Ambroxol for the treatment of fibromyalgia: science or fiction?

Fibromyalgia appears to present in subgroups with regard to biological pain induction, with primarily inflammatory, neuropathic/neurodegenerative, sympathetic, oxidative, nitrosative, or muscular factors and/or central sensitization. Recent research has also discussed glial activation or interrupted dopaminergic neurotransmission, as well as increased skin mast cells and mitochondrial dysfunction. Therapy is difficult, and the treatment options used so far mostly just have the potential to address only one of these aspects. As ambroxol addresses all of them in a single substance and furthermore also reduces visceral hypersensitivity, in fibromyalgia existing as irritable bowel syndrome or chronic bladder pain, it should be systematically investigated for this purpose. Encouraged by first clinical observations of two working groups using topical or oral ambroxol for fibromyalgia treatments, the present paper outlines the scientific argument for this approach by looking at each of the aforementioned aspects of this complex disease and summarizes putative modes of action of ambroxol. Nevertheless, at this point the evidence basis for ambroxol is not strong enough for clinical recommendation.

Tanreqing Injection Attenuates Lipopolysaccharide-Induced Airway Inflammation through MAPK/NF-κB Signaling Pathways in Rats Model

Background. Tanreqing injection (TRQ) is a commonly used herbal patent medicine for treating inflammatory airway diseases in view of its outstanding anti-inflammatory properties. In this study, we explored the signaling pathways involved in contributions of TRQ to LPS-induced airway inflammation in rats. Methods/Design. Adult male Sprague Dawley (SD) rats randomly divided into different groups received intratracheal instillation of LPS and/or intraperitoneal injection of TRQ. Bronchoalveolar Lavage Fluid (BALF) and lung samples were collected at 24 h, 48 h, and 96 h after TRQ administration. Protein and mRNA levels of tumor necrosis factor- (TNF-) α, Interleukin- (IL-) 1β, IL-6, and IL-8 in BALF and lung homogenate were observed by ELISA and real-time PCR, respectively. Lung sections were stained for p38 MAPK and NF-κB detection by immunohistochemistry. Phospho-p38 MAPK, phosphor-extracellular signal-regulated kinases ERK1/2, phospho-SAPK/JNK, phospho-NF-κB p65, phospho-IKKα/β, and phospho-IκB-α were measured by western blot analysis. Results. The results showed that TRQ significantly counteracted LPS-stimulated release of TNF-α, IL-1β, IL-6, and IL-8, attenuated cells influx in BALF, mitigated mucus hypersecretion, suppressed phosphorylation of NF-κB p65, IκB-α, ΙKKα/β, ERK1/2, JNK, and p38 MAPK, and inhibited p38 MAPK and NF-κB p65 expression in rat lungs. Conclusions. Results of the current research indicate that TRQ possesses potent exhibitory effects in LPS-induced airway inflammation by, at least partially, suppressing the MAPKs and NF-κB signaling pathways, in a general dose-dependent manner.

Xuan Bai Cheng Qi formula as an adjuvant treatment of acute exacerbation of chronic obstructive pulmonary disease of the syndrome type phlegm-heat obstructing the lungs: a multicenter, randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of morbidity and mortality. Traditional Chinese medicine (TCM) is used to treat AECOPD as adjunctive therapy. This study aimed to evaluate the efficacy and safety of the TCM formula Xuan Bai Cheng Qi as an adjuvant therapy for AECOPD patients with the syndrome type of phlegm-heat obstructing the lungs.

METHODS

A multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted. A total of 244 patients were divided into the intervention group (n = 122, treated with conventional medicine and Xuan Bai Cheng Qi) and the control group (n = 122, treated with conventional medicine and placebo). Total symptom scores (cough, phlegm, wheezing, chest congestion) before treatment and at 3, 5, 7, 10 days post-treatment were recorded. Lung function, arterial blood gas, serum inflammatory cytokines, oxidation/anti-oxidation index were observed before treatment and at the end of the 10-day treatment.

RESULTS

A total of 242 patients completed the study. The full analysis set (FAS) population was 244 and the per-protocol analysis set (PPS) population was 229. After the 10-day treatment, symptom scores of the Xuan Bai Cheng Qi group were significantly lower over time compared with the control group (FAS: mean difference -1.84, 95% CI -2.66 to -1.03, P < .001; PPS: mean difference -1.87, 95% CI -2.71 to -1.03, P < .001). FEV1, FVC, and FEV1%pred were significantly higher over time in the Xuan Bai Cheng Qi group compared with those in the control group (day 10, FAS and PPS: P < .05). PaO2 and PaCO2 were significantly improved in the Xuan Bai Cheng Qi group (day 10, FAS and PPS: P < .05). Xuan Bai Cheng Qi was also found to ameliorate cytokine levels and oxidation/antioxidant index compared with placebo. There were no differences in safety variables and adverse events between the two groups.

CONCLUSIONS

Xuan Bai Cheng Qi formula appears to be a safe and beneficial treatment for AECOPD of phlegm-heat obstructing the lungs syndrome type.

[Tanreqing Injection for community-acquired pneumonia: a systematic review of randomized evidence]

OBJECTIVE

To evaluate the efficacy and safety of Tanreqing Injection, a compound traditional Chinese herbal medicine, for community-acquired pneumonia.

METHODS

Literatures about randomized controlled trials of Tanreqing Injection for community-acquired pneumonia were reviewed. Related literatures were selected and analyzed according to different treatment strategies of the trials. The methodological quality of the trials was assessed by the Jadad scale, and evaluation was performed.

RESULTS

Twelve randomized controlled trials meeting the inclusion criteria were selected and reviewed. As Tanreqing combined group (Tanreqing Injection plus antibiotics and basic therapy) was compared with antibiotics group (antibiotics plus basic therapy), the meta-analysis indicated that the relative risk (RR) for the total cure rate was 1.51, and 95% confidence interval (CI) was [1.29, 1.77]; RR for the total obvious effect rate was 1.31,ls and 95% CI was [1.20,1.43]; RR for the effective rate was 1.17, and 95% CI was [1.11, 1.23]. The weighted mean difference (WMD) in disappearance time of fever between the two groups was -1.24, and 95% CI was [-1.71, -0.76]. The RR values between the two groups for the total obvious effect rate of cough and expectoration were 1.42 and 1.27, and 95% CIs were [1.16, 1.74] and [1.04, 1.55] respectively. The RR values between the two groups in absorption of chest X-ray shadow and neutrophil number were 1.19, 1.10 and 95% CIs were [1.09, 1.30], [1.03, 1.17] respectively. The differences were all statistically significant. Serious systematic adverse reactions had not been reported in the trials.

CONCLUSION

The effect of combined therapy with Tanreqing Injection plus antibiotics and basic therapy is better than that of antibiotics plus basic therapy. Tanreqing Injection can improve the symptoms of cough and expectoration, shorten the fever time and facilitate the absorption of chest X-ray shadow, without any significant adverse reactions. However, further high-quality trials are needed.

Long-term effects of Tiaobu Feishen therapies on systemic and local inflammation responses in rats with stable chronic obstructive pulmonary disease

OBJECTIVE

To evaluate the influence and long-term effects on systemic and local inflammation responses in rat with stable chronic obstructive pulmonary disease (COPD) treated with traditional Chinese medicine (TCM) for regulating and invigorating the lung and kidney, including invigorating the lung and spleen (Bufei Jianpi) therapy, supplementing the lung and kidney (Bufei Yishen) therapy, and nourishing qi and kidney (Yiqi Zishen) therapy.

METHODS

Rats were randomly divided into six groups: control, model, aminophyline, Bufei Jianpi, Bufei Yishen and Yiqi Zishen groups. The stable COPD model of rat was duplicated by cigarette smoke inhalations and bacterial infection. From the ninth week, the rats with stable COPD were treated with Bufei Jianpi, Bufei Yishen, Yiqi Zishen granules or aminophyline respectively until the 20th week. Half of the animals were sacrificed at the 20th or 32nd week respectively. The leukocyte count and neutrophil percentage in peripheral blood and bronchoalveolar lavage fluid (BALF) were measured; levels of interleukin (IL)-8, IL-10 and tumor necrosis factor-α (TNF-α) in BALF, and levels of IL-1β, IL-6, IL-8, IL-10 and TNF-α and soluble tumor necrosis factor receptor II (sTNFR2) in serum and lungs were detected by enzyme-linked immunosorbent assay or immunohistochemical method.

RESULTS

There were no statistical differences in leukocyte count and neutrophil percentage in peripheral blood among six groups (P>0.05). At the 20th week, leukocyte count in BALF was higher in the model group than in the control group (P<0.01), and was lower in the three TCM groups and the aminophyline group than in the model group (P<0.05, P<0.01), and that of the Bufei Jianpi group was lower than the aminophyline group (P<0.01); while at the 32nd week, leukocyte count in BALF of the three TCM groups decreased and was lower than that of the aminophyline group (P<0.05, P<0.01). At the 20th and 32nd weeks, levels of IL-1β, IL-6, IL-8, IL-10, TNF-α and sTNFR2 in serum and lungs, and IL-8, IL-10 and TNF-α in BALF of the model group increased, which were higher than those in the control group (P<0.05, P<0.01); the mentioned cytokines were decreased in the three TCM groups compared with the model group (P<0.05, P<0.01), and were also lower in serum and BALF of the three TCM groups than those of the aminophyline group (P<0.05, P<0.01). Expressions of cytokines in lung tissues were depressed in the three TCM groups as compared to those in the aminophyline group. There was no statistical difference on expressions of the mentioned cytokines either in serum and BALF or in the lungs between week 32 and week 20.

CONCLUSION

The Bufei Jianpi, Bufei Yishen and Yiqi Zishen therapies can significantly reduce the systemic and local inflammation responses in rats with stable COPD, and have evident long-term effects.

Effect of traditional Chinese medicine on outcomes in patients with mild/moderate chronic obstructive pulmonary disease: study protocol for a randomized placebo-controlled trial

Background

Chronic obstructive pulmonary disease (COPD) has become a major public health problem worldwide because of its high and increasing prevalence, morbidity, and mortality. Little attention has been paid to earlier stages of COPD or before it has developed. Reportedly, TCM may have some advantages in relieving symptoms and reducing the incidence of COPD exacerbations. We postulate that patients with COPD will benefit from therapy with TCM treatment according to syndrome differentiation.

Methods and design

A prospective, multi-center, double-blinded and randomized controlled method will be used to test the therapeutic effects of TCM treatment according to syndrome differentiation. A total of 504 patients will be enrolled into this study with 252 in each treatment group. Patients will receive medication according to their assigned group. TCM for COPD will be administered twice daily over 52 weeks, and all patients will follow the treatment program for 52 weeks. The FEV₁ and exacerbations will be used as the primary outcome measures. The quality of life and the Modified Medical Research Council (MMRC) Dyspnea Scale, and the 6-min walk test (6MWD) will be used as the secondary outcome measures.

Discussion

We postulate that patients with COPD will benefit from therapy with TCM treatment according to syndrome differentiation.

Trial registration

This study is registered at ClinicalTrials.gov, NCT01486186

Effect of sequential treatment with syndrome differentiation on acute exacerbation of chronic obstructive pulmonary disease and "AECOPD Risk-Window": study protocol for a randomized placebo-controlled trial

Background

Frequent chronic obstructive pulmonary disease (COPD) exacerbation is a major cause of hospital admission and mortality. It has been reported that Traditional Chinese Medicine (TCM) may relieve COPD symptoms and reduce the incidence of COPD exacerbations, thus improving life quality of COPD patients. The acute exacerbation of COPD risk-window (AECOPD-RW) is the period after an exacerbation and before the patient returns to baseline. In the AECOPD-RW, patients are usually at increased risk of a second exacerbation, which may lead to hospital admission and high mortality. It may be beneficial for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients to receive interventions during AECOPD-RW. During exacerbations the treatment principle is to eliminate exogenous pathogens, whereas the AECOPD-RW treatment principle focuses on enhancing body resistance.

Methods/Design

A prospective, multi-center, single-blinded, double-dummy and randomized controlled clinical trial is being conducted to test the therapeutic effects of a sequential two stage treatment, which includes eliminating pathogen and strengthening vital qi with syndrome differentiation. A total of 364 patients will be enrolled in this study with 182 in each treatment group (TCM and control). Patients received medication (or control) according to their assigned group. TCM for AECOPD were administered twice daily to patients with AECOPD over 7 to 21 days, followed by TCM for AECOPD-RW over 28 days. All patients were followed for six months. The clinical symptoms, the modified medical research council dyspnea (MMRC) scale and exacerbations were used as the primary outcome measures. Pulmonary function, quality of life and mortality rate were used as secondary outcome measures.

Discussion

It is hypothesized that sequentially eliminating pathogens and strengthening vital qi treatments with syndrome differentiation will have beneficial effects on reducing the frequency and duration of acute exacerbation, relieving symptoms and improving quality of life for COPD patients.

Trial registration

This study is registered at ClinicalTrials.gov, ChiCTR-TRC-11001460.

Anti-biofilm activity of TanReQing, a Traditional Chinese Medicine used for the treatment of acute pneumonia

AIM OF THE STUDY

TanReQing (TRQ) is a Traditional Chinese Medicine used to treat biofilm related upper respiratory infections. However, its anti-biofilm mechanism remains unknown. The aim of this study is to investigate the anti-biofilm activity of TRQ and to compare it with penicillin in vitro.

MATERIALS AND METHODS

The effect of TRQ and penicillin on free state, biofilm formation and mature biofilms of Staphylococcus aureus was studied using the crystal violet and the XTT reduction assays. Confocal Laser Scanning Microscopy was used to generate the 3D-transmission-fluorescence images of drug treated Staphylococcus aureus biofilms.

RESULTS

The in vitro data showed that TRQ is less effective than penicillin in eradicating the planktonic bacteria. However, the anti-biofilm activity of TRQ is different from that of penicillin. TRQ not only does inhibit the formation of the Staphylococcus aureus biofilm, but also kills the viable cells embed in Staphylococcus aureus biofilm matrix.

CONCLUSIONS

This study shows for the first time that TRQ possesses an antibiotic activity against biofilm bacteria. This activity is different from that of penicillin. The evaluation system applied in this study can be utilized for identifying new anti-biofilm products from Traditional Chinese Medicine.