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The Natural Products Journal

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ISSN (Print): 2210-3155
ISSN (Online): 2210-3163

Review Article

Tribulus Terrestris and its Efficacy in the Treatment of Urinary Calculi

Author(s): Mohaddese Mahboubi*

Volume 12, Issue 7, 2022

Published on: 05 July, 2022

Article ID: e310322202907 Pages: 9

DOI: 10.2174/2210315512666220331153916

Price: $65

Abstract

Background: Urolithiasis as the third most common disorder is defined as stones within the urinary tract. Calcium oxalate is the most common type of stone with a prevalence of 80-85% of cases. There is no drug treatment for urolithiasis, but the use of some stone blockers and inhibitors relaxes the ureter smooth muscles and helps the stone excretion.

Objective: High prevalence and recurrence rates of urolithiasis has encouraged scientists to find new drugs, especially from medicinal plants. Tribulus terrestris is used for the management of urinary calculi in different traditional systems. Therefore, the potential use of T. terrestris in the management of urinary stones has been the subject of this review for the first time.

Methods: The manuscript was prepared by searching the keywords “Tribulus terrestris”, “urolithiasis”, “urinary stone”, and “calcium oxalate” in scientific resources, traditional and modern books, dissertations, and documents.

Results: The results exhibited that T. terrestris fruit aqueous extract had some efficacy in the treatment of urinary calculi by demineralizing the stone, inhibiting the stone formation, increasing urine volume in 24 hrs in animal and human studies, along with protective effects against renal injury due to inhibition of oxidative stress and lipid peroxidation.

Conclusion: All these mechanisms make T. terrestris as an effective treatment for urolithiasis that needs to be evaluated in further clinical studies.

Keywords: Tribulus terrestris, urolithiasis, calcium oxalate monohydrate, renal injury, oxidative stress, urinary calculi.

Graphical Abstract

[1]
Osborne, C.A.; Lulich, J.P.; Kruger, J.M.; Polzin, D.J.; Johnston, G.R.; Kroll, R.A. Medical dissolution of feline struvite urocystoliths. J. Am. Vet. Med. Assoc., 1990, 196(7), 1053-1063.
[PMID: 2329073]
[2]
Sakhaee, K. Nephrolithiasis as a systemic disorder. Curr. Opin. Nephrol. Hypertens., 2008, 17(3), 304-309.
[http://dx.doi.org/10.1097/MNH.0b013e3282f8b34d] [PMID: 18408483]
[3]
Schissel, B.L.; Johnson, B.K. Renal stones: Evolving epidemiology and management. Pediatr. Emerg. Care, 2011, 27(7), 676-681.
[http://dx.doi.org/10.1097/PEC.0b013e3182228f10] [PMID: 21730811]
[4]
Alelign, T.; Petros, B. Kidney stone disease: An update on current concepts. Adv. Urol., 2018, 2018, 3068365.
[http://dx.doi.org/10.1155/2018/3068365] [PMID: 29515627]
[5]
Singh, K.B.; Sailo, S. Understanding epidemiology and etiologic factors of urolithiasis: An overview. Sci. Vis., 2013, 13(4), 169-174.
[6]
Daudon, M.; Jungers, P.; Bazin, D.; Williams, J.C., Jr Recurrence rates of urinary calculi according to stone composition and morphology. Urolithiasis, 2018, 46(5), 459-470.
[http://dx.doi.org/10.1007/s00240-018-1043-0] [PMID: 29392338]
[7]
Healy, K.A.; Ogan, K. Nonsurgical management of urolithiasis: An overview of expulsive therapy. J. Endourol., 2005, 19(7), 759-767.
[http://dx.doi.org/10.1089/end.2005.19.759] [PMID: 16190824]
[8]
Cassell, A., III; Jalloh, M.; Ndoye, M.; Mbodji, M.; Gaye, O.; Thiam, N.M.; Diallo, A.; Labou, I.; Niang, L.; Gueye, S. Surgical manage-ment of urolithiasis of the upper tract - current trend of endourology in Africa. Res. Rep. Urol., 2020, 12, 225-238.
[http://dx.doi.org/10.2147/RRU.S257669] [PMID: 32754452]
[9]
Tariq, M.; Mossa, J.S.; Al-yahya, M.A.; Al-meshal, I.A.; Al-badr, A.A. Phytochemical and biological screening of Saudi medicinal plants part-10* a study on saudi plants of family Compositae. Int. J. Crude Drug Res., 1987, 25(1), 17-25.
[http://dx.doi.org/10.3109/13880208709060906]
[10]
Pascual, V.C.; Cañavate, J.L.R.; Gallego, Á.J. Report of the scientific committee of the Spanish Agency for Consumer Affairs, Food Safety and Nutrition (AECOSAN) on the risk of using Tribulus terrestris in food supplements. 2015, 21, 37-44.
[11]
Bahmani, M.; Baharvand-Ahmadi, B.; Tajeddini, P.; Rafieian-Kopaei, M.; Naghdi, N. Identification of medicinal plants for the treatment of kidney and urinary stones. J. Renal Inj. Prev., 2016, 5(3), 129-133.
[http://dx.doi.org/10.15171/jrip.2016.27] [PMID: 27689108]
[12]
bin Mohammad Herawi, Y.; ala Dawiya, R. Introduction and Correction Dr. Seyed Mohammad Nazari, Tehran, Al-Muhi 2012.
[13]
Khorasani, A. Makhzan ol-Advieh; Enghelab e Eslami publishing and Educational Organization, 1992.
[14]
Arzani, M. Teb-e-Akbari [Akbari’s medicine]; Research Institute for Islamic and Complimentary Medicine: Tehran, Iran, 2008.
[15]
Satish, S.; Periasamy, P.; Namasivayam, A. Effect of Tribulus terrestris on experimental urolithiasis induced by ethylene glycol in albino rats. Pharm. Pharmacol. Commun., 1996, 2(9), 437-439.
[16]
Dirir, A.; Cheruth, A.; Ksiksi, T. Ethnomedicine, phytochemistry and pharmacology of Calotropis procera and Tribulus terrestris. J. Natur. Remed., 2017, 17(2), 38-47.
[17]
Chhatre, S.; Nesari, T.; Somani, G.; Kanchan, D.; Sathaye, S. Phytopharmacological overview of Tribulus terrestris. Pharmacogn. Rev., 2014, 8(15), 45-51.
[http://dx.doi.org/10.4103/0973-7847.125530] [PMID: 24600195]
[18]
Naseri, L. Akbari bazm, M.; Khazaei, M. A Review on therapeutic effects of Tribulus terrestris. J. Med. Plant., 2019, 18(72), 1-22.
[19]
Mahboubi, M. Tribulus terrestris in management of sexual functions. Nat. Prod. J., 2019, 9(3), 172-183.
[http://dx.doi.org/10.2174/2210315508666181022125243]
[20]
Tzou, D.T.; Taguchi, K.; Chi, T.; Stoller, M.L. Animal models of urinary stone disease. Int. J. Surg., 2016, 36(Pt D), 596-606.
[http://dx.doi.org/10.1016/j.ijsu.2016.11.018] [PMID: 27840313]
[21]
Ushijima, Y. Identity of aliphatic L- -hydroxyacid oxidase and glycolate oxidase from rat livers. Arch. Biochem. Biophys., 1973, 155(2), 361-367.
[http://dx.doi.org/10.1016/0003-9861(73)90125-2] [PMID: 4705431]
[22]
Sangeeta, D.; Sidhu, H.; Thind, S.K.; Nath, R.; Vaidyanathan, S. Thereapeutic response of Tribulus terrestris (gokhru) aqueous extract on hyperoxaluria in male adult rats. Phytother. Res., 1993, 7(2), 116-119.
[http://dx.doi.org/10.1002/ptr.2650070204]
[23]
Sangeeta, D.; Sidhu, H.; Thind, S.K.; Nath, R. Effect of Tribulus terrestris on oxalate metabolism in rats. J. Ethnopharmacol., 1994, 44(2), 61-66.
[http://dx.doi.org/10.1016/0378-8741(94)90069-8] [PMID: 7853865]
[24]
Xie, B.; Halter, T.J.; Borah, B.M.; Nancollas, G.H. Aggregation of calcium phosphate and oxalate phases in the formation of renal stones. Cryst. Growth Des., 2015, 15(1), 204-211.
[http://dx.doi.org/10.1021/cg501209h] [PMID: 25598742]
[25]
Cerini, C.; Geider, S.; Dussol, B.; Hennequin, C.; Daudon, M.; Veesler, S.; Nitsche, S.; Boistelle, R.; Berthézène, P.; Dupuy, P.; Vazi, A.; Berland, Y.; Dagorn, J-C.; Verdier, J-M. Nucleation of calcium oxalate crystals by albumin: Involvement in the prevention of stone for-mation. Kidney Int., 1999, 55(5), 1776-1786.
[http://dx.doi.org/10.1046/j.1523-1755.1999.00426.x] [PMID: 10231440]
[26]
Moriyama, M.T.; Miyazawa, K.; Noda, K.; Oka, M.; Tanaka, M.; Suzuki, K. Reduction in oxalate-induced renal tubular epithelial cell inju-ry by an extract from Quercus salicina Blume/Quercus stenophylla Makino. Urol. Res., 2007, 35(6), 295-300.
[http://dx.doi.org/10.1007/s00240-007-0114-4] [PMID: 17882411]
[27]
Pachana, K.; Wattanakornsiri, A.; Nanuam, J. Application of small caltrops (Tribulus terrestris) to inhibit calcium oxalate monohydrate crystallization. Sci. Asia, 2010, 36(2), 165-168.
[http://dx.doi.org/10.2306/scienceasia1513-1874.2010.36.165]
[28]
Gouri Sankar, K.; Gopichand, Y.; Vaidehi, D.; Devyani, M.; Neelima, V.; Madhavi, N. Anti-urolithiatic activity of Tribulus terrestris leaves. Int. J. Innov. Pharma. Sci. Res., 2018, 6(4), 97-104.
[29]
Wiederkehr, M.R.; Moe, O.W. Uric acid nephrolithiasis: A systemic metabolic disorder. Clin. Rev. Bone Miner. Metab., 2011, 9(3-4), 207-217.
[http://dx.doi.org/10.1007/s12018-011-9106-6] [PMID: 25045326]
[30]
Satish, H.; Raman, D.; Kshama, D.; Shivananda, B.; Shridhar, K. In-vitro anti-lithiatic activity study of Tribulus terrrestris fruits and Boer-haavia diffusa roots. Pharm. Lett., 2010, 2(3), 12-20.
[31]
Aggarwal, A. Antilithiatic effects of Tribulus terrestris: An in vitro and in vivo study; Jaypee University of Information Technology: India, 2011.
[32]
Kumari, G.S.; Iyer, G.Y. Preliminary studies on the diuretic effects of Hygrophila spinosa and Tribulus terrestris. Indian J. Med. Res., 1967, 55(7), 714-716.
[PMID: 6056282]
[33]
Shelke, R.D.; Ramteke, A.D.; Patankar, R.A. Phytochemical study of gokshur (Tribulus terrestris Linn.) and evaluation of its antibacterial activity with special reference to mutrakruchcha. Int. J. Ayurveda Pharma Res., 2014, 2(3), 63-68.
[34]
Al-Ali, M.; Wahbi, S.; Twaij, H.; Al-Badr, A. Tribulus terrestris: Preliminary study of its diuretic and contractile effects and comparison with Zea mays. J. Ethnopharmacol., 2003, 85(2-3), 257-260.
[http://dx.doi.org/10.1016/S0378-8741(03)00014-X] [PMID: 12639749]
[35]
Saxena, N.; Argal, A. Study of antiurolithiatic activity of a formulated herbal suspension. Herba Pol., 2015, 61(2), 41-49.
[http://dx.doi.org/10.1515/hepo-2015-0014]
[36]
Nadkarni, K.M. Indian Materia Medica; Popular Prakashan: Bombay, India, 1993.
[37]
Velázquez, H.; Wright, F.S. Effects of diuretic drugs on Na, Cl, and K transport by rat renal distal tubule. Am. J. Physiol., 1986, 250(6 Pt 2), F1013-F1023.
[PMID: 3717344]
[38]
Saurabh, C.; Tanuja, N.; Gauresh, S.; Rakesh, K.; Sadhana, S. Comparative evaluation of diuretic activity of different extracts of Tribulus terrestris fruits in experimental animals. International J. Res. Phytochem. Pharmacol, 2012, 2(3), 129-133.
[39]
Arcasoy, H.B.; Erenmemisoglu, A.; Tekol, Y.; Kurucu, S.; Kartal, M. Effect of Tribulus terrestris L. saponin mixture on some smooth muscle preparations: A preliminary study. Boll. Chim. Farm., 1998, 137(11), 473-475.
[PMID: 10077881]
[40]
Li, X.; Ma, J.; Shi, W.; Su, Y.; Fu, X.; Yang, Y.; Lu, J.; Yue, Z. Calcium oxalate induces renal injury through calcium-sensing receptor. Oxid. Med. Cell. Longev., 2016, 2016, 5203801.
[http://dx.doi.org/10.1155/2016/5203801] [PMID: 27965733]
[41]
Rashed, T.; Menon, M.; Thamilselvan, S. Molecular mechanism of oxalate-induced free radical production and glutathione redox imbal-ance in renal epithelial cells: Effect of antioxidants. Am. J. Nephrol., 2004, 24(5), 557-568.
[http://dx.doi.org/10.1159/000082043] [PMID: 15539792]
[42]
Khan, S.R. Hyperoxaluria-induced oxidative stress and antioxidants for renal protection. Urol. Res., 2005, 33(5), 349-357.
[http://dx.doi.org/10.1007/s00240-005-0492-4] [PMID: 16292585]
[43]
Thamilselvan, S.; Khan, S.R.; Menon, M. Oxalate and calcium oxalate mediated free radical toxicity in renal epithelial cells: Effect of anti-oxidants. Urol. Res., 2003, 31(1), 3-9.
[http://dx.doi.org/10.1007/s00240-002-0286-x] [PMID: 12624656]
[44]
Wagner, A.; Marc, A.; Engasser, J.M.; Einsele, A. The use of lactate dehydrogenase (LDH) release kinetics for the evaluation of death and growth of mammalian cells in perfusion reactors. Biotechnol. Bioeng., 1992, 39(3), 320-326.
[http://dx.doi.org/10.1002/bit.260390310] [PMID: 18600948]
[45]
Kamboj, P.; Aggarwal, M.; Puri, S.; Singla, S.K. Effect of aqueous extract of Tribulus terrestris on oxalate-induced oxidative stress in rats. Indian J. Nephrol., 2011, 21(3), 154-159.
[http://dx.doi.org/10.4103/0971-4065.83727] [PMID: 21886973]
[46]
Khan, S.R. Reactive oxygen species, inflammation and calcium oxalate nephrolithiasis. Transl. Androl. Urol., 2014, 3(3), 256-276.
[PMID: 25383321]
[47]
Kaushik, J.; Tandon, S.; Bhardwaj, R.; Kaur, T.; Singla, S.K.; Kumar, J.; Tandon, C. Delving into the antiurolithiatic potential of Tribulus terrestris extract through–in vivo efficacy and preclinical safety investigations in Wistar rats. Sci. Rep., 2019, 9(1), 1-13.
[http://dx.doi.org/10.1038/s41598-019-52398-w] [PMID: 30626917]
[48]
Butterweck, V.; Khan, S.R. Herbal medicines in the management of urolithiasis: Alternative or complementary? Planta Med., 2009, 75(10), 1095-1103.
[http://dx.doi.org/10.1055/s-0029-1185719] [PMID: 19444769]
[49]
Zhai, W.; Zheng, J.; Yao, X.; Peng, B.; Liu, M.; Huang, J.; Wang, G.; Xu, Y. Catechin prevents the calcium oxalate monohydrate induced renal calcium crystallization in NRK-52E cells and the ethylene glycol induced renal stone formation in rat. BMC Complement. Altern. Med., 2013, 13(1), 228.
[http://dx.doi.org/10.1186/1472-6882-13-228] [PMID: 24044655]
[50]
Harper, J.M.; Samuell, C.T.; Hallson, P.C.; Wood, S.M.; Mansell, M.A. Risk factors for calculus formation in patients with renal trans-plants. Br. J. Urol., 1994, 74(2), 147-150.
[http://dx.doi.org/10.1111/j.1464-410X.1994.tb16576.x] [PMID: 7921929]
[51]
Wu, T-S.; Shi, L-S.; Kuo, S-C. Alkaloids and other constituents from Tribulus terrestris. Phytochemistry, 1999, 50(8), 1411-1415.
[http://dx.doi.org/10.1016/S0031-9422(97)01086-8]
[52]
Arasaratnam, V.; Balakumar, S.; Senthuran, A.; Rajendraprasad, R. A study of Tribulus terrestris extract on risk factors for urinary stone in normal subjects and urolithic patients. J. Natl. Sci. Found. Sri Lanka, 2010, 38(3), 187.
[http://dx.doi.org/10.4038/jnsfsr.v38i3.2308]
[53]
Grases, F.; Genestar, C.; Conte, A.; March, P.; Costa-Bauzá, A. Inhibitory effect of pyrophosphate, citrate, magnesium and chondroitin sulphate in calcium oxalate urolithiasis. Br. J. Urol., 1989, 64(3), 235-237.
[http://dx.doi.org/10.1111/j.1464-410X.1989.tb06004.x] [PMID: 2553195]
[54]
Fellström, B.; Danielson, B.G.; Karlström, B.; Lithell, H.; Ljunghall, S.; Vessby, B.; Wide, L. Effects of high intake of dietary animal pro-tein on mineral metabolism and urinary supersaturation of calcium oxalate in renal stone formers. Br. J. Urol., 1984, 56(3), 263-269.
[http://dx.doi.org/10.1111/j.1464-410X.1984.tb05384.x] [PMID: 6544608]
[55]
EFSA. Scientific Opinion on the substantiation of health claims related to various food (s)/food constituent (s) claiming an increase in renal water elimination,“kidneys health”,“urinary health”,“bladder health”,“health of lower urinary tract”,“blood health”,“elimination”,“urinary system benefits” and/or “supports/ promotes the excretory function of the kidney”, and treatment/ prevention of renal gravel/kidney stones and urinary tract infections pursuant to Article 13 (1) of Regulation (EC) No 1924/2006. In EFSA Journal, Panel on Dietetic Products, , 2010; 8, p. 1742.
[56]
Abudayyak, M.; Jannuzzi, A.T.; Özhan, G.; Alpertunga, B. Investigation on the toxic potential of Tribulus terrestris in vitro. Pharm. Biol., 2015, 53(4), 469-476.
[http://dx.doi.org/10.3109/13880209.2014.924019] [PMID: 25471616]
[57]
Trouillas, P.; Corbière, C.; Liagre, B.; Duroux, J.L.; Beneytout, J.L. Structure-function relationship for saponin effects on cell cycle arrest and apoptosis in the human 1547 osteosarcoma cells: A molecular modelling approach of natural molecules structurally close to diosgen-in. Bioorg. Med. Chem., 2005, 13(4), 1141-1149.
[http://dx.doi.org/10.1016/j.bmc.2004.11.031] [PMID: 15670922]
[58]
Taghavi Razavizadeh, S.A.; Nourani, H. A study on clinical and laboratory features of natural poisoning with Tribulus terrestris in sheep. Iranian J. Ruminants Health Res, 2018, 3(1), 47-55.
[59]
Zia-Behbahani, M.; Barzegar, A.; Moradi, O.; Faghihi, M.; Khamooshi, M.; Khademian, S.; Zarshenas, M.M.; Mohagheghzadeh, A. Eth-nopharmacological study of medicinal plants used for treating dysuria: A collection from traditional markets in Shiraz. Complement. Med. Res., 2018, 25(4), 240-248.
[http://dx.doi.org/10.1159/000486641] [PMID: 29566362]
[60]
Manjiri, M.A.; Eslami, M.; Noras, M.R. Materia introduction of effective medicines on kidney stones in Persian medicine. J. Mazandaran Univ. Med. Sci., 2019, 29(171), b00593.
[61]
Trama, F.; Filippo, R.; Romeo, G.; Ruffo, A. “Tradamixina TP” Compound in monotherapy for three months in patients with LUTS: Ob-servational study on improvement of urinary symptoms and sexual function in men. Health (Irvine Calif.), 2019, 11(6), 621-629.
[http://dx.doi.org/10.4236/health.2019.116052]
[62]
Abegunasekara, N.; Damintha, K. Effectiveness of powder of Tribulus teristrus in the management of urinary calculi. Int. J. Res. Innov. App. Sci., 2020, 5(3), 38-40.
[63]
Ghani, A. Estimation of macro and micro nutrients in some important medicinal plants of Soon Valley, District Khushab, Pakistan. Afr. J. Biotechnol., 2012, 11(78), 14386-14391.
[http://dx.doi.org/10.5897/AJB12.762]
[64]
Yadav, H.N.; Sharma, U.S.; Singh, S.; Gupta, Y.K. Effect of combination of Tribulus terrestris, Boerhavia diffusa and Terminalia chebula reverses mercuric chloride-induced nephrotoxicity and renal accumulation of mercury in rat. Orient. Pharm. Exp. Med., 2019, 19(4), 497-507.
[http://dx.doi.org/10.1007/s13596-019-00381-1]
[65]
Abdel-Kader, M.S.; Al-Qutaym, A.; Saeedan, A.S.B.; Hamad, A.M.; Alkharfy, K.M. Nephroprotective and hepatoprotective effects of Tribulus terrestris L. growing in Saudi Arabia. J. Pharm. Pharmacogn. Res., 2016, 4(4), 144-152.

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