Could EU herbal monographs contribute to Malta’s treatment armamentarium?

Ten years have passed since Directive 2004/24/EC regulating herbal medicinal products across the EU were published. The directive created the Committee on Herbal Medicinal Products within the European Medicines Agency whose remit includes the creation and publishing of official EU monographs on herbal medicinal products. These monographs include the official uses of the products and their evidence for efficacy and safety. To this effect, we are interested in analysing the potential impact herbal product EU monographs could have on the therapeutic treatment options available for prescribers in Malta. Therefore our aim was two-fold. First, to rationalise the spread of indications of the herbal substances listed in the community herbal monograph inventory and subsequently determine if these herbal substances could potentially contribute to the treatment options available in our local scenario (Malta). 128 EU monographs were analysed resulting in a total of 230 indications which subsequently codified into 42 unique ATC codes. The Malta Medicines List contains 1456 unique ATC codes. Comparative analysis of the Malta Medicines List revealed that the 21 therapeutic areas had 4 or less pharmaceutically used substances (5th level ATC codes) registered and therefore in our opinion are areas with limited therapeutic choice. The following 4 therapeutic areas, A05 bile and liver therapy, A13 tonics, A15 appetite stimulants and D03 preparations for treatment of wounds and ulcers, could potentially benefit from the registration of herbal medicinal products according to the EU herbal monographs. If such registration is effected the aforementioned areas would no longer be considered limited because more than 4 therapeutic choices would be available to prescribers. This study is the first study across the EU to analyse the potential impact of published EU herbal monographs on therapeutic coverage in an EU member state and confirms the notion that herbal products could potentially increase the treatment options available in areas where few medical products have been registered due to Malta's small market size.     

Patient access to and ethical considerations of the application of the European Union hospital exemption rule for advanced therapy medicinal products

Hospital exemption (HE) is a regulated pathway that allows the use of advanced therapy medicinal products (ATMPs) within the European Union (EU) under restrictive conditions overseen by national medicine agencies. In some EU countries, HE is granted for ATMPs with no demonstrated safety and efficacy; therefore, they are equivalent to investigational drugs. In other countries, HE is granted for ATMPs with demonstrated quality, safety and efficacy and for which centralized marketing authorization has not been requested. The Committee on the Ethics of Cell and Gene Therapy of the International Society for Cell & Gene Therapy reflects here on the ethical issues concerning HE application from the perspective of the patient, including risk–benefit balance, accessibility and transparency, while providing evidence that HE must not be regarded as a conduit for unproven and unethical ATMP-based interventions. Indeed, HE represents a legal instrument under which a patient's need for access to novel ATMPs is reconciled with ethics. Moreover, for some unmet medical needs, HE is the only pathway for accessing innovative ATMPs. Nonetheless, HE harmonization across EU Member States and limitations of ATMP use under the HE rule when similar products have already been granted centralized marketing authorization to avoid a parallel regulatory pathway are controversial issues whose political and economic consequences are beyond the scope of this review. Finally, the institution of an EU registry of HE applications and outcomes represents a priority to improve transparency, reduce patient risks, increase efficiency of health systems, facilitate company awareness of business opportunities and boost progressive entry of ATMPs into the therapeutic repertoire of health systems.     

Les essais cliniques en médecine nucléaire

The EU clinical trials directive (2001/20/EC) was published on the 4th April 2001 and was transposed into French law in 2004. This new clinical trial regulation has modified considerably the research area including clinical trials conducted with radiopharmaceutical medicinal products. This new regulation aims at ensuring the protection of the health and safety of clinical trial participants, the ethical soundness and the reliability and robustness of data generated in clinical trials. In practice, the sponsor has to submit a clinical trial application to the Afssaps for authorization and to the concerned Ethics Committee for a positive opinion. The content of the clinical trial application regarding the investigational medicinal product is very detailed and a heavy technical dossier could be required in order to justify the quality of the medicinal product used in the clinical trial. Furthermore, pharmacy and radiopharmacy required specific authorizations for preparing these medicinal products. This new regulation could refrain nuclear medicine from conducting clinical trials.     

基于菌群调控下的天然植物活性成分与全食态健康效用评价

肠道菌群与人体共同协作,菌群在帮助宿主对食物中的营养成分进行深入消化与利用的同时,也一同分享宿主为其提供的生存空间与营养物质,这是微生物与宿主之间形成的一种互利共生的特殊共存方式。这样的精妙结合,不仅使得微生物在人体中形成了固有的菌群结构,得到赖以生存的生物基位,也通过自身的功能代谢以及群体信号,为宿主在免疫、营养等方面提供所必需的调节与支撑。围绕药食同源天然植物的健康作用研究,目前大多着眼于对其功能组分的分离提取与活性评价。如植物多糖、多酚与黄酮等活性功能成分。然而在传统中医药中,植物多以全食态进行复配应用。目前在菌群水平研究中发现,对于影响人体健康水平的菌群模式并非固定且依赖于某一单菌种变化,微生物之间的生态竞争与代谢调控均以群体的方式与宿主持续进行共进化。药食同源天然植物,对菌群的调节作用主要还是依靠其全食态,这也从菌群这个微观生态环境的角度为传统中医学理论中对于中药食材即天然植物全食状态下的药效提供了重要佐证。因此,对于药食同源天然植物的开发与利用,应当结合菌群整体的调控进行分析,并对其全食状态与活性功能组分有充分的认识与评价。     

Regulatory issues concerning the safety, efficacy and quality of herbal remedies

Herbal remedies and alternative medicines are used throughout the world, and in the past herbs were often the original sources of most drugs. Today we are witnessing an increase in herbal remedy use throughout the Western world raising the question as to how safe are these preparations for the unborn fetus? Many women use herbal products during pregnancy. The dilemma facing most regulatory authorities is that the public considers these products as either traditional medicines or natural food supplements. The user sees no reason for regulation. Most countries have laws concerning foods, drugs, and cosmetics, the details of which seldom clearly define to what section of the law and regulations alternative remedies belong. In most countries alternative remedies are regulated as foods, provided that no medicinal claim is made on the label. The global regulatory sector, however, is changing rapidly. The Therapeutic Goods Administration (TGA) in Australia created a Complimentary Medicines Evaluation Committee in late 1997 to address this issue, and Canada has created a new Natural Health Products Directorate in the realigned Therapeutic Products and Foods Branch in 2000. In parallel, the European Agency for the Evaluation of Medicinal Products has drafted test procedures and acceptance criteria for herbal drug preparations and herbal medicinal products. In the US, the Food and Drug Administration classifies these natural products as dietary supplements. Manufacturers must label a dietary supplement thus: “this statement has not been evaluated by the FDA [, and] this product is not intended to diagnose, treat, cure or prevent any disease.” Whether these products are foods or drugs is undecided. To add complexity to this issue, most of the potential deleterious effects of natural products on the unborn may be related to hormonal effects (e.g., phytoestrogens) and nutriceutical drug interactions (e.g., St. John's Wort and antidepressants), rather than direct embryotoxicity per se. We suggest that ensuring quality of herbal products should receive immediate attention by regulatory authorities, before embarking on the more arduous tasks of safety and efficacy. Birth Defects Res B 68:505–510, 2003. © 2003 Wiley‐Liss, Inc.     

植物苯丙烷代谢途径

众所周知,固着生长的植物经常受到环境中各种生物和非生物胁迫的威胁。所以在漫长的进化过程中,植物必须将多样的环境信号整合到其发育过程中,以实现适应性形态的发生和代谢途径的精确调控,最终使植物完成整个生长周期。研究显示,苯丙烷代谢作为植物重要的次级代谢途径之一,其代谢产物,例如木质素、孢粉素、花青素和有机酸等,在调控植物适应性生长的过程中发挥着重要功能。特别是在药用植物中,苯丙烷代谢还与众多药用活性成分的合成息息相关,几乎所有包含苯丙烷骨架的天然药效成分均由苯丙烷代谢途径直接或间接合成,例如黄酮类、萜类和酚类等。此外,经苯丙烷代谢途径产生的一些次级代谢产物还能由植物根系外泌到周际土壤中,通过改变根系微生物的菌群生态,而影响植物生长和抵抗生物或非生物胁迫的能力。同时,苯丙烷代谢介导的这种植物-微生物互作也与药用植物的道地品质密不可分。本文综述了近年来植物苯丙烷代谢途径的最新研究进展,重点对该代谢途径中代谢产物的生理功能及表达调控机制进行了介绍,以期更深入地理解药用植物苯丙烷代谢与药材性状之间的潜在关系,旨在指导优良中草药的遗传育种,以进一步促进我国中医药事业的蓬勃发展。     

Commercial herbal preparations in KwaZulu-Natal, South Africa: The urban face of traditional medicine

The modern trend in traditional medicines reflects an increase in the sale of complex herbal mixtures rather than those prepared from single plants. This trend is well documented in Traditional Chinese Medicine (TCM) and can be seen in recent developments in African traditional medicine. An increase in the prevalence of locally produced herbal preparations, especially those containing complex mixtures of several medicinal plants, sold in numerous retail outlets, including supermarkets and pharmacies has been observed. The appearance of these preparations is not surprising in rapidly urbanizing societies where traditional products are still desired but the users have neither the time nor resources to produce them. The production of these herbal mixtures has resulted in a growing herbal industry with about 50 to 100 private entrepreneurs in the informal market and has also contributed to creation of numerous jobs. The products are extensively advertised in newspapers, on the internet, television and radio programmes as well as through pamphlets and posters. This review examines and documents the prevalence of commercial herbal mixtures and preparations common in Pietermaritzburg, KwaZulu-Natal. Different types of herbal mixtures, claims, ethical and legal implications are discussed. Methods of preparation and marketing strategies as well as the way forward in ensuring economic impact, safety and efficacy of this new aspect of South African traditional medicine are also highlighted.     

Regulation of herbal medicinal products in the EU: an up-to-date scientific review

A new European legislation on herbal medicinal products (HMPs) was developed, in order to harmonise the use of HMPs in the 28 member states of the European Union, according to Directive 2004/24/EC which amended the basic legislation laid down in Directive 2001/83/EC. The objective of this legislation was to ensure the future existence of such products and to consider particular characteristics during the assessment of their quality, efficacy and safety, having defined two categories for herbal medicines: (a) well-established use HMPs, which can be granted a marketing authorisation; and (b) traditional herbal medicinal products which can be granted a registration based on their long-standing safe and efficient use. The Committee on Herbal Medicinal Products was established at the European Medicines Agency in 2004, in order mainly to provide community monographs and list entries on herbal substances and preparations. 120 monographs have been published since then, which offer a scientific and regulatory standard for their safety and efficacy, during their use as medicinal products. The HMPs can be placed in the market after quality, efficacy, and safety have been assessed according to the provisions of the legislation (Directive 2004/24/EC and Directive 2001/83/EC), with adequate labeling information to patients and health care professionals, distinguishing them from other product categories containing herbs like: foods, food supplements, medical devices and cosmetics.     

Paradigm shift in natural product research: traditional medicine inspired approaches

The development of traditional medicine with the perspectives of safety, efficacy and quality would help not only to preserve the traditional heritage but also to rationalize the use of herbal medicine in the human healthcare. Nature is considered as a compendium for templates of new chemical entities. The medicinal plants mentioned in the different ancient texts worldwide may be explored with the modern scientific approaches for better leads in the healthcare. Drugs from medicinal plants are unique for their chemical and biological features, and are gaining global acceptance because they offer natural ways to treat diseases and promote healthcare. Natural products are the best sources of chemical diversity for finding new drugs and leads. Globalization of traditional medicine is necessary for health care with assessment of its safety, efficacy, therapeutic and clinical evidence. Evidence based validation of the ethnopharmacological claims on traditional medicine is necessary for its promotion and development. Applications of techniques such as marker analysis, DNA bar coding, plant metabolomics, network pharmacology etc. are being taken into account for the validation and documentation of medicinal plants. This can be achieved by the scientific exploitation of the established facts from ancient systems through proper validation of the claims based on pharmacological and phytochemical assessments.     

Risk Associated with the Use of Selected Ingredients in Food Supplements

This review focuses on four new product categories of food supplements: pre-workout, fat burner/thermogenic, brain/cognitive booster, and hormone/testosterone booster. Many food supplements have been shown to be contaminated with unauthorized substances. In some cases, the ingredients in the new categories of dietary supplements were medicinal products or new synthetic compounds added without performing clinical trials. Some of the new ingredients in dietary supplements are plant materials that are registered in the pharmacopoeia as herbal medicines. In other cases, dietary supplements may contain plant materials that have no history of human use and are often used as materials to ‘camouflage’ stimulants. In the European Union, new ingredients of dietary supplements, according to European Food Safety Authority or unauthorized novel food. Furthermore, selected ingredients in dietary supplements may be prohibited in sports and are recognized as doping agents by World Anti-Doping Agency.     

云南高黎贡山怒族对植物传统利用的初步研究

采用民族生物学和文化人类学等方法,广泛调查和研究了云南西北部高黎贡山地区怒族对植物的传统利用形式。结果表明：怒族对植物的传统利用主要表现在食用、药用、观赏、宗教祟拜和文化利用等方面。讨论了怒族的传统文化在当地植物多样性利用和管理中的作用和意义,并探讨了在植物多样性管理中传统管理和现代管理之间的关系以及在我国利用文化多样性进行自然生态环境保护的可能性、必要性和可行性。此外,面对优秀的传统文化知识和文化多样性逐渐消失的现实,作者建议加以拯救和广泛的研究。     

A compilation of Bioactive Compounds from Ayurveda

This review deals with the key bioactive compounds and the role of medicinal plants in Ayurvedic systems of medicine in India and their earlier investigation. There has been an increase in demand for the Phytopharmaceutical products of Ayurvĕda in Western countries, because of the fact that the allopathic drugs have more side effects. Many pharmaceutical companies are now concentrating on manufacturing of Ayurvĕdic Phytopharmaceutical products. Ayurvĕda is the Indian traditional system of medicine, which also deals about pharmaceutical science. Different type of plant parts used for the Ayurvedic formulation; overall out line of those herbal scenario and its future prospects for the scientific evaluation of medicinal plants used by traditional healers are also discussed. In India most of them, where Ayurvedic treatment is frequently used, for their ailments and provides instructions to local people how to prepare medicine from the herbs. As much as possible importance is also given for the taxonomic literature.     

药用木本植物的生态保护

在分析我国药用木本植物的利用现状和特殊性的基础上。揭示了药用木本植物保护与利用之间的矛盾。提出了解决矛盾的根本出路和需要开展的基础研究工作．研究成树主要药用成分的器官分布、季节变化、年龄差异以及与环境因素的相关性;研究幼树主要药用成分的器官分布、季节变化特别是年龄差异;研究环境因素(培育条件)对幼树主要药用成分的影响和调控规律;进一步从蛋白质(主要药用成分代谢过程中的关键酶)和核酸(关键酶的编码基因)水平解析环境因子对幼树主要药用成分的调控机理．     

Sustainable Utilization and Economic Development of Some Plant Resources in Northern Pakistan

Overshadowed by the vast impact that habitat loss has on targeted plant species survival, it is easy to overlook the fact that utilization and harvesting of species can often result in their genetic depletion and in an often rapid downward trend of their population status. In this regard an ethnobotanical study on the medicinal plants of Shawar valley, District Swat was conducted with the aims to document medicinal plants and to examine the current status of the medicinal plants trade as well as the market chain starting from collectors to consumers. The survey reported 50 species of plants belonging to 33 families as ethnomedicinally important. These species were used as crud drugs by the local people and folk-lore for treating diseases in traditional system of medicine. The detailed local uses, recipe preparation along with their local names and diseases treated were recorded for each species.Market survey revealed that the structure of medicinal plant trade is complex and heterogeneous, involving many players. The collectors are often not aware of the high market prices and medicinal values, and most of the collected material is sold to local middlemen at a very low price. There was an increase of 3 to 5 folds in prices from collectors to the national market.Recommendations were given in the spheres of training sustainable harvesting and post harvesting of wild medicinal plant resources, trade monitoring, equitable sharing of benefits of wild resources, improved control on harvesting and trade for the conservation of resources, enhancement of cultivation efforts, future research into trade in wild harvested plants, community participation in natural resource management and value addition in the herbal products to maximize the benefits.     

Proposals to enhance the quality of observational cohort studies

For herbal medicinal products the methodology of observational cohort studies (observational studies, drug monitoring studies, Anwendungsbeobachtung) represents a useful addition to clinical trials. The key objectives are the documentation of efficacy in particular under conditions of everyday medical practice in authentic patients and the documentation of the safety profile. Supplementary to earlier activities, members of the "Clinical Trials of Herbal Medicinal Products" Working Party of the German Society for Phytotherapy have therefore again addressed the issue of observational cohort studies for to enhance the informative value and importance of this clinical research methodology. Recommendations were developed on quality aspects, methodological approaches of observation parameters, and for the reporting of the study's results. Properly planned and conducted observational cohort studies may contribute to the documentation and proof of well-established medicinal use according the EU Directive 2001/83/EC.     

Detection of pyrrolizidine alkaloids in German licensed herbal medicinal teas

BackgroundBecause of the hepatotoxic, mutagenic, and cancerogenic effects of pyrrolizidine alkaloids (PAs) the German Federal Institute for Risk Assessment (BfR) recommends not to exceed a daily PA intake of 0.007 µg/kg body weight (0.42 µg/60 kg adult). In a recent study conducted by the BfR, up to 5647 µg PA/kg dried herbal material were detected in tea products marketed as food.PurposeThe present study aimed at elucidating whether medicinal teas licensed or registered as medicinal products contain PAs as well.Study designOne hundred sixty-nine different commercially available medicinal teas, i.e. 19 nettle (Urtica dioica L.), 12 fennel (Foeniculum vulgare Mill.), 14 chamomile (Matricaria recutita L.), 11 melissa (Melissa officinalis L.) and 4 peppermint (Mentha piperita L.) teas as well as 109 tea mixtures were analyzed for the presence of 23 commercially available PAs.MethodLC/MS was used for the determination of the PAsResultsIn general, the total PA contents ranging 0–5668 µg/kg. Thirty percent of the tested single-ingredient tea products and 56.9% of the tested medicinal tea mixtures were found to contain PA concentrations above the limit of quantification (LOQ) of 10 µg/kg. In 11 medicinal teas PA contents >300 µg/kg dry herb were determined thus exceeding the recommended limit for PA intake by BfR. In addition three products of the investigated tea mixtures revealed extremely high PA contents of 4227, 5137, and 5668 µg/kg. Generally, single-ingredient tea products contained much less or even no detectable amounts of PAs when compared to the tea mixtures. PAs in the range between 13 and 1080 µg/kg were also detected in five analyzed aqueous herbal infusions of the medicinal tea mixture products with the highest PA content. Two out of the five investigated herbal infusions exceeded the recommended BfR limit for PA intake.ConclusionThis study demonstrates clearly that also medicinal teas licensed as medicinal products may partly contain high amounts of PAs exceeding current recommendations. For that reason manufacturers are advised to carry out more rigorous quality control tests devoted to the detection of PAs. This is very important to minimize PAs in medicinal teas accounting for possible additional exposure of the consumer to PAs from other food sources (e.g. honey).     

Anticancer potential of Himalayan plants

Plants used in traditional medicine have stood up to the test of time and contributed many novel compounds for preventive and curative medicine to modern science. India is sitting on a gold mine of well recorded and traditionally well practiced knowledge of herbal medicine. Specially, plants growing at high altitude in Himalayan pastures are time-honored sources of health and general well being of local inhabitants. As of today, Himalayan plants are a major contributor to the herbal pharmaceutical industry both of India and other countries. Plants growing at higher altitudes are subjected to an assault of diverse testing situations including higher doses of mutagenic UV-radiation, physiological drought, desiccation and strong winds. Plants interact with stressful environments by physiological adaptation and altering the biochemical profile of plant tissues and producing a spectrum of secondary metabolites. Secondary metabolites are of special interest to scientists because of their unique pharmacophores and medicinal properties. Secondary metabolites like polyphenols, terpenes and alkaloids have been reported to possess antimutagenic and anticancer properties in many studies. The fundamental aspiration of the current review is to divulge the antimutagenic/anticancer potential of five alpine plants used as food or medicine by the populations living at high altitudes.     

Comparison of new Brazilian legislation for the approval of advanced therapy medicinal products with existing systems in the USA,European Union and Japan

Background aimsAdvanced therapy medicinal products (ATMPs) are a class of biological products for human use that are based on genes, cells and tissues. The first ATMP received marketing authorization in Europe in 2009, whereas Brazil granted the first authorization in 2020. The objective of this study was to compare the regulatory models adopted by Brazil, the USA, Japan and the European Union, which comprise the member countries of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, with regard to the marketing authorization of ATMPs.MethodsThe authors performed a review of the scientific literature and official documents of the regulatory agencies in the aforementioned countries.ResultsThe legislation and regulatory guidelines adopted by the regulatory agencies exhibit similarities and differences. It was not possible to assess whether these differences can be translated into divergent final recommendations by regulatory authorities upon a request for marketing authorization.ConclusionsIn the future, it will be appropriate to start a progressive process of harmonization between these agencies in terms of terminology, legal recommendations and characterization requirements. This is particularly important for emerging countries such as Brazil. In this sense, some measures can be taken to achieve alignment between regulators.     

Arbuscular mycorrhizal symbiosis and active ingredients of medicinal plants: current research status and prospectives

Medicinal plants have been used world-wide for thousands of years and are widely recognized as having high healing but minor toxic side effects. The scarcity and increasing demand for medicinal plants and their products have promoted the development of artificial cultivation of medicinal plants. Currently, one of the prominent issues in medicinal cultivation systems is the unstable quality of the products. Arbuscular mycorrhiza (AM) affects secondary metabolism and the production of active ingredients of medicinal plants and thus influence the quality of herbal medicines. In this review, we have assembled, analyzed, and summarized the effects of AM symbioses on secondary metabolites of medicinal plants. We conclude that symbiosis of AM is conducive to favorable characteristics of medicinal plants, by improving the production and accumulation of important active ingredients of medicinal plants such as terpenes, phenols, and alkaloids, optimizing the composition of different active ingredients in medicinal plants and ultimately improving the quality of herbal materials. We are convinced that the AM symbiosis will benefit the cultivation of medicinal plants and improve the total yield and quality of herbal materials. Through this review, we hope to draw attention to the status and prospects of, and arouse more interest in, the research field of medicinal plants and mycorrhiza.