Biochemical effect of the Ethanolic root extract of Croton Membranaceus on the treatment of benign prostatic hyperplasia

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Benign prostatic hyperplasia (BPH) is one of the most common diseases of aging men, characterized by noncancerous enlargement of the prostate gland which is often associated with lower urinary tract symptoms (LUTS) and poses a threat to the quality of life (QoL). The prevalence of BPH is age-dependent, with the initial development usually after 40 years. The condition accounts for 80% of prostate disorders in Ghana with a peak age of 65 years. Treatment options are basically by orthodox or traditional means. Due to the fear of loss of libido in men as a result of the use of orthodox medicine, BPH patients have resorted to complementary and alternative medicine (CAM) for treatment. An ethanolic extract of Croton membranaceus (CMERE) has been used over four decades for the management of BPH based on anecdotal evidence. However, no scientific study exists to back this practice. The study therefore aimed at investigating the effect of CMERE on BPH patients. Thirty (30) clinically diagnosed BPH patients were recruited by a convenience sampling technique. Baseline information on LUTS and sexual function was obtained using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) questionnaires, respectively. Blood samples were also obtained from subjects for biochemical assays [PSA, renal function tests (RFTs), liver function tests (LFTs), lipid profile and Apo proteins A1 and B] using spectrophotometric and ELISA techniques. Treatment outcome on glutathione s-transferase T1 and M1 (GSTT1 and GSTM1) genotypes was determined by molecular techniques. Abdomenopelvic ultrasonography was also performed to determine the prostate volume. These parameters were again measured 3 months after administration with 60 mg per day CMERE in capsule form. The average age was 66 ±11 years. At the end of the study, no patient had severe prostate symptoms compared to baseline data of 37%. Furthermore, improvement in IPSS and QoL was significant (p = 0.0005 and 0.0001, respectively). CMERE did not adversely affect systemic organs generally. No significant differences were observed in RFTs, and the lipid profile except for Apo A1 which increased indicating an increase in high density lipoprotein cholesterol (HDL) (p=0.0248), LFT parameters were normal except for increases in total and indirect bilirubins (p = 0.0008, p = 0.0007, respectively). However, these were within the normal reference intervals and could be as a result of bilirubin functioning as an antioxidant. PSA decreased significantly by 40.87% (p = 0.0015), accompanied by a significant decrease of 39.71% in prostate volume (p = 0.0008) after treatment. Thirty-three percent (33%) and 67% of the subjects were GSTT1 negative and GSTT1 positive, respectively, whiles 20% of the subjects were GSTM1 negative and 80% GSTM1 positive, respectively. There was a significant reduction of PSA levels (p<0.05) in both GSTT1(+)/GSTM1(+) subjects but not GSTT1(-)/GSTM1(+) and GSTT1(+)/GSTM1(-) subjects. In conclusion, C. membranaceus use is safe and a highly desirable alternative for men with BPH. IPSS, QoL, PSA and prostate volume improved significantly. GSTT1(+)/GSTM1(+) polymorphism subjects also showed a significant and better response to treatment. This is the first evidence backing the anecdotal claims for the use of C. membranaceus in the management of BPH.
A dissertation submitted to the Department of Molecular Medicine, school of medical sciences, college of health sciences, Kwame Nkrumah University of Science and Technology, in partial fulfillment of the requirements for the award of a master of philosophy degree in Chemical Pathology,