Phyllanthus niruri as a promising alternative treatment for nephrolithiasis

Therapeutic potential of medicinal plants for the management of renal stones: A review

Kidney stone disease is the third most common urological ailment worldwide, people. The mechanism of stone formation includes: urine supersaturation, aggregation, retention, nucleation, and growth of crystals in the cells of the renal tubular epithelium. Kidney stones may cause extreme pain and blockage of urine flow. They are usually treated with conventional drugs and shock wave (ESWL) as well as a variety of medications that may cause several adverse effects. The remaining stone fragments and the risk of infection following ESWL are major challenges in the treatment of kidney stones. Recently, despite the emergence of modern drugs, medicinal plants have been recognized and utilized in many nations clinically due to their safety profile, efficiency, cultural acceptance, and fewer side effects than approved drugs. Medicinal plants are used in different cultures as a reliable source of natural remedies. The aim of this review is to provide comprehensive information about traditionally used plants as well as their scientifically proven pharmacological activities, their primary chemical ingredients, and potential mechanisms of action, such as analgesic, astringent, demulcent, diuretic activity, antioxidant activity, inhibition of the inflammatory process, nucleation inhibition, crystallization inhibition, inhibition of crystal aggregation, reducing , reducing stone size, and reducing urine supersaturation.

Chemical Profiling and In Vitro Antiurolithiatic Activity of Pleurolobus gangeticus (L.) J. St.- Hil. ex H. Ohashi & K. Ohashi Along with Its Antioxidant and Antibacterial Properties

Pleurolobus gangeticus (L.) J. St.- Hil. ex H. Ohashi & K. Ohashi (Fabaceae) is an important medicinal plant used to treat various ailments. In this study, we report the antiurolithiatic, antioxidant, and antibacterial potential of chloroform fraction (CF) from P. gangeticus roots. For the chemical profiling, HPTLC, FT-IR, and GC-MS techniques of the CF were carried out, and phytochemical investigation was revealed that stigmasterol (45.06%) is one of the major components present in the fraction. The nucleation and aggregation assays were used to evaluate the in vitro antiurolithiatic activity at various concentration (2-10 mg/mL) of the CF. The results showed that the chloroform fraction had dose-dependent effects on Calcium Oxalate (CaOx) crystal formation. In both the assays, the maximum concentration of 10 mg/mL has shown better results. This concentration resulted significant increase in CaOx crystal nucleation along with the reduction of crystal size and the inhibition of crystal aggregation. Further, the CF showed stronger antioxidant (DPPH, NO, SOD, TRC) potential with an IC₅₀ values of 415.9327, 391.729, 275.971, and 419.14 µg/mL, respectively. The antibacterial evaluation displayed effective results in the Agar well diffusion assay against selective urinary tract infection (UTI) pathogens (Escherichia coli, Klebsiella pneumonia, and Staphylococcus aureus). A maximum zone of inhibition (ZOI) 12.33 ± 1.05 mm for K pneumonia and minimum ZOI of 8.46 ± 0.27 mm for S. aureus were obtained. Further, the ADME-PK property of the stigmasterol was investigated, and it was found to pass the Lipinski and Ghose rules, supporting the drug-likeliness. This is the first record of the antiurolithiatic potential of P. gangeticus along with antioxidant and antibacterial activities. These findings give an insight into the effective drug development and treatment for kidney stones in future.

Hepatoprotective Native Plants Documented in Brazilian Traditional Medicine Literature: Current Knowledge and Prospects

The native flora of Brazil covers a large biodiversity of plants, some of which have important pharmacological properties. Ethnobotanical studies have established that the folk use of plants for hepatobiliary disorders is very common in Brazil. This review aimed to compile, describe and discuss the main native Brazilian medicinal plants used as hepatoprotective agents listed on 25 books by authors from various regions in the country. Based on the 153 species found, a comprehensive analysis of the most relevant scientific studies is presented, including Piper umbellatum, Echinodorus macrophyllus, Fevillea trilobata and Achyrocline satureioides. Some medicinal plants share both a large number of citations and scientific evidence to corroborate their hepatoprotective effects, including Solanum paniculatum, Baccharis crispa and Phyllanthus niruri, which could be of interest to develop new phytomedicines. Additionally, some active ingredients are indicated as being responsible for the liver protective effects described, particularly phenolic compounds (flavonoids, coumestans and lignans).

In vitro antiplasmodial activity of Phyllanthus amarus against Plasmodium falciparum and evaluation of its acute toxicity effect in mouse model

Background:

The emergence of widespread resistance of Plasmodium species to most antimalarial drugs has led to a more vigorous and concerted research on traditional medicinal plants for the treatment of malaria.

Objective of Study:

The study was aimed to investigate the in vitro antiplasmodial activity of crude ethanolic and aqueous extracts of Phyllanthus amarus against clinical isolates of Plasmodium falciparum in Northwestern Nigeria.

Materials and Methods:

The plant was extracted using two solvents, water and ethanol, where a high yield was obtained from the aqueous extracts (11.9%) as compared to the ethanolic extract (9.64%). The extracts were evaluated in vitro at concentrations of 6.25, 12.5, 25, 50, and 100 μg/ml, and the level of potency in each case was expressed as the concentration of the extract that exhibited a 50% reduction of the parasites relative to control (100%) parasitemia. Artemether-lumefantrine was used as a positive standard in the assay.

Results:

All extracts showed a significant reduction in parasite growth relative to control (P ≤ 0.05). Ethanolic extract exhibited a higher antiplasmodial activity of 76.8%, half-maximal inhibitory concentration (IC₅₀) of 5.80 μg/ml, and aqueous extract had an activity of 75.3%, IC₅₀ of 7.94 μg/ml. Both extracts exhibited very active antiplasmodial activity. Oral acute toxicity test in the doses of 500, 1000, and 1500 mg/kg showed no sign of toxicity on albino mice after 48 h.

Conclusion:

Although there was an increase in appetite after 24 and 48 h, the findings from this study show that P. amarus possesses a promising antimalarial activity which can be exploited for malaria therapy and justifies the traditional use of the plant in malaria treatment.

Effects of the aqueous extract of Phyllanthus niruri Linn during pregnancy and lactation on neurobehavioral parameters of rats' offspring

ETHNOPHARMACOLOGICAL RELEVANCE

Phyllanthus niruri L. (Phyllanthaceae) is a plant used in traditional medicine, mainly to treat kidney stones. However, the effects of maternal exposure to P. niruri remain poorly explored.

AIM OF THE STUDY

The objective of this study was to investigate the effects of administration of aqueous extract of P. niruri (AEPN) during pregnancy and lactation, in maternal toxicity, reflex maturation, and offspring memory.

MATERIALS AND METHODS

Pregnant rats were divided into three groups (n = 8/group): Control (vehicle), AEPN 75, and AEPN 150 (each respectively treated with P. niruri at a dose of 75 and 150 mg/kg/day). The animals were treated via intragastric gavage during pregnancy and lactation. Weight gain, feed intake, and reproductive performance were analyzed in the mothers. In the offspring, the following tests were performed: Neonatal Reflex Ontogeny, Open Field Habituation Test and the Object Recognition Test in adulthood.

RESULTS

Maternal exposure to AEPN did not influence weight gain, feed intake, or reproductive parameters. In the offspring, anticipation of reflex ontogenesis (time of completion) was observed (p < 0.05). During adulthood, the AEPN groups presented decreases in exploratory activity upon their second exposure to the Open Field Habituation Test (in a dose-dependent manner) (p < 0.05). In the Object Recognition Test, administration of the extract at 75 and 150 mg/kg induced significant dose-dependent improvements in short and long-term memory (p < 0.05).

CONCLUSION

Administration of the AEPN accelerated the reflex maturation in neonates, and improved offspring memory while inducing no maternal or neonatal toxicity.

Impact of Phyllantus niruri and Lactobacillus amylovorus SGL 14 in a mouse model of dietary hyperoxaluria

Hyperoxaluria is a pathological condition which affects long-term health of kidneys. The present study evaluates the impact of the combination of Lactobacillus amylovorus SGL 14 and the plant extract Phyllantus niruri (namely Phyllantin 14™) on dietary hyperoxaluria. Safety and efficacy of Phyllantin 14 have been evaluated in vivo. Mice C57BL6 fed a high-oxalate diet were compared to mice fed the same diet administered with Phyllantin 14 by gavage for 6 weeks. Control mice were fed a standard diet without oxalate. No adverse effects were associated to Phyllantin 14 supplementation, supporting its safety. Mice fed a high-oxalate diet developed significant hyperoxaluria and those administered with Phyllantin 14 showed a reduced level of urinary oxalate and a lower oxalate-to-creatinine ratio. Soluble and insoluble caecal oxalate were significantly lower in treated group, a finding in agreement with the colonisation study, i.e. mice were colonised with SGL 14 after 3 weeks. Microbiota analysis demonstrated that both oxalate diet and Phyllantin 14 can differently modulate the microbiota. In conclusion, our findings suggest that Phyllantin 14 supplementation represents a potential supportive approach for reducing urinary oxalate and/or for enhancing the efficacy of existing treatments.

Maternal-fetal repercussions of Phyllanthus niruri L. treatment during rat pregnancy

ETHNOPHARMACOLOGICAL RELEVANCE

Phyllanthus niruri is a well-known plant for its therapeutic purposes to treat various diseases, being widely used by the population, mainly by women. However, there is no scientific confirmation of the effects of use during pregnancy.

AIM OF THE STUDY

Evaluating the effect of Phyllanthus niruri aqueous extract on the maternal toxicity, reproductive outcomes and fetal anomaly incidence in rats.

MATERIALS AND METHODS

Pregnant rats were distributed into four experimental groups: Control = treated with water (vehicle); Treated 150 = treated with P. niruri at dose 150 mg/kg and; Treated 300 = treated with P. niruri at dose 300 mg/kg; and Treated 600 = treated with P. niruri at dose 600 mg/kg. The rats were treated by intragastric route (gavage) with P. niruri or vehicle (water) from gestational day 0 to 21. At day 21 of pregnancy, maternal reproductive outcomes, biochemical profile and maternal renal tissue were evaluated. The fetuses and placentas were collected and analyzed.

RESULTS

Treatment with P. niruri did not alter the reproductive performance outcomes of rats. However, treated 600 group presented with changes in maternal kidney weight and morphology. The plant did not present teratogenic effect, but caused fetal macrosomia and increased ossification sites.

CONCLUSION

Treatment with aqueous extract of P. niruri administered during gestation did not cause reproductive toxicity, but led to changes in maternal kidneys and in offspring weight, showing that the leaf extract of this plant can produce detrimental effects during pregnancy.

Antiurolithiatic effects of pentacyclic triterpenes: The distance traveled from therapeutic aspects

Globally, approximately 12% of the population is inflicted by various types of urolithiasis. Standard treatments are available both to avert and treat urolithiasis, but with significant adverse side effects. Pentacyclic triterpenes represent a group of naturally occurring compounds which holds immense potential as therapeutic for treating kidney stone. This review aims to provide an integrative description on how pentacyclic triterpenes can effectively treat calcium oxalate urolithiasis through various mechanisms such as antioxidant, anti-inflammatory, diuretic, and angiotensin-converting enzyme inhibition. Some of the pentacylic triterpenes which shows promising activities include lupeol, oleanolic acid, betulin, and taraxasterol. Moreover, future perspectives in the development of pentacyclic triterpenes in formulations/drugs for urinary stone prevention are highlighted. It is anticipated that compiled information would serve as a scientific baseline to advocate further investigations on the potential of pentacyclic triterpenes in urolithiasis remediation.

Evaluation of the efficacy of Phyllanthus niruri standardized extract combined with magnesium and vitamin B6 for the treatment of patients with uncomplicated nephrolithiasis

Introduction

The aim of our study was to assess the efficacy of Phyllanthus niruri standardized extract, combined with magnesium and B6 vitamin, used to treat uncomplicated nephrolithiasis.

Methods

We included in the present study 48 patients with uncomplicated nephrolithiasis, with the maximum calculi diameter of up to 15 mm, confirmed by non-contrast-enhanced computer tomography. Each patient followed a three-month therapeutic regimen with the above mentioned combination, with imaging assessment of the calculi after treatment.

Results

Per patient: The mean age of the patients was 48 years. The median number of calculi was 1 and the mean dimension was 5.5 mm. The stone-free status after treatment was not correlated with gender (p=0.7), side location (p=0.8) or with the number of calculi (p=0.3), but we found a correlation with the location in the upper or middle calyx (54.5% vs 13.8%, p=0.008) and with the maximum diameter (p=0.001).Per stone: 60 calculi were analyzed, 8.3% being located in the upper calyx, 36.7% in the middle and 55% in the lower one. After treatment, 40% were absent, 21.7% showed lower dimensions and 38.3% remained unchanged, with the mean reduction of 1.7 mm. We identified a cut-off value of ≤ 3 mm (AUC 0.9, CI:0.8-0.9, p<0.0001) for the prediction of stone-free status after treatment.

Conclusions

The current treatment had the highest efficacy in achieving stone-free status for patients with calculi ≤ 3 mm, located in the middle or upper calyx. A higher duration of the treatment might show improved results.

Phyllanthus niruri leaves aqueous extract improves kidney functions, ameliorates kidney oxidative stress, inflammation, fibrosis and apoptosis and enhances kidney cell proliferation in adult male rats with diabetes mellitus

ETHNOPHARMACOLOGICAL RELEVANCE

Phylanthus niruri has been used to treat ailments related to the urogenital organs. In this study, this herb was hypothesized to help to ameliorate kidney disease in diabetes mellitus (DM).

AIMS

To investigate P. niruri leaves aqueous extract (PN) effects on kidney functions, histopathological changes and levels of oxidative stress, inflammation, fibrosis, apoptosis and proliferation in DM.

METHODS

PN was orally administered to streptozotocin-nicotinamide-induced male diabetic rats for 28 days. At the end of the treatment, fasting blood glucose (FBG) and kidney functions were measured. Kidney somatic index, histopathological changes and levels of RAGE, Nrf2, oxidative stress markers (TBARS, SOD, CAT and GPx), inflammatory markers (NFkβ-p65, Ikk-β, TNF-α, IL-1β and IL-6), apoptosis markers (caspase-3, caspase-9 and Bax), fibrosis markers (TGF-β1, VEGF and FGF-1) and proliferative markers (PCNA and Ki-67) were determined by biochemical assays, qPCR, Western blotting, immunohistochemistry or immunofluorescence.

RESULTS

Administration of PN helps to maintain near normal FBG, creatinine clearance (CCr), blood urea nitrogen (BUN), BUN/Cr ratio, serum electrolytes, uric acid and urine protein levels in DM. Decreased RAGE, TBARS and increased Nrf2, SOD-1, CAT and GPx-1 were observed in PN-treated diabetic rat kidneys. Expression of inflammatory, fibrosis and apoptosis markers in the kidney reduced but expression of proliferative markers increased following PN treatment. Lesser histopathological changes were observed in the kidney of PN-treated diabetic rats.

CONCLUSION

PN helps to preserve near normal kidney function and prevents histopathological changes via ameliorating oxidative stress, inflammation, fibrosis and apoptosis while enhancing proliferation of the kidney in DM.

Phytochemistry and Pharmacology of Phyllanthus niruri L.: A Review

Phyllanthus niruri, a typical member of family Euphorbiaceae, is a small annual herb found throughout the tropical and subtropical regions of both hemispheres. The genus Phyllanthus has been used in traditional medicine for its wide range of pharmacological activities like antimicrobial, antioxidant, anticancer, antiinflammatory, antiplasmodial, antiviral, diuretic and hepatoprotective. This review summarizes the information about morphological, biochemical, ethanobotanical, pharmacological, biological and toxicological activities with special emphasis on mechanism of anticancer activity of P. niruri. Gaps in previous studies such as taxonomic inconsistency of P. niruri, novel phytochemicals and their therapeutic properties, especially mechanisms of anticancerous activity and market products available, have been looked into and addressed. Scientific information related to 83 phytochemicals (including many novel compounds detected recently by the authors) has been provided in a very comprehensive manner. Copyright © 2017 John Wiley & Sons, Ltd.

Evaluation of anti-inflammatory and gastric anti-ulcer activity of Phyllanthus niruri L. (Euphorbiaceae) leaves in experimental rats

BACKGROUND

The medicinal plants signify a massive basin of potential phytoconstituents that could be valuable as a substitute to allopathic drugs or considered as an analogue in drug development. Phyllanthus niruri L. (Euphorbiaceae) is generally used in traditional medicine to treat ulcer and inflammation. In this project we investigated the methanolic extract of leaves of Phyllanthus niruri for anti-inflammatory and anti-ulcer activity.

METHODS

The anti-inflammatory activity of methanol extract of Phyllanthus niruri leaves was evaluated at the doses of 100, 200 and 400 mg/kg, p.o. while using ibuprofen (20 mg/kg, p.o) as the standard drug. The animals used were Swiss albino rats. Inflammation was induced by injecting 0.1 ml carrageenan (1% w/v) into the left hind paw. Paw tissues from the different groups were examined for inflammatory cell infiltration. On the other hand, antiulcer activity of methanolic extract of P. niruri leaves at the doses of 100, 200 and 400 mg/kg, p.o. were examined against ethanol-acid induced gastric mucosal injury in the Swiss albino rats - keeping omeprazole (20 mg/kg, p.o.) as reference. The rats were dissected and the stomachs were macroscopically examined to identify hemorrhagic lesions in the glandular mucosa.

RESULTS

P. niruri significantly (p < 0.01) decreased carrageenan-induced paw edema; it exhibited a reduction of 46.80%, 55.32% and 69.14% at doses of 100, 200 and 400 mg/kg, respectively. These findings were further supported by the histological study. The methanolic extract also disclosed good protective effect against ethanol-acid induced gastric mucosal injury in the rats. Administration of the extract's doses (100, 200 and 400 mg/kg) demonstrated a significant (p < 0.01) reduction in the ethanol- acid induced gastric erosion in all the experimental groups when compared to the control. The methanolic extract at the higher dose (400 mg/kg) resulted in better inhibition of ethanol-acid induced gastric ulcer as compare to omeprazole (20 mg/kg). Histological studies of the gastric wall revealed that toxic control rats revealed mucosal degeneration, ulceration and migration of numerous inflammatory cells throughout the section. On the other hand, MEPN treatment groups showed significant regeneration of mucosal layer and significantly prevented the formation of hemorrhage and edema.

CONCLUSIONS

The investigation suggests that methanolic extract of P. niruri leaf possess anti-inflammatory activity and promotes ulcer protection as ascertained by regeneration of mucosal layer and substantial prevention of the formation of hemorrhage and edema.

The Genus Phyllanthus: An Ethnopharmacological, Phytochemical, and Pharmacological Review

The plants of the genus Phyllanthus (Euphorbiaceae) have been used as traditional medicinal materials for a long time in China, India, Brazil, and the Southeast Asian countries. They can be used for the treatment of digestive disease, jaundice, and renal calculus. This review discusses the ethnopharmacological, phytochemical, and pharmacological studies of Phyllanthus over the past few decades. More than 510 compounds have been isolated, the majority of which are lignins, triterpenoids, flavonoids, and tannins. The researches of their remarkable antiviral, antioxidant, antidiabetic, and anticancer activities have become hot topics. More pharmacological screenings and phytochemical investigations are required to support the traditional uses and develop leading compounds.

Ethnobotanical study of medicinal plants by population of Valley of Juruena Region, Legal Amazon, Mato Grosso, Brazil

ETHNOPHARMACOLOGICAL IMPORTANCE

The use of medicinal plants for treatment, cure and prevention of diseases has been described by many people since time immemorial. Because of this use, commercial and scientific interests have emerged, making it necessary to realize ethnobotanical surveys of medicinal plants species, which is important for subsequent chemical and pharmacological bioprospections.

AIM OF THE STUDY

This study aimed at surveying, identifying, cataloging and documenting the medicinal plants species used in the Valley of Juruena, Northwestern Mato Grosso, Legal Amazon Brazil for the treatment of various human diseases, as well as assessed the species of interest for bioprospecting potential.

MATERIALS AND METHODS

Informants were interviewed using semi-structured form to capture information on socio-demographic and ethnopharmacological data of medicinal plants such as vernacular name, uses, geographic origin, habit, form of preparation and part used. Results were analyzed using descriptive and quantitative means: indices of use-report (Ur) and informant consensus factor (ICF), for the selection of plant species with therapeutic potential.

RESULTS

Three hundred and thirty two (332) plants species belonging to 90 families were reported for medicinal purposes and totaling 3973 use-reports were reported by 365 (92.9%) of the people interviewed. Asteraceae (32.2%), Fabaceae (26.7%) and Lamiaceae (24.4%) families were the most represented, with majority being species native (64.45%) to Brazil. Leaves (64.5%) were the part of the plant most used and infusion (45.7%) was the most utilized form. Gastrointestinal disorders followed by respiratory complaints topped the list of use-reports. The native or naturalized plants with the highest use reports in the order of decreasing absolute frequency per each emic-category are Cymbopogon citratus (DC.) Stapfc (104), Mentha pulegium L. (94), Arrabidaea chica (Humb. & Bonpl.) B. Verl. (97), Alternanthera brasiliana (L.) Kuntze (71), Baccharis crispa Spreng (57), Phyllanthus niruri L. (48), Gossypium barbadense L. (44), Solidago microglossa DC. (40) and Bauhinia forficata L. (20). And the most cited exotics are: Chenopodium ambrosioides L. (151), Aloe vera (L.) Burm. f., (89) and Rosmarinus officinalis L. (72). In some cases, high ICF values were found, which reflects high degree of homogeneity of consensus among informants in this region on medicinal plants.

CONCLUSION

The population of Valle of Juruena makes use of a wide array of medicinal plants distributed in all use categories with predominance of those use in the treatments of gastrointestinal and respiratory ailments. The therapeutic potential of some of the species of medicinal importance extensively utilized by the population of the region have been scientifically validated, and are therefore promising prototype of new drugs. However, there are some of these species whose ethnomedicinal uses are yet to be scientifically verified and thus constitute an unexplored terrain for future biological/pharmacological studies.

Gene expression profiling reveals underlying molecular mechanism of hepatoprotective effect of Phyllanthus niruri on thioacetamide-induced hepatotoxicity in Sprague Dawley rats

Background

The liver plays an essential role in the body by regulating several important metabolic functions. Liver injury is associated with the distortion of these functions causing many health problems. Pharmaceutical drugs treat liver disorders but cause further damage to it. Hence, herbal drugs are used worldwide and are becoming increasingly popular.

Methods

The hepatoprotective activity of Phyllanthus niruri (PN) was evaluated against liver cirrhosis induced by thioacetamide (TAA) in male Sprague Dawley rats. Rats received intraperitoneal injections of thioacetamide (TAA, 200 mg/kg, b.w. three times weekly) for eight weeks. Daily treatments with plant extract (200 mg/kg) were administered orally for eight weeks. At the end of the study, hepatic damage was evaluated by monitoring transforming growth factor (TGFβ), collagen α1 (Collα1), matrix metalloproteinase-2 (MMP2) and tissue inhibitor of matrix metalloproteinase-1 (TIMP1) gene expression by real-time PCR. Moreover, different chromatographic techniques including column chromatography, thin layer chromatography, and Ultra Performance Liquid Chromatography (UPLC) with Liquid Chromatography/Mass Spectrometry (LC/MS) were used to isolate the active constituents of the plant.

Results

The results revealed that treatment with PN significantly reduced the effect of thioacetamide toxicity and exhibited effective hepatoprotective activity. The mechanism of the hepatoprotective effect of PN is proposed to be by normalizing ROSs. Additionally, PN treatment regulated the expression of TGFβ, Collα1, MMP2, and TIMP1 genes. In the active fraction of P. niruri, the isolated chemical constituents were 4-O-caffeoylquinic acid and quercetin 3-O-rhamnoside.

Conclusions

The results of the present study indicate that PN ethanol extracts possess hepatoprotective activity that is most likely because of the isolated chemical constituents.