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Herbal antioxidant products

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October 5, 2010 at 12:56 pm

The ethnomedical literature contains a large number of plants that can be used against diseases, in which ROS are thought to play a major role. A large number of plants and phytoconstituents possess antioxidant properties (Table: Potent antioxidant plants and their phytoconstituents) and many of them are now articles of commerce, claiming to prevent or reduce diseases associated with high levels of ROS. Antioxidants can also be used in the preservation of food products. An important source of antioxidants is the diet, which contains numerous plants with antioxidant activity, including the spices and condiments. The traditional medical literature describes the potential role of spices as a source of many vitamins and as domestic remedies for many human diseases and the consumption of fruits and vegetables, olive oil, red wine and tea is inversely correlated with rates of incidence of many diseases.

Table: Potent antioxidant plants and their phytoconstituents

Plants Family Part used Phytoconstituents
Artemisia monata Asteraceae Aerial Luteolin-7-O-rutinoside and Esculctin
Andrographis paniculata Acanthaceae Arial parts Andrographolide 14-deoxy-11-oxo-andrographolide, neo-andrographolide
Allium sativum Liliaceace Bulb Garlicin, allicin, S-allylcysteine, S-allylmercaptocysteine, allin, allixin, N-acetyl-S-allylcysteine
Anoectochilus formosanus Orchidaceae Whole plant Kinsenone (diarylpentanoid) andflavonoid glycosides
Asparagus racemosus Liliaceae Rhizomes Shatavarin, coniferin and undecanyl cetanoate
Broussonetia papyrifera Moraceae Leaf Broussoflavonols
Bacopa monniera Scrophulariaceae Whole plant BacosideA3, bacosaponin C
Bulbine capitata Asphodelaceae Root Isofuranonaphthoquinones
Burkea africana Leguminosae Bark Proanthocyanidins
Cedrus decodara Pinaceae Heartwood Matairesinol
Crocus sativus Iridaceae Stigmas Crocin
Curcuma longa Zingiberaceae Rhizhomes Curcumin, turmeric antioxidant protein
Chrysophyllum cainito Sapotaceae Seeds, fruits Quercetin and other polyphenols
Corylus colurna Betulaceae Leaves Flavonoids
Crataegus monogyna Rosaceae Leaves, flowers and fruits Flavonoids, proanthocyanidins, catechins
Cyanchum wilfordii Asclepiadaceae Roots Cynandione A and a biacetophenone
Dalbergia odorifera Fabaceae Root Benzophenone derivative and flavonoids
Dirca palustris Thymelaeaceae Twigs Five novel phenolic glycosides
Daphniphyllum calycinum Daphniphyllaceae Leaf Flavonoid glycoside
Dracaena cinnabari Ruscaceae (Dracaenaceae) Whole plant Homoisoflavonoids
Ephemerantha lonchophylla Orchidaceae Stem Dihydrostilbene, phenantherene
Eucalyptus globulus Myrtaceae Leaves Ellagic acid
Eriobotrya japonica Rosaceae Leaves Flavonoids; chlorogenic acid, quercetin-3-sambubioside, methyl chlorogenate kaempferol, quercetin-3-rhamnoside
Emblica officinalis Euphorbiaceae Fruits Emblicanin A and B, gallic acid, punigluconin and pedunculagin
Ficus bengalensis Moraceae Bark Rhamnoside and cellobioside
Garcinia subelliptica Clusiaceae Wood Three prenylated xanthones
Garcinia kola Clusiaceae Seeds Kolaviron (biflavones)
Camellia sinensis Theaceae Leaf Epigallocatechin, gallocatechin and epigallocatechin gallate
Hordeum vulgare Poaceae Leaves Isovitexin derivatives
Glycyrrhiza glabra Leguminosae Roots Glabridin
Ginkgo biloba Ginkgoaceae Leaf Ginkgolides, bilobalide, sciadopitysin, ginkgetin, bilobetin
Helenium aromaticum Compositae Whole plant Sesquiterpene lactones; helenalin, mexicanin-l, linifolin A, geigerinin
Hedyotis diffusa Rubiaceae Fresh aerial New acylflavonol diglycoside; kaempferol and quercetin derivatives, flavonol and iridoid glycosides
Hierochloe odorata Poaceae Aerial Benzophenanthrone derivatives
Hibiscus syriacus Malvaceae Root bark Lignans: hibiscuside, syringaresinol, E&Z feruloyltyraminesand isoflavonoids
Hypericum erectum Hypericaceae Aerial Flavonoids-quercetrin, hyperoside, isoquercetrin, orientin
Helichrysum picardii Asteraceae Aerial Gnaphalin
Iryanthera lancifolia Poaceae Pericarps Two dihydrochalcones and two flavonolignans
Amaranthaceae Aerial Waxes, β-sitosterol, cam, pestrol and methoxy flavone
Iberis amara Brassicaceae Seeds 6-O-sinapoyl sucrose
Lavandula angustifolia Lamiaceae Aerial Phenolics-romarinic acid, caffeic acid, luteolin and methyl carnosoate
Larix gmelini Pinaceae Wood Dihydroquercetin
Mahonia aquifolium Berberidaceae Root and leaf Alkaloids
Muscari racemosum Liliaceae Flower homoisoflavonoids
Magnolia coco Magnoliaceae Stem Lignans-sesamin, fargesin, syringaresinol
Myrica gale Myricaceae Fruit Flavonoids-C-methylated dihydrochalcones, myrigalone A & B
Mangifera indica Anacardiaceae Leaves, bark, fruits Mangiferin, myricetin, protocatechuic acid, quercetin, friedelin, gallic acid, homomangiferin, kaempferol and lupeol
Nelumbo nucifera Nymphaeaceae Rhizomes, seed, leaves, flower Gallic acid
Panax pseudoginseng Araliaceae Roots Trilinolein
Phyllostachys edulis Poaceae Leaves Chlorogenic acid derivatives
Punica granatum Punicaceae Fruits Flavonoids
Prunus cerasus Rosaceae Fruits Cholorgenic acid methylester derivatives
Prunus amygdalus Rosaceae Fruit skin Catechin, protocatechinic acid and flavonoids
Phaseolus aureus Fabaceae Seeds Flavonoids
Pteleopsis hylodendron Combretaceae Stem bark Ellagic acid derivatives
Psoralea corylifolia Leguminosae Seeds Monoterpene phenol-bakuchiol
Pistacia weinmannifolia Anacardiaceae Leaves Pistafolia A
Picrorhiza kurroa Scrophulariaceae Roots and rhizomes Picrovil
Panax ginseng Araliaceae Roots Ginsenosides
Palm spp. Arecaceae Oil Tocotrienols
Podocarpus nagi Podocarpaceae Root bark Totarane diterpenoids
Rosmarinus officinalis Lamiaceae Leaves Diterpenoids
Salvia officinalis Lamiaceae Leaves Phenolics-abietane diterpenes, caffeoyl glycosides, rosmarinic acid
Saururus chinensis Sauruaceae parts Underground Machilin-D
Saururus cernuus Saururaceae Whole plant Feruloylgeraniol derivative
Silybum marianum Asteraceae Seeds Silybin, silymarin
Spinacia oleracea Amaranthaceae Leaves p-Coumaric acid derivative and flavonoids
Terminalta catappa Euphorbiaceae Leaves Punicalagin and punicalin
Terminalia bellerica Com beta ceae Fruits Gallic acid, ellagic acid, ethyl gallate, galloyl glucose, chebulagic acid, bellericanin
Telekia speciosa Asteraceae Leaves and Roots Sesquiterpene lactones
Vaccinium myrtillus Ericaceae Leaves Anthocyanosides
Vitex rotundifolia Verbenaceae Fruits Labdane and abietane-type diterpenoids
Withania somnifera Solanaceae Root Glycowithanolides
Triticum aestivum Poaceae Leaves Ferulic acid dehydrodimers
Vitis vinifera Vitaceae Fruits and seeds Proanthocyanidinsand resveratrol
Zingiber cassumunar Zingiberaceae Rhizome Cassumunin A & B (cucurminoids)
Zingiber officinalis Zingiberaceae Rhizome 6-gingerol

Spices and herbs, particularly from the Lamiaceae family, demonstrate strong antioxidant properties and a shortage of antioxidants in the diet might enable diseases caused by reactive oxygen species to arise. Many vegetables and fruits used as foods are particularly rich in natural antioxidant nutrients, e.g. including vitamin C, the tocopherols and carotenoids. Phenolic antioxidants such as flavonoids, tannins, coumarins, xanthenes and more recently, procyanidins, have been shown to scavenge radicals in a dose-dependent manner and therefore are viewed as promising therapeutic potential for free-radical pathologies. A sufficient supply of antioxidants from the diet might help to prevent or delay the occurrence of pathological changes associated with oxidative stress. When diet fails to meet the antioxidant requirements, dietary supplement might be used to enhance health but more needs to be done to test this hypothesis by good clinical studies. Consumer demand for healthy food products provides an opportunity to develop food rich in antioxidants as new functional foods or nutraceuticals.

Gingko biloba (ginkgo)

Gingko biloba extract is widely used in traditional medicine for a great number of therapeutical properties. A large number of studies confirm the antioxidant nature of the extract and its phytoconstituents.

A study by Butnaru et al. (1997) in rats showed that the treatment with this extract before stress inhibited the post-stress growth MDA concentration and the process of stress ulcer formation. Gingko protects against cardiac ischaemia and reperfusion injury and these effects are shown to be dependent on its antioxidant properties. Its in-vivo free-radical scavenging action and proof of its haematological properties in rats was confirmed. Gingko biloba extract and kaem-ferol isolated from it were demonstrated to be antioxidant in a lipid peroxidation assay. Gingko biloba extracts have properties indicative of potential neuroprotective ability. From the n-butanol extract of Gingko biloba leaves, flavonoids were isolated, which showed strong antioxidant activities in DPPH and cytochrome-c reduction assays using the HL-60 cell culture system.

Bacopa monniera (brahmi)

Bacopa monniera is a component of several popular drugs of the Ayurvedic system of medicine. Its ethanol extract showed strong protection against lipid peroxidation induced by ferrous sulphate and cumene hydroperoxide. Bacopa monniera alcohol extract exerted a hepatoprotective effect against morphine-induced liver toxicity, which was found to be related to its antioxidant nature. The effect of a standardised extract of Bacopa monniera was assessed on rat brain frontal cortical, striatial and hippocampal reactive oxygen species, catalase and glutathione peroxi-dase activities and the results indicated a significant antioxidant effect.

Mangifera indica (mango)

The standardised aqueous extract of crude mango stem bark showed a powerful scavenger activity of hydroxyl radicals and hypochlorous acid and acted as an iron chelator. The extract also showed a significant inhibitory effect on the peroxidation of rat brain phospholipid and inhibited DNA damage by bleomycin or copper phenanthrolin system. Oral administration of an M. indica extract (QF 808) was found to reduce ischaemia-induced neuronal loss and oxidative damage in gerbil brain. QF 808 has the ability to scavenge free radicals involved in microsome peroxidation. An aqueous decoction of mango bark has been developed in Cuba on an industrial scale to be used as a nutritional supplement, cosmetic and phytomedicine. It is useful in preventing the production of reactive oxygen species and oxidative tissue damage in vivo. Polyphenols including mangiferin were found to be the major constituents. Mangiferin has shown to be able to maintain the cellular oxidant/antioxidant balance.

Curcuma longa (turmeric and curcumin)

Curcuma longa and a large number of its constituents exhibit potent antioxidant properties in several models. Curcumin and its sodium salt have been shown to have a strong antioxidant activity. Curcumin exhibited a significant time- and concentration-dependent effect on lipid peroxidation induced by radiation and other curcumin analogues exhibited an antioxidant activity stronger than α-tocopherol. Turmeric antioxidant proteins isolated from the aqueous extract of turmeric were found to prevent Ca2+-stimulated ATPase from inactivation in the presence of promoters of lipid peroxidation, as well as the depletion of the thiol content during peroxidation.

Withania somnifera (ashwagandha)

Witbania somnifera is used as an antistress adaptogen. Its glycowithanolides showed antioxidant effects in chronic footshock stress-induced perturbations of oxidative free-radical scavenging enzyme and lipid peroxidation in rats. Administration of plant extract, along with equivalent doses of lead acetate for 20 days, significantly decreased lipid peroxidation and increased reactive oxygen species and catalase, thus retaining normal peroxida-tive status of the tissues. The antioxidant effects depend on the presence of steroidal lactones, the withanolides.

Allium sativum (garlic)

The inhibitory property of garlic on reactive oxygen species generation and lipid peroxidation has been reported in a number of in-vitro studies. Banerjee et al. (2002) showed that chronic garlic intake dependently augmented endogenous antioxidants, which might have important direct cytoprotective effects on the heart, especially in the event of oxidative stress-induced injury. Diallyl sulphide is a flavour component from garlic and is found to attenuate lipid peroxidation in mice infected with Tricbinella spiralis. Antioxidant activity of the diallyl sulphide garlicin was due to its ability to scavenge peroxyl or alkoxyl radical intermediates of lipid peroxidation. Allicin, another component, may have multiple mechanisms of action, acting both as a stronger chain-breaking antioxidant and as an inhibitor of first chain reaction by scavenging an initiating radical species.

Punica granatum (pomegranate)

Punica granatum fermented juice and seed oil flavonoids exhibited antioxidant activities and the methanol extract of pomegranate demonstrated potent antioxidant activity using various in-vitro models. Three major anthocyanidins isolated from Punica granatum fruits showed free-radical scavenging activity and inhibitory effects on lipid peroxidation in rat brain homogenates.

Ocimum sanctum (tulsi, holy basil)

An aqueous extract of the leaves of Ocimum sanctum has been found to protect mice against radiation lethality and bone marrow damage and had strong radical scavenging activity in vitro. The extract also protected against radiation-induced lipid peroxidation, where GSH and antioxidant enzymes play an important role in protection. The hydroalcoholic extract, investigated against isoproterenol-induced myocardial infraction in rats, caused a significant reduction in GSH, SOD, LDH and TBARS levels, thus demonstrating antioxidant and cardioprotective effects.

Garcinia

Garcinia kola, Garcinia indica, Garcinia subelliptica, Garcinia atroviridis and several other Garcinia species were found to possess strong antioxidant activity and a large number of active constituents isolated from Garcinia kola fruits possess inhibitory activity against lipid peroxidation. Kolaviron, a mixture of Garcinia biflavonoids 1 and 2 and kolaflavonone isolated from Garcinia kola seed extract, acts as an in-vivo natural antioxidant and effective hepatoprotective and is as effective as BHA in rats. Garcinol, a polyisoprenylated benzophenone derivative isolated from Garcinia indica fruit rind, has shown potent free-radical scavenging activity and was able to scavenge both hydrophilic and hydrophobic reactive oxygen species, the activity being stronger than that of DL-α-tocopherol. Oral administration prevented acute ulceration in rats induced by indometacin and water-immersion stress caused by radical formation.

Emblica officinalis

The fruits of Emblica officinalis contain polyphenolic compounds such as emblicanin A and B which have been reported to exhibit antioxidant activity in vitro and in vivo. A study showed that emblicanin A and B preserve erthrocytes against oxidative stress induced by asbestos, a generator of superoxide radical. The active tannoids administered intra-peritoneally for 7 days showed augmentation of brain SOD, catalase and reduction in lipid peroxidation. The results indicate that the antioxidant activity may reside in these tannoids rather than vitamin C itself. Pretreatment with the butanol extract of the water fraction of Emblica officinalis fruits, orally administrated to rats for 10 consecutive days, was found to prevent indometacin-induced gastric ulcer; this activity was attributed to its antioxidant property.

Salvia officinalis (sage)

Salvia is an important genus, widely cultivated and used in flavouring and folk medicine. It is a rich source of polyphenols, and a large number of these are apparently constructed from the caffeic acid building block. Salvia officinalis 50% methanol extract demonstrated considerable inhibition of lipid peroxidation in both enzyme-dependent and enzyme-independent systems and supercritical fluid extracts of Salvia officinalis also showed antioxidant activity. Salvia officinalis leaves and terpenoids and flavonoids showed strong antioxidant properties using DPPH and by the oil stability index method. Various constituents such as rosmarinic acid, abietene diterpenes and caffeoyl-glycosides have been identified as antioxidant principles. The extracts of other Salvia species also displayed considerable concentration-dependent antioxidative effects that were comparable with those of Salvia officinalis.

Vitis vinifera (grapevine)

Resveratrol is a polyphenolic stilbene occurring in grapes and various other medicinal plants and has been the subject of a considerable amount of recent research. It has been identified as a potential cancer chemopreventive agent and its presence in red wine has been suggested to be linked to the low incidence of heart diseases in France. It acts as a powerful antioxidant, both by classic hydroxyl radical scavenging and also via a novel glutathione-sparing mechanism. Various studies have demonstrated the effects of resveratrol on biological mechanisms involved in cardioprotec-tion. These include modulation of lipid turnover, inhibition of eicosanoid production, prevention of low-density lipoprotein oxidation and inhibition of platelet aggregation.

Based on the quantity and diversity data available on the biological activity of resveratrol, it has to be considered to be a very promising chemoprotector and chemotherapeutic. Urgent investigation on its bioavailability and effects on in-vivo systems, especially in humans, are necessary. Martinez and Moreno (2000) showed that resveratrol treatment caused a significant impairment of COX-2 induction, stimulated by lipopolysaccharides and phorbol esters or by O2- or H2O2 exposure. It also significantly decreased [3H]arachidonic acid release induced by these agents. These results support the anti-inflammatory action of resveratrol.

Silybum marianum (milk thistle)

Silybum marianum fruits are reported to exert antioxidant and free-radical scavenging action. Silymarin and silybin, the flavonolignans present, were found to be the active constituents. Silymarin prevents doxorubicin-mediated damage to rat heart membrane primarily through free radical scavenging. Oral administration of silybin protected against iron-induced hepatotoxicity in vivo and can be used in chelation therapy of chronic iron overload.

Conclusions

It is obvious that a large number of plants possess strong antioxidant potential and these include commonly used fruits, vegetables and spices. Concentration of total phenols in the plant show close correlation with the antioxidant activity, so it is useful to determine the total phenol content of the plants before antioxidant screening. A large number of plants have been tested, based on their uses in folklore and have been found to be active, and still there is scope for antioxidant screening of a large number of plants belonging to families rich in antioxidants. Fermented extracts have been found to be more potent and the production of low-molecular-weight compounds during fermentation is responsible for the action. There is scope for evaluation of antioxidant properties of fermented extracts of plants known to possess strong antioxidant properties.

Antioxidants

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October 2, 2010 at 12:49 pm

Free radicals are chemical species possessing one or more unpaired electrons and can be considered as a fragment of molecules that are extremely reactive and short lived. They are produced continuously in cells, either as accidental byproducts of metabolism or deliberately (for example, during phagocytosis). Unpaired electrons usually make a molecule more reactive than the corresponding non-radical. The molecule acts as an electron acceptor and essentially ‘steals’ electrons from other molecules. Free radicals are referred to as oxidising agents since they cause other molecules to donate their electrons. Free radicals can be formed by the homolytic cleavage of a covalent bond of a normal molecule, with each fragment retaining one unpaired electron; by the loss of a single electron from a normal molecule; or by the addition of a single electron to a normal molecule.

The most common cellular oxygen free radicals are superoxide radical (02-), hydroxyl radical (OH·) and nitric oxide (NO). Other molecules, such as hydrogen peroxide (H202) and peroxynitrate (ONOO·) are not free radicals themselves but can lead to their generation through various chemical reactions.

Oxygen free radicals and related molecules are often classified together as reactive oxygen species (ROS), to signify their ability to promote oxidative changes within the cell.

All aerobic organisms produce free radicals, predominantly superoxide, formed as a side product during the reduction of molecular oxygen by mitochondria. An average cell utilises 1013 molecules of 02 per day. It is estimated that 1 % of respired molecular oxygen will form ROS, thus approximately 1011 ROS are produced by each cell in a day. Cells normally employ a number of defence mechanisms against damage induced by free radicals. Oxidative stress is the term referring to the imbalance between generation of reactive oxygen species and the activity of the antioxidant defences.

There is increasing evidence to support the involvement of free-radical reactions in several human diseases since reactive oxygen species play a role in a variety of normal regulatory systems, the de-regulation of which may play an important role in inflammation. ROS and other free radicals have long been known to be mutagenic and have more recently emerged as mediators of other phenotypic and genotypic changes causing mutations and neoplasia.

In the last decade, evidence has accumulated that the free-radical process known as lipid peroxidation plays a crucial and causative role in the pathogenesis of atherosclerosis, cancer, myocardial infarction and also in ageing. Participation of free-radical oxidative interactions in promoting tissue injury in conditions such as brain trauma, ischaemia, toxicity and also in neurodegenerative diseases such as Parkinson’s disease, Alzheimer’s dementia, multiple sclerosis and lipofuscinosis are now well documented. The involvement of ROS in the pathogenesis of several lung diseases has also been suggested while the pioneering studies on the role of reactive oxygen species reactions in the genesis and the expression of cellular and tissue damage has been carried out mainly in the liver, using acute rat poisoning with carbon tetrachloride.

Studies in experimental models have incriminated ROS as primary mediators in the pathogenesis of renal injury. Diabetes mellitus is also associated with oxidative reactions, particularly those that are catalysed by decompartmentalised transition metals, but their causative significance in diabetic tissue damage remains to be established.

In 1956, Harman proposed the free-radical theory of ageing, the assumption that ageing results from random deleterious effects of tissue brought about by ROS and it is very likely that reactive oxygen species contribute considerably to the development of stochastic disorders observed during the progress of ageing.

In recent years, increasing experimental and clinical data have provided compelling evidence for the involvement of oxygen free radicals in the three main disorders of prematurity — chronic lung disease, retinopathy of prematurity and intraventicular haemorrhage, the hypothesis being that oxygen-centred radical and related reactive oxygen metabolites are formed too rapidly to be detoxified by antioxidant defence mechanisms.

Defence against free radicals: antioxidants

Antioxidant defences fall in to two main categories, those whose role is to prevent the generation of free radicals and those that intercept any radicals that are generated. They exist in both the aqueous and membrane compartments of cells and can be enzymes or non-enzymes. Various animal studies have shown that antioxidants delay or protect against the oxidative damage produced by the free-radical reaction and a protective role against ailments mediated by free radicals is now well established.

Antioxidants are exogenous (natural or synthetic) or endogenous compounds acting in several ways, including removal of O2, scavenging reactive oxygen/ nitrogen species or their precursors, inhibition of reactive oxygen species formation and binding metal ions needed for catalysis of ROS generation and up-regulation of endogenous antioxidant defences. The protective efficacy of antioxidants depends on the type of reactive oxygen species that is generated, the place of generation and the severity of the damage. The natural antioxidant system can be classified into two major groups: endogenous enzymes and low-molecular-weight antioxidants.

Endogenous enzymes include extensively studied enzymes such as superoxide dismutase (SOD), cata-lase, glutathione peroxidases, DT diaphorase, and glutathione-regenerating enzyme systems. Some enzymatic systems such as SOD and catalase act specifically against reactive oxygen species, while certain other enzyme systems reduce thiols. The low-molecular-weight antioxidants can be further classified into directly acting antioxidants (e.g. scavengers and chain-breaking antioxidants) and indirectly acting antioxidants (e.g. chelating agents). The directly acting antioxidants are extremely important for defence against oxidative stress. Direct scavenging of ROS is one of the many antioxidant actions required to restore oxidative equilibrium once it is lost in different pathologies. This subgroup of antioxidants currently contains several hundred compounds including ascorbic acid (vitamin C), retinoic acid (vitamin A), melatonin, lipoic acids, polyphenols, and carotenoids, being derived from dietary and herbal sources. The hypothesis that restoring redox equilibrium through activation of intracellular signals is also an important step of the antioxidation process is gaining increasing support. It is likely that the trapping of excess free radicals could restore redox equilibrium in the initial states of cellular oxidative stress.

Free radicals in various diseases

According to Halliwell and Gutteridge (1999), oxidative stress occurs in most human diseases, although this is not the same as saying that it is the cause of most diseases. The increase in free radicals may be secondary to the disease process. Free radicals are very short lived and difficult to study in vivo. Direct detection of free radicals is possible with electron spin resonance, but it is very expensive and complex, so a variety of surrogate markers to ascertain free-radical activity must be used. Developing accurate methods to measure biomarkers for DNA damage and lipid peroxidation is challenging and methods in the current literature include urine levels of F2-isoprostanes as a biomarker for lipid peroxidation, measurement of oxidised low-density lipoprotein (LDL), use of a chemical mutagenic product of fat oxidation, and 8-oxo-deoxyguanosine, associated with a decline in mitochondrial function. There have also been efforts to detect changes in the levels of antioxidants such as SOD, glutathione or vitamin E in the body in response to oxidative stress, to identify many conditions associated with free-radical formation, but results have not been consistent. The implications of the presence of ROS in cardiovascular, pulmonary, carcinogenesis, diabetes and neurological diseases as well as inflammation are currently under intense investigation.

It is easy to appreciate that the lungs are vulnerable to inhaled agents, e.g. ozone, nitrogen dioxide, sulphur dioxide and other toxins, that stimulate reactive oxygen species production. ROS can stimulate lipid peroxidation and oxidation of DNA bases in the lungs. The irritant effect of smoke also activates lung macrophages and neutrophils with resultant production of additional ROS. Chronic lung inflammation such as asbestosis, asthma and cystic fibrosis is also associated with elevated markers of oxidative stress so reactive oxygen species may contribute to the ongoing pathology.

The brain may be especially sensitive to oxidative damage. Oxidative stress can damage neurones and glial cells in a manner similar to other issues: via products of lipid peroxidation that are neurotoxic, DNA damage, etc. Reper-fusion injury also occurs in the brain after a stroke and superoxide produced during reperfusion results in abnormalities of cerebral vascular responses and blood-brain barrier permeability. Extracellular gluta-mate levels in the brain increase rapidly during ischaemia, leading to increased production of OH radicals, calcium ion imbalance and increased neurotoxicity. If bleeding occurs with the stroke, normally sequestered iron molecules are released and may initiate harmful free-radical chain reactions. Neurodegenerative diseases associated with ROS include Parkinson’s, Alzheimer’s, and many others. It is possible that although the initiators of the disease state vary, free radicals are involved in a common pathway that leads to neural cell death.

The acute inflammatory response is typically beneficial to the organism, being a major defence against microorganisms and normally self-limited. However, the superoxide-producing neutrophil itself is destroyed in the process and healthy surrounding cells may also be damaged. With chronic inflammation, such as in rheumatoid arthritis, the overall impact of the continued generation of free radicals is deleterious. Degradation of hyaluronic acid (synovial fluid) is driven by the presence of OH. These radicals may be produced by phagocytic cells in the joint, by changes in tissue oxygenation caused by swelling, followed by reperfusion, or by some of the drugs used to treat RA. A role for reactive oxygen species in the endothelial dysfunction associated with diabetes was proposed and levels of manganese superoxide dismutase have been reported to be decreased in streptozotocin-induced diabetes in rats. Normalising mitochondrial O2 has been shown to block pathways involved in hyperglycaemic damage. Consistent with these observations, SOD pretreatment improved vasodilation in isolated aortic rings from streptozo-tocin diabetic rats. Levels of O2 are also increased in hyperinsulinaemic rats, which is believed to be related to activation of NAD(P)H oxidase.

The progression of heart failure is associated with programmed cell death or apoptosis, which studies suggest occurs in response to ischaemia, reperfusion, pressure overload and in dilated cardiomyopathies. Oxidative stress may also be critical for the activation of apoptosis in dilated cardiomyopathies.

Free radicals in cardiovascular diseases

Cardiovascular disease is a heterogeneous group of disorders that affects the heart and blood vessels. The diseases are characterised by angina pectoris, hypertension, congestive heart failure, acute myocardial infarction (heart attacks), stroke and arrhythmia. There is now considerable biochemical, physiological and pharmacological data to support a connection between free-radical reactions and cardiovascular tissue injury. Evidence shows that these disease conditions are directly or indirectly related to oxidative damage and share common mechanisms of molecular and cellular damage. As these mechanisms are elucidated, it may be possible to improve the techniques for clinical and pharmacological intervention.

Ischaemia-reperfusion myocardial injury

Exposure of myocardial tissue to a brief, transient ischaemia, followed by reperfusion, has attracted much attention in recent years as an explanation for some cardiac diseases. Myocardial ischaemia occurs when myocardial oxygen demand exceeds oxygen supply. Unless reversed, this situation results in cell injury and, clinically, myocardial infarction. Logically, reperfusion of ischaemic myocardium is recognised as potentially beneficial, because mortality is directly proportional to infarct size, and this latter to the severity and duration of ischaemia. Reperfusion of the ischaemic myocardium can restore oxygen and substrates to the ischaemic myocardial cells, but this process may create another form of myocardial damage termed ‘reperfusion injury’. Thus, restoration of a normal blood flow in the heart by methods such as angioplasty, thrombolytic agents or cardiopulmonary bypass can lead to specific lesions (arrhythmias, deficit in contractility, necrosis), the importance of which also depends on the duration of ischaemia.

Evidence suggests that this may be due, in part, to the generation of toxic reactive oxygen species. The active involvement of ROS in the ischaemia-reperfusion damage is demonstrated by direct and indirect experimental evidences. Direct evidence arises from the possibility of measuring radicals in myocardial tissue by electron spin resonance (ESR) and spin trapping methodology; indirect evidence by the measurement of the products of free-radical attack on biological substrates (e.g. malondialdehyde as a measure of lipid peroxidation extent), and intracellular and extracellular antioxidant capacity. Experimental findings suggest that in ischaemic tissue there is an impairment of antioxidant mechanisms. Evidence to support this statement comes also from the cardioprotective effects of agents capable of inducing antioxidant enzymes in the heart and from the beneficial effects of several enzymatic free-radical scavengers, anti-oxidants and iron chelators in reperfused myocardium.

Free-radical hypothesis of atherosclerosis

Considerable in-vivo evidence, animal and human, supports the important role of reactive oxygen species in atherosclerotic coronary heart disease. While the exact mechanisms for atherogenesis are not completely understood, recent studies suggest that oxidative modification of low-density lipoproteins (LDL) is a critical factor. LDL may be oxidatively modified by all major cell types of the arterial wall via their extracellular release of reactive oxygen species (ROS). Hydroxyl radicals (thus formed) may initiate the peroxidation of long-chain polyunsaturated fatty acids within LDL, giving rise to conjugated dienes and lipid hydroperoxy radicals (LOO·). This process is self propagating, since LOO· can attack adjacent fatty acids until complete fatty acid chain fragmentation occurs. A number of highly reactive products then accumulate in the LDL particle, including malondialdehyde and lysophos-phatides, which interact with the amino side chain of the apoprotein B 100 and modify it to form new epitopes that are not recognised by the LDL receptor.

Hypertension

Essential hypertension (EH) appears associated with increased superoxide anion and hydrogen peroxide production, as well as decreased antioxidant capacity. The involvement of reactive oxygen species in EH is also suggested by the observation of increased level of lipid peroxides and decreased concentrations of antioxidant vitamin E in plasma of EH patients. Recently, Simi et al. (1998) have shown that patients with EH have plasma concentrations of free-radical scavengers lower than healthy normotensive subjects. The elevated consumption of plasma antioxidants was accompanied by increased activity of extracellular antioxidant enzymes (glutathione peroxidase and SOD), suggesting that ROS production in EH overwhelms antioxidant defence capacity. Oxidative stress in patients with EH is accompanied with the decreased red blood cell counts and decreased SOD and glutathione peroxidase activity in neutrophils.

Chronic heart failure

Chronic heart failure is a state characterised by a number of processes that may promote reactive oxygen species generation in vivo, including cytokine activation, recurrent hypoxia-reperfusion, possibly genetic susceptibilities and activation of the renin-angiotensin system. There are a number of potential cellular sources implicated in enhanced ROS generation in chronic heart failure. It has recently been demonstrated that patients with chronic heart failure may have increased leucocyte 02- production, which is, in turn, related to severity of disease. Other sources of enhanced ROS generation in human chronic heart failure are both the myocardium and peripheral blood vessels. Increased activity of myocardial NADPH oxidase has been reported in heart failure.

Myocardial damage

Reactive oxygen species (ROS) have direct effects on cellular structure and function and may be integral signalling molecules in myocardial remodelling and failure. ROS result in a phenotype characterised by hypertrophy and apoptosis in isolated cardiac myocytes. ROS have also been shown to activate matrix metalloproteinase (MMP) in cardiac fibroblasts. Myocardial MMP activity is increased in the failing heart and an MMP inhibitor has been shown to limit early left ventricular dilatation in a murine model of myocardial infarction (MI). Hayashidani et al. (2003) showed significant improvement in the survival after MI in MMP-2 knockout mice, which was mainly attributable to the inhibition of early cardiac rupture and the development of subsequent LV dysfunction. Because MMP can be activated by reactive oxygen species, one proposed mechanism of ventricular remodelling is the activation of MMPs secondary to increased ROS production. Sustained MMP activation might influence the structural properties of the myocardium by providing an abnormal extracellular environment with which the myocytes interact. Kinugawa et al. (2000) demonstrated that the OH scavenger, dimethylthiourea, inhibits the activation of MMP-2 in association with the development of ventricular remodelling and failure. These data raise the interesting possibility that increased ROS after MI can be a stimulus for myocardial MMP activation, which might play an important role in the development of HF.

Left ventricular hypertrophy

In animal models of heart failure, levels of ROS are elevated and cardiac protection is observed with antioxidant treatment. The increase in ROS associated with left ventricular hypertrophy appears to be NAD(P)H oxidase-dependent. Myocardial NAD(P)H oxidase activity is elevated and expression of p22phox, gp91phox, p67phox and p47phox is increased in left ventricular tissue from guinea pigs after aortic banding. The gp91phox containing NAD(P)H oxidase has been shown to play an important role in the cardiac hypertrophic response to Ang II in mice. It has been suggested that the increase in ROS is responsible for impaired endothelial regulation of left ventricular relaxation observed in moderate pressure overload left ventricular hypertrophy.

Cardiac hypertrophy occurs in response to a sustained increase in cardiac work. The mechanisms underlying this progression from compensated hypertrophy to decompensated heart failure remain poorly understood and incompletely explored. There are data supporting at least a contributory role for alterations in ROS production in the pathophysiology of cardiac hypertrophy. There is substantial evidence from animal studies indicating that reactive oxygen species, and particularly O2, production is increased in cardiac hypertrophy. Recently, Date et al. demonstrated attenuated cardiac hypertrophy in mice subjected to pressure overload following treatment with the free-radical scavenger, N-2-mercaptopropionyl glycine. This is the first evidence in an experimental model suggesting a causal role for ROS in the development of pressure overload hypertrophy. The precise source of reactive oxygen species in this study was not apparent. In a similar study using a guinea pig model of pressure overload, an attenuation of LV hypertrophy was observed in animals treated with vitamin E. Taken together, these data support an important functional role for reactive oxygen species, in particular NADPH oxidase derived ROS, in the development of pressure-overload hypertrophy.

Free radicals in hypercholesterolaemia

Increased levels of O2 generation and attenuated NO mediated responses have been demonstrated in aortic rings from cholesterolfed rabbits. Treatment of the animals with polyethylene glycolated SODs improved endothelium-dependent vasodilation. Supplementation with L-arginine has also been shown to reduce O2 levels and restore NO-mediated responses in cholesterol-fed animals (Boger et al., 1995). O2 levels are also raised in WHHL (Watanabe heritable hyperlipidaemic) rabbits. Multiple mechanisms appear to be involved in O2- production in association with hypercholesterolaemia. Stepp and colleagues provided evidence that in canine carotid arteries eNOS, mechanisms dependent on xanthine oxidase and possibly NAD(P)H-oxidase were involved. Further evidence for the involvement of NAD(P)H oxidase was obtained in WHHL rabbits. In monkeys with atherosclerosis, disease severity is related to O2 levels, and regression of atherosclerosis is associated with decreases in O2 levels and NAD(P)H oxidase activity.

Free radicals in skeletal muscle dysfunction

Oxidative stress could be the mechanistic basis also for muscle fatigue and reduced exercise tolerance in patients with heart failure. This notion is supported by a positive correlation between ROS and exercise intolerance in these patients. Further, Tsutsui et al. (2001) demonstrated that the production of reactive oxygen species was increased in the skeletal muscle homogenates obtained from a murine model of HF and increased ROS were identified as OH originating from O2, which was associated with a concomitant increase in the oxidation of lipids. These results are consistent with the previous studies that the oxidative capacity is reduced and O2 utilisation is inadequate in skeletal muscle mitochondria from patients with heart failure. Skeletal muscle mitochondria from heart failure are associated with a decrease in the activities of complex I and complex III. As has been shown in the failing hearts, the defects in electron transfer function may lead to reactive oxygen species production. ROS may play an important role in the muscle atrophy commonly seen in patients with heart failure through the induction of apoptosis. In addition, ROS impair myoplasmic Ca2+ homeostasis and inhibit the oxidative energy production in the mitochondria, both of which may contribute to the muscle contractile dysfunction. An attempt to attenuate oxidative stress would improve, to some extent, the exercise capacity of patients with heart failure.

Tests for antioxidant activity

Antioxidant activity can be evaluated both in vitro and in vivo. There are potential models for evaluation of the antioxidant activity. Animals such as mice, rats, guinea pigs and rabbits can be used for in-vivo evaluation with the oxidative stress induced by some external chemical agent (e.g. carbon tetrachloride), physical, emotional, mental or environmental stress (e.g. torturing the animals, depriving animals from food, water and sexual activity, increasing noise or temperature of the animal housing). Even surgery can be performed for inducing oxidative stress in rats, e.g. cerebral ischaemia/reperfusion induced oxidative stress in which the induction of ischaemia in rats was performed by occluding bilateral common carotid arteries with clamps for 30 min followed by 24 h reperfusion. Following any of the methods whereby the oxidative stress can be induced in the animals, they should be grouped as treated (at least two or more doses), control and normal animals. In the end of study the animals can be sacrificed to isolate the vital organs. Enzymes such as SOD, catalase and glutathione can be measured in these tissues, together with the extent of lipid peroxidation caused by the oxidative stress, using assays such as barbituric acid reactive substances (TBARS).

In-vitro methods consist of chemical methods in which free radicals can be generated using chemical reactions, e.g. nitric oxide method or chemicals which themselves act as the source of free radicals such as DPPH (2,2-diphenyl-1-picrylhydrazyl). In-vitro methods are also available in which generated free radicals can attack tissues isolated from the animal body leading to the oxidation of lipids present in the tissues, e.g. thiobarbituric acid-reactive substances (TBARS) assay. Details on some of the in-vitro methods used for the evaluation of antioxidant activity are given below.

DPPH radical scavenging assay

The antioxidant activity of the plant extract and pure compounds was assessed on the basis of radical scavenging effect of the stable DPPH free radical, which is purple. Antioxidants react with DPPH, and convert it to 1,1-diphenyl-2-(2,4,6-trinitrophenyl) hydrazine, which is colourless. Reaction mixtures containing test samples (dissolved in DMSO) and 300 µmol/L DPPH ethanolic solutions in 96-well microtitre plates are incubated at 37°C for 30 min, and absorbances measured at 515 nm. The degree of discolouration indicates the scavenging potentials of the antioxidant compounds and IC50 values can be calculated, i.e. the concentration of sample required to scavenge 50% DPPH free radicals. DPPH reagent (0.5% in methanol) can be sprayed on to preparative TLC plates to identify active antioxidant compounds in plant extracts. Active radical scavengers give yellow colour zones against a purple background.

Nitric oxide radical scavenging assay

Nitric oxide (NO·) is a free radical and scavengers of nitric oxide compete with oxygen, leading to reduced production of nitric oxide. NO is generated from sodium nitroprusside and measured by the Griess Illosvoy reagent (Garratt, 1964), which can be modified by using naphthylethylenediamine dihydro-chloride (0.1% w/v) instead of 1-naphthylamine (5%). The extent of NO radical scavenging can be assessed by colorimetry whereby reaction mixtures containing 10 mmol/L sodium nitroprusside, phosphate buffer saline and extracts or standard solution are incubated at 25°C for 150 min. After incubation, 0.5 mL of the reaction mixture is mixed with 1 mL of sulphanilic acid reagent (0.33% in 20% glacial acetic acid) and allowed to stand for 5 min to complete diazotisation. Naphthyl ethylenediamine dihydrochloride is then added, mixed and allowed to stand for 30 min at 25°C and a pink coloured chro-mophore is formed in diffused light whose intensity is measured at 540 nm.

Scavenging of superoxideanion radicals assay

Various cellular enzymes can catalyse chemical reactions involving molecular oxygen, including admission formation of superoxide radicals, which can inactivate vital cell components. Superoxide can be generated by enzymatic oxidation of hypoxanthine with xanthine oxidase and can be detected colori-metrically by nitroblue tetrazolium (NBT) reduction. The reaction is started by adding 100 µL of phenazine methosulphate (PMS) solution (60 µmol/L PMS in 100 mmol/L phosphate buffer, pH 7.4) to the mixture, incubating at 25°C for 5 min, and measuring the absorbance at 560 nm. Decreased absorbance of the reaction mixture indicates increased superoxide anion scavenging activity.

Deoxyribose degradation assay

In this method hydroxyl radicals are generated by incubating a mixture containing KH2PO4-KOH, H2O2, FeCl2-EDTA and deoxyribose. The extent of deoxyribose degradation by the formed hydroxyl radical can be assessed by the thiobarbituric acid method. The typical reaction is started by adding Fe(II) at a final concentration of 6 µmol/L to a 0.5 mL final volume of 20 mmol/L phosphate buffer, 5 mmol/L of 2-deoxyribose, Cu(II) (5 µmol/L) (pH 7.2) and 100 µmol/L H2O2 with and without 10 µmol/L of ascorbate as an iron chelator. Reactions were carried out for 10 min at 25 °C ± 1°C and were stopped by adding of 0.5 mL of 50 mmol/L NaOH containing 4% (w/v) phosphoric acid. After boiling for 15 min, the absorbance of the solution containing the oxidation products is measured at 532 nm.

Thiobarbituric-acid-reactive substances assay

In this method the lipid peroxidation is measured in terms of malondialdehyde (MDA) content following the thiobarbituric acid method of Ohkawa et al. (1979). MDA is formed in vivo and in vitro through oxidation of unsaturated lipids by ROS, and other oxidative agents. Thiobarbituric acid reacts with MDA to form a pink chromogen, which can be detected spectrophotometrically at 532 nm.

β-Carotene-linoleic acid (linoleate) assay

The antioxidant activity is measured by the ability of a compound to minimise the coupled oxidation of linoleic acid and β-carotene in an emulsified aqueous system. β-carotene loses its orange colour when reacting with reactive oxygen species, so colorimetery can be used to investigate the decline in colour caused by oxidative stress. In this method a stock solution of β-carotene and linoleic acid is prepared by dissolving 0.5 mg of β-carotene in 1 mL of chloroform and adding 25 µL of linoleic acid together with 200 mg of Tween 40, evaporating the chloroform and adding 100 mL of aerated water to the residue. To 2.5 mL of this mixture, 300 µL of extract is added and the mixture incubated in boiling water for 2 h together with two blanks, one containing the antioxidant BHT and the other without antioxidant, before measuring the absorbance at 470 nm.

DNA nicking assay

The ability of a test drug to prevent the DNA damage caused by agents such as 2,2′-azobis (2-methylpropionamide) dihydrochloride (APPH) is measured in this method. The test substance is mixed with DNA and APPH, dissolved in phosphate-buffered saline, is added to start the reaction. The resultant mix is developed on agarose gel, elec-trophoresis carried out and then staining with ethidium bromide. DNA bands are visualised under illuminated ultraviolet light and examined for DNA breakage.

Coronary Artery Disease

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September 26, 2010 at 2:21 am

Clinical Considerations

- The prevalence of coronary artery disease (CAD) is increasing in industrialized countries. This is certainly attributable to a general lack of physical exercise, increased consumption of fatty foods, and cigarette smoking, but is also due to the fact that people now live longer.

- Despite intensive research, some risk factors of CAD are still unknown or untreatable.

Herbal treatment measures

- In Germany, topical heart ointments containing aromatic herbs that increase local blood flow of cutivisceral reflex regions are thought to be beneficial in acute functional coronary artery spasms.

- Flavonoids in hawthorn extract reduce wall tension in normal and sclerotic blood vessels. These chemicals are also presumed to stimulate beta-2 receptors and, thus, to widen coronary arteries and blood vessels in skeletal muscle. The usefulness of hawthorn in CAD is therefore arguable, but has not yet been confirmed in clinical studies.

Clinical value of herbal medicine

- The recommendations in this section are solely based on empirical experience. Clinical study data or controlled studies on most of these indications are not yet available.

- Once CAD has become manifest, herbal measures should be restricted to adjunctive treatment only.

Herbal measures to help counteract risk factors

- Antilipemic herbs: Garlic, artichoke.

- Antithrombotic herbs: Garlic.

- Antihypertensive herbs: Garlic.

Clinical value of herbal medicine for risk factors of CAD

- The herbal treatments outlined here are purely prophylactic and adj unctive measures that can be recommended as home remedies. Clinical studies are available.

Recommended Herbal Remedies (Overview)

External Remedies

Aromatic plant medicaments such as camphor (Cinnamomic camphorae aetheroleum), rosemary leaf (Rosmarini folium), pine needles (Pini aetheroleum), eucalyptus leaf (Eucalypti folium), and menthol (Menthae aetheroleum).

- Action: Stimulate cutivisceral reflexes, blood flow and spasmolysis, thereby reducing CAD-related pain.

- Dosage and administration: The preparations are applied to the left precordial region of the chest and rubbed into the skin as often as needed.

Warning: Ointments containing camphor can cause skin irritation and inflammation and should not be applied to damaged skin.

Internal Remedies

Hawthorn.

Range of Applications

Acute Angina Pectoris

Hawthorn leaf and flower.

- Dosage and administration: Dose is diluted oil or other balm applied several times daily or as needed for mild pain of angina. Apply twice daily to the left precordial region, or as needed when chest pain occurs.

- Clinical value: Clinical studies have not been conducted. Large inter-individual differences in the effects of these remedies can be observed.

Prevention and Treatment of Early-stage CAD

Hawthorn leaf and flower.

- Steep 2 teaspoons of the herb in 150 mL of boiling water for 20 minutes. Sweeten lightly. This mild infusion should be used only for health-promoting benefits.

- Hawthorn tincture: 2-4 mL several times a day.

- Extract standardized to flavonoids and/or proanthocyanins: 1 to 2 capsules or tablets.

- Dosage and administration: One dose, 2 to 3 times daily.

- Clinical value: For low-potency treatment, hawthorn extracts that are not standardized have a smaller therapeutic range than the corresponding standardized commercial products.

Early-stage CAD with Mild Hypertension

Tea Rx: Crataegi flos; Crataegi folium; Visci albi, aa ad 100,0.

- Dosage and administration: 1 to 2 teaspoons per cup, 2 times daily.

- Clinical value: For low-potency treatment. The extract is not standardized and has a smaller therapeutic range than commercial products.

CAD with Gastrocardiac Symptom Complex (Roemheld’s Syndrome)

Tincture Rx: Oil Carvi 5,0; Tincture Convallariae, Tincture Crataegi, Tincture Carminativa, Spirit. Aetheris Nitrosi, ad 10,0.

- Dosage and administration: 20 drops, 3 times a day.

- Clinical value: This has proved to be a very useful remedy in elderly patients, who often develop Roemheld’s syndrome.

Long-term Treatment of CAD

Hawthorn preparations, garlic.

Therapy and prevention of hepatocellular carcinoma using herbal drugs

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August 31, 2010 at 7:56 am

Cancer is a condition characterised by the uncontrolled growth and spread of abnormal cells, causing their massive aggregation producing either tumours or dispersal in the vascular system such as blood and lymph. Owing to a deviation from normal genetic makeup, cancer cells acquire immortality and a capability to evade apoptosis, non-responsiveness to anti-growth signals, self-sufficiency in growth factors, the ability to metastasise and to form new blood vessels that can supply nutrition and oxygen to the growing tissues. The transformation of normal to cancer cell occurs through accumulation of a series of genetic alterations or mutations, especially of oncogenes.

Carcinogenesis

There are many aetiological factors leading to cancer through a multistep process called carcinogenesis, which involves initiation, promotion, progression and malignant conversion. Mutation in a single cell initiates clonal expansion to form a premalignant lesion. These initiated cells will have resistance to cytotoxicity, defects in maturation, escape from senescence and have altered dependence on growth factors and hormones. Tumour promotion involves activation of cell surface receptors, activation/inhibition of cytosolic enzymes and nuclear transcription factors, stimulation of proliferation and inhibition of apoptotic cell death. Progression is accelerated by additional exposure to genotoxic agents and it is due to genetic instability and nonrandom sequential chromosomal aberrations. Malignant conversion involves multifocal change in premalignant lesions. There will be up-regulation of transcriptional activity and expression of modified cell surface molecules, gene amplification, alterations in cell-cycle regulatory genes, secreted proteases and methylation of DNA. All these changes facilitate migration and invasion.

Inhibition of carcinogenesis

As the progression of carcinogenesis is through a multistep pathway, there are many possible intervention sites inhibiting this progression. The procarcinogen can be detoxified and eliminated from the system. The conversion of procarcinogen to ultimate carcinogen is through multiple mechanisms including metabolic activation by enzymes. These mechanisms can be inhibited by blocking those enzymes involved in the activation step and several natural compounds of plant origin are reported as blocking agents in the chemoprevention of cancer, including flavonoids, ellagic acid and sulforaphane. These either block the conversion of carcinogen to ultimate carcinogen, or prevent the action of active metabolites on the normal cell. They may also alter carcinogen metabolism, enhance carcinogen detoxification, scavenge electrophiles and reactive oxygen species or enhance DNA repair.

The conversion of normal cells from preneoplastic cells to neoplastic cells takes several years, either by a second exposure to the carcinogen or promoting agent and accumulation of genetic variations. These steps can be inhibited by compounds such as curcumin, resveratrol, carotenoids, retinoids and genistein, which inhibit the malignant transformation of initiated cells by scavenging reactive oxygen species, altering gene expression, decreasing inflammation, suppressing proliferation, inducing differentiation, encouraging apoptosis, enhancing immunity or inhibiting angiogenesis and metastasis. Several chemopreventive phytochemicals have been shown to interfere with the cell-cycle regulatory pathways, qualifying them as potential therapeutic agents. Some are powerful inhibitors of growth factor receptors, including epidermal growth factor receptor (EGFR), and a variety of flavonoids are inhibitory, e.g. apigenin, luteolin, quercetin, catechin, epigallocatechin gallate, hesperitin, anthocyanins, genistein, with potential use in preventive anticancer treatment. Some phytochemicals undergoing clinical trials in the inhibition of carcinogenesis are given in Table: Selected ongoing Phase 1 and II cancer prevention trials sponsored by the US National Cancer Institute.

Table: Selected ongoing Phase 1 and II cancer prevention trials sponsored by the US National Cancer Institute
Target organ Agent
Phase 1 trials
Breast Soy isoflavones
Colon Curcumin
Prostate Lycopene (3 trials); Soy isoflavones
Skin Epigallocatechin gallate
Phase II trials
Anogenital warts, human papillomavirus, HIV Indole-3-carbinol
Cervix 9-cis-Retinoic acid
Prostate Soy (dietary); soy isoflavones

Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common primary malignant tumour of the liver and is the fifth most common cancer in the world, ranking fourth in annual mortality rates. An estimated 564 000 new cases of HCC are diagnosed each year, with the highest incidence in eastern and southeastern Asia, some of the western Pacific islands and sub-Saharan Africa. Men are affected four to eight times more often than women and the incidence generally increases with increasing age, although there is a definite shift towards a younger age distribution in black African and ethnic Chinese populations.

Aetiological factors

There are some well-documented aetiological associations of HCC. The aetiological association between hepatitis-B virus (HBV) and HCC is well established. Chronic HBV infection is the leading risk factor and it has been estimated that 53% of cases worldwide are related to HBV. Malignant transformation occurs after a long period of chronic liver disease, frequently associated with cirrhosis. Chronic inflammation of the liver, continuous cell death and consequent cell proliferation might increase the occurrence of genetic alterations and risk of cancer. The long-term expression of regulator gene product of the X-gene and large envelope proteins (LHBs) are thought to play a major role in tumorigenesis. This viral oncoprotein behaves as a transcriptional transactivator, which activates oncogenes, cytokines and growth factors. A direct role of the virus through integration of viral DNA directly to host genome has also been hypothesised that may enhance chromosomal instability, large inverted duplications, deletions, amplifications or chromosomal translocations which lead to the activation of oncogenic pathways.

Chronic HCV (hepatitis C virus) infection is also associated with HCC. The HCC incidence rate in patients with HCV-related cirrhosis is about 3.7%.

Chemical carcinogens which are linked to HCC include nitrites, hydrocarbons, solvents, organochlorine pesticides, primary metals and polychlorinated biphenyls. Of all the chemicals linked to HCC, ethanol is the most important one that leads to HCC. Overconsumption of alcohol is one of the leading causes of liver cirrhosis which makes the patient more susceptible to HBV and HCV infection.

Aflatoxins produced by the fungi, Aspergillus flavus and A. parasiticus have also been linked to HCC. These fungal species grow on grains, peanuts and other food products and are the most common cause of food spoilage. These fungi also produce aflatoxins, aflatoxin Bl being the most hepatotoxic and chronic exposure to these mycotoxins will lead to HCC.

Some congenital conditions also lead to development of HCC. Genetic diseases such as haemochromatosis, Wilson’s disease, hereditary tyrosinaemia, type I glycogen storage disease and porphyria, have all been linked to a high incidence of HCC.

Symptoms and markers

The symptoms related to the early stages of HCC are poor. When HCC presents with clinical symptoms, the tumour is usually advanced and there are few therapeutic options. The current effective treatments available are only applicable in a relatively small proportion of early stage cases.

Serum a-fetoprotein is a useful tumour marker for the detection and monitoring of HCC development, but gives false-negatives in about 40% of patients. Serum Ύ-glutamyl transpeptidase (GGT) is frequently overexpressed in cancer cells. GGT activity is a sensitive marker of hepatobiliary disorders, exhibiting tissue-specific expressions under various physiological and pathological conditions. Other enzymes that are increased in the blood during HCC include alkaline phosphatase, alanine trans-aminase and aspartate transaminase, but they are non-specific.

The overexpression of transforming growth factor (TGF)-β1 and TGF-β1 messenger RNA is seen in most patients with HCC. The level of insulinlike growth factor (IGF)-II and IGF-II mRNA is also overexpressed in HCC. The analysis of telomerase activity in combination with α-fetoprotein increases the accuracy of HCC diagnosis to about 93%.

Even though tumours present limitations for cytogenetic analysis, there are some reports of cytogenetic analysis of HCC. They include chromosome 1p abnormalities and 8q amplification. Molecular studies have demonstrated frequent loss of heterozygosity on 1p, 4q, 8p, 11p, 13q, 16q and 17p and amplification of 8q areas in HCC.

Models

Rodents are usually studied as models of hepatic carcinogenesis. Many chemicals induce liver cancer in rodents since their livers are very sensitive to chemical carcinogens. Thus, a single experimental protocol can be used to understand the mechanisms of a number of carcinogens. The low cost of rodents and their potential for genetic studies and manipulation are also attributes. Apart from this, a fairly extensive understanding of liver biology has made rodent HCC a popular model. Other models used for HCC study include hamsters and other non-primates.

The chemicals used to study the initiation of HCC include nitrosamines, aromatic amines, vinyl chloride, polycyclic aromatic hydrocarbons, hetero-cyclic amines, aflatoxin and tamoxifen. The promoters which are used after initiation include phenobarbital, dioxin and polychlorinated biphenyl. The mechanism of action of these chemical carcinogens is combination with DNA to form adducts, either by direct binding to DNA, or after enzymatic activation in the liver to produce the carcinogen. Some agents that produce hepatic carcinogenesis are discussed below.

Polycyclic aromatic hydrocarbons

Polycyclic aromatic hydrocarbons require metabolic activation to elicit their detrimental effect, e.g. benzo(a)pyrene is enzymatically activated to the 7,8-dihydrodiol, which induces both somatic mutations in crucial genes through DNA binding and subsequent outgrowth of irreversibly transformed cells.

Aryl amines/amides

In rodents these compounds induce tumours in the liver, e.g. acetamido-fluorine undergoes N-hydroxylation in liver cells. Additional tumour-promoting activities of acetamido-fluorine include the triggering of adaptive responses in mitochondria permeability transition pores and Bcl-2 production levels that increase resistance to apoptosis.

Alcohol

The mechanism of ethanol-induced cancer is closely related to its metabolism. Acetaldehyde, the end-product of ethanol metabolism, is the causative agent of cancer in chronic conditions. Oxidative stress and cirrhosis are important factors in ethanol-induced HCC.

Nitrosamines

These are the most widely used chemical carcinogen for animal experiments. N‘-nitrosodiethylamine (NDEA) is metabolised in the liver and its ethyl radical product is responsible for induction of HCC. This radical attacks the DNA and produces genetic changes which result in carcinogenesis. It also produces the conversion of certain proto-oncogenes to oncogenes.

Azo dyes

Para-dimethylaminoazobenzene (p-DAB) is metabolised to monoaminoazobenzene by N-demethylation and subsequently to aminoazobenzene or to N-hydroxy-N-methyl-4-aminoazobenzene. Covalent bindings of these metabolites with DNA are major carcinogenic factors.

Aflatoxins

Aflatoxins are highly mutagenic and are metabolised by cytochrome p450 to their epoxides, which results in formation of DNA adducts with the guanine N7, thus causing carcinogenicity.

Treatment

If detected early, suitable curative treatments include surgical resection, liver transplantation and percutaneous ablation. In patients with advanced stage of HCC, transarterial chemoembolisation has been proved to improve survival in selected candidates. Other therapeutic modalities such as intra-arterial chemotherapy and internal radiation offer promising results but have not been shown to improve survival. As HCC is usually chemoresistant, cytotoxic drugs are poorly tolerated in cirrhotic patients so many of the known anticancer agents, e.g. tamoxifen, octreotide, interferon, fail to produce any benefit in HCC patients. Promising results have been obtained with agents targeting receptor tyrosine kinase pathways. Since HCC is dependent on angiogenesis, molecules targeting the angiogenesis are currently under investigation. BAY 43-9006, which inhibits multiple pathways, mainly Raf kinase and VEGF, has been undergoing Phase II and III trials and has shown a partial response in a patient with advanced HCC.

The presence of unlimited chemical molecules, with diverse mechanisms, present in herbal drugs makes them interesting starting points in the search for newer drugs for cancer treatment.

Natural templates for treatment

The plant kingdom produces many potent pharmacologically active components, several of which have provided promising results to combat various diseases. Possible uses of herbal drugs in cancer are illustrated in Figure: Potential uses of herbal drugs in cancer treatment.

Figure: Potential uses of herbal drugs in cancer treatment.

Figure: Potential uses of herbal drugs in cancer treatment.

The chemical basis of some anticancer plants has been elucidated and some are now used clinically. Plant extracts and their constituents which show significant activity against hepatic cancer are described in more detail below.

Curcuma longa (turmeric)

The rhizome of C. longa (Zingiberaceae) is described as an anti-inflammatory agent in Ayurveda and is widely used in foods and as a medicine thoughout India and other Asian countries as a treatment for liver disorders, including cancer. The most-studied ingredient in the rhizome is curcumin but several related compounds are present such as demethoxy-curcumin and bidemethoxycurcumin.

Curcumin treatment has been reported to reduce tumour incidence and inhibit the liver inflammation and hyperplasia in N-nitrosodiethylamine-induced liver-cancer-bearing animals. The chemopreventive effect of turmeric and curcumin against diethylnitrosamine-induced and phenobarbital-promoted hepatocarcinogenesis has been reported. Curcumin also suppressed diethylnitrosamine-induced development of altered hepatic foci in rat liver. The number of Ύ-GT positive foci induced by aflatoxin Bl was found to be reduced by curcumin treatment. Curcumin significantly protected the liver from oxidative stress-induced damage during chemically induced hepatocarcinogenesis in rats.

In a patient study, Curcuma aromatic oil showed a positive effect in treating primary liver cancer with longer survival time and myelosuppression. Curcumin treatment reduced the tumour incidence by inhibiting angiogenesis through down-regulating cyclo-oxygenase 2 and vascular endothelial growth factor in HepG2 cells. It was reported that curcumin induces mitochondrial and nuclear DNA damage, thereby inducing apoptosis through caspase 3 and 9 activation. Curcumin also suppressed intrahepatic metastasis mediated by the inhibition of MMP-9 and through alteration of cytoskeletal organisation. In-vitro studies showed that the production of p21(ras) was inhibited by curcumin. It also inhibited transcription factor NF-kB and IAP gene expression. External curcumin application has been tried as a palliative therapy for cancerous skin lesions. Clinical trials (Phase I and II) of curcumin are being carried out in several hospitals to find out its therapeutic role against colon cancer, pancreatic cancer, hepatocellular cancinoma and multiple myeloma. Curcumin was found to be non-toxic at doses up to 12 g/day in patients.

Silybum marianum (milk thistle)

The active ingredients present in Silybum marianum (Compositae) are the flavonolignans silymarin and silybinin. Silymarin has been proposed as a promising chemotherapeutic adjuvant for the treatment of liver cancer. N‘-nitrosodiethylamine-induced hepatocellular carcinoma was found to be inhibited by silymarin by modulating antioxidant defence status in rats. Silybin was found to inhibit the growth of Hep3B and HepG2 cells by G1 arrest. The apoptosis-inducing property of silybin has been shown to be through decreasing cyclin D1, cyclin D3, cyclin E and cyclin dependent kinases 2 and 4. Silymarin can suppress the proliferation of a variety of tumour cells through cell cycle arrest at the G1/S-phase, induction of cyclin-dependent kinase inhibitors (such as p15, p21 and p27), down-regulation of anti-apoptotic gene products (e.g. Bcl-2 and Bcl-xL), inhibition of cell-survival kinases (AKT, PKC and MAPK) and inhibition of inflammatory transcription factors (e.g. NF-kβ). Silymarin can also down-regulate gene products involved in the proliferation of tumour cells (cyclin D1, EGFR, COX-2, TGF-beta, IGF-IR), invasion (MMP-9), angiogenesis (VEGF) and metastasis (adhesion molecules). The anti-inflammatory effects of silymarin are mediated through suppression of NF- kβ -regulated gene products, including COX-2, LOX, inducible iNOS, TNF and IL-1. Treatment of patients with hepatitis B or C infection with silymarin seemed to be effective, although no effect in decreasing viral load was found.

Camellia sinensis (tea)

Constituents of Camellia sinensis (Theaceae) include flavonols, e.g. myricetin, kaempferol and quercetin; as well as caffeine and proanthocyanidins such as epigallocatechin gallate. Green tea was observed to have protective effect on liver cancer in population-based studies.

In multidose NDEA-induced HCC followed by carbon tetrachloride injection and partial heptoectomy studies, it was found that treatment with tea polyphenols and pigment showed significant reduction in number and area of GST-positive foci, which is a proliferative indicator of precancerous liver lesions by immunohistochemistry.

Green tea was reported to exert antiproliferative activity towards hepatoma cells. Green tea was also reported to possess chemopreventive activity against nitrosamine-initiated hepatocellular carcinoma. It was found that the production of p21(WAF1/CIP1) was significantly induced and that of cyclin Dl and cyclin-dependent kinase 4 were inhibited in tea-treated animals. Tea catechins, black tea extract and oolong tea extract are also reported to inhibit hepatocellular carcinoma.

Allium sativum (garlic)

The bulbs of Allium sativum (Alliaceae) have been described as useful against inflammation and tumours in Ayurveda. The anticarcinogenic activity of whole garlic, as well as its isolated ingredients, against NDEA-induced hepatocellular carcinoma in animals is well documented. Aged garlic extract inhibited the development of putative lesions in rat hepatocarcino-genesis involving a slowing in the proliferation rate of liver cells after partial hepatoectomy. Garlic powder inhibited the formation of preneoplastic foci during hepatocarcinogenesis initiated by diethylnitrosamine through suppression of CYP2E1. The organosulphur compounds isolated from garlic are highly active against liver cancer. There was a decrease in the number of preneoplastic, GST-positive foci of the liver and also a down-regulation of IGF-I and iNOS mRNA expression in the liver of organosulphur-treated animals which were induced with 2-amino-3,8-dimethylimidazo [4-5-f] quinoxaline. The protective effect of diallylsulphide isolated from garlic against HCC was reported by Singh et al. (2004). S-allylcysteine, an organosulphur compound, showed inhibition of tumour incidence and lipid peroxidation in NDEA-induced hepatic cancer animals with simultaneous elevation in antioxidants.

Benzo(a)pyrene-induced cancer was found to be inhibited by garlic constituents such as diallylsulphide (DAS), diallyldisulphide (DADS) and diallyltrisulphide (DATS). Diallylsulphide prevented DNA adducts induced by the carcinogen, thereby preventing the initiation of oestrogen-induced cancer. Allylthiopyridazine derivatives induced apoptosis in Sk-Hep-1 cells through a caspase-3-dependent mechanism and this also contributes to their chemopreventive function. The antiproliferative property of aqueous garlic extract was studied in HepG2 cells and it was found that these compounds induced a p53/p21-dependent cell cycle arrest in G2/M phase and apoptosis through activation of c-Jun-NH (2) terminal kinase (JNK)/c-Jun phosphorylative cascade. DAS, DADS and DATS also caused G2/M phase arrest in human liver tumour cells.

Emblica officinalis Gaertn. (emblica)

The extract of fruits of Emblica officinalis (Euphorbiaceae) was reported to give chemoprotection against chemically induced carcinogenesis. The fruits are rich in polyphenolic compounds such as gallic acid, tannic acid, emblicanin A and B and ellagitannins. Polyphenolic compounds, such as epigallo-catechin gallate, found in tea are also present in Emblica officinalis. Because of the presence of these compounds, emblica extract has been shown to possess significant antioxidant activity and is also antimutagenic, inhibiting DNA adducts produced by benzo(a)pyrene. The polyphenolic fraction of Emblica officinalis was found to modulate NDEA-induced hepatic cancer in rats. In-vitro experiments showed that it inhibited DNA topoisomerase I in Saccharomyces cerevisiae mutant cell culture and also inhibited the activity of cdc25 tyrosine phosphatase.

Phyllanthus amarus

The fresh root of Phyllanthus amarus (Euphorbiaceae) is said to be an excellent remedy for jaundice. The components present in Phyllanthus amarus are lignans, e.g. phyllanthin; tannins, e.g. phyllanthusiin D3, amariin and amarulone; alkaloids, e.g. entnorsecurinine, diarylbutanes; and neolignans, e.g. phyllnirurin. A variety of hydrolysable tannins purified from Phyllanthus amarus were reported to be potent inhibitors of rat liver cyclic AMP-dependent protein kinase catalytic subunit. Phyllanthus amarus extract was reported to significantly inhibit NDEA-induced hepatocar-cinogenesis in rats in a dose-dependent manner. In another study the lifespan of rats bearing NDEA-induced hepatocellular carcinoma was found to be significantly increased by the treatment with Phyllanthus amarus, from 33 weeks to 52 weeks. Phyllanthus amarus extract has been shown to have antiviral activity against hepatitis B virus. In a patient study, it was found that approximately 60% of the carriers of HBV lost the virus within 1 month of Phyllanthus amarus treatment.

Picrorhiza kurroa (kutki)

The root/rhizomes of Picrorhiza kurroa (Scrophulariaceae) are used in Ayurveda against jaundice. The components present in the root include the glycosides picrorhizin and kutkin, and sterols. Picroliv, an iridoid glycoside mixture prepared from this plant, contains equal concentrations of picroside and kutkoside as well as vanillic acid and sterols. Amelioration of NDEA-induced hepatocellular carcinoma was seen in animals treated with Picrorhiza kurroa extract, and there was a significant reduction in the levels of drug-metabolising enzymes such as glutathione-S-transferase (GST) and aniline hydroxylase (AH). Liver morphology and histopathology also revealed the protective effect of the extract against chemical carcinogenesis. Picroliv was found to inhibit HCC and was also reported to possess protective effect against 1,2-dimethylhydrazine-induced HCC in animals. Picroliv significantly down-regulated transcription factor API and thereby decreased the level of c-fos mRNA as well as c-jun and c-fos proteins in liver tissue. This would indicate a base for their potential anti-HCC activity.

Semecarpus anacardium (marking nut)

The rind of the fruit of Semecarpus anacardium (Anacardiaceae) is used in Ayurvedic medicine against inflammatory diseases. The active ingredient is usually reckoned as anacardic acid. Semecarpus anacardium nut extract affords anti-cancer activity by enhancing both phase I and phase II enzymes and it has been proposed that the anticancer activity may be mediated through the induction of hepatic biotransformation enzymes. It was found to modulate the carcinogenic effect of aflatoxin by enhancing anti-oxidant capacity in the system.

Andrographis paniculata (creat)

The root of Andrographis paniculata (Acanthaceae) is used in both Ayurvedic and Chinese medicine. The component present is a diterpene lactone andrographolide. The roots also contain a variety of compounds including the sesquiterpene andrographolide. The effectiveness of Andrographis paniculata was found to be through modulating hepatic and extra-hepatic carcinogen-metabolising enzymes and antioxidant status. Andrographis paniculata extract and andrographolide stimulated CTL production through enhanced secretion of IL-2 and IFN-Ύ by T cells and thereby inhibited the tumour growth. The species has been reported to modulate the immune response through enhancing natural killer (NK) cell activity and antibody-dependent cell-mediated cytotoxicity and antibody-dependent complement mediated cytotoxicity in tumour-bearing animals.

Glycine max (soybean)

Glycine max (Papilionaceae) contains isoflavone glycosides genistein and diadzin as active principles but certain saponin constituents were also found to be biologically active. The administration of 30% soybean to the rat diet was found to have protective effect against hepatocarcinogenesis induced by DL-ethionone. There was a 92.7% increase in lifespan in rats with primary liver cancer when treated with doxorubicin encapsulated with soybean-derived sterylglycoside mixture when compared with free doxorubicin. Genistein was found to inhibit diethyl-nitrosamine-induced and phenobarbital-promoted HCC. Genistein has been reported to inhibit lung metastasis in animals. Genistein was found to inhibit cell proliferation and induced apoptosis through caspase-3 induction and caspase-2 activation. In another study apoptosis was induced by genistein in Hep 3B cells through initiating endoplasmic reticular stress relevant regulators including m-calpain, GADD 153, GRP 78 and caspase-12.

Panax ginseng (ginseng)

Panax ginseng (Araliaceae) root (white and red) is extensively used in traditional Chinese medicine against various diseases. Ginseng contains polysaccharides and saponins, those known as ginsenosides are commonly considered to be the active constituents. The incidence of liver tumour development was lower in animals treated with red ginseng extract, and the average number of tumours per mouse was significantly reduced in the treated group. White ginseng was also found to possess anticarcinogenic properties both in vitro and in vivo. In another study, red ginseng was found to possess both preventive as well as curative properties against diethylamine-induced hepatic cancers in rats.

Terminalia arjuna (arjuna bark)

Terminalia arjuna (Combretaceae) bark is extensively used against tumours in Ayurvedic medicine. Terminalia arjuna was reported to possess chemopreventive activity in NDEA-induced HCC-bearing animals. In another study, diethylnitrosamine-induced HCC was inhibited by Terminalia arjuna bark extract through modulating the antioxidant status in tumour-bearing animals. The ingredients of Terminalia arjuna bark include flavonoids, e.g. arjunone, arjunolone and luteolin; phenols, e.g. gallic acid and ellagic acid; and terpenoids, e.g. oleanolic acid. The antitumour potential of luteolin and triterpenoids has been reported, while phenolic ingredients have significant chemopreventive activity.

Other plants

Baubinia variegata and Baubinia racemosa were reported to ameliorate NDEA-induced HCC in rats through modulation of antioxidant enzymes. Chemopreventive potential of extracts from Tamarix gallica, Paullina cupana, Butea monosperma, Lygodium flexuosum, Indigofera aspalatboides, Apium graveolens, Solanum trilobatum, Ardisia compressa, Calotropis procera, Amaranthus gageticus, Astragalus membranaceus, Beta vulgaris, Cymbopogon citrates, Asteracantha longifolia, Triantbema portulacastrum etc. has been reported in hepatic cancer models in animals.

Conclusions

There is no really effective treatment for hepatocellular carcinoma and so it stands high in global cause of mortality. Chronic hepatitis and lifestyle-induced oxidative stress are the major factors associated with hepatic cancer. It is detected in the later stages in many patients, and the current treatment modalities fail to keep the disease under control. Plants and plant-derived compounds have been found to be effective against hepatic cancer in animal models and through a few clinical studies. The antiviral and free-radical scavenging activities of the plant-derived constituents in many cases have proven to be beneficial. Many of the compounds, e.g. curcumin, are in the process of being testing in clinical trials and are giving promising results, while explorations for newer compounds are still progressing.

Herbs as a Lifestyle

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July 29, 2010 at 12:24 pm

The best use of herbal remedies comes when you take a holistic view at the nature of your overall health and illnesses and then take a look at the nature of the herbs you are using. It is really all about getting the right combination to achieve the effects you are aiming for. This is why it is almost essential to consult with a holistic health practitioner of some kind to find out what is right for you, especially if you intend to use herbs nutritionally on a daily basis.

You might want to look for someone who has a method of assessing what herb or combination of herbs is correct for you. As you have learned in this site, several different herbs are helpful for a certain ailment, but how do you know which one will be the best for your particular body?

Some methods that practitioners will use to assess what might be best for you include a mixture of the following:

> Body typing

> Muscle testing

> Iridology (analysis of the iris of the eyes)

> Tongue diagnosis

> Pulse diagnosis > Blood tests

> Saliva testing

> Urine analysis

> Metabolic typing

> Hair analysis

> Live blood analysis

About overcoming an ailment with herbs

General conditions of the nails, face, skin, hair, tongue, and eyes indicate a state of health or illness.

There are many other forms of assessing your constitution and chemistry, and these methods listed can be used in combination to gain information about your health.

A good herbalist will help you put together a combination that will bring you results. It is much nicer to have a game plan with someone schooled in herbology than to take guesses and choose things randomly off the shelves at your health food store (although many qualified herbalists are available in health food stores!).

The quality of the herbal products you take will also have a lot to do with the results you get using herbs.

The FDA does not regulate the herb industry, so it is best to get your products from a reputable company that runs their manufacturing plant to the same standards as the pharmaceutical companies. These are usually large manufacturers that have been in business for decades.

A Daily Program

A good general maintenance program will differ slightly for each person because we all have special needs, but a general daily program that almost anyone can safely take to maintain health is included here. Any generally healthy adult who lives an average lifestyle can use these herbs. They won’t be necessary for those living on a macrobiotic diet of all whole, raw, fresh, organic foods. Nor will it be necessary to help those who are perfect in every way, but for most of us, this general program is designed for the maintenance of health and can be used for a lifetime.

A Daily Program for Health and Longevity

Herb Quantity Supports
Liquid chlorophyll Two to four tablespoons in water to taste, daily. Digestive, intestinal, structural, and circulatory system support. Saves energy digestion; is safe and easily assimilated. Provides minerals; deodorizes, filters pollutants we come in contact with, builds red blood count.
Psyllium hulls Four capsules twice daily. Intestinal system. Gives the bowel something to resist against, sweeps excess waste from colon, and aids weight regulation, steadies blood sugar.
Papaya Two chewable tablets before each meal, and after as needed. Digestion. This fruit (comes in a chewable tablet form usually) supplies enzymes helpful in breaking down enzyme-less (cooked) foods. Saving digestive energy will help save life energy.
Gotu kola Two capsules daily. Gotu kola is my favorite anti-aging remedy; it feeds the nervous system and will help keep the mind sharp, aids vitality and longevity.
Garlic Two cloves, or equivalent in capsules daily (if tolerated). Garlic is sometimes not suitable for sensitive stomachs, but it is a wonderful all-around food beneficial for the immune system, circulatory system, and respiratory system. It can help protect you from catching illnesses of all sorts.
Bee pollen Two capsules twice daily. Bee pollen will round off your program, providing you every substance needed to survive. It contains many vitamins and amino acids. Only those with allergic reactions to bees or bee pollen should avoid its use. (Substitute barley grass herb if so.)

Along with your other good habits — such as daily water intake, exercise, good relationships, and a variety of wholesome foods — this program can help you maintain your health and help you live a long and nourished life!

Garlic and cardiovascular risk factors

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April 30, 2010 at 11:45 am

Garlic, onions and cardiovascular risk factors. A review of the evidence from human experiments with emphasis on commercially available preparations.
J Kleijnen, P Knipschild, and G ter Riet
Br J Clin Pharmacol. 1989 November; 28(5): 535–544

This interesting review article (Kleijnen et al., 1989) did not unfortunately relate to the state of the art in clinical research concerning garlic in general and certain garlic preparations in particular. In the last 3 years more than one dozen clinical research studies have been performed with concentrated garlic tablets. Dr Kleijnen & colleagues’ review refers to only one of these trials dating from 1985 and studies of other garlic products are similarly excluded. The research program has included studies investigating cholesterol, triglycerides, LDL and HDL, blood pressure, fibrinolysis, blood viscosity, etc. This includes work carried out at different university hospitals, research institutions as well as multi-centre studies with general practitioners. Much of this work has been recently presented at the first International Garlic Symposium in Germany, the results of which have now been published in English and made widely available to the British medical profession in a special supplement of Cardiology in Practice.

A main conclusion of Dr Kleijnen was that large amounts of garlic are needed to prove clinical effectiveness (up to 28 cloves). This did indeed appear to be the case according to early trials using garlic. Certainly few patients would find such a level of daily consumption practical or socially acceptable. Very high levels of garlic clove have in the past been necessary to provide relatively very small amounts of active oils or other derivatives. This follows partly from garlic’s high water content (60%) accounting for much of its bulk and because its active substance allicin rapidly breaks down once created by cutting or crushing. It is now possible to produce dehydrated garlic powder to a standardised level of the allicin mother substance alliin. Moreover production expertise has also developed enabling these ingredients to be preserved within a protected tablet form. These developments have enabled effective clinical work to be undertaken for the first time with a standardised product available at a relatively low and acceptable dosage level. Our studies have been performed with daily dosages of 300-900 mg garlic powder (equivalent to about 1 clove of garlic). We were able to show a mean reduction of blood cholesterol of approximately 10% and of triglycerides 13%.

A second point of criticism was the postulated inherent difficulty of performing double-blind studies with garlic or garlic preparations. This, too, was certainly true in the past but has largely been circumvented by the availability of a tablet product which overcomes the odour and taste problem for most people. We absolutely agree that totally odourless garlic preparations are ineffective, since the medical effects are based on the action of alliin and its sulphur smelling secondary and tertiary products. Control of the odour problem depends on the galenic preparation of garlic powder, so that formation of smelling products occurs in the intestine. At the dosages used in our trials only 5-10% of all patients developed any such garlic ‘signs’. These cases can be easily identified and omitted prior to statistical evaluation thus enabling proper double-blind studies to be conducted. The humble garlic clove is increasingly being shown to have exciting potential as a safe prophylactic for everyday use against cardiovascular risk factors. We do hope that you will be able to incorporate this new information about garlic and garlic preparations in your Journal, and in particular the developments in dosage and double-blind study capability.