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Zhaogao L, Yaxuan W, Mengwei X, Haiyu L, Lin L, Delin X. Molecular mechanism overview of metabolite biosynthesis in medicinal plants. PLANT PHYSIOLOGY AND BIOCHEMISTRY : PPB 2023; 204:108125. [PMID: 37883919 DOI: 10.1016/j.plaphy.2023.108125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/21/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
Medicinal plants are essential and rich resources for plant-based medicines and new drugs. Increasing attentions are paid to the secondary metabolites of medicinal plants due to their unique biological activity, pharmacological action, and high utilization value. However, the development of medicinal plants is constrained by limited natural resources and an unclear understanding of the mechanisms underlying active medicinal ingredients, thereby rendering the utilization and exploration of secondary metabolites more challenging. Besides, with the advancement of research on biosynthesis and molecular metabolism of natural products from medicinal plants, the methods for studying the biological activity and pharmacological effects of these products are constantly evolving. In recent years, significant progress has been made in the biosynthetic pathways and related regulatory genes of secondary metabolites in medicinal plants, which has greatly advanced both basic research and the development of clinical applications for medicinal plants. In this review, we discuss the past two decades of international research on the development of medicinal plant resources, mainly focusing on the biosynthetic pathway of secondary metabolites, intracellular signal transduction processes, multi-omics applications, and the application of gene editing technology in related research progress. We also discuss future development trends to promote the deep mining and development of natural products from medicinal plants, providing a useful reference.
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Affiliation(s)
- Li Zhaogao
- Department of Cell Biology, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China.
| | - Wang Yaxuan
- Department of Cell Biology, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China.
| | - Xu Mengwei
- Department of Cell Biology, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China; Department of Medical Instrumental Analysis, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China.
| | - Liu Haiyu
- Department of Cell Biology, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China; Guizhou Provincial Demonstration Center of Basic Medical Experimental Teaching, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China.
| | - Li Lin
- Department of Cell Biology, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China.
| | - Xu Delin
- Department of Medical Instrumental Analysis, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China; Guizhou Provincial Demonstration Center of Basic Medical Experimental Teaching, Zunyi Medical University, No.6 Xuefuxi Road Xinpu District of Zunyi City, Zunyi, 563099, Guizhou, China.
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Prevalence of Use of Traditional, Complementary and Alternative Medicine by the General Population: A Systematic Review of National Studies Published from 2010 to 2019. Drug Saf 2022; 45:713-735. [PMID: 35788539 PMCID: PMC9296440 DOI: 10.1007/s40264-022-01189-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/13/2022]
Abstract
Introduction Traditional, complementary and alternative medicine (TCAM) refers to a broad range of health practices and products typically not part of the 'conventional medicine' system, and its use is substantial among the general population. TCAM products and therapies may be used in addition to, or instead of, conventional medicine approaches, and some have been associated with adverse reactions or other harms. Objectives The aims of this systematic review were to identify and examine recently published national studies globally on the prevalence of TCAM use in the general population, to review the research methods used in these studies and to propose best practices for future studies exploring prevalence of use of TCAM. Methods MEDLINE, Embase, CINAHL, PsycINFO and AMED were searched to identify relevant studies published since 2010. Articles/reports describing the prevalence of TCAM use in a national study among the general population were included. The quality of included studies was assessed using a risk of bias tool developed by Hoy et al. Relevant data were extracted and summarised. Results Forty studies from 14 countries, comprising 21 national surveys and one cross-national survey, were included. Studies explored the use of TCAM products (e.g. herbal medicines), TCAM practitioners/therapies, or both. Included studies used different TCAM definitions, prevalence time frames and data collection tools, methods and analyses, thereby limiting comparability across studies. The reported prevalence of use of TCAM (products and/or practitioners/therapies) over the previous 12 months was 24–71.3%. Conclusion The reported prevalence of use of TCAM (products and/or practitioners/therapies) is high, but may underestimate use. Published prevalence data varied considerably, at least in part because studies utilise different data collection tools, methods and operational definitions, limiting cross-study comparisons and study reproducibility. For best practice, comprehensive, detailed data on TCAM exposures are needed, and studies should report an operational definition (including the context of TCAM use, products/practices/therapies included and excluded), publish survey questions and describe the data-coding criteria and analysis approach used. Traditional, complementary and alternative medicine (TCAM) includes products (e.g. herbal medicines, dietary supplements) and therapies/practices (e.g. chiropractic, acupuncture), and is a popular healthcare choice for many people. This study systematically reviewed national surveys of TCAM use around the world. We identified studies carried out in 14 different countries and one continent (Europe) on the extent of use of TCAM in the general population. TCAM use was found to be substantial, ranging from 24 to 71.3% in different countries. National surveys use different methods and different survey questionnaires. Some studies did not publish the survey questionnaire that they used and/or did not describe the types of TCAM included in the study. This means that it is not possible to compare the results between countries or to do further data analysis. For example, the survey questions from different countries asked people if they had ‘used’ or ‘seen a practitioner’ for a specific therapy, such as homeopathy. These questions look similar, but could elicit different answers from people. This means that the answers to these questions cannot be pooled together or compared directly. Also, some studies collected information on use of a category of TCAM products, such as herbal medicines, but other studies collected information on use of specific herbal medicines, such as St John’s wort. New surveys of the extent of use of TCAM should provide full information on the types of TCAM products, practices and therapies included in the study and consider collecting comprehensive information on use of specific TCAM products, practices and therapies.
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Walusansa A, Asiimwe S, Nakavuma JL, Ssenku JE, Katuura E, Kafeero HM, Aruhomukama D, Nabatanzi A, Anywar G, Tugume AK, Kakudidi EK. Antibiotic-resistance in medically important bacteria isolated from commercial herbal medicines in Africa from 2000 to 2021: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2022; 11:11. [PMID: 35063036 PMCID: PMC8781441 DOI: 10.1186/s13756-022-01054-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/05/2022] [Indexed: 01/10/2023] Open
Abstract
Background Antimicrobial resistance is swiftly increasing all over the world. In Africa, it manifests more in pathogenic bacteria in form of antibiotic resistance (ABR). On this continent, bacterial contamination of commonly used herbal medicine (HM) is on the increase, but information about antimicrobial resistance in these contaminants is limited due to fragmented studies. Here, we analyzed research that characterized ABR in pathogenic bacteria isolated from HM in Africa since 2000; to generate a comprehensive understanding of the drug-resistant bacterial contamination burden in this region. Methods The study was conducted according to standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We searched for articles from 12 databases. These were: PubMed, Science Direct, Scifinder scholar, Google scholar, HerbMed, Medline, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, Commonwealth Agricultural Bureau Abstracts, African Journal Online, and Biological Abstracts. Prevalence and ABR traits of bacterial isolates, Cochran’s Q test, and the I2 statistic for heterogeneity were evaluated using MedCalcs software. A random-effects model was used to determine the pooled prevalence of ABR traits. The potential sources of heterogeneity were examined through sensitivity analysis, subgroup analysis, and meta-regression at a 95% level of significance. Findings Eighteen studies met our inclusion criteria. The pooled prevalence of bacterial resistance to at least one conventional drug was 86.51% (95% CI = 61.247–99.357%). The studies were highly heterogeneous (I2 = 99.17%; p < 0.0001), with no evidence of publication bias. The most prevalent multidrug-resistant species was Escherichia coli (24.0%). The most highly resisted drug was Ceftazidime with a pooled prevalence of 95.10% (95% CI = 78.51–99.87%), while the drug-class was 3rd generation cephalosporins; 91.64% (95% CI = 78.64–96.73%). None of the eligible studies tested isolates for Carbapenem resistance. Extended Spectrum β-lactamase genes were detected in 89 (37.2%) isolates, mostly Salmonella spp., Proteus vulgaris, and K. pneumonia. Resistance plasmids were found in 6 (5.8%) isolates; the heaviest plasmid weighed 23,130 Kilobases, and Proteus vulgaris harbored the majority (n = 5; 83.3%). Conclusions Herbal medicines in Africa harbor bacterial contaminants which are highly resistant to conventional medicines. This points to a potential treatment failure when these contaminants are involved in diseases causation. More research on this subject is recommended, to fill the evidence gaps and support the formation of collaborative quality control mechanisms for the herbal medicine industry in Africa.
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Affiliation(s)
- Abdul Walusansa
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda. .,Department of Medical Microbiology, Faculty of Health Sciences, Islamic University in Uganda, P. O. Box 2555, Kampala, Uganda. .,Department of Medical Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Mbale, Uganda.
| | - Savina Asiimwe
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
| | - Jesca L Nakavuma
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Jamilu E Ssenku
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
| | - Esther Katuura
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
| | - Hussein M Kafeero
- Department of Medical Microbiology, Faculty of Health Sciences, Islamic University in Uganda, P. O. Box 2555, Kampala, Uganda
| | - Dickson Aruhomukama
- Department of Immunology and Molecular Biology, Faculty of Health Sciences, Makerere University, Kampala, Uganda
| | - Alice Nabatanzi
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
| | - Godwin Anywar
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
| | - Arthur K Tugume
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
| | - Esezah K Kakudidi
- Department of Plant Sciences, Microbiology and Biotechnology, School of Biosciences, Makerere University, Kampala, Uganda
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Yeom J, Lee JM. Use of Complementary and Alternative Medicine (CAM) in Patients With Colorectal Cancer. Clin Nutr Res 2022; 11:255-263. [PMID: 36381470 PMCID: PMC9633969 DOI: 10.7762/cnr.2022.11.4.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
Abstract
This study was conducted to analyze the relationship between cancer-related stress and the types of complementary and alternative medicine (CAM) used by subjects diagnosed with colorectal cancer. The number of study subjects was 142, and for data analysis, descriptive statistics, t-test, χ2 test, logistic regression procedures were performed. Of the subjects, 114 were CAM users, who accounted for 79.6%. When it came to using CAM, 82 (72.6%) said they did “to prevent cancer recurrence.” The most popular reason for not using CAM was “to focus on treatment as instructed by the doctor,” with 22 (75.8%) respondents selecting the answer. Of those who used CAM, 79 (55.6%) said they took “dietary supplements,” followed by 65 (45.8%) who picked “vitamins and minerals.” Regarding CAM usage, ginger, aloe, swimming, and walking had the highest satisfaction (4.25 ± 0.71). The cancer-related stress of subjects who use CAM (18.21 ± 15.37) was higher than that of subjects who did not use CAM (10.11 ± 12.08). Logistic regression analysis determined that cancer-related stress were factors significantly associated with CAM use. Patients using CAM had higher cancer-related stress, suggesting that stress on cancer increased CAM interest. Safe and reliable CAM information and standardized recommendations should be provided to cancer survivors. We propose the development of training programs for CAM to improve communication between medical staff and patients and to protect patients.
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Affiliation(s)
- Jeongwon Yeom
- Department of Nursing, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
| | - Jung Mi Lee
- Department of Nursing, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea
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Ng JY, Tahir U, Dhaliwal S. Barriers, knowledge, and training related to pharmacists' counselling on dietary and herbal supplements: a systematic review of qualitative studies. BMC Health Serv Res 2021; 21:499. [PMID: 34034710 PMCID: PMC8147056 DOI: 10.1186/s12913-021-06502-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background Pharmacists are recognized as one of the most accessible healthcare providers and are licensed to advise patients on drugs and health products including dietary and herbal supplements (DHSs). The objective of this study was to identify barriers, knowledge, and training that pharmacists report related to DHSs counselling. Methods MEDLINE, EMBASE, AMED and CINAHL were systematically searched from database inception to May 8th, 2020. Eligible articles contained qualitative data with a specific focus on pharmacists’ perceived knowledge, training, and barriers to DHSs counselling. Relevant data were extracted, and a thematic analysis was conducted. Results Nineteen articles met the inclusion criteria. The following three main themes were identified: challenges to pharmacists obtaining DHSs education, postgraduate workplace challenges surrounding DHSs, and pharmacists’ perceived role and importance on DHSs. Low knowledge of DHSs and the limited regulations surrounding DHSs acting as a barrier to counselling were common findings supported by the eligible articles. Conclusions A lack of pharmacists’ knowledge and awareness of DHSs stems from a variety of factors including a lack of education and training in the field, limited regulations surrounding DHSs, and inadequate availability of DHS information resources in the pharmacy. Pharmacists were unable to confidently counsel patients due to these aforementioned factors in addition to reporting that they lacked time. Further research that reviews pharmacy education and workplace training, and improving DHS regulations are warranted future directions.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Umair Tahir
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Simran Dhaliwal
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Liu J, Mu W, Shi M, Zhao Q, Kong W, Xie H, Shi L. The Species Identification in Traditional Herbal Patent Medicine, Wuhu San, Based on Shotgun Metabarcoding. Front Pharmacol 2021; 12:607200. [PMID: 33664667 PMCID: PMC7921783 DOI: 10.3389/fphar.2021.607200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Traditional herbal patent medicine typically consists of multiple ingredients, making it challenging to supervise contamination by impurities and the improper use of raw materials. This study employed shotgun metabarcoding for the species identification of biological ingredients in traditional herbal patent medicine, Wuhu San. The five prescribed herbal materials found in Wuhu San were collected, and their reference sequences were obtained by traditional DNA barcoding using Sanger sequencing. Two lab-made and three commercial Wuhu San samples were collected, and a total of 37.14 Gb of shotgun sequencing data was obtained for these five samples using the Illumina sequencing platform. A total of 1,421,013 paired-end reads were enriched for the Internal Transcribed Spacer 2 (ITS2), psbA and trnH intergenic spacer region (psbA-trnH), maturase k (matK), and ribulose-1, 5-bisphosphate carboxylase (rbcL) regions. Furthermore, 80, 11, 9, and 8 operational taxonomic units were obtained for the ITS2, psbA-trnH, matK, and rbcL regions, respectively, after metagenomic assembly, annotation, and chimeric detection. In the two lab-made mock samples, all labeled ingredients in the Wuhu San prescription were successfully detected, and the positive control, Panax quinquefolius L., was detected in the HSZY172 mock sample. Three species, namely Angelica sinensis (Oliv.) Diels, Saposhnikovia divaricata (Turcz. ex Ledeb.) Schischk., and Carthamus tinctorius L., belonging to three labeled ingredients, Angelicae Sinensis Radix (Danggui), Saposhnikoviae Radix (Fangfeng), and Carthami Flos (Honghua), were detected in the three commercial samples. Angelica dahurica (Hoffm.) Benth. & Hook. f. ex Franch. & Sav., the original Angelicae Dahuricae Radix (Baizhi) species, was only detected in WHS003. Arisaema erubescens (Wall.) Schott, Arisaema heterophyllum Blume, or Arisaema amurense Maxim., the original Arisaematis Rhizoma (Tiannanxing) species, were not detected in any of the commercial samples, which could be attributed to the fact that this medicinal material underwent extensive processing. In addition, the Saposhnikovia divaricata adulterant was detected in all the commercial samples, while 24 fungal genera, including Aspergillus, were identified in both the lab-made and commercial samples. This study showed that shotgun metabarcoding provided alternative strategy and technical means for identifying prescribed ingredients in traditional herbal patent medicine and displayed the potential to effectively complement traditional methods.
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Affiliation(s)
- Jinxin Liu
- Hebei Key Laboratory of Study and Exploitation of Chinese Medicine, Chengde Medical University, Chengde, China.,Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Weishan Mu
- Hebei Key Laboratory of Study and Exploitation of Chinese Medicine, Chengde Medical University, Chengde, China
| | - Mengmeng Shi
- Hebei Key Laboratory of Study and Exploitation of Chinese Medicine, Chengde Medical University, Chengde, China
| | - Qing Zhao
- Hebei Key Laboratory of Study and Exploitation of Chinese Medicine, Chengde Medical University, Chengde, China
| | - Weijun Kong
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hongbo Xie
- Hebei Key Laboratory of Study and Exploitation of Chinese Medicine, Chengde Medical University, Chengde, China
| | - Linchun Shi
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Wang S, Li W, Yang J, Yang Z, Yang C, Jin H. Research Progress of Herbal Medicines on Drug Metabolizing Enzymes: Consideration Based on Toxicology. Curr Drug Metab 2020; 21:913-927. [PMID: 32819254 DOI: 10.2174/1389200221999200819144204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
Abstract
The clinical application of herbal medicines is increasing, but there is still a lack of comprehensive safety data and in-depth research into mechanisms of action. The composition of herbal medicines is complex, with each herb containing a variety of chemical components. Each of these components may affect the activity of metabolizing enzymes, which may lead to herb-drug interactions. It has been reported that the combined use of herbs and drugs can produce some unexpected interactions. Therefore, this study reviews the progress of research on safety issues caused by the effects of herbs on metabolizing enzymes with reference to six categories of drugs, including antithrombotic drugs, non-steroidal anti-inflammatory drugs, anti-diabetic drugs, statins lipid-lowering drugs, immunosuppressants, and antineoplastic drugs. Understanding the effects of herbs on the activity of metabolizing enzymes could help avoid the toxicity and adverse drug reactions resulting from the co-administration of herbs and drugs, and help doctors to reduce the risk of prescription incompatibility.
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Affiliation(s)
- Shuting Wang
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Wanfang Li
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Jianbo Yang
- Institute for Control of Chinese Traditional Medicine and Ethnic Medicine, National Institutes for Food and Drug Control, Beijing 100050, China
| | - Zengyan Yang
- Guangxi International Zhuang Medicine Hospital, Nanning, 530001, China
| | - Cuiping Yang
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
| | - Hongtao Jin
- New Drug Safety Evaluation Center, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, China
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Skiba MB, Hopkins LL, Hopkins AL, Billheimer D, Funk JL. Nonvitamin, Nonmineral Dietary Supplement Use in Individuals with Rheumatoid Arthritis. J Nutr 2020; 150:2451-2459. [PMID: 32805045 PMCID: PMC7540062 DOI: 10.1093/jn/nxaa197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/27/2020] [Accepted: 06/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Over-the-counter, natural product-based (nonvitamin, nonmineral) dietary supplement (NVNM DS) use is common in adults with rheumatoid arthritis (RA), a group at risk for drug-DS interactions, due to polypharmacy, but this use is underreported to health care providers. Recent dramatic changes in US sales of specific NVNM DS suggest that the prevalence and types of NVNM DS used in RA populations may also have shifted. OBJECTIVES A study was undertaken to identify current and past use of specific NVNM DS for RA disease treatment and to examine associations between use of NVNM DS, RA pharmaceuticals, and/or vitamin or mineral (VM) DS. METHODS We developed a survey instrument to capture current and ever use of specific NVNM DS, VM DS, and RA pharmaceuticals, with 696 subjects self-reporting an RA diagnosis recruited online or in clinic for survey participation. Analyses were limited to 611 subjects reporting RA diagnosis after age 18 y and treatment with specific RA pharmaceuticals. RESULTS Most participants reported DS use, with current usage prevalence 49.6% (n = 303), 83.5% (n = 510), or 87.6% (n = 535) for NVNM, VM, or any DS, respectively. While not having appeared in previous RA surveys, turmeric and ginger were among the top 3 NVNM DS in current use, along with fish oil/ω-3 (n-3) PUFA. Concurrent NVNM DS use was reported by 48.2% (n = 243) of participants currently using RA pharmaceuticals (n = 504) and was more common in those using disease-modifying antirheumatic drugs only (no biologics). Most methotrexate users (83%) reported concurrent folate supplementation, with one-third also using turmeric, which is notable because methotrexate and turmeric have been associated with hepatotoxicity. CONCLUSION Individuals with RA commonly use NVNM DS in combination with RA pharmaceuticals, including a previously undocumented but popular use of turmeric or ginger supplements with an unclear risk/benefit ratio.
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Affiliation(s)
- Meghan B Skiba
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA,Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Laura L Hopkins
- Department of Medicine, University of Arizona, Tucson, AZ, USA,Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Allison L Hopkins
- Department of Anthropology, Texas A&M University, College Station, TX, USA
| | - Dean Billheimer
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
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Enioutina EY, Job KM, Krepkova LV, Reed MD, Sherwin CM. How can we improve the safe use of herbal medicine and other natural products? A clinical pharmacologist mission. Expert Rev Clin Pharmacol 2020; 13:935-944. [PMID: 32730191 DOI: 10.1080/17512433.2020.1803739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Three major classes of natural products (NPs) for medicinal purposes or improving wellbeing are generally available in the US: conventional drugs of herbal origin, botanical drugs, and dietary supplements (DSs). Consumer consumption of DSs is growing annually. The U.S. FDA regulates conventional and botanical drugs for safety and efficacy; however, DSs are minimally regulated. AREAS COVERED This article will: i) highlight the importance of NP as a significant source of prescription drugs; ii) discuss differences in the regulation of conventional drugs of NP product, botanical drugs, and DSs; iii) discuss the safety and efficacy of DSs and iv) make recommendations for improvement of safety for minimally regulated NPs. EXPERT OPINION Toxicities associated with the use of NPs, including vitamins and DSs, are mainly due to excessive use and interactions with conventional drug(s) and may represent challenges for clinicians. Conventional and botanical-based prescription drugs are rarely associated with unknown toxicities. However, DSs are minimally regulated and can produce severe adverse effects. We believe that clinical pharmacologists can have a role in developing criteria for DS safety analysis. There is also the potential for a standardized NP stewardship program(s) and the development of NP policies and practices nationally and globally.
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Affiliation(s)
- Elena Y Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, UT, USA
| | - Kathleen M Job
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, UT, USA
| | - Lubov V Krepkova
- Toxicology Department, Center of Medicine, All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR) , Moscow, Russia
| | - Michael D Reed
- School of Medicine, Case Western Reserve University , Cleveland, OH, USA
| | - Catherine M Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine/Dayton Children's Hospital , Dayton, OH, USA
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Jyung H, Bhandiwad A, Handel MJ, Walter E, Teets R. Integrative medicine smart phrase pilot study: Evaluating an EHR tool to improve providers' attitudes, knowledge and use of herbal and dietary supplements. Explore (NY) 2020; 17:458-462. [PMID: 32624416 DOI: 10.1016/j.explore.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT While many patients use herbal and dietary supplements (H/DS) for wellness, disease prevention and treatment, providers still cite a lack of resources and formal training as barriers to responding to patients' inquiries about H/DS. Although the federal government, academic institutions and the private sector now offer more opportunities for education and research on H/DS, greater support in real time is needed to facilitate providers during the clinical encounter. OBJECTIVE This small, pilot study evaluates the effects of implementation of smart phrases in the electronic health record (EHR) and an educational intervention on providers' knowledge, attitude and use of H/DS in the clinical encounter. DESIGN, SETTING AND PARTICIPANTS The study was conducted at The Institute for Family Health (IFH), a Federally Qualified Health Center and academic health center which operates the Department of Family Medicine and Community Health in affiliation with the Icahn School of Medicine at Mount Sinai. Baseline and post-intervention surveys were conducted to explore providers' attitudes, knowledge and use of integrative medicine (IM) smart phrases on H/DS. MAIN OUTCOME MEASURES Providers' awareness of smart phrases of H/DS, knowledge of the content, confidence in using smart phrases to discuss H/DS, self-reported use of smart phrases were measured. RESULTS A total of 32 subjects participated in the intervention and completed the baseline survey. Only half of the participants were familiar with the IM smart phrases in our system and 12.5% felt they were aware of the information covered in these smart phrases. Eighteen of 32 participants completed the post-intervention assessment. The intervention was successful in statistically increasing participants' self-reported awareness of the information covered in the IM smart phrases (p<0.01). Increased confidence in using IM smart phrases to initiate patients on a new supplement showed statistical significance (p=0.03). There were no clear patterns in reported behavior changes following the training with the exception of a significant increase in the self-reported frequency of past month use of IM smart phrases during a patient visit (p=0.01). Lastly, there were no changes in the frequency of smart phrase use in the EHR. CONCLUSION The implementation and adoption of evidence-based use of H/DS in the clinical encounter requires a sustained educational component to make the availability of smart phrases via technology (EHR) an effective strategy.
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Affiliation(s)
- Hyowoun Jyung
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States.
| | - Anup Bhandiwad
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
| | - Marsha J Handel
- Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
| | - Eve Walter
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
| | - Raymond Teets
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
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11
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Chebii WK, Muthee JK, Kiemo K. The governance of traditional medicine and herbal remedies in the selected local markets of Western Kenya. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2020; 16:39. [PMID: 32590992 PMCID: PMC7320552 DOI: 10.1186/s13002-020-00389-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A lot of emphasis is often placed on modern governance systems and little or no attention is given to traditional governance practices which remain largely undocumented. The study aimed at finding out important traditional and modern governance practices that regulate traditional medicine sector in Western Kenya. MATERIALS AND METHODS The study was carried out in selected market centres of Western Kenya where the identified traditional medicine practitioners (TMPs) sell their traditional medicine. All consenting TMPs and professional experts were interviewed with the aid of a semi-structured questionnaire. Purposive sampling design with elements of snowball techniques was employed in tracing competent traditional medicine (TM) experts and relevant professional experts. The data collected was processed in Microsoft Excel and descriptive statistics performed. Pearson's chi-square statistics was carried out to determine the significance of the traditional and modern governance data sets using the STATA software. RESULTS Modern governance practices were not significantly different in all the market centres surveyed (p = 0.080). Equally, the traditional governance practices were also not significantly different in all the selected market centres (p = 1.000). CONCLUSIONS Traditional governance practices play an important role in the governance of traditional medicine and are shaped by the socio-cultural beliefs of the local communities. Modern governance practices, on the other hand, are widely perceived as top downregulation of the traditional medicine growing industry.
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Affiliation(s)
- Willy Kibet Chebii
- Department of Plant Science and Crop Protection, Wangari Maathai Institute for Peace and Environmental Studies, P.0 Box 29053, Kangemi, Nairobi, 00625, Kenya.
| | - John Kaunga Muthee
- Department of Clinical Studies, Wangari Maathai Institute for Peace and Environmental Studies, P.O Box 30197, Nairobi, 00100, Kenya
| | - Karatu Kiemo
- Department of Sociology, Wangari Maathai Institute for Peace and Environmental Studies, P.O Box 30197, Nairobi, 00100, Kenya
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12
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Ng JY, Garber A, Luong M, Cooley K, Busse JW. No improvement in disclosure of natural health product use to primary care medical doctors in the last 15 years: A survey of naturopathic patients. Complement Ther Clin Pract 2020; 39:101106. [PMID: 32379647 DOI: 10.1016/j.ctcp.2020.101106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/22/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of natural health products (NHPs) is common in North America. In 2003, we found that 42% of NHP users had not disclosed this information to their primary care medical doctors (MDs). We repeated our survey in 2018/2019 to explore if the rate of NHP use disclosure had improved. METHODS From November 2018-February 2019, a 21-item survey about NHP use and disclosure was administered to adult patients who visited the Robert Schad Naturopathic Clinic in Toronto, Canada. RESULTS Almost all patients surveyed were using NHPs (99%), and 46% were using NHPs and prescription medication concurrently. Consistent with our 2003 findings, 42% of respondents who used NHPs did not disclose this information to their MD. CONCLUSION Disclosure of NHP use to MDs by naturopathic patients is limited and remained unchanged over the past 15 years. Future research should explore primary care MDs' hesitancy to inquire about patient NHP use.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Anna Garber
- Department of Research, Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, North York, ON, M2K 1E2, Canada.
| | - Michelle Luong
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Kieran Cooley
- Department of Research, Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, North York, ON, M2K 1E2, Canada.
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Department of Anesthesia, McMaster University, 1280, Main Street West, Hamilton, Ontario, L8S 4K1, Canada; The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
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13
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HLA-A*02:01 allele is associated with tanshinone-induced cutaneous drug reactions in Chinese population. THE PHARMACOGENOMICS JOURNAL 2019; 20:408-414. [PMID: 31792370 DOI: 10.1038/s41397-019-0121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 11/09/2022]
Abstract
Tanshinone, a widely used Chinese patent medicine, has been confirmed to have various kinds of pharmacological effects although frequently causing cutaneous adverse drug reactions (cADRs). We aim to identify whether human leukocyte antigen (HLA) class I alleles are associated with tanshinone-induced cADRs in Han Chinese. The association study including 18 patients with tanshinone-induced cADRs, 67 tanshinone-tolerant volunteers, and two general population databases consisted of 10,689 and 169,995 healthy subjects was performed. The frequency of tanshinone-induced cADRs patients carrying HLA-A*02:01 was significantly higher when compared with the general control groups (OR = 6.25, Pc = 7.20 × 10-5; OR = 7.14, Pc = 8.00 × 10-6), and with the tolerant group (OR = 5.09, Pc = 0.024). The molecular docking assay confirmed high affinity of the ingredients of tanshinone towards HLA-A*02:01 (≤-7.5 kcal/mol). The result suggested HLA-A*02:01 may work as a promisingly predictive marker for tanshinone personalized therapy in Han Chinese.
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14
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Crighton E, Coghlan ML, Farrington R, Hoban CL, Power MW, Nash C, Mullaney I, Byard RW, Trengove R, Musgrave IF, Bunce M, Maker G. Toxicological screening and DNA sequencing detects contamination and adulteration in regulated herbal medicines and supplements for diet, weight loss and cardiovascular health. J Pharm Biomed Anal 2019; 176:112834. [DOI: 10.1016/j.jpba.2019.112834] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023]
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15
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Kellogg JJ, Paine MF, McCune JS, Oberlies NH, Cech NB. Selection and characterization of botanical natural products for research studies: a NaPDI center recommended approach. Nat Prod Rep 2019; 36:1196-1221. [PMID: 30681109 PMCID: PMC6658353 DOI: 10.1039/c8np00065d] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Covering: up to the end of 2018 Dietary supplements, which include botanical (plant-based) natural products, constitute a multi-billion-dollar industry in the US. Regulation and quality control for this industry is an ongoing challenge. While there is general agreement that rigorous scientific studies are needed to evaluate the safety and efficacy of botanical natural products used by consumers, researchers conducting such studies face a unique set of challenges. Botanical natural products are inherently complex mixtures, with composition that differs depending on myriad factors including variability in genetics, cultivation conditions, and processing methods. Unfortunately, many studies of botanical natural products are carried out with poorly characterized study material, such that the results are irreproducible and difficult to interpret. This review provides recommended approaches for addressing the critical questions that researchers must address prior to in vitro or in vivo (including clinical) evaluation of botanical natural products. We describe selection and authentication of botanical material and identification of key biologically active compounds, and compare state-of-the-art methodologies such as untargeted metabolomics with more traditional targeted methods of characterization. The topics are chosen to be of maximal relevance to researchers, and are reviewed critically with commentary as to which approaches are most practical and useful and what common pitfalls should be avoided.
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Affiliation(s)
- Joshua J. Kellogg
- Department of Chemistry & Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
| | - Mary F. Paine
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, Washington, USA
| | - Jeannine S. McCune
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Nicholas H. Oberlies
- Department of Chemistry & Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
| | - Nadja B. Cech
- Department of Chemistry & Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
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16
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Martinez-Farina CF, Driscoll S, Wicks C, Burton I, Wentzell PD, Berrué F. Chemical Barcoding: A Nuclear-Magnetic-Resonance-Based Approach To Ensure the Quality and Safety of Natural Ingredients. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:7765-7774. [PMID: 31240917 DOI: 10.1021/acs.jafc.9b01066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
One of the greatest challenges facing the functional food and natural health product (NHP) industries is sourcing high-quality, functional, natural ingredients for their finished products. Unfortunately, the lack of ingredient standards, modernized analytical methodologies, and industry oversight creates the potential for low quality and, in some cases, deliberate adulteration of ingredients. By exploring a diverse library of NHPs provided by the independent certification organization ISURA, we demonstrated that nuclear magnetic resonance (NMR) spectroscopy provides an innovative solution to authenticate botanicals and warrant the quality and safety of processed foods and manufactured functional ingredients. Two-dimensional NMR experiments were shown to be a robust and reproducible approach to capture the content of complex chemical mixtures, while a binary normalization step allows for emphasizing the chemical diversity in each sample, and unsupervised statistical methodologies provide key advantages to classify, authenticate, and highlight the potential presence of additives and adulterants.
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Affiliation(s)
- Camilo F Martinez-Farina
- Aquatic and Crop Resource Development , National Research Council of Canada , 1411 Oxford Street , Halifax , Nova Scotia B3H 3Z1 Canada
| | - Stephen Driscoll
- Trace Analysis Research Centre, Department of Chemistry , Dalhousie University , Post Office Box 15000, Halifax , Nova Scotia B3H 4R2 Canada
| | - Chelsi Wicks
- Trace Analysis Research Centre, Department of Chemistry , Dalhousie University , Post Office Box 15000, Halifax , Nova Scotia B3H 4R2 Canada
| | - Ian Burton
- Aquatic and Crop Resource Development , National Research Council of Canada , 1411 Oxford Street , Halifax , Nova Scotia B3H 3Z1 Canada
| | - Peter D Wentzell
- Trace Analysis Research Centre, Department of Chemistry , Dalhousie University , Post Office Box 15000, Halifax , Nova Scotia B3H 4R2 Canada
| | - Fabrice Berrué
- Aquatic and Crop Resource Development , National Research Council of Canada , 1411 Oxford Street , Halifax , Nova Scotia B3H 3Z1 Canada
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Kwon JH, Lee SC, Lee MA, Kim YJ, Kang JH, Kim JY, Lee HJ, Bae WK, Kim MJ, Chie EK, Kim J, Kim YH, Chung HC, Rha SY. Behaviors and Attitudes toward the Use of Complementary and Alternative Medicine among Korean Cancer Patients. Cancer Res Treat 2019; 51:851-860. [PMID: 31208165 PMCID: PMC6639220 DOI: 10.4143/crt.2019.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/07/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose A cross-sectional survey was conducted to explore the current awareness and use of complementary and alternative medicine (CAM), as well as attitudes toward CAM, in patients with cancer and their family members in South Korea. Materials and Methods Between September 21 and October 31, 2017, a 25-item questionnaire regarding CAM experiences among cancer patients and their family members was conducted in 10 oncology clinics in South Korea after institutional review board approval at each institution. Results In total, 283/310 patients were analyzed. The median age was 60 years, and 60% were male. Most of the patients were actively receiving anticancer treatment at the time of the survey. A total of 106 patients (37%) had experienced a median of two types (interquartile range, 1 to 3) of CAM. Belief in CAM (odds ratio [OR], 3.015; 95% confidence interval [CI], 1.611 to 5.640) and duration of disease (OR, 1.012; 95% CI, 1.004 to 1.020) were independent factors for using CAM in multivariable analysis. Belief in CAM was significantly associated with current use of CAM (OR, 3.633; 95% CI, 1.567 to 8.424). Lay referral was the most common reason for deciding to use CAM, and only 25% of patients (72/283) discussed CAM with their physicians. Conclusion Patient attitudes toward and confidence in CAM modalities were strongly associated with their CAM experiences, and only a small number of patients had an open discussion about CAM with their physicians. A patient education program for CAM is needed.
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Affiliation(s)
- Jung Hye Kwon
- Division of Hemato-Oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang-Cheol Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin Young Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Woo Kyun Bae
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Mi-Jung Kim
- Division of Medical Oncology, Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Kim
- Division of Colorectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yeul Hong Kim
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Baars EW, Zoen EBV, Breitkreuz T, Martin D, Matthes H, von Schoen-Angerer T, Soldner G, Vagedes J, van Wietmarschen H, Patijn O, Willcox M, von Flotow P, Teut M, von Ammon K, Thangavelu M, Wolf U, Hummelsberger J, Nicolai T, Hartemann P, Szőke H, McIntyre M, van der Werf ET, Huber R. The Contribution of Complementary and Alternative Medicine to Reduce Antibiotic Use: A Narrative Review of Health Concepts, Prevention, and Treatment Strategies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:5365608. [PMID: 30854009 PMCID: PMC6378062 DOI: 10.1155/2019/5365608] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022]
Abstract
AIM The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. METHODS We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. CONCLUSIONS CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.
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Affiliation(s)
- Erik W. Baars
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Eefje Belt-van Zoen
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | | | - David Martin
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Harald Matthes
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | | | - Georg Soldner
- Medical section of the Goetheanum, Rüttiweg 45 4143 Dornach, Switzerland
| | - Jan Vagedes
- ARCIM institute, Im Haberschlai 7, 70794 Filderstadt, Germany
| | | | - Olga Patijn
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
| | - Merlin Willcox
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Paschen von Flotow
- Sustainable Business Institute, Zehnthofstr. 1, 65375 Oestrich-Winkel, Germany
| | - Michael Teut
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | - Klaus von Ammon
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Madan Thangavelu
- European Ayurveda Association e.V., In den Forstwiesen 27, D- 56745 Bell, Germany
| | - Ursula Wolf
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | | | - Ton Nicolai
- Eurocam, Rue du Trône 194, 1050 Brussels, Belgium
| | - Philippe Hartemann
- University of Lorraine, School of Medicine, 7 avenue de la Forêt de Haye, 54500 Vandoeuvre-Nancy, France
| | - Henrik Szőke
- University of Pécs, 7622 Pécs, Vasvári Pál str. 4., Hungary
| | - Michael McIntyre
- Midsummer Clinic, Church Westcote, Chipping Norton, Oxon, Ox7 6SF, UK
| | - Esther T. van der Werf
- Taylor's University, School of Medicine, 1, Jalan Taylor's, 47500 Subang Jaya, Selangor D.E., Malaysia
- University of Bristol, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Roman Huber
- University of Freiburg, Faculty of Medicine, Breisacher Str. 115b, 79106 Freiburg, Germany
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Simmler C, Graham JG, Chen SN, Pauli GF. Integrated analytical assets aid botanical authenticity and adulteration management. Fitoterapia 2018; 129:401-414. [PMID: 29175549 PMCID: PMC5963993 DOI: 10.1016/j.fitote.2017.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 11/14/2017] [Accepted: 11/18/2017] [Indexed: 12/30/2022]
Abstract
This article reviews and develops a perspective for the meaning of authenticity in the context of quality assessment of botanical materials and the challenges associated with discerning adulterations vs. contaminations vs. impurities. Authentic botanicals are by definition non-adulterated, a mutually exclusive relationship that is confirmed through the application of a multilayered set of analytical methods designed to validate the (chemo)taxonomic identity of a botanical and certify that it is devoid of any adulteration. In practice, the ever-increasing sophistication in the process of intentional adulteration, as well as the growing number of botanicals entering the market, altogether necessitate a constant adaptation and reinforcement of authentication methods with new approaches, especially new technologies. This article summarizes the set of analytical methods - classical and contemporary - that can be employed in the authentication of botanicals. Particular emphasis is placed on the application of untargeted metabolomics and chemometrics. An NMR-based untargeted metabolomic model is proposed as a rapid, systematic, and complementary screening for the discrimination of authentic vs. potentially adulterated botanicals. Such analytical model can help advance the evaluation of botanical integrity in natural product research.
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Affiliation(s)
- Charlotte Simmler
- Center for Natural Product Technologies (CENAPT), United States; UIC/NIH Center for Botanical Dietary Supplements Research, Program for Collaborative Research in the Pharmaceutical Sciences (PCRPS), Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, United States
| | - James G Graham
- Center for Natural Product Technologies (CENAPT), United States
| | - Shao-Nong Chen
- Center for Natural Product Technologies (CENAPT), United States; UIC/NIH Center for Botanical Dietary Supplements Research, Program for Collaborative Research in the Pharmaceutical Sciences (PCRPS), Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, United States
| | - Guido F Pauli
- Center for Natural Product Technologies (CENAPT), United States; UIC/NIH Center for Botanical Dietary Supplements Research, Program for Collaborative Research in the Pharmaceutical Sciences (PCRPS), Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, United States.
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Shipkowski KA, Betz JM, Birnbaum LS, Bucher JR, Coates PM, Hopp DC, MacKay D, Oketch-Rabah H, Walker NJ, Welch C, Rider CV. Naturally complex: Perspectives and challenges associated with Botanical Dietary Supplement Safety assessment. Food Chem Toxicol 2018; 118:963-971. [PMID: 29626579 PMCID: PMC6087675 DOI: 10.1016/j.fct.2018.04.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Due to the extensive use of botanical dietary supplements by consumers in the United States, there is a need for appropriate research and data to support safety assessments. Complexity and variability, both natural and introduced, of botanical dietary supplements make research on these products difficult. Botanical dietary supplements are regulated by the Food and Drug Administration (FDA) under the Federal Food, Drug, and Cosmetic Act (FD&C Act), as amended by the 1994 Dietary Supplement Health and Education Act (DSHEA). They are regulated as a category of food, which differs from the regulation of pharmaceutical products. Both manufacturers and the FDA are faced with the challenge of determining the best approaches for evaluating and monitoring the safety of botanical products. High quality botanicals research requires accurate identification and characterization of the material being studied. Inconsistent results in efficacy studies of botanical dietary supplements have led to efforts to improve the rigor and reproducibility of research in the field. Addressing the challenges associated with botanical dietary supplement safety is a global effort requiring coordination between numerous stakeholders, including researchers, suppliers, manufacturers, and regulators, all of whom play a role in ensuring that high quality products are available on the market.
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Affiliation(s)
- Kelly A Shipkowski
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA; ICF International, Inc., Durham, NC, USA
| | - Joseph M Betz
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - Linda S Birnbaum
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - John R Bucher
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Paul M Coates
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - D Craig Hopp
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Duffy MacKay
- Council for Responsible Nutrition, Washington, DC, USA
| | | | - Nigel J Walker
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Cara Welch
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Cynthia V Rider
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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21
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Skiba MB, Luis PB, Alfarara C, Billheimer D, Schneider C, Funk JL. Curcuminoid Content and Safety-Related Markers of Quality of Turmeric Dietary Supplements Sold in an Urban Retail Marketplace in the United States. Mol Nutr Food Res 2018; 62:e1800143. [PMID: 29808963 PMCID: PMC6277232 DOI: 10.1002/mnfr.201800143] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/08/2018] [Indexed: 01/25/2023]
Abstract
SCOPE Turmeric is a top selling dietary supplement (DS) in the United States with rapidly expanding usage. Therefore, turmeric DS formulations available for sale in an urban US retail marketplace are analyzed, and point of sale information is related to measures of quality relevant to safety. METHODS AND RESULTS Eighty-seven unique turmeric DS are identified; a majority (94%) contained turmeric-derived curcuminoid extracts (TD-CE), which are combined with other bioactives in 47% of products, including piperine (24%), an additive that could alter the metabolism of concurrent medications. While curcuminoid content is within 80% of anticipated for a majority of products analyzed (n = 35), curcuminoid composition (% curcumin) did not meet US Pharmacopeia (USP) criteria for TD-CE in 59% and is suggestive of possible unlabeled use of synthetic curcumin in some. Lead content is associated with the inclusion of turmeric root and exceeded USP limits in one product. Residues of toxic class 1 or 2 solvents, which are not needed for TD-CE isolation, are present in 71% of products, although quantified levels were within USP-specified limits. CONCLUSION Assessment of turmeric DS quality at point of sale is difficult for consumers and may best be managed in partnership with knowledgeable healthcare professionals.
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Affiliation(s)
- Meghan B Skiba
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona,College of Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Paula B. Luis
- School of Medicine, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - Chelsea Alfarara
- College of Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Dean Billheimer
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona
| | - Claus Schneider
- School of Medicine, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - Janet L Funk
- College of Medicine, Department of Medicine, University of Arizona, Tucson, Arizona
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22
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Liu W, Li YL, Feng MT, Zhao YW, Ding X, He B, Liu X. Application of Feedback System Control Optimization Technique in Combined Use of Dual Antiplatelet Therapy and Herbal Medicines. Front Physiol 2018; 9:491. [PMID: 29780330 PMCID: PMC5945866 DOI: 10.3389/fphys.2018.00491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Aim: Combined use of herbal medicines in patients underwent dual antiplatelet therapy (DAPT) might cause bleeding or thrombosis because herbal medicines with anti-platelet activities may exhibit interactions with DAPT. In this study, we tried to use a feedback system control (FSC) optimization technique to optimize dose strategy and clarify possible interactions in combined use of DAPT and herbal medicines. Methods: Herbal medicines with reported anti-platelet activities were selected by searching related references in Pubmed. Experimental anti-platelet activities of representative compounds originated from these herbal medicines were investigated using in vitro assay, namely ADP-induced aggregation of rat platelet-rich-plasma. FSC scheme hybridized artificial intelligence calculation and bench experiments to iteratively optimize 4-drug combination and 2-drug combination from these drug candidates. Results: Totally 68 herbal medicines were reported to have anti-platelet activities. In the present study, 7 representative compounds from these herbal medicines were selected to study combinatorial drug optimization together with DAPT, i.e., aspirin and ticagrelor. FSC technique first down-selected 9 drug candidates to the most significant 5 drugs. Then, FSC further secured 4 drugs in the optimal combination, including aspirin, ticagrelor, ferulic acid from DangGui, and forskolin from MaoHouQiaoRuiHua. Finally, FSC quantitatively estimated the possible interactions between aspirin:ticagrelor, aspirin:ferulic acid, ticagrelor:forskolin, and ferulic acid:forskolin. The estimation was further verified by experimentally determined Combination Index (CI) values. Conclusion: Results of the present study suggested that FSC optimization technique could be used in optimization of anti-platelet drug combinations and might be helpful in designing personal anti-platelet therapy strategy. Furthermore, FSC analysis could also identify interactions between different drugs which might provide useful information for research of signal cascades in platelet.
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Affiliation(s)
- Wang Liu
- Institute of Interdisciplinary Integrative Biomedical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Long Li
- Institute for Personalized Medicine, State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Mu-Ting Feng
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Wei Zhao
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xianting Ding
- Institute for Personalized Medicine, State Key Laboratory of Oncogenes and Related Genes, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuan Liu
- Institute of Interdisciplinary Integrative Biomedical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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23
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Orr SL. The Evidence for the Role of Nutraceuticals in the Management of Pediatric Migraine: a Review. Curr Pain Headache Rep 2018; 22:37. [PMID: 29619575 DOI: 10.1007/s11916-018-0692-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Nutraceuticals are a form of complementary and alternative medicine that is commonly used by children and adolescents with migraine. In this review, observational studies, randomized controlled trials, systematic reviews, and meta-analyses on the efficacy and safety of single compound nutraceuticals for the management of migraine in children and adolescents were identified through a literature search of MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials. RECENT FINDINGS Twenty-one studies were reviewed, of which 11 were observational studies, 7 were randomized controlled trials, and 3 were systematic reviews. Six different nutraceuticals were included in the review: vitamin D, riboflavin, coenzyme Q10, magnesium, butterbur, and polyunsaturated fatty acids. All but three of the studies assessed the role of nutraceuticals in migraine prevention, while three studies evaluated the role of intravenous magnesium for acute migraine management. Overall, the quality and size of the studies were limited. Due to low quality evidence and limited studies, no definite conclusions can be drawn on the efficacy of nutraceuticals for the treatment of pediatric migraine. Future studies are warranted in order to establish evidence upon which to define the role of nutraceuticals in this patient population.
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Affiliation(s)
- Serena L Orr
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
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24
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Binns CW, Lee MK, Lee AH. Problems and Prospects: Public Health Regulation of Dietary Supplements. Annu Rev Public Health 2018; 39:403-420. [DOI: 10.1146/annurev-publhealth-040617-013638] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Colin W. Binns
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia;,
| | - Mi Kyung Lee
- School of Health Professions, Murdoch University, Perth, Western Australia 6150, Australia
| | - Andy H. Lee
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia;,
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25
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Muhammad U, Lu H, Wang J, Han J, Zhu X, Lu Z, Tayyaba S, Hassan YI. Optimizing the Maximum Recovery of Dihydromyricetin from Chinese Vine Tea, Ampelopsis grossedentata, Using Response Surface Methodology. Molecules 2017; 22:E2250. [PMID: 29258286 PMCID: PMC6150019 DOI: 10.3390/molecules22122250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 12/21/2022] Open
Abstract
This work provides an optimized extraction approach intended to maximize the recovery of dihydromyricetin (DHM) from Chinese vine tea (Ampelopsis grossedentata) leaves. The presented work adopts a Box-Behnken design as a response surface methodology to understand the role and influence of specific extraction parameters including: time, temperature, and solvent composition/ethanol (%) on DHM final yields. Initially, single factor experiments were used to delineate the role of above factors (temperature, time, and solvent composition) before proceeding with three factors-three levels Box-Behnken design with 17 separate runs to assess the effect of multifactorial treatments on DHM recovery rates. The collected data shows that independent variables (solvent composition, time, and temperature) can significantly affect DHM recovery rates with maximum yields resulting from a combined 60 °C, 60% aqueous ethanol, and 180 min treatment. From the empirical point of view, the above optimized extraction protocol can substantially enhance processing and profitability margins with a minimum need of interventions or associated costs.
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Affiliation(s)
- Umair Muhammad
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
| | - Hedong Lu
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
| | - Juan Wang
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
| | - Jinzhi Han
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
| | - Xiaoyu Zhu
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
| | - Zhaoxin Lu
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
| | - Sultana Tayyaba
- College of Public Administration, Nanjing Agricultural University, Nanjing 210095, China.
| | - Yousef I Hassan
- Guelph Research and Development Centre, Agriculture & Agri-Food Canada, 93 Stone Road West, Guelph, ON N1G 5C9, Canada.
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26
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Wegener T. Patterns and Trends in the Use of Herbal Products, Herbal Medicine and Herbal Medicinal Products. ACTA ACUST UNITED AC 2017. [DOI: 10.15406/ijcam.2017.09.00317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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