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Boswellia, Indian frankincense (Boswellia serrata)

Boswellia serrata is a tree prevalent in India, the Middle East, and North Africa. The gummy exudate or resin obtained by peeling away the bark is commonly known as frankincense or olibanum. The oldest written document mentioning boswellia as a drug is the papyrus Ebers written around 1500 BC.

Boswellia, Indian frankincense (Boswellia serrata)


Ayurvedic medicine uses different parts of the boswellia tree for the treatment of asthma, rheumatisms, dysentery, skin ailments, ulcers, blood purification, etc. It was also used as a perfume and in religious celebrations. The oil of boswellia is also known as Indian frankincense. The resin (a sticky substance found in trees and plants) is used to make an extract. Boswellia resin is used in Ayurvedic (traditional Indian) medicine. It is currently marketed as an anti-inflammatory supplement to support and improve joint health and mobility.


The oleo gum-resins contain 30-60% resin, 5-10% essential oils, which are soluble in organic solvents, and the rest is made up of polysaccharides. Gum-resin extracts of Boswellia serrata have been traditionally used in folk medicine for centuries to treat various chronic inflammatory diseases. The resinous part of Boswellia serrata possesses monoterpenes, diterpenes, triterpenes, tetracyclic triterpenic acids and four major pentacyclic triterpenic acids i.e. β-boswellic acid, acetyl-β-boswellic acid, 11-keto-β-boswellic acid and acetyl-11-keto-β-boswellic acid, responsible for inhibition of pro-inflammatory enzymes. Out of these four boswellic acids, acetyl-11-keto-β-boswellic acid is the most potent inhibitor of 5-lipoxygenase, an enzyme responsible for inflammation.

The primary bioactive compound in boswellia is boswellic acid, a 5-lipoxygenase inhibitor with anti-inflammatory and anti-arthritic effects. It also demonstrated cytotoxic and radio-enhancing properties and prevented intestinal tumorigenesis in a murine model. Other animal studies suggest boswellia may improve cognitive impairment and insulin resistance. Essential oil of boswellia has also been shown to have antimicrobial activities.

Clinical Studies

In clinical studies, boswellic acid extracts, a formulation containing boswellia, Terminalia chebula and turmeric, as well as boswellic acid combined with curcumin were all reported useful in patients with osteoarthritis. In addition, a supplement containing boswellia and curcumin added to standard treatments alleviated symptoms of tendinopathy, and a formula containing black sesame extract oil, turmeric, and boswellia reduced acute musculoskeletal pain and was found comparable to acetaminophen. Boswellia may also benefit patients with bronchial asthma, ulcerative colitis, mild irritable bowel syndrome, and osteo-muscular pain.

Preliminary data suggest that boswellia may be effective in reducing cerebral edema in patients with brain tumors following radiotherapy; and in reducing radio-chemotherapy-induced cerebral edema in patients with primary glioblastoma multiforme. A boswellia-based cream was found useful in preventing skin damage due to radiotherapy in breast cancer patients; and a formulation of boswellic acid, betaine, and myo-inositol helped reduce mammary density, a risk factor for breast cancer. In addition, boswellia combined with propolis-derived polyphenols decreased genitourinary pain in men with prostatitis-like symptoms.

Biomechanical Mechanism

Boswellic acid, the major constituent of boswellia, is thought to contribute to most of the herb’s pharmacological activities. In vitro and animal studies show that anti-inflammatory activity occurs via inhibition of 5-lipoxygenase and cyclooxygenase-1. It also inhibits nuclear transcription factor KappaB (NF-KappaB) signaling, markedly decreasing the production of the key proinflammatory cytokine tumor necrosis factor (TNF-alpha). Unlike other non-steroidal anti-inflammatory drugs, however, boswellic acid failed to show analgesic or antipyretic effects.

Research on cytotoxic effects of boswellic acid indicates that it induces p21 expression through a p53-independent pathway and causes apoptosis in glioma and leukemia cell lines. A boswellia extract induced apoptosis in a cervical cancer cell line by inducing endoplasmic reticulum (ER) stress. Other apoptotic mechanisms include early generation of nitric oxide and reactive oxygen species that upregulated time-dependent expression of p53/p21/PUMA, inhibition of microsomal prostaglandin E synthase-1 (mPGES-1), and decreased prostaglandin (PGE2) levels and its downstream targets.

A semisynthetic analog of boswellic acid, 3-alpha-Butyryloxy-beta-boswellic acid, demonstrated significant growth inhibition in Ehrlich Ascitic Tumour (EAT), Ehrlich Ascitic Carcinoma (EAC) and Sarcoma-180 tumor models, via NF-KappaB downregulation and induction of poly (ADP-ribose) polymerase (PARP) cleavage. Acetyl-boswellic acids inhibited topoisomerases by competing with DNA for binding sites. Acetyl-11-keto-beta-boswellic acid (AKBA) inhibited human prostate tumor growth via inhibition of VEGFR2-induced angiogenesis. In vitro, antiplatelet effects of boswellia gum resin extracts are attributed to inhibition of clotting factors Xa and XIa.


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Bhushan S, Malik F, Kumar A, et al. Activation of p53/p21/PUMA alliance and disruption of PI-3/Akt in multimodal targeting of apoptotic signaling cascades in cervical cancer cells by a pentacyclic triterpenediol from Boswellia serrata. Mol Carcinog. 2009 Dec;48(12):1093-108

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Dahmen U, Gu YL, Dirsch O, et al. Boswellic acid, a potent antiinflammatory drug, inhibits rejection to the same extent as high dose steroids. Transplant Proc. Feb-Mar 2001;33(1-2):539-541.

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Togni S, Maramaldi G, Bonetta A, Giacomelli L, Di Pierro F. Clinical evaluation of safety and efficacy of Boswellia-based cream for prevention of adjuvant radiotherapy skin damage in mammary carcinoma: a randomized placebo controlled trial. Eur Rev Med Pharmacol Sci. 2015 Apr;19(8):1338-44.

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Winking M, Sarikaya S, Rahmanian A, et al. Boswellic acids inhibit glioma growth: a new treatment option? J Neurooncol. 2000;46(2):97-103.

Yu G, Xiang W, Zhang T, Zeng L, Yang K, Li J. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020 Jul 17;20(1):225.

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