title: Applications of Higenamine in pharmacology and medicine.
abstract: BACKGROUND
  Aconitum has been used as local and traditional medicines in many asian regions for the treatment of various diseases such as collapse, syncope, painful joints, oedema, bronchial asthma et al. Higenamine, a plant-based alkaloid, was initially isolated from Aconitum and identified as the active cardiotonic component of Aconitum. It has been tested as a candidate of pharmacologic stress agent in the detection of coronary artery diseases (CADs) and now researchers have just accomplished the phase III clinical studies successfully in China. Besides, a large number of studies have revealed the various pharmacological properties and potentially multi-spectral medical applications of higenamine. However, to date, no comprehensive review on higenamine has been published.
  
  
  OBJECTIVE
  This present paper aims to compile a comprehensive update regarding the biochemistry, pharmacokinetic features, pharmacological activities, clinical and potential clinical uses and toxicities on higenamine with the ultimate objective of providing a guide for future research on this drug.
  
  
  METHODS
  The selection of relevant data was made through a search using the keyword "higenamine" in "Web of science", "Pubmed", and "China Knowledge Resource Integrated (CNKI)". Information was also acquired from local classic herbal literature, government reports and conference papers.
  
  
  RESULTS
  In addition to Aconitum, higenamine also exists in many other plants including Tinospora crispa, Nandina domestica THUNBERG, Gnetum Parvifolium C.Y. Cheng, sarum Heterotropoides,Nelumbo nucifera,N.nucifera. The pharmacokinetic studies conducted in animals and humans showed that higenamine conformed to a two-compartment pharmacokinetic model. Studies over the last four decades on higenamine have revealed its various pharmacological properties such as positive inotropic and chronotropic effect, activating slow channel effect, vascular and tracheal relaxation effect, anti-thrombotic, anti-apoptotic and anti-oxidative effect, anti-inflammatory and immunomodulatory effect. This phytochemical constituent has shown its potential therapeutic effects for diseases like heart failure, disseminated intravascular coagulation (DIC), shock, arthritis, asthma, ischemia/reperfusion (I/R) injuries and erectile dysfunction.
  
  
  CONCLUSIONS
  Extensive basic and clinical studies on higenamine showed valuable therapeutic effects on different disorders. However, the underlying mechanisms of higenamine have not been established. Therefore, the safety, tolerability and efficacy of higenamine are as yet, not fully understood. Additionally, some of the studies were small sample-sized and unreliable. To sum up, there is a need for deeper investigation in the mechanisms of higenamine action, as well as well-designed preclinical and clinical trials studies to test the safety and clinical value of the drug.
authors.affiliation: State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing, PR China; Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Beijing, PR China; Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
authors.forename: Nana
authors.initials: N
authors.lastname: Zhang
authors.affiliation: State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing, PR China; Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Beijing, PR China; Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
authors.forename: Zeqin
authors.initials: Z
authors.lastname: Lian
authors.affiliation: State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing, PR China; Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Beijing, PR China; Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
authors.forename: Xueying
authors.initials: X
authors.lastname: Peng
authors.affiliation: Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, PR China. Electronic address: lizijian@bjmu.edu.cn.
authors.forename: Zijian
authors.initials: Z
authors.lastname: Li
authors.affiliation: State Key Laboratory for Bioactive Substances and Functions of Natural Medicines, Beijing, PR China; Beijing Key Laboratory of New Drug Mechanisms and Pharmacological Evaluation Study, Beijing, PR China; Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China. Electronic address: zhuhaibo@imm.ac.cn.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhu
mesh_terms: D031841:Aconitum; D000470:Alkaloids / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D006801:Humans; D044005:Tetrahydroisoquinolines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000470:Alkaloids; D044005:Tetrahydroisoquinolines; C012348:higenamine
keywords: Higenamine; Medical application; Pharmacokinetics; Pharmacology; Toxicity