Management of Aphthous Ulceration with Topical Quercetin: A Randomized Clinical Trial

Exploring the underlying pharmacological, immunomodulatory, and anti-inflammatory mechanisms of phytochemicals against wounds: a molecular insight

BACKGROUND

Numerous cellular, humoral, and molecular processes are involved in the intricate process of wound healing.

PHARMACOLOGICAL RELEVANCE

Numerous bioactive substances, such as ß-sitosterol, tannic acid, gallic acid, protocatechuic acid, quercetin, ellagic acid, and pyrogallol, along with their pharmacokinetics and bioavailability, have been reviewed. These phytochemicals work together to promote angiogenesis, granulation, collagen synthesis, oxidative balance, extracellular matrix (ECM) formation, cell migration, proliferation, differentiation, and re-epithelialization during wound healing.

FINDINGS AND NOVELTY

To improve wound contraction, this review delves into how the application of each bioactive molecule mediates with the inflammatory, proliferative, and remodeling phases of wound healing to speed up the process. This review also reveals the underlying mechanisms of the phytochemicals against different stages of wound healing along with the differentiation of the in vitro evidence from the in vivo evidence There is growing interest in phytochemicals, or plant-derived compounds, due their potential health benefits. This calls for more scientific analysis and mechanistic research. The various pathways that these phytochemicals control/modulate to improve skin regeneration and wound healing are also briefly reviewed. The current review also elaborates the immunomodulatory modes of action of different phytochemicals during wound repair.

New Perspectives about Relevant Natural Compounds for Current Dentistry Research

Natural compounds have been used since the earliest civilizations and remain, to this day, a safer alternative for treating various dental problems. These present antimicrobial, anti-inflammatory, antioxidant, analgesic, and antimutagenic effects, making them useful in the prophylactic and curative treatment of various oral diseases such as infections, gingivitis, periodontitis, and even cancer. Due to the high incidence of unpleasant adverse reactions to synthetic compounds, natural products tend to gradually replace conventional treatment, as they can be just as potent and cause fewer, milder adverse effects. Researchers use several methods to measure the effectiveness and safety profile of these compounds, and employing standard techniques also contributes to progress across all medical disciplines.

Plant-Derived Polyphenols to Prevent and Treat Oral Mucositis Induced by Chemo- and Radiotherapy in Head and Neck Cancers Management

Oral Mucositis (OM) is the most common side effect due to chemotherapy and radiotherapy, which are the conventional treatment options for head and neck cancers. OM is a severe inflammatory condition characterized by multifactorial etiopathogenesis. It further negatively affects patients' quality of life by severe impairment of normal oral functions. Consequently, it is mandatory to identify new effective therapeutic approaches to both prevent and treat OM while also avoiding any recurrence. Polyphenols recently attracted the interest of the scientific community due to their low toxicity and wide range of biological activities making them ideal candidates for several applications in the odontostomatological field, particularly against OM. This review collects the in vivo studies and the clinical trials conducted over the past 13 years evaluating the preventive and curative effects of several polyphenolic compounds towards chemo- and radiotherapy-induced OM, both when administered alone or as a plant-extracted phytocomplex. The literature fully confirms the usefulness of these molecules, thus opening the possibility of their clinical application. However, polyphenol limitations (e.g., unfavourable physicochemical properties and susceptibility to degradation) have emerged. Consequently, the interest of the scientific community should be focused on developing innovative delivery systems able to stabilize polyphenols, thus facilitating topical administration and maximizing their efficacy.

A systematic review of medicinal plants and herbal products' effectiveness in oral health and dental cure with health promotion approach

Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative treatments for oral health care, herbal products' use may continue to increase and become more widespread. The objective of this study is to present a comprehensive systematic review of the current published literature on the effectiveness of medicinal plants and herbal products employed to improve oral health in adolescents with a health promotion approach. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The keywords "herbal medicine," "herbal extract," "herbal supplements," "plant extract," "natural drug," "pulpitis," "dental caries," "oral viral diseases," and "abscess" were used in combination with the Boolean operators OR and AND. PubMed, Embase, Scopus, and Web of Science were searched. Quality assessment of the included studies was performed using the Cochrane Handbook for Systematic Reviews of Interventions. The search yielded 49 original research studies. A total of 22 studies had low or unclear risk bias. The geographical distribution of included studies was primarily concentrated on western countries. Overall, studies reported herbal product users' age, ranging from young adults aged 18 years to elderly people aged 75 years or older. Most studies reported multiple compounds, including herbal drugs and herbal extracts. Chamomile and Aloe vera were the most frequently reported herbal compounds. The most commonly described herbal products to treat oral diseases were gels, mouth rinses, and pastes. The studies included a range of people with oral diseases, including periodontal and gingival diseases, recurrent aphthous stomatitis, oral lichen planus, and oral candidiasis. Herbal product interventions were found to be effective and safe alternatives for oral health care. One of the most important goals of the World Health Organization (until 2015) is the oral health index, so it is important that dental services be followed up more seriously. Considering the problems in reaching this goal of the World Health Organization in our country, herbal products have the ability to improve clinical oral health outcomes in adolescents. Limited adverse side effects indicate the overall safety of these treatments for a wide range of oral diseases. Therefore, the use of medicinal plants as well as alternative medicine is one of the useful methods in achieving this important goal of public health.

Sirtuin 1 as a potential biomarker of undernutrition in the elderly: a narrative review

Undernutrition and inflammatory processes are predictors of early mortality in the elderly and require a rapid and accurate diagnosis. Currently, there are laboratory markers for assessing nutritional status, but new markers are still being sought. Recent studies suggest that sirtuin 1 (SIRT1) has the potential to be a marker for undernutrition. This article summarizes available studies on the association of SIRT1 and undernutrition in older people. Possible associations between SIRT1 and the aging process, inflammation, and undernutrition in the elderly have been described. The literature suggests that low SIRT1 levels in the blood of older people may not be associated with physiological aging processes, but with an increased risk of severe undernutrition associated with inflammation and systemic metabolic changes.

The significance of quercetin-loaded advanced nanoformulations for the management of diabetic wounds

Quercetin is a well-known plant flavanol that exhibits multiple biological activities, including antioxidant, anti-inflammatory and anticancer activities. The role of quercetin in wound healing has been widely explored by a range of researchers in different models. However, the physicochemical properties, such as solubility and permeability, of this compound are low, which ultimately limits its bioavailability on the target site. To overcome these limitations for successful therapy, scientists have developed a range of nanoformulations that provide effective therapeutic potential. In this review, the broad mechanism of quercetin for acute and chronic wounds is covered. A compilation of recent advances on the horizon of wound healing via quercetin is incorporated with several advanced nanoformulations.

Flavonoids as Potential Wound-Healing Molecules: Emphasis on Pathways Perspective

Wounds are considered to be a serious problem that affects the healthcare sector in many countries, primarily due to diabetes and obesity. Wounds become worse because of unhealthy lifestyles and habits. Wound healing is a complicated physiological process that is essential for restoring the epithelial barrier after an injury. Numerous studies have reported that flavonoids possess wound-healing properties due to their well-acclaimed anti-inflammatory, angiogenesis, re-epithelialization, and antioxidant effects. They have been shown to be able to act on the wound-healing process via expression of biomarkers respective to the pathways that mainly include Wnt/β-catenin, Hippo, Transforming Growth Factor-beta (TGF-β), Hedgehog, c-Jun N-Terminal Kinase (JNK), NF-E2-related factor 2/antioxidant responsive element (Nrf2/ARE), Nuclear Factor Kappa B (NF-κB), MAPK/ERK, Ras/Raf/MEK/ERK, phosphatidylinositol 3-kinase (PI3K)/Akt, Nitric oxide (NO) pathways, etc. Hence, we have compiled existing evidence on the manipulation of flavonoids towards achieving skin wound healing, together with current limitations and future perspectives in support of these polyphenolic compounds as safe wound-healing agents, in this review.

Network pharmacology and bioinformatics analyses identify the intersection genes and mechanism of Huang Bai for recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) are complex inflammatory diseases caused by multi-factors, which severely impact patient quality of life. However, there is still no effective treatment method for RAS without side effects. Traditionally, Cortex Phellodendri known as "Huang Bai" was used to treat RAS for antibacterial and anti-inflammatory properties in China. Network pharmacology methods and bioinformatics analysis were utilized to search and fish incorporating target. Network analysis and silico validation were used to discover the pharmacological mechanisms of "Huang Bai" for the treatment of RAS. A total of 25 active ingredients in HB, 200 drug targets, and 578 differentially expressed genes (DEGs) between Recurrent aphthous stomatitis and normal samples were obtained. The Gene Ontology enrichment analysis revealed that the immune response was the most significantly enriched term within the DEGs. The KEGG pathway analysis identified 60 significant pathways, most of which involved in the inhibition of inflammation and regulation of immunological response. The functions are dependent on a multi-pathway, particularly the TNF signaling pathway and the HIF-1 signaling pathway. We identified six hub genes in the PPI network, most of which were validated as highly expressed in oral ulcers by DiseaseMeth databases. In addition, molecular docking displayed that the primary molecule combined well with the key targets. "Huang Bai" contains potential anti-RAS active compounds. This study reflects the multi-component multi-target multi-pathway action characteristics of "Huang Bai." Our study provides potential biomarkers or treatment targets for further research.

The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials

This systematic review was undertaken with the main aim of assessing the therapeutic effects of herbal medicines in recurrent aphthous stomatitis (RAS). A comprehensive search was performed in PubMed, Scopus, ISI Web of Science, and Google Scholar up to July 2021 to identify randomized clinical trials investigated the effects of herbal medicines on RAS. Thirty-three papers comprising 2,113 patients met the eligibility criteria, of which 30 studies had a high quality based on the Jadad scale. Totally, 22 out of 30 studies which assessed the pain showed that herbal agents significantly decreased the pain compared with the control group or placebo. In 17 out of 25 studies that evaluated ulcer size, herbal agents significantly reduced the size of ulcers compared with the control or placebo groups. In 15 out of 18 studies that assessed the healing time, herbal agents significantly reduced healing time in the intervention groups compared with the placebo or control groups. Few adverse events were reported only in four studies. Findings of the current review indicated medicinal plants and phytochemicals as effective and safe agents that for the treatment of RAS.

The effects of herbal medicines on cancer therapy-induced oral mucositis: A literature review

Cancer therapy-induced oral mucositis (OM) is one of the most troublesome morbidities after radio-chemotherapy. Age, nutritional status, tumor type, oral hygiene, and treatment method are the determinants for OM incidence. In addition, oxygen-free radicals can act as a trigger for an inflammatory milieu that causes OM. Based on the debilitating nature of OM, finding a safe and inexpensive agent with anti-inflammatory, anti-microbial, and antioxidative properties can be valuable for this situation. Considering the harmful effects of some chemical agents, herbal medicine has been suggested as a potential alternative owing to unique properties such as safety, availability and low cost. Many studies have illustrated several pharmacological properties of herbal medicines in recent years, such as anti-inflammatory, anti-microbial, and antioxidative activities, which are essential factors in the palliation of cancer therapy-induced OM. This review aimed to evaluate herbal medicines' effects on cancer therapy-induced OM. According to this comprehensive review, it is concluded that medicinal plants and phytochemicals can be used as practical agents in the palliation of cancer therapy-induced OM without any serious side effects.

Propolis and Its Gastroprotective Effects on NSAID-Induced Gastric Ulcer Disease: A Systematic Review

Gastric ulcer disease induced by the consumption of NSAIDs is a major public health problem. The therapy used for its treatment causes adverse effects in the patient. Propolis is a natural product that has been used for the treatments of different diseases around the world. Nevertheless, there is little information about the activity of propolis in gastric ulcers caused by treatment with NSAIDs. Therefore, this review evaluates and compares the gastroprotective potential of propolis and its function against NSAID-induced gastric ulcers, for which a systematic search was carried out in the PubMed and ScienceDirect databases. The main criteria were articles that report the gastroprotective activity of propolis against the damage produced by NSAIDs in the gastric mucosa. Gastroprotection was related to the antioxidant, antisecretory, and cytoprotective effects, as well as the phenolic compounds present in the chemical composition of propolis. However, most of the studies used different doses of NSAIDs and propolis and evaluated different parameters. Propolis has proven to be a good alternative for the treatment of gastric ulcer disease. However, future studies should be carried out to identify the compounds responsible for these effects and to determine their potential use in people.

Efficacy of Nutrients in Reducing the Symptoms of Radiation Induced Oral Mucositis in a Hamster Model

Radiation-induced oral mucositis (RIOM) is a painful, dose-limiting toxicity in cancer therapy. RIOM was induced by radiation on the left buccal pouch mucosa of Golden Syrian hamsters (n = 8/group). Animals were treated topically with polyphenols (Curcumin or Quercetin) or amino acids/metabolite mixtures (Alanyl-Glutamine or Arginine + Glutamine + β-Hydroxy β-methylbutyric acid (Arg/Gln/HMB)) for over 20 day. Progression of RIOM was assessed using a standard visual scoring six-point scale, for differences in severity of mucositis (score ≥3) (Chi-square analysis) and in the daily group scores (Mann-Whitney rank sum test). Compared to the controls, there was a significant reduction in number of days with severe RIOM (score ≥3) in the treatment groups: Curcumin (50 μg/ml) = 17%; Control = 38.5%, p < 0.001; Quercetin (50 μg/ml) = 27.6% and Quercetin (100 μg/ml) = 25%; Control = 41.3%, p = 0.007 and p = 0.001, respectively; Arg/Gln/HMB (50 mg/ml) = 31.9%; Control = 50.0%, p = 0.040. In addition, Curcumin (50 μg/ml), Quercetin (100 μg/ml) and Arg/Gln/HMB (100 mg/ml) groups had lower mucositis scores (≥3) on at least two consecutive time points over the course of the study than their respective controls. There were no significant group differences in deaths or body weight. This study demonstrates the potential benefits of topical application of either plant polyphenols or amino acid/metabolite mixtures in addressing severity and progression of RIOM.

Comparative assessment of low-level laser therapy (LLLT) vs. topical application of amlexanox + lidocaine to treat recurrent aphthous ulcers (RAUs): A randomized controlled trial

Background. The present study aimed to assess and compare the pain perception and ulcer sizes before and after applying low-level laser therapy (LLLT) and Amlexanox + lidocaine.

Methods. Twenty-six patients referring to the out-patient department of the institution and diagnosed with recurrent aphthous ulcers (RAU) were assigned to two groups to receive either LLLT or Amlexanox + lidocaine. In group 1, the patients were provided with amlexanox + lidocaine to apply topically four times daily. In group 2, the patients underwent LLLT with no tissue contact in inward circular motions for two cycles for 30 seconds. This study was registered in "the Clinical Trials Registry- India" (CTRI), with the registration number CTRI/2019/09/028222. The data were analyzed with SPSS 16.

Results. The intergroup comparison was performed using Mann-Whitney U test, and intragroup comparisons were made using Wilcoxon’s signed-rank test. The level of significance was set at P <0.05. The results showed that pain perception and ulcer size were significantly lower in group 2 subjects than group 1 subjects (P <0.05).

Conclusion. LLLT was more effective than amlexanox + lidocaine in the management of RAU. It is a cost-effective therapy for treating RAU.

Natural Products as Modulators of Sirtuins

Natural products have been used for the treatment of human diseases since ancient history. Over time, due to the lack of precise tools and techniques for the separation, purification, and structural elucidation of active constituents in natural resources there has been a decline in financial support and efforts in characterization of natural products. Advances in the design of chemical compounds and the understanding of their functions is of pharmacological importance for the biomedical field. However, natural products regained attention as sources of novel drug candidates upon recent developments and progress in technology. Natural compounds were shown to bear an inherent ability to bind to biomacromolecules and cover an unparalleled chemical space in comparison to most libraries used for high-throughput screening. Thus, natural products hold a great potential for the drug discovery of new scaffolds for therapeutic targets such as sirtuins. Sirtuins are Class III histone deacetylases that have been linked to many diseases such as Parkinson`s disease, Alzheimer’s disease, type II diabetes, and cancer linked to aging. In this review, we examine the revitalization of interest in natural products for drug discovery and discuss natural product modulators of sirtuins that could serve as a starting point for the development of isoform selective and highly potent drug-like compounds, as well as the potential application of naturally occurring sirtuin inhibitors in human health and those in clinical trials.

Phytomedicines containing Matricaria species for the treatment of skin diseases: A biotechnological approach

Skin diseases have a notable impact on the life of the affected and in their health conditions. In order to allow a more effective and economical treatment for such disorders, new therapeutic approaches have been continuously investigated. Due to its high therapeutic and phytochemical potential, Matricaria species emerges as a pleasant alternative, since it is an important source of bioactive secondary metabolites suitable for the treatment of varied skin diseases. Therefore, this review aimed to catalog inventions that have used Matricaria species as the active component for skin disease treatment in order to assess the status of the technological development of the fitomedicines. For this, a search of patents was performed in four specialized patent database, which have reported the discovery of pharmaceutical bioproducts that used Matricaria species in its composition for skin treatment. Therefore, it is possible to notice that the pharmaceutical industry has driven efforts and investment to produce medicines for the dermatopathies, using species of this genus as an active principle. Besides, a trend of growth has been identified for the last years, which is accompanied by the continuous publication of scientific articles on the subject. It is known that a long journey is traversed between the scientific findings and their applications in the pharmaceutical market, creating the perspective that new Matricaria-based medicines may reach the pharmaceutical market in the coming years.

Urban legends: recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet's disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases [e.g., celiac disease (CD) and B12 deficiency]? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested the following: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with CD; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6 years reported some effectiveness, although potential for bias was high.