Salvia miltiorrhiza bunge increases estrogen level without side effects on reproductive tissues in immature/ovariectomized mice

A Review on the Pharmacological Activities of Salvia Miltiorrhizae Radix Using International Classification of Disease, 10th Revision (ICD-10) Codes

Salvia Miltiorrhizae Radix (SMR) is a widely-used herbal medicine for the treatment of various blood stasis-related diseases (mainly circulatory system). It has been extensively studied in the field of pharmacology over the last few decades. In addition, several reviews concerning the effect of SMR are available. The purpose of this study was to review the pharmacological activities of SMC based on the 10th revision of the international disease classification (ICD-10). After an analysis of the literatures in the Medline database between January 1988 and August 2018, 691 eligible articles were chosen and 971 results were obtained (395 in vitro, 536 in vivo, and 40 human). The extracted data were categorized into the disease chapters of the ICD-10 and the major chapters were: IX Diseases of the circulatory system, II Neoplasms, XI Diseases of the digestive system, XIX Injury, poisoning and certain other consequences of external causes, IV Endocrine, nutritional, and metabolic diseases, VI Diseases of the nervous system, V Mental and behavioral disorders, etc. The major diseases and the pharmacological results of each chapter of the ICD-10 were described assiduously, along with the statistical details. The current study provided a comprehensive understanding and insight of SMR in terms of pharmacological activities.

Estrogenic activity of Sage (Salvia officinalis L.) aerial parts and its isolated ferulic acid in immature ovariectomized female rats

ETNOPHARMACOLOGICAL RELEVANCE

Common sage (Salvia officinalis L., Lamiaceae), a medicinal plant of Mediterranean origin, has been traditionally applied in cases of excessive sweating, and in menopausal complaints, including hot flushes.

AIM OF THE STUDY

This study aims to study the possible estrogenic effect of the aerial parts of S. officinalis ethanolic extract in immature ovariectomized female rats.

MATERIALS AND METHODS

The ethanolic extract was subjected to qualitative and quantitative HPLC analysis and phytochemical isolation. The estrogenic activity of S. officinalis ethanolic extract at oral doses of 50, 100 and 200 mg/kg b.wt. and its isolated ferulic acid at a dose of 50 mg/kg b.wt. for a week, was assessed on ovariectomized immature Wistar rats. The experiment was confirmed by luteinizing hormone (LH) and follicle stimulating hormone (FSH) serum levels determination, a histopathological examination and a histomorphometrical study.

RESULTS

HPLC/PDA analysis revealed fourteen phenolic compounds the major constituents were methyl rosmarinate (24.86 mg/100 g) and ferulic acid (6.06 mg/100 g) together with five flavonoids where the major constituents were rutin, naringenin and quercetin. Two compounds were isolated from the polar fraction and identified as methyl rosmarinate (1) and ferulic acid (2). Oral administration of sage ethanolic extract and ferulic acid revealed a significant increase in the uterine weight compared to ovariectomized control rats. Moreover, S. officinalis and ferulic acid showed different phases of estrus cycle denoting estrogenic activity, and significantly decreased the serum levels of FSH and LH.

CONCLUSION

From these results it could be concluded that S. officinalis ethanolic extract and its content of ferulic acid could be useful as a safe natural source for estrogenic activity, supporting its traditional use to improve postmenopausal symptoms.

Prescription of Radix Salvia miltiorrhiza in Taiwan: A Population-Based Study Using the National Health Insurance Research Database

Objective: While radix Salvia miltiorrhiza (Danshen; RSM) is commonly used in Chinese herbal medicine, its current usage has not yet been analyzed in a large-scale survey. This study aimed to investigate the conditions for which RSM is prescribed and the utilization of RSM in Taiwan.

Methods: 1 million beneficiaries enrolled in the Taiwan National Health Insurance Research Database were sampled to identify patients who were prescribed RSM. Next, the diagnoses of these patients based on the International Classification of Diseases 9th Revision Clinical Modification code were analyzed. Logistic regression analysis was employed to estimate the odds ratio (OR) for RSM utilization.

Results: Patients with disorders of menstruation and abnormal bleeding from the female genital tract due to other causes were the diagnostic group most commonly treated with RSM (9.48%), followed by those with general (9.46%) and cardiovascular symptoms (4.18%). Subjects treated with RSM were mostly aged 35–49 years (30.1%). The most common combination of diseases for which RSM was prescribed (0.17%) included menopausal disorders and general symptoms. Women were more likely to receive RSM than men (OR = 1.75, 95% confidence interval = 1.73–1.78). RSM was frequently combined with Yan-Hu-Suo and Jia-Wei-Xiao-Yao-San for clinical use.

Conclusion: To date, this is the first study to identify the most common conditions for which RSM is used in modern Taiwan. The results indicate RSM as a key medicinal herb for the treatment of gynecological diseases, including menstrual disorders, female genital pain, menopausal disorders, etc. The most common combination for which RSM is prescribed is menopausal disorders and general symptoms. Further research is needed to elucidate the optimal dosage, efficacy, and safety of RSM.

QingYan formula extracts protect against postmenopausal osteoporosis in ovariectomized rat model via active ER-dependent MEK/ERK and PI3K/Akt signal pathways

ETHNOPHARMACOLOGICAL RELEVANCE

QingYan Formula has been traditionally used to tonify kidney and benefit essence, and QingYan Formula 70% ethanol extracts (QYFE) showed estrogen-like effect on reproductive system in our previous studies. However, there were no reports of QYFE on bone.

AIM OF THE STUDY

This study offered preliminary insight of QYFE into the pharmacodynamics and mechanism of anti-bone osteoporosis in ovariectomized rats.

MATERIALS AND METHODS

OVX rats were orally administrated QYFE or estradiol valerate (EV) for 12 weeks. We investigated the pharmacodynamic effects of QYFE on anti-bone loss in OVX rats, and also investigated the role of QYFE in promoting osteogenesis and inhibiting osteoclast differentiation.

RESULTS

QYFE administration significantly reduced the degree of high bone turnover, dose-dependently repaired the damaged microstructure of trabecular and cortical bone by Hematoxylin-Eosin (HE) staining and micro-computed tomography (micro-CT), and reduced the number of femur osteoclasts by TRAP staining. QYFE enhanced the proliferation and activity of alkaline phosphatase (ALP), the phosphorylation levels of extracellular regulated kinase (ERK) and Akt in MG-63 cells, which was inhibited by ICI 182 780. Moreover, in RAW264.7 cells, QYFE inhibited osteoclasts differentiation, reduced the number of osteoclasts, decreased the activity of TRAP enzyme during formation, down-regulated the protein expression of p-ERK inhibited by ICI 182 780 and p-Akt not inhibited by ICI 182 780.

CONCLUSION

This experiment demonstrated that QYFE had a definite anti-bone loss effect and had potential effect on postmenopausal osteoporosis. The molecular mechanism was related to the activation of estrogen receptor (ER)-dependent mitogen-activated protein kinase kinase (MEK)/ERK and phosphoinositide 3-kinase (PI3K)/Akt signal pathways in osteoblast, down-regulation protein expressions of ER-dependent p-ERK and ER-independent p-Akt in osteoclast.

Dihydrotanshinone I inhibits human glioma cell proliferation via the activation of ferroptosis

The aim of the present study was to investigate the effect of dihydrotanshinone I (DHI) on the survival of human glioma cells and the expression levels of ferroptosis-associated proteins. Human U251 and U87 glioma cells were cultured in vitro and treated with different concentrations of DHI and/or the ferroptosis inhibitor ferrostatin-1. A Cell Counting Kit-8 assay was used to determine the cell survival rate. The cells were further analyzed to determine their 5-, 12- and 15-hydroxyeicosatetraenoic acid (HETE), lactate dehydrogenase (LDH) and malondialdehyde (MDA) levels, and reduced glutathione (GSH)/oxidized glutathione (GSSG) ratios. Western blotting was used to detect ferroptosis-associated glutathione peroxidase 4 (GPX4) and long-chain acyl-CoA synthetase 4 (ACSL-4). Changes in the mitochondrial membrane potential (MMP) were also observed using tetramethylrhodamine methyl ester staining and confocal fluorescence microscopy. The results revealed that DHI inhibited the proliferation of human glioma cells. Following treatment of the U251 and U87 cells with DHI, changes in the expression levels of ferroptosis-associated proteins were observed; the expression level of GPX4 decreased and that of ACSL-4 increased. DHI also increased the levels of LDH and MDA in the human glioma cells and reduced the GSH/GSSG ratio. The DHI-treated cells also exhibited a marked reduction in MMP. Furthermore, ferrostatin-1 blocked the DHI-induced effects in human glioma cells. From these results, it may be concluded that DHI inhibits the proliferation of human glioma cells via the induction of ferroptosis.

Long-time qingyan formula extract treatment exerts estrogenic activities on reproductive tissues without side effects in ovariectomized rats and via active ER to ERE-independent gene regulation

The reproductive tissues are negatively influenced by estrogens in hormone therapy. Qingyan formula ethanol extract (QYFE)’s estrogenic effects and safety on reproductive tissues after long-term administration and its mechanism via estrogen receptor (ER) pathway haven’t been studied. Here, we characterized its estrogenic effects using ovariectomized rats together with in vitro studies for further molecular characterization. Ovariectomized rats were treated with QYFE at doses of 0.7, 1.4, and 2.8g/kg for 12 weeks. The results showed QYFE has a potent estrogenic activity, as indicated by restoring the disappeared estrous cycle, antagonizing the atrophy of uterus, vagina and mammary gland, and the estrogen decline in circulation caused by ovariectomy. In addition, QYFE upregulated ERα and ERβ expressions and had a less stimulatory effect on PCNA and ki-67 antigen in reproductive tissues compared with estradiol valerate. QYFE components can bind to ERα and ERβ, significantly increased ERα/β-ERE luciferase reporter gene expression, upregulated the expressions of ERs, PR and pS2 in MCF-7 cells at protein and gene level. All these activities were significantly inhibited by the ER antagonist ICI182,780. QYFE’s estrogenic activity maybe mediated by stimulating biosynthesis of estrogen and increasing the quantity of ERs in target tissue and via active ER to ERE-independent gene regulation.

Chaiyu-Dixian Formula Exerts Protective Effects on Ovarian Follicular Abnormal Development in Chronic Unpredictable Mild Stress (CUMS) Rat Model

Background

Chronic stress has been known to impair the female reproductive function, but the mechanism remains to be further investigated. Chaiyu-Dixian Formula (CYDXF) has been reported to regulate human endocrine disorders clinically. However, whether this formula can affect chronic stress-induced ovarian follicular development is not clear.

Aim of the study

To examine effects of CYDXF on follicular development and explore possible mech anisms in a chronic unpredictable mild stress (CUMS) model.

Materials and Methods

Adult female rats were randomly divided into 5 groups control group, CUMS group (saline treatment), CUMS+Estradiol (E₂) (0.1 mg/kg) group, CUMS+CYDXF (2.73 g/kg) group, and CUMS+CYDXF (5.46 g/kg) group. Body weights and behavioral tests were documented. Serum hormone levels were determined by enzyme-linked immunosorbent assay (ELISA). Western blotting was used to detect the protein levels in the PI3K/Akt pathway and brain-derived neurotrophic factor (BDNF). The follicles were analyzed and classified according to their morphological characterization.

Results

CYDXF relieved depression-like behaviors and ameliorated the abnormality in rat estrous cycle within the rat model of CUMS. Moreover, CYDXF could regulate endocrine disorders, increase the proportion of antral follicles as well as decrease the proportion of follicular atresia, which suggested that CYDXF could alleviate abnormal follicular development and improve overall ovarian function. Furthermore, CYDXF also activated the BDNF-mediated PI3K/Akt signaling pathway.

Conclusions

CYDXF (at dose of both 2.73 and 5.46 g/kg) attenuated chronic stress-induced abnormal ovarian follicular development by relieving depression-like behaviors and improving ovarian function through partly the regulation of the BDNF-mediated PI3K/Akt pathway.

Ameliorative effects of Radix rehmanniae extract on the anxiety- and depression-like symptoms in ovariectomized mice: A behavioral and molecular study

BACKGROUND

Menopause is closely associated with the risk of anxiety and depression in a woman's life. Despite the numerous reports on the effects of Radix rehmanniae extract (RRE) on various types of depression, there are few studies exploring the effects of RRE on the menopausal anxiety and depression.

PURPOSE

To investigate whether RRE could alleviate the menopausal anxiety and depression in ovariectomized (OVX) mice submitted to chronic unpredictable mild stress (CUMS).

METHODS

OVX mice were treated with 2.6 g/kg RRE for 5 weeks. After a series of behavior tests, serum, uterus, and brain tissues were collected for the measurement of neurotransmitters and their related biomarkers, neurotrophins, and estrogen receptor α (ERα) and β (ERβ).

RESULTS

RRE showed antidepressant and anxiolytic effects through these behavior tests, but had no effects on the OVX-induced weight gains, uterine shrinkage and drop of serum estrogen level. RRE restored the levels of serotonin (5-HT), dopamine (DA) and its metabolite 3,4-dihydroxyphenylacetic acid (DOPAC), Glutamate (Glu), gamma-Aminobutyric acid (GABA) and their related biomarkers in different brain regions. RRE also reversed OVX-induced decrease in the expression levels of neurotrophins in uterus and brain regions except for uterine nerve growth factor (NGF). Moreover, RRE restored and even enhanced ERβ expression levels in uterus and brain without affecting uterine, hippocampal and cortical ERα.

CONCLUSION

This study demonstrated the antidepressant and anxiolytic effects of RRE in OVX mice, which were possibly mediated via their modulation of brain neurotransmitters, and regulation of neurotrophins and activation of ERβ.

Chinese Medicines Improve Perimenopausal Symptoms Induced by Surgery, Chemoradiotherapy, or Endocrine Treatment for Breast Cancer

The application of surgery, chemoradiotherapy, and endocrine treatment successfully increases survival rates of breast cancer patients. However, perimenopausal symptoms, the main side effects of these treatments, often afflict patients and reduce their quality of life. Perimenopausal symptoms include vasomotor symptoms, sleep problems, arthromuscular symptoms, and osteoporosis. Currently, there are no satisfactory treatments for perimenopausal symptoms that result from these treatments. Therefore, alternative and complementary therapies including herbal medicines represented by Chinese medicines (CMs), acupuncture, massage, and psychotherapy are increasingly being expected and explored. In this paper, we review the effects and potentials of several CM formulae, along with some active ingredients or fractions from CMs, Chinese herbal extracts, and other herbal medicines, which have drawn attention for improving perimenopausal symptoms in breast cancer patients. We also elaborate their possible mechanisms. Moreover, further studies for evaluation of standardized clinical efficacy should be scientifically well-designed and continuously performed to investigate the efficacy and mechanisms of CMs for perimenopausal symptoms due to breast cancer therapy. The safety and value of estrogen-containing CMs for breast cancer should also be clarified.

Estrogenic Effect of the Extract of QingYan Formula on Reproductive Tissues in Immature Mice

A Chinese herbal preparation, QingYan formula (QYF), has been used clinically for kidney-invigorating. However, no evidence base links QYF to estrogen replacement therapy. In this study, the estrogenic effects of QingYan formula 70% ethanol extract (QYFE) were investigated in immature mice. Immature mice were treated with QYFE at doses of 1, 2, and 4g/kg for 7 days. QYFE treatments promoted vaginal cornification and prolonged the estrus status of the immature mice, promoted the growth and development of uterus and vagina, upregulated ERα and ERβ expression at protein level in uterus and vagina, increased the level of estradiol (E₂), and decreased concentration of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in serum. This study demonstrated that QYFE exerts estrogenic effects by stimulating biosynthesis of estrogen and increasing estrogen receptors (ERs) in target tissues and provided an evidence base for QYFE treatment instead of estrogen replacement therapy.

Veratrum nigrum inhibits the estrogenic activity of salvia miltiorrhiza bunge in vivo and in vitro

BACKGROUND

As recorded in the 18 incompatible medicaments of Traditional Chinese Medicine theory, the combined use of Salvia miltiorrhiza bunge (SM) and Veratrum nigrum (VN) could induce toxicity and has been prohibited for thousands of years in China. However, the theory has been validated due to lack of evidence. Previous studies have focused on the chemical constituents that are responsible for the toxicity of the two agents.

PURPOSE

This study offers preliminary insight into the pharmacodynamics and mechanism of estrogenic activity responsible for their incompatibility.

STUDY DESIGN

We undertook a characterization of the interaction between estrogenic activities of SM and VN using in vivo models of immature and ovariectomized (OVX) mice, and in vitro studies focused on the estrogen receptor (ER) pathway for further mechanism.

METHODS

Immature and OVX mice were treated intragastrically with SM at doses of 1.6, 3.2 g/kg, or combine with 0.045 g/kg VN and 0.005 g/kg the ER antagonist ICI182, 780 for elucidating the effects on estrogenic activity in reproductive tissues, E₂ secretion, and the ER mechanism. ERα/β binding experiments and ERα/β transcriptional activity were performed in order to evaluate the biological action exerted through ERs.

RESULTS

VN decreased the estrogenic efficacy of SM in promoting the development of the uterus and vagina in immature mice, and reversing the atrophy of reproductive tissues in OVX mice. VN interfered with the estrogenic efficacy of SM by decreasing the serum estradiol and the upregulation of ERα and ERβ expressions in reproductive tissues by treatment with SM. VN antagonized the estrogenic efficacy of SM in promoting the viability of MCF-7 cells and stimulating the binding ability with ERα and ERβ, and increasing ERα/β-estrogen response element (ERE) luciferase activity.

CONCLUSIONS

This study provided evidence that the combined use of SM and VN could induce unfavorable effects. VN decreased the estrogenic activity of SM, which might be related to the regulation of estrogen secretion and ERs through the ER-ERE pathway.

Efficacy and safety of the compound Chinese medicine SaiLuoTong in vascular dementia: A randomized clinical trial

Introduction

No licensed medications are available to treat vascular dementia (VaD).

Methods

Patients were randomly assigned to experimental groups (SaiLuoTong [SLT] 360 or 240 mg for groups A and B for 52 weeks, respectively) or placebo group (SLT 360 mg and 240 mg for group C only from weeks 27 to 52, respectively).

Results

Three hundred twenty-five patients were included in final analysis. At week 26, the difference in VaD Assessment Scale–cognitive subscale scores was 2.67 (95% confidence interval, 1.54 to 3.81) for groups A versus C, and 2.48 (1.34 to 3.62) for groups B versus C (both P < .0001). However, at week 52, no difference was observed among the groups on the VaD Assessment Scale–cognitive subscale (P = .062) because of the emerging efficacy of SLT in placebo beginning at week 27.

Discussion

This study suggests that SLT is effective for treatment of VaD, and this compound Chinese medicine may represent a better choice to treat VaD.

Suppression Effect of Astaxanthin on Osteoclast Formation In Vitro and Bone Loss In Vivo

Osteoporosis is characterized by a reduction of the bone mineral density (BMD) and microarchitectural deterioration of the bone, which lead to bone fragility and susceptibility to fracture. Astaxanthin (AST) has a variety of biological activities, such as a protective effect against asthma or neuroinflammation, antioxidant effect, and decrease of the osteoclast number in the right mandibles in the periodontitis model. Although treatment with AST is known to have an effect on inflammation, no studies on the effect of AST exposure on bone loss have been performed. Thus, in the present study, we examined the antiosteoporotic effect of AST on bone mass in ovariectomized (OVX) mice and its possible mechanism of action. The administration of AST (5, 10 mg/kg) for 6 weeks suppressed the enhancement of serum calcium, inorganic phosphorus, alkaline phosphatase, total cholesterol, and tartrate-resistant acid phosphatase (TRAP) activity. The bone mineral density (BMD) and bone microarchitecture of the trabecular bone in the tibia and femur were recovered by AST exposure. Moreover, in the in vitro experiment, we demonstrated that AST inhibits osteoclast formation through the expression of the nuclear factor of activated T cells (NFAT) c1, dendritic cell-specific transmembrane protein (DC-STAMP), TRAP, and cathepsin K without any cytotoxic effects on bone marrow-derived macrophages (BMMs). Therefore, we suggest that AST may have therapeutic potential for the treatment of postmenopausal osteoporosis.

Danshen (Salvia miltiorrhiza) protects ovariectomized rats fed with high-saturated fat-sucrose diet from bone loss

Dietary patterns may interfere with the efficacy of herbal intervention. Our results demonstrated the protective effects of Salvia miltiorrhiza aqueous extract (SMA) on bone metabolism were influenced by levels of dietary fat and sucrose in ovariectomized (OVX) rats through its actions on attenuating lipid deposition and oxidative stress in rats.

INTRODUCTION

Salvia miltiorrhiza (SM), also known as Danshen, has been tested as an osteoporosis treatment in a series of small, short human trials that generally report improvements in bone property. However, dietary patterns may interfere with the effects of herbal intervention. We hypothesized that dietary fat and sucrose levels could influence the effects of SM supplementation on bone in estrogen-deficient animals.

METHODS

Six-month-old Sprague-Dawley sham or OVX rats were fed either a low-saturated fat-sucrose (LFS, a diet that was similar in composition to normal rat chow) or a high-fat-sucrose (HFS) diet and OVX rats were treated (8 rats/group) with SM aqueous extract (SMA, 600 mg/kg/day), 17β-estradiol (1 mg/kg/day), or vehicle for 12 weeks.

RESULTS

SMA significantly improved bone properties as revealed by the increase in trabecular bone mineral density and decrease in trabecular separation at proximal metaphysis of the tibia (PT) in HFS-fed OVX rats, but not in LFS-fed OVX rats. SMA greatly reduced lipid deposition and malondialdehyde levels, improved the activities of superoxide dismutase, catalase, and glutathione peroxidase in the livers of HFS-fed OVX rats. SMA could directly improve the proliferation and differentiation in vitro in an H₂O₂-induced preosteoblast cell model by attenuating cellular reactive oxygen species levels.

CONCLUSIONS

The protective effects of SMA on bone metabolism were influenced by dietary fat and sucrose levels in OVX rats. The ability of SMA to reduce bone loss in HFS-fed OVX rats was associated with the attenuation of lipid deposition and oxidative stress levels.