Sauropus androgynus (L.) Merr.

Last updated: 03 Nov 2016

Scientific Name

Sauropus androgynus (L.) Merr.

Synonyms

Aalius androgyna (L.) Kuntze, Aalius lanceolata (Hook.f.) Kuntze, Aalius oblongifolia (Hook.f.) Kuntze, Aalius retroversa (Wight) Kuntze, Aalius sumatrana (Miq.) Kuntze, Agyneia ovata Poir., Andrachne ovata Lam. ex Poir., Clutia androgyna L., Phyllanthus acidissimus Noronha [Invalid], Phyllanthus androgynus (L.) J.A. González, Phyllanthus speciosus Noronha [Invalid], Phyllanthus strictus Roxb., Sauropus albicans Blume, Sauropus albicans var. gardnerianus (Wight) Müll.Arg., Sauropus albicans var. intermedius Müll.Arg., Sauropus albicans var. zeylanicus (Wight) Müll.Arg., Sauropus convexus J.J.Sm., Sauropus gardnerianus Wight, Sauropus indicus Wight, Sauropus lanceolatus Hook.f., Sauropus macranthus Fern.-Vill. [Illegitimate], Sauropus oblongifolius Hook.f., Sauropus parviflorus Pax & K.Hoffm., Sauropus retroversus Wight, Sauropus scandens C.B.Rob., Sauropus sumatranus Miq., Sauropus zeylanicus Wight. [1]

Vernacular Name

Malaysia Cekop manis, chekop manis, chekor manis, [2] taruk manis, asin-asin, cekup manis, [3] cekur manis [5]
English Sweet leaf bush, [3] star-gooseberry [4][5]
China Shou gong mu, [2] ma ni chai, [3] pa wan [5]
India Sukyamuringa, [2] surasarabi (Hindi); aruni (Sanskrit); chakramunis, thavasai murungai [5]
Indonesia Babing, cekop manis, karakur, katu, katuk, katukan, memata, [2] simani (Sumatra) [5]
Thailand Pakwan [5]
Laos Hvaan baanz [5]
Philippines Binahian [5]
Cambodia Ngub [5]
Vietnam Bó ngót [5]

Geographical Distributions

Sauropus androgynus is found in India and throughout the Malay Archipelago. In Peninsular Malaysia, it is cultivated and also occurs wildly near villages. [6]

Botanical Description

S. androgynus is a member of Phyllanthaceae family. [1] It is an erect, monoecious and glabrous shrub that can grow up to 1-3 m tall. [7]

The branchlets are angular when young, terete with age, slender, and green. The stipules are lanceolate or linear-lanceolate measuring of 1.5-3 mm. The petiole is 2-4 mm. The leaf blade is ovate-lanceolate, oblong-lanceolate, or lanceolate, measuring of 3-10 x 1.5-3.5 cm, submembranous or thinly papery, base cuneate, rounded, or truncate, and acuminate at the apex. The venation is pinnate, lateral veins 5-7 pairs, elevated abaxially, flattened adaxially, reticulate veins obscure. [7]

The inflorescence is axillary, 1- or 2-flowered, or several male and female per cluster. [7]

The male flowers have slender pedicels that measure of 5-7.5 mm. The calyx is shallowly disk-shaped, 5-12 mm in diameter, shallowly 6-fid. The sepals are obovate. There are 6 disk segments that opposite to sepals incurved distally, covering the anthers. It has 3 stament, the filaments are connate, and the anther is extrorse. [7]

The female flowers are usually solitary and axillary. The pedicel is measure of 6-8 mm. The calyx is red and has 6-lobed. The sepals are obovate or obovate-triangular, measures of 5-6 x 3-5.5 mm, base attenuate into a short claw; disk absent; ovary depressed globose, ca. 0.7 x 1.5 mm, 3-locular; styles 3, bifid. Fruiting pedicel 0.5-1 cm; persistent calyx red; capsule white, depressed globose or globose, ca. 1.2 x 1.7 cm, thinly crustaceous. [7]

The seeds are black, triquetrous, ca. 7 × 5 mm. [7]

Cultivation

No documentation.

Chemical Constituent

The aerial part of S. androgynus has been reported to contain lignan diglycoside namely (-)-isolariciresinol 3α-O-β-apiofuranosyl-(1-->2)-O-β-glucopyranoside and megastigmane glucoside namely sauroposide. Other chemical ingredients that has been isolated from S. androgynus are (+)-isolariciresinol 3α-O-β-glucopyranoside, (-)-isolariciresinol 3α-O-β-glucopyranoside, (+)-syringaresinol di-O-β-glucopyranoside, guanosine and corchoionoside C. [8]

Plant Part Used

Whole plant, leaves and roots. [9][10]

Traditional Use

The roots of S. androgynus have diuretic properties which is being taken advantage of by some traditional practitioners to treat various urinary complaints. Amongst the diseases treated include symptomatic relieve of dysuria. [9][10]

The roots are also used in treatment of cardiovascular diseases or symptoms of this group of diseases including vertigo, dizziness, fainting spells. It is also being recommended to those with hypertension. [9][10]

The whole plant is given to women after delivery to enhance lactation and allow for early post-partum recovery. Decoction of the leaves and roots is a remedy for epistaxis and oriental sores. [9]

Another application of the leaves is for oral thrush in infants. Paste of leaves is applied over nasal ulcers and yaws, erythrema and measles. Juice extracted from the leaves is used as an eye lotion for eye complaints. [11]

Preclinical Data

Pharmacology

Antiobesity activity

Ethanolic and n-butanol extract of S. androgynus has been reported to exhibit antiobesity activity. 3-O-β-D-glucosyl-(1à6)-β-D-glucosyl-kaempferol (GGK) isolated from S. androgynus was tested orally on male Wistar rats for 28 days. They found that there was a reduction of foods intake by 15% which correspondingly produced decrease in the body weight of the rats. There was also a significant reduction in serum levels of free triglycerides. [12]

Cytotoxic activity

Ethanolic exctract of the leaves of S. androgynus showed cytotoxic activity as evidenced by condensation of chromatin, apoptosis and the formation of DNA ladders observed in NIH3T3 fibroblasts. These features could be related to the pathogenesis of S. androgynus-associated obliterative bronchiolitis. [13]

Induction of lactation activity

S. androgynus leaf extract has been reported to effect the expression of prolacting and oxytocin genes in lactating BALB/C mice. They found that by supplementing lactating mice with young leaf extracts of S. androgynus there was an increased in the expression of prolactin and oxytocin genes while giving the extract of the matured could further increase this expression. This was correlated with papaverine content which is higher in matured leaves. [14]

Toxicity

No documentation.

Clinical Data

Clinical findings

No documentation.

Side effects

No documentation.

Pregnancy/Breast Feeding

No documentation.

Adverse reaction

Consuming too much of the leaves of S. androgynus can cause pains in the limbs. Taking it raw or in fresh juiced form has been associated with breathing difficulties. The papaverine content can render it addictive and when consumed in large amounts it can cause sedation, dizziness, diplopia, uncontrolled eye movements, nausea, vomiting and weakness. [15]

Interaction & Depletion

No documentation.

Contraindications

This vegetable should be contraindicated in people with bronchial asthma, chronic obstructive airway disease and chronic smokers as there is the fear of developing bronchiolitis obliterans with the already compromised respiratory system. [15][16][17]

The content of papaverine is another factor of caution. Those with latex allergic should also avoid taking this due to the fear of developing anaphylactic reactions as reported. [14]

Case Report

There have been reported cases of bronchiolitis obliterans, ischaemic bronchi necrosis, irreversible obstructive ventilatory defect and breathing difficulties resulting in death. The first report of toxicity against S. androgynus consumption came from Taiwan in 1996 where 44 cases were reported [16]. The lung biopsy then shows bronchiolitis obliterans organizing pneumonia [17].

Another report showed similar histopathology with predominance of T-cells over B cells and upon immunoflourescent stains for IgG, IgM, IgA, C1q, C3 and C4 were negative. Serum concentration of TNF alpha was higher. [18]

Chen et al. believed that the altered cytokine expression and infiltration of eosinophils and neutrophils may be involved in the pathology of this condition. [19] A study described the spectrum of histological changes ranged from slight bronchiolar inflammation and fibrosis to marked submucosal fibrosis causing complete cicatricial obliterations of the lumen. There was dense infiltration of eosinophils in the bronchiolar submucosa or fibrotic tissue of the completely obliterated bronchioles. Immunohistochemical studies showed lyphocytic infiltration to be mainly T lymphocytes. Electron microscopy showed no immune complex deposition in the specimen.  The predominance of T-lymphocytic infiltrate suggests that a T-cell mediated immune response is involved in the pathogenesis of the disease. [20]

Chang et al. found focal fibromuscular sclerosis and obliteration of the bronchial arteries in the wall of the large bronchi 4–5 mm in diameter with segmental necrosis of the bronchi 2–4 mm in diameter. Bronchi immediately proximal to the necrotic zone showed fibrosis and atrophy of the cartilage, bronchial glands, and smooth muscle cells; bronchioles immediately distal showed obstruction and dilatation. Most bronchi larger than 5 mm, pulmonary vessels, small bronchioles, and alveoli were little altered. These changes were consistent with segmental ischaemic necrosis of bronchi at the water-shed zone of the bronchial and pulmonary circulation. [21]

In providing a diagnostic entity for the condition suggested that finding from high-resolution CT of air trapping were more important diagnostic feature than the findings of bronchiectasis when correlating pulmonary function. The mosaic attenuation notable on expiratory CT scans is denoted as type 1 air-trapping score while on both inspiratory and expiratory CT scans in denoted as type 2 air-trapping score. These scores are helpful in assessing airway-trapping and correlating it with pulmonary function. The type 2 air-trapping score suggest a more severe air-flow obstruction. [22]

Another study added another diagnostic criterion in the form of measurement of the 99mTc-DTPA (Technetium-99m DPTA) clearance as being the most sensitive test to detect the lung injuries causes by consuming S. androgynus. [23]

Study has been conducted on the relationship of method of preparation of S. androgynus with the incidence of bronchiolitis obliterans. They found that consumption of the vegetable in larger amounts, without cooking and food prepared by vendors posed a greater risk of developing the syndrome. [24]

Hsiue et al. noted that a larger dose of the vegetable is associated with higher risk of developing the lesion and that the lesion is irreversible during the 22 month period of observation. They also noted that 65% of patients began suffering from dyspnea in the 3rd, 4th, or 5th month after taking the vegetable. [25]

Wu et al. found that large doses of prednisolone (>0.5 mg/kg/day, >30 days) were not able to even reduce the Pulmonary Function Test like FEV1, FVC, FEV1/FVC, and carbon monoxide diffusion capacity. [26]

Study suggested an empirical treatment with corticosteroid and immunosuppressive agent as a possibility together with antifibrotic agents when available. However, lung transplantation still remains the best option. [27]

There is report in this form of treatment when they performed the transplantation in 5 patients with end-stage S. androgynus-induced bronchiolitis obliterans syndrome. Three patients survived with improved general condition and pulmonary function. Perfusion/ventilation scans revealed that these improvements were exclusively attributed to functional grafts. [28]

Dosage

No documentation.

Poisonous Management

No documentation.

Line drawing

References

  1. The Plant List. Ver1.1. Sauropus androgynus (L.) Merr. [homepage on the Internet]. c2013 [updated 2013 Mar 23; cited 2016 Nov 03]. Available from: http://www.theplantlist.org/tpl1.1/record/kew-186394.
  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. 168-169.
  3. Arifin N. Penyembuhan semula jadi dengan herba. Kuala Lumpur: PTS Litera Utama, 2005; p. 37.
  4. Wiersema JH, Leon B. World economic plants: A standard reference. Boca Raton, Florida: CRC Press, 1999; p. 448.
  5. Hanelt P. Mansfeld’s encyclopedia of agricultural and horticultural crops: (Except ornamentals). Berlin: Springer Science & Business Media, 2001; p. 1177-1178.
  6. Burkill IH. A dictionary of the economic products of the Malay Peninsula. Volume 2. London: Published on behalf of the governments of the Straits settlements and Federated Malay states by the Crown agents for the colonies, 1935; p. 1967-1968.
  7. Flora of China. Volume 11. Sauropus androgynus. [homepage on the Internet]. No date [cited 2016 Nov 04]. Available from: http://www.efloras.org/florataxon.aspx?flora_id=2&taxon_id=200012609
  8. Kanchanapoom T, Chumsri P, Kasai R, Otsuka H, Yamasaki K. Lignan and megastigmane glycosides from Sauropus androgynus. Phytochemistry. 2003;63(8):985-988.
  9. Ong HC. Sayuran: Khasiat makanan & ubatan. Kuala Lumpur: Utusan Publications & Distributors Sdn Bhd, 2003; p. 32–33.
  10. Ong HC. Vegetables for health and healing. Kuala Lumpur: Utusan Publications & Distributors Sdn Bhd, 2003; p. 164–165.
  11. Ling KH, Kian CT, Hoon TC. A guide to medicinal plants: An illustrated, scientific and medicinal approach. Singapore: World Scientific Publishing, 2009; p. 139.
  12. Yu SF, Shun CT, Chen TM, Chen YH. 3-O-beta-D-glucosyl-(1-->6)-beta-D-glucosyl-kaempferol isolated from Sauropus androgynus reduces body weight gain in Wistar rats. Biol Pharm Bull. 2006;29(12):2510-2513.
  13. Yu SF, Chen TM, Chen YH. Apoptosis and necrosis are involved in the toxicity of Sauropus androgynus in an in vitro study. J Formos Med Assoc. 2007;106(7):537-547.
  14. Stirapongsasuti P, Tanglertsampan C, Aunhachoke K, Sangasapaviliya A. Anaphylactic reaction to phuk-waan-ban in a patient with latex allergy. J Med Assoc Thai. 2010;93(5):616-619.
  15. Padmavathi P, Rao MP. Nutritive value of Sauropus androgynus leaves. Plant Foods Hum Nutr. 1990;40(2):107-113.
  16. Lin TJ, Lu CC, Chen KW, Deng JF. Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable. J Toxicol Clin Toxicol. 1996;34(1):1-8.
  17. Wu CL, Hsu WH, Chiang CD, et al. Lung injury related to consuming Sauropus androgynus vegetable. J Toxicol Clin Toxicol. 1997;35(3):241-248.
  18. Lai RS, Chiang AA, Wu MT, et al. Outbreak of bronchiolitis obliterans associated with consumption of Sauropus androgynus in Taiwan. Lancet. 1996;348(9020):83-85.
  19. Chen CW, Hsiue TR, Chen KW, Chang HY, Chen CR, Yang BC. Increased IL-5 and IL-10 transcription in bronchial cells after Sauropus androgynus ingestion. J Formos Med Assoc. 1996;95(9):699-702.
  20. Chang H, Wang JS, Tseng HH, Lai RS, Su JM. Histopathological study of Sauropus androgynus-associated constrictive bronchiolitis obliterans: A new cause of constrictive bronchiolitis obliterans. Am J Surg Pathol. 1997;21(1):35-42.
  21. Chang YL, Yao YT, Wang NS, Lee YS. Segmental necrosis of small bronchi after prolonged intakes of Sauropus androgynus in Taiwan. Am J Respir Crit Care Med. 1998;157(2):594-598.
  22. Yang CF, Wu MT, Chiang AA, et al. Correlation of high-resolution CT and pulmonary function in bronchiolitis obliterans: A study based on 24 patients associated with consumption of Sauropus androgynus. AJR Am J Roentgenol. 1997;168(4):1045-1050.
  23. Kao CH, Ho YJ, Wu CL, ChangLai SP. Using 99mTc-DTPA radioaerosol inhalation lung scintigraphies to detect the lung injury induced by consuming Sauropus androgynus vegetable and comparison with conventional pulmonary function tests. Respiration. 1999;66(1):46-51.
  24. Ger LP, Chiang AA, Lai RS, Chen SM, Tseng CJ. Association of Sauropus androgynus and bronchiolitis obliterans syndrome: A hospital-based case-control study. Am J Epidemiol. 1996;145(9):842-849.
  25. Hsiue TR, Guo YL, Chen KW, Chen CW, Lee CH, Chang HY. Dose-response relationship and irreversible obstructive ventilatory defect in patients with consumption of Sauropus androgynus. Chest. 1998;113(1):71-76.
  26. Wu CL, Hsu WH, Chiang CD. The effect of large-dose prednisolone on patients with obstructive lung disease associated with consuming Sauropus androgynus. Zhonghua Yi Xue Za Zhi (Taipei). 1998;61(1):34-38.
  27. Epler GR. Constrictive bronchiolitis obliterans: The fibrotic airway disorder. Expert Rev Respir Med. 2007;1(1):139-147.
  28. Luh SP, Lee YC, Chang YL, Wu HD, Kuo SH, Chu SH. Lung transplantation for patients with end-stage Sauropus androgynus-induced bronchiolitis obliterans (SABO) syndrome. Clin Transplant. 1999;13(6):496-503.