Effects of Choto-san on hemorheological factors and vascular function in stroke-prone spontaneously hypertensive rats

Hypertension as an Underlying Cause of Headache or Dizziness and the Usefulness of Choto-San for Both Diagnostic and Therapeutic Purposes

Background Though headache, head discomfort, and dizziness are major complaints in neurosurgical outpatient departments in Japan, these nonspecific complaints are sometimes troublesome to treat, and most symptomatic treatments are not always sufficient to resolve patients' complaints. Objective This retrospective study was conducted to identify potential hypertension underlying symptoms relating to the head by prescribing choto-san, because patients with such symptoms were found to have relatively high blood pressure, and we realized that Kampo medicine was potentially effective for resolving the patients' conditions. Methods A total of 171 patients making their first visit to the neurosurgical outpatient division of our institution from January 2020 to June 2022 were investigated retrospectively. Symptoms were classified into three categories: headache, head discomfort, and dizziness. The effectiveness of choto-san, the rate of potential hypertension, and whether improvement in symptoms had a strong relationship with the prescription of choto-san were investigated. Results Choto-san significantly improved outcomes, with an odds ratio of 3.13 (95% confidence interval 1.83-5.35, p<0.001) for choto-san and 5.50 (95% confidence interval 1.24-24.4, p=0.025) for antihypertensives. The rate of choto-san prescription was significantly higher in patients who were diagnosed with hypertension (test of independence p<0.001). Choto-san was thought to be the most effective for the aforesaid symptoms with accompanying potential hypertension. Conclusion Hypertension was shown to be one of the main causes of various nonspecific complaints. Choto-san was an effective medicine not only for improving patients' subjective symptoms but also for identifying potential hypertension, which may lead to the prevention of cerebrovascular diseases.

Choto-san versus placebo for patients with dementia: systematic review and meta-analysis

BACKGROUND

Choto-san is a traditional medicine used for hypertension and headaches in Japan and China. Some studies have shown its effectiveness in the treatment of dementia. The present review aimed to assess the effectiveness and acceptability of Choto-san in the treatment of adults with cognitive impairment.

METHODS

We included randomized controlled trials comparing Choto-san with placebo for patients with dementia or mild cognitive impairment.

RESULTS

Three randomized controlled trials evaluating 219 participants were included. Two were studies on vascular dementia, and the other was on Alzheimer's dementia. There was no difference between Choto-san and placebo in terms of short-term dichotomous judgement of improvement, but Choto-san was more effective than placebo in terms of short-term improvement of cognitive function as measured by continuous outcomes. Also, dropouts judged it to be acceptable. However, the results were imprecise and/or heterogeneous. The number of participants included in the analysis was small (n = 199 in the primary analysis) and sometimes inconsistent, as indicated by the large I ² (72% in the primary analysis).

CONCLUSION

Low-quality evidence was suggestive of Choto-san's efficacy for vascular dementia, but the present results may be overestimated. Studies with a larger sample size and conducted over longer periods should be performed. Regardless, Choto-san can be one of the choices for the treatment of vascular dementia as it is well tolerated.

Anti-atherosclerotic plants which modulate the phenotype of vascular smooth muscle cells

BACKGROUND

Cardiovascular disease (CVD) remains the leading cause of global death, with atherosclerosis being a major contributor to this mortality. Several mechanisms are implicated in the pathogenesis of this disease. A key element in the development and progression of atherosclerotic lesions is the phenotype of vascular smooth muscle cells. Under pathophysiologic conditions such as injury, these cells switch from a contractile to a synthetic phenotype that often possesses high proliferative and migratory capacities.

PURPOSE

Despite major advances made in the management and treatment of atherosclerosis, mortality associated with this disease remains high. This mandates that other approaches be sought. Herbal medicine, especially for the treatment of CVD, has been gaining more attention in recent years. This is in no small part due to the evidence-based values associated with the consumption of many plants as well as the relatively cheaper prices, easier access and conventional folk medicine "inherited" over generations. Sections: In this review, we provide a brief introduction about the pathogenesis of atherosclerosis then we highlight the role of vascular smooth muscle cells in this disease, especially when a phenotypic switch of these cells arises. We then thoroughly discuss the various plants that show potentially beneficial effects as anti-atherosclerotic, with prime attention given to herbs and plants that inhibit the phenotypic switch of vascular smooth muscle cells.

CONCLUSION

Accumulating evidence provides the justification for the use of botanicals in the treatment or prevention of atherosclerosis. However, further studies, especially clinical ones, are warranted to better define several pharmacological parameters of these herbs, such as toxicity, tolerability, and efficacy.

Medicinal uses, phytochemistry and pharmacology of the genus Uncaria

ETHNOPHARMACOLOGICAL RELEVANCE

The genus Uncaria belongs to the family Rubiaceae, which mainly distributed in tropical regions, such as Southeast Asia, Africa and Southeast America. Their leaves and hooks have long been thought to have healing powers and are already being tested as a treatment for asthma, cancer, cirrhosis, diabetes, hypertension, stroke and rheumatism. The present review aims to provide systematically reorganized information on the ethnopharmacology, phytochemistry and pharmacology of the genus Uncaria to support for further therapeutic potential of this genus. To better understanding this genus, information on the stereo-chemistry and structure-activity relationships in indole alkaloids is also represented.

MATERIAL AND METHODS

The literature study of this review is based on various databases search (SCIFinder, Science Direct, CNKI, Wiley online library, Spring Link, Web of Science, PubMed, Wanfang Data, Medalink, Google scholar, ACS, Tropicos, Council of Heads of Australasian Herbaria, The New York Botanical Garden, African Plants Database at Genera Botanical Garden, The Plant List and SEINet) and library search for Biological Abstract and some local books on ethnopharmacology.

RESULTS

19 species of the genus Uncaria are found to be important folk medicines in China, Malaysia, Phillippines, Africa and Southeast America, etc, and have been served for the treatment of asthma, rheumatism, hyperpyrexia, hypertension and headaches, etc. More than 200 compounds have been isolated from Uncaria, including indole alkaloids, triterpenes, flavonoids, phenols, phenylpropanoids, etc. As characteristic constituents, indole alkaloids have been considered as main efficacy component for hypertension, epilepsy, depressant, Parkinson's disease and Alzheimer's disease. In addition, pharmacokinetic and metabolism investigation reveal that the indole alkaloids are likely to be absorbed, metabolized and excreted at early time points. Moreover, the specific inhibition of CYP isozymes can regulate their hydroxylation metabolites at C-10 and C-11.

CONCLUSION

Preliminary investigations on pharmacological properties of the Uncaria species have enlightened their efficacious remedy for hypertension, asthma, cancer, diabetes, rheumatism and neurodegenerative diseases. To ensure the safety and effectiveness in clinical application, research on bioactive compounds, pharmacological mechanisms and toxicity of the genus Uncaria as well as the stereo-chemistry and structure-activity relationships of indole alkaloids seem very important.

Inhibitory activities of selected Kampo formulations on human aldose reductase

BACKGROUND

Diabetes complications include various symptoms such as diabetic neuropathy and cognitive disorders. Aldose reductase (AR) is the rate-limiting enzyme of the polyol pathway and is one of the causal factors of diabetes complications. In this study, the bioactivities of eight selected Kampo formulations that are currently in clinical use for diabetes complications were assessed using human AR (hAR) inhibitory activity as the primary parameter to explore the possibilities of novel clinical applications of these formulations in the treatment of diabetes complications.

METHODS

The hAR inhibitory activities of four Kampo formulations that are clinically used for diabetic neuropathy, four Kampo formulations that are used for cognitive disorders, and a total of 21 component crude drugs were measured. Furthermore, the hAR inhibitory activity of Glycyrrhizae Radix preparata was measured to determine the effect of frying, which is one of the specific processing of Glycyrrhizae Radix. hAR inhibitory activity was determined by measuring the rate of decline in the absorbance of NAPH at 340 nm using 0.5 mM NADPH, 10 mM D,L-glyceraldehyde, and 3.6 mU/mL hAR in phosphate buffer solution (0.2 M, pH 6.2).

RESULTS

All of the Kampo formulations exhibited significant hAR inhibitory activity; Chotosan exhibited particularly strong activity. Among the 21 crude drugs tested, adequate inhibitory activities were found for the following, in descending order of activity: Glycyrrhizae Radix > Paeoniae Radix > Chrysanthemi Flos > Cinnamomi Cortex > Phellodendri Cortex > Uncariae Uncis cum Ramulus > Bupleuri Radix. Glycyrrhizae Radix preparata exhibited an inhibitory activity that was nearly identical to that of Glycyrrhizae Radix.

CONCLUSIONS

Despite their seemingly different treatment objectives, all of the Kampo formulations that are clinically used for diabetes complications demonstrated significant hAR inhibitory activity. This activity might underlie the characteristic multi-target effects of Kampo formulations. Although the overall effect of a Kampo formulation is certainly difficult to evaluate based on specific herbal medications or components, the approach as taken in this study might nonetheless contribute to further advancement in the development of new drugs via the review of proper usage and re-examination of the chemical compounds from a new perspective.

The ethnobotanical, phytochemical and pharmacological profile of the genus Pinellia

The genus Pinellia (Araceae), consisting of nine species, is mainly distributed in Eastern Asia. In traditional medicine, some Pinellia species have long been used for the treatment of various ailments, such as cough, vomiting, inflammation, epilepsy, cervical cancer and traumatic injury. Pharmacological studies revealed that Pinellia species possess a wide range of biological activities including cytotoxic, anti-tumor, antiemetic, insecticidal, antitussive, antimicrobial and anticonvulsant activities. However, some species also showed significant toxicity such as reproductive toxicity, mucosal irritation and hepatotoxicity. Most of these bioactivities and toxicity can be explained by the presence of various alkaloids and lectins. This review summarizes the ethnopharmacological uses, phytochemical constituents, pharmacological activities and toxicity of Pinellia species.

HPLC separation of hesperidin and the C-2 epimer in commercial hesperidin samples and herbal medicines

Hesperidin (2S-form), the flavanone 7-O-glycoside, is the main constituent of some Citrus species. The peels of two Citrus species are used as a crude drug, Aurantii nobilis pericarpium, in the Japanese Pharmacopoeia and as components in Kampo formulae. Thus, HPLC analysis of hesperidin as a marker compound is needed for quality control of medicines. Hesperidin was separated from the corresponding C-2 epimer by normal-phase HPLC using a chiral column. Moreover, narirutin and neohesperidin were also separated from the corresponding C-2 epimer. The analyses of commercial hesperidin samples revealed that they contained the C-2 epimer and that the relative ratio of hesperidin to the epimer ranged from 92:8 to 59:41. The HPLC application to Citrus extracts suggested that naturally occurring hesperidin in Citrus has the 2S configuration; however, the dry extracts of rikkunshito and chotosan, which are Kampo formulations containing Aurantii nobilis pericarpium, were found to contain a considerable amount of the (2R)-epimer. These data suggest that the decoction process of the formulae partly converts hesperidin to the epimer. Because diastereomers differ from each other in physicochemical and biological activities, HPLC to separate hesperidin from the C-2 epimer should be introduced into the letter of approval for herbal medicines.

Antihypertensive Potential and Mechanism of Action of Astaxanthin: II. Vascular Reactivity and Hemorheology in Spontaneously Hypertensive Rats

The current study was designed to determine the effects of a dietary astaxanthin (ASX-O) on vascular reactivity in spontaneously hypertensive rats (SHR), in order to verify its antihypertensive action mechanism. We evaluated contractions induced by phenylephrine (Phe), angiotensin II (Ang II) and the xanthine/xanthine oxidase (Xan/XOD) system, and relaxations induced by sodium nitroprusside (SNP) as well as endothelium-dependent relaxations mediated by acetylcholine (ACh) in thoracic aorta of the SHR, with and without ASX-O intervention. We also investigated the effects of ASX-O on blood rheology using a microchannel array system. In this study, ASX-O showed a significant modulatory effect on nitric oxide (NO)-induced vasorelaxation by the NO-donor SNP (p<0.05). However, it did not show significant effects in restoring the impaired endothelium-dependent relaxation to ACh in the SHR. On the other hand, the constrictive effects by Phe, Ang II and Xan/XOD were ameliorated by ASX-O (p<0.05). ASX-O also demonstrated significant hemorheological effect by decreasing the microchannel transit time of whole blood. In conclusion, the results suggest that ASX-O may act in modulating the blood fluidity in hypertension, and that the antihypertensive effects of ASX-O may be exerted through mechanisms including normalization of the sensitivity of the adrenoceptor sympathetic pathway, particularly [alpha]-adrenoceptors, and by restoration of the vascular tone through attenuation of the Ang II- and reactive oxygen species (ROS)-induced vasoconstriction.

Inhibitory effect of Cho-Deung-San on human aortic smooth muscle cell migration induced by TNF-α through inhibition of matrix metalloproteinase-2 and -9 activity

The migration and matrix metalloproteinases (MMPs) production of vascular smooth muscle cells (VSMC) may play a key role in the development of atherosclerosis. A Korean traditional herbal formulation, Cho-Deung-San (CDS), which is composed of 11 herbal ingredients, has been used to treat vascular diseases for many centuries. In this study, we investigated the inhibitory effect of CDS on tumor necrosis factor-alpha (TNF-alpha)-induced human aortic smooth muscle cells (HASMC) migration and MMP-2 and -9 activity. The cytotoxocity of CDS on HASMC was very low (IC(50)>500 microg/ml) as measured by the XTT assay method. The Matrigel migration assay showed that CDS effectively inhibited the TNF-alpha-induced migration of HASMC as compared with the control group in a dose-dependent manner (IC(50)=85 microg/ml). To explain this inhibitory effect, the extracts prepared from CDS and its herbal ingredients were assayed for gelatin zymography. The results showed that CDS inhibited MMP-2 and -9 activity (IC(50)=180 and 75 microg/ml, respectively). Among the herbal ingredients of CDS, the hooks and stems of Uncaria sinensis (Oliv.) Havil (UR) has shown significant inhibition against MMP-2 and -9 activity. In addition, the inhibitory effect of UR against gelatinolytic activity of MMP-2 and -9 was higher than that of catechin and lower than that of epigallocatechin gallate. These results suggest that CDS could be used as potential antiatherosclerotic agent, and UR is major component of CDS for antimigration in TNF-alpha treated HASMC.

Choto-san prevents occurrence of stroke and prolongs life span in stroke-prone spontaneously hypertensive rats

The effects of long-term oral administration of choto-san (diao-teng-san in Chinese) extract on the occurrence of stroke and life span were investigated in stroke-prone spontaneously hypertensive rats (SHR-SPs). Twenty-four rats were ramdomized into three groups. From 8 weeks of age, 0.1% and 0.3% choto-san groups were given water containing 0.1% (150 mg/kg/day) and 0.3% (450 mg/kg/day) choto-san extract, respectively. A control group was given only water. The mean survival times of the control group, 0.1% and 0.3% choto-san groups were 122.1, 159.8 and 176.8 days, respectively. The percent survivals of both the 0.1% and 0.3% choto-san groups were significantly enhanced compared to the control (Kaplan-Meier analysis followed by log-rank test; 0.1% choto-san: p < 0.05; 0.3% choto-san: p < 0.05). Furthermore, the cumulative percent occurrence of neurological and behavioral signs accompying stroke in the 0.3% choto-san group was significantly inhibited compared to the control (p < 0.05). These results suggested that choto-san prevents the occurrence of stroke and prolongs the life span of SHR-SPs.