Sceletium for Managing Anxiety, Depression and Cognitive Impairment: A Traditional Herbal Medicine in Modern-Day Regulatory Systems

Exploring trends in natural product-based treatments to skin burn: A comprehensive review

BACKGROUND

Burns are traumatic injuries caused by thermal, chemical, or other external factor, significantly impacting organic tissue. They are among the most common and severe types of trauma worldwide, often resulting in considerable morbidity and mortality. Natural products, owing to their pharmacological properties, present promising avenues for burn management and treatment.

PURPOSE

This study aims to provide a comprehensive review of patented pharmaceutical formulations containing natural products for burn treatment and to define trends in the market.

METHODS

Patent documents were identified through searches in the World Intellectual Property Organization (WIPO) and European Patent Office (EPO) databases using "burn*" as a keyword in the title and/or abstract and International Patent Classification (IPC) code A61K36/00. The review also examines clinical trials and SWOT analyses to evaluate strengths, weaknesses, opportunities, and threats in this field.

RESULTS

A total of 82 patents were selected, highlighting the use of natural products, such as Aloe vera, Coptis chinensis, borneol, menthol, and propolis, predominantly derived from Traditional Chinese Medicine. These findings are supplemented with clinical trial data and market insights. The results underscore both the therapeutic efficacy and challenges, such as standardization and regulatory hurdles, of using natural products.

CONCLUSION

This patent review highlights the potential of natural-origin formulations in addressing the limitations of conventional burn treatments. Continued research is essential to overcome existing barriers, ensuring broader accessibility and enhanced therapeutic outcomes.

Dynamics of alkaloid accumulation in Narcissus cv. Hawera: a source of Sceletium-type alkaloids

The Sceletium-type alkaloids, known for their anxiolytic and antidepressant activities, have been recently found to be biosynthesized in Narcissus cv. Hawera, which is largely used as an ornamental plant. An alkaloid fraction enriched with Sceletium-type alkaloids from the plant has shown promising antidepressant and anxiolytic activities. In the present study, qualitative and quantitative analyses of the alkaloids in the plant organs were performed during one vegetation season by GC-MS. The alkaloid pattern and total alkaloid content was found to depend strongly on the stage of development and plant organ. The alkaloid content of bulbs was found to be highest during the dormancy period and lowest in sprouting bulbs. The leaves showed the highest alkaloid content during the intensive vegetative growth and lowest during flowering. In total, 13 alkaloids were detected in the methanol extracts of Narcissus cv. Hawera, six Sceletium-type and seven typical Amaryllidaceae alkaloids. Major alkaloids in the alkaloid pattern were lycorine, 6-epi-mesembrenol, mesembrenone, sanguinine, and galanthamine. The leaves of flowering plants were found to have the highest amount of 6-epi-mesembrenol. Mesembrenone was found to be dominant alkaloid in the leaves of sprouting bulbs and in the flowers. Considering the biomass of the plant, the dormant bulbs are the best source of alkaloid fractions enriched with 6-epi-mesembrenol. The flowers and the young leaves can be used for preparation of alkaloid fractions enriched with mesembrenone. The results indicates that Narcissus cv. Hawera is an emerging source of valuable bioactive compounds and its utilization can be extended as a medicinal plant.

Skeletons in the closet? Using a bibliometric lens to visualise phytochemical and pharmacological activities linked to Sceletium, a mood enhancer

Plants from the Sceletium genus (Aizoaceae) have been traditionally used for millennia by the Khoe and Khoen people in southern Africa, as an appetite suppressant as well as a mood elevator. In more recent times, this mood-elevating activity has been commercialised in the South African natural products industry for the treatment of anxiety and depression, with several products available both locally and abroad. Research on this species has seen rapid growth with advancements in analytical and pharmacological tools, in an effort to understand the composition and biological activity. The Web of Science (WoS) database was searched for articles related to 'Sceletium' and 'Mesembrine'. These data were additionally analysed by bibliometric software (VOSviewer) to generate term maps and author associations. The thematic areas with the most citations were South African Traditional Medicine for mental health (110) and anxiolytic agents (75). Pioneer studies in the genus focused on chemical structural isolation, purification, and characterisation and techniques such as thin layer chromatography, liquid chromatography (HPLC, UPLC, and more recently, LC-MS), gas chromatography mass spectrometry (GC-MS), and nuclear magnetic resonance (NMR) to study mesembrine alkaloids. Different laboratories have used a diverse range of extraction and preanalytical methods that became routinely favoured in the analysis of the main metabolites (mesembrine, mesembranol, mesembranone, and Sceletium A4) in their respective experimental settings. In contrast with previous reviews, this paper identified gaps in the research field, being a lack of toxicology assays, a deficit of clinical assessments, too few bioavailability studies, and little to no investigation into the minor alkaloid groups found in Sceletium. Future studies are likely to see innovations in analytical techniques like leaf spray mass spectrometry and direct analysis in real-time ionisation coupled with high-resolution time-of-flight mass spectrometry (DART-HR-TOF-MS) for rapid alkaloid identification and quality control purposes. While S. tortuosum has been the primary focus, studying other Sceletium species may aid in establishing chemotaxonomic relationships and addressing challenges with species misidentification. This research can benefit the nutraceutical industry and conservation efforts for the entire genus. At present, little to no pharmacological information is available in terms of the molecular physiological effects of mesembrine alkaloids in medical clinical settings. Research in these fields is expected to increase due to the growing interest in S. tortuosum as a herbal supplement and the potential development of mesembrine alkaloids into pharmaceutical drugs.

Uzara (Xysmalobium undulatum) - An underutilized anti-diarrhoeic and spasmolytic herbal remedy

ETHNOPHARMACOLOGICAL RELEVANCE

Uzara, Xysmalobium undulatum (L.) W.T.Aiton, a herbal medicine for diarrhoea and smooth-muscle cramps is little-known outside Germany, where it has had a market presence for ∼110 years. The early introduction of this Southern African medicinal plant into Europe and the US was entrepreneurially driven, similar to buchu (Agathosma spp.) and Umckaloabo (Pelargonium sidoides DC.). Much of its history of commercialization, from its origin, identity and supply chain to its composition and clinical evidence of efficacy and safety, has been poorly studied and/or scantly published.

AIM OF THE STUDY

The aim of this review is to uncover enough data to create a coherent timeline, many of which are published here for the first time, and to evaluate all published data, mostly historical and/or elusive, to corroborate Uzara's status as a safe and efficacious botanical medicine.

MATERIALS AND METHODS

Multiple searches were conducted in the PubMed, Scopus, Web of Science, Science Direct, and Google Scholar databases with the following keywords: all scientific and common plant names combined with taxonomy, nomenclature, ethnobotany, traditional use, ecology, cultivation, sustainability, economy, trade, CITES, chemistry, biochemistry, compounds, pre-clinical, pharmacology, clinical, RCT, safety, toxicology, veterinary, review for the period of 1600-2022. Reference sections of selected publications were searched manually. Additionally, product registration databases of national competent health authorities in Europe were consulted for products, license holders and formulations.

RESULTS

The authors find an underutilized potential of uzara as anti-diarrhoeic (with or without underlying infection) and spasmolytic remedy. A by-product of this review is a largely inclusive bibliography of publications on uzara.

CONCLUSIONS

Further clinical research supporting antidiarrhoeal and spasmolytic efficacy would be desirable.

Stevens' Cure (Umckaloabo)-the vindication of a patent medicine

Stevens' Cure (Umckaloabo) emerged as a patent medicine claiming to treat tuberculosis in the United Kingdom at the beginning of the 20th century. However, due to its identity being shrouded in secrecy, it was never truly accepted by the medical community. It was "rediscovered" in the 1970s and subsequently developed into a very popular and successful phytopharmaceutical for the treatment of upper respiratory tract infections. Whether Stevens' Cure contained the same ingredient(s) as the modern Umckaloabo has not yet been demonstrated. We attempted to elucidate for the first time the identity of the original ingredient by comparative analysis of historical product samples. Three historical samples of Stevens' Cure were compared with Pelargonium sidoides DC. and P. reniforme Curt. root per UPLC-MS analysis. We confirm that the ingredient-P. sidoides DC.-is indeed the same as used in modern phytotherapy. We also attribute the first ethnopharmacological record of P. sidoides DC. being used for the treatment of tuberculosis to C. H. Stevens, the "creator" of Umckaloabo.

Ethnopharmacology and biological activities of the Aizoaceae

ETHNOPHARMACOLOGICAL RELEVANCE

The Aizoaceae is one of the largest succulent plant families. Most members of the family are ornamental and form part of specialist succulent collections. The exceptional diversity of the Aizoaceae is not only limited to its growth forms, habitat, and chemistry, but is also reflected in its many traditional uses. Selected species are well known for their use in traditional medicines, with recent scientific studies validating their biological activity.

AIM OF THE STUDY

Herein, this review aimed to articulate foundational and current global research endeavors related to the traditional uses and pharmacological activities of the Aizoaceae.

MATERIALS AND METHODS

Research articles and search terms related to the ethnopharmacology and bioactivities of the Aizoaceae between 1940 and 2022 were evaluated using electronic databases such as Google Scholar, PubMed, ScienceDirect, Scopus, JSTOR, and Web of Science.

RESULTS

Popular Aizoaceae genera including Mesembryanthemum, Trianthema, and Tetragonia are noted for their cultural value and are key components in herbal medicines for the treatment of a myriad of disorders. Isolated bioactive compounds isolated from selected species demonstrated varied antimicrobial, antioxidant, and neuroprotective functions in basic pharmacological studies. However, most studies lacked reliable correlation to in vivo activity and did not adequately validate the safety and efficacy of potential therapeutic compounds.

CONCLUSIONS

While the cultural and therapeutic value of popular Aizoaceae species have been highlighted in the literature, there remains glaring inconsistencies among other related species. Data deficiency may be ameliorated by further studies focused on taxonomic markers, chemical characterization and underlying molecular mechanisms of activity of a wider pool of species to enhance our knowledge of this hyperdiverse family.

An acute dose-ranging evaluation of the antidepressant properties of Sceletium tortuosum (Zembrin®) versus escitalopram in the Flinders Sensitive Line rat

ETHNOPHARMACOLOGICAL RELEVANCE

Sceletium tortuosum (L.) N.E.Br. (ST) has been used by the Khoisan people of South Africa as a mood elevator. Its various pharmacological mechanisms of action suggest distinct potential as an antidepressant. Clinical studies in healthy individuals suggest beneficial effects on mood, cognition, and anxiety.

AIM OF THE STUDY

To obtain a chromatographic fingerprint of a standardized extract of S. tortuosum (Zembrin®), and to evaluate the acute antidepressant-like properties of Zembrin® versus the reference antidepressant, escitalopram, in the Flinders Sensitive Line (FSL) rat, a genetic rodent model of depression.

MATERIALS AND METHODS

The chemical profile of Zembrin® was determined by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) chromatogram method using alkaloid standards. Twelve saline treated FSL and six Flinders Resistant Line (FRL) control rats were used to confirm face validity of the FSL model using the forced swim test (FST). Thereafter, FSL rats (n = 10) received either 5, 10, 25, 50 or 100 mg/kg of Zembrin®, or 5, 10 or 20 mg/kg escitalopram oxalate (ESC), both via oral gavage, and subjected to the open field test (OFT) and FST.

RESULTS

Four main ST alkaloids were identified and quantified in Zembrin® viz. mesembrenone, mesembrenol, mesembrine, and mesembranol (47.9%, 32%, 13.2%, and 6.8% of the total alkaloids, respectively). FSL rats showed significantly decreased swimming and climbing (coping) behaviours, and significantly increased immobility (despair), versus FRL controls. ESC 5 mg/kg and Zembrin® 25 mg/kg and 50 mg/kg showed significant dose-dependent reversal of immobility in FSL rats and variable effects on coping behaviours. Zembrin® 50 mg/kg was the most effective antidepressant dose, showing equivalence to ESC 5.

CONCLUSIONS

Zembrin® (25 and 50 mg/kg) and ESC (5 mg/kg) are effective antidepressants after acute treatment in the FST, as assessed in FSL rats. Moreover, Zembrin® 50 mg/kg proved equivalent to ESC 5. Further long-term bio-behavioural studies on the antidepressant properties of Zembrin® are warranted.

Buchu (Agathosma betulina and A. crenulata): Rightfully Forgotten or Underutilized?

Today, the term buchu refers to the two species in commerce, Agathosma betulina (P.J.Bergius) Pillans and Agathosma crenulata (L.) Pillans (Rutaceae). Its traditional use in urinary tract infections and related ailments made it a popular remedy, specifically in the US, in 19th century, but with the advent of antibiotics it became largely obsolete. Recent focus is on technological use and on the essential oil for use in the perfume and food-flavouring industry. A review of the scarce pharmacological research revealed moderate antimicrobial activity for a leaf extract but not the essential oil of both species in the MIC assay. In the 5-lipoxygenase (5-LO) assay the essential oil of both species revealed IC50 values of 50.37 ± 1.87 μg/ml and 59.15 ± 7.44 μg/ml, respectively. In another study 98% inhibitory activity was determined for 250 μg/ml of an ethanolic extract of A. betulina on cyclooxygenase (COX)-1 and a 25% inhibitory activity on COX-2. Analgesic activity of an ethanolic extract of A. betulina was shown in mice. Moderate antioxidant activity was determined for methanol:dichlormethane extracts of A. betulina and A. crenulata and an aqueous extract of A. betulina showed a Trolox equivalent antioxidant capacity (TEAC) of 11.8 µM Trolox. Recent in vitro studies with a commercial aqueous extract of buchu revealed increased uptake of glucose added to 3T3-L1 cell line, significant inhibition of the respiratory burst of neutrophils and monocytes, reduction in the expression of adhesion molecules and inhibition of the release of IL-6 and TNF-α. In diabetic rats the ingestion of aqueous buchu extract completely normalized the glucose level and in rats receiving a high fat diet the consumption of aqueous buchu extract resulted in less weight gain and less intraperitoneal fat gain as well as reduction of elevated blood pressure to normal associated with cardioprotective effects. Limitations in the hitherto conducted research lie in the undisclosed composition of the buchu extracts used and the difficulty in extrapolating data from animal studies to humans. Health claims for buchu products need to be substantiated by randomized, double-blind and placebo-controlled studies. Only then can they be promoted for their true therapeutic potential.