Guilingji capsule (龟龄集胶囊) for Alzheimer's disease: secondary analysis of a randomized non-inferiority controlled trial

  • Ming ZHAO ,
  • Yimiao LUO ,
  • Huichan WANG ,
  • Yu CAO ,
  • Lina MA ,
  • Hui PEI ,
  • Hao LI
Expand
  • 1 Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China
    2 Department of Geriatrics, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China

Received date: 2022-06-12

  Accepted date: 2022-09-14

  Online published: 2023-04-04

Supported by

“Hundreds and Tens of Thousands” Talent Project ( Qihuang Project) Qihuang Scholars Project of Traditional Chinese Medicine Inheritance and Innovation(020450003)

Abstract

OBJECTIVE: To investigate the effectiveness and safety of Guilingji capsule (龟龄集胶囊, GLJC) in treatment of Alzheimer’s disease (AD) patients with kidney-marrow deficiency pattern (KMDP) compared with gingko extract tablets.
METHODS: This is a secondary analysis of a large-scale multicenter randomized non-inferiority clinical trial. A total of 120 AD patients with KMDP were enrolled in this study. The participants were randomly categorized into two groups: (a) GLJC group (n = 60) and (b) gingko group (n = 60). The GLJC group was treated with GLJC and gingko extract mimetic tablets, whereas the gingko group received gingko extract tablets and mimetic GLJC. The data on the Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Activities of Daily Living (ADL), and Chinese Medicine Symptom Scale (CM-SS) was evaluated at 0, 12, and 24 weeks of treatment. The serum levels of acetylcholine (Ach), acetylcholinesterase (AchE), B-cell lymphoma-2 (Bcl-2), and Bcl-2-associated X protein (Bax) in the participants were measured before and after 24 weeks of treatment. The safety was based on the incidence of adverse events.
RESULTS: Both interventions significantly increased the MMSE scores of the participants and decreased their ADAS-Cog, ADL, and CM-SS scores (P < 0.01). Compared with the gingko group, the GLJC group had a higher effective rate of improvement in the symptoms of “amnesia” and “dull expression and slow thinking” at the 12th week and 24th week (P < 0.05, P < 0.01). In the GLJC group, serum Bcl-2 levels were significantly increased at the 24th week (P < 0.05). Serum Bax and AchE levels of the two groups were significantly decreased at the 24th week (P < 0.01). No treatment-related adverse events were reported in the two groups.
CONCLUSIONS: GLJC is equivalent to the gingko extract tablets in terms of improving cognitive function and the quality of life in AD patients with KMDP and has good clinical efficacy and safety. When it comes to improving TCM symptoms and anti-aging, GLJC is even more advantageous.

Cite this article

Ming ZHAO , Yimiao LUO , Huichan WANG , Yu CAO , Lina MA , Hui PEI , Hao LI . Guilingji capsule (龟龄集胶囊) for Alzheimer's disease: secondary analysis of a randomized non-inferiority controlled trial[J]. Journal of Traditional Chinese Medicine, 2023 , 43(5) : 1019 -1025 . DOI: 10.19852/j.cnki.jtcm.20230404.006

References

1. Alzheimer's Association Report. 2022 Alzheimer's disease facts and figures. Alzheimers Dement 2022; 18: 700-89.
2. Reitz C, Mayeux R. Alzheimer disease: epidemiology, diagnostic criteria, risk factors and biomarkers. Biochem Pharmacol 2014; 88: 640-51.
3. Jia L, Du Y, Chu L, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study. Lancet Public Health 2020; 5: e661-71.
4. Shi J, Gao X, Zhang A, Qin X, Du G. Characterization of multiple chemical components of GuiLingJi by UHPLC-MS and 1H NMR analysis. J Pharm Anal 2022; 12: 460-9.
5. Zhao SJ, Liu XJ, Tian JS, et al. Effects of Guilingji on aging rats and its underlying mechanisms. Rejuvenation Res 2020; 23: 138-49.
6. Liu NY, Pei H, Liu MX, et al. Efficacy and safety of Guilingji capsules for treating mild-to-moderate cognitive impairment: study protocol for a randomized, double-blind, positive-controlled, multicenter and noninferiority trial. Chin J Integr Med 2020; 26: 577-82.
7. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152: 726-32.
8. Jack CR Jr, Bennett DA, Blennow K, et al. NIA-AA research framework: toward a biological definition of Alzheimer's disease. Alzheimers Dement 2018; 14: 535-62.
9. McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011; 7: 263-9.
10. Tangalos EG, Smith GE, Ivnik RJ, et al. The mini-mental state examination in general medical practice: clinical utility and acceptance. Mayo Clin Proc 1996; 71: 829-37.
11. Fernando WM, Martins IJ, Goozee KG, et al. The role of dietary coconut for the prevention and treatment of Alzheimer's disease: potential mechanisms of action. Br J Nutr 2015; 114: 1-14.
12. Breijyeh Z, Karaman R. Comprehensive review on Alzheimer's disease: causes and treatment. Molecules 2020; 25: 5789.
13. Cruchaga C, Del-Aguila JL, Saef B, et al. Polygenic risk score of sporadic late-onset Alzheimer's disease reveals a shared architecture with the familial and early-onset forms. Alzheimers Dement 2018; 14: 205-14.
14. Krauskopf J, Bergdahl IA, Johansson A, et al. Blood transcriptome response to environmental metal exposure reveals potential biological processes related to Alzheimer's disease. Front Public Health 2020; 8: 557587.
15. Minhas PS, Latif-Hernandez A, McReynolds MR, et al. Restoring metabolism of myeloid cells reverses cognitive decline in ageing. Nature 2021; 590: 122-8.
16. Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-to-severe Alzheimer's disease. N Engl J Med 2012; 366: 893-903.
17. Birks JS, Grimley Evans J. Rivastigmine for Alzheimer's disease. Cochrane Database Syst Rev 2015; 4: Cd001191.
18. Vaz M, Silvestre S. Alzheimer's disease: recent treatment strategies. Eur J Pharmacol 2020; 887: 173554.
19. Panza F, Lozupone M, Dibello V, et al. Are antibodies directed against amyloid-β (Aβ) oligomers the last call for the Aβ hypothesis of Alzheimer's disease? Immunotherapy 2019; 11: 3-6.
20. Frozza RL, Lourenco MV, De Felice FG. Challenges for Alzheimer's disease therapy: insights from novel mechanisms beyond memory defects. Front Neurosci 2018; 12: 37.
21. Li S, Wu Z, Le W. Traditional Chinese medicine for dementia. Alzheimers Dement 2021; 17: 1066-71.
22. Sreenivasmurthy SG, Liu JY, Song JX, et al. Neurogenic Traditional Chinese Medicine as a promising strategy for the treatment of Alzheimer's disease. Int J Mol Sci 2017; 18: 272.
23. Zhao SJ, Tian JS, Tai G, et al. (1)H NMR-based metabolomics revealed the protective effects of Guilingji on the testicular dysfunction of aging rats. J Ethnopharmacol 2019; 238: 111839.
24. Du K, Gao XX, Feng Y, et al. Integrated adrenal and testicular metabolomics revealed the protective effects of Guilingji on the Kidney-Yang deficiency syndrome rats. J Ethnopharmacol 2020; 255: 112734.
25. Soma S, Suematsu N, Sato AY, et al. Acetylcholine from the nucleus basalis magnocellularis facilitates the retrieval of well-established memory. Neurobiol Learn Mem 2021; 183: 107484.
26. Shalaby R, Flores-Romero H, García-Sáez AJ. The mysteries around the BCL-2 family member BOK. Biomolecules 2020; 10: 1638.
Outlines

/