Beneficial Effects of Saw Palmetto Fruit Extract on Urinary Symptoms in Japanese Female Subjects by a Multicenter, Randomized, Double-Blind, Placebo-Controlled Study.

Saw palmetto berry extract (SPE) is the most commonly consumed supplement by men with benign prostatic hyperplasia (BPH). The oral administration of SPE was previously shown to significantly attenuate urodynamic symptoms in the hyperactive bladders of female rats by increasing bladder capacity and prolonging the micturition interval. The amelioration of urodynamic symptoms by SPE may be partly attributed to its binding to muscarinic receptors in the urinary bladder and its inhibition of vanilloid receptors on afferent nerves. Therefore, SPE may be pharmacologically effective at mitigating lower urinary tract symptoms (LUTS) in women. The efficacy and safety of a 12-week treatment with SPE in adult women with urinary symptoms were examined herein. The daytime frequency score in the core lower urinary symptom score (CLSS) questionnaire was significantly lower in women with LUTS treated with SPE for 12 weeks than in the placebo group. A subgroup analysis revealed that SPE alleviated the symptoms of daytime frequency (CLSS Q1) and nocturia (CLSS Q2) in a subset of subjects with a CLSS Q5 score of 1 or higher. The daytime frequency of urination in overactive bladder symptom score (OABSS) Q1 was also significantly improved by the SPE treatment. In conclusion, the present study is the first to demonstrate the potential of SPE to mitigate LUTS in adult women.

Effects of saw palmetto extract on the vanilloid receptor TRPV1.

OBJECTIVE: Transient receptor potential vanilloid subtype 1 (TRPV1) may play a significant role in the pathophysiology of the bladder. The present study investigated the effects of the herbal product, saw palmetto extract (SPE) on TRPV1-mediated Ca2+ influx and specific [3 H]resiniferatoxin ([3 H]RTX) binding to TRPV1 in HEK293 cells expressing TRPV1 (HEK293VR11 cells). METHODS: Ca2+ influx induced by and the direct binding activity of TRPV1 were measured using a method with Fura 2-AM, a cytoplasmic calcium indicator, and a radioligand binding assay using a [3 H]RTX, respectively. RESULTS: SPE did not markedly affect Ca2+ influx in HEK293VR11 cells; however, it significantly inhibited capsaicin-induced increases in Ca2+ influx in these cells. The specific binding of [3 H]RTX in HEK293VR11 cells was saturable with Kd value of 120 ± 7 pM and Bmax of 1.07 ± 0.10 fmol/mg protein, and was inhibited by low concentrations of non-labeled RTX with Ki of 60.1 ± 7.6 nM. These results confirmed the pharmacological specificity of specific binding sites of [3 H]RTX to TRPV1 in HEK293VR11 cells. SPE inhibited the specific binding of [3 H]RTX in a concentration-dependent manner, with Ki of 24.2 ± 1.4 µg/mL. CONCLUSIONS: The present study demonstrated for the first time, that SPE inhibited capsaicin-induced Ca2+ influx with binding to TRPV1 in HEL293VR11 cells. These results will contribute to a more detailed understanding of the pharmacological effects of SPE on urinary dysfunction.

Standardized Saw Palmetto Extract Directly and Indirectly Affects Testosterone Biosynthesis and Spermatogenesis.

We investigated whether a standardized saw palmetto extract (SP, mixture of supercritical extract and ethanol extract at a ratio of 9.5 to 0.5) can relieve the symptoms of andropause, including metabolic syndrome, and decreases in muscle endurance and spermatogenesis, in old rats. Twenty-four-week-old male Sprague Dawley rats received oral supplementation of SP at 40, 80, and 160 mg/kg body weight (bw) for 4 weeks. We found that SP supplementation reduced body weight gain by decreasing visceral and epididymal fat weights and the levels of serum triglycerides, total cholesterol, and low-density lipoprotein/very low-density lipoprotein cholesterol. In addition, SP supplementation increased muscle endurance, sperm counts, and testosterone biosynthesis through hormonal regulation. In Leydig cells under hydrogen peroxide-induced oxidative stress, SP treatment directly induced testosterone biosynthesis by activating the mRNA expression of the genes encoding 17,20-desmolase and 3ß-hydroxysteroid dehydrogenase 4. In conclusion, our results suggest that supplementation of SP may be useful for alleviating the symptoms of andropause via direct and indirect regulation of testosterone biosynthesis.

Postoperative Retroperitoneal Hematoma: A Case of Saw Palmetto and the Importance of Primary Care Intervention.

Introduction: A middle-aged male with a history of bilateral inguinal hernia repair was admitted for acute abdominal pain. The patient reported that he took prescribed hydrocodone and a saw palmetto supplement prior to surgery. He denied any recent trauma after the procedure, and he was unable to schedule a follow-up appointment with the surgeon or the primary care physician. Clinical Findings: Diagnosis: The CT angiography of the abdomen/pelvis was indicative of new interval development of a large left retroperitoneal hematoma. Intervention: No emergent intervention was required following the evaluation by the surgery and interventional radiology (IR) departments. Outcome: There was no evidence of overt bleeding over the 3-day hospital course, and his hemoglobin was within normal limits. The patient was stable for discharge as the hematoma would slowly absorb over the next 2 months. Conclusions: A retroperitoneal hematoma (RPH) has a multi-factorial etiology, such as endovascular procedures and surgeries. Detection and presentation of an RPH serves as a guide in management. There are various modes of detection. However, a multi-detector computer tomography-angiography (MDCTA) provides greater information in regards to the anatomical etiology and extent of RPH. Despite the common risk factors associated with a RPH, there are understudied and underreported influences of medications and herbal supplements, such as saw palmetto, in the development of this outcome. A large portion of the population consume herbal and/or dietary supplements, which belong to the category of complementary and alternative medicine (CAM). The challenge for health care providers, especially in the primary-care setting, is the unregulated use of herbal supplements and the associated effects. It is imperative for primary-care physicians to recognize these unknown risks and attempt to inquire about supplement use. Future education should be aimed at integrating CAM into the medical curriculum to improve physician-patient interaction in addressing this topic.

Use of saw palmetto (Serenoa repens) extract for benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a noncancerous growth of the prostate. BPH commonly occurs in elderly men. Lower urinary tract symptoms (LUTS) secondary to BPH (LUTS/BPH) have significant impacts on their health. Saw palmetto (Serenoa repens) extract (SPE) has been evaluated for its effectiveness in improvement of LUTS/BPH at preclinical and clinical levels. Potential mechanisms of actions include anti-androgenic, pro-apoptotic, and anti-inflammatory effects. However, SPE efficacy was inconsistent, at least partly due to a lack of a standardized SPE formula. A hexane extract (free fatty acids, > 80%) provided more consistent results. Free fatty acids (lauric acid) were effective in inhibition of 5α-reductase, and phytosterol (ß-sitosterol) reduced prostatic inflammation. Multiple actions derived from different constituents may contribute to SPE efficacy. Evaluation of the clinical relevance of these bioactive components is required for standardization of SPE, thereby enabling consistent efficacy and recommendations for the use in the prevention and treatment of BPH.

[Effect of saw palmetto extract on the reproductive function of male rats with chronic prostatitis].

OBJECTIVE: To investigate the effect of saw palmetto extract (SPE) on the reproductive function of rats with chronic prostatitis (CP). METHODS: Forty male SD rats were equally randomized into groups A (blank control), B (blank control + SPE, C (CP model control) and D (CP model + SPE), and the CP model was made by injection of 1% λ-carrageenan solution into the prostate. The animals in groups A and C were gavaged with normal saline while those in groups B and D with SPE at 0.10 g/kg/d, all for 30 successive days. After drug withdrawal, the rats were mated with female ones in the ratio of 1∶1) and sacrificed 7 days later, their bilateral epididymides collected for detection of sperm count and motility. The numbers of pregnancies and fetuses were recorded and compared among different groups. RESULTS: Compared with the rats in group A, those in group C showed a marked decrease in epididymal sperm motility (ï¼»68.01 ± 1.80ï¼½% vs ï¼»62.59 ± 4.82ï¼½%, P < 0.05), but those in groups B and D exhibited no statistically significant difference (ï¼»67.69 ± 4.06ï¼½% and ï¼»67.93 ± 3.39ï¼½%, P > 0.05). There were no statistically significant differences in the count of epididymal sperm, rate of pregnancy and number of fetuses between group A and the other groups (P > 0.05). CONCLUSIONS: SPE can improve the semen parameters of CP rats, and has no adverse effect on the rate of pregnancy and number of fetuses.

Effect of saw palmetto extract on PI3K cell signaling transduction in human glioma.

Saw palmetto extract can induce the apoptosis of prostate cancer cells. The aim of the present study was to investigate the effect of saw palmetto extract on the phosphatidylinositol 3-kinase (PI3K)/Akt signaling transduction pathway in human glioma U87 and U251 cell lines. Suspensions of U87 and U251 cells in a logarithmic growth phase were seeded into six-well plates at a density of 104 cells/well. In the experimental group, 1 µl/ml saw palmetto extract was added, while the control group was cultured without a drug for 24 h. The expression levels of PI3K, B-cell lymphoma-extra large (Bcl-xL) and p53 were evaluated through western blot analysis. In the experimental group, the U87 and U251 cells exhibited a lower expression level of PI3K protein as compared with the control group (t=6.849; P<0.001). In addition, the two cell lines had a higher expression level of p53 protein in the experimental group as compared with the control group (t=40.810; P<0.001). Protein expression levels of Bcl-xL decreased significantly in the experimental group as compared with the control group (t=19.640; P=0.000). Therefore, saw palmetto extract induces glioma cell growth arrest and apoptosis via decreasing PI3K/Akt signal transduction.

Effects of Saw Palmetto Extract on Urodynamic Parameters, Bladder Muscarinic and Purinergic Receptors and Urinary Cytokines in Rats with Cyclophosphamide-Induced Cystitis.

OBJECTIVES: To clarify the effect of saw palmetto extract (SPE), a phytotherapeutic agent, on urodynamic parameters, bladder muscarinic and purinergic receptors, and urinary cytokines in rats with cystitis induced by cyclophosphamide (CYP). METHODS: Saw palmetto extract (60 mg/kg per day) was administered orally twice a day for 7 days to rats. The urodynamic parameters in CYP (150 mg/kg i.p.)-treated rats were monitored by a cystometric method under anesthesia. The muscarinic and purinergic receptors in the bladder and submaxillary gland were measured by radioreceptor assays using [N-methyl-(3) H] scopolamine chloride([(3) H]NMS) and αß-methylene-ATP [2,8-(3) H] tetrasodium salt ([(3) H]αß-MeATP), respectively. Urinary cytokines (interleukin-1ß [IL-1ß], IL-6 and L-17) were measured with enzyme linked immunosorbent assay kits. RESULTS: Micturition interval and micturition volume were significantly decreased and the frequency of micturition and basal pressure were significantly increased in the CYP-treated rats compared with sham-operated rats. Orally administered SPE significantly increased the micturition interval and micturition volume and decreased the frequency of micturition and basal pressure. The maximal number of sites (Bmax ) for the specific binding of [(3) H]NMS and [(3) H]αß-MeATP was significantly decreased in the bladder. The decrease in receptors was attenuated by repeated treatment with SPE. An elevation in urinary cytokine (IL-1ß and IL-17) levels were seen, and this increase was effectively suppressed by SPE treatment. CONCLUSIONS: Saw palmetto extract attenuates the alteration of urodynamic parameters, pharmacologically relevant receptors, and urinary cytokines in CYP-treated rats. Therefore, SPE may be a potential therapeutic agent for improving the clinical symptoms of cystitis.