MISTLETOE
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Background: 1,2
The word mistletoe comes from the old English word “mistitan” which is derived from the word mistel meaning twig. Although mistletoe is often remembered as a romantic gesture during Christmas time, most people don’t know that is it also a poisonous plant. Mistletoe is a semi-parasitic plant from the Santalaceae family, it penetrates the branch of a tree or shrub and absorbing the water and nutrients from the host plant. There are three main types of mistletoes: European mistletoe (Viscum album), Korean Mistletoe (Viscum album var. coloratum), and American Mistletoe (Phoradendron leucarpum). They can grow on more than 100 different types of trees but often found on pecan, hickory oak, and red maple. Mistletoes contain chlorophyll so it’s able to make it’s own food so it doesn’t completely deplete the host tree of nutrients. Mistletoes have been used as a treatment for many diseases in traditional and folk medicine. It has been shown antioxidant, anticancer, anti-inflammatory and antibacterial properties. 2
Taxonomy: 7
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- Domain – Eukarya
- Kingdom – Plantae
- Class – Magnoliopsida
- Order – Santalales
- Family – Santalaceae
- Genus – Viscum L.
Biotransformation / Toxicokinetics: 1,8
Mistletoe can be administered through subcutaneous, intramuscular, peritumoral, or intrapleural injections, it can also be given as an intravenous infusion. Mistletoe extracts are injected into the skin, vein, pleural cavity, or tumor.1 It can be absorbed by the GI tract, distributed via the bloodstream. Metabolism occurs in the liver. Mistletoe is eliminated through urine.
Cancer Therapy 1,6
Mistletoe has been used as an alternative therapy against colon, oral, lung, and pancreas cancer. This is because mistletoe extracts bolster immunity, delay tumor initiation, profession as well as kills malignant tumors. mistletoe therapy is effective in improving immune responses, quality of life, and symptom management. The impact of mistletoe therapy depends on the extract and dose used and how it is administered.
Mechanism of Action: 1, 2, 4
Mistletoe contains various types of compounds such as viscotoxin, amino acids, flavonoids, phenylpropanoids, alkaloids, polyalcohols, polysaccharides, and glycoproteins lectins. the presence of lectins leads to cell death by inhibiting protein synthesis.phoratoxins and ligatoxin are also found in mistletoes that act as cardiac depressants causing hypotension, bradycardia, and decreased contractility.
Image from NCBI
In immunologic activities, lectins have been shown to induce macrophage cytotoxic activity, stimulate phagocytosis by immune cells, and increase cytokine secretion. Preclinical studies suggest that mistletoe supports the immune system by increasing the number of activity of white blood cells and natural killer cell subset. Anticancer activities of mistletoe target two pathways, P13K/AKT and MAPK. This causes cell cycle arrest, loss of mitochondrial membrane permeability, activating caspases, and regulate pro and anti-apoptotic proteins. Mistletoe induces apoptosis by inhibiting AKT phosphorylation which is responsible for the growth and survival of cancer cells.
Target Organs: 3
- Eyes
- Ears
- Nose
- Mouth
- Throat
- Gastrointestinal system
- Nervous system
Signs and Symptoms of toxicity: 3
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Blurred Vision
Diarrhea
Nausea and Vomiting
Stomach Pain
Weakness
Drowsiness
Increased blood pressure
Hepatotoxicity
Hypotension
Bradycardia
Genetic susceptibility or heritable traits:
- No known genetic factors lead to an increased or decreased susceptibility
Historical or unique exposure: 5
The use of mistletoe dates back to 40-90 AD from a Greek physician. However, Hippocrates (460-377 BC) and his students say mistletoe was used to treat diseases of the spleen and complaints associated with menstruation. Theophrastus von Hohenheim 1493-1541 used oak mistletoe to cure epilepsy and recommended for the treatment of liver diseases, Paracelsus as week as diseases of the kidney. The use of mistletoe was also used for treating ulcers, bone-fractures, and labor pain.
Treatments: 3
- Activated charcoal
- Breathing support
- ECG
- Fluids through a vein
Biomarkers:
- No known biomarkers
References:
1- Professional Resource: Mistletoe . Ottawa Integrative Cancer Centre, www.oicc.ca/uploads/mistletoe-health-professional.pdf.
2- Szurpnicka, Anna, et al. “Biological Activity of Mistletoe: in Vitro and in Vivo Studies and Mechanisms of Action.” Archives of Pharmacal Research, Pharmaceutical Society of Korea, June 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7340679/.
3-“Mistletoe Poisoning.” UF Health, University of Florida Health, 10 Apr. 2018, ufhealth.org/mistletoe-poisoning.
4- Gwaltney-Brant, Sharon M. “Christmastime Plants.” Small Animal Toxicology (Third Edition), W.B. Saunders, 10 Dec. 2012, www.sciencedirect.com/science/article/pii/B9781455707171000399#s0245.
5- Hartmut Ramm, “Mistletoe through cultural and Medical History: The All-Healing Plant Proves to Be a Cancer-Specific Remedy”, https://ebookcentral-proquest-com.proxy.lib.ohio-state.edu/lib/ohiostate-ebooks/reader.action?docID=3563947&ppg=10
6- Patel, Seema, and Suryakanta Panda. “Emerging Roles of Mistletoes in Malignancy Management.” 3 Biotech, Springer Berlin Heidelberg, Feb. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3909578/.
7- ITIS Standard Report Page: Viscum Album, www.itis.gov/servlet/SingleRpt/SingleRpt?search_topic=TSN&search_value=27906#null.
8 – Ogunmefun, O T, et al. “The Ethnobotanical, Phytochemical and Mineral Analyses of Phragmanthera Incana (Klotzsch), a Species of Mistletoe Growing on Three Plant Hosts in South-Western Nigeria.” International Journal of Biomedical Science : IJBS, Master Publishing Group, Mar. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3644413/#:~:text=Mistletoe%20is%20used%20to%20treat,from%20the%20system%20(2).&text=Though%20these%20compounds%20act%20directly,not%20be%20ingested%20(5).