Clinical Summary
Astragalus root works by stimulating several factors of the immune system
Astragalus root is widely used in Traditional Chinese medicine for its tonifying properties. Studies done in China suggest that astragalus, when used with angelica, has reno protective effects (6). In addition, astragalus decreases the proteinuria associated with idiopathic membranous nephropathy (7) and exhibits natriuretic action (8). Astragalus may also suppress airway hyper reactivity associated with allergic asthma in vivo (9). It also increases M-cholinergic receptor density in senile rats (11), which suggests that it may have a role in combating senility. Astragalus extract acts as a nerve-growth promoting factor in vitro and in vivo (17), and alleviates obstructive uropathy in mice in combination Angelica sinensis and standard care (18).
An herbal formula containing astragalus as a major ingredient has been shown to reduce fatigue in athletes (10).
Astragalus extracts inhibit tumor growth (5), delay chemical-induced hepatocarcinogenesis in rats (4), and have antiangiogenic property (19). In vitro, animal, and anecdotal human data show that astragalus reduces immune suppression, a side effect of chemotherapy (1) (2), and may also enhance the effects of platinum-based chemotherapy (3).
Conclusions from a meta-analysis suggest benefits of astragalus-based treatments for hepatocellular cancers, but data need to be evaluated in larger, well designed trials (16).
Improvement in quality of life was reported following use of an injectable form of astragalus with vinorelbine and cisplatin in patients with advanced non-small cell lung cancer (NSCLC) (20). However, it is not known whether orally administered astragalus will exert the same effect.
Purported Uses
Cardiovascular disease
Chemotherapy side effects
Common cold
Diabetes
HIV and AIDS
Immunostimulation
Microbial infection
Strength and stamina
Cancer
Astragalus root also prevents bone loss and shows osteogenesis ability! Many cancer soften and destroy bone, such as in nasal cancer and bone cancers.
Constituents
Triperpenoid saponins (cycloastragenol, astragaloside I to VIII, and cyclocanthoside)
Cycloartane triterpene
Polysaccharide
Isoflavonoids
Amino acids
(12)
Mechanism of Action
Astragalus works by stimulating several factors of the immune system. The polysaccharides potentiate the immune-mediated antitumor activity of interleukin-2 in vitro (13), improve the responses of lymphocytes from normal subjects and cancer patients, enhance the natural killer (NK) cell activity of normal subjects, and potentiate the activity of monocytes (14), increasing phagocytosis perhaps by regulating tumor necrosis factor (TNF) production (5). The saponins potentiate NK cell activity and restore steroid-inhibited NK cell activity in vitro. They also increase phagocytosis and demonstrate hepatoprotective effects on chemically-induced liver injury in vitro (6) and in vivo (4). Chinese studies suggest that astragalus, when used with angelica, has renal protective effects by mediating gene expression. Astragaloside IV, a saponin constituent, increases tissue-type plasminogen activator (t-PA) synthesis and downregulates the expression of plasminogen activator inhibitor type 1 (PAI-1) (21). Astragalus increases M-cholinergic receptor density in senile rats, suggesting that astragalus may have a role in combating brain senility (11). An herbal formula containing astragalus can reduce fatigue in athletes by increasing uptake and utility of oxygen (10).
Adverse Reactions
Adverse effects have not been reported.
Traditional Chinese medicine Astragalus reverses predominance of Th2 cytokines and their up-stream transcript factors in lung cancer patients.
Oncol Rep. 2003.
Th2 cytokine is predominant in tumor patients and was found to be associated with tumor progression. Reversing of Th2 dominant status is thought to be a promising strategy. Our results demonstrate that traditional Chinese medicine Astragalus might reverse the Th2 predominant status in lung cancer patients, which is a probable alternative therapeutic regime in future.
Literature Summary and Critique
Most of the clinical trials on astragalus were conducted in China using multiple-herbal formulas that contain astragalus as the major component. The selection of herbs is based on Traditional Chinese Medicine.
Wu P, Dugoua JJ, Eyawo O, Mills EJ. Traditional Chinese Medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis. J Exp Clin Cancer Res. 2009 Aug 12;28:112.
This analysis included 45 randomized controlled trials of oral TCM preparations for hepatocellular cancers and involved 3,236 patients. Survival, tumor response, and performance scores were examined. The authors report that products containing ginseng, astragalus and mylabris had a larger treatment effect (OR 1.34, 95% CI, 1.04-1.71, P = 0.01) than the pooled broad estimate. They observed a similar pattern for astragalus-based treatments (OR 1.35, 95% CI, 1.001-1.80. P = 0.048).
Astragalus and other TCM products may be effective against hepatocellular cancers. However, the methodology of trials was poor; all the studies were conducted in China and publication bias in favor of only positive reports is likely. The results should be evaluated in well designed trials.
McCulloch M, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: Meta-analysis of randomized trials. J clin Oncol 2006;24(3):419-430.
This analysis sought to determine whether Chinese herbal medicine containing Astragalus increases the effectiveness of platinum-based chemotherapy for advanced non-small-cell-lung cancer. Thirty-four randomized studies involving 2,815 patients were analyzed. Results suggest that when used in conjunction with platinum-based chemotherapy, Astragalus-based medicine improved survival, tumor response, performance status, and reduced chemotherapy toxicity when compared with chemotherapy alone.
However, the low quality of the studies analyzed is a drawback and the results are therefore, not conclusive. Well-designed studies are warranted.
Taixiang W, et al. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients (Review). The Cochrane Database Syst Rev 2005; (1):CD004540.
Four clinical trials were included in this review to assess the effectiveness of Astragalus (Huangqi) compounds on the quality of life, side effects of chemotherapy, and on adverse effects in colorectal cancer patients. A decoction of Huangqi compounds was used in combination with chemotherapy in three studies, whereas the fourth study compared Huangqi compounds with two other Chinese herbal formulas. Patients who were given Huangqi compounds experienced a reduction in nausea and vomiting along with a decrease in the rate of leucopenia and an increase in CD3, CD4 and CD8 subsets of T-lymphocytes when compared to those treated with chemotherapy alone in the three studies or with other Chinese formulas in the fourth study.
Use of Chinese herbal medicine along with chemotherapy appears promising for patients with colorectal cancer; however, a major limitation of this review is that it includes only four studies and the studies are of poor quality. Further properly designed trials are needed to confirm these observations.
References
- Chu DT, Wong WL, Mavligit GM. Immunotherapy with Chinese medicinal herbs. II. Reversal of cyclophosphamide-induced immune suppression by administration of fractionated Astragalus membranaceus in vivo. J Clin Lab Immunol 1988;25:125-9.
- Taixiang W, Munro AJ, Guanjian L. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004540.
- McCulloch M, See C, Shu XJ, et al. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials. J Clin Oncol. 2006 Jan 20;24(3):419-30.
- Cui R, He J, Wang B, et al. Suppressive effect of Astragalus membranaceus Bunge on chemical hepatocarcinogenesis in rats. Cancer Chemother Pharmacol. 2003 Jan;51(1):75-80.
- Cho WC, Leung KN. In vitro and in vivo anti-tumor effects of Astragalus membranaceus.Cancer Lett. Jul 8 2007;252(1):43-54.
- Yu L, Lu Y, Li J, Wang H. Identification of a gene associated with astragalus and angelica's renal protective effects by silver staining mRNA differential display. Chin Med J (Engl) 2002;115:923-7.
- Ahmed MS, Hou SH, Battaglia MC, et al. Treatment of idiopathic membranous nephropathy with the herb Astragalus membranaceus. Am J Kidney Dis. Dec 2007;50(6):1028-1032.
- Ai P, Yong G, Dingkun G, et al. Aqueous extract of Astragali Radix induces human natriuresis through enhancement of renal response to atrial natriuretic peptide. J Ethnopharmacol. Mar 28 2008;116(3):413-421.
- Shen HH, Wang K, Li W, et al. Astragalus Membranaceus prevents airway hyperreactivity in mice related to Th2 response inhibition.J Ethnopharmacol. Mar 5 2008;116(2):363-369.
- Chen KT, Su CH, Hsin LH, et al. Reducing fatigue of athletes following oral administration of huangqi jianzhong tang. Acta Pharmacol Sin. 2002 Aug;23(8):757-61.
- Shi R, He L, Hu Y, et al. The regulatory action of radix astragali on M-cholinergic receptor of the brain of senile rats. J Tradit Chin Med 2001;21:232-5.
- Tang W, et al. Chinese Drugs of Plant Origin. Berlin: Springer-Verlag; 1992.
- Qun L, Luo Q, Zhang ZY, et al. Effects of astragalus on IL-2/IL-2R system in patients with maintained hemodialysis. Clin Nephrol. 1999 Nov;52(5):333-4.
- Chu DT, Lepe-Zuniga J, Wong WL, et al. Fractionated extract of Astragalus, a Chinese medicinal herb, potentiates LAK cell cytotoxicity generated by a low dose of recombinant interleukin-2. J Clin Lab Immunol 1988;26:183-7.
- Upton R. Astragalus root: analytical, quality control and therapeutic monograph. American Herbal Pharmacopoeia. 1999;1:1-25.
- Wu P, Dugoua JJ, Eyawo O, Mills EJ. Traditional Chinese medicines in the treatment of hepatocellular cancers: a systematic review and meta-analysis. J Exp Clin Cancer Res. 2009 Aug 12;28(1):112.
- Lu MC, Yao CH, Wang SH, et al. Effect of Astragalus membranaceus in rats on peripheral nerve regeneration: in vitro and in vivo studies. J Trauma. 2010 Feb;68(2):434-40.
- Wojcikowski K, Wohlmuth H, Johnson DW, Gobe G. Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy. Phytother Res. 2010 Jun;24(6):875-84.
- Auyeung KK, Woo PK, Law PC, Ko JK. Astragalus saponins modulate cell invasiveness and angiogenesis in human gastric adenocarcinoma cells. J Ethnopharmacol. 2011 Aug 12.
- Guo L, Bai SP, Zhao L, Wang XH. Astragalus polysaccharide injection integrated with vinorelbine and cisplatin for patients with advanced non-small cell lung cancer: effects on quality of life and survival. Med Oncol. 2011 Sep 18.
- Zhang WJ, Wojta J, Binder BR. Regulation of the fibrinolytic potential of cultured human umbilical vein endothelial cells: astragaloside IV downregulates plasminogen activator inhibitor-1 and upregulates tissue-type plasminogen activator expression. J Vasc Res. 1997 Jul-Aug;34(4):273-80.