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Hu J, Chen F, Qiu G, Sun T, Yang H, Shen H, Tong P, Chai Y, Zhang X, Zhang W, Yang Z, Jiang H, Pan Y, Zhu T, He C, Xiao W. Jingshu Keli for treating cervical spondylotic radiculopathy: The first multicenter, randomized, controlled clinical trial. J Orthop Translat 2020; 27:44-56. [PMID: 33376673 PMCID: PMC7758457 DOI: 10.1016/j.jot.2020.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background Jingshu Keli (or Jingshu granules), a traditional Chinese medicine, are widely used for treating cervical spondylotic radiculopathy in China; however, no randomized, double-blind, controlled study has verified their effectiveness. Purpose To evaluate the efficacy and safety of Jingshu Keli for the treatment of cervical spondylotic radiculopathy in a randomized controlled trial. Design From August 2015 to July 2017, a multicenter, randomized, double-blind, placebo-controlled trial was conducted at 13 large- and medium-sized hospitals in China. Patient sample A total of 360 and 120 patients were initially enrolled in the Jingshu and control groups, respectively; 386 patients completed the study, with 299 in the Jingshu group and 87 in the control group. Outcome measures The main index for evaluating the curative effect was the pain score on a visual analogue scale (VAS; 0–100 points). Methods All patients were administered a bag of Jingshu Keli or placebo 3 times a day for 4 weeks, and were interviewed at the second and fourth weeks. The decrease in pain scores and rate of change in pain scores after treatment were calculated, related laboratory indices were reviewed, and adverse reactions were recorded. Results In the Per Protocol Set (PPS) analysis, the baseline pain VAS scores in the control and Jingshu groups were 49.31 ± 6.97 and 50.06 ± 7.33, respectively, with no significant difference between the groups (P > 0.05). While there were no differences at 2 weeks between groups, at four weeks the pain VAS scores in the control and Jingshu groups decreased by 12.86 ± 13.45 and 22.72 ± 15.08, respectively relative to the values at baseline, with significant group differences (P < 0.0001). While there were similar significant differences between the groups (P < 0.0001) in the Full Analysis Set (FAS) analyses neither group achieved the minimal clinically important difference at any time point. Conclusions Jingshu Keli are effective for the treatment of cervical spondylotic radiculopathy. Translational potential statement This is the first prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial that confirmed the clinical efficacy and safety of Jingshu Keli for treating cervical spondylotic radiculopathy, which can provide evidence for clinical treatment.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- ANCOVA, analysis of covariance
- AST, aspartate aminotransferase
- BUN, blood urea nitrogen
- Cervical spondylotic radiculopathy
- Cr, creatine
- FAS, full analysis set
- Herbal medicine
- ITT, intention-to-treat
- Jingshu keli
- LOCF, last observation carried forward
- NAG, urine N-acetyl-beta-d-glucosaminidase
- PPS, per-protocol set
- PT, preferred term
- RCT, randomized controlled trial
- Randomized controlled trial
- SAS, safety analysis set
- SNL, spinal nerve ligation
- SOC, system organ class
- TBIL, total bilirubin
- Traditional Chinese medicine
- VAS, visual analogue scale
- γ-GT, γ-glutamyl transpeptidase
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Affiliation(s)
- Jianhua Hu
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Feng Chen
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Guixing Qiu
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Tiansheng Sun
- Department of Orthopedics, People's Liberation Army General Hospital, Peking, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
| | - Huiyong Shen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peijian Tong
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang, China
| | - Yimin Chai
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Xueli Zhang
- Department of Spine Surgery, Tianjin People's Hospital, Tianjin, China
| | - Weibin Zhang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhidong Yang
- Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hong Jiang
- Department of Orthopedics, Suzhou Hospital of Traditional Chinese Medicine, Soochow, Jiangsu, China
| | - Yalin Pan
- Department of Orthopedics, People's Hospital of Anyang City, Anyang, Henan, China
| | - Tianliang Zhu
- Department of Orthopedics, Chongqing General Hospital, Chongqing, China
| | - Chengjian He
- Department of Orthopedics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Weiping Xiao
- Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi China
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Abbaszadeh F, Fakhri S, Khan H. Targeting apoptosis and autophagy following spinal cord injury: Therapeutic approaches to polyphenols and candidate phytochemicals. Pharmacol Res 2020; 160:105069. [PMID: 32652198 DOI: 10.1016/j.phrs.2020.105069] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
Spinal cord injury (SCI) is a neurological disorder associated with the loss of sensory and motor function. Understanding the precise dysregulated signaling pathways, especially apoptosis and autophagy following SCI, is of vital importance in developing innovative therapeutic targets and treatments. The present study lies in the fact that it reveals the precise dysregulated signaling mediators of apoptotic and autophagic pathways following SCI and also examines the effects of polyphenols and other candidate phytochemicals. It provides new insights to develop new treatments for post-SCI complications. Accordingly, a comprehensive review was conducted using electronic databases including, Scopus, Web of Science, PubMed, and Medline, along with the authors' expertise in apoptosis and autophagy as well as their knowledge about the effects of polyphenols and other phytochemicals on SCI pathogenesis. The primary mechanical injury to spinal cord is followed by a secondary cascade of apoptosis and autophagy that play critical roles during SCI. In terms of pharmacological mechanisms, caspases, Bax/Bcl-2, TNF-α, and JAK/STAT in apoptosis along with LC3 and Beclin-1 in autophagy have shown a close interconnection with the inflammatory pathways mainly glutamatergic, PI3K/Akt/mTOR, ERK/MAPK, and other cross-linked mediators. Besides, apoptotic pathways have been shown to regulate autophagy mediators and vice versa. Prevailing evidence has highlighted the importance of modulating these signaling mediators/pathways by polyphenols and other candidate phytochemicals post-SCI. The present review provides dysregulated signaling mediators and therapeutic targets of apoptotic and autophagic pathways following SCI, focusing on the modulatory effects of polyphenols and other potential phytochemical candidates.
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Affiliation(s)
- Fatemeh Abbaszadeh
- Department of Neuroscience, Faculty of Advanced Technologies in Medical Sciences, Iran University of Medical Sciences, Tehran, Iran; Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran.
| | - Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, 23200, Pakistan.
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Meng X, Cheng W, Zhong S, Zhang P, Qin L, Wang X. Anti-inflammatory effects of Jingshu Keli capsule and its components on human synoviocyte MH7A cells. ARTHROPLASTY 2020; 2:7. [PMID: 35236422 PMCID: PMC8796523 DOI: 10.1186/s42836-020-00026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Jingshu Keli (JSKL), a traditional Chinese medicine (TCM) formula consisting of multiple active compounds, has been officially approved by National Medical Products Administration (NMPA) for treatment of cervical radiculopathy. It relieves pain, according to TCM theory, by activating blood circulation to dissipate blood stasis. The pain mainly stems from neurogenic inflammation caused by mechanical compression of the cervical nerve root. In addition, inflammation mediators also cause the development of other joint diseases, such as osteoarthritis (OA). The purpose of this paper was to evaluate the anti-inflammatory effects of JSKL and identify the biologically active herbs and compounds in vitro. METHODS Enzyme-linked immunosorbent assay (Elisa) was used to determine the expression of pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6) and interleukin 8 (IL-8), in the culture medium of human MH7A cells stimulated by lipopolysaccharides (LPS). RESULTS JSKL and three single-herb capsules, Cinnamomum cassia Presl (C.C.), Angelica Sinensis (Oliv.) Diels (A.S.) and Carthamus tinctorius L. (C.T.), significantly inhibited the secretion of TNF-α. If one of these three herbal components was removed, suppressing effect of the single-herb-deleted JSKL on TNF-α was abolished. Cinnamaldehyde (CIN) from C.C. was the most potent ingredient that inhibited the expression of IL-6 and IL-8 in the culture medium of both LPS-stimulated MH7A cells and primary synovial cells. CONCLUSIONS JSKL was found to possess anti-inflammatory effect in vitro; C.C., A.S. and C.T. were the principal and essential herbal components responsible for such activity; CIN from C.C. is one the most potent single compound among indicator components of JSKL recorded in 2015 Chinese pharmacopoeia. This study provided scientific evidence for the clinical application of JSKL as an agent for targeted treatment of cervical radiculopathy. Furthermore, CIN has potential to be used for the treatment of some inflammation-related orthopedic diseases, such as rheumatic arthritis and osteoarthritis.
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Affiliation(s)
- Xiangbo Meng
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Wenxiang Cheng
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Shan Zhong
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Peng Zhang
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Ling Qin
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.,Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Xinluan Wang
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China. .,Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China.
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Pang H, Ren Y, Li H, Chen C, Zheng X. LncRNAs linc00311 and AK141205 are identified as new regulators in STAT3-mediated neuropathic pain in bCCI rats. Eur J Pharmacol 2019; 868:172880. [PMID: 31863767 DOI: 10.1016/j.ejphar.2019.172880] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022]
Abstract
Neuropathic pain is a severe disease caused by lesions or diseases in the somatosensory system. Long non-coding RNAs (lncRNAs) are important in the development and maintenance of neuropathic pain. However, the precise role of lncRNAs in regulating neuropathic pain remains largely unknown. In this study, a rat model of bilateral chronic constriction injury (bCCI) was established, and microarray was applied to analyze differentially expressed lncRNAs among sham group, bCCI group and the experimental group (bCCI rats administrated with a specific STAT3 inhibitor WP1066). Linc00311 and lncRNA-AK141205 were uncharacterized lncRNAs both upregulated by > 2 folds in bCCI model compared with Sham group, and they were downregulated by > 2 folds following WP1066 administration compared with bCCI group. Downregulation of linc00311 and lncRNA-AK141205 by specific siRNAs significantly attenuated mechanical allodynia, thermal and cold hyperalgesia in bCCI rats. In addition, inhibition of linc00311 and lncRNA-AK141205 inactivated the signal transducer and activator of transcription 3 (STAT3) signaling in spinal microglia in vivo and in vitro. Inhibition of linc00311 and lncRNA-AK141205 could reduce activation of STAT3 and production of proinflammatory cytokines. Moreover, activating STAT3 with SD19 could antagonize the effect of the suppressive effect of siRNAs on production of proinflammatory cytokines. Hence, it is likely that silencing linc00311 and lncRNA-AK141205 may be a promising and novel treatment for neuropathic pain.
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Affiliation(s)
- Hongli Pang
- Department of Anesthesiology, The First Affiliated Hospital, Henan University, Kaifeng, 475001, China
| | - Yifeng Ren
- Department of Anesthesiology, The First Affiliated Hospital, Henan University, Kaifeng, 475001, China
| | - Huifang Li
- Department of Anesthesiology, The First Affiliated Hospital, Henan University, Kaifeng, 475001, China
| | - Chengzhe Chen
- Department of Anesthesiology, The First Affiliated Hospital, Henan University, Kaifeng, 475001, China
| | - Xiaozhen Zheng
- Department of Anesthesiology, The First Affiliated Hospital, Henan University, Kaifeng, 475001, China.
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Zhou J, Liu F, Jiang W, Hu M. Cost-Effectiveness of Jingshu Granules Compared to Placebo for the Treatment of Patients with Cervical Radiculopathy in China: A Decision-Tree Model Based on Randomized Controlled Trial. J Altern Complement Med 2019; 25:1183-1192. [PMID: 31634001 DOI: 10.1089/acm.2019.0262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: Traditional Chinese Medicines (TCMs), as well as physiotherapy and chemical drugs, are recommended for the treatment of cervical spondylosis by Chinese guidelines for cervical spondylosis diagnosis and treatment. The aim of this study was to evaluate whether TCM Jingshu Granules are cost-effective in patients with cervical radiculopathy in China. Methods: A multicenter, double-blinded, randomized placebo-controlled trial was performed. A total of 480 patients were recruited from 14 tertiary hospitals in China and were randomly divided into an experimental group (Jingshu Granules) or control group (placebo) at a 3:1 ratio. All patients received 4 weeks of treatment. Clinical outcomes and cost data were collected during the trial, including the neck disability index (NDI), visual analog scale (VAS) of pain, VAS of numbness, 36-Item Short Form Health Survey (SF-36) score, willingness to pay (WTP) for VAS of pain, direct medical costs, and transport costs. From a social perspective, a decision-tree model and cost-effectiveness analysis were conducted. Results: The treatment group has a significant advantage in reducing NDI (9.41 ± 10.51 vs. 4.83 ± 8.43, p < 0.05), VAS of pain (22.72 ± 15.08 vs. 12.86 ± 13.45, p < 0.05), and VAS of numbness (16.96 ± 17.53 vs. 11.64 ± 16.54, p < 0.05), respectively, while there was no significant difference in the improvement of quality of life (QoL; SF-36 score, p > 0.05). The expected mean cost of the experimental group was 1144.34 yuan, and the effective rates were 57.9% for NDI and 72.9% for VAS of pain. The expected mean cost of the control group was 767.41 yuan, and the effective rates were 33.3% for NDI and 51.6% for VAS of pain. For the primary indicators (VAS of pain and NDI), the incremental cost-effectiveness ratio was 17.69 and 15.32, respectively. The WTP per efficacy for pain resolution of patients was 19.10 yuan. Setting the WTP as threshold, Jingshu Granules were found to be a cost-effectiveness strategy, and sensitivity analysis showed that the effective rates and inspection fees of both groups had a greater impact on the results of both groups. Conclusions: Jingshu Granules were shown to be effective for treating patients with cervical radiculopathy. This treatment was found to be cost-effective when considering VAS of pain and NDI as clinical outcome indicators compared to no treatment (placebo). A clinical study with longer duration or real world study is needed to determine the impact on QoL of patients in the future.
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Affiliation(s)
- Jing Zhou
- Pharmaceutical Policy and Pharmacoeconomics Research Center, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Fei Liu
- Pharmaceutical Policy and Pharmacoeconomics Research Center, West China School of Pharmacy, Sichuan University, Chengdu, China
| | | | - Ming Hu
- Pharmaceutical Policy and Pharmacoeconomics Research Center, West China School of Pharmacy, Sichuan University, Chengdu, China
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