Traditional Knowledge-based Medicine: A Review of History, Principles, and Relevance in the Present Context of P4 Systems Medicine

Dalbergia sissoo phytochemicals as EGFR inhibitors: an in vitro and in silico approach

The safest and most effective sources of medications are natural and traditional medicines derived from plants and herbs. In Western India, various parts of the Dalbergia sissoo plant, which belongs to the Fabaceae family, have been traditionally used to treat different types of cancer by the local tribes. However, this claim has not been scientifically proven yet. Thus, the purpose of this study was to examine the antioxidant (2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity) and anticancer effects of different plant extracts from Dalbergia sissoo bark, root, and branch on six different cancer cell lines (K562, PC3, A431, A549, NCIH 460, and HEK 293 T) using in vitro cell viability and cytotoxicity assays. The study also involved in silico docking, MD simulation, and ADME studies of previously reported bioactive compounds from the same parts of the plant to confirm their bioactivity. The DPPH radical scavenging experiment findings showed that the methanol: water extract of the bark had a more significant antioxidant activity IC50 (45.63 ± 1.24 mg/mL). Furthermore, the extract prevented the growth of the A431, A549, and NCIH 460 cancer cell lines with the lowest IC50 values of 15.37, 29.09, and 17.02 g/mL, respectively, demonstrating remarkable anticancer potential. Molecular docking and dynamic simulation studies revealed that Prunetin, Tectorigenin, and Prunetin 4'-O-Galactoside show efficient binding to the EGFR binding domain. This study suggests that tested hits may have antioxidant and anticancer agents and can be considered for future applications in the pharma sector.Communicated by Ramaswamy H. Sarma.

Criteria for the selection, evaluation and application of traditional knowledge in contemporary health practice, education, research and policy: A systematic review

BACKGROUND

Traditional and complementary medicine (T&CM) is highly utilised and draws on traditional knowledge (TK) as evidence, raising a need to explore how TK is currently used.

OBJECTIVES

Examine criteria used to select, evaluate and apply TK in contemporary health contexts.

METHODS

Systematic search utilising academic databases (AMED, CINAHL, MEDLINE, EMBASE, SSCI, ProQuest Dissertations Theses Global), Trip clinical database and Google search engine. Citations and reference lists of included articles were searched. Reported use of TK in contemporary settings was mapped against a modified 'Exploration-Preparation-Implementation-Sustainment' (EPIS) implementation framework.

RESULTS

From the 54 included articles, EPIS mapping found TK is primarily used in the Exploration phase of implementation (n = 54), with little reporting on Preparation (n = 16), Implementation process (n = 6) or Sustainment (n = 4) of TK implementation. Criteria used in selection, evaluation and application of TK commonly involved validation with other scientific/traditional evidence sources, or assessment of factors influencing knowledge translation.

DISCUSSION

One of the difficulties in validation of TK (as a co-opted treatment) against other evidence sources is comparing like with like as TK often takes a holistic approach. This complicates further planning and evaluation of implementation.

CONCLUSION

This review identifies important criteria for evaluating current and potential contemporary use of TK, identifying gaps in research and practice for finding, appraising and applying relevant TK studies for clinical care.

Burn Wound Healing Effect of a Sterilized Traditional Formulation of Boswellia carteri vs. Silver Sulfadiazine Cream 1% in Patients Presenting Second-degree Burn Wounds: A Randomized, Double-blind Clinical Trial

Background

Burn wounds rank among the most serious healthcare issues. Many studies reported the effectiveness of natural products in the wound-healing process. The present study compared the effects of a standardized herbal formulation derived from Boswellia carteri (B. carteri) and silver sulfadiazine (SSD) cream 1% on the healing of burn wounds.

Methods

This randomized double-blind clinical trial was conducted at Shiraz Burn Hospital (Shiraz, Iran) between July 2012 to August 2013. A sterilized formulation comprising B. carteri 40% was prepared. 54 second-degree burn patients of both sexes with age ranges of 20 to 60 were invited to participate in this double-blind, randomized clinical trial. They were randomly divided into two groups and given either the Boswellia formulation or SSD cream. The healing index was determined based on the wound area assessment using the planimetry technique. The Kaplan-Meier survival analysis was used to assess the primary outcome, which was the amount of time until complete healing.

Results

The trial was completed by 17 patients from the SSD group and 15 patients from the Boswellia group. During the study period, both groups showed a progressive healing trend. The mean (95% CI) healing time in the SSD group was 10.94 (9.03-12.85) days and 10.73 (9.23-12.23) days in the Boswellia group (P=0.71), indicating no significant difference. On the 17^th day, the healing index of all patients in the Boswellia group reached 1.

Conclusion

Boswellia topical formulation had a burn wound healing effect comparable to that of the standard SSD 1% treatment. Based on the findings of this study, the likelihood of contact dermatitis with Boswellia should be taken into consideration.

Antiviral Potential of Traditional Unani Medicine with Special Emphasis on Dengue: A Review

Dengue fever has become a major public health concern. It is usually related to intravascular leaking, bleeding disorders, and thrombocytopenia and is recognized as a potent threat to humans. The scarcity of anti-dengue medication or vaccine for such a serious disease leads to an upsurge in the usage of traditional medicines for its proper management. India has diverse biodiversity and a long history of using plant-based remedies. Several medicinal plant extracts have been studied for producing anti-dengue viral activity. AYUSH traditional systems provide a plethora of plants that have been reported to be useful in the treatment of fever. Single and compound plant- based formulations in natural form have been used in Unani holistic approaches. This review serves as a new approach to illustrate the most recent evidence regarding the antiviral activity of various plants by providing scientific proof and also to validate the traditional formulations as effective treatments in dengue fever for global acceptance.

Phytochemicals and Biological Activities of Garcinia atroviridis: A Critical Review

Garcinia atriviridis Griff ex T. Anders (G. atroviridis) is one of the well-known species of the genus Garicinia that is native to Thailand, Myanmar, Peninsular Malaysia, and India. G. atroviridis is a perennial medium-sized tree that has a wide range of values, from food to medicinal use. Different parts of G. atroviridis are a great source of bioactive substances that have a positive impact on health. The extracts or bioactive constituents from G. atroviridis have demonstrated various therapeutic functions, including antioxidant, antimicrobial, anticancer, anti-inflammatory, antihyperlipidemic, and anti-diabetic. In this paper, we provide a critical review of G. atroviridis and its bioactive constituents in the prevention and treatment of different diseases, which will provide new insight to explore its putative domains of research.

Phytotherapy in Integrative Oncology-An Update of Promising Treatment Options

Modern phytotherapy is part of today's conventional evidence-based medicine and the use of phytopharmaceuticals in integrative oncology is becoming increasingly popular. Approximately 40% of users of such phytopharmaceuticals are tumour patients. The present review provides an overview of the most important plants and nature-based compounds used in integrative oncology and illustrates their pharmacological potential in preclinical and clinical settings. A selection of promising anti-tumour plants and ingredients was made on the basis of scientific evidence and therapeutic practical relevance and included Boswellia, gingko, ginseng, ginger, and curcumin. In addition to these nominees, there is a large number of other interesting plants and plant ingredients that can be considered for the treatment of cancer diseases or for the treatment of tumour or tumour therapy-associated symptoms. Side effects and interactions are included in the discussion. However, with the regular and intended use of phytopharmaceuticals, the occurrence of adverse side effects is rather rare. Overall, the use of defined phytopharmaceuticals is recommended in the context of a rational integrative oncology approach.

S, Patel AB, Chen ZS. An Ayurgenomics Approach: Prakriti-Based Drug Discovery and Development for Personalized Care

Originating in ancient India, Ayurveda is an alternative medicinal approach that provides substantial evidence for a theoretical-level analysis of all aspects of life. Unlike modern medicine, Ayurveda is based upon tridoshas (Vata, pitta, and Kapha) and Prakriti. On the other hand, the research of all the genes involved at the proteomics, metabolomics, and transcriptome levels are referred to as genomics. Geoclimatic regions (deshanupatini), familial characteristics (kulanupatini), and ethnicity (jatiprasakta) have all been shown to affect phenotypic variability. The combination of genomics with Ayurveda known as ayurgenomics provided new insights into tridosha that may pave the way for precision medicine (personalized medicine). Through successful coordination of “omics,” Prakriti-based treatments can help change the existing situation in health care. Prakriti refers to an individual’s behavioral trait, which is established at the moment of birth and cannot be fully altered during one’s existence. Ayurvedic methodologies are based on three Prakriti aspects: aushadhi (medication), vihara (lifestyle), and ahara (diet). A foundation of Prakriti-based medicine, preventative medicine, and improvement of life quality with longevity can be accomplished through these ayurvedic characteristics. In this perspective, we try to understand prakriti’s use in personalized medicine, and how to integrate it with programs for drug development and discovery.

Whole Exome Sequencing in Healthy Individuals of Extreme Constitution Types Reveals Differential Disease Risk: A Novel Approach towards Predictive Medicine

Precision medicine aims to move from traditional reactive medicine to a system where risk groups can be identified before the disease occurs. However, phenotypic heterogeneity amongst the diseased and healthy poses a major challenge for identification markers for risk stratification and early actionable interventions. In Ayurveda, individuals are phenotypically stratified into seven constitution types based on multisystem phenotypes termed “Prakriti”. It enables the prediction of health and disease trajectories and the selection of health interventions. We hypothesize that exome sequencing in healthy individuals of phenotypically homogeneous Prakriti types might enable the identification of functional variations associated with the constitution types. Exomes of 144 healthy Prakriti stratified individuals and controls from two genetically homogeneous cohorts (north and western India) revealed differential risk for diseases/traits like metabolic disorders, liver diseases, and body and hematological measurements amongst healthy individuals. These SNPs differ significantly from the Indo-European background control as well. Amongst these we highlight novel SNPs rs304447 (IFIT5) and rs941590 (SERPINA10) that could explain differential trajectories for immune response, bleeding or thrombosis. Our method demonstrates the requirement of a relatively smaller sample size for a well powered study. This study highlights the potential of integrating a unique phenotyping approach for the identification of predictive markers and the at-risk population amongst the healthy.

An exploration of barriers and enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand: A qualitative descriptive study

BACKGROUND

Most studies examining complementary and alternative medicine (CAM) stakeholder engagement with evidence-based practice have relied on quantitative research methods, which often fail to capture the nuances of this phenomena. Using qualitative methods, this study aimed to explore the experiences of CAM stakeholders regarding the barriers and enablers to the conduct and application of research.

METHODS

This research was guided by a qualitative descriptive framework. CAM practitioners and researchers of multiple CAM disciplines from across Australia and New Zealand were invited to share their personal perspectives of the study phenomena. Semi-structured interviews were conducted via Zoom, which were audio-recorded and transcribed verbatim. Rigour strategies were applied to ensure the credibility of results. The transcript was analysed using thematic analysis.

RESULTS

CAM stakeholders identified an array of barriers and enablers to the conduct and application of research within their disciplines. The barriers and enablers that emerged were found to be inter-connected with two similar constructs: capacity and culture. Captured within the construct of capacity were five themes-lack of resources, inadequate governance/leadership, lack of competency, bias directed from outside and within CAM, and lack of time for research. Within the construct of culture were two themes-intrinsic perceptions in CAM, and lack of communication within and outside CAM.

CONCLUSIONS

Promoting evidence-based practice and engaging with research in CAM continues to face challenges. This study, for the first time, has highlighted the multitude of interlinked barriers that confront CAM stakeholders when engaging with research. These findings highlight the need for a concerted and targeted approach to tackle these challenges.

Construction of a Standardized Tongue Image Database for Diagnostic Education: Development of a Tongue Diagnosis e-Learning System

Tongue examination is an important diagnostic method for judging pathological conditions in Kampo (traditional Japanese medicine), but it is not easy for beginners to learn the diagnostic technique. One reason is that there are few objective diagnostic criteria for tongue examination findings, and the educational method for tongue examination is not standardized in Japan, warranting the need for a tongue image database for e-learning systems that could dramatically improve the efficiency of education. Therefore, we constructed a database comprising tongue images whose findings were determined on the basis of votes given by five Kampo medicine specialists (KMSs) and confirmed the educational usefulness of the database for tongue diagnosis e-learning systems. The study was conducted in the following five steps: development of a tongue imaging collection system, collection of tongue images, evaluation and annotation of tongue images, development of a tongue diagnosis e-learning system, and verification of the educational usefulness of this system. Five KMSs evaluated the tongue images obtained from 125 participants in the following eight aspects: (i) tongue body size, (ii) tongue body color, (iii) tongue body dryness and wetness, (iv) tooth marks on the edge of the tongue, (v) cracks on the surface of the tongue, (vi) thickness of tongue coating, (vii) color of tongue coating, and (viii) dryness and wetness of tongue coating. Medical students (MSs) were given a tongue diagnosis test using an e-learning system after a lecture on tongue diagnosis. The cumulative and individual match rates (%) (individual match rates of 100% (5/5), 80% (4/5), and 60% (3/5) are shown in parentheses, respectively) were as follows: (i) tongue body size: 92.8 (26.4/26.4/40.0); (ii) tongue body color: 83.2 (10.4/20.8/52.0); (iii) tongue body dryness and wetness: 88.8 (13.6/34.4/40.8); (iv) tooth marks on the edge of the tongue: 88.8 (6.4/35.2/47.2); (v) cracks on the surface of the tongue: 96.8 (24.0/35.2/37.6); (vi) thickness of tongue coating: 84.8 (7.2/21.6/56.0); (vii) color of tongue coating: 88.0 (15.2/37.6/35.2); and (viii) dryness and wetness of tongue coating: 74.4 (4.8/19.2/50.4). The test showed that the tongue diagnosis ability of MSs who attended a lecture on tongue diagnosis was almost the same as that of KMSs. We successfully constructed a tongue image database standardized for training specialists on tongue diagnosis and confirmed the educational usefulness of the e-learning system using a database. This database will contribute to the standardization and popularization of Kampo education.

Ethnobotanical and antibacterial study of Primula plants traditionally used in the indigenous communities of Western Himalaya, Pakistan

Background

The upper belt of Azad Kashmir is a hilly, mountainous, and remote area where the indigenous communities mainly believe in traditional medicines for the treatment of different ailments. This study aimed to conserve scientifically and culturally important medicinal knowledge of Primula species in Azad Kashmir, Western Himalaya, Pakistan. The additional objective was to evaluate the antibacterial activity of these plants against pathogenic bacteria.

Methods

The ethnomedicinal data of Primula species was explored by conducting structured interviews with 40 informants of the study area, especially asking about the medicinal uses of Primula species. The indigenously used Primula species were further analyzed for their antibacterial activity against both gram-positive and gram-negative bacteria by using disc diffusion assay supplemented with a more robust minimum inhibitory concentration assay.

Results

Ethnomedicinal data revealed that indigenous communities living in upper regions of Azad Kashmir use 5 Primula species for the treatment of various disorders. The highly cited disease category was ophthalmic disorders. P. denticulata and P. macrophylla were the most cited plant species with higher use reports such as 104 and 93, respectively. One or more extracts of different parts of Primula species showed a noteworthy antibacterial activity against one or more tested bacteria.

Conclusion

This study provides novel information regarding several categories of traditional uses and antibacterial activity of Primula species in Azad Kashmir, Western Himalaya. The need for novel and more effective drugs derived from natural products is more important than ever, making future studies on herbal remedies both justified and urgently required.

Integrated strategies for enzyme assisted extraction of bioactive molecules: A review

Conventional methods of extracting bioactive molecules are gradually losing pace due to their numerous disadvantages, such as product degradation, lower efficiency, and toxicity. Thus, in light of the rising demand for these bioactive, enzymes have garnered much attention for their efficiency in extraction. However, enzyme-assisted extraction is also plagued with a high capital cost that cannot justify the extraction yields obtained. In order to mitigate these problems, enzyme-assisted extraction can be consorted with non-conventional methods. This review includes current progress concerning the combined approaches while converging the recent advancements in the field that outperformed conventional extraction processes. It also highlights the design of biocatalyst and key parameters involved in the effective extraction of bioactive molecules. An integrated approach for efficiently extracting polyphenols, essential oils, pigments, and vitamins has been comprehensively reviewed. Furthermore, the different immobilization strategies have been discussed for large-scale implementation of enzymes for extraction. The integration of advanced non-conventional methods with enzyme-assisted extraction will open new avenues to enhance the overall extraction efficiency.

Modelling studies reveal the importance of the C-terminal inter motif loop of NSP1 as a promising target site for drug discovery and screening of potential phytochemicals to combat SARS-CoV-2

COVID-19 pandemic causative SARS-CoV-2 coronavirus is still rapid in progression and transmission even after a year. Understanding the viral transmission and impeding the replication process within human cells are considered as the vital point to control and overcome COVID-19 infection. Non-structural Protein 1, one among the proteins initially produced upon viral entry into human cells, instantly binds with the human ribosome and inhibit the host translation process by preventing the mRNA attachment. However, the formation of NSP1 bound Ribosome complex does not affect the viral replication process. NSP1 plays an indispensable role in modulating the host gene expression and completely steals the host cellular machinery. The full-length structure of NSP1 is essential for the activity in the host cell and importantly the loop connecting N and C-terminal domains are reported to play a role in ribosome binding. Due to the unavailability of the experimentally determined full-length structure of NSP1, we have modelled the complete structure using comparative modelling and the stability and conformational behaviour of the modelled structure was evaluated through molecular dynamics simulation. Interestingly, the present study reveals the significance of the inter motif loop to serves as a potential binding site for drug discovery experiments. Further, we have screened the phytochemicals from medicinal plant sources since they were used for several hundred years that minimizes the traditional drug development time. Among the 5638 phytochemicals screened against the functionally associated binding site of NSP1, the best five phytochemicals shown high docking score of −9.63 to −8.75 kcal/mol were further evaluated through molecular dynamics simulations to understand the binding affinity and stability of the complex. Prime MM-GBSA analysis gave the relative binding free energies for the top five compounds (dihydromyricetin, 10-demethylcephaeline, dihydroquercetin, pseudolycorine and tricetin) in the range of −45.17 kcal/mol to −37.23 kcal/mol, indicating its binding efficacy in the predicted binding site of NSP1. The density functional theory calculations were performed for the selected five phytochemicals to determine the complex stability and chemical reactivity. Thus, the identified phytochemicals could further be used as effective anti-viral agents to overcome COVID-19 and as well as several other viral infections.

Ayurgenomics and Modern Medicine

Within the disciplines of modern medicine, P4 medicine is emerging as a new field which focuses on the whole patient. The development of Ayurgenomics could greatly enrich P4 medicine by providing a clear theoretical understanding of the whole patient and a practical application of ancient and modern preventative and therapeutic practices to improve mental and physical health. One of the most difficult challenges today is understanding the ancient concepts of Ayurveda in terms of modern science. To date, a number of researchers have attempted this task, of which one of the most successful outcomes is the creation of the new field of Ayurgenomics. Ayurgenomics integrates concepts in Ayurveda, such as Prakriti, with modern genetics research. It correlates the combination of three doshas, Vata, Pitta and Kapha, with the expression of specific genes and physiological characteristics. It also helps to interpret Ayurveda as an ancient science of epigenetics which assesses the current state of the doshas, and uses specific personalized diet and lifestyle recommendations to improve a patient’s health. This review provides a current update of this emerging field.

A Pentacyclic Triterpene from Ligustrum lucidum Targets γ-Secretase

Amyloid-beta peptides generated by β-secretase- and γ-secretase-mediated successive cleavage of amyloid precursor protein are believed to play a causative role in Alzheimer's disease. Thus, reducing amyloid-beta generation by modulating γ-secretase remains a promising approach for Alzheimer's disease therapeutic development. Here, we screened fruit extracts of Ligustrum lucidum Ait. (Oleaceae) and identified active fractions that increase the C-terminal fragment of amyloid precursor protein and reduce amyloid-beta production in a neuronal cell line. These fractions contain a mixture of two isomeric pentacyclic triterpene natural products, 3-O-cis- or 3-O-trans-p-coumaroyl maslinic acid (OCMA), in different ratios. We further demonstrated that trans-OCMA specifically inhibits γ-secretase and decreases amyloid-beta levels without influencing cleavage of Notch. By using photoactivatable probes targeting the subsites residing in the γ-secretase active site, we demonstrated that trans-OCMA selectively affects the S1 subsite of the active site in this protease. Treatment of Alzheimer's disease transgenic model mice with trans-OCMA or an analogous carbamate derivative of a related pentacyclic triterpene natural product, oleanolic acid, rescued the impairment of synaptic plasticity. This work indicates that the naturally occurring compound trans-OCMA and its analogues could become a promising class of small molecules for Alzheimer's disease treatment.

Uncharted Source of Medicinal Products: The Case of the Hedychium Genus

A current research topic of great interest is the study of the therapeutic properties of plants and of their bioactive secondary metabolites. Plants have been used to treat all types of health problems from allergies to cancer, in addition to their use in the perfumery industry and as food. Hedychium species are among those plants used in folk medicine in several countries and several works have been reported to verify if and how effectively these plants exert the effects reported in folk medicine, studying their essential oils, extracts and pure secondary metabolites. Hedychium coronarium and Hedychium spicatum are the most studied species. Interesting compounds have been identified like coronarin D, which possesses antibacterial, antifungal and antitumor activities, as well as isocoronarin D, linalool and villosin that exhibit better cytotoxicity towards tumor cell lines than the reference compounds used, with villosin not affecting the non-tumor cell line. Linalool and α-pinene are the most active compounds found in Hedychium essential oils, while β-pinene is identified as the most widespread compound, being reported in 12 different Hedychium species. Since only some Hedychium species have been investigated, this review hopes to shed some light on the uncharted territory that is the Hedychium genus.