Herbal remedies are the main etiologic factor in melanosis coli, a case series study

Chronic California herbal tea use causing biopsy-proven Melanosis coli

Melanosis coli is a dark to brown pigmentation of the colon due to lipofuscin deposition within the cytoplasm of cells. It is a benign condition associated with excessive use of laxatives, particularly those that are anthracene derivatives and common herbal remedies like Cassia Angustifolla (senna). It is usually asymptomatic and diagnosed incidentally during colonoscopy or histopathologic evaluation. We present a case of a 56-year-old male patient who presented with diarrhea of 3 months duration, which started after he began to use California herbal tea for his constipation. Colonoscopic evaluation revealed an intense pigmentation throughout the colon suggestive of Melanosis coli, which was confirmed on histopathology. In patients with prolonged use of California herbal tea and dark to brown pigmentations of colonic mucosa on colonoscopy, there should be a high index of suspicion for Melanosis coli. And patients should be aware of the risk of developing Melanosis coli following prolonged herbal tea use. The findings presented in our case are in support of few previous literature that showed relations between chronic herbal tea use and Melanosis coli.

Deglycosylated Azithromycin Targets Transgelin to Enhance Intestinal Smooth Muscle Function

Azithromycin (AZM) has been widely used as an antibacterial drug for many years. It has also been used to treat delayed gastric emptying. However, it exerts several side effects. We found that deglycosylated AZM (Deg-AZM or CP0119), an AZM metabolite, is a positively strong intestinal agonist that may result in the intestinal mobility experienced by patients after AZM administration. We confirmed that Deg-AZM can function strongly on intestinal peristalsis and identified transgelin as its potential molecular target. Furthermore, our pharmacological studies showed that the binding of Deg-AZM to transgelin enhanced the contractility of intestinal smooth muscle cells by facilitating the assembly of actin filaments into tight bundles and stress fibers. Specifically, Deg-AZM promoted intestinal peristaltic activity in wild-type mice but not in transgelin (-/-) mice. Moreover, Deg-AZM did not exert antibacterial activity and did not disrupt intestinal flora. Thus, Deg-AZM may become a potential drug for slow-transit constipation treatment.

Bioconcentration and Metabolism of Emodin in Zebrafish Eleutheroembryos

Emodin is a major active anthraquinone of various herbal laxatives, which can exert many pharmacological effects. However, chronic use of anthranoid laxatives, even at low dosages, may cause melanosis coli (MC). It has been suggested that the accumulation of anthraquinones is a risk factor in the MC process. To investigate the accumulation of emodin, we conducted a bioconcentration study of emodin in zebrafish eleutheroembryos. Based on the economic cooperation and development (OECD) 305 test, zebrafish eleutheroembryos were exposed to emodin at a constant concentration for 48 h, before the test media were replaced by the blank medium for 24 h of depuration. To eliminate the effect of metabolism of emodin for assessment of the bioconcentration factor (BCF), we also conducted a modified test for which zebrafish eleutheroembryos were exposed to the non-renewed test media, whose emodin concentration decreased with time. At different exposure time points, zebrafish eleutheroembryos and exposure media were sampled for analysis of emodin concentration using HPLC-MS/MS. The results showed rapid accumulation of emodin in zebrafish eleutheroembryos to reach a steady-state concentration within 24 h. Meanwhile, emodin was actively metabolized by zebrafish eleutheroembryos to result in 29.5–40.7% of its elimination. In the groups with high or low concentrations of emodin, the standardized BCF (sBCF) values in the standard test were 24.0 and 20.0, while those in the modified test were 50.4 and 52.0. These results showed that emodin could accumulate in zebrafish eleutheroembryos when used for 48 h and beyond, suggesting that the accumulation of anthraquinones may be a risk factor in the MC process. Accordingly, emodin should be unsuitable for long-term use due to its accumulation.