Ginkgo Biloba: A Famous Living Fossil Tree and an Ancient Herbal Traditional Chinese Medicine

Ginkgo biloba extract safety: Insights from a real-world pharmacovigilance study of FDA adverse event reporting system (FAERS) events

ETHNOPHARMACOLOGICAL RELEVANCE

A traditional Chinese medicine extracted from the Ginkgophyta, Ginkgo biloba is commonly used to treat cardiac cerebral disease all over the world. Limited data exist regarding adverse drug reactions associated with Ginkgo biloba extract post-marketing.

AIM OF THE STUDY

Currently, the drug safety profile of Ginkgo biloba extract is assessed using a substantial volume of case safety reports within the FDA Adverse Event Reporting System (FAERS) database.

MATERIALS AND METHODS

The study collected adverse events (AEs) data associated with Ginkgo biloba extract as the primary suspected drug from 2004 to 2023 from the FAERS database. A standardized mapping analysis of System Organ Class (SOC) and preferred term (PT) was conducted. Utilizing reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and empirical Bayes geometric mean (EBGM), significant disproportionate measurement signals of adverse drug reactions (ADR) were identified and high-intensity signals were analyzed.

RESULTS

700 reports of adverse events related to Ginkgo biloba extract were found in the FAERS database, affecting 23 organ systems. 88 significant mismatches were identified using four algorithms, leading to unexpected major adverse events like amaurosis fugax, fractional exhaled nitric oxide created, and obstructive sleep apnoea syndrome. The study observed a median onset time of AE associated with Ginkgo biloba extract at 7 days (interquartile interval [IQR] 0-109 days), with the majority of AE manifesting within the initial 7 days of drug treatment initiation. This investigation identified a noteworthy AE signal for Ginkgo biloba extract, underscoring the importance of clinical surveillance and risk assessment in its use.

CONCLUSIONS

In clinical practice, this study provides a deeper and broader understanding of suspected adverse reactions associated with Ginkgo biloba extract.

Diet and Nutraceuticals for treatment and prevention of primary and secondary stroke: Emphasis on nutritional antiplatelet and antithrombotic agents

Ischemic stroke is a devastating disease that causes morbidity and mortality. Malnutrition following ischemic stroke is common in stroke patients. During the rehabilitation, the death rates of stroke patients are significantly increased due to malnutrition. Nutritional supplements such as protein, vitamins, fish, fish oils, moderate wine or alcohol consumption, nuts, minerals, herbal products, food colorants, marine products, fiber, probiotics and Mediterranean diets have improved neurological functions in stroke patients as well as their quality of life. Platelets and their mediators contribute to the development of clots leading to stroke. Ischemic stroke patients are treated with thrombolytics, antiplatelets, and antithrombotic agents. Several systematic reviews, meta-analyses, and clinical trials recommended that consumption of these nutrients and diets mitigated the vascular, peripheral, and central complications associated with ischemic stroke (Fig. 2). Particularly, these nutraceuticals mitigated the platelet adhesion, activation, and aggregation that intended to reduce the risks of primary and secondary stroke. Although these nutraceuticals mitigate platelet dysfunction, there is a greater risk of bleeding if consumed excessively. Moreover, malnutrition must be evaluated and adequate amounts of nutrients must be provided to stroke patients during intensive care units and rehabilitation periods. In this review, we have summarized the importance of diet and nutraceuticals in ameliorating neurological complications and platelet dysfunction with an emphasis on primary and secondary prevention of ischemic stroke.

Pleiotropic attenuating effect of Ginkgo biloba against isoprenaline-induced myocardial infarction via improving Bcl-2/mTOR/ERK1/2/Na+, K+-ATPase activities

Objective

Myocardial infarction (MI) is linked to an imbalance in the supply and demand of blood oxygen in the heart muscles. Beta-blockers and calcium antagonists are just two of the common medications used to treat MI. However, these have reportedly been shown to be either ineffective or to have undesirable side effects. Extract of Ginkgo biloba leaves (GBE), a Chinese herbal product offers special compatibility benefits in therapeutic settings relating to inflammatory diseases and oxidative stress. In order to better understand how GBE affects MI in rats insulted by isoprenaline (ISO), the current study was designed.

Methods

The heart weight index, serum lipid profile, cardiac marker enzymes, endogenous antioxidants [catalase (CAT), superoxide dismutase (SOD), glutathione (GSH), nitrites and malondialdehyde (MDA)], inflammatory mediators [tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6)], immunohistochemical expressions of B-cell lymphoma factor-2 (Bcl-2), extracellular signal-regulated kinase (ERK1/2), and mammalian target of rapamycin (mTOR) and histopathological analysis were used to assess the cardioprotective properties of GBE.

Results

The findings showed that GBE effectively attenuated myocardial infarction by boosting the body's natural antioxidant defense system and reducing the release of inflammatory cytokines as well as heart injury marker enzymes. The expression of Bcl-2, ERK1/2 and mTOR was increased while the histomorphological alterations were reversed.

Conclusion

The cardioprotective effects of GBE may be due to a mechanism involving increased Bcl-2/mTOR/ERK1/2/Na+, K+-ATPase activity.

Ginkgo biloba modulates ET-I/NO signalling in Lead Acetate induced rat model of endothelial dysfunction: Involvement of oxido-inflammatory mediators

This study investigated the modulatory effect of Ginkgo biloba extract on lead acetate-induced endothelial dysfunction. Animals were administered GBE (50 mg/kg and 100 mg/kg orally) after exposures to lead acetate (25 mg/kg orally) for 14 days. Aorta was harvested after euthanasia, the tissue was homogenised, and supernatants were decanted after centrifuging. Oxidative, nitrergic, inflammatory, and anti-apoptotic markers were assayed using standard biochemical procedure, ELISA, and immunohistochemistry, respectively. GBE reduced lead-induced oxidative stress by increasing SOD, GSH, and CAT as well as reducing MDA levels in endothelium. Pro-inflammatory cytokines (TNF-α and IL-6) were reduced while increasing Bcl-2 protein expression. GBE lowered endothelin-I and raised nitrite levels. Histological changes caused by lead acetate were normalised by GBE. Our findings suggest that Ginkgo biloba extract restored endothelin-I and nitric oxide functions by increasing Bcl-2 protein expression and reducing oxido-inflammatory stress in endothelium.

TiO2-Nanowired Delivery of Chinese Extract of Ginkgo biloba EGb-761 and Bilobalide BN-52021 Enhanced Neuroprotective Effects of Cerebrolysin Following Spinal Cord Injury at Cold Environment

Military personnel during combat or peacekeeping operations are exposed to extreme climates of hot or cold environments for longer durations. Spinal cord injury is quite common in military personnel following central nervous system (CNS) trauma indicating a possibility of altered pathophysiological responses at different ambient temperatures. Our previous studies show that the pathophysiology of brain injury is exacerbated in animals acclimated to cold (5 °C) or hot (30 °C) environments. In these diverse ambient temperature zones, trauma exacerbated oxidative stress generation inducing greater blood-brain barrier (BBB) permeability and cell damage. Extracts of Ginkgo biloba EGb-761 and BN-52021 treatment reduces brain pathology following heat stress. This effect is further improved following TiO₂ nanowired delivery in heat stress in animal models. Several studies indicate the role of EGb-761 in attenuating spinal cord induced neuronal damages and improved functional deficit. This is quite likely that these effects are further improved following nanowired delivery of EGb-761 and BN-52021 with cerebrolysin-a balanced composition of several neurotrophic factors and peptide fragments in spinal cord trauma. In this review, TiO₂ nanowired delivery of EGb-761 and BN-52021 with nanowired cerebrolysin is examined in a rat model of spinal cord injury at cold environment. Our results show that spinal cord injury aggravates cord pathology in cold-acclimated rats and nanowired delivery of EGb-761 and BN-52021 with cerebrolysin significantly induced superior neuroprotection, not reported earlier.

A Comprehensive Review on Nutraceuticals: Therapy Support and Formulation Challenges

Nutraceuticals are the nourishing components (hybrid of nutrition and pharmaceuticals) that are biologically active and possess capability for maintaining optimal health and benefits. These products play a significant role in human health care and its endurance, most importantly for the future therapeutic development. Nutraceuticals have received recognition due to their nutritional benefits along with therapeutic effects and safety profile. Nutraceuticals are globally growing in the field of services such as health care promotion, disease reduction, etc. Various drug nutraceutical interactions have also been elaborated with various examples in this review. Several patents on nutraceuticals in agricultural applications and in various diseases have been stated in the last section of review, which confirms the exponential growth of nutraceuticals' market value. Nutraceuticals have been used not only for nutrition but also as a support therapy for the prevention and treatment of various diseases, such as to reduce side effects of cancer chemotherapy and radiotherapy. Diverse novel nanoformulation approaches tend to overcome challenges involved in formulation development of nutraceuticals. Prior information on various interactions with drugs may help in preventing any deleterious effects of nutraceuticals products. Nanotechnology also leads to the generation of micronized dietary products and other nutraceutical supplements with improved health benefits. In this review article, the latest key findings (clinical studies) on nutraceuticals that show the therapeutic action of nutraceutical's bioactive molecules on various diseases have also been discussed.

Sustainable Approaches to Boost Yield and Chemical Constituents of Aromatic and Medicinal Plants by Application of Biostimulants

INTRODUCTION

Biostimulants consist of natural ingredients, metabolites of fermentation, micro-organisms, algae or plant extracts, bacteria, mushrooms, humus substances, amino acids, biomolecules, etc. Methods: In this study, all relevant English-language articles were collected. The literature was reviewed using the keywords of biostimulant, medicinal plant, aromatic plant, natural products, and pharmaceutical benefits from Google Scholar, Scopus, and PubMed databases.

RESULTS

The significant and promoting impact of biostimulants has been reported for different medicinal and aromatic plants, such as salicylic acid for ajuga, artichoke, ajwain, basil, common rue, common sage, common thyme, coneflower, coriander, dendrobium, desert Indian wheat, dragonhead, fennel, fenugreek, feverfew, ginger, groundnut, guava, henna, Iranian soda, lavender, lemon balm, lemongrass, Malabar spinach; seaweed extract on almond, bird,s eye chili; amino acids on artemisia, broccoli, chamomile, beneficial bacteria on ashwagandha; humic acid on black cumin, cannabis, chicory, garlic, gerbera, Hungarian vetch, Moldavian dragonhead, niger plant; chitosan on dragon fruit, marigold, milk thistle, etc. The suggested mechanisms include the stimulatory impacts on the activity of enzymes involved in different biosynthetic processes, the hormone-like activity of biostimulant compounds and the improvement of nutrient uptake of plants.

CONCLUSION

The current manuscript gives many examples of the potential of biostimulants for medicinal and aromatic plant production. However, further studies are needed to better understand the effectiveness of different biostimulants and foliar applications in sustainable agriculture.