Astragalus
Extract
The ancient immune tonic and cellular defender
Astragalus extract, derived from Astragalus membranaceus root, is a cornerstone of traditional Chinese medicine now supported by modern research. Its bioactive compounds—including polysaccharides, saponins, and astragaloside IV—work synergistically to enhance immune function, reduce oxidative stress, support renal health, and promote resilience during chemotherapy. Evidence supports its use as an adaptogenic supplement for fatigue, immune support, and age-related conditions.
Astragalus membranaceus extract demonstrates strong evidence for immune enhancement, antioxidant effects, and renal function support based on multiple randomized controlled trials and meta-analyses. Evidence is moderate for cardiovascular protection, anti-fatigue effects, cancer-related symptom management, telomere lengthening, and glucose control. Evidence is limited for cognitive enhancement, stress reduction, wound healing, bone health, and respiratory infection prevention, though mechanistic studies and animal models are encouraging. Overall safety profile is strong with doses up to 60 g/day for 4 months well-tolerated. Primary contraindications are autoimmune diseases (due to immune activation) and pregnancy/lactation (insufficient safety data). Interactions with immunosuppressants, anticoagulants, and antidiabetic drugs require medical supervision.
Immune System Enhancement
StrongAstragalus polysaccharides (APS) and astragaloside IV directly activate macrophages, enhance T-cell function (CD4+ and CD8+), increase interferon production, and modulate Th1/Th2 cytokine balance. Multiple human studies demonstrate increased immunoglobulin levels (IgA, IgM, IgG) and enhanced immune cell proliferation. This adaptogenic effect appears to restore immune homeostasis without causing pathological activation.
Antioxidant and Anti-inflammatory Effects
StrongAstragalus upregulates antioxidant enzymes including superoxide dismutase (SOD), catalase, and glutathione peroxidase (GSH-Px). It reduces reactive oxygen species (ROS) and malondialdehyde (MDA) accumulation, suppresses pro-inflammatory cytokines (TNF-α, IL-6, IL-1β), and inhibits NF-κB signaling pathways. These effects protect against oxidative damage in multiple tissues including cardiovascular, renal, and neurological systems.
Renal Function and Proteinuria Reduction
StrongMeta-analysis of 13 studies (775 participants) demonstrates that astragalus significantly decreased serum creatinine (SCr) by 21.39 µmol/L and increased creatinine clearance (CrCl) by 5.75 mL/min compared to controls. It reduced 24-hour proteinuria by 0.53 g/24h across 10 studies (640 participants) and increased hemoglobin levels by 9.51 g/L. Astragalus injection showed superior effects compared to oral decoction, particularly in patients with elevated baseline SCr >133 µmol/L.
Cardiovascular Protection and Blood Pressure Regulation
ModerateAstragalus improves endothelium-dependent vasorelaxation by increasing nitric oxide (NO) content and endothelial nitric oxide synthase (eNOS) activity via the PI3K/Akt/eNOS signaling pathway. It reduces blood pressure in spontaneously hypertensive rats and ameliorates hyperhomocysteinemia-induced vascular dysfunction. Astragaloside IV demonstrates direct vasodilator effects and ACE inhibitory activity with IC50 of 1.85 µg/ml, suggesting antihypertensive potential comparable to pharmaceutical inhibitors.
Anti-fatigue and Exercise Performance Enhancement
ModerateIn a 6-week animal study, astragalus supplementation increased exercise endurance by 2.33-fold, increased hepatic and muscle glycogen content, and reduced exercise-induced accumulation of blood lactate and ammonia. It enhances glucose uptake via GLUT4 transporters and promotes glycogenolysis sparing, providing sustained energy during prolonged exertion. No toxic effects were observed on biochemical parameters or histology.
Cancer-Related Fatigue Reduction
ModerateA 2025 systematic review and meta-analysis of 9 randomized controlled trials showed that astragalus significantly reduced cancer-related fatigue (SMD = −1.63, 95% CI [−1.90, −1.36], P < .00001) and improved quality of life. Astragalus polysaccharide (PG2) injection is approved in Taiwan for treating cancer-related fatigue in advanced cancer patients. Benefits likely arise from immune enhancement, anti-inflammatory effects, bone marrow protection, and skeletal muscle preservation.
Chemotherapy Side Effect Mitigation
ModerateAstragalus-based traditional Chinese medicine enhanced platinum-based chemotherapy effectiveness in 2,815 advanced non-small-cell lung cancer patients while reducing toxicity. Meta-analyses demonstrate reductions in chemotherapy-induced nausea, vomiting, diarrhea, and bone marrow suppression. It protects against oxaliplatin neurotoxicity, reverses fluorouracil-associated toxicity, and reduces chemotherapy-induced anemia and leukopenia when combined with standard regimens.
Telomere Lengthening and Cellular Aging
ModerateA randomized, double-blind, placebo-controlled trial (n=40) demonstrated that an astragalus-based supplement (ASTCOQ02) significantly lengthened both median and short telomeres by increasing telomerase activity and reducing the percentage of short telomeres (<3 Kbp). TA-65 (astragaloside IV) increased telomerase activity 1.3 to 3.3-fold in human T-cell cultures. These effects support the traditional use for anti-aging and suggest potential to slow cellular senescence.
Glucose Homeostasis and Diabetes Management
ModerateAstragalus polysaccharides (APS) alleviate glucose toxicity through AMPK pathway activation, increasing insulin sensitivity index (ISI), restoring liver glycogen synthesis, and enhancing skeletal muscle glucose translocation. A 2024 meta-analysis of 20 studies (953 adults with type 2 diabetes) found that astragalus plus metformin reduced fasting blood glucose and hemoglobin A1C more than metformin alone. It regulates multiple pathways: PI3K/AKT/IRS-1, AMPK/ACC, and mTOR/4EBP-1/S6K1.
Hepatoprotection and Liver Function Support
ModerateAstragalus exhibits hepatoprotective effects by improving insulin resistance, inhibiting oxidative stress and endoplasmic reticulum injury, providing anti-inflammatory and anti-fibrosis functions, and regulating autophagy and apoptosis. Astragalus polysaccharides alleviate alcohol-induced hepatic fibrosis through inhibition of PTRF and TLR4/JNK/NF-κB/MyD88 pathways. No published reports of hepatotoxicity exist; liver injury from astragalus is considered unlikely.
Stress Reduction and Cognitive Function
LimitedIn animal models, astragalus reduced repeated stress-induced anxiety and memory loss, increased cholineacetyl transferase (ChAT) immunoreactivity in hippocampus, and normalized tyrosine hydroxylase (TH) expression in the locus coeruleus. Preclinical studies show neuroprotection via antioxidant, anti-inflammatory, and anti-apoptotic mechanisms. While clinical cognitive data are limited, a Phase 2 trial is testing astragalus (10-20g daily) in mild-to-moderate Alzheimer's disease.
Respiratory Infection Prevention
LimitedWhile systematic review of placebo-controlled trials found no qualifying high-quality studies, observational evidence supports astragalus for preventing acute respiratory tract infections (ARTIs) in children and adults. Astragalus increases interferon-inducing ability (elevated 2 months post-therapy), boosts immunoglobulin levels (IgA, IgM, IgG), and decreases soluble IL-2 receptor and IL-8. Traditional use suggests preventive potential, but rigorous RCTs are needed.
Wound Healing Acceleration
LimitedAstragalus polysaccharide (APS2-1) promoted human skin fibroblast propagation, accelerated cell cycle progression, and significantly accelerated wound closure in burn models. Complete wound closure occurred at day 21 in astragalus-treated mice versus incomplete healing in controls. Mechanisms include inhibition of inflammation, cell cycle acceleration, and promotion of repair factors (TGF-β1, bFGF, EGF), enhancing re-epithelialization and revascularization.
Bone Health and Osteoporosis Prevention
LimitedAstragalus improved femoral bone mineral density (BMD) and microstructure, elevated calcium and phosphorus content, increased Klotho and vitamin D receptor expression, and decreased FGF23 expression in aged mice. It activates alkaline phosphatase (ALP), promotes osteoblast differentiation, enhances bone-marrow-derived mesenchymal stem cell (BMSC) proliferation, and maintains positive bone balance through regulation of the VD/FGF23/Klotho pathway.
Lupus Nephritis and Systemic Lupus Erythematosus Support
ModerateAstragalus-containing Chinese herbal medicine combined with Western medicine significantly improved SLEDAI scores (SMD = 1.01, P < .001), reduced 24-hour proteinuria, decreased serum creatinine, and reduced adverse events (RR = 0.56, P < .001) compared to Western medicine alone. Mechanisms include suppression of pro-inflammatory cytokines (TNF-α, IL-6, IL-17, IFN-γ), modulation of PI3K/AKT/mTOR pathway, and enhancement of macrophage function.
Seasonal Allergic Rhinitis Symptom Relief
LimitedA 6-week double-blind placebo-controlled trial in 48 adults with seasonal allergic rhinitis showed astragalus-containing herbal-mineral complex significantly decreased rhinorrhea intensity compared to placebo. Investigators and patients equally rated the active treatment as more efficacious. In subgroup analysis, patients with weed pollen allergy showed significant improvements in symptom score and quality of life. Analysis within groups showed striking improvements favoring active treatment.
Heart Failure with Reduced Ejection Fraction Support
ModerateMeta-analysis of randomized controlled trials demonstrates that astragalus combined with conventional treatment significantly increased left ventricular ejection fraction (LVEF +5.82%), decreased left ventricular end-diastolic diameter (−4.05 mm) and end-systolic diameter (−12.24 mm), improved clinical efficacy (RR = 4.81), reduced brain natriuretic peptide (−113.57 pg/mL), and increased 6-minute walking distance (+67.62 m) compared to conventional treatment alone.
Respiratory Disease (COPD) Support
LimitedAstragaloside II (AST II) mitigated lung dysfunction, histopathological damage, inflammatory infiltration, and pro-inflammatory factor secretion in COPD models induced by cigarette smoke and lipopolysaccharide. It exerted anti-inflammatory effects by enhancing mTORC1/GSK-3β signaling, which promoted CREB-binding protein (CBP) to CREB binding, thereby antagonizing NF-κB transcriptional activity. Early evidence suggests therapeutic potential for COPD and other respiratory inflammatory conditions.
IgA Nephropathy Support
LimitedAstragalus upregulated Core I β3-Gal-T-specific molecular chaperone (Cosmc) expression and reversed IgA1 aberrant O-glycosylation in peripheral B lymphocytes from IgA nephropathy (IgAN) patients in a dose-dependent manner. It decreased LPS-induced IgA1 secretion and improved glycosylation patterns. This addresses a key pathophysiological mechanism of IgAN and suggests potential therapeutic benefit in this common glomerulonephritis.
Post-COVID Chronic Fatigue Support
ModerateA triple-blind randomized controlled trial in 64 nurses with post-COVID-19 chronic fatigue syndrome found that astragalus root extract (500 mg × 2 daily) significantly reduced chronic fatigue prevalence to 13.8% at end of intervention and 17.2% at 1-month follow-up, compared to 72.2% in placebo group (p = 0.0001). Underlying disease and control group assignment significantly increased fatigue risk, while longer treatment duration decreased risk (OR = 0.50, p = 0.0001).
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