Bloodroot

Scientific Name(s): Sanguinaria canadensis L. Family: Papaveraceae (poppies)

Common Name(s): Bloodroot ( blood root ), bloodwort , red puccoon , redroot , coon root , paucon , sweet slumber , tetterwort , snakebite , Indian paint , black paste

Uses

In vitro studies demonstrate potential for use in cancer therapy; however, animal experiments and clinical studies are lacking. Bloodroot has been marketed in toothpastes and mouthwashes for the prevention of gum disease and plaque, but studies have found it inferior to drugs such as doxycycline and chlorhexidine, with concerns of toxicity.

Dosing

Clinical studies are lacking to provide dosage guidelines.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use due to documented adverse effects.

Interactions

None well documented.

Adverse Reactions

Use of bloodroot as an escharotic agent in the form of a salve or paste has led to localized tissue damage and disfiguring scarring in a number of case reports.

Toxicology

Based on epidemiological studies, there is a correlation between the use of sanguinarine-containing toothpastes and oral leukoplakia (a possible precursor to oral cancer).

Botany

Bloodroot is an early spring wildflower that grows in the woodlands of the eastern United States and Canada. Its single white flower emerges from the ground folded within a grey-green leaf, and the delicate petals rapidly detach as the seed pod matures. The stout rhizome yields a bright red latex when cut, giving the plant its common name. The root and rhizome are collected in the fall for medicinal use. 1 , 2

History

Bloodroot was used by eastern American Indian tribes as a red dye and medicinally as a blood purifier, as well as for treating ulcers and skin conditions. These medicinal uses derived from the appearance of the blood-red latex exuded from the fresh root. The juice was also taken for coughs and sore throats, with the bitter taste masked by placing the juice on a lump of maple sugar that was then sucked. Higher oral doses were observed to have expectorant and emetic properties. The root was used in 19th century medicine as a caustic topical treatment for skin cancers, polyps, and warts. In 1983, an extract of bloodroot was marketed in toothpastes and mouthwashes for prevention of gum disease and plaque. 3

Chemistry

Sanguinaria root is an abundant source of isoquinoline alkaloids, with the two major quaternary alkaloids sanguinarine and chelerythrine having been isolated in the 19th century. While most alkaloids are colorless, sanguinarine is a bright red benzophenanthradine alkaloid and is considered to be the most active constituent in the plant. Highest levels of sanguinarine are found in the rhizomes, then the roots, with lesser amounts found in the flowers and leaves. Other related compounds include berberine, sanguidimerine, protopine, and other minor alkaloids.

The alkaloids have been characterized and quantified by a variety of methods, such as thin-layer chromatography, ion-pair high pressure liquid chromatography (HPLC), fast atom bombardment mass spectroscopy, reversed-phase HPLC, and capillary electrophoretic methods. 2 , 4 , 5 , 6 , 7 , 8

Uses and Pharmacology

Cancer

In vitro studies in human cancer cells and animal models suggest that bloodroot extracts and sanguinarine may have potential clinical applications in the treatment of various cancers. Studies have shown antiangiogenic, cytotoxic, and apoptosis-inducing properties. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19

Clinical trials are lacking. Use of bloodroot as an escharotic agent in the form of a salve or paste has led to localized tissue damage and disfiguring scarring in a number of case reports. Because there is inconsistent evidence to support the use of bloodroot in nonmelanoma skin cancer, it should not be used in this disease. 20

Other effects
Antimicrobial activity

Bloodroot extracts exhibited antimicrobial properties, primarily of the oral cavity, but also versus Helicobacter pylori and cholera bacterium. 21 , 22 , 23 , 24 Clinical applications beyond the use of sanguinarine in mouthwashes have not been investigated.

Antiplaque and gingivitis

Sanguinarine use for the prevention and treatment of dental plaque and gingivitis is considered modestly effective, but inferior to chlorhexidine, doxycycline, and other agents. 25 , 26 , 27

Cardiovascular

Inhibition of platelet aggregation has been shown in vitro. 16 , 28

Immune system

Increases in cytokine production and suppression of cyclooxygenase 1 have been demonstrated in human mononuclear cells. 7 , 28 , 29

Animal food supplement

The use of bloodroot as a food supplement in animals has been explored due to its purported appetizing and antioxidant effects. In pigs fed a sanguinarine and chelerythrine mix over 90 days, elevations in liver enzymes were observed but there were no other apparent ill effects. 30

Dosage

Clinical studies are lacking to provide dosage guidelines. Bloodroot is emetic at dosages of 30 to 125 mg in humans. It was formerly an ingredient in toothpastes and mouthwashes, but its use has largely been discontinued because of toxicity concerns. 31

Pregnancy/Lactation

Avoid use due to documented adverse reactions, including emmenogogue effect and uterine stimulant action. 32 Studies in pigs have shown antiangiogenic effects on ovarian follicle development. 33

Interactions

None well documented. Inhibition of platelet aggregation has been shown in vitro, but no case reports of clinical interactions with antiplatelet drugs have been published. 28

Adverse Reactions

Use of bloodroot as an escharotic agent in the form of a salve or paste has led to localized tissue damage and disfiguring scarring in a number of cases reports. Because tissue damage cannot be limited, and because inconsistent evidence exists to support its use in nonmelanoma skin cancer, bloodroot should not be used in this disease. 3 , 20 , 34 , 35

Epidemic edema has been reported in India, where edible cooking oils contaminated with sanguinarine-containing Argemone mexicana seeds were found. 36 , 37

Toxicology

In rats, short-term toxicity studies of sanguinarine and Sanguinaria extracts found minimal oral toxicity (median lethal dose [LD 50 ] 1,200 to 1,700 mg/kg), probably due to its very limited gastric absorption. Sanguinarine was considerably more toxic via acute intravenous administration (LD 50 29 mg/kg). A dermal LD 50 of more than 200 mg/kg in rabbits was estimated, 38 and no reproductive or developmental effects in rats and rabbits were reported. 39

Despite its DNA intercalating ability, sanguinarine was not mutagenic in the Ames test. Phototoxic effects against mosquito larvae have been reported. 40 , 41 In pigs fed a sanguinarine and chelerythrine mix over 90 days, mild elevations in liver enzymes were observed, but there were no histological changes or apparent ill effects. 30

A correlation between use of sanguinarine-containing toothpastes and oral leukoplakia has been reported in epidemiological studies and supported by in vitro studies. 31 , 42 , 43 , 44 , 45 , 46 However, the relevance of this association has been disputed, and the products included in the research ( Viadent toothpaste and mouthwash) no longer contain sanguinarine. 44 , 47 Other sanguinarine dental products are available and promoted especially via the Internet, and caution is warranted.

Bibliography

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