Efficacy and Safety of Mulberry Twig Alkaloids Tablet for Treatment of Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Multicenter Clinical Study / 中国结合医学杂志

OBJECTIVE@#To assess the efficacy and safety of mulberry twig alkaloids (Sangzhi alkaloids, SZ-A) for treatment of type 2 diabetes in a randomized, double-blind, placebo-controlled multicenter clinical trial.@*METHODS@#A total of 200 patients were randomized to receive SZ-A (n=100) or placebo (n=100) for 16 weeks. The data analysis system for electronic data capture clinical trial central randomization system was used for randomization and dispensing of drugs. The primary outcome was the change in glycosylated hemoglobin (HbA1c) level. The secondary outcome included the proportions of cases with HbA1c <7.0% and HbA1c <6.5%, fasting blood glucose (FBG), postprandial blood glucose (PBG), area under curve for the PBG (AUC0-2h), body weight, and body mass index (BMI). Adverse events (AEs), severe adverse events (SAEs), treatment-related adverse events (TAEs), gastrointestinal disorders (GDs), blood pressure, routine blood tests, and liver and kidney function were monitored.@*RESULTS@#Compared with baseline, the change of HbA1c at week 16 was -0.80% (95% CI: -0.98% to -0.62%) and -0.09% (95% CI: -0.27% to 0.09%) in SZ-A group and placebo group, respectively. The proportion of patients with HbA1c <7% and <6.5% was higher in the SZ-A group than in the placebo group (46.8% vs. 21.6% and 29.9% vs. 10.8%). The observed values and changes in FBG, 1 h-PBG, 2 h-PBG, and AUC0-2h differed significantly between groups (P<0.001), but differences were not significant in body weight and BMI (P>0.05). The incidence rates of AEs, TAEs, and GDs differed significantly between groups (P=0.010, P=0.005, and P=0.006, respectively), whereas the incidence rates of SAEs showed no significant differences between groups (P=1.000).@*CONCLUSION@#SZ-A are effective and safe for treatment of type 2 diabetes. The protocol was registered in http://www.chictr.org.cn/showproj.aspx?proj=60117 (ChiCTR2000038550).

Humanistic Spirit Contained in Traditional Chinese Medicine should Be Valued / 中国医学科学杂志(英文版)

Medicine is a science studying human's health and diseases as well as the regularity between them. Its research subject is human, who possess natural attribute, psychological attribute and social attribute. Therefore, medicine is bound to possess humanistic attribute. Rooted in Chinese traditional culture, Traditional Chinese Medicine contains abundant humanistic thoughts, for instance, pursuing the unity of human and nature, advocating the vital importance of life, sticking to the virtue of "medicine being humane art", abiding by the principle of "Benevolence prior to interest", complying with the medical rule of "Respecting peers". These are the very concrete reflections of medical humanistic spirit. In this article we aim to explore the humanistic thoughts contained in Traditional Chinese Medicine, and try to inherit and carry forward the spirit to better relieve the tensions between doctors and patients and improve the quality of medical services.

Combination of quercetin, cinnamaldehyde and hirudin protects rat dorsal root ganglion neurons against high glucose-induced injury through Nrf-2/HO-1 activation and NF-κB inhibition / 中国结合医学杂志

<p><b>OBJECTIVE</b>To examine the effects of the combination of quercetin (Q), cinnamaldehyde (C) and hirudin (H), a Chinese medicine formula on high glucose (HG)-induced apoptosis of cultured dorsal root ganglion (DRG) neurons.</p><p><b>METHODS</b>DRG neurons exposed to HG (45 mmol/L) for 24 h were employed as an in vitro model of diabetic neuropathy. Cell viability, reactive oxygen species (ROS) level and apoptosis were determined. The expression of nuclear factor of Kappa B (NF-κB), inhibitory kappa Bα(IκBα), phosphorylated IκBα and Nf-E2 related factor 2 (Nrf2) were examined using reverse transcription-polymerase chain reaction (RT-PCR) and Western blot assay. The expression of hemeoxygenase-1 (HO-1), interleukin-6 (IL-6), tumor necrosis factor (TNF-α) and caspase-3 were also examined by RT-PCR and Western blot assay.</p><p><b>RESULTS</b>HG treatment markedly increased DRG neuron apoptosis via increasing intracellular ROS level and activating the NF-κB signaling pathway (P<0.05). Co-treatment with Q, C, H and their combination decreased HG-induced caspase-3 activation and apoptosis (P<0.05 or P<0.01). The expressions of NF-κB, IL-6 and TNF-α were down-regulated, and Nrf2/HO-1 expression was up-regulated (P<0.05 or P<0.01). QCH has better effect in scavenging ROS, activating Nrf-2/HO-1, and down-regulating the NF-κB pathway than other treatment group.</p><p><b>CONCLUSIONS</b>DRG neurons' apoptosis was increased in diabetic conditions, which was reduced by QCH formula treatment. The possible reason could be activating Nrf-2/HO-1 pathway, scavenging ROS, and inhibition of NF-κB activation. The effect of QCH combination was better than each monomer or the combination of the two monomers.</p>

Jinmaitong alleviates the diabetic peripheral neuropathy by inducing autophagy / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the deregulation of autophagy in diabetic peripheral neuropathy (DPN) and investigate whether Jinmaitong ( JMT) alleviates DPN by inducing autophagy.</p><p><b>METHODS</b>DPN models were established by streptozotocin-induced diabetic rats and Schwann cells (SCs) cultured in high glucose medium. The pathological morphology was observed by the improved Bielschowsky's nerve fiber axonal staining and the Luxol fast blue-neutral red myelin staining. The ultrastructure was observed by the transmission electron microscopy. Beclin1 level was detected by immunohistochemistry and Western blot. The proliferation of cultured SCs was detected by methylthiazolyldiphenyl-tetrazolium bromide.</p><p><b>RESULTS</b>Diabetic peripheral nerve tissues demonstrated pathological morphology and reduced autophagic structure, accompanied with down-regulation of Beclin1. JMT apparently alleviated the pathological morphology change and increased the autophagy [in vivo, Beclin1 integral optical density (IOD) value of the control group 86.6±17.7, DM 43.9±8.8, JMT 73.3 ±17.8, P<0.01 or P<0.05, in vitro Beclin1 IOD value of the glucose group 0.47±0.25 vs the control group 0.88±0.29, P<0.05]. Consequently, inhibition of autophagy by 3-methyladenine resulted in a time- and concentration-dependent decrease of the proliferation of SCs (P<0.05, P<0.01).</p><p><b>CONCLUSIONS</b>Down-regulation of autophagy in SCs might contribute to the pathogenesis of DPN. JMT alleviates diabetic peripheral nerve injury at least in part by inducing autophagy.</p>

Effects of Jinmaitong Capsule () on ciliary neurotrophic factor in sciatic nerves of diabetes mellitus rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the effects of the Chinese medicine Jinmaitong Capsule (, JMT) on the pathomorphology of sciatic nerves, ciliary neurotrophic factor (CNTF), and the mRNA expressions of CNTF in rats with streptozotocin-induced diabetes mellitus (STZ-DM).</p><p><b>METHODS</b>The animal model was established by one time intraperitoneal injection of streptozotocin. The rats were simply divided by random into 5 groups including model group, low-dose JMT group (JL), medium-dose JMT group (JM), high-dose JMT group (JH) and neurotropin group. For each of the above 5 groups, a group of 10 normal Wistar rats matched in body weight, age and gender were set as normal group. Intragastric administrations were started after the animal model established. The JL group were administered with five times the JMT dose recommended for a human adult; the JM group were administered with ten times the JMT dose recommended for a human adult; the JH group were administered with twenty times the JMT dose recommended for a human adult. The neurotropin group was administered with ten times the neurotropin dose recommended for a human adult. All rats were given intragastric administration for 16 weeks and then killed. In the 4th, 8th, 12th, 16th week, body weight and blood glucose level were detected before and after the intervention. The morphologic changes of the sciatic nerves were observed by optical microscope and transmission electron microscope. The CNTFmRNA expressions were detected by real-time fluorescent quantitative polymerase chain protein, and the CNTF protein expressions were detected by immunohistochemical method.</p><p><b>RESULTS</b>The blood glucose levels of the STZ-DM rats were much higher than normal group (P<0.01), and there was no apparent difference between any treatment groups and the model group (P>0.05). Before and after the intervention in the 4th, 8th, 12th, 16th week, there were no significant differences in the body weight among all the groups (P>0.05). The sciatic nerves of STZ-DM rats might have pathomorphological changes in axons, myelin sheaths, and interstitium. The levels of CNTF and CNTF-mRNA expressions in the STZ-DM rats were both significantly decreased (P<0.01). The sciatic nerves of STZ-DM rats might have pathomorphological changes in axons, myelin sheaths, and interstitium.</p><p><b>CONCLUSION</b>JMT could improve the pathomorphology of sciatic nerves by increasing CNTF's and CNTF-mRNA expressions in sciatic nerve tissues, and promote the repair and regeneration of damaged nerve fibers.</p>

Effects of Jinmaitong capsule on nerve growth factor in diabetic rats / 中国中药杂志

<p><b>OBJECTIVE</b>To study the effects of Jinmaitong Capsule (JMT) on the expression of NGF and NGF mRNA in STZ-induced diabetic rats.</p><p><b>METHOD</b>Fifty SZT-induced diabetic rats were randomly divided into 5 groups including model group, low-dose JMT group (treated with JMT similar to the quintupling dose of adult recommended dosage), middle-dose JMT group (treated with JMT similar to the decuple dose of adult recommended dosage), high-dose JMT group (treated with JMT similar to the twenty-fold dose of adult recommended dosage) and Neurotropin group (treated with Neurotropin similar to the decuple dose of adult recommended dosage). Ten normal rats matching with weight and age served as normal control group. All rats were given intragastric administration for 16 weeks and then killed. Body weight and blood glucose were detected before and at the 4, 8, 12, 16th week after treatment. The hydrothermal tail-flick and pain threshold to mechanical stimulation with Von Frey filament were carried out before death. The expression of NGF and NGF-mRNA in sciatic nerve were detected by SABC immunohistochemical method and real-time fluorogenetic quantitative PCR respectively.</p><p><b>RESULT</b>The blood glucose levels of STZ-DM rats were much higher than those of normal rats (P < 0.01). In all the treated groups, there were no significant differences among them compared each other or compared with model group. And it got the same result when concerning about body weight no matter how the rats were dealt with. Hydrothermal tail-flick test: The tail-flick latency of STZ-DM rats were much longer than those of normal rats (P < 0.01 or P < 0.05). Compared with model group, the time shortened significantly in low, middle-dose of JMT groups and Neutrophin group. Compared with normal group, the pain thresholds of model group decreased extremely (P < 0.01). Compared with model group, the threshold values of low-dose, middle-dose JMT group and neutrophin group raised strikingly (P < 0.05). The levels of NGF-mRNA expression in STZ-DM rats were much lower than those of the normal rats (P < 0.01). Compared with model group, NGF-mRNA expression of middle-dose JMT group and Neurotropin group upregulated noticeably (P < 0.01). The integrated option density of NGF expression in STZ-DM rats was much lower than the normal (P < 0.01 or P < 0.05). And the levels of NGF in all the treated groups increased notably compared with model group (P < 0.05 or P < 0.01). There were no significant differences among middle-dose JMT group and Neutrophin group.</p><p><b>CONCLUSION</b>Traditional Chinese medicine JMT could up-regulate the expression of NGF and NGF-mRNA in sciatic nerve.</p>

Effect of Jinmaitong serum on the proliferation of rat Schwann cells cultured in high glucose medium / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of Jinmaitong (JMT) serum on the proliferation of rat Schwann cells (SCs) primarily cultured in high glucose medium.</p><p><b>METHOD</b>SCs were primarily cultured in Dulbecco's minmum essential medium (DMEM control), 50 mmol/L glucose medium (50 mmol/L Glu), 75 mmol/L glucose medium (75 mmol/L Glu), as well as 50 mmol/L glucose medium, with different concentrations of JMT serum (undiluted, 1:2 diluted and 1:8 diluted) and Neurotropin (Ntp), respectively. The proliferation of SCs under different conditions was detected by MTT.</p><p><b>RESULT</b>SCs grew exuberantly in DMEM within 24-72 h, but slowed down at 96 h. The proliferation of SCs was inhibited in 50 mmol/L Glu and 75 mmol/L Glu after cultures of 48, 72 and 96 h, which showed that both were significantly different compared to the control group (P<0.01). The inhibition was more significant in 75 mmol/L Glu than in 50 mmol/L Glu (P<0.05). Spearman's rho analysis revealed that the proliferation of SCs had a negative correlation with the concentration of glucose (r=-0.471, P<0.01). Excluding the time factor, partial correlation showed similar results (r=-0.679, P<0.01). After 48 h, the proliferation of SCs increased significantly in JMT1:2 and Ntp compared with 50 mmol/L Glu (control 0.437+or-0.019, 50 mmol/L Glu 0.367+or-0.035, JMT1:2 0.426+or-0.024, Ntp 0.422+or-0.013; P<0.01), and there were no statistically significant differences among the JMT groups, the Ntp group and the control group (P>0.05).</p><p><b>CONCLUSIONS</b>The proliferation of SCs was inhibited in high glucose medium, and the inhibition was reduced by different concentrations of JMT serum, especially at JMT1:2.</p>

Survey of current experimental studies of effects of traditional Chinese compound recipe on diabetic peripheral neuropathy / 中国中药杂志

Traditional Chinese medicine has certain effects on diabetic peripheral neuropathy and predominates in the integral medication of multi-factorial, multi-target action, et al. In this paper, the experimental studies concerning the effects of Chinese compound recipes on diabetic peripheral neuropathy in recent 6 years are reviewed in respect of the polyalcohol pathway and related metabolic disorder, the activation of protein kinase C, the formation of advanced glycation endoproducts, oxidative stress, neurotrophy factors, haemodynamics and blood vessel factors. It analyzes the existing problems and looks into the future research in this domain as well.

Survey of current experimental studies of effects of traditional chinese medicine on peripheral nerve regeneration / 中国结合医学杂志

The repairing and regeneration of peripheral nerves is a very complex biological and cytological process, its mechanism is unclear so far, and thus results in the lack of specific and effectual therapy and medicament. Chinese herbs and their effective components have their own inimitable predominance in promoting peripheral nerve regeneration, such as their multi-factorial, multi-target and multi-functional action, abundant source, inexpensive, etc. In this paper, the experimental studies reported in recent 5 years concerning the effects of Chinese herbs or their active components on peripheral nerve repairing and regeneration are reviewed in respects of the integral level, cellular level, molecular level and gene level.