slide1
Download
Skip this Video
Download Presentation
What Is CAM?

Loading in 2 Seconds...

play fullscreen
1 / 29

cam domains - PowerPoint PPT Presentation


  • 339 Views
  • Uploaded on

What Is CAM?. … medical and health care practices outside the realm of conventional medicine, which are yet to be validated using scientific methods. Complementary: together with conventional practices Alternative: in place of conventional practices. CAM Domains.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'cam domains' - PamelaLan


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
what is cam
What Is CAM?

… medical and health care practices outside the realm of conventional medicine, which are yet to be validated using scientific methods

Complementary: together with conventional practices

Alternative:in place of conventional practices

cam domains
CAM Domains

Manipulative and Body-Based Systems

Biologically Based Systems

Massage Chiropractic

Diets Herbals

Common

CAM

Practices

Yoga Prayer Meditation

Reiki Magnets Qi qong

Mind-Body Medicine

Energy Therapies

Homeopathy Naturopathy

Alternative Medical Systems

conventional medicine push factors
Conventional Medicine “Push” Factors
  • Failure to yield cures
  • Adverse effects of orthodox regimens
  • Lack of practitioner time
  • Dissatisfaction with the technical approach
  • Fragmentation of care by specialists
cam therapies pull factors
CAM Therapies “Pull” Factors
  • Media reports of dramatic results
  • Belief that CAM treatments are natural
  • Patient empowerment
  • Focus on spiritual and emotional well-being
  • Therapist providing “touch, talk, time”
cam the evidence
CAM: The Evidence
  • Efficacy
  • Abundant anecdotes and tradition
  • Small studies

Safety

  • Displacing/interfering with proven therapies
  • Inherent toxicity of CAM products
nccam s mission
NCCAM’s Mission
  • Conduct rigorous research on CAM practices
  • Educate and train CAM researchers
  • Inform consumers and health professionals
setting priorities for nih research
Setting Prioritiesfor NIH Research
  • Burden of disease
  • Use by U.S. public
  • Opportunity to reveal new principles
  • Data from preliminary studies encouraging
  • Studies are ethical, feasible
  • Private investment in research is low, lacking
investment priorities
Investment Priorities
  • Extramural Program

Phase I-III studies of many CAM approaches

Pre-clinical and translational research

Research training

  • Intramural Program

Clinical and translational studies of CAM approaches to age-related stressors

Research training

cam domains14
CAM Domains

Manipulative and Body-Based Systems

Biologically Based Systems

Massage Chiropractic

Diets Herbals

Common

CAM

Practices

Yoga Prayer Meditation

Reiki Magnets Qi qong

Mind-Body Medicine

Energy Therapies

Homeopathy Naturopathy

Alternative Medical Systems

st john s wort
St. John’s Wort
  • Medicinal herb
  • Widely used

$6 billion European sales (1998)

$140 million U.S. sales (1998)

  • Complex mixture of > 2 dozen compounds
  • Antidepressant constituent = hyperforin
  • Drug interactions

oral contraceptives

indinavir

cyclosporin

slide16

Systematic Review of SJW Studies

Shrader

Phillips

Laakmann

Bjerken

Witte

Volz

Shelton

Wiedey

Montgomery

Holoman

Quandt

Hoffmann

Hansgen

Schilch

Schmidt

Reh

Sommer

Huber

Lehrl

Osterhei

Konig

1996-2001

1996

0 10 20 30 40

Odds Ratio

Bars = one standard deviation

nih multicenter trial of sjw in major depression
NIH Multicenter Trial of SJW in Major Depression
  • 8-week acute efficacy phase
  • 18-week maintenance phase
  • Active drug and placebo control arms
study outcome
Study Outcome

Primary Endpoints

  • Change in HAM-D score
  • Rate of complete response

(CGI-I  2 and HAM-D  8)

it s all natural
It’s All “Natural”…!

“People can be induced to swallow anything, provided it is sufficiently seasoned with praise.”

Jean Moliere

st john s wort lowers blood levels of hiv protease inhibitor indinavir
St. John’s Wort Lowers Blood Levels of HIV Protease Inhibitor Indinavir

HIV Inhibition threshold

Piscitelli et al.

chemoprotection defense against toxins

Inhaled

Absorbed

Ingested

Synthesized

monooxygenases

conjugation enzymes

transporters

Liver

Intestine

Chemoprotection: Defense Against Toxins

• Xenobiotics = foreign chemicals

• Endobiotics = chemicals produced by body

cyp3a induction causes drug interactions
CYP3A Induction Causes Drug Interactions
  • Expressed in liver and intestine
  • Bind to CYP3A promoter
  • Activated by xenobiotics and endobiotics

Drug A

“Inducer”

?

Indinavir

Ethinylestradiol

Atorvostatin

Cyclosporin

Warfarin

Tamoxifen

Doxorubicin

Drug B

“Substrate”

CYP3A

XRE

CYP3A

Rifampicin

Dexamethasone

Troglitazone

Phenytoin

Taxol

St. John’s Wort?

HO-Drug B

excreted

Kliewer et al.

nuclear receptor superfamily

C

N

Classical Receptors

Orphan Receptors

Glucocorticoid

Mineralocorticoid

Progesterone

Estrogen (a,b)

Androgen

Thyroid Hormone (a,b)

Vitamin D

all-trans Retinoic Acid (a,b,g)

CAR

COUP (a,b,g)

DAX

ERR (a,b,g)

FXR

GCNF1

HNF4 (a,g)

LXR (a,b)

NGFI-B (a,b,g)

PNR

PPAR (a,g,d)

PXR

revErb (a,b)

RXR (a,b,g)

ROR (a,b,g)

SF1 (a,b)

SHP

Tlx

TR2 (a,b)

Nuclear Receptor Superfamily

DNA

Ligand

48 NRs in human genome

Kliewer et al.

human pxr expression pattern
Human PXR Expression Pattern

Northern blot

small intestine

pancreas

placenta

prostate

thymus

muscle

spleen

kidney

ovary

colon

testis

heart

brain

lung

PBL

liver

Kliewer et al.

pxr binds to cyp3a promoter
PXR Binds to CYP3A Promoter

TGAACT caaagg AGGTCA

<----- ----->

CYP3A4 XRE

CYP3A

XRE

- + +

+ - +

PXR

RXR

Kliewer et al.

st john s wort activates pxr

hyperforin

rutin

luteolin

Hypericin

extract 1

extract 2

extract 3

myricetin

sitosterol

quercetin

quercitrin

SR12813

rifampicin

hyperforin

scopoletin

hyperoside

kaempferol

isoquercitrin

umbelliferone

amentoflavone

pseudohypericin

St. John’s Wort Activates PXR

Cell-based

reporter assay

8

7

6

5

Fold activation

4

3

2

1

Kliewer et al.

sjw regulates other pxr target genes
SJW Regulates Other PXR Target Genes

1 human

hepatocytes

  • Phase I enzymes (oxidation)
  • CYP3A4
  • CYP2B6
  • CYP2A4
  • ALDH1A4
  • Phase II enzymes (conjugation)
  • SULT1A1
  • Transporters
  • MDR1

solubilization

excretion

Kliewer et al.

ad