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Background: In Russia, physicians are virtually unaware of drugs based on needle extract. However, abroad, saponins and, in particular, a combined preparation containing needle extract, hesperidin and vitamin C is one of drugs of choice, if not the leading medication in treatment of venous oedemas and other venous symptoms.

Aim: The authors conducted a systematic review of the Russian-and English-language literature using the following search terms: saponins, hesperidin, needle, ruscus, ruscogenin (and their Russian equivalents), each of which was entered in a combination with the word 'venous' or its Russian equivalent, respectively.

Results: Ruscogenin and neoruscogenin from the root of needle possess anti-inflammatory properties and induce venous wall contraction, thus making it possible to use needle extract in treatment of chronic venous insufficiency. It was experimentally determined that needle extract stimulates vein contractility, decreasing permeability of the venous wall, influencing extracellular matrix proteins, inhibiting leukocyte migration through regulation of both proteins and matrix ribonucleic acid. Analysed herein are the results of original studies of a combination of needle extract, flavonoid hesperidin methyl chalcone and ascorbic acid, also examining in detail the mechanism of action conditioned by synergism of pharmacological effects of these components. This is followed by discussing the place of saponins in the classification of phlebotropic drugs and comparing efficacy of needle root extract with that of other phlebotonics.

Conclusion: It was experimentally determined that a combination of needle extract, hesperidin and vitamin C possesses multiple additive phlebotropic effects. According to clinical trials, it leads to relief of most symptoms and a decrease in the ankle volume (high level of evidence 1A), being not inferior by clinical efficiency and duration of action to the best-known flavonoids, whereas by the venotonizing effect, decreased permeability of the vascular wall, and inhibition of leukocytic aggression even superior thereto. Further experimental and clinical studies of efficacy of this combination for various forms of chronic venous diseases and venous thromboses are warranted.

Titel:	[Efficacy of combination of needle extract, hesperidin and vitamin C in treatment of chronic venous diseases].
Autor/in / Beteiligte Person:	Shaĭdakov, EV ; Rosukhovskiĭ, DA
Zeitschrift:	Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery, Jg. 27 (2021), Heft 2, S. 82-91
Veröffentlichung:	[Moskva] : Izd-vo Info-Media, c1995-, 2021
Medientyp:	academicJournal
ISSN:	1027-6661 (print)
DOI:	10.33529/ANGIO2021208
Schlagwort:	Ascorbic Acid Humans Plant Extracts pharmacology Russia Hesperidin pharmacology Ruscus Venous Insufficiency drug therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: Russian Transliterated Title: Éffektivnost' kombinatsii ékstrakta iglitsy, gesperidina i vitamina S v lechenii khronicheskikh zabolevaniĭ ven. Publication Type: Journal Article; Systematic Review Language: Russian [Angiol Sosud Khir] 2021; Vol. 27 (2), pp. 82-91. MeSH Terms: Hesperidin* / pharmacology ; Ruscus* ; Venous Insufficiency* / drug therapy ; Ascorbic Acid ; Humans ; Plant Extracts / pharmacology ; Russia References: Nicolaides A, Kakkos S, Baekgaard N, et al. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part I. Int Angiol. 2018; 37 (3): 181–254. doi: 10.23736/S0392-9590.18.03999-8. ; Bogachev VYu, Golovanova OV, Kuznetsov AN, et al. Bioflavonoids and their significance in angiology. Focus on diosmin. Angiol Vasc Surg. 2013; 19 (1): 73–81. (In Russ.). ; Allaert FA. Meta-analysis of the impact of the principal venoactive drugs agents on malleolar venous edema. 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An open-label, randomized multicenter study comparing the efficacy and safety of Cyclo 3 fort® versus hydroxyethyl rutoside in chronic venous lymphatic insufficiency. Angiol. 2000; 51 (7): 535–544. doi: 10.1177/000331970005100702. ; Lascasas-Porto C, Milhomens A, Virgini-Magalhães C, et al. Use of microcirculatory parameters to evaluate clinical treatments of chronic venous disorder (CVD). Microvasc Res. 2008; 76 (1): 66–72. ; Guex JJ, Enriquez Vega DME, Avril L, et al. Assessment of quality of life in Mexican patients suffering from chronic venous disorder – impact of oral Ruscus aculeatus hesperidin methylchalcone ascorbic acid treatment – ‘QUALITY Study.’ Phlebol J Venous Dis. 2009; 24 (4): 157–165. doi: 10.1258/phleb.2009.008066. ; Baudet H, Collet D, Aubard Y, et al. Therapeutic test of Ruscus extract in pregnant women: evaluation of the fetal tolerance applying the pulse Doppler’s method of the cord. In: Vanhoutte PM, Ed. Return Circulation and Norepinephrine: An Update. Paris, France: John Libbey Eurotext. 1991; 1: 63–71. ; Monteil-Seurin J. Aspects cliniques et interet de Cyclo 3 dans le traitment de l`insuffisance veinuese des membres inferieurs chez la femme enceinte. Gaz Medicale. 1985; 92: 61–64. ; Kakkos SK, Allaert FA. Efficacy of Ruscus extract, HMC and vitamin C, constituents of Cyclo 3 fort®, on improving individual venous symptoms and edema: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials. Int Angiol. 2017; 36 (2): 93–106. doi: 10.23736/S0392-9590.17.03815-9. ; Kakkos SK, Bouskela E, Jawien A, et al. New data on chronic venous disease: a new place for Cyclo 3® Fort. Int Angiol. 2018; 37 (1): 85–92. doi: 10.23736/S0392-9590.17.03999-9. Contributed Indexing: Keywords: ascorbic acid; flavonoids; hesperidin; needle extract; norepinephrine; saponins; venoactive drugs; venotonics; venous oedema; venous symptoms ; Local Abstract: [Publisher, Russian] В России врачи практически незнакомы с препаратами на основе экстракта иглицы колючей. Хотя за рубежом сапонины и, в частности, комбинированный препарат экстракта иглицы, гесперидина и витамина С является одним из препаратов выбора, если не ведущим в лечении венозных отеков и других венозных симптомов. Авторы выполнили систематический обзор русскоязычной и англоязычной литературы по поисковым запросам: сапонины, гесперидин, иглица колючая, ruscus, ruscogenin, saponin, butcher’s broom, hesperidin, каждый из которых вводился в сочетании со словом 'венозный' или 'venous'. Результаты исследования. Рускогенин и неорускогенин из корня иглицы колючей обладают противовоспалительными свойствами и вызывают сокращение стенки вен. Это позволяет использовать экстракт иглицы при лечении хронической венозной недостаточности. Экспериментально установлено, что экстракт иглицы стимулирует сокращение вен, уменьшает проницаемость венозной стенки, влияет на белки экстрацеллюлярного матрикса, подавляет миграцию лейкоцитов посредством регуляции как белков, так и матричной рибонуклеиновой кислоты. Проанализированы результаты оригинальных исследований комбинации экстракта сапонина иглицы колючей, флавоноида гесперидина метилхалькона и аскорбиновой кислоты. Детально изучен механизм действия, обусловленный синергизмом фармакологических эффектов этих компонентов. Обсуждается место сапонинов в классификации флеботропных препаратов и сравнивается эффективность экстракта корня иглицы с другими флеботониками. Заключение. Экспериментально установлено, что комбинация экстракта иглицы, гесперидина и витамина C обладает множественными аддитивными флеботропными эффектами. Согласно клиническим исследованиям это вызывает уменьшение большинства симптомов, а также сокращение объема лодыжек (высокий уровень доказательности 1A), не уступая по клинической результативности и продолжительности действия наиболее известным флавоноидам, а по венотонизирующему эффекту, снижению проницаемости сосудистой стенки и подавлению лейкоцитарной агрессии превосходит последние. Необходимы дальнейшие экспериментальные и клинические исследования по изучению эффективности этой комбинации при различных формах хронических заболеваний вен и венозных тромбозах. Substance Nomenclature: 0 (Plant Extracts) ; E750O06Y6O (Hesperidin) ; PQ6CK8PD0R (Ascorbic Acid) Entry Date(s): Date Created: 20210624 Date Completed: 20210628 Latest Revision: 20210628 Update Code: 20231215

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[Efficacy of combination of needle extract, hesperidin and vitamin C in treatment of chronic venous diseases].