Medication Guide App

Soursop

Scientific Name(s): Annona muricata L. Family: Annonaceae. Synonym: Annona macrocarpa Wercklé.

Common Name(s): Araticum-grande , araticum-manso , cachiman épineux , coração-de-rainha , corossol épineux , graviola , guanábana , guanábano , jaca-de-pobre , jaca-do-Pará , sauersack , stachelannone

Uses

The seeds, fruit, and leaves have been used traditionally for stomach complaints and fever, and as a sedative. Clinical trials are lacking to support these uses.

Dosing

Information is lacking.

Contraindications

Information is lacking. Patients with established Parkinson disease should avoid consumption of the fruit or decoctions made from the leaves (see Toxicology).

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use (see Toxicology).

Interactions

None well documented.

Adverse Reactions

Information is lacking.

Toxicology

A relationship between consumption of A. muricata and atypical parkinsonism has been suggested based on epidemiological observations and animal experiments.

Botany

A. muricata (Soursop) is an evergreen tree native to the warm, humid climates of Brazil, Mexico, the Caribbean region, and Central America. The long prickly fruit measures 20 to 30 cm and weighs up to 2 kg. The fruit is composed of fibrous membranes and a white pulp with many large seeds dispersed throughout, making it difficult to eat without processing. 1 , 2 , 3

History

Because of its characteristic flavor, A. muricata is grown commercially for its fruit crop, which is used to make juice, candy, sorbet, and ice cream. Soursop has been used traditionally in the management of diarrheal and diabetes-related diseases, as well as for sedative, antimicrobial, and insecticidal properties. 2 , 4 , 5

Chemistry

The fruit is high in carbohydrates, especially fructose, and contains vitamins C, B 1 , and B 2 in large amounts. Calcium, magnesium, zinc, potassium, and phosphorous have also been identified. 5

Annonaceous acetogenins, fatty acid derivatives, are the most-studied chemical constituents of the plant parts, with estimates of 40 or more distinct compounds. 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 Annonacin is the predominant acetogenin. 10 The alkaloids reticuline and coreximine have also been identified. 18

A glycoprotein lectin has been identified in the seeds of the ripe fruits of A. muricata , 2 and N-fatty acyl tryptamines in the seeds have been described. 7

Uses and Pharmacology

Clinical trials are lacking, but are not likely to be forthcoming due to the toxicity of annonacin.

Antimicrobial/molluscicidal

Activity against both a standard strain and a clinical isolate of herpes simplex virus was demonstrated by an ethanolic extract of A. muricata stem bark. 19 In a clinical trial, acetogenins extracted from the fruit pericarp were responsible for antileishmanial activity demonstrated in an in vitro experiment. 20 Another study demonstrated in vitro activity of the leaf extract against some Leishmania species and Trypanosomia cruzi . 21

Ethanolic leaf extracts of A. muricata showed molluscicidal activity thought to be, at least in part, due to the annonacin acetogenins. 4

Cancer

Studies identifying the specific acetogenin compounds in the seeds, leaves, root, and stem bark have explored the potent cytotoxicity of these compounds. Activity against certain human cancer cell lines has been demonstrated in vitro. 3 , 6 , 9 , 11 , 12 , 17

Dosage

Information is lacking. One report estimates that the amount of annonacin ingested by an adult eating one fruit daily for a year is comparable with the intravenous dose used to induce brain lesions in rats. One fruit contains approximately annonacin 15 mg, and a can of commercial nectar contains 36 mg. 10

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Toxic neurological effects have been demonstrated in rats, 22 as well as in vitro cytotoxicity. 3 , 6 , 9 , 11 , 12 , 17 Annonacin crosses the blood-brain barrier. 22

Interactions

None well documented.

Adverse Reactions

Information is lacking. A single study evaluated the hemagglutination effect of lectin isolated from the seeds. 2 The clinical importance of this finding is unclear.

Toxicology

Based on an epidemiological observation of higher parkinsonism rates among populations regularly consuming the fruits and traditional medicines of the Annonaceae family, especially graviola, a group of researchers has investigated the plausibility of a causal relationship. 22 , 23 Among people presenting with atypical parkinsonism on the Caribbean island of Guadeloupe, the majority were levodopa unresponsive, with 1 in 2 patients reporting a high consumption of fruit and decoctions of A. muricata leaves. 22 , 23 Patients younger than 65 years of age had some resolution of symptoms (eg, gait disorders, bradykinesia, rigidity) when consumption was stopped. 23 , 24 Annonacin and the alkaloids reticuline and coreximine have been evaluated for toxic effect on rat dopaminergic neurons in vitro. The mechanisms of action remain unclear but are suspected to involve the inhibition of dopamine uptake, as well as effects on neuronal energy production and mitochondrial respiration. 18 , 22 , 23 Nigral and striatal degeneration in rats has been demonstrated 10 , 25 and alkaloid-induced cell death was also observed. 23 , 26

Ethanolic extracts from Annona muricata seeds were highly active in brine shrimp lethality testing. The fruit seeds are considered toxic and unsuitable for use as animal fodder. 3

Bibliography

1. Annona muricata L. USDA, NRCS. 2008. The PLANTS Database ( http://plants.usda.gov , Nov, 2008). National Plant Data Center , Baton Rouge, LA 70874-4490 USA.
2. Damico DC, Freire MG, Gomes VM, et al. Isolation and characterization of a lectin from Annona muricata seeds. J Protein Chem . 2003;22(7-8):655-661.
3. Rieser MJ, Gu ZM, Fang XP, Zeng L, Wood KV, McLaughlin JL. Five novel mono-tetrahydrofuran ring acetogenins from the seeds of Annona muricata . J Nat Prod . 1996;59(2):100-108.
4. Luna Jde S, De Carvalho JM, De Lima MR, et al. Acetogenins in Annona muricata L. ( annonaceae ) leaves are potent molluscicides. Nat Prod Res . 2006;20(3):253-257.
5. Lutchmedial M, Ramlal R, Badrie N, Chang-Yen I. Nutritional and sensory quality of stirred soursop ( Annona muricata L.) yoghurt. Int J Food Sci Nutr . 2004;55(5):407-414.
6. Chang FR, Wu YC. Novel cytotoxic annonaceous acetogenins from Annona muricata . J Nat Prod . 2001;64(7):925-931.
7. Li DY, Yu JG, Zhu JX, et al. Annonaceous acetogenins of the seeds from Annona muricata . J Asian Nat Prod Res . 2001;3(4):267-276.
8. Gleye C, Raynaud S, Fourneau C, et al. Cohibins C and D, two important metabolites in the biogenesis of acetogenins from Annona muricata and Annona nutans . J Nat Prod . 2000;63(9):1192-1196.
9. Liaw CC, Chang FR, Lin CY, et al. New cytotoxic monotetrahydrofuran annonaceous acetogenins from Annona muricata . J Nat Prod . 2002;65(4):470-475.
10. Champy P, Melot A, Guérineau Eng V, et al. Quantification of acetogenins in Annona muricata linked to atypical parkinsonism in guadeloupe. Mov Disord . 2005;20(12):1629-1633.
11. Kim GS, Zeng L, Alali F, et al. Muricoreacin and murihexocin C, mono-tetrahydrofuran acetogenins, from the leaves of Annona muricata . Phytochemistry . 1998;49(2):565-571.
12. Zeng L, Wu FE, Oberlies NH, McLaughlin JL, Sastrodihadjo S. Five new monotetrahydrofuran ring acetogenins from the leaves of Annona muricata . J Nat Prod . 1996;59(11):1035-1042.
13. Wu FE, Zeng L, Gu ZM, et al. Muricatocins A and B, two new bioactive monotetrahydrofuran Annonaceous acetogenins from the leaves of Annona muricata . J Nat Prod . 1995;58(6):902-908.
14. Wu FE, Zeng L, Gu ZM, et al. New bioactive monotetrahydrofuran Annonaceous acetogenins, annomuricin C and muricatocin C, from the leaves of Annona muricata . J Nat Prod . 1995;58(6):909-915.
15. Wu FE, Gu ZM, Zeng L, et al. Two new cytotoxic monotetrahydrofuran Annonaceous acetogenins, annomuricins A and B, from the leaves of Annona muricata . J Nat Prod . 1995;58(6):830-836.
16. Wu FE, Zhao GX, Zeng L, et al. Additional bioactive acetogenins, annomutacin and (2,4-trans and cis)-10R-annonacin-A-ones, from the leaves of Annona muricata . J Nat Prod . 1995;58(9):1430-1437.
17. Kim GS, Zeng L, Alali F, et al. Two new mono-tetrahydrofuran ring acetogenins, annomuricin E and muricapentocin, from the leaves of Annona muricata . J Nat Prod . 1998;61(4):432-436.
18. Kotake Y, Okuda K, Kamizono M, et al. Detection and determination of reticuline and N-methylcoculaurine in the Annonaceae family using liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci . 2004;806(1):75-78.
19. Padma P, Pramod NP, Thyagarajan SP, Khosa RL. Effect of the extract of Annona muricata and Petunia nyctaginiflora on Herpes simplex virus. J Ethnopharmacol . 1998;61(1):81-83.
20. Jaramillo MC, Arango GJ, González MC, Robledo SM, Velez ID. Cytotoxicity and antileishmanial activity of Annona muricata pericarp . Fitoterapia . 2000;71(2):183-186.
21. Osorio E, Arango GJ, Jiménez N, et al. Antiprotozoal and cytotoxic activities in vitro of Colombian Annonaceae . J Ethnopharmacol . 2007;111(3):630-635.
22. Lannuzel A, Höglinger GU, Champy P, Michel PP, Hirsch EC, Ruberg M. Is atypical parkinsonism in the Caribbean caused by the consumption of Annonacae ? J Neural Transm Suppl . 2006;(70):153-157.
23. Lannuzel A, Höglinger GU, Verhaeghe S, et al. Atypical parkinsonism in Guadeloupe: a common risk factor for two closely related phenotypes? Brain . 2007;130(pt 3):816-827.
24. Lannuzel A, Michel PP, Höglinger GU, et al. The mitochondrial complex I inhibitor annonacin is toxic to mesencephalic dopaminergic neurons by impairment of energy metabolism. Neuroscience . 2003;121(2):287-296.
25. Champy P, Höglinger GU, Féger J, et al. Annonacin, a lipophilic inhibitor of mitochondrial complex I, induces nigral and striatal neurodegeneration in rats: possible relevance for atypical parkinsonism in Guadeloupe. J Neurochem . 2004;88(1):63-69.
26. Lannuzel A, Michel PP, Caparros-Lefebvre D, Abaul J, Hocquemiller R, Ruberg M. Toxicity of Annonaceae for dopaminergic neurons: potential role in atypical parkinsonism in Guadeloupe. Mov Disord . 2002;17(1):84-90.

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