1
|
Juengsanguanpornsuk W, Poopanee N, Krittanai S, Sakamoto S, Tanaka H, Putalun W, Yusakul G. Immunoaffinity separation of miroestrol and deoxymiroestrol from Pueraria candollei var. mirifica (Airy Shaw & Suvat.) Niyomdham using fragment antigen-binding antibody produced via Escherichia coli. PHYTOCHEMICAL ANALYSIS : PCA 2023; 34:632-640. [PMID: 37254639 DOI: 10.1002/pca.3251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/20/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Miroestrol and deoxymiroestrol are potent phytoestrogens and are oestrogen markers of Pueraria candollei var. mirifica. However, purifying these compounds is difficult because they only exist in trace amounts. OBJECTIVES Active fragment antigen-binding (Fab) antibodies were produced via Escherichia coli SHuffle® T7 and used to selectively separate these compounds. MATERIALS AND METHODS Two immunoaffinity separation approaches were developed, namely the immunoaffinity column (IAC) and a cell-based method. Group-specific Fab antibodies against miroestrol and deoxymiroestrol (anti-MD Fab) were used as biological binding reagents for selective separation. RESULTS The Fab-based IAC effectively separated miroestrol and deoxymiroestrol (0.65 and 2.24 μg per 2 mL of resin, respectively) from P. mirifica root extract. When P. mirifica extract was added to E. coli cultures during Fab expression via a cell-based method, the target compound accumulated in intracellular compartments and, thus, were separated from E. coli cells after the removal of other compounds. A yield of 1.07 μg of miroestrol per gram of cell pellet weight was obtained. Miroestrol and deoxymiroestrol were successfully purified from P. mirifica extract using anti-MD Fab via the IAC and an intracellular cell-based method. CONCLUSION The proposed methods can simplify the miroestrol and deoxymiroestrol extraction process and provide a basis for applications utilising recombinant antibodies to separate target compounds.
Collapse
Affiliation(s)
| | - Nut Poopanee
- Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Supaluk Krittanai
- Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Seiichi Sakamoto
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tanaka
- Department of Pharmacognosy and Kampo, Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, Sanyo-Onoda, Yamaguchi, Japan
| | - Waraporn Putalun
- Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Gorawit Yusakul
- School of Pharmacy, Walailak University, Nakhon Si Thammarat, Thailand
- Functional Materials and Nanotechnology Center of Excellence, Walailak University, Nakhon Si Thammarat, Thailand
| |
Collapse
|
2
|
Effects of Pueraria mirifica on Vaginal Artery Vascularization in Postmenopausal Women with Genitourinary Syndrome of Menopause. Maturitas 2022; 160:4-10. [DOI: 10.1016/j.maturitas.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/28/2021] [Accepted: 01/13/2022] [Indexed: 11/22/2022]
|
3
|
Briggs P, Hapangama DK. Urogenital atrophy: The 'unknown factors' challenging current practice. Post Reprod Health 2021; 27:109-120. [PMID: 33673759 DOI: 10.1177/2053369121997673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Urogenital atrophy occurs as a result of the effect of estrogen deficiency on the tissue quality in the vulva, vagina, urethra and bladder. It is a common consequence of the menopause, with possibly up to 80% of women experiencing symptoms. Despite a number of different diagnostic methods, there is no validated objective method by which to confirm the diagnosis in clinical practice and research settings. Education, for women and clinicians, is called for to support diagnosis and treatment. However, before this can be of global benefit, development of an accessible and reproducible diagnostic test is required. Current assessment methods include routine history and clinical examination, with the clinician's opinion based on their subjective observations. A vaginal smear to assess the ratio of superficial to parabasal cells and measurement of the pH of the vaginal secretions is more commonly used in research settings. A number of formulae have been postulated to facilitate the diagnosis including the Vaginal Health Index, the Vulval Health Index, the Genitourinary Syndrome of the Menopause assessment tool, the Genital Health Clinical Evaluation and vaginal biopsy and assessment of the vaginal microbiome. However, none of these potential methods of assessment has been validated. This article focuses on what we do not know about urogenital atrophy including the prevalence, the most appropriate terminology, aetiology, pathogenesis and the most objective and reproducible method of assessment.
Collapse
Affiliation(s)
- Paula Briggs
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Dharani K Hapangama
- Liverpool Women's NHS Foundation Trust, Liverpool, UK
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| |
Collapse
|
4
|
Hocké C, Diaz M, Bernard V, Frantz S, Lambert M, Mathieu C, Grellety-Cherbero M. [Genitourinary menopause syndrome. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:394-413. [PMID: 33757926 DOI: 10.1016/j.gofs.2021.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Genitourinary menopause syndrome (SGUM) is defined as a set of symptoms associated with a decrease of estrogen and other sexual steroids during menopause. The main symptoms are vulvovaginal (dryness, burning, itching), sexual (dyspareunia), and urinary (urinary infections, pollakiuria, nycturia, pain, urinary incontinence by urgenturia). SGUM leads to an alteration of the quality of life, and affects especially women's sexuality. OBJECTIVE The objective of this review was to elaborate guidelines for clinical practice regarding the management of SGUM in postmenopausal women, and in particular, in women with a history of breast cancer, treated or not with hormone therapy. MATERIALS AND METHODS A systematic review of the literature on SGUM management was conducted on Pubmed, Medline and Cochrane Library. Recommendations from international scholarly societies were also taken into account: International Menopause Society (IMS) https://www.imsociety.org, The North American Menopause Society (NAMS) https://www.menopause.org, Canadian Menopause Society https://www.sigmamenopause.com, European Menopause and Andropause Society (EMAS) https://www.emas-online.org, International Society for the Study of Women's Sexual Health (ISSWSH) https://www.isswsh.org. RESULTS Vaginal use of lubricants, moisturizers and hyaluronic acid improves the symptoms of SGUM and may be offered to all patients. For postmenopausal women, local estrogen will be preferred to the oral route because of their safety and efficacy on all symptoms of SGUM during low-dose use. Prasterone is a local treatment that can be proposed as an effective alternative for the management of dyspareunia and sexual function disorder. Current data on oral testosterone, tibolone, oral or transdermal DHEA and herbal medicine are currently limited. Ospemifène, which has shown a significant improvement in sexual symptoms, is not currently marketed in France. In the particular case of women with a history of breast cancer, non-hormonal regimens are a first-line therapy. Current data on the risk of breast cancer recurrence when administering low-dose local estrogen are reassuring but do not support a conclusion that this treatment is safe. CONCLUSION SGUM is a common symptom that can affect the quality of life of postmenopausal women. A treatment should be systematically proposed. Local non-hormonal treatment may be offered in all women. Local low-dose estrogen therapy and Prasterone has shown an interest in the management of symptoms. In women before a history of breast cancer, local non-hormonal treatment should be offered first-line. The safety of low-dose local estrogen therapy and Prasterone cannot be established at this time. Other alternatives exist but are not currently recommended in France due to lack of data.
Collapse
Affiliation(s)
- C Hocké
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - M Diaz
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - V Bernard
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - S Frantz
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - M Lambert
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - C Mathieu
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - M Grellety-Cherbero
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| |
Collapse
|
5
|
Variation in outcome reporting and measurement tools in clinical trials of treatments for genitourinary symptoms in peri- and postmenopausal women: a systematic review. ACTA ACUST UNITED AC 2021; 27:1070-1080. [PMID: 32852462 DOI: 10.1097/gme.0000000000001570] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Genitourinary symptoms affect 40% to 60% of postmenopausal women. Evidence-based approaches to diagnosing and managing these symptoms are limited by inconsistencies in outcomes and measures used in clinical trials. OBJECTIVE The aim of the study was to systematically review all outcomes and measurement tools reported in randomized clinical trials of interventions for genitourinary symptoms associated with menopause. EVIDENCE REVIEW We searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to December 2018. Randomized controlled trials with a primary or secondary outcome of genitourinary symptoms associated with menopause, English language, and sample size of 20 or more women per study arm were included. Study characteristics, outcomes, and measurement methods were collected. FINDINGS The search yielded 3,478 articles of which 109 met inclusion criteria. Forty-eight different outcomes were reported with "atrophy" as the most common (56/109, 51%) followed by measures of sexual function (19/109, 17%). Almost all (108/109, 99%) trials included patient-reported measures, with 21 different measures and 39 symptom combinations. Clinician-reported scales of vulvovaginal appearance were used in 36 of 109 (33%) trials, with extensive variation in what was measured and reported. Cytological measures from the vaginal epithelium were the most commonly used objective tools (76/109, 70%). CONCLUSIONS AND RELEVANCE There is heterogeneity in reported outcomes and measures used in clinical trials of treatments for genitourinary symptoms at menopause and uncertainty as to which outcomes best reflect patient priorities and symptoms. The findings from this systematic review have informed an international survey of stakeholders to determine priorities for outcome selection and reporting. This survey will then inform the development of a Core Outcome Set for use in future clinical trials by the COMMA (Core OutcoMes in MenopAuse) consortium. : Video Summary:http://links.lww.com/MENO/A599.
Collapse
|
6
|
Wang S, Zhang S, Wang S, Gao P, Dai L. A comprehensive review on Pueraria: Insights on its chemistry and medicinal value. Biomed Pharmacother 2020; 131:110734. [DOI: 10.1016/j.biopha.2020.110734] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/29/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023] Open
|
7
|
Sritonchai C, Manonai J, Sophonsritsuk A, Cherdshewasart W. Comparison of the effects of Pueraria mirifica gel and of placebo gel on the vaginal microenvironment of postmenopausal women with Genitourinary Syndrome of Menopause (GSM). Maturitas 2020; 140:49-54. [DOI: 10.1016/j.maturitas.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/02/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
|
8
|
Petrine JCP, Del Bianco-Borges B. The influence of phytoestrogens on different physiological and pathological processes: An overview. Phytother Res 2020; 35:180-197. [PMID: 32780464 DOI: 10.1002/ptr.6816] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/01/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Abstract
Functional foods have nutritional properties and organic functions, which are beneficial to health. Certain types of functional food components are so-called phytoestrogens, non-steroidal compounds derived from the metabolism of precursors contained in plants, which originate secondary metabotypes known to induce biological responses and by mimicry or modulating the action of endogenous estrogen. These molecules are involved in several physiological and pathological processes related to reproduction, bone remodeling, skin, cardiovascular, nervous, immune systems, and metabolism. This review aimed to present an overview of phytoestrogens regarding their chemical structure, actions, and effects in the organism given several pathologies. Several studies have demonstrated beneficial phytoestrogen actions, such as lipid profile improvement, cognitive function, menopause, oxidative stress, among others. Phytoestrogens effects are not completely elucidated, being necessary future research to understand the exact action mechanisms, whether they are via estrogen receptor or whether other hidden mechanisms produce these effects. Thus, this review makes a general approach to the phytoestrogen actions, beneficial effects, risk and limitations. However, the complexities of biological effects after ingestion of phytoestrogens and the differences in their metabolism and bioavailability indicate that interpretation of either risk or benefits needs to be made with caution.
Collapse
Affiliation(s)
- Jéssica C P Petrine
- Departamento de Ciências da Saúde, Universidade Federal de Lavras, Lavras, Brasil
| | | |
Collapse
|
9
|
Expression of actively soluble antigen-binding fragment (Fab) antibody and GFP fused Fab in the cytoplasm of the engineered Escherichia coli. Mol Biol Rep 2020; 47:4519-4529. [PMID: 32394307 DOI: 10.1007/s11033-020-05502-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/06/2020] [Indexed: 01/11/2023]
Abstract
The expression of recombinant antibody fragments in the cytoplasmic space of Escherichia coli and the refolding process for restoring the structure and activity of such antibodies are not efficient. Herein, fragment antigen-binding (Fab) antibodies against miroestrol and deoxymiroestrol (MD-Fab) and their fusions with a green fluorescent protein (GFP) were expressed. The reactive MD-Fabs were successfully expressed as soluble and active forms in the cytoplasm of the SHuffle® T7 E. coli strain. Regarding the construct of MD-Fab alone, VH-CH1 could associate VL-CL into Fab in the oxidizing cytoplasm of the E. coli strain, and no additional in vitro refolding was needed. In the case of the fusions with GFP, when the C-terminus of VH-CH1 was linked with the N-terminus of GFP, the MD-Fab binding reactivity was retained, but the fluorescent activity of GFP interfered. When the C-terminus of GFP was linked to the N-terminus of VL-CL, the binding activity of MD-Fab was not observed. The constructed MD-Fabs had higher specificity toward deoxymiroestrol than the parental monoclonal antibody clone 12G11. In conclusion, MD-Fabs could be expressed using SHuffle® T7 E. coli cells. This process could be considered an economical, productive, and effective method to produce antibody fragments for immunoassay techniques.
Collapse
|
10
|
Yusakul G, Phaisan S, Nuntawong P, Sakamoto S, Putalun W, Morimoto S, Tanaka H. Honey as a solvent for the green extraction, analysis, and bioconversion of daidzin from Pueraria candollei var. mirifica root. Pharmacogn Mag 2020. [DOI: 10.4103/pm.pm_74_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Dizavandi FR, Ghazanfarpour M, Roozbeh N, Kargarfard L, Khadivzadeh T, Dashti S. An overview of the phytoestrogen effect on vaginal health and dyspareunia in peri- and post-menopausal women. Post Reprod Health 2019; 25:11-20. [PMID: 30786797 DOI: 10.1177/2053369118823365] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this overview was to evaluate the effectiveness of phytoestrogens on vaginal health and dyspareunia in peri- and post-menopausal women. MATERIAL AND METHODS Three databases including MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials were from inception to August 2017. RESULT Two systematic reviews and 11 RCTs were included in the overview. According to the findings, isoflavones increased the maturation value and attenuated the vaginal atrophy in the post-menopausal women. Topical isoflavones had beneficial effects on the vaginal atrophy. Similar efficacy was found in Pueraria mirifica and conjugated estrogen cream on dryness ( p = 0.277), soreness ( p = 0.124) and irritation ( p = 0.469), as well as discharge ( p = 0.225) and dyspareunia ( p = 0.089). However, the conjugated estrogen cream was more effective compared to Pueraria mirifica ( p > 0.005) regarding maturation index improvement. Comparison of fennel 5% vaginal cream and placebo gel showed significant difference in superficial cells ( p < 0.01), parabasal cells ( p < 0.01) and intermediate cells ( p < 0.01), whereas no difference was found between the oral fennel and placebo in terms of superficial, parabasal and intermediate cells as well as Maturation value. Administration of 80 mg red clover oil had a significant effect on superficial ( p < 0.005), intermediate ( p < 0.005) and parabasal and vaginal dryness ( p < 0.005) compared to the placebo. Flaxseed had also a trivial effect on maturation value. Genistein had a more prominent effect on the genital score. The severity of dyspareunia decreased by 27%. CONCLUSION Phytoestrogens have various effects based on administration route and type on the vaginal atrophy.
Collapse
Affiliation(s)
- Fatemeh R Dizavandi
- 1 Department of Community Health and Psychiatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Ghazanfarpour
- 2 Department of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Nasibeh Roozbeh
- 3 Mother and Child Welfare Research Center, Hormozgan University of Medical Science, Bander Abbas, Iran
| | - Leila Kargarfard
- 4 Instructor of Fatemeh School Nursing and Midwifery, Shiraz University of Medical Science, Shiraz, Iran
| | - Talat Khadivzadeh
- 5 Department of Evidence-Based Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sareh Dashti
- 6 Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| |
Collapse
|
12
|
Najaf Najafi M, Ghazanfarpour M. Effect of phytoestrogens on sexual function in menopausal women: a systematic review and meta-analysis. Climacteric 2018; 21:437-445. [DOI: 10.1080/13697137.2018.1472566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M. Najaf Najafi
- Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M. Ghazanfarpour
- Department of Nursing and Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
13
|
Rahmani Y, Chaleh KC, Shahmohammadi A, Safari S. Effect of Herbal Medicine on Vaginal Epithelial Cells: A Systematic Review and Meta-analysis. J Menopausal Med 2018; 24:11-16. [PMID: 29765922 PMCID: PMC5949303 DOI: 10.6118/jmm.2018.24.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/11/2017] [Accepted: 12/26/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives The present meta-analysis aimed to assess the effect of the herbal medicine on the vaginal epithelial cells (VECs) among the menopausal subjects. Methods The literature related to VECs exposed to various herbal medicines in menopausal women were searched on three databases, MEDLINE (1966–August 2017), Scopus (1990–August 2017) and Cochrane Library (Cochrane Central Register of Controlled Trials; 2014). Results Totally, the meta-analysis was conducted on 11 randomised controlled trials. Based on the findings, the standardized mean difference (SMD) of maturation value (MV) was observed to be elevated by 0.48% (95% interval confidence [CI], 0.108–0.871; P = 0.012), as well as the heterogeneity was high (I2 = 84%; P < 0.001). The MV revealed a significant increase in soy group (SMD, 0.358; 95% CI, 0.073–0.871; P = 0.014) compared to the control group. Conclusions The herbal medicines exhibited a statistically significant effect on the VECs. A significant effect on the VECs was also found in the subgroup analysis of the patients, who received soy. However, further and extensive studies are required to achieve reliable outcomes.
Collapse
Affiliation(s)
- Yousef Rahmani
- Clinical Research Development Center, Imam Ali and Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Khadijeh Chaleh Chaleh
- Clinical Research Development Center, Imam Ali and Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Medical Surgical Nursing, Kermanshah University of Medical Science, Imam Reza Hospital, Kermanshah, Iran
| | - Afshar Shahmohammadi
- Clinical Research Development Center, Imam Ali and Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahla Safari
- Clinical Research Development Center, Imam Ali and Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
14
|
Kongkaew C, Scholfield NC, Dhippayom T, Dilokthornsakul P, Saokaew S, Chaiyakunapruk N. Efficacy and safety of Pueraria candollei var. mirifica (Airy Shaw & Suvat.) Niyomdham for menopausal women: A systematic review of clinical trials and the way forward. JOURNAL OF ETHNOPHARMACOLOGY 2018; 216:162-174. [PMID: 29409850 DOI: 10.1016/j.jep.2018.01.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Pueraria candollei var. mirifica (Airy Shaw & Suvat.) Niyomdham (commonly termed P. mirifica, PM) growing in upland Thailand has a long history as a postmenopausal rejuvenant therapy for indigenants. Its amelioration of menopause symptoms in clinical trials was assessed. MATERIALS AND METHODS International and Thai databases were searched from inception to February 2017. Clinical trials investigating effects of PM menopausal or postmenopausal women were included. Outcomes were self-reported menopausal symptoms, serum reproductive hormones, urino-genital tract function, and bone surrogates. Methodological quality was assessed by Cochrane risk-of-bias v2.0, and a 22-parameter quality score based on the CONSORT checklist for herbal medicines. RESULTS Eight studies (9 articles) used data from 309 menopausal patients. Five-studies demonstrated that PM was associated with climacteric scores reduced by ~50% compared to baseline. Other PM studies using limited numbers of placebo participants suggested improved vaginal and other urogenital tract symptoms. Bone alkaline phosphatase halved (suggesting lowered bone turnover). Variable serum reproductive hormone levels suggested menopausal status differed between studies. PM active ingredients and sources were not defined. Adverse event rates (mastodynia, vaginal spotting, dizziness) were similar in all groups (PM, conjugated equine estrogen, and placebos) but serum C-reactive protein doubled. These studies had design and reporting deficiencies, high risks of biases, and low quality scores. CONCLUSIONS The efficacy of PM on menopausal symptoms remains inconclusive because of methodological short-comings especially placebo effects inherent in self-assessment/recall questionnaires and no PM standardization. PM efficacy and safety need a fundamental re-appraisal by: (i) cohort (retro- and prospective) studies on current users to define its traditional use for rejuvenation; (ii) tightly coupling long-term efficacy to safety of well-defined PM and multiple end-points; (iii) using study design related to current understanding of menopause progression and estrogen pharmacology (iv) robust pharmacovigilance.
Collapse
Affiliation(s)
- Chuenjid Kongkaew
- Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Research Department of Practice and Policy, School of Pharmacy, University College London, UK.
| | - Norman C Scholfield
- Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Teerapon Dhippayom
- Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Surasak Saokaew
- School of Pharmacy, Monash University Malaysia, Kuala Lumpur, Malaysia; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Kuala Lumpur, Malaysia; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
| |
Collapse
|
15
|
Yusakul G, Kitisripanya T, Juengwatanatrakul T, Sakamoto S, Tanaka H, Putalun W. Enzyme linked immunosorbent assay for total potent estrogenic miroestrol and deoxymiroestrol of Pueraria candollei, a Thai herb for menopause remedy. J Nat Med 2018; 72:641-650. [DOI: 10.1007/s11418-018-1194-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
|
16
|
Vaginal erbium laser as second-generation thermotherapy for the genitourinary syndrome of menopause: a pilot study in breast cancer survivors. Menopause 2018; 24:316-319. [PMID: 28231079 DOI: 10.1097/gme.0000000000000761] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment, the vaginal erbium laser, as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors. METHODS The study was performed using an erbium laser crystal yttrium-aluminum-garnet (XS Fotona Smooth, Fotona, Ljubljana, Slovenia) with a wavelength of 2,940 nm. Forty-three postmenopausal breast cancer survivors were treated with three laser applications every 30 days. Symptoms were assessed before the treatment and after 1, 3, 6, 12, and 18 months, using two methods, subjective Visual Analog Scale (VAS) and objective Vaginal Health Index Score (VHIS). The procedures were performed on an outpatient basis without anesthesia or drug use before or after the intervention. RESULTS From baseline values of 8.5 ± 1.0 cm, vaginal dryness VAS scores were 4.4 ± 1.2 cm after the third treatment and 5.5 ± 1.5 cm 12 months after the treatment (P < 0.01 vs basal values), whereas they were 7.5 ± 1.8 cm after 18 months from the last laser application (NS vs basal values). From baseline values of 7.5 ± 1.5 cm, dyspareunia VAS values decreased to 4.2 ± 0.9 cm after the third treatment and 5.1 ± 1.8 cm 12 months from the last laser application (P < 0.01 vs basal values), whereas they were 6.5 ± 1.8 cm after 18 months from the last laser application (NS vs basal values). VHIS, from baseline values of 8.1 ± 1.3, was 21.0 ± 1.4 after the third treatment and 18 ± 1.8 12 months from the last laser application (P < 0.01 vs basal values), whereas they were 14.8 ± 1.5 cm after 18 months from the last laser application (NS vs basal values). No adverse events were recorded during the study. CONCLUSIONS This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors.
Collapse
|
17
|
Comparison of Pueraria mirifica gel and conjugated equine estrogen cream effects on vaginal health in postmenopausal women. Menopause 2018; 24:210-215. [PMID: 27749740 DOI: 10.1097/gme.0000000000000742] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the effects of a 12-week treatment with Pueraria mirifica (PM) gel or a conjugated estrogen cream on vaginal maturation index, vaginal symptom score, vaginal health assessment score, and vaginal flora in postmenopausal women. METHODS In a prospective, noninferiority, randomized controlled study, 82 postmenopausal women with at least one vulvovaginal symptom, that is, dryness, soreness, irritation, dyspareunia, or discharge, were recruited. Participants were randomly assigned into two groups for treatment with either PM gel or conjugated estrogen cream (CEE). The treatment regimen consisted of application of 0.5 g of product intravaginally daily for 2 weeks, and then decreased to three times per week for 10 weeks. Vaginal maturation index, vaginal symptoms score, and vaginal health assessment score were evaluated before the beginning of the study and at 6 weeks and 12 weeks after treatment with PM or CEE. RESULTS The vaginal maturation index increased significantly in both treatment groups at week 12, from 22.44 ± 22.28 to 47.56 ± 29.00 and from 27.07 ± 26.12 to 66.90 ± 22.42 in the PM and the CEE groups, respectively (P < 0.05). A significantly higher effect was, however, observed in the CEE group (P < 0.05). Vaginal symptom scores decreased significantly after treatment in both groups, from 4.37 ± 2.79 to 0.95 ± 1.88 and from 4.15 ± 2.16 to 0.68 ± 1.64 in the PM and the CEE groups, respectively (P < 0.05), with no statistically significant different between the two groups (P > 0.05). CONCLUSIONS The use of a 12-week treatment regimen with Pueraria mirifica gel was shown to be efficacious and safe for the treatment of vulvovaginal atrophy. Conjugated estrogen cream was found to be more effective compared to Pueraria mirifica gel in improving signs of vaginal atrophy and restoring vaginal epithelium at 6 and 12 weeks.
Collapse
|
18
|
Effects of a soy-based dietary supplement compared with low-dose hormone therapy on the urogenital system. Menopause 2015; 22:741-9. [DOI: 10.1097/gme.0000000000000380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Yusakul G, Udomsin O, Tanaka H, Morimoto S, Juengwatanatrakul T, Putalun W. Enzyme‐linked immunosorbent assay by enhanced chemiluminescence detection for the standardization of estrogenic miroestrol in
Pueraria candollei
Graham ex Benth. LUMINESCENCE 2014; 30:568-75. [DOI: 10.1002/bio.2787] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/09/2014] [Accepted: 09/02/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Gorawit Yusakul
- Faculty of Pharmaceutical SciencesKhon Kaen University Khon Kaen 40002 Thailand
- Research Group for Pharmaceutical Activities of Natural Products using Pharmaceutical Biotechnology (PANPB)National Research University‐Khon Kaen University Khon Kaen 40002 Thailand
| | - Orapin Udomsin
- Faculty of Pharmaceutical SciencesKhon Kaen University Khon Kaen 40002 Thailand
- Research Group for Pharmaceutical Activities of Natural Products using Pharmaceutical Biotechnology (PANPB)National Research University‐Khon Kaen University Khon Kaen 40002 Thailand
| | - Hiroyuki Tanaka
- Graduate School of Pharmaceutical SciencesKyushu University Fukuoka 812‐8582 Japan
| | - Satoshi Morimoto
- Graduate School of Pharmaceutical SciencesKyushu University Fukuoka 812‐8582 Japan
| | | | - Waraporn Putalun
- Faculty of Pharmaceutical SciencesKhon Kaen University Khon Kaen 40002 Thailand
- Research Group for Pharmaceutical Activities of Natural Products using Pharmaceutical Biotechnology (PANPB)National Research University‐Khon Kaen University Khon Kaen 40002 Thailand
| |
Collapse
|
20
|
Weber MA, Limpens J, Roovers JPWR. Assessment of vaginal atrophy: a review. Int Urogynecol J 2014; 26:15-28. [DOI: 10.1007/s00192-014-2464-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/19/2014] [Indexed: 01/14/2023]
|
21
|
Ulbricht C, Costa D, Dam C, D'Auria D, Giese N, Isaac R, LeBlanc Y, Rusie E, Weissner W, Windsor RC. An evidence-based systematic review of kudzu (Pueraria lobata) by the Natural Standard Research Collaboration. J Diet Suppl 2014; 12:36-104. [PMID: 24848872 DOI: 10.3109/19390211.2014.904123] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An evidence-based systematic review of kudzu (Pueraria lobata) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
Collapse
|
22
|
Jungsukcharoen J, Dhiani BA, Cherdshewasart W, Vinayavekhin N, Sangvanich P, Boonchird C. Pueraria mirifica leaves, an alternative potential isoflavonoid source. Biosci Biotechnol Biochem 2014; 78:917-26. [PMID: 25036114 DOI: 10.1080/09168451.2014.910091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We investigated the major leaf isoflavonoid contents of Pueraria mirifica from three different cultivars (PM-III, PM-IV, and PM-V) using reverse RP-HPLC analysis. The proportions and net levels of puerarin, daidzin, genistin, and daidzein in P. mirifica leaves were found to depend on the plant cultivar and to correlate with cultivation temperature and rainfall amount. The crude leaf-extracts were tested using the Yeast Estrogen Screen (YES) assay with both human estrogen receptors (hERα and hERβ). Their estrogenic activity was higher when determined by the YES system containing hERβ than that with hERα and was also higher when the Δsnq2 than the wildtype yeast was employed. The results open the possibility of selecting and cultivating certain P. mirifica cultivars at a farm scale to produce a sufficient supply of leaf material to act as a starting source for the commercial scale extraction of these major isoflavonoids.
Collapse
Affiliation(s)
- Jutarmas Jungsukcharoen
- a Faculty of Science, Program in Biotechnology , Chulalongkorn University , Bangkok , Thailand
| | | | | | | | | | | |
Collapse
|
23
|
Jaroenporn S, Urasopon N, Watanabe G, Malaivijitnond S. Improvements of vaginal atrophy without systemic side effects after topical application of Pueraria mirifica, a phytoestrogen-rich herb, in postmenopausal cynomolgus macaques. J Reprod Dev 2014; 60:238-45. [PMID: 24748397 PMCID: PMC4085389 DOI: 10.1262/jrd.2013-144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The estrogenic efficacy of topical vaginal application of Pueraria mirifica extract (PM) on the restoration
of vaginal atrophy, and the presence of any systemic side effects, were investigated in postmenopausal cynomolgus macaques.
Twelve postmenopausal cynomolgus macaques, with complete cessation of menstruation for at least 5 years before start of this
experiment, were divided into three groups. They received a topical vaginal application daily of 0.1 or 1% (w/w) PM cream or
a conjugated equine estrogen (CEE) cream (a mixture of estrone, equilin, 17β-dihydroequilin, 17α-estradiol and
17α-dihydroequilin at 0.625 mg total estrogen/g cream) for 28 days. Estrogenic efficacy was assessed weekly by vaginal
cytology assay and vaginal pH measurement, whilst the plasma luteinizing hormone (LH) and sex skin coloration levels were
determined at the end of each treatment period to evaluate the systemic side effects. PM significantly increased the
proportion of superficial cells in a dose-dependent manner, with a similar efficacy between 1% (w/w) PM and CEE. Together
with increased vaginal maturation, PM decreased the vaginal pH to acidic levels, as observed in the CEE group. PM induced no
detected systemic side effects, whilst CEE decreased the plasma LH level and increased the reddish color of the sex skin
during the posttreatment period. Topical vaginal treatment with PM stimulated the maturation of the vaginal epithelium
without causing systemic side effects in postmenopausal monkeys. The implication is that PM could be a safer alternative to
treat vaginal atrophy in postmenopausal women.
Collapse
Affiliation(s)
- Sukanya Jaroenporn
- Primate Research Unit, Department of Biology, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand
| | | | | | | |
Collapse
|
24
|
Yusakul G, Udomsin O, Juengwatanatrakul T, Tanaka H, Chaichantipyuth C, Putalun W. Highly selective and sensitive determination of deoxymiroestrol using a polyclonal antibody-based enzyme-linked immunosorbent assay. Talanta 2013; 114:73-8. [DOI: 10.1016/j.talanta.2013.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 11/28/2022]
|
25
|
High performance enzyme-linked immunosorbent assay for determination of miroestrol, a potent phytoestrogen from Pueraria candollei. Anal Chim Acta 2013; 785:104-10. [DOI: 10.1016/j.aca.2013.04.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/02/2013] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
|
26
|
Medical applications of phytoestrogens from the Thai herb Pueraria mirifica. Front Med 2012; 6:8-21. [PMID: 22460444 DOI: 10.1007/s11684-012-0184-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 12/31/2011] [Indexed: 10/28/2022]
Abstract
Pueraria mirifica Airy Shaw et Suvatabandhu is a medicinal plant endemic to Thailand. It has been used in Thai folklore medicine for its rejuvenating qualities in aged women and men for nearly one hundred years. Indeed, it has been claimed that P. mirifica contains active phytoestrogens (plant substances with estrogen-like activity). Using high performance liquid chromatography, at least 17 phytoestrogens, mainly isoflavones, have been isolated. Thus, fairly considerable scientific researches, both in vitro in cell lines and in vivo in various species of animals including humans, have been conducted to date to address its estrogenic activity on the reproductive organs, bones, cardiovascular diseases and other climacteric related symptoms. The antioxidative capacity and antiproliferative effect on tumor cell lines have also been assessed. In general, P. mirifica could be applicable for preventing, or as a therapeutic for, the symptoms related to estrogen deficiency in menopausal women as well as in andropausal men. However, the optimal doses for each desirable effect and the balance to avoid undesired side effects need to be calculated before use.
Collapse
|
27
|
Gomuttapong S, Pewphong R, Choeisiri S, Jaroenporn S, Malaivijitnond S. Testing of the estrogenic activity and toxicity ofStephania venosaherb in ovariectomized rats. Toxicol Mech Methods 2012; 22:445-57. [DOI: 10.3109/15376516.2012.668573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
28
|
Bunmanop S, Sakuanrungsirikul S, Manakasem Y. White Kwao Krua variety classification by botanical characteristics and ISSR-Touchdown PCR technique. RUSS J GENET+ 2011. [DOI: 10.1134/s1022795411070039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
29
|
Boonchird C, Mahapanichkul T, Cherdshewasart W. Differential binding with ERalpha and ERbeta of the phytoestrogen-rich plant Pueraria mirifica. Braz J Med Biol Res 2009; 43:195-200. [PMID: 20027484 DOI: 10.1590/s0100-879x2009007500026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 11/27/2009] [Indexed: 11/21/2022] Open
Abstract
Variations in the estrogenic activity of the phytoestrogen-rich plant, Pueraria mirifica, were determined with yeast estrogen screen (YES) consisting of human estrogen receptors (hER) hERalpha and hERbeta and human transcriptional intermediary factor 2 (hTIF2) or human steroid receptor coactivator 1 (hSRC1), respectively, together with the beta-galactosidase expression cassette. Relative estrogenic potency was expressed by determining the beta-galactosidase activity (EC(50)) of the tuber extracts in relation to 17beta-estradiol. Twenty-four and 22 of the plant tuber ethanolic extracts interacted with hERalpha and hERbeta, respectively, with a higher relative estrogenic potency with hERbeta than with hERalpha. Antiestrogenic activity of the plant extracts was also determined by incubation of plant extracts with 17beta-estradiol prior to YES assay. The plant extracts tested exhibited antiestrogenic activity. Both the estrogenic and the antiestrogenic activity of the tuber extracts were metabolically activated with the rat liver S9-fraction prior to the assay indicating the positive influence of liver enzymes. Correlation analysis between estrogenic potency and the five major isoflavonoid contents within the previously HPLC-analyzed tuberous samples namely puerarin, daidzin, genistin, daidzein, and genistein revealed a negative result.
Collapse
Affiliation(s)
- C Boonchird
- Department of Biotechnology, Faculty of Science, Mahidol University, Ratchathewi, Bangkok, Thailand
| | | | | |
Collapse
|
30
|
Li XY, Wang XY, Nie GN. [Application of complementary and alternative therapies abroad in treatment of climacteric symptoms]. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2009; 7:89-94. [PMID: 19134465 DOI: 10.3736/jcim20090115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Xiao-yu Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 510405, China
| | | | | |
Collapse
|
31
|
Effects and safety of Pueraria mirifica on lipid profiles and biochemical markers of bone turnover rates in healthy postmenopausal women. Menopause 2008; 15:530-5. [PMID: 18202589 DOI: 10.1097/gme.0b013e31815c5fd8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effect of Pueraria mirifica on lipid profiles and biochemical markers of bone turnover rates in healthy postmenopausal women and to evaluate the safety of Pueraria mirifica on endometrium; breast tissue; and hematologic, hepatic, and renal systems. DESIGN This was a randomized, double-blind, placebo-controlled study in a university hospital of healthy postmenopausal women aged 45 to 60 years old. Women were enrolled voluntarily and randomly received 20, 30, or 50 mg Pueraria mirifica in capsules or identical placebo once daily for 24 weeks. Outcome measures were lipid profiles, bone-specific alkaline phosphatase level, endometrial thickness, endometrial histology, breast ultrasonography, complete blood count, liver function test, and renal function test. RESULTS After 24 weeks of treatment, 71 women were evaluated. Of the 71 women, 51 randomly received varying doses of Pueraria mirifica and 20 received placebo. Pueraria mirifica and placebo significantly increased triglyceride levels by 15% from baseline levels (P<0.05). The Pueraria mirifica group showed a significant decrease in bone-specific alkaline phosphatase levels after 24 weeks of treatment compared with the placebo group; from 0.22+/-0.18 U/L to 0.13+/-0.01 U/L in the Pueraria mirifica group and from 0.20+/-0.10 U/L to 0.20+/-0.14 U/L in the placebo group. Endometrial thickness did not change after treatment in both groups (P>0.05). No endometrial proliferation or hyperplasia was reported after 24 weeks of treatment in both groups. There were no significant differences in adverse effects on breast tissue, complete blood count, and liver and renal function tests between the Pueraria mirifica and placebo groups in this study. CONCLUSION Pueraria mirifica at a dose of 20, 30, and 50 mg/d for a 24-week period demonstrated an estrogen-like effect on bone turnover rate. Pueraria mirifica did not demonstrate an estrogen-like effect on endometrial thickness and endometrial histology. Mild adverse effects occurred after Pueraria mirifica and placebo treatment.
Collapse
|