Effectiveness and safety of tripterygium glycosides tablet for lupus nephritis: a systematic review and Meta-analysis.

OBJECTIVE: To investigate the effectiveness and safety of tripterygium glycosides (TG) tablet for the treatment of Lupus nephritis (LN). METHODS: Several databases were systematically searched including PubMed, Embase, Cochrane, Wiley, China National Knowledge Infrastructure Database, SinoMed and Wanfang Library till June 20, 2020. Revman5.3 was utilized to analyze the data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. RESULTS: In total, 8 randomized controlled trials involving 583 participants were identified. Meta-analyses showed that, compared with glucocorticoids (GC) alone, the combination with TG tablet provided a statistically significant improvement in total remission (TR) ( = 1.27, 95% : 1.08-1.50, = 0.004), complete remission (CR) ( = 1.61, 95% : 1.05-2.47, = 0.03) and C3 levels ( = 0.27, 95% : 0.14-0.39, < 0.000 1), C4 levels ( = 0.12, 95% : 0.07-0.17, < 0.000 01). No significant differences were seen in TR, CR, proteinuria, serum creatinine, C3 and C4 (TR: = 1.00, 95% : 0.87-1.16, = 0.95; CR: = 1.10, 95% : 0.78-1.56, = 0.58; proteinuria levels: = -0.06, 95% : -0.13 to 0.01, = 0.10; serum creatinine levels: = -0.01, 95%: -7.36 to 7.35, = 1.00; C3 levels: = 0.01, 95%: -0.06 to 0.07, = 0.84; C4 levels: = -0.01, 95%: -0.03 to 0.01, = 0.49) between azathioprine (AZA) / leflomit (LEF) + GC and TG tablet + GC. Adverse events (hepatic dysfunction, nausea, vomitting) showed no statistical differences between the TG tablet + GC group and the GC group. There were more new onset of irregular menstruation in the TG tablet + GC group than those in the AZA + GC ( = 3.57, 95% : 1.40-9.11, = 0.008) /LEF+ GC ( = 6.69, 95% : 2.42-18.46, = 0.000 2) group, but leucopenia lower than those in AZA + GC group ( = 0.38, 95% : 0.17-0.85, = 0.02) and alopecia ( = 0.14, 95% : 0.03-0.77, = 0.02) and rash ( = 0.09, 95% : 0.01-0.69, = 0.02) lower than those in LEF + GC group. CONCLUSIONS: This review indicates that TG tablet maybe effective in LN treatment. Nevertheless, adverse events cannot be ignored. Large sample, multi-center, high-quality clinical studies are needed to verify the exact effects and safety of TG tablet in treatment of LN.

Tongbiling for interleukin 2 and its receptor o-chain in vivo and in vitro / 中国组织工程研究

BACKGROUND: Tongbiling is the modified guizhi shaoyao zhimu tang (Decoction of Cinnamon Twig, Peony and Anemarrhena) recorded in Synopsis of Prescriptions of the Golden Chamber. It has been used for rheumatoid arthritis(RA) for more than ten years. Here is the experimental study on effects of tongbiling on interleukin 2(IL-2) and its α-chain, IL-2Rα(CD25), to explain the mechanism of tongbiling in regulating the cellular immunity and resisting RA From the aspects of in vivo and in vitro.OBJECTIVE: To study the effect of tongbiling on IL-2 in collagen introduced arthritis of rats and the influence of total base of tongbiling on expression of IL2-Rα (CD25).DESIGN: A totally randomized and controlled experimental study based on the experimental animalsSETTING: Department of Jinkui of a university and the center of organ transplantation and immunity of another university.MATERIALS: The experiment was carried out from April to July 2001 in the Central Laboratory of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The 36 Wistar rats, clean degree, male,bought from the Animal Experimental Center of Medical College of Sun Yat-sen University, certificate No. 2000A050, weighted(110 ± 20) g, were divided into 6 groups with 6 in each: normal group, model group, methotrexate (MTX) high dosage group, MTX low dosage group, tongbiling high dosage group, and tongbiling small dosage group.METHODS: The experiment in vivo was done with the modeled rats of collagen-induced arthritis. The foot swelling was measured with volume method, the cells of primary synovium cultured, and the upper clear fluid of culture fluid tested with radioimmunoassay to observe the effect of tongbiling on synovial IL-2. The experiment in vitro was done in the way of separating the lymphocytes, giving extraneous stimulation with phorbol 12, 13-dibutyrate (PDB) or concanavalin A(ConA), using bicolor immunofluorescence labeling, testing with flow cytometer to observe the influence of total base of tongbiling on the expression of CD3 +, CD25 +.MAIN OUTCOME MEASURES: The influence of tongbiling on the foot swelling and synovial IL-2 of rats with collagen-induced arthritis.RESULTS: In the experiment in vivo, the high dosage of tongbiling could relieve obviously the foot swelling, compared with MTX, there was no remarkable difference ( P ＞ 0.05) . Both high and low dosage of tongbiling could inhibit the synthesis of synovial IL-2 ( P ＜ 0.01 ). In the experiment in vitro, the total base of tongbiling could extremely inhibit the expression of CD3 +, CD25 + stimulated by ConA, but not effective for that stimulated by PDB plus ionomycin.CONCLUSION: Tongbiling can inhibit the IL-2 synthesis and the signal transduction of IL-2Rα (CD25) activated by ConA, relieving the inflammation of local joint. It provides an experimental evidence for the application of tongbiling in the treatment of RA.