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Andrographistpaniculata

Clinical Studies
References


Andrographis is used for preventing and treating the common cold, influenza, other viral infections, pharyngo-tonsillitis, allergies, sinusitis and to treat HIV/AIDS. It has traditionally been used for infectious diseases. Preliminary evidence suggests potential use against bacteria in raw food and water, human roundworm (Ascaris lumbricoides), Toxoplasma gondii, malaria and E. coli enterotoxin secretion.  It is also used for atherosclerosis, snake and insect bites, bronchitis, prevention of cardiovascular disease, cholera, diarrhea, flatulence, drug-induced hepatotoxicity and other hepatic disorders.

The applicable parts of Andrographis are the leaf and rhizome. Several active constituents have been identified, including andrographolide, deoxyandrographolide and other diterpenes.

Andrographis has been used for the common cold because it may have immunostimulant properties.  There is preliminary evidence that it might increase antibody activity and phagocytosis by macrophages.

Taking Andrographis significantly improves symptoms of the common cold when started within 72 hours of symptom onset.  It is often given with Siberian Ginseng.  There is evidence that taking Andrographis as a preventative for 2 months or longer may dramatically decrease the risk of developing a cold by about 50%.

Other preliminary evidence also suggests that Andrographis might have mast cell-stabilizing and antiallergy activity.

People use Andrographis for HIV/AIDS because some of its constituents have been found to have anti-HIV in vitro. High doses of the purified andrographolide constituent can also increase CD4+ cell counts in HIV patients. Andrographolide is thought to work through correction of T-lymphocyte function rather than by direct inhibition of viral replication.

There is interest in using Andrographis as an anti-cancer agent. Extracts of Andrographis inhibit proliferation of HT-29 colon cancer cells in vitro. This activity has been attributed to the diterpine constituents andrographolide, deoxyandrographolide and 14-deoxy-11,12-didehydroandrographolide. The andrographolide constituent also inhibits proliferation of breast, brain, lung, skin, ovarian, prostate and renal cancer cells in vitro. Andrographis might also have leukemia cell differentiation-inducing activity as well as the possible analgesic, antipyretic and anti-ulcerogenic effects of Andrographis that have been described.

Andrographis might protect the liver against hepatotoxic drugs (e.g., acetaminophen) and chemicals possibly by increasing bile flow, bile salt and bile acids. The Andrographis constituent, andrographolide, is a more potent hepatoprotectant than Silymarin, an active constituent of Milk Thistle (Silybum marianum).

Andrographis may be beneficial in cardiovascular disease. Early evidence suggests that it might lower blood pressure, prevent arteriosclerosis, inhibit platelet aggregation and reduce myocardial Ischemic-Reperfusion injury.

Published Clinical Studies

1. Andrograpanin, a compound isolated from anti-inflammatory traditional Chinese medicine Andrographis paniculata, enhances chemokine SDF-1alpha-induced leukocytes chemotaxis.
2. Andrographolide inhibits IFN-gamma and IL-2 cytokine production and protects against cell apoptosis.
3. Anti-malarial activity of some xanthones isolated from the roots of Andrographis paniculata.
4. A randomized, controlled study of Kan Jang versus amantadine in the treatment of influenza in Volgograd.
5. Anticancer and immunostimulatory compounds from Andrographis paniculata.
6. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy.
7. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children.
8. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials.
9. Antimicrobial activity of Andrographis paniculata.
10. A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis.
11. Immunostimulant agents from Andrographis paniculata.

Andrograpanin, a compound isolated from anti-inflammatory traditional Chinese medicine Andrographis paniculata, enhances chemokine SDF-1alpha-induced leukocytes chemotaxis.

Ji LL, Wang Z, Dong F, Zhang WB, Wang ZT.

Department of Pharmacognosy, China Pharmaceutical University, 1 Shen Nong Road, Nanjing, People's Republic of China.

Andrographis paniculata is a traditional Chinese medicine (TCM) that has been effectively used for treatment of infection, inflammation, cold, fever, and diarrhea in China. However, mechanism of its therapeutic function is not well known. In the current study, we showed one of its components, andrograpanin, could enhance chemokine stromal cell-derived factor-1alpha (SDF-1alpha) induced chemotaxis in Jurkat and THP-1 cells. Further study demonstrated that this kind of effect was CXC chemokine receptor-4 (CXCR4) specific, since andrograpanin could not enhance other chemokines, such as RANTES, monocyte chemotactic protein-1 (MCP-1), etc. induced cell chemotaxis. Mechanisms of andrograpanin exerting its effect were not directly in the receptor and G protein coupling level because it had no effect on the binding of SDF-1 to CXCR4, SDF-1 induced G protein activation and adenyly cyclase inhibition. However, receptor internalization might be involved, since we found it significantly reduced SDF-1alpha-induced CXCR4 internalization. (c) 2005 Wiley-Liss, Inc.

PMID: 15937916 [PubMed - in process]

Andrographolide inhibits IFN-gamma and IL-2 cytokine production and protects against cell apoptosis.

Burgos RA, Seguel K, Perez M, Meneses A, Ortega M, Guarda MI, Loaiza A, Hancke JL.

Laboratory of Molecular Pharmacology, Institute of Pharmacology, Faculty of Veterinary Science, Universidad Austral de Chile, Valdivia, Chile. rburgos1@uach.cl

Andrographolide is the main labdane diterpene present in Andrographis paniculata. Two lines of evidence report immunostimulant and anti-inflammatory properties for andrographolide in different models. Using murine T-cells in vitro we demonstrated that andrographolide and to a lesser extent, 14-deoxyandrographolide (14-DAP), reduced significantly, in a dose-dependent manner, the IFN-gamma production induced by concanavaline A (CON-A), with an IC50 of 1.7 +/- 0.07 microM and 35.8 +/- 0.50 microM, respectively. Andrographolide, but not 14-DAP, inhibited partially the IL-2 production induced by CON-A. Andrographolide at doses of 5 and 10 microM reduced the extracellular-signal-regulated protein kinase (ERK1/2) phosphorylation induced by CON-A, whereas 14-DAP only reduced ERK1 and partially the ERK2 phosphorylation. The inhibition of ERK1/2 phosphorylation was associated to a decrease in the IFN-gamma production, due that UO126, a specific ERK1/2 inhibitor, also reduced the IFN-gamma production in murine T-cells induced by CON-A. Additionally, andrographolide and to a lesser extent 14-DAP, at doses of 50 microM and 100 microM, respectively, reduced the apoptosis induced by hydrocortisone and PMA in thymocytes, which was associated to a decrease in caspase-3 like activity. We conclude that both diterpenic labdanes isolated from A. paniculata can exert potent immunosuppressant effects without affecting the viability of the cells.

PMID: 15931581 [PubMed - indexed for MEDLINE]

Anti-malarial activity of some xanthones isolated from the roots of Andrographis paniculata.

Dua VK, Ojha VP, Roy R, Joshi BC, Valecha N, Devi CU, Bhatnagar MC, Sharma VP, Subbarao SK.

Malaria Research Centre, Sector III, BHEL, Hardwar 249 403, India. virendradua@hotmail.com

Four xanthones were isolated from the roots of Andrographis paniculata using a combination of column and thin-layer chromatographic methods. They were characterized as (i) 1,8-di-hydroxy-3,7-dimethoxy-xanthone, (ii) 4,8-dihydroxy-2,7-dimethoxy-xanthone, (iii) 1,2-dihydroxy-6,8-dimethoxy-xanthone and (iv) 3,7,8-trimethoxy-1-hydroxy xanthone by IR, MS and NMR spectroscopic methods. In vitro study revealed that compound 1,2-dihydroxy-6,8-dimethoxy-xanthone possessed substantial anti-plasmodial activity against Plasmodium falciparum with its IC(50) value of 4 microg ml(-1). Xanthones bearing hydroxyl group at 2 position demonstrated most potent activity while xanthones with hydroxyl group at 1,4 or 8 position possessed very low activity. In vivo anti-malarial sensitivity test of this compound on Swiss Albino mice with Plasmodium berghei infection using Peters' 4-day test gave substantial reduction (62%) in parasitaemia after treating the mice with 30 mg kg(-1) dose. In vitro cytotoxicity against mammalian cells revealed that 1,2-dihydroxy-6,8-dimethoxy-xanthone is non-cytotoxic with its IC(50) > 32 microg ml(-1).

PMID: 15507344 [PubMed - indexed for MEDLINE]

A randomized, controlled study of Kan Jang versus amantadine in the treatment of influenza in Volgograd.

Kulichenko LL, Kireyeva LV, Malyshkina EN, Wikman G.

Volgograd Outpatient Clinic, Department of Outpatient Therapy.

Two randomized, parallel-group clinical studies with a verum and a control group were performed to investigate the effect of a standardized extract (SHA-10) of Andrographis paniculata (N.) fixed combination Kan Jang in the treatment of diagnosed influenza viral infection. The pilot study was performed on 540 patients with 71 Kan Jang-treated patients with the second phase conducted enrolling 66 patients. The differences in the duration of sick leave and frequency of post-influenza complications indicate that the Kan Jang phytopreparation not only contributes to quicker recovery, but also reduces the risk of post-influenza complications. Kan Jang was well tolerated by patients.

PMID: 15277072 [PubMed]

Anticancer and immunostimulatory compounds from Andrographis paniculata.

Kumar RA, Sridevi K, Kumar NV, Nanduri S, Rajagopal S.

Discovery Research, Dr. Reddy's Laboratories, Miyapur, Hyderabad 500050, India.

Andrographis paniculata extract is traditionally used as a medicine to treat different diseases in India, China and Southeast Asia. In the present study, we evaluated the anticancer and immunomodulatory activity of the methanolic extract of Andrographis paniculata in human cancer and immune cells. The methanolic extract of Andrographis paniculata was fractionated into dichloromethane, petroleum ether and aqueous extracts and screened for bioactivity. Our results indicate that the dichloromethane fraction of the methanolic extract retains the active compounds contributing for both the anticancer and immunostimulatory activity. Dichloromethane fraction significantly inhibits the proliferation of HT-29 (colon cancer) cells and augments the proliferation human peripheral blood lymphocytes (HPBLs) at low concentrations. On further fractionation of the dichloromethane extract we could isolate three diterpene compounds, i.e. [1] andrographolide, [2] 14-deoxyandrographolide and [3] 14-deoxy-11,12-didehydroandrographolide. Andrographolide showed anticancer activity on diverse cancer cells representing different types of human cancers. Whereas all the three molecules showed enhanced proliferation and interleukin-2 (IL-2) induction in HPBLs.

PMID: 15138014 [PubMed - indexed for MEDLINE]

Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy.

Coon JT, Ernst E.

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK. Jo.Thompson-Coon@pms.ac.uk

Acute respiratory infections represent a significant cause of over-prescription of antibiotics and are one of the major reasons for absence from work. The leaves of Andrographis paniculata (Burm. f.) Wall ex Nees (Acanthaceae) are used as a medicinal herb in the treatment of infectious diseases. Systematic literature searches were conducted in six computerised databases and the reference lists of all papers located were checked for further relevant publications. Information was also requested from manufacturers, the spontaneous reporting schemes of the World Health Organisation and national drug safety bodies. No language restrictions were imposed. Seven double-blind, controlled trials (n = 896) met the inclusion criteria for evaluation of efficacy. All trials scored at least three, out of a maximum of five, for methodological quality on the Jadad scale. Collectively, the data suggest that A. paniculata is superior to placebo in alleviating the subjective symptoms of uncomplicated upper respiratory tract infection. There is also preliminary evidence of a preventative effect. Adverse events reported following administration of A. paniculata were generally mild and infrequent. There were few spontaneous reports of adverse events. A. paniculata may be a safe and efficacious treatment for the relief of symptoms of uncomplicated upper respiratory tract infection; more research is warranted.

Publication Types:

•  Review
•  Review, Tutorial

PMID: 15095142 [PubMed - indexed for MEDLINE]

Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children.

Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G.

Research Institute of Pharmacology of Volgograd Medical Academy, Volgograd, Russia.

A three-arm study comparing the efficacy of Kan Jang, a fixed herbal combination containing standardized Andrographis paniculata (N.) SHA-10 extract, with Immunal, a preparation containing Echinacea purpurea (L.) extract, in uncomplicated common colds was carried out in 130 children aged between 4 and 11 years over a period of 10 days. The study was designed as an adjuvant treatment of Kan Jang and Immunal with a standard treatment. The patients were assigned to one of the three groups. In control group C; 39 patients received only standard treatment. Kan Jang and Immunal were used as an adjuvant to this therapy in the other two groups. Adjuvant group A; 53 patients treated with Kan Jang tablets concomitant to standard treatment, and adjuvant control group B; 41 patients treated with concomitant Immunal. It was found that the adjuvant treatment with Kan Jang, was significantly more effective than Immunal, when started at an early stage of uncomplicated common colds. The symptoms of the disease were less severe in the Kan Jang group. The effect of Kan Jang was particularly pronounced in two objective parameters, amount of nasal secretion g/day and nasal congestion. Kan Jang also accelerated the recovery time, whereas Immunal did not show the same efficacy. The use of standard medication was significantly less in the Kan Jang adjuvant group than in either the Immunal or standard treatment group. Kan Jang treatment was well tolerated and no side effects or adverse reactions were reported. Copyright 2004 John Wiley & Sons, Ltd.

Publication Types:

•  Clinical Trial
•  Randomized Controlled Trial

PMID: 14750201 [PubMed - indexed for MEDLINE]

Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials.

Poolsup N, Suthisisang C, Prathanturarug S, Asawamekin A, Chanchareon U.

Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon-Pathom, Thailand. nalinee@email.pharm.su.ac.th

OBJECTIVE: To assess the efficacy of Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection. METHODS: Systematic review of the literature and meta-analysis of randomized controlled trials. Mean difference in the reduction in symptom severity scores between treatment and control groups was calculated to obtain an overall estimate of effect. RESULTS: Four studies met our inclusion criteria and were reviewed. A total of 433 patients reported in three trials were included in the statistical analysis. Andrographis paniculata fixed combination with Acanthopanax senticosus was more effective than placebo. The mean difference was 2.13 points (95% CI 1.00-3.26 points, P=0.0002) on the symptom severity score. The difference in effects between A. paniculata and placebo was 10.85 points (95% CI 10.36-11.34 points, P<0.0001) in favour of A. paniculata. CONCLUSION: Current evidence suggests that A. paniculata extract alone or in combination with A. senticosus extract may be more effective than placebo and may be an appropriate alternative treatment of uncomplicated acute upper respiratory tract infection.

Publication Types:

•  Review
•  Review, Tutorial

PMID: 14748896 [PubMed - indexed for MEDLINE]

Antimicrobial activity of Andrographis paniculata.

Singha PK, Roy S, Dey S.

Plant Biotechnology Laboratory, Biotechnology Department, Indian Institute of Technology, Kharagpur 721 302, West Bengal, India.

The antimicrobial activity of aqueous extract, andrographolides and arabinogalactan proteins from Andrographis paniculata were evaluated. The aqueous extract showed significant antimicrobial activity, which may be due to the combined effect of the isolated arabinogalactan proteins and andrographolides.

PMID: 14630176 [PubMed - indexed for MEDLINE]

A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis.

Gabrielian ES, Shukarian AK, Goukasova GI, Chandanian GL, Panossian AG, Wikman G, Wagner H.

Erebuni, Medical Centre, Yerevan, Armenia.

A double blind, placebo-controlled, parallel-group clinical study was carried out to evaluate the effect of an Andrographis paniculata (N.) extract SHA-10 fixed combination, Kan Jang, in the treatment of acute upper respiratory tract infections, including sinusitis. Ninety-five individuals in the treatment group and 90 individuals in the placebo group completed the study according to the protocol. The medication was taken for 5 days. Temperature, headache, muscle aches, throat symptoms, cough, nasal symptoms, general malaise and eye symptoms were taken as outcome measures with given scores. The total score analysis showed a highly significant improvement in the verum group versus the placebo. This result applied to the group as a whole and to the sinusitis subgroups. The individual symptoms of headache and nasal and throat symptoms together with general malaise showed the most significant improvement while cough and eye symptoms did not differ significantly between the groups. Temperature was moderately reduced in the verum group. It can be concluded that Kan Jang has a positive effect in the treatment of acute upper respiratory tract infections and also relieves the inflammatory symptoms of sinusitis. The study drug was well tolerated.

Publication Types:

•  Clinical Trial
•  Randomized Controlled Trial

PMID: 12487322 [PubMed - indexed for MEDLINE]

Immunostimulant agents from Andrographis paniculata.

Puri A, Saxena R, Saxena RP, Saxena KC, Srivastava V, Tandon JS.

Division of Biochemistry, Central Drug Research Institute, Lucknow, India.

EtOH extract and purified diterpene andrographolides of Andrographis paniculata (Acanthaceae) induced significant stimulation of antibody and delayed type hypersensitivity (DTH) response to sheep red blood cells (SRBC) in mice. The plant preparations also stimulated nonspecific immune response of the animals measured in terms of macrophage migration index (MMI) phagocytosis of 14C-leucine labelled Escherichia coli and proliferation of splenic lymphocytes. The stimulation of both antigen specific and nonspecific immune response was, however, of lower order with andrographolide than with the EtOH extract, suggesting thereby that substance(s) other than andrographolide present in the extract may also be contributing towards immunostimulation.

PMID: 8377022 [PubMed - indexed for MEDLINE]

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