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Balbino NS, Lima NM, Machado HG, Lima GS, Sousa JCP, Gontijo Vaz B. Infraspecific Chemical Variability and Metabolomic Profiling by Paper Spray Ionization (PSI-MS) of Averrhoa carambola from Different Brazilian Biomes. Chem Biodivers 2024; 21:e202400458. [PMID: 38874121 DOI: 10.1002/cbdv.202400458] [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: 02/21/2024] [Accepted: 05/03/2024] [Indexed: 06/15/2024]
Abstract
This research focused on the molecular diversity of A. carambola collected from three Brazilian biomes (Cerrado, Amazônia, and Mata Atlântica), whose results revealed significant differences in metabolite profiles among these biomes through PSI-MS analysis. Chemometric analysis provided valuable insights into the clustering patterns and metabolic distinctions. Cerrado and Mata Atlântica biomes exhibited a 70 % similarity, indicating a notable degree of resemblance. In Cerrado, carambolaside A was notably abundant, while carambolaside M was low in Amazônia and moderate in Cerrado samples. Carambolaside B was abundant in Amazônia but relatively low in the Cerrado and Mata Atlântica. In contrast, the Amazônia biome samples appeared to be more dissimilar. In Cerrado, epicatechin, kaempferol, and procyanidin B showed lower abundance, while apigenin, quercetin, myricetin, and rutin displayed moderate levels. Mata Atlântica showed relatively higher levels of kaempferol, quercetin, and rutin. This study indicated the environmental influence on secondary metabolites production in A. carambola fruits.
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Affiliation(s)
- Naará S Balbino
- Chemistry Institute, Federal University of Goias, 74690-900, Goiania (GO), Brazil
| | - Nerilson M Lima
- Chemistry Institute, Federal University of Goias, 74690-900, Goiania (GO), Brazil
| | - Hugo G Machado
- Chemistry Institute, Federal University of Goias, 74690-900, Goiania (GO), Brazil
| | - Gesiane S Lima
- Chemistry Institute, Federal University of Goias, 74690-900, Goiania (GO), Brazil
| | - Jean C P Sousa
- Chemistry Institute, Federal University of Goias, 74690-900, Goiania (GO), Brazil
| | - Boniek Gontijo Vaz
- Chemistry Institute, Federal University of Goias, 74690-900, Goiania (GO), Brazil
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2
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Derrien B, Leblanc K, Evanno L, Drège E. Enantioselective Total Synthesis of the Neurotoxin Caramboxin. J Org Chem 2024; 89:6489-6493. [PMID: 38607991 DOI: 10.1021/acs.joc.4c00541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Herein, we report the first and efficient asymmetric total synthesis of the neurotoxin (-)-caramboxin. The key to success is the creation of a stereogenic center by using enantioselective catalytic phase-transfer α-alkylation of glycine imines, affording this unusual α-amino acid in good yields and up to 99% ee. This work validates the S configuration of the natural product.
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Affiliation(s)
- Benoit Derrien
- CNRS, BioCIS, Université Paris-Saclay, Orsay 91400, France
| | - Karine Leblanc
- CNRS, BioCIS, Université Paris-Saclay, Orsay 91400, France
| | - Laurent Evanno
- CNRS, BioCIS, Université Paris-Saclay, Orsay 91400, France
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3
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Jui-Chin H, Fen-Fang C, Tso-Ying L, Pao-Yu W, Mei-Hsiang L. Exploring the care experiences of hemodialysis nurses: from the cultural sensitivity approach. BMC Nurs 2024; 23:17. [PMID: 38166820 PMCID: PMC10763141 DOI: 10.1186/s12912-023-01678-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Culturally sensitive care has been identified as a best-practice approach for improving health outcomes. Hemodialysis patients require culturally sensitive care because it involves totally changing their previous life. The purpose of this study was to explore the subjective experiences of hemodialysis nurses in providing culturally sensitive care to hemodialysis patients. METHODS A qualitative study was carried out in the hemodialysis center of a teaching hospital in northern Taiwan. Purposive sampling and semi-structured interview guidelines were employed to interview 23 hemodialysis nurses. The interviews were recorded and transcribed verbatim, and the resulting data were analyzed and summarized using content analysis by constant comparative methods. RESULTS Hemodialysis nurses exhibited the characteristics for delivering culturally sensitive care, which comprised five aspects: finding the true meaning of the behavior of the participants, recognizing and honoring individual psychological states, culturally sensitive communication in line with patients' values, customizing care content through cultural transformation strategies, and empowerment rather than prohibition. CONCLUSIONS The findings of this study on the culturally sensitive care provided by hemodialysis nurses can be utilized by nursing educators and administrators as a reference to develop and enhance the nursing education related to culturally sensitive care for hemodialysis professionals.
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Affiliation(s)
- Hsu Jui-Chin
- Hemodialysis Room, Cheng Hsin General Hospital, Taipei, Taiwan, R.O.C
| | - Chung Fen-Fang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, R.O.C
| | - Lee Tso-Ying
- Nursing research center of Taipei Medical University Hospital, Taipei, Taiwan, R.O.C
| | - Wang Pao-Yu
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan, R.O.C
| | - Lin Mei-Hsiang
- EdD School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde 1st Rd. Beitou Dist, Taipei, Taiwan, R.O.C..
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Raciti C, Blanzaco M, Bernstein J. Death associated with ingestion of starfruit (Averrhoa carambola) in a patient with chronic kidney disease. Am J Emerg Med 2023; 70:208.e1-208.e3. [PMID: 37394384 DOI: 10.1016/j.ajem.2023.06.043] [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: 01/24/2023] [Revised: 05/28/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023] Open
Abstract
We detail a case of a 74-year-old female with a history of chronic kidney disease (CKD) and diabetes mellitus (DM) who initially presented to the Emergency Department (ED) with intractable hiccups after ingesting two whole starfruit (SF) and quickly became critically ill while in the ED. Our patient was admitted and received several rounds of hemodialysis, but efforts proved futile, as the patient expired during her hospital course. To the best of our knowledge, this is the first fatality reported due to SF ingestion in the U.S, and highlights the need for both a better understanding of SF intoxication and clearer guidelines and timing for treatment. Due to the increased mortality of patients who consume SF with a medical history of CKD or DM, it is prudent that Emergency Physicians are familiar with the clinical presentation and management options for SF toxicity.
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Affiliation(s)
- Christopher Raciti
- Department of Emergency Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA.
| | - Melba Blanzaco
- Florida Poison Information Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Highland Professional Building, 1(st) Floor, 1801 NW 9(th) Avenue, 1(st) Floor, Miami, FL 33136, USA
| | - Jeffrey Bernstein
- Florida Poison Information Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Highland Professional Building, 1(st) Floor, 1801 NW 9(th) Avenue, 1(st) Floor, Miami, FL 33136, USA; Department of Emergency Medicine, Jackson Memorial Hospital, 1611 N.W. 12th Avenue, Miami, FL 33136, USA
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Li A, Chen B, Jin X, Bai Y, Zhang J, Zhang C, Cheng M, Guo C, Zhang Y, Zhou J. Antiepileptic therapy in a patient with star fruit intoxication: A case report. Medicine (Baltimore) 2023; 102:e32969. [PMID: 36862861 PMCID: PMC9981371 DOI: 10.1097/md.0000000000032969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE It is rare for uremia patients to have epileptic seizures after eating star fruit, only a dozen cases are reported worldwide. Such patients usually have poor prognoses. Few patients had good prognoses, all of them were treated with expensive renal replacement therapy. At present, there is no report on the addition of drug therapy to these patients based on the initial renal replacement therapy. PATIENT CONCERNS A 67-year-old male patient with star fruit intoxication who had a history of diabetic nephropathy, hypertension, polycystic kidney, and chronic kidney disease in the uremic phase, and regular hemodialysis 3 times a week for 2 years. Initial clinical manifestations include hiccups, vomiting, speech disturbances, delayed reactions, and dizziness, which gradually progress to hearing and visual impairment, seizures, confusion, and coma. DIAGNOSES This patient was diagnosed with seizures caused by star fruit intoxication. The experience of eating star fruit and the electroencephalograms can prove our diagnosis. INTERVENTIONS We performed intensive renal replacement therapy according to the recommendations in the literature. However, his symptoms did not improve significantly until he received an extra dose of levetiracetam and resumed his previous dialysis schedule. OUTCOMES The patient was discharged after 21 days without neurologic sequelae. Five months after discharge, he was readmitted due to poor seizure control. LESSONS To improve the prognosis of these patients and to reduce their financial burden, the use of antiepileptic drugs should be emphasized.
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Affiliation(s)
- Aixun Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Baoxin Chen
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xianglan Jin
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Bai
- Department of Nephrology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingfeng Zhang
- Department of Nephrology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chengcheng Zhang
- Department of Nephrology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Miaomiao Cheng
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chunyan Guo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Zhou
- Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, Beijing, China
- * Correspondence: Jing Zhou, Staff Physician, Department of Neurology, Dong Fang Hospital, Beijing University of Chinese Medicine, No. 6, Zone 1, Fangxingyuan, Fengtai District, Beijing 100078, China (e-mail: )
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Abduh MS, Saghir SAM, Al Hroob AM, Bin-Ammar A, Al-Tarawni AH, Murugaiyah V, Mahmoud AM. Averrhoa carambola leaves prevent dyslipidemia and oxidative stress in a rat model of poloxamer-407-induced acute hyperlipidemia. Front Pharmacol 2023; 14:1134812. [PMID: 36814487 PMCID: PMC9939629 DOI: 10.3389/fphar.2023.1134812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/08/2023] Open
Abstract
Background: The star fruit [Averrhoa carambola L (Oxalidaceae)] is traditionally used in the treatment of many ailments in many countries. It possesses several pharmacological activities, including antioxidant and anti-inflammatory effects. However, it contains the neurotoxic caramboxin and its high content of oxalic acid limits its consumption by individuals with compromised kidney function. This study assessed the anti-hyperlipidemic and antioxidant activities of different fractions of the methanolic extract of A. carambola leaves (MEACL). Methods: The antioxidant activity was investigated using FRAP, and ABTS and DPPH radical-scavenging assays and the inhibitory activity toward pancreatic lipase (PL) and HMG-CoA reductase was assayed in vitro. Acute hyperlipidemia was induced by poloxamer-407 (P-407) in rats and different fractions of MEACL (n-hexane, chloroform, n-butanol, ethyl acetate (EA), water, and chloroform) were orally administered. Cholesterol and triglycerides were determined at 0, 12, 24, and 48 h and LDL-C, vLDL-C, HDL-C, lipid peroxidation (LPO) and antioxidants were assayed after 48 h. The expression of ABCA1, ABCG5, ABCG8, LDL-R, SREBP-1, and SREBP-2 and the activity of HMG-CoA reductase were assayed in the liver of P-407-administered rats treated with the EA fraction. Results: The in vitro data revealed potent radical-scavenging activities of MEACL fractions with the most potent effect showed by the EA fraction that also suppressed the activities of HMG-CoA reductase and PL. In P-407-induced hyperlipidemic rats, all fractions prevented dyslipidemia as shown by the decrease in total cholesterol, triglycerides, LDL-C, vLDL-C and atherogenic index. MEACL and its fractions prevented LPO and boosted GSH, superoxide dismutase, glutathione peroxidase, and catalase in P-407-administered rats. The EA fraction showed more effective anti-hyperlipidemic and antioxidant effects than other fractions and downregulated SREBP-2 while upregulated ABCA1 and LDL-R and ameliorated LPL and HMG-CoA reductase in hyperlipidemic rats. Conclusion: MEACL showed in vitro and in vivo antioxidant activity and the EA fraction significantly ameliorated dyslipidemia in a rat model of P-407-induced acute hyperlipidemia by modulating LPL, PL, HMG-CoA reductase, and cholesterolgenesis-related factors. Therefore, the leaves of A. carambola represent a safe alternative for the star fruit particularly in kidney disease patients, and the EA is the most effective anti-hyperlipidemic and antioxidant fraction.
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Affiliation(s)
- Maisa Siddiq Abduh
- Immune Responses in Different Diseases Research Group, Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sultan A. M. Saghir
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma’an, Jordan
- Department of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Amir M. Al Hroob
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma’an, Jordan
| | - Albandari Bin-Ammar
- Department of Clinical Nutrition, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | | | - Vikneswaran Murugaiyah
- Department of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Ayman M. Mahmoud
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Physiology Division, Department of Zoology, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
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7
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Saghir SAM, Abdulghani MAM, Alruhaimi RS, Ahmeda AF, Al-Gabri NA, Alomaisi SAMA, Sadikun A, Murugaiyah V, Mahmoud AM. Acute and sub-chronic toxicological evaluation of Averrhoa carambola leaves in Sprague Dawley rats. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:90058-90069. [PMID: 35864392 DOI: 10.1007/s11356-022-22019-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Averrhoa carambola is a species of tree native to tropical Southeast Asia. It possesses antioxidant and anti-hyperlipidemia effects and has traditionally been used to treat a variety of ailments. However, the presence of oxalic acid in its fruits might restrict its consumption by individuals suffering from kidney disease, and caramboxin can cause neurotoxicity. In this study, we evaluated the acute and sub-chronic toxicity of the methanolic extract of A. carambola leaves (MEAC) in male and female rats. In the acute study, female rats were given a single oral dose of 5000 mg/kg of MEAC and closely examined for distinct indications of toxic effects during the first 4 h, periodically for 48 h, and daily thereafter for 14 days. Rats of both sexes were employed in the sub-chronic investigation for the 28-day repeated dose oral toxicity study. Results of the acute study revealed the safety of MEAC up to a dose of 5000 mg/kg where the rats did not show changes or signs of toxicity. In the sub-chronic toxicity study, MEAC (250, 500, and 1000 mg/kg) administration did not affect the body weight, food, and water consumption, motor coordination, behavior, or mental alertness in the treated rats. In addition, no variations in hematological or biochemical markers were found in MEAC-treated rats. In conclusion, these findings pinpoint the safety of MEAC at doses up to 5000 mg/kg. The leaves of A. carambola could be safely consumed by people with kidney disease to treat other ailments.
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Affiliation(s)
- Sultan A M Saghir
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma'an, Jordan
- Department of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Mahfoudh A M Abdulghani
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - Reem S Alruhaimi
- Biology Department, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ahmad F Ahmeda
- Department of Basic Medical Sciences, College of Medicine, Ajman University, Ajman, United Arab Emirates
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Naif A Al-Gabri
- Department of Pathology, Faculty of Veterinary Medicine, Thamar University, Dhamar, Yemen
| | - Saleh A M A Alomaisi
- Department of Anatomy and Embryology, Veterinary Medicine, Sana'a University, Sana'a, Yemen
| | - Amirin Sadikun
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Vikneswaran Murugaiyah
- Department of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Ayman M Mahmoud
- Physilogy Division, Zoology Department, Faculty of Science, Beni-Suef University, Beni Suef, Egypt.
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
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8
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Wang D, Ai X, Duan Y, Xian N, Fang RH, Gao W, Zhang L. Neuronal Cellular Nanosponges for Effective Detoxification of Neurotoxins. ACS NANO 2022; 16:19145-19154. [PMID: 36354967 DOI: 10.1021/acsnano.2c08319] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neurotoxins attack and destruct the nervous system, which can cause serious health problems and security threats. Existing detoxification approaches, such as antibodies and small molecule antidotes, rely on neurotoxin's molecular structure as design cues and require toxin-specific development for each type of toxins. However, the enormous diversity of neurotoxins makes such structure-based development of antitoxin particularly challenging and inefficient. Here, we report on the development and use of neuronal membrane-coated nanosponges (denoted "Neuron-NS") as an effective approach to detoxifying neurotoxins. Specifically, Neuron-NS act as neuron decoys to lure neurotoxins, bind with and neutralize the toxins, and thus block them from attacking the host neuron cells. These nanosponges detoxify neurotoxins regardless of their molecular structures and therefore can overcome the challenge posed by toxin structural diversity. In the study, we fabricate Neuron-NS by coating the membrane of Neuro-2a cells onto polymeric cores. Meanwhile, we select tetrodotoxin (TTX) as a model neurotoxin and demonstrate the detoxification efficacy of the Neuron-NS in a cytotoxicity assay, a calcium flux assay, and a cell osmotic swelling assay in vitro. Additionally, in mouse models of TTX intoxication, the Neuron-NS significantly enhance mouse survival in therapeutic and prophylactic regimens without showing acute toxicity. Overall, the Neuron-NS contribute to the current detoxification arsenal with the potential to treat various injuries and diseases caused by neurotoxins.
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Affiliation(s)
- Dan Wang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, California 92093, United States
| | - Xiangzhao Ai
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, California 92093, United States
| | - Yaou Duan
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, California 92093, United States
| | - Nianfei Xian
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, California 92093, United States
| | - Ronnie H Fang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, California 92093, United States
| | - Weiwei Gao
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, California 92093, United States
| | - Liangfang Zhang
- Department of NanoEngineering and Chemical Engineering Program, University of California San Diego, La Jolla, California 92093, United States
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Siang LH, Arulsamy A, Yoon YK, Shaikh MF. Fruits for Seizures? A Systematic Review on the Potential Anti-Convulsant Effects of Fruits and their Phytochemicals. Curr Neuropharmacol 2022; 20:1925-1940. [PMID: 34517803 PMCID: PMC9886799 DOI: 10.2174/1570159x19666210913120637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/04/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022] Open
Abstract
Epilepsy is a devastating neurological disorder. Current anti-convulsant drugs are only effective in about 70% of patients, while the rest remain drug-resistant. Thus, alternative methods have been explored to control seizures in these drug-resistant patients. One such method may be through the utilization of fruit phytochemicals. These phytochemicals have been reported to have beneficial properties such as anti-convulsant, anti-oxidant, and anti-inflammatory activities. However, some fruits may also elicit harmful effects. This review aims to summarize and elucidate the anti- or pro-convulsant effects of fruits used in relation to seizures in hopes of providing a good therapeutic reference to epileptic patients and their carers. Three databases, SCOPUS, ScienceDirect, and PubMed, were utilized for the literature search. Based on the PRISMA guidelines, a total of 40 articles were selected for critical appraisal in this review. Overall, the extracts and phytochemicals of fruits managed to effectively reduce seizure activities in various preclinical seizure models, acting mainly through the activation of the inhibitory neurotransmission and blocking the excitatory neurotransmission. Only star fruit has been identified as a pro-convulsant fruit due to its caramboxin and oxalate compounds. Future studies should focus more on utilizing these fruits as possible treatment strategies for epilepsy.
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Affiliation(s)
| | | | | | - Mohd. Farooq Shaikh
- Address correspondence to this author at the Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia; Tel/Fax: +60 3 5514 4483; E-mail:
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10
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Asadi‐Pooya AA, Zeraatpisheh Z, Rostaminejad M, Damabi N. Caffeinated drinks, fruit juices, and epilepsy: A systematic review. Acta Neurol Scand 2022; 145:127-138. [PMID: 34694642 DOI: 10.1111/ane.13544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/01/2022]
Abstract
The aim of this systematic review was to provide the required information regarding different aspects of the relationship between epilepsy/antiseizure medications and non-alcoholic drinks. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. MEDLINE and Scopus from the inception until 7 August 2021 were systematically searched. These key words were used: "epilepsy" OR "seizure" OR "antiepileptic" OR "antiseizure" OR "anticonvulsant" AND "coffee" OR "tea" OR "soda" OR "juice" OR "drink" OR "cola" OR "diet" (35 key word combinations). The primary search yielded 21 458 publications (PubMed, n = 4778; Scopus, n = 16 680). Only 50 studies met all the inclusion criteria and were included in the current systematic review. In total, 17 articles investigated various non-alcoholic drinks in human studies, 11 studies were case reports/series, and 22 articles were animal/in vitro studies. None of the studies provided a class 1 of evidence. There is limited evidence suggesting that certain drinks (eg, caffeinated energy drinks) might trigger seizures. Patients with epilepsy should avoid excessive consumption of certain fruit juices (eg, grapefruit, lime, pomegranate, kinnow, and star fruit) and caffeinated drinks. However, daily coffee and tea intake can be part of a healthy balanced diet, and their consumption does not need to be stopped in patients with epilepsy. Coffee/tea consumption is not harmful if consumed at levels of 200 mg (caffeine) in one sitting (about 2½ cups of coffee) or 400 mg daily (about five cups of coffee).
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Affiliation(s)
- Ali A. Asadi‐Pooya
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
- Jefferson Comprehensive Epilepsy Centre Department of Neurology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Zahra Zeraatpisheh
- Epilepsy Research Center Shiraz University of Medical Sciences Shiraz Iran
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11
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Luan F, Peng L, Lei Z, Jia X, Zou J, Yang Y, He X, Zeng N. Traditional Uses, Phytochemical Constituents and Pharmacological Properties of Averrhoa carambola L.: A Review. Front Pharmacol 2021; 12:699899. [PMID: 34475822 PMCID: PMC8407000 DOI: 10.3389/fphar.2021.699899] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/02/2021] [Indexed: 11/25/2022] Open
Abstract
Averrhoa carambola L. (star fruit) is an edible fruit that is extensively cultivated in southern China, Southeast Asia, India, and northern South America. It has a sweet and juicy taste and is frequently used in fruit salads and fruit platters, as a garnish in cocktail drinks and beverages, or squeezed into juice and served as a beverage. Traditionally, it has been used for treating diabetes and diabetic nephropathy, arthralgia, vomiting, lithangiuria, coughing, hangovers, and chronic paroxysmal headache for thousands of years. Currently, approximately 132 compounds have been isolated from A. carambola. Among them, flavonoids, benzoquinone, and their glycosides have been considered as biologically active substances, which are responsible for various biological activities. Pharmacological studies have revealed that crude extracts or monomeric compounds from A. carambola exhibit multiple bioactivities, such as anti-oxidant, anti-hyperglycemic, anti-obesity, anti-hyperlipidemic, anti-tumor, anti-inflammatory, hepatoprotective, cardioprotective, anti-hypertensive, neuroprotective, and others. Thus, A. carambola is a valuable treatment in Chinese medicine with therapeutic potential for multiple diseases, especially diabetes and diabetes-related diseases. Even though it is a very promising candidate in the development of functional food and the pharmaceutical industry, reports on its bioactivities have only been conducted in vivo and in vitro and there is a gap in research regarding clinical settings and safety. This review therefore provides a comprehensive and systematic overview of current progress on botany, ethnopharmacology, phytochemistry, pharmacology, and toxicity of A. carambola, providing a valuable reference for further developments and applications of A. carambola in the pharmaceutical industry and functional food.
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Affiliation(s)
- Fei Luan
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lixia Peng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ziqin Lei
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiyu Jia
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Junbo Zou
- Department of Pharmacology, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yan Yang
- Department of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Xirui He
- Department of Bioengineering, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Nan Zeng
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Abstract
Bilimbi fruit is widely eaten in Malaysia. Rarely reported is its potential to cause acute kidney injury (AKI) in patients with prior normal renal function. The possible dangers of its consumption are still relatively unknown among many. This case highlights the importance of taking a thorough dietary history in patients with AKI. We also hope to increase awareness among healthcare professionals on the nephrotoxic and neurotoxic effects of bilimbi fruits.
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Affiliation(s)
- Koh-Wei Wong
- Department of Medicine, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | - Meryl Grace Lansing
- Medical Based Department, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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13
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Quintal Martínez JP, Segura Campos MR. Cnidoscolus Aconitifolius (Mill.) I.M. Johnst.: A Food Proposal Against Thromboembolic Diseases. FOOD REVIEWS INTERNATIONAL 2021. [DOI: 10.1080/87559129.2021.1934002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Yasawardene P, Jayarajah U, De Zoysa I, Seneviratne SL. Nephrotoxicity and neurotoxicity following star fruit (Averrhoa carambola) ingestion: a narrative review. Trans R Soc Trop Med Hyg 2021; 115:947-955. [PMID: 33693950 DOI: 10.1093/trstmh/trab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 01/06/2023] Open
Abstract
In recent times, star fruit (Averrhoa carambola) nephrotoxicity and neurotoxicity have been increasingly reported, both in individuals with pre-existing renal disease and those with previously normal renal function. We summarise the clinical findings of star fruit toxicity in humans and outline the important pathogenetic insights provided by animal studies. Google Scholar, EMBASE, Scopus and PubMed were searched from 1995 through July 2020 for case reports/series on renal or neurological manifestations of star fruit toxicity in humans and mechanisms of star fruit toxicity in animal studies. Ten case series and 28 case reports in humans (total number of individuals=136) were included and 8 animal studies were analysed. Ninety-four (69.1%) patients had prior renal impairment. Renal histology showed acute oxalate nephropathy with tubulointerstitial nephritis or tubular necrosis. Neurotoxicity manifestations ranged from hiccups to status epilepticus. Oxalate and caramboxin are considered the main substances causing nephrotoxicity and neurotoxicity. Caramboxin inhibits GABA binding and activates the glutamatergic receptors. Haemodialysis improved outcomes in neurotoxicity. Nephrotoxicity and neurotoxicity need to be looked for with star fruit toxicity, both in individuals with abnormal or normal renal function. Once star fruit intoxication is identified, early renal replacement therapy should be considered. Further studies on the mechanisms of star fruit toxicity are needed.
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Affiliation(s)
- Pamodh Yasawardene
- Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, 160, Prof. Nandadasa Kodagoda Mawatha, Colombo 07, Sri Lanka
| | - Ishan De Zoysa
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 08, Sri Lanka
| | - Suranjith L Seneviratne
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo 02, Sri Lanka
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15
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Lakmal K, Yasawardene P, Jayarajah U, Seneviratne SL. Nutritional and medicinal properties of Star fruit ( Averrhoa carambola): A review. Food Sci Nutr 2021; 9:1810-1823. [PMID: 33747490 PMCID: PMC7958541 DOI: 10.1002/fsn3.2135] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 12/18/2022] Open
Abstract
Star fruit (Averrhoa carambola), a popular fruit in many parts of the world, is considered to have many beneficial nutritional and medicinal effects. However, harmful nephrotoxic and neurotoxic effects have also been described. In this review, we have discussed the reported beneficial effects of star fruit, explored the potential mechanisms for such beneficial effects, and outline factors that may affect the safe level of consumption. The beneficial effects include the following: antioxidant (mediated via L-ascorbic acid, epicatechin, and gallic acid), hypoglycemic (mediated via high fiber levels and 2-dodecyl-6-methoxycyclohexa-2,5-diene-1,4-dione), hypotensive (mediated via apigenin), hypocholesterolemic (mediated via micronized fiber), anti-inflammatory, anti-infective, antitumor effects, and immune-boosting effects. The presence of chronic kidney disease, gastroenteropathies, chronic pancreatitis, dehydration, consumption on an empty stomach, and higher concentration of oxalate in fruit/juice consumed predisposes to toxicity. The level of ingestion at which the beneficial effects transition to nephrotoxicity and neurotoxicity is still to be accurately ascertained. Furthermore, the relationship between the amount of star fruit ingested and the severity of toxicity is not certain and warrants further study.
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Affiliation(s)
- Kasun Lakmal
- Department of SurgeryFaculty of MedicineUniversity of ColomboColomboSri Lanka
| | - Pamodh Yasawardene
- Department of SurgeryFaculty of MedicineUniversity of ColomboColomboSri Lanka
| | - Umesh Jayarajah
- Department of SurgeryFaculty of MedicineUniversity of ColomboColomboSri Lanka
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