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Sauropus androgynus

Synonyms

Sauropus albicans, Sauropus gardnerianus, Sauropus zeylanicus, Sauropus sumatranus, Clutia androgyna, Aalius androgynus, Aalius sumatranus [6] [7]

Vernacular Names:

Malaysia Asin-asin, Cekor Manis, Cekup Manis, Cermela hutan, Taruk Manis, Katuk
English Star Gooseberry 
Indonesia Asin-asin, Babing, Gerager, Katuk, Kerakur, Memata, Simani
Thailand
Phak Waan
Philippines
Binahian, Malunggay Hapon
Vietnam
Rau Nyot, Bo ngot
Laos Hvaan baanz
China
Ma Ni Chai, So Kun Mu, Fan Shu Choy, Pa wan
Japan Ruridama no ki
India

Kutchumku; Surasarabi (Hindi); Aruni (Sanskrit); Chakramunis, Thavasai murungai [1] [2] [5] [6] [7]

General Information

Description

Sauropus androgynus is a shrubby plant of the Euphorbia family. It can grow up to 3 m high. The leaves are simple, alternately arranged, lanceolate or oblong in shape, 2-6 cm long and 1-3 cm wide, two ranked and papery thin. The upper surface is dark-green in colour while the lower surface is light green. The flowers are unisexual with the female appearing first before the male, small, in axillary clusters. Mature fruit is about 5 cm in diameter. They are rounded capsules with distinct six partitions. The young branches and leaves are used as vegetable.[4] [6]

Plant Part Used

Whole plant, leaves and roots [3] [4] [6]

Chemical Constituents

(-)-isolariciresinol; (-)-isolariciresinol 3alpha-O-beta-apiofuranosyl-(1-->2)-O-beta-glucopyranoside; (-)-isolariciresinol 3alpha-O-beta-glucopyranoside;  isolariciresinol 3alpha-O-beta-glucopyranoside; (+)-syringaresinol di-O-beta-glucopyranoside; (+)-guanosine; chorchoionoside C; calcium; iron; papaverine; phosphorus; potassium; provitamin A; sauroposide;  Vitamin B1; Vitamin B2; Vitamin C.[4] [9]

Traditional Used:

Genito-urinary diseases

The roots of S. androgynus has diuretic properties which is being taken advantage of by some traditional practitioners to treat various urinary complaints. Amongst the diseases treated include symptomatic relieve of dysuria.[3] [4] [6]

Cardiovacular Diseases

Again the roots are used in treatment of cardiovascular diseases or symptoms of this group of diseases including vertigo, dizziness, fainting spells. It is also being recommended to those with hypertension.[3] [6]

Other uses

The whole plant is given to women after delivery to enhance lactation and allow for early post-partum recovery.[3] Decoction of the leaves and roots is a remedy for epistaxis and oriental sores.[3] Another application of the leaves is for oral thrush in infants.[4] Paste of leaves is applied over nasal ulcers and yaws, erythrema and measles.[4] Juice extracted from the leaves is used as an eye lotion for eye complaints.

Pre-Clinical Data

Pharmacology

Antiobesity activity

The use of Auropus androgynus as a health food for body weight reduction, had led to an outbreak of obliterative bronchitis in Taiwan, China and Japan. Yu SK et al[10] studied the toxicity and antiobesity features of 3-O-beta-D-glucosyl-(1à6)-beta-D-glucosyl-kaempferol (GGK), on male Wistar rats. They found that there was a reduction of foos intake by 15% which correspondingly produced decrease in the body weight of the rats. There was also a significant reduction in serum levels of free triglycerides.

Cytotoxic activity

Ethanolic exctract of the leaves of S. androgynus showed cytotoxic activity as evidenced by condensation of chromatin, apoptosis and the formation of DNA ladders observed in NIH3T3 fibroblasts. These features could be related to the pathogenesis of Sauropus androgynus-associated obliterative bronchiolitis.[11]

Induction of lactation activity

Soka et al[27] reported on the effects of S. androgynus leaf extract on the expression of prolacting and oxytocin genes in lactating BALB/C mice. They found that by supplementing lactating mice with young leaf extracts of Sauropus androgynus there was an increased in the expression of prolactin and oxytocin genes while giving the extract of the matured could further increase this expression. This was correlated with papaverine content which is higher in matured leaves.

Toxicities

Bronchiolitis obliterans

There have been reported cases of bronchiolitis obliterans, ischaemic bronchi necrosis, irreversible obstructive ventilatory defect and breathing difficulties resulting in death. The first report[13] [17] of toxicity against S. androgynus consumption came from Taiwan in 1996 where 44 cases were reported. The lung biopsy then shows bronchiolitis obliterans organizing pneumonia. Another report[14] showed similar histopathology with predominance of T-cells over B cells and upon immunoflourescent stains for IgG, IgM, IgA, C1q, C3 and C4 were negative. Serum concentration of TNF alpha were higher. Chen et.al[15] believed that the altered cytokine expression and infiltration of eosinophils and neutrophils may be involved in the pathology of this condition.

Study[16] described the histopathology of this conditions as follows: the spectrum of histological changes ranged from slight bronchiolar inflammation and fibrosis to marked submucosal fibriosis causing complete cicatricial obliterations of the lumen. There was dense infiltration of eosinophils in the bronchiolar submucosa or fibrotic tissue of the completely obliterated bronchioles. Imminohistochemical studies showed lyphocytic infiltration to be mainly T lymphocytes. Electronmicroscopy showed no immune complex deposition in the specimen.  The predominance of T-lymphocytic infiltrate suggests that a T-cell mediated immune response is involved in the pathogenisis of the disease. In an examination of autopsy specimen. Chang YL. et al[21] found focal fibromuscular sclerosis and obliteration of the bronchial arteries in the wall of the large bronchi 4 – 5 mm in diameter with segmental necrosis of the bronchi 2 – 4 mm in diameter. Bronchi immediately proximal to the necrotic zone showed fibrosis and atrophy of the cartilage, bronchial glands, and smooth muscle cells; bronchioles immediately distal showed obstruction and dilatation. Most bronchi larger than 5 mm, pulmonary vessels, small bronchioles, and alveoli were little altered. These changes were consistent with segmental ischaemic necrosis of bronchi at the water-shed zone of the bronchial and pulmonary circulation.

In providing a diagnostic entity for the condition[18] suggested that finding from high-resolution CT of air trapping were more important diagnositic feature than the findings of bronchiectasis when correlating pulmonary function. The mosaic attenuation notable on expiratory CT scans is denoted as type 1 air-trapping score while on both inspiratory and expiratory CT scans in denoted as type 2 air-trapping score. These scores are helpful in assessing airway-trapping and correlating it with pulmonary function. The type 2 air-trapping score suggest a more severe air-flow obstruction. Another study[23] added another diagnostic criterion in the form of measurement of the 99mTc-DTPA (Technetium-99m DPTA) clearance as being the most sensitive test to detect the lung injuries causes by consuming S. androgynus .

Study[19] on the relationship of methods of preparation of S. androgynus with the incidence of bronchiolitis obliterans. They found that consumption of the vegetable in larger amounts, without cooking and food prepared by vendors posed a greater risk of developing the syndrome. Hsiue et al[20] noted that a larger dose of the vegetable is associated with higher risk of developing the lesion and that the lesion is irreversible during the 22 month period of observation. They also noted that 65% of patients began suffering from dyspnea in the 3rd, 4th, or 5th month after taking the vegetable.

Therapeutically this condition is indeed a challange. Wu CL. et al[22] found that large doses of prednisolone (>0.5mg/kg/day, >30 days) were not able to even reduce the Pulmonary Function Test like FEV1, FVC, FEV1/FVC, and carbon monoxide diffusion capacity. Bronchodilators[24] too did not change the status of the condition which is deemed irreversible. Study[26] suggested an empirical treatment with corticosteroid and immunosuppressive agent as a possibility together with antifibrotic agents when available. However, lung transplantation still remains the best option. There are[25] reported success in this form of treatment when they performed the transplantation in 5 patients with end-stage S. androgynus-induced bronchiolitis obliterans syndrome. Three patients survived with improved general condition and pulmonary function. Perfusion/ventilation scans revealed that these improvements were exclusively attributed to functional grafts.

Clinical Data

Clinical Trials

No documentation

Adverse Effects in Human:

Consuming too much of the leaves can cause pains in the limbs. Taking it raw or in fresh juiced form has been associated with breathing difficulties. The papaverine content can render it addictive and when consumed in large amounts it can cause sedation, dizziness, diplopia, uncontrolled eye movements, nausea, vomiting and weakness.[8]

Anaphylactic reaction

Reports[27] for the first time anaphylactic reaction in one patient with latex allergy, following the ingestion of Sauropus androgynus. The patient developed urticarial rash 20 – 30 minutes after ingestion of the vegetable. The diagnostic workup showed specific IGE to latex, positive skin prick test to latex and cooked and raw S. androgynus.

Used in Certain Conditions

Pregnancy / Breastfeeding

No documentation

Age Limitations

Neonates / Adolescents

No documentation

Geriatrics

No documentation

Geriatrics
 
Elderly individuals with chronic obstructive airway diseases or chronic smokers with compromised respiratiory system should avoid taking this vegetable be it raw or cooked to avoid the incidence of S. androgynus-induced bronchiolitis obliterans.

Interactions

Interactions with drugs

No documentation

Interactions with Other Herbs / Herbal Constituents

No documentation

Contraindications

Contraindications

This vegetable should be contraindicated in people with bronchial asthma, chronic obstructive airway disease and chronic smokers as there is the fear of developing bronchiolitis obliterans with the already compromised respiratory system. The content of papaverine is another factor of caution. Those with latex allergic should also avoid taking this due to the fear of developing anaphylactic reactions as reported.

Case Reports

No documentation

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  1)  Botanical Info

References

    1. Alan M. Stevens Kamus Lengkap Indonesia Inggris Penerbit Mizan Bandung 2004 pgs. 59, 456, 627
    2. John Harry Wiersema, Blancha Leon World Economic Plants: A Standard Reference CRC Press Inc. Boca Raton 1999 pg. 448
    3. Hean Chooi Ong Sayuran: Khasiat makanan & Ubatan Utusan Publications & Distributors Sdn. Bhd. Kuala Lumpur 2003 pg. 32 – 33
    4. Koh Hwee Ling, Chua Tung Kian, Tan Chay Hoon A Guide to Medicinal Plants: An Illustrated, Scientific and Medicinal Approach World Scientific Publishing Co. Pte. Ltd. Singapore 2009 pg. 139
    5. Noraida Arifin Penyembuhan Semula Jadi dengan Herba PTS Litera Utama Kuala Lmpur 2005 pg. 37
    6. Hean Chooi Ong Vegetables for Health and Healing Utusan Publications & Distributors Sdn. Bhd. Kuala Lumpur 2003 pg. 164 – 165
    7. Peter  Hanelt Mansfeld’s Encyclopedia of Agricultural and Horticultural Crops Volume 5 Springler-Verlag Berlin 2001 pg. 1177
    8. Padmavathi P, Rao MP. Nutritive value of Sauropus androgynus leaves. Plant Foods Hum Nutr. 1990 Apr;40(2):107-13.
    9. Kanchanapoom T, Chumsri P, Kasai R, Otsuka H, Yamasaki K. Lignan and megastigmane glycosides from Sauropus androgynus. Phytochemistry. 2003 Aug;63(8):985-8.
    10. Yu SF, Shun CT, Chen TM, Chen YH. 3-O-beta-D-glucosyl-(1-->6)-beta-D-glucosyl-kaempferol isolated from Sauropus androgenus reduces body weight gain in Wistar rats. Biol Pharm Bull. 2006 Dec;29(12):2510-3.
    11. Yu SF, Chen TM, Chen YH. Apoptosis and necrosis are involved in the toxicity of Sauropus androgynus in an in vitro study. J Formos Med Assoc. 2007 Jul;106(7):537-47.
    12. Soka S, Alam H, Boenjamin N, Agustina TW, Suhartono MT. Effect of Sauropus androgynus leaf extracts on the expression of prolactin and oxytocin genes in lactating BALB/C mice. J Nutrigenet Nutrigenomics. 2010;3(1):31-6. Epub 2010 Aug 26.
    13. Lin TJ, Lu CC, Chen KW, Deng JF. Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable. J Toxicol Clin Toxicol. 1996;34(1):1-8.
    14. Lai RS, Chiang AA, Wu MT, Wang JS, Lai NS, Lu JY, Ger LP, Roggli V. Outbreak of bronchiolitis obliterans associated with consumption of Sauropus androgynus in Taiwan. Lancet. 1996 Jul 13;348(9020):83-5.
    15. Chen CW, Hsiue TR, Chen KW, Chang HY, Chen CR, Yang BC. Increased IL-5 and IL-10 transcription in bronchial cells after Sauropus androgynus ingestion. J Formos Med Assoc. 1996 Sep;95(9):699-702.
    16. Chang H, Wang JS, Tseng HH, Lai RS, Su JM. Histopathological study of Sauropus androgynus-associated constrictive bronchiolitis obliterans: a new cause of constrictive bronchiolitis obliterans. Am J Surg Pathol. 1997 Jan;21(1):35-42.
    17. Wu CL, Hsu WH, Chiang CD, Kao CH, Hung DZ, King SL, Deng JF. Lung injury related to consuming Sauropus androgynus vegetable. J Toxicol Clin Toxicol. 1997;35(3):241-8.
    18. Yang CF, Wu MT, Chiang AA, Lai RS, Chen C, Tiao WM, McLoud TC, Wang JS, Pan HB. Correlation of high-resolution CT and pulmonary function in bronchiolitis obliterans: a study based on 24 patients associated with consumption of Sauropus androgynus. AJR Am J Roentgenol. 1997 Apr;168(4):1045-50.
    19. Ger LP, Chiang AA, Lai RS, Chen SM, Tseng CJ. Association of Sauropus androgynus and bronchiolitis obliterans syndrome: a hospital-based case-control study. Am J Epidemiol. 1997 May 1;145(9):842-9.
    20. Hsiue TR, Guo YL, Chen KW, Chen CW, Lee CH, Chang HY. Dose-response relationship and irreversible obstructive ventilatory defect in patients with consumption of Sauropus androgynus. Chest. 1998 Jan;113(1):71-6.
    21. Chang YL, Yao YT, Wang NS, Lee YC. Segmental necrosis of small bronchi after prolonged intakes of Sauropus androgynus in Taiwan. Am J Respir Crit Care Med. 1998 Feb;157(2):594-8.
    22. Wu CL, Hsu WH, Chiang CD. The effect of large-dose prednisolone on patients with obstructive lung disease associated with consuming sauropus androgynus. Zhonghua Yi Xue Za Zhi (Taipei). 1998 Jan;61(1):34-8.
    23. Kao CH, Ho YJ, Wu CL, ChangLai SP. Using 99mTc-DTPA radioaerosol inhalation lung scintigraphies to detect the lung injury induced by consuming Sauropus androgynus vegetable and comparison with conventional pulmonary function tests. Respiration. 1999;66(1):46-51.
    24. Hayashi M, Tagawa A, Ogura T, Kozawa S, Nakamura M, Watanuki Y, Takahashi H. [Familial occurrence of bronchiolitis obliterans associated with sauropus androgynus] Nihon Kokyuki Gakkai Zasshi. 2007 Jan;45(1):81-6.
    25. Luh SP, Lee YC, Chang YL, Wu HD, Kuo SH, Chu SH. Lung transplantation for patients with end-stage Sauropus androgynus-induced bronchiolitis obliterans (SABO) syndrome. Clin Transplant. 1999 Dec;13(6):496-503.
    26. Epler GR. Constrictive bronchiolitis obliterans: the fibrotic airway disorder. Expert Rev Respir Med. 2007 Aug;1(1):139-47.
    27. Stirapongsasuti P, Tanglertsampan C, Aunhachoke K, Sangasapaviliya A. Anaphylactic reaction to phuk-waan-ban in a patient with latex allergy. J Med Assoc Thai. 2010 May;93(5):616-9.

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