Current regulatory challenges and approaches in the registration of herbal drugs in Europe

Exploration of facilitators and barriers to the regulatory frameworks of dietary and herbal supplements: a scoping review

Background

Over the last decade, the use of dietary and herbal supplements (DHSs) has expanded greatly across national healthcare settings for the prevention, management and/or treatment of a variety of health issues. Although regulatory policies for DHSs across different countries have been aimed towards evaluating safety and efficacy, performing quality controls, monitoring the manufacturing practices, and encouraging further research, significant safety issues have emerged from inappropriate regulatory classification, lack of suitable quality controls, and inadequate testing and labeling of these products. Therefore, the purpose of this scoping review was to identify facilitators and barriers to DHS regulation across different countries.

Methods

A scoping review was conducted and informed by the five-stage methodological framework proposed by Arksey and O’Malley and further enhanced by Levac et al. MEDLINE, EMBASE, AMED, and PsycINFO databases were systematically searched for eligible articles from database inception to September 29, 2020. Studies analyzing DHS regulatory frameworks were eligible for review. Relevant data from eligible articles were extracted and categorized into themes to provide a descriptive overview of the literature.

Results

Searches generated 4314 results, 1800 of which were duplicates, followed by 2472 that were excluded after screening the titles and abstracts of these articles. Of the remaining 42 full-texts, 15 eligible articles were included in this review. Themes identified include: (1) increased financial and human resources encouraging knowledge expansion as a facilitator to DHS regulation; (2) variances in DHS classification and regulatory requirements across countries as a barrier to DHS regulation, and (3) collaboration between various stakeholders (experts, policymakers, representatives of regulatory bodies, product companies and research institutions) facilitating DHS regulation.

Conclusion

The present scoping review identified facilitators and barriers to DHS regulation across different countries. We highlight that safety assessments of DHSs continue to be inadequate, and emerging technologies could potentially play a significant role in establishing common reference standards of herbal materials and products between regulatory agencies. Regulatory harmonization, increased scientific research, and collaboration could improve regulations globally through appropriate categorization and safe application of DHSs.

Revisiting traditional Chinese materia medica from European historical collections and perspective for current use

Background and aim

Chinese Materia Medica (CMM) is subject to changes over time. Investigating changes in botanical ingredients, applications, plant parts used as well as name changes over time, contribute to the understanding of the history and development of CMM.

Materials and methods

This study compares four historic collections of CMM, located in Europe, compiled between 1700 and the late 19th century, with a list of contemporary CMM marketed in Europe.

Results

More than 1700 specimens within these five collections. The dominant families are Fabaceae (5.3–7.2%) and Asteraceae (4.1–5.7%), while half of the medicinal parts are represented by roots or rhizomes and fruits and/or seeds. Their importance has been stable in a time span of 300 years. The proportion of animal and mineral drugs gradually decreased over time. 14 plant species appeared in all five collections. A total of 47 species are shared between the three more recent collections and the modern trade list. Among these common species, most medicinal parts remain unchanged, but for several species the used plant parts changed or new medicinal plant parts appeared. All common species have unanimously been used in ancient classical TCM formulae and/or Chinese patent medicines.

Conclusions

Over more than 300 years, the main body of CMM has hardly changed, with regard to plant taxa and plant parts used. The most prominent changes are related to conservation issues of threatened species, health safety and the discovery of new pharmacological applications of well-known species. Analyzing physical specimens from historic CMM collections complements literature-based research.

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Historical CMM collections provide the direct physical basis for research on the historical changes and development of CMM.

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This study compares four European historic collections of CMM from the 1700s to the 1980s with contemporary marketed CMM.

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The main body of CMM has hardly changed in a time span of 300 years, regarding plant taxa and medicinal plant parts.

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All the common herbal medicine species among studied collections have unanimously been used in classical TCM formulae.

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The most prominent changes are related to natural protection, medication safety and discovering the new effects of medicines.

International policies and challenges on the legalization of traditional medicine/herbal medicines in the fight against COVID-19

The coronavirus disease 2019 (COVID-19) has now rapidly spread around the world, causing an outbreak of acute infectious pneumonia. To develop effective and safe therapies for the prevention and treatment of COVID-19 has become the major global public health concern. Traditional medicine (TM)/herbal medicines (HMs) have been used to treat multiple epidemics in human history, which brings hope for the fight against COVID-19 in some areas. For example, in China, India, and South Korea with traditional medication history and theory, the governments issued a series of guidelines to support TM/HMs in the medication of COVID-19. In contrast, other countries e.g. North American and European governments are typically silent on these practices, unless to warn of possible harm and overselling. Such difference is due to the discrepancy in culture, history and philosophical views of health care and medication, as well as unharmonized policies and standards in the regulation and legalization of TM/HMs among different areas. Herein, we reviewed the responses and scientific researches from seven selected countries on the policies and legalization of TM/HMs to treat COVID-19, and also analyzed the major challenges and concerns to utilize the traditional knowledge and resource.

Development of Caco-2 cells-based gene reporter assays and evaluation of herb-drug interactions involving CYP3A4 and CYP2D6 gene expression

The indiscriminate use of medicinal plants and herbal medicinal products concomitantly with conventional drugs may result in herb-drug interactions that may lead to fluctuations in drug bioavailability, therapeutic failure, and/or toxic effects. CYP450 enzymes play an important role in drug biotransformation and herb-drug interactions. Thus, the aim of this study was to develop and apply Caco-2 cells-based gene reporter assays to study in vitro the potential occurrence of CYP3A4 and CYP2D6 gene expression modulation by standardized extracts of selected medicinal plants. Reporter cell lines developed showed a significant increase in CYP3A4 and CYP2D6 reporter fluorescent emission, 4 and 16-fold respectively, when compared to the controls. The standardized extracts of Cecropia glaziovii, Bauhinia forficata and Echinacea sp. significantly increased CYP3A4 reporter fluorescence, and those of Ilex paraguariensis, Bauhinia forficata and Echinacea sp. significantly decreased CYP2D6 reporter fluorescence in Caco-2 cells-based gene reporter assays. The data obtained suggest that CYP3A4 and CYP2D6 gene expression seem to be modulated by the extracts tested. In addition, the reporter cell lines developed are functional assays that could be used to study drug-drug and herb-drug interactions during the research and development of new drugs.