Effects of Qing Chang Suppository Powder and its Ingredients on IL-17 Signal Pathway in HT-29 Cells and DSS-induced Mice

BACKGROUND

Qingchang Suppository, a formula used for more than 30 years in Longhua Hospital, has shown satisfactory clinical effects on Ulcerative Colitis (UC). However, its therapeutic mechanism has not been fully elucidated.

PURPOSE

The study aims to investigate the effects of Qingchang Suppository powder (QCSP) and its ingredients by regulating the IL-17A signaling pathway which plays an important role in the development of UC.

METHODS

HPLC was used to analyze the main ingredients (Gallic acid, Indigo, Indirubin) in QCSP. HT-29 cells were induced by rhIL-17A and TNF-α, and IL-17A related protein expressions were determined by western blot. BALB/C mice were induced by 4% Dextran Sodium sulfate (DSS). The effects of QCSP and its ingredients were evaluated by measuring weight loss, disease activity index (DAI), colon length, histological analysis. Western blot was used for analysis of IL-17A and MAPK related proteins p-ERK, p-JNK, p-P38. Quantitative reverse transcription polymerase chain reaction (q-PCR) was used to detect the expression of IL-17A, HSP90 and ACT1 in colon tissue. Cytokines such as IL-17A, IL-1β, IFN-γ and TNF-α were determinated by enzyme-linked immunosorbent assay (ELISA).

RESULTS

QCSP had good therapeutic effect on DSS-induced colitis in mice. QCSP significantly relieved weight loss, restored colon length, repaired colon lesions, reduced histological scores and DAI, decreased TNF-α, IL-1β, IL-17 and IFN-γ contents, significantly suppressed the gene expressions of IL-17A, ACT1 and HSP90, and up-regulated the expressions of tight junction proteins like ZO-1 and Occludin. IL-17A pathway related proteins such as IL-17A, IL-17RA, HSP90, MAPKs, P-iκbα and iNOS were significantly increased in vitro and in vivo.

CONCLUSIONS

This paper reveals that QCSP inhibited the IL-17A signaling pathway in HT-29 cells and DSS induced mice, presenting a new mechanism of QCS on treating UC.

A randomized clinical trial of the efficacy and safety of terconazole vaginal suppository versus oral fluconazole for treating severe vulvovaginal candidiasis

Terconazole is a new, broad-spectrum, triazole antifungal agent. The aim of this study was to compare the efficacy and safety of a 6-day course of a terconazole vaginal suppository (80 mg) with two doses of oral fluconazole (150 mg) for the treatment of severe vulvovaginal candidiasis (SVVC). In this prospective, randomized case-control study, 140 consecutive patients with SVVC were enrolled at the Department of Obstetrics and Gynecology of Peking University Shenzhen Hospital from July 1, 2013, through June 31, 2014. Patients with SVVC, initially at a 1:1 ratio, were randomly assigned to receive treatment with either the terconazole vaginal suppository or oral fluconazole. The patients had follow-up visits at 7-14 days and 30-35 days following the last dose of therapy. The clinical cure rates in the terconazole group and the fluconazole group were, respectively, 81.0% (47/58) and 75.8% (50/66) at follow-up day 7-14 and 60.3% (35/58) and 56.1% (37/66) at day 30-35. The mycological cure rates in the two groups were, respectively, 79.3% (46/58) and 71.2% (47/66) at follow-up day 7-14 and 62.1% (36/58) and 53.0% (35/66) at day 30-35 (P > .05 for all). Local irritation was the primary adverse event associated with terconazole, whereas systemic side effects were associated with fluconazole; however, these effects were minimal. This study demonstrated that a terconazole vaginal suppository (80 mg daily for 6 days) was as effective as two dose of oral fluconazole (150 mg) in the treatment of patients with SVVC; as such, terconazole could be a choice for therapy of this disorder.

Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity

Mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption. However, previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever, rashes, colitis exacerbation and acute eosinophilic pneumonia. Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories. In light of symptom exacerbation of ulcerative colitis, increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration, and the Naranjo algorithm score of 10, the possibility of hypersensitivity reaction to mesalamine suppositories should be considered, warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories.

Acceptability of potential rectal microbicide delivery systems for HIV prevention: a randomized crossover trial

We assessed the acceptability of three of over-the-counter products representative of potential rectal microbicide (RM) delivery systems. From 2009 to 2010, 117 HIV-uninfected males (79 %) and females (21 %) who engage in receptive anal intercourse participated in a 6-week randomized crossover acceptability trial. Participants received each of three products (enema, lubricant-filled applicator, suppository) every 2 weeks in a randomized sequence. CASI and T-ACASI scales assessed product acceptability via Likert responses. Factor analysis was used to identify underlying factors measured by each scale. Random effects models were fit to examine age and gender effects on product acceptability. Three underlying factors were identified: Satisfaction with Product Use, Sexual Pleasure, and Ease of Product Use. For acceptability, the applicator ranked highest; however, differences between product acceptability scores were greatest among females and younger participants. These findings indicate that RM delivery systems impact their acceptability and should be considered early in RM development to enhance potential use.

Clinical trial: marine lipid suppositories as laxatives

Cod-liver oil and other marine products containing polyunsaturated fatty acids have anti-inflammatory, anti-bacterial and anti-viral effects and may be useful in the treatment of various inflammatory and infectious diseases. We developed suppositories and ointment with 30% free fatty acid (FFA) extract from omega-3 fish oil. Our purpose was to evaluate the safety of marine lipid suppositories and ointment in healthy volunteers and to explore the laxative effect of the suppositories. Thirty healthy volunteers were randomized either to a study group administrating 30% FFA suppositories and applying 30% FFA ointment to the perianal region twice per day for two weeks, or to a control group using placebo suppositories and ointment in a double blinded manner. Results: No serious toxic effects or irritation were observed. In the study group 93% felt the urge to defecate after administration of the suppositories as compared to 37% in the control group (P = 0.001). Subsequently 90% in the study group defecated, compared to 33% in the control group (P = 0.001). Conclusion: The marine lipid suppositories and ointment were well tolerated with no significant toxic side effects observed during the study period. The suppositories have a distinct laxative effect and we aim to explore this effect in further clinical trials.

Effectiveness and safety of vaginal suppositories for the treatment of the vaginal atrophy in postmenopausal women: an open, non-controlled clinical trial

Menopause, due to the physiological decrease in the estrogens levels, is often associated with many symptoms related to vaginal atrophy such vaginal dryness, dyspareunia, burning, itching, decreasing in libido and therefore a worsening of the quality of life and in particular of the sexual activity. There are many pharmacological remedies to solve these events, first of all hormone replacement therapy (HRT) that up to the 90s was the therapy of choice for the care of the menopause symptoms. This hormonal therapy, however, has been re-considered due to its side effects. As alternative, a clinical trial has been performed to investigate the efficacy and safety, in postmenopausal women with urogenital atrophy, of the use of suppositories for vaginal use, containing hyaluronic acid, vitamin E and vitamin A. The trial, according to a open, non-controlled design, was performed on 150 postmenopausal women, 1 vaginal suppository per day, for the first 14 days and then a vaginal suppository, day in and day out, for other 14 days. The primary endpoint was the evaluation of vaginal dryness assessed by a Visual Analogue Scale (VAS) both by the investigator and the patient. The secondary endpoints were the evaluation of all the other symptoms and signs associated with the vaginal atrophy (itching, burning, dyspareunia, vaginal inflammation or swelling, irritation, assessed by a 4-point scale, presence of vaginal abrasions and irritation), and the recording of the adverse events occurring during the trial. The patients have not reported adverse effects during the treatment, and the results in terms of effectiveness on the vaginal atrophy symptoms were markedly positive. A high level of compliance was registered. The product tested can therefore be considered a safe and effective alternative for the treatment of vaginal atrophy symptoms in postmenopausal women, especially when HRT is not recommended.

Safe use of rectal suppositories and enemas with adult patients

Medications that are given via the rectal route are prescribed for a variety of reasons and have either a local or systemic effect. The administration of suppositories and enemas is an intimate procedure which has the potential to cause embarrassment and discomfort for the patient. This article outlines the reasons for the use of rectal medications and recommends a procedure to be followed when giving them.

Suppositories in anal disorders: a review

INTRODUCTION

Drug treatment for various ano-rectal conditions has been known since ancient times. Suppositories are one of the very feasible modes of administration for medication.

MATERIALS AND METHODS

Medline (1950-2006) was searched for all published reports about suppositories. This study sum up various suppositories used in proctological practice, which either are in vogue and have been used with a proven degree of success, or suppositories which are described in the literature but are no more in use. This study attempts to highlight the advantages and drawbacks of each of them.

RESULTS

Over 30 different types of ingredients have been found which are used singly or in conjugation in suppositories formulation. While there are only few reports of adverse reaction following use of suppositories like rectal ulcer, rectal stricture and stenosis, the overall acceptance of this mode of medication is good.

CONCLUSION

Suppositories offer to the patients an option that is less invasive and less discomforting. Suppositories could well be looked as a convenient drug delivery system in patients having ano-rectal symptoms.

A randomized comparison of side effects and patient convenience between Cyclogest suppositories and Endometrin tablets used for luteal phase support in IVF treatment

OBJECTIVE

This study compared side effects and patient convenience of vaginal progesterone suppositories (Cyclogest) and vaginal progesterone tablets (Endometrin) used for luteal phase support in in vitro fertilization/embryo transfer (IVF/ET) cycles using pituitary downregulation.

STUDY DESIGN

One hundred and thirty-two infertile patients were randomized on the day of ET by a computer-generated randomization list in sealed envelopes to receive either Cyclogest 400mg or Endometrin 100mg twice daily for 14 days. On days 6 and 16 after ET, they rated side effects and patient convenience into four grades: none, mild, moderate and severe by completing a questionnaire.

RESULTS

No significant differences in perineal irritation were found on days 6 and 16 after ET between the two groups, although there was a trend of fewer patients with perineal irritation in the Endometrin group. Significantly more patients in the Endometrin group had difficulty of administration on day 6 after ET. There were no differences in the hormonal profile on day 6 after ET and IVF outcomes between the two groups.

CONCLUSION

There was no difference in perineal irritation after the use of Cyclogest suppositories or Endometrin tablets for luteal phase support although more patients found administration of Endometrin tablets difficult.

Determinants of antipyretic misuse in children up to 5 years of age: A cross-sectional study

BACKGROUND

Fever in children is a common and usually benign symptom. It is known that antipyretic treatment is ineffective in the prevention of simple febrile seizures. Caregivers' administration of antipyretic medications to children has been reported, but data concerning the formulations used, actual doses administered, and effects of ethnicity and socioeconomic status on administration practices are incomplete.

OBJECTIVE

The aim of this study was to identify the factors affecting antipyretic administration (higher-than-recommended doses in particular) by caregivers to their febrile children in 2 differing cultural-ethnic backgrounds.

METHODS

This cross-sectional survey study, conducted from January to March 2002, was part of a larger, ongoing survey study of the differences in care givers' knowledge, beliefs, and attitudes concerning children's fever in the 2 major cultural-ethnic groups in the Negev District in Israel: Jews and Bedouin Moslems. It was conducted at the Pediatric Emergency Department (PED), Soroka Medical Center, Beer-Sheva, Israel. A structured questionnaire was administered to Jewish and Bedouin Moslem parents or usual caregivers of young (age, 0-60 months) children attending the PED due to fever. Each child's weight was obtained from the PED medical record. After completion of the interview, the reported antipyretic dose per kilogram of body weight was calculated. Less-than-recommended dose was defined as <9 mg/kg for acetaminophen and <4.5 mg/kg for ibuprofen. Higher-than-recommended dose was defined as >16.5 mg/kg for acetaminophen and >11 mg/kg for ibuprofen.

RESULTS

The caregivers of a total of 201 children (mean [SD] age, 20 [17] months; mean [SD] weight, 10.4 [4.0] kg) were included in the study. The study included 101 Jewish and 100 Bedouin Moslem caregivers. The proportion of people surveyed who were parents was 98%; grandmothers, 2%. Differences existed between the 2 cultural-ethnic groups in the source of knowledge regarding antipyretic use in children (a significantly larger proportion of Jewish caregivers received their knowledge concerning antipyretic use from package inserts compared with Bedouin caregivers [25.7% vs 6.0%; P < 0.001], and a significantly lower proportion of Jewish caregivers used "other" sources [15.8% vs 39.0%; P < 0.001]). Most (65.2%) caregivers indicated that they administered antipyretics for no or minimal elevations in body temperature (<-38 degrees C); 52.7% administered individual acetaminophen doses within 10% of the recommended dose, 34.8 % administered a higher-than-recommended dose, and 21.4% repeated the dose at intervals of <or=3 hours. More Bedouin than Jewish caregivers exposed their children to higher-than-recommended antipyretic doses (48.0% vs 21.8%; P < 0.001). After adjusting for maternal education and work-for-income status, child's age, child's order in the family, and number of children in the family, a significant and independent inverse relationship was found between child's weight and higher-than-recommended acetaminophen doses, in which for each additional kilogram of body weight, a 30% decrease in the proportion of children administered higher-than-recommended doses was found (odds ratio [OR], 0.7 for each additional kg; 95% CI, 0.59-0.89; P = 0.002). In addition, a significant and independent relationship was found between the formulation of acetaminophen and the administration of higher-than-recommended doses (OR, 4.9; 95% CI, 2.32-10.23; P < 0.001), with rectal suppositories related to the administration of higher-than-recommended dose by 4.9-fold.

CONCLUSIONS

The results of this survey concerning antipyretic treatment of children by their Jewish and Bedouin Moslem caregivers suggest that lighter body weight and the use of acetaminophen rectal suppositories were associated with the administration of higher-than-recommended doses of acetaminophen. Recommended doses of acetaminophen must be based not on the age but on the weight of the child.

Diclofenac suppositories and acute ischaemic proctitis

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Anaphylaxis to gelatin-containing rectal suppositories

BACKGROUND

Some children--though the number is few-have been sensitized with gelatin.

OBJECTIVE

To investigate the relationship between the presence of antigelatin IgE and anaphylaxis to gelatin-containing rectal suppository, we measured antigelatin IgE in the sera of the children with anaphylaxis.

METHODS

Ten children showed systemic allergic reactions, including anaphylaxis, to a chloral hydrate rectal suppository containing gelatin (231 mg/dose) that had been used as a sedative. These children's clinical histories and serum samples were submitted from physicians to the National Institute of Infectious Diseases during a 2-year period from 1996 to 1997.

RESULTS

Of the 10 children, 5 showed apparent anaphylaxis, including hypotension and/or cyanosis, along with urticaria or wheezing; 2 showed both urticaria and wheezing without hypotension or cyanosis; the other 3 showed only urticaria. All of the children had antigelatin IgE (mean value +/- SD, 7.9 +/- 8.4 Ua/mL). As a control, samples from 250 randomly selected children had no antigelatin IgE. These findings suggest that the 10 children's systemic allergic reactions to this suppository were caused by the gelatin component.

CONCLUSION

Gelatin-containing suppositories must be used with the same caution as gelatin-containing vaccines and other medications.

Solitary rectal ulcer induced by excessive use of analgesic suppositories containing paracetamol, caffeine, and codeine

We report the case of a 53-yr-old woman who developed an ulcer of the distal rectum with mild stenosis after prolonged use of suppositories containing paracetamol, caffeine, and codeine. After undergoing extensive diagnostic tests with exclusion of other possible causes, she admitted to the abuse of the suppositories. She was treated with frequent endoscopic balloon dilations to prevent progression of the rectal stenosis. Because of severe pain on defecation, she needed a protective colostomy which could be closed after the healing of the ulcer 7 months later. There was no significant residual stenosis. This case is compared to cases described in the past 30 years.

[The evolution of lumbar myalgia under the influence of the product Pelnicol administered in suppositories]

After having done a wide study in vitro and in vivo reported in several publications, we applied the lyophylized extract "Pelnicol" under the form of suppositories, in 36 cases of secondary back diseases. The improvement with "Pelnicol" suppositories is observed, by mean, the 6th day of treatment. It can be seen that etiopathological factors are determining the diseases evolution, which has to be, in first rang, considered causally. It is realised with the "Pelnicol" suppositories.

[A case report: horizontal infection of typhoid fever from daughter to mother (by suppository maneuver)]

A 22-year-old female was admitted to our hospital because of general fatigue and continuous high fever. Salmonella Typhi was detected from her blood. Her mother, 44-year-old female was admitted to our hospital a few days later because of high fever. She had nursed to her daughter and inserted suppositories to her daughter several times. S. Typhi was also detected from her blood. No other member of her family was infected with S. Typhi. From the study of the route of the infection, we are confident that S. Typhi was delivered from daughter to mother by insertion of suppositories.

A novel method for the preclinical assessment of rectal irritation

The purpose of this study concerns a novel method for preclinical assessment of rectal irritation caused by suppositories introduced into the rectum. Rectal irritation was assessed by the balloon method in fasting conscious rats. This method is based on measuring rectal contractions due to possible irritation caused by the presence of drugs and adjuvants in the suppository. In control experiments (vehicle only), significant rectal contractions were not observed in a range of pH 1.5-11.0 and osmotic pressure 70-2000 mOsm kg-1 H2O, respectively. On the other hand, strong contractions were observed after rectal administration of an aqueous solution of 50% glycerin, 100 mM sodium caprate or 25 mM sodium cholate. The intensity of contraction after rectal administration of sodium caprate or sodium cholate was dependent on the concentration in the dosing solution. In addition, the effect of sodium caprate and sodium cholate on rat rectal mucosa was investigated by optical light microscopy. Although slight or moderate alteration such as the presence of mucinous substance in lumen and congestion, oedema and haemorrhage of the rectal membrane 20 min after rectal administration, there was no major damage to the rectal mucosa. There was a correlation between the median score for mucinous substance in lumen and mean intensity of rectal contraction. For comparative purposes, defecating sensations, pain, itch, burning sensations, and awareness of the presence of a foreign body after administration of suppositories containing 0, 1, 2 and 4% sodium caprate were examined in eight healthy volunteers. The defecating sensation in the human subjects correlated with the intensity of rectal contraction in rats. The results suggest that rectal contraction in conscious rats could be a useful index for prediction of a defecating sensation in man.

Allergy to lysozyme/egg white-containing vaginal suppositories

Seven patients who received a lysozyme, nystatin, and tetracycline containing vaginal suppository because of suspected vaginal infection, developed local or systemic allergic reactions. The coincidence of the symptoms with the repeated use of the suppository as well as skin and lymphocyte transformation tests indicated that the lysozyme in the suppository was responsible for the allergic reactions. This lysozyme preparation contained additional egg proteins, which contributed to the allergic reaction in certain patients: three patients with a previous history of egg allergy and serologic and/or skin test evidence for egg-white sensitization developed the allergic reaction after the first suppository. Four patients had urticaria or anaphylaxis after treatment for at least three days; none of these four patients developed egg allergy. Five of seven individuals had positive skin tests (prick or scratch) to ovomucoid and lysozyme, but none of the patients had lysozyme-specific IgE in the circulation. All seven patients, with or without egg allergy, showed vigorous T cell responses to purified lysozyme and partly to other egg-white proteins in the lymphocyte transformation test, which was absent in controls. Vaginal suppositories that contain lysozyme and other contaminating egg white proteins can either elicit allergic reactions in patients with a preexisting egg white allergy or induce sensitization to lysozyme and other egg white components.

[Peri-rectal infectious cellulitis with septicemia of anal origin. Suppository on trial]

Rectal route with local or general effects, is an interesting possibility of treatment. Easy use and rapid absorption are two major advantages. But this therapeutic modality is not riskless. We report a case of septicemia with peri-rectal cellulitis which was generated by two ano-rectal ulcerations after using Trophires suppositories. The infection was favoured by local application of cortisone. Our original observation, with ano-rectal ulcerations and short use of suppository, confirms the idea of short-term treatment stopped in case of unwanted symptom.

Ano-rectal lesions in patients taking suppositories containing non-steroidal anti-inflammatory drugs (NSAID)

We report on 3 cases in which ano-rectal lesions were associated with chronic administration of suppositories containing non-steroidal anti-inflammatory drugs (NSAID). Lesions were characterized by erosions or ulcer in the rectum and by stenosis of the anal verge. Erosions or ulcers were observed in patients taking the drugs for a relatively short time. The lesions remitted after suspension of the treatment. The cases observed indicate that suppositories containing NSAID could induce ano-rectal lesions similar to those observed after the use of suppositories containing ergotamine.

Anorectal ergotism: another cause of solitary rectal ulcers

Anorectal ulceration was observed in 6 patients who excessively used suppositories containing ergotamine tartrate. The mucosal lesions of the rectum resembled those observed in the "solitary rectal ulcer syndrome." However, characteristic features of ergotamine-induced ulcers are absence of a mucosal prolapse, lack of a history of constipation, and rapid healing after discontinuation of the drug. Furthermore, the rectal lesion may be associated with anal ulceration, which occasionally presents as the only clinical manifestation of "anorectal ergotism."

[Fat consumption, communal meals and the use of suppositories in patients with Crohn disease]

Contact with chemically modified, especially hardened, fats was found in all of 90 patients with Crohn's disease of the small or large intestine. These fats (margarine, frying or cooking fat) had been encountered before or at commencement of the disease and were used exclusively for cooking in 42 cases, additionally as bread spreads in 46 cases and as bread spread only in 2 cases. Communal meals were taken by 89 patients, in 55 of these at least once per week. 13 patients with anorectal manifestation of Crohn's disease had contact with hardened fats as rectal suppositories prior to or at commencement of the disease. These findings are compatible with the concept that chemically processed fats may play a role in the development of Crohn's disease in susceptible individuals.

[Ano-cutaneous gangrenous ergotism]

A case of ergotism by abuse of ergotamine tartrate suppositories is reported. The patient developed the clinical picture of ergotism with multiple perianal ulcers. After ergot had been withdrawn there was a spontaneous healing of these ulcers after a few weeks. It is well known that ergot abuse can develop severe vascular spasm in the arteries, but it is unknown that cutaneous ulcers may occur by topical application.