Consumption of Historical and Current Phytotherapeutic Agents for Urolithiasis: A Critical Review

Chemical Composition, Antioxidant Potentials, and Calcium Oxalate Anticrystallization Activity of Polyphenol and Saponin Fractions from Argania spinosa L. Press Cake

A wide range of biological properties and a potent therapeutic and prophylactic effect on chronic diseases are all present in Argania spinosa L. press cake. The aim of this research is to valorize the anticrystallization properties against calcium oxalate crystals of Argania spinosa L. press cake fractions and identify its bioactive components. Chemical species identification was performed using GC–MS analysis. The turbidimetric model was used to investigate crystallization inhibition in vitro. Infrared spectroscopy technique was used to characterize the synthesized crystals. Furthermore, both DPPH and FRAP methods were used to assess antioxidant activity. The results show that the fractions are equally important in crystallization inhibition percentages of calcium oxalate crystals. For saponin and polyphenol fractions, the inhibition percentages are in the orders of 83.49% and 82.83%, respectively. The results of the antioxidant activity by DPPH method show that the two fractions are equally important in the elimination of free radicals; the inhibition percentages were 77.87 ± 4.21 and 89.92 ± 1.39 for both polyphenols and saponins, respectively. FRAP method showed that the absorbance increases proportionally with concentration, and the absorbance are almost similar for both fractions and reach maximum values in the orders of 0.52 ± 0.07 and 0.42 ± 0.03, respectively, for saponins and polyphenols. These findings demonstrate that both fractions are rich in bioactive chemicals and have an anticrystallization capacity, allowing them to be employed for the curative and prophylactic effects against urolithiasis.

Screening out key compounds of Glechomae Herba for antiurolithic activity and quality control based on spectrum-effect relationships coupled with UPLC-QDA

Glechomae Herba (GH) has been widely used in the treatment of urolithiasis, especially kidney stones, in China and Southeast Asia. Pharmacological studies have suggested that the antioxidant property of GH contributes to its anticalculus effect. CaSR is one of the main locations of kidney stones, and the mechanism of action of CaSR inhibitors in the treatment of kidney stones is similar to that of GH. However, until now, the antiurolithic chemical compounds in GH and their interaction with CaSR remain unknown. In our study, we revealed the interaction between the active compounds in GH and the active compounds in CaSR inhibitors by using spectrum-effect relationship analysis, pharmacodynamics, and molecular docking techniques. The results showed ten common peaks from the fingerprints of GH extracts from different regions. Pharmacological experiments showed that GH could significantly treat renal tissue lesions. Chlorogenic acid (CA), rosmarinic acid (RA), P5, luteolin, apigenin, and P9 were screened after the analysis of spectrum-effect relationships. In vitro validation experiments showed that all the screened compounds had inhibitory effects on the development of kidney stones in our model. The molecular docking results showed that the above compounds could be docked with CaSR in a natural state, and the docking score was less than 7. This work constructs a general model for the combination of UPLC-QDA and antiurolithic drugs, studies the spectrum-effect relationship of GH, and provides a new possibility for the development of new antiurolithic drugs.

Bergenia pacumbis (Buch.-Ham. ex D.Don) C.Y.Wu & J.T.Pan: A Comprehensive Review on Traditional Uses, Phytochemistry and Pharmacology

The influence of medicinal plants on humanity spans time immemorial. These plants are also used at present with local and tribal peoples for the cures of various illnesses. Nature has produced an immense number of medicinal plants, which directly or indirectly help to treat various ailments and have numerous applications in the fields of pharmaceuticals, agriculture, food flavors and preservatives, aromas, and cosmetics. Bergenia pacumbis (Buch.-Ham. ex D.Don) C.Y.Wu & J.T.Pan (synonym: Bergenia ligulate Engl.), is an important medicinal plant belonging to the Saxifragaceae family, and not to be confused with Bergenia ciliata (Haw.) Sternb., and is popularly known as Pashanbheda (meaning to dissolve the kidney stone). This plant is a rich source of secondary metabolites (SMs) such as coumarins, flavonoids, benzenoids, lactones, tannins, phenols, and sterols, which make this plant a highly valued medicinal herb with a broad spectrum of pharmacological activities such as anti-urolithic, antioxidant, anti-viral, free radical scavenging, antidiabetic, anti-hepatotoxic, diuretic, antipyretic, anti-oxaluria, anti-tumour, antibacterial, antifungal, anti-inflammatory, antimicrobial, and cardioprotective. This review summarizes traditional uses and offers up to date data for future research on B. pacumbis.

Pharmacological Evaluation of Mentha piperita Against Urolithiasis: An In Vitro and In Vivo Study

Background: Mentha piperita L. (peppermint) is one of the most widely consumed medicinal herbs that has gained attention from food and pharmaceutical industries due to its distinct aroma and taste. Purpose: Present study was aimed to rationalize the traditional use of peppermint in urolithiasis and to explore its possible underlying mechanism. Research Design: The aqueous methanolic crude extract of Mentha piperita (Mp.Cr) was assessed for phytochemical constituents and antioxidant activity. In vitro crystallization assays were performed to determine the inhibitory effects of Mp.Cr against crystal nucleation, aggregation and growth. In vivo urolithiasis model was developed in rats by the administration of ammonium chloride and ethylene glycol in drinking water. The antiurolithic effects of Mp.Cr were evaluated by analyzing kidney homogenate, biochemical and histological parameters. Results: HPLC analysis showed the presence of epicatechin, quercetin, gallic acid, syringic acid, kaempferol, caffeic acid and coumaric acid. The maximum quantity of quercetin equivalent flavonoid and gallic acid equivalent phenolic content was found to be 63.73 ± .24 mg QE/g and 43.76 ± .6 mg GAE/g of Mp.Cr, respectively. Mp.Cr significantly normalized urinary and serum biochemistry, similar to the standard cystone treatment. Conclusions: The current study validated the preventive and curative potential of Mp.Cr against urolithiasis and justified its traditional use in kidney stone disease.

The antiurolithic activity of Origanum vulgare on rats treated with ethylene glycol and ammonium chloride: Possible pharmaco-biochemical and ultrastructure effects

Background:

Origanum vulgare (OV) Linn is one of the conventional remedies for urolithiasis. Hence, we tested the potential antiurolithic effect of OV active extract, in order to rationalize its medicinal use.

Materials and methods:

The in vivo study was of male Westar rats receiving lithogenic treatment consisting of two 0.75% ethylene glycol injections with a 1 day interval and then in drinking water given for 3 weeks along with ammonium chloride (NH₄Cl) from the 2nd day to the 7th day.

Results:

The active ethanolic extract of OV treatment (20 mg/kg) reversed toxic changes including loss of body weight gain and appetite, raised serum urea and creatinine levels, and raised blood pressure compared to controls.

Conclusions:

The acquired data thus suggested that OV showed antiurolithic effects against renal calcium oxalate crystal deposits by combined mechanisms acting on multiple sites through hypoxaliuric, hypocalciuric, and antioxidant effects.

Pharmacological Evaluation of Safoof-e-Pathar Phori- A Polyherbal Unani Formulation for Urolithiasis

Safoof-e-Pathar phori (SPP) is an Unani poly-herbomineral formulation, which has for a long time been used as a medicine due to its antiurolithiatic activity, as per the Unani Pharmacopoeia. This powder formulation is prepared using six different plant/mineral constituents. In this study, we explored the antiurolithiatic and antioxidant potentials of SPP (at 700 and 1,000 mg/kg) in albino Wistar rats with urolithiasis induced by 0.75% ethylene glycol (EG) and 1% ammonium chloride (AC). Long-term oral toxicity studies were performed according to the Organization for Economic Co-operation and Development (OECD) guidelines for 90 days at an oral dose of 700 mg/kg of SPP. The EG urolithiatic toxicant group had significantly higher levels of urinary calcium, serum creatinine, blood urea, and tissue lipid peroxidation and significantly (p < 0.001 vs control) lower levels of urinary sodium and potassium than the normal control group. Histopathological examination revealed the presence of refractile crystals in the tubular epithelial cell and damage to proximal tubular epithelium in the toxicant group but not in the SPP treatment groups. Treatment of SPP at 700 and 1,000 mg/kg significantly (p < 0.001 vs toxicant) lowered urinary calcium, serum creatinine, blood urea, and lipid peroxidation in urolithiatic rats, 21 days after induction of urolithiasis compared to the toxicant group. A long-term oral toxicity study revealed the normal growth of animals without any significant change in hematological, hepatic, and renal parameters; there was no evidence of abnormal histology of the heart, kidney, liver, spleen, or stomach tissues. These results suggest the usefulness of SPP as an antiurolithiatic and an antioxidant agent, and long-term daily oral consumption of SPP was found to be safe in albino Wistar rats for up to 3 months. Thus, SPP may be safe for clinical use as an antiurolithiatic formulation.

Compound Characterization and Metabolic Profile Elucidation after In Vitro Gastrointestinal and Hepatic Biotransformation of an Herniaria hirsuta Extract Using Unbiased Dynamic Metabolomic Data Analysis

Herniaria hirsuta L. (Caryophyllaceae) is used for treatment of urinary stones and as a diuretic. Little is known about the active compounds and the mechanism of action. The phytochemical composition of H. hirsuta was comprehensively characterized using UHPLC-UV-HRMS (Ultrahigh-Performance Liquid Chromatography-Ultraviolet-High Resolution Mass Spectrometry) data. An in vitro gastrointestinal model was used to simulate biotransformation, which allowed the monitoring of the relative abundances of individual compounds over time. To analyze the longitudinal multiclass LC-MS data, XCMS, a platform that enables online metabolomics data processing and interpretation, and EDGE, a statistical method for time series data, were used to extract significant differential profiles from the raw data. An interactive Shiny app in R was used to rate the quality of the resulting features. These ratings were used to train a random forest model. The most abundant aglycone after gastrointestinal biotransformation was subjected to hepatic biotransformation using human S9 fractions. A diversity of compounds was detected, mainly saponins and flavonoids. Besides the known saponins, 15 new saponins were tentatively identified as glycosides of medicagenic acid, acetylated medicagenic acid and zanhic acid. It is suggested that metabolites of phytochemicals present in H. hirsuta, most likely saponins, are responsible for the pharmaceutical effects. It was observed that the relative abundance of saponin aglycones increased, indicating loss of sugar moieties during colonic biotransformation, with medicagenic acid as the most abundant aglycone. Hepatic biotransformation of this aglycone resulted in different metabolites formed by phase I and II reactions.

In vitro antilithiatic activity of the hydro-alcoholic extract of Cinnamomum zeylanicum Blume bark on calcium oxalate crystallization

OBJECTIVE

The study examines the effect of the hydro-alcoholic extract of Cinnamomum zeylanicum Blume bark on crystallization of calcium oxalate.

METHODS

The antilithiatic effect of various concentrations of the hydro-alcoholic extract of C. zeylanicum was investigated at various stages of stone formation, using Cystone as a standard reference drug. The effect on calcium oxalate crystallization was evaluated by measuring the change in turbidity over time, during crystal nucleation, growth and aggregation, in the metastable solution of calcium chloride and sodium oxalate. The slope from the change in turbidity over time was measured using a spectrophotometer at 620 and 214 nm in respective tests. The inhibition rate was estimated by comparing turbidity in the presence and absence of extract. Crystals formed under experimental conditions were observed under a light microscope, and number and shape of the crystals were assessed in a randomly selected field. Phytochemical analysis and high-performance thin-layer chromatography of the extract was also carried out.

RESULTS

C. zeylanicum significantly reduced crystal nucleation at concentrations of 4, 8 and 10 mg/mL (P < 0.001). The inhibition percentage of crystal growth was between 28.30% and 92.46% in the presence of C. zeylanicum extract and from 20.76% to 64.15% with various concentrations of Cystone. The maximum inhibition of crystal growth was obtained from C. zeylanicum at 2 mg/mL (92.46%). Microscopic examination revealed a reduction in the number and size of crystals. In the aggregation assay, the inhibition percentage of C. zeylanicum was between 16.27% and 100%, while Cystone was from -214.68% to 100% at different concentrations. The highest (100%) inhibition of aggregation was found at 4 mg/mL of both the test and standard drugs.

CONCLUSION

We found that C. zeylanicum hydro-alcoholic extract has notable inhibitory effects on various stages of crystallization, in terms of turbidity of solution, as well as the crystal size, number and morphology.

Inhibitory effects of taraxasterol and aqueous extract of Taraxacum officinale on calcium oxalate crystallization: in vitro study

Objective: We investigated and compared the effects of taraxasterol, aqueous extract of T. officinale (AET) aerial part, and potassium citrate (PC) on calcium oxalate (CaOx) crystallization in vitro.

Materials and methods: CaOx crystallization was induced by adding sodium oxalate to synthetic urine. Taraxasterol (2.5, 5, 7.5 and 12.5 μg/mL), extract (1, 2, 4 and 8 mg/mL), and PC (100, 150, 200 and 350 mg/mL) were subjected to anti-crystallization activities. The absorbance and %inhibition of nucleation of CaOx crystals were evaluated by spectrophotometer at 2, 4, 6, 8, 10, 20, 30, 40, 50 and 60 min and the number and morphology of crystals were studied by light microscopy after 60 min.

Results: Presence of taraxasterol, extract and PC decreased absorbance in experimental samples compared to control, significantly. The nucleation of crystals is inhibited by taraxasterol, extract, and PC (26–64, 55–63 and 60–70%, respectively). The number of CaOx crystals were decreased in presence of taraxasterol (p < .01), extract (p < .001), and PC (p < .001) in a dose-dependent manner. Presence of taraxasterol, extract, and PC decreased the number of CaC₂O₄ monohydrate, while increased CaC₂O₄ dihydrate crystals, significantly. Also, the diameter of CaC₂O₄ dihydrate crystals was decreased in presence of taraxasterol, extract and PC, significantly.

Conclusions: This research indicated that taraxasterol and extract have anti-crystallization activities and effectiveness of the extract is more potent than taraxasterol. It could be because of another constituent in the extract with the synergistic effect.

In vitro and in vivo models for the study of urolithiasis

Preclinical animal research has greatly contributed and will continue to contribute in our understanding of various disease states and provided methods for more understanding of disease states and designs to test novel pharmaco-therapeutic interventions against these diseases. For urolithiasis, scientists have developed numerous in vitro and in vivo models that attempt to replicate human urolithiasis. In this review, I have explained in vitro and in vivo models that are more common, affordable, and easy to replicate. In the in vitro models, I have focused on the CaOx crystallization models and in the in vivo models, hyperoxaluric rat model has been explained along with other available option such as Knockout (KO) mice and fly models. Each model has been explained stepwise along with its pros and cons.

Dietary Plants for the Prevention and Management of Kidney Stones: Preclinical and Clinical Evidence and Molecular Mechanisms

Kidney stones are one of the oldest known and common diseases in the urinary tract system. Various human studies have suggested that diets with a higher intake of vegetables and fruits play a role in the prevention of kidney stones. In this review, we have provided an overview of these dietary plants, their main chemical constituents, and their possible mechanisms of action. Camellia sinensis (green tea), Rubus idaeus (raspberry), Rubia cordifolia (common madder), Petroselinum crispum (parsley), Punica granatum (pomegranate), Pistacia lentiscus (mastic), Solanum xanthocarpum (yellow-fruit nightshade), Urtica dioica (stinging nettle), Dolichos biflorus (horse gram), Ammi visnaga (khella), Nigella sativa (black-cumin), Hibiscus sabdariffa (roselle), and Origanum vulgare (oregano) have received considerable interest based on scientific evidence. Beside these dietary plants, phytochemicals—such as catechin, epicatechin, epigallocatechin-3-gallate, diosmin, rutin, quercetin, hyperoside, and curcumin—as antioxidant dietary phyto-phenols were found to be effective for the prevention of urolithiasis (the process of stone formation in the urinary tract). The main underlying mechanisms of these dietary plants and their isolated phytonutrients in the management of urolithiasis include diuretic, antispasmodic, and antioxidant activity, as well as an inhibitory effect on crystallization, nucleation, and aggregation of crystals. The results as presented in this review demonstrate the promising role of dietary plants and phytophenols in the prevention and management of kidney stones. Further investigations are required to confirm the safety and efficacy of these compounds.

Triticale crisp bread enriched with selected bioactive additives: volatile profile, physical characteristics, sensory and nutritional properties

The effect of selected plant additives (couch grass, artichoke, kale, nettle, ground buckwheat husks, broad beans, fenugreek seeds, and extracts of yellow tea and mulberry leaf) on the volatile compounds, color, texture, sensory attributes, polyphenols, and antioxidant properties of triticale crisp bread was studied. The volatile profile of control bread was dominated by lipid oxidation products with hexanal and (E)-2-nonenal predominant. The additives strongly modified the volatile profile of the extruded crisp bread. The greatest differences were recorded in the case of products with artichoke and kale additions, which had respectively about 12 and 8 times higher levels of total volatile compounds than the control crisp bread. The samples containing kale, buckwheat, and fenugreek as well as yellow tea extract characterized high levels of sulfur compounds, with methanethiol predominant. The additives, especially kale, nettle, and artichoke affected the color of the crisp breads, in most cases making them darker. In terms of texture only the crisp bread with addition of buckwheat husk was significantly harder than the control sample. On the basis of sensory evaluation it was stated that among all the additives, the artichoke and fenugreek resulted in dramatic deterioration in the extruded product taste. The used additives also affected the antioxidant properties of triticale crisp bread. The greatest content of total phenolic compounds and the highest antioxidant activity were observed for the bread with yellow tea extract addition (3.5- and 6.5-fold higher, respectively, than in control sample).

Successful treatment of sodium oxalate induced urolithiasis with Helichrysum flowers

ETHNOPHARMACOLOGICAL RELEVANCE

Helichrysum (Asteraceae) flowers, known as "altın otu, yayla çiçeği, kudama çiçeği" , are widely used to remove kidney stones and for their diuretic properties in Turkey.

AIM OF THE STUDY

To determine the curative effect of infusions prepared from capitulums of Helichrysum graveolens (M. Bieb.) Sweet (HG) and H. stoechas ssp. barellieri (Ten.) Nyman (HS) on sodium oxalate induced kidney stones.

MATERIALS AND METHODS

Infusions prepared from the capitulums of HG and HS were tested for their curative effect on calcium oxalate deposition induced by sodium oxalate (70mg/kg i.p.). Following the injection of sodium oxalate for 5 days, plant extracts were administered to rats at two different doses. Potassium citrate was used as positive control. Water intake, urine volume, body, liver and kidney weights were measured; biochemical and hematological analyses were conducted on urine and blood samples. Additionally, histopathological examinations were done on kidney samples.

RESULTS

H. stoechas extract showed prominent effect at 156mg/kg dose (stone formation score: 0.33), whereas number of kidney stones was maximum in sodium oxalate group (stone formation score: 2.33). The reduction in the uric acid and oxalate levels of urine samples and the elevation in the urine citrate levels are significant and promising in extract groups. Some hematological, biochemical and enzymatic markers are also ameliorated by the extracts.

CONCLUSIONS

This is the first report on the curative effect of immortal flowers. Our preliminary study indicated that Helichrysum extracts may be used for treatment of urolithiasis and Helichrysum extracts are an alternative therapy to potassium citrate for patients suffering from kidney stones.

Preventive treatment of calcium oxalate crystal deposition with immortal flowers

ETHNOPHARMACOLOGICAL RELEVANCE

A number of medicinal plants are used for their diuretic, urolithiatic and anti-inflammatory effects on urinary system problems in Turkey and the most common traditional remedy for kidney stones is the tea of immortal flowers. The aim of this study is to evaluate the preventive effect of infusions prepared from capitulums of Helichrysum graveolens (M.Bieb.) Sweet (HG) and Helichrysum stoechas ssp. barellieri (Ten.) Nyman (HS) on formation of kidney stones.

MATERIALS AND METHOD

Sodium oxalate (Ox-70mg/kg intraperitoneally) was used to induce kidney stones on Wistar albino rats. At the same time, two different doses of the plant extracts (HG: 62.5 and 125mg/kg; HS: 78 and 156mg/kg) were dissolved in the drinking water and administered to animals for 5 days. Potassium citrate was used as positive control in the experiments. During the experiment, water intake, urine volume and body weights of the animals were recorded. At the end of the experiments, liver, kidney and body weights of the animals were determined; biochemical analysis were conducted on urine, blood and plasma samples. Histopathological changes in kidney tissues were examined and statistical analysis were evaluated.

RESULTS

HS extract showed the highest preventive effect at 156mg/kg dose (stone formation score: 1.16), whereas a number of kidney stones were maximum in sodium oxalate group (stone formation score: 2.66). Helichrysum extracts decreased urine oxalate and uric acid levels and increased citrate levels significantly. In addition, Helichrysum extracts regulated the negative changes in biochemical and hematological parameters occurred after Ox injection.

CONCLUSIONS

We conclude that Helichrysum extracts could reduce the formation and growth of kidney stones in Ox-induced urolithiasis and can be beneficial for patients with recurrent stones. In addition, this is the first study on the preventive effect of immortal flowers.

Protective effect of Urtica dioica methanol extract against experimentally induced urinary calculi in rats

Renal calculi formation is one of the most common urological disorders. Urinary stone disease is a common disease, which affects 10‑12% of the population in industrialized countries. In males, the highest prevalence of the disease occurs between the age of 20 and 40 years, while in females, the highest incidence of the disease occurs later. Previous studies have shown that long‑term exposure to oxalate is toxic to renal epithelial cells and results in oxidative stress. In the present study, a methanolic extract of aerial parts of Urtica dioica was screened for antiurolithiatic activity against ethylene glycol and ammonium chloride‑induced calcium oxalate renal stones in male rats. In the control rats, ethylene glycol and ammonium chloride administration was observed to cause an increase in urinary calcium, oxalate and creatinine levels, as well as an increase in renal calcium and oxalate deposition. Histopathological observations revealed calcium oxalate microcrystal deposits in the kidney sections of the rats treated with ethylene glycol and ammonium chloride, indicating the induction of lithiasis. In the test rats, treatment with the methanolic extract of Urtica dioica was found to decrease the elevated levels of urinary calcium, oxalate and creatinine, and significantly decrease the renal deposition of calcium and oxalate. Furthermore, renal histological observations revealed a significant reduction in calcium oxalate crystal deposition in the test rats. Phytochemical analysis of the Urtica dioica extract was also performed using liquid chromatography‑electrospray ionization tandem mass spectrometry and high-performance liquid chromatography with photodiode array detection, to determine the chemical composition of the extract. The eight chemical constituents identified in the extract were protocatechuic acid, salicylic acid, luteolin, gossypetin, rutin, kaempferol‑3‑O‑rutinoside, kaempferol‑3‑O‑glucoside and chlorogenic acid. In conclusion, the results of the present study suggest that Urtica dioica has strong antiurolithiatic activity and may have potential as a natural therapeutic agent for various urological disorders.

Folium pyrrosiae ingestion has no effect on the thermodynamic or kinetic urinary risk factors for calcium oxalate urolithiasis in healthy subjects: a poor prognosis for alternative treatment in this type of stone former

Kidney stone disease occurs throughout the world. Conservative treatments involving herbal preparations have been used in traditional Chinese medicine. In vitro studies have suggested that Folium pyrrosiae (FP) has therapeutic potential in this context. The present study was undertaken to investigate the effects of ingested FP on urinary thermodynamic and kinetic risk factors for calcium oxalate (CaOx) stone formation in subjects from two different population groups. Healthy white (n = 9) and black (n = 9) males ingested 1.5 g FP each day for 7 days. 24 h urines (baseline and day 7) and blood samples (baseline and day 3) were collected. Urines were analyzed for lithogenic risk factors and were subjected to CaOx crystallization experiments in which the metastable limit (MSL), particle size-volume distribution and crystal deposition kinetics were determined. Urine composition values were used to calculate the relative supersaturation (RS) of CaOx and other urinary salts. Blood samples were analyzed for liver enzymes to monitor the safety of the protocol. Food diaries were recorded on days 0 and 7. Data were analyzed statistically using standard software. Nutrient intakes and the concentration of liver enzymes did not change during the study. No side effects were reported. There were no statistically significant differences in any of the thermodynamic (RS, MSL) or kinetic (particle volume-size distribution, crystal deposition rate) risk factors for CaOx stone formation in either of the groups following ingestion of FP relative to baseline values. FP does not have potential as a therapeutic agent in the management of CaOx kidney stone disease.

Inhibition of calcium oxalate crystallisation in vitro by an extract of Bergenia ciliata

OBJECTIVE

To evaluate the effectiveness of an extract obtained from the rhizomes of Bergenia ciliata (Saxifragaceae) on the inhibition of calcium oxalate (CaOx) crystallisation in vitro.

MATERIALS AND METHODS

A hydro-alcoholic extract (30:70, v/v) of rhizomes of B. ciliata was prepared at different concentrations (1-10 mg/mL). The crystallisation of CaOx monohydrate (COM) was induced in a synthetic urine system. The nucleation and aggregation of COM crystals were measured using spectrophotometric methods. The rates of nucleation and aggregation were evaluated by comparing the slope of the turbidity of a control system with that of one exposed to the extract. The results were compared with a parallel study conducted with a marketed poly-herbal combination, Cystone, under identical concentrations. Crystals generated in the urine were also analysed by light microscopy. Statistical differences and percentage inhibitions were calculated and assessed.

RESULTS

The extract of B. ciliata was significantly more effective in inhibiting the nucleation and aggregation of COM crystals in a dose-dependent manner than was Cystone. Moreover, the extract induced more CaOx dihydrate crystals, with a significant reduction in the number and size of COM crystals.

CONCLUSION

An extract of the traditional herb B. ciliata has an excellent inhibitory activity on crystalluria and therefore might be beneficial in dissolving urinary stones. However, further study in animal models of urolithiasis is needed to evaluate its potential anti-urolithiatic activity.

[Phytotherapy in urology. Current scientific evidence of its application in urolithiasis, chronic pelvic pain, erectile dysfunction and urinary tract infections]

OBJECTIVE

To assess the usefulness of phytotherapy in urolitiasis, urinary tract infections, erectile dysfunction (ED) and chronic prostatitis/chronic pelvic pain (CP/CPP).

ACQUISITION OF THE EVIDENCE

Systematic review of the evidence published until January 2011 using the following scientific terms:phytotherapy, urinary lithiasis, Chronic prostatitis, chronic pelvic pain, erectile dysfunction, urinary tract infection, cystitis and the scientific names of compounds following the rules of the International Code of Botanical Nomenclature. The databases used were Medline and The Cochrane Library.We included articles published until January 2011 written in English and Spanish. We included studies in Vitro/in vivo on animal models or human beings. Exclusion criteria were literature not in English and Spanish or articles with serious methodological flaws.

SYNTHESIS OF THE EVIDENCE

We included 86 articles selecting 40 that met the inclusion criteria. In Urolitiasis there are few works in humans. The phytate has its main use as prevention and in reducing the growth of residual fragments after extracorporeal shock wave lithotripsy (ESWL). In CP/CPP the only compound that has shown effectiveness was the extract of pollen in a field of multimodal treatment. In DE ther is no evidence for the use of herbal medicine.Most of the works have limitations in the design or low sample size. In urinary tract infections most of the products are diuretics .There is only evidence for the cranberry as prevention in young or pregnant women. It must not be used as a treatment for urinary tract infections.

CONCLUSIONS

Phytotherapy is usefull in repeat urinary tract infections and the CP/CPP. It has some role in the urolitiasis and lacks useful in the DE.

Studies on the in vitro and in vivo antiurolithic activity of Holarrhena antidysenterica

Holarrhena antidysenterica has a traditional use in the treatment of urolithiasis, therefore, its crude extract has been investigated for possible antiurolithic effect. The crude aqueous-methanolic extract of Holarrhena antidysenterica (Ha.Cr) was studied using the in vitro and in vivo methods. In the in vitro experiments, Ha.Cr demonstrated a concentration-dependent (0.25-4 mg/ml) inhibitory effect on the slope of aggregation. It decreased the size of crystals and transformed the calcium oxalate monohydrate (COM) to calcium oxalate dehydrate (COD) crystals, in calcium oxalate metastable solutions. It also showed concentration-dependent antioxidant effect against 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radicals and lipid peroxidation induced in rat kidney tissue homogenate. Ha.Cr (0.3 mg/ml) reduced (p < 0.05) the cell toxicity and LDH release in renal epithelial cells (MDCK) exposed to oxalate (0.5 mM) and COM (66 μg/cm(2)) crystals. In male Wistar rats, receiving 0.75 % ethylene glycol (EG) for 21 days along with 1 % ammonium chloride (AC) in drinking water, Ha.Cr treatment (30-100 mg/kg) prevented the toxic changes caused by lithogenic agents; EG and AC, like loss of body weight, polyurea, oxaluria, raised serum urea and creatinine levels and crystal deposition in kidneys compared to their respective controls. These data indicate that Holarrhena antidysenterica possesses antiurolithic activity, possibly mediated through the inhibition of CaOx crystal aggregation, antioxidant and renal epithelial cell protective activities and may provide base for designing future studies to establish its efficacy and safety for clinical use.

Antiurolithic activity of Origanum vulgare is mediated through multiple pathways

Background

Origanum vulgare Linn has traditionally been used in the treatment of urolithiasis. Therefore, we investigated the crude extract of Origanum vulgare for possible antiurolithic effect, to rationalize its medicinal use.

Methods

The crude aqueous-methanolic extract of Origanum vulgare (Ov.Cr) was studied using the in vitro and in vivo methods. In the in vitro experiments, supersaturated solution of calcium and oxalate, kidney epithelial cell lines (MDCK) and urinary bladder of rabbits were used, whereas, in the in vivo studies, rat model of urolithiasis was used for the study of preventive and curative effect.

Results

In the in vitro experiments, Ov.Cr exhibited a concentration-dependent (0.25-4 mg/ml) inhibitory effect on the slope of nucleation and aggregation and also decreased the number of calcium oxalate monohydrate crystals (COM) produced in calcium oxalate metastable solutions. It also showed concentration-dependent antioxidant effect against DPPH free radical and lipid peroxidation induced in rat kidney tissue homogenate. Ov.Cr reduced the cell toxicity using MTT assay and LDH release in renal epithelial cells (MDCK) exposed to oxalate (0.5 mM) and COM (66 μg/cm²) crystals. Ov.Cr relaxed high K⁺ (80 mM) induced contraction in rabbit urinary bladder strips, and shifted the calcium concentration-response curves (CRCs) towards right with suppression of the maximum response similar to that of verapamil, a standard calcium channel blocker. In male Wistar rats receiving lithogenic treatment comprising of 0.75% ethylene glycol in drinking water given for 3 weeks along with ammonium chloride (NH₄Cl) for the first 5 days, Ov.Cr treatment (10-30 mg/kg) prevented as well as reversed toxic changes including loss of body weight, polyurea, crystalluria, oxaluria, raised serum urea and creatinine levels and crystal deposition in kidneys compared to their respective controls.

Conclusion

These data indicating the antiurolithic activity in Ov.Cr, possibly mediated through inhibition of CaOx crystallization, antioxidant, renal epithelial cell protective and antispasmodic activities, rationalizes its medicinal use in urolithiasis.

A novel calcium oxalate crystal growth inhibitory protein from the seeds of Dolichos biflorus (L.)

Recurrence and persistent side effects of present day treatment for urolithiasis restrict their use, so an alternate, using phytotherapy is being sought. Dolichos biflorus seeds, which are used as dietary food in India, possess antilithiatic properties. In the present study, a novel dimeric antilithiatic protein (98 kDa) from its seeds was purified based on its ability to inhibit calcium oxalate crystallization in vitro. Amino acid analysis of Dolichos biflorus antilithiatic protein showed abundant acidic amino acids. The mascot search engine presented sequence similarity with a calcium binding protein, calnexin of Pisum sativum from the m/z data obtained by MALDI TOF mass spectrometer. Above results demonstrate the anticalcifying/antilithiatic nature of a novel protein from the seeds of Dolichos biflorus and thus open new vistas for using plant proteins as therapeutic agents to treat urolithiasis.