Use of herbal preparations in the treatment of oxidant-mediated inflammatory disorders

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Summary

Complementary and alternative medicine (CAM) use has increased in popularity in recent years and herbal therapy alone is now a billion dollar market. For centuries herbs have been used as food and for medicinal purposes. Various herbs have been identified as possessing anti-inflammatory and antioxidative properties, and they are currently being used to treat inflammatory disorders as well as those caused by reactive oxygen species (ROS). Asthma, Alzheimer's disease, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and atherogenesis are all disorders where inflammation and ROS are involved in their pathogenesis. This review examines the pathogenesis of the above mentioned ROS-mediated inflammatory disorders, as well as discusses the antioxidant and anti-inflammatory mechanisms of various herbs and the clinical trials where herbs have been used to treat these disorders.

Introduction

A 1990 national survey done by Eisenberg et al.1 on use and type of complementary and alternative medicine (CAM) by Americans demonstrated that alternative medicine has a substantial presence in the US health care system. In the US, herbs make up a substantial component of CAM. According to the survey, approximately one out of three Americans used at least one unconventional therapy per year, and 2.5% of the respondents had used herbal medicine in the previous 12 months. A repeat survey done by the same group in 1997 showed the usage of alternative therapy in the previous year increased to 42.1% and the use of herbal medicine increased to 12.1%. They estimated consumers in the United States spent approximately US$ 5.1 billion on herbal therapies alone in 1997.1 Today, we are witnessing a great deal of public interest in the use of herbal remedies based on the premise that plants contain natural substances that can safely promote health and alleviate illness.2

Various herbs have also been identified as possessing anti-inflammatory and antioxidative properties, and some of these are currently being used to treat inflammatory disorders and disorders caused by reactive oxygen species (ROS). The scope of ROS-mediated diseases is believed to be broad, and herbs that scavenge reactive oxidant chemicals before they damage tissue may prevent or slow each of these processes. However, there is limited scientific data to support such a conclusion,3 and the majority of the reports proclaiming benefits of herbs are based on testimonials, case reports, and unsubstantiated claims. There are, however, some reports of clinical trials where herbs have been effective in treating inflammatory and ROS-mediated disorders.

This review will first examine the pathogenesis of some ROS-mediated inflammatory disorders. Next, it will list the antioxidant and anti-inflammatory mechanisms of various herbs that have been advocated in treating them. Last, it will review some of the clinical trials where herbs have been used in these disorders.

Section snippets

Inflammation and mechanism of damage by ROS

Inflammation is the initial response of the body to tissue damage caused by mechanical, chemical, or microbial stimuli.4 Cytokines are the physiological messengers of the inflammatory response and some of the principal molecules involved are tumor necrosis factor-alpha (TNFα), interleukins (IL-1 and IL-6), interferons, and colony stimulating factors (CSFs).4 The main cells involved in the inflammatory response are monocytes/macrophages, polymorphonuclear leucocytes (PMNs), and endothelial

ROS-mediated inflammatory disorders

Here, we will review the mechanisms of several common inflammatory disorders with emphasis on the roles inflammation and ROS play. ROS have also been implicated in the pathogenesis of cancer. However, this review will not include this topic because it has previously been reviewed.9 There are other illnesses recently suggested to involve ROS mediated injury, such as irritable bowel syndrome, but these are not widely accepted and therefore we will not include them in this review.

Potential anti-inflammatory mechanisms of herbs

Several herbal preparations have been considered to be useful in the treatment of inflammatory disorders. Table 3 lists the potential anti-inflammatory mechanisms of some commonly used herbs that may be effective in treating ROS-mediated inflammatory disorders.

Clinical trials of herbs in ROS-mediated disorders

As stated above, many herbal preparations have antioxidant and anti-inflammatory properties. However, ultimate proof of their benefit in treatment of inflammatory disorders in man requires well-designed clinical trials.

Conclusion

In this paper, we have reviewed the role inflammation and reactive oxygen species play in the pathogenesis of several disorders. It also reviewed the mechanisms of herbs that possess antioxidant and anti-inflammatory properties. In light of the principal role inflammation and ROS play in these disorders, it is reasonable to expect that herbs possessing antioxidant and anti-inflammatory activity might be beneficial in treating them. Currently, however, there is a general lack of scientific data

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