Iranian Journal of Basic Medical Sciences

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Effect of Boswellia species on the metabolic syndrome: A review

Davood Mahdian1, 2, Kazem Abbaszadeh-Goudarzi 1, Amir Raoofi 1, Ghazaleh Dadashizadeh 1, Mina
Abroudi 1, Elahe Zarepour 1, Hossein Hosseinzadeh 3, 4*
1
Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
2
Department of Pharmacology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
3
Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
4
Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

ARTICLE INFO ABSTRACT

Article type: The metabolic syndrome, a cluster of metabolic disorders, includes abdominal obesity, hypertension,
Review article dyslipidemia, and hyperglycemia leading to insulin resistance, development of diabetes mellitus, and
cardiovascular diseases. For the treatment of metabolic syndrome, traditional herbal medicines such
Article history:
Received: Jul 26, 2019
as frankincense or Boswellia species have been used due to their anti-inflammatory, anti-oxidant,
Accepted: Jul 19, 2020 anti-obesity, antidiabetic, antihypertensive, and hypolipidemic properties. Based on the literature,
published evidence up to 2020 about the therapeutic effects of Boswellia species on the metabolic
Keywords: disorder among Medline, Scopus, and Google Scholar were precisely evaluated by keywords such as
Boswellia obesity, diabetes, hyperglycemia, hypertension, blood pressure, dyslipidemia, metabolic syndrome,
Dyslipidemia frankincense, and Boswellia. According to the results, Boswellia species have beneficial effects to control
Frankincense metabolic syndrome and its related disorders such as hyperglycemia, dyslipidemia, hypertension,
Hyperglycemia obesity, diabetes, and its complications. Boswellia species by reducing the resistance to insulin and
Hypertension restoring pancreatic beta cells decrease blood glucose. Also, Boswellia species has antithrombotic and
Metabolic syndrome anticoagulant properties that regulate blood pressure. The anti-oxidant properties of Boswellia species
Olibanum modulate the blood lipid profile via reducing TNF-α, IL-1β levels, and increasing the adiponectin level.
The therapeutic and protective effects of Boswellia species on metabolic disorders were remarkably
confirmed regarding decreasing hyperglycemia, hyperlipidemia, hypertension, and obesity.

►Please cite this article as:

Mahdian D, Abbaszadeh-Goudarzi K, Raoofi A, Dadashizadeh Gh, Abroudi M, Zarepour E, Hosseinzadeh H. Effect of Boswellia species on the
metabolic syndrome: A review. Iran J Basic Med Sci 2020; 23:1374-1381. doi: 10.22038/ijbms.2020.42115.9957

Introduction gum resin, is prepared from Boswellia species such as

The metabolic syndrome is defined as abdominal Boswellia serrata (13). Boswellia genus contains about
obesity, dyslipidemia (DL), hypertension (HTN), 25 different species. A number of the prominent species
insulin resistance with or without glucose tolerance, consist of B. frereana, B. sacra, B. ovalifoliolata, B. carterii,
pro-inflammatory and pro-thrombotic state (1, 2). B. papyrifera, B. rivae, B. neglecta, and so forth (14-17).
Moreover, metabolic syndrome is a serious problem Recent research indicated the anti-inflammatory, anti-
and challenge with an ascending trend throughout the ulcerous function, and anticancerous impacts of this
world that is caused by excessive excess calorie intake, plant (18). Of course, some studies demonstrated the
urbanization, and inactive lifestyles (3). Systemic HTN antihyperglycemic and antihyperlipidemic impacts of
that is also known as high blood pressure (HBP) and Boswellia in streptozotocin-induced diabetic rats (19).
abnormal lipid profile can be observed because of the Also, one of the studies indicated the protective impacts
resistance to insulin, which results in atherosclerotic of B. serrata gum on diabetic side effects in animal
vascular disease. Hence, metabolic syndrome enhances models (20, 21). Moreover, this plant has useful impacts
myocardial infarction (MI) and stroke risks (4). on the low-density lipoprotein (LDL), blood glucose, and
Today, studies have been focused on supplementary high-density lipoprotein (HDL) of patients with diabetes
and substitute medicine (5-7) due to inadequate efficiency who had received B. serrata gum at a dosage of 900 mg
and significant complications from recent treatments every day with no significant complications (22).
for hyperlipidemia (HLP) and diabetes (8-11). Recently, Numerous animal research projects demonstrated
researchers have paid attention to the use of medicinal the anti-oxidant features of gum resin extracts of B.
plants due to the reduced complications and different serrata (23, 24). Pandey et al. showed that the extracts
efficient compounds in the herbs as recommended by the of B. serrata gum resin resulted in a reduction in serum
World Health Organization (WHO) (12). cholesterol and the enhancement of HDL in the rats
Concerning the important clinical consequences of the (25). Another research indicated that patients with type
metabolic syndrome, investigators have mainly attended 2 diabetes who have been supplemented with gum resin
to study the values of herbal medicines or herbalism. of B. serrata for six weeks experienced a remarkable
Boswellia internationally known as Indian frankincense decline of fasting blood glucose and the augmentation
or olibanum has been used to treat various diseases. in plasma insulin level (26).
The frankincense or olibanum, a yellowish-brown oleo-

*Corresponding author: Hossein Hosseinzadeh. Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences,
Mashhad, Iran. Tel: +98-51-31801100; Email: [email protected]
Boswellia and metabolic syndrome Mahdian et al.

Pharmacognostical features of Boswellia impacts on several diseases such as diabetes mellitus

Boswellia belongs to the family Burseraceae, which (DM) (39). Azemi et al. showed that the extract of
is a deciduous tree. In general, it reaches a moderate B. serrata has antidiabetic impacts and can prevent
height (4 to 5 m). As other moderate to big size trees the microvascular complications of diabetes in the
with branches, this tree possesses a circumference of kidney and liver (40). Investigators showed that herbal
2.4 m (average 1.5 m). The color of the thin barks of formulations with B. serrata oleo-gum-resin generated
the tree changes from greenish-gray, yellow, or reddish considerable antidiabetic activities via influencing the
to ash color that its peeling may be readily done. The hepatic gluconeogenesis, pyruvate carboxylase, and
papery barks, when peeled off or cut, release translucent phosphoenolpyruvate carboxykinase (41). Shehata et al.
lumps, tear, or droplets of white to yellow color gummy studied AKBA contribution to the prevention of inducing
oleoresin (26). auto-immune reaction, insulitis, and hyperglycemia in a
model of multiple low dose streptozotocin (MLD-STZ)
Composition diabetes. The induction of hyperglycemia or high blood
There are nearly 200 phytochemicals in the oleo- sugar has been done via injection of IP 40 mg/kg STZ in
gum-resin mix in various species of Boswellia. These male mice for five days every day, whereas the second
compounds contain pure resin, mucus, and essential oil treatment group has been administered KBA with STZ
(27, 28). for ten days. In STZ treated rats, a considerable burst of
The essential oil compositions of each species are pro-inflammatory and anti-inflammatory cytokines in
different and change concerning the environment, the blood, infiltrating lymphocytes (CD3) into pancreatic
harvest condition, and geographic areas (29, 30). The islets, and emerging peri-insular apoptotic cells have
gum portion is composed of pentose and hexose sugar been registered. A significant increase in plasma glucose
containing a couple of oxidation and digestive enzymes. has been observed (124.4±6.65 versus 240.2±27.36
The essential oil is a mix of mono-terpenes, diterpenes, mg/dl, P<0.05). Nonetheless, concurrent treatments
and sesquiterpenes. β-boswellic acid (Bas) is the main with AKBA and KBA indicated a significant decrease
constituent of each species of the genus Boswellia in pro-inflammatory and anti-inflammatory cytokines.
(Figure1). There are 6 main Bas, including α- and β-BA Moreover, the detection of infiltrating lymphocytes into
(10 to 21%), acetylated α- and β-BA (0.05–6%), 11-keto- pancreatic islets and emerging peri-insular cells has not
β-boswellic acid (KBA, 2.5 to 7.5%), and 3-O-acetyl-11- been reported (42).
keto-β-boswellic acid (AKBA, 0.1– 3%), which are found Ahangarpour et al., clinically studied patients with
in each Boswellia species with variable amounts. The type 2 diabetes supplemented with extract of B. serrata
contents of BA, which can be found in the market as the gum resin for six weeks and compared them to type 2
standardized extracts, change from 37.5-65% (31, 32). diabetic patients. A considerable reduction of fasting
blood glucose and a decrease in insulin levels have been
Review literature reported (22). The researchers were satisfied with the
The search was performed by keywords such as findings, and thus developed the research and examined
diabetes or hyperglycemia, Boswellia, frankincense, antidiabetic, hypolipidemic, and hepatoprotective
olibanum, boswellic acid, elevated BP or HTN, impacts of the supplement B. serrata in 60 patients with
hypotensive or antihypertensive, DL, and metabolic type 2 diabetes from both genders. Treating diabetic
syndrome using Google Scholar, Scopus, and Medline patients with the extract of B. serrata gum resin (orally,
databases. In fact, in the current research, most of the 900 mg) for six weeks led to a considerable enhancement
papers about the effects of Boswellia on metabolic of the levels of HDL and significant decline of cholesterol,
disorders have been precisely evaluated. To better LDL, as well as the amounts of fructosamine SGPT and
review, irrelevant or duplicated papers have been SGOT. The research indicated that the administration
disregarded. Publications have been specified from of 900 mg of B. serrata supplement daily is one of the
their admission up to August 2020. healthy and efficient options for decreasing hazardous
agents related to type 2 diabetes. Diabetic patients
Dosing who receive B. serrata can keep fructosamine level,
Boswellia species are usually administered as a hepatic enzyme activity, and lipid profiles close to the
capsule, pill, or bark decoction orally. The respective standard levels and have a high-quality life (21). Herbal
dose is suggested based on historical practices or formulations with B. serrata oleo-gum-resin as an
existing trials. Today, there is ambiguity on the optimum ingredient of the supplementation led to considerable
dosage for balancing a safe and efficient method. Each antidiabetic activities on non-insulin-dependent DM in
producer has their production method of Boswellia, streptozocin induced diabetic rat model.
and these results are too inconsistent to provide a In a case study report of a male patient diagnosed
standardized product. Notably, several trials applied with Latent Autoimmune Diabetes in Adults, B. serrata
different products manufactured by different producers. gum resin during 9 months treatment reduced both the
For this reason, clinical impacts cannot be compared markers of autoimmune diabetes, i.e., GAD65 and IA2
(33). autoantibodies (43).
Some results demonstrated the decline of the blood
Hypoglycemic effect of the Boswellia species in glucose levels in patients with diabetes by orally
diabetic patients and animal models administrating the aqueous extracts of the leaf and root
Boswellia species tree and the corresponding of B. glabra. The continuous application of the extract
gummy resin are completely known due to their useful of the leaf and root for 28 days represented a reduction

Iran J Basic Med Sci, Vol. 23, No. 11, Nov 2020 1375
Mahdian et al. Boswellia and metabolic syndrome

of cholesterol, creatinine, triglyceride, serum glucose, resin were examined. Enriching B. serrata gum resin
urea, enzyme activity with considerable hypo-glycemic with triterpenoids showed their anti-oxidant activities
impacts (44). One of the auto-immune diseases is a type based on the respective chemical compositions (52,
I diabetes, in which a chronic inflammatory procedure 54). The experiments of the anti-oxidant activities of
eventually leads to beta-cell mortality and a lack of insulin B. serrata gum resin suggested antilipid per-oxidation
production. It was indicated that extracts obtained by actions in the liver and heart. Researchers studied the
the gum resin of BS have anti-inflammatory features, phytochemical ingredients of the crude extract of B.
especially via targeting agents or mediators associated serrata and demonstrated that it consists of essential oils,
with auto-immune diseases (39). The recent research resin, and gum. Boswellic acid, a pentacyclic triterpene,
demonstrated the antidiabetic impacts of BS extracts and has been recognized as an active moiety of the resin
their capability for preventing the side effects of diabetes portion (55). Primary phytochemical studies showed the
in the kidney and liver (40). existence of flavonoid and saponin in B. serrata Previous
Hypoglycemic activities in mice with type 1 diabetes observations showed that several compounds, such as
have been confirmed by BS oleo-gum and respective flavonoids, saponins, or organic acids might contribute
active ingredients, KBA and AKBA by suppressing to the herb diuretic impacts (56). Likewise, some authors
pro-inflammatory cytokines related to inducing revealed that specific flavonoids induce diuretic activities
auto-immune procedure in pancreatic islets, such as by attaching with adenosine A1 receptors related to
interleukin (IL)-1A, IL-1B, IL-2, IL-6, interferon (IFN)-γ, the diuretic actions (57). Since B. serrata has a lot of
TNF-α, granulocyte colony-stimulating factor (G-CSF), saponins and flavonoids, the diuretic activities of the herb
and granulocyte/macrophage colony-stimulating factor understudy might result from these mechanisms. It has
(GM-CSF), and infiltrating lymphocytes into islets. Two of been indicated that sodium is a prominent external agent
the major antidiabetic mechanisms include suppressing that plays a role in primary HTN (58). Several research
pancreatic islet tissue atrophy and peri-insular apoptotic projects demonstrated the adverse effects of higher
cells mediated by anticaspase 3 (39, 45). Rao et al. (2013) uptake of sodium adversely on the arterial BP (59).
revealed the improvement of chronic diabetic side effects The higher excretion of urinary sodium in the present
by oleo-gum resin and the isolated compound boswellic experimental animals revealed the antihypertensive
acid through the inhibition of polyol enzyme aldose activity of the B. serrata (Table 1).
reductase and reduction in the developed glycation
end product in vivo in rat lens and rat kidneys and in Impact on obesity and lipid profiles
vitro in human recombinant cells (20). Additionally, B. Several herbal medicines such as Ginkgo biloba can
carterii oleo-gum resin showed an antidiabetic capacity manage and improve hyperlipidemia or obesity in
by increasing the serum insulin, regenerating β-cells of patients (60). Numerous academic research projects
Langerhans islets, enhancing glycogenesis, and declining performed during recent years showed that Boswellia
glycogenolysis in rats with alloxan-induced type 1 species would be efficient hypolipidemic agents. It has
diabetes (46). been demonstrated that the water-soluble fraction of
The previous study showed that blood-glucose levels B. serrata reduces the levels of total cholesterol (38-
increased significantly (P<0.05) in the control group in 48%) (61) in experimental animals, which confirms
comparison to other groups that received 3 g B. serrata/l its hypolipidemic potentials. Moreover, Zutshi et al.
in drinking water. However, the remaining treated groups showed the antihyperlipidemic activities of Boswellia
showed a significant decrease in comparison with control gum (19). Salami gum keeps the levels of serum
(47). Also, Al-Daraji et al. (47), reported that the drinking cholesterol and triglyceride of animals within optimal
water of broiler chickens supplemented with different ranges that would be received on diets with increased
levels of B. carterii powder led to a significant decrease in cholesterol and saturated fat (61). It was reported
blood glucose concentrations, at levels 0.5, 0.75, and 1 g/l. that AKBA inhibits NF-κB activity in atherosclerosis
However, 0.75 and 1 g/l water supplementation reduced (62). Of course, AKBA has anti-adiposity properties,
the values of blood plasma concentrations of glucose. 6 through which it can induce lipolysis in mature human
weeks complementarity of B. serrata to type 2 diabetic
adipocytes that have been observed by Liu et al. in the
patients also produced a very significant decrease in
in vitro study. Moreover, this event has been followed by
fasting blood glucose and an increase in insulin level
downregulating the expression of PPAR-g2 and losing
(48). Similarly, B. glabra aqueous extract increased the
phenotypic markers (63). The study of Al-Yasiry et al.
synthesis of secretory granules in the beta-cell and led
to an increase in pancreatic enzyme resulting in reduced (46) showed that Boswellia species (3 g B. serrata/l in
blood-sugar level (49) (Tabel 1). drinking water) reduced the cholesterol level in broiler
chicken. Their findings were in agreement with those
Impact on the elevated blood pressure of Pandey et al (64). In this study, they showed that the
Not many authors assessed the positive impacts of supplementation of BS gum resins extract 15 mg/100
Boswellia species on elevated BP which is an important g body wt for 90 days caused a significant decrease in
component of the metabolic syndrome. Recent studies serum cholesterol and increased HDL in rats. It has also
have introduced some mechanisms of actions concerning been reported by Al-Daraji et al. (65) that B. carterii
B. serrata gum resin on cardiac health. There is enough (0.5, 0.75, and 1 g/l in drinking water) decreased
knowledge of the relationship between oxidative significantly cholesterol, triglycerides, and LDL levels.
stresses, inflammation, and thrombosis resulting in The results of this study suggest the probability that
cardiovascular diseases (50, 51). Hence, the anti-oxidant B. serrata supplementation restores β-cells function
and antithrombotic characteristics of B. serrata gum for insulin secretion, and that insulin helps to reduce

1376 Iran J Basic Med Sci, Vol. 23, No. 11, Nov 2020
Boswellia and metabolic syndrome Mahdian et al.

Table 1. The efficacy of Boswellia species on different animal models composed of the metabolic syndrome

Study type Metabolic syndrome component Reference

Animal studies ↓ Blood insulin levels 39

Animal studies ↓ Hyper-glycemia 42

Human studies ↓ Fasting blood glucose 22

↓ Insulin levels

Animal studies ↓Hepatic gluconeogenesis, 41

↓Blood glucose

Human studies ↓ Diabetic 21, 65, 66

Hypolipidemic

↑ Levels of HDL

↓ Total cholesterol, triglycerides, LDL

Animal studies ↓ Blood glucose 44, 49, 50, 61, 62, 46

↓ Cholesterol, creatinine, triglyceride, serum glucose, urea, enzyme activity

Animal studies ↓ Diabetic 39, 45

↓ Pancreatic damages

↓ Infiltration of lymphocytes into pancreatic islets

Animal studies ↓ Polyol enzyme aldose reductase 20

↓ The developed glycation

↓ Blood glucose

Animal studies ↓ Blood insulin levels 40

Animal studies ↓ Blood insulin levels 36

Animal studies ↓ The serum insulin 46

↑ Glycogenesis

↓ Glycogenolysis

Animal studies 38
Adjusts the lipid profile

Animal studies ↑ Anti-oxidant defense 53, 55, 57, 58

↑ Anti-oxidant and Anti thrombotic effects

↑ Antilipid peroxidation actions in liver and heart

↑Diuretic activities

↑Antihypertensive factor

↓ High sodium absorption

Animal studies Modulates vascular tones 37

Animal studies ↓ Obesity 72, 75, 76

↓Food intake

↓Concentration adiponectin

↓Hyperlipidemia

↓Oxidative stress and inflammation

↓TNF-α, IL-1β

↓leptin resistance

Animal studies ↓Oxidative stress and inflammation 75, 73

↓TNF-α, IL-1β

↓Leptin resistance

Human studies ↓ Obesity 78

DM: Diabetes Mellitus; NAFLD: Non-Alcoholic Fatty Liver Disease; HLP: Hyperlipidemia; LDL: Low-Density Lipoprotein; HDL: High-Density
Lipoprotein; BP: Blood Pressure, OB: Obesity

Iran J Basic Med Sci, Vol. 23, No. 11, Nov 2020 1377
Mahdian et al. Boswellia and metabolic syndrome

3-Acetyl-β-Boswellic acid
α-Boswellic acid

β-Boswellic acid 11-Keto-β-Boswellic acid

Acetyl α-Boswellic acid 3-O-Acetyl-11-keto-β-Boswellic acid

Figure 1. Boswellic acid and its derivatives

serum lipid profiles (66). Moreover, B. carterii may effect on cumulative food intake compared to ephedrine
have a protective effect on pancreatic β cells through used as a standard anorectic drug (76).
its anti-oxidant action (67) (Table1). Obesity, a chronic The findings of previous studies demonstrated that
disease characterized by the storage of excess energy the use of B. serrata appears safe and effective to control
in fat cells, is a result of abnormal metabolism. Obesity obesity (77). The possible mechanism of B. serrata
is a complex issue and its causes, consequences, and reported by Singh et al. consists of the stimulation of
management are an area of considerable debate as a the thyroid gland leading to an increase in metabolic
widespread disease. Several studies reported Boswellia rate. Thereby enhancing thyroid efficiency which in
species exhibited anti-obesity effects by lowering turn causes to lose weight. Regarding toxicity, B. serrata
total cholesterols, triglycerides, free fatty acids, LDL showed no toxic effect up to 500 mg/kg (78) (Figure1
concentrations, circulating adiponectin, food intake as and Table1).
well as elevating HDL (68-70). The study performed
by Tawfik showed that boswellic acid has a promising The overall mechanism of Boswellia species in the
anti-aggregatory effect by reducing the enhanced HLP, metabolic syndrome
oxidative stress, and inflammation associated with a Several features of Boswellia species have been
high-fat diet (HFD) (71). Gomaa et al. investigated that explored. The general mechanisms of the Boswellia
B. serrata extract is as effective as orlistat in preventing species include anti-oxidant, radical scavenger,
obesity, hyperlipidemia, steatosis, and insulin resistance. glutathione contents regulator, cellular membranes
These actions may be mediated by the suppression of stabilizer, and cell permeability regulator. Moreover, B.
food intake and reducing the levels of TNF-α, IL-1β, serrata extracts enhance the regeneration of the liver
and leptin resistance along with increasing adiponectin and delay developing and progressing hepatic fibrosis
(72). B. serrata extract has anti-obesity effects and can (34, 35).
be attributed to the presence of active principles such Based on numerous research projects, the major
as phenolic compounds and triterpenoids (73-75). In classifications of Boswellia mechanisms are as following:
another study, B. serrata extract showed a suppressive 1. Boswellia gum resin reduces plasma glucose in

1378 Iran J Basic Med Sci, Vol. 23, No. 11, Nov 2020
Boswellia and metabolic syndrome Mahdian et al.

Figure 2. Schematic description of the traditional effects of Boswellia on the metabolic syndrome

diabetes by decreasing the resistance to insulin and 3. Sanati S, Razavi BM, Hosseinzadeh H. A review of the
restoring pancreatic beta cells (36) (Figure2). effects of Capsicum annuum L. and its constituent, capsaicin,
2. Boswellia gum resin regulates BP in hypertensive in metabolic syndrome. Iran J Basic Med Sci 2018; 21:439-448.
conditions by modulation vascular tones, diuretic 4. Tabeshpour J, Imenshahidi M, Hosseinzadeh H. A review
effects, and suppression platelet aggregations with of the effects of Berberis vulgaris and its major component,
antithrombotic and anticoagulant properties (37) berberine, in metabolic syndrome. Iran J Basic Med Sci 2017;
20:557-568.
(Figure2).
5. Razavi BM, Hosseinzadeh H. Saffron: a promising natural
3. Boswellia gum resin adjusts the lipid profile
medicine in the treatment of metabolic syndrome. J Sci Food
via decreasing hepatic steatosis and ameliorates Agric 2017; 97:1679–1685.
liver dysfunctions tests through its anti-oxidant and 6. Mollazadeh H, Mahdian D, Hosseinzadeh H. Medicinal
cytoprotective impacts (38) (Figure2). plants in treatment of hypertriglyceridemia: a review based
4. Boswellia extracts suppress food intake and reduce on their mechanisms and effectiveness. Phytomedicine 2019;
TNF-α, IL-1β levels and leptin resistance along with 53:43-52.
increasing the adiponectin level (72) (Figure2). 7. Rahimi R, Shams-Ardekani MR, Abdollahi M. A review of
the efficacy of traditional Iranian medicine for inflammatory
Conclusion bowel disease. World J Gastroenterol 2010; 16:4504–4514.
According to the broad range of properties of Boswellia 8. Tajmohammadi A, Razavi BM, Hosseinzadeh H. Silybum
species, this review described the potential effects of marianum (milk thistle) and its main constituent, silymarin, as
Boswellia species in either the treatment or prevention of a potential therapeutic plant in metabolic syndrome: a review.
the metabolic syndrome. The previous studies shed light Phytother Res 2018;32:1933-1949.
on new ways of treatment for the metabolic syndrome by 9. Tousian Shandiz H, Razavi BM, Hosseinzadeh H. Review of
Garcinia mangostana and its xanthones in metabolic syndrome
the exhibition of the effectiveness of Boswellia species in
and related complications. Phytother Res. 2017;31:1173-1182
HBP, obesity, DL, and high blood glucose. Nevertheless,
10. Mollazadeh H, Hosseinzadeh H. Cinnamon effects on
a series of effective clinical studies should be conducted metabolic syndrome: a review based on its mechanisms. Iran J
in this regard. Basic Med Sci 2016;19:1258-1270.
11. Hosseini S, Jamshidi L, Mehrzadi S, et al. Effects of
Conflicts of Interest Juglans regia L. leaf extract on hyperglycemia and lipid profiles
The authors declare that they have no known in type two diabetic patients: a randomized double-blind,
competing financial interests or personal relationships placebocontrolled clinical trial. J Ethnopharmacol 2014;
that could have appeared to influence the work reported 152:451–456.
in this paper. 12. Razavi BM, Hosseinzadeh H. A review of the effects
of Citrus paradise (grapefruit) and its flavonoids, naringin,
and naringenin in metabolic syndrome. In Bioactive food as
References dietary interventions for diabetes (sec edition). Eds. Watson,
1. Akaberi M, Hosseinzadeh H. Grapes (Vitis vinifera) as a R. R. and Preedy, V.R. 2019, Chp.43, 515-543, London.
potential candidate for the therapy of the metabolic syndrome. 13. Forouzanfar F, Hosseinzadeh H, Ebrahimzadeh Bideskan
Phytother Res 2016; 30:540-556. A, Sadeghnia HR. Aqueous and ethanolic extracts of Boswellia
2. Hassani FV, Shirani K, Hosseinzadeh H. Rosemary serrata protect against focal cerebral ischemia and reperfusion
(Rosmarinus officinalis) as a potential therapeutic plant in injury in rats., Phytother Res 30, 1954-1967.
metabolic syndrome: a review. Naunyn Schmiedebergs Arch 14. Woolley CL, Suhail MM, Smith BL, Boren KE, Taylor LC,
Pharmacol 2016;389:931-949. Schreuder MF, et al. Chemical differentiation of Boswellia sacra

Iran J Basic Med Sci, Vol. 23, No. 11, Nov 2020 1379
Mahdian et al. Boswellia and metabolic syndrome

and Boswellia carterii essential oils by gas chromatography and applications and toxicology. Nat Med J 1999; 2: 16-20.
chiral gas chromatography-mass spectrometry. J Chromatogr 33. Siddiqui MZ. Boswellia serrata, a potential
A 2012; 1261: 158-163. antiinflammatory agent: an overview. Indian J Pharm Sci.
15. De Rapper S, Van Vuuren SF, Kamatou GP, Viljoen AM, 2011;73:255-261.
Dagne E. The additive and synergistic antimicrobial effects 34. Sferra R, Vetuschi A, Catitti V, Ammanniti S, Pompili
of select frankincense and myrrh oils-a combination from the S, Melideo D, et al. Boswellia serrata and Salvia miltiorrhiza
pharaonic pharmacopoeia. Lett Appl Microbiol 2012; 54: 352- extracts reduce DMN-induced hepatic fibrosis in mice by TGF-
358. beta1 downregulation. Eur Rev Med Pharmacol Sci 2012; 16:
16. Blain EJ, Ali AY, Duance VC. Boswellia frereana 1484- 1498.
(frankincense) suppresses cytokine-induc ed matrix 35. Khan MA, Singh M, Khan MS, Najmi AK, Ahmad S. Caspase
metalloproteinase expression and production of pro- mediated synergistic effect of Boswellia serrata extract in
inflammatory molecules in articular cartilage. Phytother Res combination with doxorubicin against human hepatocellular
2010; 24: 905-912. carcinoma. Biomed Res Int 2014; 2014: 294143.
17. Devi PR, Adilaxmamma K, Rao GS, Srilatha Ch, Raj MA. 36. Mohammad Hosein Farzaei, Roja Rahimi, Fatemeh
Safety evaluation of alcoholic extract of Boswellia ovalifoliolata Farzaei and Mohammad Abdollahi. Traditional medicinal
stembark in rats. Toxicol Int 2012; 19: 115-120. herbs for the management of diabetes and its complications:
18. Ebrahimpour S, Fazeli M, Mehri S, Taherianfard M, an evidence-based review. Int J Pharmacol 2015;11 : 874-887.
Hosseinzadeh H. Boswellic acid improves cognitive function in 37. Kokkiripati PK, Bhakshu LM, Marri S, Padmasree K,
a rat model through its antioxidant activity: Neuroprotective Row AT, Raghavendra AS, Tetali SD. Gum resin of Boswellia
effect of boswellic acid. J Pharmacopuncture 2017;20:10-17. serrata inhibited human monocytic (THP-1) cell activation and
19. Zutshi U, Rao PG, Ravi S, Singh GB, Surjeet S, Atal CK. platelet aggregation. J Ethnopharmacol 2011; 1;137:893-901.
Mechanism of cholesterol lowering effect of Salai guggal ex. 38. Ahmed A. Zaki, Nadia E. Hashish, Mohamed A. Amer,
Boswellia serrata roxb. Indian J Pharmacol 1986;18: 182–183. Mohamed-Farid Lahloub. Cardioprotective and anti-oxidant
20. Rao AR, Veeresham C, Asres K. In vitro and in vivo effects of oleogum resin “Olibanum” from Boswellia carteri
inhibitory activities of four Indian medicinal plant extracts Birdw. (Bursearceae). Chin J Nat Med 2014;12:345-350.
and their major components on rat aldose reductase and 39. Shehata AM, Quintanilla-Fend L, Bettio S, Singh CB,
generation of advanced glycation endproducts. Phytother Res. Ammon HP. Prevention of multiple low-dose streptozotocin
2013; 27: 753–760. (MLD-STZ) diabetes in mice by an extract from gum resin of
21. Ahangarpour A, Heidari H, Fatemeh RA, et al. Effect of Boswellia serrata (BE). Phytomedicine 2011; 18: 1037-1044.
Boswellia serrata supplementation on blood lipid, hepatic 40. Azemi ME, Namjoyan F, Khodayar MJ, Ahmadpour F,
enzymes and fructosamine levels in type2 diabetic patients. J Darvish Padok A, Panahi M. The antioxidant capacity and anti-
Diabetes Metab Disord. 2014;13:29. diabetic effect of Boswellia serrata Triana and planch aqueous
22. Ahangarpour A, Akbari Fatemeh Ramezani A, Heidari extract in fertile female diabetic rats and the possible effects
H, et al. The effect of Boswellia serrata on blood glucose, on reproduction and histological changes in the liver and
insulin level and insulin resistance in type 2 diabetic patients. kidneys. Jundishapur J Nat Pharm Prod 2012; 7: 168-175.
Daneshvar Med. 2013;20:11–18. 41. Alawadi F, Fatania H, Shamte U. The effect of plant
23. Sharma A, Upadhyay J, Jain A, Namdeo A, Mahadik KR. mixture extract on liver gluconeogenesis in streptozocin
Antioxidant activity of aqueous extract of Boswellia serrata. induced diabetic rats. Diabetes Res 1991; 18: 163-168.
J.Chem.Bio.Phy.Sci. 2011,1: 60-71. 42. Shehata AM, Quintanilla-Fend L, Bettio S, Jauch J, Scior
24. Al-Awadi F, Fatania H, Shamte U: The effect of a plants T, Scherbaum WA, et al. 11-Keto-b-boswellic acids prevent
mixture extract on liver gluconeogenesis in streptozocin development of autoimmune reactions, insulitis and reduce
induced diabetic rats. Diabetes Res 1991, 18:163–168. hyperglycemia during induction of multiple low-dose
25. Pandey RS, Singh BK, Tripathi YB: Extract of gum resins streptozotocin (MLD-STZ) diabetes in mice. Horm Metab Res
of Boswellia serrata L. inhibits lipopolysaccharide induced 2015; 47: 463- 469.
nitric oxide production in rat macrophages along with 43. Franić Z, Franić Z, Vrkić N, Gabaj NN, Petek I. Effect of
hypolipidemic property. Indian J Exp Biol 2005, 43:509–516. extract from Boswellia serrata gum resin on decrease of GAD65
26. Senghani MK, Patel PM. Pharmacognostic and autoantibodies in a patient with Latent Autoimmune Diabetes
phytochemical study of Oleo gum resin from Boswellia serrata. in Adults. Altern Ther Health Med 2020; AT6085. Online ahead
Res J Pharmacog Phytochem 2013; 5: 244-250. of print.
27. Gerbeth K, Meins J, Kirste S, Momm F, Schubert-Zsilavecz 44. Kavitha JV, Rossario JF, Chandran J, Anbu P, Bakkiyanathan.
M, Abdel-Tawab M. Determination of major boswellic acid Hypoglycemic and other related effects of Boswellia glabra
in plasma by high-pressure liquid chromatography/mass in alloxaninduced diabetic rats. Indian J Physiol Pharmacol
spectrometry. J Pharm Biomed Anal 2011; 56: 998-1005. 2007;51: 29-39.
28. Al-Harrasi A, Ali L, Rehman NU, Hussain H, Hussain J, 45. Shehata AM, J Jauch L. Quintanilla-Martinez and H.P.T.
Al- Rawahi A, et al. Nine triterpenes from Boswellia sacra Ammon, 2012. 11-Keto-β-boswellic acid inhibits infiltration of
Flückiger and their chemotaxonomic importance. Biochem lymphocytes into pancreatic islets in NOD-mice. Horm Metab
Syst Ecol 2013; 51: 113-116. Res 2017;49:693-700.
29. Ammon HP. Boswellic acids in chronic inflammatory 46. Al-Yasiry RMA, Jawad SAH3, Menati KJ, Naji SA and
diseases. Planta Med 2006;72:1100-1116. Lokman IH. Effects of Boswellia carterii and Boswellia serrata
30. AlHarrasi A, AlSaidi S. Phytochemical analysis of the in drinking water on the growth performance, hematology
essential oil from botanically certified oleogum resin of traits and immune response of broiler chicken. Int J Dairy
Boswellia sacra (Omni Luban). Molecules 2008;13:2181-2189. Technol 2016: 4 :27-37.
31. Shah BA, Qazi GN, Taneja SC. Boswellic acids: a group of 47. Al-Daraji J, et al. Effect of supplementation of different
medicinally important compounds. Nat Product Rep 2009; 26: levels frankincense to drinking water on certain hematological
72-89. traits of broiler. J Biol Chem Environ 2013;8:589-601.
32. Schauss A, Milholland R, Munson S. Indian frankincense 48. Kavitha JV, Rosario JF, Chandran J, Anbu P, Bakkiyanathan.
(Boswellia serrata) gum resin extract: a review of therapeutic Hypoglycemic and other related effects of Boswellia glabra

1380 Iran J Basic Med Sci, Vol. 23, No. 11, Nov 2020
Boswellia and metabolic syndrome Mahdian et al.

in alloxan-induced diabetic rats. Indian J Physiol Pharmacol property. Indian J Exp Biol 2005;43: 509-516.
2007;51:29-39. 65. Al-Daraji J, Ahmed AS, Al-Yasery ARM. Effect of
49. Helal EGE, Mostafa AM, Ashour FA, Kahwash AA. Effect supplementation of different levels frankincense to drinking
of boswellia carterii birdw on carbohydrate metabolism in water on certain hematological traits of broiler. J Biol Chem
diabetic male albino rats. Egypt J Hosp Med 2005; 20: 38-45. Environ 2013, 8:589-601.
50. Boos CJ, Lip GYH. Blood clotting inflammation and 66. Tripathi YB, Reddy MM, Pandey RS, Subhashini J, Tiwari
thrombosis in cardiovascular events: perspectives. Frontiers OP, Singh BK, Reddanna P. Anti-inflammatory properties of
in Bioscience 2006; 11: 328–336. BHUx, A polyherbal formulation to prevent atherosclerosis.
51. Ross R. Atheroscelerosis—an inflammatory disease. N Engl Inflammopharmacology 2004;12:131-152.
J Med 1999 14;340: 115-126. 67. Altmann A, Poeckel D, Fischer L, Schubert-Zsilavecz M,
52. Assimopoulou AN, Zlatanos SN, Papageorgiou VP. Steinhilber D, Werz O. Coupling of boswellic acid-induced Ca2+
Antioxidant activity of natural resins and bioactive triterpenes mobilisation and MAPK activation to lipid metabolism and
in oil substrates. Food Chemistry 2005; 92:721–727. peroxide formation in human leucocytes. Br J Pharmacol 2004
53. Bushra, S., Farooq, A., Roman, P. Antioxidant activity of 141:223-232.
phenolic components present in barks of Azadirachta indica, 68. Ventura LL, Fortes NC, Santiago HC, Caliari MV, Gomes
Terminalia arjuna, Acacia nilotica, and Eugenia jambolana MA, Oliveira DR. Obesity-induced diet leads to weight gain,
Lam. Trees. Food Chemistry 104:1106-1114. systemic metabolic alterations, adipose tissue inflammation,
54. Magesh V, Raman D, Pudupalayam KT. Genotoxicity studies hepatic steatosis, and oxidative stress in gerbils (Meriones
of dry extract of Boswellia serrata. Trop J Pharm Res 2008; unguiculatus). Peer J 2017 2;5: e2967.
7:1129–1135. 69. Song M, Um J, Jang H, Lee B. Beneficial effect of dietary
55. Sharma A, Mann A, Gajbhiye V and Kharya M. Phytochemical Ephedra sinica on obesity and glucose intolerance in high-fat
profile of Boswellia serrata: an overview. Pharmacogn Rev diet-fed mice. Exp Ther Med 2012; 3:707–712.
2007; 1: 137. 70. Xu BJ, Han LK, Zheng YN, Lee JH, Sung CK. In vitro inhibitory
56. Singh S, Khajuria A, Taneja S, Johri R, Singh J and Qazi G. effect of triterpenoidal saponins from Platycodi radix on
Boswellic acids: A leukotriene inhibitor also effective through pancreatic lipase. Arch Pharm Res 28:180–185.
topical application in inflammatory disorders. Phytomedicine 71. Mona Kamal Tawfik. Anti-aggregatory effect of boswellic
2008; 15: 400-407. acid in high-fat fed rats: involvement of redox and inflammatory
57. Yuliana N, Khatib A, Link-Struensee A, Ijzerman A, Rungkat- cascades. Arch Med Sci 2016; 12, 6: 1354–1361.
Zakaria F, Choi Y. Adenosine A1 receptor binding activity of 72. Gomaa AA, Farghaly HSM, El-Sers DA, Farrag MM, Al-Zokeim
methoxy flavonoids from orthosiphon stamineus. Planta Med NI. Inhibition of adiposity and related metabolic disturbances
2009; 75: 132- 136. by polyphenol‑rich extract of Boswellia serrata gum through
58. Asif M, Atif M, Amin MS, Zahari CD, Irshad A and Ashfaq A. alteration of adipo/cytokine profiles. Inflammopharmacology.
Diuretic activity of Trianthema portulacastrum crude extract 2019;27:549-559.
in albino rats. Trop J Pharm Res 2013, 12: 967-972. 73. Austin C, Stewart D, Allwood JW, McDougall GJ Extracts
59. Horacio J, Adrogue MD, Nicolaos E and Madias MD. from the edible seaweed, Ascophyllum nodosum, inhibit lipase
Mechanisms of disease. sodium and potassium in the activity in vitro: contributions of phenolic and polysaccharide
pathogenesis of hypertension. New Eng J Med 2007; 356: components. Food Funct 2018, 9:502–510.
1966-1978. 74. Umar S, Umar K, Sarwar AH, Khan A, Ahmad N, Ahmad
60. Eisvand F, Razavi BM, Hosseinzadeh H. The effects of S, Katiyar CK, Husain SA, Khan HA, Boswellia serrata extract
Ginkgo biloba on metabolic syndrome: A review. Phytother attenuates inflammatory mediators and oxidative stress in
Res 2020; 34:1798-1811. collagen induced arthritis. Phytomedicine 2014, 21:847–856.
61. Zutshi U, Rao PG, Kaur Samagat, Singh GB, Atal CK. 75. Du Z, Liu Z, Ning Z, Liu Y, Song Z, Wang C, Lu A. Prospects of
Mechanism of cholesterol lowering effect of Salai guggal ex- boswellic acids as potential pharmaceutics. Planta Med 2015;
Boswellia serrata. Indian J Pharm 1980; 12: 59. 81:259–271.
62. Cuaz-P´erolin C, Billiet L, Baug´e E, Copin C, Scott-Algara 76. Zheng J, DiLorenzo DJ, McLaughlin L, Roberts AT,
D, Genze F. Anti-inflammatory and antiatherogenic effects of Greenway FLV. Stimulation of sympathetic innervation in the
the NF-kappaB inhibitor acetyl-11-keto-beta-boswellic acid in upper gastrointestinal tract as a treatment for obesity. Med
LPS-challenged ApoE-/- mice. Arterioscler Thromb Vasc Biol Hypotheses 2009; 72:706–710.
2008; 28: 272-277. 77. Fatima S, Ahmad T, Shahid M et al. Comparative study of
63. Liu JJ, Toy WC, Liu S, Cheng A, Lim BK, Subramaniam Kundur (Boswellia serrata) and Tareeq (Diaphoresis) in the
T. Acetyl-keto-b-boswellic acid induces lipolysis in mature management of Samne Mufrit (Obesity) - a randomised clinical
adipocytes. Biochem Biophys Res Commun 2013; 431: 192- trial. Int J Health Sci Res 2017; 7:186-196.
196. 78. Singh P, Chacko M, Aggarwal ML, Bhat B, Khandal RK,
64. Pandey S, Singh BK, Tripathi YB. Extract of gum resins of Sultana S, et al. A 90 day gavage safety assessment of Boswellia
Boswellia serrata L. inhibits lipopolysaccharide induced nitric serrata in rats. Toxicol Int 2012; 19: 273–278.
oxide production in rat macrophages along with hypolipidernic

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