Abstract
Introduction: Astragalus is used in traditional Chinese medicine for immune system disorders. Its effect on immune system function is evaluated in multiple studies. The objective of this systematic review and meta-analysis was to evaluate the effect of Astragalus on humoral and cellular immune response in human studies. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies published up to April 2023. Studies that assessed the impact of Astragalus on humoral and cellular immune markers were included. The data were extracted, and a random-effects meta-analysis was performed to determine the overall effect size. Subgroup analyses were conducted based on outcome measures. Results: A total of 19 studies, including 1,094 human participants, were included in the meta-analysis. The analysis of humoral immune markers revealed a significant reduction in proinflammatory cytokines, including IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ, following Astragalus intervention (SMD −2.8765, 95% CI: −3.2385 to −2.5145, p < 0.0001). In the cellular immunity domain, Astragalus was found to significantly increase CD3 levels and the CD4/CD8 ratio (SMD 2.4629, 95% CI: 1.9598; 2.9661). Subgroup analyses based on outcome measures supported these findings. However, substantial heterogeneity was observed among the included studies. Conclusion: This systematic review and meta-analysis provide evidence supporting the immunomodulatory effects of Astragalus on humoral and cellular response. Astragalus demonstrated a significant reduction in proinflammatory cytokines and an enhancement of cellular immune markers, suggesting its potential as a therapeutic agent for immune-related disorders.
Journal Section:
Systematic Review / Systematische Übersichtsarbeit
References
1.
Parbat
AY
, Malode
GP
, Shaikh
AR
, Panchale
WA
, Manwar
JV
, Bakal
RL
. Ethnopharmacological review of traditional medicinal plants as immunomodulator
. World J Bio Pharm Health Sci
. 2021
;6
(2
):43
–55
.2.
Li
CX
, Liu
Y
, Zhang
YZ
, Li
JC
, Lai
J
. Astragalus polysaccharide: a review of its immunomodulatory effect
. Arch Pharm Res
. 2022
;45
(6
):367
–89
.3.
Shahrajabian
M
, Sun
W
, Cheng
Q
. A review of astragalus species as foodstuffs, dietary supplements, a traditional Chinese medicine and a part of modern pharmaceutical science
. Appl Ecol Environ Res
. 2019
;17
(6
):13371
–82
.4.
Tan
TT
, Coussens
LM
. Humoral immunity, inflammation and cancer
. Curr Opin Immunol
. 2007
;19
(2
):209
–16
.5.
Huntington
ND
, Cursons
J
, Rautela
J
. The cancer–natural killer cell immunity cycle
. Nat Rev Cancer
. 2020
;20
(8
):437
–54
.6.
Mahmoudi
M
, Abdellaoui
R
, Boughalleb
F
, Yahia
B
, Mabrouk
M
, Nasri
N
. Characterization of lipids, proteins, and bioactive compounds in the seeds of three Astragalus species
. Food Chem
. 2021
;339
:127824
.7.
Wang
J
, Jia
J
, Song
L
, Gong
X
, Xu
J
, Yang
M
. Extraction, structure, and pharmacological activities of Astragalus polysaccharides
. Appl Sci
. 2018
;9
(1
):122
.8.
Shojaii
A
, Motaghinejad
M
, Norouzi
S
, Motevalian
M
. Evaluation of anti-inflammatory and analgesic activity of the extract and fractions of Astragalus hamosus in animal models
. Iran J Pharm Res
. 2015
;14
(1
):263
–9
.9.
Li
R
, Chen
WC
, Wang
WP
, Tian
WY
, Zhang
XG
. Antioxidant activity of Astragalus polysaccharides and antitumour activity of the polysaccharides and siRNA
. Carbohydr Polym
. 2010
;82
(2
):240
–4
.10.
Li
W
, Song
K
, Wang
S
, Zhang
C
, Zhuang
M
, Wang
Y
. Anti-tumor potential of astragalus polysaccharides on breast cancer cell line mediated by macrophage activation
. Mater Sci Eng C Mater Biol Appl
. 2019
;98
:685
–95
.11.
Wang
W
, Jing
W
, Liu
Q
. Astragalus oral solution ameliorates allergic asthma in children by regulating relative contents of CD4(+)cd25(high)CD127(low) treg cells
. Front Pediatr
. 2018
;6
:255
. Epub 2018 Oct 9.12.
Luo
Z
, Liu
Y
, Zhao
Z
, Yan
X
, Wang
D
, Liu
Q
. Effects of Astragalus injection and Salvia Miltiorrhiza injection on serum inflammatory markers in patients with stable coronary heart disease: a randomized controlled trial protocol
. Trials
. 2020
;21
(1
):267
. Epub 2020 Mar 18.13.
Latour
E
, Arlet
J
, Latour
EE
, Juszkiewicz
A
, Łuczkowska
K
, Marcinkiewicz
A
. Standardized astragalus extract for attenuation of the immunosuppression induced by strenuous physical exercise: randomized controlled trial
. J Int Soc Sports Nutr
. 2021
;18
(1
):57
. Epub 2021 Jul 18.14.
Wei
H
, Sun
R
, Xiao
W
, Feng
J
, Zhen
C
, Xu
X
. Traditional Chinese medicine Astragalus reverses predominance of Th2 cytokines and their up-stream transcript factors in lung cancer patients
. Oncol Rep
. 2003
;10
(5
):1507
–12
.15.
Liu
QY
, Yao
YM
, Yu
Y
, Dong
N
, Sheng
ZY
. Astragalus polysaccharides attenuate postburn sepsis via inhibiting negative immunoregulation of CD4+ CD25high T cells
. PLoS One
. 2011
;6
(6
):e19811
.16.
Tsao
SM
, Wu
TC
, Chen
J
, Chang
F
, Tsao
T
. Astragalus polysaccharide injection (PG2) normalizes the neutrophil-to-lymphocyte ratio in patients with advanced lung cancer receiving immunotherapy
. Integr Cancer Ther
. 2021 Jan–Dec
20
1534735421995256
. Epub 2021 Feb 16.17.
Huang
WC
, Kuo
KT
, Bamodu
OA
, Lin
YK
, Wang
CH
, Lee
KY
. Astragalus polysaccharide (PG2) ameliorates cancer symptom clusters, as well as improves quality of life in patients with metastatic disease, through modulation of the inflammatory cascade
. Cancers
. 2019
;11
(8
):1054
. Epub 2019 Jul 28.18.
Zhang
C
, Wei
P
, Kou
W
, Kang
HY
, Yao
HB
. [Effect of Astragalus membranaceus on peripheral blood Th17 in patients with allergic rhinitis]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2016
;36
(11
):1364
–8
. Epub 2016 Nov 1.19.
Wang
QZ
, Chen
XP
, Huang
JP
, Jiang
XW
. [Effects of couplet medicines (Astragalus membranaceus and jiaozhen) on intestinal barrier in postoperative colorectal cancer patients]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2015
;35
(11
):1307
–12
. Epub 2016 Jan 19.20.
Lin
Y
, Wang
B
, Luo
XQ
. [Clinical study of astragalus’s preventing the recurrence of asthma in children]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2011
;31
(8
):1090
–2
. Epub 2011 Sep 14.21.
Yang
QY
, Lu
S
, Sun
HR
. [Effects of astragalus on cardiac function and serum tumor necrosis factor-alpha level in patients with chronic heart failure]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2010
;30
(7
):699
–701
. Epub 2010 Oct 12.22.
Matkovic
Z
, Zivkovic
V
, Korica
M
, Plavec
D
, Pecanic
S
, Tudoric
N
. Efficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis
. Phytother Res
. 2010
;24
(2
):175
–81
. Epub 2009 Jun 09.23.
Hu
YJ
, Li
L
, Gong
SX
. [Regulatory effect of astragalus injection on Th1/Th2 cell function in patients with cervical cancer]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2010
;30
(11
):1157
–9
. Epub 2011 Feb 1.24.
Niu
GH
, Sun
X
, Zhang
CM
. [Effect of compound astragalus recipe on lymphocyte subset, immunoglobulin and complements in patients with myasthenia gravia]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2009
;29
(4
):305
–8
. Epub 2009 Jun 17.25.
Wang
F
, Xiao
MD
, Liao
B
. [Effect of Astragalus on cytokines in patients undergoing heart valve replacement]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2008
;28
(6
):495
–8
. Epub 2008 Jul 29.26.
Wang
MS
, Li
J
, Di
HX
, Li
ZL
, Yang
SL
, Hou
W
. Clinical study on effect of Astragalus Injection and its immuno-regulation action in treating chronic aplastic anemia
. Chin J Integr Med
. 2007
;13
(2
):98
–102
. Epub 2007 Jul /5.27.
Wu
J
, Wang
YX
, Su
WL
, Zhu
WX
, Lu
JW
, Li
ZK
. Effect of astragalus injection on serious abdominal traumatic patients’ cellular immunity
. Chin J Integr Med
. 2006
;12
(1
):29
–31
. Epub 2006 Mar 31.28.
Wang
G
, Liu
CT
, Wang
ZL
, Yan
CL
, Luo
FM
, Wang
L
. Effects of Astragalus membranaceus in promoting T-helper cell type 1 polarization and interferon-gamma production by up-regulating T-bet expression in patients with asthma
. Chin J Integr Med
. 2006
;12
(4
):262
–7
. Epub 2007 Mar 17.29.
Jin-guo
Z
, Na
Y
, Hua
H
, Guang-he
W
, Dong-sheng
G
, Xiao-li
W
. [Effect of Astragalus injection on plasma levels of apoptosis-related factors in aged patients with chronic heart failure]
. Chin J Integr Med
. 2005
;11
(3
):187
–90
. Epub 2005 Sep27.30.
Mao
SP
, Cheng
KL
, Zhou
YF
. [Modulatory effect of Astragalus membranaceus on Th1/Th2 cytokine in patients with herpes simplex keratitis]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2004
;24
(2
):121
–3
. Epub 2004 Mar 16.31.
Liu
ZG
, Xiong
ZM
, Yu
XY
. [Effect of astragalus injection on immune function in patients with congestive heart failure]
. Zhongguo Zhong Xi Yi Jie He Za Zhie
. 2003
;23
(5
):351
–3
. Epub 2003 Jun 13.32.
Duan
P
, Wang
ZM
. [Clinical study on effect of Astragalus in efficacy enhancing and toxicity reducing of chemotherapy in patients of malignant tumor]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2002
;22
(7
):515
–7
. Epub 2003 Feb 21.33.
Paudyal
V
, Sun
S
, Hussain
R
, Abutaleb
MH
, Hedima
EW
. Complementary and alternative medicines use in COVID-19: a global perspective on practice, policy and research
. Res Soc Adm Pharm
. 2022
;18
(3
):2524
–8
.34.
Kany
S
, Vollrath
JT
, Relja
B
. Cytokines in inflammatory disease
. Int J Mol Sci
. 2019
;20
(23
):6008
.35.
Maluf
P
, Michelin
M
, Etchebehere
R
, Adad
S
, Murta
E
. T lymphocytes (CD3) may participate in the recurrence of cervical intraepithelial neoplasia grade III
. Arch Gynecol Obstet
. 2008
;278
(6
):525
–30
.36.
Bruno
G
, Saracino
A
, Monno
L
, Angarano
G
. The revival of an “old” marker: CD4/CD8 ratio
. AIDS Rev
. 2017
;19
(2
):81
–8
.37.
Abuelsaad
AS
. Supplementation with Astragalus polysaccharides alters Aeromonas-induced tissue-specific cellular immune response
. Microb Pathog
. 2014
;66
:48
–56
.38.
Du
X
, Chen
X
, Zhao
B
, Lv
Y
, Zhang
H
, Liu
H
. Astragalus polysaccharides enhance the humoral and cellular immune responses of hepatitis B surface antigen vaccination through inhibiting the expression of transforming growth factor β and the frequency of regulatory T cells
. FEMS Immunol Med Microbiol
. 2011
;63
(2
):228
–35
.39.
Zhang
Z
, Dai
X
, Qi
J
, Ao
Y
, Yang
C
, Li
Y
. Astragalus mongholicus (Fisch.) Bge improves peripheral Treg cell immunity imbalance in the children with viral myocarditis by reducing the levels of miR-146b and miR-155
. Front Pediatr
. 2018
;6
:139
.40.
Serrano-Villar
S
, Deeks
SG
. CD4/CD8 ratio: an emerging biomarker for HIV
. Lancet HIV
. 2015
;2
(3
):e76
–e77
.41.
Pawłowska
J
, Mikosik
A
, Soroczynska-Cybula
M
, Jóźwik
A
, Łuczkiewicz
P
, Mazurkiewicz
S
. Different distribution of CD4 and CD8 T cells in synovial membrane and peripheral blood of rheumatoid arthritis and osteoarthritis patients
. Folia Histochem Cytobiol
. 2009
;47
(4
):627
–32
.42.
Zhou
J
, Zhang
N
, Zhao
L
, Wu
W
, Zhang
L
, Zhou
F
. Astragalus polysaccharides and saponins alleviate liver injury and regulate gut microbiota in alcohol liver disease mice
. Foods
. 2021
;10
(11
):2688
.43.
Yan
F
, Zhang
QY
, Jiao
L
, Han
T
, Zhang
H
, Qin
LP
. Synergistic hepatoprotective effect of Schisandrae lignans with Astragalus polysaccharides on chronic liver injury in rats
. Phytomedicine
. 2009
;16
(9
):805
–13
.44.
Liu
W
, Gao
FF
, Li
Q
, Lv
JW
, Wang
Y
, Hu
PC
. Protective effect of astragalus polysaccharides on liver injury induced by several different chemotherapeutics in mice
. Asian Pac J Cancer Prev
. 2014
;15
(23
):10413
–20
.45.
Liu
YT
, Lv
WL
. Research progress in Astragalus membranaceus and its active components on immune responses in liver fibrosis
. Chin J Integr Med
. 2020
;26
(10
):794
–800
.46.
Sheik
A
, Kim
K
, Varaprasad
GL
, Lee
H
, Kim
S
, Kim
E
. The anti-cancerous activity of adaptogenic herb Astragalus membranaceus
. Phytomedicine
. 2021
;91
:153698
.47.
Duan
P
, Wang
ZM
. [Clinical study on effect of Astragalus in efficacy enhancing and toxicity reducing of chemotherapy in patients of malignant tumor]
. Zhongguo Zhong Xi Yi Jie He Za Zhi
. 2002
;22
(7
):515
–7
. Epub 2003 Feb 21.© 2023 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2023
You do not currently have access to this content.
