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The restrictions on antibiotic growth promoters in poultry production make the exploration of safe and effective alternatives necessary. Astragalus polysaccharides (APS), as bioactive macromolecules, have attracted significant interest from poultry scientists. In the current study, a multilevel meta-analysis was conducted to quantitatively evaluate the effects of APS administration on broiler performance, antioxidant status, and gut health. The results revealed that APS supplementation significantly improved average daily gain (ADG; SMD = 0.64 [0.13, 1.15]) and feed conversion ratio (FCR; SMD = -1.20 [-2.03, -0.35]) of broilers. The observed benefits directly correlated with increased superoxide dismutase activity (SOD; SMD = 1.35 [0.78, 1.92]) and decreased malondialdehyde levels (MDA; SMD = -1.07 [-1.54, -0.60]). Subgroup analysis demonstrated that dietary supplementation was more effective than injection for improving ADG and the villus height to crypt depth ratio (VCratio), indicating the importance of direct gut-level interaction of APS. Nonlinear dose-response modelling identified an optimal dietary APS range of 1000-1500 mg/kg for maximising growth and antioxidant parameters. This meta-analysis suggests that APS shows promise as an antibiotic alternative for improving broiler growth performance, warranting further direct comparative studies with antibiotics. In addition, further large-scale trials are required to confirm its consistent efficacy on gut health and microbial composition due to substantial heterogeneity in current datasets. © 2025 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.

BACKGROUND: TA-65®, a telomerase-activating compound derived from Astragalus membranaceus, has garnered interest for its potential to modulate cellular aging. However, its mechanistic efficacy and long-term toxicological profile remain inadequately synthesized. METHODS: This PRISMA-guided meta-analysis evaluated 8 randomized controlled trials (RCTs, n = 750 participants; mean age 63.3 years) assessing TA-65's effects on telomere dynamics, functional aging indices, and safety outcomes. Primary outcomes included leukocyte telomere length (LTL) measured by Southern blot or qPCR/or flow-FISH; secondary outcomes encompassed frailty metrics (SPPB, grip strength, 6MWT), inflammatory markers (hs-CRP, IL-6), and adverse events (CTCAE v5.0). Statistical synthesis employed random-effects models (RevMan 5.3), subgroup analyses, and GRADE evidence grading. RESULTS: TA-65 supplementation induced moderate telomere elongation (SMD = 0.47, 95% CI: 0.31-0.62; p < 0.00001), with amplified effects in adults > 60 years (SMD = 0.63 vs. 0.36; p = 0.03). Industry-funded trials reported inflated efficacy (SMD = 0.63 vs. 0.40; p = 0.03). Critically, telomere elongation did not translate to functional improvements in frailty (SMD = 0.09, p = 0.15) or inflammation (CRP/IL-6 SMD = - 0.11, p = 0.07), revealing a telomere-function disconnect. Safety analysis (n = 487) identified mild gastrointestinal toxicity (12.4% incidence; nausea: 7.1%, abdominal discomfort: 5.3%) but no severe adverse events (e.g., oncogenesis) over 12 months. Dose-response relationships (10-50 mg/day) and measurement-method variations were non-significant (p > 0.05). CONCLUSIONS: While TA-65 demonstrates telomerase-activating efficacy, particularly in older adults, its failure to improve functional aging metrics underscores limitations of unimodal biomarker targeting. The absence of dose-dependent toxicity or short-term oncogenic risk is notable, yet long-term carcinogenic potential remains unaddressed. Rigorous, independent trials must evaluate TA-65's chronic toxicity, telomere-independent mechanisms, and utility within multidimensional aging frameworks. Clinical application may consider older adults with immunosenesc

Background: Cancer-related fatigue is the most common complication in patients. Astragalus membranaceus is widely used in many countries to treat cancer, but its efficacy and safety is uncertain. Objectives: This study aimed to summarize the evidence on Astragalus membranaceus on cancer-related fatigue and quality of life in patients with cancer. Methods: Nine electronic databases were explored for the clinical randomized controlled trial of intervention with Astragalus membranaceus alone for cancer-related fatigue and quality of life in cancer patients from inception to July 1, 2022. The risk of bias assessment tool was adopted by Cochrane Handbook 6.1.0. The effect size was estimated using relative risk and mean difference with a corresponding 95% confidence interval. Review Manager 5.4 was used for meta-analysis. The evidence level was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE). Results: Eight studies were included. The results of the meta-analysis showed that the addition of Astragalus membranaceus to the control group was effective in reducing cancer-related fatigue (SMD = -1.63, 95% CI [-1.90, -1.36], P < .00001) and (RR = 1.55, 95% CI [1.19, 2.02], P = 0.001) in patients with cancer and improving quality of life (SMD = 0.86, 95% CI [0.17, 1.55], P = 0.01) and (RR = 1.57, 95% CI [1.10, 2.23], P = 0.01). Conclusion: The current evidence is supportive of the efficacy of Astragalus membranaceus in patients with cancer-related fatigue and their quality of life, but due to the small and low quality of the included literature and the lack of uniformity in terms of cancer type as well as treatment modalities, there is currently insufficient evidence to provide strong support for the clinical use of Astragalus membranaceus in the treatment of cancer-related fatigue. More high-quality evidence is needed in the future to further validate the use of Astragalus membranaceus in the treatment of clinical cancer-related fatigue. Registration: A review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD42023442277. Registered 20 July 2023.

Current evidence suggests that Astragalus membranaceus is one of the most commonly used herbal medicines for cancer treatment, with its primary component, Astragalus polysaccharide (APS), demonstrating immunomodulatory effects. However, the reliability of the available evidence remains elusive. Therefore, this systematic review and meta-analysis of studies intended to evaluate the therapeutic effects and safety of APS supplementation in malignant tumor patients. We searched eight databases for articles published from January 2010 to August 2024. Uilizing the ROB2 tool for bias risk. Meta-analysis of the objective response rate (ORR), immune function, and adverse reactions was performed using Stata 15.1 software. This study is registered with PROSPERO (ID: CRD42021272595). A total of 31 randomized controlled trials (RCTs) involving 2,648 participants were incorporated. The meta-analysis results unraveled that the treatment group outperformed the control group in terms of treatment efficacy [RR = 1.30, 95% CI (1.21, 1.39), P < 0.01], CD3 + T cell count [MD = 8.79, 95% CI (6.15, 11.43), P < 0.01], CD4 + T cell count [MD = 7.94, 95% CI (5.27, 10.61), P < 0.01], and the CD4 + /CD8 + ratio [MD = 0.40, 95% CI (0.28, 0.52), P < 0.01]. No substantial distinctions were noted between the two groups in terms of CD8 + T cell count [MD = -1.74, 95% CI (-4.66, 1.17), P = 0.242]. Regarding adverse reactions, the incidence of symptoms such as hand-foot numbness and weakness was low, indicating a high safety profile. Supplementation with APS can improve treatment outcomes, enhance immune function, and demonstrate a high level of safety in malignant tumor patients, making it a promising option for clinical use. However, given the variety of cancer types included in the studies, future research should focus on specific cancer types. © 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

OBJECTIVE: Oxaliplatin is a first-line chemotherapy drug for the treatment of colorectal cancer, but its induced oxaliplatin-induced peripheral neurotoxicity (OIPN) affect the chemotherapy process and quality of life of tumor patients. OIPN is a serious and potentially permanent side effect of cancer treatment. Currently, no unified standard has been established for preventing and treating OIPN in Western medicine. Therefore, it is very important to seek effective prevention and treatment measures. Many clinical trials have reported that Huangqi Guizhi Wuwu decoction can effectively prevent OIPN, but substantial evidence base to support this treatment is lacking. We collected existing literature and evaluated the clinical efficacy and safety of Huangqi Guizhi Wuwu decoction for OIPN by performing a meta-analysis. METHODS: We systematically searched China National Knowledge Internet (CNKI), VIP, Wan Fang Database, Pubmed, EMBASE, and Cochrane Library from inception through to Oct 2022 to identify only randomized controlled trials examining the prevention of OIPN using Huangqi Guizhi Wuwu decoction. This search was supplemented by manual retrieval, including dissertations and conference papers. All data were analyzed using RevMan 5.3 software. RESULTS: A total of 18 papers involving 564 patients in the treatment group and 523 patients in the control group were included. A total of 17 articles reported the overall incidence of peripheral neurotoxicity (I² = 0%), and the overall incidence of peripheral neurotoxicity in the treatment group was 0.27 times higher than in the control group (95% CI: 0.20-0.36). A total of 16 articles reported the incidence of level III-IV severe peripheral neurotoxicity (I² = 0%), which was 0.16 times higher in the treatment group than in the control group (95% CI: 0.09-0.32). In the Huangqi Guizhi Wuwu VS no-interference subgroup, it showed that the incidence of severe peripheral neurotoxicity in the treat group was significantly lower than in the control group (OR:0.13, 95% CI:0.06-0.28). But in the Huangqi Guizhi Wuwu VS west medicine therapy subgroup, no significant difference between Huangqi Quizhi Wuwu and conventional Western medi

BACKGROUND: Neurological disorders constitute a growing worldwide concern due to the progressive aging of the population and the risky behavior they represent. Herbal medicines have scientific relevance in the treatment of these pathologies. One of these substances, Astragaloside IV (AS-IV), is the main active compound present in the root of Astragalus membranaceus (Fisch.) Bge, a Chinese medicinal herb with neuroprotective properties. OBJECTIVE: In the present study we performed a systematic review that sought to comprehend the neuroprotective effect presented by AS-IV in experimental models of neurological disorders. METHODS: This study is a systematic review, where an electronic search in United States National Library of Medicine (PubMed), Science Direct, Cochrane Library, Scientific Electronic Library Online (SciELO), Scopus, Web of Science, Medline via Proquest and Periodicos Capes databases covering the years between 2007 and 2017, using "Astragaloside IV" and "Neurodegenerative diseases"; "Astragaloside IV" and " Neurological disorders" as reference terms was made. RESULTS: A total of 16 articles were identified, in which the efficacy of AS-IV was described in experimental models of Parkinson's disease, Alzheimer's disease, cerebral ischemia and autoimmune encephalomyelitis, by improving motor deficits and/or neurochemical activity, especially antioxidant systems, reducing inflammation and oxidative stress. CONCLUSION: The findings of the present study indicate that the administration of AS-IV can improve behavioral and neurochemical deficits largely due to its antioxidant, antiapoptotic and antiinflammatory properties, emerging as an alternative therapeutic approach for the treatment of neurological disorders.

This review assessed the effects on chemotherapy induced neutropenia (CIN) of combining oxaliplatin regimens with traditional plant-based medicines (TMs) in the management of colorectal cancer (CRC). 32 RCTs (2224 participants) were included. Meta-analysis showed reduced incidence of grade 3/4 CIN (RR 0.45[0.31, 0.65], I(2)=0%). No studies reported serious adverse events or reduction in tumour response rates associated with concurrent use of oxaliplatin and TM. Due to small sample sizes and risk of bias, these results should be interpreted with caution. Analyses of sub-groups of studies that used similar TM interventions assessed the relative contributions of individual plant-based ingredients to the results. Astragalus, Codonopsis, Atractylodes, Poria and Coix, in various combinations were consistently associated with reduced CIN incidence when administered orally. Experimental studies of these plants have reported reduced myelosuppression and/or enhanced immune response. Further studies of these plants may lead to the development of interventions to supplement conventional CIN treatment.

Type 2 diabetes is a growing health concern. The use of nutritional supplements by patients with type 2 diabetes is estimated at somewhere between 8% to 49%. The objective of this review was to search the scientific literature for advances in the treatment and prevention of type 2 diabetes with nutritional supplements. Twelve databases were searched with a focus on extracting studies published in the past 3 years. The following nutritional supplements were identified as potentially beneficial for type 2 diabetes treatment or prevention: vitamins C and E, α-lipoic acid, melatonin, red mold, emodin from Aloe vera and Rheum officinale, astragalus, and cassia cinnamon. Beta-carotene was shown to be ineffective in the prevention of type 2 diabetes. Ranging from preclinical to clinical, there is evidence that nutritional supplements may be beneficial in the treatment or prevention of type 2 diabetes. Health providers should investigate drug-nutritional supplement interactions prior to treatment.

ETHNOPHARMACOLOGICAL RELEVANCE: Diabetic sarcopenia (DS), an emerging diabetes complication, poses an increasing challenge to the elderly population. Shenqi paste (SQP) consists of 8 medicine-food homology substances: Astragalus membranaceus (Fisch.) Bge., Codonopsis pilosula (Franch.) Nannf., Polygonatum sibiricum Red., Dioscorea opposita Thunb., Poria cocos (Schw.) Wolf, Eucommia ulmoides Oliv., Hordeum vulgare L., and Ophiopogon japonicus (L.f.) Ker Gawl. SQP has shown potential benefits for sarcopenia in clinical practice. Its efficacy and safety in DS have not been validated in a randomized controlled trial. AIM OF THE STUDY: This study aimed to evaluate the efficacy, safety, and limitations, and provide insights into methods and strategies for utilizing SQP in DS management. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled trial, community-dwelling older adults (≥60 years) with DS and spleen-kidney deficiency syndrome were allocated 1:1 to receive either SQP or placebo paste for 12 weeks. Primary outcomes were skeletal muscle mass index (SMI), handgrip strength, and five-time chair stand test (FCST) duration. Secondary outcomes included health-related scales and biochemical indicators. Assessments were conducted at the baseline (T0), week 6 (T1), and week 12 (T2). Safety evaluation included blood routine, liver and kidney function tests. Intention-to-treat analysis was applied to the primary outcomes data from all participants, with per-protocol analysis for sensitivity. Generalized estimating equations with covariate adjustment and t-tests or Wilcoxon rank-sum tests were used for statistical analysis. RESULTS: Of 90 randomized participants, the SQP group showed greater improvements in handgrip strength (T2: interact p < 0.001), SMI (T2: interact p < 0.001), and FCST (T2: interact p < 0.001) versus control. Secondary outcome measures of 74 participants, including frailty, nutrition, physical activity, sleep quality, depression, and TCM syndrome scores, significantly improved (p < 0.05), with significant fasting blood glucose reduction (T2: interact p = 0.018) and C-reactive protein decrease (T2: interact p < 0.001). There was no

BACKGROUND/OBJECTIVES: Whether saponins aid in whey protein supplementation remains unclear. We aimed to investigate the effects of Astragalus and Panax saponins (APS) on whey protein absorption, intestinal permeability, and muscle function in healthy adults across different age groups. METHODS: A randomized, double-blind, placebo-controlled crossover trial was conducted with 30 healthy participants equally stratified into three age groups (18-25, 26-59, and 60-80 years), over two phases: a single-dose trial to measure immediate amino acid absorption from whey protein and a 4-week phase combining daily supplementation with resistance training to assess long-term effects on amino acid absorption kinetics, muscle function, and gut health. RESULTS: Immediate APS supplementation resulted in a 6.67% higher area under the curve for valine, 3.62% for leucine, and 0.15% for isoleucine, compared with the placebo. After 4 weeks, APS supplementation significantly increased the absorption of valine (14.07%) and leucine (8.34%) and improved the absorption of isoleucine (6.33%). The effects were most pronounced in older adults (60-80 years), who showed a 12.74% increase in total essential amino acid absorption. APS also caused a substantially greater increase (APS: +5.20% vs. placebo: +2.44%) in grip strength, an increase (APS: +0.85% vs. placebo: +0.68%) in muscle mass, and a reduction in blood zonulin levels (APS: -13.01% vs. placebo: -0.9%), indicating improved muscle function and intestinal barrier integrity, without adverse effects on liver or kidney function. CONCLUSIONS: APS supplementation enhances amino acid absorption from whey proteins, muscle function and gut barrier integrity, especially in older adults. These findings highlight its synergistic role in improving protein supplementation efficacy for those with age-related muscle loss.

PURPOSE: preclinical trial confirmed that Angelica gigas and Astragalus membranaceus had a curative effect on benign prostatic hyperplasia (BPH). Therefore, this study aimed to investigate the effects of this compound in patients with BPH symptoms. MATERIALS AND METHODS: Subjects were divided into the treatment and control groups. They underwent four visits, and medication was initiated from the 2nd visit onwards, with a total of 12 weeks of intake. The endpoints were the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), prostate-specific antigen level, testosterone, dihydrotestosterone, maximal urinary flow rate, residual urine volume, and subjective evaluation improvement. Safety tests included clinical pathology tests and checking for adverse reactions. RESULTS: A total of 39 patients from the treatment group and 45 from the control group were included in the efficacy analysis. After 12 weeks, a significant improvement was seen in IPSS total score (p=0.0219) and incomplete emptying score (p=0.0007). Furthermore, there were statistically significant improvements in the IIEF total score, erectile function, sexual desire, intercourse satisfaction, and overall satisfaction in the treatment group. The subjective improvement evaluation also showed a significant improvement (p=0.0143). Ten cases of mild adverse events were reported, including gastrointestinal problems, skeletal pain, dermatitis, and others. However, no severe adverse reactions were observed, and it was unlikely that these were related to the test product. CONCLUSIONS: After taking the trial product (SHPro®) for 12 weeks, the total and incomplete emptying IPSS improved, as did the IIEF, which indicated subjective improvements. And its safety was confirmed. © The Korean Urological Association.

OBJECTIVE: To study the traditional Chinese medicine (TCM) syndromes of patients with chronic heart failure (CHF) combined with diuretic resistance by using the Wenyang Huayin Yangxin Prescription, and to observe its therapeutic efficacy. METHODS: A total of 68 CHF patients complicated with diuretic resistance and who had Yangqi deficiency and presenting blood stasis syndrome combined with Tanyin were randomly assigned to a control group and an observation group. The control group was given intravenous furosemide (≥ 80 mg/d) via infusion pump in addition to standard Western medical treatment, while the observation group was given intravenous furosemide (< 80 mg/d) via infusion pump along with the Wenyang Huayin Yangxin Prescription (30 g Astragalus, 15 g Poria, 15 g Baizhu, 15 g Chuanxiong, 10 g Danfu tablet, 10 g Cassia, 10 g Alisma, and 10 g Zhimu). The quantitative index of diuretic resistance was used as the primary outcome measure. In addition, the differences between the two groups in TCM syndromes, cardiac function-related indicators, incidence of endpoint events, and readmission rate were compared. RESULTS: After 2 weeks of treatment, the filtration sodium excretion fraction (FENa) in the observation group was (0.18 ± 0.04)%, while that of the control group was (0.16 ± 0.03)%, showing a statistically significant difference (P = 0.037). The 24-hour urine volume and urine Na+/K+ ratio in the observation group increased significantly from baseline levels and were higher than those in the control group (P < 0.05). The differences in the changes of 24-hour urine volume, urine sodium, FENa, and urine Na+/K+ ratio between the two groups were statistically significant (P < 0.05). The TCM syndrome scores decreased in both groups after 2 weeks of treatment, with the observation group showing a significantly greater reduction compared with the control group (P < 0.001). The differences in the changes of TCM syndrome scores between the two groups were statistically significant (P < 0.001). After 2 weeks of treatment, the observation group showed significant improvements in palpitations, shortness of breath, facial and limb edema, spontaneous sweating, chest tightnes

The traditional Chinese medicine compound preparation known as Jinbei Oral Liquid (JBOL) consists of 12 herbs, including Astragalus membranaceus (Fisch.) Bge, Codonopsis pilosula (Franch.) Nannf, et al. Having been used for over 30 years in the treatment of pulmonary diseases, JBOL was evaluated in this study in order to assess its effect on idiopathic pulmonary fibrosis as well as its safety (ChiCTR2000035351, Chictr.org.cn.09/08/2020). A double-blind, multicenter, randomized, proof-of-concept trial was conducted to assess the efficacy of oral JBOL 40 ml and Corbrin Capsules 1 g compared to a placebo and Corbrin Capsules in patients with idiopathic pulmonary fibrosis (IPF). Over a 26-week period, patients received the active treatment or placebo three times daily, in a 1:1 ratio. This clinical study uses a randomized method, with a cycle of every 4 patients. TCM doctors at or above the deputy director level of the research center conduct TCM dialectics on IPF patients. To assess efficacy, over the duration of the trial, we measured serial changes in a composite indicator encompassing time to first acute exacerbation of IPF (first hospitalization or death due to respiratory cause), total lung capacity (TLC) (mL), predicted forced vital capacity (FVC%), forced vital capacity (FVC) (mL), predicted diffusing capacity of the lungs for carbon monoxide (predicted DLco%), 6-minute walk distance (6MWD), St. George's Respiratory Questionnaire (SGRQ) total score, and arterial oxygen partial pressure (PaO2) from baseline to week 26 versus placebo. A total of 103 patients were screened, and 72 received the study medication. Of these, 68 patients were included in the analysis set, with 34 receiving JBOL and 34 receiving a placebo. After 26 weeks, a statistically significant reduction in total lung capacity (TLC) was observed for the JBOL group, with a change of 136 mL compared to -523 mL for the placebo group (difference 659 mL, 95% CI -1215 to -104 mL, p = 0.02). The study found that the change in FVC% predicted was - 1.48% and - 3.58% for the JBOL and placebo groups, respectively (difference of 2.10%, 95% CI -7.13 to 2.93, p = 0.41). Additionally the differences between th

This study aimed to evaluate the effect of Astragalus polysaccharides (PG2) on reducing chemotherapy-induced fatigue (CIF) and toxicity, thereby encouraging compliance to chemotherapy. This was a randomized, placebo-controlled, phase 2 study. Patients with stage II/III early breast cancer planning to undergo adjuvant anthracycline-based chemotherapy were randomly assigned to receive PG2 500 mg or placebo on days 1, 3, and 8 every 21 days. The fatigue global score (FGS) was assessed using the brief fatigue inventory (BFI)-Taiwan. The Breast Cancer-Specific Module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core30 evaluated the health-related quality of life during the first four cycles of adjuvant chemotherapy. Overall, 66 eligible patients were equally randomized into the PG2 and placebo groups between March 01, 2018, and March 09, 2021. The mean change in the FGS and fatigue intensity did not significantly differ between both groups. However, the FGS and fatigue intensity were less aggravated in the first four cycles in the premenopausal-PG2 group than in the placebo group. Our study concluded PG2 combined with adjuvant chemotherapy can reduce CIF, insomnia, the negative effect on future perspectives, and improve global health status, especially for premenopausal patients with breast cancer. Trial registration number: NCT03314805 registered on 19/10/2017. © 2024. The Author(s).

Telomeres are ribonucleoprotein structures that form a protective buffer at the ends of chromosomes, maintaining genomic integrity during the cell cycle. A decrease in average telomere length is associated with with age and with aging-related diseases such as cancer and cardiovascular disease. In this study, we conducted a randomized, double-blind, placebo-controlled trial over six months to compare the effects of the Astragalus-based supplement versus a placebo on telomere length (TL) in 40 healthy volunteers (mean age 56.1 ± 6.0 years). Twenty subjects received the supplement, and 20 received placebo capsules. All participants completed the study, and no adverse side effects were reported at six months. Subjects taking the Astragalus-based supplement exhibited significantly longer median TL (p = 0.01) and short TL (p = 0.004), along with a lower percentage of short telomeres, over the six-month period, while the placebo group showed no change in TL. This trial confirmed that the supplement significantly lengthens both median and short telomeres by increasing telomerase activity and reducing the percentage of short telomeres (<3 Kbp) in a statistically and possibly clinically significant manner. These results align with a previous open prospective trial, which found no toxicity associated with the supplement's intake. These findings suggest that this Astragalus-based supplement warrants further investigation for its potential benefits in promoting health, extending life expectancy, and supporting healthy aging.

OBJECTIVE: This study aimed to evaluate the effect of Astragalus root extract on nurses suffering from post-COVID-19 chronic fatigue syndrome. MATERIALS AND METHODS: The study was designed as a triple-blind, randomised, controlled trial in Iran in 2023. 64 chronic fatigue syndrome nurses were randomly assigned to one of two groups: an intervention group (n=32) that received Astragalus root extract (500 mg two times per day) or a control group (n=32) that received a placebo. Changes in chronic fatigue syndrome scores were measured before to, at the end of and 1 month after the intervention. Data were analysed using descriptive and analytical statistics (T-tests, χ2, analysis of variances, Cochran's Q tests, McNemar and generalised estimating equations). RESULTS: In comparison to before, chronic fatigue prevalence decreased statistically significantly at the end of the intervention group (13.8%) and 1 month later (17.2%). Further, the frequency differed between before and after (p=0.0001) and 1 month later (p=0.0001). In the control group, chronic fatigue was statistically significantly different before and after the intervention (72.2%; p=0.003). Having an underlying disease (B=0.84, OR=2.33; p=0.04) and being in the control group (B=2.15, OR=12.36; p=0.01) increased the risk of chronic fatigue, whereas increasing the length of time decreased it (B=-0.67, OR=0.50; p=0.0001). CONCLUSION: Astragalus root extract has been shown to reduce chronic fatigue in nurses. Therefore, this herbal extract can be used to reduce the incidence and treatment of chronic fatigue in nurses. © Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.

BACKGROUND: Diabetes leads to chronic kidney disease (CKD) and kidney failure, requiring dialysis or transplantation. Astragalus, a common herbal medicine and US pharmacopeia-registered food ingredient, is shown kidney protective by retrospective and preclinical data but with limited long-term prospective clinical evidence. This trial aimed to assess the effectiveness of astragalus on kidney function decline in macroalbuminuric diabetic CKD patients. METHODS: This randomized, assessor-blind, standard care-controlled, multi-center clinical trial randomly assigned 118 patients with estimated glomerular filtration rate (eGFR) of 30-90 ml/min/1.73m2 and urinary albumin-to-creatinine ratio (UACR) of 300-5000 mg/g from 7 public outpatient clinics and the community in Hong Kong between July 2018 and April 2022 to add-on oral astragalus granules (15 gs of raw herbs daily equivalent) or to continue standard care alone as control for 48 weeks. Primary outcomes were the slope of change of eGFR (used for sample size calculation) and UACR of the intention-to-treat population. Secondary outcomes included endpoint blood pressures, biochemistry, biomarkers, concomitant drug change and adverse events. (ClinicalTrials.gov: NCT03535935) RESULTS: During the 48-week period, the estimated difference in the slope of eGFR decline was 4.6 ml/min/1.73m2 per year (95 %CI: 1.5 to 7.6, p = 0.003) slower with astragalus. For UACR, the estimated inter-group proportional difference in the slope of change was insignificant (1.14, 95 %CI: 0.85 to 1.52, p = 0.392). 117 adverse events from 31 astragalus-treated patients and 41 standard care-controlled patients were documented. The 48-week endpoint systolic blood pressure was 7.9 mmHg lower (95 %CI: -12.9 to -2.8, p = 0.003) in the astragalus-treated patients. 113 (96 %) and 107 (91 %) patients had post-randomization and endpoint primary outcome measures, respectively. CONCLUSION: In patients with type 2 diabetes, stage 2 to 3 CKD and macroalbuminuria, add-on astragalus for 48 weeks further stabilized kidney function on top of standard care.

BACKGROUND: The rise in antimicrobial resistance means that alternative approaches for the treatment and prevention of urinary tract infection (UTIs) are required. OBJECTIVE: To evaluate the safety and efficacy of a D-mannose-based dietary supplement (D-mannose, citric acid, prebiotic fibers, Astragalus, and dandelion; DAPAD complex) for the treatment of uncomplicated acute E. coli UTIs. DESIGN, SETTING, AND PARTICIPANTS: This was a single-center, randomized, double-blind, placebo-controlled trial conducted from April 2021 to October 2021 in Rajalakshmi Hospital and Research Centre (Bangalore, India). The participants were nonmenopausal women with an acute uncomplicated E. coli UTI. UTI was diagnosed according to the presence of at least one urinary symptom and bacteriuria (>100 000 CFU/ml). INTERVENTION: The DAPAD complex was administered twice a day for 5 d, with phenazopyridine and alkalizing agents as the standard of care (SOC). The control group received placebo with SOC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Subjective (clinical resolution/response) and objective (midstream bacteriuria) outcomes were evaluated at the end of therapy (day 6) and at day 35 of follow-up. Adverse events were recorded. Categorical variables were analyzed using χ2 and Fisher's exact tests; a p value <0.05 was considered significant. RESULTS AND LIMITATIONS: Seventy women were enrolled and equally randomized to the two groups. Clinical resolution was higher in the DAPAD group at 6 d (34.3% vs 0%; p < 0.0001) and 35 d from baseline (88.6% vs 20%, p < 0.0001). At day 35, no patients in the DAPAD group had moderate or severe symptoms, whereas 25.7% (nine/35) and 11.4% (four/35) of patients in the placebo group had moderate and severe symptoms, respectively. Bacteriological resolution was also higher in the DAPAD group at day 6 (85.7% vs 14.3%; p < 0.0001) and day 35 (100% vs 40%; p < 0.0001). Three mild adverse events (4.26%) unrelated to the investigated product were recorded, all of which were medically treated. CONCLUSIONS: The DAPAD complex dietary supplement is effective and safe for treatment of acute uncomplicated E. coli UTIs. PATIENT SUMMARY: Our results show that f

Renal cell carcinoma (RCC) is a highly prevalent malignant tumor of the urinary system, and resistance to the targeted drug sunitinib remains a major clinical challenge. This study investigated the mechanism underlying the action of Astragalus polysaccharide (APS) in RCC and demonstrated that APS can degrade ZEB1 via the ubiquitin proteasome pathway, downregulate the expression of downstream SCD1, and inhibit the Wnt/β-catenin signaling pathway. In vitro experiments revealed that the combination of APS and sunitinib significantly suppressed the proliferation, migration, and invasion of renal cancer cell lines such as 786-O and A498. Additionally, this combination promoted apoptosis and induced G1 phase cell cycle arrest. In vivo validation in a nude mouse xenograft model confirmed that this combined regimen synergistically reduced the tumor volume without causing obvious organ toxicity. Clinical data further verified that high ZEB1 expression is associated with poor prognosis in RCC and that ZEB1 promotes tumor progression by regulating SCD1 to activate the Wnt signaling pathway. In conclusion, APS enhances the sensitivity of RCC to sunitinib by targeting the ZEB1-SCD1-Wnt axis, thus providing a theoretical basis for the clinical application of this combined therapy.

Saline-alkaline Oreochromis niloticus Nile tilapia aquaculture is vital for expanding aquatic production, but gill rot disease causes severe losses. Conventional antibiotic use breeds resistance, pollution, and safety risks, urging eco-friendly alternatives. This study first isolated and identified the pathogen responsible for gill rot in saline-alkaline cultured tilapia as Aeromonas veronii (strain ONG-1) through morphological, biochemical, and 16S rRNA phylogenetic analyses. It then evaluated the efficacy of astragalus polysaccharide (APS), chitosan (CS), and their combination (astragalus polysaccharides + chitosan, APS + CS) against this pathogen: in vitro tests revealed both CS (stronger) and APS exerted direct bactericidal activity. In vivo experiments demonstrated that APS + CS significantly reduced cumulative mortality by 38.1 % (from 70.0 % to 43.3 %), lowered bacterial loads in tissues (gill, liver, and head kidney) and blood, alleviated tissue edema, regulated hematological indices (balancing immune cell proportions), enhanced serum innate immunity (complement C3, lysozyme), improved oxidative balance (T-SOD, MDA), and modulated immune-related genes (pro-inflammatory cytokine IL-1β, anti-inflammatory cytokine TGF-β, and antimicrobial peptide hepcidin) by downregulating IL-1β, upregulating TGF-β and hepcidin (changing 2.3, 1.8, and 2.1 -fold in head kidney, respectively). The results showed that CS had strong early bactericidal activity (disrupting bacterial membranes), while APS had long-term immunoregulatory potential (enhancing antioxidant/cytokine responses); APS + CS synergized by combining immediate pathogen clearance and sustained immune enhancement. These findings clarify the pathogenic basis of tilapia gill rot in saline-alkaline water and validate APS + CS as a promising antibiotic alternative, providing theoretical support and technical guidance for sustainable disease control in such aquaculture systems.

Ovarian cancer (OC) is a leading cause of mortality among gynecologic malignancies. Cisplatin (DDP) is a first-line chemotherapy agent, but resistance to DDP often develops, compromising its efficacy. Astragalus membranaceus (AS), a traditional Chinese medicine, has shown promise in enhancing chemotherapy sensitivity due to its anti-inflammatory and immunomodulatory properties. This study investigates the potential of AS to overcome DDP resistance in OC. We integrated multiple independent DDP-resistant OC datasets identified 337 DDP resistance-associated targets. Network pharmacology identified 20 active compounds in AS, with 22 potential targets related to DDP resistance. GO and KEGG analyses revealed enrichment in pathways involving inflammation and cell adhesion. Survival analysis indicated nine genes significantly associated with OC prognosis and immune infiltration. Molecular docking showed strong binding affinities between AS compounds and these targets. In vitro, assays demonstrated that AS combined with DDP significantly inhibited cell proliferation and migration while inducing apoptosis in DDP-resistant OC cells. Western blot analysis confirmed significant changes in critical proteins (IL1B, IL1A, SERPINE1, ITGA2, and AXL) with combined treatment. AS combined with DDP significantly enhances the inhibition of cell proliferation and migration while promoting apoptosis in DDP-resistant OC cells. These findings suggest that AS could be a valuable adjunct to DDP in overcoming chemoresistance in OC, potentially improving patient outcomes. © 2025. The Author(s).

BACKGROUND: Astragaloside IV (As), a bioactive tetracyclic triterpenoid saponin from Astragalus membranaceus, exhibits diverse pharmacological properties including anti-inflammatory, anticancer and immunomodulatory activities. However, its potential role as a targeted therapeutic agent for cisplatin sensitization in triple-negative breast cancer (TNBC) via the STING signaling pathway remains unexplored. PURPOSE: This study aimed to investigate the cisplatin-sensitizing potential of As in TNBC and elucidate its underlying molecular mechanisms. METHODS: Bioinformatic analysis identified key module genes from public databases using weighted gene co-expression network analysis (WGCNA), followed by feature selection via least absolute shrinkage and selection operator (LASSO) regression. Immune microenvironment characterization was performed using CIBERSORT deconvolution analysis. Potential targets of As in TNBC were systematically identified through multi-database mining, protein-protein interaction (PPI) network construction, pathway enrichment analysis and molecular docking simulations. Transcriptomic profiling revealed treatment-induced differentially expressed genes and enriched signaling pathways in murine tissues. The combinatorial anti-tumor efficacy was evaluated using orthotopic TNBC model (4T1 cell-derived) in vivo and 4T1, MDA-MB-231, and MCF-7 cell lines in vitro. Mechanistic validation was conducted through integrated in vivo and in vitro experiments. RESULTS: Integrated bioinformatics analysis (WGCNA, LASSO, and CIBERSORT) identified STING within a chemotherapy-sensitive module among six endoplasmic reticulum (ER)-associated gene co-expression networks. STING exhibited significant enrichment in antitumor immune pathways and correlated with heterogeneous immune cell infiltration. KEGG pathway analysis implicated immune/inflammatory signaling and DNA damage responses in the cisplatin-sensitizing effects of As. Molecular docking confirmed stable binding between As and STING (binding energy: -36.09 kcal/mol). In vivo, As synergistically enhanced cisplatin's tumor growth inhibition while mitigating cisplatin-induced toxicity, including weight loss, nephrotox

BACKGROUND: Sorafenib, as a first-line targeted drug for hepatocellular carcinoma (HCC), suffers from insufficient efficacy and dose-dependent toxic side effects, necessitating the development of combination therapy strategies. Clinical studies have shown that the Astragali radix - Curcumae rhizoma herb pair (ACHP) synergized with Sorafenib significantly enhanced the efficacy in advanced HCC patients, as well as improved immune function, but its synergistic mechanism remains unclear. PURPOSE: This study aimed to reveal the mechanisms by which ACHP synergistically enhances Sorafenib's anti-HCC efficacy through a dual-mode of "ferroptosis -immunomodulation", and to provide a solid theoretical basis for its clinical application. METHODS: UPLC-Q-TOF-MS/MS was employed for the component characterization of ACHP extract. In vivo and in vitro HCC models were established to evaluate the efficacy and safety of ACHP synergized with Sorafenib against HCC. Transcriptome sequencing was utilized to screen potential molecular mechanisms, while molecular biology techniques, flow cytometry and inhibitors were applied to detect ferroptosis-related markers and Th1 cell-mediated immune response markers, aiming to reveal the underlying mechanisms. RESULTS: A total of 30 components were identified from ACHP extract. Pharmacodynamic evaluations showed that ACHP synergized with Sorafenib significantly suppressed tumor growth and cell proliferation of HCC, and exhibited favorable safety. Transcriptome sequencing suggested that the anti-HCC effect of ACHP synergized with Sorafenib might involve the induction of ferroptosis and modulation of Th1/Th2 cell differentiation. Further in vivo and in vitro experiments demonstrated that ACHP enhanced Sorafenib's efficacy by regulating the xCT/GPX4 and ACSL4/ALOX15 pathways to induce lipid peroxidation-related ferroptosis. Meanwhile, ACHP activated the IL-12/STAT4 signaling axis, promoted Th1 cell differentiation and up-regulated IFN-γ secretion, and further induced M1-type macrophages polarization and IL-12 secretion, thereby strengthening the IL-12-driven positive feedback immune loop. CONCLUSION: ACHP enhances Sorafenib's efficacy by inducing l

Food components and herbal substances can inhibit or enhance the therapeutic effects of drugs, thus influencing their efficacy and safety. As relatively little in known of these interactions, the aim of this review is to shed further light on the potentially dangerous influences that food and herbs may have on cytochrome P450 enzyme (CYP) and monoamine oxidase (MAO) activity in the first stage of drug biotransformation. The review includes documented cases in which such interactions have led to health complications in patients. For example, fruit juices, such as grapefruit juice, cranberry juice, and pomegranate juice, have been found to interact with drugs, and to particularly inhibit CYP450 activity, and commonly used herbs are known to inhibit (e.g., Astragalus membranous) or induce (e.g., Hypericum perforatum) CYP enzymes involved in drug metabolism. CYP is also induced by polycyclic aromatic hydrocarbons (PAHs), found in grilled meat and tobacco smoke. The paper also discusses the toxic effects of tyramine, present in inter alia blue cheese, resulting from interactions with MAO-metabolised drugs. Most importantly, while the quantity of food and herbs consumed plays a significant role in the described drug interactions, it is possible for toxic effects to be observed even after the consumption of relatively small amounts. Patients are encouraged to consult a healthcare provider about any potential drug interactions that may occur when starting a new medication.

BACKGROUND: Doxorubicin (DOX) is a widely used anthracycline antibiotic for the treatment of breast cancer, liver cancer, lymphoma, and other malignant tumors. However, its clinical application is limited by the side effects and drug resistance. Astragalus injection has been combined with DOX in the treatment of cancer, which improves the curative effect and reduces drug resistance. This study investigated the interaction between DOX and Astragalus injection and elucidated the potential mechanism. METHODS: The pharmacokinetics of DOX injection (7 mg/kg, intraperitoneal injection) with or without Astragalus injection (4.25 mL/kg/day for 14 days, intraperitoneal injection) were investigated in plasma from male Sprague-Dawley rats (n = 6) by UPLC-MS/MS. The group without the Astragalus injection was set as the control group. Additionally, the effects of Astragalus injection on CYP450 enzyme activities were assessed using a rat liver microsome incubation system with cocktail probe drugs. RESULTS: Astragalus injection significantly increased the Cmax (2090.01 ± 99.60 vs. 5262.77 ± 111.15 ng/mL) and AUC0-t (1190.23 ± 104.43 vs. 3777.27 ± 130.55 μg/L × h) and prolonged the t1/2α (0.09 ± 0.02 vs. 0.14 ± 0.04 h) of DOX. Astragalus injection significantly inhibited the activity of CYP1A2, CYP2C9, CYP2E1, and CYP3A4, and enhanced the activity of CYP2D1 with a metabolic elimination rate of 30.11 ± 2.67% vs. 19.66 ± 3.41%, 35.95 ± 2.57% vs. 23.26 ± 3.57%, 13.43 ± 2.56% vs. 9.06 ± 2.51%, 47.90 ± 6.30% vs. 25.87 ± 2.55%, 17.62 ± 1.49% vs. 24.12 ± 2.91%, respectively (p < 0.05). CONCLUSION: The co-administration of DOX and Astragalus injection alters the systemic exposure of DOX by affecting the metabolism of DOX and the activity of CYP450 enzymes. These findings highlight the importance of drug-drug interactions when combining Astragalus injection with DOX and provide a basis for optimizing combination therapies to address DOX resistance and toxicity.

BACKGROUND: Cisplatin (DDP) has been used in the treatment of various human cancers. However, DDP alone lacks efficacy in treating triple-negative breast cancer (TNBC), and its clinical application is often hampered by side effects. Astragalus polysaccharide (APS) is one of the active components extracted from Astragalus membranaceus and has gained attention for its various biological properties. This research is aimed to evaluate the effectiveness of a combination of APS and DDP on TNBC and explore the potential mechanisms. METHODS: The efficacy and mechanisms of single or combined treatment were evaluated using Cell Counting Kit-8 (CCK8) assay, Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) staining, wound healing assay, trans-well invasion/migration assay, hematoxylin-eosin (HE) staining, immunohistochemical (IHC) staining, Western Blot (WB) analysis, and fluorescence-activated cell sorting (FACS). An orthotopic model of TNBC was used to assess the in vivo treatment efficacy of single or combination treatment. RESULTS: APS significantly enhanced the anti-proliferative, anti-migratory, and anti-invasive effects of DDP on TNBC cells. The combination of APS and DDP downregulated anti-apoptotic genes (Bcl2 and Bcl-xL) while upregulating pro-apoptotic genes (Puma, Cle-Caspase3, Cle-PARP), leading to enhanced apoptosis. This combination treatment increased E-cadherin levels, decreased Vimentin, Snail, Slug, and Twist levels, and effectively suppressed epithelial-mesenchymal transition (EMT)-associated cell invasion. In the orthotopic model of TNBC, a synergistic reduction in tumor growth was observed in mice treated with APS and DDP. Additionally, the combination of APS and DDP induced the infiltration of CD8+ T lymphocytes into the tumor immune microenvironment. CONCLUSION: The combination of APS and DDP exhibits more potent tumor inhibition and anti-tumor immunity than either agent alone, representing a novel approach to enhance therapeutic efficacy without increasing the side effects of DDP. © 2025 The Authors.

Astragali Radix (AR) is one of the most widely used herbs in Asia and has a wide range of biological activities. These activities are attributed to its various compounds like flavonoids, saponins, and polysaccharides. AR and its major components are often used in combination with other drugs for the treatment of diseases such as cancer and cerebral ischemia. With the expanding range of AR combinations, the potential for herb-drug interaction (HDI) has been raised. Key targets in HDI studies include drug-metabolizing enzymes (DMEs) and transporters. Existing studies have shown that AR and its major components have various regulatory effects on these targets, notably CYP2C9, CYP3A4, UGT1A6, and P-gp. AR may contribute to HDI when it is taken with substrates of these biomolecules, such as tolbutamide, midazolam, and digoxin. However, there are also different views in the current study, such as the effect of AR on CYP3A4. To better understand the interactions of AR with drugs, we review the metabolic pathways and pharmacokinetic parameters of the main components of AR. Meanwhile, the regulatory effects and mechanisms of AR on DMEs and transporters are summarized to provide a theoretical and technical basis for the rational use of AR in clinical practice.

Multidrug resistance (MDR) remains the most difficult problem facing conventional chemotherapy for cancers. Astragalus membranaceus is a historically traditional Chinese medicine. One of its bioactive components, formononetin, exhibits antitumor effects on various cancers. However, the effects of formononetin on MDR cancers have not been evaluated. Therefore, we investigated the defense's effects of formononetin on MDR. We used rhodamine 123 and doxorubicin efflux assays to analyze the inhibition kinetics of P-glycoprotein (P-gp) mediated-efflux. Cell viability was detected by sulforhodamine B assay, and the synergistic effects of formononetin combined with chemotherapeutic agents were further calculated using CompuSyn software. Molecular docking was performed with iGEMDOCK. We discovered that formononetin considerably induced oxidative stress and the disruption of mitochondrial membrane potential in MDR cancer cells. Furthermore, formononetin inhibits the P-gp efflux function by ATPase stimulation and the uncompetitive inhibition of P-gp-mediated effluxes of rhodamine 123 and doxorubicin. The molecular docking model indicates that formononetin may bind to P-gp by strong hydrogen bonds at Arginine (Arg) 489 and Glutamine (Gln) 912. Formononetin exhibits significant synergistic effects with vincristine and doxorubicin toward MDR cancer cells, and it synergistically suppressed tumor growth in vivo with paclitaxel. These results suggest that formononetin should be seen as a potential candidate for the adjuvant therapy of MDR cancers.

BACKGROUND: Cancer remains one of the leading causes of death worldwide, underscoring the need for novel therapies. SH003, an herbal mixture composed of Astragalus membranaceus, Angelica gigas, and Trichosanthes kirilowii, is a traditional Korean medicine formulation with potential to enhance chemotherapy efficacy and reduce toxicity. This study aimed to assess the safety and determine maximum tolerated dose of SH003 in combination with docetaxel in patients with advanced solid tumors, specifically lung and breast cancer. METHODS: This Phase I, multi-center, open-label, dose-escalation study enrolled patients with advanced lung or breast cancer. Participants received SH003 orally at doses of 2400, 3600, or 4800 mg daily, alongside intravenous docetaxel (75 mg/m²) every 21 days. A 3 + 3 dose-escalation design was employed to determine the maximum tolerated dose. Safety assessments and adverse event monitoring were conducted at each treatment cycle. RESULTS: Twelve participants were enrolled. SH003 was well tolerated up to 4800 mg/day, with no dose-limiting toxicities attributed to SH003. The most common adverse events were neutropenia, primarily associated with docetaxel, and mild dermatologic reactions such as eczema, rash acneiform, and pruritus. Preliminary evidence of disease stabilization was observed in several participants. CONCLUSION: The combination of SH003 and docetaxel demonstrated a favorable safety profile, with 4800 mg/day identified as maximum tolerated dose for SH003. These findings support further investigation in Phase II trials to assess therapeutic efficacy.Trial Registration: Clinical Research Information Service (https://cris.nih.go.kr) KCT0004770.

BACKGROUND: The immune system is essential for defending the body against pathogens and maintaining homeostasis. Recent global public health challenges have increased interest in natural products that enhance immune function. SH003, a compound derived from Astragalus membranaceus, Angelica gigas Radix, and Trichosanthis Radix, has shown potential as an immunomodulatory agent. This study aims to evaluate the efficacy and safety of SH003 in improving immune function in individuals with a mildly weakened immune systems. METHODS: This randomized, double-blind, placebo-controlled trial will be conducted over 8 weeks with 120 participants aged 19 to 75 years who have experienced two or more upper respiratory infections in the past year. Participants will be randomly assigned to receive either SH003 or a placebo. The primary outcome is the change in natural killer cell activity. Secondary outcomes include cytokines levels (IL-2, IL-12, IFN-γ, TNF-α), inflammation markers (CRP, ESR), and stress and respiratory symptoms. Safety outcomes will be monitored through vital signs and laboratory tests. DISCUSSION: This study represents the first clinical trial to evaluate the immune-enhancing effects of SH003 in a general population with mild immune system impairment. The results could offer valuable insights into the potential of SH003 as a novel immune support intervention. TRIAL REGISTRATION: Clinical Research Information Service (registration number: KCT0009424, May 10, 2024, https://cris.nih.go.kr ). Retrospectively registered. © 2025. The Author(s).