Sanguinaria canadensis L., commonly known as bloodroot, red puccoon, Indian paint, redroot, pauson, or tetterwort, is found throughout most of North America east of the Rocky Mountains (Reed 1999). This herbaceous perennial is a member of the Papaveraceae (poppy family) (Reed 1999). It reaches a maximum of ten inches in height, has basal leaves that can be as wide as eight inches, and a white and yellow flower appearing in late winter continuing into early spring (Reed 1999). This species is found in rich woods, usually on banks or slopes (Anon 2003).
Rhizomes of Sanguinaria canadensis produce an extract that is a mixture of benzophenanthride alkaloids, most notably sanguinarine (Godowski 1989). American Indians used the rhizome in treatment of: rheumatism, asthma, bronchitis, lung ailments, laryngyitis, fevers, and warts (Anon 1995).
Alkaloid production in S. canadensis was noted to increase with decreased light intensity and fertilizer levels and decline with topographic elevation (Salmore and Hunter 2001).
S. canadensis extracts have antibiotic activity. A study conducted by Ignatov et al (1994) found that the enzyme-specific activity of S. canadensis used in defense against pathogens may depend on the presence of methyl jasmonate and acetylsalicylic acid. They found that enzyme-specific activity could be increased up to 4- to 14- fold when cultured cells were treated with methyl jasmonate and acetylsalicylic acid (Ignatov et al 1994). Therefore, less sanguinarine is needed if it is given with methyl jasmonate and acetylsalicylic acid, than if it given alone.
Antimicrobial effectiveness of extracts of S. canadensis in traditional treatment of leprosy and tuberculosis was tested using two model species of mycobacteria, Mycobacterium aurum and M. smegmatis (Newton 2001). S. canadensis was found to have significant antimycobacterial activity against M. aurum only (MIC=62.5 microg/ml) which supports the traditional uses of this plant against those diseases (Newton et al 2001).
Effects on white blood cells are also dependent on the dosage of extracts of S.canadensis. Sanguinarine extracts are not lytic to neutrophils but even at very low concentrations (0.001%) will inhibit neutrophil chemotaxis, oxidative metabolism and degranulation within 5 minutes (Agarwal et al 1997). Therefore, both the length of exposure and the dose of the drug both are critical while considering the effectiveness of the extract in the treatment of infections (Agarwal et al 1997). An in vitro analysis of fifteen strains of Helicobacter pylori, bacteria that cause common gastrointestinal upset, were growth inhibited by a methanol extract of S. canadensis, with a MIC50 range of 12.5-50.0 microg/ml (Mahady et al 2003).
Sanguinaria has been investigated as an anti cancer treatment. The activation of human myloid cells with tumor necrosis was completely suppressed by sanguinarine in a dose- and time-dependent manner (Chaturvedi et al 1997). Uterine cervical cancer treatment with 2.12 or 4.24 microM sanguinarine induced cell death in most pathogenic cells, providing first evidence that sanguinarine is effective against cervical cancer cells via cell death (Ding et al 2002). Sanguinarine showed no specificity for cancer cells in human prostatic adenocarcinoma cells, inhibiting the growth of all cells tested, suggesting clinical usefulness is limited in cancer treatment (Debiton et al 2003). Four cases in which patients had used sanguinarine extracts in lieu of the recommended conventional treatment for basal cell carcinomas showed that scarring ensued. One patient had a residual tumor, and another "healed" for several years but then had deeply recurring basal cell carcinomas (McDaniel and Goldman 2002).
The commercially marketed product Viadent mouthrinse and toothpaste both contain sanguinarine, commonly used to treat adult periodontitis. A comparison study shows that doxycycline hyclate (a synthetic) is superior to sanguinarine chloride in treatment of adult periodontitis (Drisko 1997). In a double-blind parallel study, people using sanguinaria extract oral rinse did not show improvement (Polson et al 1990). A 14-week controlled clinical trial supported the combined use of chlorhexidine mouthrinse for 2 weeks followed by sanguinaria mouthrinse and toothpaste up to three months in treating periodontitis (Tenenbaum et al 1999). The MIC of sanguinarine ranges from 1 to 32 micrograms/ml for most species of plaque (Godowski 1987). A match case-controlled study including 58 patients diagnosed with oral leukoplakia showed that Viadent product use may cause oral leukoplakia (Mascarenhas et al 2002). Based on reviews and discussions of the database on Sanguinaria extract, the Expert Panel declared Viadent products to be safe in present use (Frankos et al 1990).
Benefits of Sanguinaria canadensis extract include leprosy and tuberculosis treatment, antimicrobial treatment for the gastrointestinal system, cervical cancer and tumor treatments, and adult periodontitis treatment. Risks include a dose and time dependent treatment that is not well understood or proven, no specificity in growth inhibition of cells (normal or cancerous), and proven harm in abandoning traditional treatments in basal cell carcinomas. More research is necessary to determine whether Sanguinaria canadensis is effective as an anticancer treatment.
Agarwal, S & N. Piesco, D. Peterson, J. Charon, J. Suzuki, K. Godowski, & G. Southard. 1997. Effects of sanguinarium, chlorhexidine and tetracycline on neutrophil viability and functions in vitro. Journal of Biological Chemistry 28;30129-34.
Anon. 1995. North Carolina Natural Bloodroot. http://ncnatural.com/wildflwr/blodroot.html
Anon. 2003. National Park Service Bloodroot. http://www.nps.gov/plants/medicinal/plants/sanguinaria_canadensis.htm
Chaturvedi, M A. Kumar, B. Darney, G. Chainy, S. Agarwal, & B. Agarwal, B. 1997. Sanguinarine (pseudochelerythrine) is a potent inhibitor of NF-kappaB activation, IkappaBalpha phosphorylation, and degradation. Journal Periodontol 68;729-33.
Debiton, E J. Madelmont, J. Legault, & C. Barthomeuf, C. 2003. Sanguinarine-induced apoptosis is associated with an early and severe cellular glutathione depletion. Cancer Chemotherapy Pharmacology 51;474-482.
Ding, Z & S. Tang, P. Weerasinghe, X. Yang, A. Pater, A. Liepins, A. 2002. The alkaloid sanguinarine is effective against multidrug resistance in human cervical cells via bimodal cell death. Biochemical Pharmacology 15;1415-21.
Drisko, C. 1997. The use of locally delivered doxycycline in the treatment of periodontitus. Clinical results. Aust Dentistry Journal 42;47-51.
Frankos, V., D. Brusick, E. Johnson, H. Maibach, I. Munro, R. Squire, C. Weil, 1990. Safety of Sanguinaria extract as used in commercial toothpaste and oral rinse products. Journal of Can Dentistry Association 56;41-7.
Godowski, K. 1989. Antimicrobial action of sanguinarine. J Clin Dent. 1989. Spring; 1:96-101.
Ignatov, A., W. Clark, S. Cline, M. Psenak, J. Krueger, & C. Coscia. 1994. Elicitation of dihydrobenzophenantride oxidase in Sanguinaria canadensis cell cultures. Planta Medicine 60;553-7.
Madady, G C. Liu, & C. Beecher, C. 1997. Involvement of protein kinase and G proteins in the signal transduction of benzophenanthridine alkaloid biosynthesis. Arch. Biochemistry and Biophysics 15;208-12
Mahadria , G S. Pendland, A. Stoia, L. Chadwick, L. 2003. In vitro susceptibility of Helicobacter pylori to isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis candensis. Phytother Research 17;217-21.
Mascarenhas, A., C. Allen, & M. Moeschberger. 2002. The association between Viadent use and oral leukoplakia &endash; results of a matched case-control study. Journal of Public Health Dentistry 62;158-62.
McDaniel, S & G. Goldman. 2002. Consequences of using escharotic agents as primary treatment for nonmelanoma skin cancer. Arch Dermatology 138;1593-6.
Newton, S C. Lau, S. Gurcha, G. Besra, & C. Wright, C. 2001. The evolution of 43 plant species for in vitro antimycobacterial activities. Journal of Chemical Ecology 27;1729-47.
Polson, A, N. Stoller, P. Hanes, C. Bandt, S. Garret, & G. Southard. 1990. Two multi-center trials assessing the clinical efficacy of 5% sanguinarine in a biodegradable drug delivery system. Journal of Can Dentistry Association 56;7-12.
Reed, D. 1999. Wildflowers of the Southeastern United States, bloodroot. http://2bnthewild.com/plants/H261.htm
Salmore, A & M. Hunter. 2001. Environmental and genotypic influences on isoquinoline alkaloid content in Sanguinaria canadensis. Journal of Chemical Ecology 27;1713-27.
Salmore, A & M. Hunter.. 2001. Elevational trends in defense chemistry, vegetation, and reproduction in Sanguinaria canadensis. Naunyn Schmiedebergs Arch Pharmacol 363;203-8.
Tenenbaum, H., M. Dahan, & M. Soell. 1999. Effectiveness of sanguinarine regimen after scaling and root planning. Journal of Clinical Periodontol 25;947-52.
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