An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid

Effect of St. John's Wort (Hypericum perforatum L.) on Male Sexual and Reproductive Health: A Narrative Review

BACKGROUND

Hypericum species are widely acknowledged for their biological attributes, with notable attention being paid to Hypericum perforatum, commonly known as St. John's wort (SJW) within the Hypericum section of the Hypericaceae family. This species is among the most thoroughly investigated herbal medicines, particularly in terms of its application in the management of mild to moderate depression. SJW is used to treat depression, menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), somatic symptom disorder, obsessive-compulsive disorder, and skin conditions, such as wounds and muscle pain. However, the usefulness and effectiveness of SJW for male sexual and reproductive health (SRH) are not well known.

OBJECTIVE

To assess the current evidence in the literature on the effect of SJW on male SRH.

METHODS

This narrative review followed a predetermined protocol and used MEDLINE and PubMed to identify articles published in English on the effects of SJW on male SRH. The search used various keywords, such as "Hypericum Perforatum", "St. John's Wort", and terms related to sexual and reproductive health issues. Articles published between the inception of the database and August 2023 were included.

RESULTS

We identified 12 articles published from 1999 to 2019, the majority of which were experimental and conducted on animals. These studies demonstrate variability in terms of design, sample size, type of SJW extract used, the dosage administered, and duration of treatment. Studies have indicated potential sexual dysfunction (SD) due to SJW, which includes reduced libido, delayed ejaculation, delayed orgasm, and erectile dysfunction. Additionally, reproductive toxicity has been suggested, as evidenced by spermicidal effects through the inhibition of sperm motility, abnormal spermatozoa, chromosomal aberrations, and DNA denaturation. Furthermore, some studies have reported potential adverse events during maternal exposure, inhibition of fertilization, and disruption of reproductive parameters.

CONCLUSIONS

Our review suggests that the safety and efficacy of SJW in the treatment of human SRH remain unclear. Further comprehensive, well-designed studies with larger samples, longer exposure periods, and specific dosages are needed to clarify SJW's effects of SJW. Therefore, consultation with healthcare professionals before using herbal remedies or supplements is crucial.

Detrimental effect of Hypericum perforatum on ovarian functions

Objective:

Hypericum perforatum is widely used for depression and distress treatment as an over-the-counter plant at any age. This study investigated the safety of H. perforatum on ovarian function and infertility.

Material and Methods:

H. perforatum was given to rats in two different dosages (100 and 300 mg/kg/day) with drinking water for four weeks. Half of the treatment groups were sacrificed at the end of the four-week intervention, the remainder was sacrificed after an additional four-week waiting period to see if there was reversibility. At the end of the experiment, blood samples and both ovarian tissues were obtained under anesthesia with ketamine and xylazine (50 mg/kg and 5 mg/kg, respectively).

Results:

Although primordial follicle numbers were not affected with a dose of 100 mg/kg, they were significantly decreased (28.6%) when the dose was tripled. Primary follicle numbers stayed the same, but secondary and tertiary follicles numbers were significantly dose-dependently decreased, and remained significantly low four weeks after the intervention. Anti-mullerian hormone (AMH) levels were not significantly different between the groups.

Conclusion:

H. perforatum treatment did not change serum levels of AMH because the primary follicle number did not decrease. However, the other follicle counts decreased in a dose-dependent manner and full recovery was not regained after four weeks. The detrimental effect of H. perforatum on primordial follicles should be taken into consideration because any woman using H. perforatum could also experience ovarian failure.

An engineered mouse embryonic stem cell model with survivin as a molecular marker and EGFP as the reporter for high throughput screening of embryotoxic chemicals in vitro

Embryonic stem cell test (EST) is the only generally accepted in vitro method for assessing embryotoxicity without animal sacrifice. However, the implementation and application of EST for regulatory embryotoxicity screening are impeded by its technical complexity, long testing period, and limited endpoint data. In this study, a high throughput embryotoxicity screening based on mouse embryonic stem cells (mESCs) expressing enhanced green fluorescent protein (EGFP) driven by a human survivin promoter and a human cytomegalovirus promoter, respectively, was developed. These EGFP expressing mESCs were cultured in three-dimensional (3D) fibrous scaffolds in microbioreactors on a multiwell plate with EGFP fluorescence signals as cell responses to chemicals monitored noninvasively in a high throughput manner. Nine chemicals with known developmental toxicity were used to validate the survivin-based embryotoxicity assay, which showed that strongly embryotoxic compounds such as 5-fluorouracil, retinoic acid, and methotrexate downregulated survivin expression by more than 50% in 3 days, while weakly embryotoxic compounds such as boric acid, methoxyacetic acid, and tetracyclin showed modest downregulation effect and nonembryotoxic saccharin, penicillin G, and acrylamide had negligible downregulation effect on survivin expression, confirming that survivin can be used as a molecular endpoint for high throughput screening of embryotoxicants. The potential developmental toxicity of three Chinese herbal medicines were also evaluated using this assay, demonstrating its application in in vitro developmental toxicity test for drug safety assessment.

Conservative Nonhormonal Options for the Treatment of Male Infertility: Antibiotics, Anti-Inflammatory Drugs, and Antioxidants

The nonhormonal medical treatment can be divided into empirical, when the cause has not been identified, and nonempirical, if the pathogenic mechanism causing male infertility can be solved or ameliorated. The empirical nonhormonal medical treatment has been proposed for patients with idiopathic or noncurable oligoasthenoteratozoospermia and for normozoospermic infertile patients. Anti-inflammatory, fibrinolytic, and antioxidant compounds, oligo elements, and vitamin supplementation may be prescribed. Infection, inflammation, and/or increased oxidative stress often require a specific treatment with antibiotics, anti-inflammatory drugs, and/or antioxidants. Combined therapies can contribute to improve sperm quality.

Echinacea purpurea: Pharmacology, phytochemistry and analysis methods

Echinacea purpurea (Asteraceae) is a perennial medicinal herb with important immunostimulatory and anti-inflammatory properties, especially the alleviation of cold symptoms. The plant also attracted scientists' attention to assess other aspects of its beneficial effects. For instance, antianxiety, antidepression, cytotoxicity, and antimutagenicity as induced by the plant have been revealed in various studies. The findings of the clinical trials are controversial in terms of side effects. While some studies revealed the beneficial effects of the plant on the patients and no severe adverse effects, some others have reported serious side effects including abdominal pain, angioedema, dyspnea, nausea, pruritus, rash, erythema, and urticaria. Other biological activities of the plant such as antioxidant, antibacterial, antiviral, and larvicidal activities have been reported in previous experimental studies. Different classes of secondary metabolites of the plant such as alkamides, caffeic acid derivatives, polysaccharides, and glycoproteins are believed to be biologically and pharmacologically active. Actually, concurrent determination and single analysis of cichoric acid and alkamides have been successfully developed mainly by using high-performance liquid chromatography (HPLC) coupled with different detectors including UV spectrophotometric, coulometric electrochemical, and electrospray ionization mass spectrometric detectors. The results of the studies which were controversial revealed that in spite of major experiments successfully accomplished using E. purpurea, many questions remain unanswered and future investigations may aim for complete recognition of the plant's mechanism of action using new, complementary methods.

Use of and attitudes toward complementary and alternative medicine among nurse-midwives in Israel

OBJECTIVE

The objective of the study was to evaluate the use and attitudes of nurse-midwives in Israel toward complementary and alternative medicine (CAM).

STUDY DESIGN

In a cross-sectional study, nurse-midwives from 5 Israeli medical centers completed the CAM Health Belief Questionnaire, a validated tool examining data regarding personal health behavior, use of CAM therapies, and attitudes toward CAM.

RESULTS

One hundred seventy-three of 238 potential respondents completed the questionnaires (72.7%). Most (87.3%) reported using CAM (67.1% massage, 48.6% herbal medicine, 42.2% meditation, 40.5% touch therapies, and 39.9% prayer) and agree with many fundamental tenets of CAM such as the existence of energy forces, self-healing, and integrating patients' health beliefs and values into their care.

CONCLUSION

The majority of nurse-midwives studied reported using and recommending CAM to their patients and believe that CAM can complement conventional medical therapies. Health care providers could benefit from education with regard to the efficacy and safety of CAM modalities during pregnancy and childbirth.

Effects of Ginkgo biloba extract on the embryo-fetal development in Wistar rats

BACKGROUND

Ginkgo biloba extract (GBE) is an herbal medicine used for treating neurodegenerative diseases, cerebrovascular insufficiency, peripheral arterial occlusive disease, and also vestibular disturbance. Some components of GBE have presented estrogenic effects and, in a previous study, high dosages of GBE caused intra-uterine growth retardation in fetuses of Wistar rats treated during the fetogenesis period.

METHODS

Pregnant Wistar rats were treated, through gavage, with different dosages of aqueous GBE (3.5, 7.0, and 14.0 mg/Kg/day), during the tubal transit and implantation period. Rats were killed on the 15th day of pregnancy and the following parameters were evaluated: clinical symptoms of maternal toxicity; maternal body weight; feed and water intake; maternal liver, kidney, and ovary weights; number of corpora lutea; implants per group ratio; pre- and post-implantation loss per group ratio; live fetuses mean; dead fetuses percentage; fetus and placenta weight per offspring ratio; and fetal external malformation.

RESULTS

No significant alteration was found for both the maternal and embryonic parameters evaluated.

CONCLUSIONS

The GBE treatment in pregnant Wistar rats, during the tubal transit and implantation period, caused no toxic effect on the maternal organism and did not induce embryonic death, growth retardation, and/or fetal malformations.

The effects of methanolic extracts of ginger (Zingiber officinale) on human sperm parameters; an in vitro study

This study was conducted on Zingiber officinale or ginger on motility, grading and morphological aspects of human sperm. Thirty human semen samples were obtained from the local hospital. The samples were swim up by Ham's F10. The samples (0.9 mL) were treated by 0.1 mL of ginger methanolic extracts (0.1, 0.2, 0.4 and 0.6% concentration). Sperm motility, grading and morphology parameters were assessed using light microscope at 0, 2, 4, 8 and 24 h after treatment. Dose and time-dependent decreases in motility accompanied by concomitant decrease in grading 3 and 4 were noticed. Morphologic profiles of the sperms were changed under different doses of ginger on the basis of time of assess. These data indicate that some exhibits a lower percentage of motility and grading when methanolic ginger is added to semen fluid. According to the results it would be concluded that ginger can induce the toxic effects on sperm parameters.

Postnatal development of pups from nursing rats treated with Gingko biloba

The Gingko biloba extract is contraindicated during pregnancy and lactation due to the lack of information about its effects on these reproductive phases. Previous studies have shown that G. biloba extract contains components with estrogenic and antiestrogenic activities, thus nursing dams treated with the extract of this plant could show reduction in milk production, resulting in malnutrition and poor development of pups. This work analyzes the postnatal development of pups, whose mothers were treated with G. biloba extract during the lactation period. Nursing Wistar rats received 3.5 mg/kg/day of G. biloba aqueous extract, corresponding to the highest human dose. Clinical signs of maternal toxicity were evaluated. The growth rate, viability, survival during treatment and lactation indices of the pups were calculated. The physical, motor and sensorial development of the pups was also evaluated. No maternal signs of toxicity were observed. As there were no biological differences between control and G. biloba treated pups, it is possible to assume that, in this experimental design, the administration of G. biloba aqueous extract to nursing rats during the lactation period seems to be devoid of toxic effect to mothers and to the physical, motor and sensory development of the pups.

Ginkgo biloba leave extract: biological, medicinal, and toxicological effects

Ginkgo biloba leave extract is among the most widely sold herbal dietary supplements in the United States. Its purported biological effects include: scavenging free radical; lowering oxidative stress; reducing neural damages, reducing platelets aggregation; anti-inflammation; anti-tumor activities; and anti-aging. Clinically, it has been prescribed to treat CNS disorders such as Alzheimer's disease and cognitive deficits. It exerts allergy and changes in bleeding time. While its mutagenicity or carcinogenic activity has not been reported, its components, quercetin, kaempferol and rutin have been shown to be genotoxic. There are no standards or guidelines regulating the constituent components of Ginkgo biloba leave extract nor are exposure limits imposed. Safety evaluation of Ginkgo biloba leave extract is being conducted by the U.S. National Toxicology Program.

Studies on the reproductive, cytological and biochemical toxicity of Ginkgo Biloba in Swiss albino mice

Ginkgo biloba (an herbal product), used as a folkloric medicine in the treatment of dementia, was evaluated for its effects on reproductive, cytological and biochemical toxicity in male Swiss albino mice. The mice were treated with different doses (25, 50 and 100mg/kg/day) of the aqueous suspension of Ginkgo biloba for 90 days by oral gavage. The following parameters were evaluated: (1) reproductive organ weight; (2) motility and content of sperms; (3) spermatozoa morphology; (4) cytology of the testes chromosomes; (5) study on reproduction; (6) biochemical study on proteins, nucleic acids, malondialdehyde (MDA) and nonprotein sulfhydryl (NP-SH). The treatment caused significant changes in the weight of caudae epididymis, prostate, chromosomal aberrations, rate of pregnancy and pre-implantation loss. However, the percent motility, sperm count and morphology of spermatozoa were not affected. Our study on biochemical parameters showed depletion of nucleic acids, NP-SH and increase of MDA, which elucidated the role of free radical species in the induced changes in testis chromosomes and the reproductive function. The exact mechanism is not known, however, the activation of GABA, glycine and glutamate under the influence of Ginkgo biloba and its constituents might have generated free radicals and depleted cellular glutathione by calcium influx and membrane depolarization. The observed toxicity is attributed to the toxic constituents (ginkgolic acids, biflavones, cardanols, cardols, bilobalides and quercetin) of Ginkgo biloba. Our results warrant careful use of Ginkgo biloba as a remedy for impotence and/or erectile dysfunction.

Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt.,Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties

This paper reviews the chemistry, pharmacology and clinical properties of Echinacea species used medicinally. The Echinacea species Echinacea angustifolia, Echinacea pallida and Echinacea purpurea have a long history of medicinal use for a variety of conditions, particularly infections, and today echinacea products are among the best-selling herbal preparations in several developed countries. Modern interest in echinacea is focused on its immunomodulatory effects, particularly in the prevention and treatment of upper respiratory tract infections. The chemistry of Echinacea species is well documented, and several groups of constituents, including alkamides and caffeic acid derivatives, are considered important for activity. There are, however, differences in the constituent profile of the three species. Commercial echinacea samples and marketed echinacea products may contain one or more of the three species, and analysis of samples of raw material and products has shown that some do not meet recognized standards for pharmaceutical quality. Evidence from preclinical studies supports some of the traditional and modern uses for echinacea, particularly the reputed immunostimulant (or immunomodulatory) properties. Several, but not all, clinical trials of echinacea preparations have reported effects superior to those of placebo in the prevention and treatment of upper respiratory tract infections. However, evidence of efficacy is not definitive as studies have included different patient groups and tested various different preparations and dosage regimens of echinacea. On the basis of the available limited safety data, echinacea appears to be well tolerated. However, further investigation and surveillance are required to establish the safety profiles of different echinacea preparations. Safety issues include the possibility of allergic reactions, the use of echinacea by patients with autoimmune diseases and the potential for echinacea preparations to interact with conventional medicines.

Complementary therapies in pregnancy: Midwives’ and obstetricians’ appreciation of risk

Complementary medicine is increasingly being integrated into maternity care, primarily by midwives in response to mothers' demands. Midwives and obstetricians must, however, develop a comprehensive evidence-based knowledge of risks, as well as benefits, to ensure that any complementary therapies in pregnancy and childbirth are not only effective but also safe. This paper discusses the results of an evaluative audit of midwives' and obstetricians' knowledge of and attitudes to complementary therapies in pregnancy in an NHS antenatal clinic which revealed a generalised lack of knowledge and poor understanding of the possible risks to women.

Development of pregnancy in rats treated withHypericum perforatum

St John's wort (Hypericum perforatum) is a medicinal plant used in the treatment of depression and other psychiatric disorders. In the present paper, the toxicity of H. perforatum administered to female rats during the period of organogenesis (day 9-15 of pregnancy) was evaluated. Thirty inseminated Wistar rats were randomly distributed into control and treated groups, which received, by gavage, 0.5 mL of saline and 36 mg/kg body weight of Jarsin dried extract diluted into 0.5 mL of saline, respectively. Maternal toxicity was evaluated through: water and food intake, body weight gain, piloerection, locomotor activity, diarrhea and death occurrence. Animals were killed on day 21 of pregnancy, when fetuses and placentas were removed and weighed. The indices of implantation and resorption were calculated. Clinical signs of maternal toxicity were not observed and none of the variables analysed showed statistically significant differences. In the dose administered in the experimental model used, H. perforatum does not seem to be toxic to the mother nor to interfere with the progress of gestation during organogenesis.

The use of herbs by pregnant and childbearing women: a risk-benefit assessment

This paper reviews some of the evidence in relation to herbal remedies, and considers both their efficacy and safety for pregnant and childbearing women. It concludes with some suggested guidelines for midwifery and obstetric practice.

Herbs for benign prostatic hyperplasia

OBJECTIVE

To review and evaluate the literature relative to the use of herbal therapies in the treatment of benign prostatic hyperplasia.

DATA SOURCES

Literature was identified by MEDLINE, Embase, International Pharmaceutical Abstracts, and the International Bibliographic Information on Dietary Supplements searches and through cross-referencing of selected articles.

STUDY SELECTION/DATA EXTRACTION

All articles identified from the data sources were evaluated and all information deemed relevant was included in this review.

DATA SYNTHESIS

A large percentage of men >50 years old begin to experience signs and symptoms of benign prostatic hyperplasia (BPH). Herbs hold promise in the treatment of BPH. Serenoa repens, Pygeum africanum, Urtica dioica radix, and Cucurbita peponis semen are some of the botanical therapies used in the treatment of BPH.

CONCLUSIONS

There are many European studies examining efficacy, dose, and adverse effects of these plants in the treatment of BPH. However, numerous questions remain. These include issues concerning long-term beneficial and adverse effects of herbal therapy, prevention of complications, standardization of extracts, and concomitant use with "mainstream" medications. Based on the information available today, these botanical therapies can be used for treatment of a number of objective and subjective symptoms in patients with BPH, stages I and II.

St John's wort: Prozac from the plant kingdom

Conventional antidepressants are associated with a range of adverse drug reactions. The herb Hypericum perforatum (St John's wort) might offer another approach to the treatment of depression. Biochemical and animal studies suggest that the phloroglucinol derivative hyperforin is the main active ingredient of St John's wort, and inhibits the synaptosomal uptake of 5-HT, noradrenaline, dopamine, glutamate and GABA. St John's wort has been shown to alleviate symptoms of mild to moderate depression, and seems to offer significant advantages over conventional antidepressants because it is associated with fewer adverse reactions. However, important herb--drug interactions have been described. In view of its efficacy and safety records, St John's wort should be considered for the first-line treatment of mild to moderate depression.

St. John's Wort

OBJECTIVE

The objective of this article is to review the current knowledge of the pharmacology, sites of action, and therapeutic effectiveness of St. John's Wort.

METHOD

The method used was a review of the available literature, using keywords to search the medline database. Bibliographies of the papers, thus obtained, were searched for further documents not referenced by medline. We reviewed papers from this collection.

RESULTS

This review reveals that most of the available data on efficacy and safety of St. John's Wort involve its use in mild to moderate depression. Much, but not all of the prevailing opinion is positive. Nevertheless, the quality of therapeutic trials vary so greatly that definitive conclusions are not possible. Both the source and mode of St. John's Wort's therapeutic effect are unclear. We need further controlled studies of effectiveness, safety, and mode of action. In addition to its use in depression, there are reports suggesting possible therapeutic effects in other conditions such as certain malignancies and infections, but these are far too preliminary to permit any conclusions.

Herbal medicine: from the past to the future

A brief discussion of the history of the use of herbal medicines from prehistoric times to the mid-twentieth century precedes an explanation of why usage of such remedies in the United States declined in the 1940s but returned to popularity in the 1980s. The provisions of the Dietary Supplement Health and Education Act of 1994 are presented together with its perceived influence, both positive and negative, on the health of the American people. Possible futures of herbal medicines are considered. The negative viewpoint that they will ultimately be rejected is refuted, and the more optimistic prediction that herbs are ultimately destined to become a part of mainstream medicine is defended. Stumbling blocks to such acceptance are evaluated and methods of overcoming them suggested. The urgent need for the development of a sensible regulatory environment encouraging the approval of botanicals as drugs is emphasized. After predicting a bright future for rational phytomedicines, the author opines that many of them will eventually play significant roles in medicinal practice.