The genus Crataegus, distributed mainly between 30° and 50° N latitudes, comprises a diverse group of shrubs and small trees native to northern temperate regions. Although many species can attain tree-like sizes up to 12 meters tall, they rarely dominate forest canopies. Approximately 250 species are recognized globally, with most endemic to the New World and about 50 native to the Old World. Several species are native or naturalized in the United States, where they are also cultivated horticulturally. The taxonomy of Crataegus has long been controversial due to frequent hybridization, especially in the New World. Crataegus species are valued worldwide for various applications, including their vitamin-rich fruit, which has uses similar to manzanilla in Central American traditional medicine.

Morphological Character

Table 1: Morphological Character of Crataegus.

Family	Rosaceae
Scientific Name	Crataegus oxyacantha
English name	European Hawthorn
Trade name	Hawthorn
Parts used	Fruit, leaf, and flowers

Figure 1: Picture of Crataegus oxyacantha

Figure 2: Identified compounds from hawthorn.

Floral Characteristics

The flowers measure 5.0–5.7 mm in length and are white. The calyx has woolly hairs at the base and five sub-acute lobes. The flowers bear numerous stamens, and the carpels are fused to the calyx tube with pubescent tips. The fruits are smooth, scarlet red, and fleshy.

Figure 3: Picture of Crataegus oxyacantha flower

Cultivation

Both sexual and asexual propagation methods are used to cultivate hawthorn in nurseries. Sexual propagation by seeds is essential for producing rootstocks onto which superior clones are budded. This method is vital for establishing clonal orchards, especially when vegetative propagation knowledge is limited. Brinkman (1974) suggested sowing seeds in early autumn to satisfy cold stratification requirements naturally, but alternative methods like fermentation or refrigeration can accelerate germination in certain species.

Distribution

Crataegus oxyacantha is cultivated in Europe for hedging and grows widely in temperate regions, including China, Western Asia, North Africa, India, and North America. It was introduced to Australia as a hedge plant in the 1800s and has become naturalized across Tasmania, Victoria, the Adelaide Hills, and parts of New South Wales. In India, it is found in the temperate Himalayas of Kashmir and Himachal Pradesh, at altitudes between 1800–3000 meters.

Figure 4: Distribution of Crataegus oxyacantha

Chemical Constituents

• Total flavonoid content in the leaves, flowers, fruits, pulp, and bark ranges from 0.48% to 1.65%, while total phenolic content ranges from 3.31% to 5.46%.
• Antioxidant potential (measured by DPPH radical inhibition at 1 mg/ml) is highest in bark (81.5%), followed by flower, leaf, pulp, and fruit.
• Other constituents include saponins, glycosides, flavonoids, ascorbic acid, condensed tannins, and amines.
• The therapeutic benefits of C. oxyacantha are mainly attributed to its flavonoids, triterpenic acids, and biogenic amines.

Figure 5: Chemical constituents structure.

Therapeutic Uses

C. oxyacantha is used for arrhythmias, angina, coronary circulation issues, congestive heart failure, hypertension, hypotension, atherosclerosis, hyperlipidemia, and Buerger’s disease. It increases cardiac output in cases of pulmonary-related reductions. Additionally, it acts as a diuretic, sedative, astringent, anxiolytic, and antispasmodic, and is used topically for frostbite and sores. Hawthorn extracts also show antioxidant properties due to their phenolic content.

Mechanism of Action

The rich flavonoid content of Crataegus contributes to its strong antioxidant properties, which protect cardiac tissue by reducing oxidative stress and preventing apoptosis. Crataegus extracts improve coronary circulation, enhance oxygen utilization, and have positive inotropic effects. The extracts also stabilize collagen, promoting vascular integrity. These combined vasodilatory and cardiotropic actions make Crataegus effective and safe for heart conditions not yet requiring digitalis therapy.

Anti-arrhythmic Activity

Crataegus extract has shown antiarrhythmic effects distinct from conventional cardioactive drugs, inducing rhythmicity in cardiomyocytes without causing β-adrenergic blockade. Commercial hawthorn preparations exhibit similar properties.

Myocardial Infarction

Amines in Crataegus extracts, such as phenethylamine, have positive inotropic effects by increasing intracellular calcium and prolonging action potentials. Extracts have also been shown to preserve mitochondrial antioxidant status and reduce oxidative damage in isoproterenol-induced myocardial injury.

Congestive Heart Failure

Clinical studies, including treatments with standardized Crataegus extracts (e.g., Crataegisan®), have shown significant improvements in patients with NYHA class II heart failure. Extract WS 1442 has demonstrated anti-restenotic effects by acting on PDGFR-beta to prevent arterial intimal hyperplasia.

Dosage

Therapeutic benefits usually appear within two weeks of use. Extracts standardized to 1.8% vitexin-4’-rhamnoside are administered three times daily at 100–250 mg per dose. Standardized extracts containing 18% OPCs are dosed at 250–500 mg per day.

Conclusion

Crataegus species, particularly C. oxyacantha, exhibit notable pharmacological effects, including antioxidant, immunostimulant, antidiabetic, cytotoxic, gastroprotective, hepatoprotective, hypotensive, and cardioprotective activities. These effects are primarily due to bioactive compounds such as flavonoids, polysaccharides, triterpenes, and oligomeric procyanidins.

Reference

• Ahmed AA, Khattab AM, Grace MH, Sahl MM 2001. A new eudesmanolide from Crataegus flava fruits. Fitoterapia 72: 756-759.

• Amanzadeh Y, Khanavi M, Khatamsaz M, Rajabi A, Ebrahimi SES 2007. High performance thin-layer chromatographic fingerprints of flavonoids and phenol carboxylic acids for standardization of Iranian species of the genus Crataegus L. Iranian J Pharm Sci 3: 143-152.

• Ammon HPT, Handel M 1981a. Crataegus, toxicology and pharmacology, Part 1: toxicity Planta Med 43: 105-120.

• Ammon HPT, Handel M 1981b. Crataegus, toxicology and pharmacology, Part III: Planta Med 43: 313-322.

• Andrade-Cetto A, Heinrich M 2005. Mexican plants with hypoglycaemic effect used in the treatment of diabetes. J Ethnopharmacol 99: 325- 348.

• Aneta W, Oszmianski J 2007. Influence of polyphenols isolated from Scutellaria baicalensis Georgi and Crataegus oxyacantha on the oxidative stability of cholesterol in butter stored in various conditions. Eur Food Res Technol 224: 635-642.

• Anna S, Oszmian J, Aneta W 2007. Antioxidant activity of phenolic compounds of Hawthorn, pine, skullcap. Food Chemistry 103: 853-859.

• Arslan R, Bor Z, Bektas N, Mericli A H, Ozturk Y 2011. Antithrombotic effects of ethanol extract of Crataegus orientalis in the carrageenan- induced mice tail thrombosis model. Thromb Res 127: 210-213.

• Bahorun T, Aumjaud E, Ramphul H, Rycha M, Luximon-Ramma A, Trotin F, Aruoma OI 2003. Phenolic constituents and antioxidant capacities of Crataegus monogyna (Hawthorn) callus extracts. Nahrung 47: 191-198.

• Bahri-Sahloul R, Ammar S, Fredj RB, Saguem S, Gree S, Trotin F, Skhiri FH 2009. Polyphenol contents and antioxidant activities of extracts from flowers of two Crataegus azarolus L. varieties. Pakistan J Biol Sci 12: 660-668.

• Batyuk VS 1966. Structure of the flavonoids of Crataegus curvisepala. Chem Nat Compd 2: 233-234. Belz GG, Butzer R, Gaus W, Loew D 2002. Camphor-Crataegus berry extract combination dose-dependently reduces tilt induced fall in blood pressure in orthostatic hypotension. Phytomedicine 9: 581-588.

• Benli M, Yig N, Geven F, Kerim G, Bingo U 2008. Antimicrobial activity of endemic Crataegus tanacetifolia (Lam.) Pers and observation of the inhibition effect on bacterial cells. Cell Biochem Funct 26: 844-851.

• Bersin T, Muller A, Schwarz H 1955. Ingredients of Crataegus oxyacantha L. III. Heptahydroxyflavan glycoside. Arzneimittelforschung 5: 490-491.

• Blesken R 1992. Crataegus in cardiology. Fortschr Med 15: 290-292. Blumenthal M, Busse W, Goldberg A 1988. The complete Germen commission E Monographs, Boston MA: American Botanical Council, p. 142-144.

• Bykov VI, Glyzin VI 1972. Flavonoids of the genus Crataegus.Chem Nat Compd 8: 672-673.