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Pilot clinical study on a proprietary elderberry extract: Efficacy in addressing influenza symptoms

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... Thirty studies involving 5,166 subjects (flavonoids group: 2636; control group: 2530) were included. Five eligible studies (20)(21)(22)(23)(24) investigated the efficacy of flavonoids in the common cold, 4 (25)(26)(27)(28) in influenza, 5 (29)(30)(31)(32)(33) in COVID−19, 3 (34)(35)(36) in acute non-streptococcal tonsillopharyngitis, 1 (37) in acute rhinosinusitis, 7 (38)(39)(40)(41)(42)(43)(44) in acute bronchitis, 1 (45) in bronchial pneumonia, and 4 (46)(47)(48)(49) in upper respiratory tract infections. In common cold, 5 RCTs with 503 patients were involved. ...
... Regarding the bias of selection of the reported result, 10 (33.3%) RCTs (24,25,27,28,36,38,43,45,48,49) were rated at some concerns for no protocols or registrations. The remaining 20 (66.7%) RCTs were rated at low risk. ...
... Four RCTs (25)(26)(27)(28) investigated the efficacy and safety of flavonoids in influenza. ...
Article
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Background: This meta-analysis aimed to investigate the efficacy and safety of flavonoids in treating viral acute respiratory tract infections (ARTIs). Methods: Randomized controlled trials (RCTs) were entered into meta-analyses performed separately for each indication. Efficacy analyses were based on changes in disease-specific symptom scores. Safety was analyzed based on the pooled data from all eligible trials, by comparing the incidence of adverse events between flavonoids and the control. Results: In this study, thirty RCTs (n = 5,166) were included. In common cold, results showed that the flavonoids group decreased total cold intensity score (CIS), the sum of sum of symptom intensity differences (SSID) of CIS, and duration of inability to work vs. the control group. In influenza, the flavonoids group improved the visual analog scores for symptoms. In COVID-19, the flavonoids group decreased the time taken for alleviation of symptoms, time taken for SARS-CoV-2 RT-PCR clearance, the RT-PCR positive subjects at day 7, time to achievement of the normal status of symptoms, patients needed oxygen, patients hospitalized and requiring mechanical ventilation, patients in ICU, days of hospitalization, and mortality vs. the control group. In acute non-streptococcal tonsillopharyngitis, the flavonoids group decreased the tonsillitis severity score (TSS) on day 7. In acute rhinosinusitis, the flavonoids group decreased the sinusitis severity score (SSS) on day 7, days off work, and duration of illness. In acute bronchitis, the flavonoids group decreased the bronchitis severity score (BSS) on day 7, days off work, and duration of illness. In bronchial pneumonia, the flavonoids group decreased the time to symptoms disappearance, the level of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α). In upper respiratory tract infections, the flavonoids group decreased total CIS on day 7 and increased the improvement rate of symptoms. Furthermore, the results of the incidence of adverse reactions did not differ between the flavonoids and the control group. Conclusion: Results from this systematic review and meta-analysis suggested that flavonoids were efficacious and safe in treating viral ARTIs including the common cold, influenza, COVID-19, acute non-streptococcal tonsillopharyngitis, acute rhinosinusitis, acute bronchitis, bronchial pneumonia, and upper respiratory tract infections. However, uncertainty remains because there were few RCTs per type of ARTI and many of the RCTs were small and of low quality with a substantial risk of bias. Given the limitations, we suggest that the conclusions need to be confirmed on a larger scale with more detailed instructions in future studies.Systematic Review Registration: inplasy.com/inplasy-2021-8-0107/, identifier: INPLASY20218010.
... The study population were primarily adults aged between 18 and 70 years, with two studies also including children aged from 5 years [7] or 12 years [8]. The most common conditions studied were influenza [7][8][9] and influenza-like symptoms [10], followed by common cold [11]. ...
... All included studies used a proprietary herbal medicine product as the intervention. Four studies used mono-herbal preparations of S.nigra berry extract [7,[9][10][11]. One study used a poly-herbal preparation, which contained S.nigra berry plus Echinacea purpurea root [8]. The preparations were administered orally in the form of a syrup [7,10], capsules [11], granules [8] or lozenges [9]. ...
... One study used a poly-herbal preparation, which contained S.nigra berry plus Echinacea purpurea root [8]. The preparations were administered orally in the form of a syrup [7,10], capsules [11], granules [8] or lozenges [9]. Doses ranged from 15 mLs four times per day (syrup), 3 capsules per day, 175 mg lozenge four times per day or 5 mL of the poly-herbal formula in 150 mL of hot water using an initial dosage of 5 times per day for days 1À3 followed by a maintenance dose of twice per day (days 4À10). ...
Article
Brief overview Collectively the evidence obtained from across five clinical studies involving 936 adults indicate that mono-herbal preparations of Sambucus nigra L. berry (S.nigra), when taken within 48 hours of the onset of acute respiratory viral infection, may reduce the duration and severity of common cold and influenza symptoms in adults. There is currently no evidence to support the use of S.nigra berry for the treatment or prevention of COVID-19. Given the body of evidence from preclinical studies demonstrating the antiviral effects of S.nigra berry, alongside the results from clinical studies involving influenza viral infections included in this review, pre-clinical research exploring the potential effects of S.nigra berry on COVID-19 are encouraged. Verdict The evidence included in this review is mostly derived from clinical studies involving adult participants and examining short-term use of commercial formulations of S.nigra berry for up to 16 days. Findings from included studies suggest that mono-herbal preparations of S.nigra berry (in extract or lozenge formulation) may reduce influenza-type symptoms, including fever, headache, nasal congestion and nasal mucous discharge in adults, when taken within the first 48 hours of symptom onset. Within 2–4 days of S.nigra treatment, most adult participants experienced significant symptom reduction, by an average of 50%. Evidence regarding the effectiveness of S.nigra berry on the symptom of cough, and need for/use of medicines (including antibiotics) to treat acute respiratory infections, is currently unclear and inconsistent. Adverse events were rare with no serious events reported. Adverse events, reported in two studies, were more common in comparators than in treatments. There is currently no reliable or sufficient scientific evidence to support the use of S.nigra in pregnant or lactating women.
... For those reasons it is difficult to compare herbal remedies containing Echinacea sp. The European Medicines Agency, EMA, has developed monographs for Echinacea purpurea herba and radix, Echinacea pallida radix and Echinacea angustifolia radix (European Medicines Agency, 2008, 2009, 2012. In accordance with these legal texts none of the licensed herbal products containing Echinacea sp. ...
... Treatment had no effect on symptom score or on proportion of participants with clinical cold. (Zakay- Rones et al., 1995Rones et al., , 2004Kong, 2009). All were randomized, controlled trials of various sizes; between 15 and 32 persons were treated with S. nigra. ...
... This may be a limitation but there are good reasons to believe that if positive results were discovered, they would be published in English to reach as wide an audience as possible. Of note, we did not have access to the trademark-products used in the studies included in this review and consequently could not evaluate their legal status and their compliment with the official plant monographs (Blumenthal et al., 2000;European Medicines Agency, 2008, 2009, 2012. ...
Article
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This review evaluates the safety of echinacea and elderberry in pregnancy. Both herbs are commonly used to prevent or treat upper respiratory tract infections (URTIs) and surveys have shown that they are also used by pregnant women. The electronic databases PubMed, ISI Web of Science, AMED, EMBASE, Natural Medicines Comprehensive Database, and Cochrane Library were searched from inception to November 2013. Relevant references from the acquired articles were included. No clinical trials concerning safety of either herb in pregnancy were identified. One prospective human study and two small animal studies of safety of echinacea in pregnancy were identified. No animal- or human studies of safety of elderberry in pregnancy were identified. Twenty clinical trials concerning efficacy of various echinacea preparations in various groups of the population were identified between 1995 and 2013. Three clinical trials concerning efficacy of two different elderberry preparations were identified between 1995 and 2013. The results from the human and animal studies of Echinacea sp. are not sufficient to conclude on the safety in pregnancy. The prospective, controlled study in humans found no increase in risk of major malformations. The efficacy of Echinacea sp. is dubious based on the identified studies. Over 2000 persons were given the treatment, but equal amounts of studies of good quality found positive and negative results. All three clinical trials of Elderberry concluded that it is effective against influenza, but only 77 persons were given the treatment. Due to lack of evidence of efficacy and safety, health care personnel should not advice pregnant women to use echinacea or elderberry against upper respiratory tract infection.
... Two clinical trials using a liquid elderberry extract (Sambucol ® , Israel) showed a reduction in symptoms and duration of influenza infection [16]. A pilot trial with elderberry extract lozenges (HerbalScience, Singapore) also confirmed a beneficial effect on severity and duration of cold and flu like symptoms [17]. ...
... This formulation however, also contains honey and raspberry extract. A pilot trial with elderberry extract (175 mg) lozenges taken by patients with flu like symptoms four times for two days also confirmed a beneficial effect on severity and duration of cold and flu like symptoms [17]. ...
... In the three beneficial influenza trials patients took 60 mL of elderberry syrup (38% extract equivalent to approx. 22.8 mg extract standardised to flavonoids) daily for 5-6 days [16] or lozenges with an equivalent of 700 mg elderberry extract daily for two days with no indication on the anthocyanin content [17]. The minimum of anthocyanin doses for the treatment of metabolic syndrome disorders was recently estimated as 110 mg per day and as 3.5 g per day for influenza [40]. ...
Article
Intercontinental air travel can be stressful, especially for respiratory health. Elderberries have been used traditionally, and in some observational and clinical studies, as supportive agents against the common cold and influenza. This randomized, double-blind placebo-controlled clinical trial of 312 economy class passengers travelling from Australia to an overseas destination aimed to investigate if a standardised membrane filtered elderberry (Sambucus nigra L.) extract has beneficial effects on physical, especially respiratory, and mental health. Cold episodes, cold duration and symptoms were noted in a daily diary and assessed using the Jackson score. Participants also completed three surveys containing questions regarding upper respiratory symptoms (WURSS-21) and quality of life (SF-12) at baseline, just before travel and at 4-days after travel. Most cold episodes occurred in the placebo group (17 vs. 12), however the difference was not significant (p = 0.4). Placebo group participants had a significantly longer duration of cold episode days (117 vs. 57, p = 0.02) and the average symptom score over these days was also significantly higher (583 vs. 247, p = 0.05). These data suggest a significant reduction of cold duration and severity in air travelers. More research is warranted to confirm this effect and to evaluate elderberry's physical and mental health benefits.
... Two clinical trials using a liquid elderberry extract (Sambucol ® , Israel) showed a reduction in symptoms and duration of influenza infection [16]. A pilot trial with elderberry extract lozenges (HerbalScience, Singapore) also confirmed a beneficial effect on severity and duration of cold and flu like symptoms [17]. ...
... This formulation however, also contains honey and raspberry extract. A pilot trial with elderberry extract (175 mg) lozenges taken by patients with flu like symptoms four times for two days also confirmed a beneficial effect on severity and duration of cold and flu like symptoms [17]. ...
... In the three beneficial influenza trials patients took 60 mL of elderberry syrup (38% extract equivalent to approx. 22.8 mg extract standardised to flavonoids) daily for 5-6 days [16] or lozenges with an equivalent of 700 mg elderberry extract daily for two days with no indication on the anthocyanin content [17]. The minimum of anthocyanin doses for the treatment of metabolic syndrome disorders was recently estimated as 110 mg per day and as 3.5 g per day for influenza [40]. ...
Article
Full-text available
Intercontinental air travel can be stressful, especially for respiratory health. Elderberries have been used traditionally, and in some observational and clinical studies, as supportive agents against the common cold and influenza. This randomized, double-blind placebo-controlled clinical trial of 312 economy class passengers travelling from Australia to an overseas destination aimed to investigate if a standardised membrane filtered elderberry (Sambucus nigra L.) extract has beneficial effects on physical, especially respiratory, and mental health. Cold episodes, cold duration and symptoms were noted in a daily diary and assessed using the Jackson score. Participants also completed three surveys containing questions regarding upper respiratory symptoms (WURSS-21) and quality of life (SF-12) at baseline, just before travel and at 4-days after travel. Most cold episodes occurred in the placebo group (17 vs. 12), however the difference was not significant (p = 0.4). Placebo group participants had a significantly longer duration of cold episode days (117 vs. 57, p = 0.02) and the average symptom score over these days was also significantly higher (583 vs. 247, p = 0.05). These data suggest a significant reduction of cold duration and severity in air travelers. More research is warranted to confirm this effect and to evaluate elderberry's physical and mental health benefits.
... Elderberry (Sambucus nigra) is hypothesized to have antiviral properties because of its ability to modulate inflammatory cytokines 42 and has been tested both in vitro [43][44][45][46][47] and in vivo against varying viruses. [48][49][50][51][52] At the time of writing, there are no published studies evaluating the use of elderberry and COVID-19. Although elderberry and its phenolic acid components exhibit antiviral activity against human coronavirus HCoV-NL63 in vitro, 44 this cannot be extrapolated to COVID-19 as previously mentioned. ...
... 7 Randomized, double-blind, placebo-controlled trials evaluating elderberry for treatment of influenza have suggested that elderberry may reduce symptom duration. [48][49][50] The utility of these findings is unclear because of the small sample size, lack of objective outcomes, omission of intention-to-treat analysis, and lack of adverse event reporting. [48][49][50] The trials do not align with standard of care because patients who received the annual influenza vaccine were excluded. ...
... [48][49][50] The utility of these findings is unclear because of the small sample size, lack of objective outcomes, omission of intention-to-treat analysis, and lack of adverse event reporting. [48][49][50] The trials do not align with standard of care because patients who received the annual influenza vaccine were excluded. [48][49][50] In these trials, 1 tablespoon of elderberry oral solution was administered 4 times daily for 3 to 5 days within 24 to 48 hours of initial symptoms. ...
Article
News and social media platforms have implicated dietary supplements in the treatment and prevention of coronavirus disease 2019 (COVID-19). During this pandemic when information quickly evolves in the presence of contradicting messages and misinformation, the role of the pharmacist is essential. Here, we review theoretical mechanisms and evidence related to efficacy and safety of select supplements in the setting of COVID-19, including vitamin C, vitamin D, zinc, elderberry, and silver. Evidence evaluating these supplements in COVID-19 patients is lacking, and providers and patients should not rely on dietary supplements to prevent or treat COVID-19. Rather, reference to evidence-based guidelines should guide treatment decisions.
... Even though S. nigra extract has already been used repeatedly for treating colds and influenza, the antiviral mechanisms of the elderberry extract are still under investigation 28,29,30,31 . The clinical study presented by Kong 28 showed that administration of the elderberry extract to patients presenting flu symptoms significantly relieve influenza-like symptoms within 24 hours from the administration of the first dose. ...
... The clinical study presented by Kong 28 showed that administration of the elderberry extract to patients presenting flu symptoms significantly relieve influenza-like symptoms within 24 hours from the administration of the first dose. According to recent studies, it can be assumed that flavonoids in elderberry can inhibit the H1N1 influenza virus infection in vitro by binding to the surface of the virus 28 . S. nigra constituents cause the deactivation of hemagglutinin and thus prevent the virus from entering and replicating in the host cell. ...
... S. nigra constituents cause the deactivation of hemagglutinin and thus prevent the virus from entering and replicating in the host cell. The flavonoids in elderberry can also bind to neuraminidase and cause its inactivation; however, confirmation of this hypothesis requires additional research 28 . ...
Article
Full-text available
Nowadays, the application of alternative methods instead of clinical treatment creates a new possibility to prevent the development of diseases. Medicinal plants such as Sambucus nigra have been well known due to their extraordinary properties. The similarity to synthetic substances makes it potentially dependable; however, a high concentration of cyanogenic glycosides may exert detrimental consequences. It has been documented that Sambucus nigra extracts are used against both human and animal viruses, like influenza A and B viruses, human immunodeficiency virus (HIV), dengue virus (DENV-2), human herpesvirus type 1 (HSV-1) and human coronavirus NL63 (HCoV-NL63). Such reports are notably valuable especially considering the widespread usage of commercial drugs, which could be ineffective. This review provides insight on recent research on the health properties of plant Sambucus nigra as an antiviral medication that may help propose new therapy.
... Patients were given spray-dried elderberry juice containing 120-4,000 mg of anthocyanins daily for 2-3 weeks (Vlachojannis, Cameron, & Chrubasik, 2010). • Influenza: Patients received 175 mg of proprietary elderberry extract lozenge four times daily for two days (Kong, 2009). Patients were given 15 mL of elderberry syrup four times daily for five days for influenza symptoms in another clinical trial by the same author group (Zakay-Rones, Thom, Wollan, & Wadstein, 2004). ...
... • Antiobesity agents: in human research, an S. nigra (elderberry)-containing product decreased mean body weight (Chrubasik et al., 2008;Hasani-Ranjbar et al., 2009). • Antivirals: in laboratory, animal, and human research, elder had antiviral effects (Kong, 2009;Konlee, 1998;Serkedjieva et al., 1990;Vlachojannis et al., 2010;Zakay-Rones et al., 1995). • Caffeine: according to secondary sources, the flavonoid quercetin, which is found in elder, has been reported to inhibit xanthine oxidase and may affect caffeine levels. ...
... • Antioxidants: elder preparations may exert antioxidant activity, and increased effects may be seen when elder is used in combination with other antioxidants, according to laboratory research (Cao & Prior, 1999;Kaack & Austed, 1998). • Antivirals: in laboratory, animal, and human research, elder had antiviral effects (Kong, 2009;Konlee, 1998;Serkedjieva et al., 1990;Vlachojannis et al., 2010;Zakay-Rones et al., 1995). • Caffeine: according to secondary sources, the flavonoid quercetin, which is found in elder, has been reported to inhibit xanthine oxidase and may affect caffeine levels. ...
Article
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ABSTRACT An evidence-based systematic review of elderberry and elderflower (Sambucus nigra) by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
... We did not identify any completed studies from preprint sources or otherwise outside the peer- For the objective of assessing the effects of elderberry in the prevention of viral respiratory illness, we found one RCT [33] with 312 participants evaluating elderberry compared to placebo for the prevention of symptoms of the common cold. For the objective of assessing the effects of elderberry in the treatment of viral respiratory illness, we found three RCTs [10,34,35] with 151 participants evaluating elderberry compared to placebo for the treatment of influenza and one RCT [36] with 473 participants evaluating a product containing echinacea and elderberry (Echinaforce® Hotdrink) compared to oseltamivir for the treatment of influenza. Because our original searches were focused on elderberry and we may have missed additional studies on this mixed product, we repeated our database searches in March 2020 with the text word 'Echinaforce'. ...
... A trial registration was available for Tiralongo, however the primary outcome in the trial registration of symptom days did not correspond to the primary reported outcome of defined cold episode days, and we therefore rated the risk of bias from selective outcome reporting as high. We rated the remaining domains of prevention and treatment studies [10,[33][34][35][36] at low risk of bias. Figure 2b provides a representation of the risk of bias judgements for each ex vivo study. We used the Cochrane risk of bias tool to assess the randomized trial assessing cytokines ex vivo after elderberry versus placebo (Curtis 2009) [37]. ...
... Three studies [10,34,35] Fig. 5). The overall time to resolution or global improvement of illness was nearly three days shorter in the elderberry group compared to the placebo group (MD − 2.68 days, 95% CI − 5.23 to − 0.13; 2 studies, 87 participants; I 2 = 94%) (see Fig. 6). ...
Article
Full-text available
Background Elderberry has traditionally been used to prevent and treat respiratory problems. During the COVID-19 pandemic, there has been interest in elderberry supplements to treat or prevent illness, but also concern that elderberry might overstimulate the immune system and increase the risk of ‘cytokine storm’. We aimed to determine benefits and harms of elderberry for the prevention and treatment of viral respiratory infections, and to assess the relationship between elderberry supplements and negative health impacts associated with overproduction of pro-inflammatory cytokines. Methods We conducted a systematic review and searched six databases, four research registers, and two preprint sites for studies. Two reviewers independently assessed studies for inclusion, extracted data from studies, assessed risk of bias using Cochrane tools, and evaluated certainty of estimates using GRADE. Outcomes included new illnesses and the severity and duration of illness. Results We screened 1187 records and included five randomized trials on elderberry for the treatment or prevention of viral respiratory illness. We did not find any studies linking elderberry to clinical inflammatory outcomes. However, we found three studies measuring production of cytokines ex vivo after ingestion of elderberry. Elderberry may not reduce the risk of developing the common cold; it may reduce the duration and severity of colds, but the evidence is uncertain. Elderberry may reduce the duration of influenza but the evidence is uncertain. Compared to oseltamivir, an elderberry-containing product may be associated with a lower risk of influenza complications and adverse events. We did not find evidence on elderberry and clinical outcomes related to inflammation. However, we found evidence that elderberry has some effect on inflammatory markers, although this effect may decline with ongoing supplementation. One small study compared elderberry to diclofenac (a nonsteroidal anti-inflammatory drug) and provided some evidence that elderberry is as effective or less effective than diclofenac in cytokine reduction over time. Conclusions Elderberry may be a safe option for treating viral respiratory illness, and there is no evidence that it overstimulates the immune system. However, the evidence on both benefits and harms is uncertain and information from recent and ongoing studies is necessary to make firm conclusions.
... The VAS score for cough increased from 2.19 ± 1.47 to 3.69 ± 1.25 in placebo group. No adverse effects related to elderberry or placebo were reported during the study (Kong 2009). Elderberry lozenges significantly improved fever; headache, muscle aches and nasal congestion during 24 h of treatment, while the cough and mucus discharge improved during 48 h of treatment. ...
... Elder berries and elder flowers were well tolerated and safe. The use of elder flowers for treatment of colds, and flu has been confirmed by German commission E (Blumenthal et al. 2000), while the clinical trials confirmed the efficacy of elder berries in treatment of clinical symptoms of flu and common cold Tiralongo et al. 2016;Kong 2009). Elder berries extract was found to be more effective against influenza A virus than influenza B type (Zakay-Rones et al. 2004). ...
Article
Common cold and flu are caused by common respiratory viral pathogens, which results in hospitalization and death in the world. Among the viral infections, influenza viruses have worldwide spread with major effects on health of societies. Change in antigenic structures of influenza viruses is associated with the lack of effective treatments. Therefore, the use of herbal medicine as alternative choice can be used for management of flu and cold. The flowers of Sambucus nigra or black elders have been approved by commission E for cold, and flu. Although, elders are used in different herbal formulates, but there is no comprehensive study. The subject of this review article was to summarize the efficacy of black elder in treatment of cold and flu. For preparing this manuscript, the electronic resources, books, and thesis were searched by key words of Sambucus, elder, cold, flu, and viral infections. The results of investigations exhibited that there are four clinical trials for elder berries, which it reduced the cold duration and severity (fever, pain, congestion, cough), while there is no clinical trial for elder flower on common cold and flu in spite of its approval by commission E. So, evaluating the efficacy of elder flowers in comparison with its berries and standard treatment on patients with viral respiratory infections should be the subject of large clinical studies.
... Less use of rescue medication than control <0.001 Absence of side-effects in patients Kong, 2009 Elderberry All studies were randomized, double-blinded, and placebo-controlled, with acceptable patient compliance. ...
... R.S. PORTER AND R.F. BODE in relieving flu-like symptoms (determined through visual analog scales) in 64 patients aged 16 to 60 years (without any identification of the influenza virus as the causative agent being required) (Kong, 2009). The study demonstrated pronounced improvement in most symptoms (fever, headache, muscle aches, and nasal congestion) within 24 h of treatment using elderberry extract (and complete cure of fever in more than half of the treatment group within 24 h), and pronounced improvement in all investigated symptoms (in addition to the aforementioned symptoms, cough and mucus discharge) within 48 h (and complete cure of fever in all treated patients, and of mucus discharge, muscle aches, and headache in at least half of all treated patients). ...
Article
Full-text available
Black elder (Sambucus nigra L.) has a long ethnobotanical history across many disparate cultures as a treatment for viral infection and is currently one of the most-used medicinal plants worldwide. Until recently, however, substantial scientific research concerning its antiviral properties has been lacking. Here, we evaluate the state of current scientific research concerning the use of elderberry extract and related products as antivirals, particularly in the treatment of influenza, as well as their safety and health impacts as dietary supplements. While the extent of black elder's antiviral effects are not well known, antiviral and antimicrobial properties have been demonstrated in these extracts, and the safety of black elder is reflected by the United States Food and Drug Administration approval as generally recognized as safe. A deficit of studies comparing these S. nigra products and standard antiviral medications makes informed and detailed recommendations for use of S. nigra extracts in medical applications currently impractical. Copyright © 2017 John Wiley & Sons, Ltd.
... Sambucus nigra has long been studied, with antiviral properties and mechanisms of action described (10). One of the most researched fields is the ability of elderberry to inhibit the influenza viruses. ...
... In traditional medicine elderberry has been used a proprietary elderberry extract formulated as a slow-dissolve lozenge was given to the patients. Patients ameliorate the symptoms within 2 days, with results revealing similar or superior efficacy in symptom mitigation than common anti-viral drugs, as oseltamivir or zanamivir (10). Considering the results obtained in vitro in both studies, as well as in the two clinical trials, elderberry extracts showed activity against influenza viruses and ability to sooth flu symptoms in infected patients, whereby it may be a hypothesis for treatment for influenza virus. ...
... The first group received 4 slow-dissolve lozenges of a proprietary elderberry extract a day (each lozenge contained 175 mg of the proprietary elderberry extract) and the second group received placebo lozenges. After 48 h of treatment, patients from the group treated by elderberry extract demonstrated significant reduction in most of the flulike symptoms -28% of patients were void of all symptoms and 60% of patients received relief of some symptoms and had one or two mild symptoms, whereas the placebo group demonstrated either no improvement or even aggravated symptoms (Kong, 2009). Selected antiviral properties of elderberry fruit (regarding to influenza A and B virus) are illustrated in Fig. 1. ...
... IC 50 values were higher than 500 µg/mL for all the five studied UGTs enzymes in vitro, such as UGT1A1, UGT1A4, UGT1A6, UGT1A9 and UGT2B7 (Choi, Park, Yoon, & Bae, 2014). (Kinoshita et al., 2012;Kong, 2009;Krawitz et al., 2011;Roschek et al., 2009;Zakay-Rones et al., 2004). ...
Research
European black elderberry naturally occurs in most of Europe and has been introduced into various parts of the world for fruit and flower production. Elderberry is rich in nutrients, such as carbohydrates, proteins, fats, fatty acids, organic acids, minerals, vitamins and essential oils. Elderberry also contains cyanogenic glycosides which are potentially toxic. Polyphenols, known for their free radical scavenging (antioxidant) activity, are the most important group of bioactive compounds present in elderberry in relatively high concentration. The high antioxidant activity of elderberry fruit and flowers is associated with their therapeutic properties. Elderberry has for a long time been used in folk medicine as a diaphoretic, antipyretic and diuretic agent. In recent years it was also found to have antibacterial, antiviral antidepressant and antitumour and hypoglycemic properties, and to reduce body fat and lipid concentration. Due to its health-promoting and sensory properties, elderberry is used primarily in food and pharmaceutical industry.
... The first group received 4 slow-dissolve lozenges of a proprietary elderberry extract a day (each lozenge contained 175 mg of the proprietary elderberry extract) and the second group received placebo lozenges. After 48 h of treatment, patients from the group treated by elderberry extract demonstrated significant reduction in most of the flulike symptoms -28% of patients were void of all symptoms and 60% of patients received relief of some symptoms and had one or two mild symptoms, whereas the placebo group demonstrated either no improvement or even aggravated symptoms (Kong, 2009). Selected antiviral properties of elderberry fruit (regarding to influenza A and B virus) are illustrated in Fig. 1. ...
... IC 50 values were higher than 500 µg/mL for all the five studied UGTs enzymes in vitro, such as UGT1A1, UGT1A4, UGT1A6, UGT1A9 and UGT2B7 (Choi, Park, Yoon, & Bae, 2014). (Kinoshita et al., 2012;Kong, 2009;Krawitz et al., 2011;Roschek et al., 2009;Zakay-Rones et al., 2004). ...
Article
Full-text available
European black elderberry naturally occurs in most of Europe and has been introduced into various parts of the world for fruit and flower production. Elderberry is rich in nutrients, such as carbohydrates, proteins, fats, fatty acids, organic acids, minerals, vitamins and essential oils. Elderberry also contains cyanogenic glycosides which are potentially toxic. Polyphenols, known for their free radical scavenging (antioxidant) activity, are the most important group of bioactive compounds present in elderberry in relatively high concentration. The high antioxidant activity of elderberry fruit and flowers is associated with their therapeutic properties. Elderberry has for a long time been used in folk medicine as a diaphoretic, antipyretic and diuretic agent. In recent years it was also found to have antibacterial, antiviral antidepressant and antitumour and hypoglycemic properties, and to reduce body fat and lipid concentration. Due to its health-promoting and sensory properties, elderberry is used primarily in food and pharmaceutical industry.
... The preparation alleviated influenza symptoms. The condition of individuals from the placebo group either remained unchanged or it deteriorated (Kong, 2009). As results from the study by Roschek and Alberte (2008), the administration of elderberry extract in lozenges increased the bioavailability of selected anti-flu components. ...
Article
Influenza is a highly dangerous disease, as it is connected with a risk of complications and in extreme cases – also death. Treatment based on virustatic drugs is not always effective, as mutations lead to the development of drug-resistant viruses. A relatively efficacious protection against influenza is provided by vaccinations; however, they are not very popular due to the common distrust in their efficacy and concerns over their supposed adverse effects. Phytotherapy uses several raw materials which may be applied in the prevention and treatment of influenza. Plant origin materials of particular interest include berry fruits containing considerable amounts of bioactive compounds. The multifaceted health-promoting action of berry fruits is connected first of all with the presence of polyphenols. Antiviral activity against influenza viruses results from the presence of anthocyanins and other classes of flavonoids, proanthocyanidins and phenolic acids. An important group of compounds other than polyphenols, which may be readily used in influenza infections comprises polysaccharides. Research indicates that components of berry fruits may inhibit replication of the virus both directly and indirectly, e.g. by blocking surface glycoproteins of influenza virus and stimulating the immune system of the organism. In consequence to their properties berry fruits are raw materials of potential use in the prevention and treatment of influenza.
... Elderberry is used in the prevention of cancer, vascular diseases and diabetes. It is characterized by antiviral and antimicrobial properties supporting the treatment of influenza and colds (Kong, 2009;Mikulic-Petkovsek, Ivancic, Schmitzer, Veberic, & Stampar, 2016;Sidor & Gramza-Michałowska, 2015). Other important ice cream ingredients treated as functional may be inulin and locust bean gum. ...
Article
The objective of the study was to characterize the effects of selected stabilizers on the freezing process and the physicochemical properties of coconut milk ice cream. Two stabilizers were used: inulin (0.8, 1.6, 2.4, 3.2 and 4 g/100 g of the mixture) and locust bean gum (LBG) (0.2, 0.4, 0.6 and 0.8 g/100 g of the mixture). Freezing process was performed in two stages. After the temperature of the ice cream mixtures reached −6 °C, they were hardened at −30 °C for 24 h. Then the samples were examined for their chemical composition, overrun, melting time and melting resistance, hardness and colour. The results showed that increasing concentration of inulin and LBG resulted in a decrease in the cryoscopic temperature and melting time of ice cream. On the other hand, ice cream produced from the mixtures containing higher inulin concentration and lower LBG concentration were characterized by higher overrun. Addition of inulin and LBG cause statistically significant changes in hardness of ice cream. The differences in colour of tested ice creams were shown. The highest scores in the sensory evaluation were obtained for ice cream with LBG and 0.8 g/100 g and 4 g/100 g of inulin.
... Of note, several clinical studies investigated the effectiveness of elderberry in common cold, flu and influenza, proving an overall symptom reduction, shortened duration of illness or reduced use of medication. Two recent reviews and a meta-analysis summarize the available data from available clinical studies (Kong, 2009;Rauš et al., 2015;Tiralongo et al., 2016;Zakay-Rones et al., 1995, 2004 on the effects of Sambucus nigra L. on acute respiratory viral infections (Harnett et al., 2020;Hawkins et al., 2019;Wieland et al., 2021), attesting elderberry the ability to substantially reduce upper respiratory symptoms. Importantly, no serious adverse events after elderberry extract consumption were reported in those studies. ...
Article
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Infections of the respiratory system, including common cold and influenza, are affecting people worldwide and are more or less prone to spread depending on the season and viral load of the host. For reducing symptoms and duration of illness, treatment options to standard prescribed drugs are in demand. Natural products could provide immune-supporting treatment alternatives. Elderberry extracts have been used in traditional medicine for the treatment of respiratory infections for decades and numerous studies describe the beneficial effects of elderberries on the immune system and respiratory infectious disease. We investigated the immunomodulative and antiviral effects of a high-quality, anthocyanin-enriched elderberry fruit extract (eldosamb®). Results reveal that elderberry extract reduced the secretion of pro-inflammatory cytokines TNF-α and IFN-γ, leading to a shift towards the Th2-Helper cell response and showing antiviral efficacy against the MVA virus. Thus, with its anti-inflammatory and antiviral bioactivity the proprietary elderberry extract suggests its use as an immunomodulatory health product.
... It has shown antiviral activity against the human coronavirus HCoV-NL63 in vitro (Weng et al. 2019). Clinical studies have hypothesized that elder may decrease the duration of symptoms in the treatment of influenza (Kong 2009). Other studies have theorized that elder may relieve cold symptoms (Tiralongo et al. 2016). ...
Article
Viral diseases have always played an important role in public and individual health. Since December 2019, the world is facing a pandemic of SARS-CoV-2, a coronavirus that results in a syndrome known as COVID-19. Several studies were conducted to implement antiviral drug therapy, until the arrival of SARS-CoV-2 vaccines. Numerous scientific investigations have considered some nutraceuticals as an additional treatment of COVID-19 patients to improve their clinical picture. In this review, we would like to emphasize the studies conducted to date about this issue and try to understand whether the use of nutraceuticals as a supplementary therapy to COVID-19 may be a valid and viable avenue. Based on the results obtained so far, quercetin, astaxanthin, luteolin, glycyrrhizin, lactoferrin, hesperidin and curcumin have shown encouraging data suggesting their use to prevent and counteract the symptoms of this pandemic infection.
... There are many studies supporting the idea that Sambucus nigra L. is a true pharmacy, considered to be rich in biologically active components, which it is available in modern medicine (Kovalenko, 1994). The consumption of elder helps in the prevention and therapy for a number of diseases, such as diabetes (Bhattacharya et al., 2013;Fowler, 2010;Folmer et al., 2014;Gray et al., 2000;Kashyap and DeFronzo, 2007;Netzel et al., 2005;Song et al., 2014), obesity (Christensen et al., 2010;Chrubasik et al., 2008), antibacterial and antifungal activity (Hearst et al., 2010;Kinoshita et al., 2012;Kong, 2009;Krawitz et al., 2011), antitumour activity (Pehlivan Karakas et al., 2012;Thole et al., 2006), immune system stimulation (Ciocoiu et al., 2012;Frøkiaer et al., 2012;Groza et al., 2010), protection against UV radiation (Chen et al., 2012;Jarzycka et al., 2013), diuretic and laxative activity (Beaux et al., 1999;Picon et al., 2010). The composition of all plant parts of black elder it depends in fact, of degree of ripeness, the variety, climatic conditions and environmental (Sidor and Gramza-Michałowska, 2015). ...
Article
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Introduction: All plant parts of elderberry (leaves, berries, inflorescences, roots, shoots, bark) have a long history of use in herbal remedy or lots of culinary uses, widespread in almost every continent of the world (1). Pro-health properties indicated a role of elderberry products intake in the prevention of cancer and diabetes. Aims: This paper presents an overview of the evaluation of biochemical compounds (sugars, organic acids, total phenolics, antioxidative activity, flavonoids, flavor and volatile compounds), found in flowers, berries and leaves of Sambucus nigra L. Materials and Methods: Chromatographic profiling, spectrophotometric evaluation, DPPH antioxidant assay, ABTS radical scavenging activity. Results: The variability of concentration compounds are found by uniform maturity of each phenophase of elderberry, hence the need varieties improve the quantity and quality of its yield. Elderberry has food industry properties associated with the presence of increased nutritive and decreased caloric value at fruits best correlated with the content of sugars and organic acids of flower, organic acids as a important metabolic pathway of proteins, lipids, carbohydrates. Several studies have confirmed that Sambucus nigra L. is a valuable raw material with many nutrients and bioactive substances, being extraordinarily rich in antioxidants, and the leaves are remarked as easily available source of antioxidant preparations in different domains (food products, pharmaceutics, or cosmetics). Conclusion: A bush of Sambucus nigra L. in the garden is our true handy pharmacy, a food market like as functional ingredient, a spot of color with unmistakable smell.
... In vivo studies performed on chimpanzees supported the in vitro findings of a standardized elderberry aqueous extract, reporting a reduction of flu-like symptoms by 2/3 [105]. Additionally, clinical studies revealed promising results as the flu related symptoms were reduced [53,100,106], as well as a higher inhibition of the hemagglutination on treated groups [53]. The suggested mechanisms of action of elderberry extract on influenza virus is that its bioactive constituents, i) stimulate the immune system; ii) inhibit the hemagglutination of the influenza virus and thus prevent the adhesion of the virus to the cell receptors (Fig. 2); iii) present anti-inflammatory effect. ...
... Elderberries were found to have significant antiviral effect and immunomodulatory activity. Clinical trials indicated that Sambucol ® is a very effective food supplement for relieving flu-like symptoms (Kong, 2009;Zakay-Rones et al., 1995. Sambucol ® also showed prophylactic effects in chimpanzees. ...
... Elderberry (Sambucus nigra L fruit) has been indicated in several clinical trials to relieve the symptoms of the common cold and influenza when ingested at the onset of infection in children and adults [21,[25][26][27]. Additionally, the effect of elderberry has been tested for prevention of respiratory symptoms in situations of high risk of infection, such as intercontinental flights, showing a reduction in the duration and severity of common cold events the travelers developed [28]. ...
Article
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Elderly people are particularly vulnerable to respiratory tract infections, so natural strategies to ameliorate the duration and severity of these infections are of great interest in this population. The objective of this study is to evaluate the efficacy of the consumption of a combination of elderberry and reishi extracts on the incidence, severity, and duration of respiratory tract infections in a group of healthy elderly volunteers. A randomized, double-blind, placebo-controlled pilot study was performed during the winter season. A group of 60 nursing home residents ≥65 years of age was randomly assigned to receive a combination of 1.5 g of elderberry +0.5 g of reishi or a placebo daily for 14 weeks. Data about the health conditions of the volunteers were evaluated and recorded by a medical doctor every 2 weeks. The incidence of respiratory infections was similar in both groups. However, volunteers in the extract group presented a significantly lower duration of common cold events (2.5 vs. 4.8 days, p = 0.033).and a significantly lower probability of having a high severity influenza-like illness event (p = 0.039). Moreover, the incidence of sleep disturbances was significantly lower in the extract group (p = 0.049). Therefore, the administration of a combination of elderberry and reishi extracts to the elderly population during the winter season might be used as a natural strategy to reduce the duration and severity of respiratory tract infections.
... After evaluating the remaining studies, a total of four articles were included in this analysis. [22][23][24][25] (See Fig. 1: PRISMA Flow Chart) After potential studies were identified, studies were coded according to the inclusion characteristics, patient demographics, and research methodology. Each study was coded by two authors, then results were compared for inter-coder reliability. ...
Article
Upper respiratory symptoms are often treated with over the counter drugs, antibiotics, and antiviral medications. Due to concerns about safety and efficacy, there is a demand for an alternative solution. Black elderberry (Sambucus nigra) has been used to treat cold and flu symptoms, but there are no large-scale studies or meta-analyses. This meta-analysis quantifies the effects of elderberry supplementation and evaluates moderators including vaccination status and the underlying pathology. This analysis included a total of 180 participants and evaluates moderators such as vaccination status and cause of the upper respiratory symptoms. Supplementation with elderberry was found to substantially reduce upper respiratory symptoms. The quantitative synthesis of the effects yielded a large mean effect size. These findings present an alternative to antibiotic misuse for upper respiratory symptoms due to viral infections, and a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.
... Recent studies confirmed the benefits of elderberry as an antiviral drug [12][13][14]. Results of many studies pointed to the beneficial effects of elderberry extracts not only in the treatment of flu-like symptoms [15], but also in the treatment and prevention of diabetes, cardiovascular diseases and cancers [16][17][18]. Investigations indicated that these berries, due to the high content of anthocyanins and other polyphenolics, possess high antioxidant activity [19][20][21][22][23]. ...
Article
A healthy diet is an important factor in a healthy lifestyle that is becoming increasingly important in today's society. The fruits of European elder (Sambucus nigra L.) are a rich source of bioactive compounds like anthocyanins. In this study, dried and fresh fruits of four cultivated and six wild growing plants were investigated for their anthocyanin pattern and content as well as their bioactive compounds. After separation on HPTLC plates silica gel 60 F254 with a mixture of ethyl acetate, 2-butanone, formic acid and water, the plates were quantitatively evaluated by densitometry and also subjected to various (bio)assays to investigate the samples for compounds acting as radical-scavengers, antimicrobials, estrogens, and acetylcholinesterase or tyrosinase inhibitors. The mean contents for the two most abundant anthocyanins in European elderberries, confirmed by HPTLC-ESI-MS, ranged from 159 to 647mg/100g in fresh and from 166 to 2764mg/100g in dried fruits for cyanidin-3-sambubioside, and from 112 to 521mg/100g in fresh and 95 to 226mg/100g in dried fruits for cyanidin-3-glucoside. Additionally, the anthocyanin content was higher in berries of cultivars than of wild growing plants. The anthocyanins' radical scavenging activity and antimicrobial effect against Aliivibrio fischeri were confirmed. Further, a radical scavenging compound affecting A. fischeri and acting as acetylcholinesterase inhibitor was tentatively assigned by its protonated molecule at m/z 456 as either ursolic or oleanolic acid by HPTLC-ESI-MS. HPTLC hyphenated with bioassays and mass spectrometry was selected as method of choice for fingerprinting, pattern recognition, and bioprofiling of elderberry samples as well as quantitation and confirmation of bioactive compounds therein.
... Elderberry is a well-known plant which supports treatment of influenza and colds, exhibiting antiviral and antibacterial activity (Kong, 2009). Elderberry flower extract at a concentration of 252 µg/mL inhibited the influenza A virus (H1N1)induced Madin-Darby canine kidney (MDCK) cell infection (Roschek, Fink, McMichael, Li, & Alberte, 2009). ...
Article
Elderberry plant (Sambucus nigra) is a good source of protein, free and conjugated forms of amino acids, unsaturated fatty acids, fibre fractions, vitamins, antioxidants and minerals. Analysis of elderberry showed that it contains high biological activity components, primarily polyphenols, mostly anthocyanins, flavonols, phenolic acids and proanthocyanidins, as well as terpenes and lectins. In folk medicine, elderberry has been used in the treatment of many diseases and ailments. Elderberry has medicinal properties associated with the presence of polyphenols, which are compounds with potential antioxidant properties. They can greatly affect the course of disease processes by counteracting oxidative stress, exerting beneficial effects on blood pressure, glycaemia reduction, immune system stimulation, antitumour potential, increase in the activity of antioxidant enzymes in the blood plasma, including also glutathione, and the reduction of uric acid levels.
... The lozenges treatment revealed the reduction of symptoms with significant improvement within 24 h of treatment, and complete eradication of infectious symptoms within 48 h recorded, whereas placebo treatment remains unchanged or with the worst condition. The lozenge group showed almost 60% symptom relief and 28% complete recovery without side effects [72]. ...
Article
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Background Influenza infection always poses a threat to human and animal health. Vaccines and antiviral drugs are recommended to deal with the situation. The drawback of these remedial agents made the scientist change their focus on an alternative therapy. The anti-influenza effects of plants have been extensively studied, and many pharmaceutical companies have prepared their products on this basis. Main body The present review documents the successfully launched anti-influenza commercial products. In specific, it exposes the scientifically validated and evidence-based supporting inhibitory action of influenza and its strains. Conclusion This review highlighted the efficacy of the commercial products which effectively combat influenza. It provides a complementary strategy to deal with the worst-case scenario of flu. Meanwhile, to face the emerging strains, brand new products are in great necessity besides prevailing and available drugs.
... In traditional medicine, plants such as elderberry (Sambucus nigra L.), has been used in treating the viral disease like colds and flu from past to present (Roxas and Jurenka, 2007). Some independent clinical trials proved a proper effect of elderberry extract against InfV A and B infection (Kong, 2009). In a randomized, double-blind, placebo-controlled study, elderberry extract (EBE) demonstrated a safe and therapeutic effect in the treatment of InfV A and B (Zakay-Rones et al., 2004). ...
Article
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As the leading cause of death worldwide, viruses significantly affect global health. Despite the rapid progress in human healthcare, there are few viricidal and antiviral therapies that are efficient enough. The rapid emergence of resistance, and high costs, as well as the related side effects of synthetic antiviral drugs, raise the need to identify novel, effective, and safe alternatives against viral diseases. Nature has been of the most exceptional help and source of inspiration for developing novel multi-target antiviral compounds, affecting several steps of the viral life cycle and host proteins. For that matter and due to safety and efficacy limitations, as well as high resistance rate of conventional therapies, hundreds of natural molecules are preferred over the synthetic drugs. Besides, natural antiviral agents have shown acceptable antiviral value in both preclinical and clinical trials.This is the first review regarding molecular and cellular pathways of the virus life cycle, treatment strategies, and therapeutic targets of several viral diseases with a particular focus on anthocyanins as promising natural compounds for significant antiviral enhancements. Clinical applications and the need to develop nano-formulation of anthocyanins in drug delivery systems are also considered.
... 3. Kong et al. (2009) also conducted a pilot RCT with 64 participants on influenza and found similar results. Patients were given a proprietary elderberry extract lozenge containing 175 mg extract or placebo, 4 lozenges a day for two days. ...
Thesis
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Elderberry extract from fruit and flowers appears to show some inhibitory effect against many microorganisms including those found as nosocomial pathogens (hospital “super-bugs”) e.g. MRSA; HIV; Mycoplasmae; IBV coronavirus (an envelope virus), and influenza (and its bacterial super-infections). These effects may be stronger in-vivo than in-vitro. The immunomodulatory effects of S. nigra have been investigated and appear to show that the plant would be likely to stimulate the immune systems of the weak or immune-compromised. It has also been investigated to see whether it would exacerbate or mitigate a cytokine storm, and does not seem to make one worse and might dampen it. Elderberry is also shown to have potential as an ingredient in a hospital disinfectant for which in-vitro trials are sufficient, and without effective disinfectants modern medicine will become impossible. The S. nigra inactivates two distinct envelope viruses and should be tested on Ebola, also an envelope virus, as it is likely that it may inactivate that too. It should also be tested on SARS and other novel coronaviruses such as COVID-19 which are all envelope viruses. Other species of Sambucus appear to have very similar properties including inhibiting coronaviruses. Elderberry seems to have potential as a useful medicine, particularly since there are reasons to believe resistance to it is unlikely to ever develop. It might be possible to use it in combination with leeks (Gallium porrum) which are also anti-viral. Elderberry has been shown to be effective against upper respiratory tract diseases including some Coronaviruses, and has potential against the current pandemic of Covid-19. Two case studies, included here, suggest it to be effective against Covid-19 caused by SARS-CoV-2, and clinical trials are under way. In-vitro trials are planned to test it against other viral possible future pandemics.
... Previous studies showed that elderberry exhibited inhibitory bacterial activity and effectively suppressed viral replication, acting against pathogens that cause infections of the upper respiratory tract. (Kong 2009;Kinoshita et al. 2012;Álvarez et al. 2018). Studies have also shown that both elderberry and elderflower extracts exerted diverse biological activities in different biological system, such as antioxidant, anti-inflammatory, antidiabetic and diuretic effects (Ulbricht et al. 2014;Sidor and Gramza-Michalowska 2014). ...
Article
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Rhinosinusitis is a common disorder related to inflammation of paranasal sinuses and nasal cavity mucosa. Herbal medicines could be an option in the treatment of rhinosinusitis due to their anti-inflammatory and anti-oxidative properties. The study aims to investigate the effect of intranasal Sambucus nigra L. subsp. nigra (SN) extract against inflammation, oxidative stress, and tissue remodeling in nasal and sinus mucosa, but also in serum, lungs, and brain, in Wistar rat model of subacute sinonasal inflammation induced by local administration of lipopolysaccharides (LPS), from Escherichia Coli. The cytokines (TNF-α, IL-1β, IL-6) and oxidative stress (malondialdehyde) in nasal mucosa, blood, lungs, and brain were analyzed. In addition, a histopathological examination was performed, and NF-kB, MMP2, MMP9, TIMP1 expressions were also evaluated in nasal mucosa. Both doses of LPS increased the production of cytokines in all the investigated tissues, especially in the nasal mucosa and blood (p < 0.01 and p < 0.05), and stimulated their secretion in the lungs, and partially in the brain. Malondialdehyde increased in all the investigated tissues (p < 0.01 and p < 0.05). In parallel, upregulation of NF-kB and MMP2 expressions with downregulation of TIMP1, particularly at high dose of LPS, was observed. SN extract reduced the local inflammatory response, maintained low levels of IL-6, TNF-α, and IL-1β. In lungs, SN reduced all cytokines levels while in the brain, the protective effect was noticed only on IL-6. Additionally, SN diminished lipid peroxidation and downregulated NF-kB in animals exposed to a low dose of LPS, with increased TIMP1 expression, while in animals treated with a high dose of LPS, SN increased NF-kB, MMP2, and MMP9 levels. In conclusion, SN extract diminished the inflammatory response, reduced generation of reactive oxygen species (ROS) and, influenced MMPs expressions, suggesting the benficial effect of SN extract on tissue remodeling in subacute rhinosinusitis and on systemic inflammatory response.
... Influenza is an acute respiratory illness caused by influenza viruses with symptoms off ever, sore throat, chills, cough, headache, muscle aches, and fatigue [1]. The disease is classified as an infectious disease caused by a virus and can infect humans as well as animals. ...
Article
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Highly Pathogenic Avian Influenza (HPAI) H5N1 poses a significant threat to animal and human health worldwide. The number of H5N1 infection in Indonesia is the highest during 2005-2013, with a mortality rate up to 83%. A mutation that occurred in H5N1 strain made it resistant to commercial antiviral agents such as oseltamivir and zanamivir, so the more potent antiviral agent is needed. In this study, virtual screening of Indonesian flavonoid as neuraminidase inhibitor of H5N1 was conducted. Total 491 flavonoid compound obtained from HerbalDB were screened. Molecular docking was performed using MOE 2008.10. This research resulted in Guajavin B as the best ligand.
Chapter
Elderberry (Sambucus nigra) is a flowering plant belonging to the Adoxaceae family that is commonly used as a supplement to treat cold and flu symptoms. Elder berries contain several anthocyanin flavonoids known to possess significant antioxidant properties. Elderberry may be beneficial for gingival recession, hyperlipidemia, dyslipidemia, metabolic syndrome, obesity, chronic constipation, upper respiratory infection, influenza, and HIV. It has been assigned Level C evidence for several of these indications. Both the berries and flowers of the elder shrub have antiviral, antibacterial, immune-modulating, antiinflammatory, antioxidant, and glucose-lowering properties. This chapter examines some of the scientific research conducted on elderberry, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of elderberry’s use in treating oral and dental, cardiometabolic, gastrointestinal, and infectious diseases. Finally, the chapter presents a list of elderberry’s Active Constituents, different Commonly Used Preparations and Dosage, and a Section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
Article
Background: Black elderberry, used medicinally for centuries, decreased influenza duration by 4 days in three previous peer-reviewed trials. US elderberry sales, possibly related to a "high severity" and "high activity" influenza season from January to March 2018, more than doubled from 2017 to 2018 to > $100 million. Objective: To determine whether elderberry extract decreases influenza's duration and severity. Design: FDA-approved, investigator-initiated, Investigational New Drug, double-blind, randomized, placebo-controlled trial. Conducted January 2018-April 2019 in three emergency rooms, two suburban and one urban, in the Midwestern Health System. Patients: Eighty-seven consecutive, consenting patients, over age four, with < 48 h of at least 2 moderate-severity influenza symptoms and positive polymerase chain reaction influenza test. Intervention: Patients from age 5 to 12 years received placebo or 15 ml (5.7 g) elderberry extract orally twice a day for 5 days; those > 12 years received 15 ml 4 times a day for 5 days. Patients were permitted to choose to also receive the standard dosage of oseltamivir. Measurements: Primary: days until all symptoms were none or mild for 21.5 h. Secondary: days to complete symptom resolution for 24 h. Results: The 87 participants were randomized to receive placebo (n = 44) or elderberry (n = 43). The average age was 25 ± 20 years, and 56% were male. The average number of days to reach all symptoms none or mild for 21.5 h in the placebo group was 4.9 ± 2.8 days compared to 5.3 ± 3.6 in the elderberry group (p = 0.57). The average number of days to complete resolution was 8.7 ± 3.8 and 8.6 ± 3.9 in the placebo and elderberry group, respectively (p = 0.87). Limitations: Small sample size, but powered > 0.90 to detect 2-day benefit of elderberry versus placebo. Conclusions: We found no evidence that elderberry benefits the duration or severity of influenza. Post hoc analysis suggested primary outcomes with elderberry taken alone (without oseltamivir) were 2 days worse than with placebo taken alone. Our results contradict previous studies and demonstrate the need for further studies. Trial registration: NCT03410862.
Article
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Mucus plays an important role in respratory system as moisturizing agent and physical of the innate immune system. The treatment for the overproduction of mucus upon the occurence of allergy or infection has gained considerable attention over the years. This study aimed to evaluate the mucolytic activity of natural herbal combination (NHC) containing Echinacea purpurea herba dry extract, Sambucus nigra (elderberry) fructus extract, Glycyrrhiza glabra (liquorice) radix extract, Vitex trifolia (Indian black pepper) folium extract, Zingiber officinale (ginger) rhizoma extract by ex vivo. The mucolytic activity of this NHC with various dose concentration 0.25%, 0.5%, 1.0% and 2.0%, was examined by measuring the viscosity of mixture of cow intestinal mucus and phosphate buffer pH 7 using Viscometer Brookfield LVDV II. N-acetylcysteine (NAC) 0.1% w/v was used as the standard mucolytic drug. Viscosity values were analyzed statistically using ANOVA single factor to determine differences between treatment groups. Our finding shows that all NHC group has a mucolytic effect and the mucolytic effect was identified as dose-dependent . The mucolytic effect from 0.5% of NHC is statistically equal to the mucolytic effect from 0.1% NAC. This result could offer a potent plausibe approach for new mucolytic medication. However, further exploration regarding the other efficacy in mucoactive and its possible mechanism of action are prompt to be done in the future. Keywords: Mucolytic, E.purpurea, S.nigra, G.glabra, V.trifolia, Z.officinal, N-Acetyl cysteine
Article
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The aim of this study was to determine the basic morphological characteristics (weight, length) and antioxidant activity (using DPPH method) of elderberry (Sambucus nigra L.) inflorescences as well as some elderberry-derived food products prepared from fresh (honey, alcoholic extract, tea infusions) and dried inflorescences (syrup). For the study of problematic, it was used 113 wild-growing genotypes of elderberry from 56 locations in Slovakia growing at an altitude of 98.15-712.32 m. The weight of fresh inflorescences ranged from 0.45 to 57.59 g (75.65% coefficient of variation value), the total length of inflorescences ranged from 19.0 to 282.0 mm (22.42%), the length of inflorescence´s stems from 9.0 to 197.0 mm (31.51%), a number of petals predominated pentanumerous petals. Variability in primary and secondary branching reported a low to high degree of variability among as well as within the genotypes. Results showed significant differences in the shape of inflorescences and the colour of flowers among each genotype. Antioxidant activity by DPPH method in elderberry inflorescence water extract was between 85.12 and 89.29%. Activation of tea infusions and beverages was ensured using a mechanism Kalyxx based on galvanic effect. In beverages made from 10% diluted honey prepared from fresh inflorescences in the carbohydrate-based extract, anti-radical activity was determined in the range of 16.81-24.16%. In an alcoholic extract from fresh inflorescences, anti-radical activity was between 90.99 and 93.16%. In beverages acquired from the syrup of flowers, we identified antioxidant activity ranging from 37.92 (10%) to 62.82% (40%). Results indicated that elderberry inflorescences and elderberry-derived food products can be attractive to consumers and in future can increase the assortments of healthy products.
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