Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial

OBJECTIVE

To compare the efficacy of curcumin versus omeprazole in improving patient reported outcomes in people with dyspepsia.

DESIGN

Randomised, double blind controlled trial, with central randomisation.

SETTING

Thai traditional medicine hospital, district hospital, and university hospitals in Thailand.

PARTICIPANTS

Participants with a diagnosis of functional dyspepsia.

INTERVENTIONS

The interventions were curcumin alone (C), omeprazole alone (O), or curcumin plus omeprazole (C+O). Patients in the combination group received two capsules of 250 mg curcumin, four times daily, and one capsule of 20 mg omeprazole once daily for 28 days.

MAIN OUTCOME MEASURES

Functional dyspepsia symptoms on days 28 and 56 were assessed using the Severity of Dyspepsia Assessment (SODA) score. Secondary outcomes were the occurrence of adverse events and serious adverse events.

RESULTS

206 patients were enrolled in the study and randomly assigned to one of the three groups; 151 patients completed the study. Demographic data (age 49.7±11.9 years; women 73.4%), clinical characteristics and baseline dyspepsia scores were comparable between the three groups. Significant improvements were observed in SODA scores on day 28 in the pain (-4.83, -5.46 and -6.22), non-pain (-2.22, -2.32 and -2.31) and satisfaction (0.39, 0.79 and 0.60) categories for the C+O, C, and O groups, respectively. These improvements were enhanced on day 56 in the pain (-7.19, -8.07 and -8.85), non-pain (-4.09, -4.12 and -3.71) and satisfaction (0.78, 1.07, and 0.81) categories in the C+O, C, and O groups, respectively. No significant differences were observed among the three groups and no serious adverse events occurred.

CONCLUSION

Curcumin and omeprazole had comparable efficacy for functional dyspepsia with no obvious synergistic effect.

TRIAL REGISTRATION NUMBER

TCTR20221208003.

Antiproliferative and Anti-Inflammatory Activities of Deprungsith Formulation and Its Bioactive Compounds Against Mild Psoriasis and Potential of Metabolic Herb-Drug Interactions

Psoriasis is an incurable, chronic and auto-immune skin disorder with a global prevalence rate of approximately 2-3%. The study investigated the antipsoriasis activities of Deprungsith formulation and its bioactive components and their potential for inhibitory activities on human cytochrome P450 (CYP450). HaCaT and peripheral blood mononuclear cells (PBMCs) from healthy volunteers (n = 9) and psoriasis patients (n = 10) were exposed to Deprungsith formulation (Thai traditional medicine for psoriasis consisting of 16 plants), ethyl p-methoxycinnamate (EPMC), ligustilide and cyclosporin for 24 and 48 h. The antiproliferative, cell apoptosis and cell cycle arrest activities were evaluated using MTT assay and flow cytometry, respectively. The pro-inflammatory cytokine mRNA expression levels were measured using real-time polymerase chain reaction (RT-PCR). The CYP450 inhibitory effect was investigated using a bioluminescent-based CYP450 assay. Deprungsith formulation and the bioactive compounds inhibited HaCaT cells and PBMCs with weak to moderate potencies. EPMC and ligustilide combination produced an additive effect. Most substances arrested cell transition at sub-G1 and S phases, leading to early and late apoptosis induction. With prolonged exposure (48 h), all test substances decreased PBMCs necrosis. The mRNA expression of all pro-inflammatory cytokines was downregulated. Deprungsith formulation, EPMC, ligustilide and ferulic acid inhibited CYP1A2, CYP2C9, CYP2D6 and CYP3A4 activities with weak to moderate potencies. Deprungsith formulation and bioactive components induced cell apoptosis by inhibiting cell transition at specific cell cycle phases, which was correlated with the mRNA downregulation of interleukin (IL-6, IL-12p19, IL-23) and tumor necrosis factor (TNF-α). There is a low risk of potential adverse drug reactions and toxicity due to CYP450 interaction when Deprungsith formulation is concurrently administered with modern medicines.

Anticancer effects of a traditional Thai herbal recipe Benja Amarit extracts against human hepatocellular carcinoma and colon cancer cell by targeting apoptosis pathways

ETHNOPHARMACOLOGICAL RELEVANCE

A preparation of Benja Amarit (BJA) has been effectively used in folk medicine to treat diseases related to the liver and colon and forms of cancer for hundreds of years in Thailand. However, there has not been any research on BJA with regard to its anticancer activity against human hepatocellular carcinoma and colon cancer cells.

AIM OF THE STUDY

This study was to obtain the scientific supports for the traditional usage in anticancer potential of BJA extracts on hepatocellular carcinoma and colon cancer.

MATERIALS AND METHODS

The cytotoxic effects were determined using MTT assay. Apoptosis was quantitated by annexin V-FITC/PI staining. Caspases activities were measured by using specific substrates and colorimetric analysis. The protein expressions were determined by Western blot analysis. Reactive oxygen species (ROS) generation, mitochondrial transmembrane potential, and calcium ion levels were measured by specific fluorescence probes and flow cytometry. The chick embryo chorioallantoic membrane model has been used to study the in vivo anticancer activity. The phytochemical identification was performed by GC-MS and LC-MS.

RESULTS

Notably, 95% (BJA-95) and 50% (BJA-50) ethanolic extract of BJA inhibited hepatocellular carcinoma and colon cancer cell viability in a dose-dependent manner. While, the water extract of BJA (BJA-W) was not found to be toxic to both kinds of cancer cell lines. BJA extract induced both the extrinsic and intrinsic or mitochondria-mediated apoptosis pathways. Moreover, BJA-95 caused ROS generation and endoplasmic reticulum stress-mediated apoptosis. The extract exhibited the growth inhibitory effects on cancer cells in vivo. Phytochemical analysis revealed that the major active compounds were piperine, xanthotoxol and dihydrogambogic acid.

CONCLUSION

This study is the first to demonstrate anticancer efficiency of BJA extracts on human cancer cells. We consider BJA extract to be a potentially alternative cancer treatment and to be a promising candidate in the future development of antitumor agents.

Risk factors for cellulitis in patients with lymphedema: a case-controlled study

Risk factors for cellulitis in lymphedema (LE) have never been evaluated in controlled studies. The objective of this study was to assess the risk factors for cellulitis in patients with LE using a case-controlled study method. Medical records of patients from November 2009 to September 2011 who met the following criteria were retrieved and analyzed: (a) clinical diagnosis of LE of the limb, (b) aged 18 or above, (c) no food allergy history and (d) no medical diagnosis of cancer metastasis. Overall, there were 179 cases of LE with cellulitis. Each case was matched by age (+/- 5 years) and gender with a patient with LE and without cellulitis for controls. Logistic regression with backward selection procedure was used to identify independent risk factors. The area under the receiver operating characteristics (ROC) curve of the final model was calculated. Independent risk factors for cellulitis in patients with LE were percentage difference in circumference of the limb (adjusted odds ratio (AOR)=1.07, 95% confidence interval (CI)=1.04-1.10), primary LE diagnosis (AOR=3.36, 95% CI=1.37-8.22), food-induced complication experiences (FIE: AOR=6.82, 95% CI=2.82-16.51) and systolic blood pressure (AOR=1.02, 95% CI=1.01-1.04). The area under the curve for the model was 0.80 (95% CI=0.75-0.85, p<0.001). No association was observed with hypertension, diabetes mellitus, body mass index and the duration of LE. This first case-controlled study highlights the important roles of dietary factors, percentage difference in circumference of the limb, and systolic blood pressure for developing cellulitis. The results suggest that controlling the percentage difference in circumference of the limb and systolic blood pressure together with restriction of fatty food and meat consumption may result in a decreased incidence of cellulitis among patients with LE.