Research progress of taste masking and evaluation technology of medicine / 中国药科大学学报

@#Most drugs taste bitter and irritating, resulting in poor compliance of patients, and the bad odor affects the therapeutic effect. The successful research and development of a drug should not only conform to the five quality characteristics of effectiveness, stability, safety, uniformity and economy, but also the compliance of patients to drugs with bad odor. The development of taste masking techniques is critical for bitter drugs.This review describes the principles, advantages and drawbacks of traditional taste masking techniques, and introduces the mechanism and application of novel taste masking techniques, such as melt granulation, hot melt extrusion, 3D printing, drug complex preparation, and bitter taste inhibitors. The in vitro evaluation methods of drug taste masking effect, such as functional magnetic resonance imaging, in vitro dissolution, and electronic tongue technology, are described. And introduce in vivo evaluation methods, such as animal and human taste, in the field of taste masking effect. A new strategy of BP neural network prediction model for drug taste evaluation is proposed, with a view to providing theoretical reference for the future research on drug taste masking.

Mechanism of Combination of Pungent Dispersing Bitter Evacuant in Treatment of Asthma Based on Theory of Five Flavor Compatibility / 中国实验方剂学杂志

Bronchial asthma， a chronic inflammatory airway disease， belongs to the category of wheezing disease in the system of traditional Chinese medicine （TCM）. The wheezing symptom of this disease is mainly caused by the imbalance of lung Qi. According to the theory of five flavor compatibility， the Chinese medicinal materials with five different flavors （pungent， bitter， sour， sweet， and salty） can be combined to produce new functions. The pungent medicinal materials have dispersing effect and the bitter medicinal materials have discharging effect， which are important components in the theory of five flavor compatibility. Pungent herbs and bitter herbs can relieve the adverse lung Qi， occupying an important position in the current medication for the treatment of asthma. However， there is still a lack of in-depth analysis of the TCM theory and mechanism of the compatibility of pungent herbs and bitter herbs in the treatment of asthma. The molecular mechanisms of action of pungent herbs and bitter herbs are closely related to transient receptor potential （TRP） channels and bitter taste receptors （TAS2Rs）， respectively. Ca2+ signaling has been recognized in the process of asthma and is involved in the development of multiple symptoms of asthma. The TRP channels and TAS2Rs located on the cell membrane have been proved to directly regulate the intracellular Ca2+ signal and play a role in the treatment of asthma. Therefore， the dispersing effect of pungent herbs and the discharging effect of bitter herbs may be realized through the Ca2+ signaling pathway mediated by TRPs/TAS2Rs. We summarized the theoretical understanding and modern studies of pungent herbs dispersing lung Qi and bitter herbs discharging lung Qi， aiming to explain the internal relationship and mechanism of the compatibility of pungent herbs and bitter herbs in the treatment of asthma from the perspective of TCM theory and modern medicine. The compatibility of pungent herbs and bitter herbs based on the theory of five flavor compatibility for the treatment of asthma has a solid theoretical basis of TCM， and its mechanism can be verified by modern research. Therefore， it may be a main research direction in the treatment of asthma by Chinese medicinal herbs in the future.

Herbal Textual Research on Polygonati Rhizoma in Famous Classical Formulas / 中国实验方剂学杂志

By consulting ancient Chinese herbal medicines and medical books， combined with modern documents， the textual research of Polygonati Rhizoma has been conducted to verify the name， origin， bitter-flavored Polygonatum species， Latin name evolution， origin， quality evaluation， harvesting and processing changes， so as to provide reference and basis for the development and utilization of the famous classical formulas. Through textual research， it can be seen that there are many other names for Polygonati Rhizoma， and Huangjing is the correct name since Mingyi Bielu. Based on the original research， it is concluded that P. sibiricum and P. cyrtonema were the mainstream of Polygonati Rhizoma before the Tang dynasty， and P. kingianum was added in the Qing dynasty. According to the shape of medicinal materials， these Polygonatum species were called Jitou Huangjing， Jiangxing Huangjing and Dahuangjing. The harvest time of Polygonati Rhizoma is spring and autumn. After harvest， it is steamed and dried in the sun， and its processing method is mainly "nine steaming and nine storms". Bitter-flavored Polygonatum is mainly P. cirrhifolium， P. zanlanscianense， P. curvistylum and P. verticillatum， which are not suitable for medicine. Based on textual research， it is recommended that when developing famous classical formulas and health products with Polygonati Rhizoma as the main raw material， the origin and producing area should be clear and fixed， and P. sibiricum or P. cyrtonema with clear origin should be used. It is necessary to conduct germplasm survey and sampling in the producing area， establish a planting base and a traceability system for Polygonati Rhizoma， in order to control the quality and stabilize the efficacy of the products. The processing method of Polygonati Rhizoma can be determined according to the product function positioning.

Baicalin Promotes the Apoptosis of Respiratory Inflammatory Cells in Asthmatic Mice through Bitter Taste Receptors / 中国生物化学与分子生物学报

Asthma is a heterogeneous disease that affects three hundred million people worldwide. About half of them are not well controlled, new therapeutic approach and more effective medicines are therefore urgently needed. Recent studies have shown that bitter taste receptors (Tas2rs) are expressed in respiratory system, and Tas2rs might be used as new targets for asthma treatment since some bitter compounds show therapeutic potential for asthma therapies. Based on this situation, we studied the effect of bitter compound baicalin (BA) on the apoptosis of inflammatory cells in the respiratory tract of asthmatic mice and its relationship with bitter signal transduction. Male BALB/c mice were selected as the tested animals randomly divided into control group (CK), asthma mouse model group stimulated by intraperitoneal injection and aerosol inhalation of ovalbumin(OVA) and intragastric administration of BA intervention OVA-induced asthma group (OVA + BA). The results showed that inflammatory cells infiltration, alveolar septum thickening and diminished alveolarspaces were observed in the OVA group after HE staining. The above symptoms were significantly alleviated in OVA+BA group. The total number of inflammatory cells and classified cell count in the bronchoalveolar lavage fluid of mice in OVA group were increased, and the number of inflammatory cells in BA intervention group were decreased significantly (P < 0. 05). Analysis of real-time quantitative PCR showed that the expression levels of mucin Muc5ac were significantly increased in the lung in OVA group (P <0. 05), while the expression levels of Muc5ac in OVA+BA group were significantly lower than that in OVA group (P <0. 05). The expression of Tas2r108, Tas2r126, Tas2r135, Tas2r143 and their downstream signal transduction molecules α-gust and Trpm5 were down-regulated in OVA group (P < 0. 05). In OVA group, the transcription of pro-apoptotic factors P53, Bax and Casp3 was inhibited, and decreased activity of caspase3 was detected, whereas the transcription of anti-apoptotic factor Bcl2 was up-regulated (P < 0. 05). In OVA+BA group, the transcription of tested Tas2rs genes and downstream signal transduction molecules (P < 0. 05), as well as pro-apoptotic genes P53, Bax and Casp3 were all up-regulated associated with the decreased Bcl2 expression and increased caspase3 activity (P < 0. 05). Our results suggest that BA might function as a bitter taste receptor agonist to mediate the regulation of respiratory tract inflammatory cells apoptosis by activating the bitter signal transduction system, and thus to reduce the lung inflammation and injury in asthmatic mice.

Review of taste masking techniques in Chinese patent medicine / 中国中药杂志

Single herbs and Chinese patent medicine preparations often have bad taste, such as bitterness and astringency, which is one of the key factors affecting patients' medication compliance, and would affect the therapeutic effect and restrict the extensive application in clinical practice. Therefore, how to make use of taste masking techniques to improve the bad taste of traditional Chinese medicines has become an important project. Through the collection and summarization of Chinese and foreign journals and papers in recent years, this paper discussed the generation mechanism of bitter taste, the new methods of masking bitter taste and the evaluation me-thods of bitter taste, in order to provide references for the taste masking of Chinese patent medicines preparations.

Inhibition of Respiratory Bitter Taste Signal Transduction is Related to Asthma in Mice / 中国生物化学与分子生物学报

Because the large number of people is suffering from asthma, and about half of them are not well controlled, new therapeutic approach and more effective medicines are therefore urgently needed. Recent studies have shown that bitter taste receptors (T2Rs) are expressed in various tissues, and T2Rs might be used as the new targets for asthma treatment since some bitter compounds show therapeutic potential for asthma therapies. In this study, the relationship between the development and exacerbation of asthma and bitter signal transduction was analyzed by establishing the asthma model in the C57BL/6 mice. The present results showed that the total number of white blood cells and the number of eosinophil, neutrophil, lymphocyte and macrophages in the bronchoalveolar lavage fluid (BALF) were significantly increased (P < 0. 05), accompanied with the up-regulation of Muc5ac gene expression (P< 0. 01) and asthma-like pathologically changes in mice lungs in OVA or OVA+SO

Preparation and evaluation of azithromycin-loaded microspheres for oral administration / 中国药科大学学报

@#To mask the bitterness of azithromycin（AZI） and improve patient compliance, an AZI-loaded microsphere (AZI-EC MS) for oral administration was prepared by O/W emulsion solvent evaporation with ethylcellulose (EC) as carrier. The release profiles and taste-masking effect of AZI-EC MS were preliminarily assessed. Its physical properties and morphology were then investigated by differential scanning calorimetry (DSC), Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM). The results indicated that the polymer weight of EC could influence the drug release behavior. With a drug polymer ratio of 1∶1 and mixed EC (N22/T10, 7∶3) as carrier, the cumulative release of AZI-EC MS at 0.5 h was less than 40% and reached 90% at 8 h; the drug loading efficiency of microspheres was (48.95 ± 0.86)% with smooth spherical morphology. The AZI bitterness threshold is 9.93 μg/mL with a strong bitter taste, which indicated a better taste masking effect. Therefore, AZI-EC MS prepared in this study can mask AZI bitterness and improve patient compliance, setting the stage for the research of new AZI preparations.

Correlation study on Tibetan medicine Pterocephalus hookeri of bitter taste receptors based on molecular docking technology / 中国中药杂志

In order to study the interaction between Pterocephalus hookeri and bitter taste receptors,three-dimensional structural models of bitter taste receptors TAS2 R16,TAS2 R14 and TAS2 R13 were established by homology modeling in this paper. Maestro software was used for docking the chemical constituents of P. hookeri with bitter taste receptors. The results showed that 25 chemical components of P. hookeri can regulate three bitter taste receptors. And these components were mainly iridoid glycosides and phenolic acids.This research focused on the comprehensive application of homology modeling and molecular docking technology to explore the interaction between bitter chemical constituents of P. hookeri and bitter taste receptors. This study provided assistance in revealing pharmacodynamic basis of bitter Tibetan medicine at molecular level. It also provided new ideas and methods for the study of Tibetan medicine.

Influences of weight, age, gender, genetics, diseases, and ethnicity on bitterness perception: a narrative review of current methodological aspects

BACKGROUND: Bitterness perception seems to be related to an enhanced intake of dietary fat and to a tendency to the development of diseases such as obesity. However, the exact factors for this possible contribution still need to be better investigated. So, gustatory perception of the bitter taste is a promising area of study because of its importance regarding food choices and consequently feeding behavior. Therefore, this short review focused on recent papers reporting correlations between bitter taste, anthropometric variables, obesity and other chronic diseases, age, gender, ethnicity, and genetics. METHODS: A survey was performed in MEDLINE (PubMed) and Scielo from September 2015 to January 2017.Only review articles, observational studies and clinical trials published in English and Portuguese over the last15 years which met the objectives of the present study were considered. A total of 40 papers were evaluated. RESULTS: Two papers showed a positive correlation between bitter taste and obesity, one indicated that this correlation is influenced by the subject's age, one suggested a negative correlation, and two found no association. Age seems to be negatively correlated with the bitterness perceived, and female gender was associated with a stronger perception of bitterness. Genetics, mostly due to differences in TAS2R38 expression, influences sensitivity to the bitter taste, feeding behavior and also alcohol intake. Ethnicity, not only the subject's phenotypic or genotypic characteristics, seems to play a role in taste perception and nutritional diseases. CONCLUSIONS: Age, gender, genetics and ethnicity seem to play a role in bitterness perception. Data about associations between bitterness perception and anthropometrics are conflicting.

Limonin inhibits the PM2.5 inhalation-induced airway inflammation and mucus hypersecretion in rats / 基础医学与临床

Objective To investigate the inhibitory effect of limonin on airway inflammation and mucus hypersecre-tion. Methods The experiment was divided into three groups(n=10),namely blank control group,PM2.5 group (the rat models of chronic airway inflammation were established by aerosolized PM2.5 suspension) and PM2.5+limonin group(intervening with the extract from tangerine peel). mRNA,protein of inflammatory cytokines,mucin (MUC) and TAS2Rs were measured by ELISA,RT-PCR and Western blot respectively. Results The mRNA and protein expression of IL-1β, CINC-1 and MUC5AC and MUC5B in PM2.5 group were significantly higher than those in control group(P<0.05),and the expression of MUC5AC protein in broncho alveolar lavage fluid(BALF) was increased. Compared with PM2.5 stimulated group,mRNA and protein of TAS2R14 in PM2.5+limonin inter-vented group were significantly higher (P<0.05). Moreover, the expression of IL-1β, CINC-1 and MUC5AC, MUC5B was lower than PM2.5 group (P<0.05).While the expression of MUC5B was mainly increased in BALF.Conclusions The production of mucin can be inhibited by aerosolized limonin, meanwhile the secretion of mucin also can be promoted.This effect is achieved by activating the expression of TAS2Rs in the lungs, which enhances the anti-inflammatory effect of airway inflammation.

Chemistry and biology research on bitter-taste Chinese materia medica with function of regulating glycolipid metabolism / 中国中药杂志

The bitter taste is one of the important properties among five flavors of Chinese materia medica (CMM), characterized by downbearing and discharging, drying dampness, and consolidating Yin. In common CMM, bitter-taste CMM accounts for a large proportion, indicating the importance of it. Through the efficacy of clearing away heat and dampness, reducing fire and removing toxin, bitter-taste CMM has achieved good results in treating diabetes in clinical application, proving their definite therapeutic effect on regulating glucose and lipid metabolism (main features of diabetes). At present, there are many reports about the chemical constituents and pharmacological effects of CMM on diabetes, but there are few reviews on the chemistry and biology of bitter-taste CMM. This study summarized the properties and compatibility characteristics of bitter-taste CMM for treating diabetes, and mainly analyzed the chemistry and biology basis of bitter-taste CMM with function of regulating glycolipid metabolism, laying foundation for further researches on properties theory of CMM.

An Expression Levels Analysis of the Bitter Taste Receptors in the Murine Exocrine Glands

Recent findings indicate that Type 2 taste receptors (T2Rs) are expressed outside the gustatory system, including in the gastrointestinal tracts and the exocrine glands, such as the submandibular (SM), parotid (P), lacrimal (L) glands and pancreas (PC). Specifically, T2Rs are found in some of the gastrointestinal endocrine cells, and these cells secreted peptide hormones in response to stimulation by bitter-tasting compounds. The results show that T2Rs may have significant physiological roles besides bitter taste reception. The functions of the T2Rs in the exocrine glands remain poorly understood. An expression levels analysis of T2Rs will help to determine those functions in the exocrine glands. The expression levels of the T2Rs in the exocrine glands were discovered via the qPCR. C57BL/6J mice of 42~60-day-old were used. Messenger RNAs were extracted from S, P, L and PC. Cloned DNAs were synthesized by reverse transcription. Quantitative PCRs were performed using the SYBR Green method. The expression levels of the T2Rs were calculated as relative expression levels to that of the GAPDH. The statistical significance among the observed exocrine glands was tested using the variance analysis (ANOVA test). Tas2r108, out of murine 35 T2Rs, was the most highly expressed in every observed exocrine gland. This finding was similar to previous results from tongue papillae, but the expression levels were lower than those of the tongue papillae. Tas2r137 of SM, P, L and PC were expressed a little lower than that of tongue papillae. The T2Rs in the exocrine glands may play slightly different roles from those in the tongue. We suggest that physiological studies such as a patch clamp and functional Ca²⁺ imaging of acinar cells are necessary for understanding the Tas2r108 functions.

Effects of denatonium benzoate on calcium binding protein S100A9 and mucus in the airways of asthmatic mice / 医学研究生学报

number of goblet cells, mucus secretion and mucin MUC5AC content in lung tissues. Results S100A9 in BALF of group B was (11.89±0.77) ng/mL, S100A9 integrated optical density (IOD) value in airway epithelial cells was 13.96±1.62, PAS stain area /epithelial cell area was (12.53±1.21)%, relative value of MUC5AC / NADPH was 173.91±4.29, all of the above were higher than those of group A [(6.19±0.61) ng/mL, 4.97±0.30, (1.94±0.18)%, 1];S100A9 levels, IOD of S100A9 in airway epithelial cells, PAS stain area / epithelial cell area (%), relative value of MUC5AC / NADPH in group C [(10.69±0.79) ng / ml, 11.80±0.72, (10.61±0.61)%, 94.65±1.59], group D[(9.49±0.99) ng/mL, 10.39±0.59, (8.63±0.62)%, 82.08±1.12], group E [(7.54± 0.42) ng/mL, 5.63±0.84, (4.59±0.87)%, 26.30±1.94] were lower than group B, which showed a dose-dependent reduction and the difference was statistically significant (P<0.05 or P<0.01). Conclusion DB downregulates the expression level of Ca2+-binding protein S100A9 and the mucus secretion amount of the airway goblet cells in rats.

Effect of denatonium benzoate on airway inflammation and remodeling in asthmatic mice / 重庆医学

Objective To evaluate the effect of denatonium benzoaten on α-smooth muscle actin (α-SMA),subepithelial collagen and airway inflammation in asthmu mice.Methods Forty-five BALB/c mice were divided into 3 groups,normal control group (A group),asthma model group (B group),asthma model+ denatonium benzoaten group(C group);α-SMA detected by using immunohistochemistry,lung sections were stained with Masson to detect subepithelial collagen,HE stain method was used to observe the airway inflammation the images were analyzed with semi-quantitative computer.Results The deposition of α-SMA、subepithelial collagen and inflammation degree in C group was significantly reduced compared with B group,the difference were statistically significant(P＜0.05).Conclusion Denatonium benzoaten can improve airway remodeling in asthmatic mice.

Containment effects of bitter taste native ingredient from traditional Chinese medicine on airway inflammation process via bitter taste receptor pathway / 中国免疫学杂志

Objective:To investigate the anti-inflammatory effects of bitter taste receptor (TAS2Rs) in the treatment of chronic airway inflammation by bitter Chinese medicine.Methods: The experiment was divided into three groups (n=8),namely blank control group,PM2.5 group (the rat models of chronic airway inflammation were established by aerosolized PM2.5 suspension) and PM2.5+limonin group (intervening with the extract from Tangerine peel).The expression of mRNA and protein of inflammatory cytokines and TAS2Rs in bronchial/pulmonary tissue were detected by ELISA,RT-PCR and Western blot respectively.Results: The mRNA and protein expression levels of TNF-α and IL-13 in PM2.5 stimulated group were significantly higher than those in control group,while the TAS2R14 were not significantly changed.The mRNA and protein expression levels of TNF-α and IL-13 in the limonin intervention group was lower than that in the PM2.5 group,and the TAS2R14 were significantly increased.Conclusion: The production and release of inflammatory cytokines in the chronic inflammatory airway can be curbed by inhaling the components of bitter Chinese herbal medicine.And then,the TAS2Rs in the lungs can be activated by the bitter components to increase its expression.Therefore,it is considered that bitter Chinese herbal medicine to play the airway anti-inflammatory effect is achieved through the activation of the airway TAS2Rs.

Expression of bitter taste of Chinese materia medica and its application in clinical compatibility / 中草药

The connotation of traditional Chinese medicine, source, and medicinal parts of bitter-taste Chinese materia medica (CMM) were summarized. And authors analyzed the relationship between bitter taste and four properties, meridian entry and other herb property theory as well as chemical ingredients. Then, authors described the use of electronic tongue of modern bionic technology in material characterization of bitter taste, and proposed the idea to split and characterize bitter-taste CMM which is based on systematic chemical separation analysis method. Finally, authors explored the clinical applications of compatibility methods of bitter-taste CMM, which will provide the references to guide clinical applications of the theory of bitter-taste CMM better.

Establishment and application of screening model for anti-asthmatic natural active ingredients based on bitter taste receptors in lung tissue / 中草药

Objective: To construct high-throughput screening cell model targeting TAS2R14 receptor and lay the foundation for the search of effective, novel natural anti-asthma drugs with low toxicity. Methods: The pLVX-AcGFP1-N1-TAS2R14 lentivirus vector carrying green fluorescent protein (GFP) was constructed. The lentiviral vector was transfected into HEK HEK293T cells, collected high titer lentiviral concentration liquid and infected HEK293T cells, established cell model highly specific expressed TAS2R14 receptor gene. The TAS2R14 cell model was used to screen 120 kinds of Chinese herb extracts and chemical monomers. Results: The calculated Z' values of the cell model were 0.69 and 0.66, and Citri Reticulatae Pericarpium extract and its efficacy material limonin, Ginkgo Semen extract and its efficacy material rutin and quinine agitated TAS2R14 cell model. Conclusion: The constructed TAS2R14 cell model is stable and sensitive for screening anti-asthma drugs, and three kinds of Chinese materia medica monomers have the potential agonist the activity on TAS2R14 receptor.

Flavored Self Microemulsifying Lipid Formulations for Masking the Organoleptic Taste of Pharmaceutical Actives.

The field of SMEDDS is designed to enhance bioavailability of poorly-water soluble compounds. Yet, these systems have the capacity to solubilize aqueous-based materials within its lipid matrix as L2 phase (W/O microemulsion). This characteristic is utilized in this investigation to incorporate aqueous flavors within oil vehicle as an approach to mask bitter taste of drugs. Miscibility profiles and self-micro-emulsifying regions for various lipid composites were screened by constructing ternary phase diagrams using different types of oil, cosurfactant and surfactant. Solubility of bitter taste model drug was measured in various optimized vehicles. Dynamic equilibrium phase studies were performed and phase boundaries were determined for the lipid-aqueous flavors-water systems. Self-micro-emulsifying system comprising Crodamol GTCC/ Glycerox 767HC /Croduret 40 ss at ratios of {0/80/20}, {6/54/40} or {10/40/50} have shown capacity to solubilize, aqueous-based materials including; strawberry flavor, sucrose and citric acid as L2 phase. Phase behavior study has revealed that clear dispersions can be obtained at all dilutions with water. Potential flavored self-microemulsifying lipid formulations representing type III lipid class system were developed. Aqueous flavors loaded into these vehicles can be used to mask bitter tastes in oral pharmaceuticals.

Study on Modern Scientific Connotation of Bitter Taste Property of Chinese Materia Medica Based on Bitter Taste Receptors / 世界科学技术-中医药现代化

Bitter taste receptors (BTRs) belong to the G protein-coupled receptors, which included 25 subtypes. BTRs, which were distributed in the oral cavity, mediated the bitter taste of mammalian. Furthermore, BTRs were also existed in the extra-oral digestive system such as the stomach and intestine to influence the digestion, absorption and energy regulation. It also can relax airway smooth muscles in the respiratory system and decrease blood pressure in the cardiovascular system. While being strikingly conformed to the latest advancements of BTRs, the efficacy of bitter taste property of Chinese materia medica (CMM) such as“excretion”,“dryness” and“strengthening” have been used in ancient theories of property and flavor in traditional Chinese medicine (TCM) for thousands of years in the treatment of multisystem diseases such as digestive, endocrine, respiratory and cardiovascular system. Therefore, applying modern techniques and new methods in the interpretation of the scientific connotation of bitter taste property of CMM based on BTRs should be a feasible way and a new research pattern. It played an important role in the enriching of the property theory in CMM, as well as enhancing the modernization and objectivization of CMM.

Assessment of effects on health due to consumption of bitter bottle gourd (Lagenaria siceraria) juice.

Background & objectives: The bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other associated benefits. However, in last few years there have been reports of suspected toxicity due to consumption of its juice. This led to the constitution of an Expert Committee by Department of Health Research at Indian Council of Medical Research (ICMR), Ministry of Health & Family Welfare, Government of India in October 2010. The committee looked into the issues related to safety of consumption of bottle gourd juice, and this paper presents the findings. Methods: Information on cases of suspected toxicity due to consumption of bottle gourd juice was collected by internet search, advertising on website of ICMR and by writing to State and district health authorities as well as to medical colleges, hospitals and private nursing homes across the country. Results: Three deaths were reported, one from Delhi and two from Uttar Pradesh after consumption of extremely bitter bottle gourd juice. Three persons who died after consumption of freshly prepared bottle gourd juice or juice mixed with bitter gourd (karela) juice were over 59 years of age and had diabetes since last 20 years. This juice was reported to be extremely bitter by all three. Twenty six persons were admitted to various hospitals of the country on complaint of abdominal pain and vomiting following consumption of freshly prepared bottle gourd juice. Diarrhoea and vomiting of blood (haematemesis) was reported in 18 (69.2%) and 19 (73.1%) patients, respectively. Biochemical investigations revealed elevated levels of liver enzymes. More than 50 per cent patients had hypotension. Endoscopic findings showed profusely bleeding stomach with excessive ulceration seen in distal oesophagus, stomach and duodenum in most of the cases. All these patients recovered fully and no sequeale was recorded for any of the cases. Interpretation & conclusions: Cucurbitaceae family, of which bottle gourd is a member contains the toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste. There is no known antidote for this toxicity and clinicians treat such cases symptomatically only. The Committee made the following recommendations: (i) The community needs to be educated that bitter tasting bottle gourd juice should not be consumed and in case there is any discomfort, nausea, vomiting, diarrhoea or any feeling of uneasiness after consumption of juice, the person should immediately be taken to a nearby hospital. (ii) Clinicians are suggested that patients coming with symptoms (discomfort, nausea, vomiting, diarrhoea, gastrointestinal bleeding after consumption of juice) should immediately be attended to and general supportive care should be provided, i.e. IV fluids/crystalloids/blood products/ fresh frozen plasma to maintain the haemodynamics and electrolyte balance; Ryle’s tube to be put in for gastric lavage and to assess gastrointestinal (GI) bleed- aspirate to be preserved; Proton pump inhibitors should be given for management of GI bleed and appropriate treatment for other complications should be given. (iii) The possible research areas identified are chemical composition studies on bitter and normal bottle gourd and other members of cucurbitaceae family; animal toxicity studies and studies on interaction between bottle gourd juice and other drugs.