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Adikusuma W, Firdayani F, Irham LM, Darmawi D, Hamidy MY, Nopitasari BL, Soraya S, Azizah N. Integrated genomic network analysis revealed potential of a druggable target for hemorrhoid treatment. Saudi Pharm J 2023; 31:101831. [PMID: 37965490 PMCID: PMC10641558 DOI: 10.1016/j.jsps.2023.101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Hemorrhoids are a prevalent medical condition that necessitates effective treatment options. The current options for treatment consist of oral medications, topical applications, or surgery, yet a scarcity of highly effective drugs still exists. Genetic markers provide promising avenues for investigating the treatment of hemorrhoids, as they may reveal intricate biological mechanisms and targeted drug therapies, ultimately enhancing more precise treatment tailored to the patient. This study aims to identify new drug candidates for treating hemorrhoids through a meticulous bioinformatics approach and integrated with genomic network analysis. After extracting 21 druggable target genes using DrugBank from 293 genes connected to hemorrhoids, 87 possible drugs were selected. Three of these drugs (ketamine, methylene blue, and fulvestrant) hold potential in addressing issues associated with hemorrhoids and have been supported by clinical or preclinical studies. Eighty-four compounds present new therapeutic possibilities for managing hemorrhoids. We highlight that our findings indicate that NOX1 and NOS3 genes are promising biomarkers, with NOS3 gaining significance owing to its robust systemic functional annotations. Sapropterin, an existing drug, is closely associated with NOS3, providing a clear target for biomarker-driven interventions. This study illustrates the potential of combining genomic network analysis with bioinformatics to repurpose drugs for treating hemorrhoids. Subsequent research will explore the mechanisms for utilizing NOS3 targeting in the treatment of hemorrhoids.
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Affiliation(s)
- Wirawan Adikusuma
- Departement of Pharmacy, University of Muhammadiyah Mataram, Mataram, Indonesia
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), South Tangerang, Indonesia
| | - Firdayani Firdayani
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), South Tangerang, Indonesia
| | | | - Darmawi Darmawi
- Department of Histology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Graduate School in Biomedical Sciences, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
| | - Muhammad Yulis Hamidy
- Department of Pharmacology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
| | | | - Soraya Soraya
- Master Program in Biomedical Sciences, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
| | - Nurul Azizah
- Master Program in Biomedical Sciences, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
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Zhou M, Jin W, Li P, Wang R, Guo X. Traditional Chinese Medicine in the treatment of hemorrhoids-a review of preparations used and their mechanism of action. Front Pharmacol 2023; 14:1270339. [PMID: 37927595 PMCID: PMC10620711 DOI: 10.3389/fphar.2023.1270339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Hemorrhoids are a proctological disease primarily characterized by bleeding, prolapse, edema, and pain, severely affecting the quality of life. Surgery is an effective treatment for hemorrhoids, but the cost is relatively high, and complications such as difficulty in defecation, persistent pain, and heavy bleeding may occur postoperatively. Traditional Chinese Medicine (TCM) has a distinctive advantage in alleviating the clinical symptoms of hemorrhoid patients, reducing pain, and improving the quality of life. However, there are few summary literature about the mechanism of TCM in the prevention and treatment of hemorrhoids. Based on the etiology of hemorrhoids in both traditional Chinese and Western medicine, this paper reviews the recent research on the mechanism of TCM in the treatment of hemorrhoids, hoping to provide a basis for the better application of TCM in clinical and experimental research.
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Affiliation(s)
- Meng’en Zhou
- Department of Anorectal, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | | | | | | | - Xiutian Guo
- Department of Anorectal, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Tao L, Wei J, Ding XF, Ji LJ. Evaluation of the clinical efficacy and safety of TST33 mega hemorrhoidectomy for severe prolapsed hemorrhoids. World J Clin Cases 2022; 10:6060-6068. [PMID: 35949822 PMCID: PMC9254172 DOI: 10.12998/wjcc.v10.i18.6060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pathogenesis of hemorrhoids is mainly anal cushion prolapse. Although the traditional treatment has a certain curative effect, it is not ideal. The remission rate of postoperative symptoms is low. Even if temporary remission is achieved, patients with hemorrhoids easily relapse after 1-2 years. The new technique of using staplers to treat prolapsed hemorrhoids has good therapeutic effects in clinical practice.
AIM To explore the effect of TST33 mega stapler prolapse and hemorrhoid mucosal resection in the treatment of patients with severe prolapsed hemorrhoids.
METHODS A total of 204 patients with severe prolapse hemorrhoids who were admitted to the department of anorectal in our hospital from April 2018 to June 2020 were selected, and the patients were randomly divided into group A and group B with 102 cases in each group using a randomized controlled clinical research program. Patients in Group A were treated with a TST33 mega stapler and hemorrhoid mucosal resection to treat prolapse, and patients in Group B were treated according to the Procedure for Prolapse and Hemorrhoids; the operation time, intraoperative blood loss, hospital stay, the difference in operation time, intraoperative blood loss, hospitalization time, pain degree before and after operation, degree of anal edema, anal Wexner score, and surgical complications were compared between the two groups of patients.
RESULTS The operation time, intraoperative blood loss and hospitalization time in Group A were significantly lower than those in Group B (P < 0.05). The cure rate of Group A was 98.04%, compared with 95.10% cure rate of Group B, and the difference was not statistically significant (P > 0.05). The visual analogue scale (VAS) at 12 h and 24 h postoperatively in Group A were significantly lower than those in Group B (P < 0.05). The comparison of the VAS scores between Group A and Group B at 48 h, 72 h and 96 h postoperatively revealed that the difference was not statistically significant (P > 0.05). One day postoperatively, the degree of perianal edema in Group A was compared with that in Group B, and the difference was not statistically significant (P > 0.05). Seven days postoperatively, the degree of perianal edema in Group A was significantly lower than that in Group B (P < 0.05). The comparison of anal Wexner scores between the two groups preoperatively and at 1 mo, 3 mo and 6 mo postoperatively showed that the difference was not statistically significant (P > 0.05). The Wexner scores of the two groups at 1 mo, 3 mo and 6 mo postoperatively were significantly lower than the scores preoperatively (P < 0.05). The postoperative complication rate of Group A was 2.94% lower than that of Group B (11.76%), which was statistically significant (P < 0.05).
CONCLUSION TST33 mega anastomotic hemorrhoidectomy treatment for patients with severe prolapse hemorrhoids, leads to less postoperative pain, the rapid recovery of perianal edema and has fewer complications.
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Affiliation(s)
- Liu Tao
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu 215500, Jiangsu Province, China
| | - Jun Wei
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu 215500, Jiangsu Province, China
| | - Xu-Feng Ding
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu 215500, Jiangsu Province, China
| | - Li-Jiang Ji
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu 215500, Jiangsu Province, China
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Effectiveness of Mayinglong Musk Hemorrhoid Ointment on Wound Healing and Complications after Internal Hemorrhoid Ligation and External Hemorrhoidectomy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5630487. [PMID: 35722161 PMCID: PMC9203207 DOI: 10.1155/2022/5630487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the effect of Mayinglong Musk Hemorrhoids Ointment on wound healing and complications after internal hemorrhoid ligation and external hemorrhoidectomy. Methods This is a retrospective study. A total of 100 patients with mixed hemorrhoids who were treated in our hospital from August 2019 to October 2020 were recruited and assigned to an operation group (n = 50, internal hemorrhoid ligation, and external hemorrhoidectomy) or a combined group (n = 50, use of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy). The wound-healing effect, wound-healing time, visual analog scale (VAS), anal function, and complications were compared between the two groups. Results The combined group exhibited a significantly higher total effective rate of wound healing when compared with the operation group (p < 0.05). The patients in the combined group experienced remarkably faster wound healing than the operation group (p < 0.05). The visual analog scale (VAS) score of the combined group was significantly lower than that of the operation group (p < 0.05). The combined group obtained superior anal function than the operation group (p < 0.001). Conclusion Mayinglong Musk Hemorrhoid Ointment combined with internal hemorrhoid ligation and external hemorrhoidectomy in the treatment of mixed hemorrhoids yields remarkable outcomes. It improves the wound healing outcomes, accelerates wound healing, relieves postoperative pain, enhances anal function, and reduces the occurrence of postoperative complications in the patient.
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Zhang H, Yao XY, Zhang DF, Guo QL, Yang JJ, Zhu BG, Shen DX, Ruan KF, Wang Y, Peng JL. Anti-hemorrhoidal activity of Lian-Zhi-San, a traditional Chinese medicine, in an experimental hemorrhoidal model in rats. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 19:42-49. [PMID: 33139224 DOI: 10.1016/j.joim.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/07/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Hemorrhoidal disease (HD) is the most common proctological disease, with an estimated prevalence rate of 4.4%, and a peak in individuals between 45 and 65 years of age. This study was done to evaluate whether Lian-Zhi-San (LZS), a clinically used anti-hemorrhoidal ointment could alleviate the inflammatory injury, with its associated changes of inflammatory cytokines and morphology of anorectal tissues, in an experimental model of HD in rats. METHODS HD was induced by croton oil preparation (COP) applied to the anorectal region. Rats were then treated with cotton swabs soaked in LZS ointment, water or white vaseline, twice a day for 7 d. At the end of the experiment, HD was evaluated by measuring hemorrhoidal and biochemical parameters along with histopathological observations. RESULTS In this study, COP induced a significant increase in the macroscopic severity score, anorectal coefficient and Evans blue extravasation, compared to normal rats. Additionally, it greatly enhanced the expression and secretion levels of some important inflammation-related cytokines along with marked histological damage, compared to normal rats. Rats treated with LZS ointment experienced significantly ameliorated Evans blue extravasation (P < 0.05), decreased macroscopic severity score (0.86 ± 0.14 vs. 1.65 ± 0.16) and the anorectal coefficient (P < 0.01); its use also attenuated tissue damage and inhibited the expression and secretion levels of inflammation-related cytokines (interleukin-1β, interleukin-6 and tumor necrosis factor-α). CONCLUSION This study validates a preliminary understanding of the use of LZS ointment to treat inflammatory factors and tissue damage in an experimental model of HD in rats.
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Affiliation(s)
- Hua Zhang
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China
| | - Xiang-Yang Yao
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China
| | - Dan-Feng Zhang
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China
| | - Qi-le Guo
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China
| | - Jun-Jun Yang
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China
| | - Bao-Guo Zhu
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China
| | - Dong-Xiao Shen
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China
| | - Ke-Feng Ruan
- Innovation Research Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Shanghai Zhangjiang Engineering Research Center of Modern Preparations of TCM, Shanghai 201203, China
| | - Yuan Wang
- Innovation Research Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jun-Liang Peng
- Anorectal Department, Shanghai Jinshan TCM-Integrated Hospital, Shanghai 201501, China.
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Gokce AH, Gokce FS, Durmus S, Hajiyeva R, Ersoz F, Gelisgen R, Uzun H. The effect of nitric oxide, endothelial nitric oxide synthetase, and asymmetric dimethylarginine in hemorrhoidal disease. ACTA ACUST UNITED AC 2020; 66:1128-1133. [PMID: 32935809 DOI: 10.1590/1806-9282.66.8.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/28/2020] [Indexed: 08/30/2023]
Abstract
AIM The aim of this study was to examine the roles of nitric oxide (NOx), endothelial nitric oxide synthetase (eNOS), and asymmetric dimethylarginine (ADMA), which is the major endogenous inhibitor of nitric oxide synthases (NOS), in the pathophysiology of hemorrhoidal disease. METHODS This study included 54 patients with grades 3 and 4 internal hemorrhoidal disease and 54 patients without the disease who attended the General Surgery Clinic. NOx, eNOS, and ADMA levels were measured with the Enzyme-Linked ImmunoSorbent Assay (ELISA) method. RESULTS The patients had higher NO and eNOS levels and lower ADMA levels than the control subjects (p<0.001). A significant highly positive correlation was found between NO and eNOS (p<0.001). Nevertheless, there was a highly negative correlation between ADMA and NO-eNOS(p<0.001, p<0.001). CONCLUSION This preliminary study reveals that higher NOx and eNOS activities and lower ADMA levels in the rectal mucosa are observed in patients with hemorrhoidal disease than in those with normal rectal tissue. The imbalance between endothelium-derived relaxing factors, such as NO and endogenous competitive inhibitor of NOS, ADMA, may cause hemorrhoidal disease. Our study proposes that hemorrhoids display apparent vascular dilatation and present with bleeding or swelling. ADMA is an effective NOS inhibitor and may be a promising therapeutic option for hemorrhoidal disease.
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Affiliation(s)
- Aylin Hande Gokce
- . Assistant Professor. Department of General Surgery, Istanbul Atlas University Faculty of Medicine, Istanbul, Turkey
| | | | - Sinem Durmus
- . Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ramila Hajiyeva
- . Assistant Doctor. Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Feyzullah Ersoz
- . Associate Professor. Department of General Surgery. Istanbul Training Research Hospital, Istanbul, Turkey
| | - Remise Gelisgen
- . Professor Doctor. Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hafize Uzun
- . Professor Doctor. Department of Medical Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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