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Bian T, Corral P, Wang Y, Botello J, Kingston R, Daniels T, Salloum RG, Johnston E, Huo Z, Lu J, Liu AC, Xing C. Kava as a Clinical Nutrient: Promises and Challenges. Nutrients 2020; 12:E3044. [PMID: 33027883 PMCID: PMC7600512 DOI: 10.3390/nu12103044] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/20/2022] Open
Abstract
Kava beverages are typically prepared from the root of Piper methysticum. They have been consumed among Pacific Islanders for centuries. Kava extract preparations were once used as herbal drugs to treat anxiety in Europe. Kava is also marketed as a dietary supplement in the U.S. and is gaining popularity as a recreational drink in Western countries. Recent studies suggest that kava and its key phytochemicals have anti-inflammatory and anticancer effects, in addition to the well-documented neurological benefits. While its beneficial effects are widely recognized, rare hepatotoxicity had been associated with use of certain kava preparations, but there are no validations nor consistent mechanisms. Major challenges lie in the diversity of kava products and the lack of standardization, which has produced an unmet need for quality initiatives. This review aims to provide the scientific community and consumers, as well as regulatory agencies, with a broad overview on kava use and its related research. We first provide a historical background for its different uses and then discuss the current state of the research, including its chemical composition, possible mechanisms of action, and its therapeutic potential in treating inflammatory and neurological conditions, as well as cancer. We then discuss the challenges associated with kava use and research, focusing on the need for the detailed characterization of kava components and associated risks such as its reported hepatotoxicity. Lastly, given its growing popularity in clinical and recreational use, we emphasize the urgent need for quality control and quality assurance of kava products, pharmacokinetics, absorption, distribution, metabolism, excretion, and foundational pharmacology. These are essential in order to inform research into the molecular targets, cellular mechanisms, and creative use of early stage human clinical trials for designer kava modalities to inform and guide the design and execution of future randomized placebo controlled trials to maximize kava's clinical efficacy and to minimize its risks.
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Affiliation(s)
- Tengfei Bian
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Pedro Corral
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Yuzhi Wang
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Jordy Botello
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Rick Kingston
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Tyler Daniels
- Thorne Research Inc., Industrial Road, 620 Omni Dr, Summerville, SC 29483, USA;
| | - Ramzi G. Salloum
- Department of Health Outcome & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Edward Johnston
- The Association for Hawaiian Awa (kava), Pepe’ekeo, HI 96783, USA;
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Junxuan Lu
- Department of Pharmacology, Penn State University College of Medicine, Hershey, PA 17033, USA;
| | - Andrew C. Liu
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Chengguo Xing
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
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Boesenbergia rotunda: From Ethnomedicine to Drug Discovery. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:473637. [PMID: 23243448 PMCID: PMC3519102 DOI: 10.1155/2012/473637] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/06/2012] [Indexed: 01/11/2023]
Abstract
Boesenbergia rotunda is a herb from the Boesenbergia genera under the Zingiberaceae family. B. rotunda is widely found in Asian countries where it is commonly used as a food ingredient and in ethnomedicinal preparations. The popularity of its ethnomedicinal usage has drawn the attention of scientists worldwide to further investigate its medicinal properties. Advancement in drug design and discovery research has led to the development of synthetic drugs from B. rotunda metabolites via bioinformatics and medicinal chemistry studies. Furthermore, with the advent of genomics, transcriptomics, proteomics, and metabolomics, new insights on the biosynthetic pathways of B. rotunda metabolites can be elucidated, enabling researchers to predict the potential bioactive compounds responsible for the medicinal properties of the plant. The vast biological activities exhibited by the compounds obtained from B. rotunda warrant further investigation through studies such as drug discovery, polypharmacology, and drug delivery using nanotechnology.
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Bodkin R, Schneider S, Rekkerth D, Spillane L, Kamali M. Rhabdomyolysis associated with kava ingestion. Am J Emerg Med 2012; 30:635.e1-3. [DOI: 10.1016/j.ajem.2011.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 01/26/2011] [Indexed: 11/17/2022] Open
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Pospíšil J, Markó IE. Metathesis-based synthesis of 3-methoxy α,β-unsaturated lactones: total synthesis of (R)-kavain and of the C1–C6 fragment of jerangolid D. Tetrahedron Lett 2008. [DOI: 10.1016/j.tetlet.2007.12.113] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kamal A, Krishnaji T, Khanna GR. Chemoenzymatic synthesis of enantiomerically enriched kavalactones. Tetrahedron Lett 2006. [DOI: 10.1016/j.tetlet.2006.09.155] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Matsuda H, Hirata N, Kawaguchi Y, Naruto S, Takata T, Oyama M, Iinuma M, Kubo M. Melanogenesis stimulation in murine B16 melanoma cells by Kava (Piper methysticum) rhizome extract and kavalactones. Biol Pharm Bull 2006; 29:834-7. [PMID: 16595931 DOI: 10.1248/bpb.29.834] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Melanogenesis stimulation activity of aqueous ethanolic extracts obtained from several different parts of five Piper species, namely Piper longum, P. kadsura, P. methysticum, P. betle, and P. cubeba, were examined by using cultured murine B16 melanoma cells. Among them, the extract of P. methysticum rhizome (Kava) showed potent stimulatory effect on melanogenesis as well as P. nigrum leaf extract. Activity-guided fractionation of Kava extract led to the isolation of two active kavalactones, yangonin (2) and 7,8-epoxyyangonin (5), along with three inactive kavalactones, 5,6-dehydrokawain (1), (+)-kawain (3) and (+)-methysticin (4), and a glucosylsterol, daucosterin (6). 7,8-Epoxyyangonin (5) showed a significant stimulatory effect on melanogenesis in B16 melanoma cells. Yangonin (2) exhibited a weak melanogenesis stimulation activity.
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Affiliation(s)
- Hideaki Matsuda
- School of Pharmaceutical Sciences, Kinki University, Higashiosaka, Osaka, Japan.
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Raimundo JM, de Almeida RR, Velozo LSM, Kaplan MAC, Gattass CR, Zapata-Sudo G. In-vitro vasodilatory activity of the hexanic extract of leaves and stems from Piper truncatum Vell. in rats. J Pharm Pharmacol 2005; 56:1457-62. [PMID: 15525454 DOI: 10.1211/0022357044779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Several plants from the Brazilian Tropical Forest are used in folk medicine for treatment of hypertension and asthma. In this study, we investigated the effects of hexanic extracts of leaves (HLE) and stems (HSE) from Piper truncatum on the contractility of cardiac, vascular and tracheal smooth muscles. Twitches of cardiac muscles obtained with electrical stimulation were recorded before and after exposure to increasing concentrations of hexanic extracts. HLE and HSE respectively reduced significantly the amplitude of twitches to 57.05 +/- 11.63 and 61.58 +/- 5.70% of control in the presence of 100 microg mL(-1). Contractile response to a single concentration of adrenaline (epinephrine) was measured before and after exposure of rat aorta rings to HLE and HSE. Both extracts inhibited aorta contraction in a concentration-dependent manner. The concentration of 50% inhibitory effect (IC50) was 32.3 +/- 13.8 and 47.0 +/- 23.8 microg mL(-1) for HLE and HSE, respectively, in aorta with intact endothelium. HLE and HSE also reduced the acetylcholine-precontracted trachea in a concentration-dependent manner with maximal effect observed at 250 and 350 microg mL(-1), respectively. Vasodilatation and trachea relaxation induced by HLE and HSE could explain the use of Piper extracts to reduce blood pressure and bronchospasm.
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Affiliation(s)
- Juliana Montani Raimundo
- Departamento de Farmacologia Básica e Clínica, Instituto de Ciências Biomédicas, Bloco J, Universidade Federal do Rio de Janeiro, 21941-590 Rio de Janeiro, RJ, Brazil
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Smith TE, Djang M, Velander AJ, Downey CW, Carroll KA, Van Alphen S. Versatile Asymmetric Synthesis of the Kavalactones: First Synthesis of (+)-Kavain. Org Lett 2004; 6:2317-20. [PMID: 15228268 DOI: 10.1021/ol0493960] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
[reaction: see text] Three asymmetric pathways to the kavalactones have been developed. The first method is chiral auxiliary-based and utilizes aldol reactions of N-acetyl thiazolidinethiones followed by a malonate displacement/decarboxylation reaction. The second approach uses the asymmetric catalytic Mukaiyama additions of dienolate nucleophile equivalents developed by Carreira and Sato. Finally, tin-substituted intermediates, prepared by either of these routes, can serve as advanced general precursors of kavalactone derivatives via Pd(0)-catalyzed Stille couplings with aryl halides.
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Affiliation(s)
- Thomas E Smith
- Department of Chemistry, Williams College, Williamstown, Massachusetts 01267, USA.
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Raduege KM, Kleshinski JF, Ryckman JV, Tetzlaff JE. Anesthetic considerations of the herbal, kava. J Clin Anesth 2004; 16:305-11. [PMID: 15261327 DOI: 10.1016/j.jclinane.2003.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2002] [Revised: 08/21/2003] [Accepted: 08/21/2003] [Indexed: 11/30/2022]
Abstract
The herbal remedy, kava, is reviewed, with special focus on the anesthetic management of the perioperative patient. Consumption of kava has potential cardiovascular consequences that could manifest in the perioperative period. Kava may act through inhibition of sodium and calcium channels to cause direct decreases in systemic vascular resistance and blood pressure. Kava inhibits cyclooxygenase to potentially cause a decrease in renal blood flow and to interfere with platelet aggregation. Kava may also cause adverse neurologic effects because of benzodiazepine and antidepressant activities on noradrenergic and/or serotoninergic pathways that may potentiate benzodiazepine and induction anesthetic potency and cause excessive perioperative sedation. Patients often do not disclose their use of herbal substances, and drug interaction can occur without being suspected as the cause for a change in patient homeostasis. A role for patient education about the potential adverse consequences of kava use in the perioperative period is suggested.
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Affiliation(s)
- Kevin M Raduege
- Division of Anesthesiology and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Kava ban highly questionable: a brief summary of the main scientific findings presented in the “in depth investigation on EU member states market restrictions on kava products”. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/j.sigm.2004.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Anxiety disorders are among the most common psychiatric disorders that affect all age groups of the general population. Currently, the preferred treatment is with pharmacological drugs that have antidepressant or anti-anxiety properties. However, these agents have numerous and often serious adverse effects, including sedation, impaired cognition, ataxia, aggression, sexual dysfunction, tolerance and dependence. Withdrawal reactions on termination after long-term administration are also a major limiting factor in the use of these agents. Herbal remedies, including kava (Piper methysticum), have been shown to be effective as alternative treatments, at least in mild to moderate cases of anxiety. Kava is a social and ceremonial herb from the South Pacific. It is available in the west as an over-the-counter preparation. Its biological effects, due to a mixture of compounds called kavalactones, are reported to include sedative, anxiolytic, antistress, analgesic, local anaesthetic, anticonvulsant and neuroprotective properties. The pharmacological properties of kava are postulated to include blockade of voltage-gated sodium ion channels, enhanced ligand binding to gamma-aminobutyric acid (GABA) type A receptors, diminished excitatory neurotransmitter release due to calcium ion channel blockade, reduced neuronal reuptake of noradrenaline (norepinephrine), reversible inhibition of monoamine oxidase B and suppression of the synthesis of the eicosanoid thromboxane A(2), which antagonises GABA(A) receptor function. Clinical studies have shown that kava and kavalactones are effective in the treatment of anxiety at subclinical and clinical levels, anxiety associated with menopause and anxiety due to various medical conditions. Until recently, the adverse effects attributed to kava use were considered mild or negligible, except for the occurrence of a skin lesion. This disorder, called kava dermopathy, occurs only with prolonged use of large amounts of kava and is reversible on reduced intake or cessation. Rare cases of interactions have occurred with pharmaceutical drugs that share one or more mechanisms of action with the kavalactones. In the past few years, about 35 cases of severe liver toxicity associated with kava intake have been reported in Europe and the US. However, a direct causal relationship with kava use has been difficult to establish in the majority of the cases, and there is insufficient evidence to implicate kava as the responsible agent. Nevertheless, until further research clarifies any causality, kava should be used with caution.
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Affiliation(s)
- Yadhu N Singh
- College of Pharmacy, South Dakota State University, Brookings, South Dakota 57007, USA.
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Abstract
Kava-kava (Piper methysticum G. Forster) has been used in social and ceremonial life in the Pacific islands from ancient times for the soporific and narcotic effects. Today several extracts standardized in the biologically active constituents kavalactones are marketed both as herbal medicinal products for anxiety disorders and as dietary supplements to improve stress disorders, nervous tension and restlessness. Unlike other substances used for these purposes, kava-kava has been shown to have minimal negative effects, and possibly positive effects, on reaction time and cognitive processing. Furthermore, it decreases anxiety without the loss of mental acuity. Although kava-kava has been found to be very effective, well tolerated, and non-addictive at therapeutic dosages, potential side effects can occur when very high doses are taken for extended periods. In addition, in the last two years unexpected high liver toxicity has been reported in two patients. Until now no studies support the liver toxicity of kavalactones and it is unknown which compound could have provoked the liver disease. On the other hand, it should be possible that unknown or unexpected constituents are the responsible or contributed to the liver toxicity.
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Affiliation(s)
- Anna Rita Bilia
- Department of Pharmaceutical Science, University of Florence, Firenze, Italy.
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Shao Y, He K, Zheng B, Zheng Q. Reversed-phase high-performance liquid chromatographic method for quantitative analysis of the six major kavalactones in Piper methysticum. J Chromatogr A 1998. [DOI: 10.1016/s0021-9673(98)00699-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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