Pycnogenol Improves Microvascular Parameters and Inflammatory Biomarkers in Patients with Lupus Vasculitis

by | Aug 18, 2020 | 2020, Autoimmune Disease, Lupus, Pycnogenol

Written by Angeline A. De Leon, Staff Writer. This pilot study suggests that pycnogenol can effectively treat the mild residual symptoms of subjects in lupus vasculitis remission.

autoimmune disease - lupusVasculitis, a condition characterized by inflammation of the blood vessels, represents one of the complications that may emerge as part of the chronic autoimmune disease known as lupus (lupus vasculitis, LV) 1. Effects of LV may vary from skin lesions and rashes to necrotic tissue and organ damage 2,3. In severe cases of LV, inflammation may also cause thrombosis (blood clotting within a blood vessel) or stenosis (narrowing of the spinal canal), potentially leading to ischemia 1. LV associated with vasospasm (reduced blood flow due to narrowing of arteries) can usually be resolved with prostaglandin E1 (PGE1) infusions in vein 4, but research suggests that Pycnogenol®, an extract of French maritime pine bark, may also be helpful in treating conditions associated with vasospasm, including those related to microcirculatory alterations and intestinal perfusional issues 5,6. Studies indicate that Pycnogenol® is a potent antioxidant 7 and can improve endothelial function in patients with microcirculatory disease by enhancing nitric oxide (NO) availability 8,9. In a 2020 study 10 published in Minerva Cardioangiologica, a pilot study was undertaken to evaluate the therapeutic efficacy of Pycnogenol® in relation to residual symptoms of LV in patients in a remission phase of lupus.

A total of 26 patients with mild systemic lupus erythematosus with LV (in remission with minimal residual symptoms) were enrolled in an open-label, pilot supplement study. While all patients received standard management (SM) for the duration of the study, 14 subjects volunteered to receive Pycnogenol® at a dosage of 150 mg/day for 8 weeks, in addition to SM. Thermographic scans and laser doppler flowmetry were used to examine perfusional discrepancies. Plasma free radicals (PFR) were also measured from peripheral blood as an index of oxidative stress at baseline and at 8-week follow-up.

Although no significant differences were observed between the two groups in terms of rash, serositis (inflammation of tissue lining heart and lungs), or neurological symptoms, Pycnogenol®, compared to SM, was seen to significantly lower the number of patients requiring corticosteroid treatment (4 vs. 10, respectively) and PGE1 infusion for peripheral ischemia (2 vs. 6) (p < 0.05 for both). At the end of 8 weeks, Pycnogenol® was associated with a significantly smaller proportion of subjects with cold thermographic areas (1 vs. 4, p < 0.05), relative to SM, and subjects in the Pycnogenol® group demonstrated significantly higher distal flux (based on laser Doppler), compared to SM (p < 0.05). PFR levels were also significantly lowered with Pycnogenol® than with SM (343 vs. 388 standard Carr units, p < 0.05). Finally, whereas 2 control patients were seen to develop superficial vein thrombosis (blood clot in vein) at the end of the study, no such cases were associated with the Pycnogenol® group (p < 0.05).

Findings from the present study suggest that for lupus patients experiencing mild residual symptoms of LV, supplementation with Pycnogenol®, in conjunction with standard treatment, may significantly improve blood perfusion and microvascular function. Treatment with Pycnogenol® was associated with lower need for corticosteroid treatment and peripheral ischemia requiring PGE1 infusion, as well as significantly lower levels of oxidative stress (based on PFR). Results confirm the potent anti-inflammatory activity of Pycnogenol® and its clinical efficacy in treating vasospastic conditions such as vasculitis. Additional work is needed to confirm the effects of oral Pycnogenol® in lupus patients with more severe symptoms of LV and to evaluate the nutraceutical’s longer-term effects. As a pilot registry study, the current trial is limited by its relatively small sample size, lack of randomization, and absence of a placebo control group.

Source: Cesarone MR, Belcaro G, Corsi M, et al. Supplementary management with Pycnogenol® in patients with lupus vasculitis in remission phases: a pilot, concept registry study. Minerva Cardioangiologica. 2020; 68(2): 146-52. DOI: 10.23736/S0026-4725.19.05027-8.

Copyright © Ediziono Minerva Medica

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

References:

  1. Zhao X, Cheng Y, Gan Y, Jia R, Zhu L, Sun X. Anti-tubulin-α-1C autoantibody in systemic lupus erythematosus: a novel indicator of disease activity and vasculitis manifestations. Clin Rheumatol. 2018;37(5):1229-1237.
  2. Mossberg M, Segelmark M, Kahn R, Englund M, Mohammad AJ. Epidemiology of primary systemic vasculitis in children: a population-based study from southern Sweden. Scand J Rheumatol. 2018;47(4):295-302.
  3. Schreiber K, Sciascia S, de Groot PG, et al. Antiphospholipid syndrome. Nature reviews Disease primers. 2018;4:17103.
  4. Yoshikawa Y, Mizutani H, Shimizu M. Systemic lupus erythematosus with ischemic peripheral neuropathy and lupus anticoagulant: response to intravenous prostaglandin E1. Cutis. 1996;58(6):393-396.
  5. Rodriguez P, Belcaro G, Dugall M, et al. Recurrence of retinal vein thrombosis with Pycnogenol® or Aspirin® supplementation: a registry study. Panminerva Med. 2015;57(3):121-125.
  6. Hatemi I, Hatemi G, Çelik AF. Systemic vasculitis and the gut. Current opinion in rheumatology. 2017;29(1):33-38.
  7. Ozer Sehirli A, Sener G, Ercan F. Protective effects of pycnogenol against ischemia reperfusion-induced oxidative renal injury in rats. Ren Fail. 2009;31(8):690-697.
  8. Nishioka K, Hidaka T, Nakamura S, et al. Pycnogenol, French maritime pine bark extract, augments endothelium-dependent vasodilation in humans. Hypertension research : official journal of the Japanese Society of Hypertension. 2007;30(9):775-780.
  9. Enseleit F, Sudano I, Périat D, et al. Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study. Eur Heart J. 2012;33(13):1589-1597.
  10. Cesarone MR, Belcaro G, Corsi M, et al. Supplementary management with Pycnogenol® in patients with lupus vasculitis in remission phases: a pilot, concept registry study. Minerva cardioangiologica. 2020;68(2):146-152.