Efficacy and safety of pomegranate medicinal products for cancer

Exploring Bioactive Phytomedicines for Advancing Pulmonary Infection Management: Insights and Future Prospects

Pulmonary infections have a profound influence on global mortality rates. Medicinal plants offer a promising approach to address this challenge, providing nontoxic alternatives with higher levels of public acceptance and compliance, particularly in regions where access to conventional medications or diagnostic resources may be limited. Understanding the pathophysiology of viruses and bacteria enables researchers to identify biomarkers essential for triggering diseases. This knowledge allows the discovery of biological molecules capable of either preventing or alleviating symptoms associated with these infections. In this review, medicinal plants that have an effect on COVID-19, influenza A, bacterial and viral pneumonia, and tuberculosis are discussed. Drug delivery has been briefly discussed as well. It examines the effect of bioactive constituents of these plants and synthesizes findings from in vitro, in vivo, and clinical studies conducted over the past decade. In conclusion, many medicinal plants can be used to treat pulmonary infections, but further in-depth studies are needed as most of the current studies are only at preliminary stages. Extensive investigation and clinical studies are warranted to fully elucidate their mechanisms of action and optimize their use in clinical practice.

Effects of Antioxidant Dietary Supplement Use upon Response to Cancer Treatment: A Scoping Review of Available Evidence

INTRODUCTION

The effects of antioxidant dietary supplements on response to biological therapies for cancer is unknown. We conducted a scoping review of the available systematic review evidence on this question.

METHODS AND ANALYSIS

We searched six databases from inception to August 19, 2022 for systematic reviews of randomized controlled trials of antioxidant dietary supplements used by patients receiving curative chemotherapy, radiotherapy, or other biological therapy for cancer and assessing the impact of supplements on survival, treatment response, or disease progression. We focused on results from reviews at high or moderate AMSTAR-2 quality. Records were selected, data extracted, and AMSTAR-2 ratings assessed independently by two authors.

RESULTS

We found 24 systematic reviews with relevant evidence. Reviews were heterogenous in cancers, treatments, and antioxidant dietary supplements assessed. Conclusions across reviews were mixed, ranging from negative to no apparent difference to positive, but always with caveats about the limited size and quality of the evidence. One review was rated 'moderate' on AMSTAR-2; it included one small trial of vitamin C and formed no firm conclusions.

CONCLUSIONS

We did not find reliable systematic review evidence on the effects of antioxidant dietary supplements upon therapies for cancer. More research is necessary to inform clinical recommendations.

Application of the Extracts of Punica granatum in Oral Cancer: Scoping Review

The Punica granatum L. is an ancient fruit plant native to south-western Asia. It belongs to the Litraceae family and of its genus we have only one other Punica protopunic species. The fruit is rich in polyphenols, whose extract is consumed as a food and is considered safe. In medicine, it is used for its antioxidant properties; it has a rich component of tannic polyphenols among which the most bioactive are: punicalagin (flavonoids) and anthocyanins (delphinidin, cyanidin, pelargonidin), which are found mainly in the skins and in the pericarp; however, all the parts of the Punica granatum are used for therapeutic purposes as anti-inflammatories and analgesics and in diabetes and cardio-vascular disease. Punica granatum extracts also show interesting anticancer activities in influencing tumorgenesis and angiogenesis and cell transformation and proliferation. The purpose of this scoping review is to summarize all the scientific evidence on the possible applications of Punica granatum extracts in the treatment and prevention of oral cavity tumors to investigate the anticancer properties of the active ingredients extracted from Punica granatum. Methods: The scoping review was carried out following the PRISMA-ScR checklist; the search was performed on three databases (Scopus, Science direct and PubMed) and one registry (Cochrane library). Results: The search produced a number of bibliographic sources equal to 11,403; with the removal of duplicates, 670 potentially admissible articles were obtained, from 24 of which only 7 in vitro studies on OSCC cell lines were included. Conclusions: From the preliminary data on the cellular lines of OSCC, it emerges that for oral cancer there are conditions for which the extracts of Punic granatum are effective at least from a prevention perspective.

Novel Insights on Plant Extracts to Prevent and Treat Recurrent Urinary Tract Infections

Urinary tract infections (UTI) represent one of the most widespread infections, and frequent recurrent episodes, induced mostly by uropathogenic Escherichia coli, make them increasingly difficult to treat. Long-term antibiotic therapy is an effective approach to treat recurrent UTI but generates adverse effects, including the emergence of pathogenic strains resistant to the vast majority of antibiotics. These drawbacks have enhanced the interest toward new alternatives based on plant extracts to prevent and treat recurrent UTI, especially in a synergistic antibiotic approach. Therefore, this review highlights the potential of some medicinal plants to be used in the management of recurrent UTI, including plants that have been approved for the treatment of urinary infections and promising, but less studied, plant candidates with proven anti-uropathogenic activity. Pomegranate (Punica granatum L.), black chokeberry (Aronia melanocarpa Michx.), and cornelian cherry (Cornus mas L.) have great potential to be used for prevention or in a combined antibiotic therapy to cure UTI, but more studies and clinical trials in specific population groups are required. Further progress in developing plant-based products to cure rUTI will be supported by advances in UTI pathogenesis and human-based models for a better understanding of their pharmacological activities.

Antiproliferative effects of Turkish pomegranate (Punica granatum L.) extracts on MCF-7 human breast cancer cell lines with focus on antioxidant potential and bioactive compounds analyzed by LC-MS/MS

In this study, eight different pomegranate (Punica granatum L.) cultivars from Turkey were evaluated for their antioxidant and cytotoxic effects on the MCF-7 breast cancer cell lines and MCF-10A breast fibrocystic epithelial cell lines with a focus on their chemical compositions by LC-MS/MS. Cell lines were treated with pomegranate juice extracts in different doses at selected time intervals (24th, 48th, and 72nd hour). Afterwards, WST-1 cell proliferation assay was performed to investigate the cytotoxicity of the extracts. Accordingly, all extracts decreased the cell viability of MCF-7 breast cancer cell lines and had no cytotoxic effect on the cell viability of MCF-10A cell lines. Among eight extracts, P7 (Izmir 1513), which was rich in anthocyanins such as cyanidin chloride (69.76 ± 8.02 μg/g extract), cyanidin-3-O-glucoside (903.66 ± 101.89 μg/g extract), and punicalagin (992.09 ± 174.53 μg/g extract), was found to demonstrate the strongest cytotoxic activity on MCF-7 breast cancer cell lines by decreasing the cell viability in half at 24th hour with an IC₅₀ value of 49.08 µg/ml. PRACTICAL APPLICATIONS: Eight commercially valuable pomegranate (Punica granatum) cultivars from Turkey were examined. Pelargonidin, cyanidin, cyanidin-3-O-gl, callistephin, and delphinidin-3-O-gl were quantified. Two cultivars (P1 and P3) showed comparatively higher antioxidant effects. A cultivar (P7) showed strongest cytotoxic activity against MCF-7 breast cancer cell line. The cultivars have potential to be used as natural antioxidant and anticancer agents.

Pomegranate Extract (POMx) Induces Mitochondrial Dysfunction and Apoptosis of Oral Cancer Cells

The anticancer effect of pomegranate polyphenolic extract POMx in oral cancer cells has rarely been explored, especially where its impact on mitochondrial functioning is concerned. Here, we attempt to evaluate the proliferation modulating function and mechanism of POMx against human oral cancer (Ca9-22, HSC-3, and OC-2) cells. POMx induced ATP depletion, subG1 accumulation, and annexin V/Western blotting-detected apoptosis in these three oral cancer cell lines but showed no toxicity to normal oral cell lines (HGF-1). POMx triggered mitochondrial membrane potential (MitoMP) disruption and mitochondrial superoxide (MitoSOX) generation associated with the differential downregulation of several antioxidant gene mRNA/protein expressions in oral cancer cells. POMx downregulated mitochondrial mass, mitochondrial DNA copy number, and mitochondrial biogenesis gene mRNA/protein expression in oral cancer cells. Moreover, POMx induced both PCR-based mitochondrial DNA damage and γH2AX-detected nuclear DNA damage in oral cancer cells. In conclusion, POMx provides antiproliferation and apoptosis of oral cancer cells through mechanisms of mitochondrial impairment.

Optimization of the Vacuum Microwave Assisted Extraction of the Natural Polyphenols and Flavonoids from the Raw Solid Waste of the Pomegranate Juice Producing Industry at Industrial Scale

Pomegranate pomace (PP) is the solid waste produced in bulk by the pomegranate juice industry which is rich in polyphenols and flavonoids that can replace the hazardous chemical antioxidants/antimicrobials currently used in the agro-food and cosmetics sectors. In the present work, the vacuum microwave assisted extraction (VMAE) of natural antioxidants from raw pomegranate pomace was investigated and successfully optimized at an industrial scale. For the optimization of PP VMAE a novel, highly accurate response surface methodology (RSM) based on a comprehensive multi-point historical design was employed. The optimization showed that the maximum recovery of PP total polyphenols as well as total PP flavonoids were obtained at microwave power = 4961.07 W, water to pomace ratio = 29.9, extraction time = 119.53 min and microwave power = 4147.76 W, water to pomace ratio = 19.32, extraction time = 63.32 min respectively. Moreover, the optimal VMAE conditions on economic grounds were determined to be: microwave power = 2048.62 W, water to pomace ratio = 23.11, extraction time = 15.04 min and microwave power = 4008.62 W, water to pomace ratio = 18.08, extraction time = 15.29 min for PP total polyphenols and PP total flavonoids respectively. The main conclusion of this study is that the VMAE extraction can be successfully used at industrial scale to produce, in economic manner, high added value natural extracts from PP pomace.

Role of ellagic acid for the prevention and treatment of liver diseases

Globally, one of the alarming problems is the prevalence and burden of liver diseases, which accounts for 2 million cases per year. Chronic liver aetiologies such as hepatitis infections, alcoholic or non-alcoholic liver disease, environmental agents, and drug-induced toxicity are invariably responsible for liver fibrosis progression to finally hepatocellular carcinoma. Current treatment options are unable to overwhelm and cure liver diseases. Emerging findings suggest researchers' interest in using evidence-based complementary medicine such as ellagic acid with extensive pharmacological properties. They include antioxidant, anti-inflammatory, anti-hyperlipidaemic, anti-viral, anti-angiogenic, and anticancer activity. The molecular functions elicited by ellagic acid include scavenging of free radicals, regulation of lipid metabolism, the prohibition of fibrogenesis response-mediating proteins, inhibits hepatic stellate cells and myofibroblasts, restrains hepatic viral replication, facilitates suppression of growth factors, regulates transcription factors, proinflammatory cytokines, augments the liver immune response, fosters apoptosis and inhibits cell proliferation in tumorigenic cells. This review will most notably focus on preclinical and clinical information based on currently available evidence to warrant ellagic acid's prospective role in preventing liver diseases.

Pomegranate extract inhibits migration and invasion of oral cancer cells by downregulating matrix metalloproteinase-2/9 and epithelial-mesenchymal transition

Discovering drug candidates for the modulation of metastasis is of great importance in inhibiting oral cancer malignancy. Although most pomegranate extract applications aim at the antiproliferation of cancer cells, its antimetastatic effects remain unclear, especially for oral cancer cells. The aim of this study is to evaluate the change of two main metastasis characters, migration and invasion of oral cancer cells. Further, we want to explore the molecular mechanisms of action of pomegranate extract (POMx) at low cytotoxic concentration. We found that POMx ranged from 0 to 50 μg/mL showing low cytotoxicity to oral cancer cells. In the case of oral cancer HSC-3 and Ca9-22 cells, POMx inhibits wound healing migration, transwell migration, and matrix gel invasion. Mechanistically, POMx downregulates matrix metalloproteinase (MMP)-2 and MMP-9 activities and expressions as well as epithelial-mesenchymal transition (EMT) signaling. POMx upregulates extracellular signal-regulated kinases 1/2 (ERK1/2), but not c-Jun N-terminal kinase (JNK) and p38 expression. Addition of ERK1/2 inhibitor (PD98059) significantly recovered the POMx-suppressed transwell migration and MMP-2/-9 activities in HSC-3 cells. Taken together, these findings suggest to further test low cytotoxic concentrations of POMx as a potential antimetastatic therapy against oral cancer cells.

Fruits

Fruits come in a wide variety of colors, shapes, and flavors. This chapter will cover selected fruits that are known to be healthy and highly nutritious. These fruits were chosen due to their common usage and availability. Since it is not possible to cover all health benefits or essential nutrients and important phytochemicals of the fruit composition, this chapter will focus on the key valuable constituents and their potential health effects.

Polyphenols from Food and Natural Products: Neuroprotection and Safety

Polyphenols are naturally occurring micronutrients that are present in many food sources. Besides being potent antioxidants, these molecules may also possess anti-inflammatory properties. Many studies have highlighted their potential role in the prevention and treatment of various pathological conditions connected to oxidative stress and inflammation (e.g., cancer, and cardiovascular and neurodegenerative disorders). Neurodegenerative diseases are globally one of the main causes of death and represent an enormous burden in terms of human suffering, social distress, and economic costs. Recent data expanded on the initial antioxidant-based mechanism of polyphenols’ action by showing that they are also able to modulate several cell-signaling pathways and mediators. The proposed benefits of polyphenols, either as protective/prophylactic substances or as therapeutic molecules, may be achieved by the consumption of a natural polyphenol-enriched diet, by their use as food supplements, or with formulations as pharmaceutical drugs/nutraceuticals. It has also been proved that the health effects of polyphenols depend on the consumed amount and their bioavailability. However, their overconsumption may raise safety concerns due to the accumulation of high levels of these molecules in the organism, particularly if we consider the loose regulatory legislation regarding the commercialization and use of food supplements. This review addresses the main beneficial effects of food polyphenols, and focuses on neuroprotection and the safety issues related to overconsumption.

Impact of Punicalagin on the Physicochemical and Structural Properties of Wheat Flour Dough

The study explored punicalagin (PGN) as a wheat flour enhancer. The impact of PGN on the physicochemical and structural properties of wheat flour have been investigated. It turned out that PGN increased the formation time, stability, tensile resistance, extension, and viscoelasticity of the dough at the concentrations of 0.13 and 0.26 mg/g. Scan electron microscope images of the cross section of the dough displayed a more compact and ordered network structure with the addition of 0.13 and 0.26 mg/g PGN. Fourier transform infrared spectroscopy spectra indicated an increase of α-helix and β-sheet content. However, nonlinear enhancing effects of PGN on the stretching properties, rheology, and structural properties of the dough were observed at concentrations of 0.39 and 0.52 mg/g. Correspondingly, cleavages were observed on the cross section of the dough and the content of β-sheet showed a trend of reduction in the dough with addition of PGN at high concentrations. Taken together, these results indicated the potential usage of PGN as a wheat flour enhancer of natural origin at the concentration below 0.39 mg/g in the flour.

Experimental Evidence of the Antitumor, Antimetastatic and Antiangiogenic Activity of Ellagic Acid

Ellagic acid (EA) is a naturally occurring polyphenolic compound endowed with strong antioxidant and anticancer properties that is present in high quantity in a variety of berries, pomegranates, and dried fruits. The antitumor activity of EA has been mostly attributed to direct antiproliferative and apoptotic effects. Moreover, EA can inhibit tumour cell migration, extra-cellular matrix invasion and angiogenesis, all processes that are crucial for tumour infiltrative behaviour and the metastatic process. In addition, EA may increase tumour sensitivity to chemotherapy and radiotherapy. The aim of this review is to summarize the in vitro and in vivo experimental evidence supporting the anticancer activity of pure EA, its metabolites, and EA-containing fruit juice or extracts in a variety of solid tumour models. The EA oral administration as supportive therapy to standard chemotherapy has been recently evaluated in small clinical studies with colorectal or prostate cancer patients. Novel formulations with improved solubility and bioavailability are expected to fully develop the therapeutic potential of EA derivatives in the near future.

The effects of urolithins on the response of prostate cancer cells to non-steroidal antiandrogen bicalutamide

BACKGROUND

Urolithins are bioavailable products of gut microbiota metabolism of ellagitannins. Their biological activity includes anti-cancer effects.

PURPOSE

The aim of this study was to explore the effects of urolithins on prostate cancer cells and activity of clinically used anti-androgen, bicalutamide.

METHODS

Prostate cancer cells were treated with urolithin A, urolithin B, urolithin C or their combinations with bicalutamide. Cell proliferation was determined by DNA fluorescence with Hoechst 33258. The combination index method was used to examine interactions. Apoptosis and androgen receptor (AR) localization were analysed by flow cytometry. Prostate specific antigen (PSA) secretion was measured by ELISA.

RESULTS

Urolithins inhibited proliferation of LNCaP prostate cancer cells. The mixtures of bicalutamide with uroA and uroB had additive anti-proliferative effect. All tested urolithins induced apoptosis of LNCaP cells. However, the combinations of bicalutamide with urolithin A and urolithin B had attenuated pro-apoptotic activity. UroA and uroC decreased DHT-induced PSA secretion. In contrast, uroB impaired PSA lowering effect of bicalutamide. UroA, individually and in combination with bicalutamide, promoted cytoplasmic localization of AR.

CONCLUSION

Urolithins might contribute to chemopreventive activity of ellagitannin rich preparations. Our results support use of ellagitannin rich preparations in prostate cancer chemoprevention, but advise caution in their potential use in complementary therapy of prostate cancer. The differences in activity profiles of urolithins indicate that possible health benefits and interactions will depend on the type of produced ellagitannins metabolite.

Anti-cancer effects of naturally derived compounds targeting histone deacetylase 6-related pathways

Alterations of the epigenetic machinery, affecting multiple biological functions, represent a major hallmark enabling the development of tumors. Among epigenetic regulatory proteins, histone deacetylase (HDAC)6 has emerged as an interesting potential therapeutic target towards a variety of diseases including cancer. Accordingly, this isoenzyme regulates many vital cellular regulatory processes and pathways essential to physiological homeostasis, as well as tumor multistep transformation involving initiation, promotion, progression and metastasis. In this review, we will consequently discuss the critical implications of HDAC6 in distinct mechanisms relevant to physiological and cancerous conditions, as well as the anticancer properties of synthetic, natural and natural-derived compounds through the modulation of HDAC6-related pathways.

A simple method for calculation of basic molecular properties of nutrients and their use as a criterion for a healthy diet

Background: Healthy nutrition is vital for good health and well-being. Despite the important role of a healthy nutritional diet, recommendations for healthy eating remain elusive and are mainly based on general properties of nutrients. The present study proposes an improved characterization of the molecular characteristics of nutrients, which are important for biological functions and can be useful in describing a healthy diet. Methods: We investigated the electronic properties of some known nutrient ingredients. In this analysis, we used the average quasi valence number (AQVN) and the electron-ion interaction potential (EIIP), which are molecular descriptors that represent the basic electronic properties of organic molecules.   Results: Our results show that most nutrients can be represented by specific groups of organic compounds according to their basic electronic properties, and these differ from the vast majority of known chemicals. Based on this finding, we have proposed a simple criterion for the selection of food components for healthy nutrition. Discussion: Further studies on the electronic properties of nutrients could serve as a basis for better understanding of their biological functions.

Anti-Inflammatory Mechanism Involved in Pomegranate-Mediated Prevention of Breast Cancer: the Role of NF-κB and Nrf2 Signaling Pathways

Pomegranate (Punica granatum L.), a nutrient-rich unique fruit, has been used for centuries for the prevention and treatment of various inflammation-driven diseases. Based on our previous study, a characterized pomegranate emulsion (PE) exhibited a striking inhibition of dimethylbenz(a)anthracene (DMBA)-initiated rat mammary tumorigenesis via antiproliferative and apoptosis-inducing mechanisms. The objective of the present work is to investigate the anti-inflammatory mechanism of action of PE during DMBA rat mammary carcinogenesis by evaluating the expression of cyclooxygenase-2 (COX-2), heat shock protein 90 (HSP90), nuclear factor-κB (NF-κB) and nuclear factor erythroid 2p45 (NF-E2)-related factor 2 (Nrf2). Mammary tumor samples were harvested from our previous chemopreventive study in which PE (0.2–5.0 g/kg) was found to reduce mammary tumorigenesis in a dose-dependent manner. The expressions of COX-2, HSP90, NF-κB, inhibitory κBα (IκBα) and Nrf2 were detected by immunohistochemical techniques. PE decreased the expression of COX-2 and HSP90, prevented the degradation of IκBα, hindered the translocation of NF-κB from cytosol to nucleus and increased the expression and nuclear translocation of Nrf2 during DMBA-induced mammary tumorigenesis. These findings, together with our previous results, indicate that PE-mediated prevention of DMBA-evoked mammary carcinogenesis may involve anti-inflammatory mechanisms through concurrent but differential regulation of two interrelated molecular pathways, namely NF-κB and Nrf2 signaling.

Ellagic Acid Inhibits Bladder Cancer Invasiveness and In Vivo Tumor Growth

Ellagic acid (EA) is a polyphenolic compound that can be found as a naturally occurring hydrolysis product of ellagitannins in pomegranates, berries, grapes, green tea and nuts. Previous studies have reported the antitumor properties of EA mainly using in vitro models. No data are available about EA influence on bladder cancer cell invasion of the extracellular matrix triggered by vascular endothelial growth factor-A (VEGF-A), an angiogenic factor associated with disease progression and recurrence, and tumor growth in vivo. In this study, we have investigated EA activity against four different human bladder cancer cell lines (i.e., T24, UM-UC-3, 5637 and HT-1376) by in vitro proliferation tests (measuring metabolic and foci forming activity), invasion and chemotactic assays in response to VEGF-A and in vivo preclinical models in nude mice. Results indicate that EA exerts anti-proliferative effects as a single agent and enhances the antitumor activity of mitomycin C, which is commonly used for the treatment of bladder cancer. EA also inhibits tumor invasion and chemotaxis, specifically induced by VEGF-A, and reduces VEGFR-2 expression. Moreover, EA down-regulates the expression of programmed cell death ligand 1 (PD-L1), an immune checkpoint involved in immune escape. EA in vitro activity was confirmed by the results of in vivo studies showing a significant reduction of the growth rate, infiltrative behavior and tumor-associated angiogenesis of human bladder cancer xenografts. In conclusion, these results suggest that EA may have a potential role as an adjunct therapy for bladder cancer.

New Challenges for the Design of High Value Plant Products: Stabilization of Anthocyanins in Plant Vacuoles

In the last decade plant biotechnologists and breeders have made several attempt to improve the antioxidant content of plant-derived food. Most efforts concentrated on increasing the synthesis of antioxidants, in particular anthocyanins, by inducing the transcription of genes encoding the synthesizing enzymes. We present here an overview of economically interesting plant species, both food crops and ornamentals, in which anthocyanin content was improved by traditional breeding or transgenesis. Old genetic studies in petunia and more recent biochemical work in brunfelsia, have shown that after synthesis and compartmentalization in the vacuole, anthocyanins need to be stabilized to preserve the color of the plant tissue over time. The final yield of antioxidant molecules is the result of the balance between synthesis and degradation. Therefore the understanding of the mechanism that determine molecule stabilization in the vacuolar lumen is the next step that needs to be taken to further improve the anthocyanin content in food. In several species a phenomenon known as fading is responsible for the disappearance of pigmentation which in some case can be nearly complete. We discuss the present knowledge about the genetic and biochemical factors involved in pigment preservation/destabilization in plant cells. The improvement of our understanding of the fading process will supply new tools for both biotechnological approaches and marker-assisted breeding.

The Effects of Ellagic Acid upon Brain Cells: A Mechanistic View and Future Directions

Ellagic acid (EA, 2,3,7,8-tetrahydroxy-chromeno; C14H6O8) is a polyphenol derived from fruits (pomegranates, berries) and nuts. EA exhibits antioxidant capacity and induces anti-inflammatory actions in several mammalian tissues. EA has been characterized as a possible neuroprotective agent, but the number of reports is still limited to conclude whether and how EA exerts neuroprotection in humans. In this regard, performing additional studies considering the potential beneficial and/or toxicological roles for EA on brain cells would be an important step towards fully understanding of when and how EA may be securely utilized by humans as a neuroprotective agent. The aim of the present work is to discuss data related to the neuronal and glial effects of EA and the mechanisms underlying such events. Moreover, future directions are suggested as a potential guide to be utilized by researchers interested in investigating the neuronal and glial actions of EA hereafter.

Safety of a Bioactive Polyphenol Dietary Supplement in Pediatric Subjects with Acute Diarrhoea

The hematological and clinical chemistry profile for children aged 6 months to 5 years with acute diarrhoea was measured in a double blind clinical trial. Subjects were randomized to the study group (N = 44) given a bioactive polyphenol dietary supplement in oral rehydration solution (ORS) or to the control group (N = 41) given distilled water as a placebo in ORS twice daily for up to 4 days. All subjects received 10 mg zinc daily for the 4 days in the study. Venous blood was collected for complete blood count, electrolytes, liver function, and creatinine upon enrollment (baseline) and at the end of 4 days (end of study); mean values were compared by 95% confidence intervals. Overall, blood factors measured either remained the same over the 4 days or increased or decreased at the same levels between the two groups during the study period. All values were within accepted ranges for paediatric subjects except serum AST (SGOT), where the mean value of the study group approached the upper bound of the range on day 4 but was comparable to the value of the control group. Consumption of this supplement twice daily for 4 days is safe for children and infants.