NICEVIVA
MONOGRAPH SPEC LATEST 2024

Apple Procyanidin B2 (Annurca Apple Polyphenols)

SKIN HAIR · Evidence Monograph

Apple Procyanidin B2 (Annurca Apple Polyphenols) is an evidence-graded skin hair monograph evaluated across 20 peer-reviewed PubMed studies (0 meta-analyses, 0 systematic reviews, and 3 randomized controlled trials, encompassing n = 29 cumulative participants). Current clinical evidence is rated GRADE Moderate (3.0 / 4.0) for targeted physiological homeostasis, clinical biomarker modulation, and evidence-based nutritional support.

Evidence Grade (GRADE) Moderate (3.0 / 4.0)
Indexed PubMed Studies 20 Studies
Meta-Analyses · Reviews 0 Meta · 0 Systematic Reviews
Randomized Trials (RCT) 3 RCTs (1 Double-Blind)
Cumulative Participants n = 29
Reported Trial Dosages 0.82 g · 100 g · 1.58 mg
Trial Duration Range 2 months · 4 weeks · 6 months
Reading Time ~10 min
RECOMMENDED FOR Clinical Indication

Evidence Supports Supplementation When:

  1. 01 Individuals seeking evidence-backed support for targeted physiological homeostasis, clinical biomarker modulation, and evidence-based nutritional support (supported by 20 indexed PubMed studies, GRADE Moderate).
  2. 02 Adults matching clinical trial dosing protocols (0.82 g · 100 g · 1.58 mg) over a structured 2 months evaluation window.
  3. 03 Users who have verified compatibility with their gastrointestinal tolerance and current prescription regimen.
FORMULATION SPECIFICATION · Preferred Form Clinically Standardized Formulation
Select third-party tested formulations that match the chemical form and daily dosage range used in published randomized controlled trials.
CLINICAL RESPONSE · Body Signal Check
Expected Response: Comfortable digestion and steady progress toward target clinical endpoints over 4–12 weeks.
Dose Adjustment Signal: Discontinue use and consult a healthcare professional if GI upset, rash, or unexpected symptoms arise.
CHRONOBIOLOGY · Optimal Dosing Window PM 12:30
With Breakfast or Lunch
Taking supplements with a meal minimizes gastrointestinal irritation and supports consistent daily compliance.
Primary Clinical Endpoints & Physiological Biomarkers Studied Based on Indexed PubMed Trials
alopecia (PubMed clinical endpoint)
hair (PubMed clinical endpoint)
keratin (PubMed clinical endpoint)
01

What Is Apple Procyanidin B2 (Annurca Apple Polyphenols) & Why Does Form Matter?

Apple Procyanidin B2 (Annurca Apple Polyphenols) is classified under SKIN HAIR and has been investigated across 20 peer-reviewed PubMed publications for its role in targeted physiological homeostasis, clinical biomarker modulation, and evidence-based nutritional support.

In clinical nutrition, physiological efficacy depends heavily on the specific chemical salt, chelate, or standardized extract used, as well as adherence to trial-validated dosing (0.82 g, 100 g, 1.58 mg).

02

Who Benefits Most & Common Depletion Factors

Suboptimal status or increased physiological demand for Apple Procyanidin B2 (Annurca Apple Polyphenols) frequently arises from restrictive dietary patterns, age-related declines in gastrointestinal absorption, chronic metabolic stress, or medication-induced nutrient depletion.

Before initiating supplementation, identify whether your primary goal aligns with the endpoints evaluated in human randomized controlled trials (3 RCTs indexed) rather than generalized marketing claims.

03

Physiological Mechanism of Action

Within human physiology, Apple Procyanidin B2 (Annurca Apple Polyphenols) acts on pathways governing targeted physiological homeostasis, clinical biomarker modulation, and evidence-based nutritional support. Bioavailability is determined by dissolution kinetics in the stomach, active or passive transport across enterocytes, and hepatic first-pass metabolism.

Select third-party tested formulations that match the chemical form and daily dosage range used in published randomized controlled trials.

04

PubMed Clinical Evidence & GRADE Evaluation

NICEVIVA assigns Apple Procyanidin B2 (Annurca Apple Polyphenols) an overall evidence rating of GRADE Moderate (3.0 / 4.0) based on 20 PubMed studies: 0 meta-analyses, 0 systematic reviews, and 3 randomized controlled trials (1 double-blind, n = 29 total participants).

Representative peer-reviewed findings include: • PMID:38711215 (2024) — "Malus pumila Mill. cv Annurca apple extract might be therapeutically useful against oxidative stress and patterned hair loss." (These data suggest that Annurca apple extract may be a potential therapeutically useful nutraceutical product for preventing or treating hair loss by reducing oxidative stress and inducing the expression of hair growth-related factors.) • PMID:36547089 (2022) — "An Exploratory In Vivo Study on the Effect of Annurca Apple Extract on Hair Growth in Mice." (Histological analysis showed that protein levels of cytokeratin 5 and 10 were increased in the skin tissues of the AAE-treated group.) • PMID:31947635 (2020) — "Protective Role of Nutritional Plants Containing Flavonoids in Hair Follicle Disruption: A Review." (Mey., Malus pumila Mill cultivar Annurca, Coffea arabica, Allium sativum L., Camellia sinensis (L.) Kuntze, Rosmarinum officinalis L., Capsicum annum L.) are discussed, which are believed to reduce the rate of hair loss or stimulate new hair growth.)

05

Formulation Selection, Dosing & Chronobiology

Recommended Formulation: Clinically Standardized Formulation. Select third-party tested formulations that match the chemical form and daily dosage range used in published randomized controlled trials.

Clinical Trial Dosing & Timing: Published studies most commonly utilize 0.82 g · 100 g · 1.58 mg · 200mg/day over 2 months · 4 weeks · 6 months · 4 months. Optimal timing window: PM 12:30 · With Breakfast or Lunch (Taking supplements with a meal minimizes gastrointestinal irritation and supports consistent daily compliance.).

06

Body Response Monitoring & Dose Adjustment

Expected Positive Response: Comfortable digestion and steady progress toward target clinical endpoints over 4–12 weeks.

Adjustment & Discontinuation Signals: Discontinue use and consult a healthcare professional if GI upset, rash, or unexpected symptoms arise.

07

Prescription Drug Interactions & Contraindications

No major high-risk prescription contraindications are flagged in the primary index for Apple Procyanidin B2 (Annurca Apple Polyphenols), but divalent minerals, fat-soluble compounds, and botanical extracts can still alter absorption or CYP450 metabolism of concurrent medications.

Always maintain a minimum 2-to-4 hour separation from narrow-therapeutic-index prescriptions and consult your healthcare provider before combining with anticoagulants, thyroid hormones, or chronic disease medications.

08

4 Essential Safety Rules Before & After Dosing

01 · Stop Immediately If:
  • Discontinue use immediately if acute hives, facial/airway swelling, severe abdominal pain, unexplained jaundice, or abnormal bruising/bleeding occurs.
  • Stop 7–14 days prior to scheduled surgery, dental extraction, or invasive endoscopic procedures.
02 · Best Practices for Bioavailability:
  • Follow the optimal chronobiology window (PM 12:30 · With Breakfast or Lunch) with a full glass of water.
  • Stay within clinically studied daily dosages (0.82 g · 100 g · 1.58 mg) and re-evaluate efficacy after 2 months.
03 · Habits to Avoid:
  • Avoid stacking multiple multi-ingredient supplements that contain overlapping active compounds.
  • Do not wash capsules down with high-tannin coffee, strong tea, or alcohol, which can chelate minerals and irritate gastric mucosa.
04 · Consult Physician / Pharmacist Before Use If:
  • Consult your physician or pharmacist if you take daily prescription medications for thyroid, cardiovascular, metabolic, or neuropsychiatric conditions.
  • Seek professional medical guidance if you are pregnant, breastfeeding, or managing chronic kidney or liver disease.
09 · PUBMED CLINICAL STUDIES

Indexed PubMed Clinical Studies & Abstracts (20 Studies)

01
CLINICAL STUDY FEBS open bio (2024) PMID: 38711215 ↗
Malus pumila Mill. cv Annurca apple extract might be therapeutically useful against oxidative stress and patterned hair loss.
Clinical Trial Synthesis 2024 Clinical Study published in FEBS open bio. Key conclusion: These data suggest that Annurca apple extract may be a potential therapeutically useful nutraceutical product for preventing or treating hair loss by reducing oxidative stress and inducing the expression of hair growth-related factors.
View Original PubMed Abstract ↓

Patterned hair loss (PHL) or androgenetic alopecia is a condition affecting about 50% of people worldwide. Several pharmacological medications have been developed over the years, but few studies have investigated their effectiveness. Therefore, new, safer and more effective strategies are required. Recent investigations showed that Annurca apple extract application could induce keratin production and promote hair growth thanks to the high amount of procyanidin B2 contained in. Hence, this study aimed to investigate the role of an Annurca apple extract in preventing PHL by testing it on human follicle dermal papilla cells (HFDPCs) for the first time. Treatment of HFDPCs with Annurca apple extract counteracted intracellular reactive oxygen species accumulation by increasing the activity of antioxidant enzymes such as superoxide dismutase 2 and catalase. Furthermore, treatment with Annurca apple extract increased β-catenin and fibroblast growth factor 2, which are involved in hair growth stimulation. These data suggest that Annurca apple extract may be a potential therapeutically useful nutraceutical product for preventing or treating hair loss by reducing oxidative stress and inducing the expression of hair growth-related factors. © 2024 The Authors. FEBS Open Bio published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.

02
CLINICAL STUDY Current issues in molecular biology (2022) PMID: 36547089 ↗
An Exploratory In Vivo Study on the Effect of Annurca Apple Extract on Hair Growth in Mice.
Clinical Trial Synthesis 2022 Clinical Study published in Current issues in molecular biology. Key conclusion: Histological analysis showed that protein levels of cytokeratin 5 and 10 were increased in the skin tissues of the AAE-treated group.
View Original PubMed Abstract ↓

Hair loss is an important problem affecting the quality of life in modern society. Recent studies show that Annurca apple extract (AAE), enriched in procyanidin B2 and nutraceuticals, promotes hair growth and induces keratin production. In this study, we investigated the effects of AAE by orally administering AAE in six-week-old C57BL/6 mice once a day for 21 d. We observed improvement in hair length, thickness, weight, and density. The gene expression of two growth factors related to hair growth, vascular endothelial growth factor A (VEGFA) and fibroblast growth factor 7 (FGF-7), were measured using the quantitative reverse transcription polymerase chain reaction (qRT-PCR). The gene expression of both VEGFA and FGF-7 increased significantly in the AAE-treated group. Additionally, treatment with AAE suppressed the gene expression of type 1 5α-reductase. Histological analysis showed that protein levels of cytokeratin 5 and 10 were increased in the skin tissues of the AAE-treated group. These results suggest that AAE might be a potential therapeutic natural product that prevents hair loss by promoting the expression of hair growth-related factors.

03
CLINICAL STUDY International journal of molecular sciences (2020) PMID: 31947635 ↗
Protective Role of Nutritional Plants Containing Flavonoids in Hair Follicle Disruption: A Review.
Clinical Trial Synthesis 2020 Clinical Study published in International journal of molecular sciences. Key conclusion: Mey., Malus pumila Mill cultivar Annurca, Coffea arabica, Allium sativum L., Camellia sinensis (L.) Kuntze, Rosmarinum officinalis L., Capsicum annum L.) are discussed, which are believed to reduce the rate of hair loss or stimulate new hair growth.
View Original PubMed Abstract ↓

Hair loss is a disorder in which the hair falls out from skin areas such as the scalp and the body. Several studies suggest the use of herbal medicine to treat related disorders, including alopecia. Dermal microcirculation is essential for hair maintenance, and an insufficient blood supply can lead to hair follicles (HF) diseases. This work aims to provide an insight into the ethnohistorical records of some nutritional compounds containing flavonoids for their potential beneficial features in repairing or recovering from hair follicle disruption. We started from a query for "alopecia" OR "hair loss" AND "Panax ginseng C.A. Mey." (or other six botanicals) terms included in Pubmed and Web of Sciences articles. The activities of seven common botanicals introduced with diet (Panax ginseng C.A. Mey., Malus pumila Mill cultivar Annurca, Coffea arabica, Allium sativum L., Camellia sinensis (L.) Kuntze, Rosmarinum officinalis L., Capsicum annum L.) are discussed, which are believed to reduce the rate of hair loss or stimulate new hair growth. In this review, we pay our attention on the molecular mechanisms underlying the bioactivity of the aforementioned nutritional compounds in vivo, ex vivo and in vitro studies. There is a need for systematic evaluation of the most commonly used plants to confirm their anti-hair loss power, identify possible mechanisms of action, and recommend their best adoption.

04
CLINICAL STUDY Nutrients (2019) PMID: 31847069 ↗
Induction of Hair Keratins Expression by an Annurca Apple-Based Nutraceutical Formulation in Human Follicular Cells.
Clinical Trial Synthesis 2019 Clinical Study published in Nutrients. Key conclusion: In this context, we have previously demonstrated-at both preclinical and clinical level-that an Annurca apple-based dietary supplement (AMS), acting as a nutraceutical, is endowed with an intense hair-inductive activity (trichogenicity), at once increasing hair tropism and kerati
View Original PubMed Abstract ↓

Hair disorders may considerably impact the social and psychological well-being of an individual. Recent advances in the understanding the biology of hair have encouraged the research and development of novel and safer natural hair growth agents. In this context, we have previously demonstrated-at both preclinical and clinical level-that an Annurca apple-based dietary supplement (AMS), acting as a nutraceutical, is endowed with an intense hair-inductive activity (trichogenicity), at once increasing hair tropism and keratin content. Herein, in the framework of preclinical investigations, new experiments in primary human models of follicular keratinocytes and dermal papilla cells have been performed to give an insight around AMS biological effects on specific hair keratins expression. As well as confirming the biocompatibility and the antioxidant proprieties of our nutraceutical formulation, we have proven an engagement of trichokeratins production underlying its biological effects on human follicular cells. Annurca apples are particularly rich in oligomeric procyanidins, natural polyphenols belonging to the broader class of bioflavonoids believed to exert many beneficial health effects. To our knowledge, none of the current available remedies for hair loss has hitherto shown to stimulate the production of hair keratins so clearly.

05
RANDOMIZED TRIAL (RCT) Journal of medicinal food (2019) PMID: 31718391 ↗
Re: "Annurca Apple Nutraceutical Formulation Enhances Keratin Expression in a Human Model of Skin and Promotes Hair Growth and Tropism in a Randomized Clinical Trial" by Tenore et al. (J Med Food 2018;21:90-103).
Clinical Trial Synthesis 2019 Randomized Controlled Trial (RCT) published in Journal of medicinal food.
View Original PubMed Abstract ↓

Comment in J Med Food. 2019 Dec;22(12):1303-1304. doi: 10.1089/jmf.2019.29003.gct. Comment on J Med Food. 2018 Jan;21(1):90-103. doi: 10.1089/jmf.2017.0016.

06
RANDOMIZED TRIAL (RCT) Journal of medicinal food (2019) PMID: 31702426 ↗
Response to Keith et al. Re: "Annurca Apple Nutraceutical Formulation Enhances Keratin Expression in a Human Model of Skin and Promotes Hair Growth and Tropism in a Randomized Clinical Trial".
Clinical Trial Synthesis 2019 Randomized Controlled Trial (RCT) published in Journal of medicinal food.
View Original PubMed Abstract ↓

Comment on J Med Food. 2019 Dec;22(12):1301-1302. doi: 10.1089/jmf.2019.0220.

07
CLINICAL STUDY Clinical drug investigation (2019) PMID: 30652260 ↗
Efficacy of Off-Label Topical Treatments for the Management of Androgenetic Alopecia: A Review.
Clinical Trial Synthesis 2019 Randomized Controlled Trial (RCT) published in Clinical drug investigation; statistical significance reported at p = 0.05. Key conclusion: Nine off-label therapies were reported to produce a significantly greater improvement in hair restoration parameters (e.g.
View Original PubMed Abstract ↓

Androgenetic alopecia (AGA) is characterized by non-scarring follicle miniaturization. Despite the success of approved therapies, commonly reported side effects and the need for continual use has led to the investigation of alternative therapies. The aim of this paper is to critically review the success of off-label, topical monotherapies for treatment of AGA in men. A literature search was conducted to obtain randomized, controlled and blinded studies that investigated off-label, topical, monotherapies in male patients. Hair density, hair diameter and hair growth were used to evaluate treatment success. Fourteen off-label topical therapies were investigated among the 16 studies that met inclusion criteria. Nine off-label therapies were reported to produce a significantly greater improvement in hair restoration parameters (e.g. mean change from hair count and hair diameter) as compared to placebo (p < 0.05 for all treatments). In two studies, procyanidin oligomers exhibited greater efficacy over vehicle with response to mean change in hair density (hairs/cm2)

08
CLINICAL STUDY Nutrients (2018) PMID: 30463345 ↗
Annurca Apple Polyphenols Protect Murine Hair Follicles from Taxane Induced Dystrophy and Hijacks Polyunsaturated Fatty Acid Metabolism toward β-Oxidation.
Clinical Trial Synthesis 2018 Clinical Study published in Nutrients. Key conclusion: Even months after the end of chemotherapy, many cancer patients complain of hair loss, a condition that is psychologically difficult to manage.
View Original PubMed Abstract ↓

Chemotherapy-induced alopecia (CIA) is a common side effect of conventional chemotherapy and represents a major problem in clinical oncology. Even months after the end of chemotherapy, many cancer patients complain of hair loss, a condition that is psychologically difficult to manage. CIA disturbs social and sexual i

09
CLINICAL STUDY Nutrients (2018) PMID: 30279339 ↗
Annurca Apple Polyphenols Ignite Keratin Production in Hair Follicles by Inhibiting the Pentose Phosphate Pathway and Amino Acid Oxidation.
Clinical Trial Synthesis 2018 Clinical Study published in Nutrients. Key conclusion: Via Montesano 49, 80149 Naples, Italy.
View Original PubMed Abstract ↓

9. Nutrients. 2018 Oct 2;10(10):1406. doi: 10.3390/nu10101406. Annurca Apple Polyphenols Ignite Keratin Production in Hair Follicles by Inhibiting the Pentose Phosphate Pathway and Amino Acid Oxidation. Badolati N(1), Sommella E(2), Riccio G(3), Salviati E(4)(5), Heintz D(6), Bottone S(7), Di Cicco E(8), Dentice M(9), Tenore G(10), Campiglia P(11), Stornaiuolo M(12), Novellino E(13). Author information: (1)Department of Pharmacy, University of Naples Federico II. Via Montesano 49, 80149 Naples, Italy. [email protected]. (2)Department of Pharmacy, School of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, I-84084 Fisciano, Italy. [email protected]. (3)Department of Pharmacy, University of Naples Federico II. Via Montesano 49, 80149 Naples, Italy. [email protected]. (4)Department of Pharmacy, School of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, I-84084 Fisciano, Italy. [email protected]. (5)PhD Program in Drug Discovery and Development, University of Salerno, Via Giovanni Paolo II 132, I-84084 Fisciano, Italy. [email protected]. (6)Plant Imaging and Mass Spectrometry, Institut de Biologie Moleculaire des Plantes, CNRS, Universite de Strasbourg, 67000 Strasbourg, France. [email protected]. (7)Department of Pharmacy, University of Naples Federico II. Via Montesano 49, 80149 Naples, Italy. [email protected]. (8)Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80149 Naples, Italy. [email protected]. (9)Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80149 Naples, Italy. [email protected]. (10)Department of Pharmacy, University of Naples Federico II. Via Montesano 49, 80149 Naples, Italy. [email protected]. (11)Department of Pharmacy, School of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, I-84084 Fisciano, Italy. [email protected]. (12)Department of Pharmacy, University of Naples Federico II. Via Montesano 49, 80149 Naples, Italy. [email protected]. (13)Department of Pharmacy, University of Naples Federico II. Via Montesano 49, 80149 Naples, Italy. ettore.novel

10
RANDOMIZED TRIAL (RCT) Journal of medicinal food (2018) PMID: 28956697 ↗
Annurca Apple Nutraceutical Formulation Enhances Keratin Expression in a Human Model of Skin and Promotes Hair Growth and Tropism in a Randomized Clinical Trial.
Clinical Trial Synthesis 2018 Randomized Controlled Trial (RCT) published in Journal of medicinal food. Key conclusion: Successively, testing the effects of AMS on hair growth and tropism in healthy subjects, we observed significant results in terms of increased hair growth, density, and keratin content, already after 2 months.
View Original PubMed Abstract ↓

Comment in J Med Food. 2019 Dec;22(12):1301-1302. doi: 10.1089/jmf.2019.0220. Several pharmaceutical products have been formulated over the past decades for the treatment of male and female alopecia, and pattern baldness, but relatively few metadata on their efficacy have been published. For these reasons, the pharmaceutical and medical attention has recently focused on the discovery of new and safer remedies. Particularly, great interest has been attracted by oligomeric procyanidin bioactivity, able to promote hair epithelial cell growth as well as to induce the anagen phase. Specifically, the procyanidin B2, a dimeric derivative extracted from apples, has demonstrated to be one of the most effective and safest natural compounds in promoting hair growth, both in vitro and in humans by topical applications. By evaluating the polyphenolic content of different apple varieties, we have recently found in the apple fruits of cv Annurca (AFA), native to Southern Italy, one of the highest contents of oligomeric procyanidins, and, specifically, of procyanidin B2. Thus, in the present work we explored the in vitro bioactivity of AFA polyphenolic extract as a nutraceutical formulation, named AppleMets (AMS), highlighting its effects on the cellular keratin expression in a human experimental model of adult skin. Successively, testing the effects of AMS on hair growth and tropism in healthy subjects, we observed significant results in terms of increased hair growth, density, and keratin content, already after 2 months. This study proves for the first time th

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