The Horse chestnut (Aesculus hippocastanum) or indian chestnut is a plant belonging to the Hippocastanaceae family. Since ancient times it was discovered that the horse chestnut seed extract was useful as a natural remedy to cure wounds, hemorrhoids and intestinal diseases and therefore widely used by populations living in the Asia Minor, India and the central area of the Balkan peninsula. It 'a large tree, 20-30 m high too, with palmate-compound leaves, fragrant and irregular flower, gathered in small unipare peaks and then assembled in terminal clusters. It produces a spiny capsule, trilocular or even unilocular fruit; in every lodge one or two smooth and shiny, brown and with a very large and white hilar area, seeds are contained. Exactly from that seeds is mainly obtained the extract that contains active ingredients such as triterpene glycosides (escin, coumarin, tannins and flavonoids), coumarins glycosides (esculin, fraxina and scopolina) and the flavonolic glycoside (quercitrin). Our days the extract is used to treat the chronic venous insufficiency, to improve blood circulation, and its related disorders such as varicose veins, venous ulcers, edema of lower limbs and hemorrhoids. The active ingredient responsible of the therapeutic properties it’s escin, therefore the horse chestnut extracts present on the market are standardized for their content in escin in percentage of 16-21%. Chronic venous insufficiency (CVI) is a disease that afflicts approximately 25% of the European Community, particularly women. CVI is caused by inborn or acquired anomalies in the functioning of the venous system, causing primary defects in the vein wall and in the valvular structure as well as the failure itself. It can also be caused by other factors influencing the weakened tension and venous structure, such as hormonal changes, pregnancy, obesity, limited activity, standing or sitting working position, and oral contraceptives. As a result of the weakened structure and vascular tension, blood congestion, flooding of the vascular bed, and hypoxia occur; consequently, the mitochondrial oxidative phosphorylation is inhibited, and the content of adenosine triphosphate (ATP) is reduced. A decrease in ATP content in endothelial cells causes a series of cellular changes, such as a cytosolic calcium concentration increase, the release of inflammatory mediators, such as prostaglandins and the platelet-activating factor (PAF) that results in the recruitment, activation and adhesion of the polymorphonuclear neutrophils. The leukocytes adhering to the vascular wall release phospholipase A2 that is responsible of inflammatory precursors, toxic oxidative metabolites and lysosomal enzymes (elastase and collagenase) production. They even lead to an increased activity of hyaluronidase that degrades the hyaluronic acid, the main component of the capillary endothelium. The increased activity of other enzymes that are components of the vascular walls, such as β-N acetylglucosaminidase, β-glucuronidase and arylsulfatase, responsible of the proteoglycan degradation, has been observed also in chronic venous insufficiency. The hyaluronic acid and proteoglycans degradation leads to violation of the integrity of blood vessel walls, increased capillary permeability and fragility . During an inflammatory reaction, histamine and serotonin are released too, enzymes influencing the capillary permeability increase. The effect of the mentioned above processes is the migration of leukocytes outside the vascular walls, the exacerbation of the inflammation, the event of edema, and pathological changes in veins. The plant origin medicines play a significant role in the drug treatment of CVI. The most popular include the horse chestnut seed extract or aescin, isolated from it and flavonoids: diosmin, hesperidin, rutin, and his derivative – troxerutin.
L’ ippocastano o castagno d’ India è una pianta appartenente alla famiglia delle Hippocastanaceae. Fin dall’ antichità è stato scoperto che l’ estratto di semi di Ippocastano era utile come rimedio naturale per curare ferite, malattie intestinali ed emorroidi e per ciò ampiamente utilizzato da popolazioni che abitavano l’ Asia Minore, l’ India e la zona centrale della penisola balcanica. E' un grande albero, alto anche 20-30 m, con foglie palmato-composte, fiori odorosi, irregolari, raccolti in piccole cime unipare e riuniti a loro volta in grappoli terminali. Produce un frutto a capsula spinosa, triloculare o anche uniloculare; in ogni loggia sono contenuti uno o due semi lisci e lucidi, di colore marrone, con un' area ilare molto ampia e bianca. Proprio da questi semi è maggiormente ricavato l’ estratto che contiene i principi attivi come i glicosidi triterpenici (escina, cumarina, tannini e flavonoidi), i glicosidi cumarinici (esculina, fraxina e scopolina) ed il glicoside flavonolico (quercitrina). L’ estratto è utilizzato ai giorni nostri per trattare l’ insufficienza cronica venosa, migliorare la circolazione venosa e i disturbi ad essa collegati come varici, ulcere venose, edemi degli arti inferiori ed emorroidi. Il principio attivo responsabile delle proprietà terapeutiche è l'escina, per cui gli estratti di Ippocastano presenti in commercio sono standardizzati al 16-21 %. L' insufficienza venosa cronica (CVI) è una patologia che affligge approssimativamente il 25% della comunità Europea, in particolare le donne. La CVI è causata da anomalie innate o acquisite nel funzionamento del sistema venoso e porta a difetti primari della parete venosa e della struttura valvolare nonché all' insufficienza venosa stessa. Può inoltre essere causata da ulteriori fattori che influenzano la già indebolita tensione e la struttura venosa, come cambiamenti ormonali, gravidanza, obesità, attività limitata, lavorare in posizione seduta o in piedi, e contraccettivi orali. Come risultato si verificano la congestione del sangue, lo straripamento del letto vascolare fino ad arrivare ad una condizione di ipossia; di conseguenza, la fosforilazione ossidativa mitocondriale è inibita ed il contenuto di adenosina trifosfato (ATP) diminuisce. Una diminuzione nel contenuto di ATP nelle cellule endoteliali causa una serie di modificazioni cellulari, come l’ aumento della concentrazione del calcio citosolico, il rilascio di mediatori infiammatori, come le prostaglandine ed il fattore attivante le piastrine che si traduce nel reclutamento, attivazione ed adesione dei neutrofili polimorfonucleati. I leucociti aderenti alla parete vascolare rilasciano la fosfolipasi A2 responsabile della produzione dei precursori infiammatori, dei metaboliti ossidativi tossici e degli enzimi lisosomiali (elastasi e collagenasi). Portano anche ad una aumentata attività della ialuronidasi che degrada l' acido ialuronico, il principale costituente dell' endotelio capillare. Inoltre l' aumentata attività di altri enzimi che sono componenti delle pareti vascolari, per esempio β-N-acetilglucosaminidasi, β-glucoronidasi ed arilsolfatasi, responsabili della degradazione dei proteoglicani, è stata osservata anche nell' insufficienza venosa cronica. La degradazione dell' acido ialuronico e dei proteoglicani sfocia nella violazione dell' integrità delle pareti dei vasi sanguigni, nell’ aumento della permeabilità capillare e nella loro maggior fragilità. Nel corso di una reazione infiammatoria sono rilasciate anche l' istamina e la serotonina, enzimi che influenzano l' aumento della permeabilità capillare. L' effetto dei processi sopra menzionati è la migrazione dei leucociti fuori dalle pareti vascolari, l' esacerbazione dell' infiammazione, l' evento dell' edema, e cambiamenti patologici nelle vene. I medicinali di origine vegetale giocano un ruolo significativo nel trattamento farmacologico della CVI.
Aesculus hippocastanum nel trattamento dell’ Insufficienza Venosa Cronica
MAURI, CAMILLA
2015/2016
Abstract
The Horse chestnut (Aesculus hippocastanum) or indian chestnut is a plant belonging to the Hippocastanaceae family. Since ancient times it was discovered that the horse chestnut seed extract was useful as a natural remedy to cure wounds, hemorrhoids and intestinal diseases and therefore widely used by populations living in the Asia Minor, India and the central area of the Balkan peninsula. It 'a large tree, 20-30 m high too, with palmate-compound leaves, fragrant and irregular flower, gathered in small unipare peaks and then assembled in terminal clusters. It produces a spiny capsule, trilocular or even unilocular fruit; in every lodge one or two smooth and shiny, brown and with a very large and white hilar area, seeds are contained. Exactly from that seeds is mainly obtained the extract that contains active ingredients such as triterpene glycosides (escin, coumarin, tannins and flavonoids), coumarins glycosides (esculin, fraxina and scopolina) and the flavonolic glycoside (quercitrin). Our days the extract is used to treat the chronic venous insufficiency, to improve blood circulation, and its related disorders such as varicose veins, venous ulcers, edema of lower limbs and hemorrhoids. The active ingredient responsible of the therapeutic properties it’s escin, therefore the horse chestnut extracts present on the market are standardized for their content in escin in percentage of 16-21%. Chronic venous insufficiency (CVI) is a disease that afflicts approximately 25% of the European Community, particularly women. CVI is caused by inborn or acquired anomalies in the functioning of the venous system, causing primary defects in the vein wall and in the valvular structure as well as the failure itself. It can also be caused by other factors influencing the weakened tension and venous structure, such as hormonal changes, pregnancy, obesity, limited activity, standing or sitting working position, and oral contraceptives. As a result of the weakened structure and vascular tension, blood congestion, flooding of the vascular bed, and hypoxia occur; consequently, the mitochondrial oxidative phosphorylation is inhibited, and the content of adenosine triphosphate (ATP) is reduced. A decrease in ATP content in endothelial cells causes a series of cellular changes, such as a cytosolic calcium concentration increase, the release of inflammatory mediators, such as prostaglandins and the platelet-activating factor (PAF) that results in the recruitment, activation and adhesion of the polymorphonuclear neutrophils. The leukocytes adhering to the vascular wall release phospholipase A2 that is responsible of inflammatory precursors, toxic oxidative metabolites and lysosomal enzymes (elastase and collagenase) production. They even lead to an increased activity of hyaluronidase that degrades the hyaluronic acid, the main component of the capillary endothelium. The increased activity of other enzymes that are components of the vascular walls, such as β-N acetylglucosaminidase, β-glucuronidase and arylsulfatase, responsible of the proteoglycan degradation, has been observed also in chronic venous insufficiency. The hyaluronic acid and proteoglycans degradation leads to violation of the integrity of blood vessel walls, increased capillary permeability and fragility . During an inflammatory reaction, histamine and serotonin are released too, enzymes influencing the capillary permeability increase. The effect of the mentioned above processes is the migration of leukocytes outside the vascular walls, the exacerbation of the inflammation, the event of edema, and pathological changes in veins. The plant origin medicines play a significant role in the drug treatment of CVI. The most popular include the horse chestnut seed extract or aescin, isolated from it and flavonoids: diosmin, hesperidin, rutin, and his derivative – troxerutin.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/21682