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Scientific name: Boswellia serrata Roxb.
Common names): Dhup, Indian incense, Indian oliban, Salai guggal
Medically reviewed by Drugs.com. Last updated on Jul 1, 2019.
The oleoresin gum of B. serrata is traditionally used for its anti-inflammatory effects under conditions such as asthma, osteoarthritis, rheumatoid arthritis, colitis and irritable bowel syndrome. It has also been used for the treatment of diabetes, urinary disorders, dermatological conditions and kidney disorders. Boswellic acids have demonstrated immunomodulatory, antiproliferative, cytotoxic and antimicrobial effects; However, there are no adequate clinical trials to support any of the uses.
Administration with high fat foods may increase plasma concentrations of B. serrata. Asthma: 300 to 400 mg of an extract (containing 60% of boswellic acids) 3 times a day. In one test, 300 mg 3 times a day of powdered gum resin capsules (compound S) or 400 mg 3 times a day of an extract (titrated at 37.5% acid) were used. Boswellic per dose). Inflammatory conditions: 300 to 400 mg of a B. serrata extract (containing 60% of boswellic acids) 3 times a day were used in a clinical trial in patients with knee osteoarthritis. Two capsules of Articulin-F (contains: B. serrata, Withania somnifera, Turmeric longa, zinc complex) 3 times a day; or supplementation with Casperome (150 mg of boswellic acids) 3 times a day has been used for inflammatory conditions such as osteoarthritis and rheumatoid arthritis. Ulcerative colitis: 350 to 400 mg 3 times a day.
Hypersensitivity to B. serrata.
Pregnancy / breastfeeding
Avoid using. Information regarding safety and effectiveness during pregnancy and breastfeeding is lacking.
Cytochrome P450 (CYP-450) substrates 1A2, 2C8, 2C9, 2C19, 2D6 and 3A4: When analyzed by mass spectrometry by liquid chromatography, incense derived from B. serrata demonstrated inhibition of CYP1A2, 2C8, 2C9, 2C19, 2D6 and 3A4 enzymes. Therefore, caution is required when using B. serrata with drugs that are substrates for these isoenzymes. Substrates for P-glycoprotein (P-gp): The data suggest that the extract of B. serrata and the major boswellic acids could be potent inhibitors of P-gp via the modulation of gastrointestinal transport activity but not at the barrier blood brain. Therefore, the concomitant administration of B. serrata may have an impact on drugs that depend on the transport of P-gp across the gastrointestinal membrane. warfarin: According to 2 case reports, concomitant administration of warfarin and B. serrata could increase International Normalized Ratio (INR) rates. The interaction can be attributed to the inhibition of lipoxygenase and the interference of COX-1 by B. serrata. In addition, B. serrata may inhibit CYP2C19, 3A4 and 2C9, which are involved in the metabolism of warfarin. The use of B. serrata in patients receiving warfarin is not recommended.
Cases of diarrhea, abdominal pain and nausea have been reported.
The family of Burseraceae trees and shrubs comprises 18 genera and more than 540 species, which grow mainly in the tropical regions of India (B. serrata), North Africa (Boswellia carteri, Boswellia frereana) and in the peninsula Arabian (Boswellia sacra). Most species contain resin ducts in the bark, which produce the products of myrrh and incense.1, 2 B. serrata is a branched tree that grows on dry and hilly areas in most of India and can reach 3.7 m in height.3 the bark is cut off, the aromatic balm or gum resin oozes and is used for medicinal purposes.4 The semi- resin Solid is usually harvested every summer and every autumn and is collected in bamboo baskets where it stays about 1 month. during which the fluid is drained. The residue, which is semi-solid to solid, is the part of the gum resin that cures slowly and is eventually broken into smaller pieces. The tree can produce a quality product for a period of 3 years, after which it must be allowed to rest before being harvested again.5 Oleoresin contains oils, terpenoids and of the gum.6
It is believed that the Indian incense tree is related to the tree of the Bible that gave the incense given by the wise men as a gift to the baby Jesus. In Ayurvedic medicine in India, different parts of the tree have been used for asthma, rheumatism, dysentery, skin conditions, ulcers, blood purification, bronchi and wound treatment. 4 In Ayurvedic texts, B. serrata is addressed under the name "Gajabhakshya". , "meaning that it was consumed by elephants.7 Incense is also used to perfume clothes, hair and coins.It was used in ancient Egypt as an ingredient in liquids. Embalming for mummification.It has always been burned during religious and / or spiritual ceremonies and would produce a psychoactive substance.8 In 2002, the European Medicines Agency classified the resin gum extract B. serrata as an orphan drug9.
B. serrata contains oils, terpenoids, sugars and volatile oils. Four pentacyclic triterpenes are also present: beta-boswellic acid, acetyl-beta-boswellic acid, 11-keto-beta-boswellic acid, and acetyl-11-keto acid. -beta-boswellic.3, 6, 10, 11
Uses and pharmacology
Animal and in vitro data
In an in vitro study, acetyl-keto-beta-boswellic acid and keto-beta-boswellic acid exerted antiproliferative and apoptotic effects on human HT-29 colon cancer cells.12 Similarly, , apoptotic effects of boswellic acid acetate were observed in myeloid leukemia cells. Cytotoxic effects were observed with acetyl-11-keto-beta-boswellic acid in the cell lines of glioblastoma and leukemia.14
In a mouse model, 50 to 200 mg / kg of acetyl-11-keto-beta-boswellic acid, administered orally, inhibited the growth of colorectal cancer cells in a dose-dependent manner, with a subsequent reduction in volume. tumor; it was also associated with reduced ascites and metastases to the liver, lungs and spleen.
An extract of B. serrata resulted in loss of viability and inhibition of the proliferation of 5 leukemia cell lines and 2 brain tumor lines in a dose-dependent manner.
In a study of patients with primary or secondary malignant brain tumors, a greater than 75% reduction in cerebral edema was observed in 60% of patients receiving radiotherapy with 4,200 mg of B. serrata per day compared to 26% of patients receiving radiotherapy alone (P= 0.023) .17
In a case study of a 39-year-old woman with metastases to the breast cancer brain, a CT scan showed complete disappearance of brain metastases after administration of 2400 mg of B. serrata per day for 10 weeks. The patient continued this treatment for 4 years without any new sign of cerebral involvement; however, she developed skeletal metastases.18
In a study of 19 children and adolescents with intracranial tumors, palliative treatment with H15, a herbal agent derived from B. serrata gum resin, resulted in various improvements in general health, symptoms and neurological (ataxia, paresis) and muscle strength; a cachectic patient gained weight.19
In a study of 12 patients with brain tumors and progressive edema associated, H15 1,200 mg 3 times daily reduced edema in 2 out of 7 patients with glioblastoma and in 3 out of 5 patients with leukoencephalopathy . In general, the maximum response to treatment was noted within 4 weeks of starting treatment and no further reduction was seen with continued treatment.
Animal and in vitro data
In a study in diabetic rats, administration of B. serrata (a dose of 200 mg / kg was found to be most effective) resulted in a significant reduction in blood glucose and hemoglobin levels. AT1 C levels after 17 days (P≤0.01) .21 An extract of B. serrata also greatly attenuated the effects in a mouse model of induced diabetes.22
In a study of 56 diabetic patients, 250 mg of B. serrata twice daily for 8 weeks had no effect on glucose or lipid levels compared with placebo23. Additional studies on the effects of B. serrata extract on late autoimmune diabetes are needed; a case report noted a clinical improvement and a decrease in IA2 antibodies in a patient treated with B. serrata extract.24
In vitro, boswellic acids are specific inhibitors of 5-lipoxygenase (5-LO), a key enzyme in the biosynthesis of leukotrienes. Leukotrienes are biochemicals in the body that maintain inflammation. Of the 4 boswellic acids, acetyl-11-keto-beta-boswellic acid is the most potent inhibitor of 5-LO11 and appears to act directly on 5-LO at a selective site for pentacyclic triterpenes25. Boswellic acids have been traditionally used inflammatory conditions such as arthritis, tendinitis and bursitis.4, 10
Animal and in vitro data
The anti-inflammatory activity of B. serrata has been studied in animals.10 The plant extract has a marked anti-inflammatory and anti-arthritic action in the rat, without significant adverse reactions26. In a report evaluating the inhibition of leukotriene synthesis by boswellic acid (via -LO), no effect on 12-lipoxygenase, cyclooxygenase or arachidonic acid peroxidation by iron and ascorbate has been observed, suggesting that boswellic acids are non-redox inhibitors of leukotriene synthesis.27 Similar results have been observed in rat peritoneal neutrophils.28, 29
In a study on mice, B. serrata was found to be ineffective in preventing weight loss or mucosal damage caused by colitis. No improvement in mortality or colon histology was noted.30
In a rat study, boswellic acids showed antiulcerogenic effects in various models of ulceration31. In addition, B. serrata exerted anti-inflammatory and antioxidant effects in an experimental model of acute colitis in rats32.
B. serrata appears to have a benefit in ulcerative colitis because of its ability to inhibit 5-LO. In a clinical trial, patients treated with B. serrata gum resin (350 mg three times daily) for 6 weeks showed improvement in ulcerative colitis parameters (stool properties, histopathology, rectal biopsies, blood test) compared to patients treated with sulfasalazine (1 g 3 times daily). The remission was 82% with the resin and 75% with the sulfasalazine.33 In a study in patients with ulcerative colitis in the phase of symptomatic remission, administration of 250 mg / day of Casperoma, a system of lecithin-based administration for B. serrata designed to improve bioavailability, had a beneficial effect on bowel pain parameters (ie, obvious and occult blood in feces, intestinal defecation, cramps, diarrhea, malaise , anemia, rectal involvement, number of white blood cells, need for additional medication or medical care) .34
A meta-analysis identified 7 placebo-controlled clinical trials evaluating the efficacy and tolerability of herbal drugs in inflammatory bowel disease. Based on 2 studies (N = 113) evaluating B. serrata in patients with Crohn's disease or collagenous colitis, a significant result was identified for the induction of clinical remission (relative risk , 2.34) .35 However, a relevant systematic review of randomized trials revealed B. serrata to be ineffective for the treatment of collagenous colitis; the authors note, however, that the studies reviewed may have been underperforming to detect a difference. One trial examined (Madisch et al.) Included 31 patients, of which 26 were included in per protocol analysis. After 6 weeks of oral administration of 400 mg of B. serrata 3 times daily, more patients in the treated group were in remission compared with those in the placebo group. The difference was significant in the per-protocol group compared with placebo (P= 0.04) but not in the intention-to-treat group (P= 0.25), indicating a possible defect in the design of the study.37, 38
In a randomized controlled trial comparing the efficacy and safety of the extract of B. serrata (H15) to mesalazine in patients with active Crohn's disease, B. serrata was found to be active. is revealed not inferior to mesalazine39. In another trial, B. serrata administered for one year was evaluated for use in maintaining remission in patients with Crohn's disease. The study was interrupted early because of a high dropout rate and low patient recruitment. The data analyzed did not reveal any difference between treatment and placebo.40
In a study of 30 patients with chronic colitis, patients received either 300 mg of B. serrata 3 times daily or 1 g of sulfasalazine 3 times daily for 6 weeks. Among patients receiving B. serrata, 90% reported improvement in at least one parameter such as stool properties, histopathology or microscopy, and 70% were in remission. With sulfasalazine, 60% showed improvement and 40% were in remission41.
In a double-blind, randomized, clinical study in high school women with gingivitis, the B. serrata extract exerted anti-inflammatory effects.
Osteoarthritis and other pain
In a double-blind, randomized, cross-over trial of healthy adult volunteers (N = 12), the threshold of pain and tolerance were significantly increased with the administration of a single oral dose of 125 mg B. serrata (2 capsules) compared with placebo. Using a mechanical pain model, subjects experienced a significant increase in mean pain threshold strength and time from baseline, 2 hours and 3 hours after drug administration, compared to placebo (P<0.05); Mean strength and time with B. serrata at the pain threshold were also statistically significant at 3 hours compared with baseline (P<0.05). In addition, the mean pain tolerance time and force were significantly increased at all three times (ie, 1, 2, and 3 hours after drug administration) compared with baseline values (P<0.05). The mean percentage change in strength and pain tolerance time from baseline was also significantly increased at all times compared to placebo (P≤0.01 .43
In a Cochrane review of combined data from 2 high-quality studies of a small number of patients (N = 85), a 100 mg / day B. serrata extract administered for 90 days improved the symptoms of the disease. ; osteoarthritis. Specifically, B. serrata reduced the mean visual analogue scale score (VAS) by 17 points compared to placebo, a number needed to treat an additional benefit of 2. Patients receiving B. serrata reported an improvement in physical function (8 (point improvement) versus placebo.44
In a randomized, double-blind, placebo-controlled crossover study of 42 osteoarthritis patients, B. serrata in a herbomineral combination was compared to placebo. B. serrata decreased pain and disability scores, but the radiological assessment showed no change45. Similarly, in a crossover study involving 30 patients with osteoarthritis of the knee, B. serrata 1 g / day for 8 weeks improved knee pain, knee flexion, walking distance and swelling46. Compared to valdecoxib, patients treated with B. serrata extract for knee osteoarthritis showed improvement in pain, stiffness and difficulties in performing activities after 2 months of treatment; these effects persisted until 1 month after stopping treatment. Valdecoxib also managed to improve these parameters after one month of treatment, but its effects persisted only as long as treatment was continued47.
New products made from B. serrata have been tested in clinical studies. Aflapine, which is derived from B. serrata gum resin, improves pain and physical function scores in patients with osteoarthritis of the knee at a dose of 100 mg / day for 30 days. . Similar results have been observed in patients with osteoarthritis of the knee. receiving 5-loxine (extract of B. serrata enriched with 30% of 3-O-acetyl-11-keto-beta-boswellic acid) from 250 to 500 mg / day for 90 days, with improvement noted as early as 7 days after the initiation of the In a study of 52 male rugby patients with knee pain without osteoarthritis, Casperoma (derived from B. serrata extract) administered at 500 mg / day for 5 days, followed by 250 mg / day for 23 days, at effort, walking distance without pain, joint effusion, structural damage, thermal imaging and VAS pain scores.
An older review of the literature suggests a potential benefit of B. serrata gum resin in the treatment of rheumatoid arthritis51. In a small study of 4 patients with chronic cluster headaches receiving B. serrata, long-term (mean, 15 months) analgesic effects were observed in 3 patients and transient analgesic effects (mean, 6 months). ) were observed in 1 patient.52
Animal and in vitro data
Acetyl-11-keto-beta-boswellic acid exerts antibacterial effects against Staphylococcus aureus in an in vitro model.
In an in vitro study, B. serrata was found to have antiprotozoal activity against Trypanosoma brucei and Plasmodium falciparum54.
In a study evaluating the antimicrobial activity of various commercially available essential oils, B. serrata essential oil exerted an antimicrobial activity against Trichophyton spp. It has also been found to have a synergistic effect with azoles against azole-resistant Candida albicans. Thus, B. serrata can be useful in the treatment of infections of the skin, scalp and nails.
Boswellic acids may be beneficial in the treatment of asthma due to the inhibition of leukotriene biosynthesis by the inhibition of 5-LO56.
A systematic review and meta-analysis conducted in 2010 evaluated several complementary substitutes, including boswellic acids, for asthma management. Given the small size of the samples, the short duration of studies and the poor methodology, among other limitations, it is difficult to make a recommendation regarding the use of boswellic acids for the management of asthma. . Individual studies have identified differences in peak expiratory flow and forced vital capacity.57
In a small, double-blind, placebo-controlled clinical trial, administration of 300 mg of B. serrata gum resin 3 times daily for 6 weeks improved physical symptoms such as dyspnea and rhonchi, number of attacks and spirometry measurements in 70% of cases. compared with 27% of those receiving placebo.58
In a randomized, double-blind, placebo-controlled study, the effects of a cream containing 0.5% of boswellic acids were evaluated in 15 women with photo-treated skin. The patients received 2 tubes, one containing boswellic acids and the other containing just an emollient. Patients were asked to apply 1 cream on each half of the face once a day for 30 days. The application of boswellic acid cream was associated with improvements in Dover's overall score for photoaging, tactile roughness, fine lines and elasticity, as well as a reduction in Excretion of sebum59, 60.
A randomized, placebo – controlled, parallel – group study of 114 women undergoing adjuvant radiotherapy after breast cancer surgery evaluated the safety and efficacy of a cream containing breast cancer. boswellic acid (Bosexil) compared to a basic cream for the prevention of dermatological effects induced by radiation. The cream was applied twice daily on radiation days immediately after radiation. The application of the boswellic acid cream was associated with reduced grade erythema, with visual intensity being described as "intense" in a greater proportion of those receiving a base cream (49%) per day. compared to those receiving a cream containing boswellic acid (22%; P= 0.009). In addition, the use of topical steroids has been reduced with the use of cream containing boswellic acid.
In a randomized, double-blind, placebo-controlled study in patients with psoriasis, administration of Bosexil twice daily for 30 days improved dander in 70% of cases and erythema in 50 % of cases. In patients with eczema, 60% reported an improvement in itching and 60%, an improvement in erythema.62
Animal and in vitro data
The stabilizing activity of mast cells has been demonstrated with a B. serrata gum resin extract in a murine model63. In an immunological study, it was shown that boswellic acids possessed anticomplementary activity via the inhibition of C3-convertase.64 C3-convertase is involved in the production of anaphylatoxin.
In a mouse model, B. serrata partially protected the kidneys in cases of acute and chronic renal failure. Gum arabic and ginger had more promising results than B. serrata66.
In a study of 16 patients with chronic non-dialyzed renal failure, the combination of B. serrata and C. longa, administered for 8 weeks, improved interleukin-6 levels; however, no difference was observed between other markers, such as tumor necrosis factor alpha, glutathione peroxidase and serum C-reactive protein.
B. serrata may be useful in the treatment of stress incontinence because of its astringent properties and its ability to tone muscles.68
In the context of a randomized, single-blind, placebo-controlled prospective clinical trial in women of reproductive age with stress incontinence, the combination of B. serrata and Cyperus scariosus (1 g of each powder twice a day for 8 weeks) in addition to the pelvic floor muscle training was associated with a 23% improvement over the reduction in stress incontinence versus pelvic floor muscle training alone (60% cure rate vs. 36.67%; P= 0.035) .68
In a randomized study in men with chronic prostatitis, antibiotics associated with Proxelan suppositories (a herbal mixture containing Boswellia) improved patients' symptoms, but did not alter microbiological results compared to patients with chronic prostatitis. antibiotics used alone. The exact species of Boswellia used is not clear.69
In an in vitro study, beta-boswellic acid exerted protective effects on endothelial function induced by blood stasis by increasing the phosphorylation of the enzyme nitric oxide synthase.70
In a fully allogenic mouse heart transplant model, boswellic acid prolonged the survival time of the graft71.
Administration with high fat foods may increase plasma concentrations of B. serrata.72
300 to 400 mg of an extract (containing 60% of boswellic acids) 3 times a day3. In one trial, 300 mg 3 times a day of powdered gum resin capsules (S-Compound) or 400 mg 3 times daily of a 37.5% boswellic acid extract per dose) was utilisé.8
300 to 400 mg of B. serrata extract (containing 60% of boswellic acids) 3 times a day were used in a clinical trial in patients with knee osteoarthritis3.
Two capsules of Articulin-F (contains: B. serrata, W. somnifera, C. longa, zinc complex) 3 times daily8; or supplementation with Casperome (150 mg of boswellic acids) 3 times a day has been used for inflammatory conditions such as osteoarthritis and rheumatoid arthritis.
350 to 400 mg 3 times a day.8
Pregnancy / breastfeeding
Avoid using. Information regarding safety and effectiveness during pregnancy and breastfeeding is lacking. Reports from Indian literature suggest that B. serrata resin could induce abortion.8
Substrates of CYP1A2, 2C8, 2C9, 2C19, 2D6 and 3A4
When analyzed by mass spectrometry by liquid chromatography, incense derived from B. serrata demonstrated inhibition of CYP1A2, 2C8, 2C9, 2C19, 2D6 and 3A4 enzymes. Therefore, caution is required when using B. serrata with drugs that are substrates for these isoenzymes.2
Substrates for P-gp
The data suggest that the extract of B. serrata and the major boswellic acids could be potent inhibitors of P-gp via modulation of gastrointestinal transport activity but not at the level of the blood-brain barrier73. Therefore, drugs that depend on the transport of P-gp Co-administration of B. serrata may affect the gastrointestinal membrane.
According to 2 case reports, concomitant administration of warfarin and B. serrata could increase INR rates. The interaction can be attributed to the inhibition of lipoxygenase and the interference of COX-1 by B. serrata. In addition, B. serrata may inhibit CYP2C19, 3A4 and 2C9, which are involved in the metabolism of warfarin. The use of B. serrata in patients treated with warfarin is not recommended74.
B. serrata is generally well tolerated. It has been associated with mild gastrointestinal disturbances such as nausea, abdominal pain, diarrhea, loss of appetite and acid reflux. 8, 75, 76, 77 Hepatotoxic effects have been reported in a study in mice.17 A case report describes the development of dermatitis contact in a 28-year-old woman who used a naturopathic cream containing B. serrata for the treatment of second-degree burns. Topical and systemic corticosteroids were needed to treat his contact dermatitis, which included a local cutaneous reaction with the development of bubbles. A patch test gave positive results when B. serrata was tested. A few months later, the patient developed contact dermatitis after applying the same cream to her husband.6
The median lethal dose (DL50) de B. serrata a été déterminée comme étant supérieure à 2 g / kg.3,7,40,40,78 Chez le rat, la DL aiguë par voie orale50 d’aflapine, une composition synergique dérivée de résine de gomme de B. serrata, était de 5 g / kg, et la DL cutanée aiguë50 La concentration d’aflapine était de 2 g / kg79. Un produit combiné contenant B. serrata, Zingiber officinale, C. longa et W. somnifera n’a été associé à aucune toxicité chez le rat recevant une dose de 10 g / kg.80
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