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Chan KW, Kwong ASK, Tsui PN, Chan GCW, Choi WF, Yiu WH, Cheung SCY, Wong MMY, Zhang ZJ, Tan KCB, Lao L, Lai KN, Tang SCW. Add-on astragalus in type 2 diabetes and chronic kidney disease: A multi-center, assessor-blind, randomized controlled trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 130:155457. [PMID: 38810556 DOI: 10.1016/j.phymed.2024.155457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/03/2024] [Accepted: 02/14/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Diabetes leads to chronic kidney disease (CKD) and kidney failure, requiring dialysis or transplantation. Astragalus, a common herbal medicine and US pharmacopeia-registered food ingredient, is shown kidney protective by retrospective and preclinical data but with limited long-term prospective clinical evidence. This trial aimed to assess the effectiveness of astragalus on kidney function decline in macroalbuminuric diabetic CKD patients. METHODS This randomized, assessor-blind, standard care-controlled, multi-center clinical trial randomly assigned 118 patients with estimated glomerular filtration rate (eGFR) of 30-90 ml/min/1.73m2 and urinary albumin-to-creatinine ratio (UACR) of 300-5000 mg/g from 7 public outpatient clinics and the community in Hong Kong between July 2018 and April 2022 to add-on oral astragalus granules (15 gs of raw herbs daily equivalent) or to continue standard care alone as control for 48 weeks. Primary outcomes were the slope of change of eGFR (used for sample size calculation) and UACR of the intention-to-treat population. Secondary outcomes included endpoint blood pressures, biochemistry, biomarkers, concomitant drug change and adverse events. (ClinicalTrials.gov: NCT03535935) RESULTS: During the 48-week period, the estimated difference in the slope of eGFR decline was 4.6 ml/min/1.73m2 per year (95 %CI: 1.5 to 7.6, p = 0.003) slower with astragalus. For UACR, the estimated inter-group proportional difference in the slope of change was insignificant (1.14, 95 %CI: 0.85 to 1.52, p = 0.392). 117 adverse events from 31 astragalus-treated patients and 41 standard care-controlled patients were documented. The 48-week endpoint systolic blood pressure was 7.9 mmHg lower (95 %CI: -12.9 to -2.8, p = 0.003) in the astragalus-treated patients. 113 (96 %) and 107 (91 %) patients had post-randomization and endpoint primary outcome measures, respectively. CONCLUSION In patients with type 2 diabetes, stage 2 to 3 CKD and macroalbuminuria, add-on astragalus for 48 weeks further stabilized kidney function on top of standard care.
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Affiliation(s)
- Kam Wa Chan
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Alfred Siu Kei Kwong
- Department of Family Medicine and Primary Healthcare, Hospital Authority Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Pun Nang Tsui
- Department of Family Medicine and Primary Healthcare, Hospital Authority Hong Kong East Cluster, Hong Kong Special Administrative Region, China
| | - Gary Chi Wang Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Wing Fai Choi
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wai Han Yiu
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Chi Yuen Cheung
- Division of Nephrology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
| | - Michelle Man Ying Wong
- Department of Family Medicine and Primary Healthcare, Hospital Authority Hong Kong East Cluster, Hong Kong Special Administrative Region, China
| | - Zhang-Jin Zhang
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kathryn Choon Beng Tan
- Division of Endocrinology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Virginia University of Integrative Medicine, VA, USA
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sydney Chi Wai Tang
- Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Su M, Tang T, Tang W, Long Y, Wang L, Liu M. Astragalus improves intestinal barrier function and immunity by acting on intestinal microbiota to treat T2DM: a research review. Front Immunol 2023; 14:1243834. [PMID: 37638043 PMCID: PMC10450032 DOI: 10.3389/fimmu.2023.1243834] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Diabetes is a significant chronic endocrine/metabolism disorder that can result in a number of life-threatening consequences. According to research, the gut microbiota is strongly linked to the development of diabetes, making it a viable target for diabetes treatment. The intestinal microbiota affects intestinal barrier function, organism immunity, and thus glucose metabolism and lipid metabolism. According to research, a disruption in the intestinal microbiota causes a decrease in short-chain fatty acids (SCFAs), alters the metabolism of bile acids (BAs), branched-chain amino acids (BCAAs), lipopolysaccharide (LPS), and endotoxin secretion, resulting in insulin resistance, chronic inflammation, and the progression to type 2 diabetes mellitus (T2DM). Astragali Radix is a medicinal herb of the same genus as food that has been extensively researched for treating diabetes mellitus with promising results in recent years. Polysaccharides, saponins, flavonoids, and other components are important. Among them, Astragaloside has a role in protecting the cellular integrity of the pancreas and liver, can leading to alleviation of insulin resistance and reducing blood glucose and triglyceride (TC) levels; The primary impact of Astragalus polysaccharides (APS) on diabetes is a decrease in insulin resistance, encouragement of islet cell proliferation, and suppression of islet β cell death; Astragali Radix flavonoids are known to enhance immunity, anti-inflammatory, regulate glucose metabolism and control the progression of diabetes. This study summarizes recent studies on Astragali Radix and its group formulations in the treatment of type 2 diabetes mellitus by modulating the intestinal microbiota.
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Affiliation(s)
- Min Su
- Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparation, Changsha Medical University, Changsha, China
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Changsha Medical University, Changsha, China
| | - Ting Tang
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Changsha Medical University, Changsha, China
| | - Weiwei Tang
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Changsha Medical University, Changsha, China
| | - Yu Long
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Changsha Medical University, Changsha, China
| | - Lin Wang
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Changsha Medical University, Changsha, China
| | - Meiling Liu
- Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparation, Changsha Medical University, Changsha, China
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Changsha Medical University, Changsha, China
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Cui Y, Zhang L, Lu C, Dou M, Jiao Y, Bao Y, Shi W. Effects of compound small peptides of Chinese medicine on intestinal immunity and cecal intestinal flora in CTX immunosuppressed mice. Front Microbiol 2022; 13:959726. [PMID: 35958151 PMCID: PMC9358959 DOI: 10.3389/fmicb.2022.959726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/28/2022] [Indexed: 12/13/2022] Open
Abstract
The study was designed to explore the improvement effect of CSPCM (compound small peptide of Chinese medicine) on intestinal immunity and microflora through the treatment of different doses of CSPCM. A total of 100 male Kunming mice were weighed and divided into five groups, namely, group A (control group), group B (model group), group C (0.1 g/kg·bw CSPCM), group D (0.2 g/kg·bw CSPCM), and group E (0.4 g/kg·bw CSPCM). The use of CTX (cyclophosphamide) caused a series of negative effects: the secretion of IL-2, IL-22, TNF-α, sIgA, length of the villi, and the area of Pey's node were significantly reduced (P < 0.05); the depth of crypt and the percent of CD3+ and CD4+ cells were significantly increased (P < 0.05); the cecal flora taxa decreased; the abundance of Firmicutes and Lactobacillus increased; and the abundance of Bacteroidetes, Deferribacteres, Proteobacteria, Mucispirillum, Bacteroides, and Flexisprra decreased. The addition of CSPCM improved the secretion of cytokines and the development of intestinal villi, crypts, and Pey's node. The number of CD3+ and CD4+ cells in groups C, D, and E was significantly higher than that in group B (P < 0.05). Compared with group B, the abundance of Firmicutes in groups C, D, and E was decreased, and the Bacteroidetes, Deferribacteres, and Proteobacteria increased. The abundance of Lactobacillus decreased, while that of Mucispirillum, Bacteroides, and Flexisprra increased. It is concluded that cyclophosphamide is extremely destructive to the intestinal area and has a great negative impact on the development of the small intestine, the intestinal immune system, and the intestinal flora. The CSPCM can improve the negative effects of CTX.
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Affiliation(s)
- Yuqing Cui
- College of Veterinary Medicine, Institute of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, China
| | - Lu Zhang
- College of Veterinary Medicine, Institute of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, China
| | - Chunyu Lu
- College of Veterinary Medicine, Institute of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, China
| | - Mengmeng Dou
- College of Veterinary Medicine, Institute of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, China
| | - Yulan Jiao
- College of Veterinary Medicine, Institute of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, China
- Research and Development Department, Ringpu (Baoding) Biological Pharmaceutical Co., Ltd, Baoding, China
- Hebei Veterinary Biotechnology Innovation Center, Hebei Agricultural University, Baoding, China
| | - Yongzhan Bao
- College of Veterinary Medicine, Institute of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, China
- Pharmacoefficacy Laboratory, Hebei Provincial Engineering Center for Chinese Veterinary Herbal Medicine, Baoding, China
| | - Wanyu Shi
- College of Veterinary Medicine, Institute of Traditional Chinese Veterinary Medicine, Hebei Agricultural University, Baoding, China
- Pharmacoefficacy Laboratory, Hebei Provincial Engineering Center for Chinese Veterinary Herbal Medicine, Baoding, China
- *Correspondence: Wanyu Shi
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Medicinal Plants and Their Impact on the Gut Microbiome in Mental Health: A Systematic Review. Nutrients 2022; 14:nu14102111. [PMID: 35631252 PMCID: PMC9144835 DOI: 10.3390/nu14102111] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Various neurocognitive and mental health-related conditions have been associated with the gut microbiome, implicating a microbiome–gut–brain axis (MGBA). The aim of this systematic review was to identify, categorize, and review clinical evidence supporting medicinal plants for the treatment of mental disorders and studies on their interactions with the gut microbiota. Methods: This review included medicinal plants for which clinical studies on depression, sleeping disorders, anxiety, or cognitive dysfunction as well as scientific evidence of interaction with the gut microbiome were available. The studies were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Eighty-five studies met the inclusion criteria and covered thirty mental health-related medicinal plants with data on interaction with the gut microbiome. Conclusion: Only a few studies have been specifically designed to assess how herbal preparations affect MGBA-related targets or pathways. However, many studies provide hints of a possible interaction with the MGBA, such as an increased abundance of health-beneficial microorganisms, anti-inflammatory effects, or MGBA-related pathway effects by gut microbial metabolites. Data for Panax ginseng, Schisandra chinensis, and Salvia rosmarinus indicate that the interaction of their constituents with the gut microbiota could mediate mental health benefits. Studies specifically assessing the effects on MGBA-related pathways are still required for most medicinal plants.
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Baughman J, Ambrogio J, Motevalli M. Irritable Bowel Syndrome and Depression: A Case Report. Integr Med (Encinitas) 2021; 20:38-43. [PMID: 34803539 PMCID: PMC8594971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 26-year-old Caucasian woman presented with a two-year history of depression concomitant with irritable bowel syndrome (IBS-C; constipation subtype, gas/bloating). Past evaluation resulted in a clinical diagnosis of IBS-C in August of 2015. Between August and November of 2015, the patient developed worsening bowel irregularities and persistent depression. The patient opted out of conventional treatment and was referred for nutritional care in November of 2017. Throughout one year of treatment with dietary interventions, Chinese herbal medicine, and targeted nutritional supplementation, the patient gradually reached full remission of all complaints.
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Affiliation(s)
- Joshuan Baughman
- Corresponding author: Joshuan Baughman, MS, RH (AHG) (C), CN E-mail address:
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Ding J, Wei D, An Z, Zhang C, Jin L, Wang L, Li Y, Li Q. Succession of the bacterial community structure and functional prediction in two composting systems viewed through metatranscriptomics. BIORESOURCE TECHNOLOGY 2020; 313:123688. [PMID: 32590304 DOI: 10.1016/j.biortech.2020.123688] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/13/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
In this work, Illumina MiSeq sequencing of cDNA from metatranscriptomics RNA reverse transcription were employed in combination with phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) to estimate the dynamic variations of bacterial community structures and metabolic functions in a bioreactor and traditional composting process. Results showed that the change of bacterial α-diversity in the first three stages exhibit opposite trends in the two composting systems. The four most abundant phyla were the same in both systems (Firmicutes, Proteobacteria, Bacteroidetes and Actinobacteria), but the most abundant genera were different. The five most abundant genus-level groups in the bioreactor were Psychrobacter, Galbibacter, Pseudomonas, Staphylococcus and Flavobacterium. Within the same phase, the functional bacteria were dramatically different in the two composting processes. In the bioreactor system both bacterial community structure and metabolism function were greatly affected by available phosphorus.
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Affiliation(s)
- Jianli Ding
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Dan Wei
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China.
| | - Zhizhuang An
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Chengjun Zhang
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Liang Jin
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Lei Wang
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Yan Li
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
| | - Qiao Li
- Institute of Plant Nutrition and Resources, Beijing Academy of Agriculture and Forestry Sciences, Beijing 100097, China
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Kang X, Zhan L, Lu X, Song J, Zhong Y, Wang Y, Yang Y, Fan Z, Jiang X, Sun R. Characteristics of Gastric Microbiota in GK Rats with Spontaneous Diabetes: A Comparative Study. Diabetes Metab Syndr Obes 2020; 13:1435-1447. [PMID: 32431527 PMCID: PMC7201022 DOI: 10.2147/dmso.s242698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Goto-Kakizaki (GK) rat, developed from repeated inbreeding of glucose-intolerant Wistar rats, has been widely used to explore the development of spontaneous type-2 diabetes mellitus (T2DM). However, the gastric microbiota of GK and Wistar rats are still unclear. This study aimed to understand the gastric microbiota characteristics of GK rats by comparing it with non-diabetic Wistar rats. MATERIALS AND METHODS Male Wistar rats and GK rats were housed in specific pathogen-free (SPF) environment for 12 weeks with free access to sterilized food and water. Body weight and random blood glucose (BG) levels were determined. At the end of the experiment, the gastric contents of the rats were collected for the identification of gastric microbiota using 16S rRNA gene sequencing. RESULTS The richness of gastric microbiota in GK rats was similar to that of Wistar rats (P > 0.05). The results of Shannon, Simpson, beta diversity indices, and ANOSIM analysis showed that alpha and beta diversity of gastric microbiota in GK rats were significantly lower than that of Wistar rats (P < 0.01). Firmicutes (96.0%), Proteobacteria (1.9%) and Cyanobacteria (0.8%) were the dominant gastric microbiota in GK rats accounting for 72.9%, 14.7% and 10.9%, respectively. Linear discriminant analysis effect size (LEfSe) revealed that phylum Firmicutes and four genera (Anaerovibrio, Collinsella, Prevotellaceae_UCG_001, and Lactobacillus) were significantly abundant in the stomachs of GK rats. In contrast, seven genera (unidentified_Chloroplast, Porphyromonas, Neisseria, Rubrobacter, Veillonella, Lachnospiraceae_UCG_005, and unidentified_Erysipelotrichaceae) were significantly abundant in the stomachs of Wistar rats. Blood glucose was positively correlated with Anaerobibrio and Lactobacillus, and negatively correlated with four genera (Porphyromonas, Rubrobacter, Lachnospiraceae_UCG_005, and unidentified_Erysipelotrichaceae). In addition, chemoheterotrophy and fermentation were the most important functions of gastric microbiota. CONCLUSION The gastric microbiota of GK rats with spontaneous T2DM showed the typical characteristics of low diversity and significant enrichment of Firmicutes phylum and four genera (Anaerovibrio, Collinsella, Prevotellaceae_UCG_001, and Lactobacillus) compared with gastric microbiota of Wistar rats.
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Affiliation(s)
- Xin Kang
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
- Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China
| | - Libin Zhan
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
- Basic Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of China
- Correspondence: Libin Zhan Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, People’s Republic of China, Basic Medical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, People’s Republic of ChinaTel +86 25-85811569 Email
| | - Xiaoguang Lu
- Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China
- Xiaoguang Lu Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China Email
| | - Jianbo Song
- Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China
| | - Yilong Zhong
- Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China
| | - Yi Wang
- Institute of Integrative Medicine, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Yilun Yang
- Graduate School, Zunyi Medical University, Zunyi, Guizhou, Republic of China
| | - Zhiwei Fan
- Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China
| | - Xiaozheng Jiang
- Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China
| | - Ruru Sun
- Department of Emergency Medicine, Affiliated Zhongshan Hospital, Dalian University, Dalian, Liaoning, People’s Republic of China
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