Turkey Rhubarb

Background & General Info

Turkey rhubarb is a leafy hardy perennial that inhabits the cool mountains and high plateaus of western and northwestern China, India, Russia, Turkey, and Tibet. It is scientifically referred to as Rheum palmatum and is called in commerce by a variety of common names, mostly in reference to this herb’s route when it was transported to the market of Europe in the early days: Chinese rhubarb, Indian rhubarb, and Russian rhubarb. ^[1]

Turkey Rhubarb - Botany

Turkey rhubarb has palmate, somewhat rough leaves; thick, oval root that is brown externally but appears deep yellow internally; and an erect, round, hollow, jointed stem that branches towards the top (around 6 to 10 feet high). It is much larger than the familiar garden rhubarb; compared to the garden rhubarb, its leaves have their oblong, rather sharp segments and its small panicles of greenish-white flowers are charmingly loose. In addition, the first buds are yellow, not red, and emerge in spring. ^[2]

Turkey Rhubarb - History & Traditional Use

According to records, Turkey rhubarb was cultivated as early as 1762 in the Botanical Gardens in Edinburgh, UK, and had gained much preference over other rhubarb species in the eighteenth century. ^[1] In several Asian countries, Turkey rhubarb is widely used in traditional medicine to treat different kinds of diseases. ^[3] In fact, the plant is considered one of the oldest and most recognized traditional Chinese medicines ^[4] and for a long time has been used in Saudi Arabia and Russia as a traditional medicine. ^[5][6] Its use as a laxative in Asia goes back to as early as the Han Dynasty (206 B.C.–A.D. 23). ^[1]

Turkey Rhubarb - Herbal Uses

The dried roots and rhizomes of Turkey rhubarb are commonly used to treat various gastrointestinal discomforts, such as diarrhea because of their “obstructive” property and constipation due to their laxative action, and in general to clean the gut and remove debris, taking into account their antiseptic and antimicrobial activities. They are also said to be helpful in cases of disorders related to the liver, spleen, and gallbladder. ^[7]

Turkey Rhubarb - Constituents / Active Components

Turkey rhubarb contains several constituents deemed pharmacologically important because of their alleged favorable effects to the body, such as neuroprotective, antioxidant, anti-inflammatory, and anticancer properties; these include various anthraquinones such as aloe emodin, rhein, emodin, chrysophanol, and physcion. ^[6]

A 1996 investigation on the composition of the volatile oil from Turkey rhubarb rhizomes isolated 108 volatile components, 27.3% of which were terpenoid. The study identified palmitic acid (22.5%), paeonol (16.2%), α-copaene (9.8%), methyl stearate (9.3%), δ-cadinene (5.7%), and methyl eugenol (5.4%) as main constituents. ^[8] Polyphenol concentration of a crude ethanol extract of Turkey rhubarb roots and rhizomes ranged from 46.11 to 76.45 mg/g; its tannin content is in the range of 7.07% to 8.67%, whereas that of anthracene derivatives and anthraquinones is 36.3 mg/g and 34 mg/g, respectively. ^[7]

Turkey Rhubarb - Medicinal / Scientific Research

Anticancer:

Slowing down the process of metastasis, or the spread of cancer cells to new body areas, is one of the anticancer strategies heavily investigated to date. A 2015 Korean study highlighted the anti-metastatic activity of Turkey rhubarb ethanol extract on the highly metastatic human MDA-MB-231 breast cancer cells in vitro. This ethanol extract has been shown to prevent the migration, motility, and invasion of cancer cells at a nontoxic concentration in a concentration-dependent manner. Results from real-time polymerase chain reaction (PCR) and Western blot analyses pointed out the downregulation of levels of extracellular matrix degradation-associated proteins and upregulation of PAI-1 as a result of Turkey rhubarb extract treatment. Additionally, Turkey rhubarb ethanol extract also degraded IkBα (a cellular protein), affecting NF-κB (the protein complex that regulates DNA transcription, cytokine production, and cell survival), and dampened the activation of p38, ERK, and Akt, influencing the mitogen-activated protein kinase signal transduction. ^[3]

Findings from a 2015 Chinese study recommend the crude extract of Turkey rhubarb as an anti-metastasis herbal alternative agent to treat human colon cancer cells. This study illustrated the ability of Turkey rhubarb crude extract to markedly inhibit the migration and invasion of LS1034 human colorectal cancer cells and suppress protein levels of matrix metalloproteinases 2 and 9, cytosolic NF-kB p65, RHO A, and ROCK 1. The protein level of Ras in contrast increased in LS1034 cells. ^[9]

Antimicrobial:

In the 2011 study of Aly and Gumgumjee, methanol and butanol extracts of Turkey rhubarb rhizomes were shown to display moderate antibacterial activity against some pathogenic bacteria tested such as Escherichia coli, Pseudomonas aeruginosa, Shigella dysenteriae, and Klebsiella pneumoniae. For methanol and butanol extracts, the diameter of inhibition zone was from 15 to 20 mm and from 12 to 20 mm, respectively. Turkey rhubarb methanol extract was also observed to exhibit antifungal activity against Candida albicans, Candida tropicalis, Aspergillus niger, etc., although at a lesser extent than turmeric. Overall, minimum inhibitory concentration was considered greater than that achieved by ampicillin (a penicillin antibiotic) or amphotericin B (an antifungal medication). ^[5]

A 2010 Polish study employed broth microdilution method and noted that Turkey rhubarb extract was more active against Staphylococcus spp. (Gram-positive bacteria) than Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (Gram-negative bacteria). ^[7] Rhein, an anthraquinone distinctly found in Turkey rhubarb and its close relative Rheum undulatum, is a natural product revealed to possess antimicrobial activity against Staphylococcus aureus. In the experimental study of Yu et al. (2008), it has been shown to display noteworthy in vitro antibacterial activity against 21 tested Staphylococcus aureus strains. ^[10]

Antiviral:

Coxsackievirus B3 is a clinically important pathogenic enterovirus whose infection can complicate to viral myocarditis and dilated cardiomyopathy. In tissue culture cells and in a mouse model, a 2012 Chinese study demonstrated the antiviral activity of ethanol extract acquired from the roots and rhizomes of Turkey rhubarb against coxsackievirus B3. Upon its addition following viral infection, this ethanol extract has been found to markedly inhibit the virus on human epithelial type 2 (HEp-2) cells, with an IC50 value of 4 μg/mL. A day after intraperitoneal injection, the pharmaceutical compound still existed in the serum of medicated mice and displayed antiviral effect on cells infected with coxsackievirus B3, specifically in mouse groups treated at dosages of 0.3 and 0.5 g/kg/day. Moreover, administration of the extract at dosages of 0.3 g/kg/day to virus-infected mice a day after their viral exposure led to diminished clinical signs, improvement in survival rate, prolonged MTD, and a reduction in viral titers in comparison to controls. ^[4]

In another 2014 study by Chang et al., the antiviral activity of Turkey rhubarb methanol extract against the Japanese encephalitis virus was evidenced in vitro. Compared with the water extract, the methanol extract of Turkey rhubarb was determined to exert more potent inhibitory effects on Japanese encephalitis virus in the plaque reduction assay. Individual components of Turkey rhubarb extract also showed antiviral action against Japanese encephalitis virus, with virucidal IC50 values of 0.75 μg/mL and 0.46 μg/mL for chrysophanol and aloe emodin, respectively. At a concentration of 10 μg/mL, the extract, chrysophanol, or aloe emodin inhibited the yields of Japanese encephalitis virus by 90% in cells and considerably triggered the promoters driven by gamma-activated sequence. ^[11]

Acute Respiratory Distress Syndrome:

A 2017 meta-analysis of randomized controlled trials was conducted on the use of Turkey rhubarb as part of treatment for acute respiratory distress syndrome, a life-threatening condition of the lungs characterized by breathing failure due to fluids filling up the air sacs. Turkey rhubarb’s role in improving the condition of patients with acute lung injury comes from its alleged ability to enhance the circulation of blood at the tissue level by decreasing the permeability of microvascular tissues, diminishing tissue edema, minimizing inflammatory exudation and necrosis, and boosting the cytoprotection mechanism. The meta-analysis included eight randomized controlled trials searched from many electronic databases. It was concluded that Turkey rhubarb therapy along with routine comprehensive treatment was suggestively better in terms of efficacy than routine comprehensive treatment alone. The combination of Turkey rhubarb therapy and routine comprehensive treatment effectively decreased the mortality, mechanical ventilation time, and the levels of interleukins 6 and 8 and improved arterial blood gas, with few untoward effects. ^[12]

Fatty Liver:

Decoctions of Turkey rhubarb had been described to ameliorate non-alcoholic fatty liver disease, in which extra fats build up in the liver cells. Yang et al. (2016) reported that Turkey rhubarb, even at low dose, alleviates fatty liver via stimulation of the activity of AMP-activated protein kinase (AMPK). In their study, fatty liver disease was induced by a high-fat diet in rats, which were then orally administered with water extract of Turkey rhubarb at low and high doses for 6 weeks. Turkey rhubarb intervention was observed to lead to a significant decrease in liver weight, a reduction of triglyceride content in the liver, and improvement in glucose tolerance in experimental rats. ^[13]

Contraindications, Interactions, And Safety

Turkey rhubarb is generally safe for use, especially when taken only in medicinal quantities for up to 3 months. In study of Aly and Gumgumjee (2011) who used Artemia salina (brine shrimp) as test organisms, the extract of Turkey rhubarb was not associated with any toxicity up to a concentration of 400 g/mL. ^[5]

A 2012 published in the journal Evidence-Based Complementary and Alternative Medicine highlighted the interaction of Turkey rhubarb rhizomes and phenytoin, an anti-epileptic medication prescribed for various types of seizures, and counseled prudence on the concurrent use of Turkey rhubarb and this drug. According to the findings of the study, acute and chronic coadministration of Turkey rhubarb can significantly lower the systemic exposure of phenytoin in rats, decreasing its bioavailability mainly through activation of P-gp. ^[6]

References:

[1] S. Chillemi and M. Chillemi, The Complete Guide to Natural Healing: A Natural Approach to Healing the Body and Maintaining Optimal Health Using Herbal Supplements, Vitamins, Minerals, Fruits, Vegetables and Alternative Medicine, Raleigh, North Carolina: Lulu Press, 2015. https://books.google.com.ph/books?id=aW0pDwAAQBAJ&pg=PT321

[2] D. Eisenreich, "Rhubarb Species," The Rhubarb Compendium, 9 April 2010. https://www.rhubarbinfo.com/species

[3] K. Nho, J. Chun, A. Lee and H. Kim, "Anti-metastatic effects of Rheum Palmatum L. extract in human MDA-MB-231 breast cancer cells," Environmental Toxicology and Pharmacology, vol. 40, no. 1, p. 30–38, 2015. https://www.ncbi.nlm.nih.gov/pubmed/26056975

[4] H. Xiong, Y. Shen, L. Lu, W. Hou, F. Luo, H. Xiao and Z. Yang, "The inhibitory effect of Rheum palmatum against coxsackievirus B3 in vitro and in vivo," The American Journal of Chinese Medicine, vol. 40, no. 4, p. 801–812, 2012. https://www.ncbi.nlm.nih.gov/pubmed/22809033

[5] M. M. Aly and N. M. Gumgumjee, "Antimicrobial efficacy of Rheum palmatum, Curcuma longa and Alpinia officinarum extracts against some pathogenic microorganisms," African Journal of Biotechnology, vol. 10, no. 56, p. 12058–12063, 2011. https://www.ajol.info/index.php/ajb/article/view/96247

[6] Y.-C. Chi, S.-H. Juang, W. K. Chui, Y.-C. Hou and P.-D. L. Chao, "Acute and chronic administrations of Rheum palmatum reduced the bioavailability of phenytoin in rats: a new herb–drug interaction," Evidence-Based Complementary and Alternative Medicine, vol. 2012, p. 9, 2012. https://www.hindawi.com/journals/ecam/2012/701205/

[7] U. Kosikowska, H. D. Smolarz and A. Malm, "Antimicrobial activity and total content of polyphenols of Rheum L. species growing in Poland," Central European Journal of Biology, vol. 5, no. 6, p. 814–820, 2010. https://www.degruyter.com/view/j/biol.2010.5.issue-6/s11535-010-0067-4/s11535-010-0067-4.xml

[8] M. Miyazawa, Y. Minamino and H. Kameoka, "Volatile components of the Rhizomes of Rheum palmatum L.," Flavour and Fragrance Journal, vol. 11, no. 1, p. 57–60, 1996. https://onlinelibrary.wiley.com/doi/10.1002/(SICI)1099-1026(199601)11:1%3C57::AID-FFJ549%3E3.0.CO;2-K/abstract

[9] Y. Ma, Y. Hsiao, J. Lin, et al., "Crude extract of Rheum palmatum L inhibits migration and invasion of LS1034 human colon cancer cells acts through the inhibition of matrix metalloproteinase-2/-9 by MAPK signaling," Environmental Toxicology, vol. 30, no. 7, p. 852–863, 2015. https://www.ncbi.nlm.nih.gov/pubmed/24497447

[10] L. Yu, H. Xiang, J. Fan, D. Wang, et al., "Global transcriptional response of Staphylococcus aureus to rhein, a natural plant product," Journal of Biotechnology, vol. 135, no. 3, p. 304–308, 2008. https://www.ncbi.nlm.nih.gov/pubmed/18514345

[11] S. Chang, S. Huang, Y. Lin, Y. Tsou and C. Lin, "Antiviral activity of Rheum palmatum methanol extract and chrysophanol against Japanese encephalitis virus," Archives of Pharmacal Research, vol. 37, no. 9, p. 1117–1123, 2014. https://www.ncbi.nlm.nih.gov/pubmed/24395532

[12] T. Yang, Y. Liu, Y. Liu, X. Ding, J. Chen, M. Kou and X. Zou, "The use of Rheum palmatum L. in the treatment of acute respiratory distress syndrome: a meta-analysis of randomized, controlled trials," African Journal of Traditional, Complementary and Alternative Medicines, vol. 14, no. 2, p. 334–347, 2017. https://www.ncbi.nlm.nih.gov/pubmed/28573250

[13] M. Yang, X. Li, X. Zeng, et al., "Rheum palmatum L. attenuates high fat diet-induced hepatosteatosis by activating AMP-activated protein kinase," The American Journal of Chinese Medicine, vol. 44, no. 3, p. 551–564, 2016. https://www.ncbi.nlm.nih.gov/labs/articles/27109162/

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