Dietary counseling: the ingredient for successfully addressing the use of herbal supplements and probiotics in chronic kidney disease

Synergetic response on herbal and probiotic applications: a review

Herbs and their by-products are important traditional medicines and food supplements; they provide numerous beneficial effects for animals. Consequently, probiotics are living cell organisms, nontoxic, and friendly microbes. Probiotics have numerous beneficial activities such as inhibition of pathogens, enhancement of the immune system, growth, disease resistance, improving water quality, reducing toxic effects, synthesis of vitamins, prevention of cancer, reduction of irritable bowel syndrome, and more positive responses in animals. Herbal and probiotic combinations have more active responses and produce new substances to enhance beneficial responses in animals. Herbal and probiotic mixture report is still limited applications for animals. However, the mechanisms by which they interact with the immune system and gut microbiota in animals are largely unclear. This review provides some information on the effect of herbal and probiotic blend on animals. This review discusses current research advancements to fulfill research gaps and promote effective and healthy animal production.

Traditional and complementary medicine in a nephrology department: practitioner knowledge and advice

BACKGROUND

Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety.

AIMS

To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients.

METHODS

This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used.

FINDINGS

This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment.

CONCLUSION

Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe.

Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

We performed this systematic review and meta-analysis to evaluate effects of probiotics on inflammation, uremic toxins, and gastrointestinal (GI) symptoms in end-stage renal disease (ESRD) patients.

METHODS

A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane Database from inception through October 2017. We included studies that assessed assessing effects of probiotics on inflammatory markers, protein-bound uremic toxins (PBUTs), and GI symptoms in ESRD patients on dialysis. Effect estimates from the individual study were extracted and combined utilizing random effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO; No. CRD42017082137.

RESULTS

Seven clinical trials with 178 ESRD patients were enrolled. There was a significant reduction in serum C-reactive protein (CRP) from baseline to post-probiotic course (≥ 2 months after treatment) with standardized mean difference (SMD) of - 0.42 (95% CI - 0.68 to - 0.16, p = 0.002). When compared to control, patients who received probiotics also had a significant higher degree of reduction in CRP level with SMDs of - 0.37 (95% CI - 0.72 to 0.03, p = 0.04). However, there were no significant changes in serum TNF-alpha or albumin with SMDs of - 0.32 (95% CI - 0.92 to 0.28, p = 0.29) and 0.16 (95% CI - 0.20 to 0.53, p = 0.39), respectively. After probiotic course, there were also significant decrease in PBUTs and improvement in overall GI symptoms (reduction in GI symptom scores) with SMDs of - 0.61 (95% CI - 1.16 to - 0.07, p = 0.03) and - 1.04 (95% CI - 1.70 to - 0.38, p = 0.002), respectively.

CONCLUSION

Our study demonstrates potential beneficial effects of probiotics on inflammation, uremic toxins, and GI Symptoms in ESRD patients. Future large-scale clinical studies are required to assess its benefits on other important clinical outcomes including patient mortality.

De novo synthesis of the sedative valerenic acid in Saccharomyces cerevisiae

Valeriana officinalis (Valerian) root extracts have been used by European and Asian cultures for millennia for their anxiolytic and sedative properties. However, the efficacy of these extracts suffers from variable yields and composition, making these extracts a prime candidate for microbial production. Recently, valerenic acid, a C15 sesquiterpenoid, was identified as the active compound that modulates the GABA_A channel. Although the first committed step, valerena-4,7(11)-diene synthase, has been identified and described, the complete valerenic acid biosynthetic pathway remains to be elucidated. Sequence homology and tissue-specific expression profiles of V. officinalis putative P450s led to the discovery of a V. officinalis valerena-4,7(11)-diene oxidase, VoCYP71DJ1, which required coexpression with a V. officinalis alcohol dehydrogenase and aldehyde dehydrogenase to complete valerenic acid biosynthesis in yeast. Further, we demonstrated the stable integration of all pathway enzymes in yeast, resulting in the production of 140 mg/L of valerena-4,7(11)-diene and 4 mg/L of valerenic acid in milliliter plates. These findings showcase Saccharomyces cerevisiae's potential as an expression platform for facilitating multiply-oxidized medicinal terpenoid pathway discovery, possibly paving the way for scale up and FDA approval of valerenic acid and other active compounds from plant-derived herbal medicines.