Lead in traditional and complementary medicine: a systematic review

Lead in the environment remains a matter of grave concern for public health. Lead has been associated with some traditional medicines and has been linked to cases of lead poisoning. A comprehensive compilation of these reports has not previously been conducted. The objective of this review is to explore how common is lead exposure after traditional medicine use, and which countries, systems and/or products are of most concern when it comes to lead contamination. A systematic search was conducted on PubMed, Ovid and EMBASE for studies published between 2005 and 2020. A grey literature search was conducted. Search terms related to lead and traditional medicine were developed for each database, and there were no limitations on language. Studies were included if they examined elevated lead in humans resulting from the use of traditional medicines reported in case reports, case-series, or observational studies. Of the papers discussing lead exposure, 85 case reports were identified and synthesized for the current review. Several themes were identified in the included studies. Traditional medicine has been used in the many parts of the world, however use is more common in South and Southeast Asian countries. The level of detectable lead in products varied widely by region and product types. Consumers of traditional medicines sought products for a wide variety of symptoms and ailments. The symptoms of lead poisoning from traditional medicine use reflected the typical symptom profile of lead poisoning, highlighting the need for awareness of traditional medicine products as a source of lead exposure. Traditional medicine usage remains an important part of health care in many regions, however there is a risk of lead exposure from several products. Health care practitioners in all regions of the world should be aware of the risk and explore the potential for traditional medicine use for patients presenting with elevated blood lead levels. Countries with a strong traditional medicine culture should explore policies for reducing lead exposure from traditional medicine products. JG, LO and MNBD are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization.

Toxicological and pharmacological assessment of a multiherbal phytopharmaceutical on Triton X-1339-induced hyperlipidemia and allied biochemical dysfunctions

This study investigated the safety and therapeutic effect of a multiherbal tea (MHT) on Triton X-1339-induced hyperlipidemia and associated biochemical and tissue dysfunctions. An infusion of the MHT was assessed for phytoconstituents, proximate and mineral composition, and antioxidant activity. Wistar rats administered 200 mg/kg Triton X-1399 were post-treated with MHT for 14 days followed by biochemical estimations in serum, heart, liver, and kidney of animals. Hematological and histopathological evaluations of the blood, and liver, respectively, were also performed. Different phytochemicals were detected in MHT, toxic metals were absent and antioxidant activity was appreciable. Disturbances in glucose level and redox homeostasis, alterations in liver, kidney, and heart function markers, and imbalances in hematological parameters precipitated by triton toxicity were mitigated by posttreatment with MHT. Multiherbal tea also ameliorated triton-induced hepatic histoarchitectural abnormalities. These results suggest that MHT is apparently an effective antilipemic tea with minimal or no side effects. PRACTICAL APPLICATIONS: Hyperlipidemia is one of the core risk factors for arteriosclerosis and a major contributor to other adverse health conditions. The prevalence of hyperlipidemia has increased drastically in the last few decades. Plant and plant products have been extensively used in the management of dyslipidemia and many plant-based antilipemic products with poorly defined toxicity and pharmacological profiles abound in the market. The results of this study demonstrated the protective effects of a MHT against triton-induced hyperlipidemia, atherogenic tendency, and dysfunction of key organs in rats and lent credence to its therapeutic relevance in the management of hyperlipidemia and related diseases.

Practical considerations when designing and conducting clinical pharmacokinetic herb–drug interaction studies

Pharmacokinetic herb–drug interaction (HDI) research has been ongoing for almost two decades and a significant body of information has been published on the subject, yet much of it is contradictory. Some of this disparity stems from the botanical dosage form itself, as product quality and dosage form performance can vary significantly among brands. Unless products are adequately characterized, HDI study results can be misleading. The purpose of this report is to identify several common weaknesses inherent in many prospective clinical HDI studies and to provide guidance in addressing these shortcomings. Topics such as study design, pharmacokinetic end points, product quality, dosage form performance, gauging clinical relevance, and efforts to minimize dietary influences while improving compliance are discussed.

Antiproliferative Activity of T. welwitschii Extract on Jurkat T Cells In Vitro

Triumfetta welwitschii is a plant used traditionally for the treatment of fever and diarrhoea. Previous work has shown that T. welwitschii has antibacterial activity. The purpose of this study was to investigate T. welwitschii extract for anticancer activity against Jurkat T cells. The Jurkat T cell line is used to study acute T cell leukaemia. An antiproliferation assay, determination of induction of apoptosis, the determination of the effect of the combination of the extract and GSH, and effects of the extract on DNA leakage were conducted. T. welwitschii was found to decrease cell viability in a dose- and time-dependent manner. T. welwitschii caused apoptosis in the Jurkat T cells as shown by DNA fragmentation. When T. welwitschii was combined with reduced GSH, it was found that the growth of the Jurkat T cells was significantly reduced compared to untreated cells after 72 h of treatment. This was unexpected, as cancer cells have elevated levels of GSH compared to normal cells. The results of this study show that T. welwitschii is a potential source of compounds that may serve as leads for anticancer compounds.

Health, Wellness, and Safety Aspects of the Consumption of Kombucha

Functional foods have been identified as whole foods and fortified, enriched, or enhanced products which have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. As consumer awareness on functional food escalates, the interest towards conducting scientific studies in this field has also proportionately increased. Many of the traditional food products are known to possess bioactive components, thus qualifying as functional food. Kombucha tea is produced by fermenting sugared black tea with a mixed culture of yeast and bacteria. Kombucha tea has gained immense popularity in recent times due to many associated health benefits. The therapeutic effects of this beverage are thought to be derived from the chemical composition of this beverage, mainly the polyphenols and secondary metabolites which are produced during fermentation. However, the safety aspects of the beverage also need to be taken into account when qualifying the beverage as a functional food. Nevertheless, Kombucha tea could be easily recognized as a beverage which is able to replace the consumption of carbonated beverages due to its possession of health benefits and therapeutic properties.

Evaluation of the antibacterial and anticancer activities of some South African medicinal plants

BACKGROUND

Several herbs are traditionally used in the treatment of a variety of ailments particularly in the rural areas of South Africa where herbal medicine is mainly the source of health care system. Many of these herbs have not been assessed for safety or toxicity to tissue or organs of the mammalian recipients.

METHODS

This study evaluated the cytotoxicity of some medicinal plants used, inter alia, in the treatment of diarrhoea, and stomach disorders. Six selected medicinal plants were assessed for their antibacterial activities against ampicillin-resistant and kanamycin-resistant strains of Escherichia coli by the broth micro-dilution methods. The cytotoxicities of methanol extracts and fractions of the six selected plants were determined using a modified tetrazolium-based colorimetric assay (3-(4, 5-dimethylthiazol)-2, 5-diphenyl tetrazolium bromide (MTT) assay).

RESULTS

The average minimum inhibitory concentration (MIC) values of the plants extracts ranged from 0.027 mg/mℓ to 2.5 mg/mℓ after 24 h of incubation. Eucomis autumnalis and Cyathula uncinulata had the most significant biological activity with the least MIC values. The in vitro cytotoxicity assay on human hepatocarcinoma cell line (Huh-7) revealed that the methanol extract of E. autumnalis had the strongest cytotoxicity with IC(50) of 7.8 μg/mℓ. Ethyl acetate and butanol fractions of C. uncinulata, Hypoxis latifolia, E. autumnalis and Lantana camara had lower cytotoxic effects on the cancer cell lines tested with IC(50) values ranging from 24.8 to 44.1 μg/mℓ; while all the fractions of Aloe arborescens and A. striatula had insignificant or no cytotoxic effects after 72 h of treatment.

CONCLUSIONS

Our results indicate that the methanol fraction of E. autumnalis had a profound cytotoxic effect even though it possessed very significant antibacterial activity. This puts a query on its safety and hence a call for caution in its usage, thus a product being natural is not tantamount to being entirely safe. However, the antibacterial activities and non-cytotoxic effects of A. arborescens and A. striatula validates their continuous usage in ethnomedicine.

Qualitative and quantitative determination of polyacetylenes in different Bupleurum species by high performance liquid chromatography with diode array detector and mass spectrometry

Polyacetylenes are main toxic ingredients in Bupleurum longiradiatum, a poisonous plant that has ever been misused as substitutes for Chaihu (Bupleuri Radix). For the first time, a high-performance liquid chromatography method coupled with diode array detector and mass spectrometry (HPLC-DAD-MS) was developed for qualitative and quantitative analysis of nine polyacetylenes in Bupleurum species. All references, including two new polyacetylenes, were isolated from B. longiradiatum and purified using a semi-preparation HPLC chromatography. The analysis was performed on a TSKgel ODS-100V C18 column (3 μm, 150 mm x 4.6 mm i.d.) using a gradient system of acetonitrile and water, with diode array detection (254 nm). The method was validated for linearity, precision, accuracy, limit of detection and quantification. A total of 27 Bupleurum samples were examined with this method, which showed a great variety in the distribution and contents of the polyacetylenes. It was found that polyacetylenes (1-8) were the main ingredients in B. longiradiatum, while a few kinds of polyacetylenes (5-8) were also identified in B. smithii, B. smithii var. parvifolium, B. bicaule and B. angustissimum. However, no polyacetylenes (1-9) were detected in the authentic Chaihu samples and the other Bupleurum species. The results indicated that the toxic B. longiradiatum could readily be distinguished from other medicinal Bupleurum species based on the polyacetylene profiles, and the guidelines and quality control of polyacetylenes for Chaihu are useful. The acute toxicity of the ethanol extract of B. longiradiatum and its fractions was also investigated.

A preliminary study on the effect of mineralization parameters on determination of metals in Viscum album species

An increasing interest in determination of various macro- and microelements in medicinal plants has been observed. The majority of studies are carried out using one mineralization method without any optimization. The present study demonstrates that changes in mineralization parameters can significantly affect the recovery of the elements determined. In the study, the dried plant material was mineralized in 12 ways and iron (Fe), copper (Cu), zinc (Zn), nickel (Ni) and manganese (Mn) levels were determined. The samples were mineralized in the dry or open microwave mode as well as 10 closed microwave modes. The influence of acid amounts, irradiation power and time, addition of hydrogen peroxide and perfluoric acid was examined. All parameters were shown to be critical — good efficiency was observed with larger amounts of acid. The determined content varied significantly in the same sample and were in the ranges (ug g−1): 46–136 (Fe), 1.4–11.8 (Cu), 4.0–11.3 (Ni), 15.4–53.8 (Zn) and 9.5–67.6 (Mn). Increased irradiation resulted in the loss of copper and zinc and better recovery of nickel. The results demonstrate that such determinations should include the mineralization optimization step.

Assessment of herbal medicinal products: challenges, and opportunities to increase the knowledge base for safety assessment

Although herbal medicinal products (HMP) have been perceived by the public as relatively low risk, there has been more recognition of the potential risks associated with this type of product as the use of HMPs increases. Potential harm can occur via inherent toxicity of herbs, as well as from contamination, adulteration, plant misidentification, and interactions with other herbal products or pharmaceutical drugs. Regulatory safety assessment for HMPs relies on both the assessment of cases of adverse reactions and the review of published toxicity information. However, the conduct of such an integrated investigation has many challenges in terms of the quantity and quality of information. Adverse reactions are under-reported, product quality may be less than ideal, herbs have a complex composition and there is lack of information on the toxicity of medicinal herbs or their constituents. Nevertheless, opportunities exist to capitalise on newer information to increase the current body of scientific evidence. Novel sources of information are reviewed, such as the use of poison control data to augment adverse reaction information from national pharmacovigilance databases, and the use of more recent toxicological assessment techniques such as predictive toxicology and omics. The integration of all available information can reduce the uncertainty in decision making with respect to herbal medicinal products. The example of Aristolochia and aristolochic acids is used to highlight the challenges related to safety assessment, and the opportunities that exist to more accurately elucidate the toxicity of herbal medicines.

An evaluation of the evidence in "evidence-based" integrative medicine programs

Alternative therapies are popular, and information about them should be included in the curricula of health profession schools. During 2000 to 2003, the National Institutes of Health National Center for Complementary and Alternative Medicine awarded five-year education grants to 14 health professions schools in the United States and to the American Medical Students Association Foundation. The purpose of the grants was to integrate evidence-based information about complementary and alternative medicine (CAM) into the curriculum. The authors reviewed the educational material concerning four popular CAM therapies-herbal remedies, chiropractic, acupuncture, and homeopathy-posted on the integrative medicine Web sites of the grant recipients and compared it with the best evidence available. The curricula on the integrative medicine sites were strongly biased in favor of CAM, many of the references were to poor-quality clinical trials, and they were five to six years out of date. These "evidence-based CAM" curricula, which are used all over the country, fail to meet the generally accepted standards of evidence-based medicine. By tolerating this situation, health professions schools are not meeting their educational and ethical obligations to learners, patients, or society. Because integrative medicine programs have failed to uphold educational standards, medical and nursing schools need to assume responsibility for their oversight. The authors suggest (1) appointing faculty committees to review the educational materials and therapies provided by integrative medicine programs, (2) holding integrative medicine programs' education about CAM to the same standard of evidence used for conventional treatments, and (3) providing ongoing oversight of integrative medicine education programs.

Nidus vespae protein inhibiting proliferation of HepG2 hepatoma cells through extracellular signal-regulated kinase signaling pathways and inducing G1 cell cycle arrest

A protein named NVP(1) was isolated from Nidus vespae. The aim of the present study was to elucidate whether and how NVP(1) modulates the proliferation of HepG2 cells. NVP(1) at a concentration of 6.6 microg/ml could arrest the cell cycle at stage G1 and inhibit the mRNA expression of cyclinB, cyclinD1 and cyclinE. NVP(1) suppressed cdk2 protein expression, but increased p27 and p21 protein expression. However, NVP(1) did not alter p16 protein expression levels. NVP(1) promoted apoptosis in HepG2 cells as indicated by nuclear chromatin condensation, and in addition, the extracellular signal-regulated kinase (ERK) signaling pathway was activated. Moreover, the p-ERK protein expression level was attenuated when the HepG2 cells were pretreated with ERK inhibitor PD98059. These results demonstrate that NVP(1) inhibits proliferation of HepG2 through ERK signaling pathway. NVP(1) could be a potential drug for liver cancer.

Canadian pharmacy students' knowledge of herbal medicine

OBJECTIVE

To determine fourth-year Canadian pharmacy students' knowledge of herbal medicine and whether that knowledge is associated with mandatory instruction in herbal medicine.

METHODS

Standardized multiple-choice tests assessing students' herbal knowledge were distributed to all fourth-year BSc pharmacy students at 5 pharmacy schools in Canada.

RESULTS

The Quebec response rate was too low to include in the analysis. Herbal knowledge test scores were positively associated with having previously taken an herbal medicine class and completion of a pharmacy practicum. However, postsecondary education, age, and gender were not associated with herbal knowledge test scores. Students at the University of British Columbia had the highest score, followed by Alberta, Nova Scotia, and Ontario.

CONCLUSION

Pharmacy students' knowledge of herbal medicine varies depending on the school attended and higher herbal knowledge test scores appear to be most closely related to mandatory herbal instruction.

A Practical Approach to Headache Treatment

The World Health Organization cites migraine headache as one of the 20 most disabling medical conditions. This article focuses on the diagnosis and treatment of the primary headache disorders, with special emphasis on migraine, the headache most likely to bring patients to physicians and pharmacists. This review begins with the warning signs of the ominous headache, which, although rare, can herald a life-threatening condition. Clinical characteristics of the primary headache types, migraine, tension-type headache, and cluster headache, are described. Although many individuals believe their headaches are “sinus,” or “stress or tension-induced,” most of the characteristics of these types of headaches actually meet International Headache Society criteria for migraine. Treatments of primary headaches, including acute therapies, abortive agents, and prophylactic medications, are uniquely specific for each headache syndrome. Chronic daily headache patients compose only 4% of the population yet make up the largest percentage of patients who seek treatment at specialty headache centers. Medication-overuse headache, the syndrome in which medications taken for the relief of headache actually foster future headaches, offers a particular challenge to health care providers, as does narcotic use in headache therapy. Complementary and alternative treatments proven efficacious in the treatment of primary headache are also described.

Heavy metal hazards of Nigerian herbal remedies

The uses of herbal products are not regulated in Nigeria and in many low-income countries and are freely available to everyone. The safety of these herbal medicines is poorly understood. This study characterizes the content of cadmium, copper, iron, nickel, selenium, zinc, lead and mercury in a random sample of Nigerian traditional products. Ready-to-use herbal products were purchased from the open market and digested using HNO3.The heavy metal content of the digested filtrate was determined by atomic absorption spectrometry Uni-cam Model 929. The result showed that 100% of the samples contained elevated amounts of heavy metals. These data alert us to the possibility of heavy metal toxicity from herbal products in Nigeria. The public health hazards from ingestion of herbal medicines should be identified and disclosed by in-depth risk assessment studies.