Disease Modifying Agents From Natural Products

DMA AND AUTO IMMUNE DISORDER

• Immune effector cells like T and B lymphocytes and macrophages play critical roles in the pathogenesis of Auto-immune disorders

• Autoimmune diseases are a group of illnesses with multiple organ involvement like Rheumatoid Arthritis

• Disease Modifying Agents are the drugs believed to alter the course of the disease particularly in Auto immune Disorders.

• The goal of DMARD therapy is to reach remission or obtain optimal control of inflammatory joint diseases

CURRENT REGIMEN

Antimalarials Hydroxychloroquine and Chloroquine), Sulfasalazine,
• TNF inhibitors (Etanercept, infliximab and Adalimumab),
• Interleukin-1 receptor antagonists, leflunomide Methotrexate,
• Gold compounds, and
• Cytotoxic agents (Azathioprine, Cyclophosphamide, and cyclosporine).

TNF INHIBITORS

• Etanercept and infliximab are TNF inhibitors. These drugs bind to and block the activity of TNF-alpha, which is a cytokine that causes inflammation and joint destruction in patients with Rheumatoid Arthritis
• Though they promise safety and efficacy compared to the earlier DMA’s, therapy cost is prohibitive


HERBS FROM OTHER REGIONS

• URTICARIA DIOTICA- NETTLE LEAF
• PANAX GINSENG
• GINKO BILOBA

INDIAN HERBS

• TINOSPORA CORDIFOLIA
• BOSWELLIA SERRATA
• ZINGIBHER OFFICINALIS
• CURCUMA LONGA
• OCIMUMSANCTUM
• CAMELIA CHINENSIS

TURMERIC- NO MYTH

• Curcumin, a flavonoid from Curcuma longa (turmeric) is a known inhibitor of TNF-alpha. An in vitro study found TNF-alpha increased intestinal permeability and curcumin inhibited the NFkappaB- induced-TNF-alpha-stimulated increase in intestinal permeability

BOSWELLIA SERRATA

• Boswellia serrata is a botanical with significant anti-inflammatory activity. In vitro, this botanical inhibits the 5-lipoxygenase product LTB4, which has been implicated in Crohn's Disease
• This is also confirmed in Randomized Double blind clinical studies carried out in comparison with known drug, Mesalamine

INTERLEUKINS

• Interleukins are the cytokines that act specifically as mediators between leucocytes
• IL-1 often acts synergistically with Tumor Necrosis Factor during the pro-inflammatory process. IL-6 also plays a role in inflammation, mainly as an inducer of acute phase proteins synthesis by hepatocytes.

TULSI- NOT JUST RELIGIOUS

• Ursolic acid, rich in Tulsi -Ocimum sanctum is a major inhibitor of IL-6 responsible for Pro-inflammatory activity
• Ursolic acid suppressed NF-kappaB activation induced by various carcinogens including tumor necrosis factor (TNF)

RASAYANEE DRUGS

• If one looks at the botanicals, we understand that most of them are Rasayanee drugs.
• This is just not coincidence
• More we understand the mechanism of pharmacological action better is our understanding of disease and choice of treatment