A formulation of Clausena anisata (Willd.) Hook. f. Ex Benth and Cassia sieberiana DC. alleviates the symptoms associated with osteoarthritis: a single-blind, randomised controlled trial of a traditional Ghanaian remedy

Background

Clinical validation of herbal medicinal products is important for their widespread acceptance and application. In this single-blind, randomised controlled trial, a traditional Ghanaian herbal medicine formulation with Clausena anisata (Willd.) Hook. f. ex Benth and Cassia sieberiana DC. as ingredients was evaluated for its safety and effectiveness in the management of patients with osteoarthritis. The formulation for the purposes of this study was labelled with the code GC-500.

Methods

A total of 57 participants were randomly assigned to receive either this herbal remedy, GC-500, or the control treatment of diclofenac. Subjects were then followed up for a period of 8 weeks using a modified Graded Chronic Pain Scale (GCPS) for their efficacy assessments. The control treatment comprised 13 subjects and the GC-500 group 44 subjects.

Results

Upon completion of the study, 28 (63.63%) subjects in the GC-500 group attained the primary outcome, (GCPS of Grade 0) compared to 5 (38.46%) subjects in the control group. Improvement in disease indicators such as characteristic pain intensity, disability score and disability days was comparable between the GC-500 and diclofenac. Intensity of pain reduced after 8 weeks of treatment; disability score and disability days also declined indicating an improvement in the quality of life of subjects. GC-500 was also shown to be safe for human use.

Conclusion

The herbal medicine formulation GC-500, provides a credible treatment option for managing the pain associated with osteoarthritis.

Trial registration

This study was retrospectively registered with the Pan-African Trial registry with a Trial ID: PACTR201909643671755 on 25th September, 2019 at https://pactr.samrc.ac.za/Search.aspx

Cassia sieberiana DC. leaves modulate LPS-induced inflammatory response in THP-1 cells and inhibit eicosanoid-metabolizing enzymes

ETHNOPHARMACOLOGICAL RELEVANCE

According to ethnobotanical surveys, Cassia sieberiana DC. (1825) is a particularly reputed species in African folk Medicine, namely due to the application of its leaves and roots for the treatment of diseases and symptomatology that appear to be related with an inflammatory background. In contrast with the roots of the plant, the leaves remain to be investigated, which prompted us to further detail mechanisms underlying their anti-inflammatory properties, by using in vitro models of disease.

AIM OF THE STUDY

Considering its use in the amelioration and treatment of conditions that frequently underlie an inflammatory response, C. sieberiana leaves extract was prioritized amongst a collection of extracts obtained from plants collected in Guinea-Bissau. As such, this work aims to deliver experimental data on the anti-inflammatory properties of C. sieberiana leaf and to establish possible associations with its chemical composition, thus providing a rationale on its use in folk Medicine.

MATERIALS AND METHODS

The chemical profile of an hydroethanol extract obtained from the leaves of the plant was established by HPLC-DAD-ESI/MSⁿ in order to identify bioactives. The extract and its main compound were tested towards a series of inflammatory mediators, both in enzymatic and cell-based models. The capacity to interfere with the eicosanoid-metabolizing enzymes 5-lipoxygenase (5-LOX), cyclooxygenase-1 (COX-1) and -2 (COX-2) was evaluated in cell-free systems, while the effects in interleukin 6 (IL-6) and tumour necrosis factor-α (TNF-α) levels produced by THP-1 derived macrophages were assessed through ELISA.

RESULTS

HPLC-DAD-ESI/MSⁿ analysis of the extract elucidated a chemical profile qualitatively characterized by a series of anthraquinones, particularly rhein derivatives, and nine flavonols, most of which 3-O-glycosylated. Considering the concentrations of the identified compounds, quercetin was detached as the main component. Effects of the hydroethanol extract obtained from C. sieberiana leaves against key enzymes of the arachidonic acid cascade were recorded, namely a concentration-dependent inhibition against 5-LOX, at concentrations ranging from 16 to 250 μg mL^-1 and a selective inhibitory action upon COX-2 (IC₅₀ = 3.58 μg mL^-1) in comparison with the isoform COX-1 (IC₅₀ = 9.10 μg mL^-1). Impact on inflammatory cytokines was also noted, C. sieberiana leaf extract significantly decreasing IL-6 levels in THP-1 derived macrophages at 250 and 500 μg mL^-1. In contrast, TNF-α levels were found to be increased in the same model. Quercetin appears to partially account for the observed effects, namely due to the significant inhibitory effects on the activity of the arachidonic acid metabolizing enzymes COX-2 and 5-LOX.

CONCLUSIONS

The anti-inflammatory effects herein reported provide a rationale for the use of C. sieberiana leaves in African folk practices, such as in the treatment of arthritis, rheumatism and body aches. Considering the occurrence of flavonoidic and anthraquinonic constituents, as well as the observed anti-inflammatory properties of quercetin, recorded effects must be related with the presence of several bioactives.

Hypolipidemic, hepatoprotective, nephroprotective and anti-lipid peroxidation properties of a methanol extract of Paullinia pinnata root-bark, in alloxan-induced hyperglycemic rats

This study evaluated the hypolipidemic, hepatoprotective, nephroprotective and anti-lipid peroxidation properties of a methanol extract of Paullinia pinnata root-bark, in alloxan-induced hyperglycemic rats. The extract of P. pinnata root-bark was prepared using a cold maceration method with 80% methanol and concentrated at 40°C in hot air oven. The extract was administered once daily per os at 50, 100 and 200 mg/kg for 21 consecutive days. Distilled water (5 mL/kg) and glibenclamide (2 mg/kg) were used as the vehicle and reference standard, respectively. The serum lipid profile, markers of liver and kidney functions, antioxidant status (malondialdehyde level, superoxide dismutase and catalase activities), histopathological changes in liver and kidney were examined 24h after the last treatment on day 21. The extract reduced serum lipid profile, markers of liver and kidney functions of treated rats relative to vehicle-treated rats. The superoxide dismutase and catalase activities of the extract treated rats were also elevated relative to the vehicle-treated rats. The extract reversed liver and kidney injuries induced by alloxan in the treated rats. This study provides some basic information which suggest that P. pinnata could be effective in managing diabetic complications.