Efficacy and Safety of Fingerroot (Boesenbergia rotunda) Extract in Patients with Functional Dyspepsia: A Randomized, Placebo-Controlled Trial

Absolute oral bioavailability and possible metabolic pathway of panduratin A from Boesenbergia rotunda extract in beagle dogs

CONTEXT

Attempts are ongoing to develop medications to fight against the COVID-19 pandemic. Our previous study revealed the in vitro anti-SARS-CoV-2 activity of fingerroot [Boesenbergia rotunda (L.) Mansf. (Zingiberaceae)] and its phytochemical, panduratin A.

OBJECTIVE

To investigate the pharmacokinetic profiles of panduratin A as a pure compound and in a fingerroot extract formulation in beagle dogs.

MATERIALS AND METHODS

A total of 12 healthy dogs were randomly divided into three groups, a single dose of 1 mg/kg panduratin A by intravenous and multiple doses of 5 and 10 mg/kg panduratin A fingerroot extract formulation by oral administration for seven consecutive days. The plasma concentration of panduratin A was determined by LCMS.

RESULTS

The peak concentrations of a single dose of 5 and 10 mg/kg panduratin A fingerroot extract formulation were 12,416 ± 2,326 and 26,319 ± 8,221 µg/L, respectively. Increasing the oral dose of fingerroot extract formulation, equivalent to panduratin A 5-10 mg/kg, showed dose proportionality, with an approximately 2-fold increase in C_max and AUC. The absolute oral bioavailability of panduratin A in the fingerroot extract formulation was approximately 7-9%. The majority of panduratin A was biotransformed into several products via oxidation and glucuronidation, and predominantly excreted via the faecal route.

CONCLUSION

The oral formulation of fingerroot extract was safe in beagle dogs, and increasing dose showed dose proportionality in terms of the systemic exposure of panduratin A. This information will support the phytopharmaceutical product development of fingerroot extract against the COVID-19 pandemic.

Nocebo response intensity and influencing factors in the randomized clinical trials of functional dyspepsia: A systematic review and meta-analysis

OBJECTIVES

In this study we aimed to evaluate the nocebo response rate in patients with functional dyspepsia (FD) and to explore its influencing factors.

METHODS

A literature search of the EMBASE, PubMed, and Cochrane Library databases was conducted for all articles published up to March 2021. Randomized, parallel-designed, placebo-controlled trials on pharmacological interventions for patients with FD were included. A meta-analysis that utilized random effects to analyze the incidence of adverse events (AEs) among participants who were given placebo was conducted, and the correlation between trial characteristics and the magnitude of the nocebo response rate was analyzed.

RESULTS

Altogether, 27 studies including 1866 paitents were deemed eligible and included in the analysis. The total nocebo response rate was 26% (95% confidence interval [CI] 18%-33%). The most frequently reported AEs included nasopharyngitis (9%), constipation (6%), headache (5%), and diarrhea (3%). There were significant differences in nocebo response rates among studies conducted in different country or region, treatment duration, types of medication, sponsorship and different versions of the Rome criteria used for FD diagnosis. While number of centers engaged in the study, types of FD diagnosis and dosing frequency were not significantly associated with the nocebo response rate.

CONCLUSIONS

Patients with FD exhibit notable nocebo response strength in clinical trials. The researchers should adopt a more careful approach when analyzing the relationships between AEs and interventions in such trials.

Interaction of panduratin A and derivatives with the SARS-CoV-2 main protease (mpro): a molecular docking study

Panduratin A (Pa-A) is a prenylated cyclohexenyl chalcone isolated from the rhizomes of the medicinal and culinary plant Boesenbergia rotunda (L.) Mansf., commonly called fingerroots. Both an ethanolic plant extract and Pa-A have shown a marked antiviral activity against the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for the COVID-19 pandemic disease. Pa-A functions as a protease inhibitor inhibiting infection of human cells by the virus. We have modeled the interaction of Pa-A, and 26 panduratin analogues with the main protease (M^pro) of SARS-CoV-2 using molecular docking. The natural product 4-hydroxypanduratin showed a higher M^pro binding capacity than Pa-A and isopanduratin A. The interaction with M^Pro of all known panduratin derivatives (Pa-A to Pa-Y) have been compared, together with more than 60 reference products. Three compounds emerged as potential robust M^Pro binders: Pa-R, Pa-V, Pa-S, with a binding capacity significantly higher than 4-OH-Pa-A and Pa-A. The empirical energy of interaction (ΔE) calculated with the best compound in the panduratin series, Pa-R bound to M^pro, surpassed that measured with the top reference protease inhibitors such a ruprintrivir, lufotrelvir, and glecaprevir. Structure-binding relationships are discussed. Compounds with a flavanone moiety (PA-R/S) are the best binders, better than those with a chromene unit (Pa-F/G). The extended molecules (such as Pa-V) exhibit good M^pro binding, but the dimeric compound Pa-Y is too long and protrudes outside the binding cavity. The work provides novel ideas to guide the design of new molecules interacting with M^pro.Communicated by Ramaswamy H. Sarma.

Toward the use ofBoesenbergia rotundaextracts and the chalcone panduratin A to treat periodontitis

Novel affordable medications are needed to treat chronic periodontitis, which is one of the most common dental pathologies worldwide. Extracts prepared from the rhizome of the medicinal plant Boesenbergia rotunda (L.) Mansf., commonly known as fingerroot, are used to treat a variety of human pathologies. These extracts contain potent anti-inflammatory compounds, including the chalcone derivative panduratin A (Pa-A), which is the lead compound of a series of analogues, designated panduratins A to Y. The anti-inflammatory properties of the extracts of B. rotunda and the most abundant bioactive products found in these extracts (including Pa-A, 4-hydroxyoanduratin, isopanduratin, and others) have been reviewed. A standardized extract of the plant has promising utility in the treatment of gingival inflammation. The effects are characterized by three actions: (i) a direct antimicrobial effect against fungi and oral pathogens such as Porphyromonas gingivalis, (ii) a marked anti-inflammatory effect via a reduced production of mediators, like prostaglandin E2 and different interleukins, and (iii) a dual bone-preserving effect, with a reduction in bone resorption and an increase in bone formation. Acting as a protease inhibitor, Pa-A is one of the main active ingredients of the extract, implicated in these actions. A Pa-A-standardized extract of B. rotunda has been used in humans for treating dyspepsia. The product is safe and well-tolerated. The development of panduratin-containing dental products, for the prevention and treatment of periodontitis, has been proposed. The structural analogues, Pa-A to-Y, should also be investigated for the treatment of dental inflammation.