Summary table of research proposals



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Relevant literatures

Moringa oleifera Lam prevents acetaminophen induced liver injury through restoration of glutathione level.


Fakurazi S, Hairuszah I, Nanthini U.

Pharmacology Unit, Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia. czsharida@medic.upm.edu.my

Initiation of acetaminophen (APAP) toxicities is believed to be promoted by oxidative stress during the event of overdosage. The aim of the present study was to evaluate the hepatoprotective action of Moringa oleifera Lam (MO), an Asian plant of high medicinal value, against a single high dose of APAP. Groups of five male Sprague-Dawley rats were pre-administered with MO (200 and 800 mg/kg) prior to a single dose of APAP (3g/kg body weight; p.o). Silymarin was used as an established hepatoprotective drug against APAP induced liver injury. The hepatoprotective activity of MO extract was observed following significant histopathological analysis and reduction of the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in groups pretreated with MO compared to those treated with APAP alone. Meanwhile, the level of glutathione (GSH) was found to be restored in MO-treated animals compared to the groups treated with APAP alone. These observations were comparable to the group pretreated with silymarin prior to APAP administration. Group that was treated with APAP alone exhibited high level of transaminases and ALP activities besides reduction in the GSH level. The histological hepatocellular deterioration was also evidenced. The results from the present study suggested that the leaves of MO can prevent hepatic injuries from APAP induced through preventing the decline of glutathione level.

Antioxidant action of Moringa oleifera Lam. (drumstick) against antitubercular drugs induced lipid peroxidation in rats.


Ashok Kumar N, Pari L.

Department of Biochemistry, Faculty of Science, Annamalai University, Annamalai Nagar-608 002, Tamil Nadu, India.

The protective effect of Moringa oleifera Lam. (Moringaceae) on hepatic marker enzymes, lipid peroxidation, and antioxidants was investigated during antitubercular drug (isoniazid, rifampicin, and pyrazinamide)-induced toxicity in rats. Enhanced hepatic marker enzymes and lipid peroxidation of antitubercular drug treatment was accompanied by a significant decrease in the levels of vitamin C, reduced glutathione, superoxide dismutase, catalase, glutathione peroxidase, and glutathione S-transferase. Administration of Moringa oleifera extract and silymarin increase in the level of antioxidants significantly decreased hepatic marker enzymes and lipid peroxidation with a simultaneous. We speculate that Moringa oleifera extract exerts its protective effects by decreasing liver lipid peroxides and enhancing antioxidants.

Hepatoprotective activity of Moringa oleifera on antitubercular drug-induced liver damage in rats.


Pari L, Kumar NA.

Department of Biochemistry, Faculty of Science, Annamalai University, Annamalai Nagar, Tamil Nadu - 608 002, India. paribala@sancharnet.in

Moringa oleifera Lam (Moringaceae), commonly known as "Drumstick," is used in Indian folk medicine for the treatment of various illness. We have evaluated the hepatoprotective effect of an ethanolic extract of M. oleifera leaves on liver damage induced by antitubercular drugs such as isoniazid (INH), rifampicin (RMP), and pyrazinamide (PZA) in rats. Oral administration of the extract showed a significant protective action made evident by its effect on the levels of glutamic oxaloacetic transaminase (aspartate aminotransferase), glutamic pyruvic transaminase (alanine aminotransferase), alkaline phosphatase, and bilirubin in the serum; lipids, and lipid peroxidation levels in liver. This observation was supplemented by histopathological examination of liver sections. The results of this study showed that treatment with M. oleifera extracts or silymarin (as a reference) appears to enhance the recovery from hepatic damage induced by antitubercular drugs.

Suggested Topic: How do PGH-OPD patients view dietary supplements as health products?
RESEARCH QUESTION:

What are the attitudes and assumptions and knowledge of PGH-OPD patients on dietary supplements?

How do PGH-OPD patients view dietary supplements as health products?
P: PGH-OPD patients

I: none


C: none

O: answers to questionnaires, patients’ point-of-view (POV) statistics

M: survey questionnaires

Literature Search:



RELEVANT ARTICLES FOUND: followed through the last search (#18)

Mehta DH, Gardiner PM, Phillips RS, McCarthy EP. Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions. J Altern Complement Med. 2008 Dec;14(10):1263-9.



  • Concludes that only 33% of patients who are supplement users disclose the fact that they are supplement users to their health provider, and therefore disclosure rates are low.

  • Further states that this discovery raises the risk of supplements in combination with allopathic care, and that future studies should focus on educating physicians on cross cultural care and on how to elicit information on these supplements from patients.

Archer EL, Boyle DK. Herb and supplement use among the retail population of an independent, urban herb store. J Holist Nurs. 2008 Mar;26(1):27-35; quiz, 38-40.



  • Pilot study

  • 41% of supplement users (N = customers in a herb retail store) get their information on these supplements from the retail staff; only 3% of them get the information from doctors, nurses and pharmacists.

  • Also confirms the above study that only 33%, or in other words , few, supplement users disclose usage of supplements to their health care providers.

Thompson JJ, Nichter M. The compliance paradox: what we need to know about "real-world" dietary supplement use in the United States. Altern Ther Health Med. 2007 Mar-Apr;13(2):48-55.



  • Quote: “we observed skepticism in the way our informants interpret scientific information about supplements, trust in referrals from those they feel are like them, and experimentation with products in order to tailor them to their bodies and needs”.

  • Quote: “we urge clinicians to pay careful attention not only to whether patients are taking dietary supplements, but also how supplements are being used alone and in combination with other supplements, pharmaceuticals, and over-the-counter (OTC) medications”.

Geller SE, Studee L, Chandra G. Knowledge, attitudes, and behaviors of healthcare providers for botanical and dietary supplement use for postmenopausal health. Menopause. 2005 Jan-Feb;12(1):49-55.



  • Concludes that knowledge about botanical therapies in health care providers are low, but they are open to learning more about these modalities.

  • Also finds that increased years in practice is associated with increased knowledge, more positive attitudes, and more proactive behaviors about these modalities.

Kemper KJ, Amata-Kynvi A, Dvorkin L, Whelan JS, Woolf A, Samuels RC, Hibberd P. Herbs and other dietary supplements: healthcare professionals' knowledge, attitudes, and practices. Altern Ther Health Med. 2003 May-Jun;9(3):42-9.



  • Also concludes that clinicians, nurses and pharmacists, even with previous training on supplements, have “substantial room for improvement” on knowledge, attitudes and practices regarding these supplements, and suggests educational interventions.



TOPIC ASSESSMENT:
Topic Itself: can be narrowed to a certain category of dietary supplements (like pain relievers or anti-cholesterol supplements or osteoporosis-delaying supplements)

Medical Significance: significant enough because of 1) beneficial educational interventions for health professionals about these supplements and 2) patients’ skepticism on scientific findings, relying more on their trusted ones’ opinions

Feasibility: good location (only in PGH-OPD), good timeframe of implementation (days, not weeks), most of the time will be spent on preparing the questionnaire to ensure its information gathering capability and on data analysis, sample size may have to be very large to make it valid

Data Analysis: presentation using plots of percentages of patients, age, sex, information source, duration of usage, frequency of usage, reason for usage, disclosure rates, etc.

Disadvantage: low disclosure rates seeing that we are medical students; also sample size as mentioned

Suggested Topic: Does the purified extract of malunggay (Moringa oleifera) leaves have a bactericidal or bacteriostatic effect on common Gram positive (S. pyogenes, S. aureus) and Gram negative (E. coli, P. aeruginosa) bacterial cultures?
P: S. pyogenes, S. aureus, E. coli, P. aeruginosa cultures

I: purified extract of malunggay (Moringa oleifera) leaves

C: broad spectrum antibiotic

O: bactericidal or bacteriostatic effect

M: minimum inhibiting concentration, zone of inhibition, etc.

Literature Search:



RELEVANT ARTICLES FOUND: followed through the last 4 searches (#17, 18, 19, 20)


  • Phrase in RED is the sense of the article in a nutshell

Suarez M, Haenni M, Canarelli S, Fisch F, Chodanowski P, Servis C, Michielin O, Freitag R, Moreillon P, Mermod N. Structure-function characterization and optimization of a plant-derived antibacterial peptide. Antimicrob Agents Chemother. 2005 Sep;49(9):3847-57.



  • Used M. oleifera seeds, crushed, and from there derived a peptide, and characterized and synthetically modified it to enhance bactericidal activity.

  • States that low concentrations of this modified peptide exhibited potent bactericidal activity against P. aeruginosa and S. pyogenes without being toxic to human RBCs.

Cáceres A, Cabrera O, Morales O, Mollinedo P, Mendia P. Pharmacological properties of Moringa oleifera. 1: Preliminary screening for antimicrobial activity. J Ethnopharmacol. 1991 Jul;33(3):213-6.



  • Tested M. oleifera leaves, roots, bark and seeds against bacteria, yeast, dermatophytes and helminthes by disc diffusion method, dilution method and a standardized method for helminth eggs

  • Fresh leaf juice and aqueous seed extracts “inhibited the growth” of P. aeruginosa and S. aureus.

  • Extraction temperatures above 56 degrees C inhibited the above (bacteriostatic) activity.

Ghebremichael KA, Gunaratna KR, Henriksson H, Brumer H, Dalhammar G. A simple purification and activity assay of the coagulant protein from Moringa oleifera seed. Water Res. 2005 Jun;39(11):2338-44.



  • This study used a coagulant protein from M. oleifera seed, extracted by water and salt extraction, purification using ion exchange, chemical, coagulation and antimicrobial properties.

  • Used coagulant protein for low cost water treatment; might be useful as an alternative study.

  • States that the protein extracted has similar flocculation properties with alum and Cecropin A.

Broin M, Santaella C, Cuine S, Kokou K, Peltier G, Joët T. Flocculent activity of a recombinant protein from Moringa oleifera Lam. seeds. Appl Microbiol Biotechnol. 2002 Oct;60(1-2):114-9. Epub 2002 Aug 23.



  • Used M. oleifera seeds; cloned the cDNA of one flocculent protein and expressed it in E. coli.

  • Test assays included light and confocal microscopy and GFP-overexpressing bacteria.

  • Showed that the protein was able to aggregate clay and bacteria, which implies potential in water purification processes.



TOPIC ASSESSMENT:
Topic Itself: can be narrowed to a certain part of the plant, and according to the literature search, the seeds exhibit the bactericidal effect; alternative topic could be water treatment

Medical Significance: significant enough because of 1) common illnesses caused by the bacterial strains proposed, 2) malunggay trees can be found locally and 3) can prove to be a low cost antibacterial substance; also 4) to partially test validity of dietary supplements from malunggay tree parts

Feasibility: will need a good seed source, moderate timeframe of implementation (about 2-3 weeks), time will be spent extracting from seeds, administration of treatment on cultures, and data analysis, good sample size (small) but needs many replications

Data Analysis: presentation using plots comparing antimicrobial activity of M. oleifera extract and broad spectrum antibiotic for the 4 proposed bacterial strains

Disadvantage: “simple” and common study, may come under heavy skepticism and criticism


Suggested Topic: Anti-inflammatory and anti-abortive property (fetal toxicity) of Hibiscus rosa sinensis compared to Carica papaya.
Anti-inflammatory activities of ethanolic extract of Carica papaya leaves (Owoyele BV, Adebukola OM, Funmilayo AA, Soladoye AO)

    • investigated in rats using carrageenan induced paw oedema, cotton pellet granuloma and formaldehyde induced arthritis models

      • reduced paw oedema in the carrageenan test

      • significant reduction in the amount of granuloma

      • significantly reduced the persistent oedema

    • Also investigated ulcerogenic properties (possible research expansion for us)

Possible immunomodulatory actions of Carica papaya seed extract. (Mojica-Henshaw MP, Francisco AD, De Guzman F, Tigno XT)

    • Uses seeds versus leaves in previous study

    • UPCM study!

    • examined in vitro using lymphocyte proliferation assays and complement-mediated hemolytic assay

    • Significant observations: Carica Seed extract…

      • significantly enhanced the phytohemagglutinin responsiveness of lymphocytes;

      • is not able to protect the lymphocytes from the toxic effects of chromium;

      • can significantly inhibit classical complement-mediated hemolytic pathway

    • Thus has both immunostimulatory and anti-inflammatory effects (Possible confounding factors that might make analysis of anti-inflammatory effects alone hard.)

Effect of Hibiscus rosa sinensis Extract on Hyperproliferation and Oxidative Damage Caused by Benzoyl Peroxide and Ultraviolet Radiations in Mouse Skin (Sonia Sharma and Sarwat Sultana )




  • Combination of a single topical application of benzoyl peroxide (20 mg/0.2 ml/animal) followed by ultraviolet radiations (0.420 J/m2/s) was used to induce hyperproliferation and oxidative stress.

    • Single benzoyl peroxide application prior to ultraviolet B radiations exposure caused significant depletion in the detoxification and antioxidant enzymes, while malondialdehyde formation, hydrogen peroxide content, ornithine decarboxylase activity and DNA synthesis were raised significantly.

  • Pretreatment of H. rosa sinensis extract (3.5 mg and 7 mg/ kg b.wt.) partly restored the levels of cellular protective enzymes (P<0.05).

Cross search of hibiscus AND fetal toxicity:




  • A 1992 study by Nath, et. al (J. Ethnopharmacol.) focused on plants that are used for fertility regulation in India. One of them is H. rosa sinensis. Observation of the teratologic effects of these plants in rats showed that only the flower of H. rosa sinensis (and Acacia arabica) appeared to lack teratologic potential at the doses tested (175 mg/kg). 100% abortive plants at the doses tested include Moringa oleifera and Adhatoda vasica (syn. Justicia adhatoda). Does this mean that gumamela (excluding the flower part) is teratologic in rats at doses of 175 mg/kg? However, the flower has been found to exhibit anti-fertility activity in clinical trials wherein benzene extract of the flower petals suppresses implantation, according to a study by the Indian Council of Medical Research (ICMR) as reported by Chadhury in 1993 (Natl Med J India).

  • Maybe the effect of the flower part is highly dependent on the dose. Lit #1 says that the flower part is not teratologic at 175 mg/kg BUT it can already suppress implantation (accdg. to Lit #2, though the dose wasn’t specified).

Cross search of hibiscus AND anti-abortive yielded 0 results.

Suggested Topic: Anti-microbial property of dayap (Limonia aurantifolia), duhat (Syzygium cumini), yakon (Smallanthus sonchifolius), bayabas (Psidium guajava), calamansi (Citrus microcarpa), and 10 other Philippine herbs/fruits.
Cross search of limonia AND anti-microbial yielded 0 results.
Cross search of syzygium cumini AND antibacterial


  • The leaf essential oils of Syzygium cumini and Syzygium travancoricum were tested for their antibacterial property. The activity of S. cumini essential oil was found to be good, while that of S. travancoricum was moderate. (Shafi, et al, 2002)

Cross search of syzygium AND antibacterial




  • This study by Khan et al 2009 concludes that A. nilotica, C. zeylanicum and Syzygium aromaticum can be used against multidrug resistant (MDR) microbes causing nosocomial and community acquired infections. They tested using MDR strains of Escherichia coli, Klebsiella pneumoniae and Candida albicans




  • The bactericidal activity of Syzygium jambulanum has already been established in vitro. Thus research in this topic now includes its effects in the clinical setting. One example is a study by Maciel et al (2008) in which they studied its prophylactic anti-septic effect in mice (specifically, polymicrobial infection induced by cecal ligation and puncture). They got positive results, but the amazing thing about it is that they concluded that its anti-septic effect is not associated to the plant’s direct microbicidal effect but it is associated to a recruitment of activated neutrophils to the infectious site and to a diminished systemic inflammatory response. Perhaps we can work on this?




    • We can instead use other plants that have established microbicidal effect that is comparable to S. jambulanum and then do the same protocol.




  • Plant extracts of S. aromaticum was tested for its efficacy when used synergistically with antimicrobial drugs. Results were good. LINK HERE.  Maybe we can also do a SYNERGISM STUDY?




  • An active compound of S. aromaticum called acetyl eugenol, was reported by Srivastava and Malhotra (1991) to inhibit aggregation and alters arachidonic acid metabolism in human blood platelets.



Suggested Topic: Application and Identification of the anti-herpetic properties of the Aqueous and ethanolic extracts of Balitbitan (Cynometra ramiflora)

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