Health Care Professional Information

Scientific Name
Annona muricata
Common Name

Guanabana, soursop, custard apple, brazilian paw paw

Clinical Summary

Graviola, a tree prevalent in the rain forests of Africa, South America, and Southeast Asia, has been used in traditional medicine in many countries.
Extracts of graviola show antiviral (1), antiparasitic, antirheumatic, astringent, emetic (2), antileishmanial and cytotoxic (3) (4), antinociceptive, anti-inflammatory (9), antihyperglycemic (10) and anticancer effects (5) (12) (13) in vitro and in vivo. However, human data are lacking.

Alkaloids extracted from graviola may cause neuronal dysfunction and degeneration leading to symptoms of Parkinson's disease (6) (11).

Purported Uses
Constituents
  • Acetogenins
  • Quinolines and isoquinolines
  • Annopentocins
  • Annomuricins
  • Coreximine and reticuline
    (6) (7)
Mechanism of Action

Annonaceous acetogenins, phytochemicals isolated from the leaves, bark and twigs of graviola, are thought to be the active ingredients. The ethanolic extract of Annona muricata was found to inhibit the Herpes simplex virus (1) and effective against Leishmania braziliensis, L. panamensis promastigotes, and the cancer cell line U 937 (3) and hepatoma cell lines (8) in vitro. Gravioloa extracts were shown to be lethal to the fresh-water mollusk Biomphalaria glabrata, which acts as a host for the parasitic worm, Schistosoma mansoni (2).
Alkaloids from graviola are detrimental to the survival of dopaminergic nerve cells in vitro. This may result in neuronal dysfunction and degeneration. Graviola-induced cell death was inhibited by glucose supplementation suggesting that cell death may have been caused by energy depletion (6).  Graviola has also been shown to stimulate serotonine receptors (7).
Graviola extracts were effective against the growth of Adriamycin-resistant human mammary adenocarcinoma (MCF-7/Adr) by blocking access of cancer cells to ATP and by inhibiting the actions of plasma membrane glycoprotein (5). They also inhibited expression of HIF-1α, NF-κB, glucose transporters, and glycolytic enzymes resulting in decreased glucose uptake and ATP production in pancreatic cancer cells (12); and downregulated EGFR expression in another study (13).

Adverse Reactions
  • Graviola may cause movement disorders and myeloneuropathy with symptoms mimicking Parkinson's disease (6) (11).
Dosage (Inside MSKCC Only)
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References
  1. Padma P, Pramod NP, Thyagarajan SP, Khosa RL. Effect of the extract of Annona muricata and Petunia nyctaginiflora on Herpes simplex virus. J Ethnopharmacol. 1998;61:81-3.
  2. dos Santos AF,.Sant'Ana AE. Molluscicidal properties of some species of Annona. Phytomedicine. 2001;8:115-20.
  3. Jaramillo MC, Arango GJ, Gonzalez MC, Robledo SM, Velez ID. Cytotoxicity and antileishmanial activity of Annona muricata pericarp. Fitoterapia 2000;71:183-6.
  4. Liaw CC, Chang FR, Lin CY, Chou CJ, Chiu HF, Wu MJ et al. New cytotoxic monotetrahydrofuran annonaceous acetogenins from Annona muricata. J Nat Prod 2002;65:470-5.
  5. Oberlies NH, Chang CJ, McLaughlin JL. Structure-activity relationships of diverse Annonaceous acetogenins against multidrug resistant human mammary adenocarcinoma (MCF-7/Adr) cells. J Med Chem. 1997;40:2102-6.
  6. Lannuzel A, Michel PP, Caparros-Lefebvre D, Abaul J, Hocquemiller R, Ruberg M.Toxicity of Annonaceae for dopaminergic neurons: potential role in atypical parkinsonism in Guadeloupe. Mov Disord. 2002;17:84-90.
  7. Roman G. Tropical myeloneuropathies revisited. Curr Opin Neurol 1998;11:539-44.
  8. Chen JC, Tsai CC, Chen LD, Chen HH, Wang WC. Therapeutic effect of gypenoside on chronic liver injury and fibrosis induced by CCl4 in rats. Am.J Chin Med. 2000;28:175-85.
  9. de Sousa OV, Vieira GD, de Jesus R G de Pinho J, Yamamoto CH, Alves MS. Antinociceptive and Anti-Inflammatory Activities of the Ethanol Extract of Annona muricata L. Leaves in Animal Models. Int J Mol Sci. 2010 May 6;11(5):2067-78.
  10. Adeyemi DO, Komolafe OA, Adewole OS, Obuotor EM, Adenowo TK. Anti hyperglycemic activities of Annona muricata (Linn). Afr J Tradit Complement Altern Med. 2008 Oct 25;6(1):62-9.
  11. Lannuzel A, Höglinger GU, Champy P, et al. Is atypical parkinsonism in the Caribbean caused by the consumption of Annonacae? J Neural Transm Suppl. 2006;(70):153-7.
  12. Torres MP, Rachagani S, Purohit V, et al. Graviola: A novel promising natural-derived drug that inhibits tumorigenicity and metastasis of pancreatic cancer cells in vitro and in vivo through altering cell metabolism. Cancer Lett. 2012 323(1):29-40.
  13. Dai Y, Hogan S, Schmelz EM, Ju YH, Canning C, Zhou K. Selective growth inhibition of human breast cancer cells by graviola fruit extract in vitro and in vivo involving downregulation of EGFR expression. Nutr Cancer 2011;63(5):795-801.

Consumer Information

How It Works

Bottom Line: Graviola showed anticancer effects in lab studies. Human data are lacking.

Graviola contains chemicals called acetogenins, which are thought to be the active ingredient. Extracts of graviola have been shown to be effective against a number of viruses, bacteria and parasites in test tubes. Laboratory studies have also shown graviola to be effective against certain breast cancer cells that are resistant to the chemotherapy drug Adriamycin. It is thought that the extract is able to block the cancer cell's access to ATP, the source of energy for the cancer cell. Substances derived from graviola damage nerve cells and may cause neurological effects similar to Parkinson's disease.

Purported Uses
  • To treat cancer
    Graviola has been shown effective against cancer cells in lab studies. Human studies have not been conducted.
  • To treat herpes
    Graviola is effective against the herpes virus in laboratory experiments. Human studies are needed.
  • To fight infections
    Lab studies indicate that graviola may prevent certain infections. Human data are lacking.
Side Effects
  • Graviola may cause movement disorders and myeloneuropathy (neuropathy that affects the myelin sheath) with symptoms similar to those of Parkinson's disease.
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