Treatment of Renal Stones With Frankincense (Boswellic Acid): A Clinical Randomized Trial

Investigator Brochure of Olibanum (Boswellic Acid):

A. Clinical Research

Olibanum has been utilized as an important fixative in perfumes, soaps, creams, lotions, and detergents in the leading products of the perfume and cosmetic industry, as it has an oriental note in its scent. The interest of pharmaceutical companies created a third market for olibanum. Since ancient times, it has been used in folk medicine for its antiseptic, antiarthritic, and anti- inflammatory effects. For this reason, olibanum has gained increasing attention from scientists in the last 20 years to better define its medical effects and identify the constituents that are responsible for these effects.4 Animal studies and pilot clinical trials support the potential of B. serrata gum resin extract (BSE) for the treatment of a variety of inflammatory diseases like inflammatory bowel disease, rheumatoid arthritis, osteoarthritis and asthma.5 Moreover, in 2002 the European Medicines Agency classified BSE as an 'orphan drug' for the treatment of peritumoral brain oedema.6 The pharmacological effects of BSE have been mainly attributed to boswellic acids, especially 11-keto-b-boswellic acid (KBA) and acetyl-11-keto-b-boswellic acid (AKBA), which were proposed as selective 5-lipoxygenase (5-LO) inhibitors.7 Thus, instead of 5-LO inhibition by AKBA, inhibition of cathepsin G (catG) and acid might represent the principal mode of action of BSE.8 The gum resin is obtained by incision of the stem or branches of B. serrata. Following air-drying, the gum resin exudate consists of translucent, roundish or irregularly shaped, variable size pieces of up to 3 cm. The main components are volatile oils (5-15%), pure resin (55-66%) and mucus (12-23%). The gum resin typically contains 30% boswellic acids.9 The β-boswellic acid, is considered to be one of the main active components of frankincense. These are some of the chemical compounds present in frankincense: acid resin (56 per cent), soluble in alcohol and having the formula C20H32O4; gum (similar to gum Arabic) 30-36%; 3-acetyl-beta-boswellic acid (Boswellia sacra); alpha-boswellic acid (Boswellia sacra); 4-O-methyl-glucuronic acid (Boswellia sacra); incensole acetate phellandrene .The work of Ibn Sina (Avicenna) of the 11th century refers to the use of frankincense in inflammation and infection of the urinary tract.10 In Kenya it is used for dressing wounds and, when mixed with sesame oil, is taken to reduce the loss of blood in the urine from schistosomiasis infestation. The Antimicrobial activity of Boswellia resin have been suggested by studies.11 The biological activities of essential oils including: Antioxidant activity; Acetylcholinesterase inhibition; Antimicrobial activity and Antifungal activity.11 The antibacterial activity of oleo-gum resins of B. sacra, known as Hoojri, Najdi, Shathari, and Shaabi has been reported.3 All the four oils were effective against both Gram-positive and Gram-negative bacteria. The clinical isolates of Bacillus subtilis, Micrococcus luteus, Staphylococcus aureus, Klebsiella pneumoniae, and Enterobacter aerogenes were sensitive to all the oils, while those of Pseudomonas aeruginosa, Escherichia coli, and Proteus vulgaris were resistant to the Shathari, Najdi, and Hoojri oils, respectively.3 Anticancer activity: multiple pathways that could be activated by frankincense oil to induce bladder cancer cell death.12 The anti-inflammatory and analgesic activities of Boswellia serrata, and B. sacra have been reported.13 Recently It has been shown that the aqueous stem bark extract of Boswellia papyrifera oral administration has a Nephro-curative effects on acetaminophen-induced kidney damage in rats and that effect was found to be dose- and time- dependent.14 In addition, Oleo-gum-resin of Boswellia serrata Roxb induced Reno-protective action against Gentamicin induced nephrotoxicity in Albino rats.15 Also Zingiber officinale Roscoe (Ginger), Arabic gum (AG), and Boswellia have been found to be beneficial adjuvant therapy in participants with acute renal failure and CRF to prevent disease progression and delay the need for renal replacement therapy.16

B. Basic Research

Morphological studies of frankincense on kidney stones done at a preclinical setup, results attached in Appendix I.