Latin name; Pelargonium sidoides
For centuries, medicine men of South African tribes have used decoctions obtained from Pelargonium sidoides to cure various infections including tuberculosis. The Zulu word for the plant is “Umckaloabo” and it means “bad cough” indicating its use in traditional Zulu medicine. In 1897, the Englishman Major Charles H. Stevens, who was suffering from pulmonary
tuberculosis, travelled to South Africa where he was cured with this traditional medicine after 4 months of treatment. He introduced this herbal remedy into the UK under the name of “Stevens’ Consumption Cure”. The identity of the root drug contained in Stevens Consumption Cure, Pelargonium sidoides, a South African plant belonging to the Pelargonium genus, Geraniaceae family, was first identified in Germany in 1972. As time went by, modern medical research discovered many of the numerous mechanisms of action of this unique plant extract (1,2).
The plant grows to a height of 20 – 80 cm, has greyish green leaves and purple flowers. The roots of Pelargonium sidoides provide the raw material used in the manufacture of the extract. Rhizomes and roots that are aged from 2 – 4 years contain the optimal amount of effective substances. Nowadays, Pelargonium sidoides is grown on specialised managed farms using ecological and sustainable cultivation methods. These methods ensure that wild habitats remain intact addressing sustainability of the species. Pelargonium contains characteristic groups of substances, namely; Polyphenols (total phenols, 40%) Proteins (10%) Purines (2%) Minerals (12%) Saccharides (12%) 7-hydroxycoumarin derivatives, in lower concentrations
Uses of Pelargonium
The following mechanisms of action have been found to be relevant in the treatment of respiratory tract infections:
1. Antiviral and cytoprotective properties:-Modulation of the production of interferons, pro-inflammatory cytokines and defensins; Anti-oxidant properties; Inhibition of leukocyte elastase
2. Antibacterial properties:-Increased adhesion of bacteria to dead epithelial cells of the respiratory tract mucosa; Inhibition of adhesion of bacteria to living epithelial cells in the respiratory tract mucosa; Stimulation of phagocytosis and chemotaxis. 6: Pathogenesis of respiratory tract infections and mechanisms of
3. Secretomotory properties:-Stimulation of the ciliary beat frequency of the respiratory ciliated epithelium
4. Inhibition of “sickness behaviour”
The cytoprotective effect of pelargonium extract against virus-induced cell destruction was confirmed in an in-vitro model. The survival capacity of the cells increased with greater concentrations of pelargonium extract up to twice that recorded in the control group. This demonstrated the whole extract and not individual compounds was responsible for the cell-protective effect (3). Pelargonium extract also increases the release of antimicrobial peptides-defensins-from neutrophilic granulocytes (4).
The antiviral effect is principally derived from the modulation of the non-specific immune system. Increase in interferon synthesis triggers stimulation of interferon (INF)-β production. A study carried out on human cell cultures confirm this effect (5). Moreover, pelargonium induces the other type-1-interferons, IFN-α and INF-γ, which also possess cytoprotective properties (6,7).
A significant improvement in the function of human phagocytes in peripheral blood was detected using Candida albicans as the target organism (8). At clinically relevant concentrations, pelargonium extract increased both the active phagocyte count, as well as the proportion of burst-active phagocytes.
The effect of pelargonium on the adhesion of bacteria to 90% vital human HEp-2 cells, a cell line of the larynx, was investigated in an in vitro study. Clinically relevant concentrations led to a significant reduction in the adhesion of A-streptococci to these cells by up to 46% (9). In the same adhesion test, streptococcal adhesion to these dead epithelial cells in the oral mucosa increased 7-fold with pelargonium extract. Pathogenic organisms can therefore be trapped and eliminated in this way. The effect of extract Pelargonium extract on the penetration of pathogens into HEp-2 cells was investigated and the result of this study showed a significant reduction in internalisation at test times 60, 120 and 180 minutes.
The recovery or stimulation of mucociliary clearance is a decisive factor in the defence against respiratory tract infections. Pelargonium extract stimulates this mechanism, as shown in an in vitro study. The extract increased the ciliary beat frequency in a dose-dependent manner by 23% and 33% at 30 μg/ml and 100 μg/ml, respectively (10).
Infections are frequently accompanied by non-specific changes in behaviour and both physical and mental symptoms (weakness, fatigue, lack of interest and drive, anorexia, social isolation, poor concentration, sleep disorders, anxiety, depression, etc.), which are mediated by the effect of pro-inflammatory cytokines (e.g. IL – 1β, TNF-α and IL-6) on the central nervous system. The effect of Pelargonium extracton sickness behaviour triggered by lipopolysaccharide (LPS) injection was assessed in a highly sensitive model to detect behavioural changes. Pelargonium extract inhibited the LPS-mediated behavioural changes in a significant, dose dependent manner (11).
Chuchalin et al. reported a multicentre, prospective, randomised, double-blind, placebo-controlled study in 124 patients. An improvement in bronchitis symptom score (BSS) of 7.2 (active drug) vs. 4.9 (placebo) (p < 0.0001) was recorded on day 7. More rapid recovery of ability to work (84.4% vs.45.0% on day 7) was also reported (12).
Matthys & Heger, performed a multicentre, prospective, randomised, double-blind, placebo-controlled study of pelargonium extract in 217 patients with a duration of treatment of 7 days. An improvement in Bronchitis symptom score (BSS) of 7.6 (active drug) vs. 5.3 (placebo) (p < 0.0001) was recorded on day 7 (13).
Matthys et al. also performed a randomised, double-blind, placebo-controlled study in 468 patients and reported a change of BSS on day 7, decrease in BSS of 5.9 (active drug) vs. 3.2 (placebo) (p < 0.0001) (14).
Matthys, et al. conducted a multicentre, prospective, open observational studyin 2099 patients aged 0-93. The BSS decreased from 7.1 at baseline to 1.0 at the last visit. Subgroup analysis: For children (patients < 18 years, n = 498): The BSS decreased from 6.3 to 0.9 at the last visit; Subgroup of infants (patients < 3 years, n = 78): The BSS decreased from 5.2 to 1.2 at the last visit (15).
Acute bronchitis in children
Kamin, performed a multicentre, prospective, randomised, double-blind, placebo-controlled study in 200 children between 1 and 18 years of age (16). An improvement in BSS of 3.4 (active drug) vs. 1.2 (placebo) (p < 0.001) was recorded on day 7. A second multicentre, prospective, randomised, double-blind, placebo-controlled study in 220 children between 1 and 18 years of age, reported that an improvement in BSS of 4.4 (active drug) vs. 2.9 (placebo) (p < 0.001) was recorded on day 7 The design and results of these studies correlate with the studies described earlier that were carried out in adults.
A multicentre, prospective, randomised, double-blind, placebo-controlled study in 103 patients with a duration of treatment of 21 days in sinusitis reported an improvement in the sinusitis severity score of 5.4 (active drug) vs. 2.5 (placebo) (p<0.0001) at the end of the double blind phase (day 21) (17).
Study of common cold in adults
A multicentre, prospective, randomised, double-blind, placebo-controlled study in 103 patients over 10 days examining the efficacy of pelargonium extract in common cold reported that Cold Intensity Score (CIS), after 5 days decreased by 10.4 in the active group and by 5.6 in the placebo group and more than 9 out of 10 patients assessed the tolerability of the active treatment as “very good” or “good”. No adverse events were reported (18).
A multicentre, randomised, double-blind, placebo controlled study in 143 children between 6 and 10 years of age in tonsillitis reported a decrease in tonsillitis specific symptoms of 7.1(active drug) vs. 2.5 (placebo) (p<0.0001) by day 4 (19).
The antiviral effect of aqueous root extract of Pelargonium sidoides against herpes simplex virus was examined in cell culture (herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2)) (20). At maximum non-cytotoxic concentrations of the extract, plaque formation was significantly reduced by more than 99.9% for HSV-1 and HSV-2 and a clear concentration-dependant antiviral activity against HSV could be demonstrated for this extract. Results indicate that Pelargonium sidoides extract affected the virus before penetration into the host cell and reveals a different mode of action when compared to the classical drug aciclovir. Hence this extract is capable of exerting an antiviral effect on herpes simplex virus and might be suitable for topical therapeutic use as an antiviral drug both in labial and genital herpes infections.
A prodelphinidin-rich extract from Pelargonium sidoides was investigated for its antiviral effects. The extract showed dose-dependent anti-influenza activity at non-toxic concentrations against pandemic H1N1, oseltamivir-sensitive and – resistant seasonal H1N1, seasonal H3N2 and the laboratory H1N1 strain A/PuertoRico/8/34, while it had no antiviral activity against adenovirus or measles virus. The extract inhibited an early step of influenza infection and impaired viral hemagglutination as well as neuraminidase activity. Importantly, it showed no propensity to resistance development in vitro. Analysis of constituents revealed that prodelphinidins represent the active principle (21).
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