Sethi Vidhu, Garg Manohar, Herve Maxime, Mobasheri Ali
Pain Relief, Medical Affairs, Consumer Healthcare R&D, Haleon, 23, Rochester Park, GSK Asia House, 139234 Singapore.
Nutraceuticals Research Program, University of Newcastle, Callaghan, NSW, Australia.
Ther Adv Musculoskelet Dis. 2022 Sep 22;14:1759720X221124545. doi: 10.1177/1759720X221124545. eCollection 2022.
For several thousand years (~4000) and have been used in Aryuvedic medicine for treatment of various illnesses, including asthma, peptic ulcers, and rheumatoid arthritis, all of which are mediated through pathways associated with inflammation and pain. Although the pharmacology of both these natural ingredients is difficult to study because of poor bioavailability, data suggest that both influence gene expression mediated through nuclear factor kappa B (NF-κB). Therefore, the activity of pathways associated with inflammation (including NF-κB and lipoxygenase- and cyclooxygenase-mediated reduction in leukotrienes/prostaglandins) and those involved in matrix degradation and apoptosis are reduced, resulting in a reduction in pain. Additive activity of boswellic acids and curcumin was observed in preclinical models and synergism was suggested in clinical trials for the management of osteoarthritis (OA) pain. Overall, studies of these natural ingredients, alone or in combination, revealed that these extracts relieved pain from OA and other inflammatory conditions. This may present an opportunity to improve patient care by offering alternatives for patients and physicians, and potentially reducing nonsteroidal anti-inflammatory or other pharmacologic agent use. Additional research is needed on the effects of curcumin on the microbiome and the influence of intestinal metabolism on the activity of curcuminoids to further enhance formulations to ensure sufficient anti-inflammatory and antinociceptive activity. This narrative review includes evidence from and preclinical studies, and clinical trials that have evaluated the mechanism of action, pharmacokinetics, efficacy, and safety of curcumin and boswellic acids individually and in combination for the management of OA pain.
数千年来（约4000年），它们一直被用于阿育吠陀医学中治疗各种疾病，包括哮喘、消化性溃疡和类风湿性关节炎，所有这些疾病都是通过与炎症和疼痛相关的途径介导的。尽管由于生物利用度差，这两种天然成分的药理学研究都很困难，但数据表明它们都影响通过核因子κB（NF-κB）介导的基因表达。因此，与炎症相关的途径（包括NF-κB以及白三烯/前列腺素的脂氧合酶和环氧化酶介导的减少）以及参与基质降解和细胞凋亡的途径的活性降低，从而减轻疼痛。在临床前模型中观察到乳香酸和姜黄素具有相加活性，并且在骨关节炎（OA）疼痛管理的临床试验中提示有协同作用。总体而言，对这些天然成分单独或联合使用的研究表明，这些提取物可缓解OA和其他炎症性疾病引起的疼痛。这可能为改善患者护理提供机会，为患者和医生提供替代方案，并有可能减少非甾体抗炎药或其他药物的使用。需要进一步研究姜黄素对微生物群的影响以及肠道代谢对姜黄素类活性的影响，以进一步改进配方，确保足够的抗炎和抗伤害感受活性。这篇叙述性综述包括来自临床前研究和临床试验的证据，这些研究评估了姜黄素和乳香酸单独及联合使用治疗OA疼痛的作用机制、药代动力学、疗效和安全性。
