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Shi M, Sun T, Ji Z, Ma Y, Zhao M, Yang F, Zhang J. Effectiveness of Shuxuening injection in coronary heart disease: a systematic review and meta-analysis. Front Pharmacol 2023; 14:1265603. [PMID: 37790809 PMCID: PMC10544985 DOI: 10.3389/fphar.2023.1265603] [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: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Background: Coronary heart disease (CHD) poses a serious threat to public health, and the current medical management still faces significant challenges. Reliable evidence on the efficacy of Shuxuening injection (SXNI) in CHD is still lacking, even though it is widely used in China. Purpose: To evaluate the efficacy of SXNI combination therapy in treating CHD. Methods: A systematic search of eight databases was conducted to identify relevant randomized controlled trials (RCTs) from the inception of each database until June 2023. ROB 2.0, RevMan 5.4, and Stata 15.1 were used for quality evaluation and data analysis. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Results: A total of 3,779 participants from 39 studies were included. The results showed SXNI combination therapy increased the clinical efficacy and decreased the frequency and duration of angina. Furthermore, SXNI combination therapy improved cardiac function of patients by decreasing LVEDD, and increased CI, CO, and LVEF. It also improved blood lipid profiles by increasing HDL, decreasing TC, TG, and LDL. The thrombosis factors of patients were also improved by decreasing FIB, PV, HCT, and HS. Moreover, SXNI combination therapy was superior to the conventional treatment in improving CRP levels, increasing ECG efficacy and BNP. However, due to the limited safety information, reliable safety conclusions could not be drawn. Furthermore, the levels of evidence ranged from very low to moderate due to publication bias and heterogeneity. Conclusion: SXNI can effectively improve angina symptoms, clinical efficacy, cardiac function, blood lipid indicators, and thrombosis factors of patients with CHD. However, more multi-center and large-sample studies are needed to confirm the conclusions due to the limitations of this study. Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399606; Identifier: CRD42023433292.
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Affiliation(s)
- Menglong Shi
- State Key Laboratory of Component-Based Chinese Medicine, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Evidence-Based Medicine Center, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tianye Sun
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhaochen Ji
- State Key Laboratory of Component-Based Chinese Medicine, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Evidence-Based Medicine Center, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yucong Ma
- State Key Laboratory of Component-Based Chinese Medicine, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Evidence-Based Medicine Center, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Min Zhao
- The First Affiliated Hospital of Henan University of CM, Zhengzhou, China
| | - Fengwen Yang
- State Key Laboratory of Component-Based Chinese Medicine, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Evidence-Based Medicine Center, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junhua Zhang
- State Key Laboratory of Component-Based Chinese Medicine, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Evidence-Based Medicine Center, College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Huajuan J, Xulong H, Bin X, Yue W, Yongfeng Z, Chaoxiang R, Jin P. Chinese herbal injection for cardio-cerebrovascular disease: Overview and challenges. Front Pharmacol 2023; 14:1038906. [PMID: 36909150 PMCID: PMC9998719 DOI: 10.3389/fphar.2023.1038906] [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: 09/07/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Cardio-cerebrovascular diseases are the leading cause of death worldwide and there is currently no optimal treatment plan. Chinese herbal medicine injection (CHI) is obtained by combining traditional Chinese medicine (TCM) theory and modern production technology. It retains some characteristics of TCM while adding injection characteristics. CHI has played an important role in the treatment of critical diseases, especially cardio-cerebrovascular diseases, and has shown unique therapeutic advantages. TCMs that promote blood circulation and remove blood stasis, such as Salvia miltiorrhiza, Carthami flos, Panax notoginseng, and Chuanxiong rhizoma, account for a large proportion of CHIs of cardio-cerebrovascular disease. CHI is used to treat cardio-cerebrovascular diseases and has potential pharmacological activities such as anti-platelet aggregation, anti-inflammatory, anti-fibrosis, and anti-apoptosis. However, CHIs have changed the traditional method of administering TCMs, and the drugs directly enter the bloodstream, which may produce new pharmacological effects or adverse reactions. This article summarizes the clinical application, pharmacological effects, and mechanism of action of different varieties of CHIs commonly used in the treatment of cardio-cerebrovascular diseases, analyzes the causes of adverse reactions, and proposes suggestions for rational drug use and pharmaceutical care methods to provide a reference for the rational application of CHIs for cardio-cerebrovascular diseases.
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Affiliation(s)
- Jiang Huajuan
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, China.,Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huang Xulong
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, China.,Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xian Bin
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, China.,Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wang Yue
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, China.,Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhou Yongfeng
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, China.,Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ren Chaoxiang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, China.,Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Pei Jin
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, China.,Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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3
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Jiang C, Zhao L, Xin C, Dong Y, Shen J, Xia Z, Shou D, Li G. Prediction of allergic reaction risk of Shenmai injection based on real-world evidence coupled with UPLC-Q-TOF-MS. Biomed Chromatogr 2021; 36:e5255. [PMID: 34612532 DOI: 10.1002/bmc.5255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/28/2021] [Accepted: 09/28/2021] [Indexed: 01/23/2023]
Abstract
The allergic reaction (AR) of Chinese herbal injection (CHI) has become one of the most noticeable focuses of public health in China. However, it still remains a considerable controversy as to whether low-molecular-weight components in CHI have potential sensitization. In this study, the relationship between AR and low-molecular-weight component profile of Shenmai injection was explored by an interdisciplinary technology integrating real-world evidence and ultra-performance liquid chromatography-quadrupole time-of-flight mass spectroscopy (UPLC-Q-TOF-MS). The AR information of hospitalized patients was obtained by comprehensively analyzing real-world evidence from January 2015 to June 2019 at two Chinese hospitals. The UPLC-Q-TOF-MS was exploited to systematically investigate the low-molecular-weight component profile with 50-1500 m/z mass range, and 3725 MS1 peaks were detected. The optimized partial least squares discriminant analysis model was established to map the influence of low-molecular-weight components on AR. The results of this study showed that high levels of organic acids administered intravenously might be a potential risk factor for inducing AR. By using this method, Shenmai injection with high AR risk could be recognized precisely with 100% accuracy before clinical use.
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Affiliation(s)
- Cheng Jiang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China.,Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, China
| | - Lisha Zhao
- Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, China
| | - Chuanwei Xin
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yu Dong
- Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, China
| | - Jie Shen
- Department of Pharmacy, Zhejiang Province Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Zhongni Xia
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Dan Shou
- Department of Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, China.,School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Gonghua Li
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China
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4
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Liang Z, Lai Y, Li M, Shi J, Lei CI, Hu H, Ung COL. Applying regulatory science in traditional chinese medicines for improving public safety and facilitating innovation in China: a scoping review and regulatory implications. Chin Med 2021; 16:23. [PMID: 33593397 PMCID: PMC7884970 DOI: 10.1186/s13020-021-00433-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/06/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The National Medical Products Administration (NMPA) in China has set to advance the regulatory capacity of traditional Chinese medicines (TCMs) with the adoption of regulatory science (RS). However, the priority of actions at the interface of RS and TCMs were yet to be defined. This research aims to identify the priority areas and summarize core actions for advancing RS for traditional medicines in China. METHODS A mixed approach of documentary analysis of government policies, regulations and official information about TCMs regulation in China, and a scoping review of literature using 4 databases (PubMed, ScienceDirect, Scopus and CNKI) on major concerns in TCMs regulation was employed. RESULTS Ten priority areas in the development of TCM-related regulatory science in China have been identified, including: (1) modernizing the regulatory system with a holistic approach; (2) advancing the methodology for the quality control of TCMs; (3) fostering the control mechanism of TCMs manufacturing process; (4) improving clinical evaluation of TCMs and leveraging real world data; (5) re-evaluation of TCMs injection; (6) developing evaluation standards for classic TCMs formula; (7) harnessing diverse data to improve pharmacovigilance of TCMs; (8) evaluating the value of integrative medicine in clinical practice with scientific research; (9) advancing the regulatory capacity to encourage innovation in TCMs; and (10) advancing a vision of collaboration for RS development in TCMs. CONCLUSIONS RS for TCMs in China encompasses revolution of operational procedures, advancement in science and technology, and cross-disciplinary collaborations. Such experiences could be integrated in the communications among drug regulatory authorities to promote standardized and scientific regulation of traditional medicines.
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Affiliation(s)
- Zuanji Liang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao Taipa, China
| | - Yunfeng Lai
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao Taipa, China
| | - Meng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao Taipa, China
| | - Junnan Shi
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao Taipa, China
| | - Chi Ieong Lei
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao Taipa, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao Taipa, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Science, University of Macau, Macao Taipa, China
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5
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Wang L, Tian J, Liu S, Zhang Y, Liu J, Yi Y, Li C, Zhao Y, Zhang Y, Han J, Pan C, Li G, Xian Z, Liang A. Shuxuening injection, derived from Ginkgo biloba leaf, induced pseudo-allergic reactions through hyperactivation of mTOR. PHARMACEUTICAL BIOLOGY 2020; 58:581-589. [PMID: 32615844 PMCID: PMC8641670 DOI: 10.1080/13880209.2020.1784238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
Context: Shuxuening injection (SXNI), derived from the leaf of Ginkgo biloba L. (Ginkgoaceae), is widely used to treat cardio-cerebral vascular system related disease due to the efficacy of dilating the blood vessels and improving the function of microcirculation. Nevertheless, SXNI induces immediate hypersensitivity reactions in clinics and the molecular mechanisms are unknown.Objective: The present study investigates the molecular mechanism of SXNI mediated hypersensitivity reactions.Materials and methods: Naive male ICR mice (n = 10) were administered (i.v.) with negative control combined with Evans blue (EB) (CTL-EB), SXNI (14 or 70 mg/kg) combined with EB (SXNI/1-EB or SXNI/4-EB), vascular leakage was evaluated, ears and lungs were collected for histopathological analysis. In vitro, TSC1 was knockdown in human umbilical vein endothelial cells (HUVECs). HUVECs were incubated with SXNI, and the alterations of endothelial cell permeability were observed. Rapamycin (mTOR inbibitor) was used to investigate SXNI-induced hypersensitivity reactions both in mice and HUVECs.Results: SXNI (70 mg/kg) induced vascular leakage in mice. Slight oedema and microvascular dilation in the ears, and broaden of alveolar septal and monocyte infiltration in the lungs were observed in SXNI (70 mg/kg) treated mice. mTOR inhibitor alleviates SXNI mediated vascular endothelial hyperpermeability both in vitro and in vivo.Discussion and conclusions: SXNI stimulates pseudo-allergic reactions through hyperactivation of mTOR signalling pathway. Our work provides the new molecular mechanism of drug related pseudo-allergic reactions, and a potential drug to prevent and treat SXNI mediated hypersensitivity reactions.
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Affiliation(s)
- Lianmei Wang
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingzhuo Tian
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Suyan Liu
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanyan Zhang
- Traditional Chinese Medicine Injection Innovation Center, Shijiazhuang, Hebei Province, China
| | - Jing Liu
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Yi
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunying Li
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yong Zhao
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yushi Zhang
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiayin Han
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chen Pan
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guiqin Li
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhong Xian
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Aihua Liang
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
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6
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Li Y, Duan J, Xia H, Shu B, Duan W. Macromolecular substances as a dangerous factor in traditional Chinese medicine injections were determined by size-exclusive chromatography. Toxicol Res (Camb) 2020; 9:323-330. [PMID: 32670563 DOI: 10.1093/toxres/tfaa024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Macromolecular substances in traditional Chinese medicine injections (TCMIs) are expected to be a main dangerous factor causing anaphylactic or anaphylactoid reaction. The main aim of the study was to verify the macromolecular substances' anaphylactic or anaphylactoid reaction in guinea pigs and establish a size-exclusive chromatographic method to detect them. The macromolecular substances from six TCMIs (Danshen injection, Dengzhanxixin injection, Honghua injection, Qingkailing injection, Shuanghuanglian injection and Shuxuening injection) were prepared by removing substances with molecular weight less than 10 kDa with an ultra-filter. The anaphylactic and anaphylactoid reactions caused by original TCMIs, injections rich in or free of macromolecules were assayed in guinea pigs. The relationship between the amount of the macromolecular substances and peak area of chromatogram was established by size-exclusive chromatography. Injections free of macromolecules were not likely to cause anaphylactic and anaphylactoid reactions, but injections rich in macromolecular substances were more likely to do so. If the macromolecular substances with molecular weight bigger than 10 kDa were removed, the signal of macromolecular substances in TCMIs was quantitatively reduced. All the results suggested that macromolecular substances in TCMIs are a dangerous factor causing safety problems, and the macromolecular substances can be quantitatively detected with size-exclusive chromatography.
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Affiliation(s)
- Yue Li
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Traditional Chinese Medicine, 1076, Yuhua Rd., Kunming 650500, China
| | - Jinlian Duan
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Traditional Chinese Medicine, 1076, Yuhua Rd., Kunming 650500, China
| | - Heng Xia
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Traditional Chinese Medicine, 1076, Yuhua Rd., Kunming 650500, China
| | - Bin Shu
- Jiangsu Center for Safety Evaluation of Drugs, Nanjing Tech University, 30, South Puzhu Rd., Nanjing 211899, China
| | - Weigang Duan
- Yunnan Provincial Key Laboratory of Molecular Biology for Sinomedicine, Yunnan University of Traditional Chinese Medicine, 1076, Yuhua Rd., Kunming 650500, China
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7
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Cheng JQ, Shi QP, Ding F, Kong LT, Yu ML, Wang C. Liver function monitoring: a prospective nested case-control study of Salvia miltiorrhiza polyphenol injection. Sci Rep 2020; 10:3538. [PMID: 32103121 PMCID: PMC7044424 DOI: 10.1038/s41598-020-60608-z] [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: 08/29/2019] [Accepted: 02/14/2020] [Indexed: 11/09/2022] Open
Abstract
Instructions for Salvia miltiorrhiza polyphenol injections indicate abnormal liver function as an occasional adverse reaction, but the incidence of this adverse drug reaction (ADR) has increased in recent years. We assessed S. miltiorrhiza polyphenol ADRs by performing a nested case-control study(NCCS) and meta-analysis. In the NCCS, 2633 patients receiving this treatment in the First Affiliated Hospital of Bengbu Medical College were enrolled. Logistic regression models found that in 58 (2.2%) patients experiencing abnormal liver function, the risk for liver dysfunction was associated with sulfa drug allergy (OR = 7.874, 95%CI (1.280, 48.447), P = 0.026), payment methods (OR = 0.106, 95%CI (0.012, 0.934), P = 0.043), duration of administration (OR = 0.922, 95%CI (0.862, 0.986), P = 0.017), cefathiamidine (OR = 0.441, 95%CI (0.216, 0.900), P = 0.025), human serum albumin (OR = 1.958, 95%CI (1.011, 3.789), P = 0.046), Dazhu Rhodiola injection (OR = 2.599, 95%CI (1.112, 6.070), P = 0.027), or reduced glutathione (OR = 0.394, 95%CI (0.188, 0.826), P = 0.014). Meta-analysis of reports on S. miltiorrhiza polyphenol ADRs in controlled trials and other observational studies included 676 patients, of which 17 (2.17%; 95%CI (0.0105, 0.0358)) presented with liver dysfunction; associated ADR risk factors included co-administration of other drugs. Our NCCS and meta-analysis had similar ADR incidence rates, which were higher than the rate in the drug instructions. This study provides guidance for assessing liver dysfunction risks associated with S. miltiorrhiza polyphenol injections.
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Affiliation(s)
- Jin-Quan Cheng
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.,School of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China
| | - Qing-Ping Shi
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China. .,School of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China.
| | - Feng Ding
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Ling-Ti Kong
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.,School of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China
| | - Mei-Ling Yu
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.,School of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China
| | - Can Wang
- School of Pharmacy, Bengbu Medical College, Bengbu, Anhui, China
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8
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Identification of high-risk patients for ADR induced by traditional Chinese medicine injection: a nested case-control study. Sci Rep 2019; 9:16721. [PMID: 31723184 PMCID: PMC6853959 DOI: 10.1038/s41598-019-53267-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023] Open
Abstract
The adverse drug reaction (ADR) of traditional Chinese medicine injection (TCMI) has become one of the major concerns of public health in China. There are significant advantages for developing methods to improve the use of TCMI in routine clinical practice. The method of predicting TCMI-induced ADR was illustrated using a nested case-control study in 123 cases and 123 controls. The partial least squares regression (PLSR) models, which mapped the influence of basic characteristics and routine examinations to ADR, were established to predict the risk of ADR. The software was devised to provide an easy-to-use tool for clinic application. The effectiveness of the method was evaluated through its application to new patients with 95.7% accuracy of cases and 91.3% accuracy of controls. By using the method, the patients at high-risk could be conveniently, efficiently and economically recognized without any extra financial burden for additional examination. This study provides a novel insight into individualized management of the patients who will use TCMI.
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9
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Wang R, Wang M, Zhou J, Ye T, Xie X, Ni D, Ye J, Han Q, Di C, Guo L, Sun G, Sun X. Shuxuening injection protects against myocardial ischemia-reperfusion injury through reducing oxidative stress, inflammation and thrombosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:562. [PMID: 31807543 DOI: 10.21037/atm.2019.09.40] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Shuxuening injection (SXNI) has a good effect on cardiovascular and cerebrovascular diseases. Here, our study aims to investigate whether SXNI have the protective effect on myocardial ischemia-reperfusion injury (MIRI) and elucidate the mechanism of SXNI's cardiac protection. Methods In this experiment, the coronary arteries of Sprague-Dawley (SD) rats were ligated for the induction of a MIRI model. TTC staining and haematoxylin-eosin (HE), as well as troponin I (TnI), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK) and CK-MB levels, were used to detect the protective effect of SXNI. In rat cardiac tissue, superoxide dismutase, catalase, glutathione and malondialdehyde (MDA) activities and glucose-regulated protein 78 (GRP78), calreticulin (CRT), CCAAT/enhancer binding protein homologous protein (CHOP) and caspase-12 expression levels were detected. In rat serum, the levels of inflammatory factors, including high-sensitivity C-reactive protein, monocyte chemoattractant protein-1, tumour necrosis factor-α, interleukin-6 (IL-6) and IL-1β, were measured by Elisa. In the rat arterial tissue, Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) expression was measured by western blot. In the rat plasma, ELISA was used to assay the levels of coagulation and plasmin system indicators, including platelet activating factor, endothelin, tissue factor (TF), plasminogen inhibitor, thromboxane B2, plasma fibrinogen. Results The results showed that SXNI can reduce the infarct size of myocardial tissue, decrease the myocardial enzyme and TnI levels and decrease the degree of myocardial damage compared with the model group. Additionally, SXNI can increase the activity of antioxidant enzymes, reduce the MDA level and decrease the GRP78, CRT, CHOP and caspase-12 expression levels. SXNI also decreased the levels of inflammatory cytokines in rat serum, lowered the level of procoagulant molecules in plasma and reduced the TLR4/NF-κB expression. Conclusions SXNI has protective effect on MIRI mainly by inhibiting oxidative stress and endoplasmic reticulum stress (ERS), thereby regulating TLR4/NF-κB pathway to reduce inflammation, and lowing procoagulant-related factors levels to reduce the risk of thrombosis.
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Affiliation(s)
- Ruiying Wang
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Beijing 100193, China.,Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Beijing 100193, China.,Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Min Wang
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Beijing 100193, China.,Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Beijing 100193, China.,Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Jiahui Zhou
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Beijing 100193, China.,Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Beijing 100193, China.,Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Tianyuan Ye
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Beijing 100193, China.,Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Beijing 100193, China.,Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Xueheng Xie
- Harbin University of Commerce, Harbin 150076, China
| | - Dong Ni
- Jilin Agricultural University, Changchun 130118, China
| | - Jingxue Ye
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Beijing 100193, China.,Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Beijing 100193, China.,Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Qiaoling Han
- Shiyao Yinhu Pharmaceutical Co., Ltd., Yuncheng 044000, China
| | - Caixia Di
- Shiyao Yinhu Pharmaceutical Co., Ltd., Yuncheng 044000, China
| | - Liang Guo
- Shiyao Yinhu Pharmaceutical Co., Ltd., Yuncheng 044000, China
| | - Guibo Sun
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Beijing 100193, China.,Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Beijing 100193, China.,Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Xiaobo Sun
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Beijing 100193, China.,Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Beijing 100193, China.,Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
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10
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Safety Concerns of Traditional Chinese Medicine Injections Used in Chinese Children. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:8310368. [PMID: 31341500 PMCID: PMC6612389 DOI: 10.1155/2019/8310368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022]
Abstract
Objective To explore risks underlying traditional Chinese medicine (TCM) injection-related adverse drug reactions (ADRs) in Chinese children, and to discuss the implications of postmarketing reevaluation studies. Methods We identified potential cases of exposure to TCM injections for children (<18 years of age) and adults (18 years and upwards) from database of ADRs. First, the associations between TCM injection-related ADRs and three administration routes (i.e., intravenous or intramuscular administration, oral administration, and external use) and the imbalance of TCM injection-related ADRs between the paediatric and adult populations were tested using the Chi-square (χ 2 ) test. Second, the proportional reporting ratio (PPR) was applied to identify statistically significant associations between drugs and anaphylactic shock in the paediatric population. Results The χ 2 test revealed that the highest frequency of paediatric ADRs was due to 5 types of herbal injections (i.e., Shuanghuanglian (SHL), Yuxingcao (YXC), Qingkailing (QKL), Xiyanping (XYP), and Reduning (RDN) herbal injections) (P<0.000), and the reports of ADRs attributed to the XYP and RDN herbal injections in children accounted for a greater proportion than the reports for adults (P<0.000). The PPR identified 5 types of herbal injections-anaphylactic shock pairs (i.e., the SHL, XYP, QKL, YXC, and Fufang Danshen herbal injections) that met the minimum criteria (i.e., a PPR of at least 2 and χ 2 of at least 4 and three or more cases), which suggested that TCM injections were significantly associated with anaphylactic shock. Conclusions TCM injections pose graver risks to the paediatric population than the adult population. To achieve optimal benefits and minimal risk to children treated with TCM injections, we suggest reevaluating the effectiveness and safety, monitoring the risks, and promoting rational use of TCM injections in Chinese children.
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11
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Li H, Deng J, Deng L, Ren X, Xia J. Safety profile of traditional Chinese herbal injection: An analysis of a spontaneous reporting system in China. Pharmacoepidemiol Drug Saf 2019; 28:1002-1013. [PMID: 31131950 DOI: 10.1002/pds.4805] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/30/2019] [Accepted: 04/24/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Although a series of serious adverse events have continually raised concerns about the potential toxicity of traditional Chinese medicine injections (TCM injections), studies on this subject are still sparse. We conducted a descriptive analysis of a spontaneous reporting system in China to describe the safety profile of TCM injections. METHODS The safety profile of TCM injections is described by descriptive analysis of 559 066 adverse reports collected from Guangdong Provincial Center for adverse drug reaction (ADR) Monitoring in China during 2003 to 2017. RESULTS The percentage of new or serious ADRs of TCM injections is much higher than average percentage of China's spontaneous reporting system (SRS) as a whole (48.70% vs <25%). Compared with conventional injections, TCM injections have a slightly lower percentage of serious ADRs (6.02% vs 6.72%) and much higher percentage of unknown (new) ADRs (46.74% vs 24.13%). The gender and age distribution for TCM injections are similar to conventional injections. The reporting rates of ADRs increased with age. Anaphylactic shock and anaphylactoid reaction are high-risk ADRs for TCM injections and, anaphylactic shock is ranked number 1 in causing deaths (50.00%). CONCLUSIONS There are some differences and similarities on the safety profile between TCM injections and conventional injections. TCM injections have higher risk of adverse effects than any other dosage forms of TCM medications and higher percentage of new or serious adverse effects than conventional injections. A lot of work need to be done to clarify the huge amount of potential unknown adverse effects related to TCM injections.
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Affiliation(s)
- Haona Li
- Department of Health Statistics, Fourth Military Medical University, Xi'an, China.,Huaihe School of Clinical Medicine, Henan University, Kaifeng, China
| | - Jianxiong Deng
- Adverse Drug Reaction Monitoring Centre of Guangdong Province, Guangzhou, China
| | - Lewen Deng
- Adverse Drug Reaction Monitoring Centre of Guangdong Province, Guangzhou, China
| | - Xuequn Ren
- Huaihe School of Clinical Medicine, Henan University, Kaifeng, China
| | - Jielai Xia
- Department of Health Statistics, Fourth Military Medical University, Xi'an, China
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