Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions

Sanguinarine synergistically potentiates aminoglycoside-mediated bacterial killing

Aminoglycosides are one of the oldest classes of antimicrobials that are being used in current clinical practice, especially on multi‐drug resistant Gram‐negative pathogenic bacteria. However, the serious side effects at high dosage such as ototoxicity, neuropathy and nephrotoxicity limit their applications in clinical practice. Approaches that potentiate aminoglycoside killing could lower down their effective concentrations to a non‐toxic dosage for clinical treatment. In this research, we screened a compound library and identified sanguinarine that acts synergistically with various aminoglycosides. By checkerboard and dynamical killing assay, we found that sanguinarine effectively potentiated aminoglycoside killing on diverse bacterial pathogens, including Escherichia coli, Acinetobacter baumannii, Klebsiella pneumonia and Pseudomonas aeruginosa. The mechanistic studies showed an elevated intracellular ROS and DNA oxidative level in the bacterial cells treated by a combination of sanguinarine with aminoglycosides. Furthermore, an enhanced level of sanguinarine was observed in bacteria in the presence of aminoglycosides, suggesting that aminoglycosides promote the uptake of sanguinarine. Importantly, sanguinarine was shown to promote the elimination of persister cells and established biofilm cells both in vivo and in vitro. Our study provides a novel insight for approaches to lower down the clinical dosages of aminoglycosides.

Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer

Oral potentially malignant disorders (OPMDs) are associated with an increased risk of occurrence of cancers of the lip or oral cavity. This paper presents an updated report on the nomenclature and the classification of OPMDs, based predominantly on their clinical features, following discussions by an expert group at a workshop held by the World Health Organization (WHO) Collaborating Centre for Oral Cancer in the UK. The first workshop held in London in 2005 considered a wide spectrum of disorders under the term "potentially malignant disorders of the oral mucosa" (PMD) (now referred to as oral potentially malignant disorders: OPMD) including leukoplakia, erythroplakia, proliferative verrucous leukoplakia, oral lichen planus, oral submucous fibrosis, palatal lesions in reverse smokers, lupus erythematosus, epidermolysis bullosa, and dyskeratosis congenita. Any new evidence published in the intervening period was considered to make essential changes to the 2007 classification. In the current update, most entities were retained with minor changes to their definition. There is sufficient evidence for an increased risk of oral cancer among patients diagnosed with "oral lichenoid lesions" and among those diagnosed with oral manifestations of 'chronic graft-versus-host disease'. These have now been added to the list of OPMDs. There is, to date, insufficient evidence concerning the malignant potential of chronic hyperplastic candidosis and of oral exophytic verrucous hyperplasia to consider these conditions as OPMDs. Furthermore, due to lack of clear evidence of an OPMD in epidermolysis bullosa this was moved to the category with limited evidence. We recommend the establishment of a global research consortium to further study the natural history of OPMDs based on the classification and nomenclature proposed here. This will require multi-center longitudinal studies with uniform diagnostic criteria to improve the identification and cancer risk stratification of patients with OPMDs, link them to evidence-based interventions, with a goal to facilitate the prevention and management of lip and oral cavity cancer.

Oral leukoplakia; a proposal for simplification and consistency of the clinical classification and terminology

There is a distinct lack of uniformity in the definitions and clinical terminologies related to oral leukoplakia and leukoplakialike lesions and disorders. Proposals have been put forward to subclassify leukoplakia into a homogeneous and a non-homogeneous type based on color only, being either predominantly white or mixed white-and-red, respectively, irrespective of the texture of the lesion. In this proposal there is no need anymore to regard the poorly defined proliferative verrucous leukoplakia as a separate entity. Since keratosis is primarily a histopathological term, its clinical use is discouraged. Alternative terminology for these so-called keratotic lesions and disorders has been put forward. Finally, a suggestion has been made to rename the term hairy leukoplakia, being a well defined, not potentially malignant disorder particularly related to HIV-infection, into 'EBV-positive white lesion of the tongue' (EBVposWLT).

Key words:Potentially malignant oral disorders, oral leukoplakia, oral keratosis, hairy leukoplakia.

A clinical diagnosis of oral leukoplakia; A guide for dentists

Background

In view of the many white or predominantly white lesions of the oral mucosa it is a challenge for dentists to clinically identify a leukoplakia, being a potentially (pre)malignant lesion.

Material and Methods

Based on the available literature and experience of the authors the parameters of a clinical diagnosis of oral leukoplakia have been studied.

Results

A guide has been presented that should help dentists to establish a clinical diagnosis of leukoplakia as accurate as possible.

Conclusions

Probably in most parts of the world dentists will need the help of a specialist for confirmation or exclusion of the clinical diagnosis of oral leukoplakia and for further management of the patient, including patient information.

Key words:Oral diseases, oral leukoplakia.

Carcinogenic potential of sanguinarine, a phytochemical used in 'therapeutic' black salve and mouthwash

Black salves are escharotic skin cancer therapies in clinical use since the mid 19th century. Sanguinaria canadensis, a major ingredient of black salve formulations, contains a number of bioactive phytochemicals including the alkaloid sanguinarine. Despite its prolonged history of clinical use, conflicting experimental results have prevented the carcinogenic potential of sanguinarine from being definitively determined. Sanguinarine has a molecular structure similar to known polyaromatic hydrocarbon carcinogens and is a DNA intercalator. Sanguinarine also generates oxidative and endoplasmic reticulum stress resulting in the unfolded protein response and the formation of 8-hydroxyguanine genetic lesions. Sanguinarine has been the subject of contradictory in vitro and in vivo genotoxicity and murine carcinogenesis test results that have delayed its carcinogenic classification. Despite this, epidemiological studies have linked mouthwash that contains sanguinarine with the development of oral leukoplakia. Sanguinarine is also proposed as an aetiological agent in gallbladder carcinoma. This literature review investigates the carcinogenic potential of sanguinarine. Reasons for contradictory genotoxicity and carcinogenesis results are explored, knowledge gaps identified and a strategy for determining the carcinogenic potential of sanguinarine especialy relating to black salve are discussed. As patients continue to apply black salve, especially to skin regions suffering from field cancerization and skin malignancies, an understanding of the genotoxic and carcinogenic potential of sanguinarine is of urgent clinical relevance.

Sanguinarine and Its Role in Chronic Diseases

The use of natural products derived from plants as medicines precedes even the recorded human history. In the past few years there were renewed interests in developing natural compounds and understanding their target specificity for drug development for many devastating human diseases. This has been possible due to remarkable advancements in the development of sensitive chemistry and biology tools. Sanguinarine is a benzophenanthridine alkaloid derived from rhizomes of the plant species Sanguinaria canadensis. The alkaloid can exist in the cationic iminium and neutral alkanolamine forms. Sanguinarine is an excellent DNA and RNA intercalator where only the iminium ion binds. Both forms of the alkaloid, however, shows binding to functional proteins like serum albumins, lysozyme and hemoglobin. The molecule is endowed with remarkable biological activities and large number of studies on its various activities has been published potentiating its development as a therapeutic agent particularly for chronic human diseases like cancer, asthma, etc. In this article, we review the properties of this natural alkaloid, and its diverse medicinal applications in relation to how it modulates cell death signaling pathways and induce apoptosis through different ways, its utility as a therapeutic agent for chronic diseases and its biological effects in animal and human models. These data may be useful to understand the therapeutic potential of this important and highly abundant alkaloid that may aid in the development of sanguinarine-based therapeutic agents with high efficacy and specificity.

Mouthwashes in the 21st century: a narrative review about active molecules and effectiveness on the periodontal outcomes

INTRODUCTION

Poor oral hygiene is a major risk factor for oral diseases. Regular home-based care is essential to maintain good oral hygiene. In particular, mouthrinses can support conventional tooth brushing in reducing accumulation of oral plaque. Areas covered: The most common molecules contained in mouthrinses (chlorhexidine, essential oils, cetyl pyridinium chloride, triclosan, octeneidine, delmopinol, polyvinylpyrrolidone, hyaluronic acid, natural compounds) are discussed, together with relevant clinical and in vitro studies, focusing on their effects on periodontal health. Currently, chlorhexidine is the most efficacious compound, with both antiplaque and antibacterial activities. Similar results are reported for essential oils and cetyl pyridinium chloride, although with a somewhat reduced efficacy. Considering the adverse effects of chlorhexidine and its time-related characteristics, this molecule may best be indicated for acute/short-term use, while essential oils and cetyl pyridinium chloride may be appropriate for long-term, maintenance treatment. Expert opinion: The literature has not clearly demonstrated which compound is the best for mouthrinses that combine good efficacy and acceptable side effects. Research should focus on substances with progressive antibacterial activity, prompting a gradual change in the composition of oral biofilm and mouthrinses that combine two or more molecules acting synergistically in the mouth.

Sanguinaria canadensis: Traditional Medicine, Phytochemical Composition, Biological Activities and Current Uses

Sanguinaria canadensis, also known as bloodroot, is a traditional medicine used by Native Americans to treat a diverse range of clinical conditions. The plants rhizome contains several alkaloids that individually target multiple molecular processes. These bioactive compounds, mechanistically correlate with the plant’s history of ethnobotanical use. Despite their identification over 50 years ago, the alkaloids of S. canadensis have not been developed into successful therapeutic agents. Instead, they have been associated with clinical toxicities ranging from mouthwash induced leukoplakia to cancer salve necrosis and treatment failure. This review explores the historical use of S. canadensis, the molecular actions of the benzophenanthridine and protopin alkaloids it contains, and explores natural alkaloid variation as a possible rationale for the inconsistent efficacy and toxicities encountered by S.canadensis therapies. Current veterinary and medicinal uses of the plant are studied with an assessment of obstacles to the pharmaceutical development of S. canadensis alkaloid based therapeutics.

Bloodroot

BLOODROOT (Sanguinaria canadensis) is a flowering herb that can be used as a drug. Historically, it was widely used by Native Americans in blood tonification and purification, pain and fever relief, and wound healing. Bloodroot plants have been advertised to impart a wide range of medical properties, and many bloodrood-containing products are commercially available. Potential side effects of bloodroot products include significant tissue destruction, escarification, and keloid formation. Therefore, it is critical for clinicians to be aware of potential risks, educate their patients on treatment options, and be able to recognize the cutaneous effects of bloodroot and other escharotic agents.

Rise and fall of oral health products with Canadian bloodroot extract

The rhizome of Sanguinaria canadensis (SC, bloodroot) contains an active principle with antimicrobial, antiinflammatory, antioxidative and immunomodulatory effects. For this reason SC extract has been added to toothpastes and mouthwashes in various concentrations. When tested separately, neither the toothpastes nor the mouthwashes with SC extract had any demonstrable clinical effectiveness against dental plaque and gingivitis. Although using them together twice a day seemed more effective than using placebo, more recent studies have shown conflicting results. Preclinical safety studies up to 2000, which did not include studies longer than 6 months, were thought not to indicate any appreciable potential for harm - to the oral mucosa in particular. In 2003, the FDA Subcommittee on Oral Health Care Drug Products for Over-the-Counter Human Use concluded from a review that using SC-containing products is safe. However, for reasons unknown, the review failed to consider publications between 1999 and 2001 that suggested a possible link between the use of SC-containing products and the pre-neoplastic lesion, leukoplakia. As it happened, bloodroot had already been removed (in 2001) from the formula of one of the most widely used products in question and the brand has since then disappeared altogether from the worldwide market.

Herbs in dentistry

Herbs have been used for centuries to prevent and control disease. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamic sense, drugs themselves. By using herbal medicines, patients have averted the many side effects that generally come with traditional medicines, but this does not mean that side effects do not occur. Only knowledgeable practitioners can prescribe the right herb and its proper dosage. Herbal medicines had been considered in every culture, however, pharmaceutical companies overturned this type of thinking. Now, pharmaceuticals are called traditional and herbs are libeled as the 'alternative'. The biggest challenge and problem is lack of information about the effect of herbs in oral tissues, mechanism of effect, and side effects. Several popular conventional drugs on the market are derived from herbs. These include aspirin (from white willow bark), digitalis (from foxglove), and sudafed (modelled after a component in the plant ephedra). Herbal products can vary in their potency. Therefore, care must be taken in selecting herbs, even so, herbal medicines have dramatically fewer side effects and are safer to use than conventional medications. The herbs described in this article are Bloodroot, Caraway, Chamomile, Echinacea, Myrrh, Peppermint, Rosemary, Sage, Thyme, Aloe Vera, Propolis, and a summary of other herbs that are useful in dentistry. Herbs may be good alternatives to current treatments for oral health problems but it is clear that we need more research.

Frictional keratoses on the facial attached gingiva are rare clinical findings and do not belong to the category of leukoplakia

PURPOSE

To investigate the clinical and histologic features of frictional keratoses located exclusively on the facial attached gingiva and establish whether these belong to the category of leukoplakia.

MATERIALS AND METHODS

Over a period of 15 years, 159 patients presenting with oral keratotic plaques, located exclusively on the facial attached gingival mucosa, excluding the edentulous alveolar ridge and retromolar pad area, were retrospectively selected. Clinical and histologic features and the symptoms and progression of these lesions were carefully assessed.

RESULTS

The presence of oral frictional keratosis located exclusively on the facial attached gingival mucosa was clinically and immunohistologically diagnosed in 14 of 159 patients (8.8%). Eleven patients (78.5%) showed unilateral involvement, whereas 3 patients (21.5%) had bilateral involvement. The disappearance of the lesions was accomplished in only 9 of 14 patients, resulting from discontinuation of bad habits. Clinically, these lesions appeared as distinct, sharply demarcated, isolated, asymptomatic, homogeneous whitish-plaques that were neither removable nor painful. The plaques did not create discomfort, change shape, or develop into malignancy. Histologically, these plaques showed features superimposable to those present in benign alveolar ridge keratoses.

CONCLUSION

The results highlighted that frictional keratoses on the facial attached gingival mucosa 1) are rare findings, 2) clinically appear as "true leukoplakia" but histologically have the same features as benign alveolar ridge keratoses, 3) have no propensity for malignant transformation, 4) have a good prognosis, and 5) have a specific cause, and resolution is accomplished if the frictional element is eliminated. Thus, these must be removed from the category of leukoplakia.

Dermatologic Manifestations of Complementary Therapy

The dermatologic manifestations of complementary therapy include reactions to herbs used orally and topically for treating skin disease, cutaneous reactions to drugs used orally and topically for treating other diseases, and reactions to alternative interventions. The safety of alternative medicine is in question. Unlike approved drugs, the quality, efficacy, and safety of herbal medicines is not regulated. Herbal medicines may be misidentified and contaminated with a variety of substances. The following review identifies and categorizes therapies according to their common uses with their adverse reactions.

Adulteration of mustard cooking oil with argemone oil: do Indian food regulatory policies and antioxidant therapy both need revisitation?

Consumption of adulterated mustard oil (Brassica nigra) with argemone oil (Argemone mexicana) even for a short duration leads to a clinical condition referred as epidemic dropsy. In humans, argemone oil contained in adulterated mustard oil causes oxidative stress and death of red blood cells via met-hemoglobin formation by altering pyridine nucleotide(s) and glutathione redox potential. Argemone oil contamination poses a serious threat to human health and should be checked by appropriate regulatory measures. Antioxidant therapy provides symptomatic relief and should be seriously considered for therapeutic interventions against argemone oil toxicity.

Survey of medical ethnobotanicals for dental and oral medicine conditions and pathologies

Ethnomedical questionnaires were distributed in Chicago, Costa Rica, and Colombia to identify the most common over-the-counter (OTC) plant or plant-based products advocated for treating oral pain, ulcerative conditions, and cancer within these locations. Over 100 plants or plant-based herbal preparations and commercial products, purchased from local botanical markets and pharmacies, were advocated for the treatment of oral medicine conditions. Locally familiar and common language names were attributed to the plant products at the time of purchase. Plant products or plant-based commercial products containing plant-based essential oils, anesthetic constituents, and or chemical compounds recommended as OTC oral medicine preparations were systematized, tabulated, and correlated with the published phytotherapeutic literature. Though pharmacognostic research is available for some of the species collected, further ethnographic research is needed to correlate common names with the accurate taxonomic identification for each plant species. Furthermore, epidemiological research is needed to verify the use and standardized dosage for OTC ethnomedicine preparations for oral medicine conditions. Pharmacognostic research and clinical trails which can verify taxonomy, dose, safety, active principles, and efficacy of these OTC oral medicine products must be enhanced in order to verify the claimed validity in contemporary, global, oral medicine practice.

The plant alkaloid Sanguinarine affects swine granulosa cell activity

Sanguinarine (SA) has been used in toothpastes and oral rinse products and has been recently applied to livestock nutrition. This study was undertaken to examine the reproductive-related consequences of this feeding supplementation, evaluating SA effects (10, 100 and 300 nM) on swine granulosa cell steroidogenesis, oxidative enzyme activities (peroxidase, catalase and superoxide dismutase), and proliferation. Since angiogenesis is fundamental for follicle development, we also tested the impact of SA exposure on vascular endothelial growth factor (VEGF) production. SA had no effect on proliferation and did not alter progesterone production, although it significantly reduced estradiol synthesis at the two highest concentrations tested (100 and 300 nM). SA addition to granulosa cell culture inhibited VEGF production and increased peroxidase and catalase activities at all tested concentrations while superoxide dismutase activity was increased only at 300 nM. Our data suggest that SA can negatively affect some key biochemical parameters of ovarian granulosa cells.

Investigation of sanguinarine and chelerythrine effects on CYP1A1 expression and activity in human hepatoma cells

Quaternary benzo[c]phenanthridine alkaloids (QBA) sanguinarine and chelerythrine exhibit a wide spectrum of biological activities whence they are used in dental care products. Recent studies indicated that cytochrome P450 CYP1A attenuates sanguinarine toxicity both in vivo [Williams, M.K., Dalvi, S., Dalvi, R.R., 2000. Influence of 3-methylcholanthrene pretreatment on sanguinarine toxicity in mice. Vet. Hum. Toxicol. 42, 196-198] and in vitro [Vrba, J., Kosina, P., Ulrichová, J., Modrianský, M., 2004. Involvement of cytochrome P450 1A in sanguinarine detoxication. Toxicol. Lett. 151, 375-387]. However, CYP1A converts sanguinarine to the products that form DNA adducts [Stiborová, M., Simánek, V., Frei, E., Hobza, P., Ulrichová, J., 2002. DNA adduct formation from quaternary benzo[c]phenanthridine alkaloids sanguinarine and chelerythrine as revealed by the 32P-postlabeling technique. Chem. Biol. Interact. 140, 231-242]. In our work we examined the effects of sanguinarine and chelerythrine on CYP1A1 expression and catalytic activity in human hepatoma cells-HepG2. Sanguinarine and chelerythrine did not affect basal and dioxin-inducible expression of CYP1A1 mRNA and protein in HepG2 cells. The enzymatic activity of CYP1A1 was assessed by the fluorescent measurement of 7-ethyxoresorufin-O-deethylase (EROD) activity. We observed a slight decrease of dioxin-induced EROD activity in HepG2 cells by sanguinarine and chelerythrine. This decrease was attributed to the inhibition of CYP1A1 catalytic activity, as revealed by enzyme kinetic studies on recombinant CYP1A1 protein. The IC50 values for the inhibition of CYP1A1 by sanguinarine and chelerythrine were 2.1 and 1.9muM, respectively. In conclusion, albeit the CYP1A modulates QBA cytotoxicity and genotoxicity, the QBA themselves do not affect CYP1A1 expression. The data indicate that studied alkaloids do not have specific cellular target and their biological effects are rather pleiotropic.

Immunohistochemical assessment of Viadent-associated leukoplakia

Studies show an association between sanguinarine, the active ingredient in Viadent oral health care products, and oral premalignant lesions. The study was undertaken to quantitatively compare the staining profiles of sanguinarine-associated leukoplakia to normal and dysplastic specimens. Archived oral mucosal specimens were stained for tumor markers p16, p53, cyclin D1, Ki-67, and Bcl-x and analyzed through Simple PCI image analysis software. Quantitative analyses showed trends towards intermediate staining in Viadent-related specimens (Ki-67: normal: 18.12+/-2.15, Viadent: 16.12+/-2.16, dysplasia: 14.53+/-2.04, p>0.05; cyclin D1: normal: 15.65+/-3.68, Viadent: 12.52+/-3.57, dysplasia: 1.94+/-3.93, p<0.05; p16: normal: 55.04+/-4.16, Viadent: 49.74+/-4.16, dysplasia: 45.03+/-4.45; p>0.05; p53:normal: 2.65+/-1.37, Viadent: 4.64+/-1.52, dysplasia: 8.71+/-1.37; p<0.05 Kruskal Wallace, Tukey/Kramer). Our Viadent profiles, intermediate between normal and dysplasia, support a preneoplastic nature of this process.

Sanguinarine activates polycyclic aromatic hydrocarbon associated metabolic pathways in human oral keratinocytes and tissues

Sanguinarine's use in human clinical applications is currently controversial. While some studies have demonstrated sanguinarine's anti-inflammatory and anti-oxidant properties, other investigations reported sanguinarine's procarcinogenic effects. Like the tobacco-associated carcinogen, benzo(a)pyrene (B(a)P), sanguinarine is a polycyclic aromatic hydrocarbon (PAH). PAH exposure activates the aryl hydrocarbon transcription activating factor (AhR), resulting in nuclear translocation, binding to the aryl hydrocarbon nuclear translocator (ARNT), which thereby increases expression of a pool of carcinogen metabolizing enzymes. The goal of this study was to investigate whether sanguinarine activates this PAH-associated signaling cascade in human oral cells and tissues. Our results demonstrate that sanguinarine: (i) results in formation of the AhR-ARNT complex, (ii) induces AhR-associated gene expression, (iii) inhibits cytochrome P450 1A1 (CYP 1A1) microsomal oxidative activity and (iv) pretreatment upregulates CYP 1A1 function. Collectively, these data provide evidence that sanguinarine activates PAH-associated signaling and metabolic pathways. Notably, previous studies have demonstrated that mammalian hepatic microsomes metabolize sanguinarine to a mutagenic epoxide. Persons who respond to sanguinarine exposure with induction of primarily Phase I relative to Phase II enzymes are, therefore, at risk for sanguinarine bioactivation and its potential mutagenic effects.

In vivo DNA damaging potential of sanguinarine alkaloid, isolated from argemone oil, using alkaline Comet assay in mice

Consumption of mustard oil contaminated with argemone oil is well known to cause clinical manifestation referred to as "Epidemic Dropsy". Our prior studies have shown that argemone oil produces genotoxic effects in mice [Ansari, K.M., et al., 2004. Int. J. Cancer 112, 890]. Since, sanguinarine alkaloid is the major component of argemone oil, the in vivo DNA damaging potential of the isolated alkaloid was investigated in blood and bone marrow cells of mice using alkaline Comet assay. Swiss albino male mice were given single intraperitoneal administration of 1.35, 2.70, 5.40, 10.80 and 21.60 mg sanguinarine alkaloid/kg b wt., while controls were treated with saline in the same manner. The results revealed a dose dependent increase in DNA damage in blood and bone marrow cells following 24 h treatment of sanguinarine alkaloid. All the three parameters of Comet assay including olive tail moment (OTM), tail length and tail DNA showed significant (p<0.05) increases in blood and bone marrow cells at respective doses of 10.80 and 5.40 mg alkaloid/kg b wt. However, some of the parameters were significantly increased even at lower doses of sanguinarine alkaloid (2.70 mg/kg b wt.). The frequency of cells exhibiting greater DNA damage were found to be increased by sanguinarine alkaloid in a concentration dependent manner. These results indicate that single exposure of sanguinarine alkaloid causes DNA damage in blood and bone marrow cells of mice, which could be responsible for the genotoxicity of argemone oil.

Sanguinarine and chelerythrine: assessment of safety on pigs in ninety days feeding experiment

Sanguinaria canadesis, Chelidonium majus and Macleya cordata have been used for centuries as alternative medicines. Currently the extracts from these medicinal plants are components of veterinary and human phytopreparations, and of oral-hygiene agents. Sanguinarine and chelerythrine (SA/CHE) are biologically active components of these extracts. They display distinct antibacterial and anti-inflammatory properties, but, on the other hand, they have been reported as having adverse effects - genotoxicity and hepatotoxicity. This paper is aimed at evaluation of the effects of daily administration of the extract from Macleya cordata (2 mg and 100 mg in 1 kg feed, sanguinarine:chelerythrine 3:1) in the diet on the health status of swine. After 90-day administration, alkaloids were retained to a different extent in tissues. The highest SA/CHE retention was detected in the gingiva (0.55 microg/g) and liver (0.15 microg/g), no SA/CHE were detected in muscles. Plasma SA levels attained 0.11 microg/ml. Treated animals did not display any results of hematological, biochemical or histological assay different from controls. A (32)P-postlabeling assay proved that no DNA-adducts with SA/CHE were detected in pig livers. We did not observe any symptom linked to epidemic dropsy syndrome often attributed to sanguinarine. In conclusion, an average daily oral dose of alkaloids up to 5 mg per 1 kg animal body weight proved to be safe.