Antimicrobial & Antidepressant: St. John's Wort

When I did the series on Antimicrobial studies, I thought that I did one on the herb St. John's wort, but when I went to search for the post I couldn't find it; therefore, I'm assuming that I didn't do one (it was around the time the computer crashed). St. John's wort is a good herb to use in combination with other herbs.

Many people associate SJW as an antidepressant and treating the nervous system. There are numerous studies on the subject, but many people don't know that SJW is also a good one to use when combating microbial organisms. There have been some studies on findings involving microbes and depression -- SJW might be a good herb to consider for it's actions covering these two subjects. The postings below are on SJW as an antimicrobial and some other studies. 

ANTIMICROBIAL

http://aac.asm.org/cgi/content/abstract/45/2/517

Antimicrobial Agents and Chemotherapy, February 2001, p. 517-524, Vol. 45, No. 2
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.2.517-524.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Pharmacokinetics, Safety, and Antiviral Effects of Hypericin, a Derivative of St. John's Wort Plant, in Patients with Chronic Hepatitis C Virus Infection

Jeffrey M. Jacobson,^1,* Lawrence Feinman,² Leonard Liebes,³ Nancy Ostrow,¹ Victoria Koslowski,¹ Alfonso Tobia,⁴ Bernard E. Cabana,⁴ Dong-Hun Lee,³ John Spritzler,⁵ and Alfred M. Prince⁶

Department of Medicine, Mount Sinai Medical Center,¹ Department of Medicine, New York University Medical Center,³ and Laboratory of Virology and Parasitology, New York Blood Center,⁶ New York, and Medical Service, Veterans Affairs Medical Center, Bronx,² New York; VimRx Pharmaceuticals, Wilmington, Delaware⁴; and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts⁵

Received 2 March 2000/Returned for modification 4 July 2000/Accepted 27 September 2000

Hypericin is a natural derivative of the common St. Johns wort plant, Hypericum perforatum. It has in vitro activity against several viruses, including bovine diarrhea virus, a pestivirus with structural similarities to hepatitis C virus (HCV). We conducted a phase I dose escalation study to determine the safety and antiviral activity of hypericin in patients with chronic HCV infection. The first 12 patients received an 8-week course of 0.05 mg of hypericin per kg of body weight orally once a day; 7 patients received an 8-week course of 0.10 mg/kg orally once a day. At the end of the 8-week period of treatment, no subject had a change of plasma HCV RNA level of more than 1.0 log₁₀. Five of 12 subjects receiving the 0.05-mg/kg/day dosing schedule and 6 of 7 subjects receiving the 0.10-mg/kg/day dosing schedule developed phototoxic reactions. No other serious adverse events associated with hypericin use occurred. The pharmacokinetic data revealed a long elimination half-life (mean values of 36.1 and 33.8 h, respectively, for the doses of 0.05 and 0.1 mg/kg) and mean area under the curve determinations of 1.5 and 3.1 µg/ml × hr, respectively. In sum, hypericin given orally in doses of 0.05 and 0.10 mg/kg/d caused considerable phototoxicity and had no detectable anti-HCV activity in patients with chronic HCV infection.

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Excerpt from site
http://www.dcmsonline.org/jax-medicine/2001journals/Feb2001/herbs.htm

St. John's Wort (Hypericum perforatum) has received national attention as an herbal anti-depressant. Surprisingly, it is most effective as an anti-vial and anti-bacterial. In vitro studies have shown that the two major compounds (hypericin and pseudohypericin) exhibit strong antiviral activity against HSV I and II as well as influenza types A and B, vesicular stomatitis virus and remarkable antiviral activity against Epstein-Barr virus.^{17, 18} St. John's Wort also have broad spectrum antimicrobial activity against both Gram-positive and Gram-negative bacteria including Staphylococcus aureus, Streptococcus mutans, Proteus vulgaris, E. coli, and Pseudomonas aeruginosa.¹⁹ Research suggests that Hypericum may be a useful adjunctive treatment for herpes simplex, mononucleosis, and influenza, and because of its antidepressant and anti-EBV activity, a promising treatment for fibromyalgia and chronic fatigue. Several studies show effectiveness of Hypericum against HIV.^20-22

St. John's Wort has a historical use as an topical aid to wound healing. Research has demonstrated antibacterial and wound healing activity.²³ The usual oral dose of Hypericum standardized to 0.3% hypericin is 300 mg three times a day. There are many potential drug interactions, including: sedative-hypnotics, 5-HT antagonists, cyclosporine, digoxin, nefazodone, NNRTI's, tricyclic antidepressants, photosensitizing drugs, protease inhibitors, theophylline, and coumadin. Hypericum is metabolized by the cytochrome P-450 system and caution should be used with any drugs using the same metabolic pathway.

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http://www.ncbi.nlm.nih.gov/pubmed/12634994?dopt=Abstract

Hautarzt. 2003 Mar;54(3):248-53. Epub 2003 Feb 18
Topical treatment of atopic dermatitis with Hypericum cream. A randomised, placebo-controlled, double-blind half-side comparison study

[Article in German]

Schempp CM, Hezel S, Simon JC.

Universitäts-Hautklinik Freiburg

BACKGROUND: Recent investigations suggest an anti-inflammatory and antibacterial effect of hyperforin, which is a major constituent of Hypericum perforatum L. (Saint John's wort). OBJECTIVE: In a half-side comparison study we assessed the efficacy of a cream containing Hypericum extract standardized to 1.5% hyperforin (verum) in comparison to the corresponding vehicle (placebo) for the treatment of subacute atopic dermatitis. The study design was a prospective randomized placebo-controlled double-blind single center study. METHODS: In twenty one patients suffering from mild to moderate atopic dermatitis (mean SCORAD 44.5) the treatment with verum or placebo was randomly allocated to the left or right site of the body, respectively. The patients were treated twice daily over a period of four weeks. Eighteen patients completed the study. The severity of the skin lesions on the left and right site was determined by means of a modified SCORAD-index (primary endpoint). RESULTS: The intensity of the eczematous lesions improved on both sites of treatment. However, the Hypericum cream was significantly superior to the vehicle at all clinical visits (days 7, 14, 28) (p<0.05). Skin colonization with Staphylococcus aureus was reduced by both verum and placebo, showing a trend to better antibacterial activity of the Hypericum cream (p=0.064). Skin tolerance and cosmetic acceptability was good or excellent with both the Hypericum cream and the vehicle (secondary endpoints). CONCLUSION: Hypericum cream was significantly superior to its vehicle in the topical treatment of mild to moderate atopic dermatitis. The therapeutic efficacy of the Hypericum cream should be evaluated in further studies with larger patient cohorts, in comparison to standard therapeutic agents (i.e. corticosteroids).

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http://www.ncbi.nlm.nih.gov/pubmed/11434846?dopt=Abstract
Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media.

Sarrell EM, Mandelberg A, Cohen HA.
Pediatric and Adolescent Ambulatory Community Clinic of General Health Services, Hairis 7 Moshav Gan-Haim, 44910 Israel. sarrell@netvision.net.il

OBJECTIVE: To determine the efficacy and tolerance of Otikon Otic Solution (Healthy-On Ltd, Petach-Tikva, Israel), a naturopathic herbal extract (containing Allium sativum, Verbascum thapsus, Calendula flores, and Hypericum perforatum in olive oil), compared with Anaesthetic (Vitamed Pharmaceutical Ltd, Benyamina, Israel) ear drops (containing ametocaine and phenazone in glycerin) in the management of ear pain associated with acute otitis media (AOM). DESIGN: Children between the ages of 6 and 18 years who experienced ear pain (otalgia) and who were diagnosed with eardrum problems associated with AOM were randomly assigned to be treated with Otikon or Anaesthetic ear drops, which were instilled into the external canal(s) of the affected ear(s). Ear pain was assessed using 2 visual analog scales: a linear scale and a color scale. Pain assessment took place throughout the course of 3 days. The mean score of pain reduction was used to measure outcome. SETTING: Primary pediatric community ambulatory centers. PARTICIPANTS: One hundred three children aged 6 to 18 years who were diagnosed with otalgia associated with AOM. RESULTS: Each of the 2 treatment groups were comparable on the basis of age, sex, laterality of AOM, and the effectiveness of ameliorating symptoms of otalgia. The 2 groups were also comparable to each other in the initial ear pain score and in the scores at each application of Otikon or Anaesthetic drops. There was a statistically significant improvement in ear pain score throughout the course of the study period (P =.007). CONCLUSIONS: Otikon, an ear drop formulation of naturopathic origin, is as effective as Anaesthetic ear drops and was proven appropriate for the management of AOM-associated ear pain.
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http://www.ncbi.nlm.nih.gov/pubmed/10893582?dopt=Abstract
J Urol. 2000 Aug;164(2):349-51

Fluorescence detection of flat bladder carcinoma in situ after intravesical instillation of hypericin.

D'Hallewin MA, De Witte PA, Waelkens E, Merlevede W, Baert L.
Division of Urology, Laboratory for Pharmaceutical Biology and Division of Biochemistry, University Hospital Gasthuisberg, K. U. Leuven, Leuven, Belgium.

PURPOSE: We determined the sensitivity and specificity of detecting flat bladder carcinoma in situ through fluorescent detection after intravesical hypericin instillations. MATERIALS AND METHODS: The study included 40 patients, of whom 26 presented with macroscopic visible tumor, 9 had a positive cytology without visible tumor and 5 underwent cystoscopy after bacillus Calmette-Guerin instillations (4) or radiotherapy (1). We instilled 40 ml. of a 8 microM. solution of hypericin intravesically for at least 2 hours. Fluorescence excitation with blue light was effective up to 16 hours after termination of the instillation. RESULTS: All visible papillary tumors showed red fluorescence. In addition, 134 flat fluorescent areas were detected. Analysis of 281 biopsies from flat bladder wall indicated 93% sensitivity and 98.5% specificity for detecting carcinoma in situ. Visible lesions resulting from radiotherapy, chemotherapy or immunotherapy did not show any fluorescent signs and, therefore, did not induce false-positive readings. There were no signs of photobleaching during inspection and resection. CONCLUSIONS: We report a simple yet comprehensive endoscopic method for early detection of bladder cancer, including carcinoma in situ. Hypericin induced fluorescence has a high sensitivity and specificity for detection of bladder transitional cell carcinoma, papillary and flat carcinoma in situ. When carcinoma in situ is suspected, this technique is highly recommended.
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http://www.ncbi.nlm.nih.gov/pubmed/16911897?dopt=Abstract

Complement Ther Med. 2006 Sep;14(3):175-84. Epub 2006 Jun 13

A Phase II study of St. John's Wort for smoking cessation.

Lawvere S, Mahoney MC, Cummings KM, Kepner JL, Hyland A, Lawrence DD, Murphy JM.
Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.

OBJECTIVES: To examine the feasibility and efficacy of St. John's Wort (SJW) for smoking cessation. DESIGN: This one-arm Phase II study utilized an exact two-stage group sequential design with a 1-week run-in period between the start of SJW treatment and the designated quit date. A total of 37 smokers (ages 18-65 years, smoking > or = 10 cigarettes/day) were started on SJW. Thirteen failed to make a verified quit attempt on the predesignated date and were taken off study resulting in 24 evaluable subjects. SETTING: Smokers completed clinic visits at a cancer center with interval telephone calls and mailings. INTERVENTION: Standardized SJW, 450 mg capsules taken orally twice daily along with cessation counseling messages. MAIN OUTCOME MEASURES: Subjects completed validated surveys and a focused physical examination at baseline. Evaluable subjects were defined as those subjects who made a confirmed quit attempt on their "quit date" 1 week following initiation of SJW. Smoking status was determined through self-report and bioverification using carbon monoxide (CO) testing. RESULTS: Among evaluable subjects, the 12-week quit rate was 37.5% (9/24). Quitters had no significant change in weight from baseline to 12-weeks cessation. Use of SJW was generally well tolerated. CONCLUSIONS: Based upon these results (which suggest that SJW may be effective in maintaining smoking cessation) and the high compliance and few AEs, we conclude that SJW demonstrates feasibility for use in smoking cessation. If SJW proves to be effective in larger controlled studies, it could represent a less expensive, more readily accessible and well-tolerated agent to promote tobacco cessation.

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ANTIDEPRESSANT

http://www.dailymail.co.uk/health/article-1072414/St-Johns-Wort-plant-effective-Prozac-treating-depression-say-scientists.html

'St John's Wort plant as effective as Prozac for treating depression', say scientists

By Daniel Martin
Last updated at 2:02 PM on 08th October 2008 - Daily

It has long been a happy alternative for those reluctant to pop pills for depression.

But the herbal extract St John's Wort now has more than just cheerful converts to testify to its mood-lifting powers.

In what is billed as the most thorough study of the plant, scientists have found it is just as effective as Prozac at treating depression.

It also had fewer side effects than many standard drugs used to help those battling despair.

Researchers compared the effects of the plant hypericum perforatum - popularly known as St John's Wort - with placebos or a wide range of old and new anti-depressants, including those from the new generation of SSRI drugs, such as Prozac and Seroxat.

The findings could prompt more GPs to prescribe St John's Wort.

In Germany, it is commonly given to children and teenagers.

Experts do not know exactly how the plant lifts depression, although most believe it probably works by keeping the chemical serotonin, which is linked to positive moods, in the brain for longer.

The study's lead author, Dr Klaus Linde, from the Centre for Complementary Medicine in Munich, pooled data from 29 studies involving 5,489 patients with mild to moderately severe depression.

'Overall, the St John's Wort extracts tested in the trials were superior to placebo, similarly effective as standard anti-depressants, and had fewer side effects than standard anti-depressants,' he said.

But he pointed out that St John's Wort products available in health food shops and chemists differed greatly and some may be more effective than others.

'Using a St John's Wort extract might be justified but products on the market vary considerably, so these results only apply to the preparations tested,' he explained.

The findings were published by the Cochrane Library, which specialises in systematic reviews of research studies.

A separate study has found St John's Wort, available in countless health shops, is the only alternative medicine proven to have an effect.

Others, including ginseng, liquid tonic, cat's claw, gingko biloba and royal jelly, had no firm base in evidence and could be dangerous when taken with other drugs, according to the study by St James' University Hospital in Leeds.

Some other studies however have indicated that St John's Wort may interfere with the effectiveness of the contraceptive pill.

Other reported effects have included dizziness, tiredness and hair loss.

The extract has become a popular alternative to anti-depressants such as Prozac and Seroxat in recent years following fears over the safety of SSRI (selective serotonin re-uptake inhibitor) drugs.

Doctors have been told not to prescribe most SSRIs to under-18s because of an increased risk of suicide.

Experts have also said they could not rule out a suicide risk to older users.

Another study found that pregnant women who take SSRI drugs were at risk of having babies with birth defects such as cleft palates and heart problems.

Four out of five GPs have admitted overprescribing Prozac and similar drugs.

They blamed a lack of suitable alternatives, including behavioural therapy and social care as well as medicines.


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