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Indole compounds may be promising medicines for ulcerative colitis

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Abstract

Indole compounds are extracted from indigo plants and have been used as blue or purple dyes for hundreds of years. In traditional Chinese medicine, herbal agents in combination with Qing-Dai (also known as indigo naturalis) have been used to treat patients with ulcerative colitis (UC) and to remedy inflammatory conditions. Recent studies have noted that indole compounds can be biosynthesized from tryptophan metabolites produced by various enzymes derived from intestinal microbiota. In addition to their action on indole compounds, the intestinal microbiota produce various tryptophan metabolites that mediate critical functions through distinct pathways and enzymes. Furthermore, some indole compounds, such as indigo and indirubin, act as ligands for the aryl hydrocarbon receptor. This signaling pathway stimulates mucosal type 3 innate lymphoid cells to produce interleukin-22, which induces antimicrobial peptide and tight junction molecule production, suggesting a role for indole compounds during the mucosal healing process. Thus, indole compounds may represent a novel treatment strategy for UC patients. In this review, we describe the origin and function of this indole compound-containing Chinese herb, as well as the drug development of indole compounds.

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References

  1. Kirsner JB. Historical aspects of inflammatory bowel disease. J Clin Gastroenterol. 1988;10:286–97.

    Article  CAS  PubMed  Google Scholar 

  2. Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365:1713–25.

    Article  CAS  PubMed  Google Scholar 

  3. Kanai T, Matsuoka K, Naganuma M, et al. Diet, microbiota, and inflammatory bowel disease: lessons from Japanese foods. Korean J Intern Med. 2014;29:409–15.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kim HJ, Hann HJ, Hong SN, et al. Incidence and natural course of inflammatory bowel disease in Korea, 2006–2012: a nationwide population-based study. Inflamm Bowel Dis. 2015;21:623–30.

    Article  PubMed  Google Scholar 

  5. Ng SC, Zeng Z, Niewiadomski O, et al. Early course of inflammatory bowel disease in a population-based inception cohort study from 8 countries in Asia and Australia. Gastroenterology. 2016;150(86–95):e3.

    PubMed  Google Scholar 

  6. Annese V, Daperno M, Rutter MD, et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis. 2013;7:982–1018.

    Article  PubMed  Google Scholar 

  7. Naganuma M, Sakuraba A, Hibi T. Ulcerative colitis: prevention of relapse. Expert Rev Gastroenterol Hepatol. 2013;7:341–51.

    Article  CAS  PubMed  Google Scholar 

  8. Naganuma M, Hisamatsu T, Matsuoka K, et al. Endoscopic severity predicts long-term prognosis in Crohn’s disease patients with clinical remission. Digestion. 2016;93:66–71.

    Article  PubMed  Google Scholar 

  9. Brown SJ, Mayer L. The immune response in inflammatory bowel disease. Am J Gastroenterol. 2007;102:2058–69.

    Article  CAS  PubMed  Google Scholar 

  10. Liu TC, Stappenbeck TS. Genetics and pathogenesis of inflammatory bowel disease. Annu Rev Pathol. 2016;. doi:10.1146/annurev-pathol-012615-044152 (in press).

    PubMed  PubMed Central  Google Scholar 

  11. Lee D, Albenberg L, Compher C, et al. Diet in the pathogenesis and treatment of inflammatory bowel diseases. Gastroenterology. 2015;148:1087–106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sheehan D, Moran C, Shanahan F. The microbiota in inflammatory bowel disease. J Gastroenterol. 2015;50:495–507.

    Article  CAS  PubMed  Google Scholar 

  13. Yurist-Doutsch S, Arrieta MC, Vogt SL, et al. Gastrointestinal microbiota-mediated control of enteric pathogens. Annu Rev Genet. 2014;48:361–82.

    Article  CAS  PubMed  Google Scholar 

  14. Goldsmith JR, Sartor RB. The role of diet on intestinal microbiota metabolism: downstream impacts on host immune function and health, and therapeutic implications. J Gastroenterol. 2014;49:785–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014;146:1489–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Clemente JC, Ursell LK, Parfrey LW, et al. The impact of the gut microbiota on human health: an integrative view. Cell. 2012;148:1258–70.

    Article  CAS  PubMed  Google Scholar 

  17. Matsuoka K, Kanai T. The gut microbiota and inflammatory bowel disease. Semin Immunopathol. 2015;37:47–55.

    Article  CAS  PubMed  Google Scholar 

  18. Lee KJ, Tack J. Altered intestinal microbiota in irritable bowel syndrome. Neurogastroenterol Motil. 2010;22:493–8.

    Article  CAS  PubMed  Google Scholar 

  19. Zhang X, Zhang D, Jia H, et al. The oral and gut microbiomes are perturbed in rheumatoid arthritis and partly normalized after treatment. Nat Med. 2015;21:895–905.

    Article  CAS  PubMed  Google Scholar 

  20. Tilg H, Moschen AR. Microbiota and diabetes: an evolving relationship. Gut. 2014;63:1513–21.

    Article  CAS  PubMed  Google Scholar 

  21. Smits LP, Bouter KE, de Vos WM, et al. Therapeutic potential of fecal microbiota transplantation. Gastroenterology. 2013;145:946–53.

    Article  PubMed  Google Scholar 

  22. Sears CL, Garrett WS. Microbes, microbiota, and colon cancer. Cell Host Microbe. 2014;15:317–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Gullett NP, Ruhul Amin AR, Bayraktar S, et al. Cancer prevention with natural compounds. Semin Oncol. 2010;37:258–81.

    Article  CAS  PubMed  Google Scholar 

  24. Stasiak N, Kukula-Koch W, Glowniak K. Modern industrial and pharmacological applications of indigo dye and its derivatives—a review. Acta Pol Pharm. 2014;71:215–21.

    PubMed  Google Scholar 

  25. Zhang GB, Li QY, Chen QL, et al. Network pharmacology: a new approach for chinese herbal medicine research. Evid Based Complement Alternat Med. 2013;2013:621423.

    PubMed  PubMed Central  Google Scholar 

  26. Fu J, Pang J, Zhao X, et al. The quantitative ideas and methods in assessment of four properties of Chinese medicinal herbs. Cell Biochem Biophys. 2014;71:1307–12.

    Article  Google Scholar 

  27. Sugimoto S, Naganuma M, Kiyohara H, et al. Clinical efficacy and safety of oral Qing-Dai in patients with ulcerative colitis: a single-center open-label prospective study. Digestion. 2016;93:193–201.

    Article  CAS  PubMed  Google Scholar 

  28. Xiao HT, Peng J, Hu DD, et al. Qing-dai powder promotes recovery of colitis by inhibiting inflammatory responses of colonic macrophages in dextran sulfate sodium-treated mice. Chin Med. 2015;10:29.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lin YK, Leu YL, Huang TH, et al. Anti-inflammatory effects of the extract of indigo naturalis in human neutrophils. J Ethnopharmacol. 2009;125:51–8.

    Article  CAS  PubMed  Google Scholar 

  30. Zhou D, Chen W, Li X, et al. Evidence-based practice guideline of Chinese herbal medicine for psoriasis vulgaris (Bai Bi). Eur J Integr Med. 2014;6:135–46.

    Article  Google Scholar 

  31. Yuan G, Ke Q, Su X, et al. Qing Dai, a traditional Chinese medicine for the treatment of chronic hemorrhagic radiation proctitis. Chinese-German J Clin Oncol. 2009;8:114–6.

    Article  Google Scholar 

  32. Han R. Highlight on the studies of anticancer drugs derived from plants in China. Stem Cells. 1994;12:53–63.

    Article  CAS  PubMed  Google Scholar 

  33. Stockinger B, Di Meglio P, Gialitakis M, et al. The aryl hydrocarbon receptor: multitasking in the immune system. Annu Rev Immunol. 2014;32:403–32.

    Article  CAS  PubMed  Google Scholar 

  34. Shertzer HG, Senft AP. The micronutrient indole-3-carbinol: implications for disease and chemoprevention. Drug metabol Drug interact. 2000;17:159–88.

    Article  CAS  PubMed  Google Scholar 

  35. Vaas S, Kreft L, Schwarz M, et al. Cooperation of structurally different aryl hydrocarbon receptor agonists and beta-catenin in the regulation of CYP1A expression. Toxicology. 2014;325:31–41.

    Article  CAS  PubMed  Google Scholar 

  36. Moura-Alves P, Fae K, Houthuys E, et al. AhR sensing of bacterial pigments regulates antibacterial defence. Nature. 2014;512:387–92.

    Article  CAS  PubMed  Google Scholar 

  37. Barker N, van Es JH, Kuipers J, et al. Identification of stem cells in small intestine and colon by marker gene Lgr5. Nature. 2007;449:1003–7.

    Article  CAS  PubMed  Google Scholar 

  38. Sato T, Clevers H. Growing self-organizing mini-guts from a single intestinal stem cell: mechanism and applications. Science. 2013;340:1190–4.

    Article  CAS  PubMed  Google Scholar 

  39. Karin M, Clevers H. Reparative inflammation takes charge of tissue regeneration. Nature. 2016;529:307–15.

    Article  CAS  PubMed  Google Scholar 

  40. Okamoto R, Watanabe M. Role of epithelial cells in the pathogenesis and treatment of inflammatory bowel disease. J Gastroenterol. 2016;51:11–21.

    Article  CAS  PubMed  Google Scholar 

  41. Maynard CL, Elson CO, Hatton RD, et al. Reciprocal interactions of the intestinal microbiota and immune system. Nature. 2012;489:231–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Qin J, Li R, Raes J, et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature. 2010;464:59–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Qiu J, Guo X, Chen ZM, et al. Group 3 innate lymphoid cells inhibit T-cell-mediated intestinal inflammation through aryl hydrocarbon receptor signaling and regulation of microflora. Immunity. 2013;39:386–99.

    Article  CAS  PubMed  Google Scholar 

  44. Zelante T, Iannitti RG, Cunha C, et al. Tryptophan catabolites from microbiota engage aryl hydrocarbon receptor and balance mucosal reactivity via interleukin-22. Immunity. 2013;39:372–85.

    Article  CAS  PubMed  Google Scholar 

  45. Spits H, Di Santo JP. The expanding family of innate lymphoid cells: regulators and effectors of immunity and tissue remodeling. Nat Immunol. 2011;12:21–7.

    Article  CAS  PubMed  Google Scholar 

  46. Eberl G. Development and evolution of RORgammat+ cells in a microbe’s world. Immunol Rev. 2012;245:177–88.

    Article  CAS  PubMed  Google Scholar 

  47. Goldberg R, Prescott N, Lord GM, et al. The unusual suspects–innate lymphoid cells as novel therapeutic targets in IBD. Nat Rev Gastroenterol Hepatol. 2015;12:271–83.

    Article  CAS  PubMed  Google Scholar 

  48. Mizuno S, Mikami Y, Kamada N, et al. Cross-talk between RORgammat+ innate lymphoid cells and intestinal macrophages induces mucosal IL-22 production in Crohn’s disease. Inflamm Bowel Dis. 2014;20:1426–34.

    Article  PubMed  Google Scholar 

  49. Kiss EA, Vonarbourg C, Kopfmann S, et al. Natural aryl hydrocarbon receptor ligands control organogenesis of intestinal lymphoid follicles. Science. 2011;334:1561–5.

    Article  CAS  PubMed  Google Scholar 

  50. Monteleone I, Rizzo A, Sarra M, et al. Aryl hydrocarbon receptor-induced signals up-regulate IL-22 production and inhibit inflammation in the gastrointestinal tract. Gastroenterology. 2011;141:237–48, 248.e1.

  51. Zelante T, Iannitti RG, Fallarino F, et al. Tryptophan feeding of the IDO1-AhR axis in host-microbial symbiosis. Front Immunol. 2014;5:640.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Veldhoen M, Ferreira C. Influence of nutrient-derived metabolites on lymphocyte immunity. Nat Med. 2015;21:709–18.

    Article  CAS  PubMed  Google Scholar 

  53. Froslie KF, Jahnsen J, Moum BA, et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology. 2007;133:412–22.

    Article  PubMed  Google Scholar 

  54. Saigusa K, Matsuoka K, Sugimoto S, et al. Ulcerative colitis endoscopic index of severity is associated with long-term prognosis in ulcerative colitis patients treated with infliximab. Dig Endosc. 2016;. doi:10.1111/den.12655 (in press).

    PubMed  Google Scholar 

  55. Ke S, Rabson AB, Germino JF, et al. Mechanism of suppression of cytochrome P-450 1A1 expression by tumor necrosis factor-alpha and lipopolysaccharide. J Biol Chem. 2001;276:39638–44.

    Article  CAS  PubMed  Google Scholar 

  56. Lindemans CA, Calafiore M, Mertelsmann AM, et al. Interleukin-22 promotes intestinal-stem-cell-mediated epithelial regeneration. Nature. 2015;528:560–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Li Y, Innocentin S, Withers DR, et al. Exogenous stimuli maintain intraepithelial lymphocytes via aryl hydrocarbon receptor activation. Cell. 2011;147:629–40.

    Article  CAS  PubMed  Google Scholar 

  58. Di Meglio P, Duarte JH, Ahlfors H, et al. Activation of the aryl hydrocarbon receptor dampens the severity of inflammatory skin conditions. Immunity. 2014;40:989–1001.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Xue J, Nguyen DT, Habtezion A. Aryl hydrocarbon receptor regulates pancreatic IL-22 production and protects mice from acute pancreatitis. Gastroenterology. 2012;143:1670–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Koning M, Ailabouni R, Gearry RB, et al. Use and predictors of oral complementary and alternative medicine by patients with inflammatory bowel disease: a population-based, case–control study. Inflamm Bowel Dis. 2013;19:767–78.

    Article  PubMed  Google Scholar 

  61. Weizman AV, Ahn E, Thanabalan R, et al. Characterisation of complementary and alternative medicine use and its impact on medication adherence in inflammatory bowel disease. Aliment Pharmacol Ther. 2012;35:342–9.

    Article  CAS  PubMed  Google Scholar 

  62. Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004;19:739–47.

    Article  CAS  PubMed  Google Scholar 

  63. Ben-Arye E, Goldin E, Wengrower D, et al. Wheat grass juice in the treatment of active distal ulcerative colitis: a randomized double-blind placebo-controlled trial. Scand J Gastroenterol. 2002;37:444–9.

    Article  CAS  PubMed  Google Scholar 

  64. Sandborn WJ, Targan SR, Byers VS, et al. Andrographis paniculata extract (HMPL-004) for active ulcerative colitis. Am J Gastroenterol. 2013;108:90–8.

    Article  PubMed  Google Scholar 

  65. Fukunaga K, Hida N, Ohnishi K, et al. A suppository Chinese medicine (xilei-san) for refractory ulcerative proctitis: a pilot clinical trial. Digestion. 2007;75:146–7.

    Article  PubMed  Google Scholar 

  66. Fukunaga K, Ohda Y, Hida N, et al. Placebo controlled evaluation of Xilei San, a herbal preparation in patients with intractable ulcerative proctitis. J Gastroenterol Hepatol. 2012;27:1808–15.

    Article  PubMed  Google Scholar 

  67. Tang T, Targan SR, Li ZS, et al. Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis—a double-blind comparison with sustained release mesalazine. Aliment Pharmacol Ther. 2011;33:194–202.

    Article  CAS  PubMed  Google Scholar 

  68. Gupta I, Parihar A, Malhotra P, et al. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med. 2001;67:391–5.

    Article  CAS  PubMed  Google Scholar 

  69. Zhang F, Li Y, Xu F, et al. Comparison of Xilei-san, a Chinese herbal medicine, and dexamethasone in mild/moderate ulcerative proctitis: a double-blind randomized clinical trial. J Altern Complement Med. 2013;19:838–42.

    Article  PubMed  Google Scholar 

  70. Biedermann L, Mwinyi J, Scharl M, et al. Bilberry ingestion improves disease activity in mild to moderate ulcerative colitis—an open pilot study. J Crohns Colitis. 2013;7:271–9.

    Article  PubMed  Google Scholar 

  71. Huber R, Ditfurth AV, Amann F, et al. Tormentil for active ulcerative colitis: an open-label, dose-escalating study. J Clin Gastroenterol. 2007;41:834–8.

    Article  PubMed  Google Scholar 

  72. Gong Y, Zha Q, Li L, et al. Efficacy and safety of Fufangkushen colon-coated capsule in the treatment of ulcerative colitis compared with mesalazine: a double-blinded and randomized study. J Ethnopharmacol. 2012;141:592–8.

    Article  PubMed  Google Scholar 

  73. Chen ZS, Nie ZW, Sun QL. Clinical study in treating intractable ulcerative colitis with traditional Chinese medicine. Chin J Integr Med. 1994;14:400–2.

    CAS  Google Scholar 

  74. Hanai H, Iida T, Takeuchi K, et al. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006;4:1502–6.

    Article  CAS  PubMed  Google Scholar 

  75. Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn’s Disease and Ulcerative Colitis (GETECCU). Am J Gastroenterol. 1999;94:427–33.

    Article  CAS  PubMed  Google Scholar 

  76. Langhorst J, Varnhagen I, Schneider SB, et al. Randomised clinical trial: a herbal preparation of myrrh, chamomile and coffee charcoal compared with mesalazine in maintaining remission in ulcerative colitis—a double-blind, double-dummy study. Aliment Pharmacol Ther. 2013;38:490–500.

    Article  CAS  PubMed  Google Scholar 

  77. Greenfield SM, Green AT, Teare JP, et al. A randomized controlled study of evening primrose oil and fish oil in ulcerative colitis. Aliment Pharmacol Ther. 1993;7:159–66.

    Article  CAS  PubMed  Google Scholar 

  78. Kanauchi O, Mitsuyama K, Homma T, et al. Treatment of ulcerative colitis patients by long-term administration of germinated barley foodstuff: multi-center open trial. Int J Mol Med. 2003;12:701–4.

    CAS  PubMed  Google Scholar 

  79. Langhorst J, Wulfert H, Lauche R, et al. Systematic review of complementary and alternative medicine treatments in inflammatory bowel diseases. J Crohns Colitis. 2015;9:86–106.

    Article  CAS  PubMed  Google Scholar 

  80. Teng L, Xin HW, Blix HS, et al. Review of the use of defined daily dose concept in drug utilisation research in China. Pharmacoepidemiol Drug Saf. 2012;21:1118–24.

    Article  PubMed  Google Scholar 

  81. Ferber KH. Toxicology of indigo. A review. J Environ Pathol Toxicol Oncol. 1987;7:73–83.

    CAS  PubMed  Google Scholar 

  82. Suzuki H, Kaneko T, Mizokami Y, et al. Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis. World J Gastroenterol. 2013;19:2718–22.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317:1625–9.

    Article  CAS  PubMed  Google Scholar 

  84. Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med. 1994;330:1841–5.

    Article  CAS  PubMed  Google Scholar 

  85. Glatigny S, Blaton MA, Mencher SK, et al. Treatment of collagen-induced arthritis by Natura-alpha via regulation of Th-1/Th-17 responses. Eur J Immunol. 2010;40:460–9.

    Article  CAS  PubMed  Google Scholar 

  86. Liang Y, Xie P, Chau F. Chromatographic fingerprinting and related chemometric techniques for quality control of traditional Chinese medicines. J Sep Sci. 2010;33:410–21.

    Article  CAS  PubMed  Google Scholar 

  87. Huber S, Gagliani N, Zenewicz LA, et al. IL-22BP is regulated by the inflammasome and modulates tumorigenesis in the intestine. Nature. 2012;491:259–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Sonnenberg GF, Artis D. Innate lymphoid cells in the initiation, regulation and resolution of inflammation. Nat Med. 2015;21:698–708.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Huang M, Lin HS, Lee YS, et al. Evaluation of meisoindigo, an indirubin derivative: in vitro antileukemic activity and in vivo pharmacokinetics. Int J Oncol. 2014;45:1724–34.

    CAS  PubMed  Google Scholar 

  90. Saito R, Tamura M, Matsui H, et al. Qing Dai attenuates nonsteroidal anti-inflammatory drug-induced mitochondrial reactive oxygen species in gastrointestinal epithelial cells. J Clin Biochem Nutr. 2015;56:8–14.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank the past and present members of the Keio IBD Group for their continued support. We also thank Dr. Kuniki Amano (Sky Clinic, Hiroshima, Japan) for useful suggestions.

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Correspondence to Takanori Kanai.

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Takanori Kanai received a research grant and lecture fees from Takeda Pharmaceutical Co., Ltd. However, this funding was not related to the generation of this article.

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Sugimoto, S., Naganuma, M. & Kanai, T. Indole compounds may be promising medicines for ulcerative colitis. J Gastroenterol 51, 853–861 (2016). https://doi.org/10.1007/s00535-016-1220-2

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