We analyzed the clinical features of 21 cases with drug-induced liver injury due to Kampo medicines between the years 2000 and 2009 in our institute. The mean age in these cases was 55.2 ± 13.4 years. Five of the cases were men, and 16 were women. In 17 of the 21 cases, drug-induced liver injury had occurred within 3 months after beginning Kampo medicines. There were no subjective symptoms in 11 cases. Nine cases of both hepatocellular injury, and of mixed-type injury were seen. Causative Kampo medicines included an Ogon (Scutellariae Radix) component in 19 cases. A drug-induced lymphocyte stimulation test (DLST) was performed in 5 cases. The test was positive for Kampo medicines in only one of the 5 cases. Liver injury improved or normalized in 18 cases (85.7%) after discontinuing causative Kampo medicines. In another 2 cases, liver injury normalized after changing a Kampo medicine to the same prescription without Ogon. These results suggest that even if patients complain of no symptoms we must perform blood tests to check liver function within 3 months of prescribing Kampo medicines, especially those including Ogon, to facilitate early diagnosis of drug-induced liver injury.drug-induced liver injury, Ogon, DLST, hepatocellular injury type, early detection

Recent findings have suggested that organic acids produced by anaerobic intestinal bacteria might contribute to the pathogenesis of colonic ulcers. In this study, it was shown that butyrate caused potent cytotoxicity in the murine normal colonic epithelial cells MCE301 at physiological concentrations. Several markers of apoptosis, such as phosphatidyl serine externalization, cytochrome c release, DNA fragmentation, and chromatin condensation were negative after butyrate exposure. Inhibitor of caspases failed to protect against butyrate cytotoxicity. By transmission electron microscopy, marked swollen mitochondria and vacuolization within the cytoplasm was observed by treatment of butyrate. Collective, these data indicated that butyrate-induced cell death caused through a necrosis-like process. Butyrate induced cell death was reduced partially by treatment with prednisolone or 5-aminosalicylates in a concentration dependent manner. These results suggest that (1) butyrate induces necrotic cell death but not apoptotic cell death, and (2) the necrotic cell death induced by butyrate may be useful as a novel in vitro model of ulcerative colitis to screen useful drugs for the treatment of the disease.

The commercial quality of Japanese Angelica radices -- Angelica acutiloba Kitagawa (Yamato-toki) and A. acutiloba Kitagawa var. sugiyama Hikino (Hokkai-toki) -- used in Kampo traditional herbal medicines, was studied by use of omics technologies. Complementary and alternative medical providers have observed in their clinical experience that differences in radix commercial quality reflect the differences in pharmacological responses; however, there has been little scientific examination of this phenomenon. The approach of omics, including metabolomics, transcriptomics, genomics, and informatics revealed a distinction between the radix-quality grades based on their metabolites, gene expression in human subjects, and plant genome sequences. Systems biology, constructing a network of omics data used to analyze this complex system, is expected to be a powerful tool for enhancing the study of radix quality and furthering a comprehensive understanding of all medicinal plants.

This exploratory study suggests that gene expression profiling is a possible approach for studying the effects of complex herbal remedies. Some of the genes studied seem to have functions related to the pharmacological effects of Kososan, which have been known for a long time.

Standardizing Kampo medical findings is a significant challenge in Kampo medical circles. These findings are fundamental to Kampo diagnosis. This paper introduces our attempt to standardize these findings in a specialized Kampo medical service facility.We started our project with verbal standardization. Nine medical doctors, all of whom were Kampo advisors or Kampo specialists, discussed issues such as subjective and objective findings, including those of the tongue, pulse, and abdomen, as well as the selection of target items, criteria for judgments on each item, and associated issues. When discussing the above issues, descriptions in prominent traditional Kampo texts were given most importance, and the wisdom of famous Kampo doctors since the Showa period was also given weight. In addition, we focused attention on clarifying the criteria for making judgments.One hundred and twenty items were selected as subjective Kampo findings. We selected 12, 6 and 10 items as objective Kampo findings in the tongue, pulse, and abdomen, respectively, and provided criteria for judgments with each.Our next challenge is to spread these standardizations in Kampo medical circles.