Context: Pimenta dioica (L.) Merr. (Myrtaceae) is used in Costa Rican traditional medicine for women's health. Our previous work showed that P. dioica extracts were oestrogenic. Objectives: This work identifies phytochemicals from P. dioica that are responsible for the plant's oestrogen-like activities. Materials and methods: P. dioica leaves were collected in Costa Rica in 2005. Fractions resulting from chromatographic separation of a methanol extract were tested at 50 mu g/mL in a competitive oestrogen receptor-binding assay. Active compounds were isolated by HPLC and identified by NMR and MS. Pure compounds were tested at 1 mu M in the oestrogen-responsive SEAP reporter gene assay. The effects on cell viability, cytotoxicity and apoptosis were investigated in breast cancer (MCF-7 and SK-BR3) and gastric cancer (AGS and NCI-N87) cell lines using the ApoTox-Glo and Caspase-Glo assays and qPCR. Results: Quercitrin and three new chromones, including a 2-phenoxychromone, 6,8-di-C-methylcapillarisin (1) were isolated and identified. Compound 1 caused a 6.2-fold increase in SEAP expression at 1 (p<0.05). This activity was blocked by the ER antagonist ICI 182,780. Compound 2 caused a 6.0-fold increase in SEAP, inhibited the growth of MCF-7, AGS and NCI-N87 cells (IC 50 54.27, 38.13 and 51.22 mu g/mL, respectively), and induced apoptosis via caspase 8 and increased the Bax/Bcl-2 mRNA ratio in MCF-7 cells. Compound 3 was anti-oestrogenic in MCF-7 cells. Discussion and conclusions: Compounds from P. dioica have oestrogenic, anti-oestrogenic and cytotoxic effects that may explain the ethnomedical use of this plant.

Similar to their US counterparts, Costa Rican women enter menopause at ∼50 years of age, have similar symptoms, including hot flashes and night sweats, as well as an overall negative attitude toward the menopausal transition. One study of rural women in Monteverde reported that women knew little about the menopausal transition, as the subject was not discussed. Similar to other Latin American women, the use of hormone therapy by Costa Rican women is low and instead they use alternative therapies, including massage, dietary changes and herbal medicines. A wide variety of herbal therapies are used, and some of these herbs have estrogenic activities in vitro. However, clinical data on the safety and efficacy of any of these treatments is lacking. Recently, a disturbing increase in the incidence of human papilloma virus infections in menopausal women has been reported, due in part to more sexual freedom after menopause. Fortunately, the strain of HPV infecting these women is not associated with cervical cancer. Overall, there is a significant lack of scientific and medical research on menopausal women in Costa Rica. Considering the aging population, the high use of herbal medicines by menopausal women and the lack of clinical studies on these treatments, future research should focus on gaining a better understanding of menopause in this population. Furthermore, new educational programs for these women and the health professionals who serve them are necessary, as well as investigations of the safety and efficacy of the herbal supplements women use to manage their menopausal symptoms.

PURPOSE The rate of contralateral prophylactic mastectomies (CPMs) continues to rise, although there is little evidence to support improvement in quality of life (QOL) with CPM. We sought to ascertain whether patient-reported outcomes and, more specifically, QOL differed according to receipt of CPM. METHODS Volunteers recruited from the Army of Women with a history of breast cancer surgery took an electronically administered survey, which included the BREAST-Q, a well-validated breast surgery outcomes patient-reporting tool, and demographic and treatment-related questions. Descriptive statistics, hypothesis testing, and regression analysis were used to evaluate the association of CPM with four BREAST-Q QOL domains. RESULTS A total of 7,619 women completed questionnaires; of those eligible, 3,977 had a mastectomy and 1,598 reported receipt of CPM. Women undergoing CPM were younger than those who did not choose CPM. On unadjusted analysis, mean breast satisfaction was higher in the CPM group (60.4 v 57.9, P < .001) and mean physical well-being was lower in the CPM group (74.6 v 76.6, P < .001). On multivariable analysis, the CPM group continued to report higher breast satisfaction (P = .046) and psychosocial well-being (P = .017), but no difference was reported in the no-CPM group in the other QOL domains. CONCLUSION Choice for CPM was associated with an improvement in breast satisfaction and psychosocial well-being. However, the magnitude of the effect may be too small to be clinically meaningful. Such patient-reported outcomes data are important to consider when counseling women contemplating CPM as part of their breast cancer treatment.

9554 Background: Retrospective data show that the rate of contralateral prophylactic mastectomies (CPMs) is increasing; meanwhile, parallel information informing impact of CPM on quality of life (QOL) is lacking. We undertook this study to ascertain whether patient-reported outcomes (PRO), and more specifically QOL, differed between women who did or did not elect CPM. Methods: Women recruited from the Army of Women (AOW) with a history of breast cancer surgery took electronically-administered surveys including a background survey to collect patient, disease, and procedure specific factors, as well as the BREAST-Q, a well-validated breast surgery outcomes patient reporting tool. Descriptive statistics, univariate hypothesis testing, and regression analysis were used to evaluate the association of CPM with PRO scores in 4 QOL domains incorporated in the BREAST-Q (satisfaction with breasts, and psychosocial, physical and sexual well-being). Results: 7628 women completed questionnaires; of these, 4152 had mastectomy and 1519 (37%) reported receipt of CPM. Women undergoing CPM were younger (median age 53.7 y vs. 59.3 y, p < 0.0001) and reported earlier breast cancer stage at presentation than those who did not choose CPM. In univariate analysis, mean breast satisfaction was significantly higher among the CPM group (60.4 vs. 58.1, p = 0.0005) and mean physical well-being was significantly higher among those who did not have a CPM (76.6.vs. 74.6, p = 0.0002). The groups did not differ with respect to psychosocial or sexual well-being. On multivariable linear regression the CPM group continued to report higher breast satisfaction (p = 0.0019) but reported no difference from the non-CPM group in the other QOL domains. Psychosocial well-being improved over time for both CPM and non-CPM groups (p < 0.0001), but did not differ significantly within time interval since surgery. Conclusions: Choice for CPM was only associated with improved QOL in the breast satisfaction domain and did not impact psychosocial, physical and sexual well-being after adjustment for other factors known to influence QOL. Such PRO data are important to consider when counseling women contemplating CPM as part of their breast cancer treatment.

Many medicinal plants are used by the Maya of Guatemala to treat all aspects of women's reproductive health. As part of an international collaboration, the eight medicinal plants were collected and extracted including Plantago major L., Wigandia urens (Ruiz & Pavón) Kunth., Hamelia patens Jacq., Smilax domingensis Willd., Pimenta guatemalensis (Lundell) Lundell, Phlebodium pseudoaureum (Cav.) Lellinger, Cecropia peltata L. and Euphorbia lancifolia Schldt. The plant extracts were tested in a wide range of bioassays including ERα and β and PR binding assays, COX-2 binding and functional assays, serotonin (5-HT1A) binding assays. Active extracts were further tested in cell based SEAP reporter gene assays in transiently transfected MCF-7 cells and endogenous gene expression in MCF-7 cells. Five plant extracts bound both to ERα and β (EC50 range 28.9 – 51.5 µg/ml); three plants bound to the PR receptor; and two bound to the 5HT1A receptor. Treatment of MCF-7 cells with the extracts (20 µg/ml) induced a SEAP reporter gene in transiently transfected MCF-7 cells, indicating estrogen agonist and antagonist effects. Smilax domingensis extracts (20 µg/ml) enhanced the expression of an ERE reporter gene, and the expression of PR mRNA in MCF-7 cells. Phlebodium pseudoaureum and Euphorbia lancifolia were not active in any assays tested.

Human epidermal growth factor 2 (HER2) is a trans-membrane tyrosine kinase that is over expressed in 20% of breast cancers. Overexpression of HER2 has been linked to tumor proliferation and poor prognosis. Numerous studies have focused on targeting HER2 for breast cancer treatment. The leaves of Pimenta dioica (L.) Merr. (Myrtaceae), commonly known as allspice, are used in Costa Rican traditional medicine for women's health. A MeOH extract of allspice leaves collected in Costa Rica, inhibited the growth of MCF-7 (ER+, low HER2) cell proliferation with IC50 of 50 µg/ml, but were more active in SK-Br3 (ER-, high HER2) cells with an IC50 of 12.5µg/ml. In a panel of fifteen receptor tyrosine kinases (RTKs), the extract and partition inhibited two erbB RTKs, namely EGFR (HER1) and HER2 RTKs. Chromatographic separation of the EtOAc partition on a 2L C18 reversed phase silica gel column with methanol/water afforded 20 fractions. Using a high-throughput 96-well HER2 assay, the active fraction was determine to be a 50% methanol/water fraction, which also inhibited the activity of HER2 RTK. Two C-methylated flavonoids, (being new 2-phenoxychromones) were the most active with an IC50 of 1 and 5.1 µg/ml, respectively. Further preliminary data demonstrated that the 50% MeOH fraction of allspice down-regulated the expression of the HER-2 receptor protein in Western blotting and using qPCR the fraction also down-regulated the expression of the HER2 mRNA in SK-Br3 cells.

Brosimum alicastrum Swingle (Moraceae) is a large, evergreen canopy tree found throughout the Neotropics and is native to Guatemala and Costa Rica. The fruit of the tree is also known as “Mayan bread fruit” or breadnut. The seeds and the fruit of the tree have been used in traditional Mayan medicine for the treatment of menopause and osteoporosis, and are thought to have hormone-like activities. Brosimum alicastrum Swingle (Moraceae) was identified and collected under an international agreement with the University of San Carlos, and the University of Costa Rica. The fruit and leaves of the tree were collected, dried, extracted and tested in several in vitro assays to determine their biological activities, particularly for their potential estrogenic and antiestrogenic effects. Methanol extracts of the fruit displaced 3H-estradiol binding from the estrogen receptors (ERα and ERβ, EC50 48 and 49 µg/ml). Methanol extracts of the fruit pulp including seeds, and an extract of the leaves (20 µg/ml) induced a SEAP reporter gene in transiently transfected MCF-7 cells, which was inhibited by the ER antagonist ICI 182,780 indicating estrogenic effects were mediated through the ER. Conversely, a methanol extract of the fruit pulp alone was not estrogenic as compared with DMSO controls, and reduced SEAP reporter gene activity in a concentration dependent manner, suggesting potential anti-estrogenic effects.

Women with early-stage breast cancer face the complex decision to undergo one of three equally effective oncologic surgical strategies: breast-conservation surgery with radiation (BCS), mastectomy, or mastectomy with breast reconstruction. With comparable oncologic outcomes and survival rates, evaluations of satisfaction with these procedures are needed to facilitate the decision-making process and to optimize long-term health.

The incidence and prevalence of breast cancer continues to rise, perpetuating the need for large sample studies evaluating women for cause, prevention, treatment efficacy, and survivorship. While there is no shortage of motivated women interested in participating in breast cancer research, many clinical trial/outcome studies are challenged by small patient samples or data from single institutions 1. How do we partner with these women to ensure that meaningful research is completed? The Dr. Susan Love Research Foundation launched the Love/AVON Army of Women (AOW) program in 2008 to help connect scientists with study volunteers. The AOW is open to any adult interested in participating in breast cancer research. Women are recruited at scientific conferences, social media, private/public meetings, speaking events, partnerships with other organizations, various grass roots efforts, and media opportunities. Studies submitted to the AOW must have funding, receive Scientific Advisory Committee and Internal Review Board (IRB) approval. When a study is launched, one or more “call-to-action” emails are sent to all AOW members (currently over 370,000 individuals). Can the AOW help to accelerate breast cancer research, especially projects focused on patient reported outcomes (PROs) like health related quality of life (HRQOL), symptoms and patient satisfaction? We learned about the AOW from a presentation by Dr. Love and wondered whether this unique strategy could contribute to a research agenda focused on the relationship between type of cancer surgery (breast conservation surgery (BCS), mastectomy (M), mastectomy with reconstruction (R)) and PROs. We also sought to evaluate the use of the Breast-Q© 2, 3, a new HRQOL and satisfaction survey conceptually grounded in women's perceptions of their breast cancer treatment, able to span the continuum of surgical procedures and validated against appropriate psychometric benchmarks. These data have been lacking because of limited access to large populations of women undergoing the spectrum of breast cancer surgery (irrespective of institution) and the need for surgery-specific PRO instruments like the Breast-Q© 4-9. Further, large samples are needed to quantify the relationship between patient preference and outcomes. In response, we administered online the Breast-Q©, the PTSD Checklist, the Impact of Cancer survey, and a demographics questionnaire to women in the AOW program who had a current or past history of breast conservation surgery, mastectomy, or mastectomy with reconstruction. We outlined this study in November 2011 and submitted a pilot grant ($10,000) in December; received funding, and approval for the study with AOW Scientific Advisory Committee, the Duke IRB and Cancer Protocol Committee all by July 2012. At the time the study was launched, the AOW consisted of 365,594 members. Over 106,000 members identified themselves as having a history of breast cancer. After the “call-to-action” e-mail was sent to all AOW members, 9,289 women with a history of breast cancer surgery expressed an interest in participating in the study; 7,619 (82%) consented and completed the set of four surveys. Half of the women (49.9%, n = 3,801) also provided narrative responses about their treatment and surgical experiences. Our participants came from the south, west, northeast, and midwest regions of the United States at 28.9%, 25.5%, 24.3%, and 20.9%, respectively. Women received their breast cancer care at community hospitals (50%), university hospitals (21%), unaffiliated standalone cancer centers (14%), or managed care centers (5%). This study will provide the first national snapshot reflecting the proportions of women undergoing breast cancer surgery that directly relates their personal experience and satisfaction with outcome. Interpretation must be tempered as the population reflects the generally Caucasian, educated, and middle/upper class women most likely to sign up for AOW, but it is a start in our journey to improve evidence-based decision-making in breast cancer surgery. The access provided by the Dr. Susan Love/Army of Women program resulted in the largest study to date on to evaluate patient-reported concerns following breast cancer surgery. This entire process took less than a year and cost under $15,000. The 82% response rate, without incentives, demonstrated the altruism and motivation exemplified by of these women. This unique and valuable resource provided a large, motivated community of women interested in advancing breast cancer research and we commend the Love/AVON Army of Women program for their efforts to partner engaged patients and community members with researchers. We would like to acknowledge the Army of Women participants for volunteering to take this series of surveys in order to help improve and further our knowledge of outcomes associated with breast cancer care. The authors also acknowledge Andrea Pusic, MD, MPH and the team of researchers at Memorial Sloan Kettering for providing us with the Breast Q©. Finally, we would like to acknowledge Donald T. Kirkendall, ELS, a medical editor employed by Duke University Medical Center, for his assistance in preparing this brief report for submission.

The Central American (CA) isthmus consists of seven countries including Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama, some of the poorest countries in the world. Over the past twenty years, CA has made good progress in improving the health status of their populations. Analysis of the peer-reviewed literature, as well as national and international reports show that life expectancy at birth has increased and child mortality rates have fallen. Maternal mortality ratios (MMR) have declined by approximately 33%, however the MMRs for indigenous women remain at unacceptable levels. Despite the advances, made in many CA countries, the overall health status remains well below Latin American averages. In fact, in most CA countries, poor health outcomes are increasingly concentrated geographically among the poor and indigenous populations. Considering indigenous people make up the second largest population group in CA, any improvements in healthcare should significantly improve the health statistics for these countries. For these populations, the integration of local cultural practices and traditional healing methods with modern medicine and healthcare facilities is critical for acceptance. Investigations and analyses of local cultures, knowledge and traditional medicine practices should be used to determine the factors that contribute to poor health in these populations. Local health educational programs are needed, especially those that would involve men (spouses), families and entire communities. Furthermore, manywomen's reproductive issues still need to be addressed, particularly those that focus specifically on maternal mortality and cancer. For reductions in maternal mortality, El Salvador and Costa Rica may be good examples to follow. Access to inexpensive (or free) healthcare that is culturally sensitive and community based, particularly for indigenous women, would greatly improve the overall health. The major stumbling blocks to progress are that the funding for programs to reduce maternal mortality is woefully inadequate and that there has not been a focus on improving healthcare for indigenous women.

Black cohosh [Actaea racemosa L., formerly Cimicifuga racemosa (L.) Nutt.] is an herbal medicine that has been used in the United States for over 100 years for the treatment of many conditions, including menopausal symptoms. To date the clinical data remain controversial. While there are over 20 positive clinical trials, all of the recent NIH-funded studies are negative, casting doubt on its efficacy. In addition, the cases of hepatoxicity are replete, although direct causality to the ingestion of black cohosh has not been demonstrated. In vitro studies have suggested possible chemopreventative effects; however, the in vivo studies to date do not support this hypothesis and suggest enhanced metastases. Unresolved issues of quality, safety, and efficacy remain and until these issues are resolved, the use of black cohosh products cannot be recommended.

The authors regret that under the “Acknowledgements” section the NIH grants details are unfortunately incorrect. The correct acknowledgement is written below. This study was made possible by Grants R21-AT02381-02 (GM), R01-CA130932-02 (JF), and F32-AT004876-02 (TL) from the National Institutes of Health. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCCAM or NIH. We would like to gratefully acknowledge Mr. Juan-Carlos Brenes, University of Costa Rica for his assistance in the plant collections and technical help, as well as Dr. Harry Besselink, BioDetection Systems B.V., Amsterdam, The Netherlands for his assistance with the ER_CALUX® assay. The authors would like to apologise for any inconvenience caused. Estrogenic and progestagenic effects of extracts of Justicia pectoralis Jacq., an herbal medicine from Costa Rica used for the treatment of menopause and PMSMaturitasVol. 66Issue 3PreviewTo investigate the biological activities of Justicia pectoralis Jacq. (Acanthaceae), an herbal medicine used in Costa Rica (CR) for the management of menopausal symptoms and dysmenorrhea. Full-Text PDF

OBJECTIVES:To investigate the biological activities of Justicia pectoralis Jacq. (Acanthaceae), an herbal medicine used in Costa Rica (CR) for the management of menopausal symptoms and dysmenorrhea. STUDY DESIGN:The aerial parts of J. pectoralis were collected, dried and extracted in methanol. To establish possible mechanisms of action of JP for the treatment of menopausal symptoms, the estrogenic and progesterone agonists, and antiinflammatory activities were investigated. MAIN OUTCOME MEASURES:The methanol extract (JP-M) was tested in ER and PR binding assays, a COX-2 enzyme inhibition assay, the ERbeta-CALUX assay in U2-OS cells, as well as reporter and endogenous gene assays in MCF-7 K1 cells. RESULTS:The JP-M extract inhibited COX-2 catalytic activity (IC(50) 4.8 microg/mL); bound to both ERalpha and ERbeta (IC(50) 50 microg/mL and 23.1 microg/mL, respectively); induced estrogen-dependent transcription in the ERbeta-CALUX; and bound to the progesterone receptor (IC(50) 22.8 microg/mL). The extract also modulated the expression of endogenous estrogen responsive genes pS2, PR, and PTGES in MCF-7 cells at a concentration of 20 microg/mL. Activation of a 2 ERE-construct in transiently transfected MCF-7 cells by the extract was inhibited by the estrogen receptor antagonist ICI 182,780, indicating that the effects were mediated through the estrogen receptor. Finally, the extract weakly enhanced the proliferation of MCF-7 cells, however this was not statistically significant as compared with DMSO controls. CONCLUSIONS:Extracts of J. pectoralis have estrogenic, progestagenic and anti-inflammatory effects, and thus have a plausible mechanism of action, explaining its traditional use for menopause and PMS.

Cranberry, the fresh or dried ripe fruit of Vaccinium macrocarpon Ait. (Ericaceae), is currently used as adjunct therapy for the prevention and symptomatic treatment of urinary tract infections. Data from clinical trials suggest that extracts of cranberry or cranberry juice reduce the bacterial load of E. coli and also suppress the inflammatory symptoms induced by E. coli infections. A methanol extract prepared from 10 kg of dehydrated cranberries did not directly inhibit the growth of E coli strains ATCC 700336 or ATCC 25922 in concentrations up to 256 μg/mL in vitro. However, the methanol extract (CR-ME) inhibited the activity of cyclooxygenase-2, with an IC50 of 12.8 μg/mL. Moreover, CR-ME also inhibited the NF-κβ transcriptional activation in human T lymphocytes with an IC50 of 19.4 μg/mL, and significantly (p < 0.01) inhibited the release of interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor-α from E. coli lipopolysaccharide (LPS)-stimulated human peripheral blood mononuclear cells in vitro, at a concentration of 50 μg/mL. The extract had no effect on inducible nitric oxide synthase activity in the murine macrophage cell line RAW 264.7. The compounds responsible for this activity were identified using a novel LC-MS based assay as ursolic acid and ursolic acid derivatives. Taken together, these data suggest CR-ME and its constituent chemical compounds target specific pathways involved in E. coli-induced inflammation.

Objective: Outcomes from the Women's Health Initiative have demonstrated adverse effects associated with hormone therapy and have prioritized the need to develop new alternative treatments for the management of menopause and osteoporosis. To this end, we have been investigating natural herbal medicines used by Costa Rican women to manage menopausal symptoms.Methods: Seventeen plant species were collected and extracted in Costa Rica. To establish possible mechanisms of action and to determine their potential future use for menopause or osteoporosis, we investigated the estrogenic activities of the herbal extracts in an estrogen-reporter gene estrogen receptor (ER) beta-Chemically Activated Luciferase Expression assay in U2-OS cells and in reporter and endogenous gene assays in MCF-7 cells.Results: Six of the plant extracts bound to the ERs. Four of the six extracts stimulated reporter gene expression in the ER-beta-Chemically Activated Luciferase Expression assay. All six extracts modulated expression of endogenous genes in MCF-7 cells, with four extracts acting as estrogen agonists and two extracts, Pimenta dioica and Smilax domingensis, acting as partial agonist/antagonists by enhancing estradiol-stimulated pS2 mRNA expression but reducing estradiol-stimulated PR and PTGES mRNA expression. Both P. dioica and S. domingensis induced a 2ERE-luciferase reporter gene in transient transfected MCF-7 cells, which was inhibited by the ER antagonist ICI 182,780.Conclusions: This work presents a plausible mechanism of action for many of the herbal medicines used by Costa Rican women to treat menopausal symptoms. However, it further suggests that studies of safety and efficacy are needed before these herbs should be used as alternative therapies to hormone therapy.

In Mexico and Central America, women typically experience menopause up to 10 years earlier than their U.S. counterparts. This may be due in part to numerous pregnancies, long periods of lactation, poor nutrition, extreme environment, and the heavy workload of the Maya women. Unlike Western culture, there is no stigma associated with aging and the menopausal period in the Mayan culture. In fact, menopause is considered to be a welcome natural phenomenon in Central America that all Maya women, who come of age, will experience. Anxiety, negative attitudes, health concerns and stress for the Maya woman are all events that are commonly associated with pregnancy and childbearing, not with menopause. Maya women perceive the menopausal period very positively, as they are no longer burdened with menstrual bleeding and child bearing, and are more relaxed about sexual activities.Thus, compared with their U.S. counterparts, Maya women have a better overall perceptions and attitudes toward the menopausal transition, have symptoms that appear to be short-lived, do not generally use HRT and appear to have a lower prevalence of osteoporosis. Besides genetics, diet and life-style may play a significant role in the overall impact of menopause in these women, as their diet is primarily plant-based, they get plenty of exercise over a lifetime, and they use primarily plant-based medicines and ma ssage to control menopausal symptoms. Thus, the impact of culture and attitude on the menopausal transition in Mexico and Central America appears to be a positive one. Future research should focus on why the prevalence of osteoporosis is low in Maya women and how women in the U.S. might benefit from this information. In addition, collections of data on cognition, as well as cardiovascular and cancer risk between these groups would be of benefit, considering that Maya women do not generally use HRT.

For thousands of years medicinal plants have played a significant role in the treatment of a wide range of medical conditions, including infectious diseases. Some naturally occurring chemical compounds serve as models for a large percentage clinically proven drugs, and many are now being re-assessed as antimicrobial agents. The primary reason for this renaissance is the fact that infectious disease remains a significant cause of morbidity and mortality worldwide, accounting for approximately 50% of all deaths in tropical countries and as much as 20% of deaths in the Americas. Despite the significant progress made in microbiology and the control of microorganisms, sporadic incidents of epidemics due to drug resistant microorganisms and previously unknown disease-causing microbes pose an enormous threat to global public health. These negative health trends call for a global initiative for the development of new strategies for the prevention and treatment of infectious disease, including natural products. Literally thousands of plant species have been tested against hundreds of bacterial strains in vitro, and many medicinal plants are active against a wide range of gram-positive and gram-negative bacteria. However, very few of these medicinal plant extracts have been tested in animal or human studies to determine safety and efficacy. This review focuses on the medicinal plants and phytochemical for which there is significant published in vitro, in vivo and clinical data available. The examples provided in this review such as St. John's wort, tree tea oil, and green tea demonstrate that even commonly used plant extracts may offer prospective new treatment of bacterial infections, including multi-drug resistant bacteria. One interesting example is St. John's wort (Hypericum perforatum) and its active constituent hyperforin, both of which have significant activity against MRSA in microgram concentrations. This antibacterial discovery was based on the ethnomedical use of St. John's wort to treat skin infections and wounds. Review of the published data indicates that medicinal plants offer significant potential for the development of novel antibacterial therapies and adjunct treatments (i.e. MDR pump inhibitors). However, new investigations should employ modern methodology, including using nationally recognized protocols and standards for microbial testing, the generation of minimum inhibitory concentrations, as well as standardization of the quality of plant materials used for testing.

Primary dysmenorrhea is a gynecological disorder characterized by nausea, menstrual cramps, headaches, and lower back pain occurring within the first few days of menstruation. This disorder affects approximately 30–60% of menstruating women, and averages to a loss of about 6 billion work hours, and nearly $200 million dollars a year. NSAIDs and oral contraceptives (OC) are essentially the first line of treatment for women with severe primary dysmenorrhea. However, there are substantial adverse events associated with the prolonged use of NSAIDs and OCs or both. In Central America, women use herbal remedies to treat a wide range of painful conditions including dysmenorrhea. One such plant-based medicine is Justicia pectoralis Jacq. (Acanthaceae). In this work, we demonstrate that extracts of J. pectoralis collected in Costa Rica inhibit COX-2 catalytic activity (IC50 4.8 μg/ml); bind to ERα and ER® (IC50 50 μg/ml and 23.1 μg/ml, respectively) and induce estrogen-dependent transcription in a reporter gene assay; bind to the progesterone receptor (IC50 22.8 μg/ml; as well as bind to the serotonin receptor 1A (IC50 50 μg/ml). These activities suggest that there is a plausible mechanism of action for the traditional use of J. pectoralis in the treatment of dysmenorrhea and other symptoms of premenstrual syndrome. This work is supported by an NIH/NCCAM grant (AT02381-02; Mahady PI).