Repurposing of Bryophyllum pinnatum for dysmenorrhea treatment: a systematic scoping review and case series

Dysmenorrhea affects women throughout their reproductive years but there has been a lack of effective and well-tolerated treatment options. Pain symptoms mainly result from inflammatory processes and increased contractile activity in the myometrium. The reported use of Bryophyllum pinnatum preparations against inflammation and pain in ethnomedicine as well as current pharmacological data on their inhibition of myometrial contractility led us to hypothesize that this medicinal plant might be a new treatment option for dysmenorrhea. In the first part of the present work, clinical, in vivo, and in vitro studies on the anti-nociceptive and anti-inflammatory, as well as on myometrium relaxing properties of B. pinnatum are reviewed. In the second part, cases of five women with dysmenorrhea who were tentatively treated with a B. pinnatum product are described. The review revealed thirty-three experimental in vivo and in vitro studies, but no clinical study, reporting anti-nociceptive and anti-inflammatory effects of B. pinnatum extracts and compounds in a wide range of conditions. Moreover, sixteen publications on smooth muscle contractility revealed relaxing effects. The latter consisted of clinical evidence, as well as of in vivo and in vitro data. The evidence reviewed therefore provided a rational basis for the use of B. pinnatum in the treatment of dysmenorrhea. We subsequently set out to tentatively treat patients with a well-tolerated B. pinnatum product that is registered (without indication) and commonly used in obstetrics and gynecology in Switzerland. All five treated patients reported a reduction in pain symptoms and 4 out of 5 indicated a reduced intake of painkillers during menstruation. Taken together, the reviewed information on the pharmacological properties and clinical evidence of B. pinnatum extracts and compounds as well as the outcomes of all five patients in the case series support our hypothesis in favor of B. pinnatum as a new, well-tolerated therapeutic approach for dysmenorrhea. Prospective clinical studies are urgently needed.

The Effect of Standardised Leaf Extracts of Gaultheria procumbens on Multiple Oxidants, Inflammation-Related Enzymes, and Pro-Oxidant and Pro-Inflammatory Functions of Human Neutrophils

The leaves of Gaultheria procumbens are polyphenol-rich traditional medicines used to treat inflammation-related diseases. The present study aimed to optimise the solvent for the effective recovery of active leaf components through simple direct extraction and verify the biological effects of the selected extract in a model of human neutrophils ex vivo. The extracts were comprehensively standardised, and forty-one individual polyphenols, representing salicylates, catechins, procyanidins, phenolic acids, and flavonoids, were identified by UHPLC–PDA–ESI–MS³. The chosen methanol–water (75:25, v/v) extract (ME) was obtained with the highest extraction yield and total phenolic levels (397.9 mg/g extract’s dw), including 98.9 mg/g salicylates and 299.0 mg/g non-salicylate polyphenols. In biological tests, ME revealed a significant and dose-dependent ability to modulate pro-oxidant and pro-inflammatory functions of human neutrophils: it strongly reduced the ROS level and downregulated the release of pro-inflammatory cytokines and tissue remodelling enzymes, especially IL-1β and elastase 2, in cells stimulated by fMLP, LPS, or fMLP + cytochalasin B. The extracts were also potent direct scavengers of in vivo relevant oxidants (O₂^•−, ^•OH, and H₂O₂) and inhibitors of pro-inflammatory enzymes (cyclooxygenase-2, hyaluronidase, and lipoxygenase). The statistically significant correlations between the tested variables revealed the synergic contribution of individual polyphenols to the observed effects and indicated them as useful active markers for the standardisation of the extract/plant material. Moreover, the safety of ME was confirmed in cytotoxicity tests. The obtained results might partially explain the ethnomedicinal application of G. procumbens leaves and support the usage of the standardised leaf extract in the adjuvant treatment of oxidative stress and inflammation-related chronic diseases.

Chemical Composition and Cytotoxicity of Kalanchoe pinnata Leaves Extracts prepared using Accelerated System Extraction (ASE)

Kalanchoe pinnata (Crassulaceae) is a medicinal plant distributed in several areas of the World. Their leaves have been used, in folk medicine, for anxiety and sleep disorders among other proposes. Chemically, this plant is composed by organic acids, flavonoids, bufadienolides, triterpenoids and some ubiquitous compounds. In this study, the fresh leaves of K. pinnata were extracted in an accelerated solvent extraction (ASE) system using H2O (cold and hot) as well as with EtOH:H2O 1:1. The obtained crude extracts were analyzed by HPLC-UV-MS. As a result, were identified organic acids and flavonoids, these being quercetin-3- O-α-L-arabinopyranosyl-(1→2)-α-L-rhamnopyranoside, kaempferol-3- O-α-L-arabinopiranosyl-(1→2)-α-L-rhamnopyranoside, quercitrin, and trans- p-coumaryl glutaric acid the main compounds in the studied extracts. Obtained results revealed the predominance of flavonoids in extracts prepared using hot H2O (70 26 α 2.19%) or EtOH:H2O 1:1 (74.65 α 5.39%) while a reduction in the amount of these compounds was observed in the extracts prepared using cold H2O (54.41 α 2.93%). Additionally, crude extracts from leaves of K. pinnata extracted with hot H2O and EtOH:H2O 1:1 showed in vitro cytotoxicity on five tested cancer cell lines: murine melanoma (B16F10), human melanoma (A2058), human cervical carcinoma (HeLa), human leukemia (HL-60), and human glioblastoma (U87-MG), with IC50 values in the range of 10.6 α 2.5-91.3 α 7.2 μg/mL. On the other hand, the extract prepared using cold H2O displayed reduced potential. These crude extracts were also tested against human foreskin fibroblasts (non-tumorigenic cells) showing IC50 values ranging from 79.5 to 90.2 μg/mL. In conclusion, our results showed the impact that different extraction methods have on the chemical composition and pharmacological activity, which are notable for the anticancer activity associated to flavonoids.

Bryophyllum pinnatum – Reverse Engineering of an Anthroposophic Herbal Medicine

Bryophyllum pinnatum (syn. Kalanchoe pinnata), a plant native to Madagascar, was introduced into anthroposophic medicine in the early 20th century. In recent years, a number of investigations were conducted on the chemical composition, pharmacological properties, and clinical efficacy of Bryophyllum. Here the phytochemistry, and pharmacological and clinical data are reviewed. With respect to pharmacology, a special focus was put on properties related to the use in anthroposophic medicine as a treatment for “hyperactivity diseases”, including preterm labor, restlessness, and sleep disorders. Recent studies suggest that B. pinnatum has also potential as a treatment option in patients suffering from overactive bladder syndrome. Tolerability of Bryophyllum is addressed, and existing toxicological data are discussed in relation to bufadienolides contained in Bryophyllum. Open questions regarding the use of Bryophyllum are also discussed.

A New Triglycosyl Flavonoid Isolated from Leaf Juice of Kalanchoe gastonis-bonnieri (Crassulaceae)

Kalanchoe gastonis-bonnieri R. Hamet & H. Perrier (Crassulaceae) is a succulent species empirically used as a vaginal contraceptive as well as to heal genitourinary infections. A phytochemical study of leaf juice prepared from specimens collected in the flowering season resulted in the isolation of the new flavonoid quercetin 3- O-α-rhamnopyranoside-7- O-β-D-glucopyranosyl-(1→3)-α-L-rhamnopyranoside, as well as the already known 6- C-β-D-glucopyranosyl-8- C-β-D-glucopyranosylapigenin (vicenin-2). The NMR spectra of this flavonoid at room temperature exhibited broad and duplicated signals, suggesting the existence of rotameric conformers, which was confirmed by coalescence of the signals at 40°C. The structural elucidation was based on 1H and 13C NMR (HMQC and HMBC) analyses and MS data. This is the first report of a C-glycosyl flavonoid (vicenin-2) in the Crassulaceae family. Additionally, this is the first study in which atropoisomerism has been shown for vicenin-2.