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Proquest Dissertations Phytochemical and Biological Studies of Thuja occidentalis and its clinical evaluation in the treatment of verruca pedis Thesis submitted for the Degree of Doctor of Philosophy in the Faculty of Medicine University of London By Mohammed Tariq Khan BSc (Hons), BSc (Pod Med), MChS, LFHom (Pod), FLS The Centre for Pharmacognosy School of Pharmacy University of London Brunswick Square London W cl October 2003 ProQuest Number: 10104864 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10104864 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ACKNOWLEDGEMENTS I would like to thank my supervisor Dr Robert Watt for his guidance and encouragement in the preparation of this thesis, Dr Rino Cerio, Consultant Dermatologist, Department of Dermatology, Royal London Hospital for his help and support with clinical trials and my appointment as Honorary research Fellow in Dermatology. My appreciation and thanks to Dr Alan Storey and Dr Harry Navsaria for his help with biological studies carried out and to Trisha Purkiss ICRF for laboratory space in the Centre for Cutaneous disease. Queen Mary and Westfield College. I am grateful to Professor Fred Evans, my first supervisor, for the help he gave prior to his enforced early retirement due to ill health. For technical assistance during my studies at the School of Pharmacy, I am indebted to Mr G. Ronngen, Mrs M. Pickett, Ms A Cavanagh (multimedia unit), Mr M. Domin (mass spectrometry unit), Mr W. Baldeo (NMR unit). Dr L. Randell (micro- elemental analysis unit) and Mr D. McCarthy (SEM unit). I am also greatly indebted to the patients who volunteered to participate in the clinical study. I am pleased to acknowledge the professional advice I received from Dr P.O. Barnes, botanist at the Royal Horticultural Society, Dr Nick Haines, Curator at the Royal Botanical Gardens, Kew Gardens. My sincere thanks to Dr Edel O’Toole and Professor Anne Stephenson for giving so much time in reading and offering guidance to improve this thesis, which is much appreciated and a special thanks for Professor Florence, for his time, support, and understanding. Finally I am deeply grateful to my family and friends for their constant support and encouragement and especially Amrita for giving me enlightenment when things became difficult. ABSTRACT This study undertakes a botanical investigation, phytochemical analysis, biological testing and chemical evaluation of Thuja occidentalis in the treatment of verruca pedis. Clinical observation over 10 years in dermatology and podiatric clinics revealed a high incidence of verruca pedis. Most medical and surgical intervention can cause a great deal of discomfort, as well as post-operative complications. Investigation of medicinal plants for the treatment of podiatric disorders led to clinical pilot studies and a double-blind controlled trial of tagetes species in the treatment of verruca pedis (Khan, 1994). In the present study, the clinical features of verruca pedis, aetiology and pathology are described and advantages and limitations of traditional treatments are discussed. In the phytochemical study of Thuja occidentalis, a flavonoid, and a lignan deoxypodophyllotoxin, were isolated and identified by chromatographic techniques and spectral analysis. In the clinical study, the effect of Thuja occidentalis crude extracts and sub fractions in different organic solvents were tested in an open study and double­ blind study over a period of 12 weeks. Ethical approval was obtained from the Clinical Lead of Dermatology Department at the Royal London Hospital and the Director of Research at the Royal London Homoeopathic Hospital. Ninety volunteers were chosen, using inclusion and exclusion criteria and were admitted to the study from a population awaiting podiatric treatment at the Royal London Hospital and the Royal London Homoeopathic Hospital. These were then systematically allocated to 3 groups of 30 in each group. Test samples were prepared on the basis of the effective dose established in pilot clinical studies of Thuja occidentalis at 300mg/ml-dose/day for crude extract and 60mg/ml- dose/day for fractions. The results of the clinical study show that ethanolic crude extract of Thuja occidentalis was effective in reduction of verruca size and clearance, with a level of significance at p<0.001. The chloroform fraction of Thuja occidentalis was shown to be the most effective in reduction of size and clearance with a level of significance at p<0.01. In biological tests, Thuja occidentalis crude extract at 1pg/ml and the chloroform fraction at 0.021 pg/ml showed no toxicity to human kératinocytes, but at concentrations of 1 pg/ml to 1 mg/ml and 0.21pg/ml to 0.21 mg/ml was toxic to cell growth respectively. These findings concurred with earlier results from a clinical study that activity of Thuja occidentalis was located in the chloroform fraction as other fractions did not affect growth rate of cells. The results of the clinical study and biological tests show a close correlation in terms of safety and efficacy in the treatment of verruca pedis. These encouraging results need further investigation using a larger number of patients over a longer period of time. CONTENTS Page Acknowledgment i Abstract il- iü Contents iv-ix List of Abbreviations x-xi List of Figures xii-xiii List of Tables xiv-xv List of Graphs xvi List of Appendices xvii CHAPTER 1 GENERAL INTRODUCTION 1 1.1 Introduction 2 1.1 Aetiology 4 1.2 Pathology 5 1.3 Classification 6 1.3.1 Verrucae Vulgares (Common warts) 7 1.3.2 Myrmecia 9 1.3.3 Verrucae Planae (Plane warts, Fiat warts) 10 1.3.4 Intermediate warts 11 1.4 Cutaneous Warts and infecting HPV type 12 1.5 Virology 13 1.6 Genome Organisation 14 1.6.1 Cell differentiation-linked transcription 16 1.6.2 Functions of viral proteins 18 1.7 Regression and Immunology 22 1.8 Clinical signs of Regression 23 1.9 Clinical Management 24 1.9.1 Chemical Therapies 25 1.9.2 Antimitotic therapy 26 1.9.3 Immune stimulation 29 1.9.4 Cryotherapy 29 1.9.5 Surgical procedures 30 1.9.6 Complementary medicines 31 1.10 The genus Thwya 35 IV 1.11 Phytochemistry of Thuja occidentalis 38 1.12 Aims of present studies 42 Page CHAPTER 2 BOTANICAL INVESTIGATION AND ISOLATION, PURIFICATION AND CHEMICAL CHARACTERISATION 43 OF COMPONENTS OF THUJA OCCIDENTALIS 2.1 Introduction 44 2.2 Macroscopic and Microscopic features of Thuja occidentalis (T.O) 46 2.2.1 Authentication of plant material 46 2.2.2 Macroscopical features 46 2.2.3 Microscopical features 47 2.2.3.1 Electronmicroscopy 50 2.3 Initial Methods and Procedures running with yield results 51 2.3.1 Plant materials 51 2.3.2 Techniques for isolation and identification of chemicals in plant materials 51 2.3.3 Extraction procedures 51 2.3.3.1 Extraction of r/7ty/a occ/c/enfa//s 55 2.3.4 Phytochemical analysis of chloroform fraction of Thuja occidentalis plant 57 2.3.4.1 Chromatographic techniques 57 2.3.5 Column chromatography 60 2.3.5.1 Sephadex LH-20 size exclusion chromatography 60 2.3.5 2 Spectral data of deoxypodophyllotoxin 64 2.3.6 Spectral analysis procedures 64 2.3.6.1 Nuclear magnetic resonance spectroscopy 64 2.3.6 2 Mass Spectrometry 69 2.3.7 Characterisation of a flavonoid isolated from Thuja occidentalis 72 2.3.7A Mass spectral analysis of the flavonoid (Kaempferol 3-methyl ether) from Thuja occidentalis 72 2.4 Discussion 76 2.4.1 Separation and isolation 76 2.4.2 Purification and identification 77 VI Page CHAPTER 3 CUNICAL EVAULATION OF THUJA OCCIDENTALIS IN THE TREATMENT OF VERRUCA PEDIS 79 3.1 Introduction 80 3.1.1 Subjects 81 3.1.2 Inclusion and exclusion criteria 81 3.1.3 Selection of patients 82 3.1.4 Role of independent assessor (lA) 82 3.1.5 Ethical consideration 82 3.1.6 Pilot studies 83 3.1.7 Samples for clinical study 83 3.2 Apparatus for measurements 85 3.2.1 Validity and reliability of measurements 86 3.3 Materials 86 3.4 Procedures 88 3.4.1 Pre-treatment 88 3.4.2 Patient characteristics pre-treatment 88 3.4.3 Patient selection 88 3.4.4 Pilot studies 88 3.4.5 Method of treatment 89 3.4.6 Post-treatment 92 3.4.7 Data collection and statistical analysis 92 3.5 Results 94 3.5.1 Demographic data 94 3.5.2 Results table study 1 101 3.5.3 Results table study 2 103 3.5.4 Results table study 3 106 3.5.5 Reduction of verruca pedis in size 108 3.5.6 Clearance of verruca pedis 108 3.6 Discussion 109 3.6.1 Patient compliance 109 3.6.2 Adverse reactions 109 3.6.3 Outcome of clinical study 109 Vll Page CHAPTER 4 BIOLOGICAL INVESTIGATION OF THUJA OCCIDENTALIS ON HUMAN KERATINOCYTES 110 4.1 Introduction 111 4.1.1 The Cell Cycle 116 4.1.2 Control of the cell cycle 117 4.1.3 Steps in the cycle 118 4.1.4 G zero 119 4.2 Materials and Methods 120 4.2.1 Tissue culture media and reagents 120 4.2.1.1 Tissue collection medium 120 4.2.1.2 Keratinocyte base medium 120 4.2.1.3 RM+concentrate 120 4.2.1.4 RM+medium 122 4.2.1.5 Cell culture 123 4.2.1.6 Cryo-preservation of cell lines 124 4.2.1.7 Recovery 124 4.3 Technique 125 4.3.1 Cell proliferation assays 125 4.3.2 Bivariate staining 125 4.4 Methodology 126
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