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Elderberry—A Clinical Perspective

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Elderberry, Sambucus nigra, the common elder is found in several regional varieties as a group of similar species such as American elder (black elder), Chinese elder and Mexican elder. Elderberries have long been used in food, wines and liquors. Flavonoids including quercetin are believed to be the active health-promoting principals; albeit, the exact nature of these active principals is yet to be determined. Four anthocyanins have been isolated from elderberry extract all with cyanidine aglycon. Absorption studies demonstrate these anthocyanins are effectively absorbed by humans and exhibit a relative short half life (one to two hours) in the blood.1

Interestingly the Sambucus species contain also plant lectins (glucoproteins) that have hemagglutinin characteristics, which may exert antiviral effects. There are two mechanisms by which lectins may exert antiviral activity—deactivating viral sialidase, the enzyme the virus produces to cleave to the cell surface; or by direct biding to the virus and inactivating it.

Although there is some in vitro evidence that anthocyanins from elderberries may have direct antiviral activity, this is yet to be proven in humans.2,3 Anthocyanins from berry extracts have been shown in vitro to increase tumor necrosis factor-alpha (TNF-a).4 Also, the flavonoid quercetin, present in elderberries, has been extensively studied for its antiviral properties both in vitro5 and in animal studies,6 as well for its immune-stimulating activity, particularly with interferon.7

By comparison, the antiviral activity of elderberry lectins has been well documented.8,9 The presence of lectins in elderberry have been found in the bark, seeds, and fruit (berries).10,11,12 Clinical evidence of elderberry's antiviral properties has been shown in studies using the patented extract Sambucol. This preparation has been shown in vitro to inhibit hemagglutination and replication of various human influenza strains.13 One placebo-controlled clinical found a threefold acceleration in speed of recovery of patients inflicted by influenza when taking a 30 mL dose of Sambucol.14 In another trial, 60 patients suffering from influenza- like symptoms were given a dose of 15 mL of Sambucol four times a day for five days.15 Again, speed of recovery occurred four days faster than the placebo group. The potential activation of the immune system by Sambucol was evaluated by examining the blood of 12 healthy subjects after ingestion of the extract; there was an increase in inflammatory cytokines, suggesting it may work by activating the immune system.16,17

Other clinical investigations on elderberry’s effects pertain to the cyanidine glucosides found in the berries; these are well absorbed and appreciably metabolized.18 The effect of anthocyanin berries at 120 mg/d and high dose 400mg/day was investigated in humans for improving blood lipids in healthy human subjects.19 Minimal effects on lipid profile composition, total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglyceride levels were noted. Elderberry juice, equivalent to 370 mg/d of cyanidine glucosides, was found in an observational study of 80 subjects to aid in weight loss and blood pressure management, and to bolster emotional well-being.20

Elderberry may produce allergic responses in sensitive individuals. Ex vivo studies done with serum from nine patients having such reactions showed a predominant allergen of 33,000 molecular weight protein common to extracts from elderberry pollen and berries, consistent to the chemical profile of proteinacious compounds present in elderberry berries; albeit such incidence is low, 0.6 percent.21

References on the next page...

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