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Shouhui Tongbian Capsule in treatment of constipation: Treatment and mechanism development 寿辉通便胶囊治疗便秘:治疗与机理研究
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2023.05.006
Liping Gong , Hang Du , Xin Guo , Jianchao Li , Xiaomin Zhu , Xianhui Shen , Zhiyan Huang , Kaiyi Wu , Guimin Zhang , Rong Sun

Constipation is common in the diseases of the digestive system in clinics. With the change in diet structure and the increase in life pressure, the prevalence rate increases year by year. In traditional Chinese medicine (TCM), the location of the disease of constipation is in the large intestine, which is related to the dysfunction of lung, spleen, liver, kidney and other viscera. Its pathogenesis is conductive dysfunction of large intestine. Based on the theory, Shouhui Tongbian Capsule (SHTB) is composed of eight traditional Chinese medicines, including Polygoni multiflori Radix (Heshouwu in Chinese), Aloe (Luhui in Chinese), Cassiae Semen (Juemingzi in Chinese), Ginseng Radix et Rhizoma (Renshen in Chinese), Lycii Fructus (Gouqizi in Chinese), Asini Corii Colla (Ejiao in Chinese), Aurantii Fructus Immaturus (Zhishi in Chinese), and Atractylodis Macrocephalae Rhizoma (Baizhu in Chinese), which could help to release excessive turbid, and nourishing yin and supplementing qi in the treatment. This study has been carried out to review the latest advances of SHTB in the treatment of constipation. The results showed that significant effect of SHTB was found in the treatment of constipation, such as functional constipation, and constipation associated with tumor chemotherapy, colitis, type 2 diabetes and chronic cardiac failure. Besides, obvious adverse reactions were not observed. SHTB could effectively treat five types of constipation, provide direction for the future exploration of SHTB in the treatment of other types of constipation.

便秘是消化系统疾病中的常见病。随着饮食结构的改变和生活压力的增大,患病率逐年上升。中医认为,便秘病位在大肠,与肺、脾、肝、肾等脏腑功能失调有关。其病机为大肠传导功能障碍。根据这一理论,寿辉通便胶囊由八味中药组成,包括何首乌、芦荟、决明子、人参、枸杞子、炙甘草、枸杞子、阿胶、鸡内金、白术等,具有泄浊、滋阴、补气的作用。本研究旨在回顾 SHTB 治疗便秘的最新进展。结果显示,SHTB 在治疗功能性便秘、肿瘤化疗相关性便秘、结肠炎、2 型糖尿病和慢性心力衰竭等便秘方面疗效显著。此外,未观察到明显的不良反应。SHTB能有效治疗五种类型的便秘,为今后探索SHTB治疗其他类型便秘提供了方向。
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引用次数: 0
Advances in research and utilization of botanical pesticides for agricultural pest management in Inner Mongolia, China 内蒙古农业病虫害治理中植物性农药的研究与利用进展
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2023.04.002
Chunyan Guo , Lingfei Wang , Namuhan Chen , Mingxu Zhang , Junying Jia , Lijuan Lv , Minhui Li

Traditional Chinese herbal medicines not only cure human diseases, but also play an important role as insecticides. Compared with conventional chemical agents, traditional Chinese herbal medicines are characterized by low toxicity, low residues, and being eco-friendly, and they have become a research hotspot. Traditional Chinese herbal medicines have tremendous flexibility and indefinite potential. Therefore, this paper reviewed the types of insecticides belonging to traditional Chinese herbal medicines in Inner Mongolia, China, including their traditional uses, secondary metabolites, biological activities, action mechanisms, application methods, and development status. In addition, the most relevant issues involved in the development of traditional Chinese herbal medicines was discussed. We believe that traditional Chinese herbal medicines can be better implemented and developed; such that its other advantages, such as an insect repellent, can be promoted. Moreover, this study lays a solid foundation for further research on traditional Chinese herbal medicines in Inner Mongolia, China.

中药材不仅能治疗人类疾病,还能发挥重要的杀虫作用。与传统化学药剂相比,中药材具有低毒、低残留、生态友好等特点,已成为研究热点。传统中药材具有巨大的灵活性和无限的潜力。因此,本文综述了中国内蒙古传统中药材中的杀虫剂种类,包括其传统用途、次生代谢物、生物活性、作用机理、应用方法和发展现状。此外,还讨论了传统中药材发展中最相关的问题。我们相信,传统中药材可以得到更好的应用和发展,从而推广其其他优势,如驱虫。此外,本研究还为进一步研究中国内蒙古的传统中草药奠定了坚实的基础。
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引用次数: 0
New indole derivatives from endophytic fungus Colletotruchum sp. HK-08 originated from leaves of Nerium indicum 源自 Nerium indicum 叶子的内生真菌 Colletotruchum sp.
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2023.07.004
Huiqin Chen , Hao Zheng , Caihong Cai , Hao Wang , Cuijuan Gai , Zhiqiong Tan , Haofu Dai , Wenli Mei

Objective

To study secondary metabolites from endophytic fungus Colletotruchum sp. HK-08 originated from the leaves of Nerium indicum.

Methods

The compounds were isolated by various column chromatographic techniques, and their structures were elucidated by spectroscopic techniques [high resolution electrospray ionization mass spectroscopy (HRESIMS), one-dimensional (1D) and two-dimensional (2D) nuclear magnetic resonance spectroscopy (NMR)], as well as comparison with literature data. The Ellman method was used to determine the acetylcholinesterase (AChE) inhibitory activity.

Results

Four indole derivatives were identified from Colletotruchum sp. HK-08, including 6′-hydroxymonaspiloindole (1), 2-(2-oxoindolin-3-yl)ethyl 2-(4-hydroxyphenyl) acetate (2), 2-(2-oxoindolin-3-yl)ethyl 2-(2-hydroxyphenyl)acetate (3), and monaspiloindole (4). Compound 4 presented weak AChE inhibitory activity with IC50 value of (69.30 ± 6.27) μmol/L [tacrine as the positive control, with IC50 value of (0.61 ± 0.07) μmol/L].

Conclusion

Compounds 1–3 were new compounds, and compound 4 had weak AChE inhibitory activity.

方法采用不同的柱层析技术分离化合物,通过光谱技术[高分辨率电喷雾离子化质谱(HRESIMS)、一维(1D)和二维(2D)核磁共振波谱(NMR)]以及与文献数据的比较阐明其结构。结果从 Colletotruchum sp.HK-08 中鉴定出四种吲哚衍生物,包括 6′-羟基单天冬氨醛(1)、2-(2-氧代吲哚啉-3-基)乙基 2-(4-羟基苯基)乙酸酯(2)、2-(2-氧代吲哚啉-3-基)乙基 2-(2-羟基苯基)乙酸酯(3)和单天冬氨醛(4)。化合物 4 具有较弱的 AChE 抑制活性,IC50 值为 (69.30 ± 6.27) μmol/L [他克林作为阳性对照,IC50 值为 (0.61 ± 0.07) μmol/L]。
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引用次数: 0
Perspective and challenges of mycorrhizal symbiosis in orchid medicinal plants 兰科药用植物菌根共生的前景与挑战
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2024.03.001
Chunyan Leng, Mengyan Hou, Yongmei Xing, Juan Chen

The family Orchidaceae is of the most diverse taxon in the plant kingdom, and most of its members are highly valuable herbal medicines. Orchids have a unique mycorrhizal symbiotic relationship with specific fungi for carbohydrate and nutrient supplies in their whole lifecycle. The large-scale cultivation of the medicinal plant Gastodia elata is a successful example of using mycorrhizal symbiotic technology. In this review, we adopted G. elata and Dendrobium officinale as examples to describe the characteristics of orchid mycorrhiza and mycorrhizal benefits for host plants’ growth and health (e.g. biotic and abiotic stress and secondary metabolite accumulation). The challenges in applying mycorrhizal technology to the cultivation of orchid medicinal plants in the future were also discussed. This review aims to serve as a theoretical guide for the cultivation of mycorrhizal technology in medicinal orchid plants.

兰科是植物王国中种类最繁多的类群,其大多数成员都是非常珍贵的中药材。兰花在其整个生命周期中与特定真菌建立了独特的菌根共生关系,以获得碳水化合物和养分供应。药用植物 Gastodia elata 的大规模种植是利用菌根共生技术的一个成功范例。在这篇综述中,我们以 G. elata 和 Dendrobium officinale 为例,阐述了兰科植物菌根的特点以及菌根对寄主植物生长和健康的益处(如生物和非生物胁迫以及次生代谢物的积累)。此外,还讨论了未来将菌根技术应用于兰科药用植物栽培所面临的挑战。本综述旨在为兰科药用植物菌根技术的栽培提供理论指导。
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引用次数: 0
Effects of plants-associated microbiota on cultivation and quality of Chinese herbal medicines 植物相关菌群对中草药栽培及品质的影响
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2022.12.004
Yue Ouyang , Qiqing Cheng , Chunsong Cheng , Ziyu Tang , Yufeng Huang , Eyu Tan , Shaofeng Ma , Xinheng Lin , Ying Xie , Hua Zhou

Microbial resource influences the life activities of medicinal plants from several perspectives. Endophytes, rhizosphere microorganisms, and other environmental microorganisms play essential roles in medicinal plant growth and development, plant yield, and clinical efficacy. The microbiota can influence the biosynthesis of active compounds in medicinal plants by stimulating specific metabolic pathways. They induce host plants to improve their resistance to environmental stresses by accumulating secondary metabolites. Microorganisms can interact with their host plants to produce long-term, targeted selection results and improve their ability to adapt to the environment. Due to the interdependence and interaction between microorganisms and medicinal plants, Chinese herbal medicines (CHMs) quality is closely related to the associated microorganisms. This review summarizes the relationship between medicinal plants and their associated microorganisms, including their species, distribution, life activities, and metabolites. Microorganisms can aid in quality control, improve the efficacy of medicinal plants, and provide markers for identifying the origin and storage time of CHMs. Therefore, a comprehensive understanding of the relationship between microorganisms and medicinal plants will help to control the quality of CHMs from different perspectives.

微生物资源从多个角度影响着药用植物的生命活动。内生菌、根瘤微生物和其他环境微生物在药用植物的生长发育、产量和临床疗效方面发挥着至关重要的作用。微生物群可以通过刺激特定的代谢途径影响药用植物中活性化合物的生物合成。它们通过积累次生代谢物诱导宿主植物提高对环境压力的抵抗力。微生物可与寄主植物相互作用,产生长期、有针对性的选择结果,并提高其适应环境的能力。由于微生物与药用植物之间的相互依存和相互作用,中药材的质量与相关微生物密切相关。本综述总结了药用植物与其相关微生物之间的关系,包括微生物的种类、分布、生命活动和代谢产物。微生物有助于质量控制,提高药用植物的功效,并为确定 CHM 的来源和储存时间提供标记。因此,全面了解微生物与药用植物之间的关系有助于从不同角度控制 CHM 的质量。
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引用次数: 0
Roles of endophytic fungi in medicinal plant abiotic stress response and TCM quality development 内生真菌在药用植物中药品质发育和非生物胁迫响应中的作用
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2023.02.006
Jiahao Zhang , Jiemiao Lu , Yichun Zhu , Xiaoxia Shen , Bo Zhu , Luping Qin

Medicinal plants, as medicinal materials and important drug components, have been used in traditional and folk medicine for ages. However, being sessile organisms, they are seriously affected by extreme environmental conditions and abiotic stresses such as salt, heavy metal, temperature, and water stresses. Medicinal plants usually produce specific secondary metabolites to survive such stresses, and these metabolites can often be used for treating human diseases. Recently, medicinal plants have been found to partner with endophytic fungi to form a long-term, stable, and win–win symbiotic relationship. Endophytic fungi can promote secondary metabolite accumulation in medicinal plants. The close relationship can improve host plant resistance to the abiotic stresses of soil salinity, drought, and extreme temperatures. Their symbiosis also sheds light on plant growth and active compound production. Here, we show that endophytic fungi can improve the host medicinal plant resistance to abiotic stress by regulating active compounds, reducing oxidative stress, and regulating the cell ion balance. We also identify the deficiencies and burning issues of available studies and present promising research topics for the future. This review provides guidance for endophytic fungi research to improve the ability of medicinal plants to resist abiotic stress. It also suggests ideas and methods for active compound accumulation in medicinal plants and medicinal material development during the response to abiotic stress.

药用植物作为药材和重要的药物成分,历来被用于传统和民间医药。然而,作为无梗生物,它们受到极端环境条件和非生物胁迫(如盐胁迫、重金属胁迫、温度胁迫和水胁迫)的严重影响。药用植物通常会产生特定的次生代谢物来抵御这些压力,这些代谢物通常可用于治疗人类疾病。最近,人们发现药用植物可以与内生真菌合作,形成长期、稳定和双赢的共生关系。内生真菌可以促进药用植物次生代谢物的积累。这种密切的关系可以提高寄主植物对土壤盐碱化、干旱和极端温度等非生物胁迫的抵抗力。它们的共生关系还能促进植物生长和活性化合物的产生。在这里,我们展示了内生真菌可以通过调节活性化合物、减少氧化应激和调节细胞离子平衡来提高宿主药用植物对非生物胁迫的抵抗力。我们还指出了现有研究的不足之处和棘手问题,并提出了未来有希望的研究课题。本综述为内生真菌研究提供了指导,以提高药用植物抵抗非生物胁迫的能力。它还为药用植物中活性化合物的积累以及在应对非生物胁迫过程中药用材料的开发提出了思路和方法。
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引用次数: 0
Metabolites isolated from Penicillium HDS-Z-1E, an endophytic fungal strain isolated from Taxus cuspidata and their activation effect of catalase 东北红豆杉内生真菌青霉HDS-Z-1E的代谢产物及其对过氧化氢酶的激活作用
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2022.12.009
Chuan Tang, Rui Gao, Xiaoyuan Tang, Yu Zhang, Weixing Feng, Baomin Feng, Xuan Lu

Objective

To study the compounds isolated from Penicillium HDS-Z-1E, an endophytic fungal strain isolated from Taxus cuspidata and their activation effect of catalase (CAT).

Methods

The chemical constituents were isolated from Penicillium HDS-Z-1E, by using silica gel, Sephadex LH-20 and HPLC. The structural elucidations of five metabolites were elucidated on the basis of spectroscopic including 1H-NMR, 13C-NMR, HMBC and HSQC. Their activation sites of catalase have been investigated by molecular docking.

Results

Five metabolites, compounds (15) were isolated from Penicillium HDS-Z-1E and identified as 4-hydroxy-4-methyltetrahydro-2H-pyran-2-one (1), 4-hydroxymethyl-5, 6-dihydro-pyran-2-one (2), 5, 6-dihydro-2-oxo-2H-pyran-4-carboxylic (3), N-acetyl-hydrazinobenzoic acid (4), and methyl 2-(2, 5-dihydroxyphenyl) acetate (5).

Conclusion

Compound 3 is a new compound. Compounds 3 and 4 may have potential activators of catalase, providing a theoretical basis for the development of CAT activators.

方法 利用硅胶、Sephadex LH-20 和 HPLC 从青霉 HDS-Z-1E 中分离出化学成分。通过 1H-NMR、13C-NMR、HMBC 和 HSQC 等光谱分析,阐明了五种代谢物的结构。通过分子对接研究了它们对过氧化氢酶的激活位点。结果从青霉 HDS-Z-1E 中分离出五种代谢物化合物(1-5),并鉴定为 4-羟基-4-甲基四氢-2H-吡喃-2-酮(1)、4-羟甲基-5、6-二氢吡喃-2-酮 (2)、5, 6-二氢-2-氧代-2H-吡喃-4-羧酸 (3)、N-乙酰基肼基苯甲酸 (4) 和 2-(2,5-二羟基苯基) 乙酸甲酯 (5)。结论化合物 3 是一种新化合物。化合物 3 和 4 可能是过氧化氢酶的潜在激活剂,为开发 CAT 激活剂提供了理论依据。
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引用次数: 0
A new tetracyclic triterpenoid from endophytic fungus Fusarium sporotrichioides 内生真菌孢毛镰刀菌的一个新的四环三萜
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2022.10.007
Yajing Wang, Chunyue Liu, Yihui Yang, Chang Li, Yuehu Pei

Objective

To isolate bioactive compounds from the endophytic fungus Fusarium sporotrichioides isolated from Rauwolfia yunnanensis, and investigate their pharmacological activities.

Methods

The chemical constituents were isolated and purified by combining with ODS column chromatography, silica gel column chromatography and by performing semipreparative HPLC. Their structures were established on the basis of 1D NMR (1H-NMR and 13C-NMR) and 2D NMR (1H–1H COSY, HSQC, HMBC and NOESY), as well as HRESIMS and comparison with literature data. In addition, the absolute configuration of compound 1 was determined by calculated ECD data.

Results

One previously undescribed tetracyclic triterpenoid derivative, named as integracide L (1), 12α-acetoxy-4,4-dimethyl-24-methylene-5α-cholesta-8,14-diene-2α,3β,11β-triol (2), 12α-acetoxy-4,4-dimethyl-24-methylene-5α-cholesta-8-momoene-2α,3β,11β-triol (3), 12α-acetoxy-4,4-dimethyl-24-methylene-5α-cholesta-8,14-diene-3β,11β-triol (4), and 12α-acetoxy-4,4-dimethyl-24-methylene-5α-cholesta-8-momoene-3β,11β-triol (5) were isolated from F. sporotrichioide. Moreover, compound 1 was rare tetracyclic triterpenoid with single methyl replacement at C-4 position.

Conclusion

Compound 1 was a new tetracyclic triterpenoid isolated from the endophytic fungus F. sporotrichioides. In addition, compound 2 could inhibit the growth of three different human cancer cells significantly. Compounds 3 and 5 were found to possess better cytotoxic activities on HepG-2 cells than the other compounds, with IC50 values of (2.8 ± 0.1) and (6.3 ± 0.3) μmol/L respectively.

方法 结合ODS柱层析、硅胶柱层析和半制备高效液相色谱法,分离纯化了云南芒萁内生真菌中的化学成分。根据一维核磁共振(1H-NMR 和 13C-NMR)、二维核磁共振(1H-1H COSY、HSQC、HMBC 和 NOESY)、HRESIMS 以及与文献数据的比较,确定了它们的结构。此外,还通过计算 ECD 数据确定了化合物 1 的绝对构型。结果一种以前未曾描述过的四环三萜类衍生物被命名为 integracide L (1),即 12α-acetoxy-4,4-dimethyl-24-methylene-5α-cholesta-8,14-diene-2α,3β,11β-triol (2),12α-acetoxy-4,4-dimethyl-24-methylene-5α-cholesta-8-momoene-2α、3β,11β-三醇(3)、12α-乙酰氧基-4,4-二甲基-24-亚甲基-5α-胆甾烯-8,14-二烯-3β,11β-三醇(4)和 12α-乙酰氧基-4,4-二甲基-24-亚甲基-5α-胆甾烯-8-亚甲基-3β,11β-三醇(5)从 F. sporotrichioide 分离出来。sporotrichioide.结论化合物 1是从内生真菌 F. sporotrichioides 中分离出的一种新的四环三萜类化合物。此外,化合物 2 能显著抑制三种不同人类癌细胞的生长。与其他化合物相比,化合物 3 和 5 对 HepG-2 细胞具有更好的细胞毒性活性,其 IC50 值分别为 (2.8 ± 0.1) 和 (6.3 ± 0.3) μmol/L。
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引用次数: 0
Osthole ameliorates chronic pruritus in 2,4-dichloronitrobenzene-induced atopic dermatitis by inhibiting IL-31 production Osthole 通过抑制 IL-31 的产生,改善 2,4-二氯硝基苯诱发的特应性皮炎的慢性瘙痒症状
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2024.01.003
Shuang He, Xiaoling Liang, Weixiong Chen, Yangji Nima, Yi Li, Zihui Gu, Siyue Lai, Fei Zhong, Caixiong Qiu, Yuying Mo, Jiajun Tang, Guanyi Wu
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引用次数: 0
Herb induced liver injury by Xianling Gubao Tablets: A case assessed for causality using updated RUCAM and integrated evidence chain 仙灵葛宝片引起的中草药肝损伤:使用更新的 RUCAM 和综合证据链评估一个病例的因果关系
IF 3.8 4区 医学 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.chmed.2023.10.005
Chunyu Li , Yingying Li , Zhaofang Bai , Jiabo Wang , Guohui Li , Xiaohe Xiao

Objective

A typical case of Xianling Gubao (XLGB) Tablets-induced liver injury was systematically studied in the clinic and the laboratory.

Methods

A patient with herb-induced liver injury (HILI) and a history of taking XLGB Tablets before disease onset was engaged as the study subject, and the case was diagnosed according to the updated Roussel Uclaf Causality Assessment Method (RUCAM) and the integrated evidence chain (iEC) method recommended by the Guidelines for Diagnosis and Treatment of Herb-induced Liver Injury (HILI Guidelines).

Results

Clinical history, biochemical indexes and imaging tests were used to exclude the influence of fundamental diseases and confusing liver diseases such as viral, alcoholic and autoimmune liver diseases on the diagnosis. Based on an investigation of the patient’s medication history, she was suspected to have HILI caused by XLGB Tablets, as the patient was only taking an oral preparation of XLGB Tablets, and the influence of other drugs on the diagnosis was excluded. This patient with alanine aminotransferase (ALT) ≥ 3 × upper limit of normal (ULN) and a calculated R of 6 was diagnosed with possible acute drug-induced hepatocellular injury. The relationship was considered “highly probable” (score of 9) using the updated RUCAM of 2016. Moreover, the fingerprint similarity between the preparation taken by the patient and a commercially available preparation was 0.99, suggesting that the patient was consuming XLGB Tablets rather than another drug. LC-MS technology and the Agilent Fake TCM-Drugs database were used to investigate the drug, and no chemical additions were found. Examination of the drug for pesticide residues, heavy metals, aflatoxins and other exogenous substances indicated compliance with the content limits of the Chinese Pharmacopoeia.

Conclusion

In summary, the final diagnosis of XLGB-induced liver injury reached the clinical diagnosis of HILI and was acute severe hepatocellular injury type by the updated RUCAM and iEC. Therefore, this study provides scientific evidence regarding the causality evaluation of compound preparations of traditional Chinese medicines-induced liver injury.

目的 在临床和实验室系统研究一例典型的仙灵葛片诱发肝损伤病例。方法 以中草药肝损伤(HILI)患者为研究对象,根据《中草药肝损伤诊断和治疗指南》(HILI指南)推荐的最新Roussel Uclaf因果关系评估法(RUCAM)和综合证据链法(iEC)对病例进行诊断。结果通过临床病史、生化指标和影像学检查,排除了病毒性、酒精性和自身免疫性肝病等基础疾病和易混淆肝病对诊断的影响。根据对患者用药史的调查,由于患者仅口服 XLGB 片制剂,排除了其他药物对诊断的影响,因此怀疑其为 XLGB 片引起的 HILI。该患者的丙氨酸氨基转移酶(ALT)≥ 3 倍正常值上限(ULN),计算的 R 值为 6,因此被诊断为可能是急性药物性肝细胞损伤。根据 2016 年更新的 RUCAM,这种关系被视为 "高度可能"(9 分)。此外,患者服用的制剂与市售制剂之间的指纹相似度为 0.99,表明患者服用的是 XLGB 片而不是其他药物。利用 LC-MS 技术和 Agilent Fake TCM-Drugs 数据库对该药物进行了调查,未发现任何化学添加物。结论综上所述,XLGB 引起的肝损伤的最终诊断符合 HILI 的临床诊断,根据最新的 RUCAM 和 iEC,诊断为急性重症肝细胞损伤型。因此,本研究为中药复方制剂诱发肝损伤的因果关系评价提供了科学依据。
{"title":"Herb induced liver injury by Xianling Gubao Tablets: A case assessed for causality using updated RUCAM and integrated evidence chain","authors":"Chunyu Li ,&nbsp;Yingying Li ,&nbsp;Zhaofang Bai ,&nbsp;Jiabo Wang ,&nbsp;Guohui Li ,&nbsp;Xiaohe Xiao","doi":"10.1016/j.chmed.2023.10.005","DOIUrl":"10.1016/j.chmed.2023.10.005","url":null,"abstract":"<div><h3>Objective</h3><p>A typical case of Xianling Gubao (XLGB) Tablets-induced liver injury was systematically studied in the clinic and the laboratory.</p></div><div><h3>Methods</h3><p>A patient with herb-induced liver injury (HILI) and a history of taking XLGB Tablets before disease onset was engaged as the study subject, and the case was diagnosed according to the updated Roussel Uclaf Causality Assessment Method (RUCAM) and the integrated evidence chain (iEC) method recommended by the <em>Guidelines for Diagnosis and Treatment of Herb-induced Liver Injury</em> (HILI Guidelines).</p></div><div><h3>Results</h3><p>Clinical history, biochemical indexes and imaging tests were used to exclude the influence of fundamental diseases and confusing liver diseases such as viral, alcoholic and autoimmune liver diseases on the diagnosis. Based on an investigation of the patient’s medication history, she was suspected to have HILI caused by XLGB Tablets, as the patient was only taking an oral preparation of XLGB Tablets, and the influence of other drugs on the diagnosis was excluded. This patient with alanine aminotransferase (ALT) ≥ 3 × upper limit of normal (ULN) and a calculated R of 6 was diagnosed with possible acute drug-induced hepatocellular injury. The relationship was considered “highly probable” (score of 9) using the updated RUCAM of 2016. Moreover, the fingerprint similarity between the preparation taken by the patient and a commercially available preparation was 0.99, suggesting that the patient was consuming XLGB Tablets rather than another drug. LC-MS technology and the Agilent Fake TCM-Drugs database were used to investigate the drug, and no chemical additions were found. Examination of the drug for pesticide residues, heavy metals, aflatoxins and other exogenous substances indicated compliance with the content limits of the <em>Chinese Pharmacopoeia</em>.</p></div><div><h3>Conclusion</h3><p>In summary, the final diagnosis of XLGB-induced liver injury reached the clinical diagnosis of HILI and was acute severe hepatocellular injury type by the updated RUCAM and iEC. Therefore, this study provides scientific evidence regarding the causality evaluation of compound preparations of traditional Chinese medicines-induced liver injury.</p></div>","PeriodicalId":9916,"journal":{"name":"Chinese Herbal Medicines","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1674638424000091/pdfft?md5=70aec6d58fce7f9b9d5adc3a5c26f656&pid=1-s2.0-S1674638424000091-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Chinese Herbal Medicines
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