Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may become intractable when treated with conventional medications such as aminosalicylates, corticosteroids, and azathioprine. The herbal medicine Qing Dai has traditionally been used in Chinese medicine to treat UC patients, but there is a lack of published data on the efficacy of Qing Dai in UC treatment. We report several cases of patients with intractable UC who take Qing Dai in a retrospective observational study. Furthermore, we explore the mechanisms of action of Qing Dai. Nine patients with active UC who received conventional medications but wished to receive Qing Dai as an alternative medication were included in our analysis. The UC severity level was determined based on the clinical activity index (CAI). Additionally, 5 of the 9 patients were endoscopically evaluated according to the Matts grading system. Each patient received 2 g/d of Qing Dai orally and continued taking other medications for UC as prescribed. Electron spin resonance was applied to explore the mechanisms of action of Qing Dai. After 4 mo of treatment with Qing Dai, the CAI score decreased from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; P < 0.001). Similarly, the endoscopic Matts grade decreased from 3.4 ± 0.5 to 2.2 ± 0.8 (P = 0.02). Six of 7 patients who were on prednisolone upon enrollment in the study were able to discontinue this corticosteroid. Electron spin resonance revealed that Qing Dai possesses strong hydroxyl radical scavenging activity. Qing Dai showed significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications. Scavenging of hydroxyl radicals appears to be a potential mechanism through which Qing Dai acts, but the significance of the scavenging ability of Qing Dai with respect to the anti-inflammatory effect in UC patients warrants further investigation.

Indigo Naturalis Ameliorates Oxazolone-Induced Dermatitis but Aggravates Colitis by Changing the Composition of Gut Microflora

“…2f). We also confirmed the known ability of IND to scavenge reactive oxygen species [1], which can also influence intestinal inflammation by electron spin resonance. Electron spin resonance results revealed a decreased spectrum of hydroxyl radical, superoxide radical, and singlet oxygen with IND treatment (online suppl.…”

“…Increased levels of IL-13 have been proven to exist in the intestines of UC patients [26,37]. Therefore, the amelioration of UC symptoms by IND reported by 2 clinical studies [1,13] may be by this mechanism. Furthermore, we have also confirmed that IND reduces free radicals (online suppl.…”

“…Despite the lack of English-language reports demonstrating clinical efficacy, the official indication of IND for UC in China and its reputation have caught the attention of Japanese gastroenterologists. Consequently, 2 recent clinical papers from Japan have documented a promising efficacy of IND for the treatment of UC [1,13]. …”

“…Indigo naturalis (IND), also known as Qing Dai, is an herbal medicine that is a blue powder made from extracts of plants such as Strobilanthes cusia and Isatis tinctoria [1]. It contains multiple ingredients including indirubin, indigo, and tryptanthrin [2].…”

Recent trends and future directions for the medical treatment of ulcerative colitis

“…These ligands induce the production of interleukin-22 from innate lymphoid cell type 3, which results in the upregulation of the expression of tight junction molecules and antimicrobial peptides to promote mucosal healing [61,62]. Previously, the usefulness of Qing-Dai for UC was reported [63,64]; however, no prospective clinical trial had been conducted. Recently, we conducted a prospective study to confirm the safety and efficacy of Qing-Dai for UC [65].…”