Greater Plantain (Plantago major) and Wounds: evidence and sources

The medicinal benefits of Plantago major have been acknowledged around the world for hundreds of years. This plant contains a number of effective chemical constituents including flavonoids, alkaloids, terpenoids, phenolic acid derivatives, iridoid glycosides, fatty acids, polysaccharides and vitamins which contribute to its exerting specific therapeutic effects. Correspondingly, studies have found that Plantago major is effective as a wound healer, as well as an antiulcerative, antidiabetic, antidiarrhoeal, anti-inflammatory, antinociceptive, antibacterial, and antiviral agent. It also combats fatigue and cancer, is an antioxidant and a free radical scavenger. This paper provides a review of the medicinal benefits and chemical constituents of Plantago major published in journals from year 1937 to 2015 which are available from PubMed, ScienceDirect and Google Scholar.

Introduction The use of herbal extracts is increasing because of the increase in bacterial resistance to conventional antibiotics. Plantago major is frequently used in traditional medicine because of its medicinal properties. The aim of the current study was to assess the antibacterial efficacy of an ethanolic extract of P. major leaves against Pseudomonas aeruginosa isolated from burn infections. Methodology One hundred and twenty burn samples were collected from hospitalized patients at the Burn Hospital in Duhok city. The bacterium was identified using Gram stain, colony morphology, biochemical tests and selective differential media. Antibacterial activity of P. major leaves was assessed by using an ethanolic extract in serial dilutions of 100, 75, 50, 25, and 10 % and disc diffusion assay. Antibiotic susceptibility testing was also performed by disk diffusion using Muller-Hinton agar medium. Results Different concentrations of the ethanolic extract of P. major leaves exhibited different zones of inhibition against P. aeruginosa from 9.93 mm to 22.18 mm in diameter. The inhibition zone increased as the concentration of the extract increased. The 100% ethanolic extract had the greatest inhibitory effect, inhibiting bacteria in the zone of 22.18 mm diameter. This bacterium showed a high level of resistance to the antibiotics used. Conclusions This study demonstrated that herbal extracts could be used as a combination therapy with antibiotics and chemical drugs in the elimination of bacterial growth. Further investigations and future experiments, need to be carried out before recommending use of herbal extracts.

Since ancient times, many scientists and doctors have used various herbs to treat diseases. Conventional drugs often have side effects, and pathogens are becoming resistant to these types of drugs. In such circumstances, the study of traditional medicinal plants is an effective and logical strategy for finding new herbal medicines. One such herb is Plantago major, a perennial plant in the Plantaginaceae family that is found throughout the world. The Plantago major plant has been used as a medicine for the treatment of various diseases. Studies have shown that plant extracts of Plantago major exhibit antimicrobial, antiviral, and anti-inflammatory effects, and have wound-healing properties. This review collects and presents the results of various studies of Plantago major plant extracts with antimicrobial, antiviral, antifungal, anti-inflammatory, and wound-healing properties, which demonstrate a wide range of therapeutic possibilities of Plantago major plant extracts and have a huge potential for use as a medicinal raw material.

PURPOSE: To determine the in vitro effectiveness of Plantago major extract, along with two of its active components, aucubin and baicalein, on the inhibition of Candida albicans growth, biofilm formation, metabolic activity, and cell surface hydrophobicity. MATERIALS AND METHODS: Twofold dilutions of P. major, aucubin, and baicalein were used to determine the minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC), and the minimum biofilm inhibitory concentration (MBIC) of each solution. Separately, twofold dilutions of P. major, aucubin, and baicalein were used to determine the metabolic activity of established C. albicans biofilm using a 2,3-bis (2- methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-carboxanilide reduction assay. Twofold dilutions of P. major, aucubin, and baicalein were used to determine the cell surface hydrophobicity of treated C. albicans biofilm by a two-phase assay using hexadecane. The hydrophobicity percentage of the cell surface was then calculated. A mixed-model ANOVA test was used for intergroup comparisons. RESULTS: The MICs of P. major extract (diluted 1:2 to 1:8), aucubin (61 to 244 μg/ml), and baicalein (0.0063 to 100 μg/ml) on the total growth of C. albicans were noticeable at their highest concentrations, and the inhibition was dose dependent. The MFC was evaluated after 48 hours of incubation, and aucubin (244 μg/ml) exhibited a strong fungicidal activity at its highest concentration against C. albicans growth. The MBIC indicated no growth or reduced growth of C. albicans biofilm at the highest concentrations of aucubin (61 to 244 μg/ml) and baicalein (25 to 100 μg/ml). Similarly, the effects of these reagents on C. albicans biofilm metabolic activity and hydrophobicity demonstrated high effectiveness at their highest concentrations. CONCLUSION: P. major extract, aucubin, and baicalein caused a dose-dependent reduction on the total growth, biofilm formation, metabolic activity, and cell surface hydrophobicity of C. albicans. This demonstrates their effectiveness as antifungals and suggests their promising potential use as solutions for C. albicans biofilm-related infections.

Background Plantago major is a medicinal plant that has been used for centuries to treat various health conditions including wounds. Purpose To investigate the effectiveness of the topical use of P major in healing skin wounds in animal models. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted. Seven (7) electronic databases (Virtual Health Library, Public/Publisher MEDLINE, Scopus, Web of Science, Embase, Cumulative Index of Nursing and Allied Health Literature, and CAB Direct) were searched for controlled studies published in English from January 2006 to March 2020. The Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies tools guided the evaluation of the studies and determined their quality. The Systematic Review Center for Laboratory Animal Experimentation was used to assess the risk of bias. Results Of the 176 publications identified, 4 met the inclusion criteria. Studies included 20 to 100 animals and varying concentrations of P major. There were no reports of losses during research. Wound healing was assessed between 17 and 21 days following wounding. The best response in terms of wound contraction rate occurred with 10%, 20%, and 50% concentrations when compared with control groups. One (1) study did not have an animal ethics committee review. All studies had a high risk of bias and a lack of methodological rigor. Conclusion The results of this review did not find evidence about the in vivo effectiveness of P major for wound healing. More rigorous preclinical studies with adequate sample sizes are required to identify the best concentrations and formulations as well as increase understanding about the mechanisms of action of P major in wound healing.

Aims: Diabetic foot ulcer (DFU) and pressure ulcer (PU) both are common types of ulcers worldwide. The wound healing effect of Plantago major leaves has been shown in a few animal studies. This study aimed to evaluate the clinical efficacy of P. major hydroalcoholic extract on DFU and PU healing. Methods: In this clinical trial, patients with DFU or PU who met the inclusion criteria were randomly assigned to drug ( P. major ) or control groups. For patients in the drug group, Plantago extract 10% topical gel was applied on the wound once daily concurrent with dressing and routine wound care for two weeks, while for the control group, an appropriate novel dressing was used along with routine wound care for the same duration. The percentage of wound size reduction at the end of the seventh and 14th days of intervention was recorded and compared between the groups. Results: Fifty and 44 patients in drug and control groups, respectively, completed the interventions. Plantago extract gel significantly resulted in more reduction in the wound size compared to control at the end of the first (64.90 ± 29.75% vs. 33.11 ± 26.55%; P P P Conclusion: The use of 10% topical gel of P. major leaf extract results in the acceleration of DFU and PU healing. Key points: Application of P. major topical gel results in the acceleration of diabetic foot ulcer and pressure ulcer healing. - P. major extract helps reducing the wound's erythema.- P. major leaf extract assists decreasing the wound size.- The number of patients completing wound healing process is higher among whom undergoing P. major dressing.

Background Plantago major L. is used by local people to improve various wounds and lesions such as pressure ulcer. In this study, the therapeutic effects of P. major topical formulation on the stage 1 pressure ulcer in patients have been investigated. Materials and methods This randomized triple blind clinical trial study was performed on 130 patients. During the 14 days of study, each of the test and control groups was checked according to check list. Also the topical formulation was standardized by HPLC based on the amount of quercetin. Results The findings of this study indicated a significant difference in resolution of the damage between the test and control groups. Topical formulation was standardized by HPLC based on the quercetin (1.88 mg/100g) and no side effects associated with this topical formulation was found. Conclusion The results confirmed the traditional use of P. major in resolution of the damage. CLINICAL TRIAL ID: (IRCT201609209014N117).

The wound-healing properties of Plantago major L. (plantain) were evaluated using an ex-vivo porcine wound-healing model. Ethanol- and water-based extracts were prepared from greenhouse-grown and freeze-dried leaves of P. major. Both types of extracts stimulated wound healing in porcine skin, but the ethanol-based extracts had a somewhat stronger effect. A concentration of 1.0 mg/mL (on dry weight basis) produced the best results for both types of extracts.

Background and Aim: Plantago major leaf has been traditionally used in Iran and many other countries for wound healing. This study presents a brief report about the depiction of the effects of Plantago major on wound healing in the major texts of Persian medicine. Moreover, the effect of Plantago major’s leaf extract on wound healing duration has been experimentally assessed in male rats. Materials and Methods: In experimental studies, the methanolic extract of Plantago major's leaf was used as an ointment. To make a wound model, a circular ulcer was made on the back of animals. Adult male Wistar rats were divided into two groups: animals in the control group were treated once a day only with the ointment's eucerin base, and the rats in Plantago major's group were treated with the ointment containing the plant extract. Ulcerous areas were measured on days 0 and 14. The durations of complete wound healing processes were determined too. Results: The difference between the mean duration of wound healing was statistically significant using independent samples t-test (20.7±0.4 days in control vs 19.1±0.4 in plant extract group, p=0.022). Furthermore, there was a significant difference in the mean wound surface area on the fourteenth day (p=0.014) despite the fact that there were no significant differences in day 0 (p=0.69). Conclusion: There is a long history of using Plantago major's leaf for wound healing in Persian medicine text books. It was determined, in the experimental studies conducted on rats, that P. major's leaf extract could accelerate wound healing process. This capability justifies its application not only in Persian medicine but also in some other traditional medicines.