Ashwinikumar Raut

Ayurvedic medicine offers a good alternative to glucosamine and celecoxib in the treatment of symptomatic knee osteoarthritis: a randomized, double-blind, controlled equivalence drug trial

OBJECTIVE To demonstrate clinical equivalence between two standardized Ayurveda (India) formulations (SGCG and SGC), glucosamine and celecoxib (NSAID). METHODS Ayurvedic formulations (extracts of Tinospora cordifolia, Zingiber officinale, Emblica officinalis, Boswellia serrata), glucosamine sulphate (2 g daily) and celecoxib (200 mg daily) were evaluated in a randomized, double-blind, parallel-efficacy, four-arm, multicentre equivalence drug trial of 24 weeks duration. A total of 440 eligible patients suffering from symptomatic knee OA were enrolled and monitored as per protocol. Primary efficacy variables were active body weight-bearing pain (visual analogue scale) and modified WOMAC pain and functional difficulty Likert score (for knee and hip); the corresponding a priori equivalence ranges were ±1.5 cm, ±2.5 and ±8.5. RESULTS Differences between the intervention arms for mean changes in primary efficacy variables were within the equivalence range by intent-to-treat and per protocol analysis. Twenty-six patients showed asymptomatic increased serum glutamic pyruvic transaminase (SGPT) with otherwise normal liver function; seven patients (Ayurvedic intervention) were withdrawn and SGPT normalized after stopping the drug. Other adverse events were mild and did not differ by intervention. Overall, 28% of patients withdrew from the study. CONCLUSION In this 6-month controlled study of knee OA, Ayurvedic formulations (especially SGCG) significantly reduced knee pain and improved knee function and were equivalent to glucosamine and celecoxib. The unexpected SGPT rise requires further safety assessment. TRIAL REGISTRATION Clinical Drug Trial Registry-India, www.ctri.nic.in, CTRI/2008/091/000063.

Integrative endeavor for renaissance in Ayurveda

Currently western medicine has assumed the central position in mainstream global healthcare. Openness to learn from contemporary disciplines of basic sciences, application of modern technology and further adoption of the evidence-based approach has helped western medicine gain its currently acknowledged position as mainstream modern medicine. Modern medicine has further developed forms of integrative medicine by developing interfaces with other systems of medicine, including traditional, complementary and alternative medicine. However, these developments do not seem to address all the problems facing global health care caused by overemphasis on pharmaco-therapeutic drug developments. On the other hand, Ayurveda which is founded on genuine fundamentals, has the longest uninterrupted tradition of healthcare practice, and its holistic approach to healthcare management emphasizes disease prevention and health promotion; if it opens up to incorporate emerging new knowledge into mainstream Ayurveda, and maintains fidelity to Ayurveda fundamentals, it will certainly provide a broad-based opportunity to address the majority of the problems that have emerged from global healthcare requirements. To bring these solutions to bear, however, it will be necessary to progress from the present “utilitarian ethos” to a “unifying ethos” for realization of medical integration.

Comparative study of amrutbhallataka and glucosamine sulphate in osteoarthritis: Six months open label randomized controlled clinical trial

Background: AmrutBhallatak (ABFN02), a ‘rasayana’ drug from Ayurveda is indicated in degenerative diseases and arthritis. Objective: To evaluate safety and efficacy of ABFN02 in osteoarthritis (OA) and compare it with Glucosamine sulphate (GS) Materials and Methods: This was a randomized open comparative study. Ambulant OPD patients of OA knees (n = 112) were enrolled for 24 weeks. Tablets (750mg each) of GS and ABFN02 were matched. Three groups of patients: (A) GS, one tablet × twice/day × 24 weeks. (B) ABFN02, incremental pulse dosage (one tablet x twice/day × two weeks, two tablets × twice/day × two weeks, three tablets × twice/day × two weeks), two such cycles of drug and non-drug phases alternately for six weeks each (C) ABFN02 continuous dosage akin to GS. Pain visual analogue score (Pain-VAS) and Western Ontario and Mc-Master University Osteoarthritis Index (WOMAC) were the primary outcome measures. Secondary outcome measures were Health assessment questionnaire (HAQ), paracetamol consumption, 50 feet walking, physician and patient global assessment, knee stiffness, knee status, urinary CTX II, serum TNFa-SRI, SRII and MRI knee in randomly selected patients. Results: ABFNO2 and GS demonstrated, adherence to treatment 87.75% and 74.3%, reduction in Pain-VAS at rest 61.05% and 57.1%, reduction in pain-VAS on activity 57.4% and 59.8%, WOMAC score drop 62.8% and 59.1% respectively. Secondary outcome measures were comparable in all groups. Safety measures were also comparable. No serious adverse events reported. However, asymptomatic reversible rise in liver enzymes was noted in the ABFNO2 group. Conclusions: ABFN02 has significant activity in OA; the formulation needs further investigation.

Acharya D. S. Antarkar: A Vaidya with a vision

Dhondo, the eldest son of Sadashiv Antarkar a priest, was born and grew up in a beautiful small village ‘Dugave’ of Ratnagiri district in Maharashtra. The village had a tranquil surrounding and abundant natural wealth. While his two younger siblings were busy playing in the courtyard of their house with make-believe toys made out of mango and jackfruit tree leaves, Antarkar was either engrossed in playing tabla or attempting carpentry. However, very early in life, he had to leave the secure surroundings of his home. He moved to Mumbai with his younger brother as their village provided only primary education. They stayed with their uncle in a joint extended family under one roof, at Worli. He adapted to the transition from a small village with surrounding bountiful greenery to a busy hustle and bustle of a metropolis like Mumbai. Soon he excelled in his studies. At school, he developed an aspiration to be a physician, with an interest in science.

Conference on natural products 2014 held in chicago 7(th) to 10(th) july.

A conference entitled “Natural Products: A celebration and a resurrection with Reverse Pharmacology” took place from 07/JUL/14 to 10/JUL/14 at the Hilton Chicago, Indian Lakes Resort, Bloomingdale, Chicago, IL, USA. This 2014 conference was organized by Fusion conferences and chaired by Dr. Mukund Chorghade (THINQ Pharma) and Professor David Kingston (Virginia Tech). About 40 presentations were made by select biomedical scientists coming primarily from academia representing universities, viz. Michigan, California, Oklahoma, North Carolina, British Columbia, Arizona State, Mississippi, Florida Atlantic, University of Kansas, Surrey, Illinois, Indiana University, Hawaii, Wisconsin Madison, Hawaii Pacific, Toledo, University of Strathclyde, Northwestern, Pune. The Harvard Medical School and the California Institute of Technology were also represented. Majority of the participants were from the US and few were from Canada, UK and India. Few select scientists were also from industries delving into natural product chemistry.

Panchgavya and cow products: A trail for the holy grail

For millennia, cow has been central to Indian economy, life and culture. There are innumerable references-Vedic and subsequent to the sacred significance of cow. The benefits of cow have been described at length in relation to agriculture, environment, health, economy and spiritual progress. However, the socio-political issues surrounding cow as a sacred animal have raised acrimonious debates. In Ayurveda also, there is a long tradition of using cow products for positive health, pharmaceutical processes and in therapeutics. There have been quite a few studies on the activity, efficacy, safety and acceptability of Panchagavya and other cow products. Paradoxically, many cow products available in the market for human consumption require improved standardization and proper regulation. Integration of cowpathy (Govaidyak) in traditional Indian systems of medicine has been natural, based on their common dravyagunavigyan. But if its integration with conventional medicine is contemplated, we will need better understanding of the ingredients of cow products, their pharmacokinetics, pharmacodynamics and therapeutic ratio. A rational beginning can be made by data collection of experiential and anecdotal responses. A meticulous analysis of database of panchgavya and other cow products should look for temporal relationships, biological plausibility and translational potential before embarking on state-of-the-art experimental and clinical studies for selected indications.

Chapter 4 – Reverse Pharmacology

The current drug discovery paradigm has a high attrition rate, postmarketing withdrawals, and costly development. Drugs have been emerging serendipitously “from the bedside,” without an organized approach. Drug discovery, at the bedside, is followed in reverse pharmacology (RP) by the relevant science of drug development for safety, efficacy, and mechanistic understanding. Such a transdisciplinary structured path can explore the large potential for novel drugs. The phytoactives can be novel scaffolds for new drugs. Ayurveda and other living traditional systems of medicine have a rich reservoir of pharmacotherapeutics. The documented therapeutic experience defines the nature of the drug targets to be studied in vitro and in vivo models. The phytomolecules may lead to newer dimensions of drug actions. Reserpine and Atremisinin exemplify such a potential. The delay in drug discovery can be eliminated by reverse pharmacology (RP). A well-structured multisystem and functionally multidisciplinary organization is needed for RP; it also needs an appropriate locus for academic growth, development, and intellectual appeal. A close and continuous collaboration between academia and industry is needed. In the future, RP can differentiate into unique specialities: Ayurvedic pharmacoepidemiology, observational therapeutics, pharmacodynamic methods, advanced pharmacokinetics, and biosynthesis. Early attention to RP is a prerequisite for achieving this. The medical pluralism in India offers observational opportunities for the bedside hits and leads for several unmet medical needs. Such leads can be facilitated by RP as drug discoveries for integrative medicine.