Astragalus


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The use of dietary supplements by cancer patients has risen significantly over the past 2 decades despite insufficient evidence of safety and effectiveness. Finding reliable sources of information about dietary supplements can be daunting. Patients typically rely on family, friends, and the Internet, often receiving misleading information. 

The ASCO Post’s Integrative Oncology series is intended to facilitate the availability of evidence-based information on alternative and complementary therapies commonly used by patients with cancer. For this installment, we chose Astragalus, an herb widely used in traditional Chinese medicine, because of its growing popularity among cancer patients.

Astragalus

Scientific Name: Astragalus membranaceus
Common Names: Huang chi, ogi, hwanggi, milk vetch.

Overview

Astragalus is a perennial flowering plant prevalent in northern China, Mongolia, and Korea. Its root has a long history of medicinal use to increase metabolism, stamina, strength, and vitality. Astragalus continues to be widely used in traditional Chinese medicine, often combined with other herbs, to boost immune function, improve endurance, prevent upper respiratory infections and colds, lower blood pressure, control night sweats, and to treat heart disease and diabetes. The medicinal value of Astragalus was first mentioned in Shen Nong Ben Cao Jing, the classical Chinese herbal treatise, written in 200 AD.

Depending on the disease and the desired therapeutic effect, Astragalus is combined with specific herbs. It is also commonly included in recipes for soups. The root is dried and sliced to prepare a decoction by boiling in water for an extended period.

The herb is also available as a dietary supplement in various forms, including tablets, capsules, tinctures, and ointments for topical use, and in injectable form for use in clinical studies.

The Science

Of the more than 2,000 species of Astragalus distributed worldwide, Astragalus membranaceus, which is prevalent in China, has been extensively studied. Its biologically active compounds include saponins, polysaccharides, and flavonoids.

When used with Angelica sinensis, an herb used widely in traditional Chinese medicine, Astragalus exhibits renoprotective effects,1 decreases proteinuria associated with idiopathic membranous nephropathy,2 and displays natriuretic action.3 It also suppresses airway hyperreactivity associated with allergic asthma in vivo.4

Astragalus was shown to increase M-cholinergic receptor density in senile rats,5 suggesting that it may help combat senility. Astragalus extract acts as a nerve growth–promoting factor in vitro and in vivo.6 In combination with Angelica sinensis and standard care, it alleviates obstructive uropathy in rats.7

A formulation containing Astragalus has been shown to alleviate fatigue in athletes.8

Data on the anticancer potential of Astragalus are limited but promising. Extracts of astragalus inhibit tumor growth,9 delay chemical-induced hepatocarcinogenesis in rats,10 and display antiangiogenic properties.11 In vitro, animal, and human data indicate that it reduces immune suppression, a side effect of chemotherapy.12,13 Astragalus extract also enhanced the effect of platinum-based chemotherapy.14

A meta-analysis suggests that Astragalus-based treatments for hepatocellular cancers may be viable, but larger trials are required.15 Use of an injectable form of Astragalus with vinorelbine and cisplatin in patients with advanced non–small cell lung cancer improved quality of life.16 Whether orally administered Astragalus exerts the same effects is not known.

A recent study suggests that Astragalus extract may help manage cancer-related fatigue.17 Astragalus demonstrated estrogenic effects in vitro.18 Studies are needed to determine if it affects hormone-sensitive cancers.

Astragalus/Drug Interactions

Cyclophosphamide: Astragalus reduces cyclophosphamide-induced immunosuppression.16

Aldesleukin: Concomitant administration of aldesleukin (Proleukin) with Astragalus caused a 10-fold potentiation of tumoricidal activity with decreased side effects.19

Cytochrome P450 Substrates: Astragalus inhibits CYP3A4 and can affect the metabolism of certain drugs metabolized by this enzyme.20

Disclosure: Dr. Cassileth and Ms. Gubili reported no potential conflicts of interest.

References

1. Yu L, Lu Y, Li J, et al: Identification of a gene associated with astragalus and angelica’s renal protective effects by silver staining mRNA differential display. Chin Med J (Engl) 115:923-927, 2002.

2. Ahmed MS, Hou SH, Battaglia MC, et al: Treatment of idiopathic membranous nephropathy with the herb Astragalus membranaceus. Am J Kidney Dis 50:1028-1032, 2007.

3. 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 116:413-421, 2008.

4. Shen HH, Wang K, Li W, et al: Astragalus membranaceus prevents airway hyperreactivity in mice related to Th2 response inhibition. J Ethnopharmacol 116:363-369, 2008.

5. 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 21:232-235, 2001.

6. 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 68:434-440, 2010.

7. Wojcikowski K, Wohlmuth H, Johnson DW, et al: Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy. Phytother Res 24:875-884, 2010.

8. Chen KT, Su CH, Hsin LH, et al: Reducing fatigue of athletes following oral administration of huangqi jianzhong tang. Acta Pharmacol Sin 23:757-761, 2002.

9. Cho WC, Leung KN: In vitro and in vivo anti-tumor effects of Astragalus membranaceus. Cancer Lett 252(1):43-54, 2007.

10. Cui R, He J, Wang B, et al: Suppressive effect of Astragalus membranaceus Bunge on chemical hepatocarcinogenesis in rats. Cancer Chemother Pharmacol 51:75-80, 2003.

11. Auyeung KK, Woo PK, Law PC, et al: Astragalus saponins modulate cell invasiveness and angiogenesis in human gastric adenocarcinoma cells. J Ethnopharmacol. August 12, 2011 (early release online).

12. 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 25:125-129, 1988.

13. Taixiang W, Munro AJ, Guanjian L: Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database Syst Rev (1):CD004540, 2005.

14. 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 24:419-430, 2006.

15. Wu P, Dugoua JJ, Eyawo O, et al: Traditional Chinese medicines in the treatment of hepatocellular cancers: A systematic review and meta-analysis. J Exp Clin Cancer Res 28:112, 2009.

16. Guo L, Bai SP, Zhao L, et al: 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. September 18, 2011. (early release online).

17. Chen HW, Lin IH, Chen YJ, et al: A novel infusible botanically-derived drug, PG2, for cancer-related fatigue: A phase II double-blind, randomized placebo-controlled study. Clin Invest Med 35:E1-11, 2012.

18. Zhang CZ, Wang SX, Zhang Y, et al: In vitro estrogenic activities of Chinese medicinal plants traditionally used for the management of menopausal symptoms. J Ethnopharmacol 98:295-300, 2005.

19. 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 26:183-187, 1988.

20. Pao LH, Hu OY, Fan HY, et al: Herb-drug interaction of 50 Chinese herbal medicines on CYP3A4 activity in vitro and in vivo. Am J Chin Med 40:57-73, 2012.

Compiled by Barrie R. Cassileth, PhD, and Jyothi Gubili, MS, Memorial Sloan-Kettering Cancer Center. The About Herbs website is managed by K. Simon Yeung, PharmD, MBA, Lac, Memorial Sloan-Kettering Cancer Center.


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