Extract of Serenoa repens in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms


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Abstract

This literature review focuses on the use of Serenoa repens extracts in the treatment of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Extracts of Serenoa repens produce marked anti-inflammatory, anti-androgenic and antiproliferative effects. Various extracts differ in their activity depending on the concentration of free fatty acids and the method of extract preparation. Extracts of Serenoa Repens from different manufacturers vary considerably in composition, effectiveness and supporting evidence. Evaluation of the effectiveness of Serenoa Repens extracts should be carried out for each extract separately, depending on the method of preparation and brand. The most studied and clinically effective is the hexane lipidosterol extract of Serenoa Repens Permixon. This assessment is supported by a report on Serenoa Repens, issued by the European Medicines Agency. In this report, only Serenoa repens hexanic extract Permixon is considered to be a well-established medical use product for the symptomatic treatment of BPH.

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About the authors

R. E Amdii

First Pavlov State Medical University

Email: R.E.Amdiy@mail.ru
Dr.Med.Sci., Prof. at the Department of Urology

A. S Al’-Shukri

First Pavlov State Medical University

Email: urolog.kaf@mail.ru
Dr.Med.Sci., professor Urology deparment

References

  1. European Union herbal monograph on Serenoa repens (W. Bartram) Small,fructus.24November2015,EMA/HMPC/280079/2013[p.1-5]. European Medicines Agency Web site. http://www.ema.europa.eu/ docs/ en_GB/document_library/Herbal_-_Herbal_monograph/2016/ 01/ WC500199750.pdf
  2. Cornu J.N., Cussenot O., Haab F., Lukacs B. A widespread population study of actual medical management of lower urinary tract symptoms related to benign prostatic hyperplasia across Europe and beyond official clinical guidelines. Eur Urol. 2010;58:450-456.
  3. Tacklind J., MacDonald R., Rutks I., Stanke J.U., Wilt T.J. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev 2012: CD001423, http://dx.doi.org/10.1002/14651858.CD001423.pub3.
  4. Laekeman G., Vlietinck A. Assessment report on Serenoa repens (W. Bartram) small, fructus. European Medicines Agency Web site. www. ema.europa.eu/ docs/en_GB/ document_library/Herbal_-_HMPC_ assessment_report/2014/WC500179593.pdf. Accessed 7 October 2015).
  5. Di Silvero F., Sciarra F. Esperienza con uno Nuevo antiestrogeno (Serenoa Repens) nella terapia dell’Ipertrofia prostatica benigna. In: Khoury S., Chatelain C., Denis L. et al., eds L’Ipertrophia prostatica benigna. Jersey: Scientific Communication International Ltd; 1993;184-188.
  6. Dathe G., Schmid H. Phytotherapie der benignen Prostatahyperplasie (BPH) mir extractum Serenoa Repens (Permixon). Urologe B. 1991;31:220-223.
  7. De Monte C., Carradori S., Granese A., Di Pierro G.B., Leonardo C., De Nunzio C. Modern extraction techniques and their impact on the pharmacological profile of Serenoa repens extracts for the treatment of lower urinary tract symptoms. BMC Urol. 2014;14:63-67.
  8. Habib F.K., Wyllie M.G. Not all brands are created equal: a comparison of selected components of different brands of Serenoa repens extract. Prostate Cancer Prostatic Dis 2004;7:195-200.
  9. Booker A., Sutera A., Krnjic A. et al. A phytochemical comparison of saw palmetto products using gas chromatography and 1H nuclear magnetic resonance spectroscopy metabolomic profilinig. J. Pharm Pharmacol. 2014;66:811-822.
  10. Sultan Ch., Terazza A., Devillier C. et al. Inhibition ofandrogen metabolism and binding by a liposterolic extract of “Serenoa Repens B” in human foreskin fibroblasts J. Steroid Biochem. 1984;20(1):515-519.
  11. El-Sheikh M., Dakkar M.R., Saddique A. The effect of permixon and androgen receptors. Acta Obstet Gynecol Scand. 1988;67:397-399.
  12. Bayne C.W., Donnelly F., Ross M. et al. Serenoa repens (Permixon®): A 5a-Reductase Types I. and II Inhibitor-New Evidence in a coculture model of BPH. The Prostate. 1999;40:232-241.
  13. Weisser H., Tunn S., Behnke B., Krieg M. Effects of the sabal serrulata extract IDS 89 and its subfractions on 5 alpha-reductase activity in human benign prostatic hyperplasia. Prostate. 1996;28(5):300-306.
  14. Palin M.F., Faguy M., LeHoux J.G., Pelletier G. Inhibitory effects of Serenoa repens on the kinetic of pig prostatic microsomal 5alpha-reductase activity. Endocrine. 1998;9(1):65-69.
  15. Habib F.K., Ross M., Ho C.K., Lyons V., Chapman K. Serenoa repens (Permixon) inhibits the 5 alpha-reductase activity of human prostate cancer cell lines without interfereng with PSA expression. Int J. Cancer. 2005;114(2):190-194.
  16. Raynard J.P., Cousse H. and Martin P.M. Inhibition of type 1 and type 2 5 alpha-reductase activity by free fatty acids, active ingredients of Permixon®. J Steroid Biochem Mol Biol. 2002;82:233-239
  17. Scaglione F., Luchini V., Pannacci M., Caronno A., Leone C. Comparison of the potency of different brands of Serenoa repens extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells. Pharmacology. 2008;82:270-275.
  18. Rhodes L., Primka R.L., Berman C., Vergult G., GabrielM., Pierre-Malice M., Gibelin B. Comparison of finasteride (Proscar), a 5 alpha reductase inhibitor, and various commercial plant extracts in in vitro and in vivo 5 alpha reductase inhibition. Prostate. 1993;22(1):43-51.
  19. Scaglione F., Lucini V., Pannacci M., Caronno A., Leone C. Comparison of the potency of different brands of Serenoa repens extract on 5alpha-reductase types I and II in prostatic co-cultured epithelial and fibroblast cells. Pharmacology. 2008;82:270-275.
  20. Scaglione F., Lucini V., Pannacci M., Dugnani S., Leone C. Comparison of the potency of 10 different brands of Serenoa repens extracts. Eur Rev Med Pharmacol Sci. 2012;16:569-574.
  21. Koch E. Pharmakologie und Wirkmechanismen von Extrakten aus Sabalfructen (Sabal fructus), Brenneeelwurzen (Urticae radix und Kurbissamen (Cucurbitae peponis semen) bei der Behandlung der benignen Prostatahyperplasie. In Loew D., Rietbrock N (Hrsg) Phytopharmaka in Forschung und klinischer Anwendung. Steinkopff Verlag, 1995. Darmstad: 57-59.
  22. Goepel M., Hecker U., Krege S., Rübben H., Michel M.C. Saw palmetto extracts potently and noncompetitively inhibit human alpha1-adrenoceptors in vitro. Prostate. 1999;38(3):208-215.
  23. Abe M., Ito Y., Oyunzul L., Oki-Fujino T., Yamada S. Pharmacologically relevant receptor binding characteristics and 5alpha-reductase inhibitory activity of free Fatty acids contained in saw palmetto extract. Biol Pharm Bull. 2009;32(4):646-650.
  24. Carilla E, Briley M., Fauran F., Sultan C., Duvilliers C. et al. Binding of Permixon, a new treatment for prostatic benign hyperplasia, to the cytosolic androgen receptor in the rat prostate. J. Steroid Biochem. 1984;20(1):521-523.
  25. De la Taille A. Therapeutic Approach: The Importance of Controlling Prostatic Inflammation. Eur Urol. 2013; Suppl. 12:116-122.
  26. Hiermann A. The contents of sabal fruits and testing of their antiinflammatory effect. Arch Pharm (Weinheim). 1989;322(2):111-114.
  27. Breu W., Hagenlocher M., Redl K., Tittel G., Stadler F., Wagner H. Antiinflammatory activity of sabal fruit extracts prepared with supercritical carbon dioxide. In vitro antagonists of cyclooxygenase and 5-lipoxygenase metabolism. Arzneimittelforschung. 1992;42(4):547-551.
  28. Paubert-Braquet M., Menciahuerta J.M., Cousse H. et al. Effect of the lipidic lipidosterolic extract of Serenoa repens (Permixon®) on the ionophore A23187-stimulated production of leukotriene B4 (LTB4) from human polymorphonuclear neutrophilis. Prostaglandins, Leukotrienes and Essential Fatty Acids, 1997.
  29. Tarayre J.P., Delhon A., Lauressergues H. et al. Anti-edematous action of a hexane extract of the stone fruit of Serenoa repens Bartr. Ann Pharm Fr. 1983;41(6):559-570.
  30. Latil A., Libon C., Templier M. et al. Hexanic lipidosterolic extract of Serenoa repens inhibits the expression of two key inflammatory mediators, MCP-1/ CCL2 and VCAM-1, in vitro. BJU Int. 2012;110 (6 Pt B):E301-07.
  31. Iglesias-Gato D. et al. Androgenindependent effects of Serenoa repens extract Prostasan(R) on prostatic epithelial cell proliferation and inflammation. Phytother Res. 2011;26:259-264.
  32. Sirab N., Robert G., Fasolo V., Descazeaud A., Vacherot F., de la Taille A., Terry S. Lipidosterolic extract of serenoa repens modulates the expression of inflammation related-genes in benign prostatic hyperplasia epithelial and stromal cells. Int J. Mol Sci. 2013;14:14301-14320.
  33. Vacher P., Prevarskaya N., Skryma R. et al. The Lipidosterolic Extract from Serenoa repens Interferes with Prolactin Receptor Signal Transduction. J. Biomed Sci. 1995;2:357-365.
  34. Paubert-Braquet M., Cousse H., Raynaud J.P. et al. Effect of the Lipidosterolic Extract of Serenoa Repens (Permixon®) and its major Components on Basic Fibroblast Growth Factor-Induced Proliferation of Cultures of Human Prostate Biopsies. Eur. Urol. 1998;33:340-347.
  35. Van Coppenolle F., Le Bourhis X., Carpentier F. et al. Pharmacological Effects of the Lipidosterolic Extract of Serenoa repens (Permixon®) on Rat Prostate Hyperplasia Induced by Hyperprolactinemia: Comparison with Finasteride. The Prostate. 2000;43:49-58.
  36. Wadsworth T.L., Carol J.M., Mallinson R.A. et al. Saw palmetto extract suppresses insulin-like growth factor-1 signaling and induces stress activated protein kinase/C-jun N-terminal kinase phosphorylation in human prostate epithelial cells. Endocrinology. 2004;145(7):3205-3214.
  37. Petrangeli E., Lenti L., Buchetti B. Lipido-sterolic extract of Serenoa repens (LSESr, Permixon®) treatment affects human prostate cancer cell membrane organization. J. Cellular Physiology. 2009;219(Issue 1):69-76.
  38. Chevalier G., Benard P., Cousse H., Bengone T. Distribution study of radioactivity in rats after oral administration of the lipidosterolic extract of Serenoa repens (Permixon) supplemented with [1-14C]-lauric acid, [1-14C]-oleic acid or [4-14C]-beta-sitosterol. Eur J. Drug Metab Pharmacokinet. 1997;22(1):73-83.
  39. Mattei F.M., Capone M., Acconcia A. Medikamentose therapie der benignen prostatahyperplasie mit einem extrakt der sagepalme. TWUrologie Nephrologie. 1990;2:346-350.
  40. Barry M.J., Meleth S., Lee J.Y. et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306:1344-1351.
  41. Gorne R.C. Systematisches Review zur Therapie von Symptomen der unteren Harnwege (LUTS) mit und ohne benigne Prostatahyperplasie (BPH) mit alkoholischen Extrakten von Sagepalmenfrüchten. Z. Phytother. 2014;35(03):111-118.
  42. Braeckman J., Denis L., De Leval J. et al. A double-blind placebo-controlled study of the plant extract Serenoa repens in the treatment of benign hyperplasia of the prostate. Eur J. Clin Res. 1997;9:247-259.
  43. Bent S., Kane C., Shinohara K. et al. Saw palmetto for benign prostatic hyperplasia. N. Engl J. Med. 2006;354:557-566.
  44. Willetts K.E., Clements M.S., Champion S. et al. Serenoa repens extract for benign prostate hyperplasia: a randomized controlled trial. BJU Int. 2003;92:267-270.
  45. Di Silverio F., Monti S., Sciarra A. et al. Effects of long-term treatment with Serenoa repens (Permixon) on the concentrations and regional distribution of androgens and epidermal growth factor in benign prostatic hyperplasia. Prostate. 1998;37(2):77-83.
  46. Latil A., Pe'trissans M.T., Rouquet J., Robert G., de la Taille A. Effects of hexanic extract of Serenoa repens (Permixon1 160 mg) on inflammation biomarkers in the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. Prostate. 2015;75:1857-1867.
  47. Vela Navarrete R., Garcia Cardoso J.V., Barat A. et al. BPH and inflammation: pharmacological effects of Permixonon histological and molecular inflammatory markers. Results of a double blind pilot clinical assay. Eur Urol. 2003;44:549-555.
  48. Boyle P., Robertson C., Lowe F., Roehrborn C. Updated meta-analysis of clinical trials of Serenoa repens extract in the treatment of symptomatic benign prostatic hyperplasia. BJU Int. 2004;93:751-756.
  49. Novara G., Giannarini G., Alcaraz A. et al. Efficacy and Safety of Hexanic Lipidosterolic Extract of Serenoa repens (Permixon) in the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus. 2016;2(5):553-561.
  50. Al-Shukri S.H., Deschaseaux P., Kuzmin I.V., Amdiy R.E. Early urodynamic effects of the lipido-sterolic extract of Serenoa repens (Permixon) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2000;3(3):195-199.
  51. Аль-Шукри С.Х., Ткачук В.Н., Горбачев А.Г., Кузьмин И.В., Амдий Р.Э., Козлов В.В. Уродинамические исследования в диагностике инфравезикальной обструкции у мужчин. Урология и нефрология. 1998;6:27-29
  52. Аль-Шукри С.Х., Амдий Р.Э. Диагностика инфравезикальной обструкции у больных аденомой предстательной железы. Урология. 2006;2:41-45
  53. Аль-Шукри С.Х., Амдий Р.Э. Значение комбинированного уродинамического обследования больных с неудовлетворительными результатами оперативного лечения аденомы предстательной железы. Урология. 2006;4:11-13
  54. Амдий Р.Э., Аль-Шукри С.Х. Связь между уродинамическими показателями и функцией почек у больных доброкачественной гиперплазией предстательной железы. Урологические ведомости. 2012;2(2):12-15
  55. Амдий Р.Э., Аль-Шукри С.Х. Связь между уродинамическими показателями и функцией почек у больных доброкачественной гиперплазией предстательной железы. Урологические ведомости. 2012;2(2):12-15.
  56. Кузьмин И.В., Аль-Шукри А.С., Амдий Р.Э., Гиоргобиани Т.Г. Уродинамическая диагностика инфравезикальной обструкции у мужчин. Урологические ведомости. 2013;3(1):14-17
  57. Кузьмин И.В., Аль-Шукри А.С., Амдий Р.Э., Гиоргобиани Т.Г. Уродинамическая диагностика инфравезикальной обструкции у мужчин. Урологические ведомости. 2013;3(1):14-17
  58. Сивков А.В., Ромих В.В., Ощепков В.Н., Малышев А.В. Препарат Пермиксон в лечении заболеваний предстательной железы с позиций доказательной медицины Эффективная Фармакотерапия. Урология и нефрология. 2007;4:12-19
  59. Carraro J.C., Raynaud J.P., Koch G. et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996;29:231-240.
  60. Debruyne F., Koch G., Boyle P. et al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Eur Urol. 2002;41:497-506.
  61. Koch G., Boyle P. et al. Comparison of a phytotherapeutic agent (Permixon) with an alpha-blocker (tamsulosin) in the treatment of benign prostatic hyperplasia: a 1-year randomized international study. Eur Urol. 2002;41:497-506.
  62. Glemain P., Coulange C., Billebaud T., Gattegno B., Muszynski R., Loeb G., OCOS workgroup. Tamsulosin with or without Serenoa repens in benign prostatic hyperplasia: the OCOS trial. Prog Urol. 2002;12:395-403.
  63. Ryu Y.W., Lim S.W., Kim J.H., Ahn S.H., Choi J.D. Comparison of tamsulosin plus serenoa repens with tamsulosin in the treatment of benign prostatic hyperplasia in Korean men: 1-year randomized open label study. Urol Int. 2015;94:187-193.
  64. Аляев Ю.Г., Лопаткин Н.А., Винаров А.З., Сивков А.В. и др. Результаты мультицентрового исследования экстракта Serenoa repens (Пермиксон®) у больных хроническим абактериальным простатитом. Урология. 2007;5:3-7.
  65. Аляев Ю.Г., Винаров А.З., Демидко Ю.Л., Спивак Л.Г. Результаты 10-летнего исследования эффективности и безопасности применения экстракта Serenoa repens у пациентов с риском прогрессирования аденомы предстательной железы. Урология. 2013;4:32-36

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