The safety and tolerability of Annona muricata leaf extract: a systematic review

Abstract

Objectives Annona muricata, also known as graviola, soursop and guanabana, has been widely utilised for the treatment of a range of cancers. The mechanism of action and the efficacy of A. muricata and its constituents in the treatment of cancer have been comprehensively reviewed. The aim of this systematic review was to summarise the available literature that reports on factors related to the safety and tolerability of A. muricata leaf extract and its acetogenins. Methods In‐vitro, preclinical animal studies and human studies of any design written in any language were included. Studies that evaluated A. muricata leaf extract and its constituents were searched through the databases Pubmed, Medline and Embase from inception to April 2019. The elaborated item 4 of Consolidated Standards of Reporting Trials statement and Animals in Research: Reporting In vivo Experiments guidelines were used to evaluate the quality of the studies. Key findings The results suggest that A. muricata and its constituents have hepatoprotective, neurotoxic, antinociceptive, anti‐ulcerative and chemopreventive effects. The dose and duration used in animal studies demonstrating toxicity may not directly translate into the effects in humans. Studies included in this review were judged to be of medium to high quality. Conclusions The overall outcome of the current review suggests that A. muricata has a favourable safety and tolerability profile. Future studies investigating its use in people diagnosed with a range of cancers are warranted.

Antiproliferative Activity, c-Myc and FGFR1 Genes Expression Profiles and Safety of Annona muricata Fruit Extract on Rhabdomyosarcoma and BALB/c Mice

“…In the hematological analysis done in this study, the effect of the fruit extract was also evaluated on the white blood cell (WBC) count. Like previous studies [55], the WBC count in this study demonstrated no significant difference compared to the control. This result may signify that that Annona muricata ethanolic fruit extract does not possess toxins suppressing the average production of WBC (leucopenia) or inducing leukocytosis.…”

Antitumor Potential of Annona muricata Linn. An Edible and Medicinal Plant in Mexico: In Vitro, In Vivo, and Toxicological Studies

“…Acetogenins have been identified as one of the major bioactive compounds of A. muricata with activity on several cancer cell lines [15,16]. The ethanol extracts obtained from aerial parts from A. muricata in combination with doxorubicin showed important cytotoxic activity on 4T1 cells and other cancer cell lines [15][16][17][18][19][20][21][22]. Although there is an extensive amount of information about the cytotoxic properties of A. muricata, no information is available regarding its anti-cancer potential in specifically breast cancer using the extracts of plants collected in different periods of the year, and regarding the location of the place of recollection and its influences on their pharmacological and toxic properties.…”

Molecular Targets of Natural Compounds with Anti-Cancer Properties

“…More than 400 compounds of acetogenins were described. This tropical plant grows in India, South and Central America, Indonesia and the Philippines [85][86][87]. Previously, graviola leaves were used in traditional folk medicine to treat several diseases, i.e., infections or inflammations, as well as insomnia, diabetes, headaches, arthritis, malaria or parasites [88,89].…”

“…Previously, graviola leaves were used in traditional folk medicine to treat several diseases, i.e., infections or inflammations, as well as insomnia, diabetes, headaches, arthritis, malaria or parasites [88,89]. Among the chemical compounds found in graviola extract, the anti-cancer agent seems to be acetogenin (Figure 1F) [85]. Graviola is usually presented in a leaf-powder form and can influence free radical production and the level of ROS by scavenging peroxy and nitrogen radicals [90].…”