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Review
. 2024 Dec;62(1):818-832.
doi: 10.1080/13880209.2024.2415652. Epub 2024 Oct 30.

Indigo naturalis as a potential drug in the treatment of ulcerative colitis: a comprehensive review of current evidence

Yu Hu  1 , Liu-Lin Chen  1 , Zhen Ye  1 , Lin-Zhen Li  1 , Huan-Zhu Qian  1 , Ming-Quan Wu  2 , Juan Wang  3 , Kai-Hua Qin  4 , Qiao-Bo Ye  1
Affiliations
Review

Indigo naturalis as a potential drug in the treatment of ulcerative colitis: a comprehensive review of current evidence

Yu Hu et al. Pharm Biol. 2024 Dec.

Abstract

Context: Ulcerative colitis (UC) is an intractable inflammatory bowel disease that threatens the health of patients. The limited availability of therapeutic strategies makes it imperative to explore more efficient and safer drugs. Indigo naturalis (IN) is a traditional Chinese medicine that possesses many pharmacological activities, including anti-inflammatory, antioxidant, and immunomodulatory activities. The treatment potential of IN for UC has been proven by numerous preclinical and clinical studies in recent years.

Objective: This article provides a comprehensive review of the utility and potential of IN in the treatment of UC.

Methods: 'Indigo naturalis' 'Qing dai' 'Qingdai' 'Ulcerative colitis' and 'UC' are used as the keywords, and the relevant literature is collected from online databases (Elsevier, PubMed, and Web of Science).

Results and conclusion: Indirubin, indigo, isatin, tryptanthrin, and β-sitosterol are considered the key components in the treatment of UC with IN. Both preclinical and clinical studies support the efficacy of IN for UC, especially in severe UC or in those who do not respond to or have poor efficacy with existing therapies. The mechanisms of IN for UC are associated with the aryl hydrocarbon receptor pathway activation, immune regulation, oxidative stress inhibition, and intestinal microbial modulation. However, the clinical use of IN has the risks of adverse events such as pulmonary hypertension, which suggests the necessity for its rational application. As a potential therapeutic agent for UC that is currently receiving more attention, the clinical value of IN has been initially demonstrated and warrants further evaluation.

Keywords: AhR; IN; Traditional Chinese medicine; clinical evidence; intestinal microbiota; mechanism.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1.
Figure 1.
The chemical structures of five components in in.
Figure 2.
Figure 2.
Schematic diagram of the activation process of AhR pathway.
Figure 3.
Figure 3.
The protective role of AhR pathway activation in intestinal inflammation. AhR is widely expressed in immune and non-immune cells of the intestine. The AhR pathway activation by binding to ligands affects macrophage activation and antigen presentation by dendritic cells to reduce the secretion of inflammatory mediators. In adaptive immunity, AhR pathway activation reduces the release of IL-5 and IL-13 by regulating the ILC2/ILC3 balance and promotes the expression of IL-22. In addition, the AhR pathway can suppress intestinal inflammation by restoring the Th17/Treg balance to reduce IL-17 expression and increase IL-10 expression. Moreover, the AhR pathway can regulate the intestinal barrier and restore microbial homeostasis.
Figure 4.
Figure 4.
The possible mechanisms of IN in the treatment of UC.
See this image and copyright information in PMC

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References

    1. Adachi S, Hoshi N, Inoue J, Yasutomi E, Otsuka T, Dhakhwa R, Wang Z, Koo Y, Takamatsu T, Matsumura Y, et al. . 2017. Indigo naturalis ameliorates oxazolone-induced dermatitis but aggravates colitis by changing the composition of gut microflora. Int Arch Allergy Immunol. 173(1):23–33. doi: 10.1159/000471923. - DOI - PubMed
    1. Adachi J, Mori Y, Matsui S, Takigami H, Fujino J, Kitagawa H, Miller CA, Kato T, Saeki K, Matsuda T.. 2001. Indirubin and indigo are potent aryl hydrocarbon receptor ligands present in human urine. J Biol Chem. 276(34):31475–31478. doi: 10.1074/jbc.C100238200. - DOI - PubMed
    1. Bankoti J, Rase B, Simones T, Shepherd DM.. 2010. Functional and phenotypic effects of AhR activation in inflammatory dendritic cells. Toxicol Appl Pharmacol. 246(1-2):18–28. doi: 10.1016/j.taap.2010.03.013. - DOI - PMC - PubMed
    1. Barker N, van Es JH, Kuipers J, Kujala P, van den Born M, Cozijnsen M, Haegebarth A, Korving J, Begthel H, Peters PJ, et al. . 2007. Identification of stem cells in small intestine and colon by marker gene Lgr5. Nature. 449(7165):1003–1007. doi: 10.1038/nature06196. - DOI - PubMed
    1. Ben-Horin S, Kopylov U, Salomon N.. 2022. Curcumin-QingDai combination as treatment for moderate-severe ulcerative colitis. Case Rep Gastroenterol. 16(3):563–568. doi: 10.1159/000526646. - DOI - PMC - PubMed

MeSH terms

Grants and funding

This work was supported by the National Natural Science Foundation of China (nos. 81973742), Xing Lin Scholars Program of Chengdu University of TCM (QJJJ2022002), Sichuan Provincial Natural Science Foundation (2023NSFSC0686) and Chengdu University of Traditional Chinese Medicine University-Institute Joint Innovation Fund (Hospital Special) (LH202402022).