Alteration of Coagulation Test Results and Vaginal Bleeding Associated With the Use of Feverfew (Tanacetum parthenium)

Tanacetum parthenium (feverfew) is a member of the daisy family; it is used to prevent and treat migraine and rheumatoid arthritis. It has a long history of use as a traditional and folk medicine in Chinese, Greek, Indian and Arabic medicine, having been used for hundreds of years. The term feverfew comes from the Latin word febrifugia and means fever reducer. However, Short term use of feverfew (up to 4 months) is considered safe in adults. According to a few clinical trials, Tanacetum parthenium was not associated with serious adverse events but rather with mild and reversible events. Adverse events leading to withdrawals were mainly of a gastrointestinal nature. There is no major safety issue. Nevertheless, we report one case of a 36-year-old woman with known migraine who visited the obstetrics and gynecology clinic upon developing vaginal bleeding, prolonged duration of the menstrual cycle, and reddish skin without bruising. The patient suffered from these symptoms over a period of 3 months prior to the clinic visit. Based on history, the patient began taking 800 mg capsules of feverfew three times per day 9 months ago. We applied the Naranjo scale in our case, and it indicated that a probable relationship exists between feverfew and vaginal bleeding. Feverfew should be used cautiously by patients planning elective surgery, having coagulant disorders or taking antithrombotic drugs.

Substrate promiscuity of enzymes from the sesquiterpene biosynthetic pathways from Artemisia annua and Tanacetum parthenium allows for novel combinatorial sesquiterpene production

The therapeutic properties of complex terpenes often depend on the stereochemistry of their functional groups. However, stereospecific chemical synthesis of terpenes is challenging. To overcome this challenge, metabolic engineering can be employed using enzymes with suitable stereospecific catalytic activity. Here we used a combinatorial metabolic engineering approach to explore the stereospecific modification activity of the Artemisia annua artemisinic aldehyde ∆11(13) double bond reductase2 (AaDBR2) on products of the feverfew sesquiterpene biosynthesis pathway (GAS, GAO, COS and PTS). This allowed us to produce dihydrocostunolide and dihydroparthenolide. For dihydroparthenolide we demonstrate that the preferred order of biosynthesis of dihydroparthenolide is by reduction of the exocyclic methylene of parthenolide, rather than through C4-C5 epoxidation of dihydrocostunolide. Moreover, we demonstrate a promiscuous activity of feverfew CYP71CB1 on dihydrocostunolide and dihydroparthenolide for the production of 3β-hydroxy-dihydrocostunolide and 3β-hydroxy-dihydroparthenolide, respectively. Combined, these results offer new opportunities for engineering novel sesquiterpene lactones with potentially improved medicinal value.

A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study

BACKGROUND

Feverfew (Tanacetum parthenium L.), magnesium and coenzyme Q10 are frequently used for migraine prophylaxis. Supplementation with a fixed combination of these three agents (Antemig®, PiLeJe) was investigated in an observational study.

METHODS

Adult patients suffering from migraine according to the criteria of the International Headache Society were enrolled by general practitioners (≥2 migraine attacks during previous month; exclusion of chronic migraine and medication overuse) and after a one-month baseline phase, supplemented with one tablet of 100 mg feverfew, 100 mg coenzyme Q10 and 112.5 mg magnesium per day for 3 months.

RESULTS

Supplementation significantly reduced the number of days with migraine headache during third month of supplementation compared to baseline phase (1.3 days ±1.5 versus 4.9 days ±2.6, p < 0.0001; n = 68 intention to treat; primary criterion). The decrease was progressive over the period of supplementation and significant from first month (1st month: -2.5 days ±3.1, p < 0.0001; 2nd month: -3 days ±2.8, p < 0.0001). The proportion of patients with a reduction of at least 50% in the number of days with migraine headache was 75% (51/68) after 3 months, with a progressive increase over the period of supplementation (63.2% [43/68] after 1 month and 70.6% [48/68] after 2 months). The proportion of patients with anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) decreased between baseline phase and third month of supplementation from 61.9% (39/63 patients with information available) to 35% (21/60) for depression and from 52.4% (33/63) to 30% (18/60) for anxiety. An improvement of quality of life (Qualité de Vie et Migraine questionnaire) was also observed. The combination was well tolerated.

CONCLUSIONS

Results suggest that the proprietary supplement containing feverfew, coenzyme Q10 and magnesium assessed could be beneficial and safe for the prevention of migraine in adult patients and merits further study.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02901756 , retrospectively registered on August 24, 2016.

Cadmium and copper induced changes in growth, oxidative metabolism and terpenoids of Tanacetum parthenium

Morphological and biochemical responses of feverfew plants exposed to low (5 μM) and high (35 and 70 μM) levels of Cd or Cu were investigated. Increasing metal supply notably reduced the plant biomass. Elevated Cd and Cu levels also resulted in an increase in the leaf proline content. Besides, decrease in ascorbic acid (AsA) and glutathione (GSH) contents was similar in the leaves of Cd- and Cu-treated plants, indicating altered biosynthesis of AsA and GSH under metal excess. High metal doses stimulated increase in antioxidative enzyme activities that could be related to elevated hydrogen peroxide (H₂O₂) content and subsequent lipid peroxidation. Cd was typically more accumulated in shoots and roots than Cu, leading to higher translocation factor at high Cd doses. In terms of essential oil content, it seems that Cd had an inhibitory effect during the experiment, whereas Cu was found to stimulate it only at 5 μM. Furthermore, high Cd supply enhanced the relative proportion of monoterpene hydrocarbons, while Cu increased the proportion of sesquiterpenes, especially at 5 μM. This result provides the first evidence of the response of feverfew plants to Cd or Cu by associating stress-related responses with changes in terpenoids.

Magnesium and manganese affect photosynthesis, essential oil composition and phenolic compounds of Tanacetum parthenium

The accumulation of plant defense metabolites is closely associated with the concentration of nutrient elements, yet data related to the interactive effects of two nutrients on the deployment of phenolics and terpenoids are scare. In the present study, the interaction between magnesium (Mg) and manganese (Mn) on nutrient uptake, photosynthesis, oxidative status and the accumulation of phenolics and terpenoids in the leaves of feverfew plants grown at different concentrations of Mg and Mn was investigated. Nutrient uptake and photosynthesis were associated with the amount of applied Mg but could be modified by the concentration of Mn. Phenolic biosynthetic enzymes and individual phenolics were not only induced by Mg, but their levels were also dependent on the Mn supply. Additionally, the proportion of monoterpenes was enhanced by a deficiency of Mg rather than an excess of Mn. Deprivation of Mg also decreased the proportion of sesquiterpenes in the essential oil. Therefore, it appears that a high Mg and a low Mn supply lead to a marked shift from monoterpene to sesquiterpene production. Phenolic compounds also differentially accumulated under varying Mg and Mn concentrations. These results suggest a profound effect of the combined supply of Mg and Mn on the biosynthesis of terpenes and phenolics.

Magnesium and manganese interactively modulate parthenolide accumulation and the antioxidant defense system in the leaves of Tanacetum parthenium

A balanced nutrient supply is a critical factor affecting accumulation of terpenoids in plants, yet data related to the interactive effects of two essential nutrients for the biosynthesis of sesquiterpenes are scarce. Here, the interactional effects between magnesium (Mg) and manganese (Mn) on plant growth, oxidative status, parthenolide accumulation and expression of key genes involved in parthenolide biosynthesis including 1-deoxy-d-xylulose-5-phosphate reductoisomerase (DXR), hydroxy-2-methyl-2-(E)-butenyl-4-diphosphate reductase (HDR), 3-hydroxy-3-methylglutarylcoenzyme A reductase (HMGR), germacrene A synthase (GAS), germacrene A oxidase (GAO), costunolide synthase (COS) and parthenolide synthase (PTS) in the leaves of feverfew plants grown at different Mn and Mn levels were assessed. Plant growth and leaf pigment concentrations were associated with the amount of applied Mg but could be modified by the Mn level. Deprivation and the addition of both Mg and Mn induce oxidative stress. Mg supply also alleviated the adverse effects of Mn excess on plant growth and oxidative status. In addition, parthenolide biosynthesis decreased under deprivation of Mg or Mn, but the addition of Mn up to 50μM under 2mM Mg supply considerably increased its accumulation. The parthenolide accumulation trend might reflect the up-regulation of terpenoid-related genes and enzyme activities as well as the oxidative status of feverfew leaves. Our data suggest a profound effect of the combined supply of Mg and Mn on parthenolide biosynthesis through the activation of terpene synthases, which concomitantly modulate by oxidative status.

Widespread pain reliever profile of a flower extract of Tanacetum parthenium

BACKGROUND

Tanacetum parthenium L., commonly called Feverfew, is known for anti-inflammatory and anti-migraine properties.

PURPOSE

Aimed to individuate new therapeutical strategies to control acute and persistent pain induced by different origins we tested two hydroalcoholic extracts obtained from Feverfew flowers and leaves, respectively.

STUDY DESIGN

Extracts were characterized according to the European Pharmacopoeia monograph. Both the extracts were tested after acute per os administration in the dose range 30-1000 mg kg(-1). The anti-nociceptive properties were evaluated by the Writhing test in mice.

RESULTS

The number of abdominal contractions was dose dependently reduced by the flower extract. It reduced mechanical hypersensitivity (Paw pressure test) related to the acute inflammatory phase induced by carrageenan similarly to diclofenac and ibuprofen. In the osteoarthritis model induced by intra articular injection of monoiodoacetate (MIA) the flower extract significantly increased the pain threshold peaking 30 min after treatment. Moreover, it was effective in the chronic constriction injury model of neuropathic pain showing activity similar to the anti-epileptic drug gabapentin. The flower extract activity was confirmed in rat models of chemotherapy-induced neuropathic pain. The mechanical hypersensitivity induced by repeated treatments with the anticancer drug oxaliplatin and with the antiviral dideoxycytidine was significantly reduced after a single injection of Feverfew flower extract. The leaf extract showed lesser efficacy and potency and it was devoid of any effect in carrageenan-, MIA- and chemotherapy-induced pain.

CONCLUSION

The present Feverfew flower extract behaves as a potent pain reliever in acute, inflammatory, articular and neuropathic pain. It appears as a natural strategy potentially suitable for the treatment of different kinds of pain.

Elucidation and in planta reconstitution of the parthenolide biosynthetic pathway

Parthenolide, the main bioactive compound of the medicinal plant feverfew (Tanacetum parthenium), is a promising anti-cancer drug. However, the biosynthetic pathway of parthenolide has not been elucidated yet. Here we report on the isolation and characterization of all the genes from feverfew that are required for the biosynthesis of parthenolide, using a combination of 454 sequencing of a feverfew glandular trichome cDNA library, co-expression analysis and metabolomics. When parthenolide biosynthesis was reconstituted by transient co-expression of all pathway genes in Nicotiana benthamiana, up to 1.4μgg(-1) parthenolide was produced, mostly present as cysteine and glutathione conjugates. These relatively polar conjugates were highly active against colon cancer cells, with only slightly lower activity than free parthenolide. In addition to these biosynthetic genes, another gene encoding a costunolide and parthenolide 3β-hydroxylase was identified opening up further options to improve the water solubility of parthenolide and therefore its potential as a drug.

John's Wort seed and feverfew flower extracts relieve painful diabetic neuropathy in a rat model of diabetes

Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes and the few approved therapies for the management of pain have limited efficacy and side effects. With the aim to explore and develop new pharmacological treatments, we investigated the antihyperalgesic properties of St. John's Wort (SJW) and feverfew in streptozotocin (STZ)-diabetic rats. Acute administration of a SJW seed extract reversed mechanical hyperalgesia with a prolonged effect. A SJW extract obtained from the aerial portion of the plant and a feverfew flower extract partially relieved neuropathic pain whereas a feverfew leaf extract was ineffective. The antihyperalgesic efficacy of these herbal drugs was comparable to that of clinically used antihyperalgesic drugs (carbamazepine, lamotrigine, l-acetyl-levocarnitine). Further examinations of SJW and feverfew composition revealed that hyperforin and hypericin might be responsible for the antihyperalgesic properties of SJW whereas the efficacy of feverfew seems to be related to the presence of parthenolide. Rats undergoing treatment with SJW and feverfew did not show any behavioral side effect or sign of altered locomotor activity. Our results suggest that SJW and feverfew extracts may become new therapeutic perspectives for painful DPN.

A purified feverfew extract protects from oxidative damage by inducing DNA repair in skin cells via a PI3-kinase-dependent Nrf2/ARE pathway

BACKGROUND

Environmental factors such as solar ultraviolet (UV) radiation and other external aggressors provide an oxidative challenge that is detrimental to skin health. The levels of endogenous antioxidants decrease with age, thus resulting in less protection and a greater potential for skin damage. The NF-E2-related factor-2 (Nrf2) - antioxidant response element (ARE) pathway is a primary defense mechanism against oxidative stress, and induces the expression of antioxidant, detoxification and repair genes. Activation of ARE-Nrf2 can help restore oxidative homeostasis of the skin and play a role in inflammatory response and DNA repair mechanisms.

OBJECTIVE

To evaluate the role of a purified parthenolide-depleted Feverfew (PD-Feverfew) extract on the ARE-Nrf2 pathway and DNA repair in skin cells.

METHODS

These studies were undertaken in primary human keratinocytes or KB cells using Luciferase Promoter assay, siRNA transfection studies, Western blot analyses, Immunofluorescence microscopy, comet assay and quantitative real-time PCR.

RESULTS

PD-Feverfew was found to induce Nrf2 nuclear translocation and to increase ARE activity in a dose dependent manner. Furthermore, knockdown of Nrf2 resulted in suppression of PD-Feverfew-induced ARE activity. PD-Feverfew was also found to induce phosphorylation of Akt, a kinase downstream of PI3K. Inhibition of PI3K via pre-treatment with the selective pharmacological inhibitor, LY294002, abolished PD-Feverfew-induced Nrf2/ARE activation. PD-Feverfew also reduced UV-induced DNA damage in a PI3K and Nrf2-dependent manner.

CONCLUSIONS

Therefore, by increasing endogenous defense mechanisms and aid in DNA repair of damaged skin cells via activation of a PI3K-dependent Nrf2/ARE pathway, PD-Feverfew may help protect the skin from numerous environmental aggressors.