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Fang M, Kong LY, Ji GH, Pu FL, Su YZ, Li YF, Moore M, Willcox M, Trill J, Hu XY, Liu JP. Chinese medicine Phragmites communis (Lu Gen) for acute respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol 2024; 15:1242525. [PMID: 38510651 PMCID: PMC10953292 DOI: 10.3389/fphar.2024.1242525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Acute respiratory tract infections (ARTIs) are the most common cause of morbidity and mortality worldwide, with most people experiencing at least one episode per year. Current treatment options are mainly symptomatic therapy. Antivirals, antibiotics, and glucocorticoids are of limited benefit for most infections. Traditional Chinese medicine has shown potential benefits in the treatment of ARTIs. Objective: The objective of this study was to determine the efficacy, effectiveness, and safety of Phragmites communis Trin. (P. communis, a synonym of Phragmites australis (Cav.) Trin. ex Steud) as monotherapy or as part of an herb mixture for ARTIs. Method: Eight databases and two clinical trial registries were searched from inception to 8 February 2023 for randomized controlled trials (RCTs) evaluating any preparation involving P. communis without language restrictions. The Risk of Bias Tool 2.0 was used to assess the risk of bias of the included trials. RevMan 5.3 software was used for data analyses with effects estimated as risk ratios (RRs), mean differences (MDs), or standardized mean differences (SMDs) with 95% confidence intervals (CIs). The online GRADEpro tool was used to assess the certainty of the evidence, if available. Results: Forty-two RCTs involving 6,879 patients with ARTIs were included, with all trials investigating P. communis as part of an herbal mixture. Of the included trials, the majority (38/42) were considered high risk. Compared to the placebo, P. communis preparations improved the cure rate [RR = 1.60, 95% CI (1.13, 2.26)] and fever clearance time [MD = -2.73 h, 95% CI (-4.85, -0.61)]. Compared to usual care alone, P. communis preparations also significantly improved the cure rate [RR = 1.57, 95% CI (1.36, 1.81)] and fever clearance time [SMD = -1.24, 95% CI (-2.37, -0.11)]. P. communis preparations plus usual care compared to usual care alone increased the cure rate [RR = 1.55, 95% CI (1.35, 1.78)], shortened the fever clearance time [MD = -19.31 h, 95% CI (-33.35, -5.27)], and improved FEV1 [ MD = 0.19 L, 95% CI (0.13, 0.26)] and FVC [ MD = 0.16 L, 95% CI (0.03, 0.28)]. Conclusion: Low- or very low-certainty evidence suggests that P. communis preparations may improve the cure rate of ARTIs, shorten the fever clearance time in febrile patients, and improve the pulmonary function of patients with acute exacerbation of chronic obstructive pulmonary disease or chronic bronchitis. However, these findings are inconclusive and need to be confirmed in rigorously designed trials. Systematic review registration: PROSPERO, identifier CRD42021239936.
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Affiliation(s)
- Min Fang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ling-Yao Kong
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Guang-He Ji
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Feng-Lan Pu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - You-Zhu Su
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Fei Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Michael Moore
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Merlin Willcox
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jeanne Trill
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Xiao-Yang Hu
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Research Design Service South Central, National Institute of Health Research, Southampton, United Kingdom
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Willcox ML, Hu XY, Oliver T, Thorne K, Boxall C, He G, Simpson C, Brotherwood B, O’Neil A, Waugh R, Tilt E, Trill J, Goward N, Francis N, Thomas M, Little P, Wilkinson T, Liu JP, Griffiths G, Moore M. Treating acute exacerbations of COPD with Chinese herbal medicine to aid antibiotic use reduction (Excalibur): a randomised double-blind, placebo-controlled feasibility trial. Front Pharmacol 2023; 14:1221905. [PMID: 37818189 PMCID: PMC10561384 DOI: 10.3389/fphar.2023.1221905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Background: Although many acute exacerbations of COPD (AECOPD) are triggered by non-bacterial causes, they are often treated with antibiotics. Preliminary research suggests that the Chinese herbal medicine "Shufeng Jiedu" (SFJD), may improve recovery and therefore reduce antibiotic use in patients with AECOPD. Aims: To assess the feasibility of conducting a randomised placebo-controlled clinical trial of SFJD for AECOPD in UK primary care. Methods: GPs opportunistically recruited patients experiencing an AECOPD. Participants were randomised 1:1 to usual care plus SFJD or placebo for 14 days. Participants, GPs and research nurses were blinded to treatment allocation. GPs could prescribe immediate, delayed or no antibiotics, with delayed prescribing encouraged where appropriate. Participants were asked to complete a participant diary, including EXACT-PRO and CAT™ questionnaires for up to 4 weeks. Outcomes included recruitment rate and other measures of study feasibility described using only descriptive statistics and with no formal comparisons between groups. We also conducted qualitative interviews with recruited and non-recruited COPD patients and clinicians, analysed using framework analysis. Results: Over 6 months, 19 participants (6 SFJD, 13 placebo) were recruited. Sixteen (84%) participants returned diaries or provided a diary by recall. Overall, 1.3 participants were recruited per 1,000 patients on the COPD register per month open. Median duration of treatment was 9.8 days in the intervention group vs 13.3 days in the placebo group. The main reason for discontinuation in both groups was perceived side-effects. in both groups. Point estimates for both the EXACT-PRO and CAT™ outcomes suggested possible small benefits of SFJD. Most patients and clinicians were happy to try SFJD as an alternative to antibiotics for AECOPD. Recruitment was lower than expected because of the short recruitment period, the lower incidence of AECOPD during the COVID-19 pandemic, patients starting antibiotics from "rescue packs" before seeing their GP, and workforce challenges in primary care. Conclusion: Recruitment was impaired by the COVID-19 pandemic. Nevertheless, we were able to demonstrate the feasibility of recruiting and randomising participants and identified approaches to address recruitment challenges such as including the trial medication in COPD patients' "rescue packs" and delegating recruitment to a central trials team. Clinical Trial Registration: Identifier, ISRCTN26614726.
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Affiliation(s)
- Merlin L. Willcox
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Xiao-Yang Hu
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Tom Oliver
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Kerensa Thorne
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Cherish Boxall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - George He
- Phoenix Medical Ltd, Chelmsford, United Kingdom
| | - Catherine Simpson
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Becci Brotherwood
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Alice O’Neil
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Robert Waugh
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Emma Tilt
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Jeanne Trill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Neville Goward
- Patient and Public Representative, Southampton, United Kingdom
| | - Nick Francis
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Michael Thomas
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Tom Wilkinson
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jian-Ping Liu
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Michael Moore
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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Hu XY, Oliver T, Willcox M, Simpson C, Thorne K, Trill J, Francis N, Stuart B, Thomas M, Little P, Liu JP, Griffiths G, Moore M. Treating Acute EXacerbations of COPD with Chinese HerbAL MedIcine to aid AntiBiotic Use Reduction (EXCALIBUR): study protocol of a randomised double-blind, placebo-controlled feasibility trial. Pilot Feasibility Stud 2022; 8:262. [PMID: 36536462 PMCID: PMC9761047 DOI: 10.1186/s40814-022-01224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major reason for consultations in primary care, hospital admissions, deterioration in function, and mortality. Despite the majority of exacerbations not being caused by bacteria, as many as 70% of patients who present in UK primary care with AECOPD are prescribed antibiotics as part of standard care. However, finding effective non-antibiotic treatments for COPD exacerbations is a priority to reduce antibiotic use. The Chinese herbal medicine Shufeng Jiedu® (SFJD) has the potential to reduce treatment failure and duration of hospital stay. This study aims to determine the feasibility of conducting a fully powered randomised, double blind, placebo-controlled clinical trial on SFJD for AECOPD in UK primary care. METHODS This study is a phase III, two-arm individually double blind, randomised, placebo-controlled feasibility trial with nested qualitative study, coordinated by the Southampton Clinical Trial Unit (SCTU). Patients aged ≥ 40 years, with a current AECOPD, presenting with increased sputum purulence/volume, or breathlessness, and for whom the GP is considering use of antibiotics, will be eligible to participate. We aim to recruit seven eligible participants per month and randomise them to receive either the patent Chinese herbal medicine SFJD capsules or placebo for 14 consecutive days and to follow-up for 12 weeks. The primary outcomes include the feasibility of recruitment, study retention, and the percentage of diary completion. DISCUSSION If this trial demonstrates the feasibility of recruitment, delivery, and follow-up, we will seek funding for a fully powered placebo-controlled trial of SFJD for the treatment of AECOPD in primary care. TRIAL REGISTRATION This trial is registered via ISRCTN on 1 July 2021, identifier: ISRCTN26614726.
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Affiliation(s)
- Xiao-Yang Hu
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tom Oliver
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Merlin Willcox
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Catherine Simpson
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Kerensa Thorne
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Jeanne Trill
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nick Francis
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Beth Stuart
- grid.4868.20000 0001 2171 1133Pragmatic Trial Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael Thomas
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Gareth Griffiths
- grid.5491.90000 0004 1936 9297Southampton Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Michael Moore
- grid.5491.90000 0004 1936 9297Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Zhang XW, Xia RY, Gao JQ, Liu JJ, Xu DH, Li X, Hu XY, Willcox M, Moore M, Dai MY, Trill J, Fei YT, Liu JP. Chinese Patent Medicine Shufeng Jiedu Capsules as an Adjuvant Therapy for Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Pharmacol 2022; 13:923395. [PMID: 35860018 PMCID: PMC9289368 DOI: 10.3389/fphar.2022.923395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/27/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Shufeng Jiedu (SFJD) capsules can be used as adjunctive treatment for patients with community-acquired pneumonia, but the effectiveness and safety of SFJD are not clear. This review aims to evaluate the effectiveness and safety of SFJD based on randomized controlled trials (RCTs). Methods: A systematic review was conducted by searching PubMed, Embase, Scopus, Web of Science, CENTRAL, CNKI, VIP, CBM, Wanfang and trial registry platforms from their inception to March 2022. Two reviewers screened studies, extracted the data and assessed risk of bias independently. The data were pooled for meta-analysis or presented narratively. Results: Seventeen RCTs involving 1840 participants were included. All trials compared SFJD plus antibiotics to antibiotics, or combined with symptomatic treatment in both groups. The overall certainty of evidence was assessed as moderate to very low certainty. Compared with routine treatment (antibiotics alone or antibiotics plus symptomatic treatment), SFJD plus routine treatment showed beneficial effects in resolution of fever (MD -1.20 days, 95%CI -1.73 to -0.67; 10 RCTs; very low certainty), cough (MD -1.02 days, 95%CI -1.23 to -0.81; 9 RCTs; moderate certainty), phlegm (MD -1.46 days, 95%CI -2.84 to -0.08; 6 RCTs; very low certainty), pulmonary crepitations (MD -1.61 days, 95%CI -2.64 to -0.59; 8 RCTs; low certainty), shortness of breath (MD -2.80 days, 95%CI -2.88 to -2.72; 2 RCTs; low certainty) and chest pain (MD -2.85 days, 95%CI -3.01 to -2.69; 1 RCT; low certainty). There was no significant difference in pathogen clearance (1 RCT). No serious adverse events were reported, but 2.60% (5/192) patients reported nausea in the SFJD groups, 1.04% (2/192) participants in routine group, and no significant difference was identified. Conclusions: Current evidence suggests that adding SFJD may shorten the duration of symptom relief in community-acquired pneumonia for 1-2 days. The adverse events were minor and controllable, and no serious adverse events were reported. Well-reported trials and potential of reducing antibiotics were expected in the future studies.
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Affiliation(s)
- Xiao-Wen Zhang
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ru-Yu Xia
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jia-Qi Gao
- School of Qi-Huang Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jin-Jun Liu
- School of Qi-Huang Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - De-Hao Xu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xun Li
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Yang Hu
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, United Kingdom
| | - Merlin Willcox
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, United Kingdom
| | - Michael Moore
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, United Kingdom
| | - Meng-Yuan Dai
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jeanne Trill
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, United Kingdom
| | - Yu-Tong Fei
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jian-Ping Liu
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- The National Research Center in Complementary and Alternative Medicine (NAFKAM) Department of Community Medicine, Faculty of Health Science, UiT, the Arctic University of Norway, Tromsø, Norway
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Wang ZJ, Trill J, Tan LL, Chang WJ, Zhang Y, Willcox M, Xia RY, Jiang Y, Moore M, Liu JP, Hu XY. Reynoutria japonica Houtt for Acute Respiratory Tract Infections in Adults and Children: A Systematic Review. Front Pharmacol 2022; 13:787032. [PMID: 35281919 PMCID: PMC8911541 DOI: 10.3389/fphar.2022.787032] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction: Respiratory tract infections (RTIs) are a major cause of morbidity and mortality in some high-risk groups including children and older adults. There is evidence that Chinese herbal medicine has an effect on RTIs. Reynoutria japonica Houtt (better known under its synonym Fallopia japonica (Houtt.) Ronse Decr.) (F. japonica), a commonly used Chinese herbal medicine, has a high content of resveratrol and glycosides. In traditional Chinese medicine theory, F. japonica has the effect of clearing heat in the body, improving blood and qi circulation, eliminating phlegm, and relieving cough, so it may have an effect on RTIs. Methods: This systematic review was registered under PROSPERO CRD42020188604. Databases were searched for randomized controlled trials of F. japonica as a single herb, or as a component of a complex herbal formula for RTIs. Quality of methodology was assessed by two reviewers independently using the Cochrane Risk of Bias Tool. The primary outcome was symptom improvement rate. The secondary outcome measures were fever clearance time, Murray lung injury score and incidence of adverse effects. The extracted data were pooled and meta-analysed by RevMan 5.3 software. Results: Eight RCTs with 1,123 participants with acute RTIs were included in this systematic review, and all the RCTs used F. japonica as part of a herbal mixture. Only one included trial used F. japonica in a herbal mixture without antibiotics in the treatment group. The findings showed that herbal remedies that included F. japonica could increase the symptom improvement rate (risk ratio 1.14, 95% confidence intervals [1.09, 1.20], I2 = 0%, p < 0.00001, n = 7 trials, 1,013 participants), shorten fever duration, reduce Murray lung injury score and did not increase adverse events (RR 0.33, 95% CI [0.11, 1.00], I2 = 0%, p = 0.05, n = 5 trials, 676 participants). Conclusion: There is limited but some evidence that F. japonica as part of a herbal mixture may be an effective and safe intervention for acute RTIs in clinical practice. In future studies it would be preferable to evaluate the effectiveness and safety of using F. japonica without antibiotics for acute RTIs.
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Affiliation(s)
- Zhi-Jie Wang
- Department of Oncology, Shanxi Province Hospital of Tradition Chinese Medicine, Taiyuan, China
- The Institute of Shanxi Traditional Chinese Medicine, Taiyuan, China
| | - Jeanne Trill
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Lin-Lin Tan
- The Institute of Shanxi Traditional Chinese Medicine, Taiyuan, China
| | - Wen-Jing Chang
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Merlin Willcox
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ru-Yu Xia
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Jiang
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Michael Moore
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jian-Ping Liu
- Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Xiao-Yang Hu, ; Jian-Ping Liu,
| | - Xiao-Yang Hu
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- *Correspondence: Xiao-Yang Hu, ; Jian-Ping Liu,
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Yan LJ, Wang ZJ, Fang M, Lan HD, Moore M, Willcox M, Trill J, Hu XY, Liu JP. Bupleuri radix for Acute Uncomplicated Respiratory Tract Infection: A Systematic Review of Randomized Controlled Trials. Front Pharmacol 2022; 12:787084. [PMID: 35185539 PMCID: PMC8855037 DOI: 10.3389/fphar.2021.787084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: To evaluate the efficacy, clinical effectiveness, and safety of the Chinese herb Bupleuri radix for the treatment of acute uncomplicated respiratory tract infections (ARTIs). Methods: Four English and four Chinese databases were searched from their inception to June 2021. Randomized controlled trials (RCTs) assessing therapeutic effects of Bupleuri radix on ARTI were eligible for inclusion. The risk of bias for each trial was assessed using the Cochrane Risk of Bias Tool 2.0. RevMan 5.4 software was used for data analyses with effects estimated as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). The certainty of the evidence was assessed using the online GRADEpro tool. Results: Seven randomized trials involving 910 patients with acute upper respiratory tract infection (AURTI) were included. The review identified Bupleuri radix agents with four administration routes (oral, acupoint injection, intramuscular injection, nebulized inhalation). Bupleuri radix acupoint injection compared with placebo showed statistically significant effects in reducing fever resolution time (MD: −33.32 h, 95%CI: −35.71, −30.93), and in increasing the proportion of participants with fever resolved within 48 h from treatment onset (RR: 14, 95%CI: 1.96, 99.94). Bupleuri radix acupoint injection combined with usual care is more effective in reducing the temperature at day 1 from treatment onset (MD: −1.00°C, 95%CI: −1.19, −0.81) compared with usual care alone. Bupleuri radix pills showed similar antipyretic effects to acetaminophen. However, Bupleuri radix intramuscular injection plus vitamins failed to demonstrate an effect in reducing fever, when compared with ribavirin plus vitamins. It suggested that oral administration of Bupleuri radix solution for injections, pills, and Bupleuri radix decoction have a similar effect on improving global AURTI symptoms including two key symptoms (nasal discharge and cough), when compared with usual care alone. Only two trials reported whether or not there were any AEs and found no occurrence of adverse events in the herbal group. Conclusion: Low-certainty or very low-certainty evidence demonstrated that Bupleuri radix (solution for injections and pills) has an antipyretic effect on febrile patients with AURTI, but it has no effect on other AURTI symptoms. However, these findings need to be further confirmed by well-designed clinical trials with adequate sample sizes. Systematic review registration: (https://www.crd.york.ac.uk/prospero/#recordDetails), PROSPERO registration number: CRD42021234066.
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Affiliation(s)
- Li-Jiao Yan
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-Jie Wang
- Department of Oncology, Shanxi Provincial Hospital of Traditional Chinese Medicine, Shanxi, China
| | - Min Fang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Hui-Di Lan
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Michael Moore
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Merlin Willcox
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jeanne Trill
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Xiao-Yang Hu
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Research Design Service South Central, National Institute of Health Research, Southampton, United Kingdom
- *Correspondence: Jian-Ping Liu, ; Xiao-Yang Hu,
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jian-Ping Liu, ; Xiao-Yang Hu,
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Trill J, Simpson C, Webley F, Radford M, Stanton L, Maishman T, Galanopoulou A, Flower A, Eyles C, Willcox M, Hay A, Griffiths G, Little P, Lewith G, Moore M. Uva-ursi extract and ibuprofen as alternative treatments of adult female urinary tract infection (ATAFUTI): study protocol for a randomised controlled trial. Trials 2017; 18:421. [PMID: 28886751 PMCID: PMC5591533 DOI: 10.1186/s13063-017-2145-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with acute uncomplicated urine infection are usually treated with antibiotics. One trial has demonstrated that delayed antibiotic treatment offered without symptom relief results in a modest reduction in antibiotic use. There is some evidence that ibuprofen provides symptom relief and reduces antibiotic use. Uva-ursi, a herbal product, has a traditional use for urinary infection symptom relief. We set out to test: in adult women with suspected UTI who accept the delayed prescription strategy: Do NSAIDs or uva-ursi (a herbal product) provide relief from urinary symptoms and reduce antibiotic use. METHODS/DESIGN Adult women with suspected urinary tract infection presenting to primary care will be randomised using a factorial trial design in which patients will be randomised to one of two interventions as below: Group 1 - Uva-ursi + advice to take ibuprofen Group 2 - Placebo + advice to take ibuprofen Group 3 - Uva-ursi + no advice to take ibuprofen Group 4 - Placebo + no advice to take ibuprofen Patients and physicians will be blinded to the randomised group for the herb. The main outcome is symptom severity at days 2-4 recorded in a validated, self-report diary used in previous studies. Secondary outcomes include antibiotic use and symptom duration. In total the trial will require 328 patients in order to achieve at least 90% power for the primary endpoint and 80% for the secondary endpoint. In accordance with CONSORT guidelines all comparative analyses will be conducted on an intention-to-treat basis using SPSS or similar package. DISCUSSION The outcomes from this trial have the potential to modify the current approach to the management of acute urinary symptoms with less dependence on the use of antibiotics. TRIAL REGISTRATION ISRCTN registry, ID: ISRCTN43397016 . Registered on 11 February 2015.
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Affiliation(s)
- Jeanne Trill
- Primary Care and Population Science, University of Southampton Faculty of Medicine, Aldermoor Health Centre, Southampton, SO16 5ST England
| | - Catherine Simpson
- Southampton Clinical Trials Unit, University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD England
| | - Frances Webley
- Southampton Clinical Trials Unit, University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD England
| | - Mike Radford
- Southampton Clinical Trials Unit, University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD England
| | - Louise Stanton
- Southampton Clinical Trials Unit, University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD England
| | - Tom Maishman
- Southampton Clinical Trials Unit, University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD England
| | - Angeliki Galanopoulou
- Southampton Clinical Trials Unit, University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD England
| | - Andrew Flower
- Primary Care and Population Science, University of Southampton Faculty of Medicine, Aldermoor Health Centre, Southampton, SO16 5ST England
| | - Caroline Eyles
- Primary Care and Population Science, University of Southampton Faculty of Medicine, Aldermoor Health Centre, Southampton, SO16 5ST England
| | - Merlin Willcox
- Primary Care and Population Science, University of Southampton Faculty of Medicine, Aldermoor Health Centre, Southampton, SO16 5ST England
| | - Alastair Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Whatley Road, Bristol, BS8 2PS England
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton Clinical Trials Unit MP131, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD England
| | - Paul Little
- Primary Care and Population Science, University of Southampton Faculty of Medicine, Aldermoor Health Centre, Southampton, SO16 5ST England
| | - George Lewith
- Primary Care and Population Science, University of Southampton Faculty of Medicine, Aldermoor Health Centre, Southampton, SO16 5ST England
| | - Michael Moore
- Primary Care and Population Science, University of Southampton Faculty of Medicine, Aldermoor Health Centre, Southampton, SO16 5ST England
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Charlwood J, Dingwall C, Matico R, Hussain I, Johanson K, Moore S, Powell DJ, Skehel JM, Ratcliffe S, Clarke B, Trill J, Sweitzer S, Camilleri P. Characterization of the glycosylation profiles of Alzheimer's beta -secretase protein Asp-2 expressed in a variety of cell lines. J Biol Chem 2001; 276:16739-48. [PMID: 11278492 DOI: 10.1074/jbc.m009361200] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Amyloid 39-42 beta -peptides are the main components of amyloid plaques found in the brain of Alzheimer's disease patients. Amyloid 39-42 beta-peptide is formed from amyloid precursor protein by the sequential action of beta- and gamma-secretases. Asp-2 is a transmembrane aspartic protease expressed in the brain, shown to have beta-secretase activity. Mature Asp-2 has four N-glycosylation sites. In this report we have characterized the carbohydrate structures in this glycoprotein expressed in three different cell lines, namely Chinese hamster ovary, CV-1 origin of SV40, and baculovirus-infected SF9 cells. Biantennary and triantennary oligosaccharides of the "complex" type were released from glycoprotein expressed in the mammalian cells, whereas mannose-rich glycans were identified from glycoprotein synthesized in the baculovirus-infected cells. Site-directed mutagenesis of the asparagine residues at amino acid positions 153, 172, 223, and 354 demonstrate that the protease activity of Asp-2 is dependent on its glycosylation.
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Affiliation(s)
- J Charlwood
- Department of Analytical Sciences, SmithKline Beecham Pharmaceuticals, Harlow, Essex CM19 5AW, United Kingdom
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9
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Chambers JK, Macdonald LE, Sarau HM, Ames RS, Freeman K, Foley JJ, Zhu Y, McLaughlin MM, Murdock P, McMillan L, Trill J, Swift A, Aiyar N, Taylor P, Vawter L, Naheed S, Szekeres P, Hervieu G, Scott C, Watson JM, Murphy AJ, Duzic E, Klein C, Bergsma DJ, Wilson S, Livi GP. A G protein-coupled receptor for UDP-glucose. J Biol Chem 2000; 275:10767-71. [PMID: 10753868 DOI: 10.1074/jbc.275.15.10767] [Citation(s) in RCA: 266] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Uridine 5'-diphosphoglucose (UDP-glucose) has a well established biochemical role as a glycosyl donor in the enzymatic biosynthesis of carbohydrates. It is less well known that UDP-glucose may possess pharmacological activity, suggesting that a receptor for this molecule may exist. Here, we show that UDP-glucose, and some closely related molecules, potently activate the orphan G protein-coupled receptor KIAA0001 heterologously expressed in yeast or mammalian cells. Nucleotides known to activate P2Y receptors were inactive, indicating the distinctly novel pharmacology of this receptor. The receptor is expressed in a wide variety of human tissues, including many regions of the brain. These data suggest that some sugar-nucleotides may serve important physiological roles as extracellular signaling molecules in addition to their familiar role in intermediary metabolism.
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Affiliation(s)
- J K Chambers
- Department of Vascular Biology, New Frontiers Science Park, SmithKline Beecham Pharmaceuticals, Southern Way, Harlow, Essex CM19 5AW, United Kingdom.
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10
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Taylor G, Porter T, Dillon S, Trill J, Ganguly S, Hart T, Davis C, Wyde P, Tempest P, Harris W. Anti-respiratory syncytial virus monoclonal antibodies show promise in the treatment and prophylaxis of viral disease. Biochem Soc Trans 1995; 23:1063-7. [PMID: 8654682 DOI: 10.1042/bst0231063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- G Taylor
- Institute for Animal Health, Compton, Berkshire, U.K
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Abstract
A functional mouse adenine phosphoribosyltransferase (APRT) gene was identified and cloned by screening a mouse sperm genomic DNA library in lambda Charon 4A. The probe utilized for screening was a restriction fragment encoding much of the hamster APRT gene. Six recombinants that hybridized with the probe were identified, and after digestion with restriction enzymes EcoRI and PvuII revealed three different patterns of digestion for each enzyme. Of the six recombinants, five representing two of the restriction patterns possessed transforming activity. A sixth recombinant, which has a unique restriction pattern, lacks transforming activity but hybridizes well with hamster APRT coding sequences and is a possible candidate for a pseudogene. We used three criteria for conclusively identifying the mouse APRT genes. (1) DNA from the recombinant lambda phage hybridizes with DNA encoding hamster APRT. (2) The recombinant lambda phages and their DNAs transform mouse, hamster and human APRT- cells to the APRT+ phenotype. (3) The hamster and human transformants display APRT activity that migrates with a mobility characteristic of mouse APRT and not of hamster or human. A 3.1-kb EcoRI-SphI restriction fragment which retains transforming activity has been subcloned into the plasmid pBR328. Comparison of restriction enzyme sites with those contained in a mouse APRT cDNA, coupled with loss of transforming activity after enzyme digestion, indicates that the mouse APRT gene is larger than 1.8 kb and contains at least three introns.
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Tischfield J, Schafer IA, Dickerman LH, Trill J, Mulivor RA, Greene AE, Coriell LL. Lesch-Nyhan syndrome. Repository identification Nos. GM-2290, 2291, 2292, 2338, 3115, 3116, and 3117. Cytogenet Cell Genet 1979; 24:199-200. [PMID: 477417 DOI: 10.1159/000131379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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