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Fitoterapia
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / f i t o t e
Review
a r t i c l e i n f o a b s t r a c t
Article history: The longstanding, successful use of herbal drug combinations in traditional medicine demands
Received 6 November 2010 that we find a rationale for their comparative pharmacological and therapeutic superiority to
Accepted 8 November 2010 isolated single constituents. The synergistic efficacy of these combinations can be evaluated
Available online 12 November 2010
and verified by Berenbaum's isobole method, followed by clinical studies performed in
comparison with synthetic standard drugs. There are many examples of mono- and multi-
Keywords: extract combinations used presently, which exhibit synergistic efficiency based on multi-target
Synergy effects mechanisms of action. Among the natural products, gallocatechins of green tea and
Multi-target therapy curcuminoids of ginger are the presently favoured polyphenols for a possible future use in
Isobologram
co-medication with antibiotics and standard anticancer drugs. The main targets were found to
Polyphenols
Multi-resistance NF-κB
be COX 1 + 2, NF-κB, and membrane glycoproteins that belong to the ATP-binding cassette
Transporter glycoproteins (ABC) transporter family.
© 2010 Elsevier B.V. All rights reserved.
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2. Pharmacological approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3. What are the possible mechanisms underlying the synergy effects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4. Synergy effects in interference with resistance mechanisms of bacteria, fungi [8] and tumor cells . . . . . . . . . . . . . . . 36
4.1. Antimicrobial synergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
4.2. Anti-tumor synergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
5. Clinically proven synergy efficacies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
0367-326X/$ – see front matter © 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.fitote.2010.11.016
H. Wagner / Fitoterapia 82 (2011) 34–37 35
Fig. 1. Isobole curve for 50% inhibition of a combination of ginkgolides A and B; IC50 values (μg/ml) of PAF-induced in vitro thrombocyte aggregation are shown for
various dose combinations [2,3].
36 H. Wagner / Fitoterapia 82 (2011) 34–37
Table 3
Therapeutic equivalence of standardized plant extracts with synthetic drugs for a given indication, as evidenced by comparative placebo controlled clinical studies [3].