Viscum album L.

Last updated: 21 Sep 2016

Scientific Name

Viscum album L.   

Synonyms

Viscum album var. album, Stelin album Bubani [unresolved] [1]

Vernacular Name

English European mistletoe, mistletoe [2]
India Ban, banda, bhanga, bhangra, chulakavanda, chuluka-banda, dibki, harchur, hattjora, rasna, vandakah [2]
Nepal Sun ti pro (Lepcha) [2]
Nigeria Kurle, sukule [2].

Geographical Distributions

No documentation.

Botanical Description

No documentation.

Cultivation

No documentation.

Chemical Constituent

V. album  has been reported to contain phenylpropanoids syringin, syringenin-apiosylglucoside, eleutheroside E [3], and viscumun [4].

Plant Part Used

No documentation.

Traditional Use

No documentation.

Preclinical Data

Pharmacology

Anticancer activity

V. album has been a plant of interest in cancer treatment for decades. Laboratory studies report extracts from V. album stimulate immunity and cause cancer cell death [5][6]. A lectin namely viscumin (a complex protein–sugar compound that can bind to cell surfaces) seem to provide the most anticancer activity that appears to interfere with intracellular protein synthesis [7], stimulate the production of cytokines (which increase the production of leukocytes) and activate leukocytes [8]. Viscumin may also affect the processes of metastasis and apoptosis [9]. Viscumin is known as ML-1 lectin. In addition, a small proteins compound namely viscotoxins appeared to be more cytotoxic and more likely to induce cellular necrosis [10].

Extracts of V. album have been reported to have a direct toxic effect on tumor cells [11]. Another reported activity is stabilization of white blood cell DNA, including white blood cells that have been exposed to DNA-damaging chemotherapy drugs [12]. V. album stimulates production of white blood cells and improves cytokine production, such as IL-1, IL-6, and TNF-alpha [13]. Other reports suggest that V. album inhibits protein synthesis of cancer cells, thereby inducing apoptosis [14]. A laboratory study found efficacy of V. album (Iscador) treatment of various tumors to be comparable to the chemotherapy drug vincristine [15].

Similar to European mistletoe (V. album), extracts from a type of Korean mistletoe (V. albumcoloratum Kom.) have demonstrated in vitro andin vivo cytoxocity in laboratory studies. [16]

Toxicity

No documentation.

Clinical Data

Clinical findings

Reports of more than 30 clinical trials of V. album as an injectable treatment for cancer have been published since the early 1960s [17][18]. Results of these clinical trials support the thought that use of V. album has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, these results need to be supported with more randomized, double blind placebo controlled studies [19].

A recent clinical trial involving subQ injections of 20mg V. album twice weekly was reported to enhance humoral and cellular immune responses in 4 cancer patients [20]. A case report and objective and subjective results from clinical trials suggests that V. album may have a dose-dependent effect on cancer-related fatigue, helping patients to have more energy [21].

A review of the safety and efficacy of standardized V. album extract  (HELIXOR) in 681 cancer patients revealed the V. album extract was beneficial for breast cancer patients since it significantly improved quality of life and significantly reduced persistent signs/symptoms of the disease/treatment for 5 years during aftercare. [22]

A 2008 review of the current clinical trials for all V. album extracts in the treatment of various cancers (overall comprising 3484 randomized cancer patients) found the evidence of V. album extracts improving the survival or leading to an improved ability to fight cancer or to withstand anticancer treatments to be weak. The authors concluded that although weak, there is some evidence that V. album extracts may offer benefits on measures of QOL during chemotherapy for breast cancer. [23][24]

Precautions

V. album, which includes various species of Phoradendron, are similar in constituents but have not been widely studied. [25] 

Avoid use of V. album extract in individuals with cardiovascular diseases. [25]

Avoid use of V. album in active/uncontrolled hyperthyroid patients, as metabolism may be altered. [25] 

Use with caution in individuals with diabetes and blood sugar regulation problems, as V. album may alter blood sugar levels. [25]

V. album may increase liver enzymes in high dosages. Use with caution in those with liver impairment or disease. [25]

Use cautiously in individuals with glaucoma or in those on cholinergics. [25]

Side effects

V. album preparations have been reported safe in recommended doses. Common side effects include soreness and inflammation at injection sites, headache, fever, and chills. [26][27]

Pregnancy/Breast Feeding

No documentation.

Age limitation

No documentation.

Adverse reaction

V. album's white berries are potentially toxic and should be avoided. Seizures, vomiting, and death have been reported following ingestion of these substances. The severity of the toxic effects associated with V. album ingestion may depend on the amount consumed and the type of V. album plant. [25]

A few cases of severe allergic reactions, including anaphylactic shock, have been reported. [28]

Interaction & Depletion

No documentation.

Contraindications

No documentation.

Dosage

No documentation.

Poisonous Management

No documentation.

Line drawing

No documentation.

References

  1. The Plant List. Ver1.1. Viscum album L. [homepage on the Internet]. c2013 [updated 2012 Apr 18; cited 2016 Aug 10]. Available from: http://www.theplantlist.org/tpl1.1/record/kew-2461327
  2. Quattrocchi U. CRC world dictionary of medicinal and poisonous plants: Common names, scientific names, eponyms, synonyms, and etymology. Volume V R-Z. Boca Raton, Florida: CRC Press, 2012; p. 752.
  3. Wagner H, Jordan E, Feil B. Studies on the standardization of mistletoe preparations. Oncology 1986;43(1):16-22.
  4. Olsnes S, Stirpe F, Sandvig K, Pihl A. Isolation and characterization of viscumin, a toxic lectin from Viscum album L. (mistletoe). J Biol Chem. 1982;257(22):13263-13270.
  5. Mengs U, Göthel D, Leng-Peschlow E. Mistletoe extracts standardized to mistletoe lectins in oncology: review on current status of preclinical research. Anticancer Res. 2002;22(3):1399-1407.
  6. Hajto T, Hostanska K, Frei K, Rordorf C, Gabius HJ. Increased secretion of tumor necrosis factors alpha, interleukin 1 and interleukin 6 by human mononuclear cells exposed to beta-galactoside-specific lectin from clinically applied mistletoe extract. Cancer Res. 1990;50(11):3322-3326.
  7. Stirpe F, Sandvig K, Olsnes S, Pihl A. Action of viscumin, a toxic lectin from mistletoe, on cells in culture. J Biol Chem. 1982;257(22):13271-13277.
  8. Männel DN, Becker H, Gundt A, Kist A, Franz H. Induction of tumor necrosis factor expression by a lectin from Viscum album. Cancer Immunol Immunother. 1991;33(3):177-182.
  9. Stirpe F, Sandvig K, Olsnes S, Pihl A. Action of viscumin, a toxic lectin from mistletoe, on cells in culture. J Biol Chem. 1982;257(22):13271-13277.
  10. Khwaja TA, Dias CB, Pentecost S. Recent studies on the anticancer activities of mistletoe (Viscum album) and its alkaloids. Oncology. 1986;43(1):42-50.
  11. Stauder H, Kreuser ED. Mistletoe extracts standardised in terms of mistletoe lectins (ML I) in oncology: Current state of clinical research. Onkologie. 2002;25(4):374-380.
  12. Büssing A, Azhari T, Ostendorp H, Lehnert A, Schweizer K. Viscum album L. extracts reduce sister chromatid exchanges in cultured peripheral blood mononuclear cells. Eur J Cancer. 1994;30A(12):1836-1841.
  13. Hajto T. Immunomodulatory effects of iscador: A Viscum album preparation. Oncology. 1986;43(1):51-65.
  14. Zarkovic N, Vukovic T, Loncaric I, et al. An overview on anticancer activities of the Viscum album extract Isorel. Cancer Biother Radiopharm. 2001;16(1):55-62.
  15. Kovacs E, Link S, Toffol-Schmidt U. Comparison of Viscum album QuFrF extract with vincristine in an in vitro model of human B cell lymphoma WSU-1. Arzneimittelforschung. 2008;58(11):592-597.
  16. 15 Khil LY, Kim W, Lyu S, Park WB, Yoon JW, Jun HS. Mechanisms involved in Korean mistletoe lectin-induced apoptosis of cancer cells. World J Gastroenterol. 2007;13(20):2811-2818.
  17. Kleijnen J, Knipschild P. Mistletoe treatment for cancer: Review of controlled trials in humans. Phytomedicine. 1994;1(3):255-260.
  18. Schöffski P, Riggert S, Fumoleau P, et al. Phase I trial of intravenous aviscumine (rViscumin) in patients with solid tumors: A study of the European Organization for Research and Treatment of Cancer New Drug Development Group. Ann Oncol. 2004;15(12):1816-1824.
  19. Horneber MA, Bueschel G, Huber R, Linde K, Rostock M. Mistletoe therapy in oncology. Cochrane Database Syst Rev. 2008;(2):CD00329.
  20. Gardin NE. Immunological response to mistletoe (Viscum album L.) in cancer patients: a four-case series. Phytother Res. 2009;23(3):407-411.
  21. Wode K, Schneider T, Lundberg I, Kienle GS. Mistletoe treatment in cancer-related fatigue: A case report. Cases J. 2009;2(1):77.
  22. Beuth J, Schneider B, Schierholz JM. Impact of complementary treatment of breast cancer patients with standardized mistletoe extract during aftercare: A controlled multicenter comparative epidemiological cohort study. Anticancer Res. 2008;28(1B):523-527.
  23. Horneber MA, Bueschel G, Huber R, Linde K, Rostock M. Mistletoe therapy in oncology. [Cochrane review] In: The Cochrane Library, Issue 2, 2008.
  24. Onnweiler O. Mistletoe in tumour therapy – basic research and clinical practice. Abstracts of the 4th Mistletoe Symposium, 8-10 November 2007. Germany Phytomedicine. 2007;14(7):1-54,37-43.
  25. Hall AH, Spoerke DG, Rumack BH. Assessing mistletoe toxicity. Ann Emerg Med. 1986;15(11):1320-1323.
  26. Bock PR, Friedel WE, Hanisch J, Karasmann M, Schneider B. [Efficacy and safety of long-term complementary treatment with standardized European mistletoe extract (Viscum album L.) in addition to the conventional adjuvant oncologic therapy in patients with primary non-metastasized mammary carcinoma. Results of a multi-center, comparative, epidemiological cohort study in Germany and Switzerland]. Arzneimittelforschung. 2004;54(8):456-466. German.
  27. Stauder H, Kreuser ED. Mistletoe extracts standardised in terms of mistletoe lectins (ML I) in oncology: Current state of clinical research. Onkologie. 2002;25(4):374-380.
  28. Hutt N, Kopferschmitt-Kubler M, Cabalion J, Purohit A, Alt M, Pauli G. Anaphylactic reactions after therapeutic injection of mistletoe (Viscum album L.). Allergol Immunopathol (Madr). 2001;29(5):201-203.