Black Elder and Its Constituents: Molecular Mechanisms of Action Associated with Female Reproduction

Elderberry interaction with pazopanib in a patient with soft‑tissue sarcoma: A case report and literature review

Elderberry flower extract is marketed as an herbal supplement with purported benefits in boosting the immune system. The use of elderberry increased during the coronavirus pandemic. However, the interaction of elderberry with cytotoxic medicines has remained elusive. Pazopanib is a multikinase inhibitor approved for patients diagnosed with soft-tissue sarcoma. The present study reported on the case of a middle-aged woman diagnosed with localized intermediate-grade sarcoma of the left sartorius muscle who received neoadjuvant pazopanib with radiation therapy. The patient had no other medical comorbidities and only took over-the-counter (OTC) elderberry supplements for numerous years to 'boost' her immune system. She started pazopanib at 400 mg per os (PO) daily, which was increased to 800 mg PO daily after a week. By week three on pazopanib, the patient reported intense nausea and a number of loose stools, requiring anti-nausea medication. By the fourth week on pazopanib, laboratory tests showed grade 3 liver injury, as demonstrated by a fivefold rise in liver enzymes along with severe nausea and loose stools. All medications, including elderberry supplement, were stopped. Within two weeks of stopping all medicines, the liver enzymes started normalizing within two weeks and were normal by the end of four weeks. Pazopanib treatment was resumed without the recurrence of side effect. Pazopanib is metabolized in the liver via the cytochrome P 450 (CYP)3A4 enzyme pathway. Hence, potent inhibitors of CYP3A4 are avoided for concurrent use with pazopanib. Small in vitro studies on elderberry extracts have shown weak inhibition of CYP3A4. However, considering the wide usage of elderberry and the availability of mixed supplements OTC, it is essential to pursue clinical studies in cancer patients to understand the interactions of elderberry extracts with cytotoxic medicines. In this report, the scientific evidence behind the use of elderberry was reviewed and a hypothesis of its interaction with pazopanib was proposed.

Elder (Sambucus nigra), identified by high-content screening, counteracts foam cell formation without promoting hepatic lipogenesis

Cholesterol deposition in intimal macrophages leads to foam cell formation and atherosclerosis. Reverse cholesterol transport (RCT), initiated by efflux of excess cholesterol from foam cells, counteracts atherosclerosis. However, targeting RCT by enhancing cholesterol efflux was so far accompanied by adverse hepatic lipogenesis. Here, we aimed to identify novel natural enhancers of macrophage cholesterol efflux suitable for the prevention of atherosclerosis. Plant extracts of an open-access library were screened for their capacity to increase cholesterol efflux in RAW264.7 macrophages trace-labeled with fluorescent BODIPY-cholesterol. Incremental functional validation of hits yielded two final extracts, elder (Sambucus nigra) and bitter orange (Citrus aurantium L.) that induced ATP binding cassette transporter A1 (ABCA1) expression and reduced cholesteryl ester accumulation in aggregated LDL-induced foam cells. Aqueous elder extracts were subsequently prepared in-house and both, flower and leaf extracts increased ABCA1 mRNA and protein expression in human THP-1 macrophages, while lipogenic gene expression in hepatocyte-derived cells was not induced. Chlorogenic acid isomers and the quercetin glycoside rutin were identified as the main polyphenols in elder extracts with putative biological action. In summary, elder flower and leaf extracts increase macrophage ABCA1 expression and reduce foam cell formation without adversely affecting hepatic lipogenesis.

Association of pre-diagnosis specific color groups of fruit and vegetable intake with ovarian cancer survival: results from the ovarian cancer follow-up study (OOPS)

Background: The colors of fruits and vegetables (FV) reflect the presence of pigmented bioactive compounds. The evidence of pre-diagnosis specific FV color group intake contributing to ovarian cancer (OC) survival is limited and inconsistent. Methods: A prospective cohort study was conducted between 2015 and 2020 with 700 newly diagnosed OC patients. Pre-diagnosis dietary information was assessed by a validated food frequency questionnaire. We classified FV into five groups based on the color of their edible parts (e.g., green, red/purple, orange/yellow, white, and uncategorized groups). Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of specific color groups of FV before diagnosis with OC survival. Potential multiplicative and additive interactions were assessed. Results: 130 patients died during a median follow-up of 37.57 (interquartile: 24.77-50.20) months. We observed the improved survival with a higher pre-diagnosis intake of total FV (HRtertile 3 vs. tertile 1 = 0.63, 95%CI = 0.40-0.99), total vegetables (HRtertile 3 vs. tertile 1 = 0.57, 95%CI = 0.36-0.90), and red/purple FV (HRtertile 3 vs. tertile 1 = 0.52, 95%CI = 0.33-0.82). In addition, we observed significant dose-response relationships for per standard deviation increment between total vegetable intake (HR = 0.79, 95%CI = 0.65-0.96) and red/purple group intake (HR = 0.77, 95%CI = 0.60-0.99) before diagnosis with OC survival. Additionally, pre-diagnosis green FV intake was borderline associated with better OC survival (HRper standard deviation increment = 0.83; 95%CI = 0.69-1.00). In contrast, we did not observe significant associations between pre-diagnosis intake of total fruits, orange/yellow, white, and uncategorized groups and OC survival. Conclusion: Pre-diagnosis FV intake from various color groups, especially the green and red/purple ones, may improve OC survival. Further studies are needed to validate our findings.

Effect of Enriching Gingerbread Cookies with Elder (Sambucus nigra L.) Products on Their Phenolic Composition, Antioxidant and Anti-Glycation Properties, and Sensory Acceptance

Elder products are still underutilized sources of phytochemicals, mainly polyphenols, with extensive pharmacological effects on the human body. In this study, gingerbread cookies covered in chocolate (GC) were enriched with elderflower dry extract (EF) and juice concentrate (EB). The cookies (GC, GCEF, and GCEFEB) and the additives (EF and EB) were analyzed for total phenolic content (TPC), phenolic compound profile, antioxidant capacity (AC), and advanced glycation end products' (AGEs) formation in both the free and bound phenolic fractions. Sensory analysis of the cookies was performed using an effective acceptance test (9-point hedonic scale), and purchase intent was evaluated using a 5-point scale. It was found that the flavonoid content was significantly increased (20-60%) when EF and EB were added to the cookies. Moreover, the EF addition to chocolate-covered GCs enhanced the content of phenolic acids (up to 28%) in the bound phenolic fraction. An increase in the AC values of enriched cookies was found, and the free phenolic fraction differed significantly in this regard. However, inhibition of AGEs by elder products was only observed in the bound phenolic fraction. In addition, EF and EB improved the overall acceptance of the cookies, mostly their taste and texture. Thus, elder products appear to be valuable additives to gingerbread cookies, providing good sensory quality and functional food characteristics.

Optimization of Major Extraction Variables to Improve Recovery of Anthocyanins from Elderberry by Response Surface Methodology

Elderberry, which is well known for its richness in anthocyanin, is attracting attention in the bioindustry as a functional material with high antioxidant capacity. The aim of this study is to optimize extraction conditions to more effectively recover anthocyanins from elderberry. In a fundamental experiment to determine the suitable solvent, various GRAS reagents, such as acetone, ethanol, ethyl acetate, hexane, and isopropyl alcohol, were used, and total phenol and anthocyanin contents were detected as 9.0 mg/g-biomass and 5.1 mg/g-biomass, respectively, only in the extraction using ethanol. Therefore, ethanol was selected as the extraction solvent, and an experimental design was performed to derive a response surface model with temperature, time, and EtOH concentration as the main variables. The optimal conditions for maximal anthocyanin recovery were determined to be 20.0 °C, 15.0 min, and 40.9% ethanol, and the total anthocyanin content was 21.0 mg/g-biomass. In addition, the total phenol and flavonoid contents were detected as 67.4 mg/g-biomass and 43.8 mg/g-biomass, respectively. The very simple and economical extraction conditions suggested in this study contributed to improving the utilization potential of anthocyanin, a useful antioxidant derived from elderberry.