Butcher's Broom

JUN 2006

Ruscus aculeatus L. Family: Liliaceae (lilies)

Butcher's broom , box holly , knee holly , pettigree , sweet broom , ¹ Jew's myrtle ¹

Uses

Butcher's broom has been used in many forms as a laxative, diuretic, treatment for circulatory disease, and cytotoxic agent, although limited results from clinical trials are available.

Dosing

Butchers broom has been used in clinical trials for chronic venous insufficiency standardized to 7 to 11 mg of ruscogenin. Hesperidin methyl chalcone has also been used as a marker for standardization in the product Cyclo 3 Fort. Extracts have been dosed at 16 mg daily for chronic phlebopathy, while a topical cream formulation was used to apply 64 to 96 mg of extract daily.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.

Interactions

None well documented.

Adverse Reactions

No adverse reactions have been reported.

Toxicology

Not known to be toxic.

Butcher's broom is a low-growing common evergreen shrub. It is widely distributed, from Iran to the Mediterranean ^2, and the southern United States. ^3, The plant develops edible shoots from rhizomes that are similar to asparagus in form. ^4, Butcher's broom has tough, erect, striated stems with false thorny leaves called cladophylles. ⁵ The nomenclature of this plant should not be confused with broom ( Cytisus scoparius L.) or Spanish broom ( Spartium junceum L.).

R. aculeatus was given its common name, butcher's broom, because its stiff twigs were bound together and used by butchers in Europe to keep their cutting boards clean. The plant has a long history of use; more than 2000 years ago, it was noted as a laxative, diuretic, and a phlebotherapeutic agent. ¹ Extracts, decoctions, and poultices have been used throughout the ages, but the medicinal use of this plant did not become common until the last century. Early investigations during the 1950s indicated that extracts of the rhizomes of butcher's broom could induce vasoconstriction and therefore might have use in the treatment of circulatory diseases. The increasing popularity of natural and herbal remedies in Europe in the 1970s reaffirmed its position in modern medicine. Novel uses for this plant have included its use as an anti-inflammatory agent and to prevent atherosclerosis. Butcher's broom is the active component in several drug formulations and topical treatments for venous disease. Structural elucidation of active compounds and the discovery of new pharmacological activity, particularly as a cytotoxic agent, demonstrate the need for continued research on butcher's broom.

A variety of compounds have been isolated from butcher's broom. The 2 primary saponin compounds are ruscogenin and neoruscogenin. ^6, The ruscogenin content in underground and aboveground parts is approximately 0.12% and 0.08%, respectively. ^7, The plant also contains numerous furanostanol and spirostanol saponins. ^8, , ^9, Two bisdesmosidic spirostanol saponins, aculeoside A and aculeoside B, also have been isolated. ^9, In addition, a variety of flavonoids, a fatty acid mixture composed primarily of tetracosanoic acid and related compounds, chrysophanic acid, sitosterol, campesterol and stigmasterol, have been isolated from the roots. ^3, Butcher's broom also contains triterpenes, coumarins, sparteine, tyramine, and glycolic acid. ^10, The benzofuran euparone ^7, and the phenolic ruscodibenzofuran ^11, have been isolated. Plant extracts have revealed the presence of sulfated steroid saponins ^12, and the steroid glycosides, rusin and ruscoside. ⁵

Lower Limb Venous Disease

Animal data In dogs, an extract of the root was shown to cause a dose-dependent increase in the contraction of isolated veins. These contractions were inhibited by the alpha-adrenergic blocking agent phentolamine, suggesting that compounds in Ruscus activated alpha-1 and alpha-2 receptors in smooth muscle. Ruscus had no influence on prostaglandin levels in these tests. ¹³ Prazosin, an alpha-1-adrenoceptor antagonist, also reduced the activity of Ruscus extract. ^14, Topical application of the extract on hamster cheek pouch microvasculature displayed concentration- and temperature-dependent responses in the vessels. ¹⁵

Clinical data In humans, RAES , a venotropic drug containing Ruscus extract, has been shown to be effective in improving the signs and symptoms of lower limb venous disease in patients with chronic phlebopathy. ¹⁶ RAES is composed of 16.5 mg Ruscus extract, 75 mg hesperidin, and 50 mg ascorbic acid. ¹⁶ The effectiveness and tolerability of this product was evaluated during a 2-month, double-blind, placebo-controlled, crossover trial involving 40 patients with chronic phlebopathy of the lower limbs. A trend toward improvement was noted among treated patients, although statistical significance was not reached. In particular, edema, itching, and paresthesias improved, as did a feeling of limb heaviness and cramping. In another randomized, double-blind study, 18 healthy volunteers applied 4 to 6 g of a cream containing 64 to 96 mg of Ruscus extract to their legs; a reduction in the diameter of the femoral vein was noted ( P = 0.014). ¹⁷

Extracts of Ruscus have been included in commercial therapeutic agents designed for the management of venous insufficiency. The most commonly known oral formulation, Cyclo 3 Fort , is composed of R. aculeatus extract, hesperidin methylchalcone, and ascorbic acid. In France, Ruscus extract is the standard treatment in preventing postoperative thrombosis. ¹ Ruscus has venotonic properties, such as reducing venous capacity and pooling of blood in the legs. It also has a protective effect on capillaries, the vascular endothelium, and smooth muscle. ¹

Formulations of suppositories containing 100 mg of dry Ruscus extract are being investigated for the treatment of hemorrhoids and other venous diseases. A 100 mg extract contains 0.5 mg of active ruscogenins. ¹⁸

Orthostatic Hypotension

Animal data As orthostatic hypotension generally worsens under hot environmental conditions, Ruscus extract is unique in that under these conditions, the response of cutaneous veins improves greatly. ¹⁴

Clinical data Ruscus is used to treat orthostatic hypotension and does not cause supine hypertension like other related drug therapies. ¹ It is noted in several references that treatment of venous diseases is best accomplished using Ruscus extracts along with other nonpharmacologic therapies.

Cytotoxic Several studies indicate that compounds found in butcher's broom may possess cytotoxic activity. Researchers have found cytotoxic activity in aculeoside A; it exhibited inhibitory activity against HL-60 cancer cell growth with an IC₅₀ of 0.48 mcg/mL. ^19, A furanosterol and its corresponding spirostanol have exhibited inhibition of HL-60 cells in vitro. The presence of acetyl and 2-hydroxy-3-methyl pentanoyl groups attached to the diglycoside moiety is suspected to contribute to the observed cytostatic activity. ²⁰

Cytotoxic activity also has been demonstrated with Ruscus diglycoside and its corresponding saponin in culture. ⁸

Anti-inflammatory The combined action of flavonoids, sterols, and proteolytic enzymes found in the root has been shown to reduce dextran and carrageenan-induced rat paw edema, indicating that the extract has some anti-inflammatory activity. ²¹ This mixture of compounds was administered intraduodenally, thereby reducing the possibility of inactivation by stomach acids.

Diuretic Glycolic acid found in the plant is credited for short-term diuretic activity. ¹

Other uses Researchers have found that when a Ruscus extract is applied topically, a dose-dependent inhibition of the macromolecular permeability-increasing effect of histamine occurs. ²² Ruscus extract given IV (5 mg/kg) inhibits the macromolecular permeability-increasing effect of bradykinin, leukotriene B4, and histamine. ^22, Ruscogenins are ineffective on hyaluronidase activity but show exceptional antielastase activity. ²³

Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.

None well documented.

The German Commission E approves oral use of the rhizome for supportive therapy for discomforts of chronic venous insufficiency and complaints of hemorrhoids and reports no known interactions. ^26, In a clinical trial, no adverse events were attributable to therapy by the 40 patients evaluated. ¹⁶

Butcher's broom has not been associated with toxicity. The rhizomes and shoots have been eaten in a manner similar to asparagus in some early cultures.

1. Redman DA. Ruscus aculeatus (butcher's broom) as a potential treatment for orthostatic hypotension, with a case report. J Altern Complement Med . 2000;6:539-549. PubMed

2. Tyler VE. The New Honest Herbal . Philadelphia, PA: G.F. Stickley Co.; 1987.

3. ElSohly M, Knapp JE, Slatkin KF, Schiff PL Jr, Doorenbos NJ, Quimby MW. Constituents of Ruscus aculeatus . Lloydia . 1975;38:106-108. PubMed

4. Mabberly DJ. The Plant-book . New York, NY: Cambridge University Press; 1987.

5. Di Lazzaro A, Morana A, Schiraldi C, Martino A, Ponzone C, De Rosa M. An enzymatic process for the production of the pharmacologically active glycosides desglucodesrhamnoruscin from Ruscus aculeatus L. J Mol Catal, B Enzym . 2001;11:307-314.

6. Pourrat H, Lamaison JL, Gramain JC, Remuson R. Isolation and confirmation of the structure by 13C-NMR of the main prosapogenin from Ruscus aculeatus L [in French]. Ann Pharm Fr . 1983;40:451-458. PubMed

7. ElSohly MA, Doorenbos NJ, Quimby MW, Knapp JE, Slatkin DJ, Schiff PL Jr. Euparone, a new benzofuran from Ruscus aculeatus L. J Pharm Sci . 1974;63:1623-1624. PubMed

8. Mimaki Y, Kuroda M, Kameyama A, Yokosuka A, Sashida Y. Steroidal saponins from the underground parts of Ruscus aculeatus and their cytostatic activity on HL-60 cells. Phytochemistry . 1998;48:485-493. PubMed

9. Mimaki Y, Kuroda M, Yokosuka A, Sashida Y. A spirostanol saponin from the underground parts of Ruscus aculeatus . Phytochemistry . 1999;51:689-692. PubMed

10. Ruscus aculeatus (butcher's broom). Altern Med Rev . 2001;6:608-612.

11. ElSohly MA, Slatkin DJ, Knapp JF, Doorenbos NJ, Quimby MW, Schiff PI Jr. Ruscodibenzofuran, a new dibenzofuran from Ruscus aculeatus L. (Liliaceae). Tetrahedron . 1977;33:1711-1715.

12. Oulad-Ali A, Guillaume D, Belle R, David B, Anton R. Sulphated steroidal derivatives from Ruscus aculeatus . Phytochemistry . 1996;42:895-897.

13. Marcelon G, Verbeuren TJ, Lauressergues H, Vanhoutte PM. Effect of Ruscus aculeatus on isolated canine cutaneous veins. Gen Pharmacol . 1983;14:103-106. PubMed

14. Rubanyi G, Marcelon G, Vanhoutte PM. Effect of temperature on the responsiveness of cutaneous veins to the extract of Ruscus aculeatus . Gen Pharmacol . 1984;15:431-434. PubMed

15. Bouskela E, Cyrino FZ, Marcelon G. Effect of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation. J Cardiovasc Pharmacol . 1993;22:221-224. PubMed

16. Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res . 1988;14:277-283. PubMed

17. Berg D. Venous constriction by local administration of Ruscus extract [in German]. Fortschr Med . 1990;108:473-476. PubMed

18. Bouskela E, Cyrino FZ, Marcelon G. Inhibitory effect of Ruscus extract and of the flavonoid hesperidine methylchalcone on increased microvascular permeability induced by various agents in the hamster cheek pouch. J Cardiovasc Pharmacol . 1993;22:225-230. PubMed

19. Mimaki Y, Kuroda M, Kameyama A, Yokosuka A, Sashida Y. Aculeoside B, a new bisdesmosidic spirostanol saponin from the underground parts of Ruscus aculeatus . J Nat Prod . 1998;61:1279-1282. PubMed

20. Mimaki Y, Kuroda M, Kameyama A, Yokosuka A, Sashida Y. New steroidal constituents of the underground parts of Ruscus aculeatus and their cytostatic activity on HL-60 cells. Chem Pharm Bull . 1998;46:298-303. PubMed

21. Tarayre JP, Lauressergues H. The anti-edematous effect of an association of proteolytic enzymes, flavonoids, sterolic heteroside of Ruscus aculeatus and ascorbic acid [in French]. Ann Pharm Fr . 1979;37:191-198. PubMed

22. Peneva B, Krasteva I, Nikolov S, Minkov E. Formulation and in vitro release of suppositories containing dry extract of Ruscus aculeatus L. Pharmazie . 2000;55:956. PubMed

23. Facino RM, Carini M, Stefani R, Aldini G, Salbene L. Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedra helix , Aesculus hippocastanum , and Ruscus aculeatus : factors contributing to their efficacy in the treatment of venous insufficiency. Arch Pharm . 1995;328:720-724. PubMed

24. Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung . 2002;52(4):243-50. PubMed

25. Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res . 1988;14(4):277-83. PubMed

26. Blumenthal M, ed. The Complete German Commission E Monographs . Austin, TX: American Botanical Council; 1998.