Preliminary clinical assessment and non- toxicity evaluation of an ayurvedic formulation BGR-34 in NIDDM

Estimation of genetic diversity and population genetic structure in Gymnema sylvestre (Retz.) R. Br. ex Schult. populations using DAMD and ISSR markers

BACKGROUND

Gymnema sylvestre (Retz.) R. Br. ex Schult. is a well-known medicinal plant against diabetes in India. There is as such no organized cultivation in India, and the plant is still being collected from the wild for their therapeutic uses. It is, therefore, important to estimate the genetic diversity and population genetic structure of G. sylvestre to ascertain the genetically diverse germplasm. The present study, therefore, was undertaken to analyze the genetic variability in 118 accessions belonging to 11 wild populations of G. sylvestre using directed amplification of minisatellite-region DNA (DAMD) and inter simple sequence repeats (ISSR).

RESULTS

The present genetic analyses of 11 populations with 25 markers (8 DAMD and 17 ISSR) revealed significant genetic diversity (H = 0.26, I = 0.40, PPL = 80.89%) at a species level, while the average genetic diversity at the population level was low. Among the 11 populations studied, PCH and UTK populations showed maximum genetic diversity, followed by KNR and AMB, while TEL population revealed the lowest genetic diversity. AMOVA and G_st values (0.18) revealed that most of the genetic variations are found within populations and very less among populations, and higher gene flow (N_m = 2.29) was found to be responsible for the genetic homogenization of the populations. The clustering pattern resulting from the UPGMA dendrogram was in congruence with STRUCTURE and PCoA, segregating all the 11 populations into two main genetic clusters: cluster I (populations of North and Central India) and cluster II (populations of South India). The clustering patterns obtained from all three statistical methods indicate that the genetic structure in G. sylvestre populations corresponds to the geographical diversity of the populations and represents a strong genetic structure.

CONCLUSION

The genetically diverse populations identified during the present study could be a potential genetic resource for further prospecting and conserving this important plant resource.

Effectiveness and Safety of Ayurvedic Medicines in Type 2 Diabetes Mellitus Management: A Systematic Review and Meta-Analysis

Introduction: Many Ayurvedic medicines have the potential for managing type 2 diabetes mellitus (T2DM), with previous systematic reviews demonstrating effectiveness and safety for specific Ayurvedic medicines. However, many of the reviews need updating and none provide a comprehensive summary of all the Ayurvedic medicines evaluated for managing T2DM.

Objective: The objective of this systematic review was to evaluate and synthesize evidence on the effectiveness and safety of Ayurvedic medicines for managing T2DM.

Inclusion criteria: Published and unpublished RCTs assessing the effectiveness and safety of Ayurvedic medicines for managing T2DM in adults.

Methods: The JBI systematic review methodology was followed. A comprehensive search of sources (including 18 electronic databases) from inception to 16 January 2021 was made. No language restrictions were applied. Data synthesis was conducted using narrative synthesis and random effects meta-analyses, where appropriate. Pooled results are reported as mean differences (MD) with 95% confidence intervals (CI).

Results: Out of 32,519 records identified from the searches, 219 articles were included in the systematic review representing 199 RCTs (21,191 participants) of 98 Ayurvedic medicines. Overall, in the studies reviewed the methodology was not adequately reported, resulting in poorer methodological quality scoring. Glycated hemoglobin (HbA1c) was reduced using Aegle marmelos (L.) Corrêa (MD -1.6%; 95% CI −3 to −0.3), Boswellia serrata Roxb. (−0.5; −0.7 to −0.4), Gynostemma pentaphyllum (Thunb.) Makino (−1; −1.5 to −0.6), Momordica charantia L. (−0.3; −0.4 to −0.1), Nigella sativa L. (−0.4; −0.6 to −0.1), Plantago ovata Forssk. (−0.9; −1.4 to −0.3), Tinospora cordifolia (Willd.) Hook.f. and Thomson (−0.5; −0.6 to −0.5), Trigonella foenum-graecum L. (−0.6; −0.9 to −0.4), and Urtica dioica L. (−1.3; −2.4 to −0.2) compared to control. Similarly, fasting blood glucose (FBG) was reduced by 4–56 mg/dl for a range of Ayurvedic medicines. Very few studies assessed health-related quality of life (HRQoL). Adverse events were not reported in many studies, and if reported, these were mostly none to mild and predominately related to the gastrointestinal tract.

Conclusion: The current evidence suggests the benefit of a range of Ayurvedic medicines in improving glycemic control in T2DM patients. Given the limitations of the available evidence and to strengthen the evidence base, high-quality RCTs should be conducted and reported.

A review on phytochemical and pharmacological facets of tropical ethnomedicinal plants as reformed DPP-IV inhibitors to regulate incretin activity

Type 2 diabetes mellitus is a metabolic disorder resulting from impaired insulin secretion and resistance. Dipeptidyl peptidase (DPP)-IV is an enzyme known to trigger the catalysis of insulinotropic hormones, further abating the endogenous insulin levels and elevating the glucose levels in blood plasma. In the field of drug development, DPP-IV inhibitors have opened up numerous opportunities for leveraging this target to generate compounds as hypoglycemic agents by regulating incretin activity and subsequently decreasing blood glucose levels. However, the practice of synthetic drugs is an apparent choice but poses a great pharmacovigilance issue due to their incessant undesirable effects. The ideology was set to inventively look upon different ethnomedicinal plants for their anti-diabetic properties to address these issues. To date, myriads of phytochemicals are characterized, eliciting an anti-diabetic response by targeting various enzymes and augmenting glucose homeostasis. Antioxidants have played a crucial role in alleviating the symptoms of diabetes by scavenging free radicals or treating the underlying causes of metabolic disorders and reducing free radical formation. Plant-based DPP-IV inhibitors, including alkaloids, phenolic acid, flavonoids, quercetin, and coumarin, also possess antioxidant capabilities, providing anti-diabetic and antioxidative protection. This review article provides a new gateway for exploring the ability of plant-based DPP-IV inhibitors to withstand oxidative stress under pathological conditions related to diabetes and for reforming the strategic role of ethnomedicinal plants as potent DPP-IV inhibitors through the development of polyherbal formulations and nanophytomedicines to regulate incretin activity.

Drug Repurposing Approach, Potential Drugs, and Novel Drug Targets for COVID-19 Treatment

Novel coronavirus first appeared in Wuhan, China, in December 2019, and it speedily expanded globally. Some medications which are used to treat other diseases seem to be effective in treating COVID-19 even without explicit support. The existing drugs that are summarized in this review primarily focused on therapeutic agents that possessed activity against other RNA viruses such as MERS-CoV and SARS-CoV. Drug repurposing or repositioning is a promising field in drug discovery that identifies new therapeutic opportunities for existing drugs such as corticosteroids, RNA-dependent RNA polymerase inhibitors, interferons, protease inhibitors, ivermectin, melatonin, teicoplanin, and some others. A search for new drug/drug targets is underway. Thus, blocking coronavirus structural protein, targeting viral enzyme, dipeptidyl peptidase 4, and membrane fusion blocker (angiotensin-converting enzyme 2 and CD147 inhibitor) are major sites based on molecular targets for the management of COVID-19 infection. The possible impact of biologics for the management of COVID19 is promising and includes a wide variety of options such as cytokines, nucleic acid-based therapies targeting virus gene expression, bioengineered and vectored antibodies, and various types of vaccines. This review demonstrates that the available data are not sufficient to suggest any treatment for the eradication of COVID-19 to be used at the clinical level. This article aims to review the roles of existing drugs and drug targets for COVID-19 treatment.

A Recent Achievement in the Discovery and Development of Vaccines and Therapeutic Agents in the Race for COVID-19 Protection and Treatment

Currently, the coronavirus disease 2019 (COVID-19) is a big challenge to the healthcare systems in the world. Several researchers in the world have immediately carried out clinical investigations for the discovery of vaccines and drugs. Different studies have shown that antiviral measures including small bioactive compounds targeting multifaceted molecular communications take in COVID-19 infection. The drug development archived in this review emphasizes mainly on drugs that are effective for the Management of MERS-CoV, SARS-CoV, and other RNA viruses. The investigation of therapeutic agents for COVID-19 includes anti-inflammatory agents, antibodies, and nucleic acid-based treatments targeting virus gene expression as well as different sorts of vaccines. Numerous patents revealed techniques of these biologics with the potential for treating and preventing coronavirus infections, which may apply to COVID-19. Phase 3 clinical trials such as Sputnik V, AZD1222, mRNA-1273, BNT162b2, Ad5-nCoV, Anti-COVID antibodies, Kevzara; Actemra, Jakafi; Baricitinib, and some others were undergoing in the race for Covid-19 treatment. However, there's still a lack of a review on vaccines and drugs for COVID-19 management. Therefore, this review summarizes different studies that are ongoing in the race for Covid-19 protection and treatment.

Effectiveness of polyherbal formulations for the treatment of type 2 Diabetes mellitus - A systematic review and meta-analysis

Background

The mortality and morbidity rate of diabetes patients is increasing worldwide which requires an ideal treatment to prevent the disease worsening. Traditional medicine is gaining more attention in diabetes due to its efficacy and safety. We, therefore performed a systematic review study of clinical trials to assess the comparative effect of polyherbal formulations in type 2 Diabetes mellitus.

Objectives

To find the effectiveness of polyherbal formulations in blood sugar and lipid level for type 2 Diabetes mellitus.

Material and methods

PubMed, Scopus and CINAHL databases for clinical trials investigating the effect of polyherbal formulations in Type 2 Diabetes mellitus patients were searched. Meta-analysis of eligible trials was conducted employing Revman 5.2 software.

Results

Fourteen randomized controlled trials were found eligible for meta-analysis. Meta-analysis of findings showed a significant effect of polyherbal formulations on blood sugar level compared to control group. The estimated standard mean changes at 95% confidence interval, following polyherbal formulations treatment were −0.59, (−0.91 to – 0.27) mg/dL; for fasting blood sugar(p < 0.001), −0.69, (−1.18 to −0.21) mg/dL; for postprandial blood sugar (p = 0.005) and −0.46, (−0.88 to −0.04) gm%; for glycated haemoglobin (p = 0.03). The reduction in postprandial sugar and glycated haemoglobin was statistically significant with polyherbal formulations compared to metformin treatment but not for fasting sugar. Similarly in lipid profile the reduction for total cholesterol and triglycerides was statistically significant with polyherbal formulations compared to control group but was not significant for HDL and LDL whereas in other group of polyherbal formulations and metformin only HDL was favouring polyherbal formulations.

Conclusion

Polyherbal formulations occurred to be effective in lowering blood sugar level in Type 2 diabetes but their further efficacy in managing diabetes needs to be validated. Therefore, a qualitative, long term, randomized placebo-controlled trials of adequate sample size are necessary to determine the efficacy of polyherbal formulation in managing diabetes.

TLC-MS Bioautography-Based Identification of Free-Radical Scavenging, α-Amylase, and α-Glucosidase Inhibitor Compounds of Antidiabetic Tablet BGR-34

BGR-34 is a polyherbal formulation frequently used to combat diabetes around the globe especially in Asian countries. It provides an attractive treatment option to prediabetics, diabetics, and in metabolic disorders by controlling the altered blood glucose level. The lack of phytopharmacological studies on BGR-34 prompted as to reveal the compounds responsible for the antidiabetic and free-radical scavenging activity of BGR-34. An attempt was made to assess in vitro α-amylase and α-glucosidase enzyme inhibition of BGR-34 along with its free-radical scavenging potential via DPPH scavenging activity. Further, HPTLC profiling and quantitative analysis of berberine and palmatine in BGR-34 were carried out. Thereafter, the TLC-bioautographic-MS analysis was performed to identify the compounds responsible for antidiabetic and antioxidant activities in BGR-34. The results had shown a significant and dose-dependent inhibition potential of BGR-34 against in vitro α-amylase and α-glucosidase enzymatic reactions along with significant inhibition in DPPH free-radical scavenging activity. The HPTLC profiling and quantitative validation studies showed the presence of berberine and palmatine 44.926 ± 0.2907 and 10.507 ± 0.154 μg/g, respectively. The TLC-MS bioautography revealed a total of four DPPH-active, two α-amylase-active, and nine α-glucosidase-active compounds in BGR-34. It was observed from the study that BGR-34 possesses verities of bioactive compounds, which are reasonable not only for its antidiabetic effect but also for its antioxidant activity.

Hypoglycemic, Anti-Hyperglycemic and Anti-Hyperlipidemic Effects of Bersama abyssinica Fresen (Melianthaceae) Leaves' Solvent Fractions in Normoglycemic and Streptozotocin-Induced Diabetic Mice

Background

The leaves of Bersama abyssinica are used by traditional healers and the community for the treatment of diabetes mellitus. Thus, the current study intended to evaluate the hypoglycemic, anti-diabetic, and anti-hyperlipidemic effects of Bersama abyssinica.

Methods

The solvent fractions of Bersama abyssinica leaves were prepared. A total of 132 healthy, male Swiss albino mice weighing 20-28 grams (age of 6-10 weeks) were used. The antidiabetic activity of all the doses (100, 200, and 400 mg/kg) of Bersama abyssinica solvent fractions was evaluated by animal models: normoglycemic mice, oral glucose loaded mice, and diabetic mice. Diabetes was induced by a single intraperitoneal injection of streptozotocin (150mg/kg body weight). The effect of the plant extract on body weight and serum lipid levels were measured in diabetic mice. Statistical analysis was performed by using statistical package for social sciences version 24. The analyses were carried out using one-way ANOVA, followed by Tukey's multiple comparison tests. The result was considered significant when p <0.05.

Results

The solvent fractions of B. abyssinica at all tested doses (100, 200, and 400 mg/kg) exhibited significant (P<0.05-0.001) BGL reduction in all animal models. In hypoglycemic activity, the percentage reduction of baseline BGL was 25.90%, 26.36%, 38.43%, 30.96% and 49.42% for EAF200mg/kg, AQF200mg/kg, EAF400mg/kg, AQF400mg/kg, and GLC 5mg/kg, respectively. B. abyssinica at the dose of AQF 200 mg/kg (p<0.05), AQF 400mg/kg (p<0.001), EAF 200mg/kg (p<0.01), and GLC 5mg/kg (p<0.001) significantly reduced the BGL following 1-hour post-treatment as compared to the negative control. Likewise, the higher doses of the solvent fractions (400mg/kg) significantly (p<0.001) reduced the BGL following 2- and 3-hours post-treatment as compared to the negative control. Daily administration of aqueous fraction of B. abyssinica caused a maximum reduction in fasting BGL at the fourteenth day of administration by 33.29%, 38.59%, 52.71%, and 59.66%, respectively, for AQF100, AQF200, AQF400, and GLC 5mg/kg. The aqueous fraction of B. abyssinica and the glibenclamide significantly (p<0.05) prevent loss of body weight and showed improvement in serum lipid levels.

Conclusion

The solvent fractions of Bersama abyssinica exhibit noticeable antidiabetic activity in all animal models (normoglycemic mice, oral glucose loaded mice, and diabetic mice) and showed improvement in body weight and serum lipid profile levels, which rationalizes the claimed use of the B. abyssinica in the treatment of diabetes mellitus.

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.

Antidiabetic activity of Cassia angustifolia Vahl. and Raphanus sativus Linn. leaf extracts

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Senna and radish leaf extracts reduced hyperglycemia in diabetic animals.

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Treatment with study extracts improved lipid profile and decreased atherogenicity.

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Treatment reduced insulin resistance and ameliorated pancreatic histology.

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Antidiabetic action attributed to synergistic effect of phytoconstituents.

Lycium shawii Roem. & Schult.: A new bioactive antimicrobial and antioxidant agent to combat multi-drug/pan-drug resistant pathogens of wound burn infections

The Multidrug Drug Resistance (MDR) and Pan-Drug Resistance (PDR) remain an intractable challenge issue in public health, worldwide. Plant extracts-based biological macromolecules containing a diverse array of secondary metabolites could be potentially used as alternative approaches to control or limit MDR/PDR infections. Plants of the Solanaceae family exhibit a wide variety of secondary metabolites with antioxidant and antimicrobial properties, which render them a significant role in food and pharmaceutical applications. To our knowledge, this is the first report on phytochemical constituents, antioxidant, antimicrobial activities and in vivo toxicological safety of Lycium shawii leaf extracts. Results revealed that phenolics and flavonoids were found to be the most abundant compounds in all extracts. Antioxidant activity of extracts was measured using DPPH^• and ABTS^•+ assays and the methanol extract displayed superior scavenging activity (IC₅₀ = 0.06 and 0.007 mg/mL for DPPH^• and ABTS^•+, respectively). Results of the GC-MS analysis revealed the identity of 10 compounds. Moreover, in vivo toxicological assessment can confirm the safety of L. shawii for use. Overall, L. shawii leaves are a promising natural source for the development of novel antimicrobial and antioxidant agents that could potentially combat clinical MDR/PDR pathogens.

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The drug resistance remains an intractable challenge in public health.

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Phenolics and flavonoids were the most abundant compounds in all extracts.

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Methanol extract was the most antioxidant and antimicrobial agent.

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p-coumaric acid, apigenin, and fisetin are the major identified compounds.

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In vivo toxicological assessment can confirm the safety of L. shawii for use.