AprèsFlex® - Clinical Research Data Summary

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AprèsFlex® Boswellia serrata Extract

AprèsFlex® is a clinically studied ingredient used in the following Silver Fern™ Brand product:

Introduction

AprèsFlex® is a clinically studied Boswellia serrata extract standardized to 20% acetyl-11-keto-β-boswellic acid (AKBA) and designed to enhance bioavailability using both acidic and non-acidic resin fractions. Human clinical studies suggest that daily supplementation with 100 mg of AprèsFlex® may support joint comfort, mobility, and physical function. Across multiple randomized, double-blind, placebo-controlled trials lasting from 30 days to 6 months, supplementation with AprèsFlex® has been associated with improvements in validated assessments of joint comfort, stiffness, and mobility in adults experiencing knee joint discomfort, while also supporting healthy joint function and physical mobility. Several studies also reported changes in biomarkers associated with the body's normal inflammatory response and cartilage metabolism. Preclinical research further suggests that the Boswellia extract used in AprèsFlex® may influence pathways involved in inflammatory balance, including inhibition of the 5-lipoxygenase (5-LOX) enzyme, which plays a role in leukotriene signaling. In cellular models, the extract has been shown to influence signaling pathways associated with TNF-α and modulate matrix metalloproteinase-3 (MMP-3), an enzyme involved in cartilage turnover, while animal models evaluating joint stress have demonstrated support for normal joint structure and inflammatory balance. Toxicology assessments further support the ingredient's safety profile at levels consistent with human supplementation.*

These are the studies for AprèsFlex®. Below, we provided a summary of each key data for each study, along with a link to the complete clinical research.

  1. Summary of Study 1 – Full Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC2974165/
  2. Summary of Study 2 – Full Study: https://pmc.ncbi.nlm.nih.gov/articles/PMC3198257/
  3. Summary of Study 3 – Full Study: https://pubmed.ncbi.nlm.nih.gov/39700461/
  4. Summary of Study 4 – Full Study: https://pubmed.ncbi.nlm.nih.gov/35512759/

Ingredient Manufacturer Link: https://www.plthealth.com/product-catalog/apresflex



Study 1 Summary

Complete Study Information: https://pmc.ncbi.nlm.nih.gov/articles/PMC2974165/

Comparative Efficacy and Tolerability of 5-Loxin® and Aflapin® Against Osteoarthritis of the Knee: A Double Blind, Randomized, Placebo Controlled Clinical Study
Int J Med Sci. 2010;7(6):366–377. doi:10.7150/ijms.7.366. PMID: 21072225 | PMCID: PMC2999070.

This double-blind, randomized, placebo-controlled clinical trial evaluated two Boswellia serrata–derived ingredients, 5-Loxin® and Aflapin®, in adults with knee osteoarthritis. Researchers assessed changes in joint comfort and physical function using validated measurement tools commonly used in osteoarthritis research, including the Visual Analog Scale (VAS), Lequesne's Functional Index (LFI), and the WOMAC index (pain, stiffness, and physical function). The study was conducted over 90 days to examine the magnitude of changes in these measures as well as the time course of response compared with placebo.

Study Design Highlights

  • Study design: Double-blind, randomized, placebo-controlled clinical trial (three arms)
  • Participants: 60 adults; approximately 19 participants per group completed the 90-day analysis
  • Dose:
    • 5-Loxin®: 100 mg/day
    • Aflapin®: 100 mg/day
    • Placebo
  • Duration: 90 days
  • Assessment points: Baseline (Day 0), Day 7, Day 30, Day 60, Day 90

Key Findings (What the Study Showed)

1. Improvements at Day 90 (Compared with Placebo)

5-Loxin® 100 mg/day:

  • VAS pain score improvement: 31.6%
  • WOMAC pain score improvement: 30.3%
  • WOMAC stiffness score improvement: 42.2%
  • Additional improvements also observed in LFI and WOMAC physical function scores

Aflapin® 100 mg/day:

  • VAS pain score improvement: 47.3%
  • Lequesne Functional Index improvement: 35.8%
  • WOMAC pain score improvement: 61.7%
  • WOMAC stiffness score improvement: 60.1%
  • WOMAC physical function score improvement: 49.4%

2. Early Response Observed

Changes in study measurements were also observed early in the intervention period. By Day 7 (vs. baseline):

5-Loxin®:

  • VAS: 8.09%
  • WOMAC pain: 8.68%
  • WOMAC function: 8.35%

Aflapin®:

  • VAS: 12.8%
  • LFI: 9.17%
  • WOMAC pain: 11.78%
  • WOMAC stiffness: 18.48%
  • WOMAC function: 10.24%

Benefits of AprèsFlex® Demonstrated by This Study

Based directly on the clinical outcomes, AprèsFlex® (Aflapin®) was shown to:
✓ Support improvements in validated measures of joint comfort compared with placebo
✓ Improve WOMAC pain, stiffness, and physical function scores at 90 days
✓ Demonstrate measurable changes in joint comfort and function within the first week
✓ Produce greater improvements across several outcome measures than 5-Loxin®
✓ Be well tolerated with no significant adverse events reported

Why This Study Matters

The outcome measures used in this study reflect everyday activities such as walking, climbing stairs, standing from a seated position, and general mobility. Improvements in WOMAC and LFI scores therefore suggest potential benefits related to joint comfort and ease of movement in daily activities. The study also reported good tolerability, supporting the use of Boswellia-derived ingredients such as Aflapin® as a nutritional approach to supporting joint comfort and mobility.*

Reference Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC2974165/



Study 2 Summary

Complete Study Information: https://pmc.ncbi.nlm.nih.gov/articles/PMC3198257/

A Double Blind, Randomized, Placebo Controlled Clinical Study Evaluates the Early Efficacy of Aflapin® in Subjects with Osteoarthritis of the Knee
Int J Med Sci. 2011;8(7):615–622. doi:10.7150/ijms.8.615. PMID: 22022214 | PMCID: PMC3198257.

This randomized, double-blind, placebo-controlled clinical study evaluated the effects of Aflapin® (AprèsFlex®), a standardized Boswellia serrata extract enriched to 20% AKBA, in 60 adults with knee osteoarthritis. Participants received either 100 mg per day of Aflapin® or placebo for 30 days. Researchers evaluated changes in joint comfort and physical function using validated assessment tools including the Visual Analog Scale (VAS), Lequesne's Functional Index (LFI), and the WOMAC index. The study reported statistically significant improvements in these measurements in the Aflapin® group compared with placebo, with changes observed early in the study period.

Study Design Highlights

  • Study design: Randomized, double-blind, placebo-controlled clinical study
  • Participants: 60 adults (30 Aflapin®, 30 placebo)
  • Dose: 100 mg/day Aflapin®
  • Duration: 30 days
  • Assessment points: Baseline, Day 5, Day 15, Day 30

Key Findings (What the Study Showed)

Improvements at Day 30 (Aflapin® Group vs. Placebo)

All reported changes were statistically significant compared with placebo (p < 0.001):

  • VAS (joint comfort): 49.1% improvement
  • Lequesne's Functional Index: 34.4% improvement
  • WOMAC Pain: 49.5% improvement
  • WOMAC Stiffness: 48.4% improvement
  • WOMAC Physical Function: 45.2% improvement

Early Response Observed

Changes in VAS and other assessment measures were observed as early as Day 5, suggesting relatively early improvements in joint comfort and mobility during the study period.

Benefits of AprèsFlex® Demonstrated by This Study

Based directly on the clinical outcomes, AprèsFlex® (Aflapin®) was shown to:
✓ Support statistically significant improvements in joint comfort compared with placebo
✓ Improve WOMAC pain, stiffness, and physical function scores at 30 days
✓ Produce measurable changes in joint comfort as early as Day 5
✓ Demonstrate benefits at a low daily dose of 100 mg
✓ Be well tolerated throughout the 30-day intervention

Why This Study Matters

The validated assessment tools used in this study reflect everyday movement and mobility tasks. Improvements in these scores may correspond with better comfort during activities such as walking, standing, climbing stairs, and rising from a seated position. The early changes observed in the study suggest that Boswellia serrata extracts such as Aflapin® may support joint comfort and mobility relatively quickly when used as part of a daily supplementation routine.*

Reference Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC3198257/



Study 3 Summary

Complete Study Information: https://pubmed.ncbi.nlm.nih.gov/39700461/

A Standardized Boswellia serrata Extract Improves Knee Joint Function and Cartilage Morphology in Human Volunteers with Mild to Moderate Osteoarthritis in a Randomized Placebo-Controlled Study
J Am Nutr Assoc. 2025;44(5):375-386. doi:10.1080/27697061.2024.2438894. PMID: 39700461.

This randomized, double-blind, placebo-controlled clinical trial evaluated the effects of Aflapin® (AprèsFlex®) in 80 adults with knee osteoarthritis over 180 days. Participants received either 100 mg per day of Aflapin® or placebo. Researchers evaluated changes in joint comfort, stiffness, physical function, exercise performance, and biomarkers associated with inflammation and cartilage metabolism using validated clinical assessment tools and imaging techniques.

Study Design Highlights

  • Study design: Randomized, double-blind, placebo-controlled clinical study
  • Participants: 80 adults with knee osteoarthritis (77 completed)
  • Dose: 100 mg/day Aflapin®
  • Duration: 180 days (6 months)

Key Findings (What the Study Showed)

1. Measures of Joint Comfort and Function

  • Total WOMAC score improvement: 71%
  • VAS joint comfort score improvement: 66%
  • Lequesne Functional Index improvement: 43%
  • Six-Minute Walk Distance: 27% increase
  • Stair Climb Test time: 9% improvement

2. Biomarkers Reported in the Study

Markers associated with inflammatory balance:

  • hs-CRP: 59.23% decrease
  • MMP-3: 33.80% decrease

Markers associated with cartilage metabolism:

  • C2C (Type II collagen degradation peptide): 7.67% decrease
  • Fibulin-3: 15.92% decrease
  • uCTX-II: 23.63% decrease

3. Structural Measurements Observed

Imaging analysis conducted during the study reported changes in structural joint measurements in participants receiving Aflapin®, including:

  • Increased joint space
  • Increased cartilage thickness
  • Increased cartilage volume

These findings suggest potential support for normal cartilage structure and joint integrity during the study period.

Benefits of AprèsFlex® Demonstrated by This Study

Based directly on the clinical outcomes, AprèsFlex® (Aflapin®) was shown to:
✓ Support significant improvements in total WOMAC, VAS, and LFI scores over 6 months
✓ Support a 27% increase in six-minute walk distance
✓ Help maintain healthy hs-CRP and MMP-3 levels
✓ Support favorable markers of cartilage metabolism (C2C, Fibulin-3, uCTX-II)
✓ Support imaging-based measurements of joint space, cartilage thickness, and volume
✓ Be safe and well tolerated over a 6-month intervention period

Why This Study Matters

The outcome measures evaluated in this study reflect everyday activities such as walking, climbing stairs, standing from a seated position, and general mobility. Improvements in these assessments may correspond with better comfort and ease of movement during routine daily activities. Taken together with earlier clinical trials, this longer-term study suggests that supplementation with Aflapin® may support joint comfort, mobility, and physical function over both short- and longer-term periods. The observed changes in biomarkers associated with inflammatory balance and cartilage metabolism, combined with imaging-based measurements of joint structure, provide additional insight into potential mechanisms by which this Boswellia serrata extract may support overall joint health.*

Reference Link: https://pubmed.ncbi.nlm.nih.gov/39700461/



Study 4 Summary

Complete Study Information: https://pubmed.ncbi.nlm.nih.gov/35512759/

Efficacy and Safety of Aflapin®, a Novel Boswellia serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study
J Am Nutr Assoc. 2023;42(2):159–168. doi:10.1080/07315724.2021.2014370. PMID: 35512759.

This randomized, double-blind, placebo-controlled clinical trial evaluated the effects of Aflapin® (AprèsFlex®) in 70 adults with knee osteoarthritis over 30 days. Participants received either 100 mg per day of Aflapin® or placebo. Researchers assessed changes in joint comfort, stiffness, and physical function using validated clinical measurement tools including the WOMAC index, Visual Analog Scale (VAS), and Lequesne Functional Index (LFI). The study also evaluated biomarkers associated with inflammatory processes and cartilage metabolism.

Study Design Highlights

  • Study design: Randomized, double-blind, placebo-controlled clinical study
  • Participants: 70 adults with knee osteoarthritis (67 completed)
  • Dose: 100 mg/day Aflapin®
  • Duration: 30 days

Key Findings (What the Study Showed)

1. Measures of Joint Comfort and Function at Day 30

All reported changes were statistically significant compared with placebo (p < 0.001):

  • WOMAC Pain: 44.4% improvement
  • WOMAC Stiffness: 66.3% improvement
  • WOMAC Physical Function: 44.4% improvement
  • VAS joint comfort score: 45.94% improvement
  • Lequesne Functional Index: 40.9% improvement

2. Early Response Observed

Changes in several assessment measurements were observed as early as Day 5, suggesting relatively early improvements in joint comfort and mobility during the intervention period.

3. Biomarkers Reported in the Study

The study also reported changes in biomarkers associated with inflammatory processes and cartilage metabolism:

  • TNF-α: 59% decrease (compared with 37% in placebo)
  • hs-CRP: 20% decrease
  • MMP-3: 17% decrease

Benefits of AprèsFlex® Demonstrated by This Study

Based directly on the clinical outcomes, AprèsFlex® (Aflapin®) was shown to:
✓ Support statistically significant improvements in WOMAC pain, stiffness, and physical function at 30 days
✓ Improve VAS joint comfort scores by nearly 46% compared with placebo
✓ Produce measurable changes in joint comfort as early as Day 5
✓ Support favorable changes in TNF-α, hs-CRP, and MMP-3 biomarkers
✓ Be safe and well tolerated throughout the 30-day intervention

Why This Study Matters

The assessment tools used in this study reflect everyday movement and mobility tasks. Improvements in these measurements may correspond with better comfort during activities such as walking, standing, climbing stairs, and rising from a seated position. Together with longer-term studies, these findings contribute to a growing body of research examining the potential role of standardized Boswellia serrata extracts in supporting joint health and physical function. The early-onset changes observed in this study are particularly notable for individuals seeking relatively quick support for joint comfort.*

Reference Link: https://pubmed.ncbi.nlm.nih.gov/35512759/

Big-Picture Integration with Other Studies

  • Study 1: In a 90-day double-blind, placebo-controlled clinical trial, participants receiving 100 mg/day of Aflapin® demonstrated improvements in VAS and WOMAC scores compared with placebo, with measurable changes observed as early as Day 7.
  • Study 2: In a 30-day randomized, double-blind, placebo-controlled clinical trial, supplementation with 100 mg/day of Aflapin® was associated with statistically significant improvements in validated assessments of joint comfort, stiffness, and physical function. Changes were observed as early as Day 5, and the ingredient was well tolerated.
  • Study 3: In a 180-day randomized placebo-controlled clinical trial, participants receiving 100 mg/day of Aflapin® demonstrated improvements in WOMAC and VAS measurements, along with improvements in mobility-related performance tests such as the six-minute walk distance and stair-climb assessment. The study also reported changes in biomarkers associated with inflammatory processes and cartilage metabolism, as well as imaging-based measurements suggesting support for normal joint structure.
  • Study 4: In a 30-day randomized placebo-controlled clinical trial, supplementation with 100 mg/day of Aflapin® was associated with improvements in validated assessments of joint comfort, stiffness, and physical function, with statistically significant differences reported by Day 30. The study also reported changes in biomarkers associated with inflammatory balance and cartilage metabolism.

AprèsFlex® Ingredient Summary & Real-World Relevance

Taken together, these clinical studies suggest that supplementation with 100 mg per day of AprèsFlex® may support joint comfort, mobility, and physical function. Across multiple randomized, double-blind, placebo-controlled trials ranging from 30 days to 6 months, participants receiving AprèsFlex® demonstrated improvements in validated assessments of joint comfort and stiffness, as well as mobility-related performance outcomes such as walking distance and stair-climbing assessments. Several studies also reported changes in biomarkers associated with inflammatory balance and cartilage metabolism, along with imaging-based measurements related to joint structure.

In practical terms, improvements in these validated assessment tools may correspond with better comfort during everyday activities such as walking, standing, climbing stairs, and transitioning from sitting to standing. The clinical research supporting AprèsFlex® suggests that this standardized Boswellia serrata extract may provide a well-tolerated, low-dose option for supporting joint comfort and mobility as part of a daily supplementation routine.*

Ingredient Manufacturer Link: https://www.plthealth.com/product-catalog/apresflex

AprèsFlex® is a clinically studied ingredient used in the following Silver Fern™ Brand product:

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.