On Frankincense
Abstract
Boswellia species (Burseraceae) are trees or shrubs whose area of distribution covers the wide geographic area between North Africa and India. After incision, their bark produces oleo-gum resin known as frankincense (Olibanum). In traditional medicine, frankincense is often used for medical treatment of arthritis, asthma, ulcerative colitis, coughs, sores, and wound healing. Various frankincense preparations are marketed almost exclusively as dietary supplements. Indian frankincense, or Olibanum indicum, is official in the European Pharmacopoeia. The major components of frankincense are boswellic acids, among which the most important and abundant is 3-O-acetyl-11-keto-β-boswellic acid (AKBA). AKBA is a 5-lipoxygenase inhibitor with anti-inflammatory and anti-arthritic effects. Besides, frankincense contains essential oil, whose composition greatly depends on the biological source, as well as arabinogalactans and glycoproteins. In small clinical trials, certain benefits of various frankincense preparations have been demonstrated in cases of ulcerative colitis, bronchial asthma, mild symptoms of irritable bowel syndrome, and various disorders of osteo-muscular system. However, for collagenous colitis and Crohn’s disease remission maintenance, the evidence is ambiguous or negative. AKBA-containing extract was found advantageous in patients with osteoarthritis, and to some extent with rheumatoid arthritis. Almost all the trials had serious flaws in experimental design, such as insufficient sample size and/or incomplete reporting of data. For any clinical recommendation of frankincense preparations, larger and better-designed studies are needed.
References
Ben-Yehoshua S, Borowitz C, Hanuš LO. Frankincense, Myrrh, and Balm of Gilead: Ancient Spices of Southern Arabia and Judea. In: Janick J, editor. Horticulture Reviews 39. Hoboken (NJ): John Wiley & Sons, Inc.; 2012; p. 1-76.
Anonymous. Boswellia serrata. Alt Med Rev. 2008;13(2):165-7.
Engels G. Frankincense. HerbalGram - The Journal of the American Botanical Council. 2010;88:1-4.
McCutcheon A. Adulteration of Boswellia serrata. Austin, TX: Botanical Adulterants Prevention Program; Botanical Adulterants Bulletin. 2018.
Incense Route - Desert Cities in the Negev [Internet]. Paris: UNESCO, World Heritage Centre; [cited 2020 Oct 31]. Available from: https://whc.unesco.org/en/list/1107/
Basar S. Phytochemical Investigations on Boswellia Species. Comparative Studies on the Essential Oils, Pyrolysates and Boswellic Acids of Boswellia carterii Birdw., Boswellia serrata Roxb., Boswellia frereana Birdw., Boswellia neglecta S. Moore and Boswellia rivae Engl. [dissertation]. [Hamburg (DE)]: University of Hamburg; 2005. 238 p.
World Health Organisation. WHO Monographs on Selected Medicinal Plants, Vol. 4, World Health Organisation, Geneva, 2009.
Hamidpour R, Hamidpour S, Hamidpour M, Hamidpour R. Frankincense (Boswellia Species): The Novel Phytotherapy for Drug Targeting in Cancer. Arch Cancer Res. 2016;4(1):1-5.
Ridha Mustafa Al-Yasiry A, Kiczorowska B. Frankincense – therapeutic properties. Postepy Hig Med Dosw (online). 2016;70:380-91.
Siddiqui MZ. Boswellia serrata, a Potential Antiinflammatory Agent: An Overview. Indian J Pharm Sci. 2011 May;73(3):255-61.
European Pharmacopoeia. 8th ed, Strasbourg: Council of Europe, 2013; 2128-9.
Basch E, Boon H, Davies Heerema T, Foppo I, Hashmi S, Hasskarl J et al. Boswellia: An Evidence-Based Systematic Review by the Natural Standard Research Collaboration. J Herb Pharmacother. 2004;4(3):63-83.
Public Summary of Positive Opinion for Orphan Designation of Boswellia serrata resin extract for the treatment of peritumoral oedema derived from the brain tumors - EMEA/COMP/2247/02 Rev.1 [Internet]. London: European Medicines Agency. c2007 [cited 2020 Oct 2]. Available from: https://www.ema.europa.eu/en/documents/orphan-designation/eu/3/02/117-public-summary-positive-opinion-orphan-designation-boswellia-serrata-resin-extract-treatment_en.pdf, February 2007.
Kar A, Menon MK. Analgesic effect of the gum resin of Boswellia serata Roxb. Life Sci. 1969;8(19):1023-8.
Kapil A, Moza N. Anticomplementary activity of boswellic acids, an inhibitor of C3-convertase of the classical complement pathway. Int J Immunopharmacol. 1992;14:1139-43.
Knaus U, Wagner H. Effects of boswellic acid of Boswellia serrata and other triterpenic acids on the complement system. Phytomedicine. 1996;3(1):77-80.
Yin Q, Bai J, Sun Y, Wang Z, Wang H. Functions and Mechanisms of AKBA in Inflammation Diseases and Cancer. J Immunol Res Ther. 2017;2(1):81-9.
Sander O, Herborn G, Rau R. Ist H15 (Harzextrakt von Boswellia serrata, “Weihrauch”) eine sinnvolle Ergänzung zur etablierten medikamentösen Therapie der chronischen Polyarthritis? - Ergebnisse einer doppelblinden Pilotstudie [Is H15 (resin extract of Boswellia serrata, “incense”) a useful supplement to established drug therapy of chronic polyarthritis? Results of a double-blind pilot study]. Z Rheumatol. 1998;57(1):11-6. German.
Etzel R. Special extract of Boswellia serrata (H15) in the treatment of rheumatoid arthritis. Phytomed. 1996;3(1):91-4.
Chopra A, Lavin P, Patwardhan B, Chitre D. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol. 2000;27(6):1365-72.
Kulkarni RR, Patki PS, Jog VP, Gandage SG, Patwardban B. Efficacy of an Ayurvedic formulation in rheumatoid arthritis: A double-blind, placebo-controlled, cross-over study. Indian J Pharm. 1992;24:98-101.
Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee-a randomized double blind placebo controlled trial. Phytomedicine. 2003;10(1):3-7.
Sengupta K, Alluri KV, Satish AR, Mishra S, Golakoti T, Sarma KV, Dey D, Raychaudhuri SP. Arthritis Res Ther. 2008;10(4):R85.
Sengupta K, Krishnaraju AV, Vishal AA, Mishra A, Trimurtulu G, Sarma KVS, et al. Comparative efficacy and tolerability of 5-Loxin® and Aflapin® against osteoarthritis of the knee: A double blind, randomized, placebo controlled clinical study. Int J Med Sci. 2010;7(6):366-77.
Kulkarni RR, Patki PS, Jog VP, Gandage SG, Patwardhan B. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharmacol. 1991;33(1-2):91-5.
Gupta I, Gupta V, Parihar A, Gupta S, Lüdtke R, Safayhi H, Ammon HP. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res. 1998;3(11):511-4.
Gerhardt H, Seifert F, Buvari P, Vogelsang H, Repges R. Therapie des aktiven Morbus Crohn mit dem Boswellia-serrata-Extrakt H 15 [Therapy of active Crohn disease with Boswellia serrata extract H 15]. Z Gastroenterol. 2001;39(1):11-7. German.
Holtmeier W, Zeuzem S, Preiss J, Kruis W, Böhm S, Maaser C, Raedler A, Schmidt C, Schnitker J, Schwarz J, Zeitz M, Caspary W. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn's disease: good safety profile but lack of efficacy. Inflamm Bowel Dis. 2011;17(2):573-82.
Gupta I, Parihar A, Malhotra P, Gupta S, Lüdtke R, Safayhi H et al. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med. 2001;67(5): 391-5.
Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlisch E et al. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. Int J Colorectal Dis. 2007;22(12):1445-51.
Belcaro G, Gizzi G, Pellegrini L, Corsi M, Dugall M, Cacchio M et al. Supplementation with a lecithin-based delivery form of Boswellia serrata extract (Casperome®) controls symptoms of mild irritable bowel syndrome. Eur Rev Med Pharmacol Sci. 2017;21(9):2249-54.
Riva A, Giacomelli L, Togni S, Franceschi F, Eggenhoffner R, Zuccarini MC, Belcaro G. Oral administration of a lecithin-based delivery form of boswellic acids (Casperome®) for the prevention of symptoms of irritable bowel syndrome: a randomized clinical study. Minerva Gastroenterol Dietol. 2019;65(1):30-35.
Franceschi F, Togni S, Belcaro G, Dugall M, Luzzi R, Ledda A et al. A novel lecithin based delivery form of Boswellic acids (Casperome®) for the management of osteo-muscular pain: a registry study in young rugby players. Eur Rev Med Pharmacol Sci. 2016;20(19):4156-61.
Riva A, Allegrini P, Franceschi F, Togni S, Giacomelli L, Eggenhoffner R. A novel boswellic acids delivery form (Casperome®) in the management of musculoskeletal disorders: a review. Eur Rev Med Pharmacol Sci. 2017;21(22):5258-63.
