Questions and Answers: Echinacea – new scientific insights

Roter Son­nen­hut (Echinacea pur­pu­rea L.)

? During the 1918 flu pan­de­mic many of the natur­opa­thic doc­tors in North Ame­ri­ca used Echinacea as one of their most important her­bal drugs [1]. Except for the empi­ric evi­dence of the pro­no­un­ced the­ra­peu­tic Echinacea effects a ratio­na­le for its effec­ti­ve­ness in acu­te upper respi­ra­to­ry infec­tions (ARI), influ­en­za like ill­nesses (ILI) or influ­en­za its­elf was miss­ing for deca­des. Have the­re been any pro­blems with the “clas­si­cal theo­ry” of the assu­med “sti­mu­la­ti­on of the immu­ne sys­tem” by Echinacea extracts?

! Our under­stan­ding of the immu­ne sys­tem has chan­ged radi­cal­ly in recent years. We now view the immu­ne sys­tem as a net­work com­po­sed of sti­mu­la­to­ry and inhi­bi­to­ry respon­ses which is nor­mal­ly balan­ced in a healt­hy per­son. Howe­ver, in respon­se to a virus or bac­te­ri­al infec­tion, we often pro­du­ce an exag­ge­ra­ted inna­te immu­ne respon­se, which results in a so-cal­led pro­in­flamm­a­to­ry respon­se, with resul­ting secre­ti­on of cyto­ki­nes and other inflamm­a­to­ry media­tors. The­se media­tors are in fact respon­si­ble for many of the clas­si­cal sym­ptoms of “colds and flu”. The­se respon­ses occur within a day of the infec­tion, long befo­re the adap­ti­ve immu­ne respon­se, which is respon­si­ble for anti­bo­dy for­ma­ti­on. One of the most important effects of Echinacea, as demons­tra­ted in labo­ra­to­ry expe­ri­ments with Echina­force®, is the rever­sal of this pro­in­flamm­a­to­ry respon­se. In other words the Echinacea can act as an anti­in­flamm­a­to­ry agent and hence res­to­re the balan­ce in the immu­ne system.

The con­cept of immu­ne sti­mu­la­ti­on by Echinacea includes main­ly the pro­li­fe­ra­ti­on of seve­ral immu­ne cells and the increase of cer­tain immu­ne func­tions in vitro and in vivo. Sin­ce the­se effects are time depen­dent, they only par­ti­al­ly explain the instanta­neous the­ra­peu­tic effec­ti­vi­ty in acu­te infec­tions. Or in essence: The for­mer con­cept of the Echinacea indu­ced immu­ne sti­mu­la­ti­on was an exam­p­le of the “black and white thin­king” during the anti­bio­tic era in medi­ci­ne. The “bad” play­ers were bac­te­ria and viru­s­es, the “good” – of cour­se – were immu­ne cells and their acti­vi­ties. Yet nowa­days in micro­bio­lo­gy it has beco­me clear that this con­cept is much too simp­le to fit into reality.

? One of your new insights in Echinacea’s mode of action – the modu­la­ti­on of cyto­ki­nes – means a para­dig­ma­tic shift also for the her­bal medi­ci­ne. What is the news from your laboratory?

! We now reco­gni­ze a ran­ge of dise­a­ses in which cer­tain func­tions of the immu­ne sys­tem are exag­ge­ra­ted – aller­gy and ato­py, auto­im­mu­ne, auto­ag­gres­si­ve dise­a­ses, sep­sis and the lethal effects of avi­an influ­en­za infec­tions in healt­hy peo­p­le. One of the patho­ge­nic effects in infec­tious dise­a­ses is a dys­func­tion­al over-pro­duc­tion and ‑secre­ti­on of pro­in­flamm­a­to­ry cyto­ki­nes and che­mo­ki­nes by infec­ted cells (“cyto­ki­ne storm”). Such a “hyper­cy­to­ki­ne­mia” is the main reason for many of the typi­cal sym­ptoms during an ARI. Such a respon­se can be eli­ci­ted even for viru­s­es with rela­tively low patho­ge­nic poten­ti­al, such as rhi­no­vi­ru­s­es, which are respon­si­ble for many com­mon colds. In sum­ma­ry: The Echinacea extra­ct Echina­force® modu­la­tes and nor­ma­li­zes the cel­lu­lar hyper­se­cre­ti­on of cyto­ki­nes during a virus infec­tion in vitro [2, 3, 4]. This explains why Echinacea in sym­pto­ma­tic ARI has an imme­dia­te the­ra­peu­tic effect even though the abo­ve men­tio­ned immu­ne sti­mu­la­ti­on is only just starting.

? You and your team also could show a direct anti­vi­ral effect of the her­bal extra­ct Echina­force®?

! Yes, the Swiss pro­duct exhi­bits a very pro­no­un­ced anti­vi­ral effect in vitro – this means a com­ple­te block of the viral repli­ca­ti­on in infec­ted cells (espe­ci­al­ly pro­no­un­ced for influ­en­za virus, respi­ra­to­ry syn­cy­ti­al virus and her­pes sim­plex virus)

? Are the­re new insights of the mole­cu­lar basis of the anti­vi­ral and immun­mo­du­la­to­ry effects of Echina­force®?

! Her­bal extra­cts often con­tain a mix­tu­re of hundreds of dif­fe­rent natu­ral sub­s­tances. So we can­not yet explain the mode of action of Echinacea. Evi­dence to date sug­gests that Echinacea blocks the bin­ding of influ­en­za virus to cel­lu­lar recep­tors, effec­tively pre­ven­ting repli­ca­ti­on and spread of the virus. We also show­ed in ear­lier stu­dies that Echinacea can inter­act with intracel­lu­lar tran­scrip­ti­on fac­tors that pro­mo­te the pro­duc­tion and secre­ti­on of cytokines.

? Even if the­se results are purely expe­ri­men­tal, what is your cli­ni­cal extra­po­la­ti­on to a ratio­nal use in case of ARI, ILI or influ­en­za? Do you have any recom­men­da­ti­on for the dai­ly cli­ni­cal practice?

! Yes, our sci­en­ti­fic results ori­gi­na­te main­ly from our labo­ra­to­ry work. Howe­ver we have just com­ple­ted ana­log­ous stu­dies on virus infec­ted orga­no­ty­pic models (3D tis­sues) of human air­way tis­sues, and the results sup­port the pre­vious stu­dies done with 2D mono­lay­er cul­tures of bron­chi­al cells. In addi­ti­on we show­ed that the Echinacea did not adver­se­ly affect tis­sue struc­tu­re or the cilia on epi­the­li­al cells, and fur­ther­mo­re the virus-indu­ced secre­ti­on of mucus in the­se tis­sues was com­ple­te­ly rever­sed by Echina­force®. The­r­e­fo­re it is reasonable to pro­mo­te the tra­di­tio­nal uses of Echinacea in infec­tious dise­a­ses as descri­bed by the eclec­tic her­bal doc­tors and the North Ame­ri­can Indi­ans. Our results give insights in the phar­ma­co­ge­ne­tics of Echinacea, espe­ci­al­ly of the acti­vi­ty of very low doses and the mul­ti­ple modes of action. As the term com­ple­men­ta­ry medi­ci­ne indi­ca­tes, the use of Echinacea should com­ple­ment all other neces­sa­ry the­ra­peu­tic mea­su­res. The­r­e­fo­re I recom­mend Echina­force as useful and valuable add-on in case of a mul­ti­mo­dal the­ra­py. Of cour­se the­re are also many cases of less aggres­si­ve respi­ra­to­ry infec­tions or com­mon colds whe­re the extra­ct is useful for monotherapy.

? Would you use Echina­force in swi­ne flu by yours­elf? If yes, what are your recom­men­da­ti­ons for an opti­mal usage?

! In con­side­ra­ti­on of the mul­ti­ple bene­fi­ci­al acti­vi­ties of Echina­force just descri­bed, I would defi­ni­te­ly advo­ca­te con­sump­ti­on of Echina­force in the recom­men­ded dosa­ge. I would have no hesi­ta­ti­on in taking it mys­elf. Fur­ther­mo­re I recom­mend! use of Echina­force in the con­text of other important – natur­opa­thic – mea­su­res. E. g. reduc­tion of stress, both men­tal­ly and phy­si­cal­ly, stop­ping inten­si­ve exer­cise and sport­ing acti­vi­ties, ade­qua­te bed rest, enough sleep, ple­nty of fluids and aban­don­ment of the­ra­pies with exhaus­ting side-effects.

?! Prof. Hud­son, many thanks for your valuable information!

* the Echinacea her­bal extra­ct tes­ted is equi­va­lent, in terms of raw-mate­ri­al use, manu­fac­tu­ring and com­po­si­ti­on, to the pro­duct Echina­force® (A. Vogel Bio­f­orce AG, Rogg­wil, Switzerland).

Note: Pro­fes­sor Jim Hud­son is con­side­red to be one of the fore­most viro­lo­gists in Wes­tern Cana­da and is curr­ent­ly Pro­fes­sor Eme­ri­tus at The Uni­ver­si­ty of Bri­tish Colum­bia. He has published over 130 papers in peer-review­ed jour­nals and writ­ten a num­ber of books, inclu­ding “Anti­vi­ral Com­pounds from Plants”. His rese­arch inte­rests include elu­ci­da­ting the mole­cu­lar mecha­nisms of action of her­bal medi­ci­nes and seve­ral col­la­bo­ra­ti­ve pro­jects with Insti­tu­tes in deve­lo­ping count­ries in Afri­ca and Asia.

Rai­ner H. Buben­zer, the inter­view­er, is a seni­or health con­sul­tant, expe­ri­en­ced medi­cal aut­hor, spe­cia­list in com­ple­men­ta­ry medi­ci­ne for many years and edi­tor in chief of

Rai­ner H. Buben­zer, Ber­lin, 2009.
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