Delving into the Latest Updates on Tripterygium Glycosides with Synapse

Overview

Basic Info

Drug Type

Herbal medicine

Synonyms

tripterygium glycosides

Target

DUSP1 x HSP70 heat-shock proteins

Action

inhibitors

Mechanism

DUSP1 inhibitors(dual specificity phosphatase 1 inhibitors), HSP70 heat-shock proteins inhibitors(HSP70 heat-shock proteins inhibitors)

Therapeutic Areas

Immune System DiseasesCardiovascular DiseasesCongenital Disorders+ [6]

Active Indication

Behcet SyndromeNephrotic SyndromeRheumatoid Arthritis+ [1]

Inactive Indication

Crohn Disease

Originator Organization-

Active Organization

Beijing Hospital of the Ministry of Health

Inactive Organization-

License Organization-

Drug Highest PhaseApproved

First Approval Date-

Regulation-

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Tripterygium wilfordii Hook F. (TwHF) is a traditional Chinese medicine that has been used for centuries. Tripterygium glycoside (TG), a herbal agent extracted from the TwHF rhizome, is extensively used for the treatment of systemic lupus erythematosus, rheumatoid arthritis, nephrotic syndrome, and atopic eczema. However, its clinical application is hindered by its multi-target toxicity. Current literature highlights multiple TG-related complications, including acute liver and kidney injury, rhabdomyolysis, infertility, and lymphocyte suppression. Contrarily, concurrent severe rhabdomyolysis, acute kidney injury (AKI), and cardiogenic shock are rarely reported in cases of TG poisoning. Here, we present the case of a 50-year-old male with type 2 diabetes mellitus (T2DM) who experienced fatigue, nausea, vomiting, rhabdomyolysis, AKI, and cardiogenic shock after mistakenly consuming an excessive dose of TG. The patient consumed 20 tablets (10 mg/tablet) three times daily instead of the recommended therapeutic dose of 20 mg three times daily. Six months later, the patient developed TG-induced chronic complications, including chronic kidney disease (stage 2), polyuria, and irreversible nerve damage. Physicians must be vigilant about the potential for TG-induced life-threatening complications, and further studies are needed to elucidate the dose-effect relationship and establish a safe dosage.

01 Jan 2026·JOURNAL OF ETHNOPHARMACOLOGY

Quercetin ameliorates diminished ovarian reserve via modulating intestinal BNIP3/dct-1-mediated mitophagy and subsequently activating the ovarian TGF-β signaling pathway

Article

Author: Ren, Yibo ; Ruan, Qinli ; Xiao, Xian ; Sun, Jia ; Shi, Yuqing ; Ye, Ran ; Zheng, Mian ; Zhao, Ying ; Zheng, Zihui ; Chen, Linlin ; Huang, Kaili

ETHNOPHARMACOLOGICAL RELEVANCE:

Diminished ovarian reserve (DOR) is one of the most important reasons for decreasing fertility. Quercetin, a phytochemical, widely exists in food and natural Chinese herbs and can increase female fertility. However, how the phytochemical improves fertility through increasing ovarian reserve remains unclear.

AIM OF STUDY:

The study aims to investigated how quercetin improve ovarian reserve through improving intestinal mitophagy in a DOR mouse and C. elegans model.

METHODS:

Tripterygium glycoside/triptolide (TP) were used to establish DOR model in mice and C. elegans. Brood size was used to evaluate fertility of worms. Oogenesis in worms and proportion of follicles in mice were used to evaluate oocyte reserve. Loss-of-functional mutants and fluorescent protein transgene strains were used to evaluate gene function. PCR and RNAi were used to detect gene or protein function. Tissue-specific RNAi knockdown worms and intestine-specific AAV-Bnip3-RNAi knockdown mice were used to study the signaling transduction from intestine to gonad.

RESULTS:

Quercetin enhanced the fertility in DOR worms by improving the oogenesis, and improved the development and quality of follicles in DOR mice. Quercetin restored mitochondrial function through reducing of mitochondrial-reactive oxygen species (ROS), restoring mitochondrial membrane potential, and enhancing mitophagy in DOR worms. Quercetin increased ovarian reserve in the DOR worms via cooperation of mitophagy downstream dct-1 in gonad and intestine, while also amelioraing intestinal permeability through intestinal dct-1. Notably, dct-1 activation in intestine facilitated the TGF-β signaling pathway in the gonad of DOR worms, which was confirmed in DOR mice. Furthermore, quercetin alleviated intestinal tissue damage by longer villi via BNIP3 (the ortholog of dct-1) in DOR mice. Quercetin upregulated the protein expression of BNIP3 in both the intestine and ovary, and of HIVEP2 (the ortholog of sma-9) in the ovary of DOR mice. Meanwhile, intestine-specific BNIP3 knockdown inhibited the quercetin-induced beneficial effects and HIVEP2 expression in ovary in the DOR mice.

CONCLUSIONS:

Quercetin improved the ovarian reserve through enhancing intestinal BNIP3/dct-1-mediated mitophagy, ameliorating intestinal permeability, and improving ovarian TGF-β signaling pathway.

01 Jan 2026·CLINICAL RHEUMATOLOGY

Clinical practice guideline for the treatment of Sjögren’s disease through off-label drug use in China (English edition)

Review

Author: Yang, Wenjing ; Mo, Yingqian ; Dai, Lie ; Li, Yingxin

OBJECTIVE:

To develop evidence-based clinical practice guideline for the treatment of primary Sjögren's disease (SJD) through off-label drug use in China, addressing the current lack of approved therapies and suboptimal management options for this autoimmune disease.

METHODS:

The clinical questions outlined in the guideline were formulated using the PICO (Population, Intervention, Comparison, Outcome) framework, with efficacy criteria based on the STAR (Sjögren's Tool for Assessing Response) indices. Evidence retrieval encompassed databases such as PubMed, Embase, CNKI, among others up to December 31, 2022; this was supplemented by snowball searching. A multidisciplinary expert panel systematically evaluated the randomized controlled trial (RCT) evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology and formulated recommendations. Recommendations were categorized as strong (1), weak (2), or consensus-based recommendations, based on thresholds of expert agreement.

RESULTS:

The guideline presents a total of 21 recommendations: including 2 strong recommendations, 14 weak recommendations, and 5 consensus-based recommendations. These encompass systemic treatments for SJD-related symptoms such as xerostomia and xerophthalmia; systemic disease activity; hypergammaglobulinemia; and considerations for special populations like pregnant patients. Key therapeutic agents include hydroxychloroquine, leflunomide, iguratimod, tripterygium glycosides, and low-dose recombinant human IL-2-employing stratified approaches according to disease severity and organ involvement. For refractory cases that do not respond adequately to initial treatments, rituximab, cyclophosphamide, and mycophenolate mofetil are recommended. The guideline emphasizes individualized treatment plans along with safety monitoring and multidisciplinary care-particularly important for high-risk groups such as pregnant women who test positive for anti-SSA antibodies.

CONCLUSIONS:

This guideline represents a significant advancement in the management of SJD by introducing structured approaches tailored to patient needs while highlighting areas requiring further research. Key Points • By disaggregating the STAR composite index into its constituent outcome measures, the guideline formulates precise clinical inquiries. • GRADE methodology was used to provide standardized, evidence-based recommendations. • 21 final recommendations for managing glandular, systemic, and organ-specific manifestations in SJD, considering real-world variability. • Prioritizes domestic therapies approaches tailored for Chinese practice.

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