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Koul B, Farooq U, Yadav D, Song M. Phytochemicals: A Promising Alternative for the Prevention of Alzheimer's Disease. Life (Basel) 2023; 13:life13040999. [PMID: 37109528 PMCID: PMC10144079 DOI: 10.3390/life13040999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
Alzheimer's disease (AD) is a neurological condition that worsens with ageing and affects memory and cognitive function. Presently more than 55 million individuals are affected by AD all over the world, and it is a leading cause of death in old age. The main purpose of this paper is to review the phytochemical constituents of different plants that are used for the treatment of AD. A thorough and organized review of the existing literature was conducted, and the data under the different sections were found using a computerized bibliographic search through the use of databases such as PubMed, Web of Science, Google Scholar, Scopus, CAB Abstracts, MEDLINE, EMBASE, INMEDPLAN, NATTS, and numerous other websites. Around 360 papers were screened, and, out of that, 258 papers were selected on the basis of keywords and relevant information that needed to be included in this review. A total of 55 plants belonging to different families have been reported to possess different bioactive compounds (galantamine, curcumin, silymarin, and many more) that play a significant role in the treatment of AD. These plants possess anti-inflammatory, antioxidant, anticholinesterase, and anti-amyloid properties and are safe for consumption. This paper focuses on the taxonomic details of the plants, the mode of action of their phytochemicals, their safety, future prospects, limitations, and sustainability criteria for the effective treatment of AD.
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Affiliation(s)
- Bhupendra Koul
- Department of Biotechnology, Lovely Professional University, Phagwara 144411, Punjab, India
| | - Usma Farooq
- Department of Botany, Lovely Professional University, Phagwara 144411, Punjab, India
| | - Dhananjay Yadav
- Department of Life Sciences, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Minseok Song
- Department of Life Sciences, Yeungnam University, Gyeongsan 38541, Republic of Korea
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Cui M, You T, Zhao Y, Liu R, Guan Y, Liu J, Liu X, Wang X, Dong Q. Ginkgo biloba extract EGb 761® improves cognition and overall condition after ischemic stroke: Results from a pilot randomized trial. Front Pharmacol 2023; 14:1147860. [PMID: 37063270 PMCID: PMC10090660 DOI: 10.3389/fphar.2023.1147860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Patients who experienced an ischemic stroke are at risk for cognitive impairment. Quantified Ginkgo biloba extract EGb 761® has been used to treat cognitive dysfunction, functional impairment and neuropsychiatric symptoms in mild cognitive impairment and dementia.Objectives: To assess the cognitive-related effects of EGb 761® treatment in patients after acute ischemic stroke, as well as the feasibility of patient selection and outcome measures.Methods: We conducted a randomized, multicentric, open-label trial at 7 centers in China. Patients scoring 20 or lower on the National Institutes of Health Stroke Scale were enrolled between 7 and 14 days after stroke onset and randomly assigned to receive 240 mg per day of EGb 761® or no additional therapy for 24 weeks in a 1:1 ratio. Both groups received standard treatments for the prevention of recurrent stroke during the trial. General cognitive function and a battery of cognitive tests for sub-domains were evaluated at 24 weeks. All patients were monitored for adverse events.Results: 201 patients ≥50 years old were included, with 100 assigned to the EGb 761® group and 101 to the reference group. The mean change from baseline on the global cognitive function as assessed by the Montreal Cognitive Assessment score was 2.92 in the EGb 761® group and 1.33 in the reference group (between-group difference: 1.59 points; 95% confidence interval [CI], 0.51 to 2.67; p < 0.005). For cognitive domains, EGb 761® showed greater effects on the Hopkins Verbal Learning Test Total Recall (EGb 761® change 1.40 vs. reference −0.49) and Form 1 of the Shape Trail Test (EGb 761® change −38.2 vs. reference −15.6). Potentially EGb 761®-related adverse events occurred in no more than 3% of patients.Conclusion: Over the 24-week period, EGb 761® treatment improved overall cognitive performance among patients with mild to moderate ischemic stroke. Our findings provide valuable recommendations for the design of future trials, including the criteria for patient selection.Clinical Trial Registration:www.isrctn.com, identifier ISRCTN11815543.
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Affiliation(s)
- Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tongyao You
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yangtai Guan
- Department of Neurology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jianren Liu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Ninth People’s Hospital, Shanghai, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tong Ji University Affiliated Tenth People’s Hospital, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Qiang Dong,
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Nowak A, Kojder K, Zielonka-Brzezicka J, Wróbel J, Bosiacki M, Fabiańska M, Wróbel M, Sołek-Pastuszka J, Klimowicz A. The Use of Ginkgo Biloba L. as a Neuroprotective Agent in the Alzheimer's Disease. Front Pharmacol 2021; 12:775034. [PMID: 34803717 PMCID: PMC8599153 DOI: 10.3389/fphar.2021.775034] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/22/2021] [Indexed: 12/19/2022] Open
Abstract
Alzheimer's disease, a neurodegenerative disease, is one of the most common causes of dementia if elderly people worldwide. Alzheimer's disease leads to the alienation of individuals and their exclusion from social and professional life. It is characterized mainly by the degradation of memory and disorientation, which occurs as a result of the loss of neuronal structure and function in different brain areas. In recent years, more and more attention has been paid to use in the treatment of natural bioactive compounds that will be effective in neurodegenerative diseases, including Alzheimer's disease. G. biloba L. and its most frequently used standardized extract (EGb 761), have been used for many years in supportive therapy and in the prevention of cognitive disorders. The paper presents an overview of reports on the pathogenesis of Alzheimer's disease, as well as a summary of the properties of G. biloba extract and its effects on the possible pathogenesis of the disease. By exploring more about the pathogenesis of the disease and the benefits of G. biloba extract for patients with Alzheimer's disease, it will be possible to create an individualized therapeutic protocol to optimize the treatment.
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Affiliation(s)
- Anna Nowak
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Klaudyna Kojder
- Department of Anesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Joanna Zielonka-Brzezicka
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Jacek Wróbel
- Department of Bioengineering, West Pomeranian University of Technology in Szczecin, Szczecin, Poland
| | - Mateusz Bosiacki
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Marta Fabiańska
- Institute of Philosophy and Cognitive Science, University of Szczecin, Szczecin, Poland
| | - Mariola Wróbel
- Department of Landscape Architecture, West Pomeranian University of Technology in Szczecin, Szczecin, Poland
| | - Joanna Sołek-Pastuszka
- Department of Anesthesiology and Intensive Care, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Adam Klimowicz
- Department of Cosmetic and Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Ke J, Li MT, Huo YJ, Cheng YQ, Guo SF, Wu Y, Zhang L, Ma J, Liu AJ, Han Y. The Synergistic Effect of Ginkgo biloba Extract 50 and Aspirin Against Platelet Aggregation. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:3543-3560. [PMID: 34429584 PMCID: PMC8375244 DOI: 10.2147/dddt.s318515] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/12/2021] [Indexed: 01/04/2023]
Abstract
Purpose We aimed to investigate potential synergistic antiplatelet effects of Ginkgo biloba extract (GBE50) in combination with aspirin using in vitro models. Methods Arachidonic acid (AA), platelet activating factor (PAF), adenosine 5'-diphosphate (ADP) and collagen were used as inducers. The antiplatelet effects of GBE50, aspirin and 1:1 combination of GBE50 and aspirin were detected by microplate method using rabbit platelets. Synergy finder 2.0 was used to analyze the synergistic antiplatelet effect. The compounds in GBE50 were identified by UPLC-Q/TOF-MS analysis and the candidate compounds were screened by TCMSP database. The targets of candidate compounds and aspirin were obtained in TCMSP, CCGs, Swiss target prediction database and drugbank. Targets involving platelet aggregation were obtained from GenCLiP database. Compound-target network was constructed and GO and KEGG enrichment analyses were performed to identify the critical biological processes and signaling pathways. The levels of thromboxane B2 (TXB2), cyclic adenosine monophosphate (cAMP) and PAF receptor (PAFR) were detected by ELISA to determine the effects of GBE50, aspirin and their combination on these pathways. Results GBE50 combined with aspirin inhibited platelet aggregation more effectively. The combination displayed synergistic antiplatelet effects in AA-induced platelet aggregation, and additive antiplatelet effects occurred in PAF, ADP and collagen induced platelet aggregation. Seven compounds were identified as candidate compounds in GBE50. Enrichment analyses revealed that GBE50 could interfere with platelet aggregation via cAMP pathway, AA metabolism and calcium signaling pathway, and aspirin could regulate platelet aggregation through AA metabolism and platelet activation. ELISA experiments showed that GBE50 combined with aspirin could increase cAMP levels in resting platelets, and decreased the levels of TXB2 and PAFR. Conclusion Our study indicated that GBE50 combined with aspirin could enhance the antiplatelet effects. They exerted both synergistic and additive effects in restraining platelet aggregation. The study highlighted the potential application of GBE50 as a supplementary therapy to treat thrombosis-related diseases.
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Affiliation(s)
- Jia Ke
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Meng-Ting Li
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Ya-Jing Huo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yan-Qiong Cheng
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, People's Republic of China
| | - Shu-Fen Guo
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yang Wu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jianpeng Ma
- Multiscale Research Institute of Complex Systems, Fudan University, Shanghai, People's Republic of China
| | - Ai-Jun Liu
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, People's Republic of China
| | - Yan Han
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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Bernstein N, Akram M, Yaniv-Bachrach Z, Daniyal M. Is it safe to consume traditional medicinal plants during pregnancy? Phytother Res 2020; 35:1908-1924. [PMID: 33164294 DOI: 10.1002/ptr.6935] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 10/04/2020] [Accepted: 10/18/2020] [Indexed: 12/24/2022]
Abstract
The popularity of natural medicine is growing worldwide. Unlike conventional licensed medicines, herbal medicine practices are usually not supported by effectiveness, efficacy, or safety studies, which raise concerns about potential risks involved in their usage, particularly in high-risk patients such as pregnant women where teratogenicity is a concern. Despite a lack of science-based evidence, the use of herbal products for the management of pregnancy-associated challenges is common, due to the common notion that they are free of toxic effects and adverse reactions because they are "natural." The lack of concern about utilizing herbal remedies during pregnancy is strengthened by the lack of regulation in most countries for their marketing. However, plant-based remedies are not free of adverse reactions. Medicinal plants and herbal remedies contain substances that can be toxic to the human body and the fetus. Potential effects of indiscriminate use of medicinal plants are embryotoxicity, teratogenic, and abortifacient effects. Some plant constituents can cross the placenta and reach the fetus. Phytochemicals and their metabolites are known to induce stimulation of uterine contraction and hormone imbalance that could result in abortion. The alterations to the hormonal profile can affect conception, induce teratogenic activity, and halt the pregnancy or produce a congenital malformation. Due to the wide range of modes of action of phytochemicals, some medicinal plants may be safe to use during certain trimesters of pregnancy and harmful at other stages. This manuscript reviews available scientific information concerning potential health hazards associated with the consumption of herbal medicines during pregnancy, highlighting those herbs that should be avoided due to their potential abortifacient and/or teratogenic activity. We focused on plants that were tested by preclinical studies, and studies of these plants are summarized. Common therapeutic use of these herbs, estimated effects, toxicological effects, and animal studies of these plants is summarized. The literature reviewed suggests that consumption of the following medicinal plants should be avoided during pregnancy: Abrus precatorius, Achyranthes aspera, Ailanthus excelsa, Aloe vera, Aristolochia indica, Areca catechu, Bambusa vulgaris, Cassia occidentalis, Cicer arietinum, Cimicifuga racemose, Dolichandrone falcate, Ginkgo biloba, Hydrastis canadensis, Indigofera trifoliate, Lavandula latifolia, Maytenus ilicifolia, Momordica cymbalaria, Moringa oleifera, Musa rosacea, Oxalis corniculate, Phytolacca dodecandra, Plumeria rubra, Ricinus communis, Ruta graveolens, Stachys lavandulifolia, Senna alata, Trigonella foenum-graecum, Vitus agnus-castus, and Valeriana officinalis.
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Affiliation(s)
- Nirit Bernstein
- Institute of Soil, Water and Environmental Sciences, Volcani Center, Rishon LeZion, Israel
| | - Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad, Faisalabad, Pakistan
| | | | - Muhammad Daniyal
- TCM and Ethnomedicine Innovation & Development Laboratory, School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China.,College of Biology, Hunan Province Key Laboratory of Plant Functional Genomics and Developmental Regulation, Hunan University, Changsha, China
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Tabrizi R, Nowrouzi-Sohrabi P, Hessami K, Rezaei S, Jalali M, Savardashtaki A, Shahabi S, Kolahi AA, Sahebkar A, Safiri S. Effects of Ginkgo biloba intake on cardiometabolic parameters in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of clinical trials. Phytother Res 2020; 35:246-255. [PMID: 33090588 DOI: 10.1002/ptr.6822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/06/2020] [Accepted: 07/02/2020] [Indexed: 01/09/2023]
Abstract
Ginkgo biloba (GKB) may have a beneficial effect on cardiometabolic parameters in type 2 diabetes mellitus (T2DM), but the data is inconsistent. Therefore, the current systematic review and meta-analysis of clinical trials was conducted to assess the influence of GKB on cardiometabolic parameters in T2DM. Several online databases such as PubMed, Embase, Scopus, Web of Sciences, Google Scholar and Cochrane Library were systematically searched from inception up to September 2, 2019. Heterogeneity across included studies was assessed using the Cochran's Q statistic and I2 index. To pool weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs) as summary effect size, we selected fixed or random-effects model according to the result of heterogeneity. Seven studies comprising 768 subjects were included in the present meta-analysis which resulted in a significant effect of GKB on hemoglobin A1c (HbA1c) (WMD = 0.26, 95% CI = [0.02, 0.50], p = .034) and serum HDL-cholesterol levels (WMD = 1.99, 95% CI = [0.19, 3.79], p = .030) with no significant publication bias. GKB can significantly modulate HbA1c and HDL-cholesterol levels. However, due to uncertainties related to the limited number of studies, it is too early to conclude whether GKB has any potential effects on the cardiometabolic factors in patients with T2DM or not.
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Affiliation(s)
- Reza Tabrizi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Nowrouzi-Sohrabi
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahla Rezaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Jalali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Savardashtaki
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Halal Research Center of IRI, FDA, Tehran, Iran
| | - Saeid Safiri
- Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Rahat Breath and Sleep Research Center and School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Yaro P, Nie J, Xu M, Zeng K, Zeng S. Development and Validation of Liquid Chromatography-mass Spectrometry Method for the Determination of Intracellular Concentration of Ginkgolide A, B, C, and Bilobalide in Transporter-Expressing Cells. CURR PHARM ANAL 2020. [DOI: 10.2174/1573412915666190314142020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Terpene lactones are major components of ginkgo biloba extract which are
used in cardiovascular and degenerative diseases. To study the involvement of transporters in the
transport/disposition of ginkgolides A, B, C, and bilobalide, a bioanalytical assay was developed by LCMS/
MS system for the quantitation of intracellular levels of terpene lactones in cells expressing organic
cation transporter 2 (OCT2).
Methods:
The assay involved an optimized simple sample handling with methyl tert-butyl ether for
liquid-liquid extraction and reconstitution in modified dissolution solution. Pretreatment of samples
with 50 μM ascorbic acid and the addition of ascorbic acid and formic acid in dissolution solution significantly
reduced matrix effect and stabilized the postpreparative samples. Separations were performed
by Zobrax RRHD column (extend-C18 1.8μm, 3.0 x 100mm) and acetonitrile gradient elution. The
analysis was carried out in the negative ion scan mode using multiple reaction monitoring.
Results:
The method was validated for linearity (concentration range of 20-5000nM), accuracy
(±13.1%), precision (<11.0%), recovery (94.31–105.9%), matrix effect (93.8-111.0%) and stability.
Finally, the method was applied in the determination of intracellular concentrations of ginkgolides A, B,
C, and bilobalide in Madin-Darby canine kidney (MDCK-mock) and MDCK-OCT2 cells in uptake
study.
Conclusion:
The developed method was successfully validated. Results suggest that OCT2 is involved
in the renal disposition of ginkgolide A, B, and bilobalide. This method would foster the study of
transport mediated activity via the interaction of ginkgolides and bilobalide with cellular systems.
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Affiliation(s)
- Peter Yaro
- Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310006, China
| | - Jing Nie
- Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310006, China
| | - Mingcheng Xu
- Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310006, China
| | - Kui Zeng
- Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310006, China
| | - Su Zeng
- Institute of Drug Metabolism and Pharmaceutical Analysis, Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310006, China
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Chong PZ, Ng HY, Tai JT, Lee SWH. Efficacy and Safety of Ginkgo biloba in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:513-534. [PMID: 32349519 DOI: 10.1142/s0192415x20500263] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Ginkgo biloba and its extract have been suggested to have a neuroprotective role in patients with acute ischemic stroke. We aimed to examine the efficacy and safety of Ginkgo biloba use in patients with acute ischemic stroke. We searched seven databases for randomized controlled studies examining the use of Ginkgo biloba in patients with acute ischemic stroke. Relevant studies were retrieved, screened, and data were extracted independently by two reviewers. Random effects meta-analyses were performed to evaluate the efficacy and safety outcomes of Ginkgo biloba. We subsequently assessed the certainty of evidence using the GRADE (Grading of Recommendation Assessment, Development and Evaluation) methodology. We found 12 randomized controlled studies enrolling 1466 patients. Pooled results suggest that Ginkgo biloba use was associated with an improvement in neurological function among individuals with AIS with a reduction of 2.87 points on the National Institute of Health Stroke Scale score (95% CI: -4.01--1.74, p<0.001). Ginkgo biloba use was also associated with an improvement in activities of daily living and functional outcome (Mean Difference: 9.52; 4.66-14.33, p<0.001). Subgroup analysis suggest that the impact was larger when using an injectable formulation of Ginkgo biloba compared to the oral formulation. There was no apparent impact of Ginkgo biloba use on all-cause mortality (Risk ratio (RR): 1.21; 0.29-5.09, p=0.80) or cerebrovascular bleeding (RR: 0.82; 0.43-1.57, p=0.55). There was limited evidence on to support the use of gingko biloba in terms of improving quality of life and other stroke events. As such, more studies are needed before it can be recommended for routine use in improving neurological and cognitive function in patients with acute ischemic stroke.
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Affiliation(s)
- Phui Zee Chong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Selangor, Malaysia
| | - Huey Ying Ng
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Selangor, Malaysia
| | - Jing Tong Tai
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Selangor, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylor's, 47500 Selangor, Malaysia
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Gyamfi ET. Metals and metalloids in traditional medicines (Ayurvedic medicines, nutraceuticals and traditional Chinese medicines). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:15767-15778. [PMID: 31004267 DOI: 10.1007/s11356-019-05023-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Abstract
Traditional medicine (TM) including Ayurvedic medicines, traditional Chinese medicines and nutraceuticals are popular across the globe as dietary supplements and traditional and alternative medicines. Health risks from these remedies continue to present serious concerns, with occurrences of poisoning by metals and metalloids present at concentrations above acceptable regulatory standards. This review overviews the prevalence of TM use, cases of metal and metalloid poisoning following TM consumption, and forms of TM contamination and adulteration. The review summarises regulations by the World Health Organization (WHO) and other relevant bodies. Finally, the review recommends how to protect consumers.
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Affiliation(s)
- Eva T Gyamfi
- Department of Environmental Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
- Nuclear Chemistry and Environmental Research Centre, Ghana Atomic Energy Commission, National Nuclear Research Institute, P.O. Box LG 80, Legon, Accra, Ghana.
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10
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Xiang L, Li Y, Deng X, Kosanovic D, Schermuly RT, Li X. Natural plant products in treatment of pulmonary arterial hypertension. Pulm Circ 2018; 8:2045894018784033. [PMID: 29869936 PMCID: PMC6055327 DOI: 10.1177/2045894018784033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe disease characterized by
progressive remodeling of distal pulmonary arteries and persistent elevation of
pulmonary vascular resistance (PVR), which leads to right ventricular
dysfunction, heart failure, and eventually death. Although treatment
responsiveness for this disease is improving, it continues to be a
life-threatening condition. With the clinical efficacy of natural plant products
being fully confirmed by years of practice, more and more recognition and
attention have been obtained from the international pharmaceutical industry.
Moreover, studies over the past decades have demonstrated that drugs derived
from natural plants show unique advantages and broad application prospects in
PAH treatment, not to mention the historical application of Chinese traditional
medicine in cardiopulmonary diseases. In this review, we focus on summarizing
natural plant compounds with therapeutic properties in PAH, according to the
extracts, fractions, and pure compounds from plants into categories, hoping it
to be helpful for basic research and clinical application.
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Affiliation(s)
- Lili Xiang
- 1 Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Ying Li
- 2 Department of Health Management, The Third Xiangya Hospital, Central South University, Changsha, China.,3 Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China
| | - Xu Deng
- 4 Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Central South University, Changsha, China
| | - Djuro Kosanovic
- 5 Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Giessen, Germany
| | - Ralph Theo Schermuly
- 5 Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Giessen, Germany
| | - Xiaohui Li
- 1 Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, China.,3 Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China
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Gargouri B, Carstensen J, Bhatia HS, Huell M, Dietz GPH, Fiebich BL. Anti-neuroinflammatory effects of Ginkgo biloba extract EGb761 in LPS-activated primary microglial cells. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2018; 44:45-55. [PMID: 29895492 DOI: 10.1016/j.phymed.2018.04.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/15/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Neuroinflammation is a key factor of Alzheimer's disease (AD) and other neurodegenerative conditions. Microglia are the resident mononuclear immune cells of the central nervous system (CNS). They play an essential role in the maintenance of homeostasis and responses to neuroinflammation. Ginkgo biloba extract EGb 761 is one of the most commonly used natural medicines owing to its established efficacy and remarkable biological activities especially in respect to CNS diseases. However, only few studies have addressed the effects and mechanisms of Ginkgo biloba extract in microglia activation. METHODS We measured the production of pro-inflammatory mediators and cytokines by ELISA and analyzed gene expressions by qRT-PCR and Western Blot in LPS treated cultured primary rat microglia. RESULTS The Ginkgo biloba extract EGb 761 significantly inhibited the release of prostaglandin E2 (PGE2) and differentially regulated the levels of pro-inflammatory cytokines. The inhibition of LPS-induced PGE2 release in primary microglia was partially dependent on reduced protein synthesis of mPGES-1 and the reduction in the activation of cytosolic phospholipase A2 (cPLA2) without altering COX-2 enzymatic activity, inhibitor of kappa B alpha (IkappaBalpha) degradation, and the activation of multiple mitogen activated protein kinases (MAPKs). Altogether, we showed that EGb 761 reduces neuro-inflammatory activation in primary microglial cells by targeting PGE2 release and cytokines. CONCLUSION Ginkgo biloba extract EGb 761 displayed anti-neuroinflammatory activity in LPS-activated primary microglia cells. EGb 761 was able to reduce neuroinflammatory activation by targeting the COX/PGE2 pathway. This effect might contribute to the established clinical cognitive efficacy in Alzheimer's disease, vascular and mixed dementia.
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Affiliation(s)
- Brahim Gargouri
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany
| | - Johanna Carstensen
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany
| | - Harsharan S Bhatia
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany
| | - Michael Huell
- Zentrum für Psychiatrie Emmendingen, Neubronnstr. 25, 79312 Emmendingen, Germany
| | - Gunnar P H Dietz
- Dr. Willmar Schwabe GmbH & Co. KG, Bunsenstr. 6-10, 76275 Ettlingen, Germany
| | - Bernd L Fiebich
- Neuroimmunology and Neurochemistry Research Group, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany.
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Li S, Zhang X, Fang Q, Zhou J, Zhang M, Wang H, Chen Y, Xu B, Wu Y, Qian L, Xu Y. Ginkgo biloba extract improved cognitive and neurological functions of acute ischaemic stroke: a randomised controlled trial. Stroke Vasc Neurol 2017; 2:189-197. [PMID: 29507779 PMCID: PMC5829919 DOI: 10.1136/svn-2017-000104] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of Ginkgo biloba extract (GBE) in acute ischaemic stroke and its impact on the recurrence of vascular events. Methods We conducted a multicentre, prospective, randomised, open label, blinded, controlled clinical trial enrollingpatients with an onset of acute stroke within 7 days from five hospitals in China Jiangsu Province. Participants were assigned to the GBE group (450 mg GBE with 100 mg aspirin daily) or the control group (100 mg aspirin daily) for 6 months. The primary outcome was the decline in the Montreal Cognitive Assessment score at 6 months. Secondary outcomes were other neuropsychological tests of cognitive and neurological function, the the incidence of adverse events and vascular events. Results 348 patients were enrolled: 179 in the GBE group and 169 in the control group. With 18 patients lost to follow-up, the dropout rate was 5.17%. Admission data between two groups were similar, but in the GBE group there was a marked slow down in the decline in the Montreal Cognitive Assessment scores (-2.77±0.21 vs -1.99±0.23, P=0.0116 (30 days); -3.34±0.24 vs -2.48±0.26, P=0.0165 (90 days); -4.00±0.26 vs -2.71±0.26, P=0.0004 (180 days)) compared with controls. The National Institutes of Health Stroke Scale scores at 12 and 30 days, the modified Rankin Scale scores for independent rate at 30, 90 and 180 days, and the Barthel Index scores at 30, 90 and 180 days in the GBE group were significantly improved compared with controls. Improvements were also observedin GBE groups for Mini-Metal State Examination scores of 30, 90 and 180 days, Webster's digit symbol test scores at 30 days and Executive Dysfunction Index scores at 30 and 180 days. No significant differences were seen in the incidence of adverse events or vascular events. Conclusions We conclude that GBE in combination with aspirin treatment alleviated cognitive and neurological deficits after acute ischaemic stroke without increasing the incidence of vascular events. Trial registration number ChiCTR-TRC-12002688.
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Affiliation(s)
- Shanshan Li
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,The State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China.,Nanjing Clinic Medicine Centre for Neurological and Psychiatric Diseases, Nanjing, China
| | - Xinjiang Zhang
- Department of Neurology, Yangzhou No 1 People's Hospital, Yangzhou, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junshan Zhou
- Department of Neurology, The Affiliated Nanjing First Hospital of Nanjing Medical University, Nanjing, China
| | - Meijuan Zhang
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,The State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China.,Nanjing Clinic Medicine Centre for Neurological and Psychiatric Diseases, Nanjing, China
| | - Hui Wang
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Chen
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,The State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China.,Nanjing Clinic Medicine Centre for Neurological and Psychiatric Diseases, Nanjing, China
| | - Biyun Xu
- Departments of Analysis, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yanfeng Wu
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lai Qian
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,The State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China.,Nanjing Clinic Medicine Centre for Neurological and Psychiatric Diseases, Nanjing, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.,The State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, China.,Nanjing Clinic Medicine Centre for Neurological and Psychiatric Diseases, Nanjing, China
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Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition). Reg Anesth Pain Med 2017; 43:225-262. [DOI: 10.1097/aap.0000000000000700] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Li ZY, Chung YH, Shin EJ, Dang DK, Jeong JH, Ko SK, Nah SY, Baik TG, Jhoo JH, Ong WY, Nabeshima T, Kim HC. YY-1224, a terpene trilactone-strengthened Ginkgo biloba, attenuates neurodegenerative changes induced by β-amyloid (1-42) or double transgenic overexpression of APP and PS1 via inhibition of cyclooxygenase-2. J Neuroinflammation 2017; 14:94. [PMID: 28449688 PMCID: PMC5408406 DOI: 10.1186/s12974-017-0866-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/18/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Ginkgo biloba has been reported to possess free radical-scavenging antioxidant activity and anti-inflammatory properties. In our pilot study, YY-1224, a terpene trilactone-strengthened extract of G. biloba, showed anti-inflammatory, neurotrophic, and antioxidant effects. RESULTS We investigated the pharmacological potential of YY-1224 in β-amyloid (Aβ) (1-42)-induced memory impairment using cyclooxygenase-2 (COX-2) knockout (-/-) and APPswe/PS1dE9 transgenic (APP/PS1 Tg) mice. Repeated treatment with YY-1224 significantly attenuated Aβ (1-42)-induced memory impairment in COX-2 (+/+) mice, but not in COX-2 (-/-) mice. YY-1224 significantly attenuated Aβ (1-42)-induced upregulation of platelet-activating factor (PAF) receptor gene expression, reactive oxygen species, and pro-inflammatory factors. In addition, YY-1224 significantly inhibited Aβ (1-42)-induced downregulation of PAF-acetylhydrolase-1 (PAF-AH-1) and peroxisome proliferator-activated receptor γ (PPARγ) gene expression. These changes were more pronounced in COX-2 (+/+) mice than in COX-2 (-/-) mice. YY-1224 significantly attenuated learning impairment, Aβ deposition, and pro-inflammatory microglial activation in APP/PS1 Tg mice, whereas it significantly enhanced PAF-AH and PPARγ expression. A preferential COX-2 inhibitor, meloxicam, did not affect the pharmacological activity by YY-1224, suggesting that the COX-2 gene is a critical mediator of the neuroprotective effects of YY-1224. The protective activity of YY-1224 appeared to be more efficacious than a standard G. biloba extract (Gb) against Aβ insult. CONCLUSIONS Our results suggest that the protective effects of YY-1224 against Aβ toxicity may be associated with its PAF antagonistic- and PPARγ agonistic-potential as well as inhibition of the Aβ-mediated pro-inflammatory switch of microglia phenotypes through suppression of COX-2 expression.
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Affiliation(s)
- Zheng-Yi Li
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341 Republic of Korea
| | - Yoon Hee Chung
- Department of Anatomy, College of Medicine, Chung-Ang University, Seoul, 06974 Republic of Korea
| | - Eun-Joo Shin
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341 Republic of Korea
| | - Duy-Khanh Dang
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341 Republic of Korea
| | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, 06974 Republic of Korea
| | - Sung Kwon Ko
- Department of Oriental Medical Food and Nutrition, Semyung University, Jecheon, 27136 Republic of Korea
| | - Seung-Yeol Nah
- Ginsentology Research Laboratory and Department of Physiology, College of Veterinary Medicine and Bio/Molecular Informatics Center, Konkuk University, Seoul, 05029 Republic of Korea
| | - Tae Gon Baik
- R&D Center, Yuyu Pharma, Seoul, 04598 Republic of Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Medical School, Kangwon National University, Chunchon, 24341 Republic of Korea
| | - Wei-Yi Ong
- Department of Anatomy, National University of Singapore, Singapore, 119260 Singapore
| | - Toshitaka Nabeshima
- Nabeshima Laboratory, Graduate School of Pharmaceutical Sciences, Meijo University, Nagoya, 468-8503 Japan
| | - Hyoung-Chun Kim
- Neuropsychopharmacology and Toxicology Program, College of Pharmacy, Kangwon National University, Chunchon, 24341 Republic of Korea
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Liu J, Wang H, Shang G, Wang L, Zhao H, Liu H. Acquired hemophilia A in a patient treated by Ginkgo-dipyridamolum. Clin Case Rep 2017; 5:119-122. [PMID: 28174634 PMCID: PMC5290506 DOI: 10.1002/ccr3.712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/02/2016] [Accepted: 08/28/2016] [Indexed: 11/09/2022] Open
Abstract
Acquired hemophilia A might be caused by Ginkgo‐dipyridamolum especially by Ginkgo, and it was successfully treated with hemostasis and immune‐suppression therapy including methylprednisolone and cyclophosphamide.
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Affiliation(s)
- Jinbo Liu
- Department of Vascular Medicine Peking University Shougang Hospital Beijing China
| | - Hongyu Wang
- Department of Vascular Medicine Peking University Shougang Hospital Beijing China
| | - Guangyun Shang
- Department of Vascular Medicine Peking University Shougang Hospital Beijing China
| | - Lichun Wang
- Department of Vascular Medicine Peking University Shougang Hospital Beijing China
| | - Hongwei Zhao
- Department of Vascular Medicine Peking University Shougang Hospital Beijing China
| | - Huan Liu
- Department of Vascular Medicine Peking University Shougang Hospital Beijing China
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Al Shamiri MQ, Abdel Gader AM, Bayoumy NM. Comparing light transmission aggregometry and PFA100 for monitoring antiplatelet therapy in patients with coronary heart disease. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hakkola J, Rysä J, Hukkanen J. Regulation of hepatic energy metabolism by the nuclear receptor PXR. BIOCHIMICA ET BIOPHYSICA ACTA-GENE REGULATORY MECHANISMS 2016; 1859:1072-1082. [PMID: 27041449 DOI: 10.1016/j.bbagrm.2016.03.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 12/30/2022]
Abstract
The pregnane X receptor (PXR) is a nuclear receptor that is traditionally thought to be specialized for sensing xenobiotic exposure. In concurrence with this feature PXR was originally identified to regulate drug-metabolizing enzymes and transporters. During the last ten years it has become clear that PXR harbors broader functions. Evidence obtained both in experimental animals and humans indicate that ligand-activated PXR regulates hepatic glucose and lipid metabolism and affects whole body metabolic homeostasis. Currently, the consequences of PXR activation on overall metabolic health are not yet fully understood and varying results on the effect of PXR activation or knockout on metabolic disorders and weight gain have been published in mouse models. Rifampicin and St. John's wort, the prototypical human PXR agonists, impair glucose tolerance in healthy volunteers. Chronic exposure to PXR agonists could potentially represent a risk factor for diabetes and metabolic syndrome. This article is part of a Special Issue entitled: Xenobiotic nuclear receptors: New Tricks for An Old Dog, edited by Dr. Wen Xie.
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Affiliation(s)
- Jukka Hakkola
- Research Unit of Biomedicine, Pharmacology and Toxicology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
| | - Jaana Rysä
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Janne Hukkanen
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Research Unit of Internal Medicine, University of Oulu, Oulu, Finland; Department of Internal Medicine, Oulu University Hospital, Oulu, Finland; Biocenter Oulu, Oulu, Finland
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Unexplained Alveolar Hemorrhage Associated With Ginkgo and Ginseng Use. J Bronchology Interv Pulmonol 2015; 22:170-2. [DOI: 10.1097/lbr.0000000000000150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications. Reg Anesth Pain Med 2015; 40:182-212. [DOI: 10.1097/aap.0000000000000223] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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YY162 prevents ADHD-like behavioral side effects and cytotoxicity induced by Aroclor1254 via interactive signaling between antioxidant potential, BDNF/TrkB, DAT and NET. Food Chem Toxicol 2014; 65:280-92. [PMID: 24394491 DOI: 10.1016/j.fct.2013.12.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/27/2013] [Accepted: 12/29/2013] [Indexed: 01/23/2023]
Abstract
Methylphenidate (MP) has become the primary drug of choice for treatment of attention-deficit/hyperactivity disorder (ADHD). However, its psychotropic effects severely hamper long-term clinical use. We evaluated the effects of YY162, which consists of terpenoid-strengthened Ginkgo biloba and ginsenoside Rg3, on the ADHD-like condition induced by Aroclor1254, because both components have been suggested to modulate oxidative stress, dopaminergic neurotransmission, and brain-derived neurotrophic factor (BDNF) signaling, which may be critical targets for understanding the pathogenesis of ADHD. YY162 attenuated the increase in reactive oxygen species (ROS) and decrease in BDNF levels induced by Aroclor1254 in SH-SY5Y neuroblastoma cells. YY162 significantly attenuated Aroclor1254-induced ADHD-like behavior and oxidative stress in ICR mice. Furthermore, YY162 attenuated reductions in p-TrkB, BDNF, dopamine transporter (DAT) and norepinephrine transporter (NET) expression. These attenuating effects of YY162 were comparable to those of MP. Importantly, K252a, a TrkB antagonist, counteracted the protective effects of YY162. Our results suggest that YY162 possesses significant protective activities against ADHD-like conditions with negligible behavioral side effects, and that interactive signaling between antioxidant potential and BDNF/TrkB receptor for the positive modulation of the DAT and NET is important for YY162-mediated neuroprotective activity.
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Kudolo GB. Effect of <i>Ginkgo biloba</i> Extract Ingestion on Plasma Total Cortisol Levels during an Oral Glucose Tolerance Test in Normal Glucose Tolerant Individuals. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/fns.2014.516169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hong JM, Shin DH, Lim YA, Lee JS, Joo IS. Ticlopidine with Ginkgo Biloba extract: A Feasible Combination for Patients with Acute Cerebral Ischemia. Thromb Res 2013; 131:e147-53. [DOI: 10.1016/j.thromres.2013.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/05/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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Greenblatt DJ, von Moltke LL, Luo Y, Perloff ES, Horan KA, Bruce A, Reynolds RC, Harmatz JS, Avula B, Khan IA, Goldman P. Ginkgo bilobaDoes Not Alter Clearance of Flurbiprofen, a Cytochrome P450-2C9 Substrate. J Clin Pharmacol 2013; 46:214-21. [PMID: 16432273 DOI: 10.1177/0091270005283465] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effect of Ginkgo biloba on the activity of CYP2C9, the isoform responsible for S-warfarin clearance, was assessed in 11 healthy volunteers who received single 100-mg doses of flurbiprofen, a probe substrate for CYP2C9. Subjects also received either a standardized G biloba leaf preparation (Ginkgold, 3 doses of 120 mg) or matching placebo in a randomized, double-blind, 2-way crossover study. Mean kinetic variables for flurbiprofen with either placebo or G biloba were elimination half-life, 3.9 versus 3.5 hours; total AUC, 57 versus 55 microg/mL h; and oral clearance, 32.9 versus 31.6 mL/min. None of these differences was significant. Based on highperformance liquid chromatography analysis, each 60-mg Ginkgold tablet contained 6.6 mug of amentoflavone and 61.2 microg of quercetin, both previously identified as CYP2C9 inhibitors. These amounts were apparently too low to inhibit CYP2C9 function in vivo. The results confirm previous controlled clinical studies showing no effect of ginkgo on the kinetics or dynamics of warfarin.
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Affiliation(s)
- David J Greenblatt
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA
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Metabolic syndrome and inflammation: a critical review of in vitro and clinical approaches for benefit assessment of plant food supplements. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:782461. [PMID: 23533519 PMCID: PMC3600197 DOI: 10.1155/2013/782461] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/21/2013] [Accepted: 01/21/2013] [Indexed: 11/18/2022]
Abstract
Metabolic syndrome is defined as the clustering in an individual of several metabolic abnormalities associated with insulin resistance, type 2 diabetes, and obesity, in which low-grade chronic inflammatory activity is commonly observed. Part of the European Project PlantLIBRA is concerned with methods to assess the benefits of plant food supplements (PFSs) in countering inflammatory activity and metabolic syndrome. This paper summarizes the current methods used for benefit assessment of PFS, taking into consideration only in vitro, in silico, and clinical methodologies used to investigate the anti-inflammatory properties of plants. No in silico studies (using computer simulation) related to metabolic syndrome were found; these methods appear to be used exclusively for identifying or testing potentially effective compounds in drug development. Most in vitro methods for the assessment of beneficial effects of botanicals or plant food supplements in diabetes were based on a quantitative polymerase chain reaction (PCR), whereas the preferred kind of clinical study was the double-blind randomized controlled clinical trial. Only two parameters were observed to change after treatment with botanicals in both in vitro and in vivo studies: interleukin-6 and tumour necrosis factor-α, and these biomarkers should be carefully considered in future studies for PFS benefit assessment.
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Ginkgo biloba Extract for Patients with Early Diabetic Nephropathy: A Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:689142. [PMID: 23533513 PMCID: PMC3595672 DOI: 10.1155/2013/689142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 09/29/2012] [Indexed: 01/01/2023]
Abstract
Objectives. To evaluate the effectiveness and safety of a Ginkgo biloba extract for patients with early diabetic nephropathy. Methods. Randomised controlled trials (RCTs) conducted on adults with early diabetic nephropathy which used Gingko biloba extract were included. The major databases were searched, and manufacturers of Gingko biloba products were contacted for information on any published or unpublished studies. Two authors independently extracted the data from the included studies. Data analysis was conducted using Review Manager 5.0 software. Results. Sixteen RCTs were included. Ginkgo biloba extract decreased the urinary albumin excretion rate (UAER), fasting blood glucose (FBG), serum creatinine (SCR), and blood urea nitrogen (BUN). The extract also improved hemorheology. The methodological quality in the included studies was low. The explicit generation of the allocation sequence was described in only 6 trials. None of the included trials were confirmed to use blinding. Three studies had observed adverse events. One study using angiotensin-converting enzyme inhibitor (ACEi) reported mild cough in both groups. No serious adverse effects were reported. Conclusions. Gingko biloba extract is a valuable drug which has prospect in treating early diabetic nephropathy, especially with high UAER baseline level. The safety for early diabetic nephropathy is uncertain. Long-term, double-blinded RCTs with large sample sizes are still needed to provide stronger evidence.
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Zhu X, Li Z, Li C, Zhang J, Zou Z, Wang J. Ginkgo biloba extract and aspirin synergistically attenuate activated platelet-induced ROS production and LOX-1 expression in human coronary artery endothelial cells. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2013; 20:114-119. [PMID: 23218405 DOI: 10.1016/j.phymed.2012.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 10/14/2012] [Accepted: 10/22/2012] [Indexed: 06/01/2023]
Abstract
AIM In the present study, we investigated whether the therapeutic dosages of Ginkgo biloba extract (EGb) and Aspirin (ASP) might synergistically suppress oxidative stress through regulating the expressions of LOX-1 and phosphorylated p38MAPK (p-p38MAPK) in human coronary artery endothelial cells (HCAECs) ex vivo. METHODS HCAECs were stressed with activated platelets (2×10(8)/ml) and followed by ASP (1, 2 or 5 mmol/l), EGb (4, 40 or 400 μg/ml) and combinational (1 mmol/l ASP and 40μg/ml EGb) treatments in three groups for 12 h. Superoxide anion in HCAECs was measured with H2DCF-DA probe. The expressions of LOX-1 and p-p38MAPK were examined by Western blot. RESULTS After stimulation of activated platelets, intracellular superoxide anion was increased about 3-folds in HCAECs. Both ASP and EGb reduced superoxide anion in HCAECs in a dosage dependent manner. Combinational administration of ASP and EGb showed synergistic effect. By Western blot analysis, we were able to show that activated platelets markedly enhanced the expressions of LOX-1 and p-p38MAPK. Both ASP and EGb only inhibited LOX-1 expression in a concentration-dependent manner, but not p-p38MAPK. As expected, the combination of ASP and EGb markedly reduced not only the expression of LOX-1 but also the phosphorylation of p38MAPK. CONCLUSIONS Both EGb and ASP attenuate the oxidative stress of HCAECs stimulated by activated platelets ex vivo. It appears that the synergistic effect of EGb and ASP may correlate with the inhibition of ROS production, LOX-1 expression and p38MAPK phosphorylation.
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Affiliation(s)
- Xianguan Zhu
- Geriatrics Research Center, General Hospital of Air Force, PLA, Beijing 100142, China
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Microwave-assisted method for simultaneous extraction and hydrolysis for determination of flavonol glycosides in Ginkgo foliage using Brönsted acidic ionic-liquid [HO(3)S(CH(2))(4)mim]HSO(4) aqueous solutions. Int J Mol Sci 2012; 13:8775-8788. [PMID: 22942734 PMCID: PMC3430265 DOI: 10.3390/ijms13078775] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/20/2022] Open
Abstract
The Brönsted acidic ionic-liquid [HO3S(CH2)4mim] HSO4, a novel dual catalyst–solvent, has been successfully applied in simultaneous microwave-assisted extraction and hydrolysis for the determination of flavonol glycosides in Ginkgo foliage. The parameters, namely the [HO3S(CH2)4mim]HSO4 concentration, microwave-irradiation power, microwave-irradiation time, and solid–liquid ratio, were optimized. The optimum conditions were: an amount of 1.5 M [HO3S(CH2)4mim]HSO4, a microwave-irradiation power of 120 W, an irradiation time of 15 min, and a solid–liquid ratio of 1:30 g/mL. Compared with traditional methods the proposed approach demonstrates higher efficiency in a shorter operating time, and is an efficient, rapid, and simple sample preparation method.
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Taki Y, Yokotani K, Yamada S, Shinozuka K, Kubota Y, Watanabe Y, Umegaki K. Ginkgo biloba extract attenuates warfarin-mediated anticoagulation through induction of hepatic cytochrome P450 enzymes by bilobalide in mice. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2012; 19:177-182. [PMID: 21802929 DOI: 10.1016/j.phymed.2011.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/15/2011] [Accepted: 06/22/2011] [Indexed: 05/31/2023]
Abstract
Ginkgo biloba extract (GBE) is a popular herbal ingredient used worldwide, but it is reported to induce bleeding as a serious adverse event. In this study we examined whether GBE induced spontaneous bleeding or accelerated warfarin anticoagulation via herb-drug interaction. Mice were given GBE or various active components of GBE orally for 5 days and blood coagulation parameters and hepatic cytochrome P450 enzymes (CYPs) were measured. Mice also received warfarin (racemate, (S)- or (R)-enantiomer) for the last 3 days of the 5-day regimen to examine GBE-warfarin interactions. Neither GBE (up to 1000 mg/kg) nor ginkgolide B (up to 140 mg/kg), a platelet-activating factor antagonist, influenced blood coagulation parameters. In contrast, GBE attenuated the anticoagulant action of warfarin. Bilobalide, a component of GBE that markedly induced hepatic CYPs including (S)-warfarin hydroxylase, showed similar effects. For (S)-warfarin, the anticoagulation action and the interaction with GBE was clear, while the influence on metabolism was greater for (R)-warfarin than for (S)-warfarin, which corresponded to the CYP types induced by GBE. These results suggest that GBE and ginkgolide B have no influence on blood coagulation in vivo, and that GBE attenuates the anticoagulation action of warfarin via induction of hepatic CYPs by bilobalide.
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Affiliation(s)
- Yuko Taki
- National Institute of Health and Nutrition, Tokyo, Japan
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Zhao J, Su Y, Chen A, Yuan H, Liu L, Wu W. Effect of Ginkgo leaf parenteral solution on blood and cochlea antioxidant and immunity indexes in OM rats. Molecules 2011; 16:10433-42. [PMID: 22173336 PMCID: PMC6264202 DOI: 10.3390/molecules161210433] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 11/27/2011] [Accepted: 12/07/2011] [Indexed: 11/22/2022] Open
Abstract
Oxidative stress is involved in the development and progression of otitis media (OM). In this study, we investigated the effect of Ginkgo leaf parenteral solution on blood and cochlea antioxidant and immunity indexs in OM rats. In OM model rats, blood and cochlea malondialdehyde (MDA), nitric oxide (NO), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10 (IL-10) levels were significantly increased, whereas antioxidant enzymes activities (superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and glutathione reductase (GR)) were significantly decreased compared with normal rats. Treatment with Ginkgo leaf parenteral solution restored the altered parameters in a dose-dependent manner. We conclude that Ginkgo leaf parenteral solution confers protection against oxidative injuries in OM rats by increasing activities of antioxidants and immunity, suggesting a potential drug for the prevention and therapy of OM.
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Affiliation(s)
| | | | | | | | | | - Wenming Wu
- Department of Otolaryngology/Head and Neck Surgery, PLA General Hospital, Beijing 100853, China
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EGb 761 (Ginkgo biloba) protects cochlear hair cells against ototoxicity induced by gentamicin via reducing reactive oxygen species and nitric oxide-related apoptosis. J Nutr Biochem 2011; 22:886-94. [DOI: 10.1016/j.jnutbio.2010.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/29/2010] [Accepted: 08/05/2010] [Indexed: 12/23/2022]
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Shi G, Jiang W, Cai L, Sui G. Molecular characteristics and antitumor capacity of Glycan extracted from Cynomorium songaricum. Int J Biol Macromol 2011; 48:788-92. [DOI: 10.1016/j.ijbiomac.2011.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 11/16/2022]
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Chan AL, Leung HW, Wu JW, Chien TW. Risk of Hemorrhage Associated with Co-Prescriptions for Ginkgo biloba and Antiplatelet or Anticoagulant Drugs. J Altern Complement Med 2011; 17:513-7. [DOI: 10.1089/acm.2010.0295] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Agnes L.F. Chan
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
| | - Henry W.C. Leung
- Department of Radiation Oncology, Wan Fan Hospital, Taipei, Taiwan
| | - Jia-Wen Wu
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
| | - Tsair-Wei Chien
- Department of Administration, Chi Mei Medical Center, Tainan, Taiwan
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Lee BJ, Jo IY, Bu Y, Park JW, Maeng S, Kang H, Jang W, Hwang DS, Lee W, Min K, Kim JI, Yoo HH, Lew JH. Antiplatelet effects of Spatholobus suberectus via inhibition of the glycoprotein IIb/IIIa receptor. JOURNAL OF ETHNOPHARMACOLOGY 2011; 134:460-467. [PMID: 21211555 DOI: 10.1016/j.jep.2010.12.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/26/2010] [Accepted: 12/29/2010] [Indexed: 05/30/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The vine stem of Spatholobus suberectus is a widely used blood-activating and stasis-dispelling medicine for the treatment of diseases related to blood stasis syndrome in traditional medicine in Korea, Japan, and China. AIM OF THE STUDY To demonstrate the clinical effects of Spatholobus suberectus against blood stasis syndromes using in vitro and in vivo platelet aggregation studies and to investigate its exact mechanisms. MATERIALS AND METHODS We extracted vine stems of Spatholobus suberectus, using 95% EtOH (SSE) and investigated its antiplatelet activity on platelet aggregation induced by collagen and ADP in human platelet-rich plasma (PRP). For the mechanism study, a glycoprotein IIb/IIIa (GP IIb/IIIa) assay using flow cytometric analysis and a thromboxane A(2) (TXA(2)) assay were performed. In addition, we investigated the effects of SSE in a thromboembolic mouse model. RESULTS SSE significantly inhibited ADP- and collagen-induced platelet aggregation in human PRP concentration-dependently without affecting plasma clotting time. It also significantly inhibited fibrinogen binding to the GP IIb/IIIa receptor and partly inhibited the formation of TXA(2). In the in vivo study, oral administration of SSE dose-dependently suppressed the death of thromboembolism model mice induced by intravenous injection of collagen plus epinephrine. CONCLUSIONS SSE showed antiplatelet activity without anticoagulant effects mainly through the inhibition of fibrinogen binding to the GP IIb/IIIa receptor. Our current results support the clinical usage of SSE in the East Asian region treating atherothrombotic diseases and may represent a new natural source to develop antiplatelet agents.
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Affiliation(s)
- Beom-Joon Lee
- Kangnam Korean Hospital, Kyung Hee University, Daechi-dong, Kangnam-gu, Seoul 135-501, Republic of Korea
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Comparative pharmacokinetics and bioavailability studies of quercetin, kaempferol and isorhamnetin after oral administration of Ginkgo biloba extracts, Ginkgo biloba extract phospholipid complexes and Ginkgo biloba extract solid dispersions in rats. Fitoterapia 2010; 81:1045-52. [DOI: 10.1016/j.fitote.2010.06.028] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/24/2010] [Accepted: 06/27/2010] [Indexed: 11/22/2022]
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Biggs ML, Sorkin BC, Nahin RL, Kuller LH, Fitzpatrick AL. Ginkgo biloba and risk of cancer: secondary analysis of the Ginkgo Evaluation of Memory (GEM) Study. Pharmacoepidemiol Drug Saf 2010; 19:694-8. [PMID: 20582906 DOI: 10.1002/pds.1979] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Evidence from in vitro and in vivo studies suggests that Ginkgo biloba has cancer chemopreventive properties, but epidemiological evidence is sparse. We analyzed cancer as a secondary endpoint in the Ginkgo Evaluation of Memory (GEM) Study, the largest randomized, double-blind, placebo-controlled clinical trial of Ginkgo supplementation to date. METHODS A total of 3069 GEM participants 75+ years of age were randomized to twice-daily doses of either 120 mg Ginkgo extract (EGb 761) or placebo and followed for a median 6.1 years. We identified hospitalizations for invasive cancer by reviewing hospital admission and discharge records for all reported hospitalizations over follow-up. Using an intention-to-treat approach, we compared the risk of cancer hospitalization between participants assigned to treatment and those assigned to placebo. RESULTS During the intervention, there were 148 cancer hospitalizations in the placebo group and 162 in the EGb 761 group (Hazard ratio (HR), 1.09; 95% confidence interval (CI), 0.87-1.36; p = 0.46). Among the site-specific cancers analyzed, we observed an increased risk of breast (HR, 2.15; 95%CI, 0.97-4.80; p = 0.06) and colorectal (HR, 1.62; 95%CI, 0.92-2.87; p = 0.10) cancer, and a reduced risk of prostate cancer (HR, 0.71; 95%CI, 0.43-1.17; p = 0.18). CONCLUSIONS Overall, these results do not support the hypothesis that regular use of Ginkgo biloba reduces the risk of cancer.
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Affiliation(s)
- Mary L Biggs
- Department of Biostatistics, University of Washington, Seattle, WA 98115, USA.
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Pinto MDS, Kwon YI, Apostolidis E, Lajolo FM, Genovese MI, Shetty K. Potential of Ginkgo biloba L. leaves in the management of hyperglycemia and hypertension using in vitro models. BIORESOURCE TECHNOLOGY 2009; 100:6599-6609. [PMID: 19665890 DOI: 10.1016/j.biortech.2009.07.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 07/07/2009] [Accepted: 07/07/2009] [Indexed: 05/28/2023]
Abstract
Leaves from four different Ginkgo biloba L. trees (1 and 2--females; 3 and 4--males), grown at the same conditions, were collected during a period of 5 months (from June to October, 2007). Water and 12% ethanol extracts were analyzed for total phenolics content, antioxidant activity, phenolic profile, and the potential in vitro inhibitory effects on alpha-amylase, alpha-glucosidase, and Angiotensin I-Converting Enzyme (ACE) enzymes related to the management of diabetes and hypertension. The results indicated a significant difference among the trees in all functional benefits evaluated in the leaf extracts and also found important seasonal variation related to the same functional parameters. In general, the aqueous extracts had higher total phenolic content than the ethanolic extracts. Also, no correlation was found between total phenolics and antioxidant activity. In relation to the ACE inhibition, only ethanolic extracts had inhibitory activity.
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Affiliation(s)
- Marcia Da Silva Pinto
- Laboratório de Química, Bioquímica e Biologia Molecular de Alimentos, Departamento de Alimentos e Nutrição Experimental, FCF, Universidade de São Paulo, Av. Prof. Lineu Prestes 580, Bloco 14, 05508-900 São Paulo, SP, Brazil
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Cheng L, Han X, Shi Y. A regulatory role of LPCAT1 in the synthesis of inflammatory lipids, PAF and LPC, in the retina of diabetic mice. Am J Physiol Endocrinol Metab 2009; 297:E1276-82. [PMID: 19773578 PMCID: PMC2793047 DOI: 10.1152/ajpendo.00475.2009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Platelet-activating factor (PAF) and lysophosphatidylcholine (LPC) are potent inflammatory lipids. Elevated levels of PAF and LPC are associated with the onset of diabetic retinopathy and neurodegeneration. However, the molecular mechanisms underlying such defects remain elusive. LPCAT1 is a newly reported lysophospholipid acyltransferase implicated in the anti-inflammatory response by its role in conversion of LPC to PC. Intriguingly, the LPCAT1 enzyme also catalyzes the synthesis of PAF from lyso-PAF with use of acetyl-CoA as a substrate. The present studies investigated regulatory roles of LPCAT1 in the synthesis of inflammatory lipids during the onset of diabetes. Our work shows that LPCAT1 plays an important role in the inactivation of PAF by catalyzing the synthesis of alkyl-PC, an inactivated form of PAF with use of acyl-CoA and lyso-PAF as substrates. In support of a role of LPCAT1 in anti-inflammatory responses in diabetic retinopathy, LPCAT1 is most abundantly expressed in the retina. Moreover, LPCAT1 mRNA levels and acyltransferase activity toward lyso-PAF and LPC were significantly downregulated in retina and brain tissues in response to the onset of diabetes in Ins2(Akita) and db/db mice, mouse models of type 1 and type 2 diabetes, respectively. Conversely, treatment of db/db mice with rosiglitazone, an antidiabetes compound, significantly upregulated LPCAT1 mRNA levels concurrently with increased acyltransferase activity in the retina and brain. Collectively, these findings identified a novel regulatory role of LPCAT1 in catalyzing the inactivation of inflammatory lipids in the retina of diabetic mice.
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Affiliation(s)
- Long Cheng
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA
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Kuller LH, Ives DG, Fitzpatrick AL, Carlson MC, Mercado C, Lopez OL, Burke GL, Furberg CD, DeKosky ST. Does Ginkgo biloba reduce the risk of cardiovascular events? Circ Cardiovasc Qual Outcomes 2009; 3:41-7. [PMID: 20123670 DOI: 10.1161/circoutcomes.109.871640] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) was a preplanned secondary outcome of the Ginkgo Evaluation of Memory Study. The trial previously reported that Ginkgo biloba had no effect on the primary outcome, incident dementia. METHODS AND RESULTS The double-blind trial randomly assigned 3069 participants over 75 years of age to 120 mg of G biloba EGb 761 twice daily or placebo. Mean follow-up was 6.1 years. The identification and classification of CVD was based on methods used in the Cardiovascular Health Study. Differences in time to event between G biloba and placebo were evaluated using Cox proportional hazards regression adjusted for age and sex. There were 355 deaths in the study, 87 due to coronary heart disease with no differences between G biloba and placebo. There were no differences in incident myocardial infarction (n=164), angina pectoris (n=207), or stroke (151) between G biloba and placebo. There were 24 hemorrhagic strokes, 16 on G biloba and 8 on placebo (not significant). There were only 35 peripheral vascular disease events, 12 (0.8%) on G biloba and 23 (1.5%) on placebo (P=0.04, exact test). Most of the peripheral vascular disease cases had either vascular surgery or amputation. CONCLUSIONS There was no evidence that G biloba reduced total or CVD mortality or CVD events. There were more peripheral vascular disease events in the placebo arm. G biloba cannot be recommended for preventing CVD. Further clinical trials of peripheral vascular disease outcomes might be indicated. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00010803.
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Affiliation(s)
- Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, 130 N Bellefield Ave, Room 550, Pittsburgh, PA 15213, USA.
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Kim TE, Kim BH, Kim J, Kim KP, Yi S, Shin HS, Lee YO, Lee KH, Shin SG, Jang IJ, Yu KS. Comparison of the pharmacokinetics of ticlopidine between administration of a combined fixed-dose tablet formulation of ticlopidine 250 mg/Ginkgo extract 80 mg, and concomitant administration of ticlopidine 250-mg and ginkgo extract 80-mg tablets: An open-label, two-treatment, single-dose, randomized-sequence crossover study in healthy Korean male volunteers. Clin Ther 2009; 31:2249-57. [DOI: 10.1016/j.clinthera.2009.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2009] [Indexed: 10/20/2022]
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Kudolo GB, Wang W, Barrientos J, Elrod R, Blodgett J. The Ingestion of Ginkgo biloba Extract (EGb 761) Inhibits Arachidonic Acid-Mediated Platelet Aggregation and Thromboxane B2 Production in Healthy Volunteers. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/j157v04n04_02] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kudolo GB, Wang W, Dorsey S, Blodgett J. Oral Ingestion ofGinkgo bilobaExtract Reduces Thiobarbituric Acid Reacting (TBAR) Substances in Washed Platelets of Healthy Subjects. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/j157v03n04_01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ryu KH, Han HY, Lee SY, Jeon SD, Im GJ, Lee BY, Kim K, Lim KM, Chung JH. Ginkgo biloba extract enhances antiplatelet and antithrombotic effects of cilostazol without prolongation of bleeding time. Thromb Res 2009; 124:328-34. [PMID: 19349067 DOI: 10.1016/j.thromres.2009.02.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/13/2009] [Accepted: 02/19/2009] [Indexed: 10/20/2022]
Abstract
Thrombosis and thromboembolic occlusions of major and minor blood vessels are a major complication in various peripheral vascular diseases. Antiplatelet agents (APA), key tools in the treatment of atherothrombosis, therefore became a mainstay medication for a wide range of vascular diseases. Cilostazol and Ginkgo biloba extract (GB), commonly used remedies for peripheral arterial disease, inhibit platelet aggregation with distinct therapeutic mechanisms. In this study, we have investigated if GB can potentiate the antiplatelet effects of cilostazol to explore the utility of combination therapy of cilostazol and GB against peripheral occlusive vascular diseases. GB or cilostazol was evaluated alone or in combination for the antiplatelet activity using in vitro and in vivo models. In addition, potential bleeding side effect of the combinative therapy was assessed by measuring bleeding time, prothrombin time (PT) and activated partial thromboplastin time (aPTT) in vivo after oral administration. In in vitro assays using freshly isolated human platelets, the combination of cilostazol and GB showed superior inhibition of both the shear and the collagen-induced platelet aggregation to those of each drug alone. In accordance with these enhanced in vitro antiplatelet activities, the combinative therapy showed enhanced anti-thrombotic effects in in vivo pulmonary embolism model and arterial thrombosis model. In particular, the increase of survival rate in pulmonary embolism model by combination treatment of cilostazol (25 mg/kg) and GB (20 mg/kg) was higher more than two-fold of those of the respective drugs. Notably, the combination of cilostazol and GB did not show a significant effect on the bleeding time, PT and aPTT increase, suggesting that GB may potentiate the antiplatelet effect of cilostazol without the prolongation of bleeding time or coagulation time. With these studies, we suggest that combinative therapy of GB and cilostazol might offer enhanced anti-thrombotic efficacies without increasing side-effects.
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Affiliation(s)
- Keun Ho Ryu
- Pharmacology Team, Life Science R&D Center, SK Chemicals, Korea
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Effect of Ginkgo biloba (EGb 761) on treadmill walking time among adults with peripheral artery disease: a randomized clinical trial. J Cardiopulm Rehabil Prev 2008; 28:258-65. [PMID: 18628657 DOI: 10.1097/01.hcr.0000327184.51992.b8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Medical therapies for treatment of peripheral artery disease (PAD) are limited. Ginkgo biloba has been reported to increase maximal and pain-free walking distance among patients with PAD; however, the evidence is inconsistent. The objective of this study was to compare the effects of 300 mg/d of Ginkgo biloba (EGb 761) versus placebo on treadmill walking time and related cardiovascular measures among patients with PAD. METHODS A double-blind, placebo-controlled, parallel design trial with a 4-month duration was used. Participants were 62 adults, aged 70 +/- 8 years (mean +/- SD), with claudication symptoms of PAD. The primary study outcomes were maximal and pain-free walking time on a treadmill. Secondary outcomes included flow-mediated vasodilation, a measure of antioxidant status as assessed by determining antibody levels to epitopes of oxidized low-density lipoprotein, and questionnaires addressing walking impairment and quality of life. RESULTS Maximal treadmill walking time increased by 20 +/- 80 and 91 +/- 242 seconds in the placebo and the EGb 761 groups, respectively (P = .12). Pain-free walking time increased by 15 +/- 31 and 21 +/- 43 seconds, respectively (P = .28). No significant differences were detected between groups for any of the secondary outcomes. CONCLUSIONS In older adults with PAD, Ginkgo biloba produced a modest but insignificant increase in maximal treadmill walking time and flow-mediated vasodilation. These data do not support the use of Ginkgo biloba as an effective therapy for PAD, although a longer duration of use should be considered in any future trials.
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Bone KM. Potential interaction ofGinkgo bilobaleaf with antiplatelet or anticoagulant drugs: What is the evidence? Mol Nutr Food Res 2008; 52:764-71. [DOI: 10.1002/mnfr.200700098] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Effect of Ginkgo biloba (EGb 761) and aspirin on platelet aggregation and platelet function analysis among older adults at risk of cardiovascular disease: a randomized clinical trial. Blood Coagul Fibrinolysis 2007; 18:787-93. [DOI: 10.1097/mbc.0b013e3282f102b1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Samuels N, Finkelstein Y, Singer SR, Oberbaum M. Herbal medicine and epilepsy: proconvulsive effects and interactions with antiepileptic drugs. Epilepsia 2007; 49:373-80. [PMID: 17941846 DOI: 10.1111/j.1528-1167.2007.01379.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The use of complementary and alternative medicine is on the rise, including among patients with epilepsy. Herbal medicine, one of the most popular forms of CAM, is considered to be both safe and effective by most consumers. Yet many herbs may increase the risk for seizures, through intrinsic proconvulsant properties or contamination by heavy metals, as well as via effects on the cytochrome P450 enzymes and P-glycoproteins, altering antiepileptic drug (AED) disposition. Herb-drug interactions may be difficult to predict, especially since the quality and quantity of active ingredients are often unknown. Since most patients do not inform their physicians that they are taking herbal medicines, health care professionals must initiate a dialogue in order to prevent complications with the combined regimen. At the same time, further research is required regarding the effect of herbs on seizure activity and interactions with AED treatment.
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Affiliation(s)
- Noah Samuels
- The Center for Integrative Complementary Medicine, Shaare Zadek Medical Center, Jerusalem, Israel.
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Carlson JJ, Farquhar JW, DiNucci E, Ausserer L, Zehnder J, Miller D, Berra K, Hagerty L, Haskell WL. Safety and Efficacy of a Ginkgo Biloba–Containing Dietary Supplement on Cognitive Function, Quality of Life, and Platelet Function in Healthy, Cognitively Intact Older Adults. ACTA ACUST UNITED AC 2007; 107:422-32. [PMID: 17324660 DOI: 10.1016/j.jada.2006.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine if a ginkgo biloba-containing supplement improves cognitive function and quality of life, alters primary hemostasis, and is safe in healthy, cognitively intact older adults. DESIGN Four-month, randomized, double-blind, placebo-controlled parallel design. SUBJECTS/SETTING Ninety men and women (age range 65 to 84 years) were recruited to a university clinic. Eligibility included those without dementia or depression, not taking psychoactive medications or medications or supplements that alter hemostasis. INTERVENTION Ninety subjects were randomly assigned to placebo or a ginkgo biloba-based supplement containing 160 mg ginkgo biloba, 68 mg gotu kola, and 180 mg decosahexaenoic acid per day for 4 months. MAIN OUTCOME MEASURES Assessments included: six standardized cognitive function tests, the SF-36 Quality of Life questionnaire, the Platelet Function Analyzer-100 (Dade Behring, Eschbom, Germany), and the monitoring of adverse events. STATISTICAL ANALYSES Baseline characteristics and study hypotheses were tested using analysis of covariance. Tests were two-tailed with a 0.05 significance level. RESULTS Seventy-eight subjects (87%) completed both baseline and 4-month testing (n=36 in placebo group, n=42 in ginkgo biloba group). At baseline, the participants' cognitive function was above average. One of six cognitive tests indicated significant protocol differences at 4 months (P=0.03), favoring the placebo. There were no significant differences in quality of life, platelet function, or adverse events. CONCLUSIONS These finding do not support the use of a ginkgo biloba-containing supplement for improving cognitive function or quality of life in cognitively intact, older, healthy adults. However, high baseline scores may have contributed to the null findings. The ginkgo biloba product seems safe and did not alter platelet function, though additional studies are needed to evaluate the interaction of varying doses of ginkgo biloba and ginkgo biloba-containing supplements with medications and supplements that alter hemostasis.
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Affiliation(s)
- Joseph J Carlson
- Sport and Cardiovascular Nutrition Program, Department of Radiology, Michigan State University, College of Osteopathic Medicine, East Lansing, MI 48824, USA.
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Kudolo GB. Reply to Dr. Blumenthal's Letter. Clin Nutr 2007; 26:166-167. [PMID: 17673942 PMCID: PMC1939696 DOI: 10.1016/j.clnu.2006.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jiang X, Blair EYL, McLachlan AJ. Investigation of the effects of herbal medicines on warfarin response in healthy subjects: a population pharmacokinetic-pharmacodynamic modeling approach. J Clin Pharmacol 2006; 46:1370-8. [PMID: 17050802 DOI: 10.1177/0091270006292124] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Systematic evidence regarding herb-drug interactions is lacking. This study investigated herb-drug interactions with warfarin. S-warfarin concentration and response (prothrombin complex activity) data from healthy subjects (n = 24) who received a single warfarin dose (25 mg) and either St John's wort, Asian ginseng, Ginkgo biloba, or ginger were analyzed using a population pharmacokinetic-pharmacodynamic modeling approach. The ratio of S-warfarin apparent clearance (CL/F) compared to control was 1.39 +/- 0.06 and 1.14 +/- 0.04 after St John's wort and Asian ginseng pretreatment, respectively. Other pharmacokinetic and pharmacodynamic parameters were unaffected. Coadministration of St John's wort significantly increased S-warfarin CL/F, whereas treatment with Asian ginseng produced only a moderate increase in CL/F. Ginkgo and ginger did not affect the pharmacokinetics of warfarin in healthy subjects. None of the herbs studied had a direct effect on warfarin pharmacodynamics. Studies in anticoagulated patients are warranted to assess the clinical significance of these herb-drug interactions.
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Affiliation(s)
- Xuemin Jiang
- Faculty of Pharmacy, the University of Sydney, NSW 2006, Australia
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