Health Care Professional Information
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).
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
- 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.
- dos Santos AF,.Sant'Ana AE. Molluscicidal properties of some species of Annona. Phytomedicine. 2001;8:115-20.
- Jaramillo MC, Arango GJ, Gonzalez MC, Robledo SM, Velez ID. Cytotoxicity and antileishmanial activity of Annona muricata pericarp. Fitoterapia 2000;71:183-6.
- 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.
- 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.
- 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.
- Roman G. Tropical myeloneuropathies revisited. Curr Opin Neurol 1998;11:539-44.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Last updated: October 16, 2012
adenocarcinoma (A-deh-noh-KAR-sih-NOH-muh)
Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)Adriamycin
An anticancer drug that belongs to the family of drugs called antitumor antibiotics. It is an anthracycline. Also called doxorubicin.
(http://www.cancer.gov/dictionary)anti-inflammatory (AN-tee-in-FLA-muh-TOR-ee)
Having to do with reducing inflammation.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)antiparasitic (AN-tee-PAYR-uh-SIH-tik)
A drug used to treat infections caused by bacteria and parasites. It is also used in the treatment of some cancers.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)ATP
A substance present in all living cells that provides energy for many metabolic processes and is involved in making RNA. ATP made in the laboratory is being studied in patients with advanced solid tumors to see if it can decrease weight loss and improve muscle strength. Also called adenosine triphosphate.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)bacteria (bak-TEER-ee-uh)
A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)breast (brest)
Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)cancer cell line (KAN-ser sel line)
Cancer cells that keep dividing and growing over time, under certain conditions in a laboratory. Cancer cell lines are used in research to study the biology of cancer and to test cancer treatments.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)cytotoxic (SY-toh-TOK-sik)
Cell-killing.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)dysfunction (dis-FUNK-shun)
A state of not functioning normally.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)emetic (eh-MEH-tik)
Describes a substance that causes vomiting. Also called emetogenic.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)extract (EK-strakt)
In medicine, a preparation of a substance obtained from plants, animals, or bacteria and used as a drug or in drugs.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)glucose (GLOO-kose)
A type of sugar; the chief source of energy for living organisms.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)glycoprotein (gly-koh-PROH-teen)
A protein that has sugar molecules attached to it.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)hepatoma (HEH-puh-TOH-muh)
A liver tumor.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)in vitro (in VEE-troh)
In the laboratory (outside the body). The opposite of in vivo (in the body).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)in vivo (in VEE-voh)
In the body. The opposite of in vitro (outside the body or in the laboratory).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)mammary (MA-muh-ree)
Having to do with the breast.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)membrane (MEM-brayn)
A very thin layer of tissue that covers a surface.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)myelin (MY-eh-lin)
The fatty substance that covers and protects nerves.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)nerve (nerv)
A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)NP
A registered nurse who has additional education and training in how to diagnose and treat disease. NPs are licensed at the state level and certified by national nursing organizations. In cancer care, an NP may manage the primary care of patients and their families, based on a practice agreement with a doctor. Also called advanced practice nurse, APN, and nurse practitioner.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)pancreatic (PAN-kree-A-tik)
Having to do with the pancreas.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)parasitic (PAYR-uh-SIH-tik)
Having to do with or being a parasite (an animal or plant that gets nutrients by living on or in an organism of another species).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)plasma (PLAZ-muh)
The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)virus (VY-rus)
In medicine, a very simple microorganism that infects cells and may cause disease. Because viruses can multiply only inside infected cells, they are not considered to be alive.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)
