Adaptogenic effects of Panax ginseng on modulation of cardiovascular functions

Muhammad Irfan, Yi-Seong Kwak, Chang-Kyun Han, Sun Hee Hyun, Man Hee Rhee, Muhammad Irfan, Yi-Seong Kwak, Chang-Kyun Han, Sun Hee Hyun, Man Hee Rhee

Abstract

Cardiovascular diseases are a rapidly growing epidemic with high morbidity and mortality. There is an urgent need to develop nutraceutical-based therapy with minimum side effects to reduce cardiovascular risk. Panax ginseng occupies a prominent status in herbal medicine for its various therapeutic effects against inflammation, allergy, diabetes, cardiovascular diseases, and even cancer, with positive, beneficial, and restorative effects. The active components found in most P. ginseng varieties are known to include ginsenosides, polysaccharides, peptides, alkaloids, polyacetylene, and phenolic compounds, which are considered to be the main pharmacologically active constituents in ginseng. P. ginseng is an adaptogen. That is, it supports living organisms to maintain optimal homeostasis by exerting effects that counteract physiological changes caused by physical, chemical, or biological stressors. P. ginseng possesses immunomodulatory (including both immunostimulatory and immunosuppressive), neuromodulatory, and cardioprotective effects; suppresses anxiety; and balances vascular tone. P. ginseng has an antihypertensive effect that has been explained by its vasorelaxant action, and paradoxically, it is also known to increase blood pressure by vasoconstriction and help maintain cardiovascular health. Here, we discuss the potential adaptogenic effects of P. ginseng on the cardiovascular system and outline a future research perspective in this area.

Keywords: AD, Alzheimer's disease; APP, Amyloid precursor protein; Adaptogen; Akt, Protein kinase B; Aβ, Amyloid-beta; CVD, Cardiovascular disease; Cardioprotective; Ginsenoside; NO, Nitric oxide; PI3K, Phosphatidylinositol-3 kinase; Panax ginseng; Vascular endothelium; cGMP, Cyclic guanosine 3′,5′-monophosphate; eNOS, Endothelial nitric oxide synthase.

Conflict of interest statement

All authors have no conflict of interest to declare.

© 2020 The Korean Society of Ginseng. Publishing services by Elsevier B.V.

Figures

Fig. 1
Fig. 1
Effect of P. ginseng and ginsenosides on vascular endothelial cells.

References

    1. Brekhman I., Dardymov I. New substances of plant origin which increase nonspecific resistance. Annu Rev Pharmacol. 1969;9(1):419–430.
    1. Winston D. Simon and Schuster; 2019. Adaptogens: herbs for strength, stamina, and stress relief.
    1. Panossian A.G. Adaptogens: tonic herbs for fatigue and stress. Alternative Compl Ther. 2003;9(6):327–331.
    1. Winston D. Herbal Therapeutics Research Library; Washington, NJ: 2004. Harmony remedies: an overview of adaptogens.
    1. Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M., Das S.R., de Ferranti S., Després J.P., Fullerton H.J. Heart disease and stroke statistics-2016 update: a report from the American heart association. Circulation. 2016;133(4) e38-360.
    1. Pagidipati N.J., Gaziano T.A. Estimating deaths from cardiovascular disease: a review of global methodologies of mortality measurement. Circulation. 2013;127(6):749–756.
    1. Shafiq G., Tatinati S., Ang W.T., Veluvolu K.C. Automatic identification of systolic time intervals in seismocardiogram. Sci Rep. 2016;6:37524.
    1. Gielen S., Landmesser U. The year in cardiology 2013: cardiovascular disease prevention. Eur Heart J. 2014;35(5):307–312.
    1. Lim K.H., Ko D., Kim J.-H. Cardioprotective potential of Korean Red Ginseng extract on isoproterenol-induced cardiac injury in rats. J Ginseng Res. 2013;37(3):273.
    1. Smith J.N., Negrelli J.M., Manek M.B., Hawes E.M., Viera A.J. Diagnosis and management of acute coronary syndrome: an evidence-based update. J Am Board Fam Med: JABFM. 2015;28(2):283–293.
    1. Andrews R.K., Berndt M.C. Platelet physiology and thrombosis. Thromb Res. 2004;114(5–6):447–453.
    1. Donner L., Gremer L., Ziehm T., Gertzen C.G.W., Gohlke H., Willbold D., Elvers M. Relevance of N-terminal residues for amyloid-beta binding to platelet integrin alphaIIbbeta3, integrin outside-in signaling and amyloid-beta fibril formation. Cell Signal. 2018;50:121–130.
    1. Gowert N.S., Donner L., Chatterjee M., Eisele Y.S., Towhid S.T., Munzer P., Walker B., Ogorek I., Borst O., Grandoch M. Blood platelets in the progression of Alzheimer's disease. PloS One. 2014;9(2) e90523.
    1. Barrett N.E., Holbrook L., Jones S., Kaiser W.J., Moraes L.A., Rana R., Sage T., Stanley R.G., Tucker K.L., Wright B. Future innovations in anti-platelet therapies. Br J Pharmacol. 2008;154(5):918–939.
    1. Mackman N. Triggers, targets and treatments for thrombosis. Nature. 2008;451(7181):914–918.
    1. Grimm R.H., Jr., Grandits G.A., Prineas R.J., McDonald R.H., Lewis C.E., Flack J.M., Yunis C., Svendsen K., Liebson P.R., Elmer P.J. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women: treatment of Mild Hypertension Study (TOMHS) Hypertension. 1997;29(1):8–14.
    1. Badimon L., Vilahur G., Padro T. Nutraceuticals and atherosclerosis: human trials. Cardiovasc Therapeut. 2010;28(4):202–215.
    1. Kim J.-H. Pharmacological and medical applications of Panax ginseng and ginsenosides: a review for use in cardiovascular diseases. J Ginseng Res. 2018;42(3):264–269.
    1. Irfan M., Kim M., Rhee M.H. Anti-platelet role of Korean ginseng and ginsenosides in cardiovascular diseases. J Ginseng Res. 2020;44(1):24–32.
    1. Lee C.H., Kim J.-H. A review on the medicinal potentials of ginseng and ginsenosides on cardiovascular diseases. J Ginseng Res. 2014;38(3):161–166.
    1. Mohanan P., Subramaniyam S., Mathiyalagan R., Yang D.-C. Molecular signaling of ginsenosides Rb1, Rg1, and Rg3 and their mode of actions. J Ginseng Res. 2018;42(2):123–132.
    1. Fernandez-Moriano C., González-Burgos E., Iglesias I., Lozano R., Gómez-Serranillos M.P. Evaluation of the adaptogenic potential exerted by ginsenosides Rb1 and Rg1 against oxidative stress-mediated neurotoxicity in an in vitro neuronal model. PloS One. 2017;12(8)
    1. Patel S., Rauf A. Adaptogenic herb ginseng (Panax) as medical food: status quo and future prospects. Biomed Pharmacother. 2017;85:120–127.
    1. Nocerino E., Amato M., Izzo A.A. The aphrodisiac and adaptogenic properties of ginseng. Fitoterapia. 2000;71:S1–S5.
    1. Shin W., Yoon J., Oh G.T., Ryoo S. Korean red ginseng inhibits arginase and contributes to endotheliumdependent vasorelaxation through endothelial nitric oxide synthase coupling. J Ginseng Res. 2013;37(1):64.
    1. Jeon B.H., Kim C.S., Park K.S., Lee J.W., Park J.B., Kim K.-J., Kim S.H., Chang S.J., Nam K.Y. Effect of Korea red ginseng on the blood pressure in conscious hypertensive rats. Gen Pharmacol: Vasc Syst. 2000;35(3):135–141.
    1. Vuksan V., Sung M.-K., Sievenpiper J.L., Stavro P.M., Jenkins A.L., Di Buono M., Lee K.S., Leiter L.A., Nam K.Y., Arnason J.T. Korean red ginseng (Panax ginseng) improves glucose and insulin regulation in well-controlled, type 2 diabetes: results of a randomized, double-blind, placebo-controlled study of efficacy and safety. Nutr Metabol Cardiovasc Dis. 2008;18(1):46–56.
    1. Qin N., Gong Q-h, Wei L-w, Wu Q., Huang X-n. Total ginsenosides inhibit the right ventricular hypertrophy induced by monocrotaline in rats. Biol Pharm Bull. 2008;31(8):1530–1535.
    1. Rhee M.-Y., Kim Y.-S., Bae J.-H., Nah D.-Y., Kim Y.-K., Lee M.-M., Kim H.Y. Effect of Korean red ginseng on arterial stiffness in subjects with hypertension. Journal Alternative Compl Med. 2011;17(1):45–49.
    1. Kitagawa H., Iwaki R. Pharmacological study on panax ginseg. Nihon Yakurigaku Zasshi Folia Pharmacologica Japonica. 1963;59:348–354.
    1. Siegel R.K. Ginseng abuse syndrome: problems with the panacea. Jama. 1979;241(15):1614–1615.
    1. Chung C.H., Hong S.P., Cho S.H., Hong J.G., Lee Y.K., Lim G.H., Yang W.H., You H.J., Woo S.C., Choi C.H. Influence of total ginseng saponin on contractile responses of vasoconstrictors in the isolated rat aorta. Kor Circ J. 1999;29(9):976–984.
    1. Chen I.-J., Chang M.-Y., Chiao S.-L., Chen J.-L., Yu C.-C., Yang S.-H., Liu J.M., Hung C.C., Yang R.C., Chang H.C. Korean red ginseng improves blood pressure stability in patients with intradialytic hypotension. Evid base Compl Alternative Med. 2012;2012
    1. Park D. Pressor and depressor actions of Panax Ginseng in mammals. Kor Med J. 1960;5(85):98. 1960.
    1. Petkov W. Pharmacological studies of the drug Panax ginseng. Mitteilung Arzneim Forschung. 1961;11(418):22. 1961.
    1. Wood W.B., Roh B.L., White R.P. Cardiovascular actions of Panax ginseng in dogs. Jpn J Pharmacol. 1964;14(3):284–294.
    1. Sokabe H., Kishi K., Watanabe T.X., editors. Proceedings of the ginseng society conference. The Korean Society of Ginseng; 1984. Effect of Korean red ginseng powder (GP), administered orally, on blood pressure in hypertensive rats.
    1. Kang S.Y., Schini-Kerth V.B., Kim N.D. Ginsenosides of the protopanaxatriol group cause endothelium-dependent relaxation in the rat aorta. Life Sci. 1995;56(19):1577–1586.
    1. Kim N.D., Kang S.Y., Schini V.B. Ginsenosides evoke endothelium-dependent vascular relaxation in rat aorta. Gen Pharmacol. 1994;25(6):1071–1077.
    1. Tousoulis D., Kampoli A.-M., Tentolouris Nikolaos Papageorgiou C., Stefanadis C. The role of nitric oxide on endothelial function. Curr Vasc Pharmacol. 2012;10(1):4–18.
    1. Hien T.T., Kim N.D., Pokharel Y.R., Oh S.J., Lee M.Y., Kang K.W. Ginsenoside Rg3 increases nitric oxide production via increases in phosphorylation and expression of endothelial nitric oxide synthase: essential roles of estrogen receptor-dependent PI3-kinase and AMP-activated protein kinase. Toxicol Appl Pharmacol. 2010;246(3):171–183.
    1. Simoncini T., Hafezi-Moghadam A., Brazil D.P., Ley K., Chin W.W., Liao J.K. Interaction of oestrogen receptor with the regulatory subunit of phosphatidylinositol-3-OH kinase. Nature. 2000;407(6803):538–541.
    1. Lau W.-S., Chan R.Y.-K., Guo D.-A., Wong M.-S. Ginsenoside Rg1 exerts estrogen-like activities via ligand-independent activation of ERα pathway. J Steroid Biochem Mol Biol. 2008;108(1–2):64–71.
    1. Siegel R.K. Ginseng and high blood pressure. Jama. 1980;243(1):32.
    1. Wang X., Chu S., Qian T., Chen J., Zhang J. Ginsenoside Rg1 improves male copulatory behavior via nitric oxide/cyclic guanosine monophosphate pathway. J of Sex Med. 2010;7(2):743–750.
    1. Abdel-Wahhab M.A., Joubert O., El-Nekeety A.A., Yoon W., Kim Y., Rihn B. Aphrodisiac effects of Panax ginseng extract standardized with ginsenoside Rg3 in male rats. Gen Health Med Sci. 2014;1(1):3–8.
    1. De Andrade E., De Mesquita A.A., de Almeida Claro J., De Andrade P.M., Ortiz V., Paranhos M., Srougi M., Erdogrun T. Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction. Asian J Androl. 2007;9(2):241–244.
    1. Kim T.-H., Jeon S.H., Hahn E.-J., Paek K.-Y., Park J.K., Youn N.Y., Lee H.L. Effects of tissue-cultured mountain ginseng (Panax ginseng CA Meyer) extract on male patients with erectile dysfunction. Asian J Androl. 2009;11(3):356.
    1. Toh H. Improved isolated heart contractility and mitochondrial oxidation after chronic treatment with Panax ginseng in rats. Am J Chin Med. 1994;22:275–284. 03n04.
    1. Kong H-l, Wang J-p, Li Z-q, Zhao S-m, Dong J., Zhang W-w. Anti-hypoxic effect of ginsenoside Rbl on neonatal rat cardiomyocytes is mediated through the specific activation of glucose transporter-4 ex vivo. Acta Pharmacol Sin. 2009;30(4):396–403.
    1. Wang Y.G., Zima A.V., Ji X., Pabbidi R., Blatter L.A., Lipsius S.L. Ginsenoside Re suppresses electromechanical alternans in cat and human cardiomyocytes. Am J Physiol Heart Circ Physiol. 2008;295(2):H851–H859.
    1. Bai C.-X., Sunami A., Namiki T., Sawanobori T., Furukawa T. Electrophysiological effects of ginseng and ginsenoside Re in Guinea pig ventricular myocytes. Eur J Pharmacol. 2003;476(1–2):35–44.
    1. Choi S.-H., Shin T.-J., Lee B.-H., Chu D-h, Choe H., Pyo M.-K., Hwang S.H., Kim B.R., Lee S.M., Lee J.H. Ginsenoside Rg3 activates human KCNQ1 K+ channel currents through interacting with the K318 and V319 residues: a role of KCNE1 subunit. Eur J Pharmacol. 2010;637(1–3):138–147.
    1. Kim C-s, Son S-j, Kim H-s, Kim Y-d, Lee K-s, Jeon B-h, Kim K.J., Park J.K., Park J.B. Modulating effect of ginseng saponins on heterologously expressed HERG currents in Xenopus oocytes. Acta Pharmacol Sin. 2005;26(5):551–558.
    1. Jeong D., Irfan M., Kim S.-D., Kim S., Oh J.-H., Park C.-K., Kim H.K., Rhee M.H. Ginsenoside Rg3-enriched red ginseng extract inhibits platelet activation and in vivo thrombus formation. J Ginseng Res. 2017;41(4):548–555.
    1. Irfan M., Jeong D., Kwon H.-W., Shin J.-H., Park S.-J., Kwak D., Kim T.H., Lee D.H., Park H.J., Rhee M.H. Ginsenoside-Rp3 inhibits platelet activation and thrombus formation by regulating MAPK and cyclic nucleotide signaling. Vasc Pharmacol. 2018;109:45–55.
    1. Irfan M., Jeong D., Saba E., Kwon H.-W., Shin J.-H., Jeon B.-R., Kim S., Kim S.D., Lee D.H., Nah S.Y. Gintonin modulates platelet function and inhibits thrombus formation via impaired glycoprotein VI signaling. Platelets. 2019;30(5):589–598.
    1. Fan H.-Y., Fu F.-H., Yang M.-Y., Xu H., Zhang A.-H., Liu K. Antiplatelet and antithrombotic activities of salvianolic acid A. Thromb Res. 2010;126(1):e17–e22.
    1. Cho Y.I., Cho D.J., Rosenson R.S. Endothelial shear stress and blood viscosity in peripheral arterial disease. Curr Atheroscler Rep. 2014;16(4):404.
    1. Endale M., Lee W., Kamruzzaman S., Kim S., Park J., Park M., Park T.Y., Park H.J., Cho J.Y., Rhee M.H. Ginsenoside-Rp1 inhibits platelet activation and thrombus formation via impaired glycoprotein VI signalling pathway, tyrosine phosphorylation and MAPK activation. Br J Pharmacol. 2012;167(1):109–127.
    1. Yamamoto M., Uemura T., Nakama S., Uemiya M., Kumagai A. Serum HDL-cholesterol-increasing and fatty liver-improving actions of Panax ginseng in high cholesterol diet-fed rats with clinical effect on hyperlipidemia in man. Am J Chin Med. 1983;11(1–4):96–101.
    1. Hwang S.-Y., Son D.J., Kim I.-W., Kim D.-M., Sohn S.-H., Lee J.-J., Kim S.K. Korean red ginseng attenuates hypercholesterolemia-enhanced platelet aggregation through suppression of diacylglycerol liberation in high-cholesterol-diet-fed rabbits. Phytother Res. 2008;22(6):778–783.
    1. Saba E., Jeon B.R., Jeong D.-H., Lee K., Goo Y.-K., Kim S.-H., Sung C.K., Roh S.S., Kim S.D., Kim H.K. Black ginseng extract ameliorates hypercholesterolemia in rats. J Ginseng Res. 2016;40(2):160–168.
    1. Kwak Y.-S., Kyung J.-S., Kim J.S., Cho J.Y., Rhee M.-H. Anti-hyperlipidemic effects of red ginseng acidic polysaccharide from Korean red ginseng. Biol Pharm Bull. 2010;33(3):468–472.
    1. In G., Ahn N.-G., Bae B.-S., Lee M.-W., Park H.-W., Jang K.H., Cho B.G., Han C.K., Park C.K., Kwak Y.S. In situ analysis of chemical components induced by steaming between fresh ginseng, steamed ginseng, and red ginseng. J Ginseng Res. 2017;41(3):361–369.
    1. Laclaustra M., Corella D., Ordovas J.M. Metabolic syndrome pathophysiology: the role of adipose tissue. Nutr Metabol Cardiovasc Dis. 2007;17(2):125–139.
    1. Morrison C.D., Huypens P., Stewart L.K., Gettys T.W. Implications of crosstalk between leptin and insulin signaling during the development of diet-induced obesity. Biochim Biophys Acta (BBA)-Mol Basis Dis. 2009;1792(5):409–416.
    1. Venancio J.C., Margatho L.O., Rorato R., Rosales R.R.C., Debarba L.K., Coletti R., Antunes-Rodrigues J., Elias C.F., Elias L.L.K. Short-term high-fat diet increases leptin activation of CART neurons and advances puberty in female mice. Endocrinology. 2017;158(11):3929–3942.
    1. Kwak Y.-S., Kyung J.-S., Wee J.-J. Anti-obesity activity of red ginseng acidic polysaccharide from Korean red ginseng (Panax ginseng CA Meyer) Adv Complement Alt Med. 2019;42(2):1–10.
    1. Dıez J.J., Iglesias P. The role of the novel adipocyte-derived hormone adiponectin in human disease. Eur J Endocrinol. 2003;148(3):293–300.
    1. Gowert N.S., Donner L., Chatterjee M., Eisele Y.S., Towhid S.T., Münzer P., Walker B., Ogorek I., Borst O., Grandoch M. Blood platelets in the progression of Alzheimer’s disease. PloS One. 2014;9(2)
    1. Casoli T., Balietti M., Giorgetti B., Solazzi M., Scarpino O., Fattoretti P. Platelets in Alzheimer's disease-associated cellular senescence and inflammation. Curr Pharmaceut Des. 2013;19(9):1727–1738.
    1. Shen M.Y., Hsiao G., Fong T.H., Chen H.M., Chou D.S., Lin C.H., Sheu J.R., Hsu C.Y. Amyloid beta peptide-activated signal pathways in human platelets. Eur J Pharmacol. 2008;588(2–3):259–266.
    1. Kokjohn T.A., Van Vickle G.D., Maarouf C.L., Kalback W.M., Hunter J.M., Daugs I.D., Luehrs D.C., Lopez J., Brune D., Sue L.I. Chemical characterization of pro-inflammatory amyloid-beta peptides in human atherosclerotic lesions and platelets. Biochim Biophys Acta (BBA)-Mol Basis Dis. 2011;1812(11):1508–1514.
    1. Davies T.A., Long H.J., Eisenhauer P.B., Hastey R., Cribbs D.H., Fine R.E., Simons E.R. β amyloid fragments derived from activated platelets deposit in cerebrovascular endothelium: usage of a novel blood brain barrier endothelial cell model system. Amyloid. 2000;7(3):153–165.
    1. Lee S.-T., Chu K., Sim J.-Y., Heo J.-H., Kim M. Panax ginseng enhances cognitive performance in Alzheimer disease. Alzheimer Dis Assoc Disord. 2008;22(3):222–226.
    1. Wang Y., Liu J., Zhang Z., Bi P., Qi Z., Zhang C. Anti-neuroinflammation effect of ginsenoside Rbl in a rat model of Alzheimer disease. Neurosci Lett. 2011;487(1):70–72.
    1. Ong W.-Y., Farooqui T., Koh H.-L., Farooqui A.A., Ling E.-A. Protective effects of ginseng on neurological disorders. Front Aging Neurosci. 2015;7:129.
    1. Chen X. Cardiovascular protection by ginsenosides and their nitric oxide releasing action. Clin Exp Pharmacol Physiol. 1996;23(8):728–732.
    1. Nag S.A., Qin J., Wang W., Wang M.-H., Wang H., Zhang R. Ginsenosides as anticancer agents: in vitro and in vivo activities, structure-activity relationships, and molecular mechanisms of action. Front Pharmacol. 2012;3:25.
    1. Yang Q., Wang N., Zhang J., Chen G., Xu H., Meng Q., Du Y., Yang X., Fan H. In vitro and in silico evaluation of stereoselective effect of ginsenoside isomers on platelet P2Y12 receptor. Phytomedicine. 2019;64:152899.
    1. Azike C.G., Charpentier P.A., Hou J., Pei H., Lui E.M.K. The Yin and Yang actions of North American ginseng root in modulating the immune function of macrophages. Chin Med. 2011;6(1):21.

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