Guideline on treating community-acquired pneumonia with Chinese patent medicines

Community-acquired pneumonia (CAP) is one of the most common infectious diseases, and its morbidity and mortality increase with age. Resistance and mutations development make the use of anti-infective therapy challenging. Chinese patent medicines (CPMs) are often used to treat CAP in China and well tolerable. However, currently there are no evidence-based guideline for the treatment of CAP with CPMs, and the misuse of CPMs is common. Therefore, we established a guideline panel to develop this guideline. We identified six clinical questions through two rounds of survey, and we then systematically searched relevant evidence and performed meta-analyses, evidence summaries and GRADE decision tables to draft recommendations, which were then voted on by a consensus panel using the Delphi method. Finally, we developed ten recommendations based on evidence synthesis and expert consensus. For the treatment of severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Xuebijing injection, Shenfu injection, and Shenmai injection respectively. For the treatment of non-severe CAP in adults, we recommend Tanreqing injection, Reduning injection, Lianhua Qingwen capsule/granule, Qingfei Xiaoyan Pill and Shufeng Jiedu capsule respectively. CPMs have great potential to help in the fight against CAP worldwide, but more high-quality studies are still needed to strengthen the evidence.

Nose to brain drug delivery - A promising strategy for active components from herbal medicine for treating cerebral ischemia reperfusion

Cerebral ischemia reperfusion injury (CIRI), one of the major causes of death from stroke in the world, not only causes tremendous damage to human health, but also brings heavy economic burden to society. Current available treatments for CIRI, including mechanical therapies and drug therapies, are often accompanied by significant side-effects. Therefore, it is necessary to discovery new strategies for treating CIRI. Many studies have confirmed that the herbal medicine has the advantages of abundant resources, good curative effect and little side effects, which can be used as potential drug for treatment of CIRI through multiple targets. It's known that oral administration commonly has low bioavailability, and injection administration is inconvenient and unsafe. Many drugs can't delivery to brain through routine pathways due to the blood-brain-barrier (BBB). Interestingly, increasing evidences have suggested the nasal administration is a potential direct route to transport drug into brain avoiding the BBB and has the characteristics of high bioavailability for treating brain diseases. Therefore, intranasal administration can be treated as an alternative way to treat brain diseases. In the present review, effective methods to treat CIRI by using active ingredients derived from herbal medicine through nose to brain drug delivery (NBDD) are updated and discussed, and some related pharmacological mechanisms have also been emphasized. Our present study would be beneficial for the further drug development of natural agents from herbal medicines via NBDD.

Locally and traditionally used Ligusticum species - A review of their phytochemistry, pharmacology and pharmacokinetics

ETHNOPHARMACOLOGICAL RELEVANCE

Ligusticum species (Umbelliferae) have been widely used in traditional Chinese medicine, Korean folk medicine and Native American medicine for their medicinal and nutritional value. Decoctions of the rhizomes are used in treatment and prophylaxis of migraine, anemia and cardiovascular conditions including stroke.

AIM OF STUDY

This review is intended to fully compile the constituents of locally and traditionally used Ligusticum species, present their bioactivities and highlight potential leads for future drug design, and thus, provide a reference for further research and application of these species. Emphasis is also placed on current trends in the pharmacokinetic studies of the major constituents.

METHODS

The literature discussed is derived from readily accessible papers spanning the early 1990s to the end of 2015. Information was collected from journals, books and online searches (Google Scholar, PubMed, ScienceDirect, SciFinder, Springerlink and CNKI).

RESULTS

The major phytoconstituents, 154 of which are presented in this review, include alkaloids, phthalides and phenolic acids. The crude extracts and isolated constituents have exhibited a wide range of in vitro and in vivo pharmacologic effects, including cardioprotective, antioxidant, anti-inflammatory and neuroprotective activities. The bioactive alkaloid tetramethylpyrazine (TMP) has attracted the most attention for its potent effect on calcium channels, anti-platelet as well as anti-inflammatory effects. Pharmacokinetic studies of major constituents have also been summarized.

CONCLUSION

The pthalides, organic acids and alkaloids of Ligusticum species have emerged as a good source of traditional medicines for the management of cardio- and cerebrovascular conditions, inflammation and neurogenerative disorders. The species discussed in this review have demonstrated wide pharmacological actions and have great potential to yield multipotent drugs if challenges such as poor bioavailability, solubility and toxicological profiles are addressed. Apart from the rhizomes, pharmacological activities of other botanical parts also need to be studied further. Expansion of research to cover other species in the Ligusticum genus would provide more opportunities for the discovery of new bioactive principles.

Pharmacokinetic comparison of seven major bio-active components in normal and blood deficiency rats after oral administration of Danggui Buxue decoction by UPLC-TQ/MS

ETHNOPHARMACOLOGICAL RELEVANCE

Blood deficiency is commonly encountered among women, and is the root of many gynecological disorders. Danggui Buxue Decoction (DBD), a classical traditional Chinese formula which is composed of Astragali Radix (AR) and Angelicae Sinensis Radix (ASR) at the ratio of 5:1 (w/w), is widely used in TCM clinics for treatment of blood deficiency syndrome. This study is to compare the in vivo pharmacokinetic properties of seven major bio-active components in normal and blood deficiency rats after oral administration of DBD.

MATERIALS AND METHODS

Blood deficiency rats were induced by bleeding from orbit at the dosages of 5.0mL/kg each day for 12 days. Normal and blood deficiency rats were administrated of DBD on the 12th day at the dosage of 20g/kg, and blood was collected at different time points after then. Concentrations of ferulic acid, caffeic acid, butylphthalide, ligustilide, calycosin-7-O-β-glucoside, ononin, and astragaloside IV in plasma were quantified by UPLC-TQ/MS, and the main pharmacokinetic parameters were calculated by DAS 2.0.

RESULTS

It was found that Cmax, Tmax and MRT0~T of astragaloside IV, Cmax, T1/2Z, AUC0~T and MRT0~T of calycosin-7-O-β-glucoside, T1/2Z and AUC0~T of ferulic acid, T1/2Z, AUC0~T and MRT0~T of ononin, and MRT0~T of ligustilide, butylphthalide, and caffeic acid in blood deficiency rats was significantly different (P<0.05) from normal rats.

CONCLUSIONS

This study was the first report about pharmacokinetic investigation in blood deficiency animals which was conducted by bleeding. And the results demonstrated that the seven DBD constituents in normal and blood deficiency rats had obvious differences in some pharmacokinetic characteristics, suggesting that the rate and extent of drug metabolism were altered in blood deficiency animals.