Tinospora

Generic name: Tinospora Cordifolia (Willd.) Miers.
Brand names: Amrita, Duyutige, Gado, Galo, Giloe, Giloya, Guduchi, Gulancha, Heartleaf Moonseed, Teppatige, Tinofend

Usage of Tinospora

Alcoholism

In a clinical trial (n=54), administration of fresh T. cordifolia stem extract to alcoholic individuals given at Ayurvedic doses for 14 days was observed to improve several known, as well as novel, biomarkers of liver and metabolic damage and oxidative stress. Improvements were found to be at levels near that of healthy volunteers.(76)

Antineoplastic effects

Animal data

Tumor mass reduction and increased survival time have been observed with administration of the extract in several experiments in mice with implanted carcinomas.(10, 11) In similar experiments, tinospora extracts restored thymus homeostasis, retarded tumor growth, and prolonged survival times.(12, 13, 14, 15) Tinospora extract showed a regulatory effect on serum cytokine, with consequent angiogenesis inhibition of mouse melanoma cells.(16)

Survival time was increased after irradiation, and body weight loss was decreased in mice pretreated with a single dose of tinospora extract.(17, 18) Pretreatment with stem and root extracts was also protective of the spleen and testis in rodents(19, 20) while conversely, HeLa cells showed an increased radiosensitivity with a dichloromethane stem extract.(21)

A dose-dependent cytotoxic effect of tinospora extract in HeLa-cultured cells comparable with doxorubicin has been reported.(22) At low doses, an ethanol extract of tinospora increased bone marrow cell counts, while higher doses resulted in decreased counts in mice with induced lymphoma.(23) In vitro studies suggest T. cordifolia may contain compounds that act via the androgen receptor and cause an increase in proliferation of prostate cancer cells.(24)

Clinical data

Research reveals no clinical data regarding the use of tinospora for use in the treatment of cancers. Because of proneoplastic potential demonstrated in some experiments,(21, 23, 24) caution is warranted.

Antidiabetic and hypolipidemic effects

Animal data

Aqueous and ethanol extracts of T. cordifolia leaf, root, and stem administered to alloxan-induced diabetic rats caused a dose-dependent reduction in blood glucose levels similar to glibenclamide and insulin.(25, 26, 27, 28, 29, 30, 31, 32, 33) In similar experiments, serum and tissue cholesterol, phospholipid, and free fatty acid levels were reduced.(5, 6, 26, 34)

Clinical data

Research reveals no clinical data regarding the use of tinospora for treating diabetes. However, a small study (n=54) in alcoholic individuals documented a significant improvement in lipid parameters compared to healthy controls. Mean values of triglycerides (P<0.01), total cholesterol (P<0.05), and low-density lipoprotein (P<0.01) were significantly reduced after 2-week administration of T. cordifolia stem extract administered at Ayruvedic doses. Additionally, mean high-density lipoprotein levels were increased in the alcoholic group compared to healthy controls, and the extract administration significantly reduced this increase from 81 mg/dL to 45 mg/dL (P<0.01).(76)

Antioxidant effects

In vitro studies have demonstrated inhibition of lipid peroxidation, inhibition of nitric oxide synthase activity, and direct nitric oxide–free radical scavenging, as well as generation of superoxide and hydroxyl radicals.(23, 35, 36, 37, 38)

Animal data

Markers of oxidative stress were reduced in rodents with induced diabetes, hepatotoxicity, and renal toxicity in several studies.(15, 26, 30, 31, 39, 40, 41, 42)

Clinical data

Clinical studies have been conducted to evaluate the hepatoprotective effect of T. cordifolia extracts on isoniazid- and rifampicin-induced oxidative stress in patients with tuberculosis. One large study used a combination of tinospora with curcumin; therefore, the positive results cannot be attributed to either plant individually.(43) A second clinical trial evaluated tinospora alone and in combination with Phyllanthus emblica. In that trial, tinospora alone was no more effective than placebo.(44) In alcoholic individuals, increases in liver enzymes that resulted from oxidative stress on the liver (ie, AST, ALT) were significantly improved with administration of T. cordifolia stem extract compared to healthy controls (P<0.01 each) in a small clinical trial (n=54).(76)

Cardiovascular

Clinical data

Results from 2 low-quality controlled trials (one translated from Chinese to English via Google translate) reported significant within-group improvements in diastolic and/or systolic blood pressure with administration of berberine to adults with primary hypertension. Between-group comparisons were not reported. Dosage was 300 and 500 mg administered 3 times daily for 8 weeks and 3 months in patients with concomitant gout and newly diagnosed type 2 diabetes, respectively.(77)

CNS effects

In a tail suspension and forced swim test, tinospora showed antidepressant activity, possibly via inhibition of monoamine oxidase activity.(64)

Immunologic effects

T. cordifolia is widely used in the Indian Ayurvedic system of medicine as an immunostimulant.(45) Syringin, cordiol, cordioside, and cordifoliosides A and B are the active principles responsible for anticomplement and immunomodulatory activities(46, 47) as well as an arabinogalactan polysaccharide isolated from the dried stems and an alpha-D-glucan.(3, 45, 48, 49)

Animal data

Studies in rats have shown modulation of the immune response to stress via cytokines, and inhibition of stress-induced gastric ulceration and hypothermia has also been demonstrated in rats.(50, 51, 52, 53) A protective effect of tinospora against cyclophosphamide-induced urotoxicity was attributed to modulation of cytokines and glutathione.(42) Gunduchi fed to cows peripartum resulted in increased milk production, increased immune markers in the cow, and increased plasma growth hormone.(54) Cows with mastitis showed an increase in the phagocytic immune response when fed tinospora.(55)

Clinical data

An aqueous extract of T. cordifolia reduced allergic rhinitis, sneezing, nasal obstruction, and pruritus in a randomized clinical trial over 8 weeks.(56) A clinical trial evaluated the effect of tinospora on diabetic foot ulcers as adjuvant therapy. A decrease in the number of debridements was observed, related to increased phagocytic function. However, measures of net improvement did not favor tinospora use.(57) A decrease in reported symptoms was found in a clinical trial of tinospora in HIV patients. No differences were found in CD4 counts, and unexplained hematological measures were noted.(58, 59) A clinical study compared a polyherb formulation containing tinospora with hydroxyChloroquine sulfate in rheumatoid arthritis. However, the effectiveness cannot be attributed to any one of the several plants in the preparation.(60) Older studies suggested T. cordifolia strengthened host defenses and improved the surgical outcome in patients with extrahepatic obstructive jaundice.(61, 62, 63)

Osteoporosis

Limited studies in rats by 1 group of researchers suggest an antiporotic effect of stem extract and beta-ecdysone on bone density, considered to be acting via a mechanism independent of estrogen receptors.(65, 66, 67)

Other reported properties of the plant include a decreased infarction size in rats(68) and hepatoprotection with a return to healthy levels of ALT, AST, serum alkaline phosphatase, and serum bilirubin in carbon tetrachloride–injured rats.(69, 70, 71) Gunduchi fed to cows peripartum resulted in increased milk production but with no effect on composition.(54)

Tinospora side effects

Few adverse reactions were reported in limited clinical trials.56, 58 T. crispa produced hepatotoxicity in a 49-year-old man within 4 weeks of taking 10 pellets/day. Symptoms and lab abnormalities normalized within 2 months of cessation of T. crispa. Liquid chromatography revealed a higher relative content of borapetoside F compared to a certified reference sample.75

Before taking Tinospora

Information regarding safety and efficacy during pregnancy and lactation is lacking.

How to use Tinospora

Few clinical trials are available to determine dosing. In examining the efficacy of tinospora in allergic rhinitis, 300 mg of an aqueous extract was given 3 times daily for 8 weeks.56 Similarly, a clinical study in HIV patients used 300 mg of a standardized aqueous tinospora stem extract 3 times daily for 6 months.58

Warnings

Information is generally lacking about the toxicology of T. cordifolia in humans. At Ayurvedic therapeutic doses, no toxicity has been observed.5 No adverse events were observed in healthy volunteers given 500 mg/day for 21 days.72 No adverse reactions were noted when T. cordifolia stem extract was administered to rabbits up to the highest oral doses of 1.6 g/kg71, 73 and in rats at doses of 1,000 mg/kg of the whole plant extract.68 However, 40% mortality resulted after mice were given 500 mg/kg body weight of an extract of tinospora stems.17 Genotoxicity tests in rats given up to 250 mg/kg body weight for 7 days showed no clastogenicity or DNA damage, and T. cordifolia was not mutagenic in Salmonella typhimurium strains.74 However, hydroalcoholic extracts did promote micronuclei formation in bone marrow cells.5

What other drugs will affect Tinospora

In an experiment in mice, an extract of the aerial parts of T. cordifolia increased the activity of some cytochrome P450 enzymes.23

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