Abstract
Inflammatory bowel disease (IBD) is a group of intestinal disorders that cause prolonged inflammation of digestive tract. Chronic inflammation results in Crohn’s disease (CD) and ulcerative colitis (UC). There is a disruption of homeostasis of various regulatory factors, for example, cohesive functioning of intestinal epithelial barrier, macrophages, and cellular mediators such as cytokines and chemokines. Natural products derived from plants based on traditional system of medicine have exhibited efficacy for UC and CD in experimental models and clinical trials. In the present review, current developments of natural products and herbs for the treatment of IBD in the context of Indian traditional medicine have been highlighted. Two classes of Ayurvedic formulation, fermented preparations (Asava and Arishta) and Ghrita (preparations involving butter), are employed for the maintenance of intestinal disorders. Here, we discuss mainly about the fermented preparations, their main constituents, and correlations with modern findings. The way these fermented formulations are processed also affects the extraction of constituents in them. So, the correlation between the chemistry of the plant material (their constituents as well) with the IBD was done. These correlations may serve as a step forward to reduce the gap between modern system of medicine and traditional system of medicine.
Keywords
- inflammatory bowel disease
- traditional system of medicine
- fermented preparations
- gallotannins
- ellagitannins
1. Introduction
Inflammatory bowel disease (IBD) is the intestinal disorder induced by chronic gastrointestinal inflammation. Crohn’s disease (CD) and ulcerative colitis (UC) are global health problems, with the highest incidence and a prevalence rate of 0.5–1.0% in Europe [1]. The incidence of IBD is increasing dramatically in Asian countries, especially in China. There is rising incidence and prevalence of inflammatory bowel disease in India, topping the Southeast Asian (SEA) countries [2]. IBD is relatively complex disease that involves numerous factors such as commensal flora, genetic factors, immune system dysfunction, and environmental risk factors [3]. The human gastrointestinal tract serves as the first-line sensor, and defense against external environment stimuli is exposed to the external environment, particularly to bacterial antigens released from resident microbiota. It is the chronic inflammation in the intestinal surface that first leads to the development of UC, which can progress into CD and/or colon cancer [3]. Advances have been achieved in understanding the pathogenesis of IBD in the past few years, yet exact mechanisms remain to be elucidated. Patients usually suffer from severe pain, diarrhea, abscesses, fistulas, abdominal pain, and stenosis. Thus the development of effective treatments and/or reducing the symptoms of patients with IBD is urgently needed. The current mainstream management of IBD includes antibiotics, corticosteroids, thiopurines, anti-tumor necrosis factor (TNF) antibodies, and aminosalicylates [2]. They have severe side effects such as diarrhea, nausea, vomiting, headache, and osteoporosis when used for the long term. One-third of CD patients undergo surgery after long-term use of these mainstream treatments [4].
The Indian System of Medicine which mainly comprises of Ayurveda (meaning the
The present review mainly discusses the fermented preparations used in
2. Major constituents present in fermented preparations and correlation with inflammatory bowel disease
2.1 Gallotannins
Gallotannins are a major constituent of plant materials used for the preparation of fermented preparation
2.2 Ellagitannins
Ellagitannins are the other major phytoconstituents that are extracted during the boiling/maceration with water. This is mainly due to the presence of hexahydroxydiphenic (HHDP) moiety in ellagitannins [13]. Their extractability in water is more than the gallotannins. Terchebulin (
2.3 Flavonoid glycosides and aglycones
Flavonoid glycosides and phenolic glycosides are the other class of phytoconstituents that are extracted in substantial amount during the boiling of plants during preparation of formulation. These were evident when formulations like
RP-HPLC analysis of the decoction and the final processed formulation revealed that luteolin 4′-
Further, the addition of
2.4 5-Hydroxymethyl furfuraldehyde (5-HMF)
5-Hydroxymethyl furfuraldehyde, 5-HMF (
2.5 Bioactives present in jaggery
3. Conclusions
From the evidences cited above, it is very clear that herbal formulations and their analysis for the presence of bioactive constituents are important as far as their efficacy is concerned. Three formulations have been cited, and major constituents present in them have proven to be good agents for IBD. Natural products and herbal medicine formulas have exhibited efficacy in preclinical evaluation, improved symptoms, and decreased medical costs for IBD patients. The components of natural products and herbs are complex and have multiple mechanisms of action that may synergize to produce their overall efficacy. Intensive studies based on murine models of IBD and human studies are required for evaluating the efficacy of natural products and herbal medicine as an alternative treatment for IBD. Thus identification of the active component(s) and optimization of the dosage and development of treatment protocol(s) are of primary importance. The modern hyphenated techniques having high-throughput technologies shall enable the identification of the effective ingredient(s) and reveal the mechanisms of action of natural products and herbs in treating IBD. Natural products and herbal formulations (as co-adjuvants) with existing medications may also provide new therapy options for IBD patients.
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