Classification of OTC drugs in Japan, based on the safety.
Over the counter (OTC) drugs in Japan are classified into three groups (I, II and III), based on the safety . Group I drugs have the highest risk of exerting the adverse effects on our health. The intensity of such side effects declines in the order of Group I, II and III. Only Group III drugs with the least side effects can be purchased through the internet.
|Group II||++||Kampo medicine, herb extracts|
|Group III||+++||herb extracts, SE|
Kampo Medicines, classified as Group II, are usually available as hot water extracts of more than two different plant species. Recently, the presentation of the detailed compositional analysis by HPLC has become mandatory for the publication of the biological activity of Kampo Medicines. However, we often experience the loss of biological activity of Kampo medicines during the purification steps, thus making it difficult to assign the active principles. Herb extracts are classified into Group II and Group III. Three major products of bamboo leaf extract (products A, B, C) are classified into Group III (Table 2), and other drugs are classified into Group I.
|Product A (=SE)||Fe (II)-chlorophyllin||Pure |
|Product B||Cu (II)-chlorophyllin||LCC was removed|
|Product C||Cu (II)-chlorophyllin||Supplemented with ginseng and pine (|
Two bamboos, “Take” and “Sasa” (Japanese names) belong to grasses, but are not strictly distinguished each other botanically. There are 70 genera of bamboos in the world and 14 genera (approximately 600 species) in Japan. Sasa culms are 1-2 m high, 5-8 mm in diameter, robust, ramose at lower portions. Leaf-blades are oblong-lanceolate, 20-25 cm long and 4-5 cm broad (Figure 1A, B). They are distributed into Saghalien, the Kuriles, Hokkaido, Honshu, Shikoku and Kyushu in Japan. Product A (Sasa Health®, referred to as “SE”) (Figure 1C) is a pure alkaline extract of the leaves of
Products B (Sunchlon®, referred to as “BLE”) is an alkaline extract of Sasa Makino et Shibata (dry weight 77.6 mg/ml ) that contains Cu (II)-chlorophyllin, but approximately 80% of lignin-carbohydrate complex (LCC) has been removed as precipitate .
Product C (Shojusen®, referred to as “KS) is a hot water extract of the leaves of
These bamboo leaf products is recognized as being effective in treating various malaises including fatigue, low appetite, halitosis, body odor and stomatitis [7-10]. However, there is no scientific evidence that demonstrates their efficacy due to the lack of appropriate biomarkers, although their
Lignins are major class of natural products present in the natural kingdom, and are formed through phenolic oxidative coupling processes in the plant . Lignins are formed by the dehydrogenative polymerization of three monolignols:
However, there is a possibility that the components from SE and other plants are associated with each other, thus modify their biological activities. Also, SE components may inhibit the activity of CYP3A4, the most abundant drug-metabolizing enzyme, so as to increase the bio-availability of co-administered drugs (especially, CYP3A4 substrates). Lastly, the clinical evidences that demonstrate how the treatment of SE products improves the patient’s conditions are limited.
Based on these circumstances, we review the functional analysis of SE products as alternative medicines, citing the literatures of other groups and ours, focusing on the following points: (i) component analysis, (ii) spectrum of reported biological activities in comparison with those of Kampo medicines, (iii) possibility of complex formation between the components, (iv) inhibition of CYP3A4 activity and (v) the clinical application for the treatment of oral diseases.
2. Component analysis
Components of SE are listed in Table 3. Dietary fibre was the major component of SE. Water-soluble and water-insoluble dietary fibres are present approximately at the 1: 2 ratio.
|Ash content||900||13600||Glutamic acid||186||2800|
|Dietary fibre||2100||31800||Folic acid||0.008||0.12|
According to this information, we have fractionated the LCC into the following three fractions Fr I, II and III by repeated acid precipitation and solubization with NaHCO3 or NaOH solution, and polysaccharide fraction was recovered as Fr. IV by addition of equal volume of ethanol in Figure 2.
Luteolin glycosdes are isolated from the leaves of
Tricin [compound 4]: yellow amorphous powder, UVλmax (MeOH) nm (ε): 349 (41,000) and 269 (27,200). ESI-TOF-MS
We also isolated substances (SEE-1) that protected the cells from the UV-induced cytotoxicity, by ethanol extraction, Wakosil 40C18 chromatography (H2O elution) and preparative HPLC (Shimadzu LC-10AD pump, Shimadzu SPD-M10AVP photodiode array detector, separation column: Inatsil ODS-3, eluted with H2O : acetonitrile : formic acid (90:10:0.1), and proposed the putative structures as
3. Biological activities
3.1. Antiviral activity
Anti-human immunodeficiency virus (HIV) activity was assessed quantitatively by a selectivity index (SI=CC50/EC50, where CC50 is the 50% cytotoxic concentration against mock-infected MT-4 cells, and EC50 is the 50% effective concentration against HIV-infected cells). Products A, B and C all effectively and dose-dependently reduced the cytopathic effect of HIV infection (closed symbols in Figure 5), although their anti-HIV activity was much lower than that of positive controls [dextran sulfate (SI=1378), curdlan sulfate (SI=5606), azidothymidine (SI=17746), 2’,3’-dideoxycytidine (SI=5123)] (Table 4). The potency of anti-HIV activity was in the order of product A (Sasa-Health®, SE) (SI=607) > product C (SI=117) > product B (SI=111) (Exp. I, Table 4) . A granulated powder of
3.2. Anti-bacterial activity
Product B (BLE) significantly reduced the bacterial growth and lactate production
Product A (SE) showed a bacteriostatic, but not a bactericidal effect on
Gas chromatography demonstrated that these bacteria produced H2S and CH3SH, but not (CH3)2H. SE more efficiently reduced the production of H2S in
|Product A (SE)||607||LCC from pine trees (n=2)||27|
|Product B||111||LCC from pine seed shell||12|
|Product C||117||LCC from catuaba bark||43|
|Dextran sulfate||1378||LCC from cacao husk||311|
|Curdlan sulfate||5606||LCC from cacao mass||46|
|AZT||17746||LCC from cultured LEM||94|
|ddC||5123||LCC from mulberry juice||7|
|Phenylpropenoid polymers (n=23)||105|
|SE-10||54||Neutral polysaccharide from pine cone||1|
|ddC||905||Hydrolyzable tannins monomer (n=21)||<1|
|Hydrolyzable tannins dimer (n=39)||<1|
|Exp. 3 (SE component)||Hydrolyzable tannins trimer (n=4)||3|
|SE||36||Hydrolyzable tannins tetramer (n=3)||11|
|LCC Fr I (acid precipitation)||37||Condensed tannins (n=8)||<1|
|LCC Fr II (acid precipitation ×2))||58|
|LCC Fr III (acid precipitation × 2)||62||Flavonoids (n=160)||<1|
|Polysaccharide fraction Fr IV||><1||Gallic acid||<1|
|Butanol extract||<1||(-)-Epigallocatechin 3-||<1|
|Exp. 4 (SE component)||Chlorophyllin||5|
|Luteolin 7-||7||Kampo medicines (n=10)||<1.0|
|Luteolin 6-||>7||Constituent plant extracts (n=25)||1.3|
3.3. Antitumor activity
Oral administration of SE (
SE showed slightly higher cytotoxicity against the human squamous cell carcinoma cell lines (HSC-2, HSC-3, HSC-4, Ca9-22, NA) (mean CC50=6.22%, 3.62 mg/mL) and the human glioblastoma cell lines (T98G, U-87MG) (mean CC50=5.43%, 3.16 mg/mL), as compared with the human oral normal cells [gingival fibroblast (HGF), pulp cell (HPC), periodontal ligament fibroblast (HPLF)] (mean CC50=6.90%, 4.01 mg/mL), and was more cytotoxic to the human myelogenous leukemic cell lines (HL-60, ML-1, KG-1) (CC50=1.18%, 0.68 mg/mL) and the human T-cell leukemia cell line (MT-4) (CC50=1.41%, 0.82 mg/mL), with an approximate tumor specificity index of 1.62 (Table 5). Although SE did not show high tumor-specific cytotoxicity, it was highly cytotoxic to three human myelogenous leukemic cell lines (HL-60, ML-1, KG-1) and one T-cell leukemic cell line (MT-4). The type of cell death induced by SE remains to be investigated .
3.4. Membrane stabilizing activity
In order to investigate whether SE contains membrane -stabilizing activity, SE was defatted with hexane, and fractionated on Silica gel chromatography, according to the polarity, into Fr. 1 (eluted with
Membrane stability can be evaluated by the extracellular leakage of glutamic-oxaloacetic transaminase (GOT) and glutamic-pyruvic transamiase (GPT) from the hepatocytes. Control hepatocytes released 85.1± 5.4 (mean±SD) K.U./ml GOT into the culture medium. SE (1~5 μi=60~300 μg/ml) significantly inhibited the release of GOT. Among the SE fractions, Frs. 1, 4 and 6 showed the inhibitory effects (Figure 8A). Control hepatocytes released 37.0 ± 3.6K.U./ml GPT inoto the culture medium. SE (1~2 μl=60, 120 μg/ml) significantly inhibited the GTP release (Figure 8B) .
SE, Fr. 3 and Fr. 5 showed the surfactant action by reducing the surface tension. These substances did not significantly affect the phase-transtion temperature of dipalmitoyl phosphatidylcholine (DPPC)-liposome bilayer nor the membrane-fluidity. These data suggest that the membrane-stabilizing activity of SE may be generated by polysaccharide, lignin, or chlorophyll present in Fr. 3, 4 and 5.
|Human normal cells|
|Gingival fibroblast (HGF)||6.96||4.05|
|Pulp cell (HPC)||7.54||4.38|
|Periodontal ligament fibroblast (HPLF)||6.19||3.60|
|Human oral squamous cell carcinoma cell lines|
|Human glioblastoma cell lines|
|Human myelogenous leukemia cell lines|
|Human T-cell leukemia cell line|
We next compared the hepatocyte protective effect of SE, other Herbal extracts and tinctures (Aloe, Gambir, Swertiae, Plantaginis, Geranii, Houttuyniae extracts). Aloe extract rather enhanced the leakage of liver enzymes, whereas SE and Gambir extract were inhibitory. SE more significantly inhibited the enzyme leakage, as compared with other herbal extracts and tinctures, suggesting that the hepatocyte protective activity of SE may be more potent that other herbal extracts .
3.5. Anti-inflammatory activity
Oral administration of hot water extract of leaves of bamboo of genus
Single oral administration of SE (10~20 ml =0.6~1.2 mg/kg) slightly reduced the vasopermeability in ddY male mice (assessed by Whittle method). Single oral administration of SE (5 ml=0.3 mg/kg) slightly inhibited the formation of carrageenin-induced edema in SD male rats at 1 h, but rather enhanced the formation of edema at 3 h and thereafter (Figure 9A). Single oral administration of SE (5 ml=0.3 mg/kg) inhibited the formation of formalin-induced edema at 3 h (Figure 9B). Repeated oral administration of SE (1, 5, 10 ml/kg/day×7 or 9days) stimulated the growth of fibroblasts and neovascularization, in contrast to the enhanced formation of collagen fiber. This suggests that SE may stimulate the regeneration of normal tissue during the restoration process of inflammatory tissues .
Oral administration of SE slightly increased the phagocytic index (assessed by carbon clearance method) after 3~5 h, but did not affect the phagocytic index at 7 days, suggesting that SE does not reduce the function of reticuloendothelial system.
SE also inhibited the production of nitric oxide (NO) and prostaglandin E2 (PGE2) from the LPS-activated mouse macrophage-like cells RAW264.7
IL-1β induced one to two order higher production of proinflammatory substances (PGE2, IL-6, IL-8, MCP-1), but not NO and TNFα by human gingival fibroblast (HGF). SE also inhibited the production of IL-8 production by IL-1β-stimulated human gingival fibroblast (Figure 10).
3.6. Radical scavenging activity
ESR spectroscopy showed that SE (50%=29.1 mg/mL) did not produce any detectable ESR signal at pH 7.4 (radical intensity (RI)<0.089) and pH 10.0 (RI<0.11). At pH 13.0, a weak broad peak, similar to that of typical lignin , appeared (RI=0.14) .
Products A, B and C dose-dependently reduced the intensity of superoxide anion (O2–) (detected as DMPO-OOH) generated by hypoxanthine and xanthine oxidase reaction. The potency of O2– scavenging activity of the three products was comparable: product A (IC50=0.46 mg/ml), product B (IC50=0.52 mg/ml) and product C (IC50=0.54 mg/ml) (Table 6) .
Products A, B and C dose-dependently reduced the intensity of hydroxyl radical ( OH) (detected as DMPO-OH) generated by the Fenton reaction. The potency of products A and C was comparable with each other (IC50=2.1 and 1.9 mg/ml, respectively), but 4-fold higher than that of product B (IC50=8.0 mg/ml) (Table 6) .
|Product||0.69% (0.46 mg/ml)||3.2% (2.1 mg/ml)|
|Product ||0.67% (0.52 mg/ml)||10.3% (8.0 mg/ml)|
|Product||1.9% (0.54 mg/ml)||6.6% (1.9 mg/ml)|
3.7. Anti-UV activity
UV irradiation (6 J/m2/min) for 1 min followed by 48 h culture resulted in extensive cell death (closed circles in Figure 11). Popular antioxidants,
SE (product A) showed higher anti-UV activity (SI=20) than other
LCCs from pine cones, pine seed and cultured LEM (SI=26-42) showed comparable anti-UV activity with SE (SI=39). Lignin precursor, vanillin, showed higher anti-UV activity comparable with that of sodium ascorbate (SI=64) (Exp. 3, Table 7) [44, 45]. On the other hand, chemically-modified glucans, such as
|Exp. 1||Exp. 3 (LCCs)|
|SE||20||LCC from pine cones (n=3)||33|
|Luteolin 6-||>8||LCC from pine seed||26|
|Luteolin 7-||>6||LCC from cultured LEM||42|
|Chlorophyllin||<1||Sulfated lignin (n=2)||>8|
|Chlorophyl a||<1||Sodium acorbate||64|
|Sodium ascorbate||30||Exp. 4 (polysaccharides)|
|Catalase||<1||Exp. 5 (Plant extracts)|
|Kampo medicines (n=10)||2|
|Exp. 2 (SE products)||Constituent plant extracts (n=25)||1|
|Product A (SE)||20|
|Product B (BLE)||4||Exp. 6 (Tea extract)|
|Product C (KS)||13||Green tea||3|
|Sodium acorbate||33||Black tea||<1|
|Sodium ascorbate||90||Sodium ascorbate||30|
3.8. Synergistic action with vitamin C
Vitamin C exhibited either antioxidant or prooxidant activity, depending on the concentration . We have reported that ascorbate derivatives that produced the doublet signal of ascorbate radical (sodium-L-ascorbate, L-ascorbic acid, D-isoascorbic acid, 6-β-D-galactosyl-L-ascorbate, sodium 5,6-benzylidene-L-ascorbate) induced apoptosis (characterized by internucleosomal DNA fragmentation and an increase in the intracellular Ca2+ concentration) in HL-60 cells. On the other hand, ascorbate derivatives that did not produce radicals (L-ascorbic acid-2-phosphate magnesium salt, L-ascorbic acid 2-sulfate and dehydroascorbic acid) did not induce apoptosis [47, 48]. This suggests the possible involvement of the ascorbate radical in apoptosis-induction by ascorbic acid-related compounds.
We accidentally found that LCCs from the pine cone of
Sodium ascorbate rapidly reduced the oxygen concentration in the culture medium, possibly due to oxygen consumption
Lower concentration of LCC (pine cone Fr. VI) and sodium ascorbate showed radical scavenging activity. LCC further stimulated the superoxide anion (O2-) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity of sodium ascorbate. LCCs from
Similarly, SE and vitamin C synergistically enhanced the activity that scavenging superoxide anion radical (determined by the intensity of DMPO-OOH) and hydroxyl radical (determined by the intensity of DMPO-OH radical) (Table 8) .
|0.5% VC||0.25% + 5 μM VC||1% VC||0.5% + 5 μM VC|
|SE||48.3||47.1 < 60.4 [(48.3+72.4)/2]||65.4||75.5 < 87.3 [(65.4+109.1)/2]|
|10 μM vitamin C||72.4||109.1|
3.9. Inhibition of CYP3A4 activity
CYP3A4 activity was measured by β-hydroxylation of testosterone in human recombinant CYP3A4. Products A, B and C dose-dependently inhibited the β-hydroxylation of testosterone, generally used for the assay of CYP3A4 activity. Product C exhibited the highest CYP3A4–inhibitory activity (IC50=58 μg/ml), followed by product B (IC50=124 μg/ml) and then product A (IC50=403 μg/ml). Product B inhibited the CYP3A4 to an extent similar to that attained by Cu (II)- chlorophyllin; product A inhibited CYP3A4 to lower extent than that achieved by grapefruit juice (Figure 12) .
SE-10 and SE dose-dependently inhibited the β-hydroxylation of testosterone, generally used for the assay of CYP3A4 activity. SE-10 (IC50= 0.516 μg SE equivalent/ml) had an approximately 16% lower CYP3A4-inhibitory activity (IC50= 0.445 μg/ml) .Combined with our recent report , CYP3A4 inhibitory activity increases in the following order (from lower to higher): SE-10 < SE < products B and C. SE-10 and SE seem likely to be safer drugs as compared with products B and C, since the latter are expected to enhance the side-effects of CYP3A4-metabolizable drugs more potently.
3.10. Possibility of complex formation between the components
Solvent fractionation of SE demonstrated that the majority of chlorophyllin and the activity that inhibited the NO production by macrophages were recovered from the water layer that contains majority of compounds (more than 81%) . This suggests the possibility that chlorophyllin in SE may be associated with hydrophilic substances, especially LCC in the native state or after extraction with alkaline solution, since the preparative method of SE is the same with that of LCC. This was supported by the observation that LCC isolated from SE has greenish color (absorption peak = 655 nm), characteristic to chlorophyllin (absorption peak = 629 nm), expected to contain 1.7-2.6% chlorophyllin in the molecule, and that 68.5% of SE eluted as a single peak at the retention time of 22.175 min in HPLC . Upon binding to chlorophyllin, LCC may obtain the activity of inhibiting the NO production by activated macrophages.
3.11. Clinical application for the treatment of oral diseases
Oral intake of product B (BLE) slightly but significantly reduced the gingival crevicular fluid (determined by Periometer®), and tended to reduce gingival index in the experimentally induced gingivitis patients .
Lichen planus is a chronic mucocutaneous disease that affects the skin, tongue, and oral mucosa. The most common presentation of oral lichen planus is the reticular form that manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised areas). The cause of lichen planus is not known. Some lichen planus-type rashes occur as allergic reactions to medications and a complication of chronic hepatitis C virus infection . Hepatitis C virus has been reported to occasionally replicate in oral lichen tissue and contribute to mucosal damage [52, 53]. It has been reported that the Epstein-Barr virus is more frequently detected in oral lesions such as oral lichen planus and oral squamous cell carcinoma in comparison with healthy oral epithelium .
Potent antiviral, antibacterial, and anti-inflammatory activity of SE prompted us to investigate whether SE is effective on oral lichenoid dysplasia and osteoclastogenesis. A male patient with white lacy streaks in the oral mucosa was orally administered SE three times a day for ten months. Long-term treatment cycle of SE progressively reduced both the area of white steaks (Figure 13) and the base-line levels of salivary interleukin-6 and 8 (Figure 14) . IL-8 concentration after SE treatment was below the initial level throughout the experimental period. This was accompanied by the improvement of patient’s symptoms. Before the SE treatment, the patient felt that the mucosa is uneven, rough and cut by touching with his tongue. Three weeks after the treatment, such feeling reduced and the mucosa became much smooth. At four weeks, the rough mucosa was narrowed into smaller area, and the patient could eat without pungent feeling on the oral mucosa. Oral intake of SE also improved the patient’s symptom of pollen allergy, and loose teeth, giving an impression that the oral mucosa became much tighter. SE significantly inhibited the RANKL-induced differentiation of mouse macrophage-like RAW264.7 cells towards osteoclasts (evaluated by TRAP-positive multinuclear cell formation). These pilot clinical study suggests the therapeutic potentiality of SE against oral diseases .
SE (Sasa Health®), alkaline extract of
SE as well as LCCs, which are efficiently extracted with alkaline solution, showed higher anti-HIV and anti-UV activity, as compared with hot water extract of many plant species including Kampo medicines (Figure 16). Antitumor activity of polysaccharide fractions of pine cone extracts against ascites tumor cells transplanted in mice also increased with acidity (binding strength to DEAE-cellulose column) , suggesting the potency of alkaline extract against certain types of diseases.
We have reported broad antiviral spectrum of LCC ranging from HIV [57-59], influenza virus [60-62], herpes simplex virus [63-65]. Oral administration of LCC from pine cone extract significantly improved the symptom of HSV-infected patients [66, 67], and lichenoid dysplasia patient . These data suggest the possible application of SE to virally-induced diseases. Considering to low absorption through the intestinal tract , the application through the mucosa membrane is recommended. We are now studying the interaction between SE, antibacterial agent and charcoal to optimize the therapeutic potential of SE for the main component of toothpaste.
LCC is composed of two major components: polysaccharide and phenylpropanoide polymer [29, 30, 69, 70]. Limited digestion study demonstrated that anti-viral activity of LCC is generated by its phenylpropanoid portion [58, 61], and immnopotentiation activity possibly by polysaccharide. Using DNA microarray analysis, we have recently reported that treatment of mouse macrophage-like J774.1 cells with LCC fractions isolated from LEM (Fr4) enhanced the expression of dectin-2 (4.2-fold) and toll-like receptor (TLR)-2 (2.5-fold) prominently, but only slightly modified the expression of dectin-1 (0.8-fold), complement receptor 3 (0.9-fold), TLR1, 3, 4, 9 and 13 (0.8- to 1.7-fold), spleen tyrosine kinase (Syk)b, zeta-chain (TCR) associated protein kinase 70kDa (Zap70), Janus tyrosine kinase (Jak)2 (1.0- to 1.2-fold), nuclear factor (Nf)кb1, NFкb2, reticuloendotheliosis viral oncogene homolog (Rel)a, Relb (1.0- to 1.6-fold), Nfкbia, Nfкbib, Nfкbie, Nfкbi12 Nfкbiz (0.8- to 2.3-fold). On the other hand, LPS did not affect the expression of dectin-2 nor TLR-2. These data suggest the significant role of the activation of the dectin-2 signaling pathway in the action of LCC on macrophages . It is generally accepted that dectin- 2 is the receptor for mannan, whereas dectin-1 is that for glucan [72-76]. It remains to be investigated the signaling pathway of LCC via dectin-2.