Written by Ellen McDonell, Gabriele Dennert and the CAM-Cancer Consortium.
Updated September 11, 2018

Boswellia spp

What is it?

Names

Boswellia subspecies are trees (family: Burseraceae) found in India, Northern Africa and the Middle East 1. Frankincense is the hardened gum resin extruded from incisions in the trunk of several Boswellia species, including Boswellia carterii (African frankincense) and Boswellia serrata (Indian frankincense). The gummy oleo-resin is also known as olibanum (Boswellia carterii) and Salai Guggal (Boswellia serrata) 2.

Medicinal dry extracts from the gummy resin are traded under names such as "H15 Ayurmedica" or "Olibanum" and referred to as “Boswellia extracts” throughout this summary.

Ingredients

Boswellia resin is a mixture containing more than 200 different substances 3, for instance: resin, long-chain sugar compounds, essential oils, proteins, and inorganic compounds 4. Boswellic acids (BAs) have been identified as the putative active principle of the gum resin. BAs are pentacyclic triterpenes with different functional groups in position 3 and 11 of their carbon rings. The most important BAs are:

  • alpha-Boswellic acid
  • beta -Boswellic acid
  • Acetyl-beta-Boswellic acid
  • Acetyl-alpha-Boswellic acid
  • 11-Keto-beta-Boswellic acid (KBA)
  • Acetyl-11-beta-beta-Boswellic acid (AKBA).

Boswellia preparations vary naturally in terms of their content of the different BAs. Medicinal dry extracts are manufactured following standardised procedures to minimise sources of variation within the production process 1.

Application and dosage

Boswellia extracts are administered orally as capsules or tablets usually with a content around 400 mg of Boswellia extract. Providers recommend a daily dosage of 4 to 6 grams per day for adults in the treatment of perifocal brain oedema. Methods to enhance bioavailability have been developed such as lecithin formulations (50). Topically, creams containing 0.5%-2% Boswellic acids have been used (34-36). Essential oils of Boswellia (frankincense) are used as aromatherapy (37, 38).

History

Boswellia preparations have been used in Indian Ayurvedic medicine for the treatment of inflammatory diseases 4. It was also occasionally mentioned in European medical traditions from the Middle Ages to modern times 7. Current research is being conducted on the anti-inflammatory properties of Boswellia extracts and their use in chronic inflammatory diseases like Morbus Crohn or asthma bronchiale.

Claims of efficacy and alleged indications

Boswellia preparations have been used in Indian Ayurvedic medicine for the treatment of inflammatory diseases 4. It was also occasionally mentioned in European medical traditions from the Middle Ages to modern times 7. Current research is being conducted on the anti-inflammatory properties of Boswellia extracts and their use in chronic inflammatory diseases such as rheumatoid arthritis, Crohn’s disease, osteoarthritis, and asthma (48).

Mechanisms of action

Findings with healthy male volunteers indicated a possible initial fast gastric resorption, followed by intestinal resorption 5 depending on concomitant food intake 6. Gastrointestinal resorption of BAs was increased when taken with a high-fat meal. The concentration peak was seen after approximately 4.5 hours. Elimination half time was 6 hours in the mean and varied considerably with concomitant food intake. BAs were found to have a high volume of distribution.

A number of in-vitro molecular targets of boswellic acids have been described, such as 5-lipoxygenase (5-LO), leukocyte elastase 11, topoisomerase 1 and 2 (24), prostaglandin E2 (47), and NF-kappa B (48). The exact mechanisms remain unclear to date.

BAs selectively inhibit the key enzyme of leukotriene synthesis 5-LO 4 and reduce leukotriene biosynthesis in a concentration-dependent manner 10. Among the investigated BAs, AKBA showed the strongest inhibitory efficacy. When multicomponent extracts that contain several BAs (like all Boswellia gum resin extracts) were tested in in-vitro experiments, the composition and dose of the different Boswellic acids has been found to influence the observed effect. Inhibition of leukotriene synthesis could only be seen at higher concentrations; at lower concentrations an increased synthesis of leukotriens was observed.

Some BAs - especially AKBA (48) - have been found to reduce tumour cell proliferation and induce apoptosis in several in-vitro experiments with animal 12,13 and human malignant cell lines (15,27) including glioma (10, 40), melanoma12, leukemia14, multiple myeloma25, prostate26, breast and cervical41, and colon42, as well as in vivo animal studies (16, 43, 44). The underlying mechanism of BA-induced apoptosis and inhibition of cell proliferation are still being elucidated, but include interference with epigenetics in tumour cells 31, increase in caspase 3/7 mediated apoptosis (40, 45), increase in Bax/Bcl-2 ratio (42), modulation of Wnt/beta-catenin pathway and downregulation of NF-kappaB/COX-2 pathway (46), reduction in prostaglandin E2 and its downstream targets (47), and PARP cleavage (48) among others.

Prevalence of use

There is no data on the prevalence of use of Boswellia products in tumour or brain tumour patients.

Legal issues and providers

Boswellia products are traded as "dietary supplements". H 15 Ayurmedica is a registered Ayurvedic medication in India (Gufic, Mumbay, India). Its manufacturer also holds a partial license for Switzerland, but is not licensed within the EU. However, it can be imported to the EU for use in individual patients under specific circumstances and for use in clinical studies. Additionally, some companies sell Boswellia extracts as “dietary supplements” in the EU.

Cost(s) and expenditures

Costs for Boswellia extracts amount to between €40 to 60 per month (depending on the daily dose) when ordered via the internet (plus shipping).

Citation Ellen McDonell, Gabriele Dennert, CAM-Cancer Consortium. Boswellia spp [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Boswellia-spp. September 11, 2018.

References

  1. Ennet D, Poetsch F, Schopka D: Indischer Weihrauch. Pharmazeutische Bewertung der Harzdroge und ihrer Zubereitungen. Deutsche Apotheker Zeitung 2000;140:1887-95.
  2. Buvari PG: Wirksamkeit und Unbedenklichkeit der H15 Ayurmedica-Therapie bei chronisch-entzündlichen Erkrankungen. Med. Diss., Universität Heidelberg 2001.
  3. Kreck C, Saller R: [Herbal drugs of foreign cultures and medical systems exemplified by Indian incense. Considerations regarding social and insurance medicine expert assessment] Phytopharmaka fremder Kulturkreise beziehungsweise Medizinsysteme am Beispiel des indischen Weihrauchs. Überlegungen zur sozial- und versicherungsmedizinischen Begutachtung. Versicherungsmedizin 1999;51:122-7.
  4. Ammon HPT: [Boswellic acids (components of frankincense) as the active principle in treatment of chronic inflammatory diseases] Boswelliasäuren (Inhaltsstoffe des Weihrauchs) als wirksame Prinzipien zur Behandlung chronisch entzündlicher Erkrankungen. Wien Med Wochenschr 2002;152:373-8.
  5. Sharma S, Thawani V, Hingorani L, Shrivastava M, Bhate VR, Khiyani R: Pharmacokinetic study of 11-Keto b-Boswellic acid. Phytomedicine 2004;11:255-60.
  6. Sterk V, Büchele B, Simmet T: Effect of food intake on the bioavailability of Boswellic acids from a herbal preparation in healthy volunteers. Planta Med 2004;70:1155-60.
  7. Schrott E: Weihrauch. Mosaik, München 1998.
  8. Gesellschaft für biologische Krebsabwehr: GfBK-Info Hirntumore/Weihrauch. Heidelberg, 2012. http://www.biokrebs-heidelberg.de/images/stories/download/Therapie_Infos/Hirntumore.pdf (accessed 12.12.2012)
  9. http://www.krebs-kompass.org/forum/forumdisplay.php?f=19 (accessed 12.12.2012)
  10. Glaser T, Winter S, Groscurth P, Safayhi H, Sailer ER, Ammon HP, Schabet M, Weller M: Boswellic acids and malignant glioma: induction of apoptosis but no modulation of drug sensitivity. Br J Cancer 1999;80:756-65.
  11. Safayhi H, Rall B, Sailer ER, Ammon HPT: Inhibition by boswellic acids of human leukocyte elastase. J Pharmacol Experiment Therapeutics 1997; 281(1): 460-463
  12. Zhao W, Entschladen F, Liu H, Niggemann B, Fang Q, Zaenker KS, Han R: Boswellic acid acetate induces differentiation and apoptosis in highly metastatic melanoma and fibrosarcoma cells. Cancer Detect Prev 2003;27:67-75.
  13. Wang L-G, Liu X-M, Ji X-J: Determination of DNA topoisomerase II activity from L1210 cells - a target for screening antitumor agents. Acta Pharmacol Sinica 1991;12:114.
  14. Shao Y, Ho CT, Chin CK, Badmaev V, Ma W, Huang MT: Inhibitory activity of Boswellic acids from Boswellia serrata against human leukemia HL-60 cells in culture. Planta Med 1998;64:328-31.
  15. Hostanska K, Daum G, Saller R: Cytostatic and apoptosis-inducing activity of Boswellic acids toward malignant cell lines in vitro. Anticancer Res 2002;22:2853-62.
  16. Winking M, Sarikaya S, Rahmanian A, Jödicke A, Böker DK: Boswellic acids inhibit glioma growth: a new treatment option? J Neurooncol 2000;46:97-103.
  17. Janssen G, Bode U, Breu H, Dohrn B, Engelbrecht V, Gobel U: Boswellic acids in the palliative therapy of children with progressive or relapsed brain tumors. Klin Padiatr 2000;212:189-95.
  18. Streffer JR, Bitzer M, Schabet M, Dichgans J, Weller,M: Response of radiochemotherapy-associated cerebral oedema to a phytotherapeutic agent, H15. Neurology 2001;56:1219-21.
  19. Heldt MR, Winking M, Simmet T: Cysteinyl-leukotrienes as potential mediators of the peritumoral brain oedema in astrocytoma patients. J Neurooncol 30[2]. 1996.
  20. Böker DK, Winking M: Die Rolle von Boswellia-Säuren in der Therapie maligner Gliome. Deutsches Ärzteblatt 1997;94:A-1197.
  21. Warnke PC, Kopitzki K, Ostertag CB: Die Rolle von Boswellia-Säuren in der Therapie maligner Gliome - Methodische Mängel. Deutsches Ärzteblatt 1998;95:220-2.
  22. Flavin DF: A lipoxygenase inhibitor in breast cancer brain metastases. J Neurooncology 2007;82:91-3.
  23. Ekenel M, Hormigo AM, Peak S, Deangelis LM, Abrey LE: Capecitabine therapy of central nervous system metastases from breast cancer. J Neurooncol 2007; 85(2): 223-7.
  24. Syrovets T, Buchele B, Gedig E, Slupsky JR, Simmet T: Acetyl-boswellic acids are novel catalytic inhibitors of human topoisomerase I and IIα. Mol Pharmacol 2000; 58: 71-81.
  25. Kunnumakkara AB, Nair AS, Sung B, Pandey MK, Aggarwal BB: Boswellic acid blocks signal transducers and activators of transcription 3 signaling, proliferation, and survival of multiple myeloma via the protein tyrosine phosphatase SHP-1. Mol Cancer Res 2009; 7(1):118-28.
  26. Yuan HQ, Kong F, Wang XL, Young CY, Hu XY, Lou HX: Inhibitory effect of acetyl-11-keto-beta-boswellic acid on androgen receptor by interference of Sp1 binding activity in prostate cancer cells. Biochemical Pharmacology 2008; 75(11): 2112-21.
  27. Kaur R, Khan S, Chib R, Kaur T, Sharma PR, Singh J, Shah BA, Taneja SC: A comparative study of proapoptotic potential of cyano analogues of boswellic acid and 11-keto-boswellic acid. Eur J Medicinal Chem 2001; 46: 1356-66.
  28. Frank MB, Yang Q, Osban J, Azzarello JT, Saban MR, Saban R, Ashley RA, Welter JC, Fung K-M, Lin H-K: Frankincense oil derived from Boswellia carteri induces tumor cell specific cytotoxicity. BMC Complementary and Alternative Medicine 2009; 9(6), doi 10.1186/1472-6882-9-6.
  29. Kirste S, Trier M, Wehrle SJ, Becker G, Abdel-Tawab M, Gerbeth K, Hug MJ, Lubrich B, Grosu A-L, Momm F: Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors. Cancer 2011;117(16):3788-95.
  30. Kirste S: Antiödematöse Wirkung von Boswellia serrata auf das Strahlentherapie - assoziierte Hirnödem. Dissertation, University Freiburg/Breisgau, Germany 2009.
  31. Shen Y, Takahashi M, Byun HM, Link A, Sharma N, Balaquer F, Leung HC, Boland CR, Goel A. Boswellic acid induces epigenetic alterations by modulating DNHA methylation in colorectal cancer cells. Cancer Biology & Therapy 2012; 13: 542-552.
  32. Frank A, Unger M. Analysis of frankincense from various Boswellia species with inhibitory activity on human drug metabolising cytochrome P450 enzymes using liquid chromatography mass spectrometry after automated on-line extraction. J Chromatogr A 2006;1112:255-62.
  33. Weber CC, Reising K, Muller WE, Schubert-Zsilavecz M, Abdel-Tawab M, Modulation of Pgp function by boswellic acidsPlanta Med 2006;72:507-13.