Bimodal dose-dependent effect on autonomic, cardiac control after oral administration of Atropa belladonna

Dark Classics in Chemical Neuroscience: An Evidence-Based Systematic Review of Belladonna

Belladonna has diverse pharmacotherapeutic properties with a shadowy history of beauty, life, and death. Alkaloids present in belladonna have anti-inflammatory, anticholinergic, antispasmodic, mydriatic, analgesic, anticonvulsant, and antimicrobial activities, which makes it widely applicable for the treatment of various diseases. However, because of its associated toxicity, the medicinal use of belladonna is debatable. Therefore, an evidence-based systematic review was planned to elucidate the pharmacotherapeutic potential of belladonna. A comprehensive literature search was performed in PubMed, MEDLINE, the Cochrane database, Embase, and ClinicalTrials.gov using the keywords "belladonna", "belladonna and clinical trials", and "safety and efficacy of belladonna". Articles published from 1965 to 2020 showing the efficacy of belladonna in diverse clinical conditions are included. The quality of evidence was generated using the GRADE approach, and 20 studies involving 2302 patients were included for the systematic review. Our analyses suggest that belladonna treatment appears to be safe and effective in various disease conditions, including acute encephalitis syndrome, urethral stent pain, myocardial ischemia injury, airway obstructions during sleep in infants, climacteric complaints, irritable bowel syndrome, and throbbing headache. However, better understanding of the dosage and the toxicity of tropane alkaloids of belladonna could make it an efficient remedy for treating diverse medical conditions.

The effect of oxybutynin on cardiac autonomic modulation in healthy subjects

PURPOSE

The aim of this study was to assess the various doses of oral oxybutynin on cardiac autonomic modulation by measuring short-term heart rate variability (HRV) indexes during supine rest position.

METHODS

Eight male healthy subjects (20-23 years) participated in the double-blind crossover randomized study. The single dose of oxybutynin (2.5, 5 and 10 mg) or placebo was given to the volunteers in four sessions within 5-day intervals. Before and minutes of 30, 60, 90 and 120 after administration, lead II electrocardiogram (ECG) was recorded for 5 min. ECG extracted RR intervals data became the base of the calculation of time domain and frequency domain HRV parameters, which indicate cardiac autonomic activity. Statistical analysis was done by using the nonparametric Wilcoxon and Kruskal-Wallis tests.

RESULTS

The data analysis has revealed that MNN (P < 0.001), SDNN (P < 0.05), PNN50% (P < 0.01), RMSSD (P < 0.001), HFnu (P < 0.05) and LF/HF ratio (P < 0.05) values were significantly increased relative to baseline at various time points in all the groups except in placebo group. LFnu (P < 0.05) values were significantly increased relative to baseline at various time points in all the groups except in placebo group.

CONCLUSIONS

Our findings have revealed that acute consumption of 2.5, 5 and 10 mg oxybutynin (an anticholinergic compound) in the juvenile healthy male subjects produces a cholinergic effect according to time and frequency domain of HRV indexes.

Atropa acuminata Royle Ex Lindl. blunts production of pro-inflammatory mediators eicosanoids., leukotrienes, cytokines in vitro and in vivo models of acute inflammatory responses

ETHNOPHARMACOLOGICAL RELEVANCE

Atropa acuminata Royle Ex Lindl. has been widely used in folk medicine for several inflammatory disorders such as arthritis, asthma, conjunctivitis, encephalitis, pancreatitis, peritonitis, acute infections and neuroinflammatory disorders.

AIM OF THE STUDY

Our aim was to evaluate Atropa acuminata for its anti-inflammatory properties and to delineate its possible mechanism of action on the modulation of the inflammatory mediators.

MATERIALS AND METHODS

We investigated the inhibitory action of ethanolic extract of Atropa acuminata (AAEE) on production of NO, TNF-α and IL-1β in lipopolysaccharide (LPS)-stimulated RAW264.7 cells and also assayed it for COX 1/2 and 5-LOX inhibitory activities. Next AAEE was tested in acute inflammatory animal models., carragenean induced rat paw edema, carragenean induce pleurisy in rats and vascular permeability in mice and the effects on NO, PGE2 and LTB4 production in the pleural fluid and paw exudates were evaluated. In addition the effects on leukocyte migration and exudation and vascular permeability were also observed.

RESULTS

Our findings summarized novel anti-inflammatory mechanisms for Atropa acuminata based on dual in vitro cyclooxygenase 1/2/ and 5-Lipoxygenase inhibitory activities and also significant downregulation of nitric oxide (NO) and pro-inflammatory cytokin (TNF-α and Il-1 β) release in LPS-stimulated RAW 246.7 macrophage cell line. In acute inflammatory models in vivo (carragenean induced edema, carragenean induced pleurisy in rats and vascular permeability in mice), AAEE exhibited an extensive diverse mechanism for anti-inflammatory properties. This was indicated on the basis of dose dependent suppression of multi targeted inflammatory mediators., NO, TNF-α and IL-1β, eicosanoids., PGE2 and leukotrienes., LTB4 along with significantly decreased leucocyte migration, exudation and decreased vascular permeability. These effects were more potent and prolonged than traditional NSAIDS, thereby indicating fewer side effects. AAEE was found to be safe for long term administration, as confirmed by the results of acute toxicity studies and MTT assay. The complex mode of action of the herbs was attributed possibly due to the high polyphenolic, flavanol and flavonoid content present in the extracts as observed by means of quantitative screening for phytochemicals.

CONCLUSION

Our study provides scientific evidence to support the traditional anti-inflammatory uses of Atropa acuminata and is probably due to inhibitory effects on multiple inflammatory mediators which indicates a promising potential for the development of a strong anti-inflammatory agent from this plant.

Temporal variation of autonomic balance and diseases during circadian, seasonal, reproductive, and lifespan cycles

Many diseases show patterns of temporal variation that remain unexplained. We hypothesize that oscillation of autonomic balance over different time intervals plays a role in these variations. In the Darwinian struggle, organisms must perform various functions related to fitness such as survival, energy acquisition, and reproduction in a prioritized fashion. Autonomic systems enable differential allocation of effort to various functions under different conditions, some of which vary in patterns that are predictable such as circadian, menstrual, seasonal, and life cycles. For many species, daytime functions such as seeking food and avoiding predators are achieved with sympathetic activity while night-time functions such as internal processing are achieved with parasympathetic activity. For organisms that maintain thermal homeostasis year-round, cooler temperature seasons may demand sympathetic bias to drive adaptive thermogenesis. Reproduction may necessitate autonomic shift to sympathetic bias during the luteal phase and pregnancy to modulate immune balance towards a more tolerant Th2 bias. Many diseases including infectious, cardiovascular, inflammatory, pulmonary, metabolic, fertility, oncologic, and neurologic conditions also show variation in prevalence over these cycles. The co-variation of autonomic balance and diseases over time intervals suggests that autonomic balance, by its direct effects as well as its indirect effects through modulation of T helper immune balance, plays an under-recognized role in diseases. The theory is extended to the co-variation of autonomic balance and diseases over the lifespan. Termination of organisms during senescence, achieved by emergence of autonomic imbalance and other systemic dysfunctions, is explored from a Darwinian perspective.