Table 4.

Medicinal potential of elderberry (Sambucus nigra) preparations – in vivo studies.

Medicinal potential	Study design	Elderberry preparation	Dosage	Duration	Results	References
Antiviral activity	Female mice (6 weeks old) infected with influenza A virus	Concentrated elderberry juice separated in three fractions (low, medium and high molecular weight)	2 times/day	14 days	Suppression of the viral yield in the bronchoalveolar lavage fluids (BALFs) and lungs; increase in the level of IFV specific neutralizing antibody in the BALFs and serum and in the level of the secretory IgA in the BALFs and feces	Kinoshita et al. (2012)
	R, D-B, P-C, 60 patients (18–54 years) presenting influenza A and B symptoms	Standardized elderberry extract (Sambucol® syrup)	15 ml, 4 times/day	5 days	Symptoms of influenza A and B virus ebbed four days earlier in the elderberry group compared to the placebo group	Zakay-Rones et al. (2004)
	R, D-B, P-C, 64 patients (16–60 years) presenting flu symptoms	Proprietary elderberry extract as lozenge (175 mg of extract in each lozenge)	4 lozenges/day	48 h	28% of patients in the elderberry group were void of all flu symptoms and 60% of patients experienced a relief of some symptoms, whereas the placebo group demonstrated no improvement	Kong (2009)
Diabetes treatment	Male rats (28 weeks old) divided into four groups including diabetic rats	Polyphenolic elderberry extract	0.040 g/kg body every 2 days	16 weeks	Improvement of the bone mineral density and of the antioxidative capacity of serum; reduction in the body fat in diabetic rats; decrease in the lipid peroxidation level in serum; improvement of the osteoporosis status	Badescu et al. (2012)
	Male rats (11 weeks old) divided into four groups including type 2 diabetic rats fed a high-fat diet	Elderberry polar extract	350 mg/kg body/day	4 weeks	The polar extract lowered fasting blood glucose, the lipophilic extract decreased insulin secretion. Both extracts reduced insulin resistance	Salvador et al. (2017)
		Elderberry lipophilic extract	190 mg/kg body/day
Effect on metabolic dysfunctions in obesity	Male mice (8 weeks old) divided into four groups including diet-induced obese mice	Elderberry extract (13% of anthocyanins)	0.25% of extract (20–40 mg anthocyanins/kg body1.25% of extract (100–200 mg/kg body	16 weeks	Both elderberry groups had a lower liver weight and serum TAG concentration, and lower serum inflammatory markers, insulin resistance and hepatic lipids compared to the control obese group; the addition of 1.25% of extract reduced liver cholesterol and PPARγ2 mRNA compared to both other obese groups	Farrel, Norris, Ryan et al. (2015)
Effect on cholesterol and HDL dysfunctions	Male mice (10 weeks old) in a mouse model of hyperlipidemia and HDL dysfunction	Elderberry extract (13% of anthocyanins)	1.25% of extract (100–200 mg anthocyanins/kg body	6 weeks	No significant differences in serum lipids between groups; reduction in aspartate transaminase and fasting glucose in the elderberry group; changes in hepatic and intestinal mRNA with an improvement in HDL function and a reduction in hepatic cholesterol levels; increase in serum paraxonase-1 arylesterase activity in the elderberry group	Farrel, Norris, Lee et al. (2015)
Effect on lipid and antioxidant status	R, P-C, D-B, 34 healthy volunteers (20 males, 24 females)	400 mg spray-dried elderberry powder in gelatinous capsules (10% of anthocyanins in each capsule)	3 times/day	2 and 3 weeks	No significant differences in the changes in serum lipids and vitamin A, E and β-carotene in the elderberry group were observed compared to the placebo group; a decrease in the level of vitamin C in both groups;	Murkovic et al. (2004)
	6 volunteers	The same	A single dose	1 day	An increase in total anthocyanins in serum;
Effect on weight reduction	80 participants	Elderberry juice with flower extract; tablets containing berry powder and flower extract (1 mg anthocyanins, 370 mg flavonol glycosides, 150 mg hydroxycinnamates); Tablets containing Asparagus officinalis powder (19 mg saponins)	At least 3 L of elderberry juice, 3 Sambucus nigra tablets and 9 Asparagus officinalis tablets/day	15 days	The BMI index dropped by approx. 3%, the weight fell by an average of 3.2 kg, systolic blood pressure decreased by an average of over 5% and diastolic blood pressure by 2.5%	Chrubasik et al. (2008)
Effect on weight reduction and urinary parameters	11 volunteers	Diluted (1:5) concentrate of elderberries (from 120 g of berries) and flowers (flower juice and extract from 3.9 g of dried flowers)	200 ml divided into up 6 portions	7 days	An average weight reduction was 2.6 kg; no effect on pH, hydrogen ion concentration and 24 h hydrogen excretion in urine; no effect on the solubility of stone-inducing ions	Walz and Chrubasik (2008)
Antidepressant potential	Male mice divided into six groups	S. nigra extract and S. ebulus extract;	200–1200 mg/kg	–	S. nigra showed better activity than S. ebulus; reduction in the immobility time and increase in the activity in the Sambucus groups compared to the control group (measured by the forced swimming test and tail suspension test); a dose of 1200 mg/kg of extract significantly increased the activity compared to the imipramine group	Mahmoudi et al. (2014)
		Imipramine	10 mg/kg

^*Abbreviation: R – randomized, D-B – double-blind, P-C – placebo-controlled.