Glad to be back writing blog articles again. I've been busy getting a new practice running and all the necessary hoop jumping done. But I'm back, and my new working situation will allow me a lot more time to dig through studies and write this blog.
This is an entry for the herbalists, any patients out there, and the general public may want to tune out, because this is gonna be rich with biology mumbo jumbo and herbalist jargon.
The herb gu sui bu, some may recall, has the action of speeding the mending of broken bones. It translates to literally "bone medicine mender." Interesting stuff. Every once in a while I'll tell a patient something that is apparently completely ludicrous. Like, "this root can really speed the healing of your bones." Or better yet, "did you know that there is a type of cockroach used in chinese medicine that can help to knit fractures and tears back together?" The incredulous stares have qi and blood dispersing functions on their own. I'm often forced to go find a study in order to create any real belief that this stuff has a foundation in reality. Well, I dug up one such study regarding Gu Sui Bu, because I was trying to get a recent fracture patient to use it. The study was fascinating so I thought I'd pass on what I learned.
"The Effect of Gu-Sui-Bu (Drynaria fortunei J. Sm) on bone cell activities." Biomaterials Journal 2002.
Previous efforts to identify the mechanism by which Gu Sui Bu might increase bone mineralization have demonstrated actions, but were insufficient to fully explain the benefits. The authors of this study utilized bone cultures that included osteoblasts and osteoclasts, and used an alcohol extraction of gu sui bu, and did find multiple mechanisms.
When I hear about an herb increasing bone density I think that perhaps there is some impact on calcitonin and/or parathyroid hormone synthesis, metabolism, or signaling. Perhaps this was the target of previous studies, and explains why they didn't find any effect. If you look into the traditional use of this herb, however, you would save yourself the time, because in addition to increasing bone mineralization when taken internally, Gu Sui Bu is also used to harden the teeth used topically. (non-toxic alternative to fluoride?) This action would be absent if Gu Sui Bu's actions were mediated through hormonal activity.
The authors of this study found that adding gu sui bu extraction to a bone culture indeed did yield increased mineralization. They measured the effect of gu sui bu on a number of things: osteoblast concentration, mixed bone cell concentration, alkaline phosphatase (dephosphorylates) (ALP), acid phosphatase (phosphorylates) (ACP), and Prostaglandin E2 (mediates osteoclast binding and bone reabsorption)(PGE2). They also measured the Osetonectin and Osteopontin mRNA in the cultures. These are two extracellular matrix proteins that are involved in the spreading of osteoclasts through bone tissue, and the mineralization of new bone.
Previous studies had found that Gu Sui Bu have anti-oxidant activities for osteoblasts specifically. This study also found that Gu Sui Bu affected the cell numbers in a culture, ALP and ACP, and PGE2 as well as the expression of osteonectin and osteopontin.
They found that initially, many markers indicated slower bone formation when gu sui bu was added. ALP decreased, as did cell concentration. However by day 3 the effects had reversed considerably, and by day 7 the gu sui bu cultures were indicating significant increased bone formation over the control.
ALP increased, as did ACP in the cultures. The formation of osteopontin decreased, and with the increased presence of ACP in the matrix, the osteopontin that did present was dephosphorylated faster. When dephosphorylated, osteopontin's action of assisting the adhesion of osteoclasts is decreased, and bone breakdown slows. The PGE2 present in the gu sui bu culture also increased significantly (over 25 times that of the control). PGE2 among other things, inhibits the formation of osteoclasts into multi-nucleated super osteoclasts that break down bone rapidly, further slowing breakdown.
So, interestingly, most of the actions Gu Sui Bu has on improving bone mineralization are due to restricting the actions of osteoclasts, rather than enhancing the actions of osteoblasts. The effects are contrary initially, but pronounced after a week, so administration should continue for several weeks at least. While topical application is appropriate for teeth, the jury is still out whether or not it can be applied to the skin over a fracture and have beneficial actions. (although the pain relieving actions are fantastic!)
This is an entry for the herbalists, any patients out there, and the general public may want to tune out, because this is gonna be rich with biology mumbo jumbo and herbalist jargon.
The herb gu sui bu, some may recall, has the action of speeding the mending of broken bones. It translates to literally "bone medicine mender." Interesting stuff. Every once in a while I'll tell a patient something that is apparently completely ludicrous. Like, "this root can really speed the healing of your bones." Or better yet, "did you know that there is a type of cockroach used in chinese medicine that can help to knit fractures and tears back together?" The incredulous stares have qi and blood dispersing functions on their own. I'm often forced to go find a study in order to create any real belief that this stuff has a foundation in reality. Well, I dug up one such study regarding Gu Sui Bu, because I was trying to get a recent fracture patient to use it. The study was fascinating so I thought I'd pass on what I learned.
"The Effect of Gu-Sui-Bu (Drynaria fortunei J. Sm) on bone cell activities." Biomaterials Journal 2002.
Previous efforts to identify the mechanism by which Gu Sui Bu might increase bone mineralization have demonstrated actions, but were insufficient to fully explain the benefits. The authors of this study utilized bone cultures that included osteoblasts and osteoclasts, and used an alcohol extraction of gu sui bu, and did find multiple mechanisms.
When I hear about an herb increasing bone density I think that perhaps there is some impact on calcitonin and/or parathyroid hormone synthesis, metabolism, or signaling. Perhaps this was the target of previous studies, and explains why they didn't find any effect. If you look into the traditional use of this herb, however, you would save yourself the time, because in addition to increasing bone mineralization when taken internally, Gu Sui Bu is also used to harden the teeth used topically. (non-toxic alternative to fluoride?) This action would be absent if Gu Sui Bu's actions were mediated through hormonal activity.
The authors of this study found that adding gu sui bu extraction to a bone culture indeed did yield increased mineralization. They measured the effect of gu sui bu on a number of things: osteoblast concentration, mixed bone cell concentration, alkaline phosphatase (dephosphorylates) (ALP), acid phosphatase (phosphorylates) (ACP), and Prostaglandin E2 (mediates osteoclast binding and bone reabsorption)(PGE2). They also measured the Osetonectin and Osteopontin mRNA in the cultures. These are two extracellular matrix proteins that are involved in the spreading of osteoclasts through bone tissue, and the mineralization of new bone.
Previous studies had found that Gu Sui Bu have anti-oxidant activities for osteoblasts specifically. This study also found that Gu Sui Bu affected the cell numbers in a culture, ALP and ACP, and PGE2 as well as the expression of osteonectin and osteopontin.
They found that initially, many markers indicated slower bone formation when gu sui bu was added. ALP decreased, as did cell concentration. However by day 3 the effects had reversed considerably, and by day 7 the gu sui bu cultures were indicating significant increased bone formation over the control.
ALP increased, as did ACP in the cultures. The formation of osteopontin decreased, and with the increased presence of ACP in the matrix, the osteopontin that did present was dephosphorylated faster. When dephosphorylated, osteopontin's action of assisting the adhesion of osteoclasts is decreased, and bone breakdown slows. The PGE2 present in the gu sui bu culture also increased significantly (over 25 times that of the control). PGE2 among other things, inhibits the formation of osteoclasts into multi-nucleated super osteoclasts that break down bone rapidly, further slowing breakdown.
So, interestingly, most of the actions Gu Sui Bu has on improving bone mineralization are due to restricting the actions of osteoclasts, rather than enhancing the actions of osteoblasts. The effects are contrary initially, but pronounced after a week, so administration should continue for several weeks at least. While topical application is appropriate for teeth, the jury is still out whether or not it can be applied to the skin over a fracture and have beneficial actions. (although the pain relieving actions are fantastic!)
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