Tripterygium Wilfordii HOOK.F. (TwHF)

Toxic, immunosuppressive medicinal plant from China, see also under three-winged fruit. Tripterygium Wilfordii HOOK.F. (TwHF) is the only plant mentioned in the AMWF guidelines for rheumatoid polyarthritis.

Studies confirm its efficacy in autoimmune diseases, including psoriasis, where it is even more effective than methotrexate (Zhang W et al. 2015). The toxicity of the drug is problematic.

In China, too, only a 50 % ethanol extract of the root is approved as "Kunming-Shanhaitang tablets" for lupus erythematosus and rheumatoid arthritis (Wiebrecht A et al. 2021).

More than 70 ingredients, diterpenoids, triterpenoids, sesquiterpenoids, β-sitosterol, dulcitol and glycosides. The most effective bioactive substance is triptolide (C20H24O6). This has strong anti-inflammatory and immunosuppressive properties (Han R et al. 2012).

Modulation of type 3 inflammatory cytokines, incl. IL-22, IL-23 and IL-17, as well as Th17 lymphocytes and γδT cells (T cells with a pronounced T cell receptor on the surface), intervention in the IFN-SOCS1 signaling pathways (a suppressor of cytokine signals inhibits the signal transmission of type I interferon (IFN) via the tyrosine kinase Tyk2 associated with the interferon alpha receptor(IFNAR1)) and IL-36α. In vitro (Ru Y, 2020) Inhibition of keratinocyte proliferation, increase in the concentration of apoptosis factors, also inhibition of human peripheral blood mononuclear cells and the generation of cytotoxic T cells. Cause: Reduction of IL-2 production or IL-2 receptor expression, influence on killer cell-mediated cytotoxicity.

Gastrointestinal symptoms, reproductive disorders, amennorrhea, increase in liver values, skin reactions, hematological changes, leukopenia, proteinuria, palpitations, headaches, increased blood sugar and hair loss.

1. Zhang W et al. (2015) Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomized, controlled clinical trial. Ann Rheum Dis. 74:1078-86. doi: 10.1136/annrheumdis-2013-204807. Epub 2014 Apr 14. PMID: 24733191
2. Wiebrecht A et al. (2021) Journal of Phytotherapy 42: 213-214 DOI: 10.1055/a-1406-4868
3. Han R et al. (2012) Triptolide in the treatment of psoriasis and other immune-mediated inflammatory diseases. Br J Clin Pharmacol 74:424-36. doi: 10.1111/j.1365-2125.2012.04221.x. PMID: 22348323; PMCID: PMC3477344.
4. Wang Y et al. (2023) Tripterygium wilfordii Hook. F. and Its Extracts for Psoriasis: Efficacy and Mechanism. Drug Des Devel Ther. 20:3767-3781. doi: 10.2147/DDDT.S439534. PMID: 38144417; PMCID: PMC10749103.
5. Ru Y et al. (2020) Role of keratinocytes and immune cells in the anti-inflammatory effects of Tripterygium wilfordii Hook. f. in a murine model of psoriasis. Phytomedicine. 77:153299. doi: 10.1016/j.phymed.2020.153299. Epub 2020 Aug 13. PMID: 32823074.