Viscum Album is a parasitic plant that grows on the stems and tops of broad-leaved trees, especially apple, oak, pine and elm, having been used since the Celts to treat numerous diseases. In 1904, it started to be used in anthroposophical medicine for the treatment of cancer. Currently, it is one of the most studied complementary therapies for the management of neoplasia and in some European countries, preparations made from Viscum album are among the most prescribed drugs for cancer patients [2].
The mechanism of the antineoplastic action of Viscum album has aroused much interest since its cytotoxic and immunomodulatory qualities were documented in the 90’s [6]. Since then, several studies have sought to identify the most effective therapeutic dose, time and treatment regimen[1], noting that the impact of its pharmacological properties is reflected in increased survival of patients, including animal patients, as several studies identified[2]. There is also the injectable Viscum album ultradiluted or homeopathic form, which has been increasingly used in cancer patients, because it is effective and does not cause side effects.
So, what makes Viscum so effective?
The composition of Viscum Album is quite complex. Among its bioactive compounds, we can highlight the viscotoxins, lectins, triterpenes, flavonoids, alkaloids, phenolic acids and polysaccharides [2]. The viscotoxins are antimicrobial peptides that are part of the defense system of the plant, exerting immunomodulatory effect in patients, besides presenting high cytotoxicity to tumor cells [4].
The lectins and triterpenes have selective cytotoxic action, that is, they are toxic for the tumor cells, at the same time that they preserve the healthy cells. The combined action of these two compounds is therefore responsible for a greater induction of apoptosis of tumor cells [4]. Finally, the flavonoids, alkaloids and phenolic acids, contribute to the anti-inflammatory action [3]. There are also other components, whose mechanisms of action are not yet fully elucidated.
It also activates the cascade of caspases, which are proteases (enzymes that break peptidic bonds between amino acids of proteins), essential in cellular apoptosis (programmed cell death). Failures in this process are one of the main causes for the development of tumors and autoimmune diseases [2].
Moreover, studies have also pointed out the antioxidant capacity of Viscum Album, indicating a good action against free radicals and a good protective effect against hydroperoxide generation [5, 7].
Additionally, researches show that Viscum Album has antiangiogenic activity, that is, it reduces vascularization and, consequently, tumor growth [4, 7]. Recently, it has been suggested that Viscum exerts a potent anti-inflammatory effect through the selective inhibition of COX (cyclooxygenase) protein expression, which may contribute to the antitumor action [3].
Although Viscum Album does not have a detoxifying action, it protects the DNA of the hepatic cells, being for this reason a good adjunct to chemotherapy, helping in hepatoprotection [7]. There are also a series of studies and reviews that demonstrate the improvement of the quality of life of patients, since besides the selective and immunomodulatory cytotoxic effects, it acts reducing fatigue, improving the quality of sleep and appetite, reducing nausea, depression, anxiety and pain [2].
It should be noted that the beneficial effect of Viscum Album occurs due to the synergistic action of its compounds and not of its components in isolation. Moreover, it should be noted that the mother tincture needs to be harvested in both summer and winter, and should be mixed in order to obtain the oncologic effect, represented by immunomodulation together with cytotoxicity [2].
Viscum Album can be used as the main treatment or as an adjuvant in chemotherapy, besides having a function in palliative treatment. Besides being used for cancer, it can be successfully applied in the post-cancer period (i.e., when the tumor was removed, in order to avoid recurrence). Besides, it is indicated in elderly and fatigued patients, acting in the reduction of pain, improving the immunity, the appetite and the patient's mood, besides providing a bigger survival.
In summary, the Viscum Album acts in the:
Reduction of fatigue and improvement of quality of life;
Increased survival
Reduction of inflammation and pain;
Improvement of appetite and mood;
Inhibition of tumor growth: increases apoptosis, reduces neovascularization and promotes regression in specific cases;
Reduction of the incidence of infections;
Improved tolerance to chemotherapy;
Reduction of immunosuppression caused by chemotherapy;
Key points:
Viscum Album does not interfere in the chemotherapy treatment and can be used in conjunction with it, improving patient response and reducing the side effects often observed in this modality [2].
Viscum Album is not a promise of cure, but of a good quality of life and increased survival. However, it is important to note that even if the tumor is removed surgically, there may be recurrence. Cancer is a complex disease that involves several systems and therefore needs constant vigilance.
Viscum Album has no contraindications and can be used as main treatment or adjuvant.
REFERENCES:
1) Bonamin, L.V. et al. Viscum album (L.) in experimental animal tumors: A meta-analysis. Experimental and Therapeutical Medicine, n.13: pp.2723-2740, Sept. 2017.
2) Carvalho, AC. Atividade anti-neoplásica de Viscum album (L) em tumores experimentais: revisão crítica e estudo experimental em tumor de Erlich. Tese de Doutorado. Universidade Paulista. 2015.
3) Hegde, P. et al. Viscum album Exerts Anti-Inflammatory Effect by Selectively Inhibiting Cytokine-Induced Expression of Cyclooxygenase-2. PLoS ONE 6(10): e26312. 2011. doi:10.1371/journal.pone.0026312
4) Nazaruk, J & Orlikowski, P. Phytochemical profile and therapeutic potential of Viscum album L. Natural Product Research: Formerly Natural Product, Mar. 2015, Letters, DOI: 10.1080/14786419.2015.1022776.
5) Önay-Uçar, E. et al., Antioxidant activity of Viscum album ssp. Album. Fitoterapia, n. 77, Sept. 2006, pp. 556–560.
6) Valle ACV. Viscum album no tratamento integrativo do colangiocarcinoma em cão (Cannis familiaris): relato de caso. Rev. de Edu. Cont. em Med. Vet.e Zootec. CRMV-SP. 2018; 16(2): 80-81.
7) Szurpnicka, A. et al. Biological activity of mistletoe: in vitro and in vivo studies
and mechanisms of action. Arch. Pharm. Res. V. 43, pp. 593–629, July, 2020. https://doi.org/10.1007/s12272-020-01247-w.
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