Five-year treatment of chronic venous insufficiency with O-(β-hydroxyethyl)-rutosides: safety aspects

Synthesis of rutin derivatives to enhance lipid solubility and development of topical formulation with a validated analytical method

BACKGROUND

Rutin is available on the market as a topical formulation for the treatment of several conditions, such as internal bleeding, hemorrhoids, and varicose veins. However, these gels have low solubility and limited bioavailability due to their decreased lipid solubility.

OBJECTIVE

In this study, we aimed to synthesize potentially novel lipophilic rutin prodrugs. The suggested library of these rutin prodrugs includes changing the solubility profile to facilitate rutin transport across biological barriers, thereby improving drug delivery through topical application.

METHODS

Six rutin derivatives were synthesized based on the ester prodrug strategy. The synthesized compounds were formulated as topical ointments, and their permeability via Franz diffusion was measured. An ultraviolet (UV) analytical method was developed in our laboratories to quantify rutin derivatives both as raw materials and in final dosage forms. The analytical method was then validated.

RESULT

The results of Franz diffusion analyses showed that transdermal permeability increased by 10_Fo.jpgl height=""d for decaacetylated rutin compared to the other esterified rutins. A simple analytical method for the analysis of the formulated rutin ester was developed and validated. Moreover, the formulated ointment of decaacetylated rutin in our research laboratory was found to be stable under stability accelerated conditions. Synthesis of potentially more lipophilic compounds would yield novel rutin prodrugs suitable for topical formulation.

CONCLUSION

This project provides a synthetic approach for many similar natural products. The research idea and strategy followed in this research project could be adapted by pharmaceutical and herbal establishments.

CLINICAL-MORPHOLOGICAL CLASSIFICATION OF ACUTE THROMBOSIS OF THE EXTERNAL HEMORRHOID NODE IN RELATION TO A DIFFERENTIATED APPROACH IN ITS TREATMENT

Acute thrombosis of the external hemorrhoid node is one of the common manifestations of hemorrhoids and a frequent reason for seeking specialized medical care. Despite existing prospective studies proving the effectiveness of operative treatment, there is no clear position in determining the indications, timing and methods of surgery, nor the combination of the latter with conservative therapy.The article formulated and described the original clinical-morphological classification of acute thrombosis of the external hemorrhoid node based on the data of its ultrasound examination (ultrasound). Effectiveness of various methods of treating acute thrombobosis of external hemorrhoid node, carried out on the basis of proposed classification, is evaluated.Purpose of the study. Improving treatment outcomes for patients with acute thrombosis of the external hemorrhoid node.Results. Ultrasound types of thrombosis of external hemorrhoidal node are revealed:

– mononuclear (in ultrasound, it is a single thrombus or a dense, intimately soldered group of thrombotic masses of an an- or isoechogenic structure with untested swelling of the skin and subcutaneous fat (PWD), from 10 mm or more in size);

– polynuclear (clusters of thrombotic masses of an- or isoechogenic structure up to 10 mm in size, located at a short distance from each other, with moderate swelling of the skin and subcutaneous fat);

– edema (during sonography, multiple small, up to 2–3 mm, anechogenic thrombotic masses are visualized against the background of pronounced edema of subcutaneous fat fiber and skin).

Effectiveness of various methods of treating patients with acute thrombosis of external hemorrhoid node in groups formed on the basis of proposed classification is evaluated. It has been found that in patients with edematous sonographic type of thrombosis, it is more advisable to apply only conservative therapy or carry out surgical treatment after completion of taking diosmin-containing preparations. Such tactics reduced the duration of treatment and reduced pain syndrome. In patients with a mononuclear type of thrombosis of the external hemorrhoidal node, a similar result was noted during surgery and the beginning of conservative therapy on the day of circulation.Conclusion. Application of ultrasound diagnostics allows establishing the type of hemorrhoid node thrombosis and using the obtained data when choosing treatment tactics. A differentiated approach to treating this category of patients, based on the proposed classification, allows improving the treatment results of patients with acute thrombosis of the external hemorrhoid node.

A novel rutin-fucoidan complex based phytotherapy for cervical cancer through achieving enhanced bioavailability and cancer cell apoptosis

Recent studies on flavonoids forming complexes with macromolecules attract researchers due to their enhanced bioavailability as well as chemo-preventive efficacy. In this study, a flavonoid rutin (Ru) is non-covalently complexed with fucoidan (Fu) using the functional groups to obtain a therapeutic polymeric complex overcoming the limitations of bioavailability of rutin. The prepared novel rutin-fucoidan (Ru-Fu) complex is characterized for spectroscopic features, particle size and distribution analysis by DLS. It is shown that the complex displayed the nanostructural features that are different from that of the usual rutin-fucoidan mixture. The studies on drug release profiles at different pH (5.5, 6.8 and 7.4) show that the sustained release of compounds from complex occurs preferentially at the desired endosomal pH (5.5). Further, the chemopreventive potential of Ru-Fu complex is investigated against HeLa cells by cellular apoptotic assays and flow cytometric analysis. It showed that the complex is able to disrupt cell cycle regulation and has the ability to induce cellular apoptosis via nuclear fragmentation, ROS generation and mitochondrial potential loss. In vitro cell viability assay with Ru-Fu complex shows that the complex is biocompatible on normal cells. The hemolysis assay also reveals that the complex does not release hemoglobin from human red blood cells (RBCs). Thus, the study is envisaged to open up interests for developing such formulations against cervical cancer and other cancers.

Rutin as a Potent Antioxidant: Implications for Neurodegenerative Disorders

A wide range of neurodegenerative diseases (NDs), including Alzheimer's disease, Parkinson's disease, Huntington's disease, and prion diseases, share common mechanisms such as neuronal loss, apoptosis, mitochondrial dysfunction, oxidative stress, and inflammation. Intervention strategies using plant-derived bioactive compounds have been offered as a form of treatment for these debilitating conditions, as there are currently no remedies to prevent, reverse, or halt the progression of neuronal loss. Rutin, a glycoside of the flavonoid quercetin, is found in many plants and fruits, especially buckwheat, apricots, cherries, grapes, grapefruit, plums, and oranges. Pharmacological studies have reported the beneficial effects of rutin in many disease conditions, and its therapeutic potential in several models of NDs has created considerable excitement. Here, we have summarized the current knowledge on the neuroprotective mechanisms of rutin in various experimental models of NDs. The mechanisms of action reviewed in this article include reduction of proinflammatory cytokines, improved antioxidant enzyme activities, activation of the mitogen-activated protein kinase cascade, downregulation of mRNA expression of PD-linked and proapoptotic genes, upregulation of the ion transport and antiapoptotic genes, and restoration of the activities of mitochondrial complex enzymes. Taken together, these findings suggest that rutin may be a promising neuroprotective compound for the treatment of NDs.

Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial

BACKGROUND

The role of a mixture of phlebotonics in the treatment of acute hemorrhoid crisis is investigated to test their efficacy.

METHODS

One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study. Sixty-six of them were randomized to receive a mixture of diosmin, troxerutin and hesperidin (group A), and 68 a placebo (group B). The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit and compared using both Student's t test for independent samples and the ANOVA models for repeated measures. The presence of edema, prolapse and thrombosis were also recorded and compared using the Chi-square test. Furthermore, the trend of proportions during the time of the evaluations was assessed by the Chi-square test for linear trend.

RESULTS

Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A. After 6 days, the number of paracetamol tablets taken by patients in group A was significantly lower than the amount of flavonoid mixture.

CONCLUSIONS

The use of a mixture of diosmin, troxerutin and hesperidin is a safe and effective mean of managing symptoms of acute hemorrhoidal disease. Furthermore, in patients receiving treatment, there was faster control and lower persistence of edema and thrombosis.