CLINICAL
RESPIRATORY CPD
may be due to an activation of the
immune system. This assumption
was supported by Mativandlela et al
(2006, 2007), who investigated various
extracts and isolated compounds
from Pelargonium sidoides root with
regards to their antimycobacterial and
especially their antitubercular activities.
Strains of Moraxella catarrhalis,
Aspergillus niger, Rhizopus stolonifer,
Fusarium oxysporum, Haemophilus
influenza, Mycobacterium tuberculosis
and M. smegmatiswere exposed to
acetone and ethanol root extracts,
as well as four coumarins and two
flavonoids isolated from Pelargonium
sidoides. Significant activity could be
shown for ethanol extract against
Aspergillus niger and Fusarium
oxysporum but limited activity against
Rhizopus stolonifer and Mycobacterium
tuberculosis. None of the isolated
compounds showed any activity against
Mycobacterium tuberculosis.
Immunomodulatory properties
Kayser et al (1997, 2001, 2003)
investigated extracts and isolated
constituents of Pelargonium sidoides
for their effects on nonspecific immune
functions in various bioassays. No
significant activity against extracellular,
promastigote Leishmania donovani,
could be shown. However, all extracts
and compounds significantly reduced
the intracellular survival of Leishmania
donovani. This implies indirect
activity, possibly through activation of
leishmanicidal macrophage functions.
Activation was confirmed through the
presence of tumour necrosis factor
(TNF-alpha) and inorganic nitric
oxides (iNO). Synthesis of the latter is
a known mechanism of macrophages
against microorganisms.
Kolodziej et al (2003) and Janecki
et al (2007) observed TNF inducing
potencies for EPs 7630 as well as
interferon-like activities in supernatants
of sample-activated bone marrow-
derived macrophages in several
functional assays. Various subfractions
of EPs 7630 were tested for their NO-,
TNF- and interleukin (IL)-12-inducing
capacity. EPs 7630 induced significant
TNF levels in non-infected and GFP
transfected-Leishmania major-infected
macrophages. Production of NO and
IL-12, however, were negligible, while
flow cytometry indicated a decrease
in parasites in cells treated with EPs
7630. This suggests that radical
scavengers or low but efficient NO
levels may be present in EPs 7630.
Koch et al (2002) further
investigated if and how EPs 7630
interferes with interferon (IFN)-
beta synthesis in MG-63 human
osteosarcoma cells. IFN-beta
production increased in cells
preincubated with Umckaloabo.
Enhancement of natural killer cell
mediated cytotoxicity was also found.
Umckaloabo thus enhanced but did not
induce IFN-beta production.
Kolodziej et al (1999, 2005)
investigated polyphenol-containing
of HNP 1–3 and BPI. Thus EPs 7630
seem to stimulate host defence
through enhancing the release of
antimicrobial peptides.
Effects on the mucociliary system
Mickenhagen et al (2004) and
Neugebauer et al (2005) presented
investigations into the stimulation of
ciliary beat frequency (an important
defence mechanism of the mucociliary
system) in ciliated cell cultures of
human nasal epithelium with Eps 7630
in vitro. Three concentrations of Eps
7630 (1, 30, 100g/ml) were tested,
which significantly increased ciliary
beat frequency in a dose-dependent
manner.
Effects on symptoms of
sickness behaviour
Nöldner and Koch (2004) and Nöldner
and Schötz (2007) studied the inhibition
of sickness behaviour (anorexia,
listlessness, reduced activity) by EPs
7630 in male NMRI mice induced by a
cytokine-inducer (lipopolysaccaride).
Oral administration of EPs 7630
antagonised the above-mentioned
effects in a dose-dependent manner.
CLINICAL EVIDENCE
OF EFFICACY
A total of 18 clinical trials have thus far
been conducted, several of which were
randomised, double-blind and placebo-
controlled. EPs 7630 has been shown
to effectively shorten the severity
and duration of acute bronchitis and
tonsillopharyngitis, most notably
in children. Results from trials with
adults and children support the use of
this product as a possible alternative
to antibiotics for the acute treatment
of these conditions. Research also
focuses on the treatment of symptoms
of sickness behaviour and of acute
52 MAY 2017 | MEDICAL CHRONICLE