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 Table of Contents  
Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 120-125

Effect of ginseng against tuberculosis: A pathway interrelationship analysis

1 TWS Medical Center, Bangkok, Thailand
2 Department of Community Medicine Dr. D. Y. Patil University, Pune, Maharashtra, India; Department of Biological Science, Joseph Ayo Babalola University, Ikeji-Arakeji, Nigeria; Department of Tropical Medicine, Hainan Medical University, Haikou, China; Department of Medial Science, Faculty of Medicine, University of Nis, Nis, Serbia

Date of Submission26-Mar-2019
Date of Decision27-Apr-2019
Date of Acceptance09-May-2019
Date of Web Publication17-Jun-2019

Correspondence Address:
Dr. Won Sriwijitalai
TWS Medical Center, Bangkok
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bbrj.bbrj_55_19

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Background: The role of traditional herb in the treatment of infectious diseases is very interesting. There are many researches on the effects of herbs on infectious pathogens. The research on tuberculosis, a common public health disorder, is very interesting. Methods: In this study, the authors performed a network pharmacology analysis to assess the common biological pathway for the pharmacological effect of ginseng and the pathophysiological process of tuberculosis. Results: According to the interrelationship analysis, the authors can identify the common pathway through vimentin, showing that ginseng is useful in the treatment of tuberculosis. Conclusion: Ginseng has been found to be useful for the treatment of tuberculosis.

Keywords: Ginseng, tuberculosis, vimentin

How to cite this article:
Sriwijitalai W, Wiwanitkit V. Effect of ginseng against tuberculosis: A pathway interrelationship analysis. Biomed Biotechnol Res J 2019;3:120-5

How to cite this URL:
Sriwijitalai W, Wiwanitkit V. Effect of ginseng against tuberculosis: A pathway interrelationship analysis. Biomed Biotechnol Res J [serial online] 2019 [cited 2022 Aug 18];3:120-5. Available from: https://www.bmbtrj.org/text.asp?2019/3/2/120/260487

  Introduction Top

Illness is common to human beings. Humans were prone to diseases for a very long time, and treatment has been integral to health problem management for several millenniums. In the past, the local wisdom was widely used for health problem management. In ancient times, human usually use the locally available objects collected from surroundings for the management of diseases. This is the basic concept of traditional and alternative medicine.[1],[2],[3],[4] Of interest, several local wisdoms still persist in the present day. It is usually accepted as a valuable health-care wisdom. At present, traditional medicine is accepted for its advantage and might be used as a complementary medical therapy for common medical problems.[1],[5]

In traditional medicine, the concept of natural medicine is common.[6],[7],[8] The use of natural products is common in several traditional medicine systems.[9],[10],[11] The management of medical disorders by natural products is the basic concept in traditional medicine therapy. Focusing on traditional medicine management, medicinal herb is generally used. Several locally available plants have been well known and used by local people in different regions around the world as local herbs. Herbal therapy as a basic practice is used in traditional medicine system around the world. The role of traditional herb in the management of problematic infections is very interesting.

Several tropical infections including tuberculosis are presently studied on the usefulness of herbal therapy management.[12],[13] Herbal medicine is widely for the management of respiratory problems. Wagner et al. performed a meta-analysis on the available publications on herbal regimen for the management of cough and mentioned that “additional research, including other herbal treatments, is needed in this area.”[14] Focusing on respiratory tract infection, Anheyer et al. concluded that there is a moderate evidence for the efficacy and safety in the treatment of respiratory tract infections by herbal regimens.[15] At present, there are several reports on the usefulness of herbal regimens for therapeutic management of several diseases. For example, many herbs have proven their efficacy in the treatment of influenza.[16],[17],[18],[19],[20],[21],[22] Wu et al. concluded that traditional medicine has been widely used for treating respiratory tract infections including influenza; however, there is a lack of good designed clinical study on this topic.[23] Wu et al. suggested the use of advanced biomedical technology for systematical assessment of the efficacy of herbal regimens.[24] In addition to influenza, traditional herbal regimens are also confirmed for their effectiveness in the treatment of pneumonia.[24],[25] Yang et al. reported that herbs might help increase total effective rate and improve symptoms and signs of pneumonia.[24]

The usefulness of herbal therapy are presently studied on several tropical infections including tuberculosis. Of several chronic respiratory infections, tuberculosis is an important chronic infection that can result in chronic respiratory tract disorders. The use of herbs in the management of tuberculosis is very interesting. The effectiveness of herbal regimen is mentioned in the literature. For tuberculosis treatment, Jiang et al. performed a meta-analysis and concluded that using herbal regimen as a combined supplementary therapy to standard chemotherapy by antituberculosis drug was useful.[13] Samal retrospectively reviewed on ayurvedic management of pulmonary tuberculosis and noted that “Being a global public health crisis, it is highly recommended to carry out clinical trials on TB patients using Ayurvedic drugs and therapeutic regimens.”[26] In addition to treatment purpose, herbal regimen is also proposed as a possible useful preventive regimen against the adverse effects of common modern antituberculosis drugs.[27] Nevertheless, at present, information on the usefulness of the herbal regimens for treatment or prevention in tuberculosis is very limited. As noted by Liu et al., modern studies on the effect of drugs or herbs to treat tuberculosis or prevent liver damage in people on tuberculosis treatment are necessary.[27]

In this short article, the authors used a network pharmacology analysis to determine the common biological pathway for pharmacological effect of ginseng, a well-known traditional herb in Asia [Figure 1], and pathophysiological process of tuberculosis, an important communicable disease. From interrelationship analysis, a common pathway through vimentin node was identified. Hence, ginseng is promised for its advantage as additional therapy for tuberculosis.
Figure 1: Picture of ginseng

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  Methods Top

This study is a clinical informatics in silico investigation and does not deal with any patient, animal, or clinical specimen, and hence, it requires no written informed consent or ethical committee approval. The biological process network analysis is done. Based on network pharmacology principle,[28],[29],[30],[31],[32],[33],[34] the effect of Panax ginseng is studied for its interrelationship with the pathophysiological process of tuberculosis. In this study, P. ginseng is the reference standard of ginseng herb,[35],[36],[37],[38],[39] and the main active chemical compound is ginsenoside (chemical formula C42H72O14).[40],[41],[42],[43],[44],[45] This work requires no ethical approval from ethical committee since it does not deal with human or animal.

Information on the biological processes of pharmacological actions of ginseng and pathophysiological action of tuberculosis was obtained from direct database searching using international databases such as PubMed (www.pubmed.com) and Scopus (www.scopus.com).

After obtaining the searched information, the derived biological processes of both pharmacological actions of ginseng and pathophysiological actions of tuberculosis were reassessed and a common pathway was searched. Then, the common node was identified and used for further interrelationship network construction.

  Results Top

Based on the assessment, a common node between pharmacological action of ginseng and pathophysiological action of tuberculosis was successfully identified at vimentin. The final interrelationship network from interrelationship analysis is presented in [Figure 2].
Figure 2: Interrelationship network showing the interrelationship between pharmacological action of ginseng and pathophysiological action of tuberculosis

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  Discussion Top

Clinical pharmacology network analysis is a new applied clinical informatics technique that is applicable for the assessment of effects of traditional herbal regimens.[46],[47],[48]

Based on the informatics analysis starting from pathway searching, identifying common node, rearrangement, and final creation of the interrelationship network regarding a herbal regimen interrelated with a disease can be systematically done.[46],[47],[48] The network informatics analysis is a standard technique which has been used in many previous publications on the pathophysiology of important medical problems.[48],[49] Focusing on the use of network pharmacology analysis on herbal regimen research, there are some good examples of in silico studies. Joob and Wiwanitkit recently performed a bioinformatics network analysis to analyze the result from a combination of ginseng and arginine regimen.[50] They performed an ontology study to assess the ginseng–arginine combination.[50] Joob and Wiwanitkit found that “there is no new addition effect but some concurrent effects between ginseng and arginine can be identified.”[50] Ngam et al. performed another similar study to assess the combination of ginseng and gingko regimens.[51] Ngam et al. concluded that there was a synergistic effect demonstrated by ontology study.[51] Ngam et al. also performed another ontology study on another combination of ginseng and lingzhi.[52] Ngam et al. concluded that there was a synergistic neuroprotective effect by combining ginseng and lingzhi.[52]

In this short article, the authors preliminarily report a study on the pharmacological advantage of ginseng in the management of tuberculosis. The studied herb in this work is a well-known Asian herb. Ginseng has been used in traditional medicine in Asia for many thousands of years. Ginseng is a common herb seen in several Chinese and Korean medicinal recipes. Indeed, ginseng is proposed for several clinical advantages. As noted by Sul, “Starting from the late 17th century doctors prescribed ginseng to cure many different kinds of ailments and disease such as fatigue, general lethargy, fever, torpidity, trembling in the joints, nervous disorder, laughing and crying hysteria, scurvy, spermatic vessel infection, jaundice, leprosy, dry gripes and constipation, strangury, yellow fever, dysentery, infertility and addictions of alcohol, opium and tobacco, etc.”[53] Regarding infection management, there are many researches on the advantages of ginseng.[54],[55],[56],[57],[58],[59],[60],[61] Immunomodulation is the important property of ginseng that is proposed for possible usefulness in the management of infection.[54],[55],[56],[57],[58],[59],[60],[61] In fact, ginseng has a well-known bactericidal activity. In a recent report, the minimum inhibitory concentration was equal to 6.25 mg/mL.[62]

In the management of respiratory tract infection, ginseng is widely studied on the effectiveness of using for influenza therapy.[63],[64],[65],[66],[67],[68],[69],[70],[71],[72],[73],[74],[75],[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86] Almost all studies show that ginseng is effective and useful in influenza therapy.[63],[64],[65],[66],[67],[68],[69],[70],[71],[72],[73],[74],[75],[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86] In the present report, the authors focus on using ginseng for the treatment of tuberculosis. In fact, there are many reports on clinical observations of ginseng's effect against tuberculosis.[26],[27] Chang et al. recently assessed the effects of P. ginseng extracts on the growth of Mycobacterium tuberculosis H37Rv and noticed the inhibitory effect of ginseng.[87] Jiang et al. observed that ginseng combined with chemotherapy appeared to be associated with a low incidence of adverse effects for multidrug-resistant tuberculosis treatment.[13]

According to this study, there is a common node between pharmacological process of ginseng and pathophysiological process of tuberculosis at vimentin. Ginseng has its pharmacological effect in the suppression of vimentin expression[88] whereas vimentin expression is an important pathophysiological process in macrophage infection of M. tuberculosis pathogen.[89],[90] In fact, macrophage infection in tuberculosis is considered an important pathology in tuberculosis. Xu et al. noted that “As the first line of immune defense for Mycobacterium tuberculosis, macrophages also provide a major habitat for Mycobacterium tuberculosis to reside in the host for years.”[91] Immunoevasion and immunosuppression of the macrophage by M. tuberculosis is an observable process during infection.[92] Hmama et al. noted that the mycobacterial pathogen could subvert the macrophage's physiological mechanisms of intracellular killing and antigen presentation.[91] This pathophysiological process will result in the development of tuberculosis disease.[92] Basically, vimentin is an intermediate filament protein posing an important role in stabilizing intracellular architecture. It is also important for normal macrophage physiology.[93],[94],[95],[96],[97] Vimentin is required for proper pathogenic bacterial killing and production of reactive oxygen species which will be further used for bactericidal process.[98] Mak and Brüggemann noted that vimentin has an important role in “pathogen-binding on the cell surface and subsequent bacterial invasion and the interaction of cytosolic vimentin and intracellular pathogens with regards to innate immune signaling.”[99] Change in vimentin expression will be problematic and might increase the chance of bacterial infection including tuberculosis. For tuberculosis, the role of vimentin is reported in several recent publications.[100],[101],[102],[103],[104],[105] Garg et al. noted that vimentin expressed on M. tuberculosis-infected human monocytes was involved in binding to the NKp46 receptor,[100] which is an underlying pathological process of macrophage infection in tuberculosis. Furthermore, the role of vimentin is also reported in other pathogenic mycobacterial diseases such as leprosy[106],[107],[108] and Mycobacterium avium infection.[90],[109] The suppression of vimentin expression is related to the reduced macrophage infection in tuberculosis, which is useful in tuberculosis management.[89],[90] Comparing to the previous studies on ginseng and tuberculosis, the present study first demonstrates the possible mechanism that ginseng might be useful in the management of tuberculosis [Table 1]. Further researches focusing on using ginseng as an herbal supplementary treatment for tuberculosis are recommended. Finally, there should also be a note on the possible adverse effect of ginseng. Similar to any medicine, ginseng might also induce anaphylaxis, but it is extremely rare.[110] In a recent summarization on clinical trials by Shergis et al., only minor adverse effects were observed in patients receiving ginseng.[39]
Table 1: Summary on the importance of the study results comparing knowledge from previous studies

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  Conclusion Top

Here, pharmacological process of ginseng and pathophysiological process of tuberculosis share a common pathway through vimentin. Ginseng can promote the downregulation of vimentin which can result in decreased macrophage infection in tuberculosis. It can be concluded that ginseng is useful in additional therapy for tuberculosis.

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Conflicts of interest

There are no conflicts of interest.

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