Review of Holarrhena antidysenterica (L.) Wall. ex A. DC.: Pharmacognostic, Pharmacological, and Toxicological Perspective

Expanded Therapeutic Applications of Holarrhena Antidysenterica: A Review

BACKGROUND

The use of medicinal plants as a rich resource of therapeutic agents in the treatment and prevention of diseases & ailments has been recognized for millennia and is highly regarded worldwide. Holarrhena antidysenterica (H. antidysenterica), also called kurchi, or kutaj, has been utilized since the dawn of time, Apocynaceae member, also known as H. pubescens, is praised for the medicinal uses of its stem bark, leaves, and seeds in Ayurveda.

OBJECTIVE

The study concentrated on aggregate information regarding H. antidysenterica's therapeutic effects. The purpose of the study was to compile pharmacological activities of H. antidysentrica seeds.

METHODS

Regardless of its broad variety of biological and possible therapeutic uses, there has been increasing concern regarding the use of H. antidysenterica.

RESULT

Various phytochemicals have been extracted from H. antidysenterica in recent years and have demonstrated typical pharmacological properties, including antibacterial, anti-diarrhoeal, anti-diabetic, anti-oxidant, anti-urolithic, and anti-inflammatory activity.

CONCLUSION

This review paper investigated the in-depth description and pharmacological properties of the plant, which produced significant findings on the chemical components present and also verified the traditionally claimed properties associated with the plant.

DNA topoisomerases as a drug target in Leishmaniasis: Structural and mechanistic insights

Leishmaniasis, caused by a protozoan parasite, is among humanity's costliest banes, owing to the high mortality and morbidity ratio in poverty-stricken areas. To date, no vaccine is available for the complete cure of the disease. Current chemotherapy is expensive, has undesirable side effects, and faces drug resistance limitations and toxicity concerns. The substantial differences in homology between leishmanial DNA topoisomerase IB compared with the human counterparts provided a new lead in the study of the structural determinants that can be targeted. Several research groups explored this molecular target, trying to fill the therapeutic gap, and came forward with various anti-leishmanial scaffolds. This article is a comprehensive review of knowledge about topoisomerases as an anti-leishmanial drug target and their inhibitors collected over the years. In addition to information on molecular targets and reported scaffolds, the review details the structure-activity relationship of described compounds with leishmanial Topoisomerase IB. Moreover, the work also includes information about the structure of the inhibitors, showing common interacting residues with leishmanial topoisomerases that drive their mode of action towards them. Finally, in search of topoisomerase inhibitors at the stage of clinical trials, we have listed all the drugs that have been in clinical trials against leishmaniasis.

An ethnobotanical survey on phytomedicines based on traditional knowledge in the Barpeta district, Assam, India

BACKGROUND

Traditional knowledge (TK) is the culture as well as the identity of the majority of the ethnic communities. This knowledge is diminishing with time and with the advancement of synthetic medicines. The medicinal plants are equally effective with fewer side effects when compared to allopathic treatments for humans as well as livestock.

OBJECTIVE

The main focus of this study is to document the use of plants for the treatment of human ailments by traditional healers in the Barpeta district of Assam.

MATERIALS AND METHODS

A survey was conducted to gather information on phytomedicines from among the 30 local practitioners or traditional healers in the Barpeta district of Assam state through face-to-face interviews and discussions. The data obtained from the study was compiled through the UR (Use report). The data was analyzed by Fic (informant consensus factor) and RFC (relative frequency of citation). The botanical name of the plants was verified using https://wfoplantlist.org/plant-list.

RESULTS

A total of 50 plant species having medicinal benefits belonging to 48 genera and 30 families were recorded. The leaves were the most used parts used in treatment accounting for 74% of the total and were usually used by extracting the juice. Besides, the most common disease treated using herbal medicines includes that of the GIT (gastrointestinal tract). The GIT disease category showed the highest Fic index which is 0.25. The plant species Syzygium cumini showed the highest RFC index of 0.50.

CONCLUSIONS

The common people of the Barpeta district of Assam are found to be familiar with the practice of traditional medicines. This knowledge has mostly been passed down to generations from their ancestors who acquired it through trial and error methods. These medicinal plants are used in crude form. Therefore, the plants must be thoroughly analyzed and tested to identify the active principles involved in their mechanism of action which can be used in drug development.

The antidiabetic effect of methanolic extract of Holarrhena pubescens seeds is mediated through multiple mechanisms of action

Holarrhena pubescens is widely used in Indian and Chinese medicine in the treatment of diabetes. The current work determined the oral hypoglycemic and antidiabetic effects of seed extract in rats. The probable mechanism of action was evaluated in-vitro by α - glucosidase inhibition, glucose metabolism in insulinoma (INS-1) cells to reflect secretion of insulin, and protein glycation inhibition. Its potential for herb-drug interaction was evaluated in the cytochrome P450 3A4 (CYP3A4) inhibition assay. The seed extract increased serum insulin levels and reduced serum blood glucose levels in the oral glucose tolerance test. It also reduced the serum glucose levels in streptozocin-induced diabetes. The extract also inhibited α -glucosidase enzyme activity and demonstrated that it can increase the secretion of insulin from INS to 1-rat insulinoma cell line cells in-vitro in a concentration-dependent manner. However, it had a very weak inhibitory effect on protein glycation and it did not affect the activity of CYP3A4. The results of the study showed that H. pubescens seed extract increases insulin secretion and inhibits glucose absorption both in-vivo and in-vitro with a weak protein glycation inhibitory effect. The herb is devoid of CYP3A4 inhibitory effect indicating that it may not have pharmacokinetic interaction with the drug metabolized by this enzyme.

Demystifying the potential of inhibitors targeting DNA topoisomerases in unicellular protozoan parasites

DNA topoisomerases are a group of enzymes omnipresent in all organisms. They maintain the DNA topology during replication, repair, recombination, and transcription. However, the structure of topoisomerase in protozoan parasites differs significantly from that of human topoisomerases; thus, this enzyme acts as a crucial target in drug development against parasitic diseases. Although the therapeutic potential of drugs targeting the parasitic topoisomerase is well known, to manage the shortcomings of currently available therapeutics and the emergence of drug resistance, the discovery of novel antiparasitic molecules is an urgent need. In this review, we describe various investigational and repurposed topoisomerase inhibitors developed against protozoan parasites over the past few years. Teaser: Fatal parasitic diseases are an increasing cause for concern; here, we provide a compilation of different inhibitors targeting DNA topoisomerases, enzymes that are essential for, and unique to, protozoan parasites; therefore, inhibitors are efficient and have few adverse effects.

Holanamine, a Steroidal Alkaloid from the Bark of Holarrhena pubescens Wall. ex G. Don Inhibits the Growth of Leishmania donovani by Targeting DNA Topoisomerase 1B

Leishmaniasis is a group of neglected tropical diseases (NTDs) caused by about 20 species of obligate intracellular protozoan parasites of the genus Leishmania, which occurs in cutaneous, mucocutaneous, and visceral forms. Many researchers have sought to utilize natural products for novel and effective treatments to combat many infectious diseases, including leishmaniasis. Holarrhena pubescens Wall. ex G. Don (Apocynaceae) bark is a rich source of bioactive steroidal alkaloids. The total alkaloidal extract (IC₅₀ 6.12 ± 0.117 μg/mL), and the isolated alkaloid, holanamine, showed significant antileishmanial activity (IC₅₀ 2.66 ± 0.112 μM against AG83 and 3.80 ± 0.126 μM against BHU-575) against the Leishmania donovani parasite, better than miltefosine (IC₅₀ 19.61 ± 0.093 μM against AG83 and 23.20 ± 0.094 μM against BHU-575). Holanamine inhibited the L. donovani topoisomerase 1B (LdToP1B) in a non-competitive manner (IC₅₀ 2.81 ± 0.105 μM), indicating that it interacts with the free enzyme and enzyme-DNA complex without inhibiting human topoisomerase. Hydrogen bonding and hydrophobic interactions of holanamine with the N-terminal and hinge region of the large subunit of LTop1B is responsible for its potent antileishmanial activity, as shown by docking studies. Treatment with holanamine causes apoptotic-like cell death by generating cellular and mitochondrial reactive oxygen species, disrupting the mitochondrial membrane potential and inducing ultrastructural alterations in the promastigotes. Holanamine effectively clears intracellular amastigotes but minimally affects host macrophages with no significant cytotoxicity in HEK 293 and L929 cell lines. Thus, our studies show that holanamine can further be used to develop effective antileishmanial agents against evolving drug-resistant parasites.

Metabolic Diversity and Therapeutic Potential of Holarrhena pubescens: An Important Ethnomedicinal Plant

Holarrhena pubescens is an important medicinal plant of the Apocynaceae family that is widely distributed over the Indian subcontinent. The plant is extensively used in Ayurveda and other traditional medicinal systems without obvious adverse effects. Beside notable progress in the biological and phytochemical evaluation of this plant over the past few years, comprehensive reviews of H. pubescens are limited in scope. It has economic importance due to the extensive use of seeds as an antidiabetic. Furthermore, the plant is extensively reported in traditional uses among the natives of Asia and Africa, while scientifical validation for various ailments has not been studied either in vitro or in vivo. This review aims to summarize information on the pharmacology, traditional uses, active constituents, safety and toxicity of H. pubescens. Chemical analysis of H. pubescens extracts revealed the presence of several bioactive compounds, such as conessine, isoconnessine, conessimine, conimine, conessidine, conkurchicine, holarrhimine, conarrhimine, mokluangin A-D and antidysentericine. Overall, this review covers the ethnopharmacology, phytochemical composition, and pharmacological potential of H. pubescens, with a critical discussion of its toxicity, biological activities (in vitro and in vivo), the mechanism of action, as well as suggestions for further basic and clinical research.

Patterns of concomitant use of Ayurveda and conventional anti-diabetic formulations - Experiences at a tertiary care Ayurveda hospital, India

Background:

Majority of the population relies on traditional medicines for many of their health related problems. Particularly individuals with chronic illness like diabetes mellitus (DM) are more likely to simultaneously use herbal medicines. Many of such users believe that traditional medicines are natural and therefore safe, but this is a dangerous over simplification. Some herbal medicines may be associated with adverse effects, which include interactions with prescribed drugs. Information on such concomitant use of anti-diabetic drugs along with Ayurveda medicines is limited in Indian scenario.

Aims and objectives:

To survey the patterns of concomitant use of Ayurveda and conventional anti-diabetic drugs by diabetic patients attending an out-patient department of a tertiary care teaching hospital in New Delhi, India through a validated questionnaire.

Materials and methods:

This is a questionnaire-based survey, carried out after the approval of the Institutional Ethics Committee, subsequently registered at CTRI. A questionnaire to assess the pattern of concomitant use was developed; content was validated and pre-tested by a pilot study in 40 patients, further refined and used in the survey. The data was analyzed to evaluate the patterns of concomitant use of Ayurvedic and conventional anti-diabetic drugs.

Results:

About 95.9% of diabetic patients were taking herbo-mineral formulations concomitantly with conventional anti-diabetic drugs. Although 45.3% of diabetics were using Ayurveda interventions under the supervision of qualified AYUSH physicians, remaining involved in procuring the drugs over the counter (OTC) or from the local vendors. In majority of these instances, the use of Ayurveda formulations was not communicated with their physicians.

Conclusion:

The observations reveal that a majority of the diabetics (95.9%) were taking one or the other form of herbal preparations along with their conventional anti-diabetic drugs and about 44% among them were using these concomitantly. Thus, generating awareness on good practices of drug use seems to be essential.

Recent perspectives on the virulent factors and treatment options for multidrug-resistant Acinetobacter baumannii

Acinetobacter baumannii (AB) is one of the most notorious and opportunistic pathogens, which caused high morbidity and mortality rate and World Health Organization (WHO) declared this bacterium as priority-1 pathogen in 2017. The current antibacterial agents, such as colistins, carbapenems, and tigecyclines have limited applications, which necessitate novel and alternative therapeutic remedies. Thus, the understanding of recent perspectives on the virulent factors and antibiotic resistance mechanism exhibited by the bacteria are extremely important. In addition to many combinatorial therapies of antibacterial, there is several natural compounds demonstrated significant antibacterial potential towards these bacteria. The computational systems biology and high throughput screening approaches provide crucial insights in identifying novel drug targets and lead molecules with therapeutics potential. Hence, this review provides profound insight on the recent aspects of the virulent factors associated with AB, role of biofilm formation in drug resistance and the mechanisms of multidrug resistance. This review further illustrates the status of current therapeutic agents, scope, and applications of natural therapeutics, such as herbal medicines and role of computational biology, immunoinformatics and virtual screening in novel lead developments. Thus, this review provides novel insight on latest developments in drug-resistance mechanism of multidrug-resistant A. baumannii (MDRAB) and discovery of probable therapeutic interventions.

A Single-Center Experience on Outcomes of Complementary and Alternative Medicine Use Among Patients With Cirrhosis

Drug‐induced liver injury (DILI) due to complementary and alternative medicine (CAM) use is on the rise throughout the world by patients looking for “safer” alternatives. However, data on acute‐on‐chronic liver failure (ACLF) due to CAM are lacking. In a large cohort of patients with cirrhosis, we retrospectively studied CAM‐related health‐seeking behavior and attempted to identify those who developed possible CAM‐DILI‐related ACLF. In this study, we examine the clinical, biochemical, and liver histopathologic characteristics of possible CAM‐DILI‐related ACLF, describe implicated CAM agents, and discuss predictors of patient outcomes. Out of 1,666 patients with cirrhosis, 68% used CAM at some point. A total of 35.7% (n = 30/84) patients presented with CAM‐related DILI leading to ACLF in the whole CAM‐DILI‐related decompensation cohort. The most common CAM was unlabeled polyherbal Ayurvedic formulations. Of possible patients with ACLF, 63% self‐medicated with CAM based on social media sharing. Mean age ± SD was 51.9 ± 9.9 years, 83% were male patients, median follow‐up duration was 173 (range, 14‐584) days, median Child‐Turcotte‐Pugh score was 13 (range, 10‐14), Model for End‐Stage Liver Disease‐sodium score was 30.1 ± 4.8, median chronic liver failure‐organ failure (CLIF‐C‐OF) score was 11 (range, 8‐14), and median CLIF‐C‐ACLF score was 98 (range, 87‐127). Portal‐based neutrophilic predominant mixed inflammation, hepatocyte ballooning, autoimmune‐like features, and severe cholestasis were seen on liver biopsy. Overall, 53% of patients died (median survival 194 days). Baseline overt hepatic encephalopathy and CLIF‐C‐OF score, total bilirubin, hyponatremia and leukocytosis, and grade of ACLF predicted 1‐, 3‐, 6‐ and 12‐month mortality, respectively. Conclusion: Possible CAM‐DILI‐related ACLF has a high mortality. Strict monitoring and identification of CAM use among people with cirrhosis and an integrative public health educational practice can help ameliorate this modifiable risk factor that potentiates heavy liver disease burden and resource use.

Anti-mycobacterial activity of some medicinal plants used traditionally by tribes from Madhya Pradesh, India for treating tuberculosis related symptoms

ETHNOPHARMACOLOGICAL RELEVANCE

Tuberculosis (TB) is one of the highly infectious disease caused by the bacterium Mycobacterium tuberculosis (Mtb). Several medicinal plants are traditionally used by the tribal healers of some tribal pockets of Madhya Pradesh (M.P.), India in the treatment of various ailments including TB related symptoms. The information of traditional knowledge of plants is empirical lacking systematic scientific investigation.

AIM OF THE STUDY

To provide a scientific rationale for the traditional uses of some medicinal plants in treating prolonged cough, chest complaints and TB by ethnic groups in four districts of the state of M.P., India. The anti-mycobacterial activity of these plants was also investigated against multidrug-resistant (MDR) strains of Mtb. The active plant extracts were also assessed for general cytotoxicity by human monocytic leukemia cell line, THP-1 macrophages.

MATERIALS AND METHODS

Semi structured interviews and guided field-walk methods were used to gather information on medicinal plants used by the tribal traditional healers. The study was carried out in the tribal pockets of Anuppur, Mandla, Umariya and Dindori districts of M.P., India. A total of 35 plant species distributed in 22 families were selected based on folklore uses suggested by the tribal traditional healer. The ethanol extracts of plants were evaluated for anti-mycobacterial activity against Mtb H37Rv and six MDR clinical isolates of Mtb. The anti-mycobacterial activity of plants was determined in terms of minimum inhibitory concentration (MIC) using standard resazurin microtitre plate assay (REMA). The plant extracts found to be active against Mtb were further evaluated for general cytotoxicity against human THP-1 macrophages using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium (MTT) assay. The selectivity index (SI) of active plant extracts were also calculated on the basis of MIC and cytotoxicity.

RESULTS

Out of the 35 plants, 11 plant species showed anti-mycobacterial activity with MIC ranging from 500 to 31.25 µg/mL against Mtb H37Rv. The plant extracts also exhibited anti-mycobacterial activity against six multi-drug resistant (MDR) clinical strains of Mtb isolated from sputum samples of pulmonary TB patients. In vitro cytotoxicity of active plant extracts was also assessed in human THP-1 macrophages. The IC₅₀ (50% inhibitory concentration) values of most of the plant extracts on THP-1 was found to be higher than MIC values against Mtb, indicating that the THP-1 cells are not adversely affected at concentrations that are effective against Mtb. Significant anti-mycobacterial activity was observed for eleven plants viz., Alstonia scholaris (L.) R. Br., Glycyrrhiza glabra L., Holorrhena antidysentrica (Roth) Wall. exA.DC., Mallotus philippensis (Lam.) Müll. Arg., Eulophia nuda Lindl., Cocculus hirsutus (L.) Diels, Pueraria tuberosa (Willd.) DC., Cyperus rotundus L., Curcuma caesia Roxb., Sphaeranthus indicus L. and Plumbago zeylanica L. which lends support to their traditional uses.

CONCLUSION

The present investigation supports the potential role of plants used by tribal healers as our results have shown that these plants exhibit anti-mycobacterial activity in the acceptable range against Mtb. Our study clearly lends support to the traditional uses of some plants in TB related symptoms as we have found them to exhibit significant in vitro anti-TB activity. To the best of our knowledge, anti-mycobacterial activity in plants against Mtb is being reported for the first time from tribal areas of M.P., India by the current study.

Molecular dynamics simulation analysis of conessine against multi drug resistant Serratia marcescens

Ornithine decarboxylase (ODC) is an immediate precursor of polyamine biosynthesis in Serratia marcescens and a potential target for inhibition of its growth. We predicted the 3D structural conformation of ODC enzyme and validated it using MDS in our previous study. In this current study, the potential inhibitors of ODC were obtained by virtual screening of potential inhibitors from ZINC database and studied in depth for their different binding pose. Among the ten virtually screened inhibitors, Conessine exhibited the best binding with ODC and its inhibition property was studied further by MDS studies. The natural compound conessine is isolated from plant Holarrhena antidysenterica and it is studied against ODC of Serratia marcenses for its inhibitory potentials. This revealed unforeseen twisted position in root mean square fluctuation (RMSF) and ODC modelled conformation that influenced ligand binding. Both predicted model and ligand bound model were compared and found to be stable with Root Mean Square Deviation (RMSD) of approximately 7 nm and 0.25 nm to that of crystallographic structure over simulation time of 55 ns and 70 ns respectively. This work paves the way for future development of new drugs against nosocomial diseases caused by Serratia marcescens.

Methanol Extract of Holarrhena antidysenterica Inhibits the Growth of Human Oral Squamous Cell Carcinoma Cells and Osteoclastogenesis of Bone Marrow Macrophages

Oral squamous cell carcinoma (OSCC) frequently invades mandibular bone, and outcomes for treatment with surgical resection are typically poor, ultimately resulting in death. Holarrhena antidysenterica L. (Apocynaceae), distributed throughout Sri Lanka and India, has been used as a folk remedy to treat various diseases. Treatment with methanol extract of H. antidysenterica bark (HABE) inhibited cell viability and BrdU incorporation and induced apoptotic cell death in Ca9-22 gingival and HSC-3 tongue SCC cells. Flow cytometric analysis indicated that HABE treatment preferentially induces apoptotic cell death via increasing the sub-G1 peak in Ca9-22 cells and cell cycle arrest at the G1 phase in HSC-3 cells. HABE treatment in the presence of zVAD-fmk, a pan-caspase inhibitor, rescued cell viabilities in both OSCC cell lines. The ratio of Bax to Bcl-2 increased with reductions in the Bcl-2 protein expression, and the activation of caspase 3 and subsequent cleavage of PARP was detected in HABE-treated Ca9-22 and HSC-3 cells. Furthermore, HABE treatment at noncytotoxic concentrations inhibited osteoclast formation in RANKL-stimulated bone marrow macrophages. Taken together, HABE possesses the inhibitory activity on the growth of OSCC cells and antiosteoclastogenic activity. Therefore, HABE may be a promising alternative and complementary agent for preventing and treating OSCC.