Content analysis of systematic reviews on effectiveness of traditional Chinese medicine

The Lnc-ENST00000602558/IGF1 axis as a predictor of response to treatment with tripterygium glycosides in rheumatoid arthritis patients

AIMS

Growing clinical evidence suggests that not all patients with rheumatoid arthritis (RA) benefit to the same extent by treatment with tripterygium glycoside (TG), which highlights the need to identify RA-related genes that can be used to predict drug responses. In addition, single genes as markers of RA are not sufficiently accurate for use as predictors. Therefore, there is a need to identify paired expression genes that can serve as biomarkers for predicting the therapeutic effects of TG tablets in RA.

METHODS

A total of 17 pairs of co-expressed genes were identified as candidates for predicting an RA patient's response to TG therapy, and genes involved in the Lnc-ENST00000602558/GF1 axis were selected for that purpose. A partial-least-squares (PLS)-based model was constructed based on the expression levels of Lnc-ENST00000602558/IGF1 in peripheral blood. The model showed high efficiency for predicting an RA patient's response to TG tablets.

RESULTS

Our data confirmed that genes co-expressed in the Lnc-ENST00000602558/IGF1 axis mediate the efficacy of TG in RA treatment, reduce tumor necrosis factor-α induced IGF1 expression, and decrease the inflammatory response of MH7a cells.

CONCLUSION

We found that genes expressed in the Lnc-ENST00000602558/IGF1 axis may be useful for identifying RA patients who will not respond to TG treatment. Our findings provide a rationale for the individualized treatment of RA in clinical settings.

Supermolecules as a quality markers of herbal medicinal products

Herbal medicines have greatly contributed to human health worldwide for thousands of years. In particular, traditional Chinese medicine plays an essential role in the prevention and treatment of COVID-19. With the exponentially increasing use and global attention to herbal medicinal products (HMPs), efficacy and safety have become major public concerns in many countries. In general, the quantification and qualification of quality markers (Q-markers) is the most common way to solve this issue. In the last few decades, small molecules, including flavonoids, terpenes, phenylpropanoids, alkaloids, phenols, and glycosides have been extensively investigated as Q-markers for HMP quality control. With the development of biotechnology in the last decade, scientists have begun to explore HMPs macromolecules, including polysaccharides and DNA, for their establishment as Q-markers. In recent years, supermolecules with stronger biological activities have been found in HMPs. In this review, we summarize and discuss the current Q-markers for HMP quality control; in particular, the possibility of using supermolecules as Q-markers based on structure and activity was discussed.

Assessment of the anti-virulence potential of extracts from four plants used in traditional Chinese medicine against multidrug-resistant pathogens

BACKGROUND

Multidrug-resistant pathogens are resistant to many antibiotics and associated with serious infections. Amomum tsaoko Crevost et Lemaire, Sanguisorba officinalis, Terminalia chebula Retz and Salvia miltiorrhiza Bge, are all used in Traditional Chinese Medicine (TCM) against multidrug-resistant pathogens, and the purpose of this study was to evaluate the antibacterial and anti-virulence activity of extracts derived from them.

METHODS

The antibacterial activity of ethanol and aqueous extracts from these four plants was examined against several multi-drug resistant bacterial strains, and their anti-virulence potential (including quorum quenching activity, biofilm inhibition, and blocking production of virulence factor δ-toxin) was assessed against different S. aureus strains. The chemical composition of the most effective extract was determined by LC-FTMS.

RESULTS

Only extracts from S. officinalis and A. tsaoko were shown to exhibit limited growth inhibition activity at a dose of 256 μg·mL-1. The S. officinalis ethanol extract, the ethanol and aqueous extract of A. tsaoko, and the aqueous extract of S. miltiorrhiza all demonstrated quorum quenching activity, but didn't significantly inhibit bacterial growth. The ethanol extract of S. officinalis inhibited bacterial toxin production and biofilm formation at low concentrations. Chemical composition analysis of the most effective extract of S. officinalis showed that it mainly contained saponins.

CONCLUSIONS

The most active extract tested in this study was the ethanol root extract of S. officinalis. It inhibited δ-toxin production and biofilm formation at low concentrations and saponins may be its key active components. While the four plants showed no direct antibacterial effects, their anti-virulence properties may be key to fighting bacterial infections.

Immunomodulatory and antioxidant effects of Astragalus polysaccharide liposome in large yellow croaker (Larimichthys crocea)

Astragalus polysaccharides (APS) have been widely used as immunopotentiators in aquaculture, however, the best way of their administration remains to be explored. In the present study, APS liposome (APSL) was prepared by film dispersion-ultrasonic method. The optimal conditions of APSL preparation were determined by response surface methodology, with a ratio of 10:1 (w/w) for soybean lecithin to APS and 8:1 (w/w) for soybean lecithin to cholesterol, and an ultrasound time of 15 min, which produced an encapsulation efficiency of 73.88 ± 0.88% of APSL. In vivo feeding experiments in large yellow croaker showed that both APS and APSL could enhance the contents of serum total protein (TP) and albumin (ALB), activities of serum non-specific immune enzymes such as acid phosphatase (ACP), alkaline phosphatase (AKP), and lysozyme (LZM), and phagocytic activity of head kidney macrophages. Meanwhile, they both increased the activities of serum antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) and reduced the content of final lipid peroxidation product malondialdehyde (MDA) in serum, thus exhibiting the antioxidant effects. In vitro experiments on primary head kidney macrophages (PKM) showed that both APS and APSL inhibited ROS production, but obviously enhanced NO production and phagocytic activity of PKM. Furthermore, expression levels of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α), IFN-γ, and iNOS in PKM were significantly up-regulated after APS and APSL treatments, but no expression change of IFN-h was observed. Taken together, our results showed that both APS and APSL could improve several immune parameters and antioxidant ability of large yellow croaker either in vivo or in vitro, and the efficacy of APSL was markedly better than APS. These findings therefore indicated that the immunomodulatory and antioxidant activities of APS could be enhanced after encapsulated with liposome, and APSL may represent a potential drug delivery system of APS for development of immunoenhancers in aquaculture.

A novel gene-expression-signature-based model for prediction of response to Tripterysium glycosides tablet for rheumatoid arthritis patients

Background

Approximately 30% of rheumatoid arthritis (RA) patients treated with Tripterysium glycosides (TG) tablets fail to achieve clinical improvement, implying the essentiality of predictive biomarkers and tools. Herein, we aimed to identify possible biomarkers predictive of therapeutic effects of TG tablets in RA.

Methods

Gene expression profile in peripheral blood mononuclear cells obtained from a discovery cohort treated with TG tablets was detected by Affymetrix EG1.0 arrays. Then, a list of candidate gene biomarkers of response to TG tablets were identified by integrating differential expression data analysis and gene signal transduction network analysis. After that, a partial-least-squares (PLS) model based on the expression levels of the candidate gene biomarkers in RA patients was constructed and evaluated using a validation cohort.

Results

Six candidate gene biomarkers (MX1, OASL, SPINK1, CRK, GRAPL and RNF2) were identified to be predictors of TG therapy. Following the construction of a PLS-based model using their expression levels in peripheral blood, both the 5-fold cross-validation and independent dataset validations showed the high predictive efficiency of this model, and demonstrated a distinguished improvement of the PLS-model based on six candidate gene biomarkers’ expression in combination over the commonly used clinical and inflammatory parameters, as well as the gene biomarkers alone, in predicting RA patients’ response to TG tablets.

Conclusions

This hypothesis-generating study identified MX1, OASL, SPINK1, CRK, GRAPL and RNF2 as novel targets for RA therapeutic intervention, and the PLS model based on the expression levels of these candidate biomarkers may have a potential prognostic value in RA patients treated with TG tablets.

Electronic supplementary material

The online version of this article (10.1186/s12967-018-1549-9) contains supplementary material, which is available to authorized users.

The effectiveness of acupuncture on pain, physical function and health-related quality of life in patients with rheumatoid arthritis: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to identify and synthesize the best available evidence on the effectiveness of acupuncture on pain, physical function and health-related quality of life in patients with rheumatoid arthritis.More specifically, the review questions are:• Is acupuncture effective in improving health-related quality of life in patients with RA?• Is acupuncture effective in relieving pain in patients with RA?• Is acupuncture effective in improving physical function in patients with RA?

Serum brain-derived neurotrophic factor levels associate with cognitive improvement in patients with schizophrenia treated with electroacupuncture

Accumulating evidence supports that acupuncture has been successfully used for the treatment of neurological disorders to improve cognitive function. This study was set to evaluate the efficacy of electroacupuncture (EA, using two acupoints: Baihui and Shenting) on clinical symptoms, cognitive function and brain-derived neurotrophic factor (BDNF) levels in patients with schizophrenia. Sixty-one inpatients diagnosed schizophrenia with DSM-IV criteria were recruited. The participants were randomly divided into an experimental group (n=30) and a control group (n=31). The patients were evaluated using the Positive and Negative Symptom Scale (PANSS), the Wisconsin Card Sorting Test (WCST) and Wechsler Memory Scale (WMS) at baseline and after EA treatment. There were no significant differences in the PANSS scores and serum BDNF levels between the experimental group and the control group, either at baseline or at the end of the 4-week study period. However, the EA treatment appeared to have significant benefits on memory and moderate benefits on executive functions and problem solving. Significant positive correlation was observed between the increase of BDNF levels and memory improvement after EA treatment. Our results indicated that EA treatment could improve cognitive function, and the cognitive benefits positively associate with serum BDNF levels in patients with schizophrenia.

Chinese herbal medicine for constipation: zheng-based associations among herbs, formulae, proprietary medicines, and herb-drug interactions

Background

As current symptomatic treatments of constipation are still unsatisfactory, an increasing number of patients seek help from Chinese medicine (CM), particularly Chinese herbal medicine (CHM). This study aimed to review the most frequently used CHM herbs and formulae, proprietary CHMs, and herb–drug interactions for functional constipation using zheng (syndrome)-based differentiation, and to determine the current practice of zheng-based CHM treatments for functional constipation.

Methods

We developed a search strategy to include all the related clinical studies of CHM for constipation and set inclusion and exclusion criteria as studies on subjects with constipation of all ages and both sexes, using objective measures from laboratory or imaging techniques. The interventions included single herbs, CM classical formulae, CM new formulae, and Chinese herb-derived products and combination products. The clinical study types included were quasi- or randomized controlled trials, observational clinical studies, case series or case reports, and other types of appropriate research methods. The data concerning study design, sample size, mode of recruitment, sampling and diagnostic procedure, inclusion and exclusion criteria, and participants’ characteristics (including age, sex, and duration of constipation). CM patterns, CM treatment principles, treatment regimen, and CM treatment outcomes were recorded.

Results

A total of 29,832 relevant records were found, of which 8541 were duplicate records and 20,639 were excluded for reasons of irrelevance. The full text of 965 articles was retrieved for detailed assessment, following which 480 articles were excluded for various reasons. From the included articles, we retrieved 190 different CM zheng diagnoses from 485 individual studies. The most common zheng was dual deficiency of qi and blood (N = 48), which was diagnosed in 948 out of 15,740 subjects. The most frequently used classical formula was Ma-Zi-Ren-Wan (MZRW) (N = 75) and the most frequently used proprietary CHM was Run-Chang-Wan (N = 87). The most frequently used combined medication was Da Huang with sodium bicarbonate tablets (frequency across all studies, n = 23), followed by Fan Xie Ye with lactulose oral solution (n = 8), Ma-Ren-Ruan-Jiao-Nang with lactulose oral solution (n = 6) and Liu-Wei-An-Xiao-Jiao-Nang (n = 6) with mosapride citrate tablets.

Conclusion

This study examined the use of CHM for constipation and summarized the herbs, formulae, proprietary medicines, and herb–drug interactions application. These data indicated there were limited information about herb-drug interactions and adverse effects of CHM and further randomized controlled trials with strict design are necessary.

Electronic supplementary material

The online version of this article (doi:10.1186/s13020-016-0099-4) contains supplementary material, which is available to authorized users.

Preparation, Characterization and Pharmacokinetic Study of Xiangfu Siwu Decoction Essential Oil/β-Cyclodextrin Inclusion Complex

Xiang-Fu-Si-Wu Decoction (XFSWD), a famous Chinese herbal formula, is considered an effective prescription for treating primary dysmenorrhea. The essential oil is a significant effective ingredient of XFSWD. However, its volatility, instability and poor water-solubility influence its pharmacodynamic effects. β-Cyclodextrin (β-CD) has the intrinsic ability to form specific inclusion complexes with such drugs to enhance their stability, solubility and bioavailability. The aim of this study was thus to compare the pharmacokinetic characteristics and the oral bioavailability of XFSWD essential oil (XEO) and its β-CD inclusion complex after oral administration to rats. A simple, rapid, and sensitive ultra-high performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method was developed for the simultaneous quantification of five active components of XEO in rat plasma. The in vivo data showed that XEO/β-CD inclusion complex displayed higher maximum plasma concentration (C_max), longer half-time (T_1/2) and bigger area under the concentration-time curve (AUC_{0–24 h}). These results demonstrated that the formation of β-CD inclusion complex has significantly increased the oral bioavailability of the drugs in rats than free oil.

Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis

OBJECTIVES

In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors.

METHODS

Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics.

RESULTS

A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino).

CONCLUSION

There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.

Predicting and verifying outcome of Tripterygium wilfordii Hook F. based therapy in rheumatoid arthritis: from open to double-blinded randomized trial

Tripterygium wilfordii Hook F. (TwHF) based therapy has been proved as effective in treating rheumatoid arthritis (RA), yet the predictors to its response remains unclear. A two-stage trial was designed to identify and verify the baseline symptomatic predictors of this therapy. 167 patients with active RA were enrolled with a 24-week TwHF based therapy treatment and the symptomatic predictors were identified in an open trial; then in a randomized clinical trial (RCT) for verification, 218 RA patients were enrolled and classified into predictor positive (P+) and predictor negative (P−) group, and were randomly assigned to accept the TwHF based therapy and Methotrexate and Sulfasalazine combination therapy (M&S) for 24 weeks, respectively. Five predictors were identified (diuresis, excessive sweating, night sweats for positive; and yellow tongue-coating, thermalgia in the joints for negative). In the RCT, The ACR 20 responses were 82.61% in TwHF/P+ group, significantly higher than that in TwHF/P− group (P = 0.0001) and in M&S/P+ group (P < 0.05), but not higher than in M&S/P− group. Similar results were yielded in ACR 50 yet not in ACR 70 response. No significant differences were detected in safety profiles among groups. The identified predictors enable the TwHF based therapy more efficiently in treating RA subpopulations.

Area epidemiological research on hypertension risk factors of Keriyans in the Taklimakan Desert

INTRODUCTION

The Keriyans live in the hot, arid areas of Taklimakan Desert and maintain a primitive way of life. They have a low incidence of hypertension. However, little is known about the adaptive compensation in the organism. In the present study, we explored the the traditional risk factors of hypertension in the Keriyans.

MATERIALS AND METHODS

We performed an epidemiological survey of Keriyans in a randomly selected natural population including 508 individuals aged 16 years or more, using the WHO MONICA scheme and 151 randomly selected age/gender-matched controls, Uighurs, from the nearest villagers to the Keriyans.

RESULTS

The incidence of hypertension in the Keriyans was significantly lower than that in the controls(p<0.001). Multivariate logistic regression analysis indicated that age, hyperglycemia and salt consumption as well as sodium intake in diet were associated with traditional hypertension risk factors. Correlation between water quality and hypertension showed that calcium was positively associated with the detection rate of hypertension.

CONCLUSIONS

Age, hyperglycemia and salt consumption as well as sodium intake in diet were correlated with hypertension risk factors, which leads to the speculation that the water of the desert draught area which is characterized by low calcium and high magnesium levels might account for the low incidence of hypertension in Keriyans.