The Chinese traditional herb Tripterygium wilfordii Hook f (TwHF) has been widely used in the treatment of autoimmune and inflammatory diseases. Over the past few decades, great efforts have been made to explore modern preparations of TwHF with higher efficacy, solubility, and lower toxicity. In this study, we reviewed several examples both of naturally occurring compounds and their derivatives in TwHF, and summarized the preclinical evaluations with regard to autoimmune and inflammatory diseases. All of the candidate compounds described herein have been or are currently in clinical trials. Although some studies encountered problems, the data still provided valuable references for future studies. (5R)-5-hydroxytriptolide (LLDT-8, Leitengshu) is a novel triptolide derivative with potent immunosuppressive and anti-inflammatory activities developed at Shanghai Institute of Materia Medica. Indeed, a Phase I clinical trial for this compound has been completed in rheumatoid arthritis patients. The results will provide the basis for the further exploration of this ancient herb and encourage the research and development of valuable traditional Chinese medicine.
IntroductionFor thousands of years, natural products have played an important role throughout the world in treating and preventing human diseases [1][2][3][4][5] . The discovery and development of immunosuppressants from natural sources have an impressive record: mycophenolic acid (MPA) and cyclosporin A (CsA), the fungal metabolites isolated in 1932 [6] and 1970 [7] , respectively; rapamycin, found in 1975 [8] ; FK506, extracted from a culture filtrate of Streptomyces tsukubaensis in 1987 [9,10] ; and fingolimod (FTY720), described in 1995 [11] . Although the current industry model for drug discovery does not favor natural products, the resources are so vast as to seem unlimited, and these emerging tools will provide important discoveries, leading to new medicines [12] . Furthermore, the drugs already in use as immunosuppressants (eg, cyclophosphamide, methotrexate, azathioprine, cyclosporin) are associated with some significant problems, including toxicity, a lack of reversibility, and increased susceptibility to viral and other infections [13] . Indeed, exploring new and innovative immunosuppres-* To whom correspondence should be addressed.E-mail jpzuo@mail.shcnc.ac.cn Received 2012-06-11 Accepted 2012-07-04 sants from natural sources has now become a focus of intense research.Tripterygium wilfordii Hook f (TwHF) and its extracts have been widely used in the treatment of autoimmune and inflammatory diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and dermatomyositis (DM) [14][15][16][17][18] , and have beneficial effects on tissue and organ transplantation [19,20] . In 1993, the ethyl acetate (EA) extract of TwHF was entered into a Phase I study for the treatment of RA patients [21][22][23][24][25] , and many clinical trials have tested triptolide for the treatment of RA and psoriasis [26,27] . In addition, PG490-88/F60008 (F...