Boswellia serrata, also known as Indian frankincense, is known for its anti-inflammatory properties in Ayurveda. Due to its anti-inflammatory properties, it is widely used in the management of osteoarthritis. Oleo-gum resin obtained from the Boswellia serrata plant is reported to possess monoterpenes, diterpenes, and triterpenes. The majority of its anti-inflammatory properties are attributed to the presence of pentacyclic triterpenic acids (β-boswellic acid, acetyl-β-boswellic acid, 11-keto-β-boswellic acid and acetyl-11-keto-β-boswellic acid)1. Boswellic acids specifically inhibit 5-lipooxygenase (5-LO), a pro-inflammatory enzyme. The inhibition of 5-LO by boswellic acids blocks leukotrienes synthesis, thereby reducing inflammation.
How Boswellia Fights Inflammation in Osteoarthritis?
Boswellia serrata extract (BSE) ameliorates degenerative osteoarthritis through multiple mechanisms. A study showed that BSE improved bone marrow density and trabecular thickness in osteoarthritis mice compared to the control. Additionally, it was reported that osteoarthritis mice exhibited elevated expression of Smad3, MMPs, p-IκB, p-NF-κB, and pro-inflammatory factors, which were reduced after BSE supplementation2. Another study reported that BSE supplementation reduced inflammatory markers and cartilage degeneration in the osteoarthritis mice model. BSE-inhibited cyclooxygenase (COX)-2 and 5-LO lead to reduced prostaglandin E2 and leukotriene B4 levels. Moreover, BSE reduces the breakdown and degradation of glycosaminoglycans and aggrecan present in the articular extracellular matrix3.
Boswellia’s Clinical Efficacy in Osteoarthritis
Several clinical studies are available that validate the role of Boswellia in managing osteoarthritis. In a double-blind, placebo-controlled clinical trial, osteoarthritis patients were given BSE supplementation for 120 days. BSE supplementation improves joint function and reduces pain and inflammatory markers in the interventional group compared to placebo. Additionally, radiographic evaluation revealed reduced knee joint gap and osteophytes among the individuals receiving BSE compared to placebo4. Another 30-day clinical trial investigated the effects of BSE in osteoarthritis patients. Boswellia supplementation showed significant improvement in pain scores. Additionally, BSE supplementation reduced circulating inflammatory markers (TNFα and hsCRP) in the interventional cohort compared to placebo. Moreover, cartilage collagen neoepitope C2C level was reduced among individuals receiving BSE supplements5. A similar clinical study observed that BSE supplementation significantly reduced the VAS pain score and reduced circulatory inflammatory markers (TNFα, hs-CRP, and IL-6) in the interventional group compared to placebo6.
To conclude, Boswellia serrata extract reduces inflammation associated with osteoarthritis by targeting COX-2 and 5-LO and is clinically efficacious and safe in the management of osteoarthritis.
References
(1) Siddiqui, M. Z. Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview. www.ijpsonline.com.
(2) Kim, J.; Eun, S.; Jung, H.; Kim, J.; Kim, J. Boswellia Serrata Extracts Ameliorates Symptom of Irregularities in Articular Cartilage through Inhibition of Matrix Metalloproteinases Activation and Apoptosis in Monosodium-Iodoacetate-Induced Osteoarthritic Rat Models. Prev Nutr Food Sci 2023, 28 (3), 285–292. https://doi.org/10.3746/pnf.2023.28.3.285.
(3) Shin, M. R.; Kim, H. Y.; Choi, H. Y.; Park, K. S.; Choi, H. J.; Roh, S. S. Boswellia Serrata Extract, 5-Loxin®, Prevents Joint Pain and Cartilage Degeneration in a Rat Model of Osteoarthritis through Inhibition of Inflammatory Responses and Restoration of Matrix Homeostasis. Evidence-based Complementary and Alternative Medicine 2022, 2022. https://doi.org/10.1155/2022/3067526.
(4) Majeed, M.; Majeed, S.; Narayanan, N. K.; Nagabhushanam, K. A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial to Assess the Safety and Efficacy of a Novel Boswellia Serrata Extract in the Management of Osteoarthritis of the Knee. Phytotherapy Research 2019, 33 (5), 1457–1468. https://doi.org/10.1002/ptr.6338.
(5) Karlapudi, V.; Sunkara, K. B.; Konda, P. R.; Sarma, K. V; Rokkam, M. P. Efficacy and Safety of Aflapin®, a Novel Boswellia Serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study. Journal of the American Nutrition Association 2023, 42 (2), 159–168. https://doi.org/10.1080/07315724.2021.2014370.
(6) Majeed, A.; Majeed, S.; Satish, G.; Manjunatha, R.; Rabbani, S. N.; Patil, N. V. P.; Mundkur, L. A Standardized Boswellia Serrata Extract Shows Improvements in Knee Osteoarthritis within Five Days-a Double-Blind, Randomized, Three-Arm, Parallel-Group, Multi-Center, Placebo-Controlled Trial. Front Pharmacol 2024, 15. https://doi.org/10.3389/fphar.2024.1428440.
