, various commercial preservatives have been incorporated by Ayurvedic manufacturers to facilitate OTC preparation and prolong shelf life.

OBJECTIVES

This study aims to comprehensively analyse and compare the quality parameters and preservative content in three prominent brands of Sahacharadi Kwatha available in the Indian market.

MATERIALS AND METHODS

Organoleptic and physicochemical properties, phytochemical content, and microbial load of the samples were analyzed following standardized procedures. Sodium benzoate levels in the samples were determined using both titrimetric and High-Performance Liquid Chromatography (HPLC) methods. High-Performance Thin-Layer Chromatography (HPTLC) profiles were compared to discern differences among the samples.

RESULTS

The study revealed significant variations in organoleptic and physicochemical properties, HPTLC profiles, and microbial load among the tested samples. Sodium benzoate levels in all samples exceeded the FDA and API-approved limit. Additionally, substantial variations were noted in the phytochemical content of the samples.

CONCLUSION

This investigation underscores noteworthy disparities in quality parameters and preservative content within the tested market variants of Sahacharadi Kwatha. The findings emphasize the existence of unregulated standards in the preparation of Ayurvedic medicines available in the market, highlighting the imperative for standardization and validation of Ayurvedic formulations. Such measures are essential for enhancing consumer acceptability and fostering the overall development and growth of the Ayurveda industry.

Hemostatic bioactivity and mechanism of novel Rubia cordifolia L.-derived carbon dots

Background: Rubia cordifolia L. (RCL) Carbonisata is a typical calcined natural medicinal plant, which has been used for thousands of years for hemostasis. At present, some studies have shown that some components of processed RCL Carbonisata can enhance hemostasis, but the specific hemostatic material basis is still unclear. Novel carbon dots (CDs) were obtained from Rubia cordifolia L. and named RCL-CDs to explore the hemostatic effect and mechanism of RCL-CDs obtained from Rubia cordifolia L. Methods: RCL-CDs were characterized by transmission electron microscopy (TEM), high-resolution transmission electron microscopy (HRTEM), Fourier transform infrared spectroscopy (FT-IR), ultraviolet visible spectroscopy (UV-Vis), fluorescence spectroscopy (FL), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). The hemostatic effect of RCL-CDs was evaluated in a mouse tail amputation model and liver scratch model, and the hemostatic mechanism was explored using a capillary coagulation model and coagulation parameters. Results: The particle size distribution of RCL-CDs ranged from 1.74 nm to 9.78 nm, the maximum population was 3-4 nm, and the average particle size was 3.82 nm. The RCL-CDs were approximately spherical with a lattice spacing of 0.206 nm. The quantum yield (QY) of RCL-CDs is 1.09%, and there is a distinct diffraction peak at 2θ = 24.76°. The elemental composition of RCL-CDs was mainly C (65.28%), O (30.10%), and a small amount of N (4.62%). Pharmacological experiments showed that bleeding time and bleeding volume were reduced in mice treated with RCL-CDs. It is worth noting that the low-, medium- and high-dose RCL-CD groups can significantly reduce the blood loss, while the high-dose RCL-CD group can significantly reduce the bleeding time of the mouse tail amputation model and liver scratch model. Additionally, the fibrinogen level (FIB) and platelet counts (PLT) increased and prothrombin time (PT) decreased in rats after treatment with RCL-CDs. Conclusions: RCL-CDs have a significant hemostatic effect, and the mechanism may be exogenous coagulation and activation of fibrinogen. This explains the material basis of the hemostatic effect of RCLC and opens new avenues for more in-depth investigation. In addition, new insights into the potential biomedical applications of CDs in the field of nanohemostasis are provided and a solid foundation for the discovery of novel hemostatic agents is established.

Accelerating healing of infected wounds with G. glabra extract and curcumin Co-loaded electrospun nanofibrous dressing

This study aimed to construct a nanofibrous wound dressing composed of polyvinyl alcohol (PVA) and chitosan (CS) containing curcumin and Glycyrrhiza glabra root extract to inhibit infection and accelerate wound healing. Loading 10 wt% of G. glabra extract-curcumin (50:50) by electrospinng technique resulted in the formation of nanofibers (NFs) with diameter distribution 303 ± 38 and had a uniform and defect-free morphology. FTIR analysis confirmed the loading of the components without adverse interactions. Also, the results showed extremely high porosity, extraordinary liquid absorption capacity, and complete wettability. In addition, G. glabra extract-curcumin showed significant antioxidant activity and their release profile from NFs was continuous and sustained. Also, the prepared NF could inhibit the growth of both Gram-positive Saureus and Gram-negative E. coli strains. Wound healing evaluation in the infected animal model showed that the NFs caused full wound closure and accelerated skin regeneration. The studies on inhibiting the bacteria growth at the wound site also revealed complete inhibitory effects. Moreover, histopathology studies confirmed the complete regeneration of skin layers, formation of collagen fibers, and angiogenesis. Finally, PVA/CS NFs containing G. glabra extract-curcumin as a multifunctional bioactive wound dressing presented a promising approach for promoting the healing of infected wounds.

In Silico Approaches to Polyherbal Synergy: Protocol for a Scoping Review

BACKGROUND

According to the World Health Organization, more than 80% of the world's population relies on traditional medicine. Traditional medicine is typically based on the use of single herbal drugs or polyherbal formulations (PHFs) to manage diseases. However, the probable mode of action of these formulations is not well studied or documented. Over the past few decades, computational methods have been used to study the molecular mechanism of phytochemicals in single herbal drugs. However, the in silico methods applied to study PHFs remain unclear.

OBJECTIVE

The aim of this protocol is to develop a search strategy for a scoping review to map the in silico approaches applied in understanding the activity of PHFs used as traditional medicines worldwide.

METHODS

The scoping review will be conducted based on the methodology developed by Arksey and O'Malley and the recommendations of the Joanna Briggs Institute (JBI). A set of predetermined keywords will be used to identify the relevant studies from five databases: PubMed, Embase, Science Direct, Web of Science, and Google Scholar. Two independent reviewers will conduct the search to yield a list of relevant studies based on the inclusion and exclusion criteria. Mendeley version 1.19.8 will be used to remove duplicate citations, and title and abstract screening will be performed with Rayyan software. The JBI System for the Unified Management, Assessment, and Review of Information tool will be used for data extraction. The scoping review will be reported based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

RESULTS

Based on the core areas of the scoping review, a 3-step search strategy was developed. The initial search produced 3865 studies. After applying filters, 875 studies were short-listed for further review. Keywords were further refined to yield more relevant studies on the topic.

CONCLUSIONS

The findings are expected to determine the extent of the knowledge gap in the applications of computational methods in PHFs for any traditional medicine across the world. The study can provide answers to open research questions related to the phytochemical identification of PHFs, criteria for target identification, strategies applied for in silico studies, software used, and challenges in adopting in silico methods for understanding the mechanisms of action of PHFs. This study can thus provide a better understanding of the application and types of in silico methods for investigating PHFs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/56646.

A critical overview of challenging roles of medicinal plants in improvement of wound healing technology

PURPOSE

Chronic diseases often hinder the natural healing process, making wound infections a prevalent clinical concern. In severe cases, complications can arise, potentially leading to fatal outcomes. While allopathic treatments offer numerous options for wound repair and management, the enduring popularity of herbal medications may be attributed to their perceived minimal side effects. Hence, this review aims to investigate the potential of herbal remedies in efficiently treating wounds, presenting a promising alternative for consideration.

METHODS

A literature search was done including research, reviews, systematic literature review, meta-analysis, and clinical trials considered. Search engines such as Pubmed, Google Scholar, and Scopus were used while retrieving data. Keywords like Wound healing 'Wound healing and herbal combinations', 'Herbal wound dressing', Nanotechnology and Wound dressing were used.

RESULT

This review provides valuable insights into the role of natural products and technology-based formulations in the treatment of wound infections. It evaluates the use of herbal remedies as an effective approach. Various active principles from herbs, categorized as flavonoids, glycosides, saponins, and phenolic compounds, have shown effectiveness in promoting wound closure. A multitude of herbal remedies have demonstrated significant efficacy in wound management, offering an additional avenue for care. The review encompasses a total of 72 studies, involving 127 distinct herbs (excluding any common herbs shared between studies), primarily belonging to the families Asteraceae, Fabaceae, and Apiaceae. In research, rat models were predominantly utilized to assess wound healing activities. Furthermore, advancements in herbal-based formulations using nanotechnology-based wound dressing materials, such as nanofibers, nanoemulsions, nanofiber mats, polymeric fibers, and hydrogel-based microneedles, are underway. These innovations aim to enhance targeted drug delivery and expedite recovery. Several clinical-based experimental studies have already been documented, evaluating the efficacy of various natural products for wound care and management. This signifies a promising direction in the field of wound treatment.

CONCLUSION

In recent years, scientists have increasingly utilized evidence-based medicine and advanced scientific techniques to validate the efficacy of herbal medicines and delve into the underlying mechanisms of their actions. However, there remains a critical need for further research to thoroughly understand how isolated chemicals extracted from herbs contribute to the healing process of intricate wounds, which may have life-threatening consequences. This ongoing research endeavor holds great promise in not only advancing our understanding but also in the development of innovative formulations that expedite the recovery process.

VOLKSMED Database: A Source for Forgotten Wound Healing Plants in Austrian Folk Medicine

The global increase in the incidence of wounds is concerning and fuels the search for new treatment options. The use of traditional medicinal plants in wound healing represents an appreciated available therapeutic possibility. This work introduces the VOLKSMED database, which contains plants and other materials used in Austrian folk medicine, either as monographs or mixtures. This work focuses on the monographs of the database. Concerning wound healing, Hypericum sp., Arnica montana, Calendula officinalis, Plantago sp., and Malva sp. are the most commonly used plants. The focus of this paper is set on selected lesser-known plants (Abies alba, Anthyllis vulneraria, Brassica sp., Gentiana sp., Larix decidua, Picea abies, Sambucus sp., Sanicula europaea) and their status quo in literature concerning wound healing. A systematic search using the databases SciFinder, SCOPUS, and PubMed yielded substantial evidence for the wound healing potential of Brassica sp., Gentiana sp., the Pinaceae A. abies, L. decidua, and P. abies, as well as Sambucus nigra. In vivo and clinical studies substantiate their use in Austrian folk medicine. According to the literature, especially A. vulneraria, Sambucus racemosa, and S. europaea would be worth investigating in-depth since data concerning their wound healing effects - even though scarce - are convincing. In conclusion, the VOLKSMED database contains promising opportunities for further treatment options in the field of wound healing. Future research should consider the listed plants to support their traditional use in Austrian folk medicine and possibly promote the implementation of old knowledge in modern medicine.

Effectiveness of Ya-Samarn-Phlae in diabetic wound healing: Evidence from in vitro studies and a multicenter randomized controlled clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Ya-Samarn-Phlae (YaSP) has traditionally been widely used in southern Thailand for treating chronic and infected wounds, including diabetic foot ulcers. However, there are only a limited number of clinical studies supporting the use of this polyherbal formulation. Therefore, the present work aims to provide clinical evidence to support the application of YaSP, prepared according to a standardized traditional procedure (T-YaSP). Additionally, its potential chemical markers and wound healing-related biological activities were examined.

MATERIALS AND METHODS

The in vitro wound healing-related biological activities of YaSP ethanol extract and T-YaSP, including antibacterial activity against Staphylococcus epidermidis, inhibition and eradication of staphylococcal biofilm, anti-inflammatory effects, and enhancement of human dermal fibroblast migration in scratch wounds, were examined using well-established protocols. The chemical profiles of the ethanol extract of YaSP and T-YaSP were compared, and with promising chemical markers, arecoline, alpha-mangostin, and curcumin were selected and quantified using the HPLC method. A prospective, multicenter, randomized, controlled, parallel-group study was conducted over 12 weeks to evaluate the efficacy of the YaSP solution as an adjunct therapy, combined with standard wound care, for diabetic ulcers compared to standard treatment.

RESULTS

The YaSP extract reduces NO production and can scavenge NO radicals in LPS-induced RAW 264.7 macrophage cells. Additionally, in a scratch assay, this extract and one of its herbal components, Curcuma longa, enhance the migration of human dermal fibroblasts. T-YaSP, containing 2.412 ± 0.002 mg/g of arecoline, 2.399 ± 0.005 mg/g of curcumin, and 0.017 ± 0.000 mg/g of α-mangostin, has shown the ability to inhibit the development and eradicate the mature biofilm of S. epidermidis. The use of T-YaSP as an adjunct therapy led to a significantly higher proportion of patients achieving healing within six weeks compared to the standard treatment group (36%/9 patients vs. 4%/1 patient; p = 0.013). After 12 weeks, 19 out of 25 patients in the T-YaSP group experienced complete healing, whereas only four patients in the standard treatment group achieved complete wound healing (76% in the T-YaSP group vs. 16% in the control group; p < 0.001).

CONCLUSION

The results presented here represent the first randomized controlled trial to demonstrate the effectiveness of the traditional polyherbal solution, T-YaSP, which exhibits a wide range of wound healing-related activities. Utilizing T-YaSP as an adjunctive treatment resulted in a significant improvement in the number of type 2 diabetic patients achieving complete healing. However, to explore and utilize YaSP further, conducting a double-blind, randomized controlled trial with a larger population is necessary.

Acute and Subchronic Toxicological Study of the Cocktail Extract from Curcuma xanthorrhiza Roxb, Phyllanthus niruri L. and Morinda citrifolia L

Curcuma xanthorrhiza Roxb, Phyllanthus niruri L., and Morinda citrifolia L. are Indonesian medicinal herbs used empirically as traditional therapeutics for maintaining health. The cocktail extract of these three plants (CECPM) had been developed and demonstrated immunostimulant activity in rats. This study aimed to evaluate the acute and subchronic toxicity of CECPM in vivo. The acute toxicity assay was conducted by orally administering a range dose of CECPM (313, 625, 1250, 2500, or 5000 mg/kg body weight (bw) on female mice once and then evaluating the toxic symptom every day for 14 days later. The chronic toxicity test was carried out by giving various doses of CECPM (600, 800, and 1000 mg/kg·bw) to female and male rats orally continuously for 90 consecutive days. The signs of toxicities were evaluated at the 90- and 28 days postadministration. The acute oral toxicity assays showed that there was no toxic syndrome and mortality found during the period of the experiment. The lethal dose level (LD50) of CECPM was more than 5000 g/kg, which was categorized as practically non-toxic. Meanwhile, in the sub-chronic toxicity study, some parameters tested at 90 days postadministration and after 28 days of withdrawal, such as the body weight, relative organ weight, food intake, hematological and biochemical blood parameters, and also histopathological examination of five primary tissues (heart, liver, kidney, spleen, and lung) revealed no abnormalities. There was no-observed adverse effect level (NOAEL) for the present study of CECPM 1000 mg/kg·bw of the rat. Therefore, it is concluded that the orally administered CECPM was relatively nontoxic during acute and subchronic toxicology studies.