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Lourith N, Kanlayavattanakul M, Khongkow M, Chaikul P. Para rubber seed oil and its fatty acids alleviate photoaging and maintain cell homeostasis. Int J Cosmet Sci 2024. [PMID: 39051100 DOI: 10.1111/ics.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Para rubber seed oil was indicated for skin dullness and hair loss in regard to its cutaneous beneficial fatty acids. Nonetheless, the oil's potency against photoaging remains unexplored. We proposed that para rubber seed oil could alleviate photoaging. METHODS Para rubber seed oil was investigated in cocultures of human HaCaT cells and dermal fibroblasts (HDF). Photoaging protectant efficiency was monitored in terms of IL-6 and IL-8 as well as MMP-1 (collagenase) and MMP-9 (gelatinase) in a comparison with its fatty acid components. RESULTS Para rubber seed oil standardized in fatty acids was indicated as the promising plant oil for photoaging treatment. Its photoprotection mechanism was demonstrated in the coculture system of keratinocyte and fibroblast cells for the first time. Where the oil and its fatty acid constituents (100 μg/mL) were indicated to be safe and efficiently protect the cocultures against UV damage. The oil significantly (p < 0.001) suppressed UV-induced IL-6, IL-8, MMP-1 and MMP-9 secretions. The revealed photoprotection proficiency was abided by its fatty acids, particularly the unsaturated C18 ones. CONCLUSION The oil was indicated on its potential to maintain skin homeostasis and would alleviate senescence ageing in regard to its photoprotection abilities exhibited. Para rubber seed oil is warranted as a new generation of photoaging protectant agent with the profiled safety and efficacy demonstrated in the epidermal coculture system. The findings encourage the development of innovative anti-ageing products containing the oil, which is categorizable as a sustainable specialty material for photoaging treatment.
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Affiliation(s)
- Nattaya Lourith
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, Thailand
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, Thailand
| | - Mayuree Kanlayavattanakul
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, Thailand
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, Thailand
| | - Mattaka Khongkow
- National Nanotechnology Center (NANOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Puxvadee Chaikul
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, Thailand
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, Thailand
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Pathak D, Mazumder A. A critical overview of challenging roles of medicinal plants in improvement of wound healing technology. Daru 2024; 32:379-419. [PMID: 38225520 PMCID: PMC11087437 DOI: 10.1007/s40199-023-00502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 12/25/2023] [Indexed: 01/17/2024] Open
Abstract
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.
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Affiliation(s)
- Deepika Pathak
- Noida Institute of Engineering and Technology (Pharmacy Institute), 19 Knowledge Park-II, Institutional Area, Greater Noida, UP, 201306, India.
| | - Avijit Mazumder
- Noida Institute of Engineering and Technology (Pharmacy Institute), 19 Knowledge Park-II, Institutional Area, Greater Noida, UP, 201306, India
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Kanlayavattanakul M, Khongkow M, Klinngam W, Chaikul P, Lourith N, Chueamchaitrakun P. Recent insights into catechins-rich Assam tea extract for photoaging and senescent ageing. Sci Rep 2024; 14:2253. [PMID: 38279010 PMCID: PMC10817888 DOI: 10.1038/s41598-024-52781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/23/2024] [Indexed: 01/28/2024] Open
Abstract
Tea (Camellia spp.) is an important medicinal herb. C. sinensis var. sinensis is the most studied tea variety due to its more preferred flavor than C. sinensis var. assamica (Assam tea), the less economic importance with more bitter variety. A bitter taste highlights its potential as a candidate source for tea catechins, the health beneficial actives applicable for ageing treatment. Nonetheless, indicative data for tea on UV-induced and senescent ageing remain unclarified. Assam tea extract (ATE) was prepared and standardized in terms of TPC, TFC and TTC. EGCG was HPLC quantified as the prime ATE catechin. In vitro antioxidant activity of ATE was exhibited with ABTS, DPPH and FRAP assays. ATE's cellular antioxidant activity was indicated in HDFs at a stronger degree than ascorbic acid. The photoaging protection of ATE was evidenced in a coculture of HaCaT cells and HDFs. ATE markedly suppressed UV-induced IL-6, IL-8, MMP-1 and MMP-9 expressions. The proficiency of ATE targeting on senescent ageing was demonstrated in an ex vivo human skin model, where IL-6 and MMP-1 expressions were suppressed, whilst hyaluronic acid and collagen syntheses were promoted. ATE was chemically stabled as indicated by the catechin contents and color parameters following 6 months storage under conditions recommended for topical product. ATE enriched in catechins warrants its applicability as a new generation of photoaging protectant agent promising for the prevention and treatment for senescent ageing. The findings indicate the proficiency of ATE for innovative anti-ageing agent.
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Affiliation(s)
- Mayuree Kanlayavattanakul
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand.
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, Thailand.
| | - Mattaka Khongkow
- National Nanotechnology Center (NANOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Wannita Klinngam
- National Nanotechnology Center (NANOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Puxvadee Chaikul
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, Thailand
| | - Nattaya Lourith
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, Thailand
| | - Piyaporn Chueamchaitrakun
- School of Agro-Industry, Mae Fah Luang University, Chiang Rai, Thailand
- Tea and Coffee Institute, Mae Fah Luang University, Chiang Rai, Thailand
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Kanlayavattanakul M, Khongkow M, Lourith N. Wound healing and photoprotection properties of Acanthus ebracteatus Vahl. extracts standardized in verbascoside. Sci Rep 2024; 14:1904. [PMID: 38253627 PMCID: PMC10803370 DOI: 10.1038/s41598-024-52511-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024] Open
Abstract
Acanthus spp. have been documented in traditional Thai herbal medicine and are applicable for the treatment of inflamed skin with wound healing property. Nonetheless, the scientific evidence necessary to prove the herb's doctrine has not yet been revealed. Verbascoside-rich extracts of the herbal medicine A. ebracteatus Vahl., were therefore prepared. The extracts and verbascoside were examined for their wound healing abilities using a scratch assay with fibroblasts. The anti-inflammatory effect suppressing MMP-9 was assessed in cocultures of keratinocyte (HaCaT cells) and fibroblasts. The extracts significantly improved wound healing compared with the control (p < 0.001). The wound healing effect of the extracts significantly (p < 0.01) increased with increasing verbascoside content. It should be noted that the extract was significantly (p < 0.05) better than verbascoside at the same test concentration. The extracts were capable of protecting cocultures of HaCaT cells and fibroblasts from photodamage. The extracts significantly (p < 0.001) suppressed cellular MMP-9 secretion following UV exposure, showing a better effect than that of verbascoside (p < 0.01). A. ebracteatus extract is promising for wound healing and photoprotection, and a prominent source of verbascoside. Verbascoside-rich A. ebracteatus could be utilized for the development of innovative skin-care products.
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Affiliation(s)
- Mayuree Kanlayavattanakul
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand.
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, 57100, Thailand.
| | - Mattaka Khongkow
- National Nanotechnology Center (NANOTEC), National Science and Technology Development Agency, Pathum Thani, 12120, Thailand
| | - Nattaya Lourith
- School of Cosmetic Science, Mae Fah Luang University, Chiang Rai, 57100, Thailand
- Phytocosmetics and Cosmeceuticals Research Group, Mae Fah Luang University, Chiang Rai, 57100, Thailand
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Abbas EY, Ezzat MI, El Hefnawy HM, Abdel-Sattar E. An overview and update on the chemical composition and potential health benefits of Opuntia ficus-indica (L.) Miller. J Food Biochem 2022; 46:e14310. [PMID: 35780308 DOI: 10.1111/jfbc.14310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 12/29/2022]
Abstract
Opuntia ficus-indica (OFI), widely recognized as prickly pear, is native to Mexico and it is distributed in many areas of the world because of its socioeconomic, agronomic, and ecological benefits, besides its large amounts of functional, nutraceutical, and biological activities. Various parts of this plant including the fruit pulp and peel, cladode, and seeds are scientifically proven to have therapeutic potentials and are safe for human use. The contents of phytochemical compounds in each part of the OFI are different. Each pharmacological activity depends on the phytochemical compounds, the components used, and the extraction type. In this review, we summarize the active constituents from different parts of OFI and their pharmacological effects including the antioxidant, wound healing, skin protective, hepatoprotective, anticancer, antidiabetic, antihypercholesterolemic, and anti-obesity activities. Besides its effects on the bone health, cardiovascular system, kidneys, and gastrointestinal tract, its gastroprotective, anti-ulcer, anti-inflammatory, antiviral, neuroprotective, sedative, analgesic, anxiolytic and antimicrobial effects and effects on cognitive and memory function are also mentioned. PRACTICAL APPLICATIONS: Over the past few decades, the health benefits of Opuntia ficus-indica (OFI) have received much attention. All parts of the plant, including the fruit pulp and peel, cladode, and seeds have found use in the treatment of many diseases. The chemical composition of OFI provides both a high nutritional value and various health benefits. Therefore, the aim of this review is to present the up-to-date research carried out on OFI phytochemicals, showing the most important biological activities reported.
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Affiliation(s)
- Eman Yasser Abbas
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Marwa I Ezzat
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | | | - Essam Abdel-Sattar
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Madrigal-Santillán E, Portillo-Reyes J, Madrigal-Bujaidar E, Sánchez-Gutiérrez M, Izquierdo-Vega JA, Izquierdo-Vega J, Delgado-Olivares L, Vargas-Mendoza N, Álvarez-González I, Morales-González Á, Morales-González JA. Opuntia spp. in Human Health: A Comprehensive Summary on Its Pharmacological, Therapeutic and Preventive Properties. Part 2. PLANTS 2022; 11:plants11182333. [PMID: 36145735 PMCID: PMC9505094 DOI: 10.3390/plants11182333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/18/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
Plants of the genus Opuntia spp are widely distributed in Africa, Asia, Australia and America. Specifically, Mexico has the largest number of wild species; mainly O. streptacantha, O. hyptiacantha, O. albicarpa, O. megacantha and O. ficus-indica. The latter being the most cultivated and domesticated species. Its main bioactive compounds include pigments (carotenoids, betalains and betacyanins), vitamins, flavonoids (isorhamnetin, kaempferol, quercetin) and phenolic compounds. Together, they favor the different plant parts and are considered phytochemically important and associated with control, progression and prevention of some chronic and infectious diseases. Part 1 collected information on its preventive actions against atherosclerotic cardiovascular diseases, diabetes and obesity, hepatoprotection, effects on human infertility and chemopreventive capacity. Now, this second review (Part 2), compiles the data from published research (in vitro, in vivo, and clinical studies) on its neuroprotective, anti-inflammatory, antiulcerative, antimicrobial, antiviral potential and in the treatment of skin wounds. The aim of both reviews is to provide scientific evidences of its beneficial properties and to encourage health professionals and researchers to expand studies on the pharmacological and therapeutic effects of Opuntia spp.
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Affiliation(s)
- Eduardo Madrigal-Santillán
- Escuela Superior de Medicina, Instituto Politécnico Nacional, “Unidad Casco de Santo Tomas”, Ciudad de México 11340, Mexico
- Correspondence: (E.M.-S.); (J.A.M.-G.); Tel.: +52-55-5729-6300 (ext. 62753) (E.M.-S.)
| | - Jacqueline Portillo-Reyes
- Escuela Superior de Medicina, Instituto Politécnico Nacional, “Unidad Casco de Santo Tomas”, Ciudad de México 11340, Mexico
| | - Eduardo Madrigal-Bujaidar
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, “Unidad Profesional A. López Mateos”, Ciudad de México 07738, Mexico
| | - Manuel Sánchez-Gutiérrez
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico
| | - Jeannett A. Izquierdo-Vega
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico
| | - Julieta Izquierdo-Vega
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico
| | - Luis Delgado-Olivares
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico
| | - Nancy Vargas-Mendoza
- Escuela Superior de Medicina, Instituto Politécnico Nacional, “Unidad Casco de Santo Tomas”, Ciudad de México 11340, Mexico
| | - Isela Álvarez-González
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, “Unidad Profesional A. López Mateos”, Ciudad de México 07738, Mexico
| | - Ángel Morales-González
- Escuela Superior de Cómputo, Instituto Politécnico Nacional, “Unidad Profesional A. López Mateos”, Ciudad de México 07738, Mexico
| | - José A. Morales-González
- Escuela Superior de Medicina, Instituto Politécnico Nacional, “Unidad Casco de Santo Tomas”, Ciudad de México 11340, Mexico
- Correspondence: (E.M.-S.); (J.A.M.-G.); Tel.: +52-55-5729-6300 (ext. 62753) (E.M.-S.)
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Abd-Elhakim YM, Al-Sagheer AA. Opuntia spp. Benefits in Chronic Diseases. OPUNTIA SPP.: CHEMISTRY, BIOACTIVITY AND INDUSTRIAL APPLICATIONS 2021:423-455. [DOI: 10.1007/978-3-030-78444-7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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D’Agostino A, Pirozzi AVA, Finamore R, Grieco F, Minale M, Schiraldi C. Molecular Mechanisms at the Basis of Pharmaceutical Grade Triticum vulgare Extract Efficacy in Prompting Keratinocytes Healing. Molecules 2020; 25:E431. [PMID: 31972968 PMCID: PMC7037555 DOI: 10.3390/molecules25030431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It has been shown that many plant- or microbial-derived oligos and polysaccharides may prompt tissue repair. Among the different extracts that have been studied, the aqueous one of Triticum vulgare (TVE) that was obtained from a whole germinated plant has been proven to have different biological properties that are useful in the process of wound healing. Nevertheless, with the long tradition of its use in pharmaceutical cream and ointments, especially in Italy, a new protocol was recently proposed (and patented) to improve the extraction process. METHODS In a simplified in vitro model, human keratinocyte monolayers were scratched and used to run time lapse experiments by using time lapse video microscopy (TLVM) to quantify reparation rate while considering a dose-response effect. Contemporarily, the molecular mechanisms that are involved in tissue repair were studied. In fact, key biomarkers that are involved in remodeling, such as MMP-2 and MMP-9, and in matrix structure assembly, such as collagen I, elastin, integrin αV and aquaporin 3, were evaluated with gene expression analyses (RT-PCR) and protein quantification in western blotting. RESULTS All TVE doses tested on the HaCat-supported cell proliferation. TVE also prompted cell migration in respect to the control, correctly modulating the timing of metalloproteases expression toward a consistent and well-assessed matrix remodeling. Furthermore, TVE treatments upregulated and positively modulated the expression of the analyzed biomarkers, thus resulting in a better remodeling of dermal tissue during healing. CONCLUSIONS The in vitro results on the beneficial effects of TVE on tissue elasticity and regeneration may support a better understanding of the action mechanism of TVE as active principles in pharmaceutical preparation in wound treatment.
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Affiliation(s)
- Antonella D’Agostino
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.D.); (A.V.A.P.); (R.F.)
| | - Anna Virginia Adriana Pirozzi
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.D.); (A.V.A.P.); (R.F.)
| | - Rosario Finamore
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.D.); (A.V.A.P.); (R.F.)
| | | | | | - Chiara Schiraldi
- Department of Experimental Medicine, Section of Biotechnology, Medical Histology and Molecular Biology, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.D.); (A.V.A.P.); (R.F.)
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Protective Role of Nutritional Plants Containing Flavonoids in Hair Follicle Disruption: A Review. Int J Mol Sci 2020; 21:ijms21020523. [PMID: 31947635 PMCID: PMC7013965 DOI: 10.3390/ijms21020523] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 11/26/2022] Open
Abstract
Hair loss is a disorder in which the hair falls out from skin areas such as the scalp and the body. Several studies suggest the use of herbal medicine to treat related disorders, including alopecia. Dermal microcirculation is essential for hair maintenance, and an insufficient blood supply can lead to hair follicles (HF) diseases. This work aims to provide an insight into the ethnohistorical records of some nutritional compounds containing flavonoids for their potential beneficial features in repairing or recovering from hair follicle disruption. We started from a query for “alopecia” OR “hair loss” AND “Panaxginseng C.A. Mey.“ (or other six botanicals) terms included in Pubmed and Web of Sciences articles. The activities of seven common botanicals introduced with diet (Panaxginseng C.A. Mey., Malus pumila Mill cultivar Annurca, Coffea arabica, Allium sativum L., Camellia sinensis (L.) Kuntze, Rosmarinum officinalis L., Capsicum annum L.) are discussed, which are believed to reduce the rate of hair loss or stimulate new hair growth. In this review, we pay our attention on the molecular mechanisms underlying the bioactivity of the aforementioned nutritional compounds in vivo, ex vivo and in vitro studies. There is a need for systematic evaluation of the most commonly used plants to confirm their anti-hair loss power, identify possible mechanisms of action, and recommend their best adoption.
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