1
|
Ye C, Zhang B, Tang Z, Zheng C, Wang Q, Tong X. Synergistic action of Hedyotis diffusa Willd and Andrographis paniculata in Nasopharyngeal Carcinoma: Downregulating AKT1 and upregulating VEGFA to curb tumorigenesis. Int Immunopharmacol 2024; 132:111866. [PMID: 38603854 DOI: 10.1016/j.intimp.2024.111866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Nasopharyngeal carcinoma (NPC) remains a challenging cancer to treat. This study investigates the molecular mechanisms of Hedyotis diffusa Willd (HDW) combined with Andrographis paniculata (AP) in treating NPC. METHODS Key compounds and target genes in HDW and AP were analyzed using network pharmacology. Protein-protein interaction (PPI) networks were constructed with STRING and visualized using Cytoscape. MCODE identified critical clusters, while DAVID facilitated GO and KEGG analyses. In vivo and in vitro experiments evaluated HDW-AP effects on NPC, including tumor volume, weight, Ki-67 expression, cell apoptosis, migration, invasion, cell cycle distribution, and DNA damage. RESULTS The database identified 495 NPC-related genes and 26 compounds in the HDW-AP pair, targeting 165 genes. Fifty-eight potential therapeutic genes were found, leading to 18 key targets. KEGG analysis revealed a significant impact on 78 pathways, especially cancer pathways. Both in vivo and in vitro tests showed HDW-AP inhibited NPC cell proliferation, migration, invasion, and induced apoptosis. Mechanistically, this was achieved through AKT1 downregulation and VEGFA upregulation. CONCLUSION The combination of HDW and AP targets 16 key genes to impede the development of NPC, primarily by modulating AKT1 and VEGFA pathways.
Collapse
Affiliation(s)
- Chengyu Ye
- Department of Radiotherapy, Wenzhou Central Hospital & The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou 325000, PR China
| | - Baofan Zhang
- Second Department of Oncology, Wenzhou Central Hospital, Wenzhou 325000, PR China
| | - Zhongjie Tang
- Second Department of Oncology, Wenzhou Central Hospital, Wenzhou 325000, PR China
| | - Cuiping Zheng
- Department of Tumor Hematology, Wenzhou Central Hospital, Wenzhou 325000, PR China
| | - Qiongzhang Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, PR China.
| | - Xiangmin Tong
- Department of Hematology, the Affiliated Hangzhou First People's Hospital, westlake University School of Medicine, Hangzhou, 310006, P.R. China.
| |
Collapse
|
2
|
Hu XY, Logue M, Maund E, Santer M, Willcox ML, Islam S, Stokes T, Moore M. Pharmacists' perspectives on recommending herbal medicines for acute infections: a qualitative study. BJGP Open 2024; 8:BJGPO.2023.0138. [PMID: 38086709 PMCID: PMC11169994 DOI: 10.3399/bjgpo.2023.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/20/2023] [Accepted: 11/01/2023] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections. AIM To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines. DESIGN & SETTING A qualitative study using semi-structured interviews with community pharmacists in England. METHOD Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. RESULTS In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. CONCLUSION Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine.
Collapse
Affiliation(s)
- Xiao-Yang Hu
- Primary Care Research Centre, School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin Logue
- Primary Care Research Centre, School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Emma Maund
- Southampton Health Technology Assessments Centre, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Merlin Luke Willcox
- Primary Care Research Centre, School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Shazab Islam
- University Hospitals of North Midlands NHS Trust, UK
| | | | - Michael Moore
- Primary Care Research Centre, School of Primary Care, Population Sciences, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Jia L, Beidelschies M, Evans JM, Niemtzow RC, Niemtzow SZ, Dusek JA, Lin Y, Wu C, Su YC, Wang CJ, Lin CY, Astana PRW, Ardiyanto D, Hardjoutomo R, Visithanon K, Puagkong J, Chokpaisarn J, Lopez MV, Yotsuyanagi H, Lee MS, Ramirez HJG, Bobadilla CP, Quinteros EMG, Galanti de la Paz M, Maramba-Lazarte CC. Recommendations and guidelines of integrative medicine for COVID-19 care: The APEC project outcome. Integr Med Res 2024; 13:101022. [PMID: 38434793 PMCID: PMC10907161 DOI: 10.1016/j.imr.2024.101022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
This article - Recommendations and Guidelines of Integrative Medicine (IM) for COVID-19 Care - was one of the outcomes from an Asia-Pacific Economic Cooperation (APEC) Project (Integrative Medicine (IM) and COVID -19 Care) during the time between May 2022 and March 2023. With the efforts from care providers, researchers, health policy makers and healthcare administrative leaders among APEC economies, the purpose of this file was to provide comprehensive IM systems for COVID-19 care as recommendations and suggestive guidelines including care methods, tools, procedures, symptom conditions and targets selections, and points need to be considered during care applications. All cited COVID-19 care practices have confirmed their efficacy and usefulness either used alone or combined with conventional medicine. This article provides current useful medical information on IM for COVID-19 care which could benefit APEC economies and world health communities on their healthcare system.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - C. Jason Wang
- National Research Institute of Chinese Medicine, Chinese Taipei
| | - Chien-Yu Lin
- Hsinchu MacKay Memorial Hospital, Chinese Taipei
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - APEC Health Working Group
- National Cancer Institute, USA
- Cleveland Clinic, USA
- The Center for Functional Medicine, USA
- The US Air Force Medical Corps, USA
- Connor Whole Health, USA
- Food and Drug Administration, USA
- Stanford University, USA
- National Research Institute of Chinese Medicine, Chinese Taipei
- Hsinchu MacKay Memorial Hospital, Chinese Taipei
- Sebelas Maret University of Surakarta, Indonesia
- Ministry of Health, Indonesia
- Public Health Management, Ministry of Health, Indonesia
- Department of Thai Traditional and Alternative Medicine, Thailand
- Prince of Songkla University, Thailand
- National University of San Marcos, Peru
- University of Tokyo, Japan
- Korea Institute of Oriental Medicine, Republic of Korea
- Complementary Care System, Mexico
- Academic Network of Integrative Medicine and Health, Chile
- Ministry of Health, Chile
- Academic University of Chile, Chile
- National Institutes of Health, Philippines
| |
Collapse
|
4
|
Sulaiman I, Okwuofu EO, Mohtarrudin N, Lim JCW, Stanslas J. An Andrographis paniculata Burm. Nees extract standardized for three main Andrographolides prevents house dust mite-induced airway inflammation, remodeling, and hyperreactivity by regulating Th1/Th2 gene expression in mice. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117082. [PMID: 37652197 DOI: 10.1016/j.jep.2023.117082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Andrographis paniculata Burm. Nees (AP) is an herb used traditionally in Indian and Chinese traditional medicine for the treatment of various inflammatory and respiratory tract diseases. However, the anti-inflammatory potential of standardized Andrographis paniculata 50% ethanol extract (APEE50) in the murine model of asthma has not been investigated. AIM OF THE STUDY This study aimed to evaluate the protective anti-inflammatory potential and better understand the underlying mechanism of action of APEE50 in a clinically-relevant mouse asthma model. Thereafter, develop the ethanolic extract of AP as a supplement for asthma prophylaxis. MATERIALS AND METHOD APEE50 was prepared and standardized for AGP, NAG, and DDAG using a high-performance liquid chromatography system. Asthma was induced according to a 14-day house dust mite (HDM) induction protocol. The prophylactic potential of APEE50 (50 mg/kg - 200 mg/kg) was determined by assessing cardinal asthma features, which included BALF leukocyte and differential cell count, BALF cytokine assay, histology, gene expression, and airway hyperreactivity study. RESULTS APEE50 significantly inhibited HDM-induced airway eosinophilia and neutrophilia. In addition to decreased levels of IL-4, IL-5, IL-13, and eotaxin in bronchoalveolar fluid, APEE50 abrogated HDM-induced airway mucus over-secretion and airway hyper-responsiveness. Administration of APEE50 downregulated HDM-induced upregulation of the oxidative stress enzyme Duox1 (dual oxidase 1) and marginally induced Nfe2l2 (nuclear factor erythroid 2-related factor 2) gene expressions. Similarly, Th2-related (Serpinb2, Clca3a1, Il4 and Il13) and Muc5ac gene expression were significantly downregulated. CONCLUSION Prophylactic administration of APEE50 prevented the progression of HDM-induced asthmatic responses by down-regulating Th2 cytokine gene expression and oxidative stress level.
Collapse
Affiliation(s)
- Ibrahim Sulaiman
- Pharmacotherapeutic Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Emmanuel Oshiogwe Okwuofu
- Pharmacotherapeutic Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Jonathan Chee Woei Lim
- Pharmacotherapeutic Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Johnson Stanslas
- Pharmacotherapeutic Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
| |
Collapse
|
5
|
Gill PJ, Onakpoya IJ, Buchanan F, Birnie KA, Van den Bruel A. Treatments for cough and common cold in children. BMJ 2024; 384:e075306. [PMID: 38272497 DOI: 10.1136/bmj-2023-075306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Peter J Gill
- The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igho J Onakpoya
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary
- Alberta Children's Hospital Research Institute, Calgary
| | - Ann Van den Bruel
- Academic Centre for Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
6
|
Willcox ML, Tai CJ, Chattopadhyay K, Hu XY, Heinrich M. Editorial: Clinical phytopharmacology. Front Pharmacol 2024; 14:1353483. [PMID: 38288085 PMCID: PMC10822887 DOI: 10.3389/fphar.2023.1353483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024] Open
Affiliation(s)
- Merlin L. Willcox
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Chi-Jung Tai
- Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kaushik Chattopadhyay
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Nottingham, United Kingdom
| | - Xiao-Yang Hu
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Heinrich
- Pharmacognosy and Phytotherapy Group, UCL School of Pharmacy, London, United Kingdom
- Chinese Medicine Research Center, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
7
|
Deshmukh R, Jain AK, Singh R, Paul SD, Harwansh RK. Andrographis paniculata and Andrographolide - A Snapshot on Recent Advances in Nano Drug Delivery Systems against Cancer. Curr Drug Deliv 2024; 21:631-644. [PMID: 36740794 DOI: 10.2174/1567201820666230203115752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/15/2022] [Accepted: 11/14/2022] [Indexed: 02/07/2023]
Abstract
Cancer is one of the deadliest illnesses of the 21st century. Chemotherapy and radiation therapies both have considerable side effects. Antitumor antibiotics are one of them. Coughs, common colds, fevers, laryngitis, and infectious disorders have all been treated with Andrographis paniculata for centuries. Extracts of Andrographis effectively treat various ailments, as well as cancer. The most active molecule in Andrographis paniculata is andrographolide a, diterpene, and lactone. Andrographis paniculata and its derivatives have long been used to treat various ailments. Anti-inflammatory and cancerfighting characteristics have been observed in Andrographolide. Andrographolide, a diterpene lactone separated from Andrographis paniculata, has also been shown to have important criticalessential biological protective properties. It has also been suggested that it could be used to treat major human diseases like-rheumatoid like rheumatoid, colitis, and Parkinsons disease. This summary aims to highlight Andrographolide as a promising cancer treatment option. Several databases were searched for andrographolides cytotoxic/anti-cancer effects in pre-clinical and clinical research to serve this purpose. Several studies have shown that Andrographolide is helpful in cancer medication, as detailed in this review.
Collapse
Affiliation(s)
- Rohitas Deshmukh
- Institute of Pharmaceutical Research, GLA University, Mathura, 281406, India
| | - Aman Kumar Jain
- Institute of Pharmaceutical Research, GLA University, Mathura, 281406, India
| | - Rajesh Singh
- Institute of Pharmaceutical Research, GLA University, Mathura, 281406, India
| | - Swarnali Das Paul
- Department of Pharmacy, Shri Shankaracharya College of Pharmaceutical Sciences, Junwani, Bhilai, 490020, India
| | - Ranjit K Harwansh
- Institute of Pharmaceutical Research, GLA University, Mathura, 281406, India
| |
Collapse
|
8
|
Gasmi A, Noor S, Dadar M, Semenova Y, Menzel A, Gasmi Benahmed A, Bjørklund G. The Role of Traditional Chinese Medicine and Chinese Pharmacopoeia in the Evaluation and Treatment of COVID-19. Curr Pharm Des 2024; 30:1060-1074. [PMID: 38523518 DOI: 10.2174/0113816128217263240220060252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 03/26/2024]
Abstract
The epidemic prompted by COVID-19 continues to spread, causing a great risk to the general population's safety and health. There are still no drugs capable of curing it. Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are the two other diseases caused by coronaviruses. Traditional Chinese Medicine (TCM) showed benefits in treating SARS and MERS by preventing the disease early, substantially mitigating symptoms, shortening the treatment period, and minimizing risks and adverse reactions caused by hormone therapy. Although several vaccines have been developed and are being used for the treatment of COVID-19, existing vaccines cannot provide complete protection against the virus due to the rapid evolution and mutation of the virus, as mutated viral epitopes evade the vaccine's target and decrease the efficacy of vaccines. Thus, there is a need to develop alternative options. TCM has demonstrated positive effects in the treatment of COVID-19. Previous research studies on TCM showed broad-spectrum antiviral activity, offering a range of possibilities for their potential use against COVID-19. This study shed some light on common TCM used for SARS and MERS outbreaks and their effective use for COVID-19 management. This study provides new insights into COVID-19 drug discovery.
Collapse
Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Sadaf Noor
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, Pakistan
| | - Maryam Dadar
- CONEM Iran Microbiology Research Group, Tehran, Iran
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | | | | | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
| |
Collapse
|
9
|
Kanokkangsadal P, Mingmalairak C, Mukkasombat N, Kuropakornpong P, Worawattananutai P, Khawcharoenporn T, Sakpakdeejaroen I, Davies NM, Itharat A. Andrographis paniculata extract versus placebo in the treatment of COVID-19: a double-blinded randomized control trial. Res Pharm Sci 2023; 18:592-603. [PMID: 39005565 PMCID: PMC11246112 DOI: 10.4103/1735-5362.389947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 07/16/2024] Open
Abstract
Background and purpose Andrographis paniculata (Burm.f.) Nees has been recommended to relieve symptoms and decrease the severity of COVID-19. The clinical study aimed to investigate the efficacy and safety of A. paniculata ethanolic extract (APE). Experimental approach The efficacy and safety of APE in asymptomatic or mildly symptomatic COVID-19 patients compared with placebo were investigated through a prospective, double-blind randomized control trial. Patients received APE containing 60 mg of andrographolide, three times a day for five days. WHO progression scale, COVID-19 symptoms, and global assessment evaluated the efficacy and adverse events, liver and renal functions were monitored for safety. Findings/Results 165 patients completed the study (83 patients in the APE group and 82 patients in the placebo group). The highest WHO progression scale was 4 and COVID-19 symptoms were significantly relieved on the last day of intervention in both groups, with no significant difference between groups. APE significantly relieved headache symptoms on day 1 and olfactory loss symptoms on day 2 compared to placebo. The global assessment showed that 80.7% of patients had total recovery after 5-day treatment with APE. Mild diarrhea was the most common side effect with a high dose that resolved within a few days. No hepatic or renal toxicity was associated with treatment. Conclusion and implications APE at 180 mg/day for 5 days did not reduce COVID-19 progression in asymptomatic or mildly afflicted COVID-19 patients, however, it shortened the symptoms of olfactory loss with no adverse effects over 5 days of use.
Collapse
Affiliation(s)
- Puritat Kanokkangsadal
- Department of Applied Thai Traditional Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
- Center of Excellence on Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University, Klong Luang, Pathumthani 12120, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumtani 12120, Thailand
| | - Nichamon Mukkasombat
- Department of Applied Thai Traditional Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
- Center of Excellence on Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University, Klong Luang, Pathumthani 12120, Thailand
| | - Pranporn Kuropakornpong
- Center of Excellence on Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University, Klong Luang, Pathumthani 12120, Thailand
| | - Patsorn Worawattananutai
- Department of Applied Thai Traditional Medicine, Faculty of Allied Health Science, Burapha University, Chonburi, 20131, Thailand
| | - Thana Khawcharoenporn
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumtani 12120, Thailand
| | - Intouch Sakpakdeejaroen
- Department of Applied Thai Traditional Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
| | - Neal M. Davies
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Arunporn Itharat
- Department of Applied Thai Traditional Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
- Center of Excellence on Applied Thai Traditional Medicine Research (CEATMR), Faculty of Medicine, Thammasat University, Klong Luang, Pathumthani 12120, Thailand
| |
Collapse
|
10
|
Seely D, Legacy M, Conte E, Keates C, Psihogios A, Ramsay T, Fergusson DA, Kanji S, Simmons JG, Wilson K. Dietary supplements to reduce symptom severity and duration in people with SARS-CoV-2: a double-blind randomised controlled trial. BMJ Open 2023; 13:e073761. [PMID: 37739466 PMCID: PMC10533655 DOI: 10.1136/bmjopen-2023-073761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/20/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND COVID-19 has caused morbidity, hospitalisation and mortality worldwide. Despite effective vaccines, there is still a need for effective treatments, especially for people in the community. Dietary supplements have long been used to treat respiratory infections, and preliminary evidence indicates some may be effective in people with COVID-19. We sought to evaluate whether a combination of vitamin C, vitamin D3, vitamin K2 and zinc could improve overall health and decrease symptom burden in outpatients diagnosed with COVID-19. METHODS Participants were randomised to receive either vitamin C (6 g), vitamin D3 (1000 units), vitamin K2 (240 μg) and zinc acetate (75 mg) or placebo daily for 21 days and were followed for 12 weeks. An additional loading dose of 50 000 units vitamin D3 (or placebo) was given on day one. The primary outcome was participant-reported overall health using the EuroQol Visual Assessment Scale summed over 21 days. Secondary outcomes included health status, symptom severity, symptom duration, delayed return to usual health, frequency of hospitalisation and mortality. RESULTS 90 patients (46 control, 44 treatment) were randomised. The study was stopped prematurely due to insufficient capacity for recruitment. The mean difference (control-treatment) in cumulative overall health was -37.4 (95% CI -157.2 to 82.3), p=0.53 on a scale of 0-2100. No clinically or statistically significant differences were seen in any secondary outcomes. INTERPRETATION In this double-blind, placebo-controlled, randomised trial of outpatients diagnosed with COVID-19, the dietary supplements vitamin C, vitamin D3, vitamin K2 and zinc acetate showed no clinically or statistically significant effects on the documented measures of health compared with a placebo when given for 21 days. Termination due to feasibility limited our ability to demonstrate the efficacy of these supplements for COVID-19. Further research is needed to determine clinical utility. TRIAL REGISTRATION NUMBER NCT04780061.
Collapse
Affiliation(s)
- Dugald Seely
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Legacy
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ellen Conte
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Caitlyn Keates
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Athanasios Psihogios
- Patterson Institute for Integrative Oncology Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pharmacy, Ottawa Hospital, Ottawa, Ontario, Canada
| | - John-Graydon Simmons
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Veldman LBM, Belt-Van Zoen E, Baars EW. Mechanistic Evidence of Andrographis paniculata (Burm. f.) Wall. ex Nees, Pelargonium sidoides DC., Echinacea Species and a Combination of Hedera helix L., Primula veris L./ Primula elatior L. and Thymus vulgaris L./ Thymus zygis L. in the Treatment of Acute, Uncomplicated Respiratory Tract Infections: A Systematic Literature Review and Expert Interviews. Pharmaceuticals (Basel) 2023; 16:1206. [PMID: 37765014 PMCID: PMC10537612 DOI: 10.3390/ph16091206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Reducing inappropriate antibiotic (AB) use by using effective non-antibiotic treatments is one strategy to prevent and reduce antimicrobial resistance (AMR). Andrographis paniculata (Burm. f.) Wall. ex Nees, Pelargonium sidoides DC., Echinacea species and a combination of ivy (Hedera helix L.), primrose (Primula veris L./Primula elatior L.) and thyme (Thymus vulgaris L./Thymus zygis L.) have promising clinical effects in uncomplicated, acute upper respiratory tract infections (URTI) treatment. However, mechanistic evidence of these herbal treatments is lacking. The objective of this Pstudy is to provide an overview of mechanistic evidence for these effects. Thirty-eight databases were searched. Included studies were mechanistic studies (in vitro, animal, and human studies and reviews) on these herbs; published before June 2021. Non-mechanistic studies or studies on combinations of herbs other than ivy/primrose/thyme were excluded. Furthermore, three experts in traditional, complementary and integrative healthcare (TCIH) research and pharmacognosy were interviewed to collect additional expert knowledge. The results show that A. paniculata acts through immunomodulation and antiviral activity, possibly supplemented by antibacterial and antipyretic effects. P. sidoides acts through antiviral, indirect antibacterial, immunomodulatory and expectorant effects. Echinacea species likely act through immunomodulation. The combination of ivy/primrose/thyme combines secretolytic and spasmolytic effects from ivy with antibacterial effects from thyme. Studies on primrose were lacking. This mechanistic evidence supports the difference-making evidence from clinical studies, contributes to evidence-based recommendations for their use in URTI treatment, and guides future mechanistic studies on URTI treatments.
Collapse
Affiliation(s)
- Liesbeth B. M. Veldman
- Faculty of Healthcare, University of Applied Sciences Leiden, 2333 Leiden, The Netherlands
| | - Eefje Belt-Van Zoen
- Faculty of Healthcare, University of Applied Sciences Leiden, 2333 Leiden, The Netherlands
| | - Erik W. Baars
- Faculty of Healthcare, University of Applied Sciences Leiden, 2333 Leiden, The Netherlands
- Louis Bolk Institute, 3981 Bunnik, The Netherlands
| |
Collapse
|
12
|
Silambarasan R, Sasidharan S, Nair J H, Kumar S N, R A, Nair AS, Selavinayagam K. A multivariate and quantitative assessment of medicinal plants used by the indigenous Malayali tribes in the Javadhu hills of Tiruvannamalai district, Tamil Nadu, India. Heliyon 2023; 9:e15607. [PMID: 37305490 PMCID: PMC10256831 DOI: 10.1016/j.heliyon.2023.e15607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/13/2023] Open
Abstract
The study of medicinal plants with their traditional uses and related pharmacological studies has received more attention during the past several decades around the world. The Malayali tribes of the Javadhu Hills in the Eastern Ghats rely heavily on a system of traditional medicine for healthcare. A qualitative ethnographic method with a semi-structured questionnaire was used to interview 52 people across 11 localities in the Javadhu Hills. In the data analysis, descriptive statistics such as Use reports (UR), frequency of citations (FC), relative frequency of citations (RFC), informant agreement ratio (IAR), fidelity level (FL), and informant consensus factor (FIC) were studied. In the current investigation, 146 species from 52 families and 108 genera were discovered to treat 79 diseases. Leguminosae and Apocynaceae were the dominant families (12 species each). The most frequently used life form was the herb and the plant part were the leaf. The majority were being harvested from natural resources. Most medicines were taken orally. The most frequently cited species are Moringa oleifera and Syzygium cumini. The illnesses were divided into 21 categories. The majority of the plants mentioned are utilised to increase human immunity and health. The principal ailment (general health) was revealed by two-way cluster analysis and PCA. The species Litsea decanensis, Phoebe paniculata, Commiphora caudata, etc., were new records for the Javadhu hills according to a comparison between the current study and previous local and regional research. Documenting novel ethnomedicinal species and their therapeutic applications will encourage more phytochemical and pharmacological research and may even result in the creation of new medications. Furthermore, the study's significant novelty is that principle component analysis and two-way cluster analysis clearly revealed that the species that are used to treat various diseases, as well as species that are closely associated with treating specific ailment categories, are distinct. Significantly, species recorded in this study rely on maintaining and improving general body health of humans.
Collapse
Affiliation(s)
- Rajendran Silambarasan
- Department of R&D, Pankajakasthuri Herbal Research Foundation, Pankajakasthuri Ayurveda Medical College Campus, Trivandrum, Kerala, India
| | - Shan Sasidharan
- Department of R&D, Pankajakasthuri Herbal Research Foundation, Pankajakasthuri Ayurveda Medical College Campus, Trivandrum, Kerala, India
| | - Hareendran Nair J
- Department of R&D, Pankajakasthuri Herbal Research Foundation, Pankajakasthuri Ayurveda Medical College Campus, Trivandrum, Kerala, India
| | - Nishanth Kumar S
- Department of R&D, Pankajakasthuri Herbal Research Foundation, Pankajakasthuri Ayurveda Medical College Campus, Trivandrum, Kerala, India
| | - Aravind R
- Department of R&D, Pankajakasthuri Herbal Research Foundation, Pankajakasthuri Ayurveda Medical College Campus, Trivandrum, Kerala, India
| | - Akhila S. Nair
- Department of R&D, Pankajakasthuri Herbal Research Foundation, Pankajakasthuri Ayurveda Medical College Campus, Trivandrum, Kerala, India
| | - K.T. Selavinayagam
- Jantho Memorial Educational Foundation, Kallathikulam Village, Eluvanoor Post, Kamuthi Taluk, Ramanathapuram District, 623605, Tamil Nadu, India
| |
Collapse
|
13
|
Shanker K, Rangnekar H, Wele A, Soni P, Gaikwad P, Pal A, Bawankule DU, Chanda D. A randomized controlled pilot study of add-on therapy of CIM-MEG19 (standardized Andrographis paniculata formulation) in mild to moderate COVID-19. PHYTOMEDICINE PLUS : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 3:100398. [PMID: 36570418 PMCID: PMC9762910 DOI: 10.1016/j.phyplu.2022.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Traditional knowledge and scientific shreds of evidence strongly support the repurpose of Kalmegh (Andrographis paniculata, CIM-MEG19) as an alternate therapy for prophylactic management and treatment of severe acute respiratory syndrome coronavirus (SARS-CoV) and associated health disorders. PURPOSE The study aimed to assess the efficacy and safety of the CIM-MEG19 (standardized A. paniculata extract formulation), a proprietary Ayurvedic medicine in the COVID-19 management, clinical recovery, and outcomes in terms of hospitalization days as well as any sign of severity due to drug-drug interaction between CIM-MEG19 TM and standard of care (SoC). METHODS A randomized, parallel-group, active-controlled interventional pilot clinical study was conducted. The Group-A subjects were assigned to CIM-MEG19 add-on to SoC treatment using modern medicine without antiviral drug whereas Group-B patients with SoC treatment using modern medicine and recommended antiviral drug for COVID-19 management. Eighty RTPCR (real-time polymerase chain reaction) positive and eligible COVID-19 patients of age >18 years, having mild or moderate severity, were enrolled. RESULTS Clinical improvement in reduction of symptoms showed significant (p<0.0001) results in the average days in subjects of group-A (Investigational intervention arm) compared to Group B (SoC). The RT-PCR investigation exhibited COVID negative for 50 % in CIM-MEG19 add-on and 47% in SoC treatment after 8-11 days. Similarly, biochemical investigations showed that CIM-MEG19 group-A had a significant (p ≤ 0.05) effect on C-Reactive Protein (CRP) and Interleukin-6 (IL-6) after 14 days of treatment. Additionally, improvement in D-Dimer, ESR, and LDH in CIM-MEG19 add-on therapy was also observed. CONCLUSIONS The study demonstrated an excellent safety profile, declining the severity of the infection and halting the disease advancement/progression. CIM-Meg19 might be used as a potential natural drug for treating COVID-19.
Collapse
Affiliation(s)
- Karuna Shanker
- Analytical Chemistry, Phytochemistry Division, CSIR-Central Institute of Medicinal and Aromatic Plants (CSIR-CIMAP), Lucknow-226015, India
| | | | - Asmita Wele
- Department of Rasashastra and Bhaishajyakalpana, College of Ayurved, Bharati Vidyapeeth (Deemed to be University), Pune-411043, India
| | - Pravin Soni
- Pimpri Chinchwad Municipal Corporation's Postgraduate Institute, Yashwantrao Chavan Memorial Hospital, Pimpri, Pune-411018, India
| | - Pranesh Gaikwad
- Panchakarma Department, Dr. D. Y. Patil College of Ayurved and Research Centre, Dr. D. Y. Patil Vidyapeeth Pune (Deemed to be University), Pimpri, Pune-411018, India
| | - Anirban Pal
- Bio-Prospection and Product Development Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow-226015, India
| | - Dnyaneshwar U Bawankule
- Analytical Chemistry, Phytochemistry Division, CSIR-Central Institute of Medicinal and Aromatic Plants (CSIR-CIMAP), Lucknow-226015, India
- Bio-Prospection and Product Development Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow-226015, India
| | - Debabrata Chanda
- Bio-Prospection and Product Development Division, CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow-226015, India
| |
Collapse
|
14
|
More SJ, Tandulwadkar SS, Balap AR, Lohidasan S, Sinnathambi A, Mahadik KR. Effect of Andrographis paniculata extract and Andrographolide on the pharmacokinetics of Aceclofenac and Celecoxib in rats. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2023; 9:1. [PMID: 36620352 PMCID: PMC9808673 DOI: 10.1186/s43094-022-00450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/15/2022] [Indexed: 01/04/2023] Open
Abstract
Background In India, for the treatment of cold, fever and inflammation, people consume herbal remedies containing Andrographis paniculata Nees (APE) as main ingredient, along with NSAIDs. So the purpose of this study is to investigate the effect of APE and pure andrographolide (AN) on the pharmacokinetic of with aceclofenac (ACF) and celecoxib (CXB) after oral co-administration in wistar rats. After co-administration of APE (equivalent to 20 mg/kg of AN) and AN (20 mg/kg) with ACF (5 mg/kg) and CXB (5 mg/kg) in rats, orally, drug concentrations in plasma were determined using HPLC method. Non-compartment model was used to calculate pharmacokinetic parameters like Cmax, Tmax, t1/2, MRT, Vd, CL, and AUC. Results Co-administration of ACF and CXB with APE and pure AN altered the systemic exposure level of each compound in vivo. The Cmax, Tmax, MRT of CXB were increased whereas Vd and Cl of CXB were decreased significantly after co-administration of CXB with APE. Whereas co-administration of CXB with AN significantly decreased Vd, CL, and MRT of CXB. The concentration of ACF was increased significantly in co-administered groups with pure AN and APE. The AUC0-∞, AUMC0-∞, MRT, Vd and t1/2 of ACF were also significantly decreased in co-administered groups, hence CL of ACF was increased significantly. Conclusion This study concludes that APE and pure AN have effect on pharmacokinetic of CXB and ACF in rat. Not only patients but medical practitioners using Andrographis paniculata should have awareness regarding probable herb-drug interactions with ACF and CXB.
Collapse
Affiliation(s)
- S. J. More
- grid.411681.b0000 0004 0503 0903Department of Pharmaceutical Chemistry, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University (BVDU), Pune, India
| | - S. S. Tandulwadkar
- grid.411681.b0000 0004 0503 0903Department of Pharmaceutical Chemistry, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University (BVDU), Pune, India
| | - Aishwarya R. Balap
- Department of Pharmaceutical Chemistry, PES’s Modern College of Pharmacy, Pune, India
| | - S. Lohidasan
- grid.411681.b0000 0004 0503 0903Department of Pharmaceutical Chemistry, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University (BVDU), Pune, India
| | - A. Sinnathambi
- grid.411681.b0000 0004 0503 0903Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University (BVDU), Pune, India
| | - K. R. Mahadik
- grid.411681.b0000 0004 0503 0903Department of Pharmaceutical Chemistry, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University (BVDU), Pune, India
| |
Collapse
|
15
|
Hu XY, Oliver T, Willcox M, Simpson C, Thorne K, Trill J, Francis N, Stuart B, Thomas M, Little P, Liu JP, Griffiths G, Moore M. Treating Acute EXacerbations of COPD with Chinese HerbAL MedIcine to aid AntiBiotic Use Reduction (EXCALIBUR): study protocol of a randomised double-blind, placebo-controlled feasibility trial. Pilot Feasibility Stud 2022; 8:262. [PMID: 36536462 PMCID: PMC9761047 DOI: 10.1186/s40814-022-01224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major reason for consultations in primary care, hospital admissions, deterioration in function, and mortality. Despite the majority of exacerbations not being caused by bacteria, as many as 70% of patients who present in UK primary care with AECOPD are prescribed antibiotics as part of standard care. However, finding effective non-antibiotic treatments for COPD exacerbations is a priority to reduce antibiotic use. The Chinese herbal medicine Shufeng Jiedu® (SFJD) has the potential to reduce treatment failure and duration of hospital stay. This study aims to determine the feasibility of conducting a fully powered randomised, double blind, placebo-controlled clinical trial on SFJD for AECOPD in UK primary care. METHODS This study is a phase III, two-arm individually double blind, randomised, placebo-controlled feasibility trial with nested qualitative study, coordinated by the Southampton Clinical Trial Unit (SCTU). Patients aged ≥ 40 years, with a current AECOPD, presenting with increased sputum purulence/volume, or breathlessness, and for whom the GP is considering use of antibiotics, will be eligible to participate. We aim to recruit seven eligible participants per month and randomise them to receive either the patent Chinese herbal medicine SFJD capsules or placebo for 14 consecutive days and to follow-up for 12 weeks. The primary outcomes include the feasibility of recruitment, study retention, and the percentage of diary completion. DISCUSSION If this trial demonstrates the feasibility of recruitment, delivery, and follow-up, we will seek funding for a fully powered placebo-controlled trial of SFJD for the treatment of AECOPD in primary care. TRIAL REGISTRATION This trial is registered via ISRCTN on 1 July 2021, identifier: ISRCTN26614726.
Collapse
Affiliation(s)
- Xiao-Yang Hu
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tom Oliver
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Merlin Willcox
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Catherine Simpson
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Kerensa Thorne
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Jeanne Trill
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nick Francis
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Beth Stuart
- grid.4868.20000 0001 2171 1133Pragmatic Trial Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael Thomas
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Gareth Griffiths
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Michael Moore
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
16
|
Andrographis paniculata Dosage Forms and Advances in Nanoparticulate Delivery Systems: An Overview. Molecules 2022; 27:molecules27196164. [PMID: 36234698 PMCID: PMC9570691 DOI: 10.3390/molecules27196164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Andrographis paniculata is a well-known Asian medicinal plant with a major phytoconstituent of diterpene lactones, such as andrographolide, 14-deoxyandrographolide, and neoandrographolide. A World Health Organization (WHO) monograph on selected medicinal plants showed that A. paniculata extracts and its major diterpene lactones have promising anti-inflammatory, antidiabetic, antimalarial, anticancer, antifungal, antibacterial, antioxidant, and hypoglycemic activities. However, these active phytochemicals have poor water solubility and bioavailability when delivered in a conventional dosage form. These biological barriers can be mitigated if the extract or isolated compound are delivered as nanoparticles. This review discusses existing studies and marketed products of A. paniculata in solid, liquid, semi-solid, and gaseous dosage forms, either as an extract or isolated pure compounds, as well as their deficits in reaching maximum bioavailability. The pharmaceutics and pharmacological activity of A. paniculata as a nano-delivery system are also discussed.
Collapse
|
17
|
Songvut P, Suriyo T, Panomvana D, Rangkadilok N, Satayavivad J. A comprehensive review on disposition kinetics and dosage of oral administration of Andrographis paniculata, an alternative herbal medicine, in co-treatment of coronavirus disease. Front Pharmacol 2022; 13:952660. [PMID: 36059950 PMCID: PMC9437296 DOI: 10.3389/fphar.2022.952660] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a present global health crisis that is driving the investigation of alternative phytomedicines for antiviral purposes. The evidence suggests that Andrographis paniculata crude or extract is a promising candidate for treating symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review aims to consolidate the available reports on the disposition kinetics of andrographolide, a main active component of A. paniculata. The second objective of this review is to summarize the available reports on an appropriate oral dosage for the use of andrographolide in upper respiratory tract infections (URTIs) and other viral infectious diseases. The data were collected from the literature on absorption, distribution, biotransformation, and excretion of andrographolide, and information was also obtained from scientific databases about the use of A. paniculata. The finding of this review on pharmacokinetics indicates that andrographolide is slightly absorbed into the blood circulation and exhibits poor oral bioavailability, whereas its distribution process is unrestricted. In the termination phase, andrographolide preferentially undergoes biotransformation partly through phase I hydroxylation and phase II conjugation, and it is then eliminated via the renal excretion and hepatobiliary system. The key summary of the recommended dosage for andrographolide in uncomplicated URTI treatment is 30 mg/day for children and 60 mg/day for adults. The dose for adult patients with pharyngotonsillitis could be increased to 180 mg/day, but not exceed 360 mg/day. Co-treatment with A. paniculata in concert with the standard supportive care for influenza reduced the severity of symptoms, shortened treatment duration, and decreased the risk of developing post-influenza complications. The recommended starting dose for use in patients with mild COVID-19 is 180 mg/day of andrographolide, based on the dose used in patients experiencing a URTI with inflammation. This review is not only applicable for evaluating the appropriate doses of andrographolide for antiviral treatments but also encourages future research evaluating the effectiveness of these recommended dosages during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Phanit Songvut
- Laboratory of Pharmacology, Chulabhorn Research Institute, Bangkok, Thailand
| | - Tawit Suriyo
- Laboratory of Pharmacology, Chulabhorn Research Institute, Bangkok, Thailand
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Bangkok, Thailand
| | - Duangchit Panomvana
- Translational Research Unit, Chulabhorn Research Institute, Bangkok, Thailand
| | - Nuchanart Rangkadilok
- Laboratory of Pharmacology, Chulabhorn Research Institute, Bangkok, Thailand
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Bangkok, Thailand
| | - Jutamaad Satayavivad
- Laboratory of Pharmacology, Chulabhorn Research Institute, Bangkok, Thailand
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Bangkok, Thailand
- *Correspondence: Jutamaad Satayavivad,
| |
Collapse
|
18
|
Intharuksa A, Arunotayanun W, Yooin W, Sirisa-ard P. A Comprehensive Review of Andrographis paniculata (Burm. f.) Nees and Its Constituents as Potential Lead Compounds for COVID-19 Drug Discovery. Molecules 2022; 27:molecules27144479. [PMID: 35889352 PMCID: PMC9316804 DOI: 10.3390/molecules27144479] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic has intensively disrupted global health, economics, and well-being. Andrographis paniculata (Burm. f.) Nees has been used as a complementary treatment for COVID-19 in several Asian countries. This review aimed to summarize the information available regarding A. paniculata and its constituents, to provide critical points relating to its pharmacological properties, safety, and efficacy, revealing its potential to serve as a source of lead compounds for COVID-19 drug discovery. A. paniculata and its active compounds possess favorable antiviral, anti-inflammatory, immunomodulatory, and antipyretic activities that could be beneficial for COVID-19 treatment. Interestingly, recent in silico and in vitro studies have revealed that the active ingredients in A. paniculata showed promising activities against 3CLpro and its virus-specific target protein, human hACE2 protein; they also inhibit infectious virion production. Moreover, existing publications regarding randomized controlled trials demonstrated that the use of A. paniculata alone or in combination was superior to the placebo in reducing the severity of upper respiratory tract infection (URTI) manifestations, especially as part of early treatment, without serious side effects. Taken together, its chemical and biological properties, especially its antiviral activities against SARS-CoV-2, clinical trials on URTI, and the safety of A. paniculata, as discussed in this review, support the argument that A. paniculata is a promising natural source for drug discovery regarding COVID-19 post-infectious treatment, rather than prophylaxis.
Collapse
Affiliation(s)
- Aekkhaluck Intharuksa
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (A.I.); (W.Y.); (P.S.-a.)
| | - Warunya Arunotayanun
- Kanchanabhishek Institute of Medical and Public Health Technology, Praboromarajchanok Institute, Nonthaburi 11150, Thailand
- Correspondence:
| | - Wipawadee Yooin
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (A.I.); (W.Y.); (P.S.-a.)
| | - Panee Sirisa-ard
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (A.I.); (W.Y.); (P.S.-a.)
| |
Collapse
|
19
|
A Simple and Reliable Dispersive Liquid-Liquid Microextraction with Smartphone-Based Digital Images for Determination of Carbaryl Residues in Andrographis paniculata Herbal Medicines Using Simple Peroxidase Extract from Senna siamea Lam. Bark. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27103261. [PMID: 35630744 PMCID: PMC9147045 DOI: 10.3390/molecules27103261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023]
Abstract
A simple and reliable dispersive liquid-liquid microextraction (DLLME) coupled with smartphone-based digital images using crude peroxidase extracts from cassia bark (Senna siamea Lam.) was proposed to determine carbaryl residues in Andrographis paniculata herbal medicines. The method was based on the reaction of 1-naphthol (hydrolysis of carbaryl) with 4-aminoantipyrine (4-AP) in the presence of hydrogen peroxide, using peroxidase enzyme simple extracts from cassia bark as biocatalysts under pH 6.0. The red product, after preconcentration by DLLME using dichloromethane as extraction solvent, was measured for blue intensity by daily life smartphone-based digital image analysis. Under optimized conditions, good linearity of the calibration graph was found at 0.10–0.50 mg·L−1 (r2 = 0.9932). Limits of detection (LOD) (3SD/slope) and quantification (LOQ) (10SD/slope) were 0.03 and 0.09 mg·L−1, respectively, with a precision of less than 5%. Accuracy of the proposed method as percentage recovery gave satisfactory results. The proposed method was successfully applied to analyze carbaryl in Andrographis paniculata herbal medicines. Results agreed well with values obtained from the HPLC-UV method at 95% confidence level. This was simple, convenient, reliable, cost-effective and traceable as an alternative method for the determination of carbaryl.
Collapse
|
20
|
Abdi H, Aganj Z, Hosseinzadeh H, Mosaffa F. Crocin restores the balance of Th1/Th2 immune cell response in ConA-treated human lymphocytes. Pharmacol Rep 2022; 74:513-522. [PMID: 35294736 DOI: 10.1007/s43440-022-00362-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Following antigen stimulation, naive CD4+ T cells differentiate into different T helper (Th) subsets characterized by lineage-specific transcriptional factors and cytokines. The balance between cytokines from Th1 and Th2 cells is disrupted in autoimmune disorders, asthma, and allergic reactions. Crocin, the major carotenoid of saffron, has anti-inflammatory properties. We investigated crocin modifying effects on the human lymphocytes proliferation and Th1/Th2 balance as a possible mechanism of its anti-inflammatory effects. METHODS The human peripheral blood mononuclear cells were isolated using Ficoll density gradient centrifugation. MTT was used to evaluate the effect of 72-h treatment with different concentrations of crocin with or without ConA on lymphocytes proliferation. INF-γ/IL-4 cytokine secretion and T-bet/GATA-3 transcription factor expression ratios (as indicators of Th1/Th2 response status) were measured in non-stimulated and ConA-stimulated cells in the presence or absence of crocin by ELISA and RT-qPCR methods, respectively. RESULTS The results showed crocin at a concentration of 50 μM and higher was toxic for human lymphocytes, and at a non-toxic concentration of 25 µM, it did not affect cell proliferation. The ratio of T-bet/GATA-3 and INF-γ/IL-4 was higher in the culture supernatant of ConA-stimulated cells compared to non-stimulated ones. Crocin-treated cells showed slightly lower T-bet/GATA-3 and INF-γ/IL-4 ratios compared to untreated cells. Crocin (25 μM) was also able to restore the increased ratio of Th1/Th2 immune response induced by ConA. CONCLUSIONS Crocin can alleviate inflammatory-stimulant effects of ConA on human lymphocytes by decreasing T-bet/GATA-3 and INF-γ/IL-4 ratios, which are indicative of restoring the balance of Th1/Th2 responses.
Collapse
Affiliation(s)
- Hakimeh Abdi
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Aganj
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Fatemeh Mosaffa
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
21
|
Legacy M, Seely D, Conte E, Psihogios A, Ramsay T, Fergusson DA, Kanji S, Simmons JG, Wilson K. Dietary supplements to reduce symptom severity and duration in people with SARS-CoV-2: study protocol for a randomised, double-blind, placebo controlled clinical trial. BMJ Open 2022; 12:e057024. [PMID: 35241474 PMCID: PMC8895416 DOI: 10.1136/bmjopen-2021-057024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION COVID-19 has caused morbidity, hospitalisations and deaths worldwide. Despite four approved vaccines for COVID-19 in Canada, there is still a need for effective treatments, especially for people in the community. Vaccine efficacy is not 100% and long-term efficacy is still unknown. Furthermore, there are challenges to herd immunity including vaccine hesitancy and underlying conditions preventing vaccination. We aim to explore if the nutrients vitamin C, vitamin D, vitamin K2 and zinc are an effective treatment option for outpatients diagnosed with COVID-19. The primary outcome is the difference in participant-reported overall health; secondary outcomes include the effect on health status, symptom severity and duration, frequency and length of hospitalisations and mortality. METHODS AND ANALYSIS This study is a two-arm, parallel-group, double-blind, placebo-controlled, phase III randomised controlled trial. 200 patients will be recruited remotely from COVID-19 test centres in Ottawa, Canada associated with The Ottawa Hospital. Overall health will be measured using the EuroQol Visual Assessment Scale; health status will be measured using the EuroQol 5-dimension 5-level questionnaire; symptom severity and duration will be measured using an independently developed questionnaire; analyses will use an area under the curve approach and compare mean scores using unadjusted t tests. Study data will be recorded on electronic case report forms using the Research Electronic Data Capture platform. An independent data safety and monitoring board will perform ongoing review of the study for feasibility and safety. ETHICS AND DISSEMINATION This study has received ethical approval from the research ethics boards of the Canadian College of Naturopathic Medicine and the Ottawa Health Sciences Network, as well as regulatory approval from the Therapeutic Products Directorate and Natural and Non-Prescription Health Products Directorate of Health Canada. Results will be published in a peer-reviewed scientific journal with open access. TRIAL REGISTRATION NUMBER NCT04780061.
Collapse
Affiliation(s)
- Mark Legacy
- Research, The Centre for Health Innovation, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dugald Seely
- Research, The Centre for Health Innovation, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Ellen Conte
- Research, The Centre for Health Innovation, Ottawa, Ontario, Canada
- Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Athanasios Psihogios
- Research, The Centre for Health Innovation, Ottawa, Ontario, Canada
- Research, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John-Graydon Simmons
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
22
|
Rathinasabapathy T, Sakthivel LP, Komarnytsky S. Plant-Based Support of Respiratory Health during Viral Outbreaks. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:2064-2076. [PMID: 35147032 DOI: 10.1021/acs.jafc.1c06227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Respiratory viruses are linked to major epidemic events that have plagued humans through recorded history and possibly much earlier, ranging from common colds, influenza, and coronavirus infections to measles. However, difficulty in developing effective pharmaceutical solutions to treat infected individuals has hindered efforts to manage and minimize respiratory viral outbreaks and the associated mortality. Here we highlight a series of botanical interventions with different and often overlapping putative mechanisms of action to support the respiratory system, for which the bioactive pharmacophore was suggested and the initial structure-activity relationships have been explored (Bupleurum spp., Glycyrrhiza spp., Andrographis spp.), have been proposed with uncertainty (Echinacea spp., Zingiber spp., Verbascum spp., Marrubium spp.), or remained to be elucidated (Sambucus spp., Urtica spp.). Investigating these metabolites and their botanical sources holds potential to uncover new mediators of the respiratory health outcomes as well as molecular targets for future break-through therapeutic interventions targeting respiratory viral outbreaks.
Collapse
Affiliation(s)
- Thirumurugan Rathinasabapathy
- Plants for Human Health Institute, North Carolina State University, North Carolina Research Campus, 600 Laureate Way, Kannapolis, North Carolina 28081, United States
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, 400 Dan Allen Drive, Raleigh, North Carolina 27695, United States
| | - Lakshmana Prabu Sakthivel
- Department of Pharmaceutical Technology, College of Engineering, Anna University BIT Campus, Tiruchirappalli, Tamil Nadu 620024, India
| | - Slavko Komarnytsky
- Plants for Human Health Institute, North Carolina State University, North Carolina Research Campus, 600 Laureate Way, Kannapolis, North Carolina 28081, United States
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, 400 Dan Allen Drive, Raleigh, North Carolina 27695, United States
| |
Collapse
|
23
|
Shang YX, Shen C, Stub T, Zhu SJ, Qiao SY, Li YQ, Wang RT, Li J, Liu JP. Adverse Effects of Andrographolide Derivative Medications Compared to the Safe use of Herbal Preparations of Andrographis paniculata: Results of a Systematic Review and Meta-Analysis of Clinical Studies. Front Pharmacol 2022; 13:773282. [PMID: 35153776 PMCID: PMC8831758 DOI: 10.3389/fphar.2022.773282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective:Andrographis paniculata (AP) is a traditionally used herbaceous plant, whose main active constituent is andrographolide. Andrographolide derivative medications and herbal preparations of AP are often used to treat respiratory tract infections. This study aims to systematically evaluate the safety of andrographolide derivative medications and herbal preparations of AP based on clinical studies. Methods: English and Chinese databases were searched for all types of clinical studies that reported adverse drug reactions (ADRs) and adverse events (AEs) of andrographolide derivative medications and herbal preparations of AP. The ADRs and AEs were classified according to manifestations, and graded according to severity. Single-rate meta-analysis was performed for ADR incidence using R software. Results: A total of 262 studies were included, including 125 randomized controlled trials, 23 non-randomized controlled trials, 6 case series, and 108 case reports. In 9490 participants using andrographolide derivative injections, 383 (4.04%) reported ADRs. Meta-analysis showed that the ADR incidence of three most frequently used injections of andrographolide derivatives (andrographolide sulfonate, potassium sodium dehydroandrographolide succinate, and potassium dehydroandrographolide succinate) were 5.48% [95% CI (4.47%, 6.72%)], 3.69% [95% CI (2.59%, 4.94%)] and 5.33% [95% CI (3.68%, 7.72%)], respectively, which may be slightly higher than the actual ADR incidence, because only studies that reported the occurrence of ADRs or AEs were included, but studies without ADR and AE were not included. The ADRs of andrographolide derivative injections were mainly gastrointestinal, skin and subcutaneous tissue disorders, and anaphylaxis. Fifty-five patients experienced life-threatening anaphylactic shock, three patients died, and the causation attributed to the andrographolide derivative injection. Other ADRs were mild, moderate or medically significant. Nine herbal preparations of AP were tested in 10 studies, and the reported ADRs were mainly mild to moderate gastrointestinal, skin and subcutaneous tissue disorders. Except for five patients using andrographolide derivative injections eventually died, most of the ADRs were alleviated after drug withdrawal and symptomatic treatment. Conclusions: The ADRs of andrographolide derivative medications are few, but can be life-threatening, mainly gastrointestinal, skin and subcutaneous tissue disorders, and anaphylaxis. Injections of andrographolide derivatives should be used with caution. Herbal preparations of AP are essentially safe. Systematic Review Registration: [website], identifier [registration number]
Collapse
Affiliation(s)
- Ya-xi Shang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Shen
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Trine Stub
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Si-jia Zhu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shu-yu Qiao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-qi Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Rui-ting Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Li
- Beijing Key Laboratory of the Innovative Development of Functional Staple and the Nutritional Intervention for Chronic Disease, China National Research Institute of Food and Fermentation Industries Co, Ltd., Beijing, China
| | - Jian-ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jian-ping Liu,
| |
Collapse
|
24
|
Kaushik P, Ahlawat P, Singh K, Singh R. Chemical constituents, pharmacological activities, and uses of common ayurvedic medicinal plants: a future source of new drugs. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-021-00621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Wong SK, Chin KY, Ima-Nirwana S. A review on the molecular basis underlying the protective effects of Andrographis paniculata and andrographolide against myocardial injury. Drug Des Devel Ther 2021; 15:4615-4632. [PMID: 34785890 PMCID: PMC8591231 DOI: 10.2147/dddt.s331027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/02/2021] [Indexed: 12/23/2022] Open
Abstract
Andrographolide is the major compound found in the medicinal plant, Andrographis paniculata (Burm.f.) Nees, which accounts for its medicinal properties. Both the plant extract and compound have been reported to exhibit potential cardiovascular activities. This review summarises related studies describing the biological activities and target mechanisms of A. paniculata and andrographolide in vivo and in vitro. The current evidence unambiguously indicated the protective effects provided by A. paniculata and andrographolide administration against myocardial injury. The intervention ameliorates the symptoms of myocardial injury by interfering with the inductive phase of a) inflammatory response mediated by nuclear factor-kappa B (NF-κB), phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt), mitogen-activated protein kinase (MAPK) and signal transducer and activator of transcription 3 (STAT3) signalling molecules; b) oxidative stress via activation of nuclear factor erythroid 2-related factor (Nrf-2) and reduction of enzymes responsible for generating reactive oxygen and nitrogen species; c) intrinsic and extrinsic mechanisms in apoptosis regulated by upstream insulin-like growth factor-1 receptor (IGF-1R) and peroxisome proliferator-activated receptor-alpha (PPAR-α); d) profibrotic growth factors thus reducing cardiac fibrosis, improving endothelial function and fibrinolytic function. In conclusion, A. paniculata and andrographolide possess therapeutic potential in the management of myocardial injury, which requires further validation in human clinical trials.
Collapse
Affiliation(s)
- Sok Kuan Wong
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, 56000, Malaysia
| |
Collapse
|
26
|
Early intervention with Kan Jang® to treat upper-respiratory tract infections: A randomized, quadruple-blind study. J Tradit Complement Med 2021; 11:552-562. [PMID: 34765519 PMCID: PMC8572720 DOI: 10.1016/j.jtcme.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 01/21/2023] Open
Abstract
Background and aim Andrographis paniculata and Eleutherococcus senticosus preparations and their fixed combination, called Kan Jang®, are traditionally used for relieving symptoms of upper-respiratory tract infections (URTIs). This study aimed to assess the efficacy of early intervention with Kan Jang® on the relief and duration of inflammatory symptoms during the acute phase of the disease. Experimental procedure A total of 179 patients with URTI symptoms received six Kan Jang® (daily dose of andrographolides: 60 mg) or placebo capsules a day for five consecutive days in this randomized, quadruple-blinded, placebo-controlled, two-parallel-group phase II study. The primary efficacy outcomes were the decrease in the acute-phase duration and the mean URTI symptoms score (sore throat, runny nose, nasal congestion, hoarseness, cough, headache, and fatigue). Results Early intervention with Kan Jang® significantly increased the recovery rate and reduced the number of sick leave days by >21% (0.64/day) relative to that observed in the placebo group (2.38 vs. 3.02 days, p = 0.0053). Kan Jang® significantly alleviated all URTI symptoms starting from the second day of treatment. A superior anti-inflammatory effect of Kan Jang® to that of placebo was also observed on the white blood cell count (p = 0.007) and erythrocyte sedimentation rate (p = 0.0258). Treatment with Kan Jang® was tolerated well. Conclusion This study demonstrates that early intervention with Kan Jang® capsules reduces the recovery duration of patients by 21% and significantly relieves the severity of typical URTI symptoms.
Collapse
Key Words
- Andrographis paniculata
- Clinical trial
- ESR, erythrocyte sedimentation rate
- Eleutherococcus senticosus
- FI, farb (colour) index
- GCP, good clinical practice
- GMP, good manufacturing practice
- ICH, international conference on harmonization
- Inflammation.
- Kan Jang®
- OR, odds ratio
- QP, qualified pharmacist
- RBC, red blood cell
- TSS, total symptom score
- URTI, upper respiratory tract infection
- Upper-respiratory tract infections
- VAS, visual analog scale
- WBC, white blood cell
Collapse
|
27
|
A Randomized, Double-Blind, Placebo-Controlled Study to Assess the Efficacy and Safety of a Nutritional Supplement (ImmuActive TM) for COVID-19 Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8447545. [PMID: 34671412 PMCID: PMC8523255 DOI: 10.1155/2021/8447545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/15/2021] [Indexed: 01/28/2023]
Abstract
Background SARS-CoV-2 has emerged as a global threat due to its infectivity and rapid transmission. We evaluated the safety and efficacy of herbal and mineral formulation (ImmuActive) as an adjunct therapy in COVID-19 patients. Methods A randomized, double-blind, placebo-controlled study was conducted in 100 COVID-19 patients in three centers in Southern India, and 92 subjects completed the study. Subjects were followed up until they were discharged from the hospital or for a maximum of 28 days, whichever was earlier. The primary outcome parameters were the mean change and time required to change the ordinal scale of disease severity by one unit. The secondary outcomes were the time required to turn RT-PCR negative or get discharged from the hospital, change in modified Jackson's Symptom Severity score, and COVID-19 quality of life questionnaire. Results The ordinal scale at the end of the study was significantly lower in COVID-19 patients supplemented with ImmuActive (0.57) than placebo (1.0), with a p value of 0.0043. The ordinal scale decreased by one unit within 2.35 days in ImmuActive-supplemented patients, while it took 3.36 days in placebo-supplemented patients. Days of hospitalization and time required to turn RT-PCR negative were comparatively lower in the ImmuActive arm than the placebo arm. Change in modified Jackson's Symptom Severity Score and COVID-19 QOL were significant from screening to the end of the study in both ImmuActive and placebo arms. There were no adverse events observed during the study period. Conclusion The study results suggest that ImmuActive could be a beneficial and safe adjunct treatment for effectively managing COVID-19 infection symptoms.
Collapse
|
28
|
Kuchta K, Cameron S, Lee M, Cai SQ, Shoyama Y. Which East Asian herbal medicines can decrease viral infections? PHYTOCHEMISTRY REVIEWS : PROCEEDINGS OF THE PHYTOCHEMICAL SOCIETY OF EUROPE 2021; 21:219-237. [PMID: 34466134 PMCID: PMC8391007 DOI: 10.1007/s11101-021-09756-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2021] [Indexed: 06/13/2023]
Abstract
Whilst Western research for the COVID-19 crisis focuses on vaccination, in East Asia traditional herbal prescriptions are studied for SARS-CoV2 therapy. In Japan, Maoto (Ephedrae herba 4 g, Armeniacae semen 4 g, Cinnamomi cortex 3 g, and Glycyrrhizae radix 2 g, JPXVII) is used based on clinical evidence for its effect on early phase influenza (also caused by RNA viruses) comparable to that of oseltamivir. The Health Ministry of Thailand has approved Andrographis paniculata (Jap. Senshinren) extracts for treatment of COVID-19. Its combination (4 g) with Maoto, Maoto-ka-senshinren, seems most promising for the treatment of viral pandemics. In China, the official guideline for COVID-19 treatment contains TCM medications with antiviral, as well as immunmodulatory and anti-inflammatory effects such as: Qing-Fei-Pai-Du-Tang (Jap. Seihai-haidokuto) contains 21 drugs; Shufeng Jiedu Jiaonang (Bupleuri radix 8 g, Forsythiae fructus 8 g, Glycyrrhizae radix 4 g, Isatidis radix 8 g, Patriniae herba 8 g, Phragmitis rhizoma 6 g, Polygoni cuspidati rhizoma 10 g, Verbenae herba 8 g); Fufang Yuxingcao Heiji (Forsythiae fructus 0.6 g, Houttuyniae herba 6 g, Isatidis radix 1.5 g, Lonicerae flos 0.6 g, Scutellariae radix 1.5 g) first gained prominence during the 2002 SARS epidemic. With no Western medicine available, the following overview discusses efficacy and mechanisms in view of viral entry and replication of different East Asian herbal remedies for COVID-19 treatment.
Collapse
Affiliation(s)
- Kenny Kuchta
- Forschungsstelle Für Fernöstliche Medizin, Department of Vegetation Analysis and Phytodiversity, Albrecht Von Haller Institute of Plant Sciences, Georg August University, Göttingen, Germany
| | - Silke Cameron
- Clinic for Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Minwon Lee
- Laboratory of Pharmacognosy and Natural Product-Based Medicine, College of Pharmacy, Chung-Ang University, Seoul, 156-756 Korea
| | - Shao-Qing Cai
- International Cooperative Center for Researches of Medicinal Resources, Peking University Health Center, Peking University, Haidian District, Beijing, 100191 China
| | - Yukihiro Shoyama
- Faculty of Pharmacy, Nagasaki International University, 2825-7, Sasebo, Nagasaki 859-3298 Japan
| |
Collapse
|
29
|
Rajanna M, Bharathi B, Shivakumar BR, Deepak M, Prashanth D, Prabakaran D, Vijayabhaskar T, Arun B. Immunomodulatory effects of Andrographis paniculata extract in healthy adults - An open-label study. J Ayurveda Integr Med 2021; 12:529-534. [PMID: 34376353 PMCID: PMC8377179 DOI: 10.1016/j.jaim.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022] Open
Abstract
Background Andrographis paniculata (Burm.f.) Nees has been well-researched for its immunomodulatory effects. Objective(s) To investigate the immunomodulatory effects of standardized A. paniculata extract (SAPE) in healthy adults. Materials and methods The study was an open-label, single-centre study conducted for 30 days. Thirty participants with absolute lymphocyte counts of 1000–4000 cells/mm3 were enrolled and were instructed to ingest 200 mg of SAPE daily for 30 days. The participants visited the clinic at baseline, and days 3, 7, and 30. Immune cells such as NK cell (CD3-CD16+CD56+), T cells (CD3+), T helper cells (CD3+CD4+), T cytotoxic cells (CD3+CD8+) were measured using flow cytometry. Serum cytokines that include interferon gamma (IFN-γ), interleukin-4 (IL-4), interleukin-2 (IL-2), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNF-α) were measured using ELISA. The SAPE used in this study was a standardized proprietary extract (AP-Bio®/KalmCold®) developed from the leaf extracts of A. paniculata. Results SAPE increased T cells, T helper cells and significantly increased IFN-γ, IL-4, and decreased IL-2 at day 30. A subgroup analysis of participants with absolute lymphocyte counts of 1000–3000 cells/mm3 indicated that there is a significant increase in the T cells, T helper cells at day 7 and 30 and significant increase in IFN-γ, IL-4 and decrease in IL-2 at day 30. There was no treatment related adverse effects following SAPE intake for 30 days. Conclusion Supplementation of SAPE resulted in immunomodulatory effects evidenced by its effects on immune cells and cytokines and it was found to be safe and tolerable.
Collapse
Affiliation(s)
- M Rajanna
- Surya Medical Centre, Bangalore, 560084, India
| | - B Bharathi
- Natural Remedies Pvt Ltd, Bangalore, 560100, India.
| | | | - M Deepak
- Natural Remedies Pvt Ltd, Bangalore, 560100, India
| | | | - D Prabakaran
- In Vitro Research Solutions (iVRS) Pvt Ltd, Bangalore, 560092, India
| | - T Vijayabhaskar
- In Vitro Research Solutions (iVRS) Pvt Ltd, Bangalore, 560092, India
| | - B Arun
- In Vitro Research Solutions (iVRS) Pvt Ltd, Bangalore, 560092, India
| |
Collapse
|
30
|
Banerjee S, Kar A, Mukherjee PK, Haldar PK, Sharma N, Katiyar CK. Immunoprotective potential of Ayurvedic herb Kalmegh (Andrographis paniculata) against respiratory viral infections - LC-MS/MS and network pharmacology analysis. PHYTOCHEMICAL ANALYSIS : PCA 2021; 32:629-639. [PMID: 33167083 DOI: 10.1002/pca.3011] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Immunity boosting has emerged as a global strategy to fight the SARS-CoV-2 pandemic situation. In India, AYUSH systems of medicine have been promoted as an immune-protection strategy. Andrographis paniculata (Burm. F) Nees (AP) mentioned in Ayurveda has been widely used for treating sore throat, flu, and upper respiratory tract infections which may provide possible novel therapeutic approaches, exclusively targeting SARS-CoV-2 and its pathways. OBJECTIVES The present work uses liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics and combination synergy analysis based on network pharmacology to mine multimode evidence to understand the possible mechanism of action, diseases association, protein-protein interaction and major pathways involved therein. MATERIAL AND METHODS Metabolite profiling was performed by Agilent QTOF LC-MS/MS system. Network pharmacology analysis was performed by using functional annotation analysis based on databases like Binding DB, STRING, DAVID and KEGG for further data mining. Further combination synergy was evaluated using "neighbourhood approach" and networks were constructed through Cytoscape 3.2.1. RESULTS The molecules from kalmegh provides immune-protection and anti-viral response via involving different pathways, like toll-like receptor pathway, PI3/AKT pathway and MAP kinase pathways against COVID-19 infection. The KEGG analysis showed that in a vast majority of the most enriched pathways, AP were associated with viral infections and upper respiratory tract infections. CONCLUSIONS The results suggest a synergy between andrographolide and other molecules identified as safe and efficacious anti-inflammatory agent having effects on upper respiratory tract infections and can significantly decrease the production of cytokines and pro-inflammatory factors in viral infections.
Collapse
Affiliation(s)
- Subhadip Banerjee
- School of Natural Product Studies, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - Amit Kar
- School of Natural Product Studies, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - Pulok K Mukherjee
- School of Natural Product Studies, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
- Institute of Bioresources and Sustainable Development, An Autonomous Institute under Department of Biotechnology, Government of India, Imphal, India
| | - Pallab K Haldar
- School of Natural Product Studies, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - Nanaocha Sharma
- Institute of Bioresources and Sustainable Development, An Autonomous Institute under Department of Biotechnology, Government of India, Imphal, India
| | | |
Collapse
|
31
|
Approach to patient with cough by American and Chinese respiratory specialist. Complement Ther Med 2021; 60:102733. [PMID: 34048915 DOI: 10.1016/j.ctim.2021.102733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/07/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
Cough is a common pediatric condition. Acute cough is often considered to be self-limiting and not requiring clinical management. However, pediatric patients and their parents often seek remedies for an acute cough. Traditional Chinese Medicine (TCM) specialists have been treating pediatric cough for millennia. Here we present a case of pediatric cough and the approaches taken to it by a Western and Chinese respiratory specialist. We conclude that TCM may provide important and useful insights into the treatment of such pediatric respiratory disease.
Collapse
|
32
|
Lim XY, Chan JSW, Tan TYC, Teh BP, Mohd Abd Razak MR, Mohamad S, Syed Mohamed AF. Andrographis paniculata (Burm. F.) Wall. Ex Nees, Andrographolide, and Andrographolide Analogues as SARS-CoV-2 Antivirals? A Rapid Review. Nat Prod Commun 2021. [DOI: 10.1177/1934578x211016610] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Drug repurposing is commonly employed in the search for potential therapeutic agents. Andrographis paniculata, a medicinal plant commonly used for symptomatic relief of the common cold, and its phytoconstituent andrographolide, have been repeatedly identified as potential antivirals against SARS-CoV-2. In light of new evidence emerging since the onset of the COVID-19 pandemic, this rapid review was conducted to identify and evaluate the current SARS-CoV-2 antiviral evidence for A. paniculata, andrographolide, and andrographolide analogs. A systematic search and screen strategy of electronic databases and gray literature was undertaken to identify relevant primary articles. One target-based in vitro study reported the 3CLpro inhibitory activity of andrographolide as being no better than disulfiram. Another Vero cell-based study reported potential SARS-CoV-2 inhibitory activity for both andrographolide and A. paniculata extract. Eleven in silico studies predicted the binding of andrographolide and its analogs to several key antiviral targets of SARS-CoV-2 including the spike protein-ACE-2 receptor complex, spike protein, ACE-2 receptor, RdRp, 3CLpro, PLpro, and N-protein RNA-binding domain. In conclusion, in silico and in vitro studies collectively suggest multi-pathway targeting SARS-CoV-2 antiviral properties of andrographolide and its analogs, but in vivo data are needed to support these predictions.
Collapse
Affiliation(s)
- Xin Yi Lim
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Janice Sue Wen Chan
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Terence Yew Chin Tan
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Bee Ping Teh
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Mohd Ridzuan Mohd Abd Razak
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Saharuddin Mohamad
- Bioinformatics Programme, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Research for Computational Sciences and Informatics for Biology, Bioindustry, Environment, Agriculture and Healthcare, University of Malaya, Kuala Lumpur, Malaysia
| | - Ami Fazlin Syed Mohamed
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| |
Collapse
|
33
|
Hossain S, Urbi Z, Karuniawati H, Mohiuddin RB, Moh Qrimida A, Allzrag AMM, Ming LC, Pagano E, Capasso R. Andrographis paniculata (Burm. f.) Wall. ex Nees: An Updated Review of Phytochemistry, Antimicrobial Pharmacology, and Clinical Safety and Efficacy. Life (Basel) 2021; 11:348. [PMID: 33923529 PMCID: PMC8072717 DOI: 10.3390/life11040348] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 02/07/2023] Open
Abstract
Infectious disease (ID) is one of the top-most serious threats to human health globally, further aggravated by antimicrobial resistance and lack of novel immunization options. Andrographis paniculata (Burm. f.) Wall. ex Nees and its metabolites have been long used to treat IDs. Andrographolide, derived from A. paniculata, can inhibit invasive microbes virulence factors and regulate the host immunity. Controlled clinical trials revealed that A. paniculata treatment is safe and efficacious for acute respiratory tract infections like common cold and sinusitis. Hence, A. paniculata, mainly andrographolide, could be considered as an excellent candidate for antimicrobial drug development. Considering the importance, medicinal values, and significant role as antimicrobial agents, this study critically evaluated the antimicrobial therapeutic potency of A. paniculata and its metabolites, focusing on the mechanism of action in inhibiting invasive microbes and biofilm formation. A critical evaluation of the secondary metabolites with the aim of identifying pure compounds that possess antimicrobial functions has further added significant values to this study. Notwithstanding that A. paniculata is a promising source of antimicrobial agents and safe treatment for IDs, further empirical research is warranted.
Collapse
Affiliation(s)
- Sanower Hossain
- Department of Biomedical Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
| | - Zannat Urbi
- Department of Industrial Biotechnology, Faculty of Industrial Sciences & Technology, Universiti Malaysia Pahang, Kuantan 26300, Pahang, Malaysia;
| | - Hidayah Karuniawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Surakarta, Surakarta 57102, Indonesia;
| | - Ramisa Binti Mohiuddin
- Department of Pharmacy, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Santosh 1902, Tangail, Bangladesh;
| | - Ahmed Moh Qrimida
- Department of Agriculture, Higher Institute of Overall Occupations-Sooq Al Khamees Imsahil, Tripoli 1300, Libya; (A.M.Q.); (A.M.M.A.)
| | - Akrm Mohamed Masaud Allzrag
- Department of Agriculture, Higher Institute of Overall Occupations-Sooq Al Khamees Imsahil, Tripoli 1300, Libya; (A.M.Q.); (A.M.M.A.)
| | - Long Chiau Ming
- PAP Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Gadong BE1410, Brunei;
| | - Ester Pagano
- Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy;
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Naples Federico II, 80055 Portici, Italy
| |
Collapse
|
34
|
Peric A, Gacesa D, Barac A, Peric A. A Herbal Formula in the Therapy of Acute Postviral Rhinosinusitis. Turk Arch Otorhinolaryngol 2021; 59:33-42. [PMID: 33912859 PMCID: PMC8054925 DOI: 10.4274/tao.2020.6098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/12/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To assess the effects and adverse events of preparation Sinulan forte® containing extracts of five medicinal plants in comparison to mometasone furoate nasal spray (MFNS) in therapy of acute postviral rhinosinusitis (APRS). Methods We included 46 APRS patients in this prospective investigation and randomized to two groups. The patients in group 1 (n=23) received MFNS 200 μg two times/day for ten days, and patients in group 2 (n=23) received Sinulan forte®, tablets 225 mg per os, two times/day also for ten days. We evaluated the total symptom score (TSS), the separate scores for individual symptoms (nasal congestion, rhinorrhea, postnasal discharge, facial pain, impaired sense of smell), the quality-of-life outcome, and the findings from nasal endoscopy (edema of the nasal mucosa, nasal secretion) prior and after the therapy. Results Significantly lower absolute post-treatment scores and better relative improvement were identified for TSS, nasal congestion, facial pain, loss of the sense of smell, edema of the mucosa and nasal secretion in patients receiving herbal preparation (group 2). However, lower absolute post-treatment score and better relative improvement were found for rhinorrhea and postnasal drip in group 1. Clinically important differences were found regarding the TSS and endoscopic findings, with no adverse effects in group 2, but in group 1 two patients had mild nasal bleeding and two had sensation of dryness in the nasal mucosa. Conclusion Herbal product Sinulan forte® can be a safe and effective treatment for APRS. Our results suggest no adverse events of this herbal preparation in comparison to intranasal corticosteroid spray therapy.
Collapse
Affiliation(s)
- Aleksandar Peric
- Department of Otorhinolaryngology, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
| | - Dejan Gacesa
- Ear Nose and Throat Hospital "Doctor Zutic", Belgrade, Serbia
| | - Aleksandra Barac
- Department of Infectious and Tropical Diseases, Belgrade University School of Medicine, Belgrade, Serbia
| | - Aneta Peric
- Institute of Pharmacy, Military Medical Academy Faculty of Medicine, University of Defence, Belgrade, Serbia
| |
Collapse
|
35
|
Kulsirirat T, Honsawek S, Takeda-Morishita M, Sinchaipanid N, Udomsinprasert W, Leanpolchareanchai J, Sathirakul K. The Effects of Andrographolide on the Enhancement of Chondrogenesis and Osteogenesis in Human Suprapatellar Fat Pad Derived Mesenchymal Stem Cells. Molecules 2021; 26:1831. [PMID: 33805078 PMCID: PMC8037192 DOI: 10.3390/molecules26071831] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Andrographolide is a labdane diterpenoid herb, which is isolated from the leaves of Andrographis paniculata, and widely used for its potential medical properties. However, there are no reports on the effects of andrographolide on the human suprapatellar fat pad of osteoarthritis patients. In the present study, our goal was to evaluate the innovative effects of andrographolide on viability and Tri-lineage differentiation of human mesenchymal stem cells from suprapatellar fat pad tissues. The results revealed that andrographolide had no cytotoxic effects when the concentration was less than 12.5 µM. Interestingly, andrographolide had significantly enhanced, dose dependent, osteogenesis and chondrogenesis as evidenced by a significantly intensified stain for Alizarin Red S, Toluidine Blue and Alcian Blue. Moreover, andrographolide can upregulate the expression of genes related to osteogenic and chondrogenic differentiation, including Runx2, OPN, Sox9, and Aggrecan in mesenchymal stem cells from human suprapatellar fat pad tissues. In contrast, andrographolide suppressed adipogenic differentiation as evidenced by significantly diminished Oil Red O staining and expression levels for adipogenic-specific genes for PPAR-γ2 and LPL. These findings confirm that andrographolide can specifically enhance osteogenesis and chondrogenesis of mesenchymal stem cells from human suprapatellar fat pad tissues. It has potential as a therapeutic agent derived from natural sources for regenerative medicine.
Collapse
Affiliation(s)
- Thitianan Kulsirirat
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand; (T.K.); (J.L.)
| | - Sittisak Honsawek
- Osteoarthritis and Musculoskeleton Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Mariko Takeda-Morishita
- Laboratory of Drug Delivery Systems, Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Hyogo 650-8586, Japan;
| | - Nuttanan Sinchaipanid
- Department of Manufacturing Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
| | - Wanvisa Udomsinprasert
- Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
| | | | - Korbtham Sathirakul
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand; (T.K.); (J.L.)
| |
Collapse
|
36
|
Worakunphanich W, Thavorncharoensap M, Youngkong S, Thadanipon K, Thakkinstian A. Safety of Andrographis paniculata: A systematic review and meta-analysis. Pharmacoepidemiol Drug Saf 2021; 30:727-739. [PMID: 33372366 DOI: 10.1002/pds.5190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/17/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Andrographis paniculata is one of the commonly used herbal medicines worldwide. Nevertheless, evidences on adverse events (AEs) associated with Andrographis paniculata are very limited. This systematic review and meta-analysis was conducted to estimate and to compare the AE incidence of oral monotherapy Andrographis paniculata with others among patients with upper respiratory tract infection, noninfective diarrhea, and autoimmune disease. METHODS Systematic search was performed through six databases from inception until August 2018. Randomized controlled trial (RCT), cohort, or intensive monitoring of AEs was eligible for review if AE incidence was examined. The incidence of AEs was, then, pooled across studies using meta-analysis. RESULTS Ten RCTs and 3 intensive monitoring studies were included. Incidence of serious AEs was very rare with the pooled incidence (95% CI) from RCTs of 0.02 per 1000 patients (0.0-0.5). However, the incidence of nonserious AEs was considered very common with the pooled incidence (95% CI) from RCTs of 102.6 per 1000 patients (10.7-256.1), and the pooled incidence (95% CI) from intensive monitoring of 34.2 per 1000 patients (0.0-229.6). The most common nonserious AEs were related to gastrointestinal disorder, and skin and subcutaneous disorder system. CONCLUSIONS Like other medicine, Andrographis paniculata can cause some AEs. However, it may be generally safe. Nevertheless, prospective patients who plan to use Andrographis paniculata should be thoroughly advised and closely monitored for common AEs. Due to the increasing use of Andrographis paniculata worldwide, larger studies with adequate methodological quality are warranted to monitor the safety of such product.
Collapse
Affiliation(s)
- Wiwan Worakunphanich
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Thai Traditional Medicine Research Institute, Department of Thai Traditional and Alternative Medicine, Ministry of Public Health, Nonthaburi, Thailand
| | - Montarat Thavorncharoensap
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand.,Social and Administrative Pharmacy Excellence Research (SAPER) unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand.,Social and Administrative Pharmacy Excellence Research (SAPER) unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Kunlawat Thadanipon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand.,Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
37
|
Garg S, Roy A. A Current Perspective of Plants as an Antibacterial Agent: A Review. Curr Pharm Biotechnol 2021; 21:1588-1602. [PMID: 32568018 DOI: 10.2174/1389201021666200622121249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/15/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
Abstract
With the emergence and evolution of bacterial strains, it is now becoming difficult for pharmaceutical industries to provide remedies required for the betterment of mankind. Continuous exposure with available medication leads to the development of new strains with a significant amount of resistance, due to which pharmaceutical industries are facing various challenges. Antimicrobial resistance is the phenomenon causing a challenge in new drug development through conventional methods. Therefore, the requirement of alternative medicine is in high demand. Recently, allopathic medicines have seen a disinterest and people are preferring natural solutions due to their fewer side effects comparable to conventional medicine. Worldwide plants are utilized for various disease treatments such as bacterial infection, skin disorders, cancer, asthma, respiratory problems, etc. The presence of a wide range of phytocompounds in different plants provides an alternative to the pharmaceutical industries to counter the problem of bacterial infections. Different plants contain various phytochemicals that possess numerous therapeutic activities and provide a remedy to suppress various bacterial strains. Therefore, in this review, an overview of various plants and their phytocompounds which are responsible for antibacterial activity has been discussed.
Collapse
Affiliation(s)
- Saksham Garg
- Department of Biotechnology, Delhi Technological University, Delhi, India
| | - Arpita Roy
- Department of Biotechnology, Delhi Technological University, Delhi, India.,Department of Biotechnology, School of Engineering & Technology, Sharda University, Greater Noida, India
| |
Collapse
|
38
|
Brendler T, Al‐Harrasi A, Bauer R, Gafner S, Hardy ML, Heinrich M, Hosseinzadeh H, Izzo AA, Michaelis M, Nassiri‐Asl M, Panossian A, Wasser SP, Williamson EM. Botanical drugs and supplements affecting the immune response in the time of
COVID
‐19: Implications for research and clinical practice. Phytother Res 2020; 35:3013-3031. [DOI: 10.1002/ptr.7008] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Thomas Brendler
- Department of Botany and Plant Biotechnology University of Johannesburg Johannesburg South Africa
- Plantaphile Collingswood New Jersey USA
| | - Ahmed Al‐Harrasi
- Natural and Medical Sciences Research Centre University of Nizwa Nizwa Oman
| | - Rudolf Bauer
- Institute of Pharmaceutical Sciences, Department of Pharmacognosy University of Graz Graz Austria
| | | | - Mary L. Hardy
- Association of Integrative and Holistic Medicine San Diego California USA
| | - Michael Heinrich
- Research Group ‘Pharmacognosy and Phytotherapy’, UCL School of Pharmacy University of London London UK
- Graduate Institute of Integrated Medicine, College of Chinese Medicine China Medical University Taichung Taiwan
| | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute Mashhad University of Medical Sciences Mashhad Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy Mashhad University of Medical Sciences Mashhad Iran
| | - Angelo A. Izzo
- Department of Pharmacy, School of Medicine University of Naples Federico II Naples Italy
| | - Martin Michaelis
- Industrial Biotechnology Centre and School of Biosciences University of Kent Canterbury UK
| | - Marjan Nassiri‐Asl
- Department of Pharmacology, School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
- Neurobiology Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | | | - Solomon P. Wasser
- Institute of Evolution and Department of Evolutionary and Environmental Biology University of Haifa Haifa Israel
| | | |
Collapse
|
39
|
Kuang L, Liu Y, Wei W, Song X, Li X, Liu Q, Hong W, Liu Q, Li J, Chen Z, Fang Y, Xia S. Non-prescription sale of antibiotics and service quality in community pharmacies in Guangzhou, China: A simulated client method. PLoS One 2020; 15:e0243555. [PMID: 33301450 PMCID: PMC7728288 DOI: 10.1371/journal.pone.0243555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/23/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To measure the situation of the non-prescription sale of antibiotics and the service quality of community pharmacies in Guangzhou, China. METHODS A simulated client method was conducted to estimate the non-prescription sale of antibiotics and service quality based on scenarios about adult acute upper respiratory tract infection in 2019. A total of 595 community pharmacies from 11 districts were investigated in Guangzhou, China. We used binary logistic regression to evaluate the factors associated with the non-prescription sale of antibiotics. RESULTS The proportion of non-prescription dispensing of antibiotics was 63.1% in Guangzhou, China, with a higher incidence of antibiotic dispensing without prescription in outer districts (69.3%). Cephalosporin (44.1%) and Amoxicillin (39.0%) were sold more often than other antibiotics. Chain pharmacies had better performance on the prescription sale of antibiotics and service quality. Traditional Chinese medicine was commonly recommended by pharmacy staff. CONCLUSION Since the non-prescription sale of antibiotics is prevalent in Guangzhou, effective solutions should be determined. Strengthened public awareness and regulatory system innovation are needed.
Collapse
Affiliation(s)
- Lishan Kuang
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Yizhuo Liu
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Wei Wei
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Xueqing Song
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Xiaoqian Li
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Qiqi Liu
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Weimin Hong
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Qian Liu
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Jingwei Li
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Zhongwei Chen
- School of Pharmacy, Jinan University, Guangzhou, Guangdong, P.R. China
| | - Yu Fang
- School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
- * E-mail: (SX); (YF)
| | - Sujian Xia
- Department of Health Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong, P.R. China
- * E-mail: (SX); (YF)
| |
Collapse
|
40
|
Born TA. A Pragmatic Approach to Immunity & Respiratory Viral Infections. Integr Med (Encinitas) 2020; 19:8-15. [PMID: 33488301 PMCID: PMC7815253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
41
|
Silveira D, Prieto-Garcia JM, Boylan F, Estrada O, Fonseca-Bazzo YM, Jamal CM, Magalhães PO, Pereira EO, Tomczyk M, Heinrich M. COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy? Front Pharmacol 2020; 11:581840. [PMID: 33071794 PMCID: PMC7542597 DOI: 10.3389/fphar.2020.581840] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. AIMS To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for "respiratory diseases" within the current frame of the COVID-19 pandemic as an adjuvant treatment. METHOD The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. RESULTS A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. CONCLUSIONS Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches.
Collapse
Affiliation(s)
- Dâmaris Silveira
- Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Jose Maria Prieto-Garcia
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Fabio Boylan
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Omar Estrada
- Biophysics and Biochemistry Center, Venezuelan Institute of Scientific Research, Caracas, Venezuela
| | | | | | | | - Edson Oliveira Pereira
- Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Michal Tomczyk
- Faculty of Pharmacy, Medical University of Bialystok, Bialystok, Poland
| | - Michael Heinrich
- Pharmacognosy and Phytotherapy, School of Pharmacy, University College of London, London, United Kingdom
| |
Collapse
|
42
|
Firenzuoli F, Antonelli M, Donelli D, Gensini GF, Maggini V. Cautions and Opportunities for Botanicals in COVID-19 Patients: A Comment on the Position of the French Agency for Food, Environmental and Occupational Health & Safety. J Altern Complement Med 2020; 26:851-853. [PMID: 32960104 DOI: 10.1089/acm.2020.0266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fabio Firenzuoli
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Careggi University Hospital, Florence, Italy
| | - Michele Antonelli
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Careggi University Hospital, Florence, Italy.,Institute of Public Health, University of Parma, Parma, Italy.,Terme di Monticelli, Parma, Italy
| | - Davide Donelli
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Careggi University Hospital, Florence, Italy.,COVID19 Special Care Unit (USCA), Department of Primary Care, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy.,Consultation Service in Integrative and Complementary Medicine (SCMIC), Reggio Emilia, Italy
| | | | - Valentina Maggini
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Careggi University Hospital, Florence, Italy
| |
Collapse
|
43
|
Xiong Y, Li NX, Duan N, Liu B, Zhu H, Zhang C, Li L, Lu C, Huang L. Traditional Chinese Medicine in Treating Influenza: From Basic Science to Clinical Applications. Front Pharmacol 2020; 11:575803. [PMID: 33041821 PMCID: PMC7526665 DOI: 10.3389/fphar.2020.575803] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Influenza infection is a highly contagious, acute febrile respiratory disease caused by the influenza virus. Traditional Chinese Medicine (TCM) has dominated plenty of theoretical and practical approaches in the treatment of influenza. It is, therefore, important to highlight the effects of TCM in the clinical treatment of influenza and their impact on inhibiting the growth of this virus in laboratory experiments. We scrutinized existing evidence on whether TCM is effective in clinical applications. Moreover, we described the potential mechanisms of TCM against the influenza virus. Our findings provide analytical evidence that supports the effectiveness of TCM in treating influenza infections as well as their mechanisms against this virus.
Collapse
Affiliation(s)
- Yibai Xiong
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Na Xiao Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Naifang Duan
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bin Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui Zhu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Chi Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Li Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Cheng Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Luqi Huang
- China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
44
|
Panossian A, Brendler T. The Role of Adaptogens in Prophylaxis and Treatment of Viral Respiratory Infections. Pharmaceuticals (Basel) 2020; 13:E236. [PMID: 32911682 PMCID: PMC7558817 DOI: 10.3390/ph13090236] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of our review is to demonstrate the potential of herbal preparations, specifically adaptogens for prevention and treatment of respiratory infections, as well as convalescence, specifically through supporting a challenged immune system, increasing resistance to viral infection, inhibiting severe inflammatory progression, and driving effective recovery. The evidence from pre-clinical and clinical studies with Andrographis paniculata, Eleutherococcus senticosus, Glycyrrhiza spp., Panax spp., Rhodiola rosea, Schisandra chinensis, Withania somnifera, their combination products and melatonin suggests that adaptogens can be useful in prophylaxis and treatment of viral infections at all stages of progression of inflammation as well as in aiding recovery of the organism by (i) modulating innate and adaptive immunity, (ii) anti-inflammatory activity, (iii) detoxification and repair of oxidative stress-induced damage in compromised cells, (iv) direct antiviral effects of inhibiting viral docking or replication, and (v) improving quality of life during convalescence.
Collapse
Affiliation(s)
- Alexander Panossian
- Phytomed AB, Vaxtorp, 31275 Halland, Sweden
- EuropharmaUSA, Green Bay, WI 54311, USA
| | - Thomas Brendler
- Department of Botany and Plant Biotechnology, University of Johannesburg, Johannesburg 2000, South Africa;
- Traditional Medicinals Inc., Rohnert Park, CA 94928, USA
- Plantaphile, Collingswood, NJ 08108, USA
| |
Collapse
|
45
|
Di Sotto A, Vitalone A, Di Giacomo S. Plant-Derived Nutraceuticals and Immune System Modulation: An Evidence-Based Overview. Vaccines (Basel) 2020; 8:E468. [PMID: 32842641 PMCID: PMC7563161 DOI: 10.3390/vaccines8030468] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
Immunomodulators are agents able to affect the immune system, by boosting the immune defences to improve the body reaction against infectious or exogenous injuries, or suppressing the abnormal immune response occurring in immune disorders. Moreover, immunoadjuvants can support immune system acting on nonimmune targets, thus improving the immune response. The modulation of inflammatory pathways and microbiome can also contribute to control the immune function. Some plant-based nutraceuticals have been studied as possible immunomodulating agents due to their multiple and pleiotropic effects. Being usually more tolerable than pharmacological treatments, their adjuvant contribution is approached as a desirable nutraceutical strategy. In the present review, the up to date knowledge about the immunomodulating properties of polysaccharides, fatty acids and labdane diterpenes have been analyzed, in order to give scientific basic and clinical evidence to support their practical use. Since promising evidence in preclinical studies, limited and sometimes confusing results have been highlighted in clinical trials, likely due to low methodological quality and lacking standardization. More investigations of high quality and specificity are required to describe in depth the usefulness of these plant-derived nutraceuticals in the immune system modulation, for health promoting and disease preventing purposes.
Collapse
Affiliation(s)
- Antonella Di Sotto
- Department of Physiology and Pharmacology, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy;
| | - Annabella Vitalone
- Department of Physiology and Pharmacology, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy;
| | | |
Collapse
|
46
|
Andrographis paniculata Extract Relieves Pain and Inflammation in Monosodium Iodoacetate-Induced Osteoarthritis and Acetic Acid-Induced Writhing in Animal Models. Processes (Basel) 2020. [DOI: 10.3390/pr8070873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Osteoarthritis (OA), being the most prominent degenerative joint disease is affecting millions of elderly people worldwide. Although Andrographis paniculata is an ethnic medicine with a long history of being used as analgesic agent, no study using a monosodium iodoacetate (MIA) model has investigated its potential activities against OA. In this study, experimental OA was induced in rats with a knee injection of MIA, which represents the pathological characteristics of OA in humans. A. paniculata extract (APE) substantially reversed the loss of hind limb weight-bearing and the cartilage damage resulted from the OA induction in rats. Additionally, the levels of serum pro-inflammatory cytokines, such as IL-1β, IL-6, and TNF-α as well as the concentration of matrix metalloproteinases, including MMP-1, MMP-3, MMP-8, and MMP-13 were decreased by APE administration. Acetic acid-induced writhing responses in mice which quantitatively measure pain were significantly reduced by APE. In vitro, APE inhibited the generation of NO and downregulated the expression of IL-1β, IL-6, COX-2, and iNOS in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. The above results suggest the potential use APE as a therapeutic agent against OA.
Collapse
|
47
|
Ciampi E, Uribe-San-Martin R, Cárcamo C, Cruz JP, Reyes A, Reyes D, Pinto C, Vásquez M, Burgos RA, Hancke J. Efficacy of andrographolide in not active progressive multiple sclerosis: a prospective exploratory double-blind, parallel-group, randomized, placebo-controlled trial. BMC Neurol 2020; 20:173. [PMID: 32380977 PMCID: PMC7203851 DOI: 10.1186/s12883-020-01745-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic immune mediated disease and the progressive phase appears to have significant neurodegenerative mechanisms. The classification of the course of progressive MS (PMS) has been re-organized into categories of active vs. not active inflammatory disease and the presence vs. absence of gradual disease progression. Clinical trial experience to date in PMS with anti-inflammatory medications has shown limited effect. Andrographolide is a new class of anti-inflammatory agent, that has been proposed as a potential drug for autoimmune disorders, including MS. In the present trial, we perform an exploratory pilot study on the efficacy and safety of andrographolide (AP) compared to placebo in not active PMS. METHODS A pilot clinical trial using 140 mg oral AP or placebo twice daily for 24 months in patients with not active primary or secondary progressive MS was conducted. The primary efficacy endpoint was the mean percentage brain volume change (mPBVC). Secondary efficacy endpoints included 3-month confirmed disability progression (3-CDP) and mean EDSS change. RESULTS Forty-four patients were randomized: 23 were assigned to the AP group, and 21 were assigned to the placebo group. The median baseline EDSS of both groups was 6.0. Annualized mPBVC was - 0.679% for the AP group and - 1.069% for the placebo group (mean difference: -0.39; 95% CI [- 0.836-0.055], p = 0.08, relative reduction: 36.5%). In the AP group, 30% had 3-CDP compared to 41% in the placebo group (HR: 0.596; 95% CI [0.200-1.777], p = 0.06). The mean EDSS change was - 0.025 in the AP group and + 0.352 in the placebo group (mean difference: 0.63, p = 0.042). Adverse events related to AP were mild rash and dysgeusia. CONCLUSIONS AP was well tolerated and showed a potential effect in reducing brain atrophy and disability progression, that need to be further evaluated in a larger clinical trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02273635 retrospectively registered on October 24th, 2014.
Collapse
Affiliation(s)
- Ethel Ciampi
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile. .,Neurology, Hospital Dr. Sótero del Río, Av. Concha y Toro, 3459, Santiago, Chile.
| | - Reinaldo Uribe-San-Martin
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile.,Neurology, Hospital Dr. Sótero del Río, Av. Concha y Toro, 3459, Santiago, Chile
| | - Claudia Cárcamo
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile.
| | - Juan Pablo Cruz
- Radiology, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Ana Reyes
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Diego Reyes
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Carmen Pinto
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Macarena Vásquez
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Rafael A Burgos
- Pharmacology and Morphophysiology, Faculty of Veterinary Sciences, Universidad Austral de Chile, Independencia, 613, Valdivia, Chile
| | - Juan Hancke
- Pharmacology and Morphophysiology, Faculty of Veterinary Sciences, Universidad Austral de Chile, Independencia, 613, Valdivia, Chile
| |
Collapse
|
48
|
Willcox M, Donovan E, Hu XY, Elboray S, Jerrard N, Roberts N, Santer M. Views regarding use of complementary therapies for acute respiratory infections: Systematic review of qualitative studies. Complement Ther Med 2020; 50:102382. [PMID: 32444047 DOI: 10.1016/j.ctim.2020.102382] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Unnecessary antibiotic prescribing and use are most common for uncomplicated acute respiratory infections (ARIs). Some Complementary and Alternative Medicine (CAM) treatments have evidence of effectiveness for symptom relief and could be used instead of antibiotics. AIM To understand views of the general public and health professionals regarding use of CAM for uncomplicated ARIs. DESIGN AND SETTING Systematic review and thematic synthesis of qualitative studies. METHOD We systematically searched MEDLINE, EMBASE, AMED, COREHOM, CINAHL, Dissertation and theses global and Web of Science Core Collection. We included studies which reported qualitative data on the use of CAM for uncomplicated ARIs where participants were either patients or parents of patients, health professionals or the general public. Analysis followed thematic synthesis. RESULTS Twenty-two studies were included from four high-income and ten low-and-middle income countries; almost all focussed on non-White populations. Nineteen concerned parents' treatment of ARIs in their children. In all settings, treatment decisions were influenced by beliefs about the illness (cause, severity), beliefs about treatments (efficacy, safety), availability of treatments and of trustworthy advice. Participants mostly thought CAM is an acceptable option for treatment of mild ARIs but felt that they need trustworthy advice on which treatments to use and when. CONCLUSION Treatment decisions depend on beliefs about the illness and treatments, availability of treatments and advice. CAM treatments appear to be acceptable to people from many different settings as a possible alternative to antibiotics for mild ARIs. There is a need for reliable, evidence-based advice on which treatments to use.
Collapse
Affiliation(s)
- Merlin Willcox
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton SO16 5ST, United Kingdom.
| | - Emily Donovan
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton SO16 5ST, United Kingdom
| | - Xiao-Yang Hu
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton SO16 5ST, United Kingdom
| | - Shereen Elboray
- University Hospital Southampton, Wessex Deanery, Health Education England, United Kingdom
| | - Naomi Jerrard
- Medical School, University of Southampton, United Kingdom
| | - Nia Roberts
- Bodleian Healthcare Libraries, University of Oxford, United Kingdom
| | - Miriam Santer
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Close, Southampton SO16 5ST, United Kingdom
| |
Collapse
|
49
|
Li Y, Gao W, Huang LQ. Identification of a flavonoid 7- O-glucosyltransferase from Andrographis paniculata. JOURNAL OF ASIAN NATURAL PRODUCTS RESEARCH 2020; 22:279-286. [PMID: 31738078 DOI: 10.1080/10286020.2019.1680644] [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] [Received: 05/10/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
Andrographis paniculata is an important traditional medicinal herb in which flavonoids are part of the primary specialized metabolites. A flavonoid glucosyltransferase with broad substrate spectrum (named ApUGT3) was successfully identified by screening homologous glycosyltransferase genes from A. paniculata. The enzyme displayed glycosylation activity toward multiple flavonoids in vitro, and the major products were identified as 7-O-glucosides. Phylogenetic analysis revealed that ApUGT3 is the first reported glycosyltransferase from the Acanthaceae family that belongs to cluster I, suggesting that ApUGT3 is a new flavonoid glycosyltransferase of this subcluster. This enzyme is potentially useful as powerful glycosylation catalysts to modify flavonoid-like compounds and improve their biological activities. [Formula: see text].
Collapse
Affiliation(s)
- Yuan Li
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Wei Gao
- School of Pharmaceutical Sciences, Capital Medical University, Beijing 100069, China
| | - Lu-Qi Huang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| |
Collapse
|
50
|
Baars EW, Zoen EBV, Breitkreuz T, Martin D, Matthes H, von Schoen-Angerer T, Soldner G, Vagedes J, van Wietmarschen H, Patijn O, Willcox M, von Flotow P, Teut M, von Ammon K, Thangavelu M, Wolf U, Hummelsberger J, Nicolai T, Hartemann P, Szőke H, McIntyre M, van der Werf ET, Huber R. The Contribution of Complementary and Alternative Medicine to Reduce Antibiotic Use: A Narrative Review of Health Concepts, Prevention, and Treatment Strategies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:5365608. [PMID: 30854009 PMCID: PMC6378062 DOI: 10.1155/2019/5365608] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022]
Abstract
AIM The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. METHODS We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. CONCLUSIONS CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.
Collapse
Affiliation(s)
- Erik W. Baars
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Eefje Belt-van Zoen
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | | | - David Martin
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Harald Matthes
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | | | - Georg Soldner
- Medical section of the Goetheanum, Rüttiweg 45 4143 Dornach, Switzerland
| | - Jan Vagedes
- ARCIM institute, Im Haberschlai 7, 70794 Filderstadt, Germany
| | | | - Olga Patijn
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
| | - Merlin Willcox
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Paschen von Flotow
- Sustainable Business Institute, Zehnthofstr. 1, 65375 Oestrich-Winkel, Germany
| | - Michael Teut
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | - Klaus von Ammon
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Madan Thangavelu
- European Ayurveda Association e.V., In den Forstwiesen 27, D- 56745 Bell, Germany
| | - Ursula Wolf
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | | | - Ton Nicolai
- Eurocam, Rue du Trône 194, 1050 Brussels, Belgium
| | - Philippe Hartemann
- University of Lorraine, School of Medicine, 7 avenue de la Forêt de Haye, 54500 Vandoeuvre-Nancy, France
| | - Henrik Szőke
- University of Pécs, 7622 Pécs, Vasvári Pál str. 4., Hungary
| | - Michael McIntyre
- Midsummer Clinic, Church Westcote, Chipping Norton, Oxon, Ox7 6SF, UK
| | - Esther T. van der Werf
- Taylor's University, School of Medicine, 1, Jalan Taylor's, 47500 Subang Jaya, Selangor D.E., Malaysia
- University of Bristol, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Roman Huber
- University of Freiburg, Faculty of Medicine, Breisacher Str. 115b, 79106 Freiburg, Germany
| |
Collapse
|