心血管疾病中药材循证应用的进展-英文.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,RMIT University,10,th,SCICC,Guangzhou,China,2008,Recent Progress in the Evidence-Based Application of Herbal Medicines for Cardiovascular Diseases,Professor Shufeng Zhou,MD,PhD,School of Health Sciences,WHO Collaborating Center for Traditional Medicine,RMIT University,Bundoora,Victoria 3083,Australia,Phone:,Tel:[phone];Fax:[phone],Email:,shufeng.,11 April 2008,An Overview of Global Herbal Use,All folk medicine includes the use of plant products.,11,145 species of herbal plants worldwide;534 species of plants for Chinese Medicine.,WHO definition botanical origin,without adulteration of any synthetic drugs.,Legal status:food supplements(,FDA&TGA,),“DSHEA”;drugs/health foods(,SFDA of China,).,US$25 billion;market value,10,15%/per year.,2 billion in Australia.,40%Caucasian and 80%Asians use or used herbs.,Active,Components,Biotransformation,Excretion,Absorption,Response/Toxicity,?,?,?,?,Preclinical Stage,Phase I,Phase II,Phase III,Phase IV,Clinical Trials of Herbal Medicines,General acceptance of humans,Safety and Efficacy,More data on safety and Efficacy,Herbs,PK,PD,Pharmacokinetics of,TPNS,formula in stroked patients,OMEGA,FINAL ESTIMATE,RSE(%),95%CONFIDENCE INTERVAL,CV(%),LBOUND,UBOUND,1,，,1,0.132,30.2,0.054,0.210,36.3,2,，,2,0.0318,46.5,0.00279,0.0608,17.8,3,，,3,0.0001,.,.,.,1.00,4,，,4,0.363,47.5,0.0249,0.703,60.3,RESIDUAL VARIABILITY(SIGMA,；,CV%if proportional,S.D.if additive),1,，,1,0.00752,39.6,0.00168,0.0134,8.67,2,，,2,1.00e-005,.,.,.,SD=0.00316,Injection rate(mg/min),PT,TT,Fib,APTT,Integrated Conc.(g/ml),PT,PT,TT,Fib,APTT,Herbal medicines as multi-component therapeutics,It is possible to integrate PK and PD for herbal medicines.,Challenges:multi-component therapeutics?,Which marker compounds to measure?,How to determine therapeutic window?,Types of Clinical Reports on Herb-Drug Interactions,N=85,What Herbs Interact with Drugs?,N=85,Herb,Interacting drugs,Danggui,Warfarin,Danshen,Warfarin,Garlic,Saquinavir,ritonavir,warfarin,chlorpropamide,Ginkgo,Trazodone,warfarin,digoxin,Ginseng,Alcohol,phenelzine,warfarin,Hawthorn,Digoxin(,no change,),Kava,Alcohol,alprazolam,bromazepam,L-dopa,Milk thistle,Indinavir,Piperine,Propranolol,rifampin,sparteine,theophylline,phenytoin,Toxicity due to Herb-Drug Interactions,Herb+Drug,Toxicity,SJW+cyclosporine A,Organ rejection,SJW+oral contraceptives,Breakthrough bleeding&unplanned pregnancies,Garlic+chlorpropamide,Hypoglycemia,Kava+alprazolam,Semicoma,Kava+L-dopa,“Off”periods in Parkinson disease,Ginseng+phenelzine,Mania,Ginkgo+trazodone,Coma,Ginkgo+warfarin/aspirin,Bleeding,Danshen+warfarin,Bleeding,SJW-Drug Interactions,Antidepressants:,amitriptyline,;,SSRIs,(,sertraline,Zoloft),Anticancer drug:irinotecan(CPT-11),Anticoagulants:warfarin(,coumadin,),phenprocoumon,Antihistamine:,fexofenadine,Anti-HIV agents:PI:indinavir;,RTI:nevirapine,Bronchodilator:theophylline,Hypoglycemics,:,tolbutamide,Cardiovascualr,drugs:digoxin,simvastatin,Opiates:methadone,loperamide,Oral contraceptives,Sedatives:,alprazolam,&midazolam,Immunosuppressants:c,yclosporine,&t,acrolimus,Mechanisms for Herb-Drug Interactions,Drug Response,Metabolizing enzymes,(CYPs),Identical Targets,Transporters,(PgP),Different Targets,Pharmacokinetics(PK),Pharmacodynamics(PD),Herb-PgP Interactions,Herb,Modulation of PgP,Curcumin,inhibition,Hawthorn,?,Garlic,Inhibition,Ginseng,Mostly inhibition,Green tea,Inhibition,Milk thistle,Inhibition,Piperine,Inhibition,SJW,Induction,Rosemary,Inhibition,Acknowledgment,s,Prof.Guangji Wang,Prof.,Xiyong,Yu,Prof.Charlie Xue and,Chunguang,Li,Prof.Eli Chan,Prof.,Wen,Xie,Prof.Tony,Koon,Prof.James W Paxton&Bruce,Baguley,Prof.John O Miners,Prof.Ronald G Dickinson,Prof.,Min Huang&,Anlong,Xu,Prof.Wei,Duan,Prof.,Xiaotian,Lee,Prof.,Ge,Lin,Prof.,Qiang,Zhang,Prof.Yi-,Zhun,Zhu,National University of Singapore Academic Research Funds,Singapore Cancer Syndicate,RMIT University Grant for New Institute,NICM,grant of Australia,Auckland Medical Research Foundation,New Zealand Cancer Society Funds,Maurice&Phyllis,Paykel,Trust,Hu,Zeping,Tian Quan,Zhang Jing,Sun,Zhuming,Sun,Feng,Zhang,Yaochung,Linlin,Wang,Meredith Payne,Liping,Yang,Vivian Chan,Yuan Ming Di,Yanli,Zhou,PhD students,Dr,Xiaoxia,Yang,Dr,Gui,Jingang,Postdoc fellows,