- custard apple
- brazilian paw paw
For Patients & Caregivers
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 some types of cancer cells. However, substances derived from graviola can damage nerve cells and cause neurological side effects similar to Parkinson’s disease. Graviola may also affect nuclear imaging because it has been shown to decrease the uptake of radiopharmaceuticals used in such procedures.
- 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.
You are taking blood pressure medications: Graviola may increase their effects.
You are taking diabetic medications: Graviola may increase their effects.
You have liver or kidney disease: Graviola can cause liver and kidney toxicity with repeated use.
You are having nuclear imaging: Graviola can reduce tissue uptake of radiopharmaceuticals used for diagnosis or treatment.
You have low platelet count: Graviola may reduce platelet count.
For Healthcare Professionals
Graviola is a tree prevalent in the rain forests of Africa, South America, and Southeast Asia. The fruits (aka soursop) are consumed as food and the leaves and stems are used in traditional medicine symptoms associated with inflammation and infection. Graviola is also available as a dietary supplement and is widely promoted as an alternative treatment for cancer although clinical evidence is lacking.
Many of the health benefits from graviola are thought to be derived from its antioxidant property (1)(2)(3)(4). In animal studies, extracts from Graviola leaves showed anti-inflammatory (5), analgesic (6), antidiabetic (7), antiulcer (8) and antiviral (9) effects. The leaf extracts also have antimicrobial activities (10)(11). Graviola extracts from the leaf, fruit, and seed have been tested in laboratories for their anticancer effects. Some studies show these extracts to be active against breast (3), lung (12), colon (13), prostate (14), pancreas (15)(16), liver (17), skin cancer (18), and leukemia (19) cell lines. However, graviola products have not been studied in cancer patients.
Consumption of graviola has been associated with adverse effects. Alkaloids extracted from graviola may cause neuronal dysfunction and degeneration leading to symptoms of Parkinson’s disease (20)(21). Graviola may decrease the uptake of radiopharmaceuticals used in nuclear imaging (22) and lower platelet counts (23).
- Acetogenins: annosquamin B, bullatacin, annosquatin B, annonacin, annonacin A and annomuricin A muricins J, K, and L
- Quinolines and isoquinolines
- Coreximine and reticuline
- Volatile oils: α-pinene, β-pinene, ρ-mentha-2,4(8)-diene ,β-elemene, germacrene D
- Flavonol triglycoside: quercetin 3-O-rhamnosylsophoroside
Annonaceous acetogenins, phytochemicals isolated from the leaves, bark, and twigs of graviola, are thought to be the active ingredients of graviola. The ethanolic extract of Annona muricata shows in vitro antiviral activity against the Herpes simplex virus (9), and antimicrobial activity against Leishmania (11).
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 (20). Graviola has also been shown to stimulate serotonin receptors (24). An ethanolic extract produced cell-stimulating behaviors either by increased mitochondrial turnover indicating stimulation in protein production or by preparation to leave the G1 phase, perhaps due to promitotic stimulus present within the extract which acts like a growth factor (28).
In animal models, the antidiabetic effects of graviola are due to its antioxidant, hypolipidemic and protective effects in pancreatic beta-cells, which improves glucose metabolism (7). In rodent models of hepatic cancer, although constituents of graviola led to reduced tumor growth, the acetogenin bullatacin caused liver and kidney toxicity via increasing calcium concentration, ROS production, and Bax expression and Bax/Bcl-2 ratio with repeated treatment (25). Graviola extract demonstrated antiulcer effect by increasing nitric oxide and prostaglandin E2 activities (8).
Graviola fruit extract has anti-inflammatory and analgesic actions by inhibiting cyclooxygenase (COX)-1 and COX-2 and by blocking opioid receptors (5).
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 (29). 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 (15), and downregulated EGFR expression in breast cancer cells (16). Phenolic compounds in graviola also demonstrate free-radical scavenging potential against human breast carcinoma cells (30) and in promyelocytic leukemia cells (19). Extracts of acetogenin muricins J, K, and L have antiproliferative effects against human prostate cancer cells, with the effect of muricin K being strongest (27). In colon and in lung cancer cell lines, the ethanolic extract of graviola caused cell cycle arrest at G1 phase by up-regulating Bax and down-regulating Bcl-2 proteins (13)(12).
Antidiabetics: Graviola may have additive effects resulting in hypoglycemic symptoms (8).
Antihypertensives: Graviola may have additive effects resulting in hypotension (22).
P-glycoprotein (P-gp) substrates: Graviola contains acetogenins that are known to inhibit P-gp and may affect the metabolism of substrate drugs (31)
Nuclear imaging (radiopharmaceutical biodistribution): Graviola significantly decreased uptake of radioactivity per gram of tissue in bladder, kidney, and blood in animal models (22).
Blood glucose test: Graviola may reduce blood glucose levels (31).
Blood pressure readings: Graviola may reduce blood pressure readings (32).
Platelet count: Graviola reduced platelet count in an animal model (23)