Ackee
Scientific Name(s): Blighia sapida K.D. Konig
Common Name(s): Ackee, Ackee apple, Akee, Aki, Arbol de seso, Arbre a' fricasser, Breadfruit, Fruto de huevo, Gwanja kusa, Isin, Merey del diablo, Okpu, Pan y quesito, Pero roja, Ris de veau, Seso vegetal, Soapberry, Yeux de crabe
Medically reviewed by Drugs.com. Last updated on Dec 22, 2023.
Clinical Overview
Use
Ackee is a major source of food in Jamaica. In other regions, components of the plant have traditionally been used for a variety of conditions; however, clinical trial data are lacking to support use for any indication.
Dosing
Clinical trials are lacking to provide dosing recommendations. The ripe fruits are edible; however, the unripe fruits are toxic due to hypoglycin A and B content.
Contraindications
Unripe ackee fruit is toxic, causing severe hypoglycemia often accompanied by convulsions and death.
Pregnancy/Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
Hypoglycemia caused by ackee ingestion may be masked in patients taking beta-blockers because of their ability to suppress epinephrine-mediated warning signs of imminent hypoglycemia; use should be monitored in individuals with diabetes.
Adverse Reactions
No data.
Toxicology
Symptoms of ackee poisoning include cholestatic jaundice, vomiting, hypoglycemia, convulsions, coma, and potentially death. Onset of symptoms of poisoning may occur between 6 and 48 hours after ingestion of the unripe fruit.
Scientific Family
- Sapindaceae (soapberry)
Botany
Ackee is the national fruit of Jamaica; it is widely found throughout the West Indies and has been naturalized to parts of Central America, Florida, and Hawaii. The tall, leafy tree grows to approximately 12 m and produces fruit 2 times a year, between January and March and then between June and August. Its oval, compound leaves have 5 pairs of leaflets, the longest of which is approximately 15 cm at the tip. The plant produces small, greenish-white flowers. The red fruit pods split open at maturity, exposing 3 shiny, black seeds embedded in a white, waxy aril.(Barceloux 2009, Lampe 1985, USDA 2021)
History
The ackee tree was imported to Jamaica from West Africa in the late 1700s and is often grown as an ornamental.(Duke 1985) Although the unripe walnut-like seeds are toxic, the ripe fruits are used in traditional island cooking.(Lampe 1985) Ackee is a major source of food in Jamaica and is noted for its high protein and fat content.(Ashurst 1971) When in season, fresh ackee berries are available in markets, and canned fruit is available throughout the year. Poisonings have long been associated with the use of unripe ackee, with first published reports in Jamaica dating back to 1904.(CDC 1992) Large-scale poisonings have appeared to be limited to the island of Jamaica, where they have reached epidemic proportions during the winter months under the name "Jamaican vomiting sickness."(Lampe 1985)
In West African countries, ackee fruit has several purposes. When mixed with water, the green fruits produce a lather and are used for laundry and making soap. Medicinal purposes include for the treatment of conjunctivitis or treatment of migraine or headache. The Centre for Scientific Research into Plant Medicine in Ghana has used the B. sapida plant for treatment of diarrhea for decades. Other traditional uses include for dysentery, yellow fever, burns, and wounds.(Otegbade 2017)
Chemistry
Hypoglycins are potent hypoglycemic compounds found particularly in the seeds and flesh of the unripe ackee fruit. The most toxic is the cyclopropyl amino acid hypoglycin A and its metabolite methylenecyclopropylacetic acid, found in the aril and seeds of the unripe fruit.(Gaillard 2011, Golden 2002) The unripe ackee fruit contains hypoglycin A at concentrations significantly higher than those in the ripe fruit.(Gaillard 2011, Golden 2002) In addition, other hypoglycemic compounds, including hypoglycin B and other cyclopropanoid amino acids, are found in the seed. CNS active carboxycyclopropylglycines found in the unripe fruit are potent group II metabotrophic glutamate receptor agonists.(Natalini 2000)
Uses and Pharmacology
Analgesic effects
Animal data
In mice orally administered an aqueous leaf extract of B. sapida, analgesic effects were observed for 2 of 3 pain tests conducted. Writhing was significantly reduced at B. sapida extract doses of 250 and 500 mg/kg compared to controls; percentage inhibition at these extract doses was 52% and 67%, respectively, whereas aspirin produced a 78% inhibition. Paw licking was also significantly reduced with each B. sapida extract dose compared to controls; respective inhibitions were 65% and 54%, whereas morphine produced 100% inhibition.(Olayinka 2021)
Antioxidant effects
Animal data
Antioxidant activity of ackee has been documented via free radical scavenging properties as well as increased activity of antioxidant enzyme systems (ie, superoxide dismutase, catalase, glutathione peroxide) and reduced malonaldehyde.(Barnaby 2018, Ojo 2017)
Antiparasitic activity
Animal data
Three doses of a B. sapida stem bark ethanolic extract were safe, nontoxic, and prophylactically effective against chloroquine-resistant Plasmodium berghei in mice when compared with untreated controls (P<0.001). The lowest dose (200 mg/kg) exhibited comparable effects to the positive control artemether/lumefantrine (Coartem). The extract had little to no effect as a curative or suppressive agent at 200, 400, or 800 mg/kg.(Otegbade 2017)
Diabetes
Animal data
In a diabetic rat model, an ethanolic extract of B. sapida stem bark administered orally significantly reduced fasting blood glucose (FBG) at all 3 doses tested (50, 100, and 150 mg/kg/day) compared to untreated diabetic controls (P<0.05). After 21 days, mean FBG was similar between the 150 mg/kg/day extract group and the positive control glibenclamide (88.2 and 88.4 mg/dL, respectively); neither value was significantly different than nondiabetic controls (87.2 mg/dL). Serum insulin, insulin resistance, and pancreatic beta-cell dysfunction also improved significantly with B. sapida extract at all 3 doses versus the diabetic control (P<0.05). Values for all 3 parameters at the 150 mg/kg/day extract dose were not significantly different from the nondiabetic control and were more pronounced than in the glibenclamide-treated diabetic group. The extract significantly increased the activities of antioxidant enzymes.(Ojo 2017)
The significant FBG results documented previously with 3 doses of B. sapida stem bark extract in the diabetic rat model were repeated in another study, which also evaluated effects of the extract on lipid parameters. As with FBG, values of all 8 lipid parameters (ie, total cholesterol, low-density lipoprotein, very low–density lipoprotein, non–high-density lipoprotein [HDL], HDL, triglycerides, atherogenic index, and coronary artery index) for the 150 mg/kg/day extract dose were not significantly different from the nondiabetic control and were significantly better than in the glibenclamide-treated diabetic group (P<0.05).(Ojo 2020)
Dosing
Clinical trials are lacking to provide dosing recommendations. The ripe fruits are edible; however, the unripe fruits are toxic due to hypoglycin A and B content.
Pregnancy / Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
Hypoglycemia caused by ackee may be masked in patients taking beta-blockers because of their ability to suppress epinephrine-mediated warning signs of imminent hypoglycemia; use in individuals with diabetes should be monitored.
Adverse Reactions
Adverse reactions are related to the toxicity of unripe fruit ingestion and are further addressed in the Toxicology section.
Toxicology
Acute toxicity tests in mice determined the oral median lethal dose (LD50) to be more than 5,000 mg/kg for both the aqueous leaf extract and the ethanolic stem bark extract of B. sapida.(Olayinka 2021, Otegbade 2017)
Ackee fruits contain hypoglycin A and methylenecyclopropylglycine, which are 2 chemically related toxins that inhibit the degradation of C6 through C10 straight-chain saturated fatty acids. The metabolism and excretion of these toxins and their metabolites is a lengthy process, with metabolites detected in serum 96 hours after canned ackee fruits were ingested by an adult volunteer. Repeated consumption had a cumulative effect leading to prolonged intoxication. Findings support results from earlier animal studies; however, no disturbance of the breakdown of long-chain fatty acids was observed in this case, which conflicts with earlier findings in children.(Sander 2020) Poisoning from unripe ackee (including roasted ackee seeds) manifests as GI distress, hypoglycemia, and CNS depression developing within 6 to 48 hours of consumption. A quiescent or remission period may be followed by symptoms including lethargy, hypotonia, and hypothermia, and progress to convulsions and coma.(Barceloux 2009, Katibi 2015) Fulminant liver failure has been reported,(Grunes 2012) and a case fatality rate of 52% has been published.(USDA 2021)
Treatment of ackee poisoning is primarily supportive and includes restoration of fluid, electrolyte, glucose, and pH balance.(Barceloux 2009) Limited experimental studies suggest a role for glycine, methylene blue, and riboflavin as antagonists in hypoglycin A intoxication; however, no clinical data support this concept.(Barceloux 2009, Katibi 2015)
References
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