Effect of Cedar (Ziziphus spina-christi) topical solution in mild to moderate acne vulgaris: a randomized clinical study

Isolation and identification of novel selective antitumor constituents, sidrin and sidroside, from Zizyphus spina-christi

Background

The leaves of Zizyphus spina-christi (L.) Willd contain several compounds exhibiting different pharmacologic activities. However, studies on the cytotoxic activity of these compounds are limited.

Objectives

We aimed to investigate and isolate cytotoxic compounds with selective antitumor effects from the leaves of Z. spina-christi using bioassay-guided fractionation of methanol extract.

Methods

Powdered, dried leaves were subjected to methanol extraction and fractionated using n-hexane, chloroform, ethyl acetate, and n-butanol. Fractions with positive cytotoxicity against HeLa and THP-1 cell lines were further fractionated and eluted using various concentrations of organic solvents. Active compounds were isolated using different chromatographic methods and their chemical structures were determined using extensive spectroscopic methods, such as 1D NMR (¹H NMR, ¹³C NMR, and DEPT), 2D NMR (COSY, HMBC, and HMQC), HRFAB-MS, and IR. Furthermore, the cytotoxic effects of the isolated compounds were evaluated against 62 tumor cell lines (including HeLa and THP-1) in addition to normal bone marrow cells.

Results

The chloroform and aqueous methanol fractions of the leaves showed cytotoxic activity. Two compounds were successfully isolated and named "sidrin" (13-β-hydroxy-lup-20(30)-ene-2,3-β-epoxy-28-carboxylate) and "sidroside" (3-O-β-D-glucopyranosyl-(1-3)-α-L-arabinopyranosyl-jujubogenin-20-O-α-L-rhamnopyranoside). Sidrin exhibited cytotoxic activity against the human leukemia (Hl-60, RPMI-8226), lung cancer (A549, EKVX), breast cancer (BT-549, MDA-MB-231/ATCC), colon cancer (KM12), melanoma (M14, SK-MEL-5), and central nervous system (CNS) cancer (SF-295) cell lines, and selectivity was observed against the Hl-60, EKVX, BT-549, KM12, and SF-295 cell lines. In addition, sidrin was more active than sidroside and doxorubicin against the Hl-60 and EKVX cell lines. In contrast, sidrin had a similar effect to doxorubicin against the BT-549 and renal cancer (UO-31) cell lines. Sidroside was more selective against the leukemia (CCRF-CEM, MOLT-4), lung cancer (HOP-92, NCI-H322M), breast cancer (MDA-MB-468), melanoma (LOX IMVI), CNS cancer (SNB-19), ovarian cancer (OVCAR-8), renal cancer (UO-31, RXF 393), and prostate cancer (PC-3) cell lines. Both compounds exhibited similar activity against the breast cancer (MDA-MB-231, T-47D), colon cancer (HCC-2998, HCT-116), ovarian cancer (OVCAR-3), renal cancer (UO-31, 786-0, and SN 12C) cell lines. Normal bone marrow cells were unaffected at the same concentrations of sidrin and sidroside applied to tumor cells.

Conclusions

These results suggest tumor-selective cytotoxicity of sidrin and sidroside.

Ethnopharmacology, Biological Evaluation, and Chemical Composition of Ziziphus spina-christi (L.) Desf.: A Review

Medicinal plants are the primary raw materials used in the production of medicinal products all over the world. As a result, more study on plants with therapeutic potential is required. The tropical tree Ziziphus spina belongs to the Rhamnaceae family. Biological reports and traditional applications including management of diabetes and treatment of malaria, digestive issues, typhoid, liver complaints, weakness, skin infections, urinary disorders, obesity, diarrhoea, and sleeplessness have all been treated with different parts of Z. spina all over the globe. The plant is identified as a rich source of diverse chemical compounds. This study is a comprehensive yet detailed review of Z. spina based on major findings from around the world regarding ethnopharmacology, biological evaluation, and chemical composition. Scopus, Web of Science, BioMed Central, ScienceDirect, PubMed, Springer Link, and Google Scholar were searched to find published articles. From the 186 research articles reviewed, we revealed the leaf extract to be significant against free radicals, microbes, parasites, inflammation-related cases, obesity, and cancer. Chemically, polyphenols/flavonoids were the most reported compounds with a composition of 66 compounds out of the total 193 compounds reported from different parts of the plant. However, the safety and efficacy of Z. spina have not been wholly assessed in humans, and further well-designed clinical trials are needed to corroborate preclinical findings. The mechanism of action of the leaf extract should be examined. The standard dose and safety of the leaf should be established.

The Role of Bloodletting and Cupping in Severe Acute Urticaria and Angioedema as Skin Emergencies in Persian Medicine

Objectives

Some dermatological diseases can be life-threatening. Urticaria and angioedema are common reasons for patients to seek treatment at an emergency department. Severe, generalized urticaria and angioedema can endanger patients’ lives by involving the airways and causing anaphylactic shock. The humor-based Persian Medicine (PM) concepts of Shara and Mashara, referring to two kinds of skin lesions, have similarities to urticaria and angioedema, respectively. This article aims to provide scientific evidence regarding the application of PM as an early intervention strategy in the emergency management of urticaria and angioedema.

Methods

This was a narrative review of PM studies identified by searching medical databases using search terms related to these diseases, as well as risk-associated keywords such as “fatal”, “death”, “life-threatening”, “emergency”, “cupping”, and “bloodletting”. Data were then compared, interpreted, and analyzed.

Results

PM scholars consider the human body as a unified whole and believe in an inner power (Nature) which stems from the body. When the presence of excessive hot substances cause an imbalance of bodily humors, Nature directs their heated vapors sharply toward the skin, thus causing Shara and Mashara. If there is a high risk of inflammation spreading to vital organs under severe conditions, urgent manual interventions are crucial.

Conclusion

In serious conditions of urticaria and angioedema, Fasd or bloodletting and Hijama can be effective in speeding up the control of lesions and reducing morbidity and mortality. Consequently, the development of integrated Persian and conventional medicines may provide new therapeutic pathways for skin emergencies.

Genus Ziziphus for the treatment of chronic inflammatory diseases

Natural products and traditional medicine are rich sources for developing therapeutics for chronic inflammatory diseases. However, the way from natural products/traditional medicines to Western pharmaceutical practices is not always straightforward. According to the World Health Organization (WHO), chronic diseases are the greatest threat to human health. 3 of 5 people die due to chronic inflammatory disorders worldwide like chronic respiratory diseases, stroke, cardiovascular diseases, cancer, diabetes, and obesity. Various nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and pain, but there are many side effects of these drugs' administration. Medicinal plants have therapeutic anti-inflammatory effects with low or no side effects. Ziziphus plant species are generally safe and not toxic to humans. Many studies on the Ziziphus species have shown that their therapeutic properties are attributed to the roots, leaves and fruits. Unfortunately, Ziziphus species from different regions worldwide with anti-inflammatory properties have not been documented in a single review paper. Therefore, it is crucial to establish ethnobotanical knowledge and applications of Ziziphus species against chronic inflammatory diseases. The current article exhaustively reviews phytochemical profile, pharmacological studies, toxicological effects, and ethnobotanical uses of Genus Ziziphus in chronic anti-inflammatory diseases. The present review article also highlights the most promising experimental data on Ziziphus extracts and pure compounds active in clinical trials and animal models of chronic inflammatory diseases. This review would be a valuable resource for contemporary researchers in the field to understand the promising role of the Ziziphus genus in chronic inflammatory disorders.

Mechanistic support of traditional Persian medicine for the treatment of acne vulgaris: A scoping review

BACKGROUND

Acne vulgaris is one of the most prevalent skin diseases, which also contributes to many psychological problems. Despite the recent progress in the treatment of acne vulgaris, the necessity for discovering more effective solutions has motivated many lines of research on natural and medicinal plants. The Traditional Persian Medicine (TPM) introduced some plants and remedies for acne treatment. Given the universal welcome for herbal medicine, this review was performed to formally assess the evidence for herbal medicines for acne vulgaris in TPM.

METHODS

The medicinal plants used in this study for treating acne vulgaris were selected based on common references to the plants in five famous textbooks of TPM from different time periods. Then, the anti-inflammatory and anti-microbial effects of these medicinal plants were investigated according to the recent literature available in five electronic databases including Scopus, Web of Sciences, PubMed, Google Scholar, and Science Direct.

RESULTS

Twenty-one herbs were commonly references in traditional TPM texts as helpful for topical treatment of acne vulgaris. The data collected from the electronic databases demonstrated most of these plants (eg, Astragalus sarcocolla, Ficus carica, and Hordeum vulgare) have both anti-inflammatory and anti-microbial mechanisms, which may assist to treat acne vulgaris.

CONCLUSION

This scoping review demonstrated many medicinal plants recommended by TPM books have therapeutic potential for acne vulgaris via multiple mechanisms.