Pelargonium sidoides root extracts:

A new help for the immune system and upper respiratory infections

Summary

Extracts of the root of the South African plant Pelargonium sidoides have been long used in traditional South African folk healing against respiratory infections and intestinal problems (involving mainly diarrhea).

These uses were confirmed more recently by randomized, controlled, clinical trials in Europe. They show that these extracts indeed can shorten the duration of colds and flu and that they are a significant help in shortening the duration and minimizing the severity of both acute and chronic bronchitis.

Standardized high quality extracts are now commercially available in the USA.

The overall effectiveness of the pelargonium extracts can be increased through careful rhythmical processing and the addition of the salts and minerals inherent in the root with the result being a more full spectrum herbal product.

Botany

Pelargonium sidoides is a native plant of coastal mountainous regions of South Africa. It forms a rosette-like plant with crowded leaves and roots that when maturing after two to three years are thick and reddish brown (as shown in the photo above).It belongs to the genus pelargonium (consisting of 280 species) of the Geraniaceae family. Its growth peaks in mid -summer (our December!) and is harvested toward our spring! (1)

History

Traditionally healers of South Africa have used the root preparations for diarrhea, liver complaints, wounds, colds, fatigue, fevers, generalized weakness, and infections of the respiratory tract. The plant became famous in Europe for a while in the 19^th century when the Englishman Charles Henry Stevens was cured of tuberculosis with this herb. His claim did not withstand later the test of further scrutiny.

Root extract constituents

A reddish brown aqueous-ethanolic extract is obtained from the roots.

The main components of this extract are:

Coumarins (Umckalin!),
Tannins of the proanthocyanidine type
Simple phenolic compounds
Flavonoids and catechins derivatives

Umckalin a 5,6-Dimethoxy-7-hydroxycoumarin, is both the most characteristic and presumptively the most active ingredient.

Laboratory and animal studies

Improves lung function

Research has shown that Pelargonium increases significantly the mucous clearing from the upper respiratory system, lungs and ear, nose and throat. Pelargonium does that by accelerating the so called ciliary beat frequency (CBF) which is overall an important parameter of the defense mechanism of the mucociliary system.

Ciliated cell cultures of human nasal epithelium were obtained from partial resection of hyperplastic inferior turbinates in rhinosurgery. This study asked if a Pelargonium extract has an effect on the CBF in vitro. The influence of three concentrations of the extract (1, 30, 100 mg/ml) was tested. The extract significantly, and concentration-dependently, increased CBF up to 133% at 100 mg/ml compared to the equilibration phase (100%). After rinsing with extract-free medium the CBF of cultured cells returned to nearly the normal range. (2)

Improves immunomodulatory properties

Further research shows that pelargonium has extensive immunomodulatory properties. It:

Increases phagocytosis, in vitro exp. by approx. 50%;
Increases iNO in macrophages;
Induces the gamma-Interferon system;
Upregulates cytokines;
Increases release of secretory IgA. (3,4,5)

A more recent study (6) further specifies the following

Functional bioassays showed immune modulation through TNF –alpha, IFN and NO activation.
Gene expression experiments (iNOS, IFN-a, IFN-g, TNF-a, Interleukin (IL)-1, IL-10, IL12, IL-18) not only confirmed functional data, they also clearly showed differences in the response of infected macrophages when compared to that of non infected cells.
ELISA confirmed the protein production of TNF-a, IL-1a and IL-12, while FACS analyses reaffirmed the cytokines IL-1a and IL-12 at the singular cell level.

Kolodzie, the main author concludes that “The current data provide convincing support for the improvement of immune functions at various levels, hence, validating the medicinal uses”. (6)

Antibacterial properties

Pelargonium extracts have been shown to have antibacterial properties against both Gram-positive and Gram-negative organisms. Studies showed that Pelargonium extract develops complementary anti-infective properties to group A streptococci (GAS):

Reduces bacterial adhesion to intact epithelial cells and thus protects the organism from bacterial colonization and infection/superinfection.
Enhances the attachment of bacteria to decaying BEC. In this way pathogens may be trapped and rendered inactive.
Thirdly, the inhibition of GAS invasion of epithelial cells protects the host from microorganisms that may have evaded host defenses and antibiotic treatment, and therefore prevents recurrent infections. (7, 8, 9)

Another interesting study demonstrated that Pelargonium reduces adhesion of H. pylori to human stomach cells. (10)

Virus related studies were performed.

P. sidoides extract exhibits strong antiviral activity against the viruses herpes simplex type 1 and 2 (HSV1 and 2) before penetration into the host cell and reveals a different mode of action when compared to the classical drug acyclovir (inhibits the virus only intra-cellularly during replication).

Hence pelargonium extract is capable of exerting an antiviral effect on herpes simplex virus and might be suitable for topical therapeutic use as antiviral drug both in labial and genital herpes infection. (11)

In another study pelargonium was shown to interfere with replication of influenza A virus, RSV, human corona virus, parainfluenza and coxsackie virus. Pelargonium did not however inhibit the adeno and rhino viruses, or avian influenza virus. (12)

Significantly pelargonium inhibited the so called sickness behavior that follows or accompanies a viral illness. It reduced the post inflammatory and post viral anorexia, depressed activity, listlessness, and the malaise of “aches and pains”. (13)

Clinical Trials

Considering the huge impact virally caused “colds” and related respiratory upper tract infections (URTI’s) have on the economy the importance of pelargonium could be significant.

Some epidemiological data are as follows:

Most frequent infectious affecting humans are respiratory with adults getting them at least 2-4x/year and children up to 10x/year!

Infections tend to start in the nose / throat area and if left untreated may descend into the bronchial tubes. These illnesses are 90-95 % caused by various viruses and are often wrongly treated with antibiotics. The most frequent cause given is an inadequate immune response due to cold / damp weather, stress, etc. (14)

The most studied clinical picture was that of bronchitis both in adults and children.

A systematic literature review was conducted and reported 6 randomized, controlled, clinical studies (RCCT’s) showing that Pelargonium significantly reduced bronchitis symptom scores in patients with acute bronchitis by day 7. No serious adverse events were reported. (15)

Some specific studies are presented here.

RCCT study: 468 adults with acute bronchitis present 48 hours. The primary outcome criterion was the change of the acute bronchitis severity score (BSS) on day 7. Results: The decrease of BSS from baseline to day 7 was 5.9 ± 2.9 points in the treatment group vs. placebo (3.2 ± 4.1) –a statistically significant difference. Working inability decreased to 16% in the treatment group vs. 43% in the placebo group. The duration of illness was significantly shorter. All events were assessed as non-serious. (16)
RCCT Study: 124 patients with severe bronchitis symptoms. After 7 days remissions by day 4 occurred in 69% of the patients under active substance treatment, compared to 33% of the patients under placebo. (17)
742 children with acute bronchitis (83.4%) or acute exacerbations of chronic bronchitis (14.3%) treated up to 14 days. Five bronchitis specific symptoms (BSS) were summed up to give an overall measure of disease severity. Nonspecific disease symptoms (loss of appetite, diarrhea, headache, vomiting, and fever) were also recorded. The overall BSS score decreased during treatment from 6.073.0 points at baseline to 2.772.5 points after7 days and to 1.472.1 points after 14 days. Remission or improvement in at least 80% of patients. Loss of appetite was present in 65.8% of patients at study begin, but only in 27.6% at the time point of last observation visit. (18)
RCCT study on 217 patients with acute bronchitis: Bronchitis symptom score (BSS) went down 7.6 of 20 in treated vs. 5.3 in placebo group. There was marked improvement in sputum production, cough, rales, dyspnea, pain on coughing, hoarseness, headache, fatigue, limb aches and pains. (19)

Common cold symptoms are very often caused by rhinoviruses but are often treated with antibiotics. Alternatives are important.

Pelargonium extracts were tested also on “colds” in patients participating in studies.

In one RCCT Study 103 patients with nasal drainage, nasal congestion, sore throat, sneezing, scratchy throat, hoarseness, cough, headache, muscle aches, and fever were evaluated. After 10 days of treatment 78.8 % of treated patients vs. 31.4 % of the placebo group had complete relief of symptoms. (20)

To summarize:

In multiple randomized, controlled clinical trials pelargonium has been shown to:

Relieve annoying symptoms such as: sore throat, stuffed/runny nose, cough and mucous obstruction – in sinusitis, tonsilo-pharyngitis and bronchitis.
Speed up recovery from colds and bronchitis and reduced absence in school and at workplace

With the additional excellent safety profile in adults and children it is indeed a natural cold, cough and throat care help for adults and children.

Pelargonium use in athletes

After exhaustive exercise athletes may compromise the immune response, a phenomenon which is mainly confirmed by an increase in susceptibility to upper respiratory tract infections (URTI’s).

These episodes are probably related to the decrease in secretory immunoglobulin A in the upper airway mucosa and/or profile changes of local/systemic cytokines.

Pelargonium extracts were given to athletes after intense running.

The results show that secretory immunoglobulin A levels were increased, while levels of IL-15 and IL-6 were decreased.

The authors concluded that: “Based on this evidence, we suggest that this herbal medicine can exert a strong modulating influence on the immune response associated with the upper airway mucosa in athletes submitted to intense physical activity.” (21)

Pelargonium Safety

In all the clinical studies pelargonium extracts were very well tolerated with no, or minimal side effects;
In laboratory investigations: no liver or other organ toxicity in animals was found;
Even though umckalin, the most active of the pelargonium fractions, is of the coumarins class, studies have shown that there is no concern with combining pelargonium with other anti coagulants; pelargonium does not change bleeding parameters!

Attention!

Cough of long term duration may be a sign of a serious underlying disease. Consult with your physician for a proper diagnosis.

Can Pelargonium extracts be further optimized?

There is always room for improvement. We tend to focus inordinately on isolating “the ONE chemical principle” that may account for ALL the observed benefits. But nature does not work that way, and the “whole mixture” of ingredients present in a plant may have a synergistic role that escapes us a lot of times, not to mention the fact that each herb has a “life” factor that we generally ignore or at least have not learned to take into account. It seems reasonable to assume then that at least a beginning could be made by adding to the final extract the salts and minerals that are naturally present in the original plant. This then would increase the benefits of the preparation. The mode of manufacturing of the extract (for example at what time of the day and on what kind of day the work with the plant occurs) might also be significant.

Conclusion

Pelargonium root extracts:

Regulate and balance the mucous processes (respiratory and digestive).

Specifically:

– Shorten the duration and reduce the severity of throat, nose and bronchial irritations.

– Act fast and are proven to be safe for adults and children.

– Have a three-fold activity profile (antimicrobial, immune-modulatory and improving organ functionality).

To view the webinar hosted by the True Botanica Foundation about Pelargonium please visit the Webinar section of the True Botanica Foundation website.

To see full pdf versions of some of the references listed below please visit the Articles section of the True Botanica Foundation at www.truebotanicafoundation.org. The Foundation is a not for profit organization dedicated to research, education and social activities in the field of (anthroposophical/holistic) health care. The foundation accepts tax deductible donations.

Articles available include:

A new approach to pharmacological effects on ciliary beat frequency in cell cultures – exemplary measurements under Pelargonium sidoides extrac (EPs 7630)
Efficacy of an aqueous Pelargonium sidoides extract against herpesvirus
Efficacy and safety of an extract of Pelargonium sidoides (EPs 7630) in adults with acute bronchitis
Efficacy of a Pelargonium sidoides preparation in patients with the common cold: A randomized, double blind, placebo-controlled clinical trial
Evaluation of an aqueous-ethanolic extract from Pelargonium sidoides (EPs 7630) for its activity against group A-streptococci adhesion to human HEp-2 epithelial cells
Immune responses induced by Pelargonium sidoides extract in serum and nasal mucosa of athletes after exhaustive exercise: Modulation of secretory IgA, IL-6 and IL-15
Immunomodulatory principles of Pelargonium sidoides
Treatment effect and safety of EPs 7630-solution in acute bronchitis in childhood: Report of a multicentre observational study
Pelargonium sidoides for acute bronchitis: A systematic review and meta-analysis
EPs 7630 improves acute bronchitis symptoms and shortens time to remission. Results of a randomised, double-blind, placebo-controlled, multicentre trial
This obscure herb works for the common cold

References

1.       H. Kolodzie,et al, (1998). Pelargonium sidoides DC. Z Phytotherapie 19: 141-151
2.      P. Neugebauer, et al, Phytomedicine 12 (2005) 46–51
3.      A. Conrad, et al, Phytomedicine 14 (2007) SVI 46–51
4.      O. Kaiser, et al, Phytother. Res. 15, 122–126 (2001)
5.      A. Dorfmueller, et al, Free Papers/International Journal of Antimicrobial Agents 26S (2005)
6.      H. Kolodziej, et al, Phytomedicine 14 (2007) SVI 18–26
7.      A. Conrad, et al, Phytomedicine 14 (2007) SVI 52–59
8.       Bereznoy VV, et al, Altern Ther Health Med. 2003;9:68-79.
9.      A. Janecki, Journal of Ethnopharmacology 133 (2011) 147–152
10. N. Wittschier, et al, Phytomedicine 14 (2007) 285–288
11. P. Schnitzler et al, Phytomedicine 15 (2008) 1108–1116
12. M. Michaelis, Phytomedicine (2010), doi:10.1016/j.phymed.2010.09.008
13. M. Noeldner, et al, Phytomedicine 14 (2007) SVI 27–31
14. A. M. Fendrick, et al (2003). Arch Intern Med 163
15. T. Agbabiaka, et al, Phytomedicine 15 (2008) 378–385
16. H. Matthys, et al, Phytomedicine 10 (2003) · Supplement IV; pp. 7–17
17. Chuchalin AG, et al, Phytomedicine 14 (2007) SVI 74–75
18. M. Haidvogl, et al, Phytomedicine 14 (2007) SVI 60–64
19. H. Matthys, et al, Planta Medica, 2008, 74, 686-692
20. V. Lizogub, Explore 2007; 3:573-584
21. L. A Luna Jr, et al, Phytomedicine 18 (4), pp. 303-30