Traditional wound-healing plants used in the Balkan region (Southeast Europe)

Phlomis crinita Cav. From Algeria: A source of bioactive compounds possessing antioxidant and wound healing activities

ETHNOPHARMACOLOGICAL RELEVANCE

Phlomis crinita Cav. (Lamiaceae), locally known as "El Khayata" or "Kayat El Adjarah", is traditionally used in Algeria for its wound-healing properties.

AIM OF THE STUDY

Investigate, for the first time, the phytochemical profile, safety, antioxidant and wound-healing activities of the flowering tops methanolic extract of P. crinita (PCME) collected from Bouira Province in the North of Algeria.

MATERIALS AND METHODS

Preliminary phytochemical assays were carried out on PCME to quantify the main classes of bioactive compounds, such as total phenols, flavonoids, and tannins. An in-depth LC-DAD-ESI-MS analysis was carried out to elucidate the phytochemical profile of this plant species. Antioxidant activity was investigated by several colorimetric and fluorimetric assays (DPPH, TEAC, FRAP, ORAC, β-carotene bleaching and ferrozine assay). The acute oral toxicity of PCME (2000 mg/kg b.w.) was tested in vivo on Swiss albino mice, whereas the acute dermal toxicity and wound-healing properties of the PCME ointment (1-5% PCMO) were tested in vivo on Wistar albino rats. Biochemical and histological analyses were carried out on biological samples.

RESULTS

The phytochemical screening highlighted a high content of phenolic compounds (175.49 ± 0.8 mg of gallic acid equivalents/g of dry extract), mainly flavonoids (82.28 ± 0.44 mg of quercetin equivalents/g of dry extract). Fifty-seven compounds were identified by LC-DAD-ESI-MS analysis, belonging mainly to the class of flavones (32.27%), with luteolin 7-(6″-acetylglucoside) as the most abundant compound and phenolic acids (32.54%), with salvianolic acid C as the most abundant compound. A conspicuous presence of phenylethanoids (15.26%) was also found, of which the major constituent is forsythoside B. PCME showed a strong antioxidant activity with half-inhibitory activity (IC50) ranging from 1.88 to 37.88 μg/mL and a moderate iron chelating activity (IC50 327.44 μg/mL). PCME appears to be safe with Lethal Dose 50 (LD50) ≥ 2000 mg/kg b.w. No mortality or toxicity signs, including any statistically significant changes in body weight gain and relative organs' weight with respect to the control group, were recorded. A significant (p < 0.001) wound contraction was observed in the 5% PCMO-treated group with respect to the untreated and petroleum jelly groups between 8 and 20 days, whereas no statistically significant results were observed at the two lower doses (1 and 2% PCMO). In addition, the 5% PCMO-treated group showed a statistically significant (p < 0.05) wound healing activity with respect to the reference drug-treated group, showing, at the end of the study, the highest wound contraction percentage (88.00 ± 0.16%).

CONCLUSION

PCME was safe and showed strong antioxidant and wound-healing properties, suggesting new interesting pharmaceutical applications for P. crinita based on its traditional use.

Ethnomedical Knowledge of Plants Used in Nonconventional Medicine for Wound Healing in Lubumbashi, Haut-Katanga Province, DR Congo

Medicinal plants used for wound healing in Lubumbashi have yet to be discovered. Inventory or profile of their taxa has yet to be established. The present study was carried out to survey the plants used in traditional medicine in Lubumbashi to treat wounds and to define their ethnomedical characteristics. The study was conducted between March 2021 and August 2022, using semistructured interview surveys of households (n = 2730), herbalists (n = 48), and traditional practitioners: TPs (n = 128).The 2,906 interviewed (sex ratio M/F = 0.9; mean age: 56 ± 3 years; and experience: 17 ± 4 years) provided information on 166 taxa, 130 used against chronic wounds, among which Securidaca longepedunculata was the top cited. Most of these taxa are shrubs (33%), belonging to 48 botanical families dominated by the Fabaceae (16%). They are indicated in 70 other pathologies. From these 166 taxa, 198 healing recipes are obtained, 11 combining more than one plant. In all these recipes, the leaf (>36%) is the most used part, and the poultice (>36%) is the most popular form of use. Twelve taxa are cited for the first time as medicinal plants, of which Agelanthus zizyphifolius has the highest consensus and Erigeron sumatrensis has the highest usual value. For the various plants used to treat wounds, some of which are specific to the region, further studies should focus on validating this traditional use.

Bringing back Galium aparine L. from forgotten corners of traditional wound treatment procedures: an antimicrobial, antioxidant, and in-vitro wound healing assay along with HPTLC fingerprinting study

BACKGROUND

The wound healing process, restoring the functionality of the damaged tissue, can be accelerated by various compounds. The recent experimental analysis highlights the beneficial effects of phytochemicals in improving skin regeneration and wound healing. In traditional medicine, one of the widespread plants used for treating different injuries or skin afflictions is Galium aparine L. (GA). Besides, previously reported chemical compounds of GA suggested its therapeutic effects for the wound healing process, yet its regulatory effects on the cellular and molecular stages of the wound healing process have not been investigated.

METHODS

In the present study, the phytochemical profile of the GA extract was analyzed using HPTLC fingerprinting, and further scientific evaluation of its phytochemicals was done. The wound-healing effects of GA extract were explored at the cellular and molecular levels while accounting for cell toxicity. The wound closure enhancing effect, antibacterial activity, and antioxidant activity were assessed.

RESULTS

The HPTLC fingerprinting of the GA extract proved its previously reported phytochemical profile including phenols, flavonoids, tannins, plant acids, ergot alkaloids, flavonoids, anthraquinones, terpenoids, sterols, salicin, lipophilic compounds, saponins, iridoids, and heterocyclic nitrogen compounds. Antimicrobial assessment, of the extract, indicated the more susceptibility of S. aureus to the inhibitory effects of GA rather than E. coli and S. epidermidis. DPPH test results revealed the antioxidant property of GA extract, which was comparable to ascorbic acid. The results of the viability assay showed no cytotoxicity effects on human umbilical endothelial cell (HUVEC) and normal human dermal fibroblast (NHDF) cell lines treated with different concentrations of whole plant extract and cell viability increased in a dose-dependent manner. The results of the scratch assay showed improved cell migration and wound closure.

CONCLUSIONS

This study shows the anti-oxidant, anti-microbial, and in vitro wound healing wound-healing effects of GA hydroalcoholic extract, which aligns with its use in traditional medicine. No cytotoxicity effects were shown. The results from this study can be the basis for further investigations such as animal models and phytochemical studies. Further evaluation of its effects on mechanisms and signaling pathways involved in the wound healing processes such as angiogenesis and cell proliferation can provide novel insights into the potential therapeutic effects of the GA extract.

The potential role of Hypericum perforatum in wound healing: A literature review on the phytochemicals, pharmacological approaches, and mechanistic perspectives

St. John's Wort, commonly known as Hypericum perforatum L., is a flowering plant in the Clusiaceae family that traditionally been employed for treating anxiety, depression, wounds, burns, sunburn, irritation, and stomach ailments. This review provides a synopsis of H. perforatum L. phytoconstituents and their biological effects, highlighting its beneficial therapeutic properties for dermatological indications, as well as its antioxidant, antimicrobial, anti-inflammatory, and anti-angiogenic activity in various applications including wound healing and skin conditions such as eczema, sun burn and minor burns also spastic paralysis, stiff neck and mood disorders as anti-depressant and nerve pains such as neuralgia. The data were collected from several databases as Web of Science PubMed, ScienceDirect, Scopus and Google Scholar using the terms: "H. perforatum L.", "H. perforatum L. /phytochemistry," and "H. perforatum extracts/wound healing" collected from 1994 to 2023. The findings suggest H. perforatum L. acts through various mechanisms and plays a role in each phase of the wound healing process, including re-epithelialization, angiogenesis, wound contraction, and connective tissue regeneration. H. perforatum L. enhances collagen deposition, decreases inflammation, inhibits fibroblast migration, and promotes epithelialization by increasing the number of fibroblasts with polygonal shape and the number of collagen fibers within fibroblasts. H. Perforatum L. extracts modulate the immune response and reduce inflammation were found to accelerate the wound healing process via inhibition of inflammatory mediators' production like interleukin-6, tumor necrosis factor-α, cyclooxygenase-2 gene expression, and inducible nitric oxide synthase. Thus, H. perforatum L. represents a potential remedy for a wide range of dermatological problems, owing to its constituents with beneficial therapeutic properties. H. perforatum L. could be utilized in the development of novel wound healing therapies.

A comprehensive review on ethnomedicinal, phytochemical and pharmacological properties of genus Bistorta (L.) scop

The genus Bistorta comprises about 43 accepted species that are widely used by local people and medicinal practitioners for the treatment of rheumatism, tuberculosis, inflammation, respiratory infection, and other diseases. The objective of this review is to present up-to-date information from the scientific literature about the phytochemistry, pharmacology, and toxicology of Bistorta. At present, there is a lack of a comprehensive review that consolidates the various scientific studies conducted on the genus Bistorta. To address this knowledge gap, a global review has been compiled on the genus Bistorta, which emphasizes ethnomedicinal uses, phytochemistry, and pharmacology. To gather information about Bistorta, relevant keywords were used to search internet databases including Google scholar, PubMed, ResearchGate, Web of Science, Europe PMC, CNKI, and Wiley Online Library. Additionally, published books that provided an overview of existing literature studies were consulted for reference purposes. Chemical structures and formulas of compounds were verified using the PubChem database and drawn using Chem Draw Ultra 6.0. The scientific nomenclature utilized in this review follows The World Flora Online and The Plant of the World Online (PoWo). A comprehensive evaluation of literature sources revealed that the genus Bistorta has been recognized for its ethnomedical properties and has been used in traditional healthcare for several millennia. Chemical analysis has identified various compounds such as phenolics, flavonoids saponins, terpenes, sterols, and coumarins which have been shown to have significant pharmacological effects such as anti-tumor, anti-inflammatory, anti-oxidant anti-rheumatic and anti-microbial properties. The pharmacological research has only partially validated the traditional and local uses of Bistorta species. Further research is required to investigate the mechanisms of the plant's active compounds, as well as its potential therapeutic applications in treating conditions like diabetes and neurodegenerative diseases. Additionally, there is no clinical evidence to provide the health benefits of these plants. To confirm the pharmacological activities, clinical efficacy, and non-toxicity of Bistorta species, more comprehensive and systematic preclinical studies, and clinical trials are needed.

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.

Current use of medicinal plants for children's diseases among mothers in Southern Romania

There is a limited number of studies focusing on ethnomedical practices in children, particularly in Eastern Europe. Romania has a rich history of using medicinal plants in ethnopediatric care, and our objective was to identify the medicinal plants currently employed in treating childhood illnesses in the southern region of the country. Material and methods Our investigation used structured interviews, focusing on respondent demographics, local names of therapeutically employed herbs, the specific plant part(s) utilized, methods of preparation and administration, and local folk indications of taxa. A total of 326 mothers with children aged 0 to 18, hospitalized in the "Grigore Alexandrescu" Children Emergency Hospital Bucharest and residing in Southern Romania, were enrolled in the study. Use Value Citation Index (UVc), Informant Consensus Factor (Fic), and Fidelity Level (FL) were calculated. Results Twenty-five plants were identified for treating children's diseases in Southern Romania. The majority of informants resided in urban areas, and mothers primarily acquired knowledge from family members and healthcare professionals. The herbs most frequently employed were Mentha spp. (UV = 0.509) for diarrhea, Matricaria spp. (UV = 0.301) for skin infections (Fic = 0.99) and digestive diseases (Fic = 0.98), and Calendula officinalis L. (UV = 0.365) for skin diseases (Fic = 0.99). Less utilized were Raphanus raphanistrum subsp. sativus (L.) Domin in respiratory diseases, Prunus avium (L.) L. stalks in urinary tract ailments, Helianthus annuus L. in ear infections, Allium sativum L. in intestinal parasitosis, Viola tricolor L. in hives, Triticum aestivum L. in dermatitis and Allium ursinum L. as a tonic. In 184 cases herbal treatment was used in conjunction with conventional medications. Education level correlated with the number of employed plants and the variety of treated ailments, while residency (rural vs. urban) did not. Both residency and education influenced plant procurement methods: rural background and, surprisingly, higher education were linked to a preference for harvesting rather than purchasing plants. Conclusion Botanical remedies are still commonly used in the treatment of pediatric diseases in Southern Romania, although the variety of taxa seems reduced compared to the past. Further exploration is essential to unlock the maximum benefits of ethnopediatric practices.

Tissue Regeneration and Remodeling in Rat Models after Application of Hypericum perforatum L. Extract-Loaded Bigels

The wound-healing effect of St. John's Wort (SJW) is mainly attributed to hyperforin (HP), but its low stability restricts its topical administration. This study investigates how "free" HP-rich SJW extract (incorporated into a bigel; B/SJW) and extract "protected" by nanostructured lipid carriers (also included in a biphasic semisolid; B/NLC-SJW) affect tissue regeneration in a rat skin excision wound model. Wound diameter, histological changes, and tissue gene expression levels of fibronectin (Fn), matrix metalloproteinase 8 (MMP8), and tumor necrosis factor-alpha (TNF-α) were employed to quantify the healing progress. A significant wound size reduction was achieved after applying both extract-containing semisolids, but after a 21-day application period, the smallest wound size was observed in the B/NLC-SJW-treated animals. However, the inflammatory response was affected more favorably by the bigel containing the "free" SJW extract, as evidenced by histological studies. Moreover, after the application of B/SJW, the expression of Fn, MMP8, and TNF-α was significantly higher than in the positive control. In conclusion, both bigel formulations exhibited beneficial effects on wound healing in rat skin, but B/SJW affected skin restoration processes in a comprehensive and more efficient way.

Medicinal plants used for cutaneous wound healing in Uganda; ethnomedicinal reports and pharmacological evidences

Background

Wounds have become a major health challenge worldwide, presenting marked humanistic and economic burdens such as disabilities and death. Annually, approximately 14 million people suffer from wounds worldwide and 80 % of these occur in developing countries like Uganda. In Uganda, besides many cases of daily wound occurrences, approximately 10 % of surgical procedures become septic wounds and consequently lead to increased morbidity and mortality. Accordingly, several ethnomedicinal studies have identified plants used for wound treatment in different parts of Uganda and the wound healing activities of some plants have been reported. However, at present, these information remain largely separated without an all-inclusive repository containing ethnomedicinal and pharmacological information of the plants used for wound healing in Uganda, thus retarding appropriate evaluation. Therefore, this review focused on extensively exploring the plants used for treating cutaneous wounds in Uganda, along with associated ethnomedicinal information and their globally reported pharmacological potential.

Methods

Electronic data bases including Google Scholar, PubMed, and Science Direct were searched using key terms for required information contained in English peer reviewed articles, books, and dissertations. Additionally, correlations between selected parameters were determined with coefficient of determination (r2).

Results

The literature survey revealed that 165 species belonging to 62 families are traditionally used to treat wounds in Uganda. Most of the species belonged to families of Asteraceae (14 %), Fabaceae (10 %), and Euphorbiaceae (7 %). The commonest plant parts used for wound treatment include leaf (48 %), root (22 %), stembark (11 %), and stem (7 %), which are prepared majorly by poultice (34 %), decoction (13 %), as well as powdering (25 %). Fifty-four (33 %) of the plant species have been investigated for their wound healing activities whereas, one hundred eleven (67 %) have not been scientifically investigated for their wound healing effects. Pearson correlation coefficient between the number of wound healing plant families per part used and percent of each plant part used was 0.97, and between the number of wound healing plant families per method of preparation and percent of each method of preparation was 0.95, showing in both strong positively marked relationships.

Conclusion

The preliminarily investigated plants with positive wound healing properties require further evaluation to possible final phases, with comprehensive identification of constituent bioactive agents. Additionally, the wound healing potential of the scientifically uninvestigated plants with claimed healing effects needs examination. Subsequently, information regarding efficacy, safety, bioactive principles, and mechanism of action could prove valuable in future development of wound healing therapies.

Tussilagone ameliorates high-fat diet-induced hepatic steatosis by enhancing energy metabolism and antioxidant activity

Non-alcoholic fatty liver disease (NAFLD) is a major health problem. However, no effective treatments are currently available. Thus, there is a critical need to develop novel drugs that can prevent and treat NAFLD with few side effects. In this study, Tussilagone (TUS), a natural sesquiterpene isolated from Tussilago farfara L, was explored in vitro and in vivo for its potential to treat NAFLD. Our results showed that in vitro TUS reduced oleic acid palmitate acid-induced triglyceride and cholesterol synthesis in HepG2cells, reduced intracellular lipid droplet accumulation, improved glucose metabolism disorders and increased energy metabolism and reduced oxidative stress levels. In vivo, TUS significantly reduced fat accumulation and improved liver injury in high-fat diet (HFD)-induced mice. TUS treatment significantly increased liver mitochondrial counts and antioxidant levels compared to the HFD group of mice. In addition, TUS was found to reduce the expression of genes involved in lipid synthesis sterol regulatory element binding protein-1 (SREBP1), fatty acid synthase (FASN), and stearoy-CoA desaturase 1 (SCD1) in vitro and in vivo. Our results suggest that TUS may be helpful in the treatment of NAFLD, suggesting that TUS is a promising compound for the treatment of NAFLD. Our findings provided novel insights into the application of TUS in regulating lipid metabolism.

Cumin (Cuminum cyminum L.) seeds accelerates wound healing in rats: Possible molecular mechanisms

Wound healing is a complex, intricate, and dynamic process that requires effective therapeutic management. The current study evaluates the wound healing potentials of methanolic extract of Cuminum cyminum L. seeds (CCS) in rats. Sprague Dawley (24) rats were distributed into four cages, wounds produced on the back of the neck, and received two daily topical treatments for 14 days: A, rats received normal saline; B, wounded rats treated with intrasite gel; C and D, rats received 0.2 mL of 250 and 500 mg/kg of CCS, respectively. After that, wound area and closure percentage were evaluated, and wound tissues were dissected for histopathological, immunohistochemical, and biochemical examinations. Acute toxicity trials of methanolic extract of CCS showed the absence of any physiological changes or mortality in rats. CCS application caused a significant reduction in wound size and a statistically elevated percentage of wound contraction than those of vehicle rats. CCS treatment caused significant up-regulation of collagen fiber, fibroblasts, and fewer inflammatory cells (inflammation) in granulation tissues. TGF-β1 (angiogenetic factor) was significantly more expressed in CCS-treated rats in comparison to normal saline-treated rats; therefore, more fibroblasts transformed into myofibroblasts (angiogenesis). CCS-treated rats showed remarkable antioxidant potentials (higher SOD and CAT enzymes) and decreased MDA (lipid peroxidation) levels in their wound tissue homogenates. Hydroxyproline amino acid (collagen) was significantly up-regulated by CCS treatment, which is commonly related to faster wound closure area. The outcomes suggest CCS as a viable new source of pharmaceuticals for wound treatment.

Pharmacotherapy for Keloids and Hypertrophic Scars

Keloids (KD) and hypertrophic scars (HTS), which are quite raised and pigmented and have increased vascularization and cellularity, are formed due to the impaired healing process of cutaneous injuries in some individuals having family history and genetic factors. These scars decrease the quality of life (QOL) of patients greatly, due to the pain, itching, contracture, cosmetic problems, and so on, depending on the location of the scars. Treatment/prevention that will satisfy patients' QOL is still under development. In this article, we review pharmacotherapy for treating KD and HTS, including the prevention of postsurgical recurrence (especially KD). Pharmacotherapy involves monotherapy using a single drug and combination pharmacotherapy using multiple drugs, where drugs are administered orally, topically and/or through intralesional injection. In addition, pharmacotherapy for KD/HTS is sometimes combined with surgical excision and/or with physical therapy such as cryotherapy, laser therapy, radiotherapy including brachytherapy, and silicone gel/sheeting. The results regarding the clinical effectiveness of each mono-pharmacotherapy for KD/HTS are not always consistent but rather scattered among researchers. Multimodal combination pharmacotherapy that targets multiple sites simultaneously is more effective than mono-pharmacotherapy. The literature was searched using PubMed, Google Scholar, and Online search engines.

An ethnopharmacological, phytochemical, and pharmacological overview of onion (Allium cepa L.)

ETHNOPHARMACOLOGICAL RELEVANCE

Onion (Allium cepa L.) is one of the most widely distributed species within the Allium genus of family Amaryllidaceae. Onion has been esteemed for its medicinal properties since antiquity. It has been consumed for centuries in various indigenous cultures for the management of several ailments including microbial infections, respiratory, gastrointestinal, skin and cardio-vascular disorders, diabetes, renal colic, rheumatism, sexual impotence, menstrual pain, and headache. However, so far, there is a scarcity of recent data that compiles the plant chemistry, traditional practices, biological features, and toxicity.

AIM OF THE WORK

The aim of this review is to provide a comprehensive and analytical overview of ethnopharmacological uses, phytochemistry, pharmacology, industrial applications, quality control, and toxicology of onion, to offer new perspectives and broad scopes for future studies.

MATERIALS AND METHODS

The information gathered in this review was obtained from various sources including books, scientific databases such as Science Direct, Wiley, PubMed, Google Scholar, and other domestic and foreign literature.

RESULTS

Onion has a long history of use as a traditional medicine for management of various conditions including infectious, inflammatory, respiratory, cardiovascular diseases, diabetes, and erectile dysfunction. More than 400 compounds have been identified in onion including flavonoids, phenolic acids, amino acids, peptides, saponins and fatty acids. The plant extracts and compounds showed various pharmacological activities such as antimicrobial, antidiabetic, anti-inflammatory, anti-hyperlipidemic, anticancer, aphrodisiac, cardioprotective, and neuroprotective activities. In addition to its predominant medicinal uses, onion has found various applications in the functional food industry.

CONCLUSION

Extensive literature analysis reveals that onion extracts and bioactive constituents possess diverse pharmacological activities that can be beneficial for treating various diseases. However, the current research primarily revolves around the documentation of ethnic pharmacology and predominantly consists of in vitro studies, with relatively limited in vivo and clinical studies. Consequently, it is imperative for future investigations to prioritize and expand the scope of in vivo and clinical research. Additionally, it is strongly recommended to direct further research efforts towards toxicity studies and quality control of the plant. These studies will help bridge the current knowledge gaps and establish a solid basis for exploring the plant's potential uses in a clinical setting.

Sinomenine accelerate wound healing in rats by augmentation of antioxidant, anti-inflammatory, immunuhistochemical pathways

Sinomenine (SN) is a well-documented unique plant alkaloid extracted from many herbal medicines. The present study evaluates the wound healing potentials of SN on dorsal neck injury in rats. A uniform cut was created on Sprague Dawley rats (24) which were arbitrarily aligned into 4 groups receiving two daily topical treatments for 14 days as follows: A, rats had gum acacia; B, rats addressed with intrasite gel; C and D, rats had 30 and 60 mg/ml of SN, respectively. The acute toxicity trial revealed the absence of any toxic signs in rats after two weeks of ingestion of 30 and 300 mg/kg of SN. SN-treated rats showed smaller wound areas and higher wound closure percentages compared to vehicle rats after 5, 10, and 15 days of skin excision. Histological evaluation of recovered wound tissues showed increased collagen deposition, fibroblast content, and decreased inflammatory cells in granulated tissues in SN-addressed rats, which were statistically different from that of gum acacia-treated rats. SN treatment caused positive augmentation of Transforming Growth Factor Beta 1 (angiogenetic factor) in wound tissues, denoting a higher conversion rate of fibroblast into myofibroblast (angiogenesis) that results in faster wound healing action. Increased antioxidant enzymes (SOD and CAT), as well as decreased MDA contents in recovered wound tissues of SN-treated rats, suggest the antioxidant potentials of SN that aid in faster wound recovery. Wound tissue homogenates showed higher hydroxyproline amino acid (collagen content) values in SN-treated rats than in vehicle rats. SN treatment suppressed the production of pro-inflammatory cytokines and increased anti-inflammatory cytokines in the serum of wounded rats. The outcomes present SN as a viable pharmaceutical agent for wound healing evidenced by its positive modulation of the antioxidant, immunohistochemically proteins, hydroxyproline, and anti-inflammatory cytokines.

Skin microbiota metabolism of natural products from comfrey root (Symphytum officinale L.)

ETHNOPHARMACOLOGICAL RELEVANCE

Comfrey root (Symphytum officinale L., Boraginaceae) has been used in folk medicine for a long time to treat different diseases. It is recommended for swellings, phlebitis, contusions, gastro-duodenal ulcers, respiratory diseases, and metrorrhagia. Currently, preparations from S. officinale are only topically used due to its wound-healing effects, and for reducing inflammation and the treatment of broken bones, tendon damage, painful joints and muscles. Although it is a widespread plant material, little is known about the interaction of externally applied preparations of comfrey with the human skin microbiome.

AIM OF THE STUDY

The study aims to determine the interaction between human skin microbiota and the comfrey root extracts, by monitoring the biotransformation of the constituents present in the extract and evaluating changes in the population of the skin microbiota in an ex vivo setting.

MATERIAL AND METHODS

The comfrey root extract was incubated with the human skin microbiota from ten healthy donors. The UHPLC-DAD-MSn analysis determined the composition of the raw extract and the microbial metabolites. Bacterial genomic DNA was extracted and examined by amplification sequencing of the 16S rDNA to determine changes in the bacterial composition.

RESULTS

The hydroethanolic extract of comfrey root primarily consists of phenolic acids, pyrrolizidine alkaloids, and their derivatives, and lignans. The natural products present in the extract underwent biodegradation by the skin microbiota, leading to the formation of smaller molecules. It was observed that the skin microbial metabolism primarily focused on modifying the derivatives of pyrrolizidine alkaloids. It resulted in the production of deacetylated and deesterificated compounds. However, it did not lead to the conversion of these compounds into free alkaloids.

CONCLUSIONS

The microbiota-triggered biotransformation of the comfrey root extract was observed. A few N-oxides were metabolized to deacetylated and deesterificated forms in ex vivo conditions. It suggests that the intermittent external applications of comfrey preparations perchance are unlikely to pose a substantial risk. While it even may serve as a potential factor influencing the extract activity in treating skin diseases.

Unlocking the Power of Onion Peel Extracts: Antimicrobial and Anti-Inflammatory Effects Improve Wound Healing through Repressing Notch-1/NLRP3/Caspase-1 Signaling

Onion peels are often discarded, representing an unlimited amount of food by-products; however, they are a valuable source of bioactive phenolics. Thus, we utilized UPLC-MS/MS to analyze the metabolomic profiles of red (RO) and yellow (YO) onion peel extracts. The cytotoxic (SRB assay), anti-inflammatory (Griess assay), and antimicrobial (sensitivity test, MIC, antibiofilm, and SP-SDS tests) properties were assessed in vitro. Additionally, histological analysis, immunohistochemistry, and ELISA tests were conducted to investigate the healing potential in excisional skin wound injury and Candida albicans infection in vivo. RO extract demonstrated antibacterial activity, limited skin infection with C. albicans, and improved the skin's appearance due to the abundance of quercetin and anthocyanin derivatives. Both extracts reduced lipopolysaccharide-induced nitric oxide release in vitro and showed a negligible cytotoxic effect on MCF-7 and HT29 cells. When extracts were tested in vivo for their ability to promote tissue regeneration, it was found that YO peel extract had the greatest impact. Further biochemical analysis revealed that YO extract suppressed NLRP3/caspase-1 signaling and decreased inflammatory cytokines. Furthermore, YO extract decreased Notch-1 levels and boosted VEGF-mediated angiogenesis. Our findings imply that onion peel extract can effectively treat wounds by reducing microbial infection, reducing inflammation, and promoting tissue regeneration.

Antimicrobial Wound Dressings based on Bacterial Cellulose and Independently Loaded with Nutmeg and Fir Needle Essential Oils

The aim of the present study was to obtain antimicrobial dressings from bacterial cellulose loaded with nutmeg and of fir needle essential oils. The attractive properties of BC, such as biocompatibility, good physicochemical and mechanical stability, and high water absorption, led to the choice of this material to be used as a support. Essential oils have been added to provide antimicrobial properties to these dressings. The results confirmed the presence of oils in the structure of the bacterial cellulose membrane and the ability of the materials to inhibit the adhesion of Staphylococcus aureus and Escherichia coli. By performing antibacterial tests on membranes loaded with fir needle essential oil, we demonstrated the ability of these membranes to inhibit bacterial adhesion to the substrate. The samples loaded with nutmeg essential oil exhibited the ability to inhibit the adhesion of bacteria to the surface of the materials, with the 5% sample showing a significant decrease. The binding of essential oils to the membrane was confirmed by thermal analysis and infrared characterization.

Phytochemistry, Biological, and Pharmacological Properties of Abies alba Mill

Abies alba Mill. (Pinaceae), silver fir, is a widespread gymnosperm species in Europe, important for its ecological, economic, social, and cultural significance, as well as for its use for food and bioremediation purposes. The various parts of the plant (leaves, branches, cones, wood, bark) are also of pharmaceutical interest due to their composition of active compounds. In the last three decades, an impressive amount of research has been dedicated to this species. The variability of the chemical composition of essential oils (whether they come from leaves, oleoresin from branches, or other parts of the plant) is impressive, even in the case of specimens collected from the same geographical area. For essential oils prepared from needles or twigs and branches, limonene, β-pinene, α-pinene, camphene, β-phellandrene, and bornyl acetate are the leading compounds, although their wide variations seem to correspond to multiple chemotypes. Both bark and wood are rich in lignans and phenolic compounds. Matairesinol is apparently the dominant lignan in bark, and secoisolariciresinol and lariciresinol are the dominant ones in wood samples. Pharmacological studies with promising results have evaluated the antioxidant effect (mainly due to essential oils), but also the antimicrobial, antitumor, probiotic, antidiabetic, anti-steatosis, and anti-psoriatic activities.

Potential use of the Asteraceae family as a cure for diabetes: A review of ethnopharmacology to modern day drug and nutraceuticals developments

The diabetes-associated mortality rate is increasing annually, along with the severity of its accompanying disorders that impair human health. Worldwide, several medicinal plants are frequently urged for the management of diabetes. Reports are available on the use of medicinal plants by traditional healers for their blood-sugar-lowering effects, along with scientific evidence to support such claims. The Asteraceae family is one of the most diverse flowering plants, with about 1,690 genera and 32,000 species. Since ancient times, people have consumed various herbs of the Asteraceae family as food and employed them as medicine. Despite the wide variety of members within the family, most of them are rich in naturally occurring polysaccharides that possess potent prebiotic effects, which trigger their use as potential nutraceuticals. This review provides detailed information on the reported Asteraceae plants traditionally used as antidiabetic agents, with a major focus on the plants of this family that are known to exert antioxidant, hepatoprotective, vasodilation, and wound healing effects, which further action for the prevention of major diseases like cardiovascular disease (CVD), liver cirrhosis, and diabetes mellitus (DM). Moreover, this review highlights the potential of Asteraceae plants to counteract diabetic conditions when used as food and nutraceuticals. The information documented in this review article can serve as a pioneer for developing research initiatives directed at the exploration of Asteraceae and, at the forefront, the development of a botanical drug for the treatment of DM.

Why traditional herbal medicine promotes wound healing: Research from immune response, wound microbiome to controlled delivery

Impaired wound healing in chronic wounds has been a significant challenge for clinicians and researchers for decades. Traditional herbal medicine (THM) has a long history of promoting wound healing, making them culturally accepted and trusted by a great number of people in the world. However, for a long time, the understanding of herbal medicine has been limited and incomplete, particularly in the allopathic medicine-dominated research system. The therapeutic effects of individual components isolated from THM are found less pronounced compared to synthetic chemical medicine, and the clinical efficacy is always inferior to herbs. In the present article, we review and discuss underlying mechanisms of the skin microbiome involved in the wound healing process; THM in regulating immune responses and commensal microbiome. We additionally propose few pioneer ideas and studies in the development of therapeutic strategies for controlled delivery of herbal medicine. This review aims to promote wound care with a focus on wound microbiome, immune response, and topical drug delivery systems. Finally, future development trends, challenges, and research directions are discussed.

Ethnobotanical and Ethnopharmacological Study in the Bulgarian Mountain Rhodopes: Part II—Contemporary Use of Medicinal Plants

Rhodopes Mountain is ethnobotanically poorly studied, but our preliminary observation in a number of settlements revealed that even nowadays, the local population relies solely on previously collected medicinal plants. We aimed to assess the contemporary use of medicinal plants in the Central and East Rhodopes and the health conditions that local communities address with them. The ethnobotanical field data were collected through an in-depth method in combination with semi-structured face-to-face interviews, adapted with modifications to the objectives of this study. The following quantitative ethnobotanical indices were used in this study: informant consensus factor (ICF), fidelity level (FL), and Jaccard similarity coefficient or Jaccard index (JI). Data analyses from our field research showed that 92 informants mentioned the utilization of a total of 114 plant species. The results of this study reveal that in both regions of the Rhodopes, medicinal plants are mentioned most often in relation to diseases affecting nervous, respiratory, digestive, and cardiovascular systems, followed by reproductive, urinary, immune, and musculoskeletal. The risk of disruption or loss of traditional knowledge of medicinal plants is expected in the condition of cultural globalization. However, there is no metrified data about the use of medicinal plants in the Rhodopes from the past. The application of statistical indices in this research will make such assessment and monitoring possible in the future.

Topical Intervention of Natural Products Applied in Patients with Pressure Injuries: A Scoping Review

OBJECTIVE

Pressure injuries (PIs) represent a major medical and nursing problem in individuals with decreased or limited mobility. This scoping review aimed to map the controlled clinical trials with topical interventions of natural products applied to patients with PIs and to verify the existence of phytochemical similarities among these products.

DATA SOURCES

This scoping review was developed according to the JBI Manual for Evidence Synthesis. Controlled trials were searched in the following electronic databases from their inceptions until February 1, 2022: Cochrane Central Register of Controlled Trials, EMBASE, PubMed, SciELO, Science Direct, and Google Scholar.

STUDY SELECTION

Studies involving individuals with PIs, individuals treated with topical natural products compared to a control treatment, and outcomes with wound healing or wound reduction were included in this review.

DATA EXTRACTION

The search identified 1,268 records. Only six studies were included in this scoping review. Data were independently extracted using a template instrument from the JBI.

DATA SYNTHESIS

The authors summarized the characteristics of the six included articles, synthesized outcomes, and compared similar articles. Honey and Plantago major dressings were the topical interventions that significantly reduced wound size. The literature suggests that the effect on wound healing of these natural products may be related to the presence of phenolic compounds.

CONCLUSIONS

The studies included in this review show that natural products can positively impact the healing of PIs. However, there are limited controlled clinical trials addressing natural products and PIs in the literature.

Exploring Iberian Peninsula Lamiaceae as Potential Therapeutic Approaches in Wound Healing

Skin tissue has a crucial role in protecting the human body from external harmful agents, preventing wounds that frequently demand proper healing approaches. The ethnobotanical knowledge of specific regions with further investigation on their medicinal plants has been paramount to create new and effective therapeutical agents, including for dermatological purposes. This review attempts, for the first time, to investigate the traditional applications of Lamiaceae medicinal plants that are already used by local communities in the Iberian Peninsula in wound healing. Henceforward, Iberian ethnobotanical surveys were reviewed, and the information about the traditional wound healing practices of Lamiaceae was comprehensively summarized. Afterwards, the scientific validation of each Lamiaceae species was exhaustively checked. From this, eight out of twenty-nine Lamiaceae medicinal plants were highlighted by their wound-related pharmacological evidence and are in-depth presented in this review. We suggest that future studies should focus on the isolation and identification of the active molecules of these Lamiaceae, followed by robust clinical trials that may confirm the security and effectiveness of such natural-based approaches. This will in turn pave the way for more reliable wound healing treatments.

Ethnobotanical survey of medicinal wild plants in the Shouf Biosphere Reserve, Lebanon

BACKGROUND

Medicinal plants and associated traditional knowledge play a vital role in supporting the livelihoods and resilience of indigenous communities. This ethnobotanical survey aims to identify medicinal plants used by the local communities of the Shouf Biosphere Reserve of Lebanon (SBR) and document the associated traditional knowledge.

METHODOLOGY

Focus groups and personal interviews with 133 informants of community members of 22 villages of SBR were performed during 2019-2022. Informants were selected using purposive sampling techniques based on their knowledge of medicinal plants and experience in traditional herbal medicine. Interviews were conducted using a semi-structured questionnaire through field visits.

RESULTS

Informants were equally represented by females and males and had different demographic characteristics, and the main source of knowledge was ancestral. A total of 184 medicinal plant species belonging to 57 families were documented. The predominant families were Asteraceae (31 spp.), Lamiaceae (14 spp.), and Rosaceae (14 spp.). Leaves (23%) were the plant part most used. Decoction (45%) was the predominant preparation method, while internal (oral) use (47%) was the most frequent administration mean. Berberis libanotica, Dittrichia viscosa, and Daucus carota achieved the highest scores of frequency of citation (FC), relative frequency of citation (RFC), use value (UV), and fidelity level (FL). Furthermore, diseases and ailments of gastrointestinal tract were the category most treated.

CONCLUSIONS

Findings revealed a rich and diverse list of medicinal plants with associated traditional knowledge still actively used to treat a wide range of diseases. Future phytochemical and pharmacological studies are recommended to determine the efficacy and safety of plant species used. The management body of the SBR and all related authorities are invited to continue their conservation efforts to protect such rich biocultural heritage.

Effect of Adulteration on Quality and Preliminary Risk Assessment of the Decoction Pieces of Farfarae Flos Based on the Determination of Hepatotoxic Pyrrolizidine Alkaloids by UHPLC-MS/MS

BACKGROUND

Farfarae Flos (FF) is a frequently used traditional herbal medicine with outstanding antitussive actions. The adulteration of FF decoction pieces is common.

OBJECTIVE

This study aimed to study the effect of adulteration on the safety and quality of FF decoction pieces.

METHODS

The proportion of impurities was conducted by cone quartering method. A simple and accurate ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method was established to simultaneous determinate three pyrrolizidine alkaloids (PAs) as endogenous toxic compounds in FF. The traditional medicinal parts (flower bud), impurities (pedicel and rhizome) and unselected samples were determined respectively. The values of estimated daily intake (EDI) and margin of exposure (MOE) were used for risk assessment.

RESULTS

Twenty batches of samples were collected from different habitats, and the proportion of impurities ranged from 17.51% to 41.27%. Pedicel and rhizome were the main impurities, accounting for more than 87.40% of the total impurities. The content of PAs in impurities was significantly higher. The EDI value range was 5.34 to 16.59 μg/kg bw/day, which was much higher than the standard safety value of 7.00 × 10-3 μg/kg bw/day. The MOE values ranges for life long time and shorter exposure were 14.29 to 44.37 and 371.53 to 1153.63, respectively, indicating that at least 80% of the samples had safety risks. Correlation analysis showed that the proportion of adulterated impurities had significant correlation with the values of EDI and MOE.

CONCLUSIONS

Adulteration of non medicinal parts may significantly increase the risk of medications of FF decoction pieces.

HIGHLIGHTS

This study provides an efficient methodology reference for the control of PAs and a basis for adulteration to affect the safety and quality of FF decoction pieces.

A network pharmacology strategy combined with in vitro experiments to investigate the potential anti-inflammatory mechanism of Prunus cerasifera Ehrhart

This study aimed to investigate the anti-inflammatory activity of Prunus cerasifera Ehrhart (EHP). LC-MS/MS, network pharmacology, enzyme-linked immunosorbent assay (ELISA), and Western blot analysis methods were used to investigate the chemical composition and the anti-inflammatory mechanism of EHP. The LC-MS/MS results showed that flavonoids and phenolic acids were the major compounds in EHP. The network pharmacology analysis results indicated that EHP was related to TNF, inflammatory cytokine, and MAPK signaling pathway. ELISA and Western blot results showed that EHP impeded the increase in inflammatory factors, inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2), nuclear transcription factors κB (p65), MAPK pathway, pyrolytic relevant proteins nod-like receptor family pyrin domain-containing 3 (NLRP3), and interleukin-1β (IL-1β) induced by lipopolysaccharide (LPS) and activated the nuclear factor erythroid 2-related factor 2 (Nrf2)/hemeoxygenase-1 (HO-1) pathway. Therefore, this research highlighted the potential application of P. cerasifera in the development of anti-inflammatory foods that prevented inflammatory diseases. PRACTICAL APPLICATIONS: In recent years, many synthetic drugs with anti-inflammatory effect have the disadvantages of high price and side effects. Thus, the development of anti-inflammatory drugs from natural resources has its application value. In this study, LPS-stimulated RAW264.7 cells were used to establish inflammatory model to verify the anti-inflammatory effect of Prunus cerasifera (EHP). The results showed that P. cerasifera possessed anti-inflammatory activity through inhibiting pro-inflammatory cytokines secretion, NF-κB, MAPK pathway, and NLRP3 inflammasome activation. Therefore, P. cerasifera has the potential to develop into functional food to prevent the progress of various inflammatory-related diseases.

Wound Healing and Anti-Inflammatory Effects of a Newly Developed Ointment Containing Jujube Leaves Extract

Ziziphus jujuba Mill. (jujube) is a well-known medicinal plant with pronounced wound healing properties. The present study aimed to establish the chemical composition of the lyophilized ethanolic extract from Romanian Ziziphus jujuba leaves and to evaluate the healing and anti-inflammatory properties of a newly developed lipophilic ointment containing 10% dried jujube leaves extract. The ultra-High-Performance Liquid Chromatography Electrospray Ionization Tandem Mass Spectrometry method was used, and 47 compounds were detected, among them the novel epicatechin and caffeic acid. The extract contains significant amounts of rutin (29.836 mg/g), quercetin (15.180 mg/g) and chlorogenic acid (350.96 µg/g). The lipophilic ointment has a slightly tolerable pH, between 5.41-5.42, and proved to be non-toxic in acute dermal irritation tests on New Zealand albino rabbits and after repeated administration on Wistar rats. The ointment also has a healing activity comparable to Cicatrizin (a pharmaceutical marketed product) on Wistar rats and a moderate anti-inflammatory action compared to the control group, but statistically insignificant compared to indomethacin in the rat-induced inflammation test by intraplantar administration of kaolin. The healing and anti-inflammatory properties of the tested ointment are due to phenolic acids and flavonoids content, less because of minor components as apocynin, scopoletin, and isofraxidin.

Home Care and the Effects of Hypericum tetrapterum Oil Extract in the Treatment of Chronic Wounds During the COVID-19 Pandemic

The COVID-19 pandemic and the need for social distancing brought about sudden changes in the health system and treatment strategies. Patients with chronic wounds were affected by these changes and had limited access to professional treatment in hospitals. They were at a higher risk of infection with COVID-19 due to comorbidities and advanced age. The aim of the study was to develop an appropriate protocol for the in-home treatment of chronic wounds due to the COVID-19 pandemic when access to hospitals is limited and the risk of infection for these patients is high. In our case, Hypericum tetrapterum oil extract was applied for four months on a volunteer, a 78-year-old male patient with a chronic wound, additionally infected with Pseudomonas aeruginosa and comorbidities. His healing status was monitored by measuring the wound size and microbiological analysis at certain intervals. The scab of wound DPHR² (right lower leg chronic wound 2), with its diameters of d1 (40 mm) and d2 (20 mm), fell off after 22 days of the first Hypericum tetrapterum oil extract application. The scab of wound DPHR1 (right lower leg chronic wound 1), with its diameters of d1 (74 mm) and d2 (35 mm), fell off after two and a half months of treatment with Hypericum tetrapterum oil extract. The results of our study indicated that Hypericum tetrapterum oil extract has a significant wound-healing potential and might be used as traditional medicine in the treatment of chronic wounds.

Moroccan medicinal plants traditionally used for the treatment of skin diseases: From ethnobotany to clinical trials

ETHNOPHARMACOLOGICAL RELEVANCE

Skin diseases are among the most common human health affections. A healthy skin promotes a healthy body that can be achieved through modern, allopathic and natural medicines. Therefore, medicinal plants can be a reliable therapy in treating skin diseases in humans through a diverse range of bioactive molecules they contain.

AIM OF THE STUDY

This review aims to provide for the first-time scientific evidence related to the dermatological properties of Morocco's medicinal plants and it aims to provide a baseline for the discovery of new drugs having activities against skin issues.

METHODS

This review involved an investigation with different search engines for Moroccan ethnobotanical surveys published between 1991 and 2021. The plants used to treat skin diseases have been determined. Information regarding pharmacological effects, phytochemical, and clinical trials related to the plants listed in this review was collected from different scientific databases like PubMed, Science Direct, Google Scholar, Web of Science and Scopus. The data were analyzed and summarized in the review.

RESULTS

A total of 401 plants belonging to 86 families mainly represented by Asteraceae, Lamiaceae, Fabaceae, and Apiaceae which have been documented to be in common use by Moroccans for managing skin diseases. Among those plants recorded, the most commonly used are Allium cepa L, Chamaeleon gummifer (L.) Cass and Salvia rosmarinus Schleid. Mill. Leaves were the most commonly used plant part, while powder and decoction were the most common method of traditional drug preparation. 107 of the 401 plants (27%) have undergone pharmacological validation. A total of 44 compounds isolated from 27 plants were investigated to treat different types of skin diseases, and 25 plants have been clinically studied for their activities against skin diseases.

CONCLUSION

The beneficial effects of using Moroccan medicinal plants to treat skin diseases, according to traditional practices, have been proven in numerous scientific studies. Therefore, other studies should focus on isolating and identifying specific bioactive compounds from plant extracts, revealing more valuable therapeutic properties. Furthermore, additional reliable clinical trials are needed to confirm their beneficial effect on patients with skin diseases.

Evaluating the Effectiveness of Aqueous Extract of Persian Oak (Quercus castaneifolia C.A.Mey.) Fruit Hull on Dermal Wound Healing in the Rat Model

Background: Persian oak (Quercus castaneifolia C.A.Mey) belongs to the Fagaceae family. This plant is commonly used in Iranian traditional medicine to treat inflammatory and gastric ulcers. Objectives: This study aimed to assess the efficacy of Persian oak fruit aqueous hull extract on wound healing in rats. Methods: Thirty-five male Wistar rats were randomly divided into five groups, then two full-thickness wounds of 10 mm in diameter were created bilaterally on the back of the animals. The negative control group received saline, the positive control group was treated with phenytoin cream, and three treatment groups received 2%, 4%, and 8% Jaft aqueous extract. The animals received these medicines once daily for 15 days. The percentage of wound healing was evaluated using wound contraction ratio, re-epithelialization, tensile strength, vascular endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) content. Histopathological examination was performed on repaired tissues. Results: In the 2%, 4%, and 8% Jaft extract and the phenytoin groups, the wound closure rate was significantly higher than in the saline group. The treatment groups revealed significant healing improvement (P < 0.05) compared to the control group in wound contraction, tensile strength, epithelialization duration, VEGF, and PDGF plasma level. Histopathological investigations also exhibited development in wound healing with Jaft extract. Conclusions: This study shows that the Persian oak fruit hull aqueous extract was effective in wound healing in animal models. Clinical trials are required to prove the efficacy of Q. castaneifolia fruit hull spray in healing various wounds in humans.

When Natural Compounds Meet Nanotechnology: Nature-Inspired Nanomedicines for Cancer Immunotherapy

Recent significant strides of natural compounds in immunomodulation have highlighted their great potential against cancer. Despite many attempts being made for cancer immunotherapy, the biomedical application of natural compounds encounters a bottleneck because of their unclear mechanisms, low solubility and bioavailability, and limited efficacy. Herein, we summarize the immune regulatory mechanisms of different natural compounds at each step of the cancer-immunity cycle and highlight their anti-tumor potential and current limitations. We then propose and present various drug delivery strategies based on nanotechnology, including traditional nanoparticles (NPs)-based delivery strategies (lipid-based NPs, micelles, and polysaccharide/peptide/protein-based NPs) and novel delivery strategies (cell-derived NPs and carrier-free NPs), thus providing solutions to break through existing bottlenecks. Furthermore, representative applications of nature-inspired nanomedicines are also emphasized in detail with the advantages and disadvantages discussed. Finally, the challenges and prospects of natural compounds for cancer immunotherapy are provided, hopefully, to facilitate their far-reaching development toward clinical translation.

Anti-Coronavirus Efficiency and Redox-Modulating Capacity of Polyphenol-Rich Extracts from Traditional Bulgarian Medicinal Plants

Background: The use of various herbal therapists as part of traditional medicine in different parts of the world, including Bulgaria, is due to the knowledge accumulated over the centuries by people about their valuable biological activities. In this study, we investigate extracts from widely used Bulgarian medicinal plants for their ability to prevent the coronavirus infection of cells by testing different mechanisms of antiviral protection, their polyphenol content, and redox-modulating capacity. Methods: The influence on the stage of viral adsorption, the inhibition of extracellular virions, and the protective effect on uninfected cells of the plant’s extracts were reported by the end-point dilution method, and virus titer (in Δ lgs) was determined as compared to the untreated controls. The total content of polyphenols and flavonoids was also determined. We tested the antioxidant power of the extracts by their ability to inhibit the generation of superoxide anionic radicals and to scavenge DPPH radicals. We determined their iron-reducing, copper-reducing, and metal-chelating antioxidant powers. Results: Most of the extracts tested suppress the extracellular virions of HCov. They also inhibit the stage of viral adsorption to the host cell to varying degrees and have a protective effect on healthy cells before being subjected to viral invasion. The examined extracts contained significant levels of polyphenols and quercetin-like flavonoids and showed remarkable antioxidant, radical, and redox-modulating effects. Conclusions: All of these 13 extracts from Bulgarian medicinal plants tested can act as antioxidants and antiviral and symptomatic drugs for the management of coronavirus infection.

Medicinal Plants Used Traditionally for Skin Related Problems in the South Balkan and East Mediterranean Region—A Review

A review research was conducted to provide an overview of the ethnobotanical knowledge of medicinal plants and traditional medical practices for the treatment of skin disorders in Albania, Cyprus, Greece, and Turkey. The geographical and ecological characteristics of the Balkan Peninsula and Mediterranean Sea, along with the historical connection among those countries, gave rise to the development of a distinct flora and to the uses of common medicinal plants against various skin ailments, respectively. The review focuses on the detailed study of 128 ethnobotanical surveys conducted in these areas and the species used for skin ailments were singled out. The analysis showed that 967 taxa belonging to 418 different genera and 111 different families are used in the treatment of skin related problems. The majority of the plants belong to the families of Asteraceae (11.7%), Lamiaceae (7.4%), Rosaceae (6.7%), Plantaginaceae (5.4%), and Malvaceae (3.8%). Their usage is internal or external to treat ailments such as wounds and burns (22.1%), hemorrhoids (14.7%), boils, abscesses, and furuncles (8.2%). Beside specific skin disorders, numerous species appeared to be used for their antifungal, antimicrobial, and antiseptic activity (9.1%). Literature evaluation highlighted that, the most commonly used species are Plantago major L. (Albania, Turkey), Hypericum perforatum L. (Greece, Turkey), Sambucus nigra L. (Cyprus, Greece), Ficus carica L. (Cyprus, Turkey), Matricaria chamomilla L. (Cyprus, Greece), and Urtica dioica L. (Albania, Turkey), while many medicinal plants reported by interviewees were common in all four countries. Finally, to relate this ethnopharmacological knowledge and trace its expansion and diversification through centuries, a comparison of findings was made with the use of the species mentioned in Dioscorides’ “De Materia Medica” for skin disorders. This work constitutes the first comparative study performed with ethnobotanical data for skin ailments gathered in the South Balkan and East Mediterranean areas. Results confirm the primary hypothesis that people in Albania, Cyprus, Greece, and Turkey are closely related in terms of traditionally using folk medicinal practices. Nevertheless, more field studies conducted, especially in remote places of these regions, can help preserve the traditional medical knowledge, aiming at the discovery of new phytotherapeutics against dermatological diseases.

In vitro and in vivo evaluation of nanofibre mats containing Calendula officinalis extract as a wound dressing

OBJECTIVE

The present study aims to create Calendula officinalis-loaded nanofibre-based wound dressing materials to enhance the wound healing process. Calendula officinalis is an annual herb native to the Mediterranean region. It is antipyretic, antifungal, antioedema, antidiabetic, anti-inflammatory (wound, oral and pharyngeal mucosa), antispasmodic, treats chronic ocular surface diseases, acts as a stimulant and a diaphoretic. It is also used in the prevention of acute dermatitis, and in the treatment of gastrointestinal ulcers, wounds and burns.

METHOD

Electrospinning is an effective method for creating nano- and microfibres for biomedical applications. Calendula officinalis (CA) of various concentrations 5%, 10% and 15%)-loaded polyvinyl alcohol (PVA)/sodium alginate (SAlg) nanofibre mats were successfully produced via blend electrospinning. Nanofibre mats were evaluated using: scanning electron microscopy (SEM); Fourier transform infrared spectroscopy (FTIR) analysis; gel content; water vapour transmission rate (WVTR); swelling ratio; in vitro drug release studies; viability evaluation (cell culture and MTT assay); and an in vivo study using male Wistar rats. Rats were divided into three groups (n=3). In each group, rats were inflicted with five full-thickness wounds on the back and were treated with sterile gauze (control), PVA/SAlg nanofibre dressing (CA-free control), PVA/SAlg/CA5%, PVA/SAlg/CA10%, and PVA/SAlg/CA15% nanofibre dressing.

RESULTS

Results showed that the obtained fibres were smooth with no surface aggregates, indicating complete incorporation of Calendula officinalis. The release of Calendula officinalis from loaded PVA/SAlg fibre mats in the first four hours was burst released and then was constant. PVA/SAlg and PVA/SAlg/CA nanofibres were not toxic to L929 mouse fibroblasts and supported cell attachment and proliferation. The results of the in vivo study showed that the PVA/SAlg/CA10% nanofibre dressing had a higher full-thickness wound healing closure rate compared with the control group on days seven, 14 and 21 after treatment.

CONCLUSION

The results of this evaluation showed that PVA/SAlg/CA nanofibrous mats could be a candidate as an effective wound dressing; however, the percentage of CA in this compound needs further investigation.

Bulgarian Medicinal Extracts as Natural Inhibitors with Antiviral and Antibacterial Activity

Background: Bulgaria is a country with a wide range of medicinal plants, with uses in traditional medicine dating back for centuries. Methods: Disc diffusion assay was used to evaluate the antimicrobial activity of the plant extracts. A cytopathic effect inhibition test was used for the assessment of the antiviral activity of the extracts. The virucidal activity of the extracts, their influence on the stage of viral adsorption, and their protective effect on uninfected cells were reported using the end-point dilution method, and Δlgs was determined as compared to the untreated controls. Results: The results of the study reveal that the antibacterial potential of G. glabra and H. perforatum extracts in Gram-positive bacteria is more effective than in Gram-negative bacteria. When applied during the replication of HSV-1 and HCov-OC-43, only some of the extracts showed weak activity, with SI between 2 to 8.5. Almost all tested extracts inhibited the extracellular virions of the studied enveloped viruses (HSV-1 and HCov-OC-43) to a greater extent than of the non-enveloped viruses (PV-1 and HAdV-5). They inhibited the stage of viral adsorption (HSV-1) in the host cell (MDBK) to varying degrees and showed a protective effect on healthy cells (MDBK) before they were subjected to viral invasion (HSV-1). Conclusion: The antipathogenic potential of extracts of H. perforatum and G. glabra suggests their effectiveness as antimicrobial agents. All 13 extracts of the Bulgarian medicinal plants studied can be used to reduce viral yield in a wide range of viral infections.

A Scoping Review on the Therapeutic Potential of Resin From the Species Larix decidua Mill. [Pinaceae] to Treat Ulcerating Wounds

Malignant ulcerating wounds or neoplastic lesions are a considerable burden for patients suffering from advanced cancer. These wounds have no effective treatment and are very difficult to manage. The present review summarizes evidence in support of a hypothesis put forward in anthroposophic medicine, which suggests a beneficial role of resin from the species Larix decidua Mill. [Pinaceae] for treating such wounds. A systematic search strategy was performed using the databases PubMed, EMBASE and SciFinder. The included publications described the chemical composition of this species, as well as in vitro, in vivo, and ex vivo experiments using plant extracts and isolated compounds. The results show that among the phytochemical classes, terpenoids were the major components of this species, especially in the resin. The summarized biological experiments revealed antimicrobial, antioxidant and anti-inflammatory effects, with promising potential for the extracts and isolated compounds. However, the molecular mechanisms and toxicological effects are as of yet not conclusively evaluated. From the data of our study, we can conclude that L. decidua might indeed have a promising potential for the treatment of malignant wounds, but definitive information that can prove its effectiveness is still lacking. We therefore suggest that future efforts should be dedicated to the evaluation of L. decidua resin's therapeutic use considering its antiseptic action and proposed wound healing properties.

Valorization of Juglans regia Leaves as Cosmeceutical Ingredients: Bioactivity Evaluation and Final Formulation Development

The cosmetic industry is constantly searching for bioactive ingredients, namely, those obtained from natural sources with environmentally friendly connotations and less toxic effects. A previous study of our research group optimized the extraction of phenolic compounds from Juglans regia by heat-assisted extraction. Due to its richness in different phenolic compounds, the present work aimed to develop a formulation containing J. regia leaf extract. The extract’s antioxidant, anti-tyrosinase, antimicrobial, anti-inflammatory, wound healing, cytotoxicity, and photostability properties were evaluated. The extract was then incorporated into an O/W base cream, followed by characterization of the final formulation in terms of its antioxidant properties, phenolic composition, and stability over time and at different storage conditions. The most abundant compounds in the hydroethanolic extract were 3-O-caffeoylquinic acid (18.30 ± 0.04 mg/g), quercetin-O-pentoside (9.64 ± 0.06 mg/g), and quercetin 3-O-glucoside (6.70 ± 0.19 mg/g). Besides those, the extract presented antioxidant, anti-inflammatory, wound closure, and antibacterial effects against several skin pathogens. In addition, HaCaT cell viability was maintained up to 98% at 400 µg/mL. Within Proteus vulgaris-infected HaCaT cells, the extract also presented an over 40% bacterial mortality rate at its nontoxic concentration (200 µg/mL). After incorporating the extract, the obtained formulation presented a good physicochemical profile over time and at different storage conditions while also maintaining its antioxidant effect; as such, it can be considered stable for topical application. Future work to evaluate its performance in terms of skin permeation and detailed toxicological studies with a focus on regulatory requirements, involving skin irritation, eye irritation, genotoxicity, photo-irritation, and dermal absorption, should be conducted, as the prepared formulation demonstrated relevant properties that deserve to be further explored.

Ethnopharmacology for Skin Diseases and Cosmetics during the COVID-19 Pandemic in Lithuania

The documentation of ethnopharmaceutical knowledge has always been important for the preservation of countries’ cultural, social, and economic identity. The COVID-19 pandemic with the collapse of healthcare, which has left the individual health to self-care, has also forced us to look back at ethnopharmacology from a practical point of view. This is the first study in Lithuania, dedicated entirely to ethnopharmaceuticals used for skin diseases and cosmetics, and the first study to analyse ethnopharmacology as a Lithuanian phenomenon during the ongoing COVID-19 pandemic. The main purpose of this study was to collect and evaluate ethnopharmaceutical knowledge regarding skin diseases and cosmetics in Šiauliai District, Lithuania during the COVID-19 pandemic from July 2020 to October 2021. This study surveyed 50 respondents; the survey was conducted using the deep interview method. The respondents mentioned 67 species of medicinal plants from 37 different families used for skin diseases (64.18%), cosmetics (13.44%) and cosmeceuticals (22.38%). Of the 67 plant species, 43 (64%) were not included in the European Medicines Agency monographs and only 14 species (21%) of all included species were used with European Medicines Agency approved medical indications for skin diseases. In terms of public health, the safety of “self-treatment” and recovery rituals for skin diseases are no less important than ethnopharmacological knowledge and its application, this being especially relevant during the COVID-19 pandemic.

Antioxidant Capacity Determination of Hungarian-, Slovak-, and Polish-Origin Goldenrod Honeys

The goldenrod (Solidago) species are flowering plants that produce nectar and can be the sources of unifloral honeys. S. canadensis and S. gigantea are native to North America and invasive in several European countries, while S. virgaurea is native to Europe. The aim of this work was to determine and compare the antioxidant capacity of goldenrod honeys collected in three central European countries (Hungary, Poland, and Slovakia), from three locations within each country. The botanical origin of each honey sample was checked with melissopalynological analysis. Color intensity was determined using the Pfund scale. The antioxidant activity was determined with different spectrophotometric methods (DPPH, ABTS, and FRAP). The content of total polyphenols, flavonoids, and phenolic acids was quantified using spectrophotometric methods. The highest radical-scavenging activity was identified for Hungarian samples with all three antioxidant capacity assays. Medium antioxidant activity was described for Slovak samples. The DPPH and ABTS assays discriminated Polish honeys with the lowest antioxidant activity. The highest flavonoid and phenolic acid content was detected in Hungarian and Slovak honeys, while the lowest values were measured in Polish samples. Our study shows that the antioxidant capacity of unifloral goldenrod honeys can be different in various countries of origin, correlating with color intensity and polyphenol content.

Exudates of Picea abies, Pinus nigra, and Larix decidua: Chromatographic Comparison and Pro-Migratory Effects on Keratinocytes In Vitro

Balms and resins of Picea abies, Larix decidua, and Pinus nigra are traditionally used to treat wounds. Three chromatographic techniques differing in separation capacity and technical demands were employed to distinguish among these plant exudates. A TLC method was established for fingerprint comparison, providing a quick overview of a large number of samples at low cost. HPLC-DAD (RP18) and UHPSFC-DAD (Torus 2-Picolylamin), hyphenated to ESI-MS, represented orthogonal chromatographic systems with high separation performance. The developed methods allow for the separation and detection of major and minor constituents belonging to different compound classes (phenyl carboxylic acids, lignans, diterpene resin acids). The qualitative compositions of the diterpene resin acids, the main compounds in the exudates, were comparable in all three genera. Differences were detected in the distribution of hydroxylated diterpene resin acids, pinoresinol, and hydroxycinnamic acids. The three tested chromatographic systems with varying demands on lab equipment offer appropriate tools for the quality assessment of Picea abies, Larix decidua, and Pinus nigra. The extracts were furthermore tested at three different concentrations (10 µg/mL, 3 µg/mL, and 1 µg/mL) for boosted re-epithelialization, a crucial step in the wound-healing process, in an in vitro HaCaT keratinocyte-based scratch assay. Lysophosphatidic acid (LPA, 10 µM) and extracts of several medicinal plants well known for their wound-healing properties (birch, marigold, St. John's wort, manuka honey) were used as positive controls. Picea abies and Pinus nigra showed concentration dependency; significant activity was measured for Larix decidua at 3 µg/mL.

The Effect of Plantago major Hydroalcoholic Extract on the Healing of Diabetic Foot and Pressure Ulcers: A Randomized Open-Label Controlled Clinical Trial

Aims: Diabetic foot ulcer (DFU) and pressure ulcer (PU) both are common types of ulcers worldwide. The wound healing effect of Plantago major leaves has been shown in a few animal studies. This study aimed to evaluate the clinical efficacy of P. major hydroalcoholic extract on DFU and PU healing. Methods: In this clinical trial, patients with DFU or PU who met the inclusion criteria were randomly assigned to drug (P. major) or control groups. For patients in the drug group, Plantago extract 10% topical gel was applied on the wound once daily concurrent with dressing and routine wound care for two weeks, while for the control group, an appropriate novel dressing was used along with routine wound care for the same duration. The percentage of wound size reduction at the end of the seventh and 14th days of intervention was recorded and compared between the groups. Results: Fifty and 44 patients in drug and control groups, respectively, completed the interventions. Plantago extract gel significantly resulted in more reduction in the wound size compared to control at the end of the first (64.90 ± 29.75% vs. 33.11 ± 26.55%; P < 0.001) and second week (86.85 ± 24.34% vs. 52.87 ± 32.41%; P < 0.001). Furthermore, the number of patients with complete wound healing in the drug group (n = 32, 64%) was significantly more than the control group (n = 9, 20.45%; OR: 3.129, 95% CI: 1.685-5.809, P < 0.001). Conclusion: The use of 10% topical gel of P. major leaf extract results in the acceleration of DFU and PU healing. Key points: Application of P. major topical gel results in the acceleration of diabetic foot ulcer and pressure ulcer healing. - P. major extract helps reducing the wound's erythema.- P. major leaf extract assists decreasing the wound size.- The number of patients completing wound healing process is higher among whom undergoing P. major dressing.

The Effect of Comfrey on Enoxaparin-Induced Bruise in Patients with Acute Coronary Syndrome: A Randomised Clinical Trial

Objectives

Bruising is an important side effect of enoxaparin injection. Comfrey (Symphytum officinale) is used to treat different types of wounds, bone fractures, and bruising in traditional medicine in many countries for centuries. This study aimed to determine the effects of the Comfrey ointment on the bruise size and color following enoxaparin injection.

Methods

This double-blind randomized clinical trial was conducted on 80 patients with acute coronary syndrome (ACS). The participants were randomly divided into two groups of 40, namely Comfrey and Placebo. Changes in bruise size and color in both groups were assessed daily before and after the intervention.

Results

The Comfrey and Placebo groups were homogeneous in demographic and clinical variables. A downward trend was observed in the bruise size in both groups throughout the study. However, the bruise size was smaller in the Comfrey group than the Placebo group on day 2-5 of the intervention. Moreover, there was a significant difference in bruise color between the groups, with a shorter healing course in the Comfrey group.

Conclusion

The Comfrey ointment accelerated the healing process of enoxaparin injection-induced bruising in patients with ACS. It is recommended as a safe and simple approach for these patients.

Physically Crosslinked Chitosan/PVA Hydrogels Containing Honey and Allantoin with Long-Term Biocompatibility for Skin Wound Repair: An In Vitro and In Vivo Study

Chitosan/PVA hydrogel films crosslinked by the freeze-thaw method and containing honey and allantoin were prepared for application as wound dressing materials. The effects of the freeze-thaw process and the addition of honey and allantoin on the swelling, the gel content and the mechanical properties of the samples were evaluated. The physicochemical properties of the samples, with and without the freeze-thaw process, were compared using FTIR, DSC and XRD. The results showed that the freeze-thaw process can increase the crystallinity and thermal stability of chitosan/PVA films. The freeze-thaw process increased the gel content but did not have a significant effect on the tensile strength. The presence of honey reduced the swelling and the tensile strength of the hydrogels due to hydrogen bonding interactions with PVA and chitosan chains. Long-term cell culture experiments using normal human dermal fibroblast (NHDF) cells showed that the hydrogels maintained their biocompatibility, and the cells showed extended morphology on the surface of the hydrogels for more than 30 days. The presence of honey significantly increased the biocompatibility of the hydrogels. The release of allantoin from the hydrogel was studied and, according to the Korsmeyer-Peppas and Weibull models, the mechanism was mainly diffusional. The results for the antimicrobial activity against E. coli and S. aureus bacteria showed that the allantoin-containing samples had a more remarkable antibacterial activity against S. aureus. According to the wound healing experiments, 98% of the wound area treated by the chitosan/PVA/honey hydrogel was closed, compared to 89% for the control. The results of this study suggest that the freeze-thaw process is a non-toxic crosslinking method for the preparation of chitosan/PVA hydrogels with long term biocompatibility that can be applied for wound healing and skin tissue engineering.

Research Progression of the Genus Merremia: A Comprehensive Review on the Nutritional Value, Ethnomedicinal Uses, Phytochemistry, Pharmacology, and Toxicity

The genus Merremia Dennst. ex Endl. (Convolvulaceae) is a rich source of structurally diverse phytochemicals with therapeutic relevance. This review presents the first comprehensive, up-to-date information and research progression on the nutritional value, ethnomedicinal uses, phytochemistry, pharmacological activities, and toxicity of the genus Merremia. Using the key search term “Merremia”, relevant documents and information were retrieved from electronic databases. Relevant documents were uploaded in RStudio with installed bibliometric software packages and used for data retrieval, tabulation, and network visualization. Bibliometric analysis revealed that ca. 55% of the studies related to Merremia were published in the last decade, which can be grouped into four thematic areas: (i) drug formulation, (ii) taxonomy, (iii) chemical analysis, and (iv) treatment of diseases. Ethnomedicinal uses, phytochemistry, and biological activities studies showed that species in the genus are promising medicinal plants with various pharmaceutical potentials. However, clinical studies to validate the efficacy of the reported bioactivities and the mechanisms underlying the various activities are lacking and should constitute a future research focus. Additionally, reports on the nutritional and antinutritional constituents of Merremia species revealed that the species meet high nutritional quality criteria for animals and are therefore suitable for inclusion in livestock diets. The few available investigations on toxicity indicated that most Merremia species are safe for human and animal use but not with prolonged chronic administration.

In vitro methods used for discovering plant derived products as wound healing agents - An update on the cell types and rationale

Wounds still pose a huge burden on human health and healthcare systems in many parts of the world. Phytomedicines are being used to heal the wounds since ancient times. Now-a-days also many researchers are exploring the wound healing activity of phytomedicines. Wound healing is a complex process thus, it is always a question mark regarding the best test model (in vivo, ex vivo and in vitro) model to assess the wound healing activity of phytomedicines. In general, the researchers would opt for in vivo model - probably because of closer physiological relevance to human wounds. However, in vivo experimental models are not suitable for high throughput screening and not ethical in terms of initial screening of the phytomedicines. The in vivo models are associated with difficulties in obtaining the ethical approvals, requires huge budget, and resources. We argue that judicious selection of cell types would serve the purpose of developing a physiologically relevant in vitro experimental model. A lot of progress has been made in molecular biology techniques to bridge the gap between in vitro models and their physiological relevance. The in vitro models are the best suited for high throughput screening and to elucidate the molecular mechanisms. The main aim of this review is to provide insights on selection of the cell types for developing physiologically relevant in vitro wound healing assays, which can be used to improve the value of phytomedicines further.