Artičoka

Cynara scolimus L. = C. cardunculus L. ssp flavescens Wikl. = C. cardunculus L. ssp. cardunculus (L.) Hay., Asteraceae

engl. artichoke; fr. artichaut, bérigoule; njem. Artischoke

BOTANIČKI PODACI

Artičoka je snažna dvogodišnja ili ponekad višegodišnja biljka visoka do 2 metra, gola ili fino pustenasto dlakava. Listovi su vrlo veliki, dugi do 70 cm, jednostruko do trostruko perasto razdijeljeni sa širokim odsječcima ili gotovo nerazdijeljeni, sa ljubičastim trnovima ili bez trnova. Cvjetne glavice su pojedinačne, vrlo velike, u promjeru do 10 cm s mesnatim dnom cvata. Cvjetovi su plavoljubičasti do crveno ljubičasti. Ovojni listovi također su u donjem dijelu mesnati, gotovo bez trnova na vrhu. Artičoka se odavno uzgaja, a potječe iz Sredozemlja.

OFICINALNI DIJELOVI BILJKE

List koji se bere u prvoj godini nakon cvatnje. Cvijet korišten u prehrani nema djelovanje lista.

KEMIJSKI SASTAV (AKTIVNE TVARI)

Flavonoidi (0,5%): luteolin-7-glukozid (cinarozid), luteolin-7-rutinozid (skolimozid), luteolin-7-gentobiozid. Fenoli i kiseline: esteri klorogenične kiseline (0,02-2%). 1,5-dikaveoilkininska kiselina (cinarin). Seskviterpenski laktoni (0-4%): cinaropikrin. organske kiseline: malati, sukcinati, laktati, fumarati, citrati.

Gorak okus daju seskviterpenski laktoni.

Pravi cinarin (1,5-dikaveoilkininska kiselina) nalazi se samo u svježem listu i SIPF pripravku. Sušenjem i vodenom ekstrakcijom dolazi do transesterifikacije i nastajanja 1,3-dikaveoilkininske kiseline. Mnogi proizvođači, te u nekim znanstvenim radovima  navode 1,3-dikaveoilkininsku kiselinu kao cinarin odnosno 1,5-dikaveoilkininsku kiselinu zbog prijašnje pogreške u nomenklaturi i krivog naziva neusklađenog s IUPAC nomenklaturom (ESCOP, Bruneton, Wichtl/Anton).

INDIKACIJE/DJELOVANJE

Komisija E: dispepsija.

ESCOP: digestivne smetnje (bolovi u želucu, mučnina, osjećaj punog želuca, nadutost), hepatobilijarne smetnje. Adjuvantna terapija dislipidemija udružena prehranom s niskim udjelom masnoća.

Druge upotrebe: hiperlipidemija, pretilost, prevencija alergijskih i kožnih bolesti.

TIPOVI EKSTRAKATA

Infuz, dekokt, tinktura, suhi standardizirani ekstrakti, SIPF.

POSOLOGIJA

Komisija E: 6g suhe droge dnevno ili preparati ekvivalentne doze.

ESCOP: 5-10g suhe droge dnevno kao suhi ekstrakt ili infuz. Drugi ekvivalentni ekstrakti.

Druga doziranja: SIPF, 5mL u čaši vode, prije obroka 2-3x dnevno.

KONTRAINDIKACIJE

Bilijarna opstrukcija i alergijske reakcije na Asteraceae (ESCOP, Komisija E).

INTERAKCIJE S LIJEKOVIMA

Nepoznate (komisija E, ESCOP).

Suspektne: varfarin.

OSOBNA ISKUSTVENA PRAKSA

Artičoka je jedna od mojih omiljenih biljaka, vjerojatno zbog djelovanja na jetra i cjelokupni metabolizam, pa ima posebno mjesto u mojoj praksi kao jedan od glavnih "čistača" organizma. No, glavna namjena artičoke je povišen kolesterol, prije svega kod oniha pacijenata gdje postoje i objektivni znakovi bilijarne insuficijencije (nadutost nakon obroka, otežana probava). Razlog djelovanja artičoke je jednostavan - povećano lučenje žuči omogućuje i povećan katabolizam kolesterola u žučne kiseline.

Najčešće pitanje koje mi postavljaju i pacijenti i profesionalci glasi: da li je zbilja artičoka dovoljna kao monoterapija kod hiperkolesterolemije? Nakon puno iskustva u hiperkolesterolemiji, empirijski mogu reći da artičoka dobro djeluje na povećanje omjera HDL vs. LDL kolesterol i može biti monoterapija kod ne odveć povišenog kolesterola (oko 6-6,5 mM). No, kod izraženije hiperkolesterolemije, artičoka uglavnom nije dovoljna kao monoterapija. To vrijedi i za ljude kojima je hiperkolesterolemija posljedica konzumiranja ugljikohidrata. Standardna kombinacija najčešće uključuje ili piskavicu (pogotovo kod "ugljikohidratnih" tipova) ili zlatni standard gljivicu crvene riže (Monascus purpureus). S njima pokazuje snažan sinergijski učinak. Kao i kod svake koleretične biljke, vrlo je bitno pitati pacijenta postoji li problem opstipacije. Žučne kiseline se reapsorbiraju u portalni krvotok, stoga slab motilitet crijeva pojačava razinu reapsorpcije i time se smanjujekatabolizam kolesterola mehanizmom kontrole putem FXR receptora.

Artičoku također nije monoterapija u metaboličkom sindromu i gotovo redovito se komibinira s piskavicom. Artičoka je prema mom iskustvu jedan od najsnažnijih koleretika i odlična biljka za "čišćenje", pogotovo u rano proljeće. No, s njom je doista i potreban oprez kod kolelitijaze, pa se prije njene upotrebe treba dobro promisliti - započinje se duža početna terapija Rowacholom prije upotrebe artičoke (2 kapsule 3x dnevno). Oprez je potreban i kod akutnog i kroničnog hepatitisa, te toksičnih oštećenja jetre. Premda je višestruko klinički ispitana u tim indikacijama i premda postoji cijeli niz predkliničkih ispitivanja koje govore u prilog njenom hepatoportektivnom djelovanju, moja je sugestija da se prije upotrebe artičoke započne kroz mjesec dana (ovisno i o intenzitetu oštećenja jetre) terapija sikavicom (vidi monografiju sikavice). Sikavica je ipak čisto hepatoprotektivna biljka, dok je artičoka koleretik i potrebno je najprije pomoći parenhimu jetre, a tek poslije potaknuti i ekskretornu ulogu jetre.

Artičoka je jedan od mojih omiljenih odabira u pretilosti. Premda ona ima skroman učinak i manje je klinički ispitana od drugih biljaka za mršavljenje, njen utjecaj na metabolizam lipida je od neprocjenjive važnosti u kurama mršavljenja.

Imajući na umu razgradnju cinarina tijekom sušenja, SIPF pripravak ili tinktura svježe biljke je po mojem mišljenju potpuno opravdani odabir. Uobičajena doza u kojoj ju preporučam je 5mL SIPF-a, 2x dnevno. Po potrebi, doza se može povećati i na 10mL kroz kraće vremensko razdoblje (2-3 tjedna). Drugo uobičajeno pitanje je koliko dugo se može koristiti artičoka. Premda je ona tipična biljka koja se koristi u kurama, a ne toliko u kroničnoj terapiji, moguće je i duže vrijeme koristiti dozu od 5mL 1x dnevno, ukoliko postoji potreba za time.

Smije li se artičoka kombinirati s drugim koleretičnim biljkama? Da. Budimo realni, SIPF pripravak nekima je prilično zahtjevan za kućni budžet, stoga vrlo često znam pacijentima ponuditi varijantu gdje spravljaju dekokt korijena maslačka 1-2x dnevno, a jednom dnevno koriste SIPF artičoke. To je od praktičnog značenja i za zaposlene ljude, koji obično rade u doba kada imaju i najveći obrok, ručak, i nemaju vremena kuhati dekokt na radnom mjestu.

Što se tiče kontraindikacija, osim već spomenute sugestije protokola kod žučnih kamenaca i hepatitisa, nisam u svojoj praksi susreo nuspojave artičoke niti alergijske reakcije na nju. Dosta sam obazriv kod pacijenata na terapiji varfarinom, ali nisam susreo znatniji utjecaj na INR kod pacijenata sa stabiliziranom terapijom.

REFERENCE

KLINIČKA ISPITIVANJA

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Artichoke leave extract for chronic hepatitis C - a pilot study. Huber R, Müller M, Naumann J, Schenk T, Lüdtke R. Phytomedicine. 2009 Sep;16(9):801-4. Epub 2009 May 8.

[Nonalcoholic fatty liver disease and metabolic syndrome: equality of pathogenetic mechanisms and therapeutic approaches]. Tkachenko EI, Uspenskiĭ IuP, Belousova LN, Petrenko VV. Eksp Klin Gastroenterol. 2008;(2):92-6. Russian.

Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomized, double blind placebo controlled trial. Bundy R, Walker AF, Middleton RW, Wallis C, Simpson HC. Phytomedicine. 2008 Sep;15(9):668-75.

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Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials. Pittler MH, Verster JC, Ernst E. BMJ. 2005 Dec 24;331(7531):1515-8. Review.

Bioavailability and pharmacokinetics of caffeoylquinic acids and flavonoids after oral administration of Artichoke leaf extracts in humans. Wittemer SM, Ploch M, Windeck T, Müller SC, Drewelow B, Derendorf H, Veit M. Phytomedicine. 2005 Jan;12(1-2):28-38.

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Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. Bundy R, Walker AF, Middleton RW, Marakis G, Booth JC. J Altern Complement Med. 2004 Aug;10(4):667-9.

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Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Holtmann G, Adam B, Haag S, Collet W, Grünewald E, Windeck T. Aliment Pharmacol Ther. 2003 Dec;18(11-12):1099-105.

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Artichoke leaf extract reduces mild dyspepsia in an open study. Marakis G, Walker AF, Middleton RW, Booth JC, Wright J, Pike DJ. Phytomedicine. 2002 Dec;9(8):694-9

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Artichoke leaf extract for treating hypercholesterolaemia. Pittler MH, Thompson CO, Ernst E. Cochrane Database Syst Rev. 2002;(3):CD003335. Review

Artichoke leaf extract reduces symptoms of irritable bowel syndrome in a post-marketing surveillance study. Walker AF, Middleton RW, Petrowicz O. Phytother Res. 2001 Feb;15(1):58-61

Efficacy of Artichoke dry extract in patients with hyperlipoproteinemia. Englisch W, Beckers C, Unkauf M, Ruepp M, Zinserling V. Arzneimittelforschung. 2000 Mar;50(3):260-5.

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The artichoke (Cynara scolymus) from antiquity to the present day. ROCCHIETTA S. Panminerva Med. 1960 Feb;2:89-94.

 

PREDKLINIČKA ISPITIVANJA

Evidence of glycemia-lowering effect by a Cynara scolymus L. extract in normal and obese rats. Fantini N, Colombo G, Giori A, Riva A, Morazzoni P, Bombardelli E, Carai MA. Phytother Res. 2010 Aug 25.

Antiproliferative, protective and antioxidant effects of artichoke, dandelion, turmeric and rosemary extracts and their formulation. Menghini L, Genovese S, Epifano F, Tirillini B, Ferrante C, Leporini L. Int J Immunopathol Pharmacol. 2010 Apr-Jun;23(2):601-10.

Effects of artichoke leaf extract on acute gastric mucosal injury in rats. Ishida K, Kojima R, Tsuboi M, Tsuda Y, Ito M. Biol Pharm Bull. 2010 Feb;33(2):223-9.

The effect of artichoke (Cynara scolymus L.) extract on respiratory chain system activity in rat liver mitochondria. Juzyszyn Z, Czerny B, Myśliwiec Z, Pawlik A, Droździk M. Phytother Res. 2010 Jun;24 Suppl 2:S123-8. Erratum in: Phytother Res. 2010 Jun;24 Suppl 2:S233-4.

Artichoke leaf extract reduces oxidative stress and lipoprotein dyshomeostasis in rats fed on high cholesterol diet. Küskü-Kiraz Z, Mehmetçik G, Dogru-Abbasoglu S, Uysal M. Phytother Res. 2010 Apr;24(4):565-70.

Effect of artichoke leaf extract on hepatic and cardiac oxidative stress in rats fed on high cholesterol diet. Küçükgergin C, Aydin AF, Ozdemirler-Erata G, Mehmetçik G, Koçak-Toker N, Uysal M. Biol Trace Elem Res. 2010 Jun;135(1-3):264-74. Epub 2009 Aug 4.

The effect of artichoke (Cynara scolymus L.) extract on ROS generation in HUVEC cells. Juzyszyn Z, Czerny B, Pawlik A, Droździk M. Phytother Res. 2008 Sep;22(9):1159-61.

Effect of pretreatment with artichoke extract on carbon tetrachloride-induced liver injury and oxidative stress. Mehmetçik G, Ozdemirler G, Koçak-Toker N, Cevikbaş U, Uysal M. Exp Toxicol Pathol. 2008 Sep;60(6):475-80. Epub 2008 Jun 25.

Phenolic composition of Cynara cardunculus L. organs, and their biological activities. Falleh H, Ksouri R, Chaieb K, Karray-Bouraoui N, Trabelsi N, Boulaaba M, Abdelly C. C R Biol. 2008 May;331(5):372-9. Epub 2008 Mar 17.

Effect of artichoke extract (Cynara scolymus L.) on palmitic-1-14C acid oxidation in rats. Juzyszyn Z, Czerny B, Pawlik A, Drozdzik M. Mol Nutr Food Res. 2008 May;52(5):589-94.

Flavonoids of Cynara scolymus possess potent xanthinoxidase inhibitory activity in vitro but are devoid of hypouricemic effects in rats after oral application. Sarawek S, Feistel B, Pischel I, Butterweck V. Planta Med. 2008 Feb;74(3):221-7. Epub 2008 Feb 26.

Effects of artichoke extract supplementation on gonads of cadmium-treated rats. Gurel E, Caner M, Bayraktar L, Yilmazer N, Dogruman H, Demirci C. Biol Trace Elem Res. 2007 Oct;119(1):51-9.

Antigenotoxic effect of extract from Cynara cardunculus L. Miadokova E, Nadova S, Vlckova V, Duhova V, Kopaskova M, Cipak L, Rauko P, Mucaji P, Grancai D. Phytother Res. 2008 Jan;22(1):77-81.

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Antispasmodic activity of fractions and cynaropicrin from Cynara scolymus on guinea-pig ileum. Emendörfer F, Emendörfer F, Bellato F, Noldin VF, Cechinel-Filho V, Yunes RA, Delle Monache F, Cardozo AM. Biol Pharm Bull. 2005 May;28(5):902-4.

Effects of plant extracts on angiogenic activities of endothelial cells and keratinocytes. Łoboda A, Cisowski J, Zarebski A, Jaźwa A, Riviera Nunez D, Kypriotakis Z, Heinrich M, Dulak J. J Physiol Pharmacol. 2005 Mar;56 Suppl 1:125-37.

Antifungal activity of Cynara scolymus L. extracts. Zhu XF, Zhang HX, Lo R. Fitoterapia. 2005 Jan;76(1):108-11.

Triterpenoid cynarasaponins from Cynara cardunculus L. reduce chemically induced mutagenesis in vitro. Krizková L, Mucaji P, Nagy M, Krajcovic J. Phytomedicine. 2004 Nov;11(7-8):673-8.

Experimental mycotoxicosis in chickens induced by ochratoxin A and penicillic acid and intervention with natural plant extracts. Stoev SD, Stefanov M, Denev S, Radic B, Domijan AM, Peraica M. Vet Res Commun. 2004 Nov;28(8):727-46.

Phenolic compounds from the leaf extract of artichoke (Cynara scolymus L.) and their antimicrobial activities. Zhu X, Zhang H, Lo R. J Agric Food Chem. 2004 Dec 1;52(24):7272-8.

Vasomodulating potential of mediterranean wild plant extracts. Grande S, Bogani P, de Saizieu A, Schueler G, Galli C, Visioli F. J Agric Food Chem. 2004 Aug 11;52(16):5021-6.

Flavonoids from artichoke (Cynara scolymus L.) up-regulate endothelial-type nitric-oxide synthase gene expression in human endothelial cells. Li H, Xia N, Brausch I, Yao Y, Förstermann U. J Pharmacol Exp Ther. 2004 Sep;310(3):926-32. Epub 2004 May 3.

In vitro antioxidant activities of edible artichoke (Cynara scolymus L.) and effect on biomarkers of antioxidants in rats. Jiménez-Escrig A, Dragsted LO, Daneshvar B, Pulido R, Saura-Calixto F. J Agric Food Chem. 2003 Aug 27;51(18):5540-5.

Screening pharmaceutical preparations containing extracts of turmeric rhizome, artichoke leaf, devil's claw root and garlic or salmon oil for antioxidant capacity. Betancor-Fernández A, Pérez-Gálvez A, Sies H, Stahl W. J Pharm Pharmacol. 2003 Jul;55(7):981-6.

Choleretic activity and biliary elimination of lipids and bile acids induced by an artichoke leaf extract in rats. Saénz Rodriguez T, García Giménez D, de la Puerta Vázquez R. Phytomedicine. 2002 Dec;9(8):687-93.

Anti-hyperlipidemic sesquiterpenes and new sesquiterpene glycosides from the leaves of artichoke (Cynara scolymus L.): structure requirement and mode of action. Shimoda H, Ninomiya K, Nishida N, Yoshino T, Morikawa T, Matsuda H, Yoshikawa M. Bioorg Med Chem Lett. 2003 Jan 20;13(2):223-8.

Protective properties of artichoke (Cynara scolymus) against oxidative stress induced in cultured endothelial cells and monocytes. Zapolska-Downar D, Zapolski-Downar A, Naruszewicz M, Siennicka A, Krasnodebska B, Kołdziej B. Life Sci. 2002 Nov 1;71(24):2897-08.

Prevention of taurolithocholate-induced hepatic bile canalicular distortions by HPLC-characterized extracts of artichoke (Cynara scolymus) leaves. Gebhardt R. Planta Med. 2002 Sep;68(9):776-9.

Anticholestatic activity of flavonoids from artichoke (Cynara scolymus L.) and of their metabolites. Gebhardt R. Med Sci Monit. 2001 May;7 Suppl 1:316-20.

Antioxidative properties of cardoon (Cynara cardunculus L.) infusion against superoxide radical, hydroxyl radical, and hypochlorous acid. Valentão P, Fernandes E, Carvalho F, Andrade PB, Seabra RM, Bastos ML. J Agric Food Chem. 2002 Aug 14;50(17):4989-93.

Hepatoprotective effects of Turkish folk remedies on experimental liver injury. Aktay G, Deliorman D, Ergun E, Ergun F, Yeşilada E, Cevik C. J Ethnopharmacol. 2000 Nov;73(1-2):121-9.

Inhibition of cholesterol biosynthesis in primary cultured rat hepatocytes by artichoke (Cynara scolymus L.) extracts. Gebhardt R. J Pharmacol Exp Ther. 1998 Sep;286(3):1122-8.

Antioxidative and protective properties of extracts from leaves of the artichoke (Cynara scolymus L.) against hydroperoxide-induced oxidative stress in cultured rat hepatocytes. Gebhardt R. Toxicol Appl Pharmacol. 1997 Jun;144(2):279-86.

[An experimental study of the effect of an artichoke preparation on the activity of the sympathetic-adrenal system in carbon disulfide exposure]. Khalkova Zh, Vangelova K, Zaĭkov Kh. Probl Khig. 1995;20:162-71. Bulgarian.

Hepatoprotective activity of polyphenolic compounds from Cynara scolymus against CCl4 toxicity in isolated rat hepatocytes. Adzet T, Camarasa J, Laguna JC. J Nat Prod. 1987 Jul-Aug;50(4):612-7.

[Effect of Cynara scolymus-extracts on the regeneration of rat liver. 2]. Maros T, Seres-Sturm L, Rácz G, Rettegi C, Kovács VV, Hints M. Arzneimittelforschung. 1968 Jul;18(7):884-6. German.

[Effects of Cynara Scolymus extracts on the regeneration of rat liver. 1]. Maros T, Rácz G, Katonai B, Kovács VV. Arzneimittelforschung. 1966 Feb;16(2):127-9. German.

[Effect of the atherogenic diet and Cynara scolymus L, and Cynara cardunculus L. on the histopathological picture of the coronary vessels and myocardium in rats]. SAMOCHOWIEC L, HABCZYNSKA D, WAZNA-BOGUNSKA C. Patol Pol. 1962 Jul-Sep;13:337-48. Polish.

[Pharmacodynamic research on the active principle of Cynara scolimus (1,4-dicaffeiylquinic acid): effect on blood cholesterol values & on triton-induced hypercholesterolemia]. PREZIOSI P, LOSCALZO B. Boll Soc Ital Biol Sper. 1957 May;33(5):679-82. Italian.

[Pharmacodynamic research on the active principle of Cynara scolimus (1,4-dicaffeiylquinic acid): effect of diuresis]. PREZIOSI P, CILENTO A. Boll Soc Ital Biol Sper. 1957 May;33(5):675-9. Italian.

[Pharmacodynamic research on the active principle of Cynara scolimus (1,4-dicaffeiylquinic acid): effect on choleresis]. PREZIOSI P, LOSCALZO B, BIANCHI A. Boll Soc Ital Biol Sper. 1957 May;33(5):672-4. Italian.

 

TOKSIČNOST I INTERAKCIJE

Cardoon allergy. Davila Fernández G, Zapatero L, Bartolomé B, Fuentes V, Alonso E. Allergol Immunopathol (Madr). 2010 May-Jun;38(3):165-6. Epub 2009 Dec 22.

Phytocontact dermatitis caused by artichoke: an exceptionally rare case. Pipili C, Cholongitas E, Ioannidou D. Clin Exp Dermatol. 2009 Jun;34(4):534-5. Epub 2009 Feb 19.

[Acute hepatic injury secondary to ingestion of artichoke extracts (Hepanephrol]. Sinayoko L, Mennecier D, El Jahir Y, Corberand D, Harnois F, Thiolet C, Farret O. Gastroenterol Clin Biol. 2007 Nov;31(11):1039-40. French.

Occupational rhinitis and bronchial asthma due to artichoke (Cynara scolymus). Miralles JC, García-Sells J, Bartolomé B, Negro JM. Ann Allergy Asthma Immunol. 2003 Jul;91(1):92-5.

Occupational contact urticaria syndrome caused by globe artichoke (Cynara scolymus). Quirce S, Tabar AI, Olaguibel JM, Cuevas M. J Allergy Clin Immunol. 1996 Feb;97(2):710-1.

Allergic contact dermatitis from artichoke, Cynara scolymus. Meding B. Contact Dermatitis. 1983 Jul;9(4):314.

Compositae dermatitis in South Australia: contact dermatitis from Ixodia achillaeoides and Cynara cardunculus or the tribulations of a dry flower arranger. Turner T. Contact Dermatitis. 1980 Oct;6(6):444