Determinants of prakriti, the human constitution types of Indian traditional medicine and its correlation with contemporary science

Unravelling the gut-lung axis: insights into microbiome interactions and Traditional Indian Medicine's perspective on optimal health

The microbiome of the human gut is a complex assemblage of microorganisms that are in a symbiotic relationship with one another and profoundly influence every aspect of human health. According to converging evidence, the human gut is a nodal point for the physiological performance matrixes of the vital organs on several axes (i.e. gut-brain, gut-lung, etc). As a result of COVID-19, the importance of gut-lung dysbiosis (balance or imbalance) has been realised. In view of this, it is of utmost importance to develop a comprehensive understanding of the microbiome, as well as its dysbiosis. In this review, we provide an overview of the gut-lung axial microbiome and its importance in maintaining optimal health. Human populations have successfully adapted to geophysical conditions through traditional dietary practices from around the world. In this context, a section has been devoted to the traditional Indian system of medicine and its theories and practices regarding the maintenance of optimally customized gut health.

Ayurgenomics in Anti-Viral Therapy: A Literature Synthesis

This review focuses on Ayurgenomics (AG) used in antiviral therapy. According to Ayurveda, three doshas govern Prakriti, the natural organizational structure of humans. AG is a new field in modern medicine that focuses on establishing individualized self-care. It is a modern therapeutic and preventive method that enhances a person's mental and physical well-being. Due to the threat of emerging lethal viruses and the significant role of Ayurveda in the pandemic, modern genetics studies have emerged. Prakriti, an Ayurvedic notion that AG incorporates, correlated with three doshas (phenotypes) called vata, pitta, and kapha. Each Prakriti individual had a specific balance for each dosha. To date, the most recent field of AG, which aims to characterize Prakriti types in terms of current genetics and physiology, has provided the best definition. Four databases were searched for studies on this topic using the keywords "Ayurgenomics" and "Anti-Viral Therapy." Four articles that demonstrated a favorable approach for the application of AG were gathered for synthesis. According to this study, employing Adhatoda Vasica and Cissampelos pareira L extracts improved the viral structure of the SAR-CoV-2 virus. Further studies involving human participants are required to rule out the positive effects of AG in real-world contexts.

Development of database structure and indexing for siddha medicine system - A platform for siddha literature analytics

Background

Siddha Medicine system is one among the oldest traditional systems of medicines in India and has its entire literature in the Tamil language in the form of poems (padal in tamil). Even if the siddha poems are available in public domain, they are not known to other parts of the world because, researchers of other languages are not able to understand the contents of these poems and there exists a language barrier. Hence there is a need to develop a system to extract structured information from these texts to facilitate searching, comparing, analysis and implementing.

Objective

This study aimed at creating a comprehensive digital database system that systematically stores information from classical Siddha poems and to develop a web portal to facilitate information retrieval for comparative and logical analysis of Siddha content.

Methods

We developed an expert system for siddha (eSS) that can collect, annotate classical siddha text, and visualizes the pattern in siddha medical prescriptions (Siddha Formulations) that can be useful for exploration in this system using modern techniques like machine learning and artificial learning. eSS has the following three aspects: (1) extracting data from Siddha classical text (2) defining the annotation method and (3) visualizing the patterns in the medical prescriptions based on multiple factors mentioned in the Siddha system of medicine. The data from three books were extracted, annotated and integrated into the developed eSS database. The annotations were used for analyzing the pattern in the drug prescriptions as a pilot work.

Results

Overall, 110 medicinal preparations from 2 Siddhars (Agathiyar and Theran) were extracted and annotated. The generated annotations were indexed into the data repository created in eSS. The system can compare and visualize individual and multiple prescriptions to generate a hypothesis for siddha practitioners and researchers.

Conclusions

We propose an eSS framework using standard siddha terminologies created by WHO to have a standard expert system for siddha. This proof-of-concept work demonstrated that the database can effectively process and visualize data from siddha formulations which can help students, researchers from siddha and other various fields to expand their research in herbal medicines.

Using Traditional Typologies to Understand Posture Movement and Cognitive Performance - A cross sectional study

CONTEXT

We employed two classification methods that characterize psycho-somatotype categorization to understand motor and cognitive performance. The Trunk Index produces three somatotypes/body type categories: ectomorphs, mesomorphs, and endomorphs, and Prakriti classifications categorizes people into three categories: Vata, Pitta, and Kapha. Comparing these two categorization methods offers insights into anthropometric measures that combine psychological and physical characteristics to account for motor and cognitive behavior.

AIMS

The present study examined variations in cognitive and motor performances using the two typologies - prakriti and somato body types using cross-sectional study design.

SUBJECTS AND METHODS

The study employed fifty-eight healthy young adults, classified into prakriti (vata, pitta, kapha) and ecto-, meso-, endo-morph body types, to examine their cognitive performance (reaction time [RT] and accuracy), and motor performance (posture stability and posture accuracy) in standing yoga postures.

STATISTICAL ANALYSIS USED

Analysis of covariance was performed to compare the cognitive and postural performance across the three somato and prakriti types after adjusting for age and gender as covariates. Post-hoc analysis of Bonferroni was performed with the consideration of Levene's test. Partial correlations were employed to investigate the correlation between postural stability and cognitive performance measures for each of the prakriti- and somato-body types as well as between the prakriti typology (scores) and trunk index values (adjusting the effects of age and gender as control variables). A P < 0.05 was selected at the statistical significance level. SPSS 26.0 version was used for the analysis.

RESULTS

Cognitive performance was observed to vary in terms of RT across somato- and prakriti body types (P < 0.05). Postural stability and cognitive performance are positively connected only for ectomorph body types (P < 0.05). Variations in motor performance were not significant. Barring ectomorph type, no other somato- and prakriti body types showed significant relationships between postural stability and cognitive performance. Likewise, the association between the features used for prakriti classification, and the trunk index scores showed marginal significance, only for a small subset of physical features of prakriti assessment (P = 0.055) (P1).

CONCLUSIONS

Comparing classifications that use psychophysical attributes might offer insights into understanding variations in measures of motor and cognitive performance in a sample of healthy individuals.

S, Patel AB, Chen ZS. An Ayurgenomics Approach: Prakriti-Based Drug Discovery and Development for Personalized Care

Originating in ancient India, Ayurveda is an alternative medicinal approach that provides substantial evidence for a theoretical-level analysis of all aspects of life. Unlike modern medicine, Ayurveda is based upon tridoshas (Vata, pitta, and Kapha) and Prakriti. On the other hand, the research of all the genes involved at the proteomics, metabolomics, and transcriptome levels are referred to as genomics. Geoclimatic regions (deshanupatini), familial characteristics (kulanupatini), and ethnicity (jatiprasakta) have all been shown to affect phenotypic variability. The combination of genomics with Ayurveda known as ayurgenomics provided new insights into tridosha that may pave the way for precision medicine (personalized medicine). Through successful coordination of “omics,” Prakriti-based treatments can help change the existing situation in health care. Prakriti refers to an individual’s behavioral trait, which is established at the moment of birth and cannot be fully altered during one’s existence. Ayurvedic methodologies are based on three Prakriti aspects: aushadhi (medication), vihara (lifestyle), and ahara (diet). A foundation of Prakriti-based medicine, preventative medicine, and improvement of life quality with longevity can be accomplished through these ayurvedic characteristics. In this perspective, we try to understand prakriti’s use in personalized medicine, and how to integrate it with programs for drug development and discovery.

Correlation of body composition parameters and anthropometric somatotypes with Prakriti body types among the Meitei adults of Manipur, India

BACKGROUND

Body composition and types are often considered essential health indicators for lifestyle-related disease. Assessment of body type based on tridosha is regarded as a prerequisite in Ayurveda.

AIM

To correlate body compositions and somatotypes with Prakriti body types.

SUBJECTS AND METHODS

A cross-sectional study on 463 adult individuals was done. Anthropometric and body composition parameters were measured. Heath-Carter somatotypes and Prakriti body types were also determined. Tests of association were calculated. Correlation and concordance analysis was also done to infer the correlation between body composition parameters and Prakriti body types.

RESULTS

Kapha Prakriti have significantly higher body weight, body mass index (BMI), body fat percentage and body fat mass. Vata have the lowest mean values in all body composition parameters with Pitta in the intermediate position compared to the other Prakriti types. There is a strong and positive statistical association between Prakriti body types and body composition parameters, except height. Cohen's Kappa analysis reveals there is a fair concordance between Prakriti body types and somatotype.

CONCLUSIONS

Prakriti assessment can explain an individual's fatness as it correlates with body composition parameters and could be used to predict risk susceptibility to various complex disorders.

Correlation of prakriti diagnosis using AyuSoft prakriti diagnostic tool with clinician rating in patients with psychiatric disorders

Assessment of individual constitution (prakriti) has been an important basic construct of the Ayurveda system of medicine. The AyuSoft prakriti diagnostic tool has been extensively used in Ayurveda research. However, we could not find any literature regarding reliability of a prakriti diagnostic tool in patients with psychiatric conditions. One hundred and twelve patients (M = 70) suffering from various psychiatric disorders as per ICD-10 criteria were recruited (Depression = 31; Schizophrenia = 30, Anxiety disorders = 27; OCD = 9; BPAD = 15). The AyuSoft tool (developed by C-DAC, Pune, India) was applied to determine their prakriti after obtaining written informed consent. Two Ayurveda physicians independently assessed prakriti of the same patients through clinical examination. Inter-rater reliability was assessed between prakriti scores obtained from AyuSoft and those from the Ayurveda physicians by determining Cohen’s Kappa intra-class correlation coefficient (ICC). ICC estimates and their 95% confidence intervals were calculated using SPSS statistical package (version 24.0) based on a mean-rating (k = 2), consistency and two-way mixed-effects model. We observed that there was a significant correlation between dosha scores obtained through AyuSoft and those from the two Ayurveda physicians (for all three doshas: p < 0.01). Inter-rater reliability was moderately strong for vata (ICC = 0.72; Cronbach’s alpha = 0.83), good for pitta (ICC = 0.58; Cronbach’s alpha = 0.62) and comparatively weak for kaphadosha (ICC = 0.44; Cronbach’s alpha = 0.51) respectively. Prakriti diagnosis by AyuSoft was feasible in stabilized psychiatric patients and was found comparable to clinical diagnosis of prakriti by Ayurveda physicians in patients with psychiatric disorders.

Ayurgenomics and Modern Medicine

Within the disciplines of modern medicine, P4 medicine is emerging as a new field which focuses on the whole patient. The development of Ayurgenomics could greatly enrich P4 medicine by providing a clear theoretical understanding of the whole patient and a practical application of ancient and modern preventative and therapeutic practices to improve mental and physical health. One of the most difficult challenges today is understanding the ancient concepts of Ayurveda in terms of modern science. To date, a number of researchers have attempted this task, of which one of the most successful outcomes is the creation of the new field of Ayurgenomics. Ayurgenomics integrates concepts in Ayurveda, such as Prakriti, with modern genetics research. It correlates the combination of three doshas, Vata, Pitta and Kapha, with the expression of specific genes and physiological characteristics. It also helps to interpret Ayurveda as an ancient science of epigenetics which assesses the current state of the doshas, and uses specific personalized diet and lifestyle recommendations to improve a patient’s health. This review provides a current update of this emerging field.

Prakriti phenotypes as a stratifier of gut microbiome: A new frontier in personalized medicine?

Ayurveda has a rich history and its significance woven deeply in the Indian culture. The concept of prakriti (a person’s “nature” or constitutional type determined by the proportion of three doshas, namely - vata, pitta and kapha) in Ayurveda is deeply rooted in personalized health management. While the attributes of prakriti has been established to have a genomic basis, there is dearth of elaborate evidences linking prakriti with manifestation of diseases. Next generation sequencing studies have provided a causal link between variation in the gut microbiome and its effect on an individual’s fitness. Separately, reports have identified gut microbial patterns associated with several host variables such as geography, age, diet and extreme prakriti phenotypes. Recently, few reports have identified a “core gut microbiome” consisting of Bacteroides, Faecalibacterium, Prevotella and Ruminococcus prevalent across the Indian population; however, a few bacterial genera were specifically enriched in certain prakritis. Hence, in this review we aim to analyse the role of prakriti variations on dysbiosis of the gut microbiome and concomitantly its effect on human health. We suggest that prakriti phenotyping can function as a potential stratifier of the gut microbiome in a given population and may provide evidence for the conceptual framework of personalized medicine in Ayurvedic system of medicine.

Effect of mindfulness meditation protocol in subjects with various psychometric characteristics at high altitude

INTRODUCTION

Incidence of high altitude-related sickness is increasing due to more number of people visiting the areas of high altitude which may result in life-threatening conditions including acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), high altitude cerebral edema (HACE), and High-altitude pulmonary hypertension (HAPH). We hypothesized that an advanced yoga regimen may be beneficial in dealing with the physiology of acclimatization.

METHODS

Anthropometric, Biochemical, and Psychological assessments were carried out in 48 participants before and after the advance meditation program (AMP) in the experimental group. Individuals with an age range of 20-65 years with no comorbidities were included in the study. Participants were exposed to AMP for 4 days. All assessments were carried out at the baseline and after the course. Prakriti was constituted for all participants using a standard questionnaire. The study was carried out after obtaining the written informed consent as per the guidelines outlined by the Institute Ethics Committee.

RESULTS

Po2 and glucose levels were found significantly reduced along with changes in the Happiness index, anxiety, and mental well-being. However, participants with lowered Po2, after 4 days of mindfulness intervention, showed a positive outcome measured by the established scales of anxiety, happiness, and information processing. Psychometric or Prakriti wise analysis revealed that subject with "Pitta" constitution exposed to high altitude and advance meditation showed changes in more parameters than "Vatta" or "Kapha" Constitution.

CONCLUSIONS

Advance meditation in the high altitude zone confers biochemical and neuro-cognitive benefits. Molecular studies may require to understand the role of hypoxic condition in improving the disease state.

Understanding the association between the human gut, oral and skin microbiome and the Ayurvedic concept of prakriti

Ayurveda is one of the ancient systems of medicine which is widely practised as a personalized scientific approach towards the general wellness. Ayurvedic prakriti is broadly defined as the phenotypes which are determined on the basis of physical, psychological and physiological traits irrespective of their social, ethnic, dietary and geographical stature. Prakriti is the constitution of a person, which comprises vata, pitta, and kapha and is a key determinant of how one individual is different from the other. Human microbiome is considered the 'latest discovered' human organ and microbiome research reiterates the fundamental principles of Ayurveda for creating a healthy gut environment by maintaining the individual-specific microbiome. Hence, it is important to understand the association of human microbiome with the Ayurvedic prakriti of an individual. Here, we provide a comprehensive analysis of human microbiome from the gut, oral and skin samples of healthy individuals (n=18) by 16S rRNA gene-based metagenomics using standard QIIME pipeline. In the three different prakriti samples differential abundance of Bacteroides, Desulfovibrio, Parabacteroides, Slackia, and Succinivibrio was observed in the gut microbiome. Analysis also revealed prakriti-specific presence of Mogibacterium, Propionibacterium, Pyramidobacter, Rhodococcus in the kapha prakriti individuals Planomicrobium, Hyphomicrobium, Novosphingobium in the pitta prakriti individuals and Carnobacterium, Robiginitalea, Cetobacterium, Psychrobacter in the vata prakriti individuals. Similarly, the oral and skin microbiome also revealed presence of prakriti-specific differential abundance of diverse bacterial genera. Prakriti-specific presence of bacterial taxa was recorded and only 42% microbiome in the oral samples and 52% microbiome in the skin samples were shared. Bacteria known for preventing gut inflammation by digesting the resistant starch were abundant in the pitta prakriti individuals, who are more prone to develop gut-inflammation-related disorders. In summary, human gut, oral and skin microbiome showed presence or high abundance of few bacterial taxa across three prakriti types, suggesting their specific physiological importance.

Functional signature analysis of extreme Prakriti endophenotypes in gut microbiome of western Indian rural population

Ayurveda is practiced in India from ancient times and stratifies the individuals based on their Prakriti constitution. Advancements in modern science have led to the association of Prakriti with molecular, biochemical, genomic and other entities. We have recently explored the gut microbiome composition and microbial signatures in healthy extreme Prakriti endo-phenotypes. However, their functional potentials are still lacking. The present study includes 63 females (29 Vata, 11 Pitta, and 23 Kapha) and 50 males (13 Vata, 18 Pitta, and 19 Kapha) samples. The predictive functional profiling and organism level functional traits of the human gut microbiome have been carried out in Prakriti groups using imputed metagenomic approach. A higher functional level redundancy is found than the taxonomy across the Prakriti groups, however the dominant taxa contributing to the functional profiles are found to be different. A high number of functional signatures specific to the Prakriti groups were identified in female datasets. Some of the functional signatures were found to be gender specific. For example, a higher abundance of microbes contributing potential pathogenic and stress tolerance related functions was found in Kapha in female and Pitta in male. The functional signatures correlated well with phenotypes and disease predisposition of Prakriti groups.

Can the vagus nerve serve as biomarker for vata dosha activity?

This 'discussion paper' raises 'provocative questions' to identify physiological systems underlying vata dosha and candidate biomarkers for vata activity. We explained the strong correlations between survival and homeostatic functions of the parasympathetic vagus nerve, and functions governed by the five major sub-types of vata dosha (Praana, Udana, Vyaana, Samaana, and Apana). Four reasons were provided to hypothesize that vagal activity is a reliable candidate biomarker of important vata dosha functions. First, normal vata dosha and the vagus maintain neural, respiratory, and digestive homeostasis, and dysfunctions in both entities cause very similar diseases. Second, vata dosha regulates higher neural functions such as mental health and behaviour, and the 'polyvagal theory' proposes similar functions for the vagus. Third, the similar roles of vata dosha and vagus in maintaining gut homeostasis, suggest that vagal activity in the 'gut-brain' link is a candidate biomarker of pakwashaya (lower gut), a primary regulatory site for vata dosha. Fourth, the vagus is the only vital nerve whose activity can be reliably measured and manipulated. Indeed, vagal nerve stimulation is a USA-FDA approved therapy for certain ailments attributed to impaired vata dosha. No other nerve or dosha, has such multi-functional and life-sustaining properties. These arguments position vagal activity as a suitable candidate biomarker for certain functions of vata dosha.

Reliability of Ayurvedic Diagnosis for Knee Osteoarthritis Patients: A Nested Diagnostic Study Within a Randomized Controlled Trial

Background: Ayurveda is a traditional Indian system of medicine. The customized Ayurvedic approach consists of a combination of several diagnostic procedures and subsequent individualized therapeutic interventions. Evaluation of inter-rater reliability (IRR) of Ayurvedic diagnoses has rarely been performed. The aim of this study was to evaluate IRR of Ayurvedic diagnosis for patients with knee osteoarthritis.

Methods: A diagnostic reliability study of 30 patients and 4 Ayurvedic experts was nested in a randomized controlled trial. Patients were diagnosed in a sequential order by all experts utilizing a semistructured patient history form. A nominal group technique as consensus procedure was performed to reach agreement on the items to be diagnosed. An IRR analysis using Fleiss' and Cohen's kappa statistics was performed to determine a chance-corrected measure of agreement among raters.

Results: One hundred and twenty different ratings and 30 consensus ratings were performed and analyzed. While high percentages of agreement for main diagnostic entities and the final Ayurveda diagnosis (95% consensus agreement on main diagnosis) could be observed, this was not reflected in the corresponding kappa values, which largely yielded fair-to-poor inter-rater agreement kappas for central diagnostic aspects such as prakriti and agni (κ values between 0 and 0.4). Notably, agreement on disease-related entities was better than that on constitutional entities.

Conclusions: This is the first diagnostic study embedded in a clinical trial on patients with knee osteoarthritis utilizing a multimodality whole systems approach. Results showed a contrast between the high agreement of the consented final diagnosis and disagreement on certain diagnostic details. Future diagnostic studies should have larger sample sizes and a methodology more tailored to the specificities of traditional whole systems of medicine. Equal emphasis will need to be placed on all core diagnostic components of Ayurveda, both constitutional and disease specific, using detailed structured history taking forms.

Western Indian Rural Gut Microbial Diversity in Extreme Prakriti Endo-Phenotypes Reveals Signature Microbes

Heterogeneity amidst healthy individuals at genomic level is being widely acknowledged. This, in turn, is modulated by differential response to environmental cues and treatment regimens, necessitating the need for stratified/personalized therapy. We intend to understand the molecular determinants of Ayurvedic way (ancient Indian system of medicine) of endo-phenotyping individuals into distinct constitution types termed “Prakriti,” which forms the basis of personalized treatment. In this study, we explored and analyzed the healthy human gut microbiome structure within three predominant Prakriti groups from a genetically homogenous cohort to discover differentially abundant taxa, using 16S rRNA gene based microbial community profiling. We found Bacteroidetes and Firmicutes as major gut microbial components in varying composition, albeit with similar trend across Prakriti. Multiple species of the core microbiome showed differential abundance within Prakriti types, with gender specific signature taxons. Our study reveals that despite overall uniform composition of gut microbial community, healthy individuals belonging to different Prakriti groups have enrichment of specific bacteria. It highlights the importance of Prakriti based endo-phenotypes to explain the variability amongst healthy individuals in gut microbial flora that have important consequences for an individual's health, disease and treatment.

Plasma metabolomics reveal the correlation of metabolic pathways and Prakritis of humans

BACKGROUND

Ayurveda, an ancient Indian medicinal system, has categorized human body constitutions in three broad constitutional types (prakritis) i.e. Vata, Pitta and Kapha.

OBJECTIVES

Analysis of plasma metabolites and related pathways to classify Prakriti specific dominant marker metabolites and metabolic pathways.

MATERIALS AND METHODS

38 healthy male individuals were assessed for dominant Prakritis and their fasting blood samples were collected. The processed plasma samples were subjected to rapid resolution liquid chromatography-electrospray ionization-quadrupole time of flight mass spectrometry (RRLC-ESI-QTOFMS). Mass profiles were aligned and subjected to multivariate analysis.

RESULTS

Partial least square discriminant analysis (PLS-DA) model showed 97.87% recognition capability. List of PLS-DA metabolites was subjected to permutative Benjamini-Hochberg false discovery rate (FDR) correction and final list of 76 metabolites with p < 0.05 and fold-change > 2.0 was identified. Pathway analysis using metascape and JEPETTO plugins in Cytoscape revealed that steroidal hormone biosynthesis, amino acid, and arachidonic acid metabolism are major pathways varying with different constitution. Biological Go processes analysis showed that aromatic amino acids, sphingolipids, and pyrimidine nucleotides metabolic processes were dominant in kapha type of body constitution. Fat soluble vitamins, cellular amino acid, and androgen biosynthesis process along with branched chain amino acid and glycerolipid catabolic processes were dominant in pitta type individuals. Vata Prakriti was found to have dominant catecholamine, arachidonic acid and hydrogen peroxide metabolomics processes.

CONCLUSION

The neurotransmission and oxidative stress in vata, BCAA catabolic, androgen, xenobiotics metabolic processes in pitta, and aromatic amino acids, sphingolipid, and pyrimidine metabolic process in kapha Prakriti were the dominant marker pathways.

Wipeout period of spinal anesthesia in hemorrhoidectomy in relation to Prakriti: An observational study

Background:

A maximum number of hemorrhoidectomies are performed under spinal anesthesia. However, the effect of spinal anesthesia varies from person to person due to difference in their physical and psychological properties, which is well explained in Ayurveda as Prakriti (physiology of an individual). In this study, we have tried to establish a relation between wipeout period of spinal anesthesia and different Prakriti.

Objectives:

To observe wipeout period of spinal anesthesia in hemorrhoidectomy in relation to different Prakriti.

Materials and Methods:

A total of 30 individuals who underwent hemorrhoidectomy under spinal anesthesia were selected for the study and their Prakriti was assessed as per the standard Prakriti assessment chart before surgery. Apart from demographic data, pain assessment was also recorded by following visual analog scale. Postoperative follow-up was done until the wipeout effect of spinal anesthesia was observed. GraphPad Prism software was used to analyze the data; P < 0.05 was considered statistically significant.

Results:

Male predominance was observed in hemorrhoidectomy cases. Majority of the patients were 20–25 years of age with body weight between 61 and 70 kg. Distribution of Prakriti was observed to be highest in Vata-Pitta Prakriti (36.6%). A significant difference was observed in the wipeout period among Prakriti where the duration of wipeout period was more in the Kapha Prakriti individuals (P < 0.0001).

Conclusion:

Kapha involvement increases the wipeout period in posthemorrhoidectomy; however, in Pitta and Vata Prakriti individuals, the wipeout period is less. Future studies could include a larger sample size and various other factors to analyze the involvement of Kapha.

A prospective study to assess the association between genotype, phenotype and Prakriti in individuals on phenytoin monotherapy

Background

Genetic polymorphisms in drug metabolizing enzymes (DMEs) impart distinct drug metabolizing capacity and a unique phenotype to an individual. Phenytoin has large inter-individual variability in metabolism due to polymorphisms in CYP2C9 and CYP2C19. As per Ayurveda, Prakriti imparts a unique phenotype to an individual.

Objective

To assess whether Prakriti can substitute phenotyping [therapeutic drug monitoring (TDM)] and genotyping in individualizing therapy with phenytoin in epilepsy patients.

Methods and materials

This was a cross-sectional study conducted over a period of three years. Prakriti was assessed using standardized and validated software. Polymorphisms in CYP2C9 and CYP2C19 were assessed using Polymerase Chain Reaction (PCR)-Restriction fragment length polymorphism (PCR-RFLP). Plasma concentrations of phenytoin (phenotype) were determined using reverse phase-high performance liquid chromatography (RF-HPLC).

Results

Total 351 patients were enrolled for the study. Kapha vata (KV) (39%) was the predominantly observed Prakriti followed by vata kapha (VK) (20.8%) and vata pitta (VP) (8.83%) among the patients. The CYP2C9 and CYP2C19 genotype distributions were in accordance with Hardy–Weinberg equilibrium. There was no association between Prakriti and genotypes and Prakriti and phenotype (p > 0.05 each). Patients with CYP2C9 *1/*3 genotype were thrice more likely to have toxic plasma concentrations of phenytoin as compared to those with wild-type genotype (*1/*1) (Adjusted odds ratio – 3.36; 95% C.I. 1.61, 7.01). However, no such association was observed between polymorphisms of CYP2C19 and phenotype.

Conclusions

We did not find any association between Prakriti and either phenotype or genotypes suggesting that Prakriti assessment would be of limited utility in individualizing phenytoin therapy in epilepsy patients.

Exploring Ayurvedic Knowledge on Food and Health for Providing Innovative Solutions to Contemporary Healthcare

Ayurveda, a traditional system of medicine that originated over three millennia ago in the South Asian region, offers extensive insights about food and health based on certain unique conceptual as well as theoretical positions. Health is defined as a state of equilibrium with one's self (svasthya) but which is inextricably linked to the environment. Ayurvedic principles, such as the tridosa (three humors) theory, provide the relationship between the microcosm and the macrocosm that can be applied in day-to-day practice. Classical Ayurveda texts cover an array of themes on food ranging from diversity of natural sources, their properties in relation to seasons and places and to their specific function both in physiological and pathological states. The epistemic perspective on health and nutrition in Ayurveda is very different from that of biomedicine and modern nutrition. However, contemporary knowledge is reinventing and advancing several of these concepts in an era of systems biology, personalized medicine, and the broader context of a more holistic transition in sciences in general. Trans-disciplinary research could be important not only for pushing the boundaries of food and health sciences but also for providing practical solutions for contemporary health conditions. This article briefly reviews the parallels in Ayurveda and biomedicine and draws attention to the need for a deeper engagement with traditional knowledge systems, such as Ayurveda. It points out that recreation of the methodologies that enabled the holistic view point about health in Ayurveda may unravel some of the complex connections with Nature.

A glimpse of Ayurveda - The forgotten history and principles of Indian traditional medicine

Ayurveda is considered as one of the oldest of the traditional systems of medicine (TSMs) accepted worldwide. The ancient wisdom in this traditional system of medicine is still not exhaustively explored. The junction of the rich knowledge from different traditional systems of medicine can lead to new avenues in herbal drug discovery process. The lack of the understanding of the differences and similarities between the theoretical doctrines of these systems is the major hurdle towards their convergence apart from the other impediments in the discovery of plant based medicines. This review aims to bring into limelight the age old history and the basic principles of Ayurveda. This would help the budding scholars, researchers and practitioners gain deeper perspicuity of traditional systems of medicine, facilitate strengthening of the commonalities and overcome the challenges towards their global acceptance and harmonization of such medicinal systems.

Genome-wide analysis correlates Ayurveda Prakriti

The practice of Ayurveda, the traditional medicine of India, is based on the concept of three major constitutional types (Vata, Pitta and Kapha) defined as “Prakriti”. To the best of our knowledge, no study has convincingly correlated genomic variations with the classification of Prakriti. In the present study, we performed genome-wide SNP (single nucleotide polymorphism) analysis (Affymetrix, 6.0) of 262 well-classified male individuals (after screening 3416 subjects) belonging to three Prakritis. We found 52 SNPs (p ≤ 1 × 10⁻⁵) were significantly different between Prakritis, without any confounding effect of stratification, after 10⁶ permutations. Principal component analysis (PCA) of these SNPs classified 262 individuals into their respective groups (Vata, Pitta and Kapha) irrespective of their ancestry, which represent its power in categorization. We further validated our finding with 297 Indian population samples with known ancestry. Subsequently, we found that PGM1 correlates with phenotype of Pitta as described in the ancient text of Caraka Samhita, suggesting that the phenotypic classification of India’s traditional medicine has a genetic basis; and its Prakriti-based practice in vogue for many centuries resonates with personalized medicine.

DNA methylation analysis of phenotype specific stratified Indian population

Background

DNA methylation and its perturbations are an established attribute to a wide spectrum of phenotypic variations and disease conditions. Indian traditional system practices personalized medicine through indigenous concept of distinctly descriptive physiological, psychological and anatomical features known as prakriti. Here we attempted to establish DNA methylation differences in these three prakriti phenotypes.

Methods

Following structured and objective measurement of 3416 subjects, whole blood DNA of 147 healthy male individuals belonging to defined prakriti (Vata, Pitta and Kapha) between the age group of 20-30years were subjected to methylated DNA immunoprecipitation (MeDIP) and microarray analysis. After data analysis, prakriti specific signatures were validated through bisulfite DNA sequencing.

Results

Differentially methylated regions in CpG islands and shores were significantly enriched in promoters/UTRs and gene body regions. Phenotypes characterized by higher metabolism (Pitta prakriti) in individuals showed distinct promoter (34) and gene body methylation (204), followed by Vata prakriti which correlates to motion showed DNA methylation in 52 promoters and 139 CpG islands and finally individuals with structural attributes (Kapha prakriti) with 23 and 19 promoters and CpG islands respectively. Bisulfite DNA sequencing of prakriti specific multiple CpG sites in promoters and 5′-UTR such as; LHX1 (Vata prakriti), SOX11 (Pitta prakriti) and CDH22 (Kapha prakriti) were validated. Kapha prakriti specific CDH22 5′-UTR CpG methylation was also found to be associated with higher body mass index (BMI).

Conclusion

Differential DNA methylation signatures in three distinct prakriti phenotypes demonstrate the epigenetic basis of Indian traditional human classification which may have relevance to personalized medicine.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-015-0506-0) contains supplementary material, which is available to authorized users.