AKEAKE: For Autoimmune Conditions

Posted: March 2022
Author: Phil Rasmussen | M.Pharm., M.P.S., Dip. Herb. Med.; M.N.I.M.H.(UK),  F.N.Z.A.M.H. 

Akeake (Dodonaea viscosa), is an evergreen woody shrub used in many different types of traditional medicines in various countries. Apart from Aotearoa New Zealand, these include Australia, India, Indonesia, various Pacific islands, Central and South America, and Africa. Main constituents include flavonoids, saponins, terpenoids and tannins.

Autoimmune diseases range from skin conditions such as eczema and psoriasis, to type 2 diabetes, to rheumatoid arthritis. Their aetiology remains elusive but seems to be a combination of environmental and genetic factors leading to the over-activation of immune cells and chronic inflammation. Oxidative stress is a common feature,¹ and we are increasingly learning how important the gut microbiome is in terms of our predisposition to many such chronic so-called autoimmune conditions.^{2, 3}

As a medicinal plant that has diverse antimicrobial (antibacterial, antifungal, and antiviral) and anti-inflammatory properties, not to mention strong antioxidant actions,⁴ the fact that Dodonaea is a popular traditional treatment for many autoimmune conditions, is therefore not surprising.

Asthma

Dodonaea preparations are popular treatments in southern, eastern and northern Africa for the treatment of pulmonary infections including pneumonia, TB, croup and diphtheria,^{5, 6} and decoctions of the leaves are used both as inhalations or internal medicines for respiratory tract infections in India and Pakistan.⁷

Antibacterial activities have been shown for leaf preparations against many pathogens, including against Streptococcus pyogenes, Staph aureus, Escherichia coli, Salmonella typhi, and Pseudomonas aeruginosa,^8-11 as well as activity against various respiratory tract viruses.¹² While clinical trials are lacking, ethnopharmacological records exist of indigenous communities in the Indian, African and South American continents using it for asthma and related symptoms.¹³ Where asthma arises as a result of an upper respiratory tract infection, Dodonaea could have some useful applications.

Skin conditions

As with so many of our New Zealand native plants, Akeake can also be used successfully as a topical treatment for a range of inflammatory skin conditions, including rashes, eczema and psoriasis.  While such use by early Māori was not as prominent as that of other native species, preparations made from grinding the leaves and adding water to make a paste, are popular remedies for inflammatory and pruritic skin problems in Australia, Africa, India and Pakistan.^{7, 14}

Apart from its anti-inflammatory effects, the antimicrobial and astringent actions of topical Dodonaea preparations, probably contribute to this reputation for the treatment of a wide range of inflammatory skin conditions. 

Inflammatory joint conditions

In India and Pakistan, Dodonea is a popular topical application for musculoskeletal ailments, particularly where pain is a prominent symptom.^{16, 17} Stems, leaves and bark are often heated when preparing such traditional preparations.

Tincture and other preparations are taken internally and applied topically for gout, rheumatism and inflammations in Mexico, Peru and Panama. In Australia also, Dodonaea (‘hopbush’) is used for painful swellings and rheumatic joints.¹⁵

In vitro studies and tests using an animal model of arthritis, have shown the diterpenoid compound hautriwaic acid to be contributory to these anti-inflammatory and local anaesthetic properties.¹⁸

Diabetes mellitus

Finally, aerial parts of Dodonaea have been reported to increase insulin sensitivity and have antidiabetic effects in diabetic rats fed a high-fat diet.¹⁹ It may thus be potentially useful for the prevention or management of type 2 diabetes mellitus.  Inhibitory effects on protein tyrosine phosphatase 1B enzyme,²⁰ adipocyte or gut microflora modulation and improvement of oxidative stress-caused endothelial dysfunction by polyphenolic compounds found in Dodonaea,²¹ are possible mechanisms of action in its likely usefulness in this as well as other autoimmune conditions.

References:

1. Wójcik P, Gęgotek A, Žarković N, Skrzydlewska E. Oxidative Stress and Lipid Mediators Modulate Immune Cell Functions in Autoimmune Diseases. Int J Mol Sci. 2021;22(2):723.
2. Craciun CI, Neag MA, Catinean A, et al. The Relationships between Gut Microbiota and Diabetes Mellitus, and Treatments for Diabetes Mellitus. Biomedicines. 2022;10(2):308.
3. Gebrayel P, Nicco C, Al Khodor S, et al. Microbiota medicine: towards clinical revolution. J Transl Med. 2022;20(1):111.
4. Checkouri, Eloïse et al. “Evaluation of Polyphenol Content and Antioxidant Capacity of Aqueous Extracts from Eight Medicinal Plants from Reunion Island: Protection against Oxidative Stress in Red Blood Cells and Preadipocytes.” Antioxidants (Basel, Switzerland) vol. 9,10 959.
5. Cock IE, Van Vuuren SF. The traditional use of southern African medicinal plants for the treatment of bacterial respiratory diseases: A review of the ethnobotany and scientific evaluations. J Ethnopharmacol. 2020;263:113204.
6. Obakiro SB, Kiprop A, Kowino I, et al. Ethnobotany, ethnopharmacology, and phytochemistry of traditional medicinal plants used in the management of symptoms of tuberculosis in East Africa: a systematic review. Trop Med Health. 2020;48:68.
7. Alamgeer, Younis W, Asif H, et al. Traditional medicinal plants used for respiratory disorders in Pakistan: a review of the ethno-medicinal and pharmacological evidence. Chin Med. 2018;13:48.
8. Heyman HM, Hussein AA, Meyer JJ, et al. Antibacterial activity of South African medicinal plants against Methicillin-resistant Staphylococcus aureus (MRSA) Pharmaceu Biol. 2009;47:67–71.
9. Mothana RA et al, Evid Based Complement Alternat Med 2010 Sept; 7(3):323-330.
10. Khurram M, Khan MA, Hameed A, Abbas N, Qayum A, Inayat H. Antibacterial activities of Dodonaea viscosa using contact bioautography technique. Molecules. 2009;14(3):1332-1341.
11. Khurram, Muhammad et al. “Rapid Bioassay-Guided Isolation of Antibacterial Clerodane Type Diterpenoid from Dodonaea viscosa (L.) Jaeq.” International journal of molecular sciences vol. 16,9 20290-307.
12. Cock IE, Van Vuuren SF. The traditional use of southern African medicinal plants in the treatment of viral respiratory diseases: A review of the ethnobotany and scientific evaluations. J Ethnopharmacol. 2020;262:113194.
13. Semenya SS, Maroyi A. Plants Used by Bapedi Traditional Healers to Treat Asthma and Related Symptoms in Limpopo Province, South Africa. Evid Based Complement Alternat Med. 2018;2018:2183705.
14. Malik, Khafsa et al. “An ethnobotanical study of medicinal plants used to treat skin diseases in northern Pakistan.” BMC complementary and alternative medicine vol. 19,1 210. 13 Aug. 2019.
15. Pengelly Andrew, Medicinal activity of Dodonaea viscosa:  a preliminary study. Rural Industries Research and Development Corporation, Australia, 2008.
16. Shanmugavasan A, Ramachandran T. J Ethnopharmacol 2011; 137(3):1172-1176
17. Esakkimuthu, S et al. “Quantitative analysis of medicinal plants used to treat musculoskeletal ailments by non-institutionally trained siddha practitioners of Virudhunagar district, Tamil Nadu, India.” Journal of Ayurveda and integrative medicine vol. 12,1 (2021): 58-64.
18. Salinas-Sánchez DO, Herrera-Ruiz M, Pérez S, Jiménez-Ferrer E, Zamilpa A. Anti-inflammatory activity of hautriwaic acid isolated from Dodonaea viscosa leaves. Molecules. 2012;17(4):4292-4299.
19. Veerapur VP et al, Indian J Exp Biol 2010; 48(8):800-810.
20. Uddin Z, Song YH, Ullah M, Li Z, Kim JY, Park KH. Isolation and Characterization of Protein Tyrosine Phosphatase 1B (PTP1B) Inhibitory Polyphenolic Compounds From Dodonaea viscosa and Their Kinetic Analysis. Front Chem. 2018;6:40.
21. Taïlé J, Arcambal A, Clerc P, Gauvin-Bialecki A, Gonthier MP. Medicinal Plant Polyphenols Attenuate Oxidative Stress and Improve Inflammatory and Vasoactive Markers in Cerebral Endothelial Cells during Hyperglycemic Condition. Antioxidants (Basel). 2020;9(7):573.