Phytotherapy and hypertension treatment

Hypertension 1996 : One Medicine, Two Cultures

D. Franzoso, S. Serrano, U. Solimene
W.H.O. Collaborating Centre for Traditional and Natural Medicine, University of Milan

Hypertension represents a risk factor for Arteriosclerosis, but the exact mechanism of such pathologic phenomenon, has not been demonstrated yet. The two pathologic processes have common relations and mechanisms. Endothelium is the converging point of the two pathologic processes. In fact, there is a major agreement, to retain that arteriosclerosis can be considered an inflammatory disease. Atherogenic stimulation as Hyperlipidaemia can activate the inflammatory response through the expression of genetic mechanism, regarding the inflammatory response. V.C.A.M.-1. The gene or one of these mechanisms, is controlled mainly by some factors, whose starting point is oxidative stress, that modifies the redox tract of the endothelial cell Endothelial cells alterations are the base for muscular vascular tissue's growth This work means to emphasise the hypertension's role in arteriosclerosis, mediating oxidative stress A therapeutic approaching technique to this problem, using bioenergetic phitotherapy, that uses fresh plants turned into hydro-alcoholic extracts, is also considered by the authors. The study of such clinical indications, evidenced vascular-tropism of four phytocomplexes belonging to the forest of the Andes, in the preventing treatment of the atherogenic process' inflammatory phase, promoted by arterial hypertension.
The first observation of a vasomotorial dysfunction in arteriosclerosis concerns a study on coronary pathology and vasal tone. In that study, it is demonstrated that endothelium releases a vasodilatation agent in response to much stimulation, included the colinergic. This agent has been called detaining factor endothelial (nitrossido). The converging point between hyperlipaemia and atherogenic endotrielitis can be the metabolic stress, produced on the endothelium by an excessive production of oxygen’s free radicals. Such production has practical consequences, as the anomalous vascular tone can be cured with anti-oxidants.
Recently the relation between oxidative stress and vascular inflammation, has been clarified In fact the stimulation by macrophage cytochine, as IL-1 is mediated by the endothelial oxidation-reduction through the V.C.A.M.-1 gene.
Hypertension and hyperlipidaemia have very similar effects on the arterial wall. The increase of oxidative stress, a common mechanism in both the conditions, can activate genes involved in an inflammatory response that, in case of contemporary hyperlipidaemia leads to the formation of atherogenic plaques. There is a big interest in using vegetal antioxidants in the arteriosclerosis treatment The possibility of using this class of compounds can also improve the vascular damage in hypertension. In the past ages, the Peruvians discovered the benefits of the plants from the Andes in the illness treatment, through direct practice based on the deep communion between man and nature; this knowledge has been handed on to the next generations, becoming the actual back-bone of the Peruvian traditional medicine. The Amazonian and Peruvian forest is one of the largest sources in the world for medicine used vegetables. We have to consider that the therapeutic effects of the Peruvian phytoextracts rely on the affinities with the pathologic situation of the ill subject.
Thanks to the recent studies we are able to report the use of some plants from the Andes, in clinical treatment of atherogenic hypertension and, moreover, to give a methods able to measure a patient's affinity to a particular phytoextract.

Endothelium: inflammation, tissular repairing, neoplastic processes, atherosclerosis

In this paragraph, we will unite in one unique model, the role of the endothelium in inflammation, in the tissular repairing and in two aspects of the tumoral pathology of ematic metastatic process and of solid tumour vascularization. Moreover we will discuss about the role of endothelium in the atherosclerosis' pathogenesis. The reason of this choice is that the primer and maintenance mechanism of these processes is the same. It is due to the bifunctional interaction between endothelial and other kinds of cells; (immunocompetent cells, leukocytes, tumoral and vascular panes cells), mediate by soluble factors as cytochines, growth factors and mediators. Such molecules are produced by the endothelium, arid they modify its qualities during the inflammation, the thrombosis and angiogenesis. Besides, the: endothelium, stimulated by these soluble factors, produces other polypeptides involved in the aemopoiesis, in the ageing process of the vascular tissue, and in the passage of the cells circulating from blood to the tissues.

Endothelium and cytochines

The endothelium is the target of many cytochines, mainly produced by the immunocom petent cells (T-lymphocytes, monocytes /macrophages) as the interleukin (IL-1 alpha and beta tumour necrosis factor (TNF), gamma interferon, granulocyte-macrophage (GM) - colony stimulating factor (CSF). Furthermore endothelium can produce and release, after stimulation also, cytochines as IL-1, IL-6, IL-8, G-CSF, GM-CSF, alpha and beta interferon, and MCP–1.
IL-1 is the prototype of a cytochine that activates the endothelium and modifies its qualities, from anti-inflammatory and antithrombotic to pro-inflammatory and pro-thrombotic. This cytochine is principally produced by monocytes and by macrophages stimulated with lipopolysaccharides, which are present in Gram-negative bacteria, or with TNF. It has many activities: it co-operates to the T-lymphocytes' growth; it acts on the central nervous system, on the bone's absorption, on the lipid and Glico-metabolism, and at last, it is an inflammation mediator.
IL-1 causes the genetic reprogramming of endothelium, with the appearance of new functions. In fact, one of The IL-1’ is most precocious actions is to induce the expression of two proto-oncogenes (c-fos and c-jun) involved with the regulation of the other genes expression.
IL-1 deeply alters the anti -thrombotic qualities of endothelium, inducing the appearance of a pro-coagulant activity on its cellular surface and damping the anti-coagulant activity of the C-protein-thrombomoduline system; it inhibits the fibrinolytic qualities dampening TPA synthesis and increasing the inhibitor's plaminogen activator synthesis; it modifies The anti-aggregating qualities, promoting the platelet's activating factor synthesis.
IL-1 is able to induce a late production of prostacyclin. Such phenomenon seems to have a major importance on the vasodilatation during the inflammation and delayed-hypersensitivity rather than the regulation thrombocytic functionality Endothelium, treated with IL-1, gets pro-inflammatory qualities. Besides, to produce the platelet activating factor, a powerful leukocytes and platelet activator, endothelium, when stimulated by this cytochine increases its own capability to stick on the neutrophils, linphocytes and tumoral cells, modulating the molecules present on its surface (ICAM- 1, ICAM-2) or with the appearance of new ones (ELAM- 1, INCAM- 100), that are able to bond the circulating cells (see below). Besides, IL-1 induces endothelium to synthesize cytochines with chemiotactic activity (IL-8 and MCP-1) all this data, obtained in vitrum, have been checked in vivo. An intradermal injection of IL-1 causes an infiltration of leukocytes, tile treatment of the naked-mice with IL-7, increases the pneumal metastasis of tumoral cells injected by endovenous.
IL-I induces also, other cytochines' synthesis, as CSF, PDGF and IL-6, that mediates endothelium's involvement in processes as aemopoiesis, atherosclerotic aetiopathogenesis and immune response.

Bibliography

LARSON, R. A. (1988): The antioxidants of higher plants. Phytochemistry 27, 969-978.
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ASADA, K and TAKAHASHI M. (1987) production and scavenging of active oxygen in photosynthesis. In Photoinhibition (D.J. Kyle, C.B. Osmond and C.J. Arntzen, Eds.) Elevier, New York, pp.227-287.

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Edited by Aldo Campana,