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Fermentation of traditional medicine: present and future

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Traditional medicine has been used for a very long time, but scientific evidence regarding the therapeutic properties of traditional medicine has recently been required. Many components of herbs have been isolated, and their biological activities, evaluated. However, many of these herbs need to be biotransformed by bacteria in the large intestine in order to be biologically activated. The presence or absence of metabolically active bacteria in the large intestine is therefore important for biological activation. Inter-individual differences exist in the composition of human intestinal bacteria; biotransformation of traditional medicine outside the human body by using bacterial strains such as lactic acid bacteria (which are considered safe) has been used in an attempt to overcome such differences. This process yields what is referred to as fermented traditional medicine (FTM). FTMs have garnered attention for their enhanced biological activity compared to traditional medicine. Several studies using single herbs and formula support the availability of FTMs. However, the concrete concept of FTM is not yet established, and further discussions regarding the bacterial strains that have been used during fermentation and their safety are necessary. This report provides a general review and discussion of FTM with a view to promote better usage and safety in the future.

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  • Akao T, Che QM, Kobashi K, Yang L, Hattori M, Namba T (1994) Isolation of a human intestinal anaerobe, Bifidobacterium sp. strain SEN, capable of hydrolyzing sennosides to sennidins. Appl Environ Microbiol 60:1041–1043

    PubMed  CAS  Google Scholar 

  • Bhatia Y, Mishra S, Bisaria VS (2002) Microbial beta-glucosidases: cloning, properties, and applications. Crit Rev Biotechnol 22:375–407

    Article  PubMed  CAS  Google Scholar 

  • Chung TH, Kang TJ, Cho WK, Im GY, Lee GS, Yang MC, Cho CW, Ma JY (2012) Effectiveness of the novel herbal medicine, KIOM-MA, and its bioconversion product, KIOM-MA128, on the treatment of atopic dermatitis. Evid Based Complement Alternat Med. doi:10.1155/2012/762918

  • Eum HA, Lee JH, Yang MC, Shim KS, Lee JH, Ma JY (2011) Protective effect of ssanghwa-tang fermented by Lactobacillus fermentum against carbon tetrachloride-induced acute hepatotoxicity in rats. Afr J Tradit Complement Altern Med 8:312–321

    PubMed  Google Scholar 

  • Han CC, Wei H, Guo J (2011) Anti-inflammatory effects of fermented and non-fermented Sophora flavescens: a comparative study. BMC Complement Altern Med 11:100

    Article  PubMed  Google Scholar 

  • Hasani-Ranjbar S, Nayebi N, Larijani B, Abdollahi M (2009) A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity. World J Gastroenterol 15:3073–3085

    Article  PubMed  CAS  Google Scholar 

  • Hasegawa H (2004) Proof of the mysterious efficacy of ginseng: basic and clinical trials: metabolic activation of ginsenoside: deglycosylation by intestinal bacteria and esterification with fatty acid. J Pharmacol Sci 95:153–157

    Article  PubMed  CAS  Google Scholar 

  • Humblot C, Murkovic M, Rigottier-Gois L, Bensaada M, Bouclet A, Andrieux C, Anba J, Rabot S (2007) Beta-glucuronidase in human intestinal microbiota is necessary for the colonic genotoxicity of the food-borne carcinogen 2-amino-3-methylimidazo[4,5-f]quinoline in rats. Carcinogenesis 28:2419–2425

    Article  PubMed  CAS  Google Scholar 

  • Jeon WJ, Oh JS, Park MS, Ji GE (2012) Anti-hyperglycemic effect of fermented ginseng in type 2 diabetes mellitus mouse model. Phytother Res. doi:10.1002/ptr.4706

  • Jin H, Seo JH, Uhm YK, Jung CY, Lee SK, Yim SV (2012a) Pharmacokinetic comparison of ginsenoside metabolite IH-901 from fermented and non-fermented ginseng in healthy Korean volunteers. J Ethnopharmacol 139:664–667

    Article  PubMed  CAS  Google Scholar 

  • Jin JS, Tobo T, Chung MH, Ma CM, Hattori M (2012b) Transformation of trachelogenin, an aglycone of tracheloside from safflower seeds, to phytoestrogenic (-)-enterolactone by human intestinal bacteria. Food Chem 134:74–80

    Article  CAS  Google Scholar 

  • Kato M, Ishige A, Anjiki N, Yamamoto M, Irie Y, Taniyama M, Kibe R, Oka J, Benno Y, Watanabe K (2007) Effect of herbal medicine Juzentaihoto on hepatic and intestinal heat shock gene expression requires intestinal microflora in mouse. World J Gastroenterol 13:2289–2297

    PubMed  CAS  Google Scholar 

  • Kim DH, Jin YH (2001) Intestinal bacterial beta-glucuronidase activity of patients with colon cancer. Arch Pharm Res 24:564–567

    Article  PubMed  CAS  Google Scholar 

  • Kim DS, Kim SH, Kim BK, Yang MC, Ma JY (2012) Antiasthmatic effects of herbal complex MA and its fermented product MA128. Evid Based Complement Alternat Med. doi:10.1155/2012/769508

  • Kitaoka K, Uchida K, Okamoto N, Chikahisa S, Miyazaki T, Takeda E, Séi H (2009) Fermented ginseng improves the first-night effect in humans. Sleep 32:413–421

    PubMed  Google Scholar 

  • Ko SJ, Ryu B, Kim J, Hong BG, Yeo I, Lee BJ, Lee JM, Park JW (2011) Effect of herbal extract granules combined with probiotic mixture on irritable bowel syndrome with diarrhea: study protocol for a randomized controlled trial. Trials 12:219

    Article  PubMed  Google Scholar 

  • Lee HS, Kim MK, Kim YK, Jung EY, Park CS, Woo MJ, Lee SH, Kim JS, Suh HJ (2011) Stimulation of osteoblastic differentiation and mineralization in MC3T3-E1 cells by antler and fermented antler using Cordyceps militaris. J Ethnopharmacol 133:710–717

    Article  PubMed  Google Scholar 

  • Macfarlane GT, Macfarlane S (2012) Bacteria, colonic fermentation, and gastrointestinal health. J AOAC Int 95:50–60

    Article  PubMed  CAS  Google Scholar 

  • Matsumoto M, Ishige A, Yazawa Y, Kondo M, Muramatsu K, Watanabe K (2012) Promotion of intestinal peristalsis by Bifidobacterium spp. capable of hydrolysing sennosides in mice. PLoS One 7:e31700

    Article  PubMed  CAS  Google Scholar 

  • Oh YC, Cho WK, Oh JH, Im GY, Jeong YH, Yang MC, Ma JY (2012) Fermentation by Lactobacillus enhances anti-inflammatory effect of Oyaksungisan on LPS-stimulated RAW 264.7 mouse macrophage cells. BMC Complement Altern Med 12:17

    Article  PubMed  CAS  Google Scholar 

  • Ramesh T, Kim SW, Sung JH, Hwang SY, Sohn SH, Yoo SK, Kim SK (2012) Effect of fermented Panax ginseng extract (GINST) on oxidative stress and antioxidant activities in major organs of aged rats. Exp Gerontol 47:77–84

    Article  PubMed  CAS  Google Scholar 

  • Rosell JM (1929) Studies in the pathology of digestion: I. Intestinal fermentation and putrefaction. Can Med Assoc J 21:42–46

    PubMed  CAS  Google Scholar 

  • Seo JY, Lee JH, Kim NW, Kim YJ, Chang SH, Ko NY, Her E, Yoo YH, Kim JW, Lee BY, Lee HY, Kim YM, Choi WS (2005) Inhibitory effects of a fermented ginseng extract, BST204, on the expression of inducible nitric oxide synthase and nitric oxide production in lipopolysaccharide-activated murine macrophages. J Pharm Pharmacol 57:911–918

    Article  PubMed  CAS  Google Scholar 

  • Takasuna K, Hagiwara T, Hirohashi M, Kato M, Nomura M, Nagai E, Yokoi T, Kamataki T (1996) Involvement of beta-glucuronidase in intestinal microflora in the intestinal toxicity of the antitumor camptothecin derivative irinotecan hydrochloride (CPT-11) in rats. Cancer Res 56:3752–3757

    PubMed  CAS  Google Scholar 

  • Wakabayashi C, Murakami K, Hasegawa H, Murata J, Saiki I (1998) An intestinal bacterial metabolite of ginseng protopanaxadiol saponins has the ability to induce apoptosis in tumor cells. Biochem Biophys Res Commun 246:725–730

    Article  PubMed  CAS  Google Scholar 

  • Yuan HD, Chung SH (2010a) Fermented ginseng protects streptozotocin-induced damage in rat pancreas by inhibiting nuclear factor-kappaB. Phytother Res 2:S190–S195

    Article  Google Scholar 

  • Yuan HD, Chung SH (2010b) Protective effects of fermented ginseng on streptozotocin-induced pancreatic beta-cell damage through inhibition of NF-kappaB. Int J Mol Med 25:53–58

    PubMed  Google Scholar 

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Correspondence to Jong-Sik Jin.

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Lee, JH., Lee, JH. & Jin, JS. Fermentation of traditional medicine: present and future. Orient Pharm Exp Med 12, 163–165 (2012).

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