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The major benefits of A. hippocastanum are related to its ability to prevent the degradation of vascular walls, maintaining vascular integrity and in turn preventing vascular hyperpermeability and the resulting oedema. VASOPROTECTIVE/NORMALISES VASCULAR PERMEABILITY

Horse chestnut appears to prevent the activation of leucocytes and therefore inhibit the activity of lysosomal enzymes (hyaluronidase and possibly elastase) involved in the degradation of proteoglycan (the main component of the extravascular matrix), thus reducing the breakdown of mucopolysaccharides in vascular walls (Pittler & Ernst 2004). Escin is the major constituent thought to be responsible for the inhibitory effects on hyaluronidase. Interestingly, ruscogenins found in Ruscus aculeatusl. (butcher's broom) while ineffective on hyaluronidase activity exhibits significant anti-elastase activity (Facino et al 1995), which may explain the practice by many herbalists of combining the two herbs.

By reducing degradation, the synthesis of proteoglycans is able to occur, which reduces capillary hyperpermeability, preventing the leakage of fluid into intercellular spaces that results in oedema. The anti-exudative activity appears to be mediated by PGFjaipha (Berti et al 1977). In animal studies the escins la, lb, I la, and lib have been shown to reduce capillary hypermermeability induced by histamine, ascetic acid, carrageenan and serotonin (Guillaume & Padioleau 1994, Matsuda et al 1997).

Aesculus hippocastanum promotes the proliferation behaviour of human endothelial cells in vitro in a dose-dependent manner (Fallier-Becker et al 2002) and may therefore also play a role in maintaining as well as protecting vascular walls.

By improving vascular tone, horse chestnut standardised extract (HCSE) may improve the flow of blood back to the heart, as demonstrated in animal studies in which it significantly increased, within normal arterial parameters, femoral venous pressure and flow, as well as thoracic lymphatic flow (Guillaume & Padioleau 1994).

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