Health Care Professional Information

Scientific Name
Boswellia serrata
Common Name

Indian frankincense

Clinical Summary

Boswellia or Indian frankincense is an ayurvedic herb that is derived from the resin of the plant. It is used traditionally to treat arthritis, ulcerative colitis, coughs, sores, snakebite, and asthma. The major component is boswellic acid (1), which was shown in animal studies to be a potent 5-lipoxygenase inhibitor with anti-inflammatory and antiarthritic effects (1) (2) (3). Other studies suggest that it has cytotoxic properties (4) (5) (6) (7).

Data from clinical trials indicate effectiveness of Boswellia for bronchial asthma (8) and ulcerative colitis (9). However, evidence is mixed for its benefits for osteoarthritis (10) (11) and collagenous colitis (12) (13) (14). Boswellia was also investigated for its role in maintenance of Crohn's disease remission, but it demonstrated no significant benefit (15). Preliminary findings suggest boswellia's effectiveness in reducing cerebral edema in patients with brain tumors following radiotherapy (23).

Boswellic acid has fewer adverse effects than steroids and non-steroidal anti-inflammatory drugs. However, its long-term effects on humans are unknown. Although similar in many functions, boswellia should not be confused with guggul or myrrh.

Purported Uses
  • Arthritis
  • Asthma
  • Colitis
  • Inflammation
  • Menstrual cramps
Constituents

Triterpene Acids: Boswellic acid and its isomers
Essential oils: Mainly alpha-thujene and p-cymene
(24) (25)

Mechanism of Action

Boswellic acid, the major constituent of boswellia, is thought to contribute to most of the herb's pharmacological activities. In vitro studies and animal models show that boswellic acid inhibits 5-lipoxygenase selectively (1) (3) and has anti-inflammatory (13), antiarthritic, and anti-proliferative effects (2). Boswellia reduces chemically-induced edema and inflammation in rodents. Boswellic acid was also shown to inhibit NF-KB signaling pathways in macrophages in mouse model of psoriasis, markedly decreasing the production of the proinflammatory key cytokine TNF-alpha and the chemokine MCP-1. This effect was accompanied by the resolution of inflammatory infiltrates and normalization of hyperkeratosis (17). Unlike other non-steroidal anti-inflammatory drugs, however, boswellic acid fails to show analgesic or antipyretic effects (16). In addition, it does not cause gastric ulcers in animals. This suggests that the action of boswellic acid is through other mechanisms than the inhibition of prostaglandin synthesis.
Research on the cytotoxic effects of boswellic acid indicates that it induces p21 expression through a p53-independent pathway and causes apoptosis in glioma (4) (6) and leukemia (5) cell lines. In addition, a Boswellia extract induced apoptosis in a cervical cancer cell line by inducing endoplasmic reticulum (ER) stress (18); another apoptotic mechanism exhibited by Boswellia is via oxidative stress by early generation of nitric oxide and reactive oxygen species that up regulate time-dependent expression of p53/p21/PUMA (19). One study suggests that acetyl-boswellic acids can inhibit topoisomerases by competing with DNA for binding sites (20). Another study found that acetyl-11-keto-beta-boswellic acid (AKBA) inhibits the activation of signal transducers and activators of transcription-3 (STAT-3), which has been linked with survival, proliferation, chemoresistance, and angiogenesis of tumor cells (21). Further, AKBA inhibits human prostate tumor growth via inhibition of angiogenesis induced by VEGFR2 signaling pathways (22).

Pharmacokinetics

Two to three hours after an oral dose of 1.2 g dry extract boswellia gum resin, plasma concentrations were measured at 10 to 32 micromolar of 11-keto-beta-boswellic acid and 18 to 20 micromolar of acetyl-11-keto-beta-boswellic acid. (8)

Literature Summary and Critique

Holtmeier W, et al. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn's disease: Inflamm Bowel Dis. 2010;May 19.
In this randomized, placebo-controlled, double-blind trial, patients with Crohn's disease (CD) were treated with two oral capsules of 400 mg Boswellia serrata extract (n=42) or placebo (n=40) three times daily for 12 months. Enrolled patients were currently in remission from CD but had experienced at least two documented relapses during the last 4 years. This study found that 59.9% of the Boswellia-treated and 55.3% of the placebo-treated patients maintained remission from Crohn's disease, indicating no statistically significant difference in efficacy between the active and control groups (p=0.085). Time to remission was 171 days for the active group and 185 days for placebo (p=0.69). There was also no statistically significant difference in tolerability between the active and placebo groups (p=0.087). The investigators concluded that Boswellia serrata demonstrated good tolerability in the long-term treatment of CD. However, the superiority of this treatment to placebo in the maintenance of CD remission could not be established.

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References
  1. Dahmen U, Gu YL, Dirsch O, et al. Boswellic acid, a potent antiinflammatory drug, inhibits rejection to the same extent as high dose steroids. Transplant Proc. Feb-Mar 2001;33(1-2):539-541.
  2. Safayhi H, Boden SE, Schweizer S, et al. Concentration-dependent potentiating and inhibitory effects of Boswellia extracts on 5-lipoxygenase product formation in stimulated PMNL. Planta Med. Mar 2000;66(2):110-113.
  3. Safayhi H, Mack T, Sabieraj J, et al. Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase. J Pharmacol Exp Ther. Jun 1992;261(3):1143-1146.
  4. Glaser T, Winter S, Groscurth P, et al. Boswellic acids and malignant glioma: induction of apoptosis but no modulation of drug sensitivity. Br J Cancer. May 1999;80(5-6):756-765.
  5. Jing Y, Nakajo S, Xia L, et al. Boswellic acid acetate induces differentiation and apoptosis in leukemia cell lines. Leuk Res. Jan 1999;23(1):43-50.
  6. Winking M, Sarikaya S, Rahmanian A, et al. Boswellic acids inhibit glioma growth: a new treatment option? J Neurooncol. 2000;46(2):97-103.
  7. Frank MB, Yang Q, Osban J, et al. Frankincense oil derived from Boswellia carteri induces tumor cell specific cytotoxicity. BMC Complement Altern Med. 2009 Mar 18;9:6.
  8. Gupta I, Gupta V, Parihar A, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res. Nov 17 1998;3(11):511-514.
  9. Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. Jan 1997;2(1):37-43.
  10. Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. Jul 2007;21(7):675-683.
  11. Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin(R) for treatment of osteoarthritis of the knee. Arthritis Res Ther. Jul 30 2008;10(4):R85.
  12. Chande N, McDonald JW, MacDonald JK. Interventions for treating collagenous colitis. Cochrane Database Syst Rev. 2006(4):CD003575.
  13. Madisch A, Miehlke S, Eichele O, et al. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. Int J Colorectal Dis. Dec 2007;22(12):1445-1451.
  14. Chande N, MacDonald JK, McDonald JW. Interventions for treating microscopic colitis: a Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Review Group systematic review of randomized trials. Am J Gastroenterol. 2009 Jan;104(1):235-41.
  15. Holtmeier W, Zeuzem S, PreiB, J, et al. Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn's disease. Inflamm Bowel Dis. 2010 May 19.
  16. Singh GB, Atal CK. Pharmacology of an extract of salai guggal ex-Boswellia serrata, a new non-steroidal anti-inflammatory agent. Agents Actions. Jun 1986;18(3-4):407-412.
  17. Wang H, Syrovets T, Kess D, et al. Targeting NF-KB with a natural triterpenoid alleviates skin inflammation in a mouse model of psoriasis. J Immunol. Oct 2009;183(7):4755-63.
  18. Kim HR, Kim MS, Kwon DY, et al. Boswellia serrata-induced apoptosis is related with ER stress and calcium release. Genes Nutr. Feb 2008;2(4):371-374.
  19. Bhushan S, Malik F, Kumar A, et al. Activation of p53/p21/PUMA alliance and disruption of PI-3/Akt in multimodal targeting of apoptotic signaling cascades in cervical cancer cells by a pentacyclic triterpenediol from Boswellia serrata. Mol Carcinog. 2009 Jun 18.
  20. Syrovets T, Buchele B, Gedig E, et al. Acetyl-boswellic acids are novel catalytic inhibitors of human topoisomerases I and IIalpha. Mol Pharmacol. Jul 2000;58(1):71-81.
  21. Kunnumakkara AB, Nair AS, Sung B, et al. 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 Jan;7(1):118-28.
  22. Pang X, Yi Z, Zhang X, et al. Acetyl-11-keto-beta-boswellic acid inhibits prostate tumor growth by suppressing vascular endothelial growth factor receptor 2-mediated angiogenesis. Cancer Res. 2009 Jul 15;69(14):5893-900.
  23. Kirste S, Treier M, Wehrle SJ, et al. Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors: A prospective, randomized, placebo-controlled, double-blind pilot trial. Cancer. 2011; 117(16):3788-95.

  24. Camarda L, Dayton T, Di Stefano V, Pitonzo R, Schillaci D. Chemical composition and antimicrobial activity of some oleogum resin essential oils from Boswellia spp. (Burseraceae). Ann Chim. 2007 Sep;97(9):837-44.
  25. Mikhaeil BR, Maatooq GT, Badria FA, Amer MM. Chemistry and immunomodulatory activity of frankincense oil. Z Naturforsch C. 2003 Mar-Apr;58(3-4):230-8.

Consumer Information

How It Works

Bottom Line: Boswellia is effective for inflammatory conditions, such as arthritis. Its anticancer effects have not been demonstrated in humans.

Boswellia, a tree gum resin often used in Ayurvedic medicine, was analyzed in the laboratory and found to contain boswellic acid, which scientists think accounts for its biological activity. In lab animals, boswellic acid inhibited an enzyme that is important in the process of inflammation, and it therefore reduces swelling caused by chemicals or arthritis. It also slowed down the replication of cancer cells and caused cell death of some cancer cells in the laboratory. Unlike other anti-inflammatory drugs , boswellic acid does not appear to reduce pain or fever, in lab animals. Boswellia's anti-inflammatory effects were supported in a few clinical trials of patients with colitis and osteoarthritis. But larger studies are needed. Boswellia was also studied in the maintenance of Crohn's disease remission, but showed no significant benefit.

Purported Uses
  • To treat osteoarthritis
    A randomized controlled trial demonstrated that Boswellia serrata extract is better than a placebo for osteoarthritis, but other studies do not find a benefit.
  • To treat asthma
    Results from a clinical trial showed that boswellia may reduce symptoms of bronchial asthma, but more studies are needed to draw a conclusion.
  • To treat colitis
    Studies in laboratory animals suggest that boswellia can reduce inflammation, and clinical trials support this use in humans, but further research is needed.
  • To reduce inflammation
    Studies in laboratory animals and from clinical trials show that this herb can reduce certain inflammatory conditions.
  • To relieve menstrual cramps
    No scientific evidence supports this use.
  • To treat cancer
    No evidence supports the idea that boswellia has a role in cancer treatment.
Research Evidence

Crohn's Disease:
In a clinical trial of patients with Crohn's disease (CD) in remission, 42 patients were given two oral capsules of 400 mg Boswellia serrata extract and 40 patients received two capsules of placebo three times a day for 12 months. This study found that 59.9% of the Boswellia-treated and 55.3% of the placebo-treated patients maintained remission from Crohn's disease. The investigators concluded that Boswellia serrata demonstrated good tolerability in the long-term treatment of CD. However, the superiority of Boswellia treatment to placebo in the maintenance of CD remission could not be established.

Side Effects

None known

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