Pick your poison: hERG-blocking alkaloids in the emetic herbal drug ipecac

The human ether a-go-go related gene (hERG) channel is an important antitarget associated with QT interval prolongation and increased risk of fatal arrhythmias [1]. Although hERG-safety evaluation is mandatory in formal drug discovery, natural products are rarely evaluated. As botanicals continue to rise in popularity, there is an urgent need for hERG-related cardiotoxic risks assessment. Here, we implemented in silico/in vitro approaches for the fast identification of hERG-blocking constituents in highly consumed herbal remedies. Firstly, we virtually screened a multi-conformational 3D molecular natural product database with a previously validated pharmacophore model [2]. For pharmacological profiling, lead-like enhanced extracts from virtually predicted and commonly consumed botanicals (n = 55) were prepared [3] and screened in Xenopus oocytes (100 µg/mL). The combined approach revealed 32.5% hERG blockade for the Carapichea ipecacuanha root extract, and six virtually predicted blockers from the group of ipecac alkaloids. Chromatographic separation resulted in the isolation and identification of five alkaloids (emetine, cephaeline, N-methylemetine, psychotrine and O-methylpsychotrine). All compounds were virtual hits and blocked hERG currents to different extents in vitro. The underground parts of C. ipecacuanha, alkaloid-enriched organs, are extracted for producing ipecac syrup, which is used as an emetic in emergency poisoning. Major ipecac constituents, emetine and cephaeline, showed IC50 values of 21.4 and 5.3µM, respectively, in HEK293 cells. Chronic abuse of ipecac products is known to induce cardiotoxicity in patients with eating disorders. However, this is the first report on the hERG-blockage of ipecac's major alkaloids. Our findings raise further questions regarding the safety of such herbal products, especially due to their tissue accumulation [4]. If combined with drugs or dietary supplements containing hERG blockers [5] they might boost cardiotoxicity.