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Reproductive Sciences

, Volume 19, Issue 5, pp 534–538 | Cite as

Trichosanthin, a Chinese Medicine for the Medical Treatment of Ectopic Pregnancy With High Levels of β-hCG

  • D. J. Xiang
  • L. M. Chen
  • J. S. Gu
  • P. Stone
  • Qi ChenEmail author
Original Articles

Abstract

This was a retrospective study of the effectiveness of trichosanthin (TCS), an active component isolated from the Chinese herb root tuber of Trichosanthes kirilowii on 140 cases of ectopic pregnancy with higher levels of β-human chorionic gonadotropin (β-hCG) managed with a single dose of TCS treatment. Trichosanthin has been used for medical treatment of ectopic pregnancy in China since the 1980s. This study was performed in a major teaching hospitals in China. The mean pretreatment level of β-hCG in the TCS treatment group was 3387.57 IU/L. The success rate of TCS treatment was 85% (119 of 140) which was similar to methotrexate (MTX) treatment. In 86 women with a high level of β-hCG (over 2000 IU/ L), the success rate was 80.08% when treated with TCS. Of this group, 26 women who had a high level of β-hCG (over 5000 IU/L) showed a success rate of 73%. The level of β-hCG on days 4, 7, and 10 in TCS group was significantly decreased. This study has shown that TCS may be an option for the medical treatment of unruptured ectopic pregnancy or an option for the treatment of ectopic pregnancy with higher levels of β-hCG than currently recommended for medical management with MTX.

Keywords

ectopic pregnancy trichosanthin β-hCG 

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References

  1. 1.
    Anon, Ectopic pregnancies: United States, 1990–1992, MMWR Morb Mortal Wkly Rep 44. 1995, 46–48.Google Scholar
  2. 2.
    Egger M, Low N, Smith GD, Lindblom B, Herrmann B. Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis, BMJ. 1998;316(7147):1776–1786.CrossRefGoogle Scholar
  3. 3.
    RCOG. Why Mothers die 1997–1999: the Fifth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom 1997–1999. London, UK: RCOG Press; 2001.Google Scholar
  4. 4.
    Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ectopic pregnancy. N Engl J Med. 2000;343(18):1325–1329.CrossRefGoogle Scholar
  5. 5.
    American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: the practice committee of the American society for reproductive medicine. Fertil Steril. 2006;86(6):S96–S102.Google Scholar
  6. 6.
    Farquhar CM. Ectopic pregnancy. Lancet. 2005;66(9485):583–591.CrossRefGoogle Scholar
  7. 7.
    Stovall TG, Ling FW. Single dose methotrexate: an expanded clinical trial. Am J Obstet Gynecol. 1993;68(6 pt 1):1759–1765.CrossRefGoogle Scholar
  8. 8.
    Fylstra DL. Medical Management of Ectopic Pregnancy: ACOG Practice Bulletin no. 94. Washington, DC: American College of Obstetricians and Gynecologists; 2008.Google Scholar
  9. 9.
    May MJ, Hartley MR, Roberts LM, Krieg PA, Osborn RW, Lord JM. Ribosome inactivation by ricin a chain: a sensitive method to assess the activity of wild-type and mutant polypeptides. EMBO J. 1989;8(1):301–308.CrossRefGoogle Scholar
  10. 10.
    Maraganore JM, Joseph M, Bailey MC. Purification and characterization of TCS. Homology to the ricin a chain and mplications as to mechanism of abortifacient activity. J Biol Chem. 1987;262(24):11628–11633.PubMedGoogle Scholar
  11. 11.
    Liu Shu-Lian, Wu Xu-Dong, Liu Guo-Wu, et al. Primary study on safety of trichosanthin combined with reserpine and testosterone propionate for termination of early & middle stage pregnancy: a clinical report of 7754 cases [In Chinese]. Reprod Contraception. 1991;11(3):46–51.Google Scholar
  12. 12.
    Jin YC. Crystal trichosanthin protein intramuscular or intracervical injection for the termination of pregnancy at 10 to 14 weeks gestation: clinical analysis of 200 cases [In Chinese]. Reprod Contraception. 1990;10(1):34–37.Google Scholar
  13. 13.
    Dai RX, Xu GJ, Lin XY, et al. Studies on injury-mechanism of trichosanthin on trophoblast cells and choriocarcinoma cells in culture [In Chinese]. Acta Biologiae Experimentalis Sinica. 1993;26(4):411–427.PubMedGoogle Scholar
  14. 14.
    Kahn JO, Kaplan LD, Gambertoglio JG, et al. The safety and pharmacokinetics of GLQ223 in subjects with AIDS and AIDS-related complex: a phase I study. AIDS. 1990;4(12):1197–1204.CrossRefGoogle Scholar
  15. 15.
    Mayer RA, Sergios PA, Coonan K, O’Brien L. Trichosanthin treatment of HIV-induced immune dysregulation. Eur J Clin Invest. 1992;22(2):113–122.CrossRefGoogle Scholar
  16. 16.
    Byers VS, Levin AS, Waites LA, et al. A phase I/II study of trichosanthin treatment of HIV disease. AIDS. 1990;4(12):1189–1196.CrossRefGoogle Scholar
  17. 17.
    Jiang HZ, Zhou ZM. Crystal trichosanthin treatment of Ectopic pregnancy: a clinnical report of 26 cases [In Chinese]. Hubei J Tradit Chin Med. 1992;14(5):7–8.Google Scholar
  18. 18.
    Lu PX, Jin YC. Ectopic pregnancy treated with trichosanthin. Clinical analysis of 71 patients. Chin Med J (Engl). 1989;102(5):365–367.Google Scholar
  19. 19.
    Egarter C, Husslein P, Yeung HW. Trichosanthin injection in tubal pregnancy. Gynecol Obstet Invest. 1991;31(2):119–120.CrossRefGoogle Scholar
  20. 20.
    Stovall TG, Ling FW, Buster JE. Outpatient chemotherapy of unruptured ectopic pregnancy. Fertil Steril. 1989;51(3):435–438.CrossRefGoogle Scholar
  21. 21.
    Erdem M, Erdem A, Arslan M, Oç A, Biberoğlu K, Gürsoy R. Single-dose methotrexate for the treatment of unruptured ectopic pregnancy. Arch Gynecol Obstet. 2004;270(4):201–204.CrossRefGoogle Scholar
  22. 22.
    Yao M, Tulandi T. Current status of surgical and nonsurgical management of ectopic pregnancy. Fertil Steril. 1997;67(3):421–433.CrossRefGoogle Scholar
  23. 23.
    Clasen K, Camus M, Tournaye H, Devroey P. Ectopic pregnancy: let’s cut! strict laparoscopic approach to 194 consecutive cases and review of literature on alternatives. Hum Reprod. 1997;12(3):596–601.CrossRefGoogle Scholar
  24. 24.
    Stika CS, Anderson L, Frederiksen MC. Single-dose methotrexate for the treatment of ectopic pregnancy: Northwestern memorial hospital three-year experience. Am J Obstet Gynecol. 1996;174(6):1840–1848.CrossRefGoogle Scholar
  25. 25.
    Barnhart K, Sammel MD, Chung K, Zhou L, Hummel AC, Guo W. Decline of serum human chorionic gonadotropin and spontaneous complete abortion: defining the normal curve. Obstet Gynecol. 2004;104(5 pt 1):975–981.CrossRefGoogle Scholar
  26. 26.
    Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abulafia O. Do serum beta-human chorionic gonadotropin levels on day 4 following methotrexate treatment of patients with ectopic pregnancy predict successful single-dose therapy? Am J Perinatol. 2006;23(3):193–196.CrossRefGoogle Scholar
  27. 27.
    Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D. Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis. Ultrasound Obstet Gynecol. 2004;23(6):552–556.CrossRefGoogle Scholar
  28. 28.
    Barnhart KT, Gosman G, Ashby R. Sammel M. The medical management of ectopic pregnancy: a meta-analysis comparing ‘single dose’ and ‘multidose’ regimens. Obstet Gynecol. 2003;101(4):778–784.PubMedGoogle Scholar
  29. 29.
    Shaw PC, Lee KM, Wong KB. Recent advances in trichosanthin, a ribosome-inactivating protein with multiple pharmacological properties. Toxicon. 2005;45(6):683–689.CrossRefGoogle Scholar
  30. 30.
    Wang JH, Nie HL, Tarn SC, Huang H, Zheng YT. Anti-HIV-1 property of trichosanthin correlates with its ribosome inactivating activity. FEBS Lett. 2002;531(2):295–298.CrossRefGoogle Scholar
  31. 31.
    Cheng KF. Midtrimester abortion induced by radix trichosanthis: morphologic observations in placenta and fetus. Obstet Gynecol. 1982;59(4):494–498.Google Scholar

Copyright information

© Society for Reproductive Investigation 2012

Authors and Affiliations

  • D. J. Xiang
    • 1
  • L. M. Chen
    • 2
  • J. S. Gu
    • 1
  • P. Stone
    • 3
  • Qi Chen
    • 1
    • 2
    • 3
    Email author
  1. 1.Wuxi Maternity and Child Health Hospital Affiliated Nanjing Medical UniversityWuxiChina
  2. 2.The Obstetrics and Gynaecology Hospital of Fudan UniversityChina
  3. 3.Department of Obstetrics & GynaecologyThe University of AucklandNew Zealand

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