Dose-response relationship and irreversible obstructive ventilatory defect in patients with consumption of Sauropus androgynus

Sauropus androgynus (L.) Merr.: a multipurpose plant with multiple uses in traditional ethnic culinary and ethnomedicinal preparations

Various plants form the basis of multiple traditional ethnic cuisines and ethnomedicinal practices across the globe. The ethnic cuisines cater to the nutritional, dietary and medicinal requirements of the tribal and rural communities even today. Using literature from various scholarly databases, this study was conducted to consolidate a comprehensive review on the use of Sauropus androgynus (L.) Merr. in various traditional ethnic cuisines and ethnomedicinal preparations across the globe. The survey shows that it is used in multiple ethnic cuisines and is variously known in different countries and among the communities. Further, it possesses multiple nutritional and ethnomedicinal properties. Considering its importance in ethnic foods and ethnomedicinal preparations, it is important to investigate the nutritional composition, phytochemical constitution and pharmacological basis of ethnomedicinal uses. Therefore, we further compiled this information and found that it is a rich source of both micro- and macronutrients and packed with several bioactive compounds. Survey of pharmacological studies on its traditional medicinal uses supports its ethnomedicinal properties. Despite its importance in traditional food and ethnomedicinal systems, it remains underexplored. Limited information on the toxicity of its various extracts shows that further studies should be conducted to understand its safety aspects. Further clinical studies to prospect possible drug candidates from it should be attempted.

Sauropus androgynus L. Merr.-A phytochemical, pharmacological and toxicological review

ETHNOPHARMACOLOGICAL RELEVANCE

Sauropus androgynus L. Merr is an underexploited perennial shrub traditionally used as a medicinal plant in South Asia and Southeast Asia. The plant is regarded as not just a green vegetable for diet, but as a traditional herb for certain aliments. For instance, it has traditionally been used to relieve fever, to treat ulcers and diabetes, to promote lactation and eyesight, and to reduce obesity.

AIM OF THE STUDY

This paper aims to review the botany, phytochemistry, ethnopharmacology, and pharmacological activities of S. androgynus, and discuss the known chemical constituents at work in S. androgynus-induced bronchiolitis obliterans for providing new ideas to the mechanism of the disease and pharmacology research of the plant.

MATERIALS AND METHODS

The data presented in this review were collected from published literatures as well as the electronic databases of PubMed, CNKI, Web of Science, SCI finder, ACS, Science Direct, Wiley, Springer, Taylor, Google Scholar, and a number of unpublished resources, (e.g. books, and Ph.D. and M.Sc. dissertations).

RESULTS

The scientific literature indicates that S. androgynus is a valuable and popular herbal medicine whose nutritional value is also higher than that of other commonly used vegetables. Phytochemical analyses identified high content of fatty acids, flavonoids, and polyphenols as the major bioactive components in S. androgynus. Crude extracts and phytochemical compounds isolated from S. androgynus show a wide spectrum of in vitro and in vivo pharmacological activities such as antioxidant, anti-inflammatory, anti-ulcer, skin whitening, anti-diabetic, and immunoregulatory activities. The traditional use, such as increasing lactation, treating ulcers and diabetes, and reducing obesity, have been evaluated and studied with various methods. Numerous reports have revealed the unusual link between the consumption of S. androgynus and the induction of a chronic and irreversible obstructive disease (namely, bronchiolitis obliterans), indicating that the toxicity and side effects of this plant that is presently used in health care and medicine are a major area of concern.

CONCLUSION

Though little importance was attached to this green plant, S. androgynus has notable phytochemical constituents and various pharmacological activities including antioxidant, anti-inflammatory, and anti-obesity activities. Studies have firmly established the association between excessive consumption of the uncooked S. androgynus juice over a period of time and the occurrence of bronchiolitis obliterans. It is inadvisable to ingest excessive amounts of S. androgynus before fully understanding the pathogenesis and induction mechanism of this fatal disease. The phytochemistry of S. androgynus, its pharmacology for traditional use, S. androgynus-induced bronchiolitis obliterans still need further investigation.

DLI Induced by Herbal Medicine: What Are the Characteristics of DLI due to Herbal Medicines?

In many countries, herbal medicine has been developed and is currently practiced. Herbal medicine involves the use of the stalks, roots, leaves, flowers, and berries of several different plant species for medical treatment. Many practitioners believe that herbal medication has no side effects because of its natural origin. Thus, herbal medication has been used for a long time with little awareness of its side effects. However, there is an increasing incidence of interstitial pneumonia due to a drug-induced lung injury (DLI), which could be induced by common drugs. Moreover, increasing cases of bronchiolitis obliterans and pulmonary hypertension are being reported; further, these are drug-induced conditions. Clinicians should be more aware of DLI symptoms caused by herbal medication and interrogate patients regarding their use of herbal medication and supplements as well as prescription drugs.

Recent advances in the management of acute bronchiolitis

Acute bronchiolitis is characterized by acute wheezing in infants or children and is associated with signs or symptoms of respiratory infection; it is rarely symptomatic in adults and the most common etiologic agent is respiratory syncytial virus (RSV). Usually it does not require investigation, treatment is merely supportive and a conservative approach seems adequate in the majority of children, especially for the youngest ones (<3 months); however, clinical scoring systems have been proposed and admission in hospital should be arranged in case of severe disease or a very young age or important comorbidities. Apnea is a very important aspect of the management of young infants with bronchiolitis. This review focuses on the clinical, radiographic, and pathologic characteristics, as well as the recent advances in management of acute bronchiolitis.

Pulmonary function change in patients with Sauropus androgynus-related obstructive lung disease 15 years later

BACKGROUND/PURPOSE

Little is understood about the clinical course and prognosis of patients with Sauropus androgynus-related obstructive lung disease. The aim of this study was to investigate their clinical manifestations and pulmonary function change 15 years after the acute episode.

METHODS

A descriptive, observational study of patients with S androgynus-related obstructive lung disease, diagnosed 15 years ago, was conducted. We evaluated their pulmonary function and the Modified Medical Research Council (MMRC) dyspnea scale. Saint George's Respiratory Questionnaire (SGRQ) was also performed. Age- and forced expiratory volume in one second (FEV1)-matched chronic obstructive pulmonary disease (COPD) patients were used as a reference group for comparison of clinical manifestations.

RESULTS

Twenty-nine of 49 patients, diagnosed at our hospital 15 years ago, could be contacted. Four patients died and one patient was ventilator-dependent. Sixteen patients were willing to come to our hospital to have pulmonary function and questionnaire evaluation. The FEV1 of these patients declined only 1.6 ± 21.6 mL/year over a 15-year period. Meanwhile, the severity of their dyspnea and their health-related quality of life were better than age- and FEV1-matched COPD patients as shown by the MMRC dyspnea scale (1.4 ± 0.8 vs. 2.0 ± 1.0; p = 0.037) and symptom domain of the SGRQ (32.6 ± 18.4 vs. 43.5 ± 20.3; p = 0.006).

CONCLUSION

After an acute deterioration, patients with S androgynus-related obstructive lung disease had a stationary pulmonary function over a period of 15 years, and their clinical manifestations were less severe than age- and FEV1-matched COPD patients. A further study with a larger sample size may be needed to confirm these findings.

Pathology of small airways disease

CONTEXT

The term small airways disease encompasses a generally poorly understood group of lung diseases that may arise primarily within the small airways or secondarily from diseases primarily affecting the bronchi or lung parenchyma. Their histology may be confusing; however, because treatments and prognoses vary, correct pathologic diagnosis is important.

OBJECTIVE

To present a nonexhaustive review of the pathology of primary and secondary small airways diseases, including small airways disease related to tobacco; to various other exposures, including mineral dusts; to diseases involving other areas of the lung with secondary bronchiolar involvement; and to recently described bronchiolitic disorders.

DATA SOURCES

Current literature is reviewed.

CONCLUSIONS

Small airways diseases include a wide variety of diseases of which the pathologist must consider. Uncommon conditions such as diffuse idiopathic neuroendocrine cell hyperplasia and diffuse panbronchiolitis may show relatively specific diagnostic features histologically; however, most small airways diseases exhibit nonspecific histologic features. Conditions not considered primary pulmonary diseases, such as collagen vascular diseases, bone marrow transplantation, and inflammatory bowel disease, must also be considered in patients with small airways changes histologically. Clinical and radiologic correlation is important for obtaining the best possible diagnosis.

Apoptosis and necrosis are involved in the toxicity of Sauropus androgynus in an in vitro study

BACKGROUND/PURPOSE

The raw juice of the young sticks and leaves of Sauropus androgynus (SA) has been widely used as a natural food for body weight reduction and vision protection in Taiwan and Southeast Asia. But as has been reported, SA-associated obliterative bronchiolitis can develop after taking SA for more than 3 months. Lung transplantation was carried out in severe cases.

METHODS

To study the toxic effect, we separated the SA extract into three parts, namely CHCl3, EtOAc and n-BuOH fractions, using polarity dissection. NIH3T3 fibroblasts were treated with the SA fractions 300 microg/mL and subjected to a series of cytotoxic assays.

RESULTS

The EtOAc fraction exhibited the strongest effect of cell growth inhibition, followed by the CHCl3 and n-BuOH fractions. Features of condensed chromatin and apoptosis were observed in cells exposed to n-BuOH and EtOAc fractions using fluorescence microscopy. Formation of DNA ladders was also observed in the above cells. Instead, the CHCl3 fraction induced DNA smearing. In bivariate dot plots of annexin V and propidium iodide double staining, necrosis and apoptosis appeared in cells treated with CHCl3 and n-BuOH fractions, respectively, and a mixed type of necrosis and apoptosis appeared in EtOAc fraction-treated cells.

CONCLUSION

Our results indicate that necrosis and apoptosis are involved in the toxic effect of SA in NIH3T3 fibroblasts. More evidence is needed to clarify if necrosis and apoptosis are also related to the pathogenesis of SA-associated obliterative bronchiolitis.