Pharmacokinetics study of 16 representative components from Baoyuan Decoction in rat plasma by LC-MS/MS with a large-volume direct injection method.
Lu Ying-Yuan,Chen Jin-Feng,Song Jin-Yang,Du Zhi-Yong,Wang Jin-Long,Qian Yi,Jiang Yong,Guo Xiao-Yu,Tu Peng-Fei
Phytomedicine : international journal of phytotherapy and phytopharmacology
BACKGROUND:Baoyuan decoction (BYD), a well-known traditional Chinese medicine (TCM) formula, is clinically used for the treatment of aplastic anemia, chronic renal failure, coronary heart disease, etc. PURPOSE: The purpose of this study was to develop a large-volume direct injection liquid chromatography-mass spectrometry (LC-MS) method for simultaneous determination of 16 representative flavonoids and saponins in rat plasma after oral administration of BYD. METHODS:The rat plasma sample was injected directly into a pre-column, which was eluted firstly by 0.05% formic acid in water. Then, the accumulated components were eluted from the pre-column and transferred into a Waters BEH C18 column with acetonitrile and water system (contain 0.05% formic acid) as the mobile phase at a rate of 0.3 ml/min. The detection was accomplished in a negative mode using the schedule multiple-reaction monitoring (sMRM). RESULTS:The correlation coefficients for calibration curves were all higher than 0.9920 for formononetin, ononin, calycosin, liquiritigenin, isoliquiritigenin, glycyrrhizic acid, glycyrrhetinic acid, liquiritin, isoliquiritin, liquiritin apioside, isoliquiritin apioside, ginsenoside Rb1, ginsenoside Re, ginsenoside Rd, ginsenoside Rg1 and astragaloside. The intra- and inter-day precisions (RSD) and accuracy (RE) for the investigated components were in the range of -10.9 to 13.7%. The average recoveries were in the range of 75.7-108.6%. This method was successfully applied to investigate the pharmacokinetics of 16 compounds of BYD in rats. The absorption and elimination rates of the representative saponins were significantly slower than most of the targeted-flavonoids after oral administration of BYD in rats. CONCLUSION:The results demonstrated that the large-volume direct injection LC-MS method provided a rapid and efficient approach for multi-components pharmacokinetics of TCM.
10.1016/j.phymed.2018.09.002
Acupuncture Application in Chronic Kidney Disease and its Potential Mechanisms.
Xiong Wei,He Fang-Fang,You Ren-Yu,Xiong Jing,Wang Yu-Mei,Zhang Chun,Meng Xian-Fang,Su Hua
The American journal of Chinese medicine
Chronic kidney disease (CKD) is an increasing major public health problem worldwide. The number of CKD patients on hemodialysis is growing rapidly as well. Acupuncture technique is one of the traditional Chinese medicine methods and has been used in a variety of diseases. Nowadays, the clinical application of acupuncture technique for CKD patients has become the focus for its effectiveness and security. In this paper, we will review the therapeutic effects and mechanisms of different acupuncture techniques for CKD patients. In patients with CKD, acupuncture improves renal function, reduces proteinuria, controls hypertension, corrects anemia, relieves pain, and controls many hemodialysis-related complications such as uremic pruritus, insomnia and fatigue. The mechanisms are related to the regulation of sympathetic nerve and the activation of bioactive chemicals. In conclusion, acupuncture is proved to be beneficial for CKD patients. More research, however, is needed to verify the potential mechanisms.
10.1142/S0192415X18500611
A Telemedicine-Based Registration System for the Management of Renal Anemia in Patients on Maintenance Hemodialysis: Multicenter Study.
Ni Zhaohui,Jin Haijiao,Jiang Gengru,Wang Niansong,Peng Ai,Guo Zhiyong,Bai Shoujun,Zhou Rong,Lu Jianrao,Wang Yi,Li Ying,Zhuang Shougang,Yu Chen,Deng Yueyi,Jin Huimin,Xu Xudong,Zhang Junli,Zhao Junli,Yu Xiuzhi,Wang Xiaoxia,Zhang Liming,Niu Jianying,Liu Kun,Bao Xiaorong,Wang Qin,Ma Jun,Hu Chun,Zang Xiujuan,Yu Qing
Journal of medical Internet research
BACKGROUND:Renal anemia is one of the most important complications in patients on maintenance hemodialysis (MHD). Telehealth-based dialysis registration systems have the advantage of real-time monitoring and have gradually been applied to the management of chronic diseases. OBJECTIVE:The objective of our study was to evaluate the impact of a telehealth-based dialysis registration system on patients on MHD in terms of renal anemia control. METHODS:The Red China project aimed to develop a dialysis registration system based on the WeChat mobile platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, and baseline creatinine levels were recorded using this system. In addition, the hemoglobin and hematocrit levels were recorded monthly. The platform then generated a hemoglobin and hematocrit statistics report for each hemodialysis center monthly, including the detection rate, target rate, and distribution of hemoglobin and released it to physicians via the WeChat mobile phone app. The physicians were then able to treat the individual's anemia appropriately by changing the doses of erythropoiesis-stimulating agents or iron use on the basis of this report. We analyzed the demographic and baseline laboratory parameters, detection rate, target rate, and average level and distribution of hemoglobin 28 months after the launch of the project. RESULTS:A total of 8392 patients on MHD from 28 hemodialysis centers in Shanghai were enrolled from June 2015 to October 2017. The detection rate of hemoglobin increased from 54.18% to 73.61% (P<.001), the target rate of hemoglobin increased from 47.55% to 56.07% (P<.001), and the mean level of hemoglobin increased from 10.83 (SD 1. 60) g/dL to 11.07 (SD 1.60) g/dL (P<.001). In addition, the proportion of patients with hemoglobin levels ≥11 g/dL but <13 g/dL increased from 40.40% to 47.48%. CONCLUSIONS:This telehealth-based dialysis registration system can provide timely reporting of the anemia status in patients on MHD, which may improve the awareness of anemia and the attention to and compliance with anemia monitoring.
10.2196/13168
Efficacy and safety of Danggui Buxue Decoction in combination with western medicine treatment of anemia for renal anemia: a systematic review and meta-analysis.
Zhao Ming-Ming,Zhang Yu,Li Liu-Sheng,Yu Zi-Kai,Li Bo
Annals of translational medicine
BACKGROUND:To evaluate the efficacy and safety of Danggui Buxue Decoction for renal anemia when combined with western medicine treatment of anemia. METHODS:Electronic searching Medline, Embase, Web of Science, Cochrane Library, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang data, Chinese Sci-tech periodical full-text database (VIP). Randomized controlled trials reported results of efficacy and safety of Danggui Buxue Decoction in combination with western medicine treatment of anemia for renal anemia. The "risk of bias assessment tool (Version 5.1.0)" of Cochrane Handbook was applied to assess the quality of included trials and RevMan 5.3 software was used for data analysis. RESULTS:A total of 111 studies was retrieved, seven studies including 460 cases were included, the methodological quality of included trials was poor. The result of meta-analysis demonstrated that there was no difference in hemoglobin (Hb) [weighted mean differences (WMD) =-8.75, 95% confidence interval (CI): (-18.64, 1.13), P=0.08], whereas the subgroup analysis showed the difference was significant when the ratio of Radix Astragali to Radix Angelicae Sinensis was 5:1 [WMD =-16.27, 95% CI: (-28.73, -3.80), P=0.01], increase of Hb was more effective in experimental group than control group and the difference was not significant when the ratio of Radix Astragali to Radix Angelicae Sinensis was 5≠1 [WMD =-0.57, 95% CI: (-4.52, 3.39), P=0.78]. There were significant differences in red blood cell (RBC) [WMD =-0.49, 95% CI: (-0.69, -0.28), P<0.00001], hematocrit (HCT) [WMD =-1.92, 95% CI: (-3.15, -0.69), P=0.002] and clinical efficacy [odd ratio (OR) =0.30, 95% CI: (0.13, 0.69), P=0.004] between Danggui Buxue Decoction combination group and control group, the experimental group was better than control group. There was no adverse event reported in the experimental group. CONCLUSIONS:Danggui Buxue Decoction in combination with conventional western medicine (CWM) for renal anemia might be superior to CWM alone and there was no adverse event in the experimental group, it might be more effective when the ratio of Radix Astragali to Radix Angelicae Sinensis was 5:1. However, the quality of included studies was not high, and less attention was paid to the safety, high quality randomized controlled trials are needed to further confirm the findings.
10.21037/atm.2017.01.17
Chinese herbal medicine for oesophageal cancer.
The Cochrane database of systematic reviews
BACKGROUND:Oesophageal cancer is the seventh leading cause of cancer death worldwide. Traditional Chinese herbal medicine is sometimes used as an adjunct to radiotherapy or chemotherapy for this type of cancer. This review was first published in 2007 and updated in 2009; this 2016 update is the latest version of the review. OBJECTIVES:To assess the efficacy and possible adverse effects of the addition of Chinese herbal medicine to treatment with radiotherapy or chemotherapy for oesophageal cancer. SEARCH METHODS:We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register, the Cochrane Library, MEDLINE, EMBASE, Allied and Complementary Medicine Database (AMED), China National Knowledge Infrastructure (CNKI), VIP database, Wanfang database and the Chinese Cochrane Centre Controlled Trials Register up to 1 October, 2015. We also searched databases of ongoing trials, the Internet and reference lists. SELECTION CRITERIA:Randomised controlled trials (RCTs) comparing the use of radiotherapy or chemotherapy with and without the addition of Chinese herbal medicine. DATA COLLECTION AND ANALYSIS:At least two review authors independently extracted data and assessed trial quality. MAIN RESULTS:We tried to contact the 142 study authors by telephone, and finally included nine studies with 490 participants. All included studies were conducted in China, and allocated advanced oesophageal cancer patients to radiotherapy or chemotherapy groups, with and without additional Chinese herbal medicine. Quality of life, short-term therapeutic effects, TCM symptoms and adverse events caused by radiotherapy or chemotherapy were reported in these studies. Overall, we considered the trials to be at unclear or high risk of bias.The quality of life measure was conducted before and after the intervention; our analysis showed a beneficial effect, both in number of participants experiencing an improvement (risk ratio (RR) 2.20, 95% confidence interval (CI) 1.42 to 3.39; 5 RCTs, 233 participants, change of performance status score ≥ 10) and number of participants experiencing a deterioration (RR 0.41, 95% CI 0.27 to 0.62; 6 RCTs, 287 participants, change of performance status score ≤ 10). We judged this to have low quality evidence, downgrading quality of evidence for risk of bias and imprecision, and upgrading quality of evidence for the large effect.For short-term therapeutic effects, the results suggest that traditional Chinese medicine (TCM) has a positive impact on improvement (complete response + partial response) (RR 1.17, 95% CI 1.02 to 1.35; 8 RCTs, 450 participants), moderate quality evidence and downgrading for risk of bias. There was no significant difference for progressive disease (RR 0.73, 95% CI 0.52 to 1.01; 8 RCTs, 450 participants), low quality evidence and downgrading for risk of bias and imprecision. Three studies assessed this outcome after four weeks or three months' follow-up, the remaining studies gave no detailed information for this outcome. TCM symptoms, which was similar to short-term therapeutic effects evaluated with TCM clinical criteria, was diagnosed in two studies of 88 people at the end of the intervention. The results suggest that TCM has a positive impact on both total effectiveness (RR 1.84, 95% CI 1.20 to 2.81) and ineffectiveness (RR 0.22, 95% CI 0.05 to 0.93); we judged the studies to have very low quality evidence, downgrading for risk of bias and imprecision.Nine studies reported a series of adverse events caused by radiotherapy or chemotherapy at the end of the intervention, including mucositis, radiation oesophagitis, arrest of bone marrow, gastrointestinal reactions, renal and hepatic impairment, white blood cell descent, neurotoxicity, cardiac toxicity and anaemia. For those containing multiple studies, we conducted a pooled analysis. As a result, TCM showed a significant effect on radiation oesophagitis (RR 0.66, 95% CI 0.47 to 0.94; 2 RCTs, 90 participants), gastrointestinal reactions (RR 0.54, 95% CI 0.36 to 0.81; 4 RCTs, 268 participants) and white blood cell descent (RR 0.60, 95% CI 0.44 to 0.83; 4 RCTs, 224 participants). The quality of evidence was low or very low, downgrading for risk of bias and imprecision. AUTHORS' CONCLUSIONS:We currently find no evidence to determine whether TCM is an effective treatment for oesophageal cancer. The effect of TCM on short-term therapeutic effects is uncertain. TCM probably has positive effects on quality of life and on some adverse events caused by radiotherapy or chemotherapy in advanced oesophageal cancer patients undergoing radiotherapy or chemotherapy. The results of the review need to be interpreted cautiously owing to overall low quality evidence. Future trials should be large and correctly designed to detect important clinical effects and minimise risk of bias.
10.1002/14651858.CD004520.pub7
Meta-Analysis of Astragalus-Containing Traditional Chinese Medicine Combined With Chemotherapy for Colorectal Cancer: Efficacy and Safety to Tumor Response.
Lin Shuang,An Xiaoxia,Guo Yong,Gu Jianzhong,Xie Tian,Wu Qibiao,Sui Xinbing
Frontiers in oncology
This meta analysis evaluated the comparative safety and efficacy for the addition of Astragalus-based Chinese medicines combined with chemotherapy and chemotherapy alone for colorectal cancer (CRC) treatment. Systematic literature search was performed by PubMed, EMBSAE, Ovid, Web of Science, Cochrane Library, Chinese Science and Technology Journals (CQVIP), China Academic Journals (CNKI), and Chinese Biomedical Literature database. A total of 22 studies which reported on 1,409 subjects were identified. This meta-analysis indicated that the combination of Astragalus-based Chinese medicines and chemotherapy may increase the efficiency of tumor response rate (TRR) for the treatment of CRC patients (RR: 1.52; 95% CI: 1.24-1.87; < 0.0001), improve their life quality based on KPS (RR: 2.51; 95% CI: 1.85-3.42; < 0.00001 and WMD: 10.96; 95% CI: 9.45-12.47; < 0.00001), and reduce the adverse reactions, including neutropenia (RR: 0.52; 95% CI: 0.44-0.62; < 0.00001), anemia (RR: 0.49; 95% CI: 0.34-0.70; < 0.0001), thrombocytopenia (RR: 0.59; 95% CI: 0.46-0.77; = 0.0001), nausea and vomiting (RR: 0.56; 95% CI: 0.46-0.68; < 0.00001), diarrhea (RR: 0.55; 95% CI: 0.40-0.75; = 0.0001), and neurotoxicity (RR: 0.56; 95% CI: 0.49-0.65; < 0.00001). Hepatic dysfunction (RR: 0.76; 95% CI: 0.53-1.09; = 0.13) and renal dysfunction (RR: 0.95; 95% CI: 0.51-1.76; = 0.87) were similar between two groups. The results showed that Astragalus-based Chinese medicines combined with chemotherapy in the treatment of CRC may increase the efficiency of TRR, reduce chemotherapeutic agents-associated adverse reactions, and improve their life quality when compared with chemotherapy alone, but further randomized studies are warranted.
10.3389/fonc.2019.00749
Possible mechanisms by which silkworm faeces extract ameliorates adenine-induced renal anaemia in rats.
Mei Hao,Wu Niuniu,Huang Xiao,Cui Zheng,Xu Jingya,Yang Xiawen,Zeng Fang,Wang Kaiping
Journal of ethnopharmacology
ETHNOPHARMACOLOGICAL RELEVANCE:Silkworm faeces are the dry faeces of the insect Bombyx mori (Linnaeus) and have historically been used in traditional Chinese medicine to treat blood deficiency and rheumatic pain. Silkworm faeces extract (SFE) is derived from silkworm faeces. AIM OF THE STUDY:Clinical observations of patients in the Department of Nephrology have shown that SFE effectively improves renal anaemia. However, the molecular mechanism remains unclear. This article mainly explores the regulatory effects of SFE on erythropoietin (EPO) and hepcidin to identify the molecular mechanism of SFE. MATERIALS AND METHODS:A rat model of renal anaemia was established by feeding rats food containing 0.75% adenine. SFE was orally administered to the rats, while recombinant human erythropoietin (rhEPO) was used as a positive control drug. Haematological parameters and inflammation levels were compared between rats from each group, and pathological kidney sections from each rat were observed. The serum EPO and hepcidin levels were detected using enzyme-linked immunosorbent assay (ELISA) kits, while Western blot analyses were performed to detect the levels of proteins involved in the EPO-related hypoxia-inducible factor 2α (HIF-2α)/prolyl hydroxylase 2 (PHD2) signalling pathway and hepcidin-related BMP6/SMAD4 and interleukin-6 (IL-6)/STAT3 signalling pathways. RESULTS:SFE significantly ameliorated haematological parameters, renal function, and inflammation levels in the rats. A mechanistic study showed that SFE promoted EPO expression by upregulating HIF-2α expression and inhibiting the expression of NF-κB and GATA2 both in vivo and in vitro. In particular, SFE inhibited PHD2 expression, resulting in a decrease in the enzymatic reaction of HIF-2α to increase EPO expression. Furthermore, SFE inhibited hepcidin expression by blocking the BMP6/SMAD4 and IL-6/STAT3 pathways. CONCLUSIONS:SFE regulated iron metabolism by inhibiting hepcidin and simultaneously promoted EPO synthesis to improve renal anaemia in rats.
10.1016/j.jep.2020.113448
Effects of Baoyuan decoction, a traditional Chinese medicine formula, on the activities and mRNA expression of seven CYP isozymes in rats.
Lu Ying-Yuan,Du Zhi-Yong,Li Yan,Wang Jin-Long,Zhao Ming-Bo,Jiang Yong,Guo Xiao-Yu,Tu Peng-Fei
Journal of ethnopharmacology
ETHNOPHARMACOLOGICAL RELEVANCE:Baoyuan decoction (BYD), a traditional Chinese medicine (TCM) formula, is composed of four herbs and widely used with western drugs to treat coronary heart disease, aplastic anemia and chronic renal failure in clinic. However, no study of the effect of BYD on the cytochrome P450 (CYP) activities has been reported. AIM OF THE STUDY:The purpose of the present study was to evaluate the potential influences of BYD on the activities of seven CYP isozymes (CYP1A2, 2B6, 2C9, 2C19, 2D6, 2E1, and 3A4) in rats. MATERIALS AND METHODS:A sensitive and selective UPLC-MS/MS method for simultaneous determination of seven probe drugs and internal standard (IS) in rat plasma was developed and validated. The influence of BYD on the activities of CYP isozymes and mRNA expression levels were carried out by comparing plasma pharmacokinetics and real-time reverse transcription-polymerase chain reaction (RT-PCR) of probe drugs between control and BYD treatment groups respectively. RESULTS:The calibration curve were linear, with correlation coefficient (r) > 0.99 for seven probe drugs. The intra and inter-assay accuracy and precision of the method were within ± 14.9% and the recoveries ranged from 83.2% to 106.1%. Compared with control group, BYD at low (1.46 g/kg) and high (7.30 g/kg) dosages could significantly increase C and AUC of chlorzoxazone and testosterone, while decrease AUC of phenacetin at high dosage and increase AUC of tolbuamide and metoprolol. Additionally, BYD had increased AUC of bupropion at low dosage and decreased it at high dosage. The mRNA expression results were in accordance with those of pharmacokinetic. CONCLUSION:BYD exhibited inhibitory effects on CYP2C9, CYP2E1, and CYP3A4. Moreover, BYD had induction effects on CYP1A2, and CYP2D6 activities. However, no significant change in CYP2C19 activity was observed. It would be useful for the safe and effective usage of BYD in clinic.
10.1016/j.jep.2018.07.023