Mistletoe as a treatment for cancer

The future of chemical pleurodesis: A review of novel and investigational sclerosant agents

Chemical pleurodesis is a technique in which an injurious and inflammatory substance is instilled into the pleural cavity to cause adhesion and fibrosis. It is commonly used in the management of recurrent malignant pleural effusions. Historically, many different types of sclerosants have been described, though only a few, including talc, the tetracycline derivatives, and anti-septic compounds such as silver nitrate and iodopovidone, have found their way into mainstream use. However, over the past several years, there has been increasing interest in alternative pleurodesis agents. In this review, we will explore future directions in the field, with an eye toward novel and investigational agents.

Mistletoe extracts for cancer treatment

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To assess the effects of mistletoe extracts (Viscum album , European mistletoe) as antitumour treatment and for supportive/palliative care in adults with cancer. We will assess whether mistletoe extracts administered alone or in combination with tumour‐specific therapies prolong progression free‐intervals (PFI) and/or overall survival (OS); enhance tumour response; alleviate treatment‐related adverse effects from conventional cancer treatment e.g. chemo‐ or radiotherapy; improve patient‐reported outcomes including health‐related QOL; and whether mistletoe extracts produce adverse effects.

Assessment of Antidiabetic Potential and Phytochemical Profiling of Viscum album, a Traditional Antidiabetic Plant

The traditional antidiabetic plant Viscum album (V. album) was collected from the oak plant in the wild at Maidan, Khyber District, of Pakistan, for assessment of its antidiabetic potential and phytochemical profile. Lowering of blood glucose level, antioxidant effect, lipids profile, liver function marker enzymes, and kidney function markers were evaluated in extract and glibenclamide treated groups, in normal as well as in diabetic control groups. An elevated level of blood glucose level, lipids (Cholesterol, TG, LDL), liver function marker enzymes (ALT, AST, ALP), and kidney function markers (bilirubin, creatinine, urea) were observed in alloxan-induced diabetic rats; however, a HDL level was decreased. Administration of V. album hydroalcoholic extract for 28 days renovated significantly ( $p<0.05$ ) all the above biochemical parameters. The antioxidant enzymes SOD, CAT, and GPX were also considerably restored. In vitro, antioxidant assay indicated that the extract of 2,000 µg/mL scavenges free radicals of DPPH 68.4%, ABTS 69.5%, and H2O2 50.6%. The extracts revealed the presence of saponins, flavonoids, alkaloids, terpene, tannins, phenols, protein, amino acids, sterols, and glycosides. The extract has shown phenolic contents 421 ± 4.8 mg GAE/100 g d. w and flavonoids content 127 ± 1.4 mg equiv. Rut/100 g d. w. The findings of this research recommend V. album could be a potent source of natural antidiabetic constituents.

Mistletoe viscin: a hygro- and mechano-responsive cellulose-based adhesive for diverse material applications

Mistletoe viscin is a natural cellulosic adhesive consisting of hierarchically organized cellulose microfibrils (CMFs) surrounded by a humidity-responsive matrix that enables mechanical drawing into stiff and sticky fibers. Here, we explored the processability and adhesive capacity of viscin and demonstrated its potential as a source material for various material applications, as well as a source for bioinspired design. Specifically, we revealed that viscin fibers exhibit humidity-activated self-adhesive properties that enable "contact welding" into complex 2D and 3D architectures under ambient conditions. We additionally discovered that viscin can be processed into stiff and transparent free-standing films via biaxial stretching in the hydrated state, followed by drying, whereby CMFs align along local stress fields. Furthermore, we determined that viscin adheres strongly to both synthetic materials (metals, plastics, and glass) and biological tissues, such as skin and cartilage. In particular, skin adhesion makes viscin a compelling candidate as a wound sealant, as we further demonstrate. These findings highlight the enormous potential of this hygro- and mechano-responsive fiber-reinforced adhesive for bioinspired and biomedical applications.

Anthroposophic Medicine: A Short Monograph and Narrative Review-Foundations, Essential Characteristics, Scientific Basis, Safety, Effectiveness and Misconceptions

INTRODUCTION

Anthroposophic medicine is a form of integrative medicine that originated in Europe but is not well known in the US. It is comprehensive and heterogenous in scope and remains provocative and controversial in many academic circles. Assessment of the nature and potential contribution of anthroposophic medicine to whole person care and global health seems appropriate.

METHODS

Because of the heterogenous and multifaceted character of anthroposophic medicine, a narrative review format was chosen. A Health Technology Assessment of anthroposophic medicine in 2006 was reviewed and used as a starting point. A Medline search from 2006 to July 2020 was performed using various search terms and restricted to English. Books, articles, reviews and websites were assessed for clinical relevance and interest to the general reader. Abstracts of German language articles were reviewed when available. Reference lists of articles and the author's personal references were also consulted.

RESULTS

The literature on anthroposophic medicine is vast, providing new ways of thinking, a holistic view of the world, and many integrating concepts useful in medicine. In the last ∼20 years there has been a growing research base and implementation of many anthroposophical concepts in the integrated care of patients. Books and articles relevant to describing the foundations, scientific status, safety, effectiveness and criticisms of anthroposophic medicine are discussed.

DISCUSSION

An objective and comprehensive analysis of anthroposophic medicine finds it provocative, stimulating and potentially fruitful as an integrative system for whole person care, including under-recognized life processes and psychospiritual aspects of human beings. It has a legitimate, new type of scientific status as well as documented safety and effectiveness in some areas of its multimodal approach. Criticisms and controversies of anthroposophic medicine are often a result of lack of familiarity with its methods and approach and/or come from historically fixed ideas of what constitutes legitimate science.

Metabolic and toxicological considerations of botanicals in anticancer therapy

INTRODUCTION

Cancer is a complex disease, characterized by redundant aberrant signaling pathways as a result of genetic perturbations at different levels. Botanicals consist of a complex mixture of constituents and exhibit pharmacological effects by the interaction of many phytochemicals. The multitarget nature of botanicals could, therefore, be a relevant strategy to address the biological complexity that characterizes tumors.

AREAS COVERED

This article reviews the current status of botanicals in the oncological field and the challenges associated with their complex nature.

EXPERT OPINION

Botanicals are an important new pharmacological strategy, which are potentially exploitable in the oncological area but are characterized by a number of problems still unresolved. Content variation of products is one of the primary problems with botanicals and, consequently, there is a concern about the therapeutic consistency in marketed batches. Furthermore, metabolic interactions with antineoplastic drugs and the genotoxic potential of botanicals need to be properly addressed throughout the various phases of botanical drug development. These issues not only pose a serious problem to the approvability of those botanical products as new drugs but also present as a limitation to their post-approval clinical use.

Mistletoe therapy in oncology

BACKGROUND

Mistletoe extracts are commonly used in cancer patients. It is claimed that they improve survival and quality of life (QOL) in cancer patients.

OBJECTIVES

To determine the effectiveness, tolerability and safety of mistletoe extracts given either as monotherapy or adjunct therapy for patients with cancer.

SEARCH STRATEGY

Search sources included the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2007) Cochrane Complementary Medicine Field Registry of randomized clinical trials (RCTs) and controlled clinical trials, MEDLINE, EMBASE, HEALTHSTAR, INT. HEALTH TECHNOLOGY ASSESSMENT, SOMED, AMED, BIOETHICSLINE, BIOSIS, CancerLit, CATLINE, CISCOM (August 2007). For the search the Standard Operating Procedures of the Information System in Health Economics at the German Institute for Medical Documentation and Information (DIMDI) were utilized. Reference lists of relevant articles and authors extensive files were searched for additional studies. Manufacturers of mistletoe preparations were contacted.

SELECTION CRITERIA

We included RCTs of adults with cancer of any type. The interventions were mistletoe extracts as sole treatments or given concomitantly with chemo- or radiotherapy. The outcome measures were survival times, tumor response, QOL, psychological distress, adverse effects from antineoplastic treatment and safety of mistletoe extracts.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed trials for inclusion in the review. All review authors independently took part in the extraction of data and assessment of study quality and clinical relevance. Disagreements were resolved by consensus. Study authors were contacted where information was unclear. Methodological quality was narratively described and additionally assessed with the Delphi list and the Jadad score. High methodological quality was defined if six out of nine Delphi criteria, or four out of five Jadad criteria were fulfilled. Results were presented qualitatively.

MAIN RESULTS

Eighty studies were identified. Fifty-eight were excluded for various reasons, usually as there was no prospective trial design with randomised treatment allocation. Of the 21 included studies 13 provided data on survival, 7 on tumour response, 16 on measures of QOL or psychological outcomes, or prevalence of chemotherapy-related adverse effects and 12 on side effects of mistletoe treatment; overall comprising 3484 randomised cancer patients. Interventions evaluated were 5 preparations of mistletoe extracts from 5 manufacturers and one commercially not available preparation. The general reporting of RCTs was poor. Of the 13 trials investigating survival, 6 showed some evidence of a benefit, but none of them was of high methodological quality. The results of two trials in patients with melanoma and head and neck cancer gave some evidence that the used mistletoe extracts are not effective for improving survival. Of the 16 trials investigating the efficacy of mistletoe extracts for either improving QOL, psychological measures, performance index, symptom scales or the reduction of adverse effects of chemotherapy, 14 showed some evidence of a benefit, but only 2 of them including breast cancer patients during chemotherapy were of higher methodological quality. Data on side effects indicated that, depending on the dose, mistletoe extracts were usually well tolerated and had few side effects.

AUTHORS' CONCLUSIONS

The evidence from RCTs to support the view that the application of mistletoe extracts has impact on survival or leads to an improved ability to fight cancer or to withstand anticancer treatments is weak. Nevertheless, there is some evidence that mistletoe extracts may offer benefits on measures of QOL during chemotherapy for breast cancer, but these results need replication. Overall, more high quality, independent clinical research is needed to truly assess the safety and effectiveness of mistletoe extracts. Patients receiving mistletoe therapy should be encouraged to take part in future trails.