Zhang Yanqiong, Mao Xia, Li Weijie, Chen Wenjia, Wang Xiaoyue, Ma Zhaochen, Lin Na
Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.
Med Res Rev. 2021 May;41(3):1337-1374. doi: 10.1002/med.21762. Epub 2020 Dec 9.
Tripterygium wilfordii Hook F (TwHF)-based therapy is among the most efficient and crucial therapeutics for the treatment of rheumatoid arthritis (RA), which indicates that TwHF is a potential source of novel anti-RA drugs. However, accumulating studies have observed that TwHF-based therapy induces multi-organ toxicity, which prevents the wide use of this herb in clinical practice, although several recent studies have attempted to reduce the toxicity of TwHF. Notably, our research group developed a "Clinical Practice Guideline for Tripterygium Glycosides/Tripterygium wilfordii Tablets in the Treatment of Rheumatoid Arthritis" (No. T/CACM 1337-2020) approved by the China Association of Chinese Medicine to standardize the clinical application of TwHF-based therapy and thus avoid adverse effects. Although great strides have been made toward the characterization of TwHF-based therapy and revealing its underlying pharmacological and toxicological mechanisms, several crucial gaps in knowledge remain as potential barriers to enhance its therapeutic effects on the premise of safety assurance. This review offers a global view of TwHF, ranging from its chemical constituents, quality control, clinical observations, and underlying pharmacological mechanisms to toxic manifestations and mechanisms. We focus on the important and emerging aspects of this field and highlight the major challenges and strategies for using novel techniques and approaches to gain new insights into unresolved questions. We hope that this review will improve the understanding of TwHF application and draw increasing interdisciplinary attention from clinicians that practice both Chinese and Western medicine, basic researchers, and computer scientists.
雷公藤多苷（TwHF）为基础的疗法是治疗类风湿关节炎（RA）最有效且关键的疗法之一，这表明TwHF是新型抗RA药物的潜在来源。然而，越来越多的研究发现，以TwHF为基础的疗法会引发多器官毒性，这阻碍了这种草药在临床实践中的广泛应用，尽管最近有几项研究试图降低TwHF的毒性。值得注意的是，我们的研究团队制定了由中国中医药协会批准的《雷公藤多苷片/雷公藤片治疗类风湿关节炎临床实践指南》（编号：T/CACM 1337-202０），以规范以TwHF疗法的临床应用，从而避免不良反应。尽管在以TwHF为基础的疗法的特征描述及其潜在的药理和毒理机制揭示方面已经取得了很大进展，但在知识方面仍存在一些关键差距，这些差距是在确保安全性的前提下提高其治疗效果的潜在障碍｡本综述全面介绍了TwHF，涵盖其化学成分、质量控制、临床观察、潜在药理机制、毒表现及机制｡我们重点关注该领域重要且新出现的方面，并强调利用新技术和方法对未解决问题获得新见解的主要挑战和策略｡我们希望这篇综述能增进对TwHF应用的理解，并吸引越来越多中西医结合临床医生､基础研究人员和计算机科学家跨学科的关注｡
