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Neurological Sciences

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01-07-2019 | Vitamin B12 Deficiency | Quiz Cases

Subacute combined degeneration of the spinal cord is associated with tripterygium glycoside tablet usage

Authors: Wei Zhuang, Nan Sun, Chongching Chan, Liyuan Huang, Li Gao, Juexian Song, Xiaolan Lin

Published in: Neurological Sciences | Issue 7/2019

Abstract

Background

Subacute combined degeneration (SCD) is a neurodegenerative disease caused by vitamin B₁₂ deficiency. The lesions mainly involve the posterior cord, lateral cord, and peripheral nerves. Occasionally, the lesions also involve brain white matter and optic nerves in severe cases. Reports of drug-induced impaired absorption and metabolism of vitamin B₁₂ resulting in SCD are scarce.

Introduction

A patient developed SCD after long-term use of tripterygium glycoside tablets in the treatment of glomerulonephritis. However, after discontinuation and vitamin B₁₂ treatment with tripterygium glycoside tablet, the symptoms of SCD were significantly resolved.

Conclusion

Drug-induced SCD is a less commonly reported cause of the disease. Tripterygium glycoside tablets can induce adverse reactions in the digestive system, causing damage to absorption and metabolism of vitamin B₁₂. Physicians should be aware of the possibility of tripterygium glycoside tablet-induced SCD after excluding more common causes such as inadequate dietary intake and impaired absorption due to gastrointestinal diseases or genetic disorders.

Zhang Y, Jiang Z, Xue M, Zhang S, Wang Y, Zhang L (2012) Toxicogenomic analysis of the gene expression changes in rat liver after a 28-day oral Tripterygium wilfordii multiglycoside exposure. J Ethnopharmacol 141(1):170–177CrossRefPubMed

Pyatt DW, Yang Y, Mehos B, le A, Stillman W, Irons RD (2000) Hematotoxicity of the chinese herbal medicine Tripterygium wilfordii Hook F in CD34-positive human bone marrow cells. Mol Pharmacol 57(3):512–518CrossRefPubMed

Kannaiyan R, Shanmugam MK, Sethi G (2011) Molecular targets of celastrol derived from Thunder of God Vine: potential role in the treatment of inflammatory disorders and cancer. Cancer Lett 303(1):9–20CrossRefPubMed

Zhu W, Li Y, Gong J, Zuo L, Zhang W, Cao L, Gu L, Guo Z, Li N, Li J (2015) Tripterygium wilfordii Hook. F. versus azathioprine for prevention of postoperative recurrence in patients with Crohn’s disease: a randomized clinical trial. Dig Liver Dis 47(1):14–19CrossRefPubMed

Wang D, Zhao XH, Cui Y, Zhang TT, Wang F, Hu YH (2018) Efficacy and safety of Tripterygium wilfordii Hook F for CKD in Mainland China: A systematic review and meta-analysis. Phytother Res 32(3):436–451

Hong Y, Gui Z, Cai X, Lan L (2016) Clinical efficacy and safety of tripterygium glycosides in treatment of stage IV diabetic nephropathy: A meta-analysis. Open Med (Wars)11(1): 611–617

Li XJ, Jiang ZZ, Zhang LY (2014) Triptolide: progress on research in pharmacodynamics and toxicology. J Ethnopharmacol 155(1):67–79CrossRefPubMed

Fan D, Parhira S, Zhu GY, Jiang ZH, Bai LP (2016) Triterpenoids from the stems of Tripterygium regelii. Fitoterapia 113:69–73CrossRefPubMed

Zhang C et al (2016) Safety profiles of Tripterygium wilfordii Hook F: a systematic review and meta-analysis. Front Pharmacol 7:402PubMedPubMedCentral

10.

Li HG, Ji W, Su JM (2012) Literature research of the hepatotoxicity of glucoside tripterygium total and its synergism and toxicity reducing effects. Zhongguo Zhong Xi Yi Jie He Za Zhi 32(3):415–418

11.

Hemmer B, Glocker FX, Schumacher M, Deuschl G, Lucking CH (1998) Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J Neurol Neurosurg Psychiatry 65(6):822–827CrossRefPubMedPubMedCentral

12.

Smith AD, Warren MJ, Refsum H (2018) Vitamin B12, in Advances in food and nutrition research. Elsevier, Amsterdam, pp 215–279

13.

Scott J et al (1981) Pathogenesis of subacute combined degeneration: a result of methyl group deficiency. Lancet 318(8242):334–337CrossRef

14.

Chatthanawaree W (2011) Biomarkers of cobalamin (vitamin B12) deficiency and its application. J Nutr Health Aging 15(3):227–231CrossRefPubMed

15.

Qu L, et al (2015) Comprehensive two-dimensional liquid chromatography coupled with quadrupole time-of-flight mass spectrometry for chemical constituents analysis of tripterygium glycosides tablets. J Chromatogr A 1400:65–73

16.

Leng Q, Cui RQ, Lu B (2011) Effects of multi-glycosides of tripterygium wilfordii on histological structures and c-kit expression in testes of pubertal rats. Zhongguo Dang Dai Er Ke Za Zhi 13(10):832–836

17.

Jing X, et al (2017) Toxic effects of Tripterygium wilfordii Hook F on the reproductive system of adolescent male rats. Biomed Pharmacother 95:1338–1345

18.

Peng B, Miao MS, Wang YL (2003) Initial discussion of mice acute hepatic injury caused by Tripterygium glycosides]. Zhongguo Zhong Yao Za Zhi 28(11):1067–1070

19.

Huang GZ, Li L, Liu L (2009) Pathological study on autopsy died of Tripterygium intoxication--report of 4 cases. Zhongguo Zhong Xi Yi Jie He Za Zhi 29(2):165–168

20.

Li J, Lu Y, Xiao C, Lu C, Niu X, He X, Zhao H, Tan Y, Lu A (2011) Comparison of toxic reaction of Tripterygium wilfordii multiglycoside in normal and adjuvant arthritic rats. J Ethnopharmacol 135(2):270–277CrossRefPubMed

21.

Ma ZJ, et al (2015) Tripterygium Glycosides Tablet Ameliorates Renal Tubulointerstitial Fibrosis via the Toll-Like Receptor 4/Nuclear Factor Kappa B Signaling Pathway in High-Fat Diet Fed and Streptozotocin-Induced Diabetic Rats. J Diabetes Res 2015:390428

22.

Su M, et al (2011) Study on influence of glucoside Tripterygium total tablets on metabolism in rats by NMR metabonomic technique. Zhongguo Zhong Yao Za Zhi 36(11):1449–1453

23.

Chen M, Ni Y, Duan H, Qiu Y, Guo C, Jiao Y, Shi H, Su M, Jia W (2008) Mass spectrometry-based metabolic profiling of rat urine associated with general toxicity induced by the multiglycoside of Tripterygium wilfordii Hook. F. Chem Res Toxicol 21(2):288–294CrossRefPubMed

24.

Minjun C et al (2008) Mass spectrometry-based metabolic profiling of rat urine associated with general toxicity induced by the multiglycoside of Tripterygium wilfordii Hook. F. Chem Res Toxicol 21(2):288CrossRef

Title: Subacute combined degeneration of the spinal cord is associated with tripterygium glycoside tablet usage
Authors: Wei Zhuang
Nan Sun
Chongching Chan
Liyuan Huang
Li Gao
Juexian Song
Xiaolan Lin
Publication date: 01-07-2019
Publisher: Springer International Publishing
Keyword: Vitamin B12 Deficiency
Published in: Neurological Sciences / Issue 7/2019
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-019-03845-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Subacute combined degeneration of the spinal cord is associated with tripterygium glycoside tablet usage

Abstract

Background

Introduction

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Introduction

Conclusion

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