Echinacea (Echinacea purpurea, Echinacea angustifolia, Echinacea pallida)
The genus Echinacea belongs to the family Compositae, commonly referred to as the sunflower family. Of the known species, E. purpurea, E. angustifolia, and E. pallida are commonly used in herbal medicine. Extracts derived from the root and aerial parts are widely used in Europe and the United States as nonspecific immunostimulants and to prevent or treat the common cold and influenza.
Depending on how this Asteraceae family member is classified, there are up to 12 different species of Echinacea. The most commonly used species for medicinal purposes is Echinacea purpurea, which is easy to cultivate and therefore, product demand does not put stress on native populations of Echinacea species that are difficult to cultivate. Most preparations found in the market are derived from the above-ground, or aerial, parts of E. purpurea and/or underground parts of E. purpurea; these preparations account for 80% of commercial production. In addition, E. angustifolia and E. pallida are also utilized in commerce but much less than E. purpurea. All three species of Echinacea seen in commercial preparations have undergone chemical and pharmacological studies. However, there are several other species of Echinacea that have little to no research on their chemistry and pharmacology.
Usos
Internal: Supportive therapy for colds and chronic infections of the respiratory tract and lower urinary tract.
External use: Poorly healing wounds and chronic ulcerations.
The native Americans utilized Echinacea for several uses including as an anesthetic, analgesic, for coughs and sore throats, and as an antidote for poisons such as snake venom. The physicians of the early 20th century learned many of these uses from the native Americans and utilized Echinacea for many indications, including sepsis, as well as less severe infections. At this time, Echinacea spp. has been documented in therapeutic use for more than a century by physicians for a variety of infections.
Indications given are for E. purpurea root.
The common cold, flu, and upper respiratory tract infections.
General immune system function.
Vaginal candidiasis in combination with an antifungal.
Non-healing wounds (topical or oral formulation).
Prophylaxis of common cold, flu, and upper respiratory tract infections. (weak evidence)
Química/Farmacología
The complex chemical composition of the roots and herbs of Echinacea involves alkamides, ketoalkenes, caffeic acid derivatives, polysaccharides, and glycoproteins, which are believed to be responsible for noted immunostimulatory and anti-inflammatory activities.
Estudios clínicos
Preclinical studies suggest immunostimulatory and anti-inflammatory effects. A standardized echinacea preparation inactivated influenza viruses and may improve respiratory activity. In animal models, echinacea stimulated erythropoiesis, increased blood-oxygen transport, produced anxiolytic effects, and exhibited wound-healing properties.
Clinical data indicate that echinacea is ineffective in preventing the common cold caused by rhinoviruses or in treating upper respiratory infections. Studies of its ability to reduce the incidence and duration of the common cold yielded mixed results. Other analyses do not indicate any benefits for treating colds, and weak evidence for a prophylactic benefit, but a large, randomized trial found an echinacea formulation to be as effective as oseltamivir for influenza, and with fewer adverse events in the echinacea group. In a review of 17 clinical trials involving 3,363 participants, echinacea supplements were found to affect reductions in pro-inflammatory cytokines that play a role in the progression of cytokine storm and acute respiratory distress syndrome.
Other studies have shown that a standardized echinacea root extract has immunomodulating activity; an echinacea/sage spray was useful in treating acute sore throats, and a formula containing dry root extracts of Echinacea purpurea and Echinacea angustifolia may be useful as an adjuvant therapy for decreasing relapse incidence in patients treated for genital condylomatosis. A topical echinacea extract was reported effective in alleviating symptoms associated with atopic eczema. Echinacea may also have anticancer potential evidenced by the cytotoxic effects exerted by an extract and a major compound, cichoric acid, in human colon cancer cells.
Some studies suggest that echinacea could decrease plasma levels, affect therapeutic efficacy, or cause adverse effects with some anticancer drugs. In HIV-infected patients, co-administration with etravirine was found to be safe and well-tolerated. In a large population-based study, use of echinacea was associated with a slight increase in diastolic blood pressure. There is insufficient evidence regarding the efficacy and safety of echinacea during pregnancy.
Mecanismo biomecánico
Echinacea’s active constituents include cichoric and caftaric acids, polysaccharides, and alkylamides. Immune-modulating effects of a standardized echinacea root extract include upregulation of interleukin (IL)-2 and IL-8 and downregulation of pro-inflammatory cytokines tumor necrosis factor (TNF)-alpha and IL-6. Immunemodulation by alkylamides occurs through binding to human cannabinoid receptors 1 and 2, and by inhibiting TNF-alpha. Alkylamides may also be responsible for anti-inflammatory effects. Although echinacea does not appear to have significant ergogenic or anabolizing effects, it appears to enhance the immune system and decrease oxidative damage.
In vitro and in vivo, echinacea extracts were shown to stimulate phagocytosis, enhance mobility of leukocytes, stimulate TNF and IL-1 secretion from macrophages and lymphocytes, and improve respiratory activity. However, their effects on innate immunity such as phagocytosis could not be confirmed, and showed only minimal effects on tumor progression, although echinacea did stimulate natural killer cell activity. Other studies suggest that bacterial components of echinacea are responsible for immune benefits, as total bacterial load differences and content of bacterial lipopolysaccharides within echinacea samples have correlated with NF-kappaB activation in THP-1 cells.
In human colon cancer cells, cichoric acid decreased telomerase activity and induced apoptosis via DNA fragmentation, caspase-9 activation, poly-ADP-ribose polymerase (PARP) cleavage, and beta-catenin downregulation.
Fuentes/Artículos
Aucoin M, Cooley K, Saunders PR, et al. The effect of Echinacea spp. on the prevention or treatment of COVID-19 and other respiratory tract infections in humans: A rapid review. Adv Integr Med. 2020 Dec;7(4):203-217.
Allan GM, Arroll B. Prevention and treatment of the common cold: making sense of the evidence. Cmaj. Feb 18 2014;186(3):190-199.
Barnes, Joanne, Linda A. Anderson, Simon Gibbons, and J. David Phillipson. "Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties." Journal of Pharmacy and Pharmacology 57, no. 8 (2005): 929-954.
https://onlinelibrary.wiley.com/doi/pdf/10.1211/0022357056127
Barrett, Bruce, Monica Vohmann, and Carlo Calabrese. "Echinacea for upper respiratory infection." Journal of Family Practice 48 (1999): 628-635.
https://cdn.mdedge.com/files/s3fs-public/jfp-archived-issues/1999-volume_48/JFP_1999-01_vX_iX_echinacea-for-upper-respiratory-infectio.pdf
Barrett B, Brown R, Rakel D, et al. Echinacea for treating the common cold: a randomized trial. Ann Intern Med. 2010 Dec 21;153(12):769-77.
Barrett, B. "Medicinal properties of Echinacea: a critical review." Phytomedicine 10, no. 1 (2003): 66-86. https://www.sciencedirect.com/science/article/abs/pii/S0944711304701993
Dapas B, Dall’Acqua S, Bulla R, et al. Immunomodulation mediated by a herbal syrup containing a standardized Echinacea root extract: a pilot study in healthy human subjects on cytokine gene expression. Phytomedicine. Sep 25 2014;21(11):1406-1410.
De Rosa N, Giampaolino P, Lavitola G, et al. Effect of Immunomodulatory Supplements Based on Echinacea Angustifolia and Echinacea Purpurea on the Posttreatment Relapse Incidence of Genital Condylomatosis: A Prospective Randomized Study. Biomed Res Int. 2019 Apr 11;2019:3548396.
Dogan Z, Ergul B, Sarikaya M, et al. The antioxidant effect of Echinacea angustifolia and Echinacea purpurea in rat colitis model induced by acetic acid. Bratisl Lek Listy. 2014;115(7):411-415.
Gertsch J, Schoop R, Kuenzle U, et al. Echinacea alkylamides modulate TNF-alpha gene expression via cannabinoid receptor CB2 and multiple signal transduction pathways. FEBS Lett. Nov 19 2004;577(3):563-569.
Giles JT, Palat CT, 3rd, Chien SH, Chang ZG, Kennedy DT. Evaluation of echinacea for treatment of the common cold. Pharmacotherapy 2000;20:690-7.
Goel V, Chang C, Slama JV, et al. Alkylamides of Echinacea purpurea stimulate alveolar macrophage function in normal rats. Int Immunopharmacol. Feb 2002;2(2-3):381-387.
Goey AK, Rosing H, Meijerman I, et al. The bioanalysis of the major Echinacea purpurea constituents dodeca-2E,4E,8Z,10E/Z-tetraenoic acid isobutylamides in human plasma using LC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci. Aug 1 2012;902:151-156.
Gorski JC, Huang SM, Pinto A, et al. The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo. Clin Pharmacol Ther. Jan 2004;75(1):89-100.
Grimm W, Muller HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med 1999;106:138-43.
Haller J, Krecsak L, Zámbori J. Double-blind placebo controlled trial of the anxiolytic effects of a standardized Echinacea extract. Phytother Res. 2020 Mar;34(3):660-668.
Hu, Chun, and David D. Kitts. "Studies on the antioxidant activity of Echinacea root extract." Journal of Agricultural and Food chemistry 48, no. 5 (2000): 1466-1472. https://pubs.acs.org/doi/abs/10.1021/jf990677+
Karsch-Volk M, Barrett B, Kiefer D, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;2:Cd000530.
Karsch-Volk M, Barrett B, Linde K. Echinacea for preventing and treating the common cold. Jama. Feb 10 2015;313(6):618-619.
Kligler, Benjamin. "Echinacea." American family physician 67, no. 1 (2003): 77-80. https://www.aafp.org/afp/2003/0101/p77.html
Kumar, K. M., and Sudha Ramaiah. "Pharmacological importance of Echinacea purpurea." International Journal of Pharma and Bio Sciences 2, no. 4 (2011): 304-314. https://d1wqtxts1xzle7.cloudfront.net/52753132/echinacea-with-cover-page-v2.pdf?Expires=1642451777&Signature=WNqzJsFDFdE~c656GcoVmFNWz8BIX1I8A4XGHqDbQM-QkknSDN6Ddixa~lDMLhWBIQlg5lIi7fnLZ5r7e4sHLAAKg7SNmorW5W6UyoceiCoL8wqU7D8rYSh0Yn-NAX9YWiKhl8AHBDnj9agUeCYY7l6MEgdfRbto93iqvASAwrEAAh1QJtQGkhiVBHm6gQQVyfOmIJWDi~XNCDE6bYTGBvZG-ZOrCx53Nf6yQFtFqxFfuQ7KfVhmOyD449X3HxlwsDyBj7bJYErVKE5Fgjswtn7e7gIb4AVVDrTX7BX7M0VAHhsdNhnXR42W8SiwvnLhWGjk-WvHnzTCSedBHp3kGQ__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA
Linde K, Barrett B, Wolkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2006;(1):CD000530.
Melchart D, Clemm C, Weber B, et al. Polysaccharides isolated from Echinacea purpurea herba cell cultures to counteract undesired effects of chemotherapy-a pilot study. Phytotherapy Res 2002;16:138-42.
Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2001;4:1-15.
O’Neil J, Hughes S, Lourie A, Zweifler J. Effects of echinacea on the frequency of upper respiratory tract symptoms: a randomized, double-blind, placebo-controlled trial. Ann Allergy Asthma Immunol. 2008 Apr;100(4):384-8.
Percival, Susan S. "Use of Echinacea in medicine." Biochemical pharmacology 60, no. 2 (2000): 155-158. https://www.sciencedirect.com/science/article/abs/pii/S000629529900413X
Pleschka S, Stein M, Schoop R, et al. Anti-viral properties and mode of action of standardized Echinacea purpurea extract against highly pathogenic avian influenza virus (H5N1, H7N7) and swine-origin H1N1 (S-OIV). Virol J. 2009;6:197.
Pugh ND, Jackson CR, Pasco DS. Total bacterial load within Echinacea purpurea, determined using a new PCR-based quantification method, is correlated with LPS levels and in vitro macrophage activity. Planta Med. Jan 2013;79(1):9-14.
Raus K, Pleschka S, Klein P, et al. Effect of an Echinacea-Based Hot Drink Versus Oseltamivir in Influenza Treatment: A Randomized, Double-Blind, Double-Dummy, Multicenter, Noninferiority Clinical Trial. Curr Ther Res Clin Exp. Dec 2015;77:66-72.
Schapowal A, Berger D, Klein P, Suter A. Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomized double-blind trial. Eur J Med Res. 2009 Sep 1;14(9):406-12.
Schulten B, Bulitta M, Ballering-Bruhl B, Koster U, Schafer M. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomized, double-blind clinical trial. Arzneimittelforschung 2001;51:563-8.
Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis 2007;7(7):473-80.
Taylor JA, Weber W, Standish L, et al. Efficacy and Safety of Echinacea in Treating Upper Respiratory Tract Infections in Children: A Randomized Controlled Trial. JAMA 2003;290:2824-30.
Tsai YL, Chiu CC, Yi-Fu Chen J, et al. Cytotoxic effects of Echinacea purpurea flower extracts and cichoric acid on human colon cancer cells through induction of apoptosis. J Ethnopharmacol. Oct 11 2012;143(3):914-919.
Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections. N Engl J Med. 2005;353(4):341-348.
Yale SH, Liu K. Echinacea purpurea Therapy for the Treatment of the Common Cold. Arch Intern Med. 2004;164:1237-1241.
Zhai Z, Haney DM, Wu L, et al. Alcohol extract of Echinacea pallida reverses stress-delayed wound healing in mice. Phytomedicine. Jun 2009;16(6-7):669-678.