The efficacy of complementary treatment with marshmallow (Althaea officinalis L.) on vulvovaginal candidiasis: A randomized double-blinded controlled clinical trial

BACKGROUND

Vulvovaginal candidiasis is a common gynecologic infection, and recurring cases are yet incurable. This trial was based on Persian medicine to compare how effective marshmallow aqueous extract 4% plus clotrimazole 1% (CLOT-M) is compared to clotrimazole 1% vaginal creams on VVC.

METHODS

This study randomly assigned 100 women with VVC into two groups. The target group (n = 50) was treated with CLOT-M while controls (n = 50) with clotrimazole vaginal creams for seven consecutive nights. Different VVC symptoms and signs, and yeast culture from vaginal discharge were evaluated as the outcome measures before the intervention and 7 and 30 days after.

RESULTS

The efficacy of CLOT-M vaginal cream was assessed during the 1st and 2nd follow-ups, indicating a significant decrease in mean itching (P = 0.001 for both comparisons) and dyspareunia score (P = 0.001 and P = 0.04, respectively) as compared to treatment with clotrimazole vaginal cream. Moreover, after 7 days of the intervention, patients in the CLOT-M group experienced significant improvement in mean dysuria score compared to those in the control group (P = 0.001). Neither cream caused any significant adverse events.

CONCLUSION

It seems that CLOT-M vaginal cream had a significant effect on the VVC symptoms improvement, without any significant side effects. However, larger sample-sized trials are needed for more evidence-based judgment.

Protective effects of Althaea officinalis L. extract against N-diethylnitrosamine-induced hepatocellular carcinoma in male Wistar rats through antioxidative, anti-inflammatory, mitochondrial apoptosis and PI3K/Akt/mTOR signaling pathways

Hepatocellular carcinoma is the fourth cause of death due to cancer and includes 90% of liver tumors. Therefore, in this study, it was tried to show that Althaea officinalis L. flower extract (ALOF) can protect hepatocytes against N-diethylnitrosamine (DEN)-induced hepatocellular carcinoma. Totally, 70 Wistar rats were divided into seven groups (n = 10/group) of sham, DEN, treatment with silymarin (SIL; DEN + SIL), treatment with ALOF (DEN + 250 and 500 ALOF), and cotreatment with SIL and ALOF (DEN + SIL + 250 and 500 ALOF). At the end of the study, the serum levels of liver indices (albumin, total protein, bilirubin, C-reactive protein, ALT, AST, and ALP), inflammatory cytokines (IL-6, IL-1β, IL-10, and TNF-α), and oxidants parameters (glutathione peroxidase [GPx], superoxide dismutase [SOD], catalase [CAT] activity along with nitric oxide [NO] levels) were evaluated. The level of Bax, Bcl-2, Caspase-3, p53, PI3K, mTOR, and AKT genes were measured. ALOF in cotreatment with SIL was able to regulate liver biochemical parameters, improve serum antioxidant indices, and decrease the level of proinflammatory cytokines significantly (p < .05). ALOF extract in both doses of 250 and 500 mg/kg in cotreatment with SIL caused a significant (p < .05) decrease in the p53-positive cells and a significant (p < .05) increase in Bcl-2-positive cells. Therefore, ALOF was able to modulate the proliferation of cancer cells and protect normal cells through the regulation of Bax/Bcl-2/p53 and PI3K/Akt/mTOR signaling pathways. It seems that ALOF can be used as a prodrug or complementary treatment in the protection of hepatocytes in induced damages caused by carcinogens.

Phytohustil® and root extract of Althaea officinalis L. exert anti-inflammatory and anti-oxidative properties and improve the migratory capacity of endothelial cells in vitro

Introduction: Althaea officinalis L.'s root extract (REA) has been used as a medicinal plant since ancient times to treat a cough. Applying REA leads to a protective film that induces a faster regeneration of the lesioned laryngopharyngeal mucosa caused by dry coughs. The buccopharyngeal mucosa is a highly vascularized tissue. In this regard, anti-inflammatory/-oxidant phytochemicals that improve the repair of the lesion site, e.g., neovascularization in the wound, are critical for promoting healing. For this reason, it is essential to investigate the effects of Phytohustil^® and REA on different cellular components of the mucosa under conditions similar to those found in the injured mucosa. Thus, this in vitro study investigated the anti-inflammatory/oxidative and pro-migratory properties of Phytohustil^® cough syrup on vascular endothelial cells. Methods: Human umbilical vein endothelial cells (HUVEC) were pretreated (24 h) with Phytohustil^®, its excipients, or REA, followed by incubation with hydrogen peroxide (H₂O₂; 1 h; pro-oxidative) or with lipopolysaccharides (LPS; 3 h; pro-inflammatory). Viability and cytotoxicity were measured by PrestoBlue^® assay. Intracellular reactive oxygen species (ROS) were quantified with 20-70-dichlorofluorescein diacetate (DCFDA). The release of interleukin 6 (IL6) was determined by enzyme-linked immunosorbent assay (ELISA). The migratory capacity of HUVEC was measured using a scratch assay. Results: Our results show that Phytohustil^®, its excipients and REA were not cytotoxic. Pretreatment of HUVEC (24 h) with Phytohustil^® or REA inhibited the LPS-activated IL6 release. Phytohustil^® or REA inhibited the H₂O₂-induced cytotoxicity and intracellular ROS production. Phytohustil^® and REA significantly stimulated wound closure compared to the control. Conclusion: Our data show that Phytohustil^® and REA have anti-inflammatory/-oxidant properties and improve the migratory capacity of vascular endothelial cells. These properties may contribute to the healing characteristics of Phytohustil^® and support the benefit of Phytohustil^® in patient's treatment of irritated oral mucosa.

Polysaccharide extracted from Althaea officinalis L. root: New studies of structural, rheological and antioxidant properties

A water-soluble acidic polysaccharide (AOP-2) from Althaea officinalis L. root was isolated by water extraction and purified by ion exchange chromatography (Cellulose DEAE-52) and gel filtration (Sephadex G-200). The structure characteristics of AOP-2 was determined by gel permeation chromatography (GPC), high performance liquid chromatography (HPLC), fourier transform infrared (FT-IR), nuclear magnetic resonance (NMR) spectrum and gas chromatography-mass spectrometry (GC_MS). The results indicated that the AOP-2 was an acidic hetropolysaccharide with the molecular weight of 639.27 kDa. The AOP-2 composed of 51% galacturonic acid, 32.56% rhamnose, 12.73% glucose and 3.71% galactose. It could be found that the main backbone chain of AOP-2 consisted of →3)-α-D-GalpA-(1→, →3)-α-D-Rhap-(1→ and→3,4)-β-D-Galp-(1→ with branches of →4)-α-D-Rhap-(1→, →4)-α-D-Glcp-(1→ and α-D-Rhap-(1 → . Thermal analysis revealed that the AOP-2 had high thermal stability and according to the results obtained from XRD analysis, it had a semi-crystalline structure. The results of Steady-shear flow and dynamical viscoelasticity showed that AOP-2 solutions exhibited shear-thinning behavior with high viscosity and a weak gel-like behavior at concentrations above 1% in linear viscoelastic region. In addition, it showed relatively high antioxidant property.

Anti-inflammatory and Anti-oxidative Effects of Phytohustil® and Root Extract of Althaea officinalis L. on Macrophages in vitro

Introduction

The medicinal plant marshmallow Althaea officinalis L. (A. officinalis), is used for the treatment of cough since centuries. Application of medicinal extracts of marshmallow roots shows immediate effects like a protective film on the inflamed mucosa. Because the soothing layer reduce irritation of the mucous system, a faster regeneration is supported by defense mechanisms required to protect the respiratory tract from environmental injury. Macrophages (MΦ), which belong to a group of multipurpose defensive cells, provide the first line of defense against mucosal invasive pathogens. The present study was performed to investigate, whether the herbal medicinal product has anti-inflammatory or anti-oxidative effects on pro-inflammatorily activated MΦ or after oxidative stress induction. Special attention should be payed to elucidate the effects of A. officinalis on the mechanism of intracellular defense as well as on migratory capacity of the MΦ.

Results

Treatment of PMA-differentiated human THP-1 MΦ with Phytohustil^® increased their viability without affecting the cell number. Phytohustil^® or root extracts of A. officinalis (REAo) – an active component of Phytohustil^® – were able to protect human MΦ against H₂O₂-induced cytotoxicity and H₂O₂-induced ROS production. Phytohustil^®, REAo or diclofenac used as anti-inflammatory reference substance, inhibited the LPS-induced release of tumor necrosis factor-alpha (TNF-α) as well as of IL6 in MΦ. Treatment with Phytohustil^®, its excipients or REAo did not impair the mitochondrial membrane potential (MMP). Finally, Phytohustil^® and REAo activated the migratory capacity of MΦ.

Conclusion

The present in vitro investigations indicate protective, i.e., anti-oxidative and anti-inflammatory effects of REAo and Phytohustil^®, additionally improving the migratory capacity of MΦ. These antiinflammatory effects were similar or even better than diclofenac. Thus, our data support and may explain the positive effect of Phytohustil^® observed in patients during the therapy of inflamed buccal mucosal membranes or treatment of cough.