Clinical randomized trial study of hearing aids effectiveness in association with Ginkgo biloba extract (EGb 761) on tinnitus improvement / Estudo clínico randomizado da eficácia da prótese auditiva associada ao extrato de Ginkgo biloba (EGb 761) na melhoria do zumbido

Abstract Introduction: Tinnitus is defined as the perception of sound without its actual presence in the environment. It has been the subject of a great number of studies, especially considering its consequences on patient's quality of life. Objective: This study aimed to investigate the effect of hearing aids and/or Ginkgo biloba extract EGb 761 on tinnitus in patients with hearing loss. Methods: This is a trial randomized-controlled treatment, parallel, double-blind, with three-arm. Thirty-three adults subjects were divided into three groups: group 1 — subjects undergoing drug therapy with Ginkgo biloba extract EGb 761; group 2 — individuals fitted with digital hearing aids; group 3 — individuals submitted to drug therapy with Ginkgo biloba extract EGb 761 and using hearing aids. The tinnitus handicap inventory and visual analogue scale were used to evaluate self-perception of tinnitus loudness and severity before treatment and 90 days after treatment. Results: This study demonstrated a significant correlation between tinnitus handicap inventory and visual analogue scale, before and after treatment. We observed a significant improvement in self-perception of tinnitus loudness and severity after 90 days of treatment with Ginkgo biloba extract EGb 761 and/or hearing aids. No correlation was found between tinnitus onset time and self-perception of tinnitus loudness and severity. Hearing aids were more effective in patients with a shorter tinnitus onset time and Ginkgo biloba extract was effective regardless of tinnitus duration. Conclusions: It was possible to prove the effectiveness of the hearing aids and/or Ginkgo biloba extract EGb 761 treatment, which shows success in the control of tinnitus contributing to the improvement of this symptom.

Resumo Introdução: O zumbido é definido como a percepção de um som sem a sua presença real no ambiente e tem sido objeto de um grande número de estudos, especialmente devido às suas consequências na qualidade de vida do paciente. Objetivo: Investigar o efeito de próteses auditivas e/ou extrato de Ginkgo biloba EGb 761 sobre o zumbido em pacientes com perda auditiva. Método: Ensaio clínico randomizado controlado, paralelo, duplo-cego, com três braços. Trinta e três indivíduos adultos foram divididos em três grupos: Grupo 1 - indivíduos submetidos à terapia medicamentosa com extrato de Ginkgo biloba EGb 761; Grupo 2 - indivíduos equipados com próteses auditivas digitais; Grupo 3 - indivíduos submetidos à terapia medicamentosa com extrato de Ginkgo biloba EGb 761 e próteses auditivas. O Tinnitus handicap inventory e a escala visual analógica foram usados para avaliar a autopercepção de intensidade e da gravidade do zumbido antes do tratamento e 90 dias após o tratamento. Resultados: Este estudo demonstrou uma correlação significante entre o Tinnitus handicap inventory e a escala visual analógica, antes e após o tratamento. Observou-se melhoria significativa na autopercepção de loudness e da intensidade do zumbido após 90 dias de tratamento com extrato de Ginkgo biloba EGb 761 e/ou prótese auditiva. Não foi encontrada correlação entre o tempo de início do zumbido e a autopercepção da intensidade e gravidade do zumbido. As próteses auditivas foram mais eficazes em pacientes com menor tempo de início de zumbido e o extrato de Ginkgo biloba foi eficaz, independentemente da duração do zumbido. Conclusões: Foi possível comprovar a eficácia do tratamento com a prótese auditiva e/ou extrato de Ginkgo biloba EGb 761, o que demonstra sucesso no controle do zumbido e contribui para a melhoria desse sintoma.

The Potentiation of Anti-inflammatory Effect and INOS and COX-2 Gene Expression Inhibition by Rut in When Complexed with Cooper.

Aims: The aim of this study was to evaluate both the antioxidant effect and antiinflammatory activity of a new transition metal coordinated rut in compound, Rutin-Cu2 complex. Study Design: Flavonoids have proven antioxidant and anti-inflammatory activities. Moreover, recent researches demonstrate that the antioxidant activity of flavonoids is believed to increase when they are coordinated with transition metal ions. Our group has recently synthesized new compounds by the reaction of rut in (a flavonoid) with divalent metal salts (copper acetate, nickel acetate or iron sulfate), rendering new transitional metal coordinated rut in compounds, named R-Fe1 [(FeC27H32O21S)2], R-Cu2 [C31H32O18Cu.2H20] and R-Ni2 (C31H42O23Ni). In order to investigate the ability of these new compounds in modulating biological activity and to compare if metal coordinated rut in could increase anti-inflammatory activity of rut in alone, we used murine experimental model of peritonitis to measured cell migration and In vitro models of antioxidant activity to evaluate radical superoxide scavenging activity and of macrophage cell line culture to quantify nitric oxide production and iNOS and COX-2 gene expression. Methodology: To characterize physical-chemical the new generated compounds we used elemental analysis, FT-IR and UV/Vis. The antioxidant effect was evaluate by radical superoxide scavenging assay, using NBT methodology. The anti-inflammatory activity of the new compounds were investigated by peritonitis models induced by carrageenan (1%, 4h), bradikynin (10nmol/cavity, 1h), histamine (100μg/cavity, 1h), substance P (20nmol/cavity, 1,5h) and PGE2 (10nmol/cavity, 1h). Total and leucocytes subtypes numbers were evaluated in harvest cells from mice peritoneum after phlogistic agents administration, in controls groups (not treated or treated with dexamethasone or rut in alone) or tested groups (treated with metal coordinated compounds). RAW 264.7 cells were stimulated with LPS on the absence or presence of rut in alone (0.01–90mMr), or Rutin-Cu2 complex (0.01–90mM). The production of NO was measured in culture supernatant after 24h of cell incubation, by Griess assay. And iNOS and COX-2 transcripts were quantified by real time PCR with SYBR GREEN, on cDNAs obtained after 24h of cell incubation, in a step one instrument (Applied bio systems). Results: Complex formation was also verified by 1H RNM, using DMSO-d6 as solvent. The proton signals from Hydroxyl groups 5-OH, 7-OH, 3’-OH and 4’-OH shifted to lower and broader frequencies in coordinated complex R-Fe1, R-Cu2 and R-Ni2, compared with signals from free rut in. The results showed that R-Cu2 complex presented a higher superoxide scavenging effect when compared with rut in alone (6.95% and 46.42%, at 10μM; and 51.80% and 71.32%, at 100μM, respectively). The results also showed that R-Cu2 inhibited significantly (P<0.05; ANOVA) cell migration (neutrophils, lymphocytes and monocytes) in peritonitis induced by carrageenan, bradikynin and PGE2, in mice, when compared to controls ones (without treatment or Ru alone treatment). Furthermore, rutin and R-Cu2 significantly (P<0.05, paired t test) inhibited iNOS and COX-2 gene expression in LPS-induced macrophage cells. Conclusions: Taken together, our results show for the first time that the R-Cu2 complex, a metal coordinated rut in compound, produces anti-inflammatory effects in mice, at least in part, by means of increasing the antioxidant activity and inhibition of iNOS and COX-2 gene expression. We suggest that cooper coordinated rut in compound can potentiates some biological properties of this flavonoid and could be more effective for therapeutic treatment of diseases related to oxidative stress.