The different immunomodulation of indirect moxibustion on normal subjects and patients with systemic lupus erythematosus

Immunopotentiating effects of herb-partitioned moxibustion on the spleens of cyclophosphamide-induced immunosuppressed rats

BACKGROUND

To investigate the effec of the herb-partitioned moxibustion on T-lymphocyte activity in immunosuppressed rats through differential modulation of the immune checkpoint molecules CD28 and CTLA-4.

METHODS

Forty-eight Sprague‒Dawley rats were randomly divided into the normal group (NG), the cyclophosphamide model group (CTX), the herb-partitioned moxibustion group (HPM), the CD28 inhibitor + herb-partitioned moxibustion group (aCD28 + HPM), the CTLA-4 inhibitor + herb-partitioned moxibustion group (aCTLA-4 + HPM), and the levamisole group (LEV) (8 rats per group). The immunosuppression model was prepared using cyclophosphamide. HPM treatments was performed via herb-partitioned moxibustion at 4 acupoints, Zhongwan (CV12), Shenque (CV8), Guanyuan (CV4), and Zusanli (ST36). Subsequently, the moxa floss was made into a conical moxa cone, which was then placed on the herbal cake and ignited. Five consecutive moxibustion strokes were performed daily for 10 consecutive days. In addition to the same moxibustion, each rat in the aCD28 + HPM group was injected intraperitoneally with 0.5 mg/kg of CD28 inhibitor per rat on the first day of treatment, and 100 μL of CTLA-4 inhibitor was injected into the aCTLA-4 + HPM group on Days 1, 4, and 7. For the positive control, levamisole (LEV) was administered by gavage at a dose of 2 mg/kg once daily for 10 days.

RESULTS

Compared with those in CTX model rats, the WBC counts in the HPM and other groups were significantly higher. The immobility time of EPM in the HPM group was significantly lower than that of the CTX group. The HE stainin results also showed that after treatment, the the marginal zone area of the spleen tissue in the HPM increased, the number of lymphatic sheath lymphocytes around the small central artery of the spleen increased, and the amount of red pulp containing a small amount of pigmentation was partially reduced. Compared with those in the CTX group, the serum levels of CD28, CTLA-4, B7-1, and B7-2 were significantly lower, and the levels of α-MSH, TrkB, and BDNF were significantly greater in the HPM group. The results of the flow cytometry assay showed a significant increase in the number of CD8 + T lymphocytes after treatment with HPM or other agents compared to that in the CTX group. The immunofluorescence results showed that the levels of CD28 and CTLA-4 lower in spleen tissues than in control tissues, and the binding ability of CD28 to B7-1 and B7-2 was weakened after treatment with HPM and other treatments compared with CTX rats, PCR for CD28, CTLA-4 and B7-1 showed similar results.

CONCLUSION

In the immunosuppressive rat model induced by cyclophosphamide, HPM upregulated the expression of α-MSH, TrkB, and BDNF, and downregulated the expression of CD28 and CTLA-4, thereby enhancing the activity of CD8+ T lymphocytes, restoring spleen function, improving the immunosuppressive state, restoring immune function, and effectively alleviating depressive symptoms.

Cortisol Secretion and Subsequent Impaired Lymphopoiesis after Starvation Can Be Reduced by Moxibustion Treatment

As a known steroid hormone, cortisol is involved in gluconeogenesis. Uninterrupted cortisol secretion has fatal effects, both physically and psychologically, because cortisol counteracts the immune response. Moxibustion (Mox) treatment is a traditional technique used in East Asia, which therapeutically transfers heat to certain points on the body surface. In the present study, the effect of Mox treatment on stress hormone secretion was investigated using a mouse model of starvation, in which Mox was applied on the Zhongwan acupoint (CV12). First, high cortisol levels induced by starvation were dose-dependently reduced by Mox treatment. In addition, the stress-induced decline in lymphoid progenitor cell production accompanied by altered cellularity in the thymus, bone marrow, and spleen was also significantly recovered by Mox treatment. Taken together, these findings indicated that Mox treatment reduces stress hormone secretion, which may rescue stress-induced lymphopoiesis impairment. These observations also suggested that enhanced resistance to stress may be one of the mechanisms underlying the immunomodulatory effects of Mox treatment.

Moxibustion as an Adjuvant Therapy for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of 23 Randomized Controlled Trials

OBJECTIVE

This systematic review aims to investigate the efficacy and safety of moxibustion for chronic kidney disease (CKD).

METHODS

Nine databases were searched to identify relevant evidence up to March 8, 2020. Randomized controlled trials (RCTs) that tested moxibustion + basic treatments versus basic treatments alone for patients with CKD and reported, at least, one of the outcomes of interest were included. In the meta-analyses, the mean differences (MDs) and 95% confidence intervals (CIs) were used to measure the effect size.

RESULTS

Twenty-three RCTs (n = 1571) with a moderate to high risk of bias were included. The pooled estimates showed that compared with the controls, patients after moxibustion had a significant reduction in serum creatinine (MD -17.34 μmol/L, 95% CI -28.44 to -6.23; I 2 = 87%), 24-hour urine protein excretion (MD -0.75 g/h, 95% CI -1.07 to -0.42; I 2 = 84%), and blood urea nitrogen (MD -0.63 mmol/L, 95% CI -1.09 to -0.18; I 2 = 37%) and a significant improvement in the quality of life (MD 10.18, 95% CI 3.67 to 16.69; I 2 = 57%). Moxibustion did not show a significant effect on the estimated glomerular filtration rate (eGFR), creatinine clearance, or hemoglobin. The subgroup analyses showed that a longer course of moxibustion (>8 weeks) and indirect moxibustion had a greater effect on reducing serum creatinine. The effect of moxibustion on blood urea nitrogen changed to be nonsignificant after excluding RCTs with a high risk of bias (MD -0.96 mmol/L, 95% CI -2.96 to 1.03). Only one adverse event of burn was reported.

CONCLUSIONS

This systematic review suggests that, as an adjuvant therapy, moxibustion may improve serum creatinine, urinary protein excretion, blood urea nitrogen, and quality of life in patients with CKD. Moxibustion may not have effects on eGFR, creatinine clearance, or hemoglobin. The quality of evidence is weakened by the limitations of risk of bias, heterogeneity, and imprecision.

Acupuncture inhibits neuroinflammation and gut microbial dysbiosis in a mouse model of Parkinson's disease

Growing evidences show that gut microbiota is associated with the pathogenesis of Parkinson's disease (PD) and the gut-brain axis can be promising target for the development of the therapeutic strategies for PD. Acupuncture has been used to improve brain functions and inflammation in neurological disorders such as PD, and to recover the gastrointestinal dysfunctions in various gastrointestinal disorders. Thus, we investigated whether acupuncture could improve Parkinsonism and gut microbial dysbiosis induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. First, we observed that acupuncture treatment at acupoints GB34 and ST36 could improve motor functions and comorbid anxiety in PD mice. Next, we found that acupuncture increased the levels of dopaminergic fibers and neurons in the striatum and the substantia nigra, respectively. Acupuncture also restored the overexpression of microglia and astrocyte as well as conversion of Bax and Bcl-2 expression in both the striatum and the substantia nigra, indicating that inflammatory responses and apoptosis were blocked by acupuncture. Additionally, via 16S rRNA sequence analysis, we observed that the relative abundance of 18 genera were changed in acupuncture-treated mice compared to the PD mice. Of them, Butyricimonas, Holdemania, Frisingicoccus, Gracilibacter, Phocea, and Aestuariispira showed significant correlations with anxiety as well as motor functions. Furthermore, the predicted functional analyses showed that acupuncture restored the physiology functions such as glutathione metabolism, methane metabolism, and PD pathway. In conclusion, we suggest that the effects of acupuncture on the enhanced motor function and the protection of the dopaminergic neurons may be associated with the regulation of the gut microbial dysbiosis and thus the inhibition of the neuroinflammation in the PD mice.

Integrative therapy decreases the risk of lupus nephritis in patients with systemic lupus erythematosus: A population-based retrospective cohort study

ETHNOPHARMACOLOGICAL RELEVANCE

Evidence on alleviating the risk of lupus nephritis by integrative therapy with conventional medicine (CM) and herbal medicine (HM) had not been addressed.

AIM OF THE STUDY

We investigated the integrative effect associated the risk by a retrospective Systemic Lupus Erythematosus (SLE) cohort from Taiwan National Health Insurance Research Database (NHIRD).

MATERIALS AND METHODS

SLE patients with a catastrophic illness certificate (CIC) were retrospectively enrolled from the SLE cohort of the Taiwan NHIRD between 1997 and 2011. The patients were divided into an integrative medicine (IM: integrated CM plus HM) and a non-IM (CM only) group with 1:1 propensity score matching. Cox proportional regression model and the Kaplan-Meier method were conducted to estimate the hazard ratio (HR) for lupus nephritis in the cohort.

RESULTS

Among 16,645 newly diagnosed SLE patients holding a CIC (SLE/CIC), 1933 had received HM and 1571 had received no HM treatment. After propensity score matching, there were 273 patients with lupus nephritis-120 in the IM group and 153 in the non-IM group. The adjusted HR (0.68, 95% confidence interval [CI]: 0.54-0.87, p<0.01) for lupus nephritis was lower in the IM group than in the non-IM group. The adjusted HR (0.69, 95% CI: 0.54-0.88, p<0.001) for lupus nephritis was also lower in the group of patients who had received CM plus HM than in the group that received CM only. The core pattern of HM prescriptions, which were integrated with CM for preventing lupus nephritis, was "Sheng-Di-Huang" (raw Rehmannia glutinosa Libosch.), "Mu-Dan-Pi" (Paeonia suffruticosa Andr.), "Dan-Shan" (Salvia miltiorrhiza Bge.), "Zhi-Bo-Di-Huang-Wan.", and "Chi-Shao" (Paeoniae lactiflorae Rubra).

CONCLUSION

Integrative therapy decreased the risk of lupus nephritis among SLE patients in Taiwan. Further investigation of the pharmacological mechanism and clinical efficacy are warranted.

Gene Expression Profiles at Moxibustioned Site (ST36): A Microarray Analysis

As a major alternative therapy in Traditional Chinese Medicine, it has been demonstrated that moxibustion could generate a series of molecular events in blood, spleen, and brain, and so forth. However, what would happen at the moxibustioned site remained unclear. To answer this question, we performed a microarray analysis with skin tissue taken from the moxibustioned site also Zusanli acupoint (ST36) where 15-minute moxibustion stimulation was administrated. The results exhibited 145 upregulated and 72 downregulated genes which responded immediately under physiological conditions, and 255 upregulated and 243 downregulated genes under pathological conditions. Interestingly, most of the pathways and biological processes of the differentially expressed genes (DEGs) under pathological conditions get involved in immunity, while those under physiological conditions are involved in metabolism.

Changes in skin surface temperature at an acupuncture point with moxibustion

OBJECTIVE

This study evaluates the thermographic changes associated with moxa burner moxibustion at the SP6 acupuncture point to establish an appropriate, safe distance of efficacy for moxibustion.

METHODS

Baseline temperature changes using a moxa burner were obtained for a paper substrate at various distances and times, and the tested with volunteers in a pilot study. A single-group trial was then conducted with 36 healthy women to monitor temperature changes on the body surface at the acupuncture point (SP6).

RESULTS

Based on the temperature changes seen for the paper substrate and in the pilot study, a distance of 3 cm was chosen as the intervention distance. Moxibustion significantly increased the SP6 point skin surface temperature, with a peak increase of 11°C at 4 min (p <0.001). This study also found that during moxibustion the temperature of the moxa burner's rubber layer and moxa cautery were 56.9±0.9°C and 65.8±1.2°C, as compared to baseline values of 35.1°C and 43.8°C (p<0.001).

CONCLUSIONS

We determined 3 cm was a safe distance between the moxa burner and acupuncture point. Moxibustion can increase the skin surface temperature at the SP6 point. This data will aid traditional Chinese medicine (TCM) practitioners in gauging safer treatment distances when using moxibustion treatments.

Is there a difference between the effects of one-point and three-point indirect moxibustion stimulation on skin temperature changes of the posterior trunk surface?

OBJECTIVE

To determine whether any difference exists in responses to indirect moxibustion relative to thermal stimulation sites.

METHODS

Twenty one healthy men of mean±SD age 22.5±6.1 years were randomly divided into two groups, one receiving a single moxibustion stimulation in three locations (the three-point stimulation group, n=10 participants) and the other receiving three stimulations in one location (the one-point stimulation group, n=11 participants). The thermal stimulation sites were GV14, GV9 and GV4 acupuncture points. A thermograph was used to obtain the skin temperature on the posterior trunks of the participants. To analyse skin temperature, four arbitrary frames (the scapular, interscapular, lumbar and vertebral regions) were made on the posterior trunk.

RESULT

An increase in skin temperature on the posterior trunk was observed following both one- and three-point moxibustion administrations. The skin temperature of the lumbar region showed a significant increase after three-point stimulation compared with single-point stimulation (p=0.011). There was also a significant increase in skin temperature of the spinal region after three-point stimulation compared with one-point stimulation (p=0.046).

CONCLUSION

Administration of single moxibustion doses on the GV14, GV9 and GV4 points produces greater changes in skin temperature than three applications of moxibustion to the GV14 point only.

The effectiveness of moxibustion: an overview during 10 years

Moxibustion has been used to treat various types of disease. However, there is still insufficient evidence regarding its effectiveness. This study was performed to summarize and evaluate the effectiveness of moxibustion. A search was performed for all randomized controlled trials in PubMed between January 1998 and July 2008 with no language restriction. The results yielded 47 trials in which six moxibustion types were applied to 36 diseases ranging from breech presentation to digestive disorders. Moxibustion was compared to three types of control group: general care, Oriental medical therapies or waiting list. Moxibustion was superior to the control in 14 out of 54 control groups in 46 studies. There were no significant differences among groups in 7 studies, and the outcome direction was not determined in 33 studies. Seven studies were included in a meta-analysis. Moxibustion was more effective than medication in two ulcerative colitis studies (relative risk (95% CI), 2.20 (1.37, 3.52), P = .001, I² = 0%). Overall, our results did not support the effectiveness of moxibustion in specific diseases due to the limited number and low quality of the studies and inadequate use of controls. In order to provide appropriate evidence regarding the effectiveness of moxibustion, more rigorous clinical trials using appropriate controls are warranted.

The antioxidative effect of electro-acupuncture in a mouse model of Parkinson's disease

Accumulating evidence indicates that oxidative stress plays a critical role in Parkinson's disease (PD). Our previous work has shown that 100 Hz electro-acupuncture (EA) stimulation at ZUSANLI (ST36) and SANYINJIAO (SP6) protects neurons in the substantia nigra pars compacta from 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) toxicity in male C57BL/6 mice, a model of PD. In the present study we administered 100 Hz EA stimulation at the two acupoints to MPTP-lesioned mice for 12 sessions starting from the day prior to the first MPTP injection. We found that in the striatum of MPTP treated mice 100 Hz EA stimulation effectively inhibited the production of hydrogen peroxide and malonaldehyde, and increased glutathione concentration and total superoxide dismutase activity through biochemical methods. However, it decreased glutathione peroxidase activity via biochemical analysis and did not affect the level of 1-methyl-4-phenylpyridinium in the striatum revealed by high performance liquid chromatography with ultraviolet detection. These data suggest that 100 Hz EA stimulation at ST36 and SP6 has antioxidative effects in the MPTP model of PD. This data, along with our previous work, indicates that 100 Hz EA stimulation at ST36 and SP6 protects the nigrostriatal system by multiple mechanisms including antioxidation and antiapoptosis, and suggests that EA stimulation is a promising therapy for treating PD.