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The Role of Botanicals in Cardiovascular Health
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Botanical medicine, also referred to as herbal medicine or phytotherapy, utilizes plants, plant parts, and preparations made from them for therapeutic and/or preventive purposes. The role of plants in the management of cardiovascular disease has been a long and distinguished one. Thousands of years ago, it was noted that lily-of-the-valley (Convallaria majalis L.), sea squill (Drimia maritima (L.) Stearn), and foxglove (Digitalis purpurea L.) could ease the suffering from dropsy, an older term for congestive heart failure (CHF), due to the presence of cardioactive glycosides. Hawthorn (Crataegus spp.) was noted to benefit the aging heart centuries ago. Foxglove would eventually serve as the source for standardized digitalis, a drug still in use today (Norn 2004). Our first truly effective antihypertensive drug, reserpine, was extracted from Rauwolfia serpentina, a plant with a long history of use in Ayurveda, the traditional medicine of India, for the treatment of anxiety, insanity, and venomous bites (Griebenow et al. 1997).
The sixteenth century
Published in Michael J. O’Dowd, The History of Medications for Women, 2020
Bernard de Gordon, professor at the famous French medical school of Montpellier, followed the fashion among medieval medical men and called his renowned book after a flower: Bernard’s manuscript, the Lilium Medicinae of 1303, was one of the most highly-regarded medical treatises of the era and was eventually published at Naples in 1480. The lily has been part of the materia medica of women since antiquity, used in the treatment of menstrual and uterovaginal disorders. Over the centuries oil of lily (and oil of almonds) was an important ingredient of the pharmacopoeia for labor, used to lubricate the mother’s vagina and the fingers of the probing midwives, and as an emollient to soothe the tissues of the birth canal. The lily-of-the-valley (Convallaria majus) contains cardiac glycosides similar to digoxin (Reynolds, 1996).
Pharmacological actions of chemical constituents
Published in C. P. Khare, Evidence-based Ayurveda, 2019
Cardiac glycosides are found in several plants, including foxglove (Digitalis purpurea), lily of the valley (Convallaria majalis), oleander (Nerium oleander), yellow oleander (Thevetia peruviana), Strophanthus kombe/gratis/gratus seeds, squill (Urginea maritima/sea onion/indica bulbs), Digitalis lanata, dogbane (Apocynum cannabinum) and Adonis vernalisare. Medical professions prefer foxglove, while most of the herbalists prefer lily of the valley. Due to structural differences, the glycosides in the lily of the valley have less potential for cumulative poisoning.
Foxglove poisoning: diagnostic and therapeutic differences with medicinal digitalis glycosides overdose
Published in Acta Clinica Belgica, 2022
Koen R. Maes, Pieter Depuydt, Joris Vermassen, Peter De Paepe, Walter Buylaert, Cathelijne Lyphout
Cardiac glycosides can be found in several plant leaves, flowers and seeds. These plants include but are not limited to foxglove (Digitalis purpurea), Digitalis lanata, lily of the valley (Convallaria majalis), oleander (Nerium oleander), yellow oleander (Thevetia peruviana), Strophanthus kombe, squill (Urginea maritima/sea onion/indica bulbs), dogbane (Apocynum cannabinum), and Adonis vernalisare [12]. It is important to realize that these plants contain not one but many different compounds with cardiac glycoside effects, such as digoxin, digitoxin, digitoxigenin and digoxigenin [13]. Many of these compounds have complex pharmacokinetic properties with entero-hepatic recirculation and biotransformation to active metabolites (including digoxin) and are eventually excreted by the kidneys. These characteristics result in a long plasma half-life of up to seven days [11]. The exact composition of these plants is known to be highly variable due to seasonal differences and genetic differences [13]. With regard to pharmacodynamics, the inotropic effects of different Digitalis purpurea leaf compounds have been compared by Lüllman et al. in animal studies, showing an almost equal inotropic dose-effect relationship for digoxin and digitoxin but other compounds such as digitoxigenin were shown to be even more potent. It is unknown whether these differences correlate with the risk of arrhythmias [14].
Anticalin® proteins: from bench to bedside
Published in Expert Opinion on Biological Therapy, 2021
Friedrich-Christian Deuschle, Elena Ilyukhina, Arne Skerra
Recently, another promising Anticalin antidote, dubbed ‘Colchicalin’, was developed on the basis of human Lcn2 with a remarkably low dissociation constant (KD) of 120 pM against colchicine [31]. Colchicine is not only widely used as a drug to treat gout but can also be accidentally ingested upon mix-up between bears garlic, an edible plant, and autumn crocus or lily of the valley, which both contain high concentrations of the strongly toxic plant alkaloid. In any case, overdosing of colchicine leads to multi-organ failure, eventually with fatal outcome, with no available treatment to date. Based on the strong ligand affinity of Colchicalin, a highly sensitive diagnostic ELISA was established that allows facile and precise determination of the colchicine concentration in biological samples. Furthermore, Colchicalin offers a promising candidate for the treatment of acute colchicine intoxication, as it will tightly complex colchicine in the bloodstream, triggering redistribution of the drug from its intracellular target tubulin as well as subsequent excretion.
Veratrum parviflorum poisoning: identification of steroidal alkaloids in patient blood and breast milk
Published in Clinical Toxicology, 2022
Jared T. Seale, Joseph E. Carpenter, Matthew D. Eisenstat, Emily A. Kiernan, Brent W. Morgan, Daniel P. Nogee, Xinzhu Pu, Colin A. Therriault, Michael Yeh, Owen M. McDougal
Both patients were treated with IV fluid resuscitation and antiemetics. Their clinical presentation was concerning for cardiac glycoside ingestion, and the plant leaf material was initially noted to resemble lily of the valley (Convallaria majalis). Both patients were treated empirically with five vials of digoxin immune Fab (DIF) (200 mg) IV. Serum digoxin levels were undetectable in both patients.