Brief overview: Collectively the evidence obtained from across five clinical studies involving 936 adults indicate that mono-herbal preparations of Sambucus nigra L. berry (S.nigra), when taken within 48 hours of onset of acute respiratory viral infection, may reduce the duration and severity of common cold and influenza symptoms in adults.There is currently no evidence to support the use of S.nigra berry for the treatment or prevention of COVID-19. Given the body of evidence from preclinical studies demonstrating the antiviral effects of S.nigra berry, alongside the results from clinical studies involving influenza viral infections included in this review, pre-clinical research exploring the potential effects of S.nigra berry on COVID-19 are encouraged.
Verdict: The evidence included in this review is mostly derived from clinical studies involving adult participants and examining short-term use of commercial formulations of S.nigra berry for up to 16 days. Findings from included studies suggest that mono-herbal preparations of S.nigra berry (in extract or lozenge formulation) may reduce influenza-type symptoms, including fever, headache, nasal congestion and nasal mucous discharge in adults, when taken within the first 48 hours of symptom onset. Within 2–4 days of S.nigra treatment, most adult participants experienced significant symptom reduction, by an average of 50–4 days of S.nigra treatment, most adult participants experienced significant symptom reduction, by an average of 50 %. Evidence regarding the effectiveness of S.nigra berry on the symptom of cough, and need for / use of medicines (including antibiotics) to treat acute respiratory infections, is currently unclear and inconsistent. Adverse events were rare with no serious events reported. Adverse events, reported in two studies, were more common in comparators than in treatments. There is currently no reliable or sufficient scientific evidence to support the use of S.nigra in pregnant or lactating women
Keywords: Sambucus nigra Acute Respiratory Infection Common cold
The effects of Sambucus nigra berry on acute respiratory viral infections: A rapid review of clinical studies Joanna Harnett, Advances in Integrative Medicine

Abstract Upper respiratory symptoms are often treated with over the counter drugs, antibiotics, and antiviral medications. Due to concerns about safety and efficacy, there is a demand for an alternative solution. Black elderberry (Sambucus nigra) has been used to treat cold and flu symptoms, but there are no large-scale studies or meta-analyses. This meta-analysis quantifies the effects of elderberry supplementation and evaluates moderators including vaccination status and the underlying pathology.
This analysis included a total of 180 participants and evaluates moderators such as vaccination status and cause of the upper respiratory symptoms.
Supplementation with elderberry was found to substantially reduce upper respiratory symptoms. The quantitative synthesis of the effects yielded a large mean effect size. These findings present an alternative to antibiotic misuse for upper respiratory symptoms due to viral infections, and a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.
Conclusion Supplementation with a standardized elderberry extract is significantly effective at reducing the total duration and severity of upper respiratory symptoms, as compared to a placebo group. The effect of elderberry supplementation is larger among cases of the flu than the common cold, but supplementation successfully reduces the symptoms regardless of underlying cause. These findings present an alternative to antibiotic misuse for upper respiratory symptoms due to viral infections, and a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.
Keywords: elderberry, sambucus, influenza, common cold
Black Elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials - Jessie Hawkins, Colby Baker, Lindsey Cherry, Elizabeth Dunne, Complementary Therapies in Medicine (2018)

Abstract : Consumption of anthocyanins (ACNs), due to their antioxidant, anti-inflammatory and anti-apoptotic effects, has been proposed for the prevention and treatment of several different diseases and conditions. ACNsare recognized as one of the leading nutraceuticals for prolonging health benefits through the attenuation of oxidative stress, and inflammatory or age-related diseases. Increased consumption of ACNs has the potential to attenuate the damage ensuing from oxidative stress, inflammation, enhance cardiometabolic health, and delay symptoms in predisposed neuropathology. A myriad of evidence supports ACN consumption as complementary or standalone treatment strategies for non-communicable diseases (NCDs) including obesity, diabetes, cardiovascular disease (CVD), neurodegenerative diseases, as well as, more recently, for the modulation of gut bacteria and bone metabolism. While these findings indicate the beneficial effects of ACN consumption, their food sources differ vastly in ACN composition and thus potentially in their physiological effects. Consumption of foods high in ACNs can be recommended for their potential beneficial health effects due to their relatively easy and accessible addition to the everyday diet.
Conclusion : We reviewed the effects of ACNs beyond their antioxidant capacity in relation to overall human health, specifically regarding NCD progression and prevention. Sources of ACNs found naturally in the diet including, but not limited to strawberries, mulberries, blueberries, elderberry and pomegranate, may represent a suitable non-pharmaceutical approach to the regulation of oxidative stress, and inflammatory-related diseases. A vast majority of the literature included were from animal models or in vitro studies. While promising, the findings from these studies warrant further exploration in human populations. This review did not focus on the bioavailability of specific ACNs or ACN-rich food sources, and with a plethora of literature available it is recommended to consider this information when designing human trials, as there are factors affecting absorption that may render the molecules less effective. Overall, consumption of ACNs as standalone or combination therapy may prove to be a reliable and effective approach to the prevention and management of age or inflammatory-related diseases.
Keywords : anthocyanins; flavonoids; antioxidant activity; inflammation; disease; oxidative damage
Anthocyanins and Human Health—A Focus on Oxidative Stress, Inflammation and Disease, Hollie Speer, Nathan M. D’Cunha, Natalie I. Alexopoulos, Andrew J. McKune and Nenad Naumovski - Antioxidants 2020, 9

Abstract : Black elder (Sambucus nigra L.) has a long ethnobotanical history across many disparate cultures as a treatment for viral infection and is currently one of the most-used medicinal plants worldwide. Until recently, however, substantial scientific research concerning its antiviral properties has been lacking. Here, we evaluate the state of current scientific research concerning the use of elderberry extract and related products as antivirals, particularly in the treatment of influenza, as well as their safety and health impacts as dietary supplements. While the extent of black elder’s antiviral effects are not well known, antiviral and antimicrobial properties have been demonstrated in these extracts, and the safety of black elder is reflected by the United States Food and Drug Administration approval as generally recognized as safe. A deficit of studies comparing these S. nigra products and standard antiviral medications makes informed and detailed recommendations for use of S. nigra extracts in medical applications currently impractical.
Keywords: black elder; Sambucus nigra; antiviral; review; influenza; elderberry.
A Review of the Antiviral Properties of Black Elder (Sambucus nigra L.) Products - Randall S. Porter and Robert F. Bode - PHYTOTHERAPY RESEARCH Phytother. Res. (2017)

Abstract : Anthocyanins are a class of water-soluble flavonoids widely present in fruits and vegetables. Dietary sources of anthocyanins include red and purple berries, grapes, apples, plums, cabbage, or foods containing high levels of natural colorants. Cyanidin, delphinidin, malvidin, peonidin, petunidin, and pelargonidin are the six common anthocyanidins. Following consumption, anthocyanin, absorption occurs along the gastrointestinal tract, the distal lower bowel being the place where most of the absorption and metabolism occurs. In the intestine, anthocyanins first undergo extensive microbial catabolism followed by absorption and human phase II metabolism. This produces hybrid microbial–human metabolites which are absorbed and subsequently increase the bioavailability of anthocyanins. Health benefits of anthocyanins have been widely described, especially in the prevention of diseases associated with oxidative stress, such as cardiovascular and neurodegenerative diseases. Furthermore, recent evidence suggests that health-promoting effects attributed to anthocyanins may also be related to modulation of gut microbiota. In this paper we attempt to provide a comprehensive view of the state-of-the-art literature on anthocyanins, summarizing recent findings on their chemistry, biosynthesis, nutritional value and on their effects on human health.
Conclusion : Anthocyanins are colored molecules widespread in nature that display a wide array of beneficial e
ects on human health. An adequate daily intake of these substances may provide protection from numerous disease and disorders, particularly neurodegenerative and cardiovascular diseases. The chemistry and biochemistry of these compounds have been deeply investigated during the past years, with the aim to improve their stability and to use them as colorants or additives to supply nutritional values to foods. New nanoformulations or encapsulation of anthocyanins, along with chemical modifications such as acylation, provide more stable anthocyanins that may be useful in nutraceutical products. These formulations may also improve anthocyanins’ bioavailability, thus further improving their beneficial effects on health. Further studies devoted to the elucidation of the mechanism of disease prevention are needed. The protective effects of anthocyanins in CVDs and neurodegenerative diseases are similar and related mainly with their antioxidant and anti-inflammatory properties. In order to increase the knowledge about anthocyanins’ effects, it could be a good option to address together those age-related diseases, for example, using the apoE-deficient mouse - a widely used model of human atherosclerosis that has hyperlipidemia and develops all human atherosclerotic lesions. This model is also used to study AD.
Keywords : anthocyanins; anthocyanidins; bioavailability; antioxidants; colorants; biological activity; biosynthesis
Study for Elderberry Anthocyanins
Anthocyanins: A Comprehensive Review of Their Chemical Properties and Health Effects on Cardiovascular and Neurodegenerative Diseases - Roberto Mattioli, Antonio Francioso, Luciana Mosca and Paula Silva - Molecules 2020, 25

Abstract : Elderberries are good sources of anthocyanins, which are poorly absorbed in the upper gastrointestinal tract but extensively transformed into phenolic metabolites at the colonic level. Because different gut microbiota strains have different metabolism, the catabolism of anthocyanins may lead to interindividual differences in metabolite production. In this work, an anthocyanin-rich elderberry extract was incubated with three single gut microbial strains (Enterobacter cancerogenous, Bifidobacterium dentium, and Dorea longicatena) up to 4 days, to assess differences in their phenolic metabolism. All of the strains degraded the elderberry anthocyanins, but the metabolic pathways followed were different. Although some metabolites were common for all of the strains, a wide disparity was observed in the kind and amount of several phenolic metabolites produced by each species. These in vitro preliminary results may be of help in the interpretation of the bioavailability of anthocyanins and give a clue to understand interindividual variability in metabolite production.
Conclusion : In conclusion, the present study highlighted a considerable variability in the type and concentration of the anthocyanin degradation products among three gut bacterial strains. These findings support the idea that the presence of certain strains as well as the ecological competition among them are key factors on the basis of the interindividual variability in anthocyanin bioavailability. Further studies are required to fully elucidate the degradation pathways of the most representative bacterial species and their relation to different gut microbiome compositions. Moreover, the effect of the food matrix or other sources of anthocyanins on the catabolism by individual bacterial strains of anthocyanins should be further explored.
Keywords :anthocyanin, phenolic acids, gut microbiota, metabolism, interindividual variability
Differential Catabolism of an Anthocyanin-Rich Elderberry Extract by Three Gut Microbiota Bacterial Species - Letizia Bresciani, Donato Angelino, Eugenio I. Vivas, Robert L. Kerby, Cristina García-Viguera, Daniele Del Rio, Federico E. Rey, and Pedro Mena