Medication Guide App

Mastic

Scientific Name(s): Pistacia lentiscus L. Family. Anacardiaceae

Common Name(s): Mastic , mastick (tree) , mastix , mastich , lentisk

Uses

The pharmacology and medicinal use of mastic is diverse. The resin has been used in cancer, infection, surgical wound adhesion, and ulcers. Studies also document its use as an antioxidant and an insecticide, and for treatment of high cholesterol, Crohn disease, diabetes, and hypertension. However, clinical trials to support these uses are limited.

Dosing

Mastic resin has been studied as a treatment for ulcers at a dosage of 1 g daily. Various commercial products are available including Mastika , which contains mastic gum 250 mg in capsule form. The manufacturer's dosage guidelines are 4 capsules by mouth before bed or on an empty stomach for 4 weeks, followed by a maintenance dosage of 2 capsules daily to maintain GI health.

Contraindications

Avoid use with hypersensitivity to any ingredients of mastic gum as well as with pollen hypersensitivity.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Most adverse reactions are associated with hypersensitivity to the plant or to allergic reactions.

Toxicology

Most toxicity involves allergic reactions.

Botany

Mastic is collected from an evergreen, dioecious shrub, which can grow to about 3 m in height. It is native to the Mediterranean region, primarily in the Greek island of Chios. Its leaves are green, leather-like, and oval. The small flowers grow in clusters and are reddish to green. The fruit is an orange-red drupe that ripens to black.

Mastic is tapped from June to August by making numerous, longitudinal gouges in the tree bark. An oleoresin exudes and hardens into an oval tear shape, about the size of a pea (3 mm). The transparent, yellow-green resin is collected every 15 days. If chewed, it becomes “plastic,” with a balsamic/turpentine-like odor and taste. A related species is Pistacia vera , the pistachio nut. 1 , 2 , 3 , 4 , 5

Mastic resembles the resin sanderach (obtained from Tetraclinis articulata ), without the chewable qualities of mastic. 4 , 5

History

Mastic resin was used in ancient Egypt as incense and to embalm the dead. 3 , 6 It has also been used as a preservative and a breath sweetener. Mastic oil was mentioned by Dioskourides in ancient Grecian times and by Christopher Columbus in 1493. Mastic resin is still used as a flavoring in some Greek alcoholic beverages (eg, retsina wine) and in chewing gum from Chios. 6

Commercial application of mastic resin includes its use as an adherent, in protecting luster for glass, porcelain, bone, wood, and metal. Mastic resin is used in alcoholic and nonalcoholic beverages, in some cosmetic mixtures and perfumery, and in dentistry as a filling material ingredient and in toothpaste production. The resin has been used traditionally as a chewing gum and for use against lip dryness. 7

Chemistry

Mastic is an oleoresin containing approximately 2% volatile oil. 2 , 4 The resin contains alpha and beta masticoresins, masticin, mastic acid, masticoresene, and tannins. 3 It is a complex mixture of tri-, tetra-, and pentacyclic triterpene acids and alcohols. 8 Reports of certain fractions from the plant include polymer fraction isolation/characterization, 9 , 10 and acidic triterpenic fractions of mastic gum. 11

The essential oil component in mastic contains more than 70 compounds, some of the primary constituents being alpha-pinene, myrcene, caryophyllene, beta-pinene, linalool, and germacrene D. 12 , 13 , 14 , 15 , 16 A later report lists certain percentages of essential oils from galls and aerial parts of the plant, such as sequiterpene hydrocarbons (47%), beta-caryophyllene (13%), and cadinene (8%). 17 Essential oil composition in the species P. lentiscus differs from region to region. Reports from the areas of Chios, 18 Egypt, 19 and Corsica 20 are available. Essential oil chemical composition in mastic also changes with solidification and storage, 21 as well as with the time of year samples are taken. 22 Chemical composition of various parts of the plant have been discussed, including leaves, fruits, and aerial parts. 23 , 24 , 25 , 26 Lipids in the bark of P. lentiscus have been addressed. 27

Uses and Pharmacology

The pharmacology and use of mastic are diverse.

Cancer

In vitro, Chios mastic gum treatment of human colon cancer cells induced cell arrest at cell cycle G1, detachment of the cells from the substrate, activation of pro-caspases-8, -9 and -3, and other changes typical of apoptosis in cell organelles. 28 , 29

Mechanism of action against human leukemia cells and endothelial cell proliferation is associated with activation of extracellular signal-regulated kinases (involved with controlling leukemia cell proliferation) and RhoA (involved with regulating neovessel organization). 30

The monoterpene alpha-pinene may be associated with the mechanism of action repressing androgen receptor expression in a prostate cancer cell line. 31 Mastic gum inhibits androgen-independent prostate cancer cells by suppressing nuclear factor kB activity and nuclear factor kB signal pathway. 32 Gum mastic enhanced gene maspin activity by suppressing androgen receptor activity and increasing Sp1 (involved in regulation of cell growth, apoptosis, and angio-genesis) binding activity. 33

In vitro

A 50% ethanol Chios mastic gum (CMG) extract induced apoptotic death of human colon cancer cells. The CMG extract induced an anoikis form of cell death associated with caspase-dependent pathways. 28 , 29

Mastic oil exerted an antiproliferative and proapoptotic effect on human leukemia cells and inhibited the release of vascular endothelial growth factor (VEGF) from mouse melanoma cells. It also exerted a concentration-dependent inhibition of endothelial cell (EC) proliferation, with no affect on cell cycle survival, and a decrease of microvessel formation. 30

Mastic gum inhibited androgen-stimulated growth of a prostate cancer cell line and the expression of several androgen up-regulated genes. Mastic gum inhibited 2 proteins, cyclin D1 and p21, believed to be associated with cell proliferation and survival. Mastic gum also decreased prostate-specific antigen and expression of androgen receptor expression, resulting in down-regulation of both androgen receptor messenger DNA and protein levels. 31 Another study reported that mastic gum inhibits the growth of androgen-independent prostate cancer cells through nuclear factor proteins involved with immune and inflammatory responses. 32 Mastic gum also inhibited androgen receptor function and increased androgen-mediated gene maspin (protease inhibitor with tumor suppressive activity) in a prostate cancer cell line. 33

Infection

Activity against several bacterial and fungal pathogens is documented in the scientific literature. Clinical trials document oral antiseptic activity for use in dentistry.

In vitro

The monoterpenes are the primary chemical components contributing to the antibacterial activity of mastic oil against gram-positive and gram-negative strains. 34 , 35 Activity against the following organisms is documented: Sarcina lutea , Staphylococcus aureus , Escherichia coli , and Bacillus subtilis . 36

Mastic also possesses antifungal activity. The growth of the fungi Candida albicans , C. parapsilosis , Torulopsis glabrata , and Trichophyton sp. have been inhibited by mastic. 37 Activity is documented against the agricultural pathogen Rhizoctonia solani 7 and Aspergillus flavus . 38

Clinical data

The antibacterial activity and commercial use of mastic gum is documented against oral pathogens, such as Streptococcus mutans and lactobacilli , primarily associated with dental caries. Mastic versus placebo gum had antibacterial activity against S. mutans and mutans streptococci in a preliminary study of 25 periodontally-healthy patients. 39 Another study reported similar results, 40 with growth inhibition against lactobacilli in saliva of orthodontically-treated patients with fixed appliances chewing mastic versus placebo gum.

Surgical wound adhesive
Clinical data

A comparative study documented that mastic gum ( Mastisol ) adhesive plus surgical adhesive strips exhibited the strongest adhesion when compared with 4 other anchoring methods. 41 , 42 Mastic gum adhesive has a lower incidence of postoperative contact dermatitis and skin discoloration, 43 as well as providing increased adhesiveness compared with compound tincture of benzoin. 44

Ulcer

Mastic's ability to improve benign gastric ulcers has been discussed. 45 Triterpenic acids may be responsible for reducing Helicobacter pylori colonization. 46

In vitro

Microdilution assay revealed that mastic gum killed 50% of the isolates of H. pylori strains tested at a concentration of 125 mcg/mL and 90% at a concentration of 500 mcg/mL. 47

Animal data

A report in rats proposed antisecretory and cytoprotective effects of mastic. 48 A study in mice with mastic extracts and isolated pure triterpenic acids (or mastic extract without polymer) documents greater activity with the latter compound against H. pylori . 46 Another study in mice concluded that monotherapy with mastic was not efficacious in eradicating H. pylori infection. 49

Clinical data

A double-blind, controlled clinical trial of 38 patients with duodenal ulcers given mastic 1 g daily for 2 weeks exhibited ulcer-healing effects determined by endoscopy compared with placebo. 50 A letter in the New England Journal of Medicine discusses this study, as well as others, concluding that mastic 1 g daily for 2 weeks can rapidly cure peptic ulcers. Its antibacterial actions against H. pylori may explain, in part, these beneficial effects. 51 However, another clinical study of 8 patients concluded that mastic gum had no effect on eradicating H. pylori . 52

Other pharmacological activity
Antioxidant

The antioxidant activity of the plant against free radicals is well documented. 53 , 54 , 55 , 56 Anthocyanins, 55 tannins (eg, gallic acid), 56 and tocopherol content 57 , 58 , 59 all contribute to its activity.

Cholesterol

An animal study documents the effects on blood lipids by mastic. 60 In another study, patients consuming Chios mastic powder exhibited a decrease in serum total cholesterol, LDL, total cholesterol/HDL ratio, lipoprotein (a), apolipoprotein A-1, apolipoprotein B, liver enzymes, gamma-GT levels, and glucose levels. 61 , 62

Crohn disease

A 4-week pilot study examined the efficacy of mastic capsules (6 capsules per day or mastic 0.37 g per capsule) administered to 18 patients (8 controls) with mild to moderately active Crohn disease. Mastic was effective in regulating inflammatory mediators such as CRP, IL-6, TNF-alpha, and MCP-1 in plasma, and oxidative stress. The therapy induced remission in 7 out of 10 patients. Nutritional status also improved in patients as a result of mastic therapy. 63

Diabetes

An herbal mixture including mastic was effective in treating diabetic rats. 64

Hypertension

Mastic also possesses some hypotensive effects. 9 , 65

Insecticide

Mastic has proven to be an effective insecticide. 66

Dosage

Mastic resin has been studied as a treatment for ulcers at a daily dose of 1 g daily. 50 Various commercial products are available including Mastika , which contains mastic gum 250 mg in capsule form. The manufacturer dosage guidelines are 4 capsules by mouth before bedtime or on an empty stomach for 4 weeks followed by a maintenance dose of 2 capsules daily to maintain GI health. 67

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Most adverse reactions are associated with hypersensitivity to the plant species or allergic reactions.

Toxicology

Most toxicity related to mastic or source P. lentiscus involves allergic reactions. The plant pollen is a major source for allergic reactions. 68 , 69 , 70 The first report of immunological reactions to pollen extracts of Pistacia genus occurred in 1987. 68 A monographic review of mastic's chemistry, pharmacology, and toxicity is available. 71 Children ingesting mastic may develop diarrhea. 72

A 13-week toxicity study in rats documented changes in hematological parameters including increased white blood cell and platelet counts. Increases in total proteins, albumin, and total cholesterol were also documented. Liver weights increased in a dose-dependent manner and decreased body weight was documented at high doses. 73 Interestingly, some studies report hepatoprotective effects 74 from the aqueous extracts, while others identify hepatotoxic effects. 75

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50. Al Habbal M, et al. A double-blind controlled clinical trial of mastic and placebo in the treatment of duodenal ulcer. Clin Exp Pharmacol Physiol . 1984;11(5):541-544.
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