Rikkunshito increases peripheral incretin-hormone levels in humans and rats

BACKGROUND

It was reported that rikkunshito (TJ-43) improved the cisplatin-induced decreases in the active form of ghrelin in plasma; however, other effects on gastrointestinal hormones have not been investigated.

AIM

To investigate the effects of TJ-43 on peripheral levels of incretin hormones, including gastric inhibitory polypeptide (GIP) and glucagon-like polypeptide-1 (GLP-1), in humans and rats.

METHODS

Patients were divided into two groups, namely patients who received TJ-43 immediately following surgery [TJ-43(+) group] and those who received TJ-43 on postoperative day 21 [TJ-43(-) group], and the plasma levels of active GIP and active GLP-1 were assessed. In animal experiments, rats were treated with TJ-43 [rat (r)TJ-43(+) group] or without [rTJ-43(-) group] by gavage for 4 wk, and the plasma active GIP and active GLP-1 levels were measured. The expression of incretin hormones in the gastrointestinal tract and insulin in the pancreas were investigated by immunohistochemistry. Furthermore, the cyclic adenosine monophosphate activities were assessed in pancreatic tissues from rats treated with or without TJ-43 in vivo, and the blood glucose levels and plasma insulin levels were measured in rats treated with or without TJ-43 in oral glucose tolerance tests.

RESULTS

In humans, the active incretin hormone levels increased, and values were significantly greater in the TJ-43(+) group compared those in the TJ-43(-) group. In rats, the plasma active incretin levels significantly increased in the rTJ-43(+) group compared with those in the rTJ-43(-) group. GIP and GLP-1 expressions were enhanced by TJ-43 treatment. Moreover, plasma insulin levels increased and blood glucose levels were blunted in the rTJ-43(+) group.

CONCLUSION

The results show that TJ-43 may be beneficial for patients who undergo pancreatic surgery.

Rikkunshito increases appetite by enhancing gastrointestinal and incretin hormone levels in patients who underwent pylorus-preserving pancreaticoduodenectomy: A retrospective study

BACKGROUND

Rikkunshito (TJ-43) relieves gastrointestinal disturbance by increases in the levels of acylated ghrelin.

AIM

To investigate the effects of TJ-43 in patients undergoing pancreatic surgery.

METHODS

Forty-one patients undergoing pylorus-preserving pancreaticoduodenectomy (PpPD) were divided into two groups; patients took daily doses of TJ-43 after surgery or after postoperative day (POD) 21. The plasma levels of acylated and desacylated ghrelin, cholecystokinin (CCK), peptide YY (PYY), gastric inhibitory peptide (GIP), and active glucagon-like peptide (GLP)-1 were evaluated. Oral calorie intake was assessed at POD 21 in both groups. The primary endpoint of this study was the total food intake after PpPD.

RESULTS

The levels of acylated ghrelin were significantly greater in patients treated with TJ-43 than those in patients without TJ-43 administration at POD 21, and oral intake was significantly increased in patients treated with TJ-43. The CCK and PYY levels were significantly greater in patients treated with TJ-43 than those in patients without TJ-43 treatment. Furthermore, the GIP and active GLP-1 levels increased and values at POD 21 were significantly greater in patients treated with TJ-43 than those in patients without TJ-43 administration. Insulin secretion tended to increase in patients treated with TJ-43.

CONCLUSION

TJ-43 may have advantages for oral food intake in patients in the early phase after pancreatic surgery. Further investigation is needed to clarify the effects of TJ-43 on incretin hormones.

The use of maoto (Ma-Huang-Tang), a traditional Japanese Kampo medicine, to alleviate flu symptoms: a systematic review and meta-analysis

Background

Influenza is a common viral infection worldwide. Maoto (ma-huang-tang) was developed in ancient China and is used to alleviate flu symptoms. Currently, no meta-analyses have evaluated the efficacy and safety of maoto for alleviating flu symptoms.

Methods

In the present study, we searched MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, a Japanese database (Ichushi), two Chinese databases (China National Knowledge Infrastructure and VIP), and two Korean databases (Korean Medical database and Korean Association of Medical Journal Editors) for studies published in or before October 2017. Clinical studies that compared maoto plus neuraminidase inhibitors (NAIs) vs. NAIs alone, or maoto alone vs. NAIs alone, were included in the present analysis. The primary outcome measure (efficacy) was the length of time from the start of medication to resolution of influenza symptoms (fever, headache, malaise, myalgia, and chills) and virus isolation. The secondary outcome measures (safety) were as follows: (1) side effects and adverse reactions, such as nausea, abnormal behaviour, or discontinuation of symptomatic treatment; (2) morbidity (complications caused by influenza infection) or mortality; and (3) hospitalisation for any reason.

Results

Twelve relevant studies were identified, including two randomised controlled trials (RCTs, N = 60) and ten non-randomised studies (NRSs, N = 1110). We found that maoto plus NAIs was superior to NAIs alone in terms of the duration of fever in one RCT (P < 0.05, median difference = − 6 h) and four NRSs (P = 0.003, weighted mean difference = − 5.34 h). The duration of symptoms or virus isolation did not differ between maoto and NAIs. No severe side effects or adverse reactions were reported related to maoto or NAIs.

Conclusions

Although we could not reach a definitive conclusion because of the small sample sizes and high risk of bias in the analysed studies, maoto may lower the duration of fever when it is used alone or in combination with NAIs and may be a well-tolerated treatment. More RCTs are needed to determine the efficacy and safety of maoto.

Electronic supplementary material

The online version of this article (10.1186/s12906-019-2474-z) contains supplementary material, which is available to authorized users.

Kamikihito improves cancer-related fatigue by restoring balance between the sympathetic and parasympathetic nervous systems

Background

Cancer-related fatigue is one of the most prevalent symptoms that patients with cancer experience, but the mechanisms underlying it are unknown. We aimed to quantify and mechanistically evaluate the improvement in fatigue related to administration of the Kampo medicine, Kamikihito.

Materials and methods

Initially, we recruited outpatients with urological diseases and compared fatigue levels of 37 patients with cancer with a control group of 23 volunteers who had recovered completely from cancer or who were being treated for dysuria. Fatigue level was estimated using an autonomic function analyzer. Then, Kamikihito was administered to another 35 patients treated with hormone or antitumor therapy for prostate cancer and metastatic renal cell cancer. Subjective fatigue and other problems of the patients were assessed using the Chalder fatigue scale, the Center for Epidemiologic Studies Depression scale, and the Epworth sleepiness scale. Serum levels of derivatives of reactive oxygen species and biological antioxidant potential were also measured.

Results

Patients in the cancer treatment group experienced more fatigue compared with the control patients when evaluated using an autonomic function analyzer. The group of 35 patients who were administered Kamikihito showed improved scores for fatigue, depression, and sleepiness. Autonomic nervous system balance was also improved with Kamikihito administration. The Kamikihito group also had significantly lower reactive oxygen species metabolite levels and significantly higher antioxidant potential.

Conclusions

Fatigue was more serious in patients with cancer than in control patients. Kamikihito rescued this fatigue and improved anxiety and sleepiness. It restored autonomic nervous system balance and antioxidant function.

Japanese traditional herbal medicine reduces use of pregabalin and opioids for pain in patients with lumbar spinal canal stenosis: a retrospective cohort study

Background

There has been an increase in the number of Japanese patients with lumbar spinal canal stenosis (LSCS) who complain of chronic pain or motor disturbance in the lower back or extremities. These patients are often treated with anti-convulsive drugs, opioids, antidepressants, acetaminophen, or nonsteroidal anti-inflammatory drugs, all of which can cause side effects. For this reason, Japanese traditional herbal medicine (Kampo) is of interest, because it produces fewer adverse reactions. The aim of this retrospective cohort study was to analyze the effects of Kampo in patients with LSCS.

Findings

A total of 151 patients with LSCS were divided into two groups based on treatment with (n = 111, group K) and without (n = 40, group N) Kampo. Use of pregabalin and opioids decreased significantly in group K (p < 0.001). The hazard ratio for opioid discontinuation was 0.220 (p = 0.004) for group N vs. group K, while that for pregabalin and antidepressants discontinuation were 0.589 (p = 0.202) and 0.509 (p = 0.377), respectively. The mean duration of hospital visits and treatment did not differ between the groups, but the number of dropouts was significantly higher in group N (p < 0.0001). The hazard ratio for patient dropout was 4.118 (p = 0.001) for group N vs. group K.

Conclusions

Kampo led to discontinuation of opioid use for pain in patients with LSCS, and patients who were treated with Kampo were more likely to continue treatment.

Determination of β-d-glucan and endotoxin levels in Kampo extracts

Aims

Kampo medicine is based on the use of established formulations combining natural extracts with no "brand-name" products or corresponding "generic" formulation. Due to differences in manufacturing practices, products of different pharmaceutical companies may contain different concentrations of β-d-glucan and endotoxins. The aim of this study was to compare the concentrations of β-d-glucan and endotoxins in five Kampo extracts from four pharmaceutical companies.

Methods

Packages of Kampo extracts were dissolved in distilled water. β-d-Glucan and endotoxin concentrations were measured using high-sensitivity kinetic turbidimetric Limulus assay.

Results

All Kampo extracts examined in this study were found to contain detectable concentrations of β-d-glucan and endotoxins. Significant differences in the concentration of β-d-glucan and endotoxins (P = 0.0024 and P = 0.0013, respectively) were observed between products of different pharmaceutical companies.

Conclusions

High β-d-glucan and endotoxin contents were detected in Kampo extracts, with a large variability in the concentrations of both β-d-glucan and endotoxins among extracts from different pharmaceutical companies.