Health Care Professional Information

Common Name

Inorganic: Germanium dioxide, germanium-lactate-citrate (Ge-lac-cit) Organic: Spirogermanium, Bis-2-Carboxyethyl Germanium Sesquioxide (Ge-132, Germanium sesquioxide, CEGS, SK-818)

Brand Name
  • Vitamin “O”
  • Pro-oxygen
  • Oxy-G2
Clinical Summary

Germanium is a naturally occurring mineral that is used in the manufacturing of electronics and optical equipments. Whereas trace amounts can be found in some foods, it is not thought to be essential for normal body functions. But inorganic and organic germanium products, which have different biological activities, have been promoted to treat wide range of diseases, including cancer and AIDS.

Germanium compounds have immunomodulating and antioxidant activities (9) (10) (11) (12) (13) (14). Spirogermanium, an azaspiran compound, was investigated as an anticancer drug. Severe renal, hepatic, myelogenous, and neurologic toxicities have been reported (2) (3) (6) (7) (15). Germanium sesquioxide (Ge-132), an organic compound that is supposed to have lower toxicities, has been marketed as a dietary supplement to help fight cancers. In a single case study, tumor remission was reported following oral supplementation (17). However, there is no conclusive evidence showing this compound is an effective cancer treatment. A phase II clinical trial of germanium in reducing radiation-induced fatigue in cancer patients is underway (18).

There are concerns of contamination of germanium products by the toxic inorganic germanium dioxide. The FDA has issued warning letters to marketers of germanium about unsubstantiated claims. Importation of germanium for human consumption is not allowed (19) (20) (21).

Food Sources

Shiitake mushrooms, garlic, tuna, pan fish, tomato juice
(2)

Purported Uses
  • Arthritis
  • Cancer treatment
  • Health maintenance
  • HIV and AIDS
Mechanism of Action

The atomic structure of germanium allows it to act as a free-radical scavenger (1). Spirogermanium has been shown to inhibit DNA and RNA synthesis in HeLa cells (2). Germanium sesquioxide enhances the activities of macrophage and T-cells (22) and stimulates the production of gamma interferon (23). Inorganic germanium dioxide enhances cellular radiosensitivity (24).

Pharmacokinetics

Absorption:
Oral administration of germanium dioxide (GeO2) to rats demonstrates approximately 95% bioavailability. Organic radiolabeled germanium (Ge-132) has repeatedly been shown to have 30% bioavailability in humans and animal models.
Distribution:
Extensive throughout body, but detectable levels in tissue vary based on dose and frequency of administration. Also detected in blood, lung, and spleen with preferential accumulation in liver and kidneys.
Elimination:
Excreted primarily by the kidneys.
(3)

Warnings

Germanium supplements should not be consumed because they can cause renal, hepatic, and neurotoxicities. Although studies in animals revealed low potential for toxicity (25), low-dose chronic toxicity has been demonstrated repeatedly. Renal toxicity is characterized by vacuolar degeneration in renal tubular epithelial cells, without proteinuria or hematuria, in the absence of glomerular changes (2) (7).

Adverse Reactions

Common: Weight loss, fatigue, nausea, vomiting, anorexia, anemia, muscle weakness, paresthesias, and sensory ataxia (1).
Rare: Chronic renal failure, elevated liver enzymes, hepatic steatosis, peripheral neuropathies, cerebellar ataxia, and bone marrow hypoplasia (4) (5) (6).

Herb-Drug Interactions

Theoretically, may have additive toxicity with other drugs known to cause renal (e.g. aminoglycosides), hepato- or neurotoxicity (e.g. taxanes), and myelosuppression.

Literature Summary and Critique

Many clinical trials evaluating spirogermanium for various cancers were conducted in the early 1980s. A significant incidence of renal, hepatic, and neurological toxicity was documented.

Dosage (Inside MSKCC Only)
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References
  1. Goodman S. Therapeutic effects of organic germanium. Med Hypotheses 1988;26:207-15.
  2. Schauss AG. Nephrotoxicity and neurotoxicity in humans from organogermanium compounds and germanium dioxide. Biol Trace Elem Res 1991;29:267-79.
  3. Tao SH, Bolger PM. Hazard assessment of germanium supplements. Regul Toxicol Pharmacol 1997;25:211-9.
  4. Asaka T, et al. Germanium intoxication with sensory ataxia. J Neurol Sci 1995;130:220-3.
  5. van der Spoel JI. Dangers of dietary germanium supplements. Lancet 1990;336:117.
  6. Krapf R, Schaffner T, Iten PX. Abuse of germanium associated with fatal lactic acidosis. Nephron 1992;62:351-6.
  7. Boros L, et al. Phase II Eastern Cooperative Oncology Group study of spirogermanium in previously treated lymphoma. Cancer Treat Rep 1986;70:917-8.
  8. Woolley PV, et al. A phase I trial of spirogermanium administered on a continuous infusion schedule. Invest New Drugs 1984;2:305-9.
  9. Kopf-Maier, P. Complexes of metals other than platinum as antitumor agents. Eur J Clin Pharmacol. 1994;47:1-16.
  10. Dhingra HM, Umsawasdi T, Chiuten DF, et al. Phase II study of spirogermanium in advanced (extensive) non-small cell lung cancer. Cancer Treat Rep. 1986;70:673-674.
  11. Kuebler JP, Tormey DC, Harper GR, et al. Phase II study of spirogermanium in advanced breast cancer. Cancer Treat Rep. 1984;68:1515-1516.
  12. Schulman P, Davis RB, Ralfa S, et al. Phase II trial of spirogermanium in advanced renal cell carcinoma: a Cancer and Leukemia Group B study. Cancer Treat Rep. 1984;68:1305-1306.
  13. Dexeus FH, Logothetis C, Samuels ML, et al. Phase II study of spirogermanium in metastatic prostate cancer.Cancer Treat Rep. 1986;70:1129-1130.
  14. Vogelzang NJ, Gesme DH, Kennedy BJ. A phase II study of spirogermanium in advanced human malignancy.Am J Clin Oncol. 1985;8:341-344.
  15. Lück BE, Mann H, Melzer H, Dunemann L, Begerow J. Renal and other organ failure caused by germanium intoxication. Nephrol Dial Transplant. 1999 Oct;14(10):2464-8.
  16. Zhang CL, Li TH, Niu SH, et al. Synthesis and evaluation of novel organogermanium sesquioxides as antit-tumor agents. Bioinorg Chem Appl. 2009:908625.
  17. Mainwaring MG, Poor C, Zander DS, Harman E. Complete Remission of Pulmonary Spindle Cell Carcinoma After Treatment With Oral Germanium Sesquioxide. Chest. 2000 (117);2:591-593.
  18. Use of Organic Germanium or Placebo for the Prevention of Radiation Induced Fatigue.
    http://www.clinicaltrials.gov/ct2/show/NCT00651417?term=germanium&rank=1. Accessed October 5, 2012.
  19. FDA Import Alert # 54-07 “Germanium Products”. October 2, 2009. Accessed October 5, 2012.
  20. FDA News and Events. The Status of Dietary Supplements in the United States. March 24, 2004. Accessed Octoer 5, 2012.
  21. FDA Inspections, Compliance, Enforcement, and Criminal Investigations, Warning Letter FLA-08-23, July 9, 2008. Accessed October 5, 2012.
  22. Suzuki F, Brutkiewicz RR, Pollard RB. Importance of T-cells and macrophages in the antitumor activity of carboxyethylgermanium sesquioxide (Ge-132). Anticancer Res.1985 Sep-Oct;5(5):479-83.
  23. Suzuki F, Pollard RB. Prevention of suppressed interferon gamma production in thermally injured mice by administration of a novel organogermanium compound, Ge-132. J Interferon Res. 1984 Spring;4(2):223-33.
  24. Lin MH, Hsu TS, Yang PM, et al. Comparison of organic and inorganic germanium compounds in cellular radiosensitivity and preparation of germanium nanoparticles as a radiosensitizer. Int J Radiat Biol. 2009 Mar;85(3):214-26.
  25. Sabbioni E, Fortaner S, Bosisio S, et al. Metabolic fate of ultratrace levels of GeCl(4) in the rat and in vitro studies on its basal cytotoxicity and carcinogenic potential in Balb/3T3 and HaCaT cell linesdagger. J Appl Toxicol. 2010 Jan;30(1):34-41.

Consumer Information

How It Works

Bottom Line: Germanium shows anticancer properties but it has caused severe side effects and death.

Germanium is a naturally occurring element that can be found in foods such as shiitake mushrooms, garlic, tuna, and tomato juice. It is not an essential nutrient for human health. Germanium acts as an antioxidant, neutralizing free radicals that can damage DNA and cells. In laboratory experiments, a derivative of germanium called spirogermanium has been shown to inhibit replication in certain cancer cells, but human studies show it has adverse effects and is not suitable as an anticancer treatment.

Purported Uses
  • To treat arthritis
    No scientific evidence supports this use.
  • To treat cancer
    Clinical trials do not support this use.
  • To reduce side effects of cancer therapy
    There is an ongoing study on germanium's effect in reducing radiation-induced fatigue in cancer patients
  • To treat HIV and AIDS
    No scientific evidence supports this use.
Patient Warnings
  • Because of the frequency of toxic side effects such as kidney, liver, and nerve damage, germanium supplements should not be used, even at low doses.
Side Effects
  • Weight loss
  • Fatigue
  • Nausea and vomiting
  • Loss of appetite
  • Anemia
  • Muscle weakness
  • Abnormal sensations such as numbness, burning, tingling, or prickling
  • Sensory ataxia (failure of muscle coordination)
  • Less frequent side effects of germanium include chronic kidney failure, elevated liver enzymes, fatty degeneration of the liver, peripheral nerve problems, cerebellar ataxia, and slowed growth of the bone marrow.
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