Aged garlic extract reduces blood pressure in hypertensives: a dose-response trial

Effects of aged garlic extract on macrophage functions: a short review of experimental evidence (Review)

Macrophages play crucial roles in both the innate and adaptive immune systems, contributing to the removal of pathogens and subsequent immune responses. Conversely, aberrant macrophage functions are associated with the onset and progression of various diseases, highlighting macrophages as potential therapeutic targets. Aged garlic extract (AGE) is derived from garlic that has undergone a maturation process of over 10 months in an ethanol solution and contains a variety of bioactive components which are produced in the aging process. Previous animal studies and clinical trials have demonstrated that AGE and its constituents exert a range of health benefits, including immune modulation and amelioration of disease conditions. Experimental studies indicate that AGE modulates macrophage functions associated with pathological conditions. To facilitate understanding of AGE's potential as a functional alleviation for macrophage-associated diseases, the present short review summarizes experimental evidence supporting the notion that AGE and its components modify macrophage functions, including phagocytosis, production of reactive oxygen species and polarization.

Randomized, double-blind clinical trial evaluating the impact of freeze-dried garlic extract capsules on blood pressure, lipid profile, and nitric oxide levels in individuals at risk for hypertension

OBJECTIVES

Hypertension, substantially heightens the risk of cardiovascular disease. This study aims to evaluate the effectiveness of freeze-dried garlic extract in blood pressure and lipid profiles in prehypertensive individuals.

METHODS

Participants (age of 30-70 years) were allocated to intervention (n=47) or control (n=49) groups. The intervention group received two capsules of freeze-dried garlic extract daily for eight weeks, while the control group received identical placebo capsules. Primary outcomes, SBP, DBP, PP, MAP, TC, TG, LDL and HDL levels, serum NO levels, were assessed at baseline, four weeks, and eight weeks.

RESULTS

At the end of study, results showed significant changes in the values of SBP, DBP, and MAP except for PP. In comparison to those who received the placebo, a significant drop in SBP, DBP (p<0.001), and MAP (p<0.001) was observed in the intervention group. Also, there were significant changes in TG, LDL, TC, and HDL levels in the interventional group. A noticeable decline was reported in TG (p<0.001), LDL (p<0.001), and TC (p<0.001), while HDL levels increased (p<0.001) in the intervention group compared to those receiving the placebo. Following garlic supplementation, a significant increase in blood NO levels was reported in the intervention group (p<0.001).

CONCLUSIONS

The study showed that garlic supplementation was effective in lowering blood pressure, improving lipid profile, and increasing nitric oxide levels in prehypertensive participants. These results indicate that garlic could be a valuable complementary therapy for managing prehypertension.

Effects of aged garlic extract on blood pressure in hypertensive patients: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

There is no consensus based on the existing literature regarding the effect of aged garlic extract (AGE) on blood pressure. The present systematic review and meta-analysis was conducted to synthesize existing data from randomized clinical trials (RCTs) concerning the impact of AGE supplementation on blood pressure in hypertensive patients.

METHODS

We searched English web databases including, PubMed, Scopus, Embase, Web of Science until August 2024. Random-effects meta-analysis was used to pool weighted mean differences (WMD) and 95 % CI for the outcomes.

RESULTS

Overall, nine RCTs with584 participants met inclusion criteria. AGE tea supplementation reduces systolic blood pressure (SBP) (WMD: -4.03; %95CI: -6.87, -1.20; I2: 57.1 %) and diastolic blood pressure (DBP) (WMD: -1.44; 95 % CI= -2.87, -0.02; P = 0.052; I2: 36.8 %; P: 0.105). Moreover, subgroup analysis indicated that higher doses of AGE supplementation in hypertensive patients significantly decreased DBP, and SBP.

CONCLUSION

The results of this study suggest that AGE supplements may be beneficial for improving blood pressure in hypertensive patients, but significant effects are observed only at doses over 1200 mg/day. To confirm these results, well-designed future trials will be needed.

Micronutrient interactions: Magnesium and its synergies in maternal-fetal health

Magnesium is an essential nutrient for various physiological processes and becomes even more vital during pregnancy, contributing to muscle relaxation, bone development, electrolyte balance, and blood pressure regulation. Despite the fact that the dietary sources of magnesium are diversified, it is still challenging to obtain it in sufficient quantities during pregnancy. We have elucidated its interactions and its specific impact on maternal-fetal health in different research publications. Magnesium also interacts synergistically with other micronutrients like calcium, vitamin D, potassium, zinc, iron, and vitamin B6, emphasizing its significance in promoting optimal outcomes for both the mother and the fetus. Inadequate magnesium intake during pregnancy has been linked to complications like gestational diabetes, preeclampsia, preterm birth, and low birth weight. Therefore, there should be an emphasis on the importance of maintaining adequate magnesium levels through a balanced diet and supplementation. This research therefore studies the complex mechanisms of micronutrient interactions and their specific impacts on maternal-fetal health to enhance prenatal care practices.

Identification of the BZR Family in Garlic (Allium sativum L.) and Verification of the AsBZR11 under Salt Stress

Brassinazole-Resistant (BZR) is an important transcription factor (TF) in the brassinosteroid (BR) signaling pathway, which plays a crucial role in plant growth, development and stress resistance. In this study, we performed a genome-wide analysis of BZRs in garlic (Allium sativum L.) and identified a total of 11 members of the AsBZR gene family. By comparing the expression patterns of AsBZR genes under salt stress, the candidate gene AsBZR11 with salt tolerance function was identified. Subcellular localization results showed that AsBZR11 was localized in the nucleus. The salt tolerance of overexpression lines improved, and the germination rate and root length of overexpression lines increased as compared with wild type. The content of reactive oxygen species (ROS) decreased, and the activity of antioxidant enzymes increased in AsBZR11-OE, suggesting that AsBZR11 has the function of improving plant salt tolerance. Our results enriched the knowledge of plant BZR family and laid a foundation for the molecular mechanism of salt tolerance of garlic, which will provide a theoretical basis for the subsequent creation of salt-tolerant germplasm resources.

Garlic and Hypertension: Efficacy, Mechanism of Action, and Clinical Implications

Hypertension is a major risk factor for heart disease and stroke. Garlic has a long history of use in traditional medicine for various conditions, including hypertension. This narrative review examined the scientific evidence on the efficacy of garlic in lowering blood pressure. It explores the historical uses of garlic in different cultures for medicinal purposes and delves into the phytochemical composition of garlic, highlighting key components, like allicin and ajoene, that are believed to contribute to its potential health benefits. Clinical studies that investigated the effects of garlic and garlic-based supplements on blood pressure are presented, with the findings suggesting that garlic consumption may modestly reduce blood pressure, particularly in individuals with mild hypertension. Potential mechanisms of action include increased nitric oxide production, improved endothelial function, and antioxidant properties. While garlic may offer some benefits for blood pressure management, it should not be considered a substitute for conventional antihypertensive medications. Further large-scale, long-term clinical trials are warranted to establish the efficacy of garlic in managing hypertension, including the optimal dosage and formulation.

Advances in the study of vascular related protective effect of garlic (Allium sativum) extract and compounds

Garlic (Allium sativum) is a functional food containing multiple bioactive compounds that find widespread applications in culinary and medicinal practices. It consists of multiple chemical components, including allicin and alliin. This article offers a comprehensive review of the protective effects of garlic extracts and their active constituents on the vascular system. In vitro and in vivo experiments have shown that garlic extracts and their active ingredients possess various bioactive properties. These substances demonstrate beneficial effects on blood vessels by demonstrating anti-inflammatory and antioxidant activities, inhibiting lipid accumulation and migration, preventing lipid peroxidation, promoting angiogenesis, reducing platelet aggregation, enhancing endothelial function, and inhibiting endothelial cell apoptosis. In clinical studies, garlic and its extracts have demonstrated their efficacy in managing vascular system diseases, including atherosclerosis, diabetes, and high cholesterol levels. In summary, these studies highlight the potential therapeutic roles and underlying mechanisms of garlic and its constituents in managing conditions like diabetes, atherosclerosis, ischemic diseases, and other vascular disorders.

Oleanolic acid rescues critical features of umbilical vein endothelial cells permanently affected by hyperglycemia

Skin wound healing is a physiological process that involves several cell types. Among them, endothelial cells are required for inflammation resolution and neo-angiogenesis, both necessary for tissue restoration after injury. Primary human umbilical vein endothelial cells (C-HUVECs) are derived from the umbilical cord. When women develop gestational diabetes, chronic exposure to hyperglycemia induces epigenetic modifications in these cells (GD-HUVECs), leading to a permanent pro-inflammatory phenotype and impaired angiogenesis in contrast to control cells. Oleanolic acid (OA) is a bioactive triterpenoid known for its epithelial cell migration promotion stimulation and higher tensile strength of wounds. However, the potentially anti-inflammatory and pro-angiogenic properties of OA are still under investigation. We tested OA on C- and GD-HUVECs under inflammatory conditions induced by low levels of the inflammatory cytokine TNF-α. Reduced expression of adhesion molecules VCAM1, ICAM1, and SELE was obtained in OA-pre-treated C- and GD-HUVECs. Additionally, protein VCAM1 levels were also decreased by OA. Coherently, monocyte adhesion assays showed that a lower number of monocytes adhered to GD-HUVEC endothelium under OA pre-treatment when compared to untreated ones. It is noteworthy that OA improved angiogenesis parameters in both phenotypes, being especially remarkable in the case of GD-HUVECs, since OA strongly rescued their poor tube formation behavior. Moreover, endothelial cell migration was improved in C- and GD-HUVECs in scratch assays, an effect that was further confirmed by focal adhesion (FA) remodeling, revealed by paxillin staining on immunocytochemistry assays. Altogether, these results suggest that OA could be an emergent wound healing agent due to its capacity to rescue endothelial malfunction caused by hyperglycemia.

The effect of ellagic acid on the metabolic syndrome: A review article

Objective

(s): Metabolic syndrome is a collection of metabolic abnormalities that includes hyperglycemia, dyslipidemia, hypertension, and obesity. Ellagic acid is found in various fruits and vegetables. It has been reported to have several pharmacological properties, such as antibacterial, antifungal, antiviral, anti-inflammatory, hepatoprotective, cardioprotective, chemopreventive, neuroprotective, gastroprotective, and antidiabetic. Our current study aims to shed light on the probable efficiency of ellagic acid in managing metabolic syndrome and its complications.

Materials and methods

To prepare the present review, the databases or search engines utilized included Scopus, PubMed, Science Direct, and Google Scholar, and relevant articles have been gathered with no time limit until March 2023.

Results

Several investigations indicated that ellagic acid could be a potent compound for the treatment of many disorders such as diabetes, hypertension, and hyperlipidemia by various mechanisms, including increasing insulin secretion, insulin receptor substrate protein 1 expression, regulating glucose transporter 4, triglyceride, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), attenuating tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), reactive oxygen species (ROS), malondialdehyde (MDA), and oxidative stress in related tissues. Furthermore, ellagic acid ameliorates mitochondrial function, upregulates uncoupling protein 1 (found in brown and white adipose tissues), and regulates blood levels of nitrate/nitrite and vascular relaxations in response to acetylcholine and sodium nitroprusside.

Conclusion

Ellagic acid can treat or manage metabolic syndrome and associated complications, according to earlier studies. To validate the beneficial effects of ellagic acid on metabolic syndrome, additional preclinical and clinical research is necessary.

Bioactive molecules from terrestrial and seafood resources in hypertension treatment: focus on molecular mechanisms and targeted therapies

Hypertension (HTN), a complex cardiovascular disease (CVD), significantly impacts global health, prompting a growing interest in complementary and alternative therapeutic approaches. This review article seeks to provide an up-to-date and thorough summary of modern therapeutic techniques for treating HTN, with an emphasis on the molecular mechanisms of action found in substances found in plants, herbs, and seafood. Bioactive molecules have been a significant source of novel therapeutics and are crucial in developing and testing new HTN remedies. Recent advances in science have made it possible to understand the complex molecular mechanisms underlying blood pressure (BP)-regulating effects of these natural substances better. Polyphenols, flavonoids, alkaloids, and peptides are examples of bioactive compounds that have demonstrated promise in influencing several pathways involved in regulating vascular tone, reducing oxidative stress (OS), reducing inflammation, and improving endothelial function. The article explains the vasodilatory, diuretic, and renin-angiotensin-aldosterone system (RAAS) modifying properties of vital plants such as garlic and olive leaf. Phytochemicals from plants are the primary in traditional drug development as models for novel antihypertensive drugs, providing diverse strategies to combat HTN due to their biological actions. The review also discusses the functions of calcium channel blockers originating from natural sources, angiotensin-converting enzyme (ACE) inhibitors, and nitric oxide (NO) donors. Including seafood components in this study demonstrates the increased interest in using bioactive chemicals originating from marine sources to treat HTN. Omega-3 fatty acids, peptides, and minerals obtained from seafood sources have anti-inflammatory, vasodilatory, and antioxidant properties that improve vascular health and control BP. Overall, we discussed the multiple functions of bioactive molecules and seafood components in the treatment of HTN.

Targeting temperature-sensitive transient receptor potential channels in hypertension: far beyond the perception of hot and cold

Transient receptor potential (TRP) channels are nonselective cation channels and participate in various physiological roles. Thus, changes in TRP channel function or expression have been linked to several disorders. Among the many TRP channel subtypes, the TRP ankyrin type 1 (TRPA1), TRP melastatin type 8 (TRPM8), and TRP vanilloid type 1 (TRPV1) channels are temperature-sensitive and recognized as thermo-TRPs, which are expressed in the primary afferent nerve. Thermal stimuli are converted into neuronal activity. Several studies have described the expression of TRPA1, TRPM8, and TRPV1 in the cardiovascular system, where these channels can modulate physiological and pathological conditions, including hypertension. This review provides a complete understanding of the functional role of the opposing thermo-receptors TRPA1/TRPM8/TRPV1 in hypertension and a more comprehensive appreciation of TRPA1/TRPM8/TRPV1-dependent mechanisms involved in hypertension. These channels varied activation and inactivation have revealed a signaling pathway that may lead to innovative future treatment options for hypertension and correlated vascular diseases.

Antihypertensive Effects of an Optimized Aged Garlic Extract in Subjects with Grade I Hypertension and Antihypertensive Drug Therapy: A Randomized, Triple-Blind Controlled Trial

The use of garlic (Allium sativum) for treating arterial hypertension has been recognized as effective for several decades. However, tolerance to treatment is low, and several technological modifications have been developed to improve its tolerability, such as the aging process at controlled temperature and humidity. This study aims to validate the antihypertensive effects of an optimized extract of aged black garlic with low doses of s-allyl-cysteine (SAC) in a Grade I hypertensive population with drug treatment. A randomized, triple-blind, placebo-controlled parallel trial was developed, where a daily supplementation with 0.25 mg/day of SAC for 12 weeks was performed. A reduction in systolic and diastolic blood pressure of 1.8 mmHg (0.7 to 4.1 95% CI) and 1.5 mmHg (0.3 to 3.0 95% CI), respectively, was observed. Similarly, an increase in blood nitric oxide (10.3 µM, 1.1 to 19.5 95% CI) and antioxidant capacity (7 × 10-3 µM TE/min, (1.2 to 13 × 10-3 95% CI) and a reduction in uric acid levels (-0.3 mg/dL, -0.5 to -0.001 95% CI) and ACE activity (-9.3 U/L; -18.4 to -0.4 95% CI) were observed. No changes in endothelial function and inflammatory cytokines were observed. It was concluded that low-dose SAC supplementation in an optimized black-garlic extract allows for an extra-significant reduction in blood pressure in a Grade I hypertensive population receiving drug treatment.

Integrated Transcriptomics and Metabolomics Analysis of the Fructan Metabolism Response to Low-Temperature Stress in Garlic

As the main reserve carbohydrate in garlic, fructan contributes to garlic's yield and quality formation. Numerous studies have shown that plant fructan metabolism induces a stress response to adverse environments. However, the transcriptional regulation mechanism of garlic fructan in low-temperature environments is still unknown. In this study, the fructan metabolism of garlic seedlings under low-temperature stress was revealed by transcriptome and metabolome approaches. With the extension of stress time, the number of differentially expressed genes and metabolites increased. Using weighted gene co-expression network analysis (WGCNA), three key enzyme genes related to fructan metabolism were screened (a total of 12 transcripts): sucrose: sucrose 1-fructosyltransferase (1-SST) gene; fructan: fructan 6G fructosyltransferase (6G-FFT) gene; and fructan 1-exohydrolase (1-FEH) gene. Finally, two hub genes were obtained, namely Cluster-4573.161559 (6G-FFT) and Cluster-4573.153574 (1-FEH). The correlation network and metabolic heat map analysis between fructan genes and carbohydrate metabolites indicate that the expression of key enzyme genes in fructan metabolism plays a positive promoting role in the fructan response to low temperatures in garlic. The number of genes associated with the key enzyme of fructan metabolism in trehalose 6-phosphate was the highest, and the accumulation of trehalose 6-phosphate content may mainly depend on the key enzyme genes of fructan metabolism rather than the enzyme genes in its own synthesis pathway. This study not only obtained the key genes of fructan metabolism in garlic seedlings responding to low temperatures but also preliminarily analyzed its regulatory mechanism, providing an important theoretical basis for further elucidating the cold resistance mechanism of garlic fructan metabolism.

Screening potential hypertensive peptides using two consecutive bioassay-guided SPE fractionations and identification of an ACE inhibitory peptide, DHSTAVW (DW7), derived from pearl garlic protein hydrolysate

The pearl garlic (Allium sativum L.) protein (PGP) was digested using pepsin, trypsin, α-chymotrypsin, thermolysin, and simulated gastrointestinal digestion. The α-chymotrypsin hydrolysate showed the highest angiotensin-I-converting enzyme inhibitory (ACEI) activity, with an IC₅₀ value of 190.9 ± 11µg/mL. A reversed-phase C₁₈ solid-phase extraction (RP-SPE) cartridge was used for the first fractionation, and the S4 fraction from RP-SPE showed the most potent ACEI activity (IC₅₀ = 124.1 ± 11 3µg/mL). The S4 fraction was further fractionated using a hydrophilic interaction liquid chromatography SPE (HILIC-SPE). The H4 fraction from HILIC-SPE showed the highest ACEI activity (IC₅₀ = 57.7 ± 3µg/mL). Four ACEI peptides (DHSTAVW, KLAKVF, KLSTAASF, and KETPEAHVF) were identified from the H4 fraction using liquid chromatography-tandem mass spectrometry (LC-MS/MS), and their biological activities were appraised in silico. Among the identified α-chymotryptic peptides, DHSTAVW (DW7), derived from I lectin partial protein, exhibited the most potent ACEI activity (IC₅₀ value of 2.8 ± 0.1µM). DW7 was resistant to simulated gastrointestinal digestion, and it was classified as a prodrug-type inhibitor according to the preincubation experiment. The inhibition kinetics indicated that DW7 was a competitive inhibitor, which was rationalized by the molecular docking simulation. The quantities of DW7 in 1mg of hydrolysate, S4 fraction, and H4 fraction were quantified using LC-MS/MS to give 3.1 ± 0.1, 4.2 ± 0.1, and 13.2 ± 0.1µg, respectively. The amount of DW7 was significantly increased by 4.2-fold compared with the hydrolysate, which suggested that this method is efficient for active peptide screening.

H2S Donors with Cytoprotective Effects in Models of MI/R Injury and Chemotherapy-Induced Cardiotoxicity

Hydrogen sulfide (H2S) is an endogenous signaling molecule that greatly influences several important (patho)physiological processes related to cardiovascular health and disease, including vasodilation, angiogenesis, inflammation, and cellular redox homeostasis. Consequently, H2S supplementation is an emerging area of interest, especially for the treatment of cardiovascular-related diseases. To fully unlock the medicinal properties of hydrogen sulfide, however, the development and refinement of H2S releasing compounds (or donors) are required to augment its bioavailability and to better mimic its natural enzymatic production. Categorizing donors by the biological stimulus that triggers their H2S release, this review highlights the fundamental chemistry and releasing mechanisms of a range of H2S donors that have exhibited promising protective effects in models of myocardial ischemia-reperfusion (MI/R) injury and cancer chemotherapy-induced cardiotoxicity, specifically. Thus, in addition to serving as important investigative tools that further advance our knowledge and understanding of H2S chemical biology, the compounds highlighted in this review have the potential to serve as vital therapeutic agents for the treatment (or prevention) of various cardiomyopathies.

Influence of Agaricus bisporus Mushroom on Pb Toxicokinetic in Pregnant Rats

(Pb) is a toxic metal, responsible for several damages to human health. Agaricus bisporus (Ab) is a mushroom with promising antioxidant properties to be used as an alternative chelator in Pb intoxication. The aim was to understand the Pb toxicokinetic and the potential of Ab as a protective agent. A total of 20 female Wistar rats were distributed into 4 groups (n = 5/group): Control (receiving water); Group Ab 100 mg/kg (gavage); Group Pb 100 mg/L in water; and Group Ab + Pb-100 mg/kg + 100 mg/L (gavage and water). Pb administration occurred daily until the 19th day of pregnancy. On day 19 of gestation, the rats were euthanized, and the blood and tissues were collected for Pb measurement, using an inductively coupled plasma mass spectrometer. The results showed that the levels of Pb in the blood, placenta, and liver of the mothers, and in the brain of the fetuses increased significantly in the Pb group. On the other hand, the combined exposure to Pb + Ab showed a significant decrease in the metal concentration in relation to the Pb group, returning to normal levels. Kidney and bone lead levels also increased significantly in the Pb group. However, in the combined exposure group, levels did not return to the control amounts; there was protection, but the Pb concentration was still significantly higher than in the control. In the brain, no significant differences were observed. In conclusion, we suggest A. bisporus is a natural chelator, because the co-administration of the mushroom was able to interact with Pb ions, minimizing the Pb absorption and distribution. These effects are suggested since A. bisporus have antioxidants and beta glucan that interact with Pb, chelating it and, thus, reducing its toxic effects.

Screening and Verification of Reference Genes for Analysis of Gene Expression in Garlic (Allium sativum L.) under Cold and Drought Stress

The principal objective of this study was to screen and verify reference genes appropriate for gene expression evaluation during plant growth and development under distinct growth conditions. Nine candidate reference genes were screened based on garlic transcriptome sequence data. RT-qPCR was used to detect the expression levels of the aforementioned reference genes in specific tissues under drought and cold stress. Then, geNorm, NormFinder, BestKeeper, and ReFinder were used to consider the consistency of the expression levels of candidate reference genes. Finally, the stress-responsive gene expression of ascorbate peroxidase (APX) was quantitatively evaluated to confirm the chosen reference genes. Our results indicated that there were variations in the abundance and stability of nine reference gene transcripts underneath cold and drought stress, among which ACT and UBC-E2 had the highest transcript abundance, and 18S rRNA and HIS3 had the lowest transcript abundance. UBC and UBC-E2 were the most stably expressed genes throughout all samples; UBC and UBC-E2 were the most stably expressed genes during cold stress, and ACT and UBC were the most stably expressed genes under drought stress. The most stably expressed genes in roots, pseudostems, leaves, and cloves were EF1, ACT, HIS3, UBC, and UBC-E2, respectively, while GAPDH was the most unstable gene during drought and cold stress conditions and in exclusive tissues. Taking the steady reference genes UBC-E2, UBC, and ACT as references during drought and cold stress, the reliability of the expression levels was further demonstrated by detecting the expression of AsAPX. Our work thereby offers a theoretical reference for the evaluation of gene expression in garlic in various tissues and under stress conditions.

Effect of garlic extract on markers of lipid metabolism and inflammation in coronary artery disease (CAD) patients: A systematic review and meta-analysis

Several preclinical studies have focused on the beneficial effects of garlic on cardiovascular diseases, but the results were inconsistent. We performed a systematic review and meta-analysis on the effect of garlic powder tablets and aged garlic extract (AGE) in CAD patients, mainly focusing on blood pressure, coronary artery calcification, lipid profile, and inflammatory markers. We searched PubMed, Cochrane CENTRAL, and Google Scholar to identify randomized controlled trials which examined garlic's effect on CAD patients. The standardized mean difference with 95% CI was calculated using fixed-effect or random-effect models. Garlic has shown statistically significant changes of HDL (SMD = 0.18; 95% CI = -0.00 to 0.37; p = .05); LDL (SMD = -0.27; 95% CI = -0.46 to -0.08; p = .004), apolipoprotein-A (SMD = 0.68; 95% CI = 0.24 1.13; p = .002), C-RP (SMD = -0.59; 95% CI = -0.92 to -0.25; p = .0007), IL-6 (SMD = -1.08; 95% CI = -2.17 to 0.01; p = .05), homocysteine (SMD = -0.66; 95% CI = -1.04 to -0.28; p = .0007) and CAC score (SMD = -1.61; 95% CI = -2.66 to -0.57; p = .003). In the case of subgroup analysis, the overall effect was significantly effective in reducing TC, LDL levels and improving HDL levels in CV risk patients. Our study findings provide consistent evidence that intake of garlic reduces CVD risk factors. However, garlic could be considered a safe natural medicine to debilitate inflammation in CAD patients.

Foods of the Mediterranean diet: garlic and Mediterranean legumes

The Mediterranean diet is a dietary regime derived from the one followed by the ancient civilizations of the Mediterranean region. It is characterized by many healthy constituents, among which are cereals, legumes, fruits, vegetables, olives, and white meat. Many studies suggest that this dietary regime is the key to obtaining a healthy and long life, like that of the Mediterranean peoples. Despite its popularity among health professionals, this diet is still confined to a certain geographical area of the world. Due to globalization and the modern busy lifestyle, this cultural diet is losing ground even in its home region, with more and more people embracing the so-called Western diet. An awareness of health benefits of the individual components of the Mediterranean diet will therefore draw attention from all over the world to this healthy and affordable dietary pattern, which can not only improve the overall health, but also reduce the risk of developing chronic and infectious diseases. In this regard, garlic and Mediterranean legumes present a huge repertoire of phytochemicals having both nutritive and nutraceutical properties, which therefore should be included in our daily dietary routines in moderate proportions. This narrative review aims at summarizing the principal components and health benefits of the Mediterranean diet, in particular of garlic and legumes.

The Role of Garlic in Metabolic Diseases: A Review

Garlic (Allium sativum L.) is a popular spice that has been widely used for thousands of years in traditional medicine. Several organosulfur compounds in garlic have been linked to its beneficial effects on health. Evidence from preclinical studies and clinical trials supports garlic's antihypertensive, antidiabetic, antiobesity, and hypolipidemic effects. This study aims to summarize clinical trial evidence regarding the effects of garlic on metabolic diseases and its mechanisms of action.

Alterations in the Physicochemical Properties and Antioxidant Activity during Aging of Stored Raw Garlic

Garlic, a once-a-year crop, is mass-produced in a single event. Most of the garlic harvested during the year, unless consumed or processed immediately, should be stored. Stored raw garlic (SRG) can be used to make black garlic (BG) via aging, and storage may affect the properties and quality of the BG compared with the use of raw garlic that has not been stored. This study was performed to identify the effect of long-term storage of raw garlic on the quality of BG products. SRG was aged for 21 days at 40–86 °C for BG production. Moisture content and pH gradually decreased with the aging period. Total phenolic, total flavonoid, and fructose contents were significantly increased during the aging period. Compared with non-stored raw garlic (NSRG), alliin and S-allylcysteine (SAC) contents were 1.7-fold and 5.9-fold higher in SRG, respectively, and γ-glutamyl-S-allylcysteine (γ-GSAC) content was 2.8-fold lower in SRG. The contents of alliin and γ-GSAC reduced as the aging period of SRG and NSRG progressed. However, the SAC content of NSRG increased with aging, but the SAC content of SRG decreased or increased slightly with extended aging. The antioxidant activity was also higher in BG made from NSRG rather than SRG. These results show that the SAC content is relatively low in BG manufactured from SRG compared with NSRG. Our findings suggest that it is necessary to establish an aging method suitable for SRG in BG production with high SAC content, a representative indicator of BG.

Potential Effects of Natural H2S-Donors in Hypertension Management

After the discovery of hydrogen sulfide (H₂S) in the central nervous system by Abe and Kimura in 1996, the physiopathological role of H₂S has been widely investigated in several systems such as the cardiovascular. In particular, H₂S plays a pivotal role in the control of vascular tone, exhibiting mechanisms of action able to induce vasodilation: for instance, activation of potassium channels (KATP and Kv7) and inhibition of 5-phosphodiesterase (5-PDE). These findings paved the way for the research of natural and synthetic exogenous H₂S-donors (i.e., molecules able to release H₂S) in order to have new tools for the management of hypertension. In this scenario, some natural molecules derived from Alliaceae (i.e., garlic) and Brassicaceae (i.e., rocket or broccoli) botanical families show the profile of slow H₂S-donors able to mimic the endogenous production of this gasotransmitter and therefore can be viewed as interesting potential tools for management of hypertension or pre-hypertension. In this article, the preclinical and clinical impacts of these natural H₂S-donors on hypertension and vascular integrity have been reviewed in order to give a complete panorama of their potential use for the management of hypertension and related vascular diseases.

The association of garlic intake and cardiovascular risk factors: A systematic review and meta-analysis

Garlic is a common cooking ingredient and used in traditional medicine in Asian countries. There is a growing attention on garlic due to its preventive characteristics in cardiovascular diseases (CVDs). Many studies have reviewed the association between garlic intake and CVDs; however, no consistent conclusions have been drawn. New clinical trials have also been conducted and could contribute to more solid statements. In order to systematically review the reliability of previous studies regarding the implication of garlic in the management of CVDs, we performed in-depth meta-analysis using the most up-to-date randomized clinical trials (RCTs) data with more systematic controls. According to the 22 studies included, the effects of garlic intake on lowering total cholesterol (TC) and low-density lipoprotein (LDL) are more noticeable with lower dosage and longer duration, especially in patients with CVDs. In addition, subgroup analysis indicated that appropriate diet intervention could be an important control factor that should be taken into consideration in any future study designs.

Evaluating the effects of dark chocolate formulated with micro-encapsulated fermented garlic extract on cardio-metabolic indices in hypertensive patients: A crossover, triple-blind placebo-controlled randomized clinical trial

This study aimed to investigate the health-related effects of microencapsulated fermented garlic extract (FGE) containing dark chocolate in hypertensive adults. For this purpose, 36 hypertensive adults (15 males vs. 21 females) were randomized to receive the FGE (5 g/day) dark chocolate containing 650 mg of FGE powder or the placebo. Intervention periods lasted for 6 weeks and were separated by a 3-week wash-out period. The response variables included blood pressure, anthropometric indices, lipid profile, and inflammatory and oxidative stress indices. Statistical analyses were performed using the Pkcross procedure, and Cohen's d was estimated for all response variables. There was no significant inter-period difference between the mean changes of body weight, waist circumference, and body mass index (BMI). Furthermore, no significant change was confirmed in participants' blood pressure, triglycerides, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), serum homocysteine, high-sensitive c-reactive protein (hs-CRP), malondialdehyde (MDA), and total antioxidant capacity (TAC). It seems that the dose of FGE used in this study was not sufficient to cause any significant changes in the outcomes. Therefore, further studies with dose-response designs and longer durations are recommended.

The antinociceptive effect of garlic, garlic preparations, and derivative compounds

The antinociceptive effects of garlic have shown promise in treating different chronic diseases in humans, such as knee osteoarthritis, rheumatoid arthritis, and peripheral arterial occlusive disease stage II. The most common garlic products are garlic powder (dried garlic), steam distilled garlic oils, garlic oil macerate, and aged garlic extract. These commercial products contain organosulfur compounds (OSC) that have been extensively evaluated in preclinical models and some clinical assays to treat different diseases against pain. In this review, we describe the importance of some bioactive compounds found in garlic and its role in treating pain. A systematic search of the literature in Dimensions, PubMed, Scopus, Web of Science was performed. Terms and preselected keywords relating to garlic, its derivates and organusulfur compunds in pain, were used to perform a systematic literature search. Two independent reviewers screened papers for inclusion and assessed the methodological quality. The antinociceptive activity of garlic and its OSC is related to its antioxidant and anti-inflammatory properties, which may be explained by the ability to block the synthesis of PGs, pro-inflammatory cytokines and interferon-γ, by the reduction COX- 2 activity and by increases the levels of anti-inflammatory cytokines. Besides, garlic extract is an activator of TRPA1 and TRPV1, where the principal responsible for this activation are OSC. The relationship between these pathways allows a better understanding how garlic and its derivates could be carrying out its pharmacological action over the management of acute and chronic pain and provide a base by further investigations.

K, P. UD. Spices and Hypertension: An Insight for Researchers

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Hypertension is a global public health concern since it can lead to complications like stroke, heart disease, and kidney failure. These complications can add to a disability, increase healthcare costs, and can even result in mortality. In spite of the availability of a large number of anti-hypertensive drugs, the control of blood pressure is suboptimal in many patients. Spices have been used as flavouring agents and in treating diseases in folk medicine since they are considered to be rich sources of phytochemicals, especially polyphenols. Hence, during recent years, there has been renewed interest among researchers in exploring natural sources, especially spices, in an attempt to find cheaper alternatives with fewer side effects. Our aim is to review the relevant preclinical and clinical studies focused on the potential use of spices in the management of hypertension. Studies conducted on the most common spices, such as celery, cinnamon, cardamom, garlic, ginger, saffron, and turmeric, have been elaborated in this review. These spices may lower blood pressure via several possible mechanisms, including antioxidant effect, increase in nitric oxide production, reduction in calcium ion concentration, modulation of the renin-angiotensin pathway, etc.

Garlic: A systematic review of the effects on cardiovascular diseases

Allium sativum (garlic) certainly is one of the oldest horticultural crops in the world and presents bioactive compounds that are related to the garlic's effects on human health. Several authors have shown beneficial effects on diabetes, hypertension, dyslipidemia, obesity, and cardiovascular diseases (CVD), which are among the most relevant causes of mortality in the world. The aim of this systematic review was to evaluate the effects of garlic in the risk factors of CVD and evaluate its economic importance. MEDLINE-PubMed, COCHRANE, EMBASE, and Google Scholar databases were searched. The included studies showed that the use of garlic can reduce blood pressure, waist circumference, body mass index, LDL-c, non-HDL-c, total cholesterol, triglycerides, and inflammatory markers. It also can increase the levels of HDL-c and can improve cardiovascular parameters such as coronary artery calcium, microcirculation, epicardial and periaortic adipose tissue, post occlusive reactive hyperemia, low attenuation plaque, carotid intima-media thickness; and carotid intima-media thickness. Due to these reasons, garlic can be considered in the prevention and treatment of CVD risk factors.

The garlic-derived organosulfur compound diallyl trisulphide suppresses tissue factor function

Tissue factor (TF) is a critical initiator of extrinsic coagulation that sometimes causes thromboembolism. Diallyl trisulphide (DATS) is a secondary metabolite of allicin generated in crushed garlic, with various pharmacological effects. This study aimed to clarify the effect of DATS on the extrinsic coagulation elicited by TF and arteriosclerosis. TF activity was measured using a clotting assay in TF-expressing HL60 cells. DATS inhibited TF activity in a dose-dependent manner. TF expression in TNF-α-stimulated human umbilical vein endothelial cells was examined using real-time PCR and western blotting. DATS inhibited TF mRNA and protein expression induced by TNF-α via inhibition of JNK signalling. The effect of DATS on arteriosclerosis was also examined in apolipoprotein E-deficient mice. DATS administration in these mice tended to decrease atherosclerotic lesion size. These results strongly suggest that DATS prevents thromboembolism triggered by atherosclerosis via the inhibition of plaque formation and TF function.

Effects of an Optimized Aged Garlic Extract on Cardiovascular Disease Risk Factors in Moderate Hypercholesterolemic Subjects: A Randomized, Crossover, Double-Blind, Sustainedand Controlled Study

The consumption of aged black garlic (ABG) has been related to improvements in several cardiovascular disease (CVD) risk factors. However, the extent of the beneficial effects depends on the garlic aging process and the amount and type of chemical compounds accumulated. The main objective of this study was to assess the effect of daily intake of a well-characterized ABG extract with a standardized S-allyl-L-cysteine (SAC) yield in combination with dietary recommendations regarding CVD risk factors in individuals with moderate hypercholesterolemia. Sixty-seven hypercholesterolemic individuals with low-density lipoprotein cholesterol levels ≥115 mg/dL were randomized in a crossover, double-blind, sustained, and controlled intervention study. The participants consumed 250 mg (1.25 mg SAC)/tablet/day ABG or a placebo for 6 weeks, with 3 weeks of washout. Blood and pulse pressure and other CVD risk biomarkers were determined at the beginning and end of each intervention. At 6 weeks, ABG extract reduced diastolic blood pressure (DBP) (mean (95% CI) −5.85 (−10.5; −1.3) mm Hg) compared to the placebo, particularly in men with a DBP > 75 mm Hg. The consumption of an improved ABG extract with 1.25 mg of SAC decreased DBP, particularly in men with moderate hypercholesterolemia. The potential beneficial effects of ABG may contribute to obtaining an optimal DBP.

Medicinal Plants in the Treatment of Hypertension: A Review

Traditional medicine is a comprehensive term for ancient, culture-bound health care practices that existed before the use of science in health matters and has been used for centuries. Medicinal plants are used to treat patients with cardiovascular diseases, which may occur due to ailments of the heart and blood vessels and comprise heart attacks, cerebrovascular diseases, hypertension, and heart failure. Hypertension causes difficulty in the functioning of the heart and is involved in atherosclerosis, raising the risk of heart attack and stroke. Many drugs are available for managing these diseases, though common antihypertensive drugs are generally accompanied by many side effects. Medicinal herbs have several active substances with pharmacological and prophylactic properties that can be used in the treatment of hypertension. This review presents an overview of some medicinal plants that have been shown to have hypotensive or antihypertensive properties.

S-1-Propenylcysteine promotes IL-10-induced M2c macrophage polarization through prolonged activation of IL-10R/STAT3 signaling

Atherosclerosis is a chronic inflammatory disease that may lead to the development of serious cardiovascular diseases. Aged garlic extract (AGE) has been reported to ameliorate atherosclerosis, although its mode of action remains unclear. We found that AGE increased the mRNA or protein levels of arginase1 (Arg1), interleukin-10 (IL-10), CD206 and hypoxia-inducible factor 2α (HIF2α) and decreased that of CD68, HIF1α and inducible nitric oxide synthase in the aorta and spleen of apolipoprotein E knockout mice. We also found that S-1-propenylcysteine (S1PC), a characteristic sulfur compound in AGE, increased the level of IL-10-induced Arg1 mRNA and the extent of M2c-like macrophage polarization in vitro. In addition, S1PC increased the population of M2c-like macrophages, resulting in suppressed the population of M1-like macrophages and decreased lipopolysaccharide-induced production of pro-inflammatory cytokines. These effects were accompanied by prolonged phosphorylation of the IL-10 receptor α (IL-10Rα) and signal transducer and activator of transcription 3 (STAT3) that inhibited the interaction between IL-10Rα and Src homology-2-containing inositol 5'-phosphatase 1 (SHIP1). In addition, administration of S1PC elevated the M2c/M1 macrophage ratio in senescence-accelerated mice. These findings suggest that S1PC may help improve atherosclerosis due to its anti-inflammatory effect to promote IL-10-induced M2c macrophage polarization.

Black Garlic and Its Bioactive Compounds on Human Health Diseases: A Review

Black garlic (BG) is a form of aged garlic obtained from raw garlic (Allium sativum) via Millard reaction under high temperature (60-90 °C) and humidity (70-90%) for a period of time. Several studies reported higher contents of water-soluble antioxidants compounds (S-allyl cysteine, S-allyl-mercapto cysteine), 5-hydroxymethylfurfural, organosulfur compounds, polyphenol, volatile compounds, and products of other Millard reactions compared to fresh garlic after the thermal processing. Recent studies have demonstrated that BG and its bioactive compounds possess a wide range of biological activities and pharmacological properties that preserve and show better efficacy in preventing different types of diseases. Most of these benefits can be attributed to its anti-oxidation, anti-inflammation, anti-obesity, hepatoprotection, hypolipidemia, anti-cancer, anti-allergy, immunomodulation, nephroprotection, cardiovascular protection, and neuroprotection. Substantial studies have been conducted on BG and its components against different common human diseases in the last few decades. Still, a lot of research is ongoing to find out the therapeutic effects of BG. Thus, in this review, we summarized the pre-clinical and clinical studies of BG and its bioactive compounds on human health along with diverse bioactivity, a related mode of action, and also future challenges.

Phytotherapy of Hypertension: An Updated Overview

BACKGROUND

Cardiovascular disorders are the leading cause of morbidity and mortality throughout the globe. Hypertension is the main risk factor that contributes to the development of many diseases. The use of herbal therapies, medicinal plants and their derivatives for the remedy and management of hypertension is well-recognized and popular among a wide part of the world population.

METHODS

The aim of the current review was to collect, treat, and critically analyze the published research studies relative to experimental and clinical investigations which have studied the blood pressure lowering abilities of medicinal plant derivatives in the last decade. This review was organized into three principal axes; the first axis was attributed to the in vivo and in vitro experimental studies; the second treated the clinical trials; while, the last one is devoted to analyze the mechanisms of action underlying the therapeutic antihypertensive effectiveness of phytochemicals.

RESULTS

Different types of extracts and isolated molecules obtained from a large variety of species demonstrated their efficiency in improving the increase of blood pressure either experimentally or clinically. Medicinal species such as garlic (Allium sativum), celery (Apium graveolens), Black Cumin (Nigella sativa) and Ginseng (Panax) are among the most common and therapeutically used plant derivatives for controlling hypertension while Asteraceae, Apiaceae and Rosaceae are among the botanical families which were frequently studied in the last decade. Isolated compounds such as allicin and apigenin have received more interest in this field. Recent evidence from clinical trials suggests that a wide variety of herbal preparations and plant extracts or natural isolated compounds have a favorable therapeutic impact on blood flow. Interestingly, phytochemicals can either act directly on blood vessels via a vasorelaxant effect involving a variety of signaling cascades or indirectly through inhibiting or stimulating diversity of systems such as angiotensin-converting enzyme (ACE), renin-angiotensin system (RAS) or the diuretic activity. Hence, based on the findings of the present review medicinal plant derivatives could be used as preventive and curative agents in the case of cardiovascular disorders, particularly hypertension and could play a promoting function for the discovery of new antihypertensive agents.

CONCLUSION

The analysis of the published data shows that a great effort remains to be done to investigate the medicinal plants cited as antihypertensive through published ethnopharmacological surveys. The analysis of the literature in this field shows the lack of standardization at the level of experimental study methods as well as the need to study purified molecules. Moreover, the mechanistic studies when they exist remain in the whole partial. On the other hand, few advanced clinical studies have been conducted. Finally, the determination of the efficacy/safety ratio remains absent in almost all studies.

Cytoprotective Potential of Aged Garlic Extract (AGE) and Its Active Constituent, S-allyl-l-cysteine, in Presence of Carvedilol during Isoproterenol-Induced Myocardial Disturbance and Metabolic Derangements in Rats

This study was conducted to determine the potential interaction of aged garlic extract (AGE) with carvedilol (CAR), as well as to investigate the role of S-allyl-l-cysteine (SAC), an active constituent of AGE, in rats with isoproterenol (ISO)-induced myocardial dysfunction. At the end of three weeks of treatment with AGE (2 and 5 mL/kg) or SAC (13.1 and 32.76 mg/kg), either alone or along with CAR (10 mg/kg) in the respective groups of animals, ISO was administered subcutaneously to induce myocardial damage. Myocardial infarction (MI) diagnostic predictor enzymes, lactate dehydrogenase (LDH) and creatinine kinase (CK-MB), were measured in both serum and heart tissue homogenates (HTH). Superoxide dismutase (SOD), catalase, and thiobarbituric acid reactive species (TBARS) were estimated in HTH. When compared with other groups, the combined therapy of high doses of AGE and SAC given alone or together with CAR caused a significant decrease in serum LDH and CK-MB activities. Further, significant rise in the LDH and CK-MB activities in HTH was noticed in the combined groups of AGE and SAC with CAR. It was also observed that both doses of AGE and SAC significantly increased endogenous antioxidants in HTH. Furthermore, histopathological observations corroborated the biochemical findings. The cytoprotective potential of SAC and AGE were dose-dependent, and SAC was more potent than AGE. The protection offered by aged garlic may be attributed to SAC. Overall, the results indicated that a high dose of AGE and its constituent SAC, when combined with carvedilol, has a synergistic effect in preventing morphological and physiological changes in the myocardium during ISO-induced myocardial damage.

An evidence-based appraisal of complementary and alternative medicine strategies for the management of hypertension

: Hypertension is a major risk factor for cardiovascular disease and all-cause mortality. Numerous antihypertensive medications and lifestyle changes have proven effective for the reduction of blood pressure (BP). Over the past few decades, the emergence of complementary and alternative medicine (CAM)-based strategies to lower BP have broadened the therapeutic armamentarium for hypertension. CAM is defined as a group of heterogeneous medical treatments that are used to enhance the effect of standard therapy, or, conversely, are implemented as an alternative to standard practice. The available body of evidence does substantiate the BP-lowering effects of certain CAM-based therapies in individuals with and without established hypertension. Collectively, alternative strategies for BP reduction have undergone less rigorous testing than traditional BP-lowering strategies and the lack of robust clinical data has greatly hampered the broad-scale adoption of CAM therapies into clinical practice. Despite these limitations, CAM-based therapies for the reduction of BP require consideration as they could offer substantial public health benefits given the high prevalence of hypertension in the general population. This article reviews some of the most promising CAM-based therapies for the reduction of BP and cardiovascular outcomes based on the current literature.

Review of Natural Resources With Vasodilation: Traditional Medicinal Plants, Natural Products, and Their Mechanism and Clinical Efficacy

For decades, chronic diseases including cardiovascular and cerebrovascular diseases (CCVDs) have plagued the world. Meanwhile, we have noticed a close association between CCVDs and vascular lesions, such as hypertension. More focus has been placed on TMPs and natural products with vasodilation and hypotension. TMPs with vasodilatory and hypotensive activities are mainly from Compositae, Lamiaceae, and Orchidaceae (such as V. amygdalina Del., T. procuinbens L., M. glomerata Spreng., K. galanga L., etc.) whereas natural products eliciting vasorelaxant potentials were primarily from flavonoids, phenolic acids and alkaloids (such as apigenin, puerarin, curcumin, sinomenine, etc.). Furthermore, the data analysis showed that the vasodilatory function of TMPs was mainly concerned with the activation of eNOS, while the natural products were primarily correlated with the blockage of calcium channel. Thus, TMPs will be used as alternative drugs and nutritional supplements, while natural products will be considered as potential therapies for CCVDs in the future. This study provides comprehensive and valuable references for the prevention and treatment of hypertension and CCVDs and sheds light on the further studies in this regard. However, since most studies are in vitro and preclinical, there is a need for more in-depth researches and clinical trials to understand the potential of these substances.

Plants Used as Antihypertensive

Hypertension is a critical health problem and worse other cardiovascular diseases. It is mainly of two types: Primary or essential hypertension and Secondary hypertension. Hypertension is the primary possibility feature for coronary heart disease, stroke and renal vascular disease. Herbal medicines have been used for millions of years for the management and treatment of hypertension with minimum side effects. Over aim to write this review is to collect information on the anti-hypertensive effects of natural herbs in animal studies and human involvement as well as to recapitulate the underlying mechanisms, from the bottom of cell culture and ex-vivo tissue data. According to WHO, natural herbs/shrubs are widely used in increasing order to treat almost all the ailments of the human body. Plants are the regular industrial units for the invention of chemical constituents, they used as immunity booster to enhance the natural capacity of the body to fight against different health problems as well as herbal medicines and food products also. Eighty percent population of the world (around 5.6 billion people) consume medicines from natural plants for major health concerns. This review provides a bird's eye analysis primarily on the traditional utilization, phytochemical constituents and pharmacological values of medicinal herbs used to normalize hypertension i.e. Hibiscus sabdariffa, Allium sativum, Andrographis paniculata, Apium graveolens, Bidenspilosa, Camellia sinensis, Coptis chinensis, Coriandrum sativum, Crataegus spp., Crocus sativus, Cymbopogon citrates, Nigella sativa, Panax ginseng,Salviaemiltiorrhizae, Zingiber officinale, Tribulus terrestris, Rauwolfiaserpentina, Terminalia arjuna etc.

Trends in H2S-Donors Chemistry and Their Effects in Cardiovascular Diseases

Hydrogen sulfide (H₂S) is an endogenous gasotransmitter recently emerged as an important regulatory mediator of numerous human cell functions in health and in disease. In fact, much evidence has suggested that hydrogen sulfide plays a significant role in many physio-pathological processes, such as inflammation, oxidation, neurophysiology, ion channels regulation, cardiovascular protection, endocrine regulation, and tumor progression. Considering the plethora of physiological effects of this gasotransmitter, the protective role of H₂S donors in different disease models has been extensively studied. Based on the growing interest in H₂S-releasing compounds and their importance as tools for biological and pharmacological studies, this review is an exploration of currently available H₂S donors, classifying them by the H₂S-releasing-triggered mechanism and highlighting those potentially useful as promising drugs in the treatment of cardiovascular diseases.

From the distinctive smell to therapeutic effects: Garlic for cardiovascular, hepatic, gut, diabetes and chronic kidney disease

Garlic, a member of the Allium family, widely used in cooking for many centuries, displays well described antioxidant and anti-inflammatory properties, as a result of its constituent organosulfur compounds, such as alliin, allicin, ajoene S-allyl-cysteine, diallyl sulfide and diallyl disulfide, among others. Although garlic has demonstrated beneficial effects in cardiovascular disease, diabetes, and cancer, its efficacy as a therapeutic intervention in chronic kidney disease remains to be proven. This review thus focuses on the potential benefits of garlic as a treatment option in chronic kidney disease. and its ability to mitigate associated cardiovascular complications and gut dysbiosis.

Phytotherapy for Cardiovascular Disease: A Bench-to-Bedside Approach

At present, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, and global trends suggest that this panorama will persist or worsen in the near future. Thus, optimization of treatment strategies and the introduction of novel therapeutic alternatives for CVD represent key objectives in contemporary biomedical research. In recent years, phytotherapy-defined as the therapeutic use of whole or minimally modified plant components-has ignited large scientific interest, with a resurgence of abundant investigation on a wide array of medicinal herbs (MH) for CVD and other conditions. Numerous MH have been observed to intervene in the pathophysiology of CVD via a myriad of molecular mechanisms, including antiinflammatory, anti-oxidant, and other beneficial properties, which translate into the amelioration of three essential aspects of the pathogenesis of CVD: Dyslipidemia, atherosclerosis, and hypertension. Although the preclinical data in this scenario is very rich, the true clinical impact of MH and their purported mechanisms of action is less clear, as large-scale robust research in this regard is in relatively early stages and faces important methodological challenges. This review offers a comprehensive look at the most prominent preclinical and clinical evidence currently available concerning the use of MH in the treatment of CVD from a bench-to-bedside approach.

The use of complementary and alternative medicine among hypertensive and type 2 diabetic patients in Western Jamaica: A mixed methods study

BACKGROUND

The simultaneous or intermittent use of alternative treatments and prescription medications for hypertension and type 2 diabetes mellitus can have adverse health effects.

OBJECTIVES

To identify beliefs and practices associated with the use of alternative treatments for hypertension and type 2 diabetes mellitus among patients.

METHODS

A mixed-methods study including an investigator-administered survey and focus group discussion sessions using convenience sampling was conducted among patients aged ≥18 years during May to August 2018. Descriptive statistics were used to describe and compare demographic characteristics among groups of survey participants using JMP Pro 14.0. Thematic analysis was conducted to analyze the qualitative data using NVivo.

RESULTS

Most study participants (87-90%) were on prescription medication for their condition. Of survey participants, 69% reported taking their medication as prescribed and 70% felt that prescription medicine was controlling their condition. Almost all participants (98%) reported using alternative treatments, mainly herbal medications, and 73-80% felt that herbal medicines controlled their conditions. One-third believed that herbal medicines are the most effective form of treatment and should always be used instead of prescription medication. However, most participants (85%) did not believe that prescription and herbal treatments should be used simultaneously. Most (76-90%) did not discuss herbal treatments with their healthcare providers. Four themes emerged from the focus group sessions: 1) Simultaneous use of herbal and prescription medicine was perceived to be harmful, 2) Patients did not divulge their use of herbal medicine to healthcare providers, 3) Alternative medicines were perceived to be highly effective, and 4) Religiosity and family elders played key roles in herbal use.

CONCLUSIONS

This study provides useful insights into perceptions and use of alternative treatments by patients that can be used by healthcare providers in developing appropriate interventions to encourage proper use of prescription medicines and alternative medicines resulting in improved management of these chronic diseases.

Identification and Characterization of Sulfur Heterocyclic Compounds That Contribute to the Acidic Odor of Aged Garlic Extract

The aroma of aged garlic extract (AGE) has been recently characterized as a complexity of seasoning-like, metallic, fatty, and acidic notes; most of the important aroma compounds were identified in a previous study. Besides the 25 previously identified aromas of AGE, several of the odor compounds that contribute to the acidic notes were isolated and identified using various analytical techniques, including gas chromatography coupled with an olfactometry monitoring system (GC-O), accurate and high-performance preparative GC system, GC-MS analysis, and sensory evaluation. The identified aromas include: 2,4-dimethyl-1,3-dithiolane, 2,5-dimethyl-1,4-dithiane, and 2,6-dimethyl-1,4-dithiane. Interestingly, AGE contains all stereoscopic isomers of each of these components. An aroma recombinant composed of the newly identified acidic odors with other key odorants showed good agreement with the aroma of AGE.

Antileukemic activity of sulfoxide nutraceutical allicin against THP-1 cells is associated with premature phosphatidylserine exposure in human erythrocytes

Background

Allicin (ACN), a sulfoxide in freshly crushed garlic, is known for its diverse bioactive properties. Among the most notable effects of ACN is its antitumor activity against a wide array of cancer types. Thus, ACN may be a promising anticancer therapeutic. Nevertheless, chemotherapy-induced anemia is a major obstacle in cancer management with a prevalence of up to 70%. Although the pathophysiology behind it remains elusive, a number of medications known to cause anemia in patients have been shown to induce premature programmed cell death in red blood cells (RBCs) known as eryptosis. This study, thus, investigates the anticancer potential of ACN against THP-1 monocytic leukemia cells, its toxic effects on human RBCs, and delineate the underlying biochemical mechanisms.

Methods

Cytotoxicity was detected using the MTT assay, while hemoglobin leakage was used as a surrogate for hemolysis which was photometrically measured. Major eryptotic events were examined using flow cytometry with fluorescent probes. Phosphatidylserine (PS) exposure was detected by Annexin-V-FITC, cytosolic calcium with Fluo4/AM, and reactive oxygen species with H₂DCFDA.

Results

Our results show that ACN induces hemolysis in a dose-dependent fashion, which is significantly abrogated in absence of extracellular calcium. Moreover, ACN stimulates PS exposure, intracellular calcium overload, and oxidative stress. Using small-molecule inhibitors, we demonstrate that the pro-eryptotic activity of ACN is ameliorated in presence of zVAD(OMe)-FMK, SB203580, and D4476.

Conclusion

ACN possesses both hemolytic and eryptotic properties mediated through elevated intracellular calcium levels, oxidative stress, caspase, p38 MAPK, and CK1α.

A Paradoxical Vasodilatory Nutraceutical Intervention for Prevention and Attenuation of Migraine-A Hypothetical Review

Studies suggest that migraine pain has a vascular component. The prevailing dogma is that peripheral vasoconstriction activates baroreceptors in central, large arteries. Dilatation of central vessels stimulates nociceptors and induces cortical spreading depression. Studies investigating nitric oxide (NO) donors support the indicated hypothesis that pain is amplified when acutely administered. In this review, we provide an alternate hypothesis which, if substantiated, may provide therapeutic opportunities for attenuating migraine frequency and severity. We suggest that in migraines, heightened sympathetic tone results in progressive central microvascular constriction. Suboptimal parenchymal blood flow, we suggest, activates nociceptors and triggers headache pain onset. Administration of NO donors could paradoxically promote constriction of the microvasculature as a consequence of larger upstream central artery vasodilatation. Inhibitors of NO production are reported to alleviate migraine pain. We describe how constriction of larger upstream arteries, induced by NO synthesis inhibitors, may result in a compensatory dilatory response of the microvasculature. The restoration of central capillary blood flow may be the primary mechanism for pain relief. Attenuating the propensity for central capillary constriction and promoting a more dilatory phenotype may reduce frequency and severity of migraines. Here, we propose consideration of two dietary nutraceuticals for reducing migraine risk: L-arginine and aged garlic extracts.

-1-Propenylcysteine, a sulfur compound in aged garlic extract, alleviates cold-induced reduction in peripheral blood flow in rat via activation of the AMPK/eNOS/NO pathway

Aged garlic extract (AGE) has been shown to improve peripheral circulatory disturbances in both clinical trials and experimental animal models. To investigate the effect of S-1-propenylcysteine (S1PC), a characteristic sulfur compound in AGE, on cold-induced reduction in tail blood flow of rat, Wistar rats were individually placed in a restraint cage and given the treatment with cold water (15˚C) after the oral administration of AGE or its constituents S1PC, S-allylcysteine (SAC) and S-allylmercaptocysteine (SAMC). After the cold-treatment the tail blood flow of rats was measured at the indicated times. The pretreatment with AGE (2 g/kg BW) and S1PC (6.5 mg/kg BW) significantly alleviated the reduction of rat tail blood flow induced by cold treatment. The effect of S1PC was dose-dependent and maximal at the dose of 6.5 mg/kg BW, whereas SAC and SAMC were ineffective. To gain insight into the mechanism of S1PC action, the concentration of nitrogen oxide metabolites (NOx) in the plasma and the levels of phosphorylated endothelial nitric oxide synthase (eNOS) and 5'-AMP-activated protein kinase (AMPK) in the aorta were measured. The pretreatment with S1PC significantly increased the plasma concentration of NOx as well as the level of phosphorylated form of AMPK and eNOS in the aorta after cold-treatment. The present findings suggest that S1PC is a major constituent responsible for the effect of AGE to alleviate the cold-induced reduction of peripheral blood flow in rat by acting on the AMPK/eNOS/NO pathway in the aorta.

Potential Health Benefit of Garlic Based on Human Intervention Studies: A Brief Overview

Garlic is a polyphenolic and organosulfur enriched nutraceutical spice consumed since ancient times. Garlic and its secondary metabolites have shown excellent health-promoting and disease-preventing effects on many human common diseases, such as cancer, cardiovascular and metabolic disorders, blood pressure, and diabetes, through its antioxidant, anti-inflammatory, and lipid-lowering properties, as demonstrated in several in vitro, in vivo, and clinical studies. The present review aims to provide a comprehensive overview on the consumption of garlic, garlic preparation, garlic extract, and garlic extract-derived bioactive constituents on oxidative stress, inflammation, cancer, cardiovascular and metabolic disorders, skin, bone, and other common diseases. Among the 83 human interventional trials considered, the consumption of garlic has been reported to modulate multiple biomarkers of different diseases; in addition, its combination with drugs or other food matrices has been shown to be safe and to prolong their therapeutic effects. The rapid metabolism and poor bioavailability that have limited the therapeutic use of garlic in the last years are also discussed.

Relieving the tension in hypertension: Food-drug interactions and anti-hypertensive mechanisms of food bioactive compounds

Hypertension is a global health problem. Statistics report from the World Health Organization reveals its prevalence in about a quarter of the world global population. Due to the complications associated with hypertension, it is required to be well managed or prevented pharmacologically or non-pharmacologically. Pharmacologically, the major antihypertensive drugs used are centrally acting sympatholytic drugs, diuretics, vasodilators, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers while non-pharmacological means of management include lifestyle changes, intake of diet or supplements with antihypertensive effects. Interestingly, the use of diet as a complement with drug intake has become very popular due to occurring side effects over time. Recent research efforts have revealed that foods such as fruits and vegetables contain bioactive substances that modulate the activities of macromolecules involved in the development, complications, and management of hypertension. PRACTICAL APPLICATIONS: Recent research efforts have suggested the efficacy of diets rich in fruits and vegetables in the management of hypertension. This review examines some of the mechanisms involved in the dietary management or prevention of hypertension by bioactive compounds found in foods. This review promotes the use of diet in the management of the condition and also suggests that precautions to be taken in the combined use of food and drugs.

Comparison Among Garlic, Berberine, Resveratrol,Hibiscus sabdariffa, GenusZizyphus, Hesperidin, Red Beetroot,Catha edulis,Portulaca oleracea, and Mulberry Leaves in the Treatment of Hypertension and Type 2 DM: A Comprehensive Review

Diabetes mellitus (DM) and hypertension are 2 of the most prevalent diseases with poor impact on health status worldwide. In most cases, they coexist with other metabolic disorders as well as cardiac, micro- and macrovascular complications. Many plants are known for their hypotensive, cardioprotective, and/or antidiabetic activities. Their active ingredients either identified and isolated or still utilized as herbal preparations of certain plant parts. The use of medicinal plants comprises the main basis for most of the traditional medicine (TM) systems and procedures. As conventional medicines seem insufficient to control such progressive diseases, herbal agents from TM could be used as adjuvant with good impact on disease control and progression as well as other concomitant health conditions. The aim of this study is to compare the efficacy of 10 different herbal medicines of botanical origin or herbal preparations in the management of hypertension and its cardiovascular complications and type 2 DM along with various coexisting health disorders. These herbal medicines are garlic, berberine, resveratrol, Hibiscus sabdariffa, Zizyphus ( oxyphylla, mucronate, jujube, rugosa), hesperidin, red beetroot, Catha edulis, mulberry leaves, and Portulaca oleracea.

Therapeutic role of garlic and vitamins C and E against toxicity induced by lead on various organs

Due to industrial and urban sewage, the metal contaminations in aquatic and terrestrial environments are increasing day by day, especially in developing countries. Despite the study of several years, we are inert far away from an actual medication for prolonged toxicity of heavy metals such as mercury, lead, cadmium etc. Lead is one of the most common heavy metals that possess toxicological effects on numerous tissues of animals as well as humans. Several toxic effects of lead on reproductive organs, renal system, central nervous system, liver, lungs, blood parameters, and bones have been reported. On the other hand, several reports depicted that garlic is operative in declining the absorption of lead in bones as well as soft tissues. A combination of vitamin C and vitamin E enhances the biological recovery induced by lead and mobilize the heavy metal such as lead from intra-cellular positions. This review provides therapeutic approaches such as vitamin C, vitamin E, and extract of garlic to treat the detrimental effects caused after the exposure of lead. These therapeutic strategies are beneficial for both the prevention and alleviation of lead noxiousness.