Immunostimulant echinacea

A 36-year-old patient started taking a combination of herbal products including Echinacea, and 2 weeks later she presented with generalized muscle weakness that limited her ambulation and ability to use her hands. She was found to have distal renal tubular acidosis and was extremely hypokalemic (K+ of 1.3). Over 4 days she received 1200 mEq of sodium bicarbonate and 400 mEq of potassium chloride along with other electrolyte supplements to correct the imbalances. After her serum electrolytes were corrected, her muscle weakness improved rapidly. She was diagnosed and treated for Sjogren s syndrome and her condition rapidly improved. The researchers suggested that her use of the immunostimulant Echinacea could have contributed to the activation of her autoimmune disease, which ultimately caused her severe metabolic disturbances. Because she had remained symptom free for more than 3 years, the authors concluded that, after review, her disease was relatively mild and was exacerbated by Echinacea (34). 

Wagner et al. obtained immunostimulating pectic polysaccharides from plant cell culture of Echinacea purpurea [5]. From the extracellular polysaccharide... 

There are several botanicals that have purported immunostimulating effects. These include Panax ginseng and Echinacea purpurea (74), which have both been used as an immune stimulant. Any potential adverse effect on the pharmacological activity of immunosuppressants has not been reported in patients or evaluated in clinical studies. Given the lack of data, it would be prudent to advise against concurrent intake of these botanicals, and closely monitor changes in efficacy in patients who self-administer these botanicals. 

The effect of echinacea on the immune system is controversial. In vivo human studies using commercially marketed formulations of E purpurea have shown increased phagocytosis, total circulating white blood cells, monocytes, neutrophils, and natural killer cells but not immunostimulation. In vitro, Epurpurea juice increased production of interleukins-1, -6, and -10, and tumor necrosis factor- by human macrophages. Enhanced natural killer cell activity and antibody-dependent cellular toxicity was also observed with E purpurea extract in cell lines from both healthy and immunocompromised patients. Studies using the isolated purified polysaccharides from Epurpurea have also shown cytokine activation. Polysaccharides by themselves, however, are unlikely to accurately reproduce the activity of the entire extract. 

Echinacea is believed to have antiseptic, antiviral, and peripheral vasodilator properties. Traditionally, it has been used for furunculosis, septicemia, nasopharyngeal catarrh, pyorrhea, tonsillitis, and specifically for boils, carbuncles, and abscesses. Scientists are currently researching its immunostimulant action. 

Echinacea has been used for centuries as a medicinal plant and has been promoted recently as an immunostimulant. Research from the last two decades has shown that Echinacea can enhance the immune system using in vitro and in vivo indicators. Jager et al. (2002) reported that dodeca-2E,4 , 8Z,10 yZ-tetraenoic acid isobutylamides could cross biological barriers via passive diffusion, suggesting that the alkamides may contribute to the in vivo effects noted by researchers. In contrast, conflicting results have... 

Lamidey, A., Fernon, L., Pouysegu, L., Delattre, C., Quideau, S., and Pardon, P. 2002. A convenient synthesis of the Echinacea-derived immunostimulator and HIV-1 integrase inhibitor (— )-(2S, 3R)-chicoric acid. Helv. Chim. Acta 85, 2328-2334. 

Lersch, C., Zeuner, M., Bauer, A., Siemens, M., Hart, R., Drescher, M., Fink, U., Dancygier, H., and Classen, M. 1992. Nonspecific immunostimulation with low doses of cyclophosphamide (LDCY), Thymnostimulin, Echinacea purpurea extracts (Echinacin ) in patients with far advanced colorectal cancers preliminary results. Cancer Investig. 10, 343-348. 

CANNABIS ECHINACEA AND OTHER IMMUNOSTIMULANTS May i immunostimulant effects The cannabinoid receptor is considered to mediate immunosuppressant effects and is currently being investigated in the development of novel immunosuppressants Be aware... 

Echinacea species (coneflower, black Sampson hedgehog, Indian head, snakeroot, red sunflower, scurvy root) have become increasingly popular, particularly for the prophylaxis and treatment and prevention of cold and flu symptoms. However, the claimed efficacy of Echinacea in the common cold has not been confirmed in a randomized, double-blind, placebo-controlled trial (20) or a systematic review (21). Echinacea is claimed to have antiseptic and antiviral properties and is under investigation for its immunostimulant action. The active ingredients are glycosides (echinacoside), polysaccharides, alkamides, and flavonoids. 

Echinacea remains a popular supplement used as an immunostimulant in the prevention and treatment of infection. Despite inconsistent results from clinical trials attempting to assess effectiveness, its relatively wide margin of safety makes the herb an attractive alternative for prevention and treatment of common infections such as upper respiratory infections. Given the herb s inherent ability to inhibit various C YP450 enzymes, further studies to identify the clinical implications for herb-drug interactions are needed. 

The majority of literature published about Echinacea focuses on its activity as an immunostimulant. Many of the studies focus on the activity of macrophages and Echinacea s ability to activate and stimulate immune function. 

The majority of the published literature about echinacea focuses on the plant s activity as an immunostimulant. In many in vitro studies, echinacea extracts have been shown to stimulate phagocytosis, increase leukocyte mobility, and increase cellular respiration. Lipophilic extracts appear to be more active than hydrophilic extracts (Anonymous, 1996). 

Actions Immunostimulant (increases phagocytosis to four times that of echinacea), diaphoretic, febrifuge, mucous membrane tonic, smooth muscle relaxant, anti-inflammatory, cytotoxic, mild emetic, peripheral circulatory stimulant, gastric bitter. 

Clinical trials have shown that boneset stimulates phagocytosis better than echinacea, is analgesic (at least as effective, as aspirin), and reduces cold and flu symptoms. In mice it has shown strong immunostimulant activity and cytotoxic action against cancer cells. 

Answer the questions that follow regarding the following compound, which has been found in herbal preparations of Echinacea, the genus name for a variety of plants marketed for their immunostimulant properties. 

Proksch A, Wagner H (1987) Structural analysis of a 4-0-Methylglucurono-arabinoxy-lan with immunostimulating activity from Echinacea purpurea. Phytochemistry 26 1989-1993... 

The influence of various Echinacea extracts alone and in combination with other components on a number of immune parameters with a focus on the phagocytosis of polymorphonuclear neutrophile granulocytes has been investigated in five place-bo-controlled trials in healthy volunteers with conflicting results [38-40]. While in two trials an immunostimulative effect could be shown, this was not the case in the three remaining studies. 

Benefit and risks of the squeezed sap of the purple coneflower (Echinacea purpurea) for long-term oral immunostimulant therapy ... 

A recent double-blind, placebo-controlled study indicates that a dose of450 mg/day of E. purpurea root extract (1 5 in 55% ethanol) significantly relieved the severity and duration of flu symptoms. A double-blind, monocentric, placebo-controlled clinical trial examined the immunostimulating influence of an expressed fresh juice E. purpurea preparation on the course and severity of colds and flulike symptoms with patients deemed to have greater susceptibility to infections. At a dose of 2-4 mL/day, patients with diminished immune response (expressedby a low T4 T8 cell ratio) were found to benefit significantly from preventative treatment with the Echinacea... 

Two extracts of E. purpurea were capable of in vitro reversing the release of more than 30 cytokine-related mediators of inflammation in human bronchial cells infected with rhino vims 14. The fact that the same extracts stimulated cytokine production in uninfected cells further substantiated the reputed immunostimulant effects of Echinacea. ... 

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