A Review of Danshen Combined with Clopidogrel in the Treatment of Coronary Heart Disease

Recent developments in Salvia miltiorrhiza polysaccharides: Isolation, purification, structural characteristics and biological activities

In recent years, natural polysaccharides have attracted more and more attention and research because of their value in the medicine, beauty and food fields. Salvia miltiorrhiza is a traditional Chinese herb that has been used for thousands of years and has antidiabetic, antifibrotic, neuroprotective, antioxidation, anti-inflammatory and other effects. It mainly includes rosmarinic acid, tanshinone I, tanshinone IIA, tanshinone IIB, procatechualdehyde, polysaccharide and salvianolic acids. Salvia miltiorrhiza polysaccharide is a polysaccharide extracted and isolated from Salvia miltiorrhiza and has diverse biological functions, including antioxidation, anti-tumor, hepatoprotective, anti-inflammatory, immune regulatory and cardioprotective effect. In this review, the extraction, purification, structural characterization and biological activity of SMPs are summarized and new perspectives for the future work of SMPs were also proposed, we hope our research can provide a reference for further research on SMPs.

Interaction study of Salvianolic acids for injection on pharmacokinetics of clopidogrel in rats by LC-MS/MS

Salvianolic acids for injection (SAI) is developed from traditional Chinese medicine and approved for the treatment of cardiovascular and cerebrovascular diseases. Clopidogrel is an inhibitor of platelet aggregation, which is often prescribed to patients in combination with SAI. This present study is aiming to assess the influences of SAI on the pharmacogenomics, pharmacokinetics and pharmacodynamics of clopidogrel, thereby ensuring the safety and efficacy of the co-administration. In vitro Cytochrome P450 isoenzymes assays were performed in human liver microsomes by LC-MS/MS method to assess the metabolites of CYPs substrates. The influences of SAI on the pharmacokinetics and pharmacodynamics behavior of clopidogrel were investigated in rats. The main pharmacokinetic parameters were analyzed by LC-MS/MS. Prothrombin time, activated partial thromboplastin time, bleeding time and inhibition of platelet aggregation were measured to evaluate the effects of pharmacodynamics. In our study, SAI at the clinical dose has no significant inhibitory effect on clopidogrel-related liver microsomes metabolic CYP450 isoenzymes. Moreover, SAI didn't affect the pharmacokinetics of clopidogrel both single dose and multiple dose in rats. In pharmacodynamics study, SAI has no effect on the platelet aggregation rate, PT and APTT time of clopidogrel, but could significantly prevent the risk of bleeding caused by clopidogrel.

Combined Therapy with Traditional Chinese Medicine and Antiplatelet Drugs for Ischemic Heart Disease: Mechanism, Efficacy, and Safety

Ischemic heart disease is a significant risk factor that threatens human health, and antiplatelet drugs are routinely used to treat cases in clinical settings. Chinese medicine for promoting blood circulation and removing blood stasis (PBCRBSCM) can often be combined with antiplatelet drugs to treat ischemic heart disease. PBCRBSCM can inhibit platelet adhesion, activation, and aggregation; moreover, PBCRBSCM in combination with antiplatelet drugs exerts antiplatelet effects. The mechanism is related to several factors, including the inhibition of platelet activation and aggregation, improvement of the hemodynamic status and coagulation function, and correction of metabolism and inflammation. PBCRBSCM can also regulate the absorption and metabolism of conventional antiplatelet drugs and protect the gastric mucosal epithelial cells against damage induced by conventional antiplatelet drugs. Randomized controlled trials have confirmed that PBCRBSCM preparations and the active ingredients in these preparations can reduce resistance to aspirin and clopidogrel so that the combination of these drugs can exert their antiplatelet effects. In the perioperative treatment of patients with stable angina pectoris, unstable angina pectoris, and acute coronary syndrome undergoing percutaneous coronary intervention therapy, preparations of the active ingredients of PBCRBSCM combined with antiplatelet drugs and other conventional Western medicine treatments have been proven effective. The efficacy and safety of such combinations have also been extensively verified. Considerable progress has been made to understand the antiplatelet mechanism of PBCRBSCM. However, most clinical studies had problems, such as limited sample size and inappropriate research design, which has limited the translational use of PBCRBSCM in antiplatelet therapy. A large-scale, multicenter, randomized controlled study with cardiovascular events as the endpoint is still to be conducted to provide evidence for the combined application of PBCRBSCM and antiplatelet drugs in the prevention and treatment of ischemic heart disease.

Salvia miltiorrhiza-Derived Sal-miR-58 Induces Autophagy and Attenuates Inflammation in Vascular Smooth Muscle Cells

Autophagy is associated with the cytoprotection of physiological processes against inflammation and oxidative stress. Salvia miltiorrhiza possesses cardiovascular protective actions and has powerful anti-oxidative and anti-inflammatory effects; however, whether and how Salvia miltiorrhiza-derived microRNAs (miRNAs) protect vascular smooth muscle cells (VSMCs) by inducing autophagy across species are unknown. We first screened and identified Sal-miR-58 from Salvia miltiorrhiza as a natural autophagy inducer. Synthetic Sal-miR-58 suppresses chronic angiotensin II (Ang II) infusion-induced abdominal aortic aneurysm (AAA) formation in mice, as well as induces autophagy in VSMCs and attenuates the inflammatory response elicited by Ang II in vivo and in vitro. Mechanistically, Sal-miR-58 downregulates Krüppel-like factor 3 (KLF3) expression through direct binding to the 3' UTR of KLF3, which in turn relieves KLF3 repression of E3 ubiquitin ligase neural precursor cell-expressed developmentally downregulated 4-like (NEDD4L) expression, whereas NEDD4L upregulation increases the ubiquitination and degradation of the platelet isoform of phosphofructokinase (PFKP), subsequently leading to a decrease in the activation of Akt/mammalian target of rapamycin (mTOR) signaling and facilitating VSMC autophagy induced by Sal-miR-58 in the context of chronic Ang II stimulation and aneurysm formation. Our results provide the first evidence that plant-derived Sal-miR-58 induces autophagy and attenuates inflammation in VSMCs through cross-species modulation of the KLF3/NEDD4L/PFKP regulatory pathway.