Clinical Efficacy and Safety of Buyang Huanwu Decoction for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of 19 Randomized Controlled Trials

Hao, Chizi; Wu, Fan; Shen, Jiangang; Lü, Lin; Fu, Deng-lei; Liao, Weijing; 鄭, 国慶

doi:10.1155/2012/630124

Cited by 68 publications

(55 citation statements)

References 22 publications

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“…BYHWD is one of the classic formulas for post-stroke disability with intensive investigations. Several recent systematic reviews and meta-analysis studies conducted by us and others provide experimental and clinical evidence to support the application of BYHWD in the post-stroke treatments [67,68]. Although the quality of clinical trials needs to be improved, the effects of this formula on improving neurological functions have been well accepted.…”

Section: Classic Concepts and Representative Therapeutics For Stroke mentioning

confidence: 99%

Targeting Neurogenesis: A Promising Therapeutic Strategy for Post-Stroke Treatment with Chinese Herbal Medicine

Shen¹,

Chen²,

Chen³

et al. 2014

Integr Med Int

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Recent progress suggests that neural stem/progenitor cells can potentially develop into new functional neurons in adult brain, offering hope for regeneration therapies for stroke treatment. Targeting adult neurogenesis becomes a novel and promising therapeutic strategy for brain repair and recovery of neurological functions. Traditional Chinese Medicine (TCM) has a long history with accumulated experiences and case reports using herbal formulas to treat stroke disability. The combination of Chinese herbal medicine and stem cell biology approaches provides great potential for post-stroke rehabilitations. In the last decade, large efforts have been made to investigate the molecular targets for the regulation of adult neurogenesis and to explore the active compounds and molecular targets of herbal medicine for regeneration therapy. Herein, we reviewed the current progress concerning the molecular targets and cellular signaling pathways involved in adult neurogenesis after cerebral ischemia. We then briefly introduced Chinese medical theory and herbs for stroke treatment in TCM. Finally, we reviewed the current knowledge about the effects of Chinese herbal formulas, active fractions and active compounds on promoting adult neurogenesis as well as their molecular targets. Although the precise mechanisms and molecular targets of herbal medicine for neurogenesis are still unclear, current progress at least provides a cue for exploring the therapeutic principles of Chinese herbal medicine and developing new drugs for brain repair after stroke.

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Section: Classic Concepts and Representative Therapeutics For Stroke mentioning

confidence: 99%

Targeting Neurogenesis: A Promising Therapeutic Strategy for Post-Stroke Treatment with Chinese Herbal Medicine

Shen¹,

Chen²,

Chen³

et al. 2014

Integr Med Int

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“…BHD can tonify Qi flow, promote blood circulation and eventually revitalize stroke patients. Meta-analyses have demonstrated the efficacy and safety of BHD for acute ischemic stroke in both clinical applications and experimental settings [9,10]. Transcriptome and proteome analyses reveal that BHD can regulate genes and proteins that inhibit inflammation and ameliorate BBB disruption 24 hours after focal cerebral ischemia in mice [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Buyang Huanwu Decoction Attenuates Infiltration of Natural Killer Cells and Protects Against Ischemic Brain Injury

Dou

Zhou

et al. 2018

Cell Physiol Biochem

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Background/Aims: Natural killer (NK) cells are among the first immune cells that respond to an ischemic insult in human brains. The infiltrated NK cells damage blood-brain barrier (BBB) and exacerbate brain infarction. Buyang Huanwu Decoction (BHD), a classic Chinese traditional herbal prescription, has long been used for the treatment of ischemic stroke. The present study investigated whether BHD can prevent brain infiltration of NK cells, attenuate BBB disruption and improve ischemic outcomes. Methods: Transient focal cerebral ischemia was induced in rats by a 60-minute middle cerebral artery occlusion, and BHD was orally administrated at the onset of reperfusion, 12 hours later, then twice daily. Assessed parameters on Day 3 after ischemia were: neurological and motor functional deficits through neurological deficit score and rotarod test, respectively; brain infarction through TTC staining; BBB integrity through Evans blue extravasation; matrix metalloproteinase-2/9 activities through gelatin zymography; tight junction protein, nuclear factor-kB (NF-kB) p65 and phospho-p65 levels through Western blotting; NK cell brain infiltration and CXCR3 levels on NK cells through flow cytometry; interferon-γ production through ELISA; CXCL10 mRNA levels through real-time PCR; CXCL10 expression and p65 nuclear translocation through immunofluorescence staining. Results: BHD markedly reduced brain infarction, improved rotarod performance, and attenuated BBB breakdown. Concurrently, BHD attenuated the upregulation of matrix metalloproteinase-2/9 activities and the degradation of tight junction proteins in the ischemic brain. Infiltration of NK cells was observed in the ischemic hemisphere, and this infiltration was blunted by treatment with BHD. BHD suppressed brain ischemia-induced interferon-γ and chemokine CXCL10 production. Furthermore, BHD significantly reduced the expression of CXCR3 on brain-infiltrated NK cells. Strikingly, BHD did not affect NK cell levels or its CXCR3 expression in the spleen or peripheral blood after brain ischemia. The nuclear translocation of NF-kB p65 and phospho-p65 in the ischemic brain was inhibited by BHD. Conclusion: Our findings suggest that BHD prevents brain infiltration of NK cells, preserves BBB integrity and eventually improves ischemic outcomes. The inhibitory effects of BHD on NK cell brain invasion may involve its ability of suppressing NF-kB-associated CXCL10-CXCR3-mediated chemotaxis. Notably, BHD only suppresses NK cells and their CXCR3 expression in the ischemic brain, but not those in periphery.

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“…Systematic reviews and meta-analyses of BYHWD have demonstrated that BYHWD is generally safe and possesses substantial neuroprotective action in patients and various animal models of focal ischemia (2,3). The protective effect of BYHWD against focal ischemia involves multiple mechanisms, for instance, reducing calcium overload injury, attenuating reactive oxygen stress (ROS) (4), inhibiting the inflammatory response and apoptosis (5), and promoting nerve regeneration and synapse formation (6).…”

Section: Introductionmentioning

confidence: 99%

Upregulation of glutamate metabolism by BYHWD in cultured astrocytes following oxygen-glucose deprivation/reoxygenation in part depends on the activation of p38 MAPK

Guan

Zhou

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Recent studies have demonstrated that Buyang Huanwu Decoction (BYHWD) decreased glutamate levels subsequent to cerebral ischemia. Glutamate transporter-1 (GLT-1) and glutamine synthetase (GS), which are located in astrocytes, mainly contribute to glutamate transportation, thus reducing glutamate concentration. BYHWD has previously been demonstrated to upregulate GLT-1 and GS following ischemia in vivo. However, whether BYHWD can directly influence astrocytic GLT-1/GS levels remains unknown. In the present study, the effect of BYHWD containing serum (BYHWD-CS) on GLT-1/GS levels in astrocytes following oxygen-glucose deprivation/reoxygenation (OGD/R) was investigated. The results revealed that BYHWD-CS enhanced the expression levels of GLT-1 and GS in cultured astrocytes, which reduced glutamate concentration in the culture medium. Meanwhile, increased p38 mitogen-activated protein kinase (p38 MAPK) was phosphorylated (activation form) by BYHWD-CS in cultured astrocytes, and the specific p38 inhibitor SB203580 blocked the increase of GLT-1/GS accompanied by decreased cell viability. Furthermore, SB203580 suppressed the effect of BYHWD-CS on the level of glial fibrillary acidic protein (an astrocytic marker), thus confirming that astrocytes are directly involved in the protective role of BYHWD after OGD/R. These findings suggest that BYHWD upregulates GLT-1 and GS via p38 MAPK activation, and protects cultured astrocytes from death caused by OGD/R (typical in vitro model), which complemented the role of astrocytes in the protective effect of BYHWD.

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Clinical Efficacy and Safety of Buyang Huanwu Decoction for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of 19 Randomized Controlled Trials

Cited by 68 publications

References 22 publications

Targeting Neurogenesis: A Promising Therapeutic Strategy for Post-Stroke Treatment with Chinese Herbal Medicine

Targeting Neurogenesis: A Promising Therapeutic Strategy for Post-Stroke Treatment with Chinese Herbal Medicine

Buyang Huanwu Decoction Attenuates Infiltration of Natural Killer Cells and Protects Against Ischemic Brain Injury

Upregulation of glutamate metabolism by BYHWD in cultured astrocytes following oxygen-glucose deprivation/reoxygenation in part depends on the activation of p38 MAPK

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