Chinese herbal medicine in treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis

Ethnopharmacological relevance

To investigate the influence of paeoniflorin (major bioactive component of Paeonia lactiflora Pall.) on the pharmacokinetic behavior of aconitine (major toxic and bioactive component of Aconitum carmichaeli Debx.) and potential detoxifying effect of paeoniflorin on the acute toxicity of aconitine, which may provide in depth understanding to the toxicity reduction effect of Paeonia lactiflora to Aconitum carmichaeli.

Materials and methods

Ultra high performance liquid chromatography coupled with triple quadrupole mass spectrometer (UHPLC–MS/MS) was employed to determine the plasma content of aconitine. Aconitine was administrated by oral to SD rats at the dosage of 200 μg/kg with or without paeoniflorin given by intraperitoneal injection at the dosage of 20 mg/kg. Plasma samples were collected for determination and analysis of pharmacokinetic parameters of aconitine. The LD₅₀ of aconitine and acute animal death induced by aconitine were examined when aconitine was given alone or jointly with paeoniflorin in ICR mice.

Results

A sensitive, accurate, precise, reliable and repeatable UHPLC–MS/MS method was successfully established for determination of the plasma content of aconitine in 12.5 μL plasma sample. The lower limit of quantification of aconitine was 0.01 ng/mL. Compared with the SD rats that were orally administrated with aconitine alone, the rats received aconitine and co-administrated with paeoniflorin by peritoneal injection showed a remarkably lower C_max (5.69 ng/mL vs 9.66 ng/mL, P < 0.05) and delayed T_max (70 min vs 46 min, P < 0.05), as well as a trend of reduction in AUC_0–t (1082.75 ng-min/mL vs 1650.27 ng-min/mL, P = 0.395). The LD₅₀ values of aconitine coadministered with 120 or 240 mg/kg of paeoniflorin were obviously increased to 2.30 and 2.15 mg/kg against 1.80 mg/kg of aconitine by oral administration alone. Mice treated with paeoniflorin (240 mg/kg) and aconitine (1.8 mg/kg) together revealed a significant decreased death rate than that received aconitine treatment alone (15% vs 50%, P < 0.05).

Conclusions

The acute oral toxicity of aconitine in rats was significantly reduced by paeoniflorin; this might result from the alterations of pharmacokinetic behavior of aconitine in the animals by coadministration of paeoniflorin.     

Aconitine-induced Ca overload causes arrhythmia and triggers apoptosis through p38 MAPK signaling pathway in rats

Aconitine is a major bioactive diterpenoid alkaloid with high content derived from herbal aconitum plants. Emerging evidence indicates that voltage-dependent Na⁺ channels have pivotal roles in the cardiotoxicity of aconitine. However, no reports are available on the role of Ca^2 + in aconitine poisoning. In this study, we explored the importance of pathological Ca^2 + signaling in aconitine poisoning in vitro and in vivo. We found that Ca^2 + overload lead to accelerated beating rhythm in adult rat ventricular myocytes and caused arrhythmia in conscious freely moving rats. To investigate effects of aconitine on myocardial injury, we performed cytotoxicity assay in neonatal rat ventricular myocytes (NRVMs), as well as measured lactate dehydrogenase level in the culture medium of NRVMs and activities of serum cardiac enzymes in rats. The results showed that aconitine resulted in myocardial injury and reduced NRVMs viability dose-dependently. To confirm the pro-apoptotic effects, we performed flow cytometric detection, cardiac histology, transmission electron microscopy and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay. The results showed that aconitine stimulated apoptosis time-dependently. The expression analysis of Ca^2 + handling proteins demonstrated that aconitine promoted Ca^2 + overload through the expression regulation of Ca^2 + handling proteins. The expression analysis of apoptosis-related proteins revealed that pro-apoptotic protein expression was upregulated, and anti-apoptotic protein BCL-2 expression was downregulated. Furthermore, increased phosphorylation of MAPK family members, especially the P-P38/P38 ratio was found in cardiac tissues. Hence, our results suggest that aconitine significantly aggravates Ca^2 + overload and causes arrhythmia and finally promotes apoptotic development via phosphorylation of P38 mitogen-activated protein kinase.     

槐胺碱抗清醒大鼠实验性心律失常的作用

iv 乌头碱30μg/kg 可引起清醒大鼠多种心律失常。槐胺碱13.3,15mg/kgiv 可使清醒大鼠室性早搏(VP)和室速(VT)的出现延迟,并明显降低室颤(VF)的发生率,死亡时间延迟,死亡率亦降低。结果显示槐胺碱有较好的抗乌头碱诱发的心律失常作用。     

附子与干姜、甘草配伍使用后乌头碱含量的变化研究

目的：研究附子与干姜、甘草配伍使用后乌头碱含量的改变。方法：将附子分别和干姜、甘草配伍,利用高效液相色谱法（HPLC）对其配伍后乌头碱含量改变情况加以检测。结果：附子与干姜、附子与甘草中乌头碱含量及有毒生物总碱含量显著低于附子,且附子与甘草中乌头碱含量及有毒生物总碱含量显著低于附子与干姜。结论：附子在许多疾病治疗中有显著效果,在临床中使用时可根据实际需求将之和干姜、甘草等合理配伍,促使附子内乌头碱含量降低,有效降低毒性,从而为患者的安全用药提供有力保证。     

附子总碱及其模拟炮制品对大鼠离体心脏的毒性作用

目的:研究附子总碱及其模拟炮制品对大鼠离体心脏的毒性作用,探讨其作用机制。方法:建立SD大鼠的Langendorff离体心脏灌注模型。用附子总碱及其模拟炮制品的不同炮制时间点(0,20,40,60,80,120 min)炮制品以及不同累积给药剂量(0,50,100,150,300μg)对灌注模型进行干预,以左心室收缩压(left ventricular systolic pressure,LVSP),左心室舒张末期压(left ventricular end-diastolic pressure,LVEDP),左心室舒张压(left ventricular developed pressure,LVDP),左心室内压最大上升速率(+dp/dt),左心室内压最大下降速率(-dp/dt)等血流动力学参数以及心率(heart rate,HR)为指标,观察附子总碱及其模拟炮制品对大鼠离体心脏的影响。结果:与给药前平衡比较,模拟炮制80 min组累积给药100μg时显示心脏毒性,炮制100,120 min组累积给药300μg时才出现毒性(P0.05)。附子总碱及其模拟炮制品都能增加心率,都能使LVSP,LVDP,±dp/dt明显降低,并且与累积给药量呈正相关趋势,同时使LVEDP上升。结论:附子总碱及其模拟炮制品对大鼠离体心脏均呈现出毒性作用,随炮制时间的延长,毒性下降。     

LC-MS/MS测定大鼠血浆中乌头碱的浓度

目的:建立LC-MS/MS法检测大鼠血浆中乌头碱的浓度。方法:以维拉帕米作内标,血浆样品经MTBE液液萃取后,采用HyPURITYCyano(150mm×2.1mm,5μm)柱分离,流动相为乙腈:10mmol/L甲酸铵=(70∶30,V/V),流速为0.30mL/min。然后采用电喷雾离子源(ESI源)正离子多反应监测(MRM)扫描分析,乌头碱和维拉帕米的离子选择通道分别为:m/z646.4→586.4和455.2→164.9。结果:乌头碱的线性范围为9.3～2390pg/mL,最低检测浓度为9.3pg/mL,日内和日间变异均<15%。结论:本方法灵敏度高,适用于乌头碱在鼠内的药物代谢动力学研究。     

优化附子生物碱提取工艺的实验研究

目的优化附子生物碱提取的工艺。方法采用紫外-可见分光光度法建立乌头碱含量的测定方法;考察不同提取溶剂对提取率的影响,通过正交实验考察提取时间、溶剂质量浓度、溶剂用量等因素进一步优化工艺条件。结果乌头碱的线性回归方程为：y=2.8819x-0.0019（r2=0.9991）,乌头碱在0.025～0.255mg/mL范围内呈良好的线性关系。经过正交设计研究并通过工艺验证,乌头碱的最佳提取工艺条件为10倍量1.5mol/L的盐酸溶液煎煮3h。结论优化的提取工艺可为含乌头碱类成分的药材提取及制剂的制备提供参考。     

食物中毒样品中的乌头碱的SPE—UFLC／MS／MS快速测定法

目的建立SPE．UFLC／MS／MS快速测定食物中毒事件中乌头碱、次乌头碱、中乌头碱的方法。方法各种食物样品及呕吐物经0．1mol／LHCl提取,SPE固相萃取小柱净化,经AgilentSBC182．1mm×50mm,1．8μm分离,在正离子模式下用串联质谱仪定性定量分析。结果食物样品及呕吐物中乌头碱、次乌头碱、中乌头碱的方法检出限为1—3μg／L,2个水平的加标回收率为79．8％～112．5％,相对标准偏差均小于9．4％。结论该方法测定各种食物样品及呕吐物中的乌头碱、次乌头碱、中乌头碱快速,准确,可靠,灵敏度高。     

铁牛七生物碱提取工艺研究

目的:优选铁牛七中生物碱的提取工艺。方法:采用L16(45)正交设计并结合单因素轮换法,以酸性染料比色法测定总生物碱含量,以高效液相色谱法测定乌头碱含量,对铁牛七中生物碱的提取条件进行优化。结果:总碱和乌头碱具有不同的最佳提取条件。采用6倍量酸性乙醇溶液(无水乙醇∶pH 3.0 HAc=85∶15,v/v)回流提取1 h时总生物碱提取量最高,3次提取基本可将其完全提出,测得总生物碱含量为0.980%;采用4倍量酸性乙醇溶液(无水乙醇∶pH 3.0 HAc=15∶85,v/v)回流提取0.5 h时乌头碱提取量最高,3次提取基本可将其完全提出,测得乌头碱含量为0.109%。结论:实验证明该提取工艺科学、合理。     

《中国药典》2020年版一部含乌头碱制剂质量控制探讨

为了较全面了解《中国药典》2020年版一部收载含乌头碱制剂的质量控制情况,本文以制剂的鉴别、检查和含量测定项目为依据,结合用法和用量项目,对87种制剂的含乌头碱饮片质控情况进行整理和分析。结果显示,大多数制剂的含乌头碱饮片质量控制很不完善,相关项目指标和内容建议在新版药典中修订,以便规范控制制剂质量,保证药品安全有效。