Ruscus aculeatus

Ruscus aculeatus (of the family Liliaceae) is an herb commonly referred to as Butcher's Broom, a name which arose from the use of its roots to clean the cutting boards of butchers since the essential oil was thought to have antibacterial properties.^[1] The extract of the root/rhizome also was traditionally used for the treatment of circulatory disorders with mild diuretic and laxative effects.^{[1] [2]} Other uses associated with venous insufficiency treatment such as hemorrhoids and varicose veins are also traditionally treated with Ruscus aculeatus extract. ^[3]

The traditional usage of the rhizome involves the dried root powder concentrated anywhere between 3.5-6.5:1 (water extract) to 15-20:1 (60% methanolic).^[1] The preparations are said to contain no less than 1% total ruscogenins by weight; the traditional recommendations for total ruscogenin intake ranges from 7-11mg daily.^[1]

Ruscus aculeatus is a traditionally used medicinal herb that, similar to Horse Chestnut, has been used for venous circulatory disorders.

The rhizome of ruscus aculeatus (medicinally used component) contains:

• Ruscogenin ^[4] at 0.111% in the rhizome and 0.02% in the roots ^[5] as well as its glycosides ^[6] and both sulfated and acetylated glycosides (not quantified). ^{[6] [7]}

• Neoruscogenin ^[4] at 0.173% in the rhizome and 0.046% in the roots ^[5] and its glycosides ruscin, desglucoruscin, and desglucodesrhamnoruscin ^[8]

• Ruscoside and Desglucoruscoside ^[8]

• Friedeline ^[9] and D:A-friedo-olean-2-one-3a-ol ^[9]

• 22R-hydroxycholesterol ^[9]

• β-sitosterol (as a 3-O-β-D-glucopyranosyl glycoside ^[9] )

The content of the major bioactive (ruscogenin) appears to be comparably high in the phylloclades of the plant when compared to the rhizome, whereas neoruscogenin is significantly lower. ^[5]

The herb's rhizome (vertical root above the ground) appears to be a source of a variety of different saponins, although the ones that attract the most attention are the ruscogenins and neoruscogenins due to their high contents in the active parts of the plant.

Ruscus aculeatus may help orthostatic hypotension due to its contrictive properties on veins. This helps prevent the pooling of blood in lower extremities (phlebotherapeutic properties) while not causing hypertension in a supine position like other potential orthostatic hypotension treatments, ^[10] although no controlled trials in humans to date have confirmed this use.

Ruscus aculeatus appears to have α-adrenergic stimulating properties, and vasoconstricting properties are thought to be associated with release of noradrenaline from nerve terminals (as cholinergic, prostaglandin, and serotonergic mechanisms have been ruled out^[1]). In vitro, phentolamine (an α-adrenergic antagonist) is able to nearly abolish the contractile response ^{[11] [12]} while both rauwolscine and prazosin are effective implicating both the α1 and α2 subsets of these receptors, ^[12] and as chemical denervation (6-hydroxydopamine) and reducing noradrenaline content in the synaptic gap (through cocaine) can both reduce the efficacy of Ruscus aculeatus it is thought that it stimulates neurons to release noradrenaline which then acts upon the α-adrenergic receptors.^[1]

These vasoconstrictive properties are additive with cholinergic stimulation ^[11] and with warm temperatures. ^[12] While one study suggested that the contractile response of venous smooth muscle to Ruscus aculeatus is enhanced by chronic exposure to progesterone^[13] later studies excising veins from human females found no relation between the efficacy of Ruscus aculeatus and circulating hormones levels (Marcelon et al. 1988b, as cited in this review^[1]).

At 37°C (average body temperature), the contribution from the α1 and the α2 receptor subsets are equivalent. ^[12]

When looking at veins, Ruscus aculeatus appears to be able to contsrict veins secondary to stimulating noradrenaline release from nerves which then act on the alpha adrenergic receptors. Both major receptors are implicated, and this is thought to underlie the ability of Ruscus aculeatus to treat venous diseases and ailments.

The vasoconstrictive effects of Ruscus aculeatus are partially attenuated by the integrety of the endotheilial cells in dogs, while the endothelium was not found to play a role in its contractile effect in varicose veins excised from humans; a contradiction which may be accounted for by the fact that the endothelium of vericose veins may be dysfunctional.^[1] There is evidence to suggest that Ruscus aculeatus causes some indirect relaxation mediated through stimulating the release of endothelium-derived factors, at least in coronary arteries.^[1]

Ruscus aculeatus may have some relaxing effects on blood vessels which counterbalances its constrictive effects. This may be mediated through stimulating the endothelium. There is no evidence on practical relevance of this effect as it pertains to oral supplementation of Ruscus aculeatus.

Significant reductions were noted in fasting blood glucose (10.6%), fructosamine (7.8%), and HbA1c concentrations (15.6%) after supplementation of 37.5mg Ruscus aculeatus extract (twice daily for three months) relative to baseline in type II diabetic persons.^[14]

Supplementation of Ruscus aculeatus (37.5mg twice daily for three months; saponin content not listed) in diabetic persons with retinopathy was able to decrease the amplitude of oscillating potentials of the eyes by 15%, although this value was not statistically significant when compared to baseline and underperformed relative to the reference drug (troxerutin).^[14] This slight decrease was accompanied by an increase in visual acuity, although this was also not statistically significant and weak in size. However, progression of diabetic retinopathy (assessed by opthalmoscope) was reversed in 23.1% of patients with no instances of disease progression noted, and this was comparable to troxerutin.^[14]

Ruscus aculeatus has been tested in persons with chronic venous insufficiency (CVI) in combination supplementation with hesperidin methylchalcone and sometimes Vitamin C ^{[15] [16] [17] [18]} which have been concluded effective when subject to meta-analysis (despite some variability in the structures of the studies). ^[19]

Limited studies have tested the efficacy of Ruscus aculeatus in isolation. One study in women with CVI given a capsule containing 36-37.5mg of a 15-20:1 concentration twice daily for twelve weeks showed a reduction in limb circumference (an anti-edemic action), but Ruscus aculeatus did not alter quality of life compared to placebo. ^[20]

Although the majority of evidence on Ruscus aculeatus and CVI is conducted in a manner where hesperidin and vitamin C confound the results, the limited evidence assessing the herb alone have found benefit with it. The efficacy of this herb against other possible interventions for CVI has not been directly assessed.

There is a case study of a diabetic woman on stable therapy (insulin and metformin) who experienced ketoacidosis associated with taking Ruscus aculeatus supplementation for improving circulation in extremities. ^[21] While causation was not established (due to no reintroduction to Ruscus aculeatus) the ketoacidosis occurred 5 days after the start of supplementation and it was controlled under medical supervision. ^[21]

Ruscus aculeatus supplementation (dosage and brand unspecified) has been associated with a case of ketoacidosis in a diabetic woman on controlled antidiabetic therapy