Traditional medicines of plant origin used for the treatment of inflammatory disorders in Pakistan: A review

Targeting chemokine-receptor mediated molecular signaling by ethnopharmacological approaches

ETHNOPHARMACOLOGICAL RELEVANCE

Infection and inflammation are critical to global human health status and the goal of current pharmacological interventions intends formulating medications/preventives as a measure to deal with this situation. Chemokines and their cognate receptors are major regulatory molecules in many of these ailments. Natural products have been a keen source to the drug development industry, every year contributing significantly to the growing list of FDA approved drugs. A multiverse of natural resource is employed as a part of curative regimen in folk/traditional/ethnomedicine which can be employed to discover, repurpose, and design potent medications for the diseases of clinical concern.

AIM OF THE STUDY

This review aims to systematically document the ethnopharmacologically active agents targeting the infectious-inflammatory diseases through the chemokine-receptor nexus.

MATERIALS AND METHODS

Articles related to chemokine/receptor modulating ethnopharmacological anti-inflammatory, anti-infectious natural sources, bioactive compounds, and formulations have been examined with special emphasis on women related diseases. The available literature has been thoroughly scrutinized for the application of traditional medicines in chemokine associated experimental methods, their regulatory outcomes, and pertinence to women's health wherever applicable. Moreover, the potential traditional regimens under clinical trials have been critically assessed.

RESULTS

A systematic and comprehensive review on the chemokine-receptor targeting ethnopharmaceutics from the available literature has been provided. The article discusses the implication of traditional medicine in the chemokine system dynamics in diverse infectious-inflammatory disorders such as cardiovascular diseases, allergic diseases, inflammatory diseases, neuroinflammation, and cancer. On this note, critical evaluation of the available data surfaced multiple diseases prevalent in women such as osteoporosis, rheumatoid arthritis, breast cancer, cervical cancer and urinary tract infection. Currently there is no available literature highlighting chemokine-receptor targeting using traditional medicinal approach from women's health perspective. Moreover, despite being potent in vitro and in vivo setups there remains a gap in clinical translation of these formulations, which needs to be strategically and scientifically addressed to pave the way for their successful industrial translation.

CONCLUSIONS

The review provides an optimistic global perspective towards the applicability of ethnopharmacology in chemokine-receptor regulated infectious and inflammatory diseases with special emphasis on ailments prevalent in women, consecutively addressing their current status of clinical translation and future directions.

Ameliorative effects of Atriplex crassifolia (C.A.Mey) on pain and inflammation through modulation of inflammatory biomarkers and GC-MS-based metabolite profiling

Atriplex crassifolia (A. crassifolia) is a locally occurring member of Chenopodiaceae family that has been used in folk medicine for the treatment of joint pain and inflammation. The present study was focused to determine the analgesic and anti-inflammatory potential of the plant. n-hexane (ACNH) and methanol (ACM) extracts of A. crassifolia were evaluated for in vitro anti-inflammatory potential using protein denaturation inhibition assay. In vivo anti-inflammatory potential was determined by oral administration of 250, 500, and 1000 mg/kg/day of extracts against carrageenan and formalin-induced paw edema models. Inflammatory mediators such as TNF-α, IL-10, IL-1β, NF-kB, IL-4, and IL-6 were estimated in blood samples of animals subjected to formalin model of inflammation. Analgesic activity was determined using acetic acid-induced writhing and tail flick assay model. Phytochemical profiling was done by GC-mass spectrophotometer. The results of in vitro anti-inflammatory activity revealed that both ACNH and ACM displayed eminent inhibition of protein denaturation in concentration-dependent manner. In acute in vivo carrageenan-induced paw edema model, both extracts reduced inflammation at 5th and 6th hour of study (p < 0.05). A. crassifolia extracts exhibited significant inhibition against formalin-induced inflammation with maximum effect at 1000 mg/kg. ACNH and ACM significantly augmented the inflammatory mediators (p < 0.05). Levels of TNF-α, IL-6, IL-1β, and NF-kB were reduced, while those of IL-4 and IL-10 were upregulated. ACNH displayed maximum analgesic effect at 1000 mg/kg, while ACM showed potent activity at 500 and 1000 mg/kg. The extracts restored the CBC, TLC and CRP toward normal. GC-MS analysis revealed the presence of compounds like n-hexadecanoic acid, Phytol, (9E,11E)-octadecadienoic acid, 2-hydroxy-1-(hydroxymethyl) ethyl ester, 1-hexacosene, vitamin E, campesterol, stigmasterol, gamma sitosterol in both extracts. These compounds have been reported to suppress inflammation by inhibiting inflammatory cytokines. The current study concludes that A. crassifolia possesses significant anti-nociceptive and anti-inflammatory potential owing to the presence of phytochemicals.

In Vitro Assessment of the Antidiabetic and Anti-Inflammatory Potential of Artemisia absinthium, Artemisia vulgaris and Trigonella foenum-graecum Extracts Processed Using Membrane Technologies

Recently, there has been increased interest in the discovery of new natural herbal remedies for treating diabetes and inflammatory diseases. In this context, this work analyzed the antidiabetic and anti-inflammatory potential of Artemisia absinthium, Artemisia vulgaris and Trigonella foenum-graecum herbs, which have been studied less from this point of view. Therefore, extracts were prepared and processed using membrane technologies, micro- and ultrafiltration, to concentrate the biologically active principles. The polyphenol and flavone contents in the extracts were analyzed. The qualitative analysis of the polyphenolic compounds was performed via HPLC, identifying chlorogenic acid, rosmarinic acid and rutin in A. absinthium; chlorogenic acid, luteolin and rutin in A. vulgaris; and genistin in T. foenum-graecum. The antidiabetic activity of the extracts was analyzed by testing their ability to inhibit α-amylase and α-glucosidase, and the anti-inflammatory activity was analyzed by testing their ability to inhibit hyaluronidase and lipoxygenase. Thus, the concentrated extracts of T. foenum-graecum showed high inhibitory activity on a-amylase-IC50 = 3.22 ± 0.3 μg/mL-(compared with acarbose-IC50 = 3.5 ± 0.18 μg/mL) and high inhibitory activity on LOX-IC50 = 19.69 ± 0.52 μg/mL (compared with all standards used). The concentrated extract of A. vulgaris showed increased α-amylase inhibition activity-IC50 = 8.57 ± 2.31 μg/mL-compared to acarbose IC50 = 3.5 ± 0.18 μg/mL. The concentrated extract of A. absinthium showed pronounced LOX inhibition activity-IC50 = 19.71 ± 0.79 μg/mL-compared to ibuprofen-IC50 = 20.19 ± 1.25 μg/mL.

Comparison study of Beninese and Chinese herbal medicines in treating COVID-19

ETHNOPHARMACOLOGICAL RELEVANCE

The worldwide use of natural remedies is an alternative therapeutic solution to strengthen immunity, fight, and prevent this disease. The rapid spread of the coronavirus disease worldwide has promoted the search for therapeutic solutions following different approaches. China and Benin have seen the use of natural remedies such as Chinese herbal medicine and local endemic plants as alternative solutions in treating COVID-19.

AIM OF THE STUDY

The present study was designed to identify the prevalence of medicinal plant use in four municipalities of Benin most affected by COVID-19 and compare them with traditional Chinese medicine and finally verify the efficacy of the main components of the six plants most frequently used, via in vitro experiments.

MATERIALS AND METHODS

This study targeting market herbalists and traditional healers was conducted in the form of an ethnomedicinal survey in four representative communities (Cotonou, Abomey-Calavi, Zè, and Ouidah) of southern Benin. The chemical compositions of the six most commonly used herbs were investigated using network pharmacology. Network-based global prediction of disease genes and drug, target, function, and pathway enrichment analysis of the top six herbs was conducted using databases including IPA and visualised using Cytoscape software. The natural botanical drugs involved three medicines and three formulas used in the treatment of COVID-19 in China from the published literature were compared with the top six botanical drugs used in Benin to identify similarities between them and guide the clinical medication in both countries. Finally, the efficacy of the common ingredients in six plants was verified by measuring the viability of BEAS-2B cells and the release of inflammatory factors after administration of different ingredients. Binding abilities of six components to COVID-19 related targets were verified by molecular docking.

RESULTS

According to the medication survey investigation, the six most used herbs were Citrus aurantiifolia (13.18%), Momordica charantia (7.75%), Ocimum gratissimum (7.36%), Crateva adansonii (6.59%), Azadirachta indica (5.81%), and Zanthoxylum zanthoxyloides (5.42%). The most represented botanical families were Rutaceae, Lamiaceae, Cucurbitaceae, Meliaceae, and Capparaceae. The network pharmacology of these six herbal plants showed that the flavonoids quercetin, kaempferol, and β-sitosterol were the main active ingredients of the Benin herbal medicine. Chinese and Beninese herbal medicine are similar in that they have the same targets and pathways in inflammation and oxidative stress relief. Mild COVID-19-related targets come from C. aurantiifolia and M. charantia, and severe COVID-19-related targets come from A. indica A. Juss. Cell viability and enzyme-linked immunosorbent assay results confirmed that six major compounds could protect BEAS-2B cells against injury by inhibiting the expression of inflammatory factors, among which quercetin and isoimperatorin were more effective. Docking verified that the six compounds have good binding potential with COVID-19 related targets.

CONCLUSIONS

These results suggest that Benin herbal medicine and Chinese herbal medicine overlap in compounds, targets, and pathways to a certain extent. Among the commonly used plants in Benin, C. aurantiifolia and M. charantia may have a good curative effect on the treatment of mild COVID-19, while for severe COVID-19, A. indica can be added on this basis.

Diversity of Citrullus colocynthis (L.) Schrad Seeds Extracts: Detailed Chemical Profiling and Evaluation of Their Medicinal Properties

Seeds and fruits of Citrullus colocynthis have been reported to possess huge potential for the development of phytopharmaceuticals with a wide range of biological activities. Thus, in the current study, we are reporting the potential antimicrobial and anticancer properties of C. colocynthis seeds extracted with solvents of different polarities, including methanol (M.E.), hexane (H.E.), and chloroform (C.E.). Antimicrobial properties of C. colocynthis seeds extracts were evaluated on Gram-positive and Gram-negative bacteria, whereas, anticancer properties were tested on four different cell lines, including HepG2, DU145, Hela, and A549. All the extracts have demonstrated noteworthy antimicrobial activities with a minimum inhibitory concentration (MIC) ranging from 0.9-62.5 µg/mL against Klebsiella planticola and Staphylococcus aureus; meanwhile, they were found to be moderately active (MIC 62.5-250 µg/mL) against Escherichia coli and Micrococcus luteus strains. Hexane extracts have demonstrated the highest antimicrobial activity against K. planticola with an MIC value of 0.9 µg/mL, equivalent to that of the standard drug ciprofloxacin used as positive control in this study. For anticancer activity, all the extracts of C. colocynthis seeds were found to be active against all the tested cell lines (IC₅₀ 48.49-197.96 µg/mL) except for the chloroform extracts, which were found to be inactive against the HepG2 cell line. The hexane extract was found to possess the most prominent anticancer activity when compared to other extracts and has demonstrated the highest anticancer activity against the DU145 cell line with an IC₅₀ value of 48.49 µg/mL. Furthermore, a detailed phytoconstituents analysis of all the extracts of C. colocynthis seeds were performed using GC-MS and GC-FID techniques. Altogether, 43 phytoconstituents were identified from the extracts of C. colocynthis seeds, among which 21, 12, and 16 components were identified from the H.E., C.E., and M.E. extracts, respectively. Monoterpenes (40.4%) and oxygenated monoterpenes (41.1%) were the most dominating chemical class of compounds from the hexane and chloroform extracts, respectively; whereas, in the methanolic extract, oxygenated aliphatic hydrocarbons (77.2%) were found to be the most dominating chemical class of compounds. To the best of our knowledge, all the phytoconstituents identified in this study are being reported for the first time from the C. colocynthis.

Dereplication and Quantification of Major Compounds of Convolvulus arvensis L. Extracts and Assessment of Their Effect on LPS-Activated J774 Macrophages

Convolvulus arvensis is used in Pakistani traditional medicine to treat inflammation-related disorders. Its anti-inflammatory potential was evaluated on hexane, dichloromethane, ethyl acetate, methanol, and aqueous extracts of whole plant on pro-inflammatory mediators in LPS-activated murine macrophage J774 cells at the non-cytotoxic concentration of 50 µg/mL. Ethyl acetate (ARE) and methanol (ARM) extracts significantly decreased mRNA levels of IL-6, TNF-α, MCP-1, COX-2, and iNOS. Furthermore, both extracts dose dependently decreased IL-6, TNF-α, and MCP-1 secretion. Forty-five compounds were putatively identified in ARE and ARM by dereplication (using HPLC-UV-HRMSⁿ analysis and molecular networking), most of them are reported for the first time in C. arvensis, as for example, nineteen phenolic derivatives. Rutin, kaempferol-3-O-rutinoside, chlorogenic acid, 3,5-di-O-caffeoylquinic acid, N-trans-p-coumaroyl-tyramine, and N-trans-feruloyl-tyramine were main constituents identified and quantified by HPLC-PDA in ARE and ARM. Furthermore, chlorogenic acid, tyramine derivatives, and the mixture of the six identified major compounds significantly decreased IL-6 secretion by LPS-activated J774 cells. The activity of N-trans-p-coumaroyl-tyramine is shown here for the first time. Our results indicate that ARE, ARM and major constituents significantly inhibited the expression of pro-inflammatory mediators, which supports the use of this plant to treat inflammatory diseases.

Deciphering Chemical Profiling, Pharmacological Responses and Potential Bioactive Constituents of Saussurea lappa Decne. extracts through In Vitro Approaches

Despite advancement in modern medicines, plant derived medicines have still wide range utilities as they have less side effects and are cheap and biocompitable. Sassurea lappa is an extensively used plant in traditional medicinal formulations. Plant roots are used to cure various diseases including cancer, rheumatic pain, abdominal and nervous disorders. The present study was aimed for the evalution of biological potentials of methanolic and chloroform extracts of Saussurea lappa root, leaf, seed and flower. The methanolic and chloroform extracts were subjected to qualitative and quantitative phytochemical analyses. Identification of functional groups was performed using Fourier Transform infrared (FT-IR) spectroscopy. Antioxidant potential was determined via diphenyl-1-picrylhydrazyl (DPPH), total reducing power (TRP) and total antioxidant capacity (TAC) method, anti-hemolytic potential was conducted on human RBCs, antibacterial activity was evaluated against six American type culture collection (ATCC) and three multi drug resistance (MDR) strains, cytotoxic and phytotoxic potentials were evaluated through brine shrimp lethality assay and raddish seed assay respectively. Experiments were performed in triplicates and analysis of variance (ANOVA) was applied using statistics version-8.1. Phytochemical analysis revealed the presence of sixteen secondary metabolites. Fourteen functional groups were identified through FTIR. S. lappa root methanolic (SLRM) showed maximum antioxidant activity index (AAI-79.42%) whereas chloroform extract of leaves (SLLC) gave highest antibacterial activity with maximum zone of inhibition (ZOI) against Pseudomonas aeruginosa (21.4 mm). Maximum cytotoxicity was observed for SLRM with lethal dose concentration (LC₅₀) of 58.8 µg/mL. However, root extracts showed significant phytotoxicity (15% germination). The current study investigated that bioactive compounds present in S. lappa leaves, seed, flower and roots were responsible for enhanced biological potentials. Further studies on isolation and characterization of these bioactive compounds may help in drug development. In future, we recommend different in-vitro and in-vivo studies to further confirm it biopharmacological potencies.

Ethnopharmacological Study of Medicinal Plants in Bajwat Wildlife Sanctuary, District Sialkot, Punjab Province of Pakistan

Bajwat Wildlife Sanctuary is a complex riverine ecosystem and is unique because of the presence of river Chenab, various seasonal streams, lakes, and Head Marala barrage. These ecogeographic conditions provide diverse natural habitats for various plant and animal species to grow uninterrupted and have undocumented ethnopharmacologically important medicinal flora. The present study involves the first-ever extensive investigation to document the ethnopharmacological knowledge on medicinal plants of local healers and inhabitants of the Bajwat Wildlife Sanctuary to treat ailments. The unstructured and semistructured interviews of the local healers and inhabitants were conducted that included 130 individuals. The ethnomedicinal formulations, their method of preparation, mode of administration, parts of the plant used, diseases cured, and their categorization along with species use report (UR) were analyzed. The ethnopharmacological study led to the enlisting of 114 medicinal plant species belonging to 97 genera and distributed among 47 plant families. 2029 URs were collected with 42 general disease categories. Each plant species was reported 18 times to cure various diseases (∼18 UR), while ∼48 URs were collected on each disease category by local informants. Digestive issues (290 URs, ∼14.29%) and skin infections (279 URs, ∼13.75%) were found most commonly among the occupants of the area. The oral administration (69%) of herbal drugs and the preparation of plant extracts (32%) were the most common ethnopharmacological strategies. Inhabitants of the area were well aware of the limited use of poisonous plants. 8 (∼7%) out of the total 114 medicinal plant species were listed in the IUCN Red List of Threatened Species as Least Concern, while Eucalyptus camaldulensis Dehnh. was enlisted as near-threatened. The results of the present investigation show that the occupants of the Bajwat have sound information about the ethnopharmacological consumption of medicinal plants, and some of the novel ethnomedicinal formulations were reported which provide the basic data for further pharmacological research.

Antibacterial and antifungal activity of methanolic extracts of Salix alba L. against various disease causing pathogens

The present study was aimed to manifest the antibacterial and antifungal activity of methanolic extracts of Salix alba L. against seven Gram-positive and Gram-negative bacterial pathogens e.g. Streptococcus pyogenes, Staphylococcus aureus (1), S. aureus (2), Shigella sonnei, Escherichia coli (1), E. coli (2) and Neisseria gonorrhoeae and three fungal isolates from the air such as Aspergillus terreus, A. ornatus, and Rhizopus stolonifer. Two different serotypes of S. aureus and E. coli were used. The agar well-diffusion method results showed the dose-dependent response of plant extracts against bacterial and fungal strains while some organisms were found resistant e.g. E. coli (1), S. sonnei, A. terreus and R. stolonifer. The highest antibacterial activity was recorded at 17.000±1.732 mm from 100 mg/mL of leaves methanolic extracts against S. pyogenes while the activity of most of the pathogens decreased after 24 h of incubation. The highest antifungal activity was reported at 11.833±1.0 mm against A. ornatus at 50 mg/mL after 48 h of the incubation period. These experimental findings endorse the use of S. alba in ethnopharmacological formulations and suggest the use of methanolic extracts of the said plant to develop drugs to control the proliferation of resistant disease causing pathogenic microbes.

Medicinal plants used against various inflammatory biomarkers for the management of rheumatoid arthritis

OBJECTIVES

Rheumatoid arthritis is a chronic autoimmune disease manifested clinically by polyarthralgia associated with joint dysfunction triggering the antibodies targeting against the self-neoepitopes determined by autoimmune responses associated with chronic arthritic attacks. The activation of macrophages and other defence cells in response to self-epitopes as biomarkers in RA provides a better understanding of pathogenesis of disease and has led to the development of novel therapeutic approaches acting as potent inhibitors of these cells.

KEY FINDINGS

The current review retrieved the various medicinal plants possessing an active phytoconstituents with anti-inflammatory and antioxidant properties, which tends to be effective alternative approach over the synthetic drugs concerned with high toxic effects. The current available literature provided an evident data concluding that the active constituents like fatty acids, flavonoids, terpenes and sesquiterpene lactones attenuate the RA symptoms by targeting the inflammatory biomarkers involved in the pathogenesis of RA.

SUMMARY

Despite the various synthetic treatment approaches targeting immune cells, cytokines improved the quality of life but still the drug management is challenging due to toxic and chronic teratogenic effects with anti-arthritic drugs. The current review has elaborated the selected traditionally used herbal medicinal plants with phytoconstituents possessing anti-inflammatory activity by suppressing the inflammatory biomarkers with lesser side effects and providing the future exploration of natural drug therapy for rheumatoid arthritis.

A review of traditional uses, phytochemistry and pharmacology of the genus Indigofera

ETHNOPHARMACOLOGICAL RELEVANCE

Indigofera is the third-largest genus in the family of Fabaceae, with approximately 750 species. It is distributed across all tropical regions. Indigofera species are widely employed in traditional medicine all around the world, against many ailments. Thus, based on these medicinal properties, various investigations have been undertaken in order to appraise the pharmacological activities and the chemical composition of these species. A recent paper provides a summary of the phytochemistry and pharmacology of the genus Indigofera. Consequently, this review is a continuation of this previous study by updating some data and adding information about the phylogeny and traditional uses of the genus.

AIM OF THE STUDY

To provide an overview of the phylogeny, traditional uses, phytochemistry, pharmacology and toxicity of the genus Indigofera, and to identify the remaining gaps and thus supply a basis for further investigations.

MATERIALS AND METHODS

A review of the literature was performed by consulting scientific databases such as 'ScienceDirect', 'PubMed', 'Google Scholar' and 'SpringerLink' and using the keyword Indigofera.

RESULTS

Over 60 Indigofera species are reported in traditional medicine. The uses depend on the country and the species, but similarities have been noticed. Indeed, treatments of gastrointestinal disorders, inflammatory conditions and pain, skin ailments, and respiratory and infectious diseases are recurring. Phytochemical studies have led to the identification of more than 200 compounds, notably flavonoids and terpenoids. Many pharmacological activities have been demonstrated, particularly antimicrobial, cytotoxic and anti-inflammatory activities, and thus allowed to assert most of the traditional uses of the genus. Some active compounds have been isolated and have shown remarkable therapeutic potential, like the alkaloid indirubin, which is currently being clinically trialed.

CONCLUSIONS

The data on the genus Indigofera are extensive, but gaps still remain. Indeed, some promising species have not been assessed for their phytochemistry and/or pharmacology and thus remain unexplored. Moreover, relatively few active compounds have been isolated and tested for their biological activity, and studies to explain their mechanism of action are nearly inexistent. Furthermore, some pharmacological studies have inappropriate methodologies that make the results difficult to interpret. Consequently, further in-depth and relevant research is required to supplement the knowledge on this wide-ranging genus and to confirm its reported therapeutic potential.

Ethnopharmacological review of medicinal plants used to manage diabetes in Morocco

Diabetes is a chronic metabolic disorder which affects millions of people every year. If diabetes is not controlled, it can cause serious damage and a number of health complications. The aim of this paper was to review published ethnobotanical and ethnopharmacological evidences of Moroccan plants with antidiabetic potentials. Publications describing the medicinal plants used for the treatment of diabetes in Morocco were searched from the databases, including Google Scholar, Elsevier, Medline, Web of Science, SCOPUS and Pubmed. Other literature source was also used including books and theses available in library. About 750 literature references were studied, and only 240 research publications based on data from different Moroccan provinces published until June 2019 were included in this review. In total, 255 plants species belonging to 70 families were reported. Compositae and Lamiaceae were mentioned as the most represented families. The frequently used plant species in the dwellers of most regions of Morocco are Trigonella foenum-graecum, Artemesia herba-alba, Nigella sativa, Olea europaea, Allium cepa and Marrubium vulgare. This review provides useful information and current scientific knowledge on the medicinal plants used to manage diabetes in Morocco. Medicinal plants reported should be submitted to chemical, pharmacological and clinical studies to identify pharmacologically active metabolites and to confirm their antidiabetic activity.

Inula L. Secondary Metabolites against Oxidative Stress-Related Human Diseases

An imbalance in the production of reactive oxygen species in the body can cause an increase of oxidative stress that leads to oxidative damage to cells and tissues, which culminates in the development or aggravation of some chronic diseases, such as inflammation, diabetes mellitus, cancer, cardiovascular disease, and obesity. Secondary metabolites from Inula species can play an important role in the prevention and treatment of the oxidative stress-related diseases mentioned above. The databases Scopus, PubMed, and Web of Science and the combining terms Inula, antioxidant and secondary metabolites were used in the research for this review. More than 120 articles are reviewed, highlighting the most active compounds with special emphasis on the elucidation of their antioxidative-stress mechanism of action, which increases the knowledge about their potential in the fight against inflammation, cancer, neurodegeneration, and diabetes. Alantolactone is the most polyvalent compound, reporting interesting EC50 values for several bioactivities, while 1-O-acetylbritannilactone can be pointed out as a promising lead compound for the development of analogues with interesting properties. The Inula genus is a good bet as source of structurally diverse compounds with antioxidant activity that can act via different mechanisms to fight several oxidative stress-related human diseases, being useful for development of new drugs.