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Bian YY, Hou J, Khakurel S. Treatment of a patient with aconitine poisoning using veno-arterial membrane oxygenation: A case report. World J Clin Cases 2024; 12:4842-4852. [PMID: 39070832 PMCID: PMC11235513 DOI: 10.12998/wjcc.v12.i21.4842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/23/2024] [Accepted: 06/12/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Aconitine poisoning is highly prone to causing malignant arrhythmias. The elimination of aconitine from the body takes a considerable amount of time, and during this period, patients are at a significant risk of death due to malignant arrhythmias associated with aconitine poisoning. CASE SUMMARY A 30-year-old male patient was admitted due to accidental ingestion of aconitine-containing drugs. Upon arrival at the emergency department, the patient intermittently experienced malignant arrhythmias including ventricular tachycardia, ventricular fibrillation, ventricular premature beats, and cardiac arrest. Emergency interventions such as cardiopulmonary resuscitation and defibrillation were promptly administered. Additionally, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy was initiated. Successful resuscitation was achieved before ECMO placement, but upon initiation of ECMO, the patient experienced recurrent malignant arrhythmias. ECMO was utilized to maintain hemodynamics and respiration, while continuous blood purification therapy for toxin clearance, mechanical ventilation, and hypothermic brain protection therapy were concurrently administered. On the third day of VA-ECMO support, the patient's respiratory and hemodynamic status stabilized, with only frequent ventricular premature beats observed on electrocardiographic monitoring, and echocardiography indicated recovery of cardiac contractile function. On the fourth day, a significant reduction in toxin levels was observed, along with stable hemodynamic and respiratory functions. Following a successful pump-controlled retrograde trial occlusion test, ECMO assistance was terminated. The patient gradually improved postoperatively and achieved recovery. He was discharged 11 days later. CONCLUSION VA-ECMO can serve as a bridging resuscitation technique for patients with reversible malignant arrhythmias.
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Affiliation(s)
- Yu-Yao Bian
- Department of Emergency Medicine, Hebei Petro China Central Hospital, Langfang 065000, Hebei Province, China
| | - Jin Hou
- Department of Internal Medicine, Langfang Health Vocational College, Langfang 065000, Hebei Province, China
| | - Sudha Khakurel
- Dallas Campus, UT Health Houston School of Public Health, Dallas, TX 75201, United States
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2
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Yang N, Guo J, Zhang J, Gao S, Xiang Q, Wen J, Huang Y, Rao C, Chen Y. A toxicological review of alkaloids. Drug Chem Toxicol 2024:1-15. [PMID: 38465444 DOI: 10.1080/01480545.2024.2326051] [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: 06/14/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
Alkaloids are naturally occurring compounds with complex structures found in natural plants. To further improve the understanding of plant alkaloids, this review focuses on the classification, toxicity and mechanisms of action, providing insight into the occurrence of alkaloid-poisoning events and guiding the safe use of alkaloids in food, supplements and clinical applications. Based on their chemical structure, alkaloids can be divided into organic amines, diterpenoids, pyridines, isoquinolines, indoles, pyrrolidines, steroids, imidazoles and purines. The mechanisms of toxicity of alkaloids, including neurotoxicity, hepatoxicity, nephrotoxicity, cardiotoxicity and cytotoxicity, have also been reviewed. Some cases of alkaloid poisoning have been introduced when used as food or clinically, including accidental food poisoning, excessive consumption, and poisoning caused by the improper use of alkaloids in a clinical setting, and the importance of safety evaluation was illustrated. This review summarizes the toxicity and mechanism of action of alkaloids and provides evidence for the need for the safe use of alkaloids in food, supplements and clinical applications.
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Affiliation(s)
- Nannan Yang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiafu Guo
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jian Zhang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Song Gao
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qiwen Xiang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiayu Wen
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Huang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chaolong Rao
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- R&D Center for Efficiency, Safety and Application in Chinese Materia Medica with Medical and Edible Values, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Chen
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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3
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The Immunoregulatory Effect of Aconite Treatment on H22 Tumor-Bearing Mice via Modulating Adaptive Immunity and Natural Killer-Related Immunity. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:1481114. [PMID: 36756040 PMCID: PMC9902160 DOI: 10.1155/2023/1481114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and, in its advanced stages, has a 5-year survival rate of only 3% to 5%. Despite novel mechanisms and treatments being uncovered over the past few years, effective strategies for HCC are currently limited. Previous studies have proven that aconite can suppress tumor growth and progression and prevent the recurrence and metastasis of multiple cancers, but the underlying molecular mechanisms are largely unknown. In this study, different doses of aconite were applied to mice bearing subcutaneous HCC tumors. It was found that aconite had a therapeutic effect on H22 tumor-bearing mice in a dose-dependent manner by reducing tumor volumes and prolonging survival times, which could be attributed to the immunoregulatory effect of aconite. Furthermore, results showed that high-dose administration of aconite could enhance adaptive immunity and natural killer (NK) cell-mediated immunity by regulating the secretion of interferon-γ, upregulating T cells and NK cells, and modulating the expression of the NK cytotoxicity biomarker CD107a and the inhibitory receptor TIGIT. This study revealed a novel mechanism through which aconite exerts antitumor effects, not merely through apoptosis induction pathways, providing more sound evidence that aconite has the potential to be developed into an effective anti-HCC agent.
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4
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Jiang Z, Deng C, Zhou L, Wang Z, Wang F, Wu X, Ma X, Nan Z. High‐performance liquid chromatography coupled with quadrupole time‐of‐flight tandem mass spectrometry for profiling diterpenoid alkaloids in Aconitum species. SEPARATION SCIENCE PLUS 2022. [DOI: 10.1002/sscp.202200100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Zhi‐Bo Jiang
- Department of Pharmaceutical Engineering School of Chemistry and Chemical Engineering Key Laboratory of Chemical Engineering and Technology of State Ethnic Affairs Commission North Minzu University Yinchuan P. R. China
- Ningxia Low‐grade Resource High‐value Utilization and Environmental Chemical Integration Technology Innovation Team Project Yinchuan P. R. China
| | - Chao‐Fan Deng
- Department of Pharmaceutical Engineering School of Chemistry and Chemical Engineering Key Laboratory of Chemical Engineering and Technology of State Ethnic Affairs Commission North Minzu University Yinchuan P. R. China
| | - Le‐Ru Zhou
- Department of Pharmaceutical Engineering School of Chemistry and Chemical Engineering Key Laboratory of Chemical Engineering and Technology of State Ethnic Affairs Commission North Minzu University Yinchuan P. R. China
| | - Zhen‐Zhen Wang
- Department of Pharmaceutical Engineering School of Chemistry and Chemical Engineering Key Laboratory of Chemical Engineering and Technology of State Ethnic Affairs Commission North Minzu University Yinchuan P. R. China
| | - Fang Wang
- Shandong Academy of Pharmaceutical Sciences Jinan P. R. China
| | - Xiu‐Li Wu
- College of Pharmacy Ningxia Medical University Yinchuan P. R. China
| | - Xiao‐Li Ma
- Department of Pharmaceutical Engineering School of Chemistry and Chemical Engineering Key Laboratory of Chemical Engineering and Technology of State Ethnic Affairs Commission North Minzu University Yinchuan P. R. China
| | - Ze‐Dong Nan
- Department of Pharmaceutical Engineering School of Chemistry and Chemical Engineering Key Laboratory of Chemical Engineering and Technology of State Ethnic Affairs Commission North Minzu University Yinchuan P. R. China
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5
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Wu J, Duan R, Deng H, Li L, Zhao Y, Yu Z. The effect of compatibility of Aconiti Radix and honey on the pharmacokinetics of five Aconitum alkaloids in rat plasma. Biomed Chromatogr 2022; 36:e5453. [PMID: 35853731 DOI: 10.1002/bmc.5453] [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: 04/27/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/06/2022]
Abstract
Aconiti Radix (Chuanwu [CW]), is widely used for the treatment of the chronic and intractable diseases due to its remarkable curative effect. CW has been combined with honey for thousands of years to reduce toxicity and enhance efficacy. This study first clarified compatibility mechanism of CW co-used with honey using a comparative pharmacokinetic idea. We developed and validated a simple, sensitive, specific, and accurate UHPLC-MS/MS method to simultaneously determine five Aconitum alkaloids in rat plasma after oral administration of CW decoction and CW-honey concentrated solution. Pharmacokinetic parameters were significantly different between the two groups (P<0.01 and P<0.05). Compared with CW group, Cmax and AUC0→t were decreased in CW-honey group for three diester-diterpenoid alkaloids (hypaconitine, mesaconitine and aconitine); Tmax and T1/2 were prolonged. However, Cmax and AUC0→t were increased in CW-honey group for two monoester-diterpenoid alkaloids (benzoylaconine and benzoylmesaconine); Tmax was shortened; T1/2 was prolonged. These findings suggest that honey affected the pharmacokinetic behaviors of five Aconitum alkaloids. We speculate that the detoxification and synergism of honey might result from reducing the toxicity of diester-diterpenoid alkaloids and promoting the biological activity of monoester-diterpenoid alkaloids in vivo. This study provides a theoretical basis for the clinical use of CW combined with honey.
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Affiliation(s)
- Jiaofeng Wu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Rong Duan
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Haoran Deng
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Lele Li
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Yunli Zhao
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Zhiguo Yu
- School of Pharmacy, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
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6
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Yin T, Yu Y, Liu Q, Zhou M, Zhu G, Bai L, Zhang W, Jiang Z. 2D NMR
‐based
MatchNat
Dereplication Strategy Enables Explosive Discovery of Novel Diterpenoid Alkaloids. CHINESE J CHEM 2022. [DOI: 10.1002/cjoc.202200250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tian‐Peng Yin
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
- Faculty of Bioengineering, Zhuhai Campus of Zunyi Medical University Zhuhai China
| | - Yi Yu
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
| | - Qing‐Hua Liu
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
| | - Ming‐Yue Zhou
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
| | - Guo‐Yuan Zhu
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
| | - Li‐Ping Bai
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
| | - Wei Zhang
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
| | - Zhi‐Hong Jiang
- State Key Laboratory of Quality Research in Chinese Medicines, Macau Institute for Applied Research in Medicine and Health, Guangdong‐Hong Kong‐Macao Joint Laboratory of Respiratory Infectious Disease, Macau University of Science and Technology Taipa Macau China
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7
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Xiao L, Niu L, Xu X, Zhao Y, Yue L, Liu X, Li G. Comparative Efficacy of Tonic Chinese Herbal Injections for Treating Sepsis or Septic Shock: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2022; 13:830030. [PMID: 35370733 PMCID: PMC8972587 DOI: 10.3389/fphar.2022.830030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Sepsis has high mortality and is responsible for significant healthcare costs. Chinese herbal injections (CHIs) have been widely used in China as a novel and promising treatment option for sepsis. Therefore, this study assessed and ranked the effectiveness of CHIs to provide more sights for the selection of sepsis treatment. Method: Eight databases were searched from their inception up to September 1, 2021. The methodological quality of included study was evaluated by the Revised Cochrane risk-of-bias tool for randomized trials. Then Bayesian network meta-analysis was performed by OpenBUGS 3.2.3 and STATA 14.0 software. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the examined treatments. Publication bias was reflected by a funnel plot. Results: A total of 50 eligible randomized controlled trials involving 3,394 participants were identified for this analysis. Five CHIs including Shenfu injection, Shenmai injection, Shengmai injection, Shenqifuzheng injection, and Huangqi injection were included. The results of the NMA and sensitivity analysis showed that Shenqifuzheng (MD = -4.48, 95% CI = -5.59 to -3.24), Shenmai (MD = -3.38, 95% CI = -4.38 to -2.39), Shenfu (MD = -2.38, 95% CI = -3.03 to -1.70) and Shengmai (MD = -1.90, 95% CI = -3.47 to -0.31) combined with Western medicine (WM) had a superior effect in improving the APACHE II score. Based on SUCRA values, Shenqifuzheng injection (95.65%) ranked highest in the APACHE II score, followed by Shenmai (74%), Shenfu (47.1%), Shengmai (35.3%) and Huangqi injection (33.2%). Among the secondary outcomes, Shenmai injection was the most favorable intervention in reducing PCT and CRP levels, and Shenqifuzheng injection was the second favorable intervention in reducing CRP level. Shenfu injection combined with WM was more effective than the other treatments in decreasing the serum IL-6 and TNF-α levels and lowering the 28-days mortality. Regarding the improvement of immune function, Shenqifuzheng injections had obvious advantages. Conclusion: In conclusion, Shenqifuzheng injection was the optimum treatment regimen to improve APACHE II score, reduce CRP level, and regulate immune function. Shenfu injection was superior in reducing the expression of inflammatory factors and decreasing 28-days mortality. Nevertheless, more multicenter, diverse, and direct comparisons randomized controlled trials are needed to further confirm the results. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=254531, identifier CRD42021254531.
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Affiliation(s)
- Lu Xiao
- Department of Emergency, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.,State Key Laboratory of Multi-Fractions Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Liqing Niu
- Department of Emergency, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xinyi Xu
- Department of Emergency, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuetong Zhao
- Department of Emergency, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Linkai Yue
- Department of Emergency, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xinqiao Liu
- Department of Emergency, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Guiwei Li
- Department of Emergency, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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8
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Wang A, Zhao W, Yan K, Huang P, Zhang H, Zhang Z, Zhang D, Ma X. Mechanisms and Efficacy of Traditional Chinese Medicine in Heart Failure. Front Pharmacol 2022; 13:810587. [PMID: 35281941 PMCID: PMC8908244 DOI: 10.3389/fphar.2022.810587] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/24/2022] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is one of the main public health problems at present. Although some breakthroughs have been made in the treatment of HF, the mortality rate remains very high. However, we should also pay attention to improving the quality of life of patients with HF. Traditional Chinese medicine (TCM) has a long history of being used to treat HF. To demonstrate the clinical effects and mechanisms of TCM, we searched published clinical trial studies and basic studies. The search results showed that adjuvant therapy with TCM might benefit patients with HF, and its mechanism may be related to microvascular circulation, myocardial energy metabolism, oxidative stress, and inflammation.
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Affiliation(s)
- Anzhu Wang
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China.,Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Zhao
- Yidu Central Hospital of Weifang, Weifang, China
| | - Kaituo Yan
- Yidu Central Hospital of Weifang, Weifang, China
| | - Pingping Huang
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China.,Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongwei Zhang
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China.,Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhibo Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Xiyuan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Dawu Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Xiaochang Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
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9
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Rangelov Kozhuharov V, Ivanov K, Ivanova S. Higenamine in Plants as a Source of Unintentional Doping. PLANTS (BASEL, SWITZERLAND) 2022; 11:354. [PMID: 35161335 PMCID: PMC8838985 DOI: 10.3390/plants11030354] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Higenamine is a β2 agonist of plant origin. The compound has been included in WADA's prohibited list since 2017. Higenamine may be detected in different plants and many food supplements of natural origin. METHODS Our literature search was conducted through PubMed, Science Direct, Google Scholar, and Web of Science studies investigating the presence of higenamine in plants that are used in traditional folk medicine or included in food supplements. Our study aimed to assess the risk of adverse analytical findings caused by higenamine-containing plants. RESULTS Based on our literature search, Nelumbo nucifera, Tinospora crispa, Nandina domestica, Gnetum parvifolium, Asarum siebodii,Asarum heterotropoides, Aconitum carmichaelii, and Aristolochia brasiliensis are higenamine-containing plants. Based on data from Eastern folk medicine, these plants can provide numerous health benefits. Professional athletes likely ingest these plants without knowing that they contain higenamine; these herbs are used in treatments for different conditions and various foods/food supplements in addition to folk medicine. CONCLUSION Athletes and their teams must be aware of the issues associated with the use of plant-based products. They should avoid consuming higenamine-containing plants during and outside of competition periods.
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