CC BY 4.0 · Pharmaceutical Fronts 2021; 03(03): e129-e137
DOI: 10.1055/s-0041-1736234
Original Article

Enhanced Efficacy and Reduced Hepatotoxicity by Combination of Gnaphalium affine Extract and Benzbromarone in the Treatment of Rats with Hyperuricemic Nephropathy

Fei Liu#
1   State Key Lab. of New Drug and Pharmaceutical Process, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
2   The Laboratory of Marine Glycodrug Research and Development, Marine Biomedical Research Institute of Qingdao, Qingdao, People's Republic of China
,
Xi-Zi Liu#
1   State Key Lab. of New Drug and Pharmaceutical Process, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
,
Qian Yang
1   State Key Lab. of New Drug and Pharmaceutical Process, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
,
Shi-Yi Han
1   State Key Lab. of New Drug and Pharmaceutical Process, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
,
Si-Yang Fan
1   State Key Lab. of New Drug and Pharmaceutical Process, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China
› Author Affiliations
Funding This work was supported by the National Natural Science Foundation of China (Grant No. 81603279) and the Natural Science Foundation of Shanghai (Grant No. 15ZR1440100). The authors would like to thank Mr. Tuyou Zheng and Mr. Genming Zheng for their help in herb collection.


Abstract

Simultaneous oral intake of herbal medicine with chemical drugs may result in beneficial pharmacodynamic efficacy, including additive and synergistic effects with reduced toxicity. Gnaphalium affine D. Don (GAD) is a traditional Chinese Medicine that has been used for the management of hyperuricemia and gout. Benzbromarone (BBR) is one of the first-line drugs used for urate-lowering therapy in China but is toxic to the liver. The present study aimed to determine the effects of GAD and BBR, both alone and in co-treatment (with dosing interval of 1 hour), on chronic hyperuricemic nephropathy (HN) and hepatotoxicity in rats. Our data indicated that GAD significantly inhibited the elevation of serum uric acid, blood urea nitrogen, and creatinine levels in chronic HN rats at doses of 450 and 900 mg/kg/day. The rise in serum alanine aminotransferase and aspartate aminotransferase in BBR (or vehicle)-treated HN rats was significantly reduced by pre- (or post)-administration of GAD (450 mg/kg/day). The q-value >1.15 (by Jin method) indicated synergistic effects of co-treatments of BBR (50 mg/kg) with GAD (450 mg/kg). The synergistic beneficial effects were validated by comparison of BBR alone at a dose of clinical usage (4.5 mg/kg/day, in two divided doses) and BBR + GAD at half dose plus half dose (2.25 + 225 mg/kg/day) or half dose plus full dose (2.25 + 450 mg/kg/day). In conclusion, co-treatment with GAD and BBR holds promise for the management of hyperuricemia and gout.

# These authors contributed equally to this work.




Publication History

Received: 21 July 2021

Accepted: 24 August 2021

Article published online:
15 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Chen D, Zhao J, Cong W. Chinese herbal medicines facilitate the control of chemotherapy-induced side effects in colorectal cancer: progress and perspective. Front Pharmacol 2018; 9: 1442
  • 2 Wang W, Zhou H, Liu L. The role of Chinese herbal medicine in the management of adverse drug reactions of leflunomide in treating rheumatoid arthritis. Phytomedicine 2020; 68: 153136
  • 3 Luo X, Ni X, Lin J. et al. The add-on effect of Chinese herbal medicine on COVID-19: a systematic review and meta-analysis. Phytomedicine 2021; 85: 153282
  • 4 Liu F, Lin S, Wu C. et al. Hypouricemic activity of Gnaphalium affine D. Don [in Chinese]. Shenyang Yaoke Daxue Xuebao 2020; 37 (01) 12-20
  • 5 Zhang W, Wu CZ, Fan SY. Chemical constituents from Gnaphalium affine and their xanthine oxidase inhibitory activity. Chin J Nat Med 2018; 16 (05) 347-353
  • 6 Zhang HJ, Li LN, Zhou J. et al. Effects of Gnaphalium affine D. Don on hyperuricemia and acute gouty arthritis. J Ethnopharmacol 2017; 203: 304-311
  • 7 Li C, Wang E, Elshikh MS. et al. Extraction and purification of total flavonoids from Gnaphalium affine D. Don and their evaluation for free radicals' scavenging and oxidative damage inhabitation potential in mice liver. Arab J Chem 2021; 14 (03) 103006
  • 8 Jiang L, Piao J, Liu Y. et al. Protective effect of Gnaphalium tranzscelii against acute liver injury in mice [in Chinese]. Shizhen Guo Yi Guo Yao 2008; 19 (08) 1901-1902
  • 9 Chinese Society of Endocrinology CMA. Guideline for the diagnosis and management of hyperuricemia and gout in China (2019) [in Chinese]. Zhonghua Neifenmi Daixie Zazhi 2020; 36 (01) 1-13
  • 10 Lee MH, Graham GG, Williams KM, Day RO. A benefit-risk assessment of benzbromarone in the treatment of gout. Was its withdrawal from the market in the best interest of patients?. Drug Saf 2008; 31 (08) 643-665
  • 11 Parzefall W, Schuppler J, Barthel G, Meyer-Rogge B, Schulte-Hermann R. Toxicological studies on a benzofurane derivative. I. A comparative study with phenobarbital on rat liver. Toxicol Appl Pharmacol 1990; 106 (03) 482-499
  • 12 Sun P, Zhu JJ, Wang T. et al. Benzbromarone aggravates hepatic steatosis in obese individuals. Biochim Biophys Acta Mol Basis Dis 2018; 1864 (6, Pt A): 2067-2077
  • 13 Liu N, Wang L, Yang T. et al. EGF receptor inhibition alleviates hyperuricemic nephropathy. J Am Soc Nephrol 2015; 26 (11) 2716-2729
  • 14 Liu X, Shang Q, Li C. et al. HPLC method for determination of uric acid in plasma of hyperuricemia model mice [in Chinese]. Yaowu Pingjia Yanjiu 2017; 40 (03) 319-323
  • 15 Dai T. Quantitative analysis in drug combination (author's transl) [in Chinese]. Zhongguo Yaolixue Tongbao 1998; 14 (05) 479-480
  • 16 Hoffmann D, Fuchs TC, Henzler T. et al. Evaluation of a urinary kidney biomarker panel in rat models of acute and subchronic nephrotoxicity. Toxicology 2010; 277 (1–3): 49-58
  • 17 Mende C. Management of chronic kidney disease: the relationship between serum uric acid and development of nephropathy. Adv Ther 2015; 32 (12) 1177-1191
  • 18 Strilchuk L, Fogacci F, Cicero AF. Safety and tolerability of available urate-lowering drugs: a critical review. Expert Opin Drug Saf 2019; 18 (04) 261-271
  • 19 Richette P, Bardin T. Gout. Lancet 2010; 375 (9711): 318-328
  • 20 Billiet L, Doaty S, Katz JD, Velasquez MT. Review of hyperuricemia as new marker for metabolic syndrome. ISRN Rheumatol 2014; 2014: 852954
  • 21 Takemura A, Gong S, Sekine S, Ito K. Inhibition of biliary network reconstruction by benzbromarone delays recovery from pre-existing liver injury. Toxicology 2019; 423: 32-41
  • 22 Zhang F, Huang J, Liu W. et al. Inhibition of drug-metabolizing enzymes by Qingfei Paidu decoction: implication of herb-drug interactions in COVID-19 pharmacotherapy. Food Chem Toxicol 2021; 149: 111998
  • 23 Zhang F, Huang J, He RJ. et al. Herb-drug interaction between Styrax and warfarin: molecular basis and mechanism. Phytomedicine 2020; 77: 153287
  • 24 Kobayashi K, Kajiwara E, Ishikawa M, Oka H, Chiba K. Identification of CYP isozymes involved in benzbromarone metabolism in human liver microsomes. Biopharm Drug Dispos 2012; 33 (08) 466-473
  • 25 Yoshida M, Cho N, Akita H, Kobayashi K. Association of a reactive intermediate derived from 1′,6-dihydroxy metabolite with benzbromarone-induced hepatotoxicity. J Biochem Mol Toxicol 2017; 31 (10) e21946
  • 26 Kimura Y, Ito H, Ohnishi R, Hatano T. Inhibitory effects of polyphenols on human cytochrome P450 3A4 and 2C9 activity. Food Chem Toxicol 2010; 48 (01) 429-435
  • 27 Rastogi H, Jana S. Evaluation of inhibitory effects of caffeic acid and quercetin on human liver cytochrome p450 activities. Phytother Res 2014; 28 (12) 1873-1878