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Capparis Spinosa L. (Caper) Fruit Extract in
Capparis Spinosa L. (Caper) Fruit Extract in
Pharmacology and Applied Medicine Department of Medicinal Plants research Center, Institute of
Medicinal Plants, ACECR, Karaj, Iran
b
Obesity and Eating Habit Research Center, Endocrinology and Metabolism Molecular - Cellular Sciences
Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran,
Iran
c
Endocrinology and Metabolism Research center, Endocrinology & Metabolism research institute, Tehran
University of Medical Sciences, Tehran, Iran
d
Department of Pharmacognosy, Research Institute of Medicinal Plants, ACECR, Karaj, Iran
e
Diabetic Patient Association, Karaj, Iran
Available online 7 August 2013
KEYWORDS
Capparis spinosa;
Diabetes;
Medicinal plants;
Clinical trial
Summary
Objectives: Capparis spinosa L. (Caper) fruit is traditionally used as an anti-hyperglycemic food
by Iranian diabetic patients. But yet, no controlled human study has determined its efcacy in
treatment of hyperglycemia in type 2 diabetic patients.
Design: The present study was undertaken to explore the possible anti-hyperglycemic effects
of the caper fruit extract in type 2 diabetic patients. A randomized clinical trial was conducted
in 54 type 2 diabetic patients. Two groups 28 and 26 patients on standard anti-diabetic therapy,
received 400 mg caper fruit extract and placebo capsules three times a day respectively for two
months.
Main outcome measures: The patients fasting blood glucose, glycosylated hemoglobin, lipids
levels, liver and renal function tests were determined at baseline and endpoint.
Results: Results showed signicant decrease in fasting blood glucose levels (p = 0.037) and glycosylated hemoglobin (p = 0.043) in caper treated patients compared to control group at the
end of the study. Triglyceride level also decreased signicantly (p = 0.29) in caper treated group
at the end of the study compared to baseline. No liver, kidney and other side effects were
observed in these two groups.
Corresponding author at: Endocrinology and Metabolism Research Center, 5th oor, Shariati Hospital, North Kargar Avenue,
Tehran 14114, Iran. Tel.: +98 21 88220037; fax: +98 21 88220053.
E-mail address: shirinhasanir@yahoo.com (S. Hasani-Rnjbar).
0965-2299/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ctim.2013.07.003
448
Introduction
Diabetes mellitus type 2 is one of the most prevalent and
fastest growing diseases in most of the countries.1 Apart
from conventional anti diabetic therapy, several studies
have shown that diet, medicinal plants, complementary and
alternative medicine therapies have benecial effects and
improve glucose homeostasis in diabetic patients.2,3 Capparis spinosa L. (caper) belongs to family Capparidaceae and
probably originated from dry regions in west or central Asia.4
The caper fruits and ower buds pickles are used as a food
by diabetic patients due to the belief that they have hypoglycemic and hypolipidemic actions.57 The pickled fruits of
caper are eaten at the dose of 28 g daily as a remedy by
diabetic patients in Iran. Despite a few ethno-botanical surveys indicating use of caper in anti-diabetic formulations in
folk medicine.57 and few experimental studies conrmed
the blood glucose lowering and hypolipidemic properties
of caper,8,9 to our knowledge no clinical studies have been
conducted to determine the caper anti-hyperglycemic efcacy and safety in diabetic patients so far. This randomized,
double-blind, placebo controlled study, was designed to
investigate the anti-hyperglycemic effects of 1200 mg caper
fruit extract daily (5 g caper fruit average daily doses used
by diabetic patients) in type 2 diabetic patients.
Plant extract
Patients
Sixty Iranian male and female type 2 diabetic patients (aged
4065 years) registered at the
Diabetic Clinic registry of Shariati Hospital Tehran Iran,
who was eligible according to the inclusion and exclusion criteria, participated in this study. The patients were
visited by investigators and informed about the rationale
and main aims of the study. Written informed consent was
obtained from the patients. The medical ethics committee of the Tehran University of Medical Sciences approved
the protocol. All the patients who participated had conrmed diabetes type 2 according to ADA criteria12 and were
on treatment for at least two months with diabetic food
regimen and had not taken any herbal medicine and did
Results
Caper fruits yielded 24% dried extract. The fruit extract
possessed total avonoids expressed as rutin equivalent
449
Table 1
group.
Age (year)
Duration of
Disease (year)
Weight (kg)
BMI
Caper (N = 28)
Placebo (N = 26)
53.3 5.6
6.4 2.34
54.5 5.4
7.3 3.2
73.1 11.9
26.3 2.1
70.8 10.8
25.7 2.3
Discussion
The results suggest that caper fruit safely improves
hyperglycemia and hypertriglyceridemia in type 2
diabetic patients. The ndings of the present study
agree with the traditional use of caper for treatment
of diabetes,7,56 and previous animal studies demonstrating its anti-hyperglycemic and hypolipidemic
effect.8,9
The exact mechanisms of caper blood glucose-lowering
and hypolipidemic effects are unknown. In a study it
was reported that caper had hypoglycemic activity without effect on insulin secretion in diabetic rats.7 In other
studies hypoglycemic and lipid lowering effect of caper
have been reported but their mechanisms have not been
determined.8,13
In diabetic patients elevation of glucose and free
fatty acid levels leads to generation of reactive oxygen
species and oxidative stress.14 These metabolic abnormalities not only induce late diabetic complications but
also lead to insulin resistance, cell dysfunction and
impaired insulin secretion.1517 The favorable effects of substances with antioxidant properties on diabetic prole have
450
Table 2
The fasting blood parameters at baseline and after 2 months (endpoint) of the study in caper (1) and placebo (2) groups.
Baseline mean (SD)
p-Value
compared to
placebo
Endpoint mean
(SD)
p-Value
compared to
placebo
Percent change
endpoint compared
to baseline
p-Value endpoint
compared to
baseline
0.037
1
2
11.19
4.17
0.005
0.351
0.043
1
2
4.81
2.04
0.313
0.367
1
2
6.16
1.73
0.105
0.282
0.240
1
2
23.99
16.12
0.029
0.129
1
2
HbA1c (%)
1
2
Cholesterol (mg/dl)
1
2
196.4 (40)
201.8 (37)
Triglyceride (mg/dl)
1
2
250.5 (110)
221.2 (130)
HDL (mg/dl)
1
2
42.4 (11.2)
45.8 (10.9)
0.371
1
2
41.9 (10.1)
43.9 (12.1)
0.540
1
2
1.17
2.35
0.675
0.165
LDL (mg/dl)
1
2
108.7 (24.4)
112.4 (21.3)
0.482
1
2
100.8 (27.7)
107.6 (20.6)
0.360
1
2
7.26
4.27
0.084
0.209
BUN (mg/dl)
1
2
13.7 (1.6)
13.7 (2.9)
0.982
1
2
14.2 (3.8)
16.6 (2.5)
0.381
1
2
3.64
4.30
0.525
0.318
Creatinine (mg/dl)
1
2
0.423
1
2
0.531
1
2
3.26
1.09
0.401
0.815
SGOT (U/L)
1
2
22.8 (9.8)
19.9 (5.4)
0.193
1
2
21.4 (3.7)
18.6 (4.6)
0.384
1
2
4.14
4.02
0.368
0.240
SGPT (U/L)
1
2
19.8 (3.6)
15.3 (7.0)
0.062
1
2
17.1 (7.5)
14.5 (7.1)
0.851
1
2
3.63
2.31
0.402
0.301
ALP (IU/L)
1
2
184.3 (65.3)
186.5 (47.4)
0.643
1
2
185.2 (54.0)
179.8 (45.5)
0.715
1
2
0.488
3.59
0.893
0.168
180.5 (31)
179.8 (37)
8.3 (2.1)
8.3 (1.2)
0.92 (0.21)
0.89 (0.15)
0.913
1
2
0.921
1
2
0.770
1
2
184.3 (41)
198.3 (38)
1
2
190.4 (126)
184.4 (101)
0.612
160.3 (36)
187.3 (50)
7.9 (1.9)
8.5 (1.3)
0.89 (0.20)
0.90 (0.17)
p < 0.05 was considered as statistically signicant. SD, standard deviation; decreased; increased.
0.320
FBG (mg/dl)
451
Figure 1
been reported in other studies.1820 However, the antioxidant properties of caper fruits due to the presence of
appreciable levels of phenolic compounds, tocopherols,
carotenoids and vitamin C may explain caper effects on
diabetic patients.2124 Caper fruits also contains compound
such as rutin and lectin,25,26 with favorable effects on
glucose and insulin metabolism.27,28 Furthermore many
bioactive compounds such as saccharides, glycosides, alkaloids, terpenoids, volatile oils, fatty acids, steroids and
several minerals present in caper may directly or indirectly
inuence glucose or insulin metabolism.2931
Considering the present study and previous data, caper
can be used as an adjuvant agent for treatment of diabetic
patients but this requires more additional validation studies. However it should be also noted that small sample size
and lack of identication of the active constituent(s)
responsible for the effects of caper fruit extract
are limitations of the present study. In conclusion,
more clinical trials are recommended to evaluate
the long-term efcacy and safety of caper in diabetic
patients.
Acknowledgement
We are grateful to the Endocrinology and Metabolism
Research Center, Tehran University of Medical Sciences, and
Research Institute of Medicinal Plants for nancial and other
supports in conduction of the present study.
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