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Lee HG, Arai I, Kwon S. A Herbal Prescription of Insamyangyeongtang as a Therapeutic Agent for Frailty in Elderly: A Narrative Review. Nutrients 2024; 16:721. [PMID: 38474849 DOI: 10.3390/nu16050721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Frailty is a major geriatric syndrome with a multifactorial etiology that induces a decline in multiple physiological and psychological functions. In traditional East Asian medicine (TEAM), qi and blood deficiency clinically represent as fatigue, anemia, anorexia, decreased strength after illness, and weakness, commonly interpretated as frailty. An herbal prescription of Insamyangyeongtang (IYT, Ninjin'yoeito in Japanese, Ren-Shen-Yang-Rong-Tang in Chinese) tonifies qi and blood and has the potential to treat multiple targets caused by qi and blood deficiency. As the population ages and frailty increases, there is an increase in the potential effectiveness of IYT in frailty. This study reviewed relevant clinical trials to provide an updated view on the effect of IYT on frailty. IYT has therapeutic effects on frailty associated with chronic respiratory diseases (e.g., chronic obstructive pulmonary disease) and cognitive impairments (e.g., Alzheimer's disease) and improves respiratory symptoms and cognition. IYT also has therapeutic effects on weight gain, muscle mass, and strength, and improves nutritional status in frail elderly individuals who have decreased muscle mass and strength, loss of appetite, and weight loss. The same effect has been shown in frailty in elderly individuals with rehabilitation treatment and chronic diseases. IYT also improves frailty associated with symptoms such as intractable dizziness and genitourinary symptoms. The beneficial effects of IYT in several diseases could be important for medication replacement, reduction, and prevention of polypharmacy. Based on the results of this review, we suggest that IYT has the potential to be a therapeutic agent against frailty.
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Affiliation(s)
- Han-Gyul Lee
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Ichiro Arai
- Graduate School of Pharmaceutical Sciences, Nihon Pharmaceutical University, Tokyo 113-0034, Japan
| | - Seungwon Kwon
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
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Takemoto R, Sejima T, Han LK, Michihara S, Takahashi R. Disuse muscle atrophy-improving effect of ninjin'yoeito in a mouse model. Neuropeptides 2021; 90:102199. [PMID: 34610544 DOI: 10.1016/j.npep.2021.102199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022]
Abstract
Disuse syndrome indicates psychosomatic hypofunction caused by excess rest and motionless and muscle atrophy is termed disuse muscle atrophy. Disuse muscle atrophy-induced muscle weakness and hypoactivity further induces muscle atrophy, leading to a vicious cycle, and this is considered a factor causing secondary sarcopenia and subsequently frailty. Since frailty finally leads to a bedridden state requiring nursing, in facing a super-aging society, intervention for a risk factor of frailty, disuse muscle atrophy, is important. However, the main treatment of disuse muscle atrophy is physical therapy and there are fewer effective preventive and therapeutic drugs. The objective of this study was to search for Kampo medicine with a disuse muscle atrophy-improving effect. Ninjin'yoeito is classified as a qi-blood sohozai (dual supplement) in Chinese herbal medicine, and it has an action supplementing the spleen related to muscle. In addition, improvement of muscle mass and muscle weakness by ninjin'yoeito in a clinical study has been reported. In this study, the effect of ninjin'yoeito on disuse muscle atrophy was investigated. A disuse muscle atrophy model was prepared using male ICR mice. After surgery applying a ring for tail suspension, a 1-week recovery period was set. Ninjin'yoeito was administered by mixing it in the diet for 1 week after the recovery period, followed by tail suspension for 14 days. Ninjin'yoeito administration was continued until autopsy including the hindlimb suspension period. The mice were euthanized and autopsied immediately after completion of tail suspension, and the hindlimb muscles were collected. The food and water intakes during the hindlimb unloaded period, wet weight of the collected muscle, and muscle synthesis and muscle degradation-related factors in blood and muscle were evaluated. Ingestion of ninjin'yoeito inhibited tail suspension-induced reduction of the soleus muscle wet weight. In addition, an increase in the blood level of a muscle synthesis-related factor, IGF-1, and promotion of phosphorylation of mTOR and 4E-BP1 in the soleus muscle were observed. It was suggested that ninjin'yoeito has a disuse muscle atrophy-improving action. Promotion of the muscle synthesis pathway was considered the action mechanism of this.
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Affiliation(s)
- Risa Takemoto
- Kampo Research Laboratories, Kracie Pharma Ltd., 3-1 Kanebo machi, Takaoka, Toyama 933-0856, Japan.
| | - Takehiro Sejima
- Kampo Research Laboratories, Kracie Pharma Ltd., 3-1 Kanebo machi, Takaoka, Toyama 933-0856, Japan
| | - Li-Kun Han
- Kampo Research Laboratories, Kracie Pharma Ltd., 3-1 Kanebo machi, Takaoka, Toyama 933-0856, Japan
| | - Seiwa Michihara
- Kampo Research Laboratories, Kracie Pharma Ltd., 3-1 Kanebo machi, Takaoka, Toyama 933-0856, Japan
| | - Ryuji Takahashi
- Kampo Research Laboratories, Kracie Pharma Ltd., 3-1 Kanebo machi, Takaoka, Toyama 933-0856, Japan
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Aomatsu N, Shigemitsu K, Nakagawa H, Morooka T, Ishikawa J, Yamashita T, Tsuruoka A, Fuke A, Motoyama K, Kitagawa D, Ikeda K, Maeda K, Shirano M, Rinka H. Efficacy of Ninjin'yoeito in treating severe coronavirus disease 2019 in patients in an intensive care unit. Neuropeptides 2021; 90:102201. [PMID: 34753072 PMCID: PMC8484001 DOI: 10.1016/j.npep.2021.102201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023]
Abstract
Coronavirus Disease-2019 (COVID-19), an infectious disease associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a global emergency with high mortality. There are few effective treatments, and many severe patients are treated in an intensive care unit (ICU). The purpose of this study was to evaluate whether the Japanese Kampo medicine ninjin'yoeito (NYT) is effective in treating ICU patients with COVID-19. Nine patients with confirmed SARS-CoV-2 infection admitted to the ICU were enrolled in this study. All patients underwent respiratory management with invasive mechanical ventilation (IMV) and enteral nutrition. Four patients received NYT (7.5 g daily) from an elemental diet tube. We retrospectively examined the prognostic nutritional index (PNI), length of IMV, length of ICU stay, length of hospital stay, rate of tracheostomy, and mortality rate. The median age of the enrolled participants was 60.0 years (4 men and 5 women). The median body mass index was 27.6. The most common comorbidity was diabetes (4 patients, 44%), followed by hypertension (3 patients, 33%) and chronic kidney disease (2 patients, 22%). The median length of IMV, ICU stay, and hospital stay were all shorter in the NYT group than in the non-NYT group (IMV; 4.0 days vs 14.3 days, ICU; 5.3 days vs 14.5 days, hospital stay; 19.9 days vs 28.2 days). In the NYT and non-NYT groups, the median PNI at admission was 29.0 and 31.2, respectively. One week after admission, the PNI was 30.7 in the NYT group and 24.4 in non-NYT group. PNI was significantly (p = 0.032) increased in the NYT group (+13.6%) than in the non-NYT group (-22.0%). The Japanese Kampo medicine NYT might be useful for treating patients with severe COVID-19 in ICU. This study was conducted in a small number of cases, and further large clinical trials are necessary.
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Affiliation(s)
- Naoki Aomatsu
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan; Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan.
| | - Kazuaki Shigemitsu
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Hidenori Nakagawa
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Takaya Morooka
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Junichi Ishikawa
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Tomoya Yamashita
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Ayumu Tsuruoka
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Akihiro Fuke
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Koka Motoyama
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Daiki Kitagawa
- Department of Emergency and Critical Care Medical center, Osaka City General Hospital, Osaka, Japan
| | - Katsumi Ikeda
- Department of Breast Surgical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Hiroshi Rinka
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
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Zhang L, Clark T, Gopalasingam G, Neely GG, Herzog H. Ninjin'yoeito modulates feeding and activity under negative energy balance conditions via the NPY system. Neuropeptides 2021; 87:102149. [PMID: 33882337 DOI: 10.1016/j.npep.2021.102149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
The central and peripheral neuropeptide Y (NPY) system is critically involved in feeding and energy homeostasis control. Disease conditions as well as aging can lead to reduced functionality of the NPY system and boosting it represents a promising option to improve health outcomes in these situations. Here we show that Ninjin-yoeito (NYT), a Japanese kampo medicine comprising twelve herbs, and known to be effective to treat anorexia and frailty, mediates part of its action via NPY/peptide YY (PYY) related pathways. Especially under negative energy homeostasis conditions NYT is able to promote feeding and reduces activity to conserve energy. These effects are in part mediated via signalling through the NPY system since lack of Y4 receptors or PYY leading to modification in these responses highlighting the possibility for combination treatment to improve aging related conditions on energy homeostasis control.
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Affiliation(s)
- Lei Zhang
- Neuroscience Division, Garvan Institute of Medical Research, St Vincent's Hospital, Darlinghurst, Sydney, Australia; St. Vincent's Clinical School, University of NSW, Sydney, Australia.
| | - Tereli Clark
- The Charles Perkins Centre, School of Life & Environmental Sciences, The University of Sydney, NSW 2006, Australia
| | - Gopana Gopalasingam
- Neuroscience Division, Garvan Institute of Medical Research, St Vincent's Hospital, Darlinghurst, Sydney, Australia
| | - G Gregory Neely
- The Charles Perkins Centre, School of Life & Environmental Sciences, The University of Sydney, NSW 2006, Australia
| | - Herbert Herzog
- Neuroscience Division, Garvan Institute of Medical Research, St Vincent's Hospital, Darlinghurst, Sydney, Australia; School of Medical Sciences, University of NSW, Sydney, NSW, Australia; Faculty of Medicine, University of NSW, Sydney, NSW, Australia
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Miyamoto A, Asai K, Kadotani H, Maruyama N, Kubo H, Okamoto A, Sato K, Yamada K, Ijiri N, Watanabe T, Kawaguchi T. Ninjin'yoeito Ameliorates Skeletal Muscle Complications in COPD Model Mice by Upregulating Peroxisome Proliferator-Activated Receptor γ Coactivator-1α Expression. Int J Chron Obstruct Pulmon Dis 2020; 15:3063-3077. [PMID: 33273811 PMCID: PMC7708308 DOI: 10.2147/copd.s280401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Sarcopenia, the loss of skeletal muscle mass and strength, is a common systemic consequence of chronic obstructive pulmonary disease (COPD) and is correlated with higher mortality. Ninjin’yoeito (NYT) is a Japanese herbal medicine used to treat athrepsia and anorexia and is reported to ameliorate weight loss and muscular dysfunction. Recent studies have shown that its crude components upregulate the peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α)-related pathway, which is involved in skeletal muscle functions. Here, we examined whether NYT improves skeletal muscle complications by upregulating PGC-1α in COPD model mice. Materials and Methods Mice were divided into four groups: control, NYT, smoking, and smoking + NYT. The smoking and smoking + NYT groups were exposed to cigarette smoke for 60 min once daily. The mice in the NYT and smoking + NYT groups were fed an NYT-containing diet (3% w/w). We performed cellular analysis of bronchoalveolar lavage fluid, assessed pulmonary morphological changes, examined the expression of PGC-1α mRNA and protein in the gastrocnemius and soleus muscle, measured the hindlimb muscle volume with micro-computed tomography, and determined the myofiber proportion in soleus muscle after 12 weeks. Results Cigarette smoke exposure resulted in reduced skeletal muscle volume and slow-twitch muscle fibers and development of pulmonary emphysema. NYT feeding induced partial recovery of the damaged alveolar wall; however, NYT did not ameliorate smoke-induced alveolar enlargement. These findings revealed that NYT did not have sufficient efficacy in suppressing pulmonary emphysema. On the other hand, PGC-1α expression in muscle tissue of the NYT-fed mice increased significantly, resulting in suppression of smoke-induced loss of muscle mass and alteration in the muscle fiber distribution. Conclusion NYT increases PGC-1α expression in the muscle of COPD model mice and is involved in suppressing cigarette smoke-induced muscle complications. NYT may be a novel preventive and therapeutic medication for muscular dysfunctions in COPD.
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Affiliation(s)
- Atsushi Miyamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Hideaki Kadotani
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Naomi Maruyama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Hiroaki Kubo
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Atsuko Okamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Kanako Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Kazuhiro Yamada
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Naoki Ijiri
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka-City, Osaka, Japan
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