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Yeom JW, Cho CH. Herbal and Natural Supplements for Improving Sleep: A Literature Review. Psychiatry Investig 2024; 21:810-821. [PMID: 39086164 PMCID: PMC11321869 DOI: 10.30773/pi.2024.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/30/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVE Herbal and natural supplements have gained popularity as alternative treatments to insomnia and sleep disorders due to their perceived safety and potential effectiveness. This literature review summarizes the current evidence on the efficacy, safety, and mechanisms of action of commonly used supplements for sleep, including valerian, hops, kava, German chamomile, cherry, tryptophan, theanine, melatonin, magnesium, and zinc. METHODS We conducted literature review of clinical research on herbal and supplements for sleep reported to date. We summarized key findings and reviewed outcomes related to clinical efficacy and side effects. RESULTS Findings suggest that certain supplements, particularly valerian, hops, and melatonin, could be effective in improving sleep quality and reducing insomnia symptoms through modulation of neurotransmitter systems and regulation of sleep-wake cycles. However, the strength of the evidence varies with unestablished optimal dosages, formulations, and treatment durations. Although generally considered safe, these supplements are not without risks, such as rare but serious adverse effects associated with kava and potential interactions with prescription medications. The quality and purity of supplements also vary widely due to a lack of strict regulations. CONCLUSION Healthcare providers should remain informed about the latest research and work closely with patients to develop personalized treatment plans. Herbal and natural supplements may offer promising alternatives or adjunct treatments for insomnia and sleep disorders, but their use should be guided by the best available evidence and individual patient requirements. Larger, well-designed clinical trials are needed to establish the efficacy and safety of these supplements for clinical decision-making.
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Affiliation(s)
- Ji Won Yeom
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Savage K, Sarris J, Hughes M, Bousman CA, Rossell S, Scholey A, Stough C, Suo C. Neuroimaging Insights: Kava's ( Piper methysticum) Effect on Dorsal Anterior Cingulate Cortex GABA in Generalized Anxiety Disorder. Nutrients 2023; 15:4586. [PMID: 37960239 PMCID: PMC10649338 DOI: 10.3390/nu15214586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/07/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Generalised Anxiety Disorder (GAD) is a prevalent, chronic mental health disorder. The measurement of regional brain gamma-aminobutyric acid (GABA) offers insight into its role in anxiety and is a potential biomarker for treatment response. Research literature suggests Piper methysticum (Kava) is efficacious as an anxiety treatment, but no study has assessed its effects on central GABA levels. This study investigated dorsal anterior cingulate (dACC) GABA levels in 37 adult participants with GAD. GABA was measured using proton magnetic resonance spectroscopy (1H-MRS) at baseline and following an eight-week administration of Kava (standardised to 120 mg kavalactones twice daily) (n = 20) or placebo (n = 17). This study was part of the Kava for the Treatment of GAD (KGAD; ClinicalTrials.gov: NCT02219880), a 16-week intervention study. Compared with the placebo group, the Kava group had a significant reduction in dACC GABA (p = 0.049) at eight weeks. Baseline anxiety scores on the HAM-A were positively correlated with GABA levels but were not significantly related to treatment. Central GABA reductions following Kava treatment may signal an inhibitory effect, which, if considered efficacious, suggests that GABA levels are modulated by Kava, independent of reported anxiety symptoms. dACC GABA patterns suggest a functional role of higher levels in clinical anxiety but warrants further research for symptom benefit. Findings suggest that dACC GABA levels previously un-examined in GAD could serve as a biomarker for diagnosis and treatment response.
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Affiliation(s)
- Karen Savage
- Centre for Human Psychopharmacology, Swinburne University of Technology, 427-451 Burwood Road, Melbourne 3122, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne 3121, Australia
| | - Jerome Sarris
- Florey Institute of Neuroscience and Mental Health, Melbourne University, Melbourne 3121, Australia
- NICM Health Research Institute, Western Sydney University, Sydney 2751, Australia
| | - Matthew Hughes
- Centre for Mental Health, Swinburne University of Technology, Melbourne 3122, Australia
| | - Chad A. Bousman
- Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology, and Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne 3122, Australia
- Mental Health, St Vincent’s Hospital Melbourne, Melbourne 3065, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, 427-451 Burwood Road, Melbourne 3122, Australia
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne 3168, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, 427-451 Burwood Road, Melbourne 3122, Australia
| | - Chao Suo
- Brain Park, Turner Institute of Brain and Mind, Monash University, Melbourne 3800, Australia
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Kavain ablates the radio-resistance of IDH-wildtype glioblastoma by targeting LITAF/NF-κB pathway. Cell Oncol (Dordr) 2023; 46:179-193. [PMID: 36464713 DOI: 10.1007/s13402-022-00743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Glioblastoma multiforma (GBM) is the most malignant intrinsic tumor of the central nervous system (CNS), with high morbidity of 3.19/100,000 per year and a poor 5-year survival rate (< 5%) worldwide. Numerous studies have indicated that GBM shows remarkable radioresistance and aggressive recurrence. However, the mechanisms to endow GBM cells with radioresistance are complex and unclear. METHODS Cell growth curve and colony formation assays were used to analyze the radioresistance of GBM. Immunoprecipitation and immunoblotting experiments were carried out to analyze protein expression and interaction. RESULTS In the present study, we found that LITAF, lipopolysaccharide (LPS)-induced tumor necrosis factor (TNF)-α factor, is up-regulated both in mRNA and protein in GBM tumors. Meanwhile, we observed that high LITAF expression contributes to radioresistance of GBM cell lines (including U87, U251, DK, and AM38 cells), indicated by knockout or knockdown of LITAF in cells sensitizing them to radiation treatment both in vitro and in vivo. Furthermore, we demonstrated that kavain, an active constituent of Piper methysticum Forst., effectively ablates GSC-like cells' (such as CD133 + U87, U251, DK, and AM38 populations) radioresistance in a LITAF-dependent manner. CONCLUSION In mechanism, our results indicated that 1) the elevation of LITAF in GBM cells activates the NF-κB pathway to promote mesenchymal transition, and 2) kavain disturbs STAT6B/LITAF protein interaction and then expels LITAF from the nucleus. Therefore, we consider that kavain may be a potential candidate to develop an irradiation therapy adjuvant for GBM.
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Pont-Fernandez S, Kheyfets M, Rogers JM, Smith KE, Epstein DH. Kava ( Piper methysticum) in the United States: the quiet rise of a substance with often subtle effects. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:85-96. [PMID: 36410029 DOI: 10.1080/00952990.2022.2140292] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Piper methysticum, commonly called kava, has long been consumed in beverage form in the Pacific Islands. Kava use in the US has slowly increased since the 1990s, but is not assessed in major epidemiological surveys.Objectives: To analyze social-media posts about kava from current, past, and prospective users, for motivations, patterns of co-use, and effects.Methods: Text from Reddit posts, and accompanying metadata, were collected and thematically coded by two independent raters.Results: 423 posts were collected, spanning January 2006 through December 2021. Of the 1,211 thematic codes applied, 1,098 (90. 7%) were concordant. Motivations for use bifurcated into self-treatment (for psychiatric or physical health conditions) and recreation; these were not mutually exclusive. Kava was rarely considered strongly euphoriant, but was valued as an anxiolytic. Kava was frequently used with other substances, most commonly kratom. Kava was used at lower doses for self-treatment than for other purposes (pseudo-R2 = 0.11). Undesirable effects (gastrointestinal upset, fatigue) were mentioned, though less often than benefits. Hepatotoxicity, reported elsewhere as a rare, non-dose-related risk, was disputed on the basis of its not having been experienced by those posting.Conclusion: Kava appears to be conceptualized among Reddit posters as an anxiolytic with few risks or adverse effects. As it grows in popularity, especially among people who use other drugs that are more liable to misuse or addiction, it should be assessed in probability samples (i.e. in the major national drug surveys) and clinical practice for its risks, potential benefits, and possible drug-drug interactions.
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Affiliation(s)
- Salma Pont-Fernandez
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Marina Kheyfets
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Jeffrey M Rogers
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - Kirsten E Smith
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
| | - David H Epstein
- Real-world Assessment, Prediction, and Treatment Unit, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, USA
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Cheng C, Zhao S, Gu YL, Pang J, Zhao Y. Characterization and identification of the metabolites of dihydromethysticin by ultra-high-performance liquid chromatography orbitrap high-resolution mass spectrometry. J Sep Sci 2022; 45:2914-2923. [PMID: 35689602 DOI: 10.1002/jssc.202200250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Abstract
Dihydromethysticin, a natural component from Piper methysticum Forst, has been reported to display pharmacological effects in mental disorders and some malignant tumors. However, the metabolism of this component remained unknown. The goal of this work was conducted to discover the metabolic profiles of dihydromethysticin. The in vitro incubation was performed by incubating dihydromethysticin with rat, monkey, and human liver microsomes and hepatocytes. An analytical assay of ultra-high performance liquid chromatography combined with Orbitrap high-resolution mass spectrometry was utilized to detect and identify the metabolites. With high resolution mass spectrometric determination, the accurate mass, elemental composition, and product ions of the metabolites were determined, which enabled structural characterization to become easy. Under the present conditions, four phase-I metabolites, as well as six phase-II metabolites, were detected and their tentative structures were characterized by mass spectra. M4 was found as the most abundant metabolite both in liver microsomes and hepatocytes. Cytochrome P450 1A2, 2C9, and 3A4 contributed to the formation of this metabolite by using human recombinant P450 enzymes. M4 can be oxidized into reactive ortho-quinone intermediate followed by conjugating with glutathione. M4 was also subject to glucuronidation (M1 and M2) and methylation (M5). Demethylenation, oxidation, hydroxylation, glucuronidation, glutathionylation, and methylation were the primary metabolic pathways of dihydromethysticin. This study provides in vitro metabolism data of dihydromethysticin, which is indispensable for understanding the disposition of this compound.
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Affiliation(s)
- Cong Cheng
- Department of Pharmacy, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, P. R. China
| | - Shanshan Zhao
- Jiangsu Wanbang Pharmaceutical Technology Co. Ltd, P. R. China
| | - Yong-Li Gu
- Department of Pharmacy, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, P. R. China
| | - Jie Pang
- Department of Pharmacy, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, P. R. China
| | - Yanyun Zhao
- Department of Pharmacy, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, P. R. China
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Rotondo E, Riva A, Graziosi A, Pellegrino N, Di Battista C, Di Stefano V, Striano P. Non-pharmacological treatments for pediatric refractory epilepsies. Expert Rev Neurother 2022; 22:337-349. [PMID: 35320056 DOI: 10.1080/14737175.2022.2057847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Antiseizure medications (ASMs) are the primary treatment option for epilepsies of wide etiologies, however, about 10-20% of children do not gain sustained seizure control and in this case, it is worth investigating "alternative" therapeutic approaches aside from ASMs. Nowadays, non-pharmacological strategies for epilepsy treatment encompass dietary interventions, neurostimulation-based techniques, and biobehavioral approaches. AREAS COVERED A search on PubMed database was conducted. Experimental and clinical studies, as well as meta-analysis and structured reviews on the latest non-pharmacological treatments for drug-resistant epilepsy (DRE) in children, were included. Special attention is given to the efficacy and tolerability outcomes, trying to infer the role novel approaches may have in the future. EXPERT OPINION The large heterogeneity of primary clinical outcomes and the unavoidable subjective response of each patient to treatments prevents Researchers from the identification of a single, reliable, approach to treat DRE. The understanding of fine pathophysiologic processes is giving the way to the use of alternative therapies, such as the well-known ketogenic diet, in a "personalized" view of treatment. The goal is to apply the non-pharmacological treatment most suitable for the patient's sake.
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Affiliation(s)
- Eleonora Rotondo
- Division of Pediatrics and Neonatology, Ciri Hospital, ASL TO4, Ciri, Torino, Italy
| | - Antonella Riva
- Paeditric Neurology and Muscular Disease Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genova, Italy
| | - Alessandro Graziosi
- Department of Neuroscience Imaging and Clinical Sciences, University G. D'Annunzio, Chieti, Italy
| | - Noemi Pellegrino
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | | | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and advanced Diagnostic (BIND), University of Palermo, Italy
| | - Pasquale Striano
- Paeditric Neurology and Muscular Disease Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genova, Italy
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Dimmito MP, Stefanucci A, Della Valle A, Scioli G, Cichelli A, Mollica A. An overview on plants cannabinoids endorsed with cardiovascular effects. Biomed Pharmacother 2021; 142:111963. [PMID: 34332376 DOI: 10.1016/j.biopha.2021.111963] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/14/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022] Open
Abstract
Nowadays cardiovascular diseases (CVDs) are the major causes for the reduction of the quality of life. The endocannabinoid system is an attractive therapeutic target for the treatment of cardiovascular disorders due to its involvement in vasomotor control, cardiac contractility, blood pressure and vascular inflammation. Alteration in cannabinoid signalling can be often related to cardiotoxicity, circulatory shock, hypertension, and atherosclerosis. Plants have been the major sources of medicines until modern eras in which researchers are experiencing a rediscovery of natural compounds as novel therapeutics. One of the most versatile plant is Cannabis sativa L., containing phytocannabinoids that may play a role in the treatment of CVDs. The aim of this review is to collect and investigate several less studied plants rich in cannabinoid-like active compounds able to interact with cannabinoid system; these plants may play a pivotal role in the treatment of disorders related to the cardiovascular system.
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Affiliation(s)
- Marilisa Pia Dimmito
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Azzurra Stefanucci
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
| | - Alice Della Valle
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giuseppe Scioli
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Angelo Cichelli
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Adriano Mollica
- Department of Pharmacy, G. d'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
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Thomsen M, Schmidt M. Health policy versus kava (Piper methysticum): Anxiolytic efficacy may be instrumental in restoring the reputation of a major South Pacific crop. JOURNAL OF ETHNOPHARMACOLOGY 2021; 268:113582. [PMID: 33189846 DOI: 10.1016/j.jep.2020.113582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Kava (Piper methysticum G. Forst. f.) is by far the most important plant used in the islands of Melanesia, Polynesia and Micronesia for its relaxing effects. Kava drinking is a pillar of South Pacific societies and is also the foundation of their economies. Preparations of kava extract as herbal medicinal drugs were banned in Germany in 2002 and again in 2019, with dramatic consequences for the South Pacific economies. In 2002, the major regulatory argument for the ban of kava was safety issues. In 2019, the assessment report of the European Medicines Agency's Herbal Medicinal Product Committee (HMPC) justified a negative benefit-to-risk ratio by a supposed lack of efficacy of ethanolic extracts for an indication of which kava extract preparations never had an approval. In this HMPC report the efficacy in the approved indications 'nervous anxiety, tension and restlessness' was attributed to the extract branded as 'WS 1490', which was assumed to have been prepared with acetone as an extraction solvent. In addition to this change of indication and the attribution of efficacy to acetone kava extract alone, the German health authorities and the HMPC still refuse to discuss quality issues as a likely factor impacting drug safety. The first case reports of liver toxicity were observed with an acetone extract in a timely relationship with the introduction of 'two-day kava' instead of 'noble kava' as used in ethanolic kava extracts. AIM OF THE STUDY The correlation between clinical benefits and the type of extract preparation was examined. METHODS In order to identify the types of kava material and extracts used in clinical trials, the respective publications were compared with regulatory databases and protocols of a German regulatory advisory board. RESULTS AND CONCLUSIONS The comparison reveals inconsistencies in the regulatory decisions. In all studies with WS 1490, the evidence points to the use of an ethanolic extract. The efficacy of kava extract for the approved indication was clearly demonstrated. The HMPC report and the recent renewed German regulatory ban of kava therefore require major revision, which should include the impact of the use of "two-day kava" on drug safety. Such a revision could contribute to restoring the reputation of "noble kava" on the international markets.
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Affiliation(s)
- Michael Thomsen
- Discipline of Pharmacology, The University of Sydney Medical Schoo, Australia.
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Khan A, Akram M, Thiruvengadam M, Daniyal M, Zakki SA, Munir N, Zainab R, Heydari M, Mosavat SH, Rebezov M, Shariati MA. Anti-anxiety properties of selected medicinal plants. Curr Pharm Biotechnol 2021; 23:1041-1060. [PMID: 33480339 DOI: 10.2174/1389201022666210122125131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/21/2020] [Accepted: 12/27/2020] [Indexed: 11/22/2022]
Abstract
Exploration of new drugs targeting anxiety treatment is a major concern worldwide. Medicinal plants are being used as a potential source of novel drugs for anxiety disorders. The objective of this review is to provide information about the healing outcomes of anxiety treatment with natural products. Valeriana officinalis, Citrus aurantium, Commelina benghalensis, Achyranthes aspera, Mimosa pudica, Achillea millefolium, Nymphaea alba, Leonurus cardiac, Camellia sinensis, Turnera aphrodisiaca, Crataegus oxyacantha and Piper methysticum showed promising effects on anxiety in animal models. In clinical studies, passion flower, kava, valerian, St John's wort, and ashwagandha showed the most positive results. More studies are needed for the exploration of the anti-anxiety of medicinal plants. In drugs derived from natural sources have explored many components that are playing an essential role in curing anxiety disorders and associated complications.
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Affiliation(s)
- Asmatullah Khan
- Department of Eastern Medicine, University of Poonch, Rawalakot, Azad Jammu and Kashmir. Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | | | - Muhammad Daniyal
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Drug Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha. China
| | - Shahbaz Ahmad Zakki
- Department of Public Health, Faculty of Medicine, Graduate School of Medicine & Pharmaceutical Sciences, University of Toyama, Sugitani, Toyama 9300194. Japan
| | - Naveed Munir
- Department of Biochemistry, Government College University Faisalabad. Pakistan
| | - Rida Zainab
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | - Mojtaba Heydari
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz. Iran
| | - Seyed Hamdollah Mosavat
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz. Iran
| | - Maksim Rebezov
- V.M.Gorbatov Federal Research Center for Food System of Russian Academy of Science, Moscow. Russian Federation
| | - Mohammad Ali Shariati
- K.G.Razumovsky Moscow State University of technologies and management (the First Cossack University), Moscow109004. Russian Federation
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Wilson LM, White KM. Integrating complementary and alternative therapies into psychological practice: A qualitative analysis. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/j.1742-9536.2011.00022.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lee‐ann M. Wilson
- School of Public Health, Queensland University of Technology, Kelvin Grove, and
| | - Katherine M. White
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Bian T, Corral P, Wang Y, Botello J, Kingston R, Daniels T, Salloum RG, Johnston E, Huo Z, Lu J, Liu AC, Xing C. Kava as a Clinical Nutrient: Promises and Challenges. Nutrients 2020; 12:E3044. [PMID: 33027883 PMCID: PMC7600512 DOI: 10.3390/nu12103044] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/20/2022] Open
Abstract
Kava beverages are typically prepared from the root of Piper methysticum. They have been consumed among Pacific Islanders for centuries. Kava extract preparations were once used as herbal drugs to treat anxiety in Europe. Kava is also marketed as a dietary supplement in the U.S. and is gaining popularity as a recreational drink in Western countries. Recent studies suggest that kava and its key phytochemicals have anti-inflammatory and anticancer effects, in addition to the well-documented neurological benefits. While its beneficial effects are widely recognized, rare hepatotoxicity had been associated with use of certain kava preparations, but there are no validations nor consistent mechanisms. Major challenges lie in the diversity of kava products and the lack of standardization, which has produced an unmet need for quality initiatives. This review aims to provide the scientific community and consumers, as well as regulatory agencies, with a broad overview on kava use and its related research. We first provide a historical background for its different uses and then discuss the current state of the research, including its chemical composition, possible mechanisms of action, and its therapeutic potential in treating inflammatory and neurological conditions, as well as cancer. We then discuss the challenges associated with kava use and research, focusing on the need for the detailed characterization of kava components and associated risks such as its reported hepatotoxicity. Lastly, given its growing popularity in clinical and recreational use, we emphasize the urgent need for quality control and quality assurance of kava products, pharmacokinetics, absorption, distribution, metabolism, excretion, and foundational pharmacology. These are essential in order to inform research into the molecular targets, cellular mechanisms, and creative use of early stage human clinical trials for designer kava modalities to inform and guide the design and execution of future randomized placebo controlled trials to maximize kava's clinical efficacy and to minimize its risks.
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Affiliation(s)
- Tengfei Bian
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Pedro Corral
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Yuzhi Wang
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Jordy Botello
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
| | - Rick Kingston
- College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Tyler Daniels
- Thorne Research Inc., Industrial Road, 620 Omni Dr, Summerville, SC 29483, USA;
| | - Ramzi G. Salloum
- Department of Health Outcome & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Edward Johnston
- The Association for Hawaiian Awa (kava), Pepe’ekeo, HI 96783, USA;
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Junxuan Lu
- Department of Pharmacology, Penn State University College of Medicine, Hershey, PA 17033, USA;
| | - Andrew C. Liu
- Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Chengguo Xing
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA; (T.B.); (P.C.); (Y.W.); (J.B.)
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Evaluation of Anti-Convulsive Properties of Aqueous Kava Extract on Zebrafish Using the PTZ-Induced Seizure Model. Brain Sci 2020; 10:brainsci10080541. [PMID: 32796575 PMCID: PMC7463627 DOI: 10.3390/brainsci10080541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
Kava roots have been extensively studied in clinical trials as potential candidate anti-anxiety drugs. However, anti-convulsive properties of various tissues of stems of Kava have not been reported to date. The objective of the study was to evaluate the anti-convulsive potential of aqueous extracts prepared from specific tissues of Kava (Piper methysticum) stems in zebrafish, using the PTZ-induced seizure model. The potency of each extract was compared in terms of the intensity of seizure scores and onset time after pre-treating the zebrafish before the PTZ challenge. The results indicate that aqueous extract of Kava stems without peel after 45 min of pre-treatment exhibited anti-convulsive potential at the dose of 50 mg/L. This study provides evidence to the anti-convulsive properties of peeled Kava stems and its potential for investigation and design of candidate anti-convulsive drugs.
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Sleep timing and duration in indigenous villages with and without electric lighting on Tanna Island, Vanuatu. Sci Rep 2019; 9:17278. [PMID: 31754265 PMCID: PMC6872597 DOI: 10.1038/s41598-019-53635-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/31/2019] [Indexed: 11/09/2022] Open
Abstract
It has been hypothesized that sleep in the industrialized world is in chronic deficit, due in part to evening light exposure, which delays sleep onset and truncates sleep depending on morning work or school schedules. If so, societies without electricity may sleep longer. However, recent studies of hunter-gatherers and pastoralists living traditional lifestyles without electricity report short sleep compared to industrialized population norms. To further explore the impact of lifestyles and electrification on sleep, we measured sleep by actigraphy in indigenous Melanesians on Tanna Island, Vanuatu, who live traditional subsistence horticultural lifestyles, in villages either with or without access to electricity. Sleep duration was long and efficiency low in both groups, compared to averages from actigraphy studies of industrialized populations. In villages with electricity, light exposure after sunset was increased, sleep onset was delayed, and nocturnal sleep duration was reduced. These effects were driven primarily by breastfeeding mothers living with electric lighting. Relatively long sleep on Tanna may reflect advantages of an environment in which food access is reliable, climate benign, and predators and significant social conflict absent. Despite exposure to outdoor light throughout the day, an effect of artificial evening light was nonetheless detectable on sleep timing and duration.
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Recent advances in the applications of Wittig reaction in the total synthesis of natural products containing lactone, pyrone, and lactam as a scaffold. MONATSHEFTE FUR CHEMIE 2019. [DOI: 10.1007/s00706-019-02465-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wang P, Zhu J, Shehu AI, Lu J, Chen J, Zhong XB, Ma X. Enzymes and Pathways of Kavain Bioactivation and Biotransformation. Chem Res Toxicol 2019; 32:1335-1342. [DOI: 10.1021/acs.chemrestox.9b00098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Pengcheng Wang
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Junjie Zhu
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Amina I. Shehu
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Jie Lu
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Jing Chen
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Xiao-bo Zhong
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Xiaochao Ma
- Center for Pharmacogenetics, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
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Yuan Y, Yang JX, Nie LH, Li BL, Qin XB, Wu JW, Qiu SX. Three new kavalactone dimers from Piper methysticum (kava). JOURNAL OF ASIAN NATURAL PRODUCTS RESEARCH 2018; 20:837-843. [PMID: 28868919 DOI: 10.1080/10286020.2017.1367768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/11/2017] [Indexed: 06/07/2023]
Abstract
Three new dimeric kavalactones, designated as diyangonins A-C (1-3), along with two known analogs were isolated from the roots of Piper methysticum. Their structures were elucidated by means of extensive analysis of their 1D, 2D NMR, and mass spectroscopic data. All these dimers possess a skeleton featuring a cyclobutane ring connecting two kavalactone units in head-to-tail or head-to-head mode. Compounds 1-5 were evaluated for their cytotoxic activities against human tumor cell lines.
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Affiliation(s)
- Yao Yuan
- a Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden , Chinese Academy of Sciences , Guangzhou 570650 , China
- b College of Life Sciences , University of Chinese Academy of Sciences , Beijing 100049 , China
| | - Jian-Xiang Yang
- a Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden , Chinese Academy of Sciences , Guangzhou 570650 , China
| | - Ling-Hui Nie
- c College of Traditional Chinese Medicine , Southern Medical University , Guangzhou 510515 , China
| | - Bai-Lin Li
- a Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden , Chinese Academy of Sciences , Guangzhou 570650 , China
- b College of Life Sciences , University of Chinese Academy of Sciences , Beijing 100049 , China
| | - Xu-Bing Qin
- a Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden , Chinese Academy of Sciences , Guangzhou 570650 , China
- b College of Life Sciences , University of Chinese Academy of Sciences , Beijing 100049 , China
| | - Jie-Wei Wu
- a Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden , Chinese Academy of Sciences , Guangzhou 570650 , China
| | - Sheng-Xiang Qiu
- a Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden , Chinese Academy of Sciences , Guangzhou 570650 , China
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Abstract
SummaryPlants have been used for medicinal purposes for centuries, treating everything from non-specific ailments such as backache and colds to serious conditions, including depression and cancer. In this review, a few commonly known plants with psychotropic effects (St John's wort, Ginkgo biloba, kava, ginseng and valerian) are discussed by way of illustration. The readers' attention is brought to important interactions between herbal remedies and conventional drugs. A background to the constituents of herbs, possible mechanisms of action and an explanation of their antioxidant properties is given.
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Firoozabadi A, Kolouri S, Zarshenas MM, Salehi A, Mosavat SH, Dastgheib SA. Efficacy of a freeze-dried aqueous extract of Nepeta menthoides Boiss. & Buhse in the treatment of anxiety in patients with depression: A double-blind, randomized, controlled trial. J Herb Med 2017. [DOI: 10.1016/j.hermed.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kuchta K, de Nicola P, Schmidt M. Randomized, dose-controlled double-blind trial: Efficacy of an ethanolic kava (Piper methysticum
rhizome) extract for the treatment of anxiety in elderly patients. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/tkm2.1079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kenny Kuchta
- Clinic for Gastroenterology and Gastrointestinal Oncology; University of Göttingen; Göttingen Germany
| | - Pietro de Nicola
- University Hospital for Gerontology; University of Pavia; Pavia Italy
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So HC, Chau CKL, Chiu WT, Ho KS, Lo CP, Yim SHY, Sham PC. Analysis of genome-wide association data highlights candidates for drug repositioning in psychiatry. Nat Neurosci 2017; 20:1342-1349. [PMID: 28805813 DOI: 10.1038/nn.4618] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
Knowledge of psychiatric disease genetics has advanced rapidly during the past decade with the advent of genome-wide association studies (GWAS). However, less progress has been made in harnessing these data to reveal new therapies. Here we propose a framework for drug repositioning by comparing transcriptomes imputed from GWAS data with drug-induced gene expression profiles from the Connectivity Map database and apply this approach to seven psychiatric disorders. We found a number of repositioning candidates, many supported by preclinical or clinical evidence. Repositioning candidates for a number of disorders were also significantly enriched for known psychiatric medications or therapies considered in clinical trials. For example, candidates for schizophrenia were enriched for antipsychotics, while those for bipolar disorder were enriched for both antipsychotics and antidepressants. These findings provide support for the usefulness of GWAS data in guiding drug discovery.
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Affiliation(s)
- Hon-Cheong So
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research of Common Diseases, Kunming Zoology Institute of Zoology and The Chinese University of Hong Kong, China
| | - Carlos Kwan-Long Chau
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Wan-To Chiu
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kin-Sang Ho
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cho-Pong Lo
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | | | - Pak-Chung Sham
- Department of Psychiatry, University of Hong Kong, Pokfulam, Hong Kong, China.,Centre for Genomic Sciences, University of Hong Kong, Pokfulam, Hong Kong, China.,State Key Laboratory for Cognitive and Brain Sciences, University of Hong Kong, Pokfulam, Hong Kong, China.,Centre for Reproduction, Development and Growth, University of Hong Kong, Pokfulam, Hong Kong, China
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López-Gil S, Nuño-Lámbarri N, Chávez-Tapia N, Uribe M, Barbero-Becerra VJ. Liver toxicity mechanisms of herbs commonly used in Latin America. Drug Metab Rev 2017; 49:338-356. [PMID: 28571502 DOI: 10.1080/03602532.2017.1335750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mexico owns approximately 4500 medicinal plants species, a great diversity that position it at the second place after China. According to the Mexican health department, 90% of common population consumes them to treat various diseases. Additionally, herbal remedies in Latin America (LA) are considered a common practice, but the frequency of use and the liver damage related to its consumption is still unknown. Despite the high prevalence and indiscriminate herbal consumption, the exact mechanism of hepatotoxicity and adverse effects is not fully clarified and is still questioned. Some herb products associated with herb induced liver injury (HILI) are characterized by presenting a different chemical composition that may vary from batch to batch, also the biological activity of many medicinal plants and other natural products are directly related to their most active component and its concentration. There are two main biological components that are associated with liver damage, alkaloids, and flavonoids, which are frequent constituents of commonly used herbs. The interaction with the different cytochrome P-450 isoforms, inflammatory, and oxidative activities seem to be the main damage pathway involved in the liver. It is important to know the herbal adverse effects and mechanisms involved; therefore, this article is focused on the beneficial and deleterious effects as well as the possible toxicity mechanisms and interactions of the herbs that are frequently used in LA, since the herb-host interaction may not always be the expected or desired depending on the clinical context in which it is administered.
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Affiliation(s)
- Sofía López-Gil
- a Translational Research Unit , Medica Sur Clinic & Foundation , Mexico City , Mexico.,b Universidad Popular Autónoma del Estado de Puebla , Puebla , Mexico
| | - Natalia Nuño-Lámbarri
- a Translational Research Unit , Medica Sur Clinic & Foundation , Mexico City , Mexico
| | - Norberto Chávez-Tapia
- a Translational Research Unit , Medica Sur Clinic & Foundation , Mexico City , Mexico.,c Obesity and Digestive Diseases Unit , Medica Sur Clinic & Foundation , Mexico City , Mexico
| | - Misael Uribe
- c Obesity and Digestive Diseases Unit , Medica Sur Clinic & Foundation , Mexico City , Mexico
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Song JL, Li BL, Yuan Y, Nie LH, Niu J, Chiu D, Xu ZF, Wu JW, Qiu SX. Yangonindimers A-C, three new kavalactone dimers from Piper methysticum (kava). Nat Prod Res 2017; 31:2459-2466. [DOI: 10.1080/14786419.2017.1312395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jia-Ling Song
- Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Bai-Lin Li
- Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Yao Yuan
- Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - Ling-Hui Nie
- College Of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Jia Niu
- Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
- College of Life Sciences, University of Chinese Academy of Sciences, Beijing, China
| | - David Chiu
- Intern, High School Junior of Davis Senior High School, Davis, CA, USA
| | - Zhi-Fang Xu
- Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
| | - Jie-Wei Wu
- Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
| | - Sheng-Xiang Qiu
- Program for Natural Products Chemical Biology, Key Laboratory of Plant Resources Conservation and Sustainable Utilization, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, China
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23
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Michel JL, Caceres A, Mahady GB. Ethnomedical research and review of Q'eqchi Maya women's reproductive health in the Lake Izabal region of Guatemala: Past, present and future prospects. JOURNAL OF ETHNOPHARMACOLOGY 2016; 178:307-322. [PMID: 26680589 PMCID: PMC4729212 DOI: 10.1016/j.jep.2015.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In Central America, most Maya women use ethnomedicines for all aspects of their reproductive cycle including menstruation, pregnancy and menopause. However, very few of these plants have been documented, collected and tested in appropriate pharmacological assays to determine possible safety and efficacy. The aim of this work was to provide an overview of information on the ethnomedical uses, ethnopharmacology, chemistry and pharmacological research for medicinal plants used for women's reproductive health in Guatemala, with a special emphasis on the Q'eqchi Maya of the Lake Izabal region, to demonstrate therapeutic potential and support future research in the field. MATERIALS AND METHODS Reviews of the ethnobotanical, ethnomedical and ethnopharmacological literature were performed for 30 plants collected in the Lake Izabal region of Guatemala and used by the Q'eqchi Maya for treatment of reproductive health issues were performed up to and including July 2015 using multiple databases, library searches for abstracts, books, dissertations, and websites. RESULTS AND CONCLUSIONS Review of the published research confirms that many of the plants used by Q'eqchi Maya women for the management of reproductive health issues have pharmacological activities, including analgesic, anti-inflammatory, estrogenic, progestagenic and/or serotonergic effects, that support the use of these plants and provide plausible mechanisms of action for their traditional uses. Furthermore, a new serotonin agonist, 9, 10-methylenedioxy-5, 6-Z-fadyenolide was isolated, thereby demonstrating an untapped potential for drug discovery. However, to date much of the pharmacological assays have been in vitro only, and few in vivo studies have been performed. Considering the large percentage of the Maya population in Guatemala that use traditional medicines, there remains a significant lack of pharmacological and toxicological data for these plants. Future research should focus on the safety and efficacy of medicinal plants using in vivo preclinical studies and clinical trials, as well as chemical analysis. Since medicinal plants from the Piperaceae are most commonly used as traditional medicines by the Q'eqchi Maya women, and new bioactive compounds have been identified from Piper species, investigations of commonly used plants from this family would be an appropriate place to start. Data generated from such studies would contribute to Guatemala's national effort to promote a complementary relationship between traditional Maya medicine and public health services.
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Affiliation(s)
- Joanna L Michel
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Armando Caceres
- School of Biological Chemistry, Faculty of Chemical Science and Pharmacy, Universidad de San Carlos, Guatemala City, Guatemala
| | - Gail B Mahady
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, 833 South Wood St., MC 877, Chicago, IL 60612, USA.
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Savage KM, Stough CK, Byrne GJ, Scholey A, Bousman C, Murphy J, Macdonald P, Suo C, Hughes M, Thomas S, Teschke R, Xing C, Sarris J. Kava for the treatment of generalised anxiety disorder (K-GAD): study protocol for a randomised controlled trial. Trials 2015; 16:493. [PMID: 26527536 PMCID: PMC4630875 DOI: 10.1186/s13063-015-0986-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 09/30/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Generalised anxiety disorder (GAD) is a chronic and pervasive condition that generates high levels of psychological stress, and it is difficult to treat in the long term. Current pharmacotherapeutic options for GAD are in some cases only modestly effective, and may elicit undesirable side effects. Through targeted actions on the gamma-aminobutyric acid (GABA) pathway, the South Pacific medicinal plant kava (Piper methysticum) is a non-addictive, non-hypnotic anxiolytic with the potential to treat GAD. The evidence for the efficacy of kava for treating anxiety has been affirmed through clinical trials and meta-analyses. Recent research has also served to lessen safety concerns regarding the use of kava due to hepatotoxic risk, which is reflected in a recent German court overturning the previous kava ban in that country (which may in turn influence a reinstatement by the European Union). The aim of current research is to assess the efficacy of an 'aqueous noble cultivar rootstock extract' of kava in GAD in a larger longer term study. In addition, we plan to investigate the pharmacogenomic influence of GABA transporters on response, effects of kava on gene expression, and for the first time, the neurobiological correlates of treatment response via functional and metabolic imaging. METHODS/DESIGN This clinical trial is funded by the Australian National Health and Medical Research Council (APP1063383) and co-funded by MediHerb (Integria Healthcare (Australia) Pty. Ltd). The study is a phase III, multi-site, two-arm, 18-week, randomised, double-blind, placebo-controlled study using an aqueous extract of noble kava cultivar (standardised to 240 mg of kavalactones per day) versus matching placebo in 210 currently anxious participants with diagnosed GAD who are non-medicated. The study takes place at two sites: the Centre for Human Psychopharmacology (Swinburne University of Technology), Hawthorn, Melbourne, Australia; and the Academic Discipline of Psychiatry (The University of Queensland) based at the Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia. Written informed consent will be obtained from each participant prior to commencement in the study. The primary outcome is the Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A). The secondary outcomes involve a range of scales that assess affective disorder symptoms and quality of life outcomes, in addition to the study of mediating biomarkers of response (assessed via genomics and neuroimaging). DISCUSSION If this study demonstrates positive findings in support of the superiority of kava over placebo in the treatment of GAD, and also is shown to be safe, then this plant-medicine can be considered a 'first-line' therapy for GAD. Genomic and neuroimaging data may reveal clinical response patterns and provide more evidence of the neurobiological activity of the plant extract. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov: NCT02219880 Date: 13 August 2014:.
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Affiliation(s)
- Karen M Savage
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Con K Stough
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Gerard J Byrne
- Department of Psychiatry, The University of Queensland, Melbourne, Australia.
| | - Andrew Scholey
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
| | - Chad Bousman
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
- Department of Psychiatry, The University of Melbourne, Parkville, Australia.
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
- Department of General Practice, The University of Melbourne, Parkville, Australia.
| | - Jenifer Murphy
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
| | - Patricia Macdonald
- Department of Psychiatry, The University of Queensland, Melbourne, Australia.
| | - Chao Suo
- Brain and Mental Health Laboratory, School of Psychological Science, Monash University, Monash, Australia.
| | - Matthew Hughes
- Swinburne University of Technology, Brain and Psychological Sciences Centre, Swinburne, Australia.
| | - Stuart Thomas
- School of Psychological Science, Monash University, Monash, Australia.
| | - Rolf Teschke
- Department of Internal Medicine II, Section of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Johann Wolfgang Goethe University of Frankfurt/Main, Frankfurt, Germany.
| | - Chengguo Xing
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Duluth, USA.
| | - Jerome Sarris
- The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Melbourne, Australia.
- Swinburne University of Technology, Centre for Human Psychopharmacology, Swinburne, Australia.
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Possible toxicity and withdrawal seizures in Aboriginal kava drinkers in Arnhem Land, (Australia). ACTA ACUST UNITED AC 2015. [DOI: 10.1017/s025754340000033x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground: In the 1990s, heavy kava use in Aboriginal communities was linked to reports of unusual neurological events which were often described as ‘fits’ or ‘seizures’. Kava use has also been associated with extra-pyramidal movements. We now raise the possibility that kava toxicity and kava withdrawal may be associated with grand mal seizures. This paper describes some of ’these “seizure” episodes’ in kava drinkers. Nine communities and associated homelands in the eastern Arnhem Land (Miwatj) region (Northern Territory, NT) including 7001 Aboriginal people of whom 4217 were over 15 years. Twenty-one kava users experienced 32 “seizure” episodes for which the date of occurrence and other data was recorded in notes in community health clinic files dating from the 1980s up to 1999 in a sample of the Miwatj population. Kava, alcohol, tobacco, cannabis use and petrol sniffing, year in which “seizure” occurred, notes of kava toxicity or withdrawal. Kava toxicity effects were suspected in 15 and withdrawal effects in six of 32 “seizure” episodes. In seven episodes impaired consciousness and abnormal movements were adequately documented to suggest grand mal seizures. The maximum number of “seizures” experienced was three and three individuals experienced this number between 1990 and 1999. One was a heavy kava user. Six other individuals experienced two “seizures” each and five of these were heavy users. Sixteen individuals experienced 19 “seizures” during 1994-1997 when kava supply may have reached its peak. Fifteen of the 21 individuals experiencing “seizures” were heavy users described locally as dja[aw'marama. The clinical data and the coincidence of peak supply with records of “seizures” suggest kava toxicity and withdrawal seizures may both occur with heavy kava use. Further systematic analysis is warranted to confirm this and to assess kava's effects with respect to possible confounders such as alcohol.
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Stickel F, Shouval D. Hepatotoxicity of herbal and dietary supplements: an update. Arch Toxicol 2015; 89:851-65. [DOI: 10.1007/s00204-015-1471-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/05/2015] [Indexed: 12/15/2022]
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Narayanapillai SC, Leitzman P, O'Sullivan MG, Xing C. Flavokawains a and B in kava, not dihydromethysticin, potentiate acetaminophen-induced hepatotoxicity in C57BL/6 mice. Chem Res Toxicol 2014; 27:1871-6. [PMID: 25185080 PMCID: PMC4203398 DOI: 10.1021/tx5003194] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
![]()
Anxiolytic
kava products have been associated with rare but severe
hepatotoxicity in humans. This adverse potential has never been captured
in animal models, and the responsible compound(s) remains to be determined.
The lack of such knowledge greatly hinders the preparation of a safer
kava product and limits its beneficial applications. In this study
we evaluated the toxicity of kava as a single entity or in combination
with acetaminophen (APAP) in C57BL/6 mice. Kava alone revealed no
adverse effects for long-term usage even at a dose of 500 mg/kg bodyweight.
On the contrary a three-day kava pretreatment potentiated APAP-induced
hepatotoxicity, resulted in an increase in serum ALT and AST, and
increased severity of liver lesions. Chalcone-based flavokawains A
(FKA) and B (FKB) in kava recapitulated its hepatotoxic synergism
with APAP while dihydromethysticin (DHM, a representative kavalactone
and a potential lung cancer chemopreventive agent) had no such effect.
These results, for the first time, demonstrate the hepatotoxic risk
of kava and its chalcone-based FKA and FKB in vivo and suggest that herb–drug interaction may account for the
rare hepatotoxicity associated with anxiolytic kava usage in humans.
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Affiliation(s)
- Sreekanth C Narayanapillai
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota , Minneapolis, Minnesota 55455, United States
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Rather MA, Bhat BA, Qurishi MA. Multicomponent phytotherapeutic approach gaining momentum: Is the "one drug to fit all" model breaking down? PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2013; 21:1-14. [PMID: 24035674 DOI: 10.1016/j.phymed.2013.07.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/22/2013] [Accepted: 07/26/2013] [Indexed: 06/02/2023]
Abstract
Natural product based drugs constitute a substantial proportion of the pharmaceutical market particularly in the therapeutic areas of infectious diseases and oncology. The primary focus of any drug development program so far has been to design selective ligands (drugs) that act on single selective disease targets to obtain highly efficacious and safe drugs with minimal side effects. Although this approach has been successful for many diseases, yet there is a significant decline in the number of new drug candidates being introduced into clinical practice over the past few decades. This serious innovation deficit that the pharmaceutical industries are facing is due primarily to the post-marketing failures of blockbuster drugs. Many analysts believe that the current capital-intensive model-"the one drug to fit all" approach will be unsustainable in future and that a new "less investment, more drugs" model is necessary for further scientific growth. It is now well established that many diseases are multi-factorial in nature and that cellular pathways operate more like webs than highways. There are often multiple ways or alternate routes that may be switched on in response to the inhibition of a specific target. This gives rise to the resistant cells or resistant organisms under the specific pressure of a targeted agent, resulting in drug resistance and clinical failure of the drug. Drugs designed to act against individual molecular targets cannot usually combat multifactorial diseases like cancer, or diseases that affect multiple tissues or cell types such as diabetes and immunoinflammatory diseases. Combination drugs that affect multiple targets simultaneously are better at controlling complex disease systems and are less prone to drug resistance. This multicomponent therapy forms the basis of phytotherapy or phytomedicine where the holistic therapeutic effect arises as a result of complex positive (synergistic) or negative (antagonistic) interactions between different components of a cocktail. In this approach, multicomponent therapy is considered to be advantageous for multifactorial diseases, instead of a "magic bullet" the metaphor of a "herbal shotgun" might better explain the state of affairs. The different interactions between various components might involve the protection of an active substance from decomposition by enzymes, modification of transport across membranes of cells or organelles, evasion of multidrug resistance mechanisms among others.
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Affiliation(s)
- Manzoor A Rather
- Medicinal Chemistry Division, Indian Institute of Integrative Medicine, Sanat Nagar, Srinagar, India.
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Weissenstein A, Straeter A, Villalon G, Luchter E, Bittmann S. The Role of Complementary Medicine in a Pediatric Day Center in Germany. Complement Med Res 2013; 20:281-5. [DOI: 10.1159/000354141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Background:</i></b> The role of complementary alternative medicine (CAM) in pediatrics has considerably increased in the last years. The knowledge about potential side effects and possible interactions with conventional drugs is still limited, and often pediatricians do not know whether their patients use CAM. This can be critical, as in order to diagnose and treat illnesses properly physicians need to know about the full extent of the self-administered therapy of their patients. Many studies have been conducted in other countries in order to assess the extent of CAM use and the types of substances that are consumed, but in Germany data in regard to pediatric interventions are lacking. We therefore developed a questionnaire to evaluate the frequency of CAM use among German pediatric patients. <b><i>Patients and Methods:</i></b> 115 parents visiting the pediatric day center in Epe between September and November 2011 responded to the questionnaire. The survey contains questions concerning the prevalence of CAM use and data about socioeconomic factors. <b><i>Results:</i></b> A total of 75.7% of all children enrolled in the study had already been treated with CAM by their parents, while only 43.6% of the parents knew that there can be interactions with CAM and prescribed drugs. In only half of the cases (50.6%) the pediatrician knew about the CAM usage of the child. <b><i>Conclusion:</i></b> The frequency of CAM usage among children is higher than anticipated. It is essential that pediatricians know about possible interactions with conventional medicine, and it lies in their responsibility to include the question about CAM usage in their standard protocols.
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Lee RA. Anxiety. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
OBJECTIVES A new class of beverages called relaxation drinks advertises calming effects and an easy way to wind down when life gets stressful. This article examines these drinks in the context of their use in adolescents. METHODS A review of the literature relevant to relaxation drinks and their functional ingredients was conducted. RESULTS The beverages contain ingredients such as melatonin, valerian, kava, tryptophan, and other products traditionally thought to play a role in sleep, sedation, or neurocognitive function. Studies of the efficacy and safety of these supplements are limited and many have significant methodological limitations. Despite appropriate warnings placed on the labels of relaxation drinks, marketing is cleverly designed to appeal to young consumers and often evokes the experiences produced by alcohol and drug use. CONCLUSION Although moderate consumption of these beverages by healthy individuals is likely safe, an objective reduction in stress is improbable and associated adverse effects are possible.
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Affiliation(s)
- Sylvie Stacy
- University of Massachusetts Medical School, Uxbridge, Massachusetts 01569, USA.
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Chirumbolo S. Plant-derived extracts in the neuroscience of anxiety on animal models: biases and comments. Int J Neurosci 2011; 122:177-88. [PMID: 22050267 DOI: 10.3109/00207454.2011.635829] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Generalized anxiety disorders probably represent one of the world's biggest mental health problems. A large number of studies have also shown that anxiety disorders and depression are often associated with quality of life impairments. As anxiety represents a big concern in public health, a substantial literature supports clinically important associations between psychiatric illness and chronic medical conditions. Actually, most research focuses on depression, finding that depression can adversely affect self-care and increase the risk of incident medical illness, complications, and mortality. Anxiety disorders are less well studied, but robust epidemiological and clinical evidences show that they play an equally important role. Recent reported articles have raised a debate about the effectiveness of some plant-derived extracts in anxiety-like models in mice. Biases about several aspects related with experimental setting, animal selection, environments, operators and investigators, selection and performance of behavioral tests, controls, results managing, and statistics are here discussed.
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Gilmour J, Harrison C, Asadi L, Cohen MH, Vohra S. Natural health product-drug interactions: evolving responsibilities to take complementary and alternative medicine into account. Pediatrics 2011; 128 Suppl 4:S155-60. [PMID: 22045857 DOI: 10.1542/peds.2010-2720c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Natural health products (NHPs) (known as dietary supplements in the United States) are a popular form of self-care, yet many patients do not disclose their use to clinicians. NHP-drug interactions are known to occur and can harm patients and affect the efficacy of conventional treatment. Using the example of an HIV-positive adolescent who had been responding well to antiretroviral therapy but then experienced a sudden unexplained deterioration in her condition, we review (1) clinicians' obligation to inquire about complementary and alternative medicine (CAM) use when assessing, treating, and monitoring patients, (2) how clinicians' duty to warn about risks associated with treatment has evolved and expanded, and (3) patients' and parents' responsibility to disclose CAM use. It also addresses the responsibility of hospitals and health facilities to ensure that the reality of widespread CAM/NHP use is taken into account in patient care to effectively protect patients from harm.
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Affiliation(s)
- Joan Gilmour
- Osgoode Hall Law School, York University, Toronto, Ontario, Canada
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Behl M, Nyska A, Chhabra RS, Travlos GS, Fomby LM, Sparrow BR, Hejtmancik MR, Chan PC. Liver toxicity and carcinogenicity in F344/N rats and B6C3F1 mice exposed to Kava Kava. Food Chem Toxicol 2011; 49:2820-9. [PMID: 21871523 PMCID: PMC3190036 DOI: 10.1016/j.fct.2011.07.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/25/2011] [Accepted: 07/27/2011] [Indexed: 02/06/2023]
Abstract
Kava Kava is an herbal supplement used as an alternative to antianxiety drugs. Although some reports suggest an association of Kava Kava with hepatotoxicity , it continues to be used in the United States due to lack of toxicity characterization. In these studies F344/N rats and B6C3F1 mice were administered Kava Kava extract orally by gavage in corn oil for two weeks, thirteen weeks or two years. Results from prechronic studies administered Kava Kava at 0.125 to 2g/kg body weight revealed dose-related increases in liver weights and incidences of hepatocellular hypertrophy. In the chronic studies, there were dose-related increases in the incidences of hepatocellular hypertrophy in rats and mice administered Kava Kava for up to 1g/kg body weight. This was accompanied by significant increases in incidences of centrilobular fatty change. There was no treatment- related increase in carcinogenic activity in the livers of male or female rats in the chronic studies. Male mice showed a significant dose-related increase in the incidence of hepatoblastomas. In female mice, there was a significant increase in the combined incidence of hepatocellular adenoma and carcinoma in the low and mid dose groups but not in the high dose group. These findings were accompanied by several nonneoplastic hepatic lesions.
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Affiliation(s)
- Mamta Behl
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, 27709, USA
| | - Abraham Nyska
- Integrated Laboratory Systems Inc., Research Triangle Park, NC 27709
| | - Rajendra S. Chhabra
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, 27709, USA
| | - Gregory S. Travlos
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, 27709, USA
| | | | | | | | - Po C. Chan
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, 27709, USA
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Pearl PL, Drillings IM, Conry JA. Herbs in epilepsy: evidence for efficacy, toxicity, and interactions. Semin Pediatr Neurol 2011; 18:203-8. [PMID: 22062945 DOI: 10.1016/j.spen.2011.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Herbs and dietary supplements enjoy widespread use in the treatment of epilepsy although supportive data yielding efficacy and safety are lacking. Ten specific products, American hellebore, betony, blue cohosh, kava, mistletoe, mugwort, pipsissiwa, skullcap, valerian, and melatonin, have either multiple-cited recommendations for use in epilepsy or a rationale for antiepileptic action and are discussed in detail. These items paradoxically often have a proconvulsant effect in addition to potentially serious adverse effects. Herb-drug interactions also occur at the level of the P450 hepatic enzyme system of drug catabolism and the P-glycoprotein transport system regulating the entry of exogenous compounds into the vasculature or blood-brain barrier. Thus, significant pharmacokinetic interactions may occur, in addition to pharmacodynamic interactions and proconvulsant effects of alternative medications themselves. Patients should be inquired as to the nature of any alternative medicine products they are using, with the view that these products may be reasonable if traditional antiepileptic drug therapy is continued, potential adverse effects of the alternative agents are monitored, and the alternative and traditional agents do not conflict.
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Affiliation(s)
- Phillip L Pearl
- Department of Neurology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC 20010-2970, USA
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Perioperative Herbal and Supplement Use. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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LaPorte E, Sarris J, Stough C, Scholey A. Neurocognitive effects of kava (Piper methysticum): a systematic review. Hum Psychopharmacol 2011; 26:102-11. [PMID: 21437989 DOI: 10.1002/hup.1180] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/21/2011] [Indexed: 11/10/2022]
Abstract
RATIONALE Kava (Piper methysticum) elicits dose-dependent psychotropic effects and thus may potentially deleteriously affect cognitive performance. Clinical trials have assessed the effects of kava on cognition, however, to our knowledge no systematic review has been conducted in this area. OBJECTIVE To systematically review the effects of kava on cognition, providing an analysis of the individual study's methodological quality, results and effect sizes. METHODS A systematic review was conducted of publications up to June 15th 2010, using the electronic databases MEDLINE, PsychINFO, CINAHL, Web of Science and The Cochrane Library. The search criteria involved kava and cognition related terms, e.g. memory and attention. RESULTS Ten human clinical trials met inclusion criteria (acute n = 7, chronic n = 3). One acute study found that kava significantly improved visual attention and working memory processes while another found that kava increased body sway. One chronic study found that kava significantly impaired visual attention during high-cognitive demand. Potential enhanced cognition may be attributed to the ability of kava to inhibit re-uptake of noradrenaline in the pre-frontal cortex, while increased body sway may be due to GABA pathway modulation. CONCLUSIONS The majority of evidence suggests that kava has no replicated significant negative effects on cognition.
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Affiliation(s)
- E LaPorte
- Brain Sciences Institute, University of Technology, Melbourne, Victoria, Australia.
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Weier KM, Beal MW. Complementary Therapies as Adjuncts in the Treatment of Postpartum Depression. J Midwifery Womens Health 2010; 49:96-104. [PMID: 15010661 DOI: 10.1016/j.jmwh.2003.12.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Postpartum depression affects an estimated 13% of women who have recently given birth. This article discusses several alternative or complementary therapies that may serve as adjuncts in the treatment of postpartum depression. The intent is to help practitioners better understand the treatments that are available that their clients may be using. Complementary modalities discussed include herbal medicine, dietary supplements, massage, aromatherapy, and acupuncture. Evidence supporting the use of these modalities is reviewed where available, and a list of resources is given in the appendix.
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Muedra V, Moreno L. [Knowledge of perioperative risk associated with use of medicinal plants]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:467-473. [PMID: 19994614 DOI: 10.1016/s0034-9356(09)70436-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To assess physicians' knowledge of perioperative risk for patients who consume medicinal plants. To review interactions between drugs and the main medicinal plants with a view to justifying a plan for preoperative intervention. MATERIAL AND METHODS Surgeons and anesthesiologists were sent an e-mail survey with questions on knowledge of and attitudes toward surgical patients' consumption of medicinal plants. At the same time, we performed a literature search on the species of plants that can interact with anesthetic and surgical processes. The species included were Allium sativum, Ephedra sinica, Echinacea purpurea, Ginkgo biloba, Panax ginseng, Hypericum perforatum, Piper methysticum, Glycyrrhiza glabra and Valeriana officinalis. The focus of the search was on indications for the use of these plants and their interactions with drugs. RESULTS The questionnaire was sent to 131 physicians. The response rate was 80.5%. Twenty-two physicians had trained in Spanish hospitals and 3 in hospitals abroad. Medicinal plants were believed to be effective by 55%, but 78% did not ask patients about their use. Only 3% knew the interactions of some of the plants mentioned in the survey and only 7% knew that the use of some should be suspended before surgery. CONCLUSIONS Medicinal plants are currently being used in our culture. In spite of appropriate warnings from such scientific bodies as the American Society of Anesthesiologists on timing the withdrawal of medicinal plants before surgery, our results indicate that the advice is not followed. We also found that physicians lacked knowledge of the indications for using these plants and their interactions, a situation which is alarming.
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Affiliation(s)
- V Muedra
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor. Hospital Universitario La Ribera, Alzira, Valencia.
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Keaton D, Lamkin N, Cassidy KA, Meyer WJ, Ignacio RV, Aulakh L, Blow FC, Sajatovic M. Utilization of herbal and nutritional compounds among older adults with bipolar disorder and with major depression. Int J Geriatr Psychiatry 2009; 24:1087-93. [PMID: 19274637 DOI: 10.1002/gps.2227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Herbal and nutritional compounds (HNC) are widely used among geriatric populations with depression, however little data exists on HNC use in older populations with bipolar disorder. The goal of this study was to evaluate orally- ingested HNC use in individuals with bipolar disorder and with major depression. METHODS This was a cross-sectional analysis of self-reported factual knowledge of HNC, individual perspective on efficacy and safety of HNC, patterns of HNC use, and discussion of HNC with health care providers in 50 older adults with bipolar disorder and 50 older adults with major depression. RESULTS In this sample, approximately 30% of older individuals with depression or bipolar disorder used orally- ingested HNC. Over 40% of older adults believed that HNC is FDA-regulated and 14-20% preferred to take HNC compared to physician-prescribed psychotropic medications. Use of HNC was more common among older adults with bipolar disorder (44%) compared to older adults with major depression (16%, p = 0.003). The majority of older adults with mood disorders (64%) had not discussed use of HNC with their treating physicians. CONCLUSION Orally ingested HNC was used by nearly one in three older adults with mood disorders, and was more common among those with bipolar disorder compared to those with major depression. Most individuals did not discuss HNC use with their physicians. Clinicians need to assess for HNC use, particularly with respect to potential drug-drug interactions.
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Affiliation(s)
- Daniel Keaton
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
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Sarris J, Kavanagh DJ, Byrne G, Bone KM, Adams J, Deed G. The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled crossover trial using an aqueous extract of Piper methysticum. Psychopharmacology (Berl) 2009; 205:399-407. [PMID: 19430766 DOI: 10.1007/s00213-009-1549-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 04/15/2009] [Indexed: 01/12/2023]
Abstract
RATIONALE Piper methysticum (Kava) has been withdrawn in European, British, and Canadian markets due to concerns over hepatotoxic reactions. The WHO recently recommended research into "aqueous" extracts of Kava. OBJECTIVE The objective of this study was to conduct the first documented human clinical trial assessing the anxiolytic and antidepressant efficacy of an aqueous extract of Kava. DESIGN AND PARTICIPANTS The Kava Anxiety Depression Spectrum Study was a 3-week placebo-controlled, double-blind crossover trial that recruited 60 adult participants with 1 month or more of elevated generalized anxiety. Five Kava tablets per day were prescribed containing 250 mg of kavalactones/day. RESULTS The aqueous extract of Kava reduced participants' Hamilton Anxiety Scale score in the first controlled phase by -9.9 (CI = 7.1, 12.7) vs. -0.8 (CI = -2.7, 4.3) for placebo and in the second controlled phase by -10.3 (CI = 5.8, 14.7) vs. +3.3 (CI = -6.8, 0.2). The pooled effect of Kava vs. placebo across phases was highly significant (p < 0.0001), with a substantial effect size (d = 2.24, eta(2)(p)). Pooled analyses also revealed highly significant relative reductions in Beck Anxiety Inventory and Montgomery-Asberg Depression Rating Scale scores. The aqueous extract was found to be safe, with no serious adverse effects and no clinical hepatotoxicity. CONCLUSIONS The aqueous Kava preparation produced significant anxiolytic and antidepressant activity and raised no safety concerns at the dose and duration studied. Kava appears equally effective in cases where anxiety is accompanied by depression. This should encourage further study and consideration of globally reintroducing aqueous rootstock extracts of Kava for the management of anxiety.
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Affiliation(s)
- J Sarris
- School of Medicine, The University of Queensland, Brisbane, Australia,
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Xing C, Johnson TE, Limburg PJ. Diets, Phytochemicals, and Chemoprevention of Tumorigenesis. J Diet Suppl 2009; 5:95-105. [DOI: 10.1080/19390210802332877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pinkerton JV, Stovall DW, Kightlinger RS. Advances in the Treatment of Menopausal Symptoms. WOMENS HEALTH 2009; 5:361-384; quiz 383-4. [DOI: 10.2217/whe.09.31] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vasomotor symptoms and vaginal atrophy are both common menopausal symptoms. Hormone therapy is currently the only FDA-approved treatment for hot flashes. Current recommendations are to use the lowest dose of hormone therapy for the shortest period that will allow treatment goals to be met. Although the reanalysis of the WHI in 2007 by Roussow et al. provided evidence of coronary heart safety for users of hormone therapy under the age of 60 years and within 10 years of the onset of menopause, not all women desire or are candidates for hormone therapy. In this review we present an evidence-based discussion considering the effectiveness of hormonal and nonhormonal therapies for the relief of vasomotor symptoms and vaginal atrophy. Concern exists regarding systemic absorption of vaginal estrogen and possible adverse effects on the breast and uterus. Selective estrogen receptor modulators and estrogen agonists offer benefits through targeted estrogen agonist/antagonistic effects and are being evaluated with and without estrogen for symptomatic menopausal women. Centrally acting nonhormonal therapies that are effective for the relief of vasomotor symptoms include various antidepressants, gabapentin and clonidine. A limited number of clinical trials have been conducted with nonprescription remedies, including paced respiration, yoga, acupuncture, exercise, homeopathy and magnet therapy, and some, but not all of these, have been found to be more effective than placebo. Dietary herbal supplements, such as soy and black cohosh, have demonstrated mixed and inconclusive results in placebo-controlled trials. Potential therapies for vasomotor symptoms and vaginal atrophy require randomized, placebo-controlled trials of sufficient duration to establish efficacy and safety. Agents under investigation for vasomotor symptoms relief include neuroactive agents, such as gabapentin and desvenlafaxine; an estrogen receptor-β-targeted herbal therapy, MF-101; and the selective estrogen receptor modulator, bazedoxifene, paired with estrogen.
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Affiliation(s)
- JoAnn V Pinkerton
- JoAnn V Pinkerton, MD, Box 801104, University of Virginia Health System, Charlottesville, VA 22908, USA, Tel.: +1 434 243 4727, Fax: +1 434 243 4706,
| | - Dale W Stovall
- Dale Stovall, MD, Department of Obstetrics & Gynecology, Divisions of Midlife Health & Reproductive Endocrinology, University of Virginia Health System, Charlottesville, VA 22908, USA, Tel.: +1 434 243 4570,
| | - Rebecca S Kightlinger
- Rebecca Kightlinger, Department of Obstetrics & Gynecology, Divisions of Midlife Health & Reproductive Endocrinology, University of Virginia Health System, Charlottesville, VA 22908, USA, Tel.: +1 434 243 4727,
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Sarris J, Kavanagh D, Adams J, Bone K, Byrne G. Kava Anxiety Depression Spectrum Study (KADSS): A mixed methods RCT using an aqueous extract of Piper methysticum. Complement Ther Med 2009; 17:176-8. [DOI: 10.1016/j.ctim.2009.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 01/06/2009] [Accepted: 01/06/2009] [Indexed: 11/29/2022] Open
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Abstract
Liver toxicity from the use of kava dietary supplements has been reported, but little is known about the side effects of traditional kava preparations. We present a case study of a tourist who developed serious toxic liver disease after consumption of kava beverages in traditional Samoan kava ceremonies.
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Affiliation(s)
- Stefan U Christl
- Department of Gastroenterology, Asklepios Klinik Harburg, Hamburg, Germany.
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Johnson TE, Kassie F, O'Sullivan MG, Negia M, Hanson TE, Upadhyaya P, Ruvolo PP, Hecht SS, Xing C. Chemopreventive Effect of Kava on 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone plus Benzo[a]pyrene–Induced Lung Tumorigenesis in A/J Mice. Cancer Prev Res (Phila) 2008; 1:430-8. [DOI: 10.1158/1940-6207.capr-08-0027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Although very few drugs are currently approved by regulatory authorities for treating multi-factorial ailments and disorders of cognition such as Alzheimer's disease, certain plant-derived agents, including, for example, galantamine and rivastigmine (a semi-synthetic derivative of physostigmine) are finding an application in modern medicine. However, in Ayurveda, the Indian traditional system of medicine which is more than 5000 years old, selected plants have long been classified as 'medhya rasayanas', from the Sanskrit words 'medhya', meaning intellect or cognition, and 'rasayana', meaning 'rejuvenation'. These plants are used both in herbal and conventional medicine and offer benefits that pharmaceutical drugs lack. In the present article, an attempt has been made to review the most important medicinal plants, including Ginkgo biloba, St John's wort, Kava-kava, Valerian, Bacopa monniera and Convolvulus pluricaulis, which are widely used for their reputed effectiveness in CNS disorders.
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Affiliation(s)
- Vikas Kumar
- Department of Pharmaceutical Sciences, Texas Tech University, Health Sciences Center, School of Pharmacy, Amarillo, TX 79106, USA.
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Lasme P, Davrieux F, Montet D, Lebot V. Quantification of kavalactones and determination of kava (Piper methysticum) chemotypes using near-infrared reflectance spectroscopy for quality control in vanuatu. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2008; 56:4976-4981. [PMID: 18540613 DOI: 10.1021/jf800439g] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Kava ( Piper methysticum Forst f., Piperaceae) has anxiolytic properties and the ability to promote a state of relaxation without the loss of mental alertness. The rapid growth of the nutraceutical market between 1998 and 2000 has been stopped by a ban in Europe and Australia because of some suspicion of liver toxicity. It is now important to develop a fast, cheap, and reliable quality test to control kava exports. The aim of this study is to develop a calibration of the near-infrared reflectance spectroscopy (NIRS) using partial least-squares (PLS) regression. Two hundred thirty-six samples of kava roots, stumps, and basal stems were collected from the Vanuatu Agricultural Research and Technical Centre germplasm collection and from four villages. These samples, representing 45 different varieties, were analyzed using NIRS to record their absorption spectra between 400 and 2500 nm. A set of 101 selected samples was analyzed for their kavalactone content using HPLC. The results were used for PLS calibration of the NIRS. The NIRS prediction of the kavalactone content and the dry matter were in agreement with the HPLC results. There were good correlations between these two series of results, and coefficients ( R (2)) were all close to 1. The measurements were reproducible and had repeatability on par with the HPLC method. The NIRS system has been calibrated for the six major kavalactone content measurements, and it is suggested that this method could be used for quality control in Vanuatu.
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