THE CHINESE ANTI-INFLAMMATORY AND IMMUNOSUPPRESSIVE HERBAL REMEDY TRIPTERYGIUM WILFORDII HOOK F

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• 作者：Xuelian Tao ; MD^* ; Peter E. Lipsky ; MD^*
• 刊名：Rheumatic Disease Clinics of North America
• 出版年：2000
• 出版时间：1 February 2000
• 年：2000
• 卷：26
• 期：1
• 页码：29-50
• 全文大小：1269 K

文摘

Tripterygium wilfordii Hook F (TwHF) is a member of Celastraceae family of perennial vine-like plants that grow in the wild in southern China along the Yongzhi River and in Fujian Province and Taiwan. TwHF and three additional members of the Celastraceae family, T. hypoglaucum Hutch, T. regeli Spraque et Takeda (TrST) and T. forresti Dicls (TfD), have been used as remedies to treat arthritis, muscle and skeletal injury, and skin diseases for several centuries. Because of the associated toxicity, the major use of the agents in China outside of traditional medicine has been as agricultural insecticides until recently. Despite their broad use in Chinese traditional medicine, they have only been used in Chinese allopathic medicine for the past 30 years. In the early 1960s, TwHF was successfully used to treat patients with inflammatory lesions of leprosy, and patients with rheumatoid arthritis were treated in three county hospitals in Fujian Province. About the same time, T. hypoglaucum was reported to be effective in the treatment of rheumatoid arthritis (RA) patients in Yunan Province, where this plant grows abundantly.

Originally, a decoction of TwHF, or hot water extract, which is one of the most common preparations in traditional Chinese medicine, was employed to treat patients. Results from these uncontrolled trials reported excellent therapeutic effects but noted a large number of adverse effects. This stimulated pharmaceutical development with the goal of maintaining efficacy but diminishing toxicity of the TwHF preparations. As a result of this activity, two new preparations of TwHF were developed in China in the 1970s. One was an ethyl acetate (EA) extract, and the second was a chloroform-methanol extract known as T2. Both of these extracts of TwHF claimed to have better therapeutic benefit with reduced adverse effects. Both of these preparations have become commercially available in China and have been used extensively. The availability of these preparations has made it possible to carry out numerous clinical trials of TwHF in a variety of autoimmune and inflammatory diseases.

In parallel with clinical trials, there has been extensive pharmacologic, toxicologic, chemical, and pharmaceutic analysis of TwHF. Most investigators have agreed that the diterpenoid components with epoxide structures are responsible for the therapeutic effect of TwHF, although many other components of this plant have also been shown to have certain anti-inflammatory or immunosuppressive activities. Results from studies on the effects of TwHF on in vitro and in vivo inflammatory and immune responses suggest that the anti-inflammatory and immunosuppressive effects are related to inhibition of the production of a series of pro-inflammatory cytokines, including interleukin-2 (IL-2) and interferon-¦Ã (IFN-¦Ã), and other inflammatory mediators, including prostaglandin E₂ (PGE₂) and nitric oxide. More detailed analysis of the impact of TwHF on the signaling pathways leading to the production of IL-2 and cyclooxygenase-2 (COX-2) further documented that suppression of the upregulation of expression of proinflammatory and immunologically active molecules is one of the major mechanisms by which TwHF exerts its immunosuppressive and anti-inflammatory effects.