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Gancitano G, Mucci N, Stange R, Ogal M, Vimalanathan S, Sreya M, Booker A, Hadj-Cherif B, Albrich WC, Woelkart-Ardjomand K, Kreft S, Vanden Berghe W, Hoexter G, Schapowal A, Johnston SL. Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA). Antibiotics (Basel) 2024; 13:364. [PMID: 38667040 PMCID: PMC11047471 DOI: 10.3390/antibiotics13040364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 04/29/2024] Open
Abstract
Respiratory tract infections (RTIs) are the leading cause of antibiotic prescriptions, primarily due to the risk for secondary bacterial infections. In this study, we examined whether Echinacea could reduce the need for antibiotics by preventing RTIs and their complications, and subsequently investigated its safety profile. A comprehensive search of EMBASE, PubMed, Google Scholar, Cochrane DARE and clinicaltrials.gov identified 30 clinical trials (39 comparisons) studying Echinacea for the prevention or treatment of RTIs in 5652 subjects. Echinacea significantly reduced the monthly RTI occurrence, risk ratio (RR) 0.68 (95% CI 0.61-0.77) and number of patients with ≥1 RTI, RR = 0.75 [95% CI 0.69-0.81] corresponding to an odds ratio 0.53 [95% CI 0.42-0.67]. Echinacea reduced the risk of recurrent infections (RR = 0.60; 95% CI 0.46-0.80), RTI complications (RR = 0.44; 95% CI 0.36-0.54) and the need for antibiotic therapy (RR = 0.60; 95% CI 0.39-0.93), with total antibiotic therapy days reduced by 70% (IRR = 0.29; 95% CI 0.11-0.74). Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days, IRR 0.21 [95% CI 0.15-0.28]. An equal number of adverse events occurred with Echinacea and control treatment. Echinacea can safely prevent RTIs and associated complications, thereby decreasing the demand for antibiotics. Relevant differences exist between Echinacea preparations.
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Affiliation(s)
- Giuseppe Gancitano
- 1st Carabinieri Paratrooper Regiment “Tuscania”, Italian Ministry of Defence, 57127 Livorno, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Rainer Stange
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany;
| | - Mercedes Ogal
- Pediatric Clinic Brunnen, 6440 Brunnen, Switzerland;
| | - Selvarani Vimalanathan
- Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (S.V.); (M.S.)
| | - Mahfuza Sreya
- Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (S.V.); (M.S.)
| | - Anthony Booker
- Research Group for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London W1B 2HW, UK; (A.B.); (B.H.-C.)
- Research Group ‘Pharmacognosy and Phytotherapy’, UCL School of Pharmacy, London WC1N 1AX, UK
| | - Bushra Hadj-Cherif
- Research Group for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London W1B 2HW, UK; (A.B.); (B.H.-C.)
| | - Werner C. Albrich
- Division of Infectious Disease, Infection Prevention and Travel Medicine, Cantonal Hospital, 9000 St. Gallen, Switzerland;
| | - Karin Woelkart-Ardjomand
- Department of Pharmacognosy, Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria;
| | - Samo Kreft
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubliana, Slovenia;
| | - Wim Vanden Berghe
- Department of Biomedical Sciences, University of Antwerp, 2000 Antwerp, Belgium;
| | - Godehard Hoexter
- Statistical Consulting Godehard Hoexter, 79100 Freiburg, Germany;
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Wang X, Chen J, Chan Y, Li S, Li M, Lin F, Mehmood K, Idrees A, Lin R, Su Y, Wang C, Shi D. Effect of Echinacea purpurea (L.) Moench and its extracts on the immunization outcome of avian influenza vaccine in broilers. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117306. [PMID: 37839770 DOI: 10.1016/j.jep.2023.117306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Echinacea purpurea (L.) Moench (EP) is a perennial herbaceous flowering plant with immunomodulatory effects. However, the immunomodulatory effects of EP on broilers after vaccination are still unclear. AIM OF THE STUDY The aim is to study the effect of EP and Echinacea purpurea (L.) Moench extracts(EE) on avian influenza virus (AIV) immunity, and further explore the potential mechanism of immune regulation. MATERIALS AND METHODS Broilers were fed with feed additives containing 2% EP or 0.5% EE, and vaccinated against avian influenza. The samples were collected on the 7th, 21st, and 35th day after vaccination, and the feed conversion ratio (FCR) was calculated. Blood antibody titer, jejunal sIgA content, tight junction protein, gene and protein expression of TLR4-MAPK signaling pathway were also detected. RESULTS The results showed that vaccination could cause immune stress, weight loss, increase sIgA content, and up-regulate the expression of tight junction proteins, including zonula occludens-1 (ZO-1), Occludin, and Claudin-1, as well as the genes of Toll-like receptor 4 (TLR4), myeloid differentiation primary response 88 (MyD88), receptor-associated factor 6 (TRAF6), activator protein 1 (AP-1) protein gene expression on TLR4-mitogen-activated protein kinase (MAPK) signaling pathway, and the protein expression of MyD88, extracellular regulated protein kinases (ERK), and c-Jun N-terminal kinase (JNK). EP and EE could increase the body weight of broilers, further improve antibody titers, decrease FCR, increase sIgA levels, up-regulate the expression of tight junction proteins, including ZO-1, Occludin, and Claudin-1, as well as the genes of TLR4, MyD88, TRAF6, and AP-1 and the protein expression of MyD88, ERK, and JNK in the TLR4-MAPK signaling pathway. CONCLUSION In conclusion, EP and EE can increase the broiler's production performance and improve vaccine immune effect through the TLR4-MAPK signaling pathway.
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Affiliation(s)
- Xinyue Wang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Jiaxin Chen
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China; Nanomedicine Center, The GBA National Institute for Nanotechnology Innovation, 136 Kaiyuan Avenue, Guangzhou, 510700, China.
| | - Yanzi Chan
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Sihan Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Menglin Li
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Fei Lin
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Khalid Mehmood
- Faculty of Veterinary and Animal Science, The Islamia University of Bahawalpur, 63100, Pakistan.
| | - Asif Idrees
- KBCMA, College of Veterinary and Animal Sciences, Narowal, Pakistan.
| | - Renzhao Lin
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Yalin Su
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Chunkai Wang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
| | - Dayou Shi
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
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Kolev E, Mircheva L, Edwards MR, Johnston SL, Kalinov K, Stange R, Gancitano G, Berghe WV, Kreft S. Echinacea Purpurea For the Long-Term Prevention of Viral Respiratory Tract Infections During Covid-19 Pandemic: A Randomized, Open, Controlled, Exploratory Clinical Study. Front Pharmacol 2022; 13:856410. [PMID: 35559249 PMCID: PMC9087554 DOI: 10.3389/fphar.2022.856410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
SARS-CoV-2 vaccination is effective in preventing severe Covid-19, but efficacy in reducing viral load and transmission wanes over time. In addition, the emergence of novel SARS-CoV-2 variants increases the threat of uncontrolled dissemination and additional antiviral therapies are urgently needed for effective containment. In previous in vitro studies Echinacea purpurea demonstrated strong antiviral activity against enveloped viruses, including SARS-CoV-2. In this study, we examined the potential of Echinacea purpurea in preventing and treating respiratory tract infections (RTIs) and in particular, SARS-CoV-2 infections. 120 healthy volunteers (m,f, 18-75 years) were randomly assigned to Echinacea prevention or control group without any intervention. After a run-in week, participants went through 3 prevention cycles of 2, 2 and 1 month with daily 2,400 mg Echinacea purpurea extract (Echinaforce®, EF). The prevention cycles were interrupted by breaks of 1 week. Acute respiratory symptoms were treated with 4,000 mg EF for up to 10 days, and their severity assessed via a diary. Naso/oropharyngeal swabs and venous blood samples were routinely collected every month and during acute illnesses for detection and identification of respiratory viruses, including SARS-CoV-2 via RT-qPCR and serology. Summarized over all phases of prevention, 21 and 29 samples tested positive for any virus in the EF and control group, of which 5 and 14 samples tested SARS-CoV-2 positive (RR = 0.37, Chi-square test, p = 0.03). Overall, 10 and 14 symptomatic episodes occurred, of which 5 and 8 were Covid-19 (RR = 0.70, Chi-square test, p > 0.05). EF treatment when applied during acute episodes significantly reduced the overall virus load by at least 2.12 log10 or approx. 99% (t-test, p < 0.05), the time to virus clearance by 8.0 days for all viruses (Wilcoxon test, p = 0.02) and by 4.8 days for SARS-CoV-2 (p > 0.05) in comparison to control. Finally, EF treatment significantly reduced fever days (1 day vs 11 days, Chi-square test, p = 0.003) but not the overall symptom severity. There were fewer Covid-19 related hospitalizations in the EF treatment group (N = 0 vs N = 2). EF exhibited antiviral effects and reduced the risk of viral RTIs, including SARS-CoV-2. By substantially reducing virus loads in infected subjects, EF offers a supportive addition to existing mandated treatments like vaccinations. Future confirmatory studies are warranted.
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Affiliation(s)
- Emil Kolev
- Clinical Research Center DCC Convex Ltd., Sofia, Bulgaria
| | | | - Michael R. Edwards
- Virtus Respiratory Research Limited, London Bioscience Innovation Centre, London, United Kingdom
- National Heart Lung Institute, Imperial College London St Marys Campus, London, United Kingdom
| | - Sebastian L. Johnston
- Virtus Respiratory Research Limited, London Bioscience Innovation Centre, London, United Kingdom
- National Heart Lung Institute, Imperial College London St Marys Campus, London, United Kingdom
| | | | - Rainer Stange
- Charité—Universitätsmedizin Berlin, Immanuel Hospital Berlin, Berlin, Germany
| | - Giuseppe Gancitano
- 1st “Tuscania” Paratrooper Regiment Carabinieri, Italian Ministry of Defence, Livorno, Italy
| | - Wim Vanden Berghe
- Laboratory of Protein Chemistry, Proteomics and Epigenetic Signaling (PPES) and Integrated Personalized and Precision Oncology Network (IPPON), Department of Biomedical Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Samo Kreft
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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Nicolussi S, Ardjomand-Woelkart K, Stange R, Gancitano G, Klein P, Ogal M. Echinacea as a Potential Force against Coronavirus Infections? A Mini-Review of Randomized Controlled Trials in Adults and Children. Microorganisms 2022; 10:211. [PMID: 35208665 PMCID: PMC8879308 DOI: 10.3390/microorganisms10020211] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 01/03/2023] Open
Abstract
Echinacea purpurea has been shown to broadly inhibit coronaviruses and SARS-CoV-2 in vitro. This review discusses the available clinical evidence from randomized, blinded and controlled human studies. Two RCTs capturing incidence of viral respiratory tract infections during Echinacea preventative treatment were identified including coronavirus infections. Incidence and/or viral loads were measured by RT-PCR and symptom severity was recorded. In a first study, Jawad et al. collected nasopharyngeal swabs from adults (N = 755) over 4 months of continuous prevention. Overall, 24 and 47 enveloped virus infections occurred, including 21 and 33 coronavirus detections (229E; HKU1; OC43) with Echinaforce® extract (2400 mg daily) and placebo, respectively (p = 0.0114). In a separate study, Ogal et al. administered the same extract (1200 mg) or control for 4 months to children (4-12 years) (N = 203). Echinacea reduced the incidence of enveloped virus infections from 47 to 29 (p = 0.0038) whereas 11 and 13 coronavirus detections (229E, OC43, NL63) were counted (p > 0.05). Respiratory symptoms during coronavirus infections were significantly lower with area-under-curve AUC = 75.8 (+/-50.24) versus 27.1 (+/-21.27) score points (p = 0.0036). Importantly, viral loads in nasal secretions were significantly reduced by 98.5% in the Echinacea group, with Ct-values 31.1 [95% CI 26.3; 35.9] versus 25.0 [95% CI 20.5; 29.5] in the control group (p = 0.0479). Results from clinical studies confirm the antiviral activity found for Echinacea in vitro, embracing enveloped respiratory pathogens and therefore coronaviruses as well. Substantiating results from a new, completed study seem to extrapolate these effects to the prevention of SARS-CoV-2 infections. As hypothesized, the established broad antiviral activity of Echinacea extract appears to be inclusive for SARS-CoV-2.
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Affiliation(s)
| | - Karin Ardjomand-Woelkart
- Department of Pharmacognosy, Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria;
| | - Rainer Stange
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 10117 Berlin, Germany;
| | - Giuseppe Gancitano
- 1st “Tuscania” Paratrooper Regiment Carabinieri, Italian Ministry of Defence, 57127 Livorno, Italy;
| | - Peter Klein
- d.s.h. Statistical Services GmbH, 85296 Rohrbach, Germany;
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