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Clinical efficacy of cordyceps sinensis for chronic kidney diseases: A systematic review
Abstract
Objective: To assess the clinical efficacy of Cordyceps sinensis in the treatment of chronic kidney diseases. Methods: Randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) were identified from MEDLINE (1996 to Oct. 2005), EMbase (1984 to Oct. 2005), The Cochrane Central Register of controlled Trials (Issue 3, 2005) and CBMdisc (1978 to Oct. 2005). We also handsearched related published and unpublished data and their references. Data were extracted and evaluated by two reviewers independently with a designed extraction form. RevMan4.2.7 software was used for data analysis. Results: One RCT and 5 quasi-RCTs involving 434 patients were included. Results of meta-analysis were presented as follows: Circled digit one Response rate: five studies showed that, compared with the blank control group, significant differences were observed after the treatment with Cordyceps (RR 2.13, 95%CI 1.06 to 4.26); one study showed that there was no difference between Cordyceps and Shenyankangfu tablet (RR 2.17, 95%CI 0.73 to 6.460). Circled digit two Total effective rate: five studies showed that, compared with the blank control group, significant differences were observed after the treatment with Cordyceps (RR1.94, 95 %CI 1.14 to 3.30); one study showed that there was no difference between Cordyceps and Shenyankangfu tablet (RR 1.39, 95%CI 0.89 to 2.16). Circled digit three Adverse reactions: adverse reactions were rare only with mild symptoms. Conclusions: Cordyceps sinensis may improve the response rate and total effective rate of chronic kidney diseases. More high quality trials are required.
... 11 Several systematic reviews have examined the therapeutic effects of Cordyceps sinensis in people with all stages of CKD. [18][19][20] However, none of these reviews specifically addressed the clinical benefits of cordyceps in patients undergoing maintenance hemodialysis. Therefore, this systematic review aims to systematically evaluate the existing evidence regarding the efficacy and safe-ty of wild cordyceps or its fermented products used as adjuvants in hemodialysis patients receiving conventional treatment. ...
... To our knowledge, this review remains the only systematic review of RCTs that investigated the clinical effects of cordyceps in a hemodialysis population. There have been several other reviews [18][19][20] that have focused on the use of cordyceps in people with all stages of CKD. In a recent review of 22 studies that involved 1746 participants, the combined use of cordyceps and convention-al treatment had significantly decreased SCr, increased creatinine clearance and reduced proteinuria in non-dialysis CKD patients. ...
... 20 Meanwhile, another review of six studies that involved patients with earlier stages of CKD concluded that patients treated with cordyceps had a significantly higher response rate and total effective rate than patients receiving no treatment. 18 Our review involved hemodialysis patients and we did not find any significant difference between the cordyceps and control groups in SCr and BUN levels reduction. This seems to indicate that people with earlier stages of CKD may have gained a greater improvement in kidney function with cordyceps compared with people on hemodialysis. ...
Objective:
To evaluate current evidence on the efficacy and safety of Cordyceps sinensis (cordyceps) or its fermented products used as an adjunctive treatment in patients undergoing maintenance hemodialysis.
Methods:
The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, China National Knowledge Infrastructure (CNKI) and Wanfang Database were searched for relevant randomized controlled trials up to March 2016. Two review authors independently selected trials for inclusion, extracted data, assessed the methodological quality and rated the quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluation approach.
Results:
Twelve studies involving 655 participants were included. Evidence of low to moderate-quality showed that cordyceps plus conventional treatment compared to conventional treatment alone significantly improved C-reactive protein [standardized mean difference (SMD) －0.61; 95% confidence intervals (CI) －1.00 to －0.22], high-sensitivity C-reactive protein [weighted mean difference (WMD) －3.44 mg/L; 95% CI －3.89 to －2.99], serum albumin (WMD 3.07 g/L; 95% CI 1.59 to 4.55), malondialdehyde (WMD －1.95 nmol/L; 95% CI －2.24 to －1.66), and hemoglobin (WMD 9.56 g/L; 95% CI 3.65 to 15.47) levels. However, there was no significant improvement for serum creatinine and low-density lipoprotein cholesterol. Overall, most trials either did not monitor adverse events or poorly documented them.
Conclusion:
Given the small number of trials included, the unclear methodological quality of the included trials, and the high heterogeneity in pooled analyses, the evidence obtained in this review is insufficient to recommend the use of cordyceps as adjunctive treatment in hemodialysis patients.
... Over 20 bioactive ingredients found in O.sinensis which includes ergosterol (Panda and Swain., 2011), extracellular polysaccharides (Zhong et al., 2009), intracellular polysaccharides (Dong and Yao., 2011), cordycepin (Zhou et al., 2009), adenosine (Zhang et al., 2010), guanosine (Zhang et al., 2012), cordymin (Shrestha et al., 2010), lovastatin (Jin et al., 2005, γaminobutyric acid (Xu and Li., 2010), sitosterol (Chen et al., 2010), myriocin (Liu et al., 2007, melanin (Xu et al., 2006), and serine protease (Shrestha et al., 2012). ...
Ophiocordyceps sinensis is a high valued therapeutic fungus endemic to the alpine ecosystems of the Tibetan Plateau and surrounding Himalayas at an altitude of 3000–5000 msl. This fungus is widely used as an excellent performance enhancer in traditional Chinese medicine (TCM). The objective of this work was to determine and compare the antioxidant potential of methanolic extract of natural and in vitro cultured mycelium of O. sinensis. The antioxidant capacity of the samples was assessed using 2, 2-Diphenyl-1- pikrylhydrazyl (DPPH) free radical scavenging assay, hydroxyl radical eliminating ability, ferrous ion chelating activity and 2, 2’- azino-bis- [3-ethylbenzthiazoline-6- sulphonic acid) (ABTS) free radical scavenging assay. The methanolic extract of in vitro cultured O. sinensis showed enhanced antioxidant potential than the natural samples. The IC50 value of natural and in vitro cultured samples were 2.98 mg/ml and 2.81 mg/ml against DPPH, 3.28 mg/ml and 2.95 mg/ml against Hydroxyl radical and 4.94 mg/ml and 4.65 mg/ml against ABTS free radicals respectively. Both natural and cultured sample extract showed 81% and 86 % iron chelating activity at 1.6 mg/ml concentration. The results obtained herein allow one to conclude that in vitro cultured O. sinensis can be used as a good source of antioxidants as compared to natural one. Further, the better antioxidant activity suggests its role in preventing disorders like cancer, necrosis and aging, induced by reactive oxygen species (ROS).
... where EDI (mg/kg·day) is the estimated daily intake of As, C As (mg/kg) is the concentration of total As or toxic As in O. sinensis (dry weight), IR (0.01 kg/day) is the daily ingestion rate of O. sinensis [36], and BW is the average body weight (58.7 kg) [37] of the consumer. Risk characterization was quantified according to the potential non-carcinogenic risks of As exposure from O. sinensis ingestion and was reflected by the hazard quotient (HQ). ...
This study sought to determine the concentration and distribution of arsenic (As) species in Ophiocordyceps sinensis (O. sinensis), and to assess its edible hazard for long term consumption. The total arsenic concentrations, measured through inductively coupled plasma mass spectrometry (ICP-MS), ranged from 4.00 mg/kg to 5.25 mg/kg. As determined by HPLC-ICP-MS, the most concerning arsenic species—AsB, MMAV, DMAV, AsV, and AsШ—were either not detected (MMAV and DMAV) or were detected as minor As species (AsB: 1.4–2.9%; AsV: 1.3–3.2%, and AsШ: 4.1–6.0%). The major components were a cluster of unknown organic As (uAs) compounds with AsШ, which accounted for 91.7–94.0% of the As content. Based on the H2O2 test and the chromatography behavior, it can be inferred that, the uAs might not be toxic organic As. Estimated daily intake (EDI), hazard quotient (HQ), and cancer risk (CR) caused by the total As content; the sum of inorganic As (iAs) and uAs, namely i+uAs; and iAs exposure from long term O. sinensis consumption were calculated and evaluated through equations from the US Environmental Protection Agency and the uncertainties were analyzed by Monte-Carlo Simulation (MCS). EDItotal As and EDIi+uAs are approximately ten times more than EDIiAs; HQtotal As and HQi+uAs > 1 while HQiAs < 1; and CRtotal As and CRi+uAs > 1 × 10−4 while CRiAs < 1 × 10−4. Thus, if the uAs is non-toxic, there is no particular risk to local consumers and the carcinogenic risk is acceptable for consumption of O. sinensis because the concentration of toxic iAs is very low.
... Since 1998, there have been more than 25 reviews or special reports published discussing Cordyceps, and 14 of them have focused on C. sinensis. For example, these studies have emphasized: terminology, life strategy, and ecology;[5] traditional uses and medicinal potential in Sikkim;[10] the reliability of fungal materials;[2] ecology, trade, and development in Tibet;[15] production and sustainability on the Tibetan Plateau and in the Himalayas;[16] origin of scientific name, morphological characteristics, micromorphological characteristics of the teleomorph, identification, hosts, and synonymy;[6] ethnomycological use, collection, discovery, protection, and the range of diseases treated in Northern Yunnan Province in China;[9] host spectrum, distribution, artificial rearing host, infection technology, and substitute products;[17] clinical efficacy for chronic kidney diseases;[18] markers and analytical methods for quality control;[19] history, use, and implications;[20] pharmacological functions;[21] safety, effects on the nervous system, glucose metabolism, effects on the respiratory, hepatic, cardiovascular, immune systems, immunological disease, inflammatory conditions, cancer, and diseases of the kidney;[22] and in vitro and in vivo studies, open-label and double-blinded clinical trials on the respiratory, renal, hepatic, cardiovascular, immunological, and nervous systems, and in its effects on cancer, glucose metabolism, inflammatory conditions, and toxicological studies.[23] Two papers have focused on C. militaris, placing emphasis on: biological aspects including the host range, mating system, cytology and genetics, insect- and noninsect nutritional requirements, environmental influence on stroma development, and commercial development;[24] and active principles and culture techniques.[25] ...
The caterpillar fungus Ophiocordyceps sinensis (syn.†
Cordyceps sinensis), which was originally used in traditional Tibetan and Chinese medicine, is called either “yartsa gunbu” or “DongChongXiaCao (冬蟲夏草 Dōng Chóng Xià Cǎo)” (“winter worm-summer grass”), respectively. The extremely high price of DongChongXiaCao, approximately USD $20,000 to 40,000 per kg, has led to it being regarded as “soft gold” in China. The multi-fungi hypothesis has been proposed for DongChongXiaCao; however, Hirsutella sinensis is the anamorph of O. sinensis. In Chinese, the meaning of “DongChongXiaCao” is different for O. sinensis, Cordyceps spp.,‡ and Cordyceps spƒ. Over 30 bioactivities, such as immunomodulatory, antitumor, anti-inflammatory, and antioxidant activities, have been reported for wild DongChongXiaCao and for the mycelia and culture supernatants of O. sinensis. These bioactivities derive from over 20 bioactive ingredients, mainly extracellular polysaccharides, intracellular polysaccharides, cordycepin, adenosine, mannitol, and sterols. Other bioactive components have been found as well, including two peptides (cordymin and myriocin), melanin, lovastatin, γ-aminobutyric acid, and cordysinins. Recently, the bioactivities of O. sinensis were described, and they include antiarteriosclerosis, antidepression, and antiosteoporosis activities, photoprotection, prevention and treatment of bowel injury, promotion of endurance capacity, and learning-memory improvement. H. sinensis has the ability to accelerate leukocyte recovery, stimulate lymphocyte proliferation, antidiabetes, and improve kidney injury. Starting January 1st, 2013, regulation will dictate that one fungus can only have one name, which will end the system of using separate names for anamorphs. The anamorph name “H. sinensis” has changed by the International Code of Nomenclature for algae, fungi, and plants to O. sinensis.
During the last three decades or so, interest on caterpillar fungus (Ophiocordyceps sinensis) from the high-altitude areas of the Himalaya has grown across the globe. Fast-growing global market demand and year by year increasing price at international markets have made this fungus very lucrative to local indigenous communities inhabiting higher Himalayan villages, which have transformed their socio-economic status. Such collection and marketing of this fungus have emerged as an important source of income in parts of Bhutan, China, India, and Nepal. However, increasing the popularity and growing demand of caterpillar fungus has also become a curse to the unique alpine ecosystems. While the fungus has been in use for a long in the Chinese traditional medicine system, it became globally famous with its recognition as Himalayan Herbal Viagra in recent decades.
The book is an attempt to present the status of Caterpillar Fungus in the Himalaya, its distribution, marketing, and sustainability issues. The book contains chapters on the collection, grading, and market; caterpillar fungus linked socio-economic development; evolving trade and marketing; and ecological consequences of fungus collection. Also, an attempt has been made to touch upon governance issues, and provide a way forward. An extensive bibliography at the end brings all available researches on target species at one place. We sincerely believe the book will be of immense value for the diverse stakeholders, ranging from local communities to researchers, from practitioners to policy people.
Aim: To investigate the antiarrhythmic effect of Cordyceps Cephalosporium Mycelia (CCM) extracts. Methods: The conventional antiarrhythmic methods were used. Arrhythmia was induced by chloroform in mice. The intravenous injection of aconitine and coronary artery ligation method were performed to induce arrhythmia in rat model, which were given CCM extraction in preoperation. Electrocardiogram currve was recorded and analysed. Results: Administration of CCM extraction reduced the occurrence of ventricular fibrillation induced by chloroform in a dose-dependent manner in mice. CCM significantly prolonged the onset of arrhythmia induced by aconitine in rats. Compared with control, arrhythmia score was lower in ischemia/reperfusion rats pretreated with CCM extracts. Conclusion: CCM extracts has obvious protective effects on chloroform, conitine- and ischemia-reperfusion induced arrhythmia.
Objective: To assess the quality of published systematic reviews and meta-analyses on Traditional Chinese Medicine (TCM) published in Chinese journals. Methods: We searched CNKI, CMB from January 1995 to December 2006 and The Cochrane Library (Issue 4, 2006) for systematic reviews and meta-analyses on TCM. We extracted details of the interventions used in the treatment and control groups, analyzed the validity of included studies and investigated whether the reports used QUOROM statement or not. Results: We identified 111 reports, of which 1 on prevention, 1 on adverse events, 1 on risk factors and premonitory symptoms, 2 on physiochemical parameters, and 106 on effectiveness and safety assessment. In total, 42 types of diseases were involved, and 41 reports were related to cerebrovascular diseases. As for the investigated interventions, 25 studies assessed TCM and 12 assessed acupuncture. Two had no control intervention design control in the group, 15 did not describe the interventions in the control group, 50 used active control (26 for western medicine, 12 for Chinese medicine, 12 for western plus Chinese medicine), 14 used blank control, 17 used baseline control, 4 used sham acupuncture or acupoint injection control etc., 5 used placebo control and 4 used "mutual control". The interventions used in the treatment and control groups varied widely. The number of trials included in the reviews and meta-analyses ranged from 1 to 35, and 24 studies included non-randomized controlled trials. Of the 111 reports, 14 were Cochrane reviews, 16 did not assess the quality of included randomized trials and a further 22 performed only simple and nonstandard quality assessment of the included trials. None of the reviews or meta-analyses used the QUOROM statement to report their results. Conclusions: Because of the unique characteristics of TCM, systematic reviews of TCM should focus on a specific topic, avoid the selection of too many drugs, address the target indications of the test drugs and pay attention on intervention evaluation. High quality systematic reviews of TCM are needed but they will only be produced through the concerted efforts of clinicians, TCM practitioners and methodologists.
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