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Extract of Perilla Frutescens Enriched for Rosmarinic Acid, a Polyphenolic Phytochemical, Inhibits Seasonal Allergic Rhinoconjunctivitis in Humans

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Extract of Perilla Frutescens Enriched for Rosmarinic Acid, a Polyphenolic Phytochemical, Inhibits Seasonal Allergic Rhinoconjunctivitis in Humans Extract of Perilla frutescens Enriched for Rosmarinic Acid, a Polyphenolic Phytochemical, Inhibits Seasonal Allergic Rhinoconjunctivitis in Humans , ,1 HIROHISA TAKANO,* NAOMI OSAKABE,à CHIAKI SANBONGI,à RIE YANAGISAWA, KEN-ICHIRO INOUE,* AKIKO YASUDA,à MIDORI NATSUME,à SEIGO BABA,à EI-ICHIRO ICHIISHI,* AND TOSHIKAZU YOSHIKAWA* *First Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; Pathophysiology Research Team, National Institute for Environmental Studies, Tsukuba 305-0053, Japan; and àHealth and Bioscience Laboratories, Meiji Seika Kaisha, Ltd., Sakado 350-2889, Japan. Extract of Perilla frutescens enriched for rosmarinic acid, rosmarinic acid can be an effective intervention for mild a polyphenolic phytochemical, suppresses allergic immunoglob- SAR at least partly through inhibition of PMNL infiltration into ulin responses and inflammation caused by polymorphonuclear the nostrils. Use of this alternative treatment for SAR might leukocytes (PMNL) in mice. However, few placebo-controlled reduce treatment costs for allergic diseases. Exp Biol Med clinical trials have examined the efficacy and safety of poly- 229:247–254, 2004 phenolic phytochemicals for treatment of allergic inflammatory Key words: rosmarinic acid; seasonal allergic rhinoconjunctivitis; diseases in humans. The present study determined whether polymorphonuclear leukocytes; alternative medicine; randomized, oral supplementation with rosmarinic acid is an effective double-blind, age-matched, placebo-controlled parallel group study; intervention for patients with seasonal allergic rhinoconjunc- extract of Perilla frutescens tivitis (SAR). In this 21-day, randomized, double-blind, age- matched, placebo-controlled parallel group study, patients with mild SAR were treated daily with extract of Perilla uring the latter half of the 20th century, the frutescens enriched for rosmarinic acid (200 mg [n 5 10] or incidence of allergic rhinitis increased worldwide, 50 mg [n 5 9]) or placebo (n 5 10). Patients recorded leading to dramatic escalation in direct and indirect symptoms daily in a diary. Profiles of infiltrating cells and D concentrations of eotaxin, IL-1b, IL-8, and histamine were treatment costs (1). In 1996, direct and indirect costs for measured in nasal lavage fluid. Serum IgE concentrations allergic rhinitis were estimated at $7 billion and $3 billion, and routine blood tests were also examined. As compared respectively. Despite steady advances in conventional ther- with placebo supplementation, supplementation with extract apies for allergy symptoms, phytochemicals and herbal of Perilla frutescens enriched for rosmarinic acid resulted in a significant increase in responder rates for itchy nose, products have been widely used by consumers as alter- watery eyes, itchy eyes, and total symptoms (P < 0.05). natives to prescription drugs without definitive clinical Active treatment significantly decreased the numbers of evidence (2). In the United States, the prevalence of neutrophils and eosinophils in nasal lavage fluid (P < 0.05 alternative therapy use for allergies rose from 8.7% in vs. placebo). Patients reported no adverse events, and no 1990 to 16.6% in 1997 (3). significant abnormalities were detected in routine blood tests. In conclusion, extract of Perilla frutescens enriched for Among a variety of phytochemicals, polyphenolic phy- tochemicals have been shown experimentally to inhibit inflammatory and vascular processes (4–7). Furthermore, a This work was supported by a grant from Meiji Seika Kaisha, Ltd. randomized, blinded, crossover investigation of the cocoa polyphenol, procyanidin, has shown that it can favorably alter 1 To whom requests for reprints should be addressed at Pathophysiology Research eicosanoid (prostacyclin) synthesis in humans, providing Team, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305- a possible mechanism by which it could inhibit atherogenic 0053, Japan. E-mail: [email protected] disorders (8). In addition, another well-controlled clinical trial Received September 8, 2003. has demonstrated that a polyphenol-rich cocoa beverage Accepted December 8, 2003. suppresses ADP- and epinephrine-stimulated platelet activa- tion (9). In contrast, few placebo-controlled clinical trials 1535-3702/04/2293-0001$15.00 have examined the efficacy or safety of polyphenolic Copyright Ó 2004 by the Society for Experimental Biology and Medicine phytochemicals on allergic inflammatory diseases in humans. 247 Downloaded from http://ebm.rsmjournals.com/ by guest on October 14, 2011 248 TAKANO ET AL Figure 1. The pollen counts during the study period. At Days 0, 3, and 21 (arrows), daily symptoms, tablet intake, and adverse events were collected and confirmed, and nasal washes were performed. All patients were tested on the same day in the morning at the same location. A randomized, double-blind, placebo-controlled study of lived within 10 km of the same company and commuted there grape seed extract has shown no significant difference daily except on weekends. Participants were fully informed between active and placebo groups in rhinitis quality of life regarding the experimental procedures, and written consent assessments, symptom disease scores, or requirements for was obtained. Safety was monitored by clinical history, rescue antihistamine treatment (10). physical examinations, and routine blood tests, including Rosmarinic acid, a polyphenolic phytochemical, exists hepatic and renal function tests and complete blood counts. in a variety of medicinal species within the plant genus Study Design. The study used a randomized, double- Lamiaceae, such as basil, sage, rosemary, mint, and Perilla blind, age-matched, placebo-controlled parallel group de- frutescens, a popular garnish in Japan. Oral supplementation sign. The protocol was approved by the ethics committees with rosmarinic acid in Perilla decoction reportedly sup- of the Kyoto Prefectural University of Medicine. The presses allergic reaction in mice (11). study was carried out in accordance with the Declaration of The present study was undertaken to investigate whether Helsinki. The trial was carried out from late February to late extract of Perilla frutescens enriched for rosmarinic acid is March. During the study period, the mean concentration of a beneficial intervention for patients with seasonal allergic Japanese cedar pollen was 2.48 million grains/m3 (SD ¼ rhinoconjunctivitis (SAR). Furthermore, we assessed its 2.41 million; Fig. 1). effects on mediator release and on polymorphonuclear Ten patients each were randomized to the rosmarinic leukocyte (PMNL; neutrophils and eosinophils) infiltration acid (200 mg ) group, the rosmarinic acid (50) mg group, into nasal lavage fluid. and to the placebo group. At Day 0, patients were instructed to record their daily symptoms and medication on a diary card. For 21 days, each patient took tablets daily after Materials and Methods breakfast. Tablets were indistinguishable between groups Subjects. We enrolled 30 patients aged 21 to 53 years and contained rosmarinic acid from Perilla frutescens with mild SAR to Japanese cedar (Cryptomeria japonica) extracts at a daily dose of 200, 50, or 0 mg. At Days 0, 3, pollen. All had a known medical history of allergic and 21, daily symptoms, tablet intake, and adverse events rhinoconjunctivitis only during the pollen season for at least were collected and confirmed, and nasal washes were the previous 2 years and had a positive serum test for performed. All patients were tested on the same day in the Japanese cedar pollen specific for IgE of Class 2 or greater. morning at the same location in the company. Cellular Patients were excluded if they had received any drugs or had profiles and concentrations of eotaxin, IL-1b, IL-8, and an active respiratory infection within the previous 3 weeks or histamine were measured in nasal lavage fluid. Routine during the study period. Exclusion criteria also included laboratory examinations and specific IgE concentrations a history of drug allergies, presence of other medical condi- were measured in blood samples. At Day 21, patient tions, an established history of wheezing or asthma, and use evaluations of global symptoms were assessed using a self- of immunotherapy or nasal surgery. The enrolled patients report health-related quality of life questionnaire. Downloaded from http://ebm.rsmjournals.com/ by guest on October 14, 2011 ROSMARINIC ACID INHIBITS RHINOCONJUNCTIVITIS 249 Figure 2. HPLC profile of the tablet containing the extract of Perilla frutescens. The concentration of polyphenolic substances including rosmarinic acid was determined by HPLC using a Develosil HG-5 column with solvents A (0.1% v/v trifluoroacetic acid [TFA] in distilled water) and B (0.1% v/v TFA in acetonitrile) under the following conditions: 10%–50% linear gradient of A in B; flow rate, 0.8 ml/min; detection, 280 nm. Tablets. All test tablets were prepared by Meiji Seika was 95% of the instillation volume (6.0 ml); the amounts did Kaisha, Ltd. In brief, fresh Perilla leaves were extracted with not differ by treatment. The lavage fluid was centrifuged at 1.0% w/v citric acid at 908C for 30 mins. The extract was 300 g for 10 mins, and the total cell count was determined filtered and freeze-dried. The concentration of polyphenolic on a fresh fluid specimen. Differential cell counts were substances including rosmarinic acid in this extract was assessed on cytologic preparations stained with Diff-Quik determined by high performance liquid chromatography (International
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