Chinese proprietary medicine in Singapore: regulatory control of toxic heavy metals and undeclared drugs

Environmental impact of endocrine-disrupting chemicals and heavy metals in biological samples of petrochemical industry workers with perspective management

Exposure to endocrine disrupting chemicals (EDCs) or heavy metals are synthetic compounds that can lead to negative effect on health, including immune and endocrine system disruption, respiratory problems, metabolic issues, diabetes, obesity, cardiovascular problems, growth impairment, neurological and learning disabilities, and cancer. Petrochemical industry drilling wastes, which contain varying levels of EDCs, are known to pose a significant risk to human health. This study aimed to investigate the levels of toxic elements in biological samples of individuals working in the petrochemical drilling sites. Biological samples, including scalp hair and whole blood, were collected from petrochemical drilling workers, individuals residing in the same residential area, and control age-matched persons from nonindustrial areas. The samples were oxidized by an acid mixture before analysis using atomic absorption spectrophotometry. The accuracy and validity of the methodology were verified through certified reference materials from scalp hair and whole blood. The results showed that the concentrations of toxic elements, such as cadmium and lead, were higher in biological samples of petrochemical drilling employees, while lower essential element levels (iron and zinc) were detected in their samples. This study highlights the significance of adopting better practices to reduce exposure to harmful substances and protect the health of petrochemical drilling workers and the environment. It also suggests that perspective management including policymakers and industry leaders should take measures to minimize exposure to EDCs and heavy metals to promote worker safety and public health. These measures could include the implementation of strict regulations and better occupational health practices to reduce toxic exposure and promote a safer work environment.

The importance of monitoring endocrine-disrupting chemicals and essential elements in biological samples of fertilizer industry workers

Exposure to endocrine-disrupting chemicals (EDCs) can lead to adverse health effects, including immune and endocrine system disruption, respiratory problems, metabolic issues, diabetes, obesity, cardiovascular problems, growth impairment, neurological and learning disabilities, and cancer. Fertilizers, which contain varying levels of heavy metals, are known to pose a significant risk to human health, especially for those residing or working near fertilizer industries. This study aimed to investigate the levels of toxic elements in biological samples of individuals working in a fertilizer industry's quality control and production units and those residing within 100-500 m of the industry. Biological samples, including scalp hair and whole blood, were collected from fertilizer workers, individuals living in the same residential area, and control age-matched persons from nonindustrial areas. The samples were oxidized by an acid mixture before analysis using atomic absorption spectrophotometry. The accuracy and validity of the methodology were verified through certified reference materials from scalp hair and whole blood. The results showed that the concentrations of toxic elements, such as cadmium and lead, were higher in biological samples of quality control and production employees. In contrast, lower essential element levels (iron and zinc) were detected in their samples. These levels were higher than those found in samples collected from residents living within 10-500 m of the fertilizer manufacturing facilities and unexposed areas. This study highlights the significance of adopting better practices to reduce exposure to harmful substances and protect the health of fertilizer industry workers and the environment. It also suggests that policymakers and industry leaders should take measures to minimize exposure to EDCs and heavy metals to promote worker safety and public health. These measures could include implementing strict regulations and better occupational health practices to reduce toxic exposure and promote a safer work environment.

Toxic Elemental Impurities in Herbal Weight Loss Supplements; A Study Using ICP-OES Microwave-Assisted Digestion

The tendency of using weight loss herbal preparations is continuously increasing, especially for the widespread consumption of junk food that is characterized by high calories. Weight loss herbal preparations are considered a type of food supplement product, and, as such, the regulations governing their quality control might be minimal. These products could be locally formulated in any country or internationally imported. Being non-controlled products, the herbal weight-loss products may contain high levels of elemental impurities that might exceed the permissible ranges. Moreover, these products contribute to the total daily intake (TDI) of such elements, which might represent concerns about their potential toxicological danger. In this research, the elemental contents in such products were investigated. The inductively coupled plasma with optical emission spectrometer (ICP-OES) was used to determine the levels of 15 elemental contents, namely, Na, K, Ca, Mg, Al, Cu, Fe, Li, Mn, As, Co, Cr, Cd, Ni and Pb. The results showed that seven micro-elements, namely Cd, Co, Ni, Cr, Pb, Li and Cu, were either not detectable or at a concentration much lower than their tolerable limits. However, all studied macro-elements (Na, K, Ca and Mg), together with Fe, were found at considerable, yet safe levels. On the other hand, Mn, Al and As contents showed perturbing levels in some of the studied products. Finally, a conclusion was highlighted for the necessity for stricter surveillance of such herbal products.

The ignored risk: heavy metal pollution of medicine and food homologous substances

A survey was conducted to investigate the effects of cadmium (Cd), arsenic (As), chromium (Cr), lead (Pb), and copper (Cu) in medicine and food homologous substances (MFHs) on human health. Nine common and typical MFHs (Dendrobium, Bulbus lilii, Poria, Semen nelumbinis, Radix puerariae, Gardenia jasminoides, Hordeum vulgare L, Semen coicis, and Ganoderma Karst) in the form of medicinal slices ready for decoction were purchased from pharmacies. Five among the MFHs (Dendrobium, Bulbus lilii, Poria, Semen nelumbinis, and Radix puerariae) were further obtained from a local field as raw materials for comparison. The results showed that raw materials of MFHs collected from the field had higher contents of heavy metal and greater health risks than medicinal slices purchased from pharmacy. Generally, the heavy metal residues in MFHs of different medicinal parts were different, and MFHs from roots or stems had significantly higher contents of heavy metals than those from fruits or seeds. Most importantly, the contents of Cd in Bulbus lilii and As in wild Poria from field were higher than the contents described in the Pharmacopoeia of the People's Republic of China (ChP). Non-carcinogenic and carcinogenic risk assessments revealed that Poria from field had larger non-carcinogenic and carcinogenic risks to human health; Bulbus lilii showed no non-carcinogenic risk but exhibited carcinogenic risks, whereas Cr showed carcinogenic risks in all samples. Given that MFHs are incorporated in regular foods, care should be taken to minimize health hazards caused by heavy metals to human. This study creates awareness on the safety issues associated with MFHs, and provides basic information for establishing the maximum allowable contents of medicinal and food substances in normal diets.

An Insight into Pathway and Health Risk Assessment of Toxic Metals in Herbal Medicine

Introduction. Along with and in competition with orthodox medicines, herbal medicines have converted into a popular form of cure. While cumulative investigation reports on adverse effects by herbal drug uptake are few, systematic review along with deep insight into other relevant topics (carcinogenic and noncarcinogenic risk assessment, mechanism of toxicity, and entering toxic metal from source to herbal drug) is sporadic. Methods. Therefore, existing research and their published outputs pointing safety assessment of herbal medicines in terms of toxic metals have been reviewed systematically and information synthesized thematically while suggesting mechanism of toxicity, consequence of prolong exposure, and pathway of toxic metal from source to herbal drugs. Result and Discussion. Our study suggests that most of the herbal medicines were unsafe to consume although claimed harmless. Possible pathways regarding migration of toxic metals into herbal medicine are discussed. Conclusion. There should have appropriate screening from herb collection, and manufacturing to selling of finished herbal medicine by authority concerned is backed.

Research progress on speciation analysis of arsenic in traditional Chinese medicine

Traditional Chinese medicine contains arsenic (As), which in the natural environment accumulates in plants during the growth of Chinese medicinal materials; there are mineral medicines containing As in Chinese patent medicine such as As4S4, As2S3, etc. Due to the toxicity of As-containing compounds and its role in inflammation and treatment of cancers such as leukemia, it is necessary to analyze the chemical form of As. A comprehensive investigation of the compound forms of heavy metals rather than the simple total amount of elements will lay the foundation for the scientific and objective evaluation of the safety of heavy metals. This article summarizes the speciation of As in bulk Chinese medicinal materials and Chinese patent medicines in recent years, and reviews the main research methods of As speciation analysis. The separation and detection combined analysis method focuses on the high-performance liquid chromatography-plasma mass spectrometry and high-performance liquid chromatography-hydride generation-atomic fluorescence spectroscopy, etc. Taking the advanced synchrotron radiation source as the research platform, the use of X-ray near edge absorption fine structure spectrum and micro-area X-ray fluorescence analysis as a microscopic analysis technique supports direct analysis of the As speciation in situ. It is the most promising morphological analysis method.

Therapeutic Effects of Traditional Chinese Medicine for Patients With Coronary Heart Disease After Treatment of Revascularization: A Prospective Cohort Study in the Northern of China

Aim: To investigate the compliance and the outcome of Traditional Chinese Medicine (TCM) in patients with coronary heart disease (CHD) after treatment of revascularization.

Methods: In this prospective cohort study, the non-exposure group (NEG), low-exposure group (LEG), and high-exposure group (HEG) were divided after 2 years follow-up. The primary outcome was a composite of death from cardiovascular causes, non-lethal myocardial infarction, heart transplantation, or stroke. Time-to-event data were evaluated by using the Cox regression analysis with hazard ratios (HRs) and 95% CIs. Then, the two-sided p-values were calculated by using the Cox models. In order to indicate the therapeutic effects of TCM on the CHD after revascularization, the survival analysis and the nested case–control study were conducted separately.

Results: There were 1,003 patients with CHD enrolled, 356 patients (35.49%) did not choose the TCM, 379 patients (37.79%) used the TCM seldom, and only 268 patients (26.72%) used TCM regularly. A total of 653 patients with revascularization participated in the prospective cohort study. Over the duration of the trial, the primary endpoints occurred in 12 (4.35%), 11 (4.80%), and 2 (1.35%) patients in the NEG, LEG, and HEG, while the secondary endpoints occurred in 84 (30.43%), 57 (24.89%), and 15 (10.14%) patients in the NEG, LEG, and HEG, respectively. The occurrence time of secondary endpoint events in HEG was significantly postponed (p < 0.001) compared with the other cohorts. The Cox regression analysis indicated that the HRs in the primary endpoints, the secondary endpoint events, the major adverse cardiac and cerebrovascular events (MACCE), and the composite endpoint events for HEG were all around 0.3 (p < 0.05) and HRs for LEG were all around 0.8. The results of the nested case–control study showed that the TCM exposure was significantly different between the cases and controls in the secondary endpoints (p < 0.05), while no significant difference in the primary endpoints (p > 0.05), but the percentage of HEG in the cases was extremely lower than the controls.

Conclusion: The HEG-TCM may improve the outcomes of the patients with CHD after treatment of revascularization.

Registration:http://www.chictr.org.cn. Unique identifier: ChiCTR-OOC-17012995.

Oleuropein-Induced Acceleration of Cytochrome P450-Catalyzed Drug Metabolism: Central Role for Nuclear Receptor Peroxisome Proliferator-Activated Receptor α

Oleuropein (OLE), the main constituent of Olea europaea, displays pleiotropic beneficial effects in health and disease, which are mainly attributed to its anti-inflammatory and cardioprotective properties. Several food supplements and herbal medicines contain OLE and are available without a prescription. This study investigated the effects of OLE on the main cytochrome P450s (P450s) catalyzing the metabolism of many prescribed drugs. Emphasis was given to the role of peroxisome proliferator-activated receptor α (PPARα), a nuclear transcription factor regulating numerous genes including P450s. 129/Sv wild-type and Ppara-null mice were treated with OLE for 6 weeks. OLE induced Cyp1a1, Cyp1a2, Cyp1b1, Cyp3a14, Cyp3a25, Cyp2c29, Cyp2c44, Cyp2d22, and Cyp2e1 mRNAs in liver of wild-type mice, whereas no similar effects were observed in Ppara-null mice, indicating that the OLE-induced effect on these P450s is mediated by PPARα. Activation of the pathways related to phosphoinositide 3-kinase/protein kinase B (AKT)/forkhead box protein O1, c-Jun N-terminal kinase, AKT/p70, and extracellular signal-regulated kinase participates in P450 induction by OLE. These data indicate that consumption of herbal medicines and food supplements containing OLE could accelerate the metabolism of drug substrates of the above-mentioned P450s, thus reducing their efficacy and the outcome of pharmacotherapy. Therefore, OLE-induced activation of PPARα could modify the effects of drugs due to their increased metabolism and clearance, which should be taken into account when consuming OLE-containing products with certain drugs, in particular those of narrow therapeutic window. SIGNIFICANCE STATEMENT: This study indicated that oleuropein, which belongs to the main constituents of the leaves and olive drupes of Olea europaea, induces the synthesis of the major cytochrome P450s (P450s) metabolizing the majority of prescribed drugs via activation of peroxisome proliferator-activated receptor α. This effect could modify the pharmacokinetic profile of co-administered drug substrates of the P450s, thus altering their therapeutic efficacy and toxicity.

Assessment of essential and non-essential elements in selected traditional medicines from India, Ghana and China

Traditional medicine (TM) also known as folk medicine consists of medical knowledge systems that were developed over generations in various countries before the era of modern medicine. Over the last few years, there has been a shift in universal trend from modern medicine to TM because it is believed that these medicines are non-toxic to humans, have little to no side-effects, are readily available and affordable. The purpose of this study was to investigate the essential and non-essential elemental concentrations of ayurvedic medicines (AM), Ghanaian traditional medicines (GTM) and Chinese traditional medicines (CTM). The results indicate that the mean elemental concentrations in TM varied greatly. The mean concentrations of copper and mercury in AM, GTM and CTM ranged from 4 to 45 mg/kg and 0.01 to 2 mg/kg, respectively. Multivariate statistical analyses applied to recognise inter-element associations indicated that at 0.05 significant level, there was a positive correlation between elements suggesting they may have originated from the same source. The study concludes by highlighting the need for monitoring of the elemental concentrations in commonly consumed traditional medicines regularly to detect contamination in these medicines since the occurrence of metals in these medicines above or below legally permissible limits can be harmful to consumers.

Heavy Metal contamination of Dietary Supplements products available in the UAE markets and the associated risk

A specific safety concern is the possibility that a dietary supplement could be contaminated with heavy metals. This research was undertaken to investigate the daily exposure levels of heavy metals in dietary supplements available in the UAE and to explore the factors associated with the contamination of dietary supplements with heavy metals. A total of 277 dietary supplement samples were collected from the UAE market and prepared for the analysis of selected heavy metal contamination. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the presence of heavy metals. The average daily intake of cadmium was 0.73 μg [95% CI 0.61-0.85], compared to the acceptable daily intake (ADI) of 6 μg; the daily intake of lead was 0.85 μg [95% CI 0.62-1.07], compared to the acceptable daily intake (ADI) of 20 μg; and the daily intake of arsenic was 0.67 μg [95% CI 0.57-0.78], compared to the acceptable daily intake of 10 μg. Although the dietary supplements available in the UAE have low levels of heavy metal contamination, numerous individuals are consuming a number of different dietary supplements every day and thereby may experience a cumulative level of toxic exposure. Dietary supplements formulations (Categories), dosage forms and country of origin are strong determents of heavy metal contamination in dietary supplements products.

Chlorella vulgaris Extract as a Serum Replacement That Enhances Mammalian Cell Growth and Protein Expression

The global cell culture market is experiencing significant growth due to the rapid advancement in antibody-based and cell-based therapies. Both rely on the capacity of different living factories, namely prokaryotic and eukaryotic cells, plants or animals for reliable and mass production. The ability to improve production yield is of important concern. Among many strategies pursued, optimizing the complex nutritional requirements for cell growth and protein production has been frequently performed via culture media component titration and serum replacement. The addition of specific ingredients into culture media to modulate host cells’ metabolism has also recently been explored. In this study, we examined the use of extracted bioactive components of the microalgae Chlorella vulgaris, termed chlorella growth factor (CGF), as a cell culture additive for serum replacement and protein expression induction. We first established a chemical fingerprint of CGF using ultraviolet-visible spectroscopy and liquid chromatography-mass spectrometry and evaluated its ability to enhance cell proliferation in mammalian host cells. CGF successfully promoted the growth of Chinese hamster ovary (CHO) and mesenchymal stem cells (MSC), in both 2D and 3D cell cultures under reduced serum conditions for up to 21 days. In addition, CGF preserved cell functions as evident by an increase in protein expression in CHO cells and the maintenance of stem cell phenotype in MSC. Taken together, our results suggest that CGF is a viable culture media additive and growth matrix component, with wide ranging applications in biotechnology and tissue engineering.

Quality tracing evaluation strategies of compatible materials in Aconitum proprietary Chinese medicines

The proprietary Chinese medicine (PCM) has become a significant supplement of modern medicine. Nevertheless, the absence of quality control standard of compatible materials in PCM has led to serious adulteration, which has an extremely bad effect on safety of drug use and clinical efficacy. Here, a quality tracing evaluation strategy of compatible materials in 32 Aconitum proprietary Chinese medicines (APCMs) was established, including data normalization, model development, model verification, and unknown prescription cracking. The model was delimited based on the weighted content of total 9 key alkaloids in 24 APCMs, which were 5.65-57.10 μg/g for extract medicines and 42.62-380.61 μg/g for powder medicines. Three newly published commercial APCMs, including Wangbi Tablet, Wangbi Granule, and Fengshigutong Capsule, were used to verify its reliability and the results proved to be positive. Moreover, a novel prescription cracking approach was proposed to decode the content of each material in five unknown prescriptions including Yaoxitong Capsule, Tongrendahuoluo Pill, Xinbao Pill, Dahuoluo Capsule, and Mugua Pill. Ultimately, the single or two compatible Aconitum materials in APCMs was successfully decoded and the processed level of the materials were effectively judged. This study for the first time established a practical strategy for supervision and cracking of compatible materials in PCMs and is of great significance to improve the quality control of PCMs.

Evaluation of a Web-Based, 'Purchase Event' Intensive Monitoring Method for Pharmacovigilance of Natural Health Products: Lessons and Insights from Development Work in New Zealand

INTRODUCTION

Intensive monitoring methods are used in pharmacovigilance for prescription medicines but have not yet been implemented for natural health products (NHPs).

OBJECTIVES

Our objective was to assess feasibility issues with a new 'purchase event' intensive monitoring method for pharmacovigilance of NHPs, including pharmacy and NHP purchaser recruitment rates, collection of NHP purchaser key patient identifier information for data linkage and quality and completeness of data.

METHODS

For the Ginkgo study, 213 community pharmacies in the Auckland (Aotearoa New Zealand) District Health Board area were invited to participate. Staff in participating pharmacies (n = 3 [1.4%]) recorded ginkgo product sales and gave purchasers a study invitation card (October 2015-January 2016). Ginkgo purchaser participants were emailed links to web-based baseline and follow-up questionnaires about adverse events occurring during/after taking ginkgo. Participating pharmacists and consumers were invited to provide qualitative feedback about the study. For the NHP-Lite study, all NHPs were included for monitoring. Community pharmacies in the Green Cross Health network were invited to participate. Participating pharmacy staff gave all NHP purchasers a study invitation card over a 2-week period (May 2016). NHP purchaser participants were emailed links to web-based baseline, follow-up and feedback questionnaires.

RESULTS

Few community pharmacists (Ginkgo study, n = 3; NHP-Lite study, n = 18) and NHP purchasers (Ginkgo study, n = 0; NHP-Lite study, n = 4) participated. Pharmacists (Ginkgo study, 3/3; NHP-Lite study, 11/18) described several reasons for participating and suggested ways to increase consumer recruitment, including simplifying study procedures.

CONCLUSIONS

These web-based, purchase event, intensive monitoring studies, with cohorts built through NHP purchases in pharmacies, identified substantial issues with recruiting pharmacists/pharmacies and NHP purchasers that, at present, render such studies unfeasible. Future studies need to consider other methods of recruiting NHP purchasers and develop a simple method for recording NHP purchases.

Assessment of lead and cadmium in fifty-four Indian herbal medicine: tribal and marketed varieties

The objective of this study was to assess the toxic metal content in herbal medicines being used by Indian people. Trace elements, lead (Pb) and cadmium (Cd), in fifty-four herbal medicines (marketed and tribal varieties) of India were estimated, and the potential health risks were characterized by estimating the tolerable daily intake (TDI) and the total hazard quotient (THQ) associated with their consumption. A total of 12% of the marketed varieties had Pb above WHO permissible limits of 10 mg Pb/kg. In tribal varieties, none of the samples exceeded this limit. In contrast, all the marketed varieties and 17% of the tribal varieties exceeded WHO limit of 0.3 mg Cd/kg. Consumption of ~ 0.01 kg of herbal medicine per day contributed almost 20-28% of TDI of Pb and Cd for marketed varieties and < 10% for tribal varieties. Although the consumption of the Indian herbal medicine, especially the tribal varieties, posed no immediate concern as the average THQ was less than 1, 24% of the marketed varieties had a higher metal burden and could pose threat on long-term use. Our findings advocate the use of tribal medicines for therapeutic purposes owing to a relatively lesser metal burden than the marketed varieties. However, for the marketed varieties, appropriate standardization in terms of effective quality control and consistency is needed to ensure the health of the consumers.

Blood lead concentration and exposure related factors in Korea from the National Environmental Health Survey (KoNEHS) II (2012-2014)

This study evaluated lead concentrations in blood and related factors among the South Korean population based on data from the Korea National Environmental Health Survey (KoNEHS) II (2012-2014) conducted by the National Institute of Environmental Research and the Ministry of Environment. Personal data were obtained from non-institutionalized civilian Korean individuals in an interview with trained community surveyors using a structured questionnaire (n = 6,455, aged 19 or older, mean age 49.7 years). The lead concentrations in whole blood were analyzed by atomic absorption spectrophotometry (AAS) with a Zeeman-effect-based background corrector. The precision and accuracy of the analytical methods were verified by internal and external quality controls (G-EQUAS, Germany). Statistical analysis was performed using weighted KoNEHS II data separated by sex, and the lead concentration was expressed as a geometric mean (GM). Multiple linear regression was performed using the SPSS 23.0 software package (SPSS Inc., Chicago, IL, USA). The total GM of lead concentrations was 19.5 µg/L. Lead concentrations increased with age and were higher in males (22.8 µg/L) than in females (16.6 µg/L). Smokers and drinkers had higher concentrations than non-smokers and non-drinkers of both sexes. People who used herbal medications had higher concentrations than those who did not among females. People of both sexes living in rural areas had higher lead concentrations than those in urban areas. Lead concentrations also varied with educational level, total family income, the type of water regularly consumed, and occupation. The average lead concentration of the general adult population in Korea has rapidly decreased over time from 45.8 µg/L (1999) to 19.45 µg/L (2012-2014); however, it remains higher than that of the United States, Germany, and Canada. The factors significantly related to lead concentration in South Korea were age, sex, smoking and alcohol drinking status, herbal medication usage by females, residential area, drinking water at home, and occupation. These factors could be used to improve occupational and environmental hygiene among the Korean population.

Assesment of Adulterated Traditional Chinese Medicines in China: 2003-2017

Traditional Chinese medicines (TCMs) represent one form of complementary and alternative medicine. The popularity and complexity in production make them attractive and vulnerable to adulteration in stages ranging from planting to production. Adulteration refers to the addition of extraneous, improper, or inferior ingredients that should not be present in TCMs. To detect and combat adulterated TCMs, supplementary testing methods (STMs), which expand the capability of routine testing standards, have been applied in China since 2003. From 2003 to 2017, a total of 184 STMs for TCMs were approved by the Chinese national drug regulatory authority. By assessing these STMs, this research intends to identify those TCMs vulnerable to adulteration, to list common adulterants, and to characterize the techniques of analysis. The results show that adulteration of TCMs can be classified into three main categories: the addition of undeclared drugs/chemical substances, substitution with non-drug components, and the addition of foreign non-drug materials. The top five therapeutic areas of TCMs vulnerable to adulteration are diabetes, calm and sleep, sexual dysfunction, pain relief, and rheumatism. A total of 166 adulterants were detected in the adulterated TCM preparations and herbal products studied here, with 158 adulterants in TCM preparations and 43 in herbal products, with 35 adulterants in common. Each STM consists of different pharmaceutical analysis techniques, including tests for physical-chemical properties, chromatography, spectroscopic techniques, and mass spectrometry. The analytical methodology of STMs relies on the combination of these techniques, with HPLC ranking the highest percentage (76.1%) and physical-chemical techniques the lowest percentage (11.4%). This research shows that STMs have played a crucial role in combating adulterated TCMs. However, STMs represent merely a product testing-centered regulatory strategy. The inspection of cultivation and manufacturing processes should also be strengthened. More importantly, the awareness and self-discipline of TCM manufacturers in implementing good manufacturing practices and regulating the planting and cultivation of raw materials should be improved.

Role of Unani Medicines in Cancer Control and Management

Background:

Cancer is a havoc and killer disease. Several ways including allopathic chemotherapy have been used in the cancer treatment. Allopathic chemotherapy has several limitations and side effects. Unani medicine is also one of the therapies to cure cancer.

Objective:

In this type of treatment, herbal drugs are used for the treatment and prevention of cancer. The main attractive thing about herbal drug is no side effect as compared to allopathic chemotherapy.

Methods:

Actually, herbal drugs are the extracts of medicinal plants. The plant extracts are obtained by crushing and heating the main part of the plants; showing anticancer activity. The main plants used in the treatment of cancer are oroxylum indicum, dillenia indica, terminalia arjuna etc.

Results:

Mainly the cancers treated are of digestive system, breast, cervical, brain, blood, bone, lungs, thyroid, uterine, bladder, throat etc.

Conclusion:

The present review article discusses the importance of Unani system of medicine for the treatment of cancer. Besides, the future perspectives of Unani medicine in cancer treatment are also highlighted.

Collective exposure to lead from an approved natural product-derived drug in Korea

Background

In Asian countries, including Korea, lead poisoning caused by traditional herbal medicines is often observed in the clinic. However, there have been no reports thus far of lead poisoning caused by drugs that were approved by the Korea Food and Drug Administration (KFDA). Here, we describe seven patients who ingested a problematic natural product-derived drug (NPD).

Case presentation

In July 2018, seven patients visited a university hospital after ingesting an NPD, S. capsules. These patients complained of various symptoms, and their blood lead levels (BLLs) were elevated relative to those of the general population (arithmetic mean: 19.5 ± 11.6 µg/dL, range: 6.28–35.25 µg/dL). The total doses and BLLs were directly proportional to each other among the patients (r = 0.943, p = 0.001). After the patients discontinued drug intake, their BLLs decreased gradually. The capsule was confirmed to contain lead above the standard value (arithmetic mean: 2,547 ± 1,821.9 ppm).

Conclusion

This incident highlights the need to strengthen standards for the management of NPD ingredients in Korea. NPDs are more likely to be contaminated than other drugs. Thorough management by the KFDA is essential to prevent a recurrence. Moreover, systematic health care is needed for many patients who have taken problematic NPDs.

Metals and metalloids in traditional medicines (Ayurvedic medicines, nutraceuticals and traditional Chinese medicines)

Traditional medicine (TM) including Ayurvedic medicines, traditional Chinese medicines and nutraceuticals are popular across the globe as dietary supplements and traditional and alternative medicines. Health risks from these remedies continue to present serious concerns, with occurrences of poisoning by metals and metalloids present at concentrations above acceptable regulatory standards. This review overviews the prevalence of TM use, cases of metal and metalloid poisoning following TM consumption, and forms of TM contamination and adulteration. The review summarises regulations by the World Health Organization (WHO) and other relevant bodies. Finally, the review recommends how to protect consumers.

Emerging Applications of Metabolomics in Traditional Chinese Medicine Treating Hypertension: Biomarkers, Pathways and More

Hypertension is a prevalent, complex, and polygenic cardiovascular disease, which is associated with increased mortality and morbidity. Across the world, traditional Chinese medicine (TCM) constituted by herbal medicine and non-pharmacological therapies is used to assist blood pressure management. Though widely accepted in daily practice, its mechanism remains largely unknown. Recent years saw a number of studies utilizing metabolomics technologies to elucidate the biological foundation of the antihypertensive effect of TCM. Metabolomics is a relatively "young" omics approach that has gained enormous attention recently in cardiovascular drug discovery and pharmacology studies of natural products. In this review, we described the use of metabolomics in deciphering TCM diagnostic codes for hypertension and in revealing molecular events that drive the antihypertensive effect. By corroborating the diagnostic rules, there's accumulating evidence showing that metabolic profile could be the signature of different syndromes/patterns of hypertension, which offers new perspectives for disease diagnosis and efficacy optimization. Moreover, TCM treatment significantly altered the metabolic perturbations associated with hypertension, which could be a crucial mechanism of the therapeutic effect of TCM. Not only significantly rebalances the dynamics of metabolic flux, TCM but also elicits metabolic network reorganization through restoring the functions of key metabolites, and metabolic pathways. The role of TCM in regulating metabolic perturbations will be informative to researchers seeking new leads for drug discovery. This review further envisioned the promises of employing metabolomics to explore network pharmacology, host-gut microbiota interactions and metabolic reprogramming in TCM, and possible herb-drug interactions in this field in future.

Heavy metal pollution and potential health risks of commercially available Chinese herbal medicines

A survey was conducted to investigate the pollution and health risks of copper (Cu), cadmium (Cd), lead (Pb), arsenic (As), mercury (Hg) and zinc (Zn) in 60 Chinese herbal medicines (CHMs) collected from a market in Kunming City, Yunnan Province, China. Furthermore, eight CHMs (Cyathulae radix, Drynariae rhizoma, Peucedani radix, Homalomenae rhizoma, Dryopteris setosa, Polygonati rhizoma, Lilii bulbus, and Linderae radix) containing high Cd concentrations were selected to further analyse their Cd chemical forms. Additionally, the dissolution rates of six heavy metals in decoction liquid were also analysed for four CHMs (Typhonii rhizoma, Linderae radix, Homalomenae rhizoma, and Cyathulae radix), and the health risks of heavy metals in CHMs were evaluated. The results showed that the Cd, Hg and Cu concentrations in the 60 CHMs exceeded the limiting values of the "Green Trade Standards of Importing & Exporting Medicinal Plants & Preparations" (WM2-2001), with exceedance ratios of 38.8%, 8.3% and 1.7%, respectively. The majority of Cd was integrated with pectates and protein in CHMs, and the other five Cd chemical forms followed the order of water-soluble > insoluble heavy metal phosphates > oxalate > residual > inorganic form, indicating that Cd had relatively low bioactivity and toxicity. The average dissolution rates of Zn, Cu, Cd, Hg, As and Pb in the four CHMs were 47.4%, 33.8%, 20.5%, 6.1%, 5.4% and 4.8%, respectively. The calculation results of hazard quotients (HQs) for Cd and Hg showed that the CHMs did not pose a threat to human health.

Dermatoses caused by cultural practices: Therapeutic cultural practices

With globalization and widespread immigration, physicians increasingly encounter patients from varying backgrounds and diverse customs. Although certain cultural practices are widely performed, there is limited medical literature describing their dermatologic and systemic effects and complications. Population diversity and sharing of traditions make it increasingly important for dermatologists to understand the role of cultural practices and recognize physiologic and pathologic sequelae. In addition, dermatologists are often adjured to assess skin findings that may be mistaken for abuse. Child abuse misdiagnosis can be traumatizing to all those involved, and immigrant families with limited English proficiency may have difficulty explaining their traditional practices. The first article of this 2-part continuing medical education series begins with a review of therapeutic cultural practices, including traditional Chinese medicine, Ayurveda, acupuncture, cupping, moxibustion, and coining, and the clinically relevant complications that may occur. Therapeutic practices can cause a range of complications, including contact dermatitis, heavy metal toxicity, and severe cutaneous adverse reactions.

Herb-Induced Liver Injuries in Developing Nations: An Update

The last few decades have seen a rise in the use of herbal supplements, natural products, and traditional medicines. However, there are growing concerns related to the safety and toxicities of these medicines. These herbal medicines are associated with complications such as liver damage with a high incidence of mortalities and morbidities. Clinical manifestations range from asymptomatic cases with abnormal liver functions tests to sudden and severe liver failure necessitating liver transplantation. This work aimed to review the etiology, risk factors, diagnosis, clinical manifestations and selected clinical case reports of herbal hepatotoxicity in developing nations. PubMed and Google Scholar searches were undertaken to identify relevant literature. Furthermore, we scanned the reference lists of the primary and review articles to identify publications not retrieved by electronic searches. Little data exists on clinical cases of herb-induced liver injury in some developing countries such as Nigeria, as most incidences are either not reported to health care providers or reports from hospitals go unpublished. Studies in Nigeria have highlighted a possible correlation between use of herbs and liver disease. In Uganda, and association between the use of traditional herbal medicine with liver fibrosis in HIV-infected and non-HIV patients was demonstrated. Reports from China have revealed incidences of acute liver failure as a result of herbal medicine use. The actual incidence and prevalence of HILI in developing nations remain largely unknown due to both poor pharmacovigilance programs and non-application of emerging technologies. Improving education and public awareness of the potential risks of herbals and herbal products is desirable to ensure that suspected adverse effects are formally reported. There is need for stricter regulations and pre-clinical studies necessary for efficacy and safety.

Heavy metals in contaminated environment: Destiny of secondary metabolite biosynthesis, oxidative status and phytoextraction in medicinal plants

Contamination of soils, water and air with toxic heavy metals by various human activities is a crucial environmental problem in both developing and developed countries. Heavy metals could be introduced into medicinal plant products through contaminated environment (soil, water and air resources) and/or poor production practices. Growing of medicinal plants in heavy metal polluted environments may eventually affect the biosynthesis of secondary metabolites, causing significant changes in the quantity and quality of these compounds. Certain medicinal and aromatic plants can absorb and accumulate metal contaminants in the harvestable foliage and, therefore, considered to be a feasible alternative for remediation of polluted sites without any contamination of essential oils. Plants use different strategies and complex arrays of enzymatic and non-enzymatic anti-oxidative defense systems to cope with overproduction of ROS causes from the heavy metals entered their cells through foliar and/or root systems. This review summarizes the reports of recent investigations involving heavy metal accumulation by medicinal plants and its effects on elicitation of secondary metabolites, toxicity and detoxification pathways, international standards regarding in plants and plant-based products, and human health risk assessment of heavy metals in soil-medicinal plants systems.

Sources, distribution, bioavailability, toxicity, and risk assessment of heavy metal(loid)s in complementary medicines

The last few decades have seen the rise of alternative medical approaches including the use of herbal supplements, natural products, and traditional medicines, which are collectively known as 'Complementary medicines'. However, there are increasing concerns on the safety and health benefits of these medicines. One of the main hazards with the use of complementary medicines is the presence of heavy metal(loid)s such as arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg). This review deals with the characteristics of complementary medicines in terms of heavy metal(loid)s sources, distribution, bioavailability, toxicity, and human risk assessment. The heavy metal(loid)s in these medicines are derived from uptake by medicinal plants, cross-contamination during processing, and therapeutic input of metal(loid)s. This paper discusses the distribution of heavy metal(loid)s in these medicines, in terms of their nature, concentration, and speciation. The importance of determining bioavailability towards human health risk assessment was emphasized by the need to estimate daily intake of heavy metal(loid)s in complementary medicines. The review ends with selected case studies of heavy metal(loid) toxicity from complementary medicines with specific reference to As, Cd, Pb, and Hg. The future research opportunities mentioned in the conclusion of review will help researchers to explore new avenues, methodologies, and approaches to the issue of heavy metal(loid)s in complementary medicines, thereby generating new regulations and proposing fresh approach towards safe use of these medicines.

Adulteration of proprietary Chinese medicines and health products with undeclared drugs: experience of a tertiary toxicology laboratory in Hong Kong

AIMS

Proprietary Chinese medicines (pCMs) and health products, generally believed to be natural and safe, are gaining popularity worldwide. However, the safety of pCMs and health products has been severely compromised by the practice of adulteration. The current study aimed to examine the problem of adulteration of pCMs and health products in Hong Kong.

METHODS

The present study was conducted in a tertiary referral clinical toxicology laboratory in Hong Kong. All cases involving the use of pCMs or health products, which were subsequently confirmed to contain undeclared adulterants, from 2005 to 2015 were reviewed retrospectively.

RESULTS

A total of 404 cases involving the use of 487 adulterated pCMs or health products with a total of 1234 adulterants were identified. The adulterants consisted of approved drugs, banned drugs, drug analogues and animal thyroid tissue. The six most common categories of adulterants detected were nonsteroidal anti-inflammatory drugs (17.7%), anorectics (15.3%), corticosteroids (13.8%), diuretics and laxatives (11.4%), oral antidiabetic agents (10.0%) and erectile dysfunction drugs (6.0%). Sibutramine was the most common adulterant (n = 155). The reported sources of these illicit products included over-the-counter drug stores, the internet and Chinese medicine practitioners. A significant proportion of patients (65.1%) had adverse effects attributable to these illicit products, including 14 severe and two fatal cases. Psychosis, iatrogenic Cushing syndrome and hypoglycaemia were the three most frequently encountered adverse effects.

CONCLUSIONS

Adulteration of pCMs and health products with undeclared drugs poses severe health hazards. Public education and effective regulatory measures are essential to address the problem.

Raisins and Currants as Conventional Nutraceuticals in Italian Market: Natural Occurrence of Ochratoxin A

The healthy consumers make a strong pressure to natural products that can prevent the chronic diseases and improve the general health status, and therefore an important aspect that have to be considered is the safe level of the nutraceuticals. This study reports the occurrence of Ochratoxin A (OTA) and associated fungal contamination in 35 samples of dried vine fruits imported in the European community potentially used for the development of new nutraceutical supplements. High pressure liquid chromatography analysis identified 18 samples as contaminated by OTA with an average level of 2.6 μg/kg. OTA was measured in 4 samples of currants (mean value of 6.6 μg/kg) and 13 samples of raisins (mean value of 1.4 μg/kg). In one sample of currants and one of raisins from Turkey OTA exceeded the limits set by European Commission of 10 μg/kg, being contaminated with 12.61 and 15.99 μg/kg, respectively. All the positive samples were confirmed by Orbitrap Q Exactive through their molecular weight and the corresponding fragmentation. The worldwide consumption of dried vine fruits contributed to OTA exposure in several group of consumers. In particular, considering the potential nutraceutical approach, this consumption may be represent a severe risk for healthy consumers that consider these products like healthy and salutistic for their contents in antioxidants, flavonoids, and polyphenols. Data reported in this study confirmed the need to regularly monitor mycotoxin levels in these food products and optimize the process of fruits drying in order to reduce the development of toxigenic molds.

Unproven Therapies for Diabetes and Their Implications

Diabetes is a chronic disease and is one of the leading causes of morbidity and mortality worldwide. Being an ancient disease, many individuals follow complementary and alternative medicinal (CAM) therapies for either the cure or prevention of the disease. The popularity of these practices among the general public is in no way a testimony to their safety and efficacy. Due to the possibility of undesirable interactions with conventional medicines, it is imperative that patients are asked about CAM use during patient assessment. Patient- and physician-targeted awareness programs on various aspects of CAM use must be initiated to create a better understanding of evidence-based use of these practices. In addition, there should be guidelines in place based on clinical trial outcomes, and stricter regulations need to be enforced on CAM practices to ensure their safety and effectiveness.

Multi-elements determination in medical and edible Alpinia oxyphylla and Morinda officinalis and their decoctions by ICP-MS

Contents of twenty elements (Mg, K, Ca, Na, Fe, Al, Zn, Ba, Mn, Cu, Mo, Cr, Ni, As, Se, Cd, Hg, Tl, Pb and V) in two medical and edible plant species, Alpinia oxyphylla and Morinda officinalis were simultaneously determined by inductively coupled plasma-mass spectrometry (ICP-MS) method after microwave digestion with HNO₃-H₂O₂ (6:1, v/v) as the digestion solvent. Certified standard reference material Poplar leaf was used to assess the accuracy of the method. The greatest contents of Mg, K, Ca, Al, Fe and Na were found in dried Alpinia oxyphylla and Morinda officinalis samples. The contents of five heavy metals including Pb, Cd, As, Hg and Cu in Alpinia oxyphylla did not exceed the limits. The contents of Pb in 76.67% samples and Cd in two batches of Morinda officinalis samples exceeded the limits set by Chinese Pharmacopeia. The contents of the selected elements in different parts (leaves, stems, roots and fruits) of Alpinia oxyphylla varied considerably. The highest concentrations of Mg, Ca, Mn and Se were found in the leaves of Alpinia oxyphylla, at the same time, while, the contents of 9 elements including Cd, Cr, Cu, As, Pb in the roots were the highest. The transfer ratios of selected elements from both species of herbs into their decoctions were reduced. Especially for the heavy metals, the transfer ratios were below 30% except As (79.73%) in Morinda officinalis. The results showed that decoction of the samples may reduce the intake of heavy metals.

Determination of Lead in Smilax luzonensis Herbal Preparations in Malaysia

The DCA (Drug Control Authority) of Malaysia implemented the phase 3 registration of traditional medicines on 1 January 1992. As such, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation containing Smilax luzonensis, either single or combined preparations, were analyzed for the presence of lead, using atomic absorption spectrophotometry. Results showed that 14% of the above products possessed 10.02 to 21.21 ppm of lead, and, therefore, they failed to comply with the quality requirement for traditional medicines in Malaysia (<10 ppm). Although this study showed that 86% of the products complied with the quality requirement for traditional medicines in Malaysia pertaining to lead, they cannot be assumed safe from lead contamination because of batch-to-batch inconsistency.

Evaluation of toxic metals in biological samples (scalp hair, blood and urine) of steel mill workers by electrothermal atomic absorption spectrometry

The determination of toxic metals in the biological samples of human beings is an important clinical screening procedure. This study aimed to assess the possible influence of environmental exposure on production workers (PW) and quality control workers (QCW) of a steel mill, all male subjects aged 25-55 years. In this investigation, the concentrations of Pb, Cd, Ni and Cr were determined in biological samples (blood, urine and scalp hair samples) from these steel mill workers in relation to controlled unexposed healthy subjects of the same age group. After pre-treatment with nitric acid-hydrogen peroxide, the samples were digested via a microwave oven, and for comparison purposes, the same samples were digested by the conventional wet acid digestion method. The samples digested were subjected to graphite furnace atomic absorption spectrometry (GFAAS).

To assess the reliability of these methods, critical factors, such as detection limit(s), calibration range(s), accuracy and precision, were studied. Quality control for these procedures was established with certified sample of human hair, urine and whole blood. The results indicate that the level of lead, cadmium and nickel in scalp hair, blood and urine samples were significantly higher in both groups of exposed workers (QW and PW) than those of the controls. The possible connection of these elements with the etiology of disease is discussed. The results also show the need for immediate improvements in workplace ventilation and industrial hygiene practices. Toxicology and Industrial Health 2006; 22: 381-393.

Cadmium accumulation in Panax notoginseng: levels, affecting factors and the non-carcinogenic health risk

Cadmium (Cd) contamination has been reported to be a problem for the safe usage of Panax notoginseng (Sanchi); thus, it is necessary to elucidate the Cd accumulation in Sanchi and to assess its associated health risk. Samples were collected from major producing areas in Yunnan, China. The average concentration of Cd in Sanchi was 0.43 mg/kg, which exceeds the standard level for herbal medicine in China (0.3 mg/kg). A stepwise regression analysis showed that zinc and the pH were the related factors that most significantly impacted Cd in Sanchi roots. The hazard quotient values were estimated as 0.0010 (men) and 0.0012 (women) for consumers taking preparations and were 0.011 (men) and 0.013 (women) for consumers taking health products, implying that there is no non-carcinogenic hazard associated with Sanchi consumption. However, a Monte Carlo simulation showed that approximately 0.80 % of male and 1.02 % of female consumers via drug consumption and 36.28 % of male and 41.87 % of female consumers via health product consumption had an exposure exceeding the acceptable daily intake (ADI) of Cd from drugs (1 % of the total oral ADI as suggested by the World Health Organization). These people should control their oral Cd intake from both Sanchi consumption and diet as a whole.

Estimation of bioaccessibility and potential human health risk of mercury in Chinese patent medicines

Mercury (Hg), mainly in cinnabar species, has been used in medicine for thousands of years in China, and worldwide concern has been raised on its toxicity. In this work, the amount of bioaccessible mercury in 16 Chinese patent medicines (CPMs) was measured by using an in vitro simulated digestion system, consisting of simulated gastric and intestinal fluid, to investigate the bioavailability of mercury in CPMs and evaluate its potential risk to human health. Total mercury and mercury in the gastrointestinal extracts were measured by inductively coupled plasma mass spectrometry (ICP-MS). The levels of total Hg in 16 CPMs ranged from not detected to 11.89 mg/g, with a mean value of 1.13 mg/g, while the extractable Hg ranged from not detected to 4.37 μg/g, with a mean value of 0.42 μg/g. Mercury bioaccessibility varied significantly in the investigated CPMs, depending on the ingredient. Compared to the CPMs without cinnabar (2.5%-30.9%), the percentage of mercury in the gastrointestinal supernatants for CPMs with cinnabar was quite a bit lower (0.037%). By comparing with the Food and Agricultural Organization/World Health Organization Joint Expert Committee on Food Additives (FAO/WHO) safety guideline, the average daily intake dose (ADD) of Hg in the medicines was then calculated to access the risk of mercury to human health from taking CPMs.

Estimation of calcium, magnesium, cadmium, and lead in biological samples from paralyzed quality control and production steel mill workers

The determination of trace and toxic metals in the biological samples of human beings is an important clinical screening procedure. The aim of the present study was to compare the level of essential trace and toxic elements cadmium (Cd), calcium (Ca), lead (Pb), and magnesium (Mg) in biological samples (whole blood, urine, and scalp hair) of male paralyzed production (PPW) and quality control workers (PQW) of a steel mill, age ranged (35-55 years). For comparison purposes, healthy age-matched exposed referent subjects (EC), working in steel mill and control subjects (NEC), who were not working in industries and lived far away from the industrial areas, were selected as control subjects. The concentrations of electrolytes and toxic elements in biological samples were measured by atomic absorption spectrometry after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked using certified reference materials. The results of this study showed that the mean values of Cd and Pb were significantly higher in scalp hair, blood, and urine samples of PPW and PQW as compared to NEC and EC (p < 0.001), whereas the concentrations of Ca and Mg were found to be lower in the scalp hair and blood but higher in the urine samples of PPW and PQW. The results show the need for immediate improvements in workplace, ventilation, and industrial hygiene practices.

Chemical Composition and Insecticidal Activity of Essential Oils from Zanthoxylum dissitum Leaves and Roots against Three Species of Storage Pests

This work aimed to investigate chemical composition of essential oils obtained from Zanthoxylum dissitum leaves and roots and their insecticidal activities against several stored product pests, namely the cigarette beetle (Lasioderma serricorne), red flour beetle (Tribolium castaneum) and black carpet beetle (Attagenus piceus). The analysis by GC-MS of the essential oils allowed the identification of 28 and 22 components, respectively. It was found that sesquiterpenoids comprised a fairly high portion of the two essential oils, with percentages of 74.0% and 80.9% in the leaves and roots, respectively. The main constituents identified in the essential oil of Z. dissitum leaves were δ-cadinol (12.8%), caryophyllene (12.7%), β-cubebene (7.9%), 4-terpineol (7.5%) and germacrene D-4-ol (5.7%), while humulene epoxide II (29.4%), caryophyllene oxide (24.0%), diepicedrene-1-oxide (10.7%) and Z,Z,Z-1,5,9,9-tetramethyl-1,4,7-cycloundecatriene (8.7%) were the major components in the essential oil of Z. dissitum roots. The insecticidal activity results indicated that the essential oil of Z. dissitum roots exhibited moderate contact toxicity against three species of storage pests, L. serricorne, T. castaneum and A. piceus, with LD₅₀ values of 13.8, 43.7 and 96.8 µg/adult, respectively.

Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network

The Drug-Induced Liver Injury Network (DILIN) studies hepatotoxicity caused by conventional medications as well as herbals and dietary supplements (HDS). To characterize hepatotoxicity and its outcomes from HDS versus medications, patients with hepatotoxicity attributed to medications or HDS were enrolled prospectively between 2004 and 2013. The study took place among eight U.S. referral centers that are part of the DILIN. Consecutive patients with liver injury referred to a DILIN center were eligible. The final sample comprised 130 (15.5%) of all subjects enrolled (839) who were judged to have experienced liver injury caused by HDS. Hepatotoxicity caused by HDS was evaluated by expert opinion. Demographic and clinical characteristics and outcome assessments, including death and liver transplantation (LT), were ascertained. Cases were stratified and compared according to the type of agent implicated in liver injury; 45 had injury caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Liver injury caused by HDS increased from 7% to 20% (P < 0.001) during the study period. Bodybuilding HDS caused prolonged jaundice (median, 91 days) in young men, but did not result in any fatalities or LT. The remaining HDS cases presented as hepatocellular injury, predominantly in middle-aged women, and, more frequently, led to death or transplantation, compared to injury from medications (13% vs. 3%; P < 0.05).

CONCLUSIONS

The proportion of liver injury cases attributed to HDS in DILIN has increased significantly. Liver injury from nonbodybuilding HDS is more severe than from bodybuilding HDS or medications, as evidenced by differences in unfavorable outcomes (death and transplantation). (Hepatology 2014;60:1399-1408).

Adverse events associated with metal contamination of traditional chinese medicines in Korea: a clinical review

This study was performed to review studies carried out in Korea reporting toxic reactions to traditional Chinese medicines (TCMs) as a result of heavy metal contamination. PubMed (1966-August 2013) and International Pharmaceutical Abstracts (1965-August 2013) were searched using the medical subject heading terms of "Medicine, Chinese Traditional," "Medicine, Korean Traditional," "Medicine, Traditional," "Metals, Heavy," and "Drug Contamination". For Korean literature, Korea Med (http://www.koreamed.org), the Korean Medical Database (http://kmbase.medric.or.kr), National Discovery for Science Leaders (www.ndsl.kr), Research Information Sharing Service (http://www.riss.kr), and Google Scholar were searched using the terms "Chinese medicine," "Korean medicine," "herbal medicine," and "metallic contamination" in Korean. Bibliographies of case reports and case series, identified using secondary resources, were also utilized. Only literature describing cases or studies performed in Korea were included. Case reports identified clear issues with heavy metal, particularly lead, contamination of TCMs utilized in Korea. No international standardization guidelines for processing, manufacturing and marketing of herbal products exist. Unacceptably high levels of toxic metals can be present in TCM preparations. Health care providers and patients should be educated on the potential risks associated with TCMs. International advocacy for stricter standardization procedures for production of TCMs is warranted.

Liver injury induced by herbal complementary and alternative medicine

Herbal and dietary supplement use is common. Most marketed products consist of complex mixtures. Although they are perceived as safe, instances of hepatotoxicity attributable to these products underscore their potential for injury, but the exact component that is responsible for injury is difficult to discern. The lenient regulatory environment in the United States, which opens the possibility of adulteration and contamination, adds to the challenge of disease attribution. Although many different herbal and dietary supplements have been reported to cause liver injury, in the United States, products used for bodybuilding and weight loss are the most commonly implicated.

Microbial and heavy metal contamination in commonly consumed traditional Chinese herbal medicines

OBJECTIVE

The increasing popularity and widespread use of traditional Chinese herbs as alternative medicine have sparked an interest in understanding their biosafety, especially in decoctions that are consumed. This study aimed to assess the level of microbial and heavy metal contamination in commonly consumed herbal medicine in Malaysia and the effects of boiling on these contamination levels.

METHODS

Four commonly consumed Chinese herbal medicine in Malaysia-"Eight Treasure Herbal Tea", "Herbal Tea", Xiyangshen (Radix Panacis Quinquefolii) and Dangshen (Radix Codonopsis) were evaluated in this study. Herbal medicines were prepared as boiled and non-boiled decoctions, and their microbial enumeration and heavy metal detection were conducted with plate assay and atomic absorption spectroscopy, respectively.

RESULTS

Findings revealed that herbal medicines generally had 6 log10cfu/mL microbial cells and that boiling had significantly reduced microbial contaminants, where no Bacillus spp., Staphylococcus spp. and Clostridium spp. were recovered. Heavy metals such as Mn, Cu, Cd, Pb, Fe and Zn were also detected from all the samples, generally in low concentrations (< 1 mg/L) except for Mn (18.545 mg/L). All decoctions (after boiling) have reduced concentrations of Cu, while others were not significantly different. Comparisons between samples with single and multi-herbs suggest level of microbial and metal contamination is not influenced by number of herbs in sample.

CONCLUSION

Herbal medicines generally have microbial and heavy metal contaminants. However, the boiling process to generate decoctions was able to successfully reduce the number of microbes and Cu, ensuring safety of herbal medicines for consumption.

Arsenic speciation in Chinese Herbal Medicines and human health implication for inorganic arsenic

Rice and drinking water are recognized as the dominant sources of arsenic (As) for human intake, while little is known about As accumulation and speciation in Chinese Herbal Medicines (CHMs), which have been available for many hundreds of years for the treatment of diseases in both eastern and western cultures. Inorganic arsenic was the predominant species in all of CHMs samples. The levels of inorganic arsenic in CHMs from fields and markets or pharmacies ranged from 63 to 550 ng/g with a mean of 208 ng/g and 94 to 8683 ng/g with a mean of 1092 ng/g, respectively. The highest concentration was found in the Chrysanthemum from pharmacies. It indicates that the risk of inorganic As in CHMs to human health is higher in medicines from markets or pharmacies than that collected directly from fields. Some CHMs may make a considerable contribution to the human intake of inorganic arsenic.

Toxic element contamination of natural health products and pharmaceutical preparations

BACKGROUND

Concern has recently emerged regarding the safety of natural health products (NHPs)-therapies that are increasingly recommended by various health providers, including conventional physicians. Recognizing that most individuals in the Western world now consume vitamins and many take herbal agents, this study endeavored to determine levels of toxic element contamination within a range of NHPs.

METHODS

Toxic element testing was performed on 121 NHPs (including Ayurvedic, traditional Chinese, and various marine-source products) as well as 49 routinely prescribed pharmaceutical preparations. Testing was also performed on several batches of one prenatal supplement, with multiple samples tested within each batch. Results were compared to existing toxicant regulatory limits.

RESULTS

Toxic element contamination was found in many supplements and pharmaceuticals; levels exceeding established limits were only found in a small percentage of the NHPs tested and none of the drugs tested. Some NHPs demonstrated contamination levels above preferred daily endpoints for mercury, cadmium, lead, arsenic or aluminum. NHPs manufactured in China generally had higher levels of mercury and aluminum.

CONCLUSIONS

Exposure to toxic elements is occurring regularly as a result of some contaminated NHPs. Best practices for quality control-developed and implemented by the NHP industry with government oversight-is recommended to guard the safety of unsuspecting consumers.