Next Article in Journal
Activity of Aqueous Extracts from Native Plants of the Yucatan Peninsula against Fungal Pathogens of Tomato In Vitro and from Croton chichenensis against Corynespora cassiicola on Tomato
Next Article in Special Issue
Potentilloside A, a New Flavonol-bis-Glucuronide from the Leaves of Potentilla chinensis, Inhibits TNF-α-Induced ROS Generation and MMP-1 Secretion
Previous Article in Journal
The Effects of Temperature and Water on the Seed Germination and Seedling Development of Rapeseed (Brassica napus L.)
Previous Article in Special Issue
Molecular Mechanisms Underlying Qi-Invigorating Effects in Traditional Medicine: Network Pharmacology-Based Study on the Unique Functions of Qi-Invigorating Herb Group
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Plants
Volume 11
Issue 21
10.3390/plants11212820
plants-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

The Therapeutic Efficacy of Punica granatum and Its Bioactive Constituents with Special Reference to Photodynamic Therapy

by
Nosipho Thembekile Fakudze
,
Eric Chekwube Aniogo
,
Blassan P. George
* and
Heidi Abrahamse
Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, P.O. Box 17011, Doornfontein 2028, South Africa
*
Author to whom correspondence should be addressed.
Plants 2022, 11(21), 2820; https://doi.org/10.3390/plants11212820
Submission received: 23 September 2022 / Revised: 17 October 2022 / Accepted: 20 October 2022 / Published: 24 October 2022
(This article belongs to the Special Issue Pharmacological and Toxicological Study of Medicinal Plants)
Browse Figures
Versions Notes

Abstract

:
Punica granatum (P. granatum) is a fruit-bearing tree from the Punicaceae family, indigenous to Iran. This plant has healing qualities that have drawn the interest of the medical community as an alternative treatment for malignancies and non-malignancies. Its healing quality is due to the phytochemicals present in the plant. These include ellagic acid, punicic acid, phenols, and flavonoids. In traditional medicine, P. granatum has been used in treating diseases such as dysentery, bleeding disorders, leprosy, and burns. This review explores the effects of the phytochemical constituents of P. granatum on photodynamic therapy for cancer, chronic inflammation, osteoarthritis, and viral infections. Its antioxidant and antitumor effects play a role in reduced free radical damage and cancer cell proliferation. It was concluded that P. granatum has been used for many disease conditions for a better therapeutic outcome. This paper will give visibility to more studies and expand the knowledge on the potential use of P. granatum in photodynamic cancer treatment.

1. Introduction

Punica granatum (pomegranate) is a small shrub or tree that belongs to the family Punicaceae, depicted in Figure 1 [1,2]. This tree grows to about 3 to 5 m with shiny, spear-shaped leaves, big white, red or multi-colored flowers, and fruits [3]. It is indigenous to Iran and Afghanistan but cultivated in Africa, Europe, and South and North America [4]. The history of the pomegranate shows that it was widely used as folk medicine in countries like Greece and Russia. Doctors described its juice as the medical treatment for various illnesses in Greece, including inflammation, dysentery, diarrhea, persistent coughs, and intestinal worms. At the same time, in the Georgian Republic of Russia, it was believed to inhibit inert hemorrhages, diarrhea, chronic mucous discharges, and night sweats [5].
The plant parts are all utilized in traditional medicine, especially in the Ayurvedic system [3]. The early conventional medicine systems used P. granatum in their herbal (drug) formulation for the Unani system, Ayurveda system, and traditional Chinese medicine in the treatment of diseases. Traditional medicine falls into the category of naturopathic medicine. It forms part of Western medicine in homeopathy and is in its infancy [6]. P. granatum comprises phytochemicals that assist in anticancer and antioxidant effects on acute or chronic conditions [3,7,8]. These phytochemicals are responsible for specific mechanisms of action that result in the diminished effect or elimination of cancer cells. The primary classes of phytochemicals are ellagic acid (antioxidant and anticancer properties), flavonoids (antiproliferation properties), and anthocyanins (antioxidant, antiviral, anti-inflammatory) [9,10,11].
The medical community has directed its attention to P. granatum in cancer therapy, treating diabetes, and chronic inflammation [12,13]. The phytochemicals in P. granatum have been used in many in vivo and in vitro studies. These include the treatment of cancers, such as skin, breast, prostate, oral, colon, etc., with positive therapeutic outcomes [14,15]. Phytochemicals are also used in photodynamic therapy for cancer [16,17,18,19]. These phytochemicals are used as photosensitizers and include riboflavin, punicalagin, and quercetin [16,20,21].

2. Phytochemical Constituents of P. granatum

Various parts, such as the fruit (arils & seeds), peel, flowers, and bark, of P. granatum contain different phytochemicals. The fruit consists of anthocyanins, polyphenols, polysaccharides, ascorbate, pectins, vitamins, organic acids, fatty acids, and malate [8,22,23]. The juice (part of the fruit) of P. granatum contains 85.4% water, approximately 1% polyphenols, 10.6% sugars, and 1.4% pectin. The juice is rich in minerals and contains varying concentrations of elements such as cobalt, sodium, calcium, magnesium, cesium, selenium, and zinc [8]. The seeds also possess an antioxidant capacity and a nutritional composition, such as sugars, vitamins, polyunsaturated fatty acids, polysaccharides, minerals, and polyphenols [24]. Approximately 80% of the seed oil is composed of a trienoic fatty acid, called punicic acid, which is capable of antitumor action [25]. The peel contains seven carbonic anhydrase inhibitors: highly active punicalin, tellimagrandin, pedunculagin, granatin B, punicalagin, and gallagyldilactone [26]. The rind (part of the pericarp/peel) contains ellagitannins and polyphenolic flavanols [27]. The flower contains ursolic acid, gallic acid, and triterpenoids, while the bark has ellagitannins, tannins, and alkaloids [22,23,28]. Table 1 comprehensively lists the phytochemicals of each part of the P. granatum [26] plant. These phytochemicals are not isolated to just P. granatum but are found in numerous other plants [29]. Many studies have been conducted on medicinal plants to investigate their anticancer therapeutic potential and mechanism of action, as indicated in Table 2.

3. P. granatum in Traditional Medicine

The traditional systems of medicine, such as Ayurveda, Traditional Chinese Medicine, and Unani, have used P. granatum for multiple purposes. The Ayurveda system, invented around 800 BCE, has been used as a traditional means of alleviating certain disease conditions to improve health [59]. It is accomplished through dietary controls, physical fitness, surgery, the management of stress, and herbal drugs. The drug preparation used in the system is derived from minerals, plants, and animal sources [59]. Unani was introduced by Muslims to India around a thousand years ago. It identifies the emotional, mental, physical, and spiritual causes of disease and well-being. The treatment is directed at self-healing through addressing lifestyle factors, e.g., eating healthier and regular exercise, but advanced disease medicine (herbal formulation) is also advised [59]. In Chinese medicine, diagnosis is through assessing four points: observations, patient questionnaires about their hearing and sense of smell, and taking the patient’s pulse. The treatment entails diet, herbs, acupuncture, etc., which are used for dysentery, pulmonary complications, infections (microbial, helminth), bleeding, etc. [59,60,61]. It can also be used for colic, menorrhagia, colitis, oxyuriasis, headache, allergic dermatitis, diuretic, acne, leprosy, piles, burns, snakebite, diabetes, and oral diseases [26,30]. In Chinese medicine, the P. granatum peel was used for its hemostasis, deworming, and antidiarrheal effects [62]. In Ayurveda, the P. granatum root and bark are believed to possess anti-parasitic and anthelminthic properties, and are therefore used in treating dysentery, ulcers, and diarrhea [62]. In Unani, the P. granatum flower is used for asthenia, while the seed formulation treats whooping cough, indigestion, vomiting, and nausea [63,64].

4. Photodynamic Therapy

The discovery of healing by sunlight can be traced from ancient times in Greece, India, and Egypt, and is known as heliotherapy [65,66]. The evolution of heliotherapy, later renamed phototherapy by Rikli, started with sunlight and now utilizes ultraviolet (UV) radiation [65]. Photodynamic Therapy (PDT) is an alternative method for non-malignant and malignant treatments. It utilizes light, a photosensitizer (PS), and oxygen to treat disease states [66,67,68]. The PDT mode of action entails cellular, vascular, and systemic immune levels of function, which may occur almost concurrently [66,67]. The cellular mechanism entails the elimination of tumors through necrosis and apoptosis. The necrosis of malignant cells occurs when a high-intensity light is introduced and causes quick cell destruction, in addition to a local and systemic immune response. Apoptosis in malignant cells occurs when a low light is introduced, and the cells stop their functions and go through programmed cell death. The immune response is not activated in apoptosis since no hazardous compounds are released from dead cells. The disruption in the vasculature of malignant cells caused by applying suitable light will lead to necrosis and, as a moderate reaction, apoptosis [67]. PDT is responsible for the activation of the immune system when necrosis is induced in malignant cells [69].
In PDT, a PS is introduced, and light of the required wavelength and intensity is applied to activate it. The PS can use multiple pathways to reach tumor cells, such as low-density lipoprotein receptor binding, lipid binding, uptake via tyrosine kinase, diffusion, etc. The photochemical reactions (type I and type II) are pathways that PS can go through and result in apoptosis or necrosis [63,66]. Aside from oxygen and light, the PS is the most vital part of the PDT mechanism. Clinically, only a limited number of PS are being utilized because of their particular specificity in cell uptake and photochemistry [66]. Photofrin is one of the most used and approved PS. Active research is still undergoing to identify other PS of clinical importance, and novel properties that would mitigate the limitations of poor chemical purity and insufficient penetration of the PS [70].
PDT is an alternative form of cancer treatment, and can be combined with other treatment options [16]. One such combination of medicine includes the use of phytochemicals. A study by Thakur and colleagues combined the PS, zinc phthalocyanine, with quercetin to improve the cancer-killing effects [19]. A study that combined quercetin and PDT with an aluminum phthalocyanine tetrasulfonate PS on human larynx carcinoma cells resulted in cell cytotoxicity [16]. Combining ellagic acid and PDT treatment on leukemia cells showed an improved induction of the cell apoptosis, which thus suggests that phytocompounds help to improve the therapeutic efficacy of the PDT [17].

5. Mechanism of Action and Therapeutic Properties of P. granatum

Some of the phytochemicals of P. granatum can cause the down-regulation of extracellular, signal-regulated kinase ½ and c-Jun N-Terminal Protein Kinase 1, and up-regulation of tumor suppressor p53, which leads to cellular DNA damage [71]. These compounds induce therapeutic effects, such as antioxidant, anti-inflammatory, antiviral, anti-osteoarthritis, anticancer, etc., as shown below in Figure 2.

5.1. Anticancer Properties

In a breast cancer study, the P. granatum pericarp phytochemical, genistein, was used to inhibit the proliferation of ER+ MCF-7 cancer cells. Genistein modulates the ER-α and ER-β selective estrogen receptors, and activates the cell cycle arrest and tumor suppression, respectively [8]. Another study that evaluated the antioxidant, antiproliferative, and apoptotic effects of the methanol extract from pomegranate peel found a decreased proliferative and increased apoptotic activities of MCF-7 human breast cancer cells [72]. These findings support the theory of the anticancer effect of P. granatum. The polyphenolic component, ellagic acid, in P. granatum also contributed to these observed impacts. These findings are further supported by works from Modaeinama and colleagues [73,74]. They reported that ellagic acid could induce the upregulation of Bax (Bcl-2-associated X) and Bcl-2 (B-cell lymphoma 2) proteins [73,74]. The expression of Bax (Bcl-2-associated X), a pro-apoptotic gene, was increased, while the anti-apoptotic gene, Bcl-2 (B-cell lymphoma 2), expression was decreased/inhibited, as depicted in Figure 3 [73].
The anticancer components of P. granatum are polyphenols, specifically ellagitannins (ET), flavonoids, punicalagin, to mention a few. The ET metabolize into active compounds named urolithin A (UA) and ellagic acid through the gut microbiota [9]. The urolithins suppress colon cancer cell proliferation, activate cell cycle cessation, and amend specific cellular processes linked with colon cancer progression, such as mitogen-activated protein kinase (MAPK) signaling [9]. A study using bioactive compounds of pomegranate, such as ellagitannins and punicalagin, showed that the inflammatory cell signaling in colon cancer cells was suppressed by significantly decreasing the cyclooxygenase-2 (COX-2) expression [75]. The ellagic acid metabolites of P. granatum ET have been shown to block intestinal inflammation, by suppressing the inflammatory mediators of inducible nitric oxide synthase (iNOS) and COX-2 [76].
In medicine, ellagic acid showed a probable chemo-preventive activity against prostate cancer. The inhibition of the motility and invasion of androgen-independent prostate cancer, PLS10 and PC3 cell lines, was seen when the cells were treated with a nontoxic concentration of ellagic acid. This was achieved by regulating the matrix metalloproteinases [74]. The study of the effect of pomegranate peel polyphenols on prostate cancer cells showed that the extract inhibited the proliferation of the cells and activated their apoptotic mechanism. After treatment with P. granatum juice extracts (punicic acid, luteolin and ellagic acid), the chemotactic proteins, which play a role in metastatic cancer (prostate, breast, renal, and colorectal), were in decline. This was accomplished by inhibiting the stromal cell-derived factor 1 alpha, and blocking the proteins that signal the C-X-C chemokine receptor type 4 (chemotactic proteins) [77]. The treatment of prostate cancer in vivo and in vitro with P. granatum peel extract showed the presence of apoptosis when viewed under fluorescence microscopy [78]. The treatment of lung cancer cells (A549) with P. granatum leaf extract resulted in the inhibition of cell proliferation, apoptosis induction, and the inhibition of cancer spread [79].
Punicic acid is a conjugated linolenic acid that contributes to the anticancer effects of P. granatum seed oil [80]. The performed studies showed cytotoxic effects on cancer cells. Its mechanism of action is not clearly understood, as other phytochemicals can be responsible for cancer cell breakdown, but it can be speculated to involve cytokine regulation, apoptosis activation, and malignant cell proliferation suppression [80]. As shown through the different studies elaborated, P. granatum phytochemicals show anticancer effects in other cancers with promising results through modulation, inhibition, and promotion of different proteins, hormones, and enzymes.

5.2. Antioxidant Properties

Equilibrium between the generation and removal of free radicals is imperative; hence, the term oxidative cellular stress results in imbalanced reactive oxygen species (ROS) production. ROS includes charged species (hydroxyl and superoxide radical) and uncharged species (hydrogen peroxide and singlet oxygen) [81]. Reactive atoms or molecules with unpaired electron/s in their external shell are termed free radicals. They are formed during the interactions of specific molecules with oxygen. Radicals are produced when a molecule receives or gains an electron [7]. ROS are reactive radical derivatives of oxygen, while reactive nitrogen species (RNS) are non-radical derivatives of nitrogen. Reactive oxygen and nitrogen species can either be endogenous or exogenous and can cause oxidative alteration of major cellular macromolecules like lipids, DNA, carbohydrates, and proteins [82].
Natural antioxidants are found in fruits and vegetables and have been of medical interest due to their prevention of oxidative damage by utilizing their -OH group to scavenge reactive radicals [83]. Grapes, berries, pomegranates, oranges, spinach, cabbage, etc. are among those fruits and veggies [83,84]. These antioxidants comprise flavonoids and phenolic compounds [10]. In P. granatum antioxidant properties are found in ellagic acid, hydrolyzable tannins, punicalagin, punicic acid, and anthocyanins [83]. Althunibat and colleagues performed a study on oxidative damage in experimental diabetic rats, which showed improved activity of antioxidant enzymes such as catalase, glutathione-S-transferase, glutathione reductase, superoxide dismutase, and glutathione peroxidase [85]. There is feasible suppression of tissue damage and inhibition of organ dysfunction caused by chronic hyperglycemia through the improvement of the activity of antioxidant enzymes by peel extract of P. granatum. The phenolic components of P. granatum peel extracts have been found to act as free radical scavengers thus, reducing the toxicity of ROS generated [85]. The anti-inflammatory action of punicic acid works by suppressing tissue necrosis factor α, which induced an increase in NADPH oxidase and hydroxyl radical scavenging action [25,86].

5.3. Anti-Osteoarthritis Properties

Osteoarthritis is a chronic musculoskeletal disorder that affects about 1.71 billion individuals worldwide [87]. Osteoarthritis disrupts the equilibrium between the production and breakdown of extracellular matrix components by chondrocytes. Osteoarthritis is considered the most common form of arthritis, and the causative agent of this osteoarthritis is still largely unknown [88]. The main treatment option for osteoarthritis is disease management, a known cure [89]. This is in the form of treating symptoms like inflammation, and slowing disease progression with therapies like acupuncture, physical therapy, and drugs [90,91].
Phytochemicals like anthocyanins, tannins, and punicalagin in P. granatum are effective in treating arthritis and can be used as an alternative treatment [91]. Studies show the improvement of the molecular pathway responsible for the development of osteoarthritis when treated with P. granatum [92,93,94]. Mahdavi and Javadivala demonstrated that treatment with P. granatum juice improved osteoarthritis. This was observed through better- functioning chondrocytes, leading to reduced damage to proteoglycans [94,95]. Similarly, Liu and colleagues (2021) reported a decrease in the progression of osteoarthritis in their study due to the protective effect of Punicalagin on chondrocytes [93].
The study by Choi and colleagues on anti-arthritic effects of Achyranthis radix, pomegranate, and Eucommiae cortex extracts on the primary cultured rat articular chondrocytes showed an inhibition of inflammatory response and associated extracellular matrix degradation and chondrocyte apoptosis [92].

5.4. Anti-Inflammatory Properties

Inflammation is a natural response by the immune system against substances that seem foreign or are harmful to the body, and is vital for tissue repair [27]. Acute and chronic inflammation are the two phases in the inflammation process. Innate immunity is an inflammation that occurs for a short duration and is advantageous to the host’s health. Chronic inflammation persists for longer, predisposing the host to various chronic illnesses, including cancer [27].
Okada, and Shimizu and colleagues have studied the relationships between cancer and inflammation, which suggested that elevated levels of inflammatory cytokines are responsible for cancer formation in low-grade chronic inflammation [96,97]. This accounts for an estimated 20–25% of cancer cases caused by a microbial infection inflammation [97]. The research has shown that the transcription factor, nuclear factor kappa B (NF-κB), the most recognized molecule, links the inflammation and cancer initiation, specifically tumor progression [96].
Houston and colleagues studied the anti-inflammatory action of P. granatum pericarp extract, and the results showed that the tannins (80% punicalagin and 1.3% ellagic acid) could cause the downregulation of COX-2 [27]. The punicic acids and their counterparts from pomegranate oil were used to treat cancer cell lines (breast, colon, prostate, and liver), decreasing the pro-inflammatory cytokines [36,37]. Ellagitannins and ellagic acid were utilized to treat intestinal colitis-induced inflammation and ulcers, with results showing the inhibition of HIF1α, which can be responsible for the colitis-induced inflammation, induction of tumor suppression, and decrease in the cytokines expression [98]. Osteoarthritis can advance due to damage to chondrocytes caused by inflammation in the disease. The treatment with ellagic acid caused the inhibition of NF-κB [99]. Ben-Saad and colleagues conducted a study that showed the suppression of cytokines and inflammatory mediators, such as nitrous oxide, using gallic acid, punicalagin, and ellagic acid found in P. granatum [100,101]. The literature on the anti-inflammatory action of P. granatum phytochemicals shows promising results, with possible future consideration for clinical trials after sufficient in vivo and in vitro studies.

5.5. Antiviral Properties

Research on P. granatum on viruses (herpes simplex virus, influenza virus, and human deficiency virus) was done by (Moradi et al., 2019; Howell and D’Souza, 2013) [27,102,103] and their findings showed a decrease in the viral titer load. The pomegranate peel inhibited replication against the influenza virus [103]. Evidence showed that punicalagin in P. granatum was an effective anti-influenza that blocked the virus’s RNA replication and inhibited red cell agglutination in chickens. The potential of effective viral treatment in human immunodeficiency virus (HIV) is postulated by Kotwal, Neurath, and colleagues due to the pomegranate’s potential to neutralize infectivity and block binding of HIV-1 to a cluster of differentiation 4 (CD4) receptors [102,104].
In the era where we find resistant strains of influenza, natural remedies can be explored as an alternative treatment. Flavonoids such as catechin, quercetin, rutin, and prodelphindin, found to have antioxidant, anti-inflammatory, antibacterial, antineoplastic, and antiviral properties, can be used for influenza treatment [105]. Influenza-infected MDCK cells treated with pomegranate peel extract (PPE) exhibited viral adsorption and RNA transcription inhibition [105]. Punicalagin was utilized against the alphavirus Mayaro virus, resulting in antiviral effects [106]. Phenolic components (n-butanol and gallic acid) caused inhibition of virus replication in adenovirus [107]. The antiviral effect of P. granatum is through the inhibition of replication and does not necessarily entail virucidal action [107].

5.6. Toxicity of P. granatum

The medical community has focused on herbal drugs as an alternative to synthetic pharmaceuticals for treating diseases. Natural remedies were employed in the past, and some traditional medicine systems are still being used today in countries, such as India and throughout Asia, benefiting human health. For patient safety, the toxicity of herbal therapies needs to be evaluated. The studies on the toxicity of P. granatum have been carried out by various authors and tabulated in the table below (Table 3).

6. Conclusions and Future Considerations

Photodynamic therapy has been of much interest to the medical community, due to its benefits in cancer treatment with minimal surgery requirements, reduced systemic toxicity, and its overall reduction in side effects. Improvements in its efficacy can lead to better survival statistics. Plants are the next alternative treatment option, due to their anticancer properties. Natural plants, such as P. granatum, contain phytochemicals such as flavonoids, phenolics, and ellagic acid, which are responsible for the cytotoxicity of malignant cells. The research has shown its role in cancer cell proliferation and apoptotic cell death pathway activation.
P. granatum’s ability as an antioxidant, antitumor, and anti-inflammatory agent has shown a cancer cell DNA fragmentation activity, reduction in tumor cell growth, an inhibition of NF-κB, and activation of ROS production. We have discussed this plant’s therapeutic properties, as reported in much of the research. Still, more is needed as the scientific community continues to explore the potential of P. granatum in combination therapies with photodynamic therapy to enhance its killing effect. The clinical studies geared toward treating with P. granatum have included preclinical and clinical trials of diseases such as inflammation, cancer, cardiovascular disorders, metabolic disorders, and infections, to name a few [113]. The current studies focus on the different parts of the pomegranate plant, including the peel [73,114,115], juice [75,93,116], leaf [79], etc.
Other studies on several phytochemicals for their beneficial properties are necessary to eliminate the toxicity of chemically synthesized drugs, especially the ones used for cancer treatment. P. granatum phytotherapy can be combined with surgery, immunotherapy, and hormonal therapy to maximize its efficacy and achieve better patient survival. The effective dose for treatment is an important aspect that needs to be explored in using P. granatum for cancer treatment. If all these areas are factored in the future, P. granatum will be a better plant source for alternative cancer treatment.

Author Contributions

Conceptualization, E.C.A. and B.P.G.; writing—original draft preparation, N.T.F.; writing—review and editing, E.C.A., B.P.G. and H.A.; supervision, B.P.G. and E.C.A.; project administration, B.P.G. and H.A.; funding acquisition, B.P.G. and H.A. All authors have read and agreed to the published version of the manuscript.

Funding

This work is based on the research supported by the South African Research Chairs Initiative of the Department of Science and Technology and the National Research Foundation of South Africa (Grant No 98337), as well as grants received from the African Laser Centre (ALC), the University of Johannesburg, the National Research Foundation (NRF), and the Council for Scientific and Industrial Research (CSIR)—National Laser Centre (NLC) Laser Rental Pool Program. The research reported in this article was supported by the South African Medical Research Council (SAMRC EIP007/2021) through its Division of Research Capacity Development, under the Research Capacity Development Initiative, from funding received from the South African National Treasury.

Data Availability Statement

Not Applicable.

Acknowledgments

The authors would like to thank the Department of Science and Technology and National Research Foundation of South Africa, the University Research Council of the University of Johannesburg (URC), the National Research Foundation (NRF), and the CSIR–NLC Laser Rental Pool Program. The work reported herein was made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development the South African Medical Research Council (SAMRC); the content and findings reported/illustrated are the sole deduction, view, and responsibility of the authors and do not reflect the official position and sentiments of the SAMRC.

Conflicts of Interest

The authors declare no conflict of interest.

List of Abbreviations

ER+Estrogen receptor-positive
ErαEstrogen receptors alpha
ErβEstrogen receptors beta
Bcl-2B-cell lymphoma 2
BaxBcl-2-associated X
ETEllagitannins
UAUrolithin A
MAPKMitogen-activated protein kinase
ERKExtracellular signal-regulated kinase
COX-2Cyclooxygenase-2
iNOSInducible nitric oxide synthase
MCF-7Breast cancer cell line
PC3Human prostate cancer cell lines
HIF1αHypoxia-inducible factor 1-alpha
ROSReactive oxygen species
RNSReactive nitrogen species
NF-κB_Nuclear factor kappa B
IL-1β_Interleukin-1β
HIV-1Human immunodeficiency virus
CD4Cluster of differentiation 4
MDCKMadin-Darby canine kidney
PPEPomegranate peel extract

References

  1. Uzuner, S. Pomegranate. In Nutritional Composition and Antioxidant Properties of Fruits and Vegetables; Academic Press: Cambridge, MA, USA, 2020; pp. 549–563. ISBN 978-0-12-812780-3. [Google Scholar]
  2. Perez, J. Food as Medicine Pomegranate (Punica granatum, Lythraceae)—American Botanical Council. Available online: https://www.herbalgram.org/resources/herbalegram/volumes/volume-18/issue-1-january-2021/food-as-medicine-pomegranate/food-as-medicine-pomegranate/ (accessed on 16 May 2022).
  3. Bhandari, P.R. Pomegranate (Punica granatum L). Ancient Seeds for Modern Cure? Review of Potential Therapeutic Applications. Int. J. Nutr. Pharmacol. Neurol. Dis. 2012, 2, 171. [Google Scholar] [CrossRef]
  4. Bonesi, M.; Tundis, R.; Vincenzo, S.; Loizzo, M. The Juice of Pomegranate (Punica granatum L.): Recent Studies on Its Bioactivities. In Quality Control in the Beverage Industry; Academic Press: Cambridge, MA, USA, 2019; pp. 459–489. ISBN 978-0-12-816681-9. [Google Scholar]
  5. Kumari, A.; Dora, J.; Kumar, A. Pomegranate (Punica granatum)—Overview. Int. J. Pharm. Chem. Sci. 2012, 1, 1218–1222. [Google Scholar]
  6. Hechtman, L. Clinical Naturopathic Medicine; Elsevier Health Sciences: Amsterdam, The Netherlands, 2018; ISBN 978-0-7295-8576-7. [Google Scholar]
  7. Liguori, I.; Russo, G.; Curcio, F.; Bulli, G.; Aran, L.; Della-Morte, D.; Gargiulo, G.; Testa, G.; Cacciatore, F.; Bonaduce, D.; et al. Oxidative Stress, Aging, and Diseases. Clin. Interv. Aging 2018, 13, 757–772. [Google Scholar] [CrossRef] [Green Version]
  8. Moga, M.A.; Dimienescu, O.G.; Bălan, A.; Dima, L.; Toma, S.I.; Bîgiu, N.F.; Blidaru, A. Pharmacological and Therapeutic Properties of Punica granatum Phytochemicals: Possible Roles in Breast Cancer. Molecules 2021, 26, 1054. [Google Scholar] [CrossRef]
  9. Ahmed, H.H.; El-Abhar, H.S.; Hassanin, E.A.K.; Abdelkader, N.F.; Shalaby, M.B. Punica granatum Suppresses Colon Cancer through Downregulation of Wnt/β-Catenin in Rat Model. Rev. Bras. Farmacogn. 2017, 27, 627–635. [Google Scholar] [CrossRef]
  10. Sotler, R.; Poljšak, B.; Dahmane, R.; Jukić, T.; Pavan Jukić, D.; Rotim, C.; Trebše, P.; Starc, A. Prooxidant Activities of Antioxidants and Their Impact on Health. Acta Clin. Croat. 2019, 58, 726–736. [Google Scholar] [CrossRef]
  11. Salehi, B.; Sharifi-Rad, J.; Cappellini, F.; Reiner, Ž.; Zorzan, D.; Imran, M.; Sener, B.; Kilic, M.; El-Shazly, M.; Fahmy, N.M.; et al. The Therapeutic Potential of Anthocyanins: Current Approaches Based on Their Molecular Mechanism of Action. Front. Pharmacol. 2020, 11, 1300. [Google Scholar] [CrossRef]
  12. Banihani, S.; Swedan, S.; Alguraan, Z. Pomegranate and Type 2 Diabetes. Nutr. Res. 2013, 33, 341–348. [Google Scholar] [CrossRef]
  13. Stefanou, V.; Papatheodorou, S.; Tsakni, A.; Lougovois, V.; Talelli, A.; Panourgias, G.; Dariatos, A.; Tsaknis, I. Anti-Inflammatory Properties of Pomegranate. Int. J. Adv. Res. Microbiol. Immunol. 2020, 2, 1–13. [Google Scholar]
  14. Miguel, M.G.; Neves, M.A.; Antunes, M.D. Pomegranate (Punica granatum L.): A Medicinal Plant with Myriad Biological Properties—A Short Review. J. Med. Plants Res. 2010, 4, 2836–2847. [Google Scholar] [CrossRef]
  15. Panth, N.; Manandhar, B.; Paudel, K.R. Anticancer Activity of Punica granatum (Pomegranate): A Review. Phytother. Res. 2017, 31, 568–578. [Google Scholar] [CrossRef]
  16. de Paula Rodrigues, R.; Tini, I.R.P.; Soares, C.P.; da Silva, N.S. Effect of Photodynamic Therapy Supplemented with Quercetin in HEp-2 Cells. Cell Biol. Int. 2014, 38, 716–722. [Google Scholar] [CrossRef] [PubMed]
  17. Sun, D.; Lu, Y.; Zhang, S.-J.; Wang, K.-G.; Li, Y. The Effect of Ellagic Acid on Photodynamic Therapy in Leukemia Cells. Gen. Physiol. Biophys. 2018, 37, 319–328. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  18. Senapathy, G.J.; George, B.P.; Abrahamse, H. Enhancement of Phthalocyanine Mediated Photodynamic Therapy by Catechin on Lung Cancer Cells. Molecules 2020, 25, 4874. [Google Scholar] [CrossRef]
  19. Thakur, N.S.; Mandal, N.; Patel, G.; Kirar, S.; Reddy, Y.N.; Kushwah, V.; Jain, S.; Kalia, Y.N.; Bhaumik, J.; Banerjee, U.C. Co-Administration of Zinc Phthalocyanine and Quercetin via Hybrid Nanoparticles for Augmented Photodynamic Therapy. Nanomed. Nanotechnol. Biol. Med. 2021, 33, 102368. [Google Scholar] [CrossRef]
  20. Abrahamse, H.; Hamblin, M.R. New Photosensitizers for Photodynamic Therapy. Biochem. J. 2016, 473, 347–364. [Google Scholar] [CrossRef] [Green Version]
  21. Chrubasik-Hausmann, S.; Hellwig, E.; Müller, M.; Al-Ahmad, A. Antimicrobial Photodynamic Treatment with Mother Juices and Their Single Compounds as Photosensitizers. Nutrients 2021, 13, 710. [Google Scholar] [CrossRef] [PubMed]
  22. Venkitasamy, C.; Zhao, L.; Zhang, R.; Pan, Z. Chapter 8—Pomegranate. In Integrated Processing Technologies for Food and Agricultural By-Products; Pan, Z., Zhang, R., Zicari, S., Eds.; Academic Press: Cambridge, MA, USA, 2019; pp. 181–216. ISBN 978-0-12-814138-0. [Google Scholar]
  23. Puneeth, H.R.; Chandra, S.S.P. A Review on Potential Therapeutic Properties of Pomegranate (Punica granatum L.). Plant Sci. Today 2020, 7, 9–16. [Google Scholar] [CrossRef]
  24. Pereira de Melo, I.; Carvalho, E.; Filho, J. Pomegranate Seed Oil (Punica Granatum L.): A Source of Punicic Acid (Conjugated α-Linolenic Acid). J. Hum. Nutr. Food Sci. 2014, 2, 1024. [Google Scholar]
  25. Aruna, P.; Venkataramanamma, D.; Singh, A.K.; Singh, R.P. Health Benefits of Punicic Acid: A Review. Compr. Rev. Food Sci. Food Saf. 2016, 15, 16–27. [Google Scholar] [CrossRef]
  26. Arun, N.; Singh, D.P. Punica granatum: A review on pharmacological and therapeutic properties. Int. J. Pharm. Sci. Res. 2012, 3, 1240–1245. [Google Scholar]
  27. Houston, D.M.J.; Bugert, J.; Denyer, S.P.; Heard, C.M. Anti-Inflammatory Activity of Punica granatum L. (Pomegranate) Rind Extracts Applied Topically to Ex Vivo Skin. Eur. J. Pharm. Biopharm. 2017, 112, 30–37. [Google Scholar] [CrossRef] [PubMed]
  28. Shaygannia, E.; Bahmani, M.; Zamanzad, B.; Rafieian-Kopaei, M. A Review Study on Punica granatum L. J. Evid.-Based Complement. Altern. Med. 2016, 21, 221–227. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  29. Kooti, W.; Servatyari, K.; Behzadifar, M.; Asadi-Samani, M.; Sadeghi, F.; Nouri, B.; Zare Marzouni, H. Effective Medicinal Plant in Cancer Treatment, Part 2: Review Study. J. Evid.-Based Complement. Altern. Med. 2017, 22, 982–995. [Google Scholar] [CrossRef] [PubMed]
  30. Rahimi, H.R.; Arastoo, M.; Ostad, S.N. A Comprehensive Review of Punica granatum (Pomegranate) Properties in Toxicological, Pharmacological, Cellular and Molecular Biology Researches. Iran. J. Pharm. Res. IJPR 2012, 11, 385–400. [Google Scholar]
  31. Wu, S.; Tian, L. Diverse Phytochemicals and Bioactivities in the Ancient Fruit and Modern Functional Food Pomegranate (Punica granatum). Molecules 2017, 22, 1606. [Google Scholar] [CrossRef] [Green Version]
  32. Singh, B.; Singh, J.P.; Kaur, A.; Singh, N. Phenolic Compounds as Beneficial Phytochemicals in Pomegranate (Punica granatum L.) Peel: A Review. Food Chem. 2018, 261, 75–86. [Google Scholar] [CrossRef]
  33. Jasuja, N.D.; Saxena, R.; Chandra, S.; Sharma, R. Pharmacological Characterization and Beneficial Uses of Punica granatum. Asian J. Plant Sci. 2013, 11, 251–267. [Google Scholar] [CrossRef] [Green Version]
  34. Haque, N.; Lecture; Sofi, G.; Lecture; Sofi, G.; Ali, W.; Rashid, M.; Itrat, M. Comprehensive Review of Phytochemical and Pharmacological Profile of Anar (Punica granatum Linn): A Heaven’s Fruit. J. Ayurvedic Herb. Med. 2015, 1, 22–26. [Google Scholar] [CrossRef]
  35. Sharma, J.; Maity, A. Pomegranate Phytochemicals: Nutraceutical and Therapeutic Values. Fruit Veg. Cereal Sci. Biotech. 2010, 4, 56–76. [Google Scholar]
  36. Costantini, S.; Rusolo, F.; De Vito, V.; Moccia, S.; Picariello, G.; Capone, F.; Guerriero, E.; Castello, G.; Volpe, M.G. Potential Anti-Inflammatory Effects of the Hydrophilic Fraction of Pomegranate (Punica granatum L.) Seed Oil on Breast Cancer Cell Lines. Molecules 2014, 19, 8644–8660. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  37. Mandal, A.; Bhatia, D.; Bishayee, A. Anti-Inflammatory Mechanism Involved in Pomegranate-Mediated Prevention of Breast Cancer: The Role of NF-ΚB and Nrf2 Signaling Pathways. Nutrients 2017, 9, 436. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  38. Jamali, B.; Bonyanpour, A. Comparison of Fruit Quality Characteristics and Polyphenolic Compounds in Seven Iranian Pomegranate Cultivars. Hortic. Int. J. 2018, 2, 469–473. [Google Scholar] [CrossRef] [Green Version]
  39. Mohammad, S.M.; Kashani, H.H. Chemical Composition of the Plant Punica granatum L. (Pomegranate) and Its Effect on Heart and Cancer. J. Med. Plants Res. 2012, 6, 5306–5310. [Google Scholar] [CrossRef]
  40. Saeed, M.; Naveed, M.; BiBi, J.; Kamboh, A.A.; Arain, M.A.; Shah, Q.A.; Alagawany, M.; El-Hack, M.E.A.; Abdel-Latif, M.A.; Yatoo, M.I.; et al. The Promising Pharmacological Effects and Therapeutic/Medicinal Applications of Punica granatum L. (Pomegranate) as a Functional Food in Humans and Animals. Recent Pat. Inflamm. Allergy Drug Discov. 2018, 12, 24–38. [Google Scholar] [CrossRef] [PubMed]
  41. Jacob, J.; Rajiv, P.; Gopalan, R.; Lakshmanaperumalsamy, P. An Overview of Phytochemical and Pharmacological Potentials of Punica granatum L. Pharmacogn. J. 2019, 11, 1167–1171. [Google Scholar] [CrossRef]
  42. Prasad, D.; Kunnaiah, R. Punica granatum: A Review on Its Potential Role in Treating Periodontal Disease. J. Indian Soc. Periodontol. 2014, 18, 428–432. [Google Scholar] [CrossRef]
  43. Lechner, J.F.; Stoner, G.D. Red Beetroot and Betalains as Cancer Chemopreventative Agents. Molecules 2019, 24, 1602. [Google Scholar] [CrossRef] [Green Version]
  44. Govind, J.K.; Magnus, A.A.; Subba Rao, G.; Takanari, A.; Akira, I.; Harukuni, T. Cytotoxic Effect of the Red Beetroot (Beta vulgaris L.) Extract Compared to Doxorubicin (Adriamycin) in the Human Prostate (PC-3) and Breast (MCF-7) Cancer Cell Lines. Anticancer Agents Med. Chem. 2011, 11, 280–284. [Google Scholar]
  45. Kapadia, G.J.; Rao, G.S. Anticancer Effects of Red Beet Pigments. In Red Beet Biotechnology: Food and Pharmaceutical Applications; Neelwarne, B., Ed.; Springer US: Boston, MA, USA, 2012; pp. 125–154. ISBN 978-1-4614-3458-0. [Google Scholar]
  46. Shang, A.; Cao, S.-Y.; Xu, X.-Y.; Gan, R.-Y.; Tang, G.-Y.; Corke, H.; Mavumengwana, V.; Li, H.-B. Bioactive Compounds and Biological Functions of Garlic (Allium sativum L.). Foods 2019, 8, 246. [Google Scholar] [CrossRef] [Green Version]
  47. Li, Z.; Le, W.; Cui, Z. A Novel Therapeutic Anticancer Property of Raw Garlic Extract via Injection but Not Ingestion. Cell Death Discov. 2018, 4, 108. [Google Scholar] [CrossRef]
  48. Bayan, L.; Koulivand, P.H.; Gorji, A. Garlic: A Review of Potential Therapeutic Effects. Avicenna J. Phytomed. 2014, 4, 1–14. [Google Scholar]
  49. Anaya Esparza, L.M.; Montalvo-González, E. Bioactive Compounds of Soursop (Annona muricata L.) Fruit. In Bioactive Compounds in Underutilized Fruits and Nuts; Murthy, H.N., Bapat, V.A., Eds.; Reference Series in Phytochemistry; Springer International Publishing: Cham, Switzerland, 2019; pp. 1–15. ISBN 978-3-030-06120-3. [Google Scholar]
  50. Hadisaputri, Y.E.; Habibah, U.; Abdullah, F.F.; Halimah, E.; Mutakin, M.; Megantara, S.; Abdulah, R.; Diantini, A. Antiproliferation Activity and Apoptotic Mechanism of Soursop (Annona muricata L.) Leaves Extract and Fractions on MCF7 Breast Cancer Cells. Breast Cancer Targets Ther. 2021, 13, 447–457. [Google Scholar] [CrossRef]
  51. Ahmad, T.; Cawood, M.; Iqbal, Q.; Ariño, A.; Batool, A.; Tariq, R.M.S.; Azam, M.; Akhtar, S. Phytochemicals in Daucus Carota and Their Health Benefits—Review Article. Foods 2019, 8, 424. [Google Scholar] [CrossRef] [Green Version]
  52. Mroueh, M.A.; Shebaby, W.; Smith, K.; Karam, M.; Mansour, A.; Asmar, M.E.; El-Sibai, M.; Daher, C.F. The Anti-Cancer Effect of the Pentane Fraction of Daucus Carota Oil Extract Is Mediated through Cell Cycle Arrest and an Increase in Apoptosis. Planta Med. 2013, 79, PN66. [Google Scholar] [CrossRef]
  53. Nigam, M.; Atanassova, M.; Mishra, A.P.; Pezzani, R.; Devkota, H.P.; Plygun, S.; Salehi, B.; Setzer, W.N.; Sharifi-Rad, J. Bioactive Compounds and Health Benefits of Artemisia Species. Nat. Prod. Commun. 2019, 14, 1934578–19850354. [Google Scholar] [CrossRef] [Green Version]
  54. Lang, S.J.; Schmiech, M.; Hafner, S.; Paetz, C.; Steinborn, C.; Huber, R.; Gaafary, M.E.; Werner, K.; Schmidt, C.Q.; Syrovets, T.; et al. Antitumor Activity of an Artemisia Annua Herbal Preparation and Identification of Active Ingredients. Phytomedicine 2019, 62, 152962. [Google Scholar] [CrossRef]
  55. Mukavi, J.W.; Mayeku, P.W.; Nyaga, J.M.; Kituyi, S.N. In Vitro Anti-Cancer Efficacy and Phyto-Chemical Screening of Solvent Extracts of Kigelia Africana (Lam.) Benth. Heliyon 2020, 6, e04481. [Google Scholar] [CrossRef]
  56. Nabatanzi, A.M.; Nkadimeng, S.; Lall, N.; Kabasa, J.D.; McGaw, L.J. Ethnobotany, Phytochemistry and Pharmacological Activity of Kigelia Africana (Lam.) Benth. (Bignoniaceae). Plants 2020, 9, 753. [Google Scholar] [CrossRef]
  57. del Socorro Santos Díaz, M.; Barba de la Rosa, A.-P.; Héliès-Toussaint, C.; Guéraud, F.; Nègre-Salvayre, A. Opuntia Spp.: Characterization and Benefits in Chronic Diseases. Oxid. Med. Cell. Longev. 2017, 2017, e8634249. [Google Scholar] [CrossRef] [Green Version]
  58. Heikal, A.; Abd El-Sadek, M.E.; Salama, A.; Taha, H.S. Comparative Study between in Vivo- and in Vitro-Derived Extracts of Cactus (Opuntis Ficus-Indica L. Mill) against Prostate and Mammary Cancer Cell Lines. Heliyon 2021, 7, e08016. [Google Scholar] [CrossRef] [PubMed]
  59. Lloyd, I. Traditional and Complementary Systems of Medicine. In The Energetics of Health; Elsevier: Amsterdam, The Netherlands, 2009; pp. 13–27. ISBN 978-0-443-06955-0. [Google Scholar]
  60. Che, C.-T.; George, V.; Ijinu, T.P.; Pushpangadan, P.; Andrae-Marobela, K. Chapter 2—Traditional Medicine. In Pharmacognosy; Badal, S., Delgoda, R., Eds.; Academic Press: Boston, MA, USA, 2017; pp. 15–30. ISBN 978-0-12-802104-0. [Google Scholar]
  61. Izquierdo-Vega, J.A.; Morales-González, J.A.; Sánchez-Gutiérrez, M.; Betanzos-Cabrera, G.; Sosa-Delgado, S.M.; Sumaya-Martínez, M.T.; Morales-González, Á.; Paniagua-Pérez, R.; Madrigal-Bujaidar, E.; Madrigal-Santillán, E. Evidence of Some Natural Products with Antigenotoxic Effects. Part 1: Fruits and Polysaccharides. Nutrients 2017, 9, 102. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  62. Ge, S.; Duo, L.; Wang, J.; GegenZhula; Yang, J.; Li, Z.; Tu, Y. A Unique Understanding of Traditional Medicine of Pomegranate, Punica granatum L. and Its Current Research Status. J. Ethnopharmacol. 2021, 271, 113877. [Google Scholar] [CrossRef]
  63. Gairola, S.; Sharma, J.; Bedi, Y.S. A Cross-Cultural Analysis of Jammu, Kashmir and Ladakh (India) Medicinal Plant Use. J. Ethnopharmacol. 2014, 155, 925–986. [Google Scholar] [CrossRef]
  64. Kumar, K.; Sharma, Y.P.; Manhas, R.K.; Bhatia, H. Ethnomedicinal Plants of Shankaracharya Hill, Srinagar, J&K, India. J. Ethnopharmacol. 2015, 170, 255–274. [Google Scholar] [CrossRef] [PubMed]
  65. Abdel-Kader, M.H. Photodynamic Therapy: From Theory to Application; Springer Science & Business Media: Berlin/Heidelberg, Germany, 2014; ISBN 978-3-642-39629-8. [Google Scholar]
  66. dos Santos, A.F.; de Almeida, D.R.Q.; Terra, L.F.; Baptista, M.S.; Labriola, L. Photodynamic Therapy in Cancer Treatment—An Update Review. J. Cancer Metastasis Treat. 2019, 5, 25. [Google Scholar] [CrossRef] [Green Version]
  67. Allison, R.R.; Moghissi, K. Photodynamic Therapy (PDT): PDT Mechanisms. Clin. Endosc. 2013, 46, 24–29. [Google Scholar] [CrossRef]
  68. Chilakamarthi, U.; Giribabu, L. Photodynamic Therapy: Past, Present and Future. Chem. Rec. 2017, 17, 775–802. [Google Scholar] [CrossRef]
  69. Kwiatkowski, S.; Knap, B.; Przystupski, D.; Saczko, J.; Kędzierska, E.; Knap-Czop, K.; Kotlińska, J.; Michel, O.; Kotowski, K.; Kulbacka, J. Photodynamic Therapy—Mechanisms, Photosensitizers and Combinations. Biomed. Pharmacother. 2018, 106, 1098–1107. [Google Scholar] [CrossRef]
  70. Rkein, A.M.; Ozog, D.M. Photodynamic Therapy. Dermatol. Clin. 2014, 32, 415–425. [Google Scholar] [CrossRef] [PubMed]
  71. Khwairakpam, A.D.; Bordoloi, D.; Thakur, K.K.; Monisha, J.; Arfuso, F.; Sethi, G.; Mishra, S.; Kumar, A.P.; Kunnumakkara, A.B. Possible Use of Punica granatum (Pomegranate) in Cancer Therapy. Pharmacol. Res. 2018, 133, 53–64. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  72. Dikmen, M.; Ozturk, N.; Ozturk, Y. The Antioxidant Potency of Punica granatum L. Fruit Peel Reduces Cell Proliferation and Induces Apoptosis on Breast Cancer. J. Med. Food 2011, 14, 1638–1646. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  73. Modaeinama, S.; Abasi, M.; Abbasi, M.M.; Jahanban-Esfahlan, R. Anti Tumoral Properties of Punica granatum (Pomegranate) Peel Extract on Different Human Cancer Cells. Asian Pac. J. Cancer Prev. 2015, 16, 5697–5701. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  74. Ceci, C.; Lacal, P.M.; Tentori, L.; De Martino, M.G.; Miano, R.; Graziani, G. Experimental Evidence of the Antitumor, Antimetastatic and Antiangiogenic Activity of Ellagic Acid. Nutrients 2018, 10, 1756. [Google Scholar] [CrossRef] [Green Version]
  75. Akhtar, S.; Ismail, T.; Layla, A. Pomegranate Bioactive Molecules and Health Benefits. In Bioactive Molecules in Food; Mérillon, J.-M., Ramawat, K.G., Eds.; Reference Series in Phytochemistry; Springer International Publishing: Cham, Switzerland, 2019; pp. 1253–1279. ISBN 978-3-319-78030-6. [Google Scholar]
  76. Marín, M.; María Giner, R.; Ríos, J.-L.; Carmen Recio, M. Intestinal Anti-Inflammatory Activity of Ellagic Acid in the Acute and Chronic Dextrane Sulfate Sodium Models of Mice Colitis. J. Ethnopharmacol. 2013, 150, 925–934. [Google Scholar] [CrossRef]
  77. Ahmadiankia, N. Molecular Targets of Pomegranate (Punica granatum) in Preventing Cancer Metastasis. Iran. J. Basic Med. Sci. 2019, 22, 977–988. [Google Scholar] [CrossRef]
  78. Deng, Y.; Li, Y.; Yang, F.; Zeng, A.; Yang, S.; Luo, Y.; Zhang, Y.; Xie, Y.; Ye, T.; Xia, Y.; et al. The Extract from Punica granatum (Pomegranate) Peel Induces Apoptosis and Impairs Metastasis in Prostate Cancer Cells. Biomed. Pharmacother. 2017, 93, 976–984. [Google Scholar] [CrossRef]
  79. Li, Y.; Yang, F.; Zheng, W.; Hu, M.; Wang, J.; Ma, S.; Deng, Y.; Luo, Y.; Ye, T.; Yin, W. Punica granatum (Pomegranate) Leaves Extract Induces Apoptosis through Mitochondrial Intrinsic Pathway and Inhibits Migration and Invasion in Non-Small Cell Lung Cancer in Vitro. Biomed. Pharmacother. 2016, 80, 227–235. [Google Scholar] [CrossRef]
  80. Koba, K.; Yanagita, T. Chapter 108—Potential Health Benefits of Pomegranate (Punica granatum) Seed Oil Containing Conjugated Linolenic Acid. In Nuts and Seeds in Health and Disease Prevention; Preedy, V.R., Watson, R.R., Patel, V.B., Eds.; Academic Press: San Diego, CA, USA, 2011; pp. 919–924. ISBN 978-0-12-375688-6. [Google Scholar]
  81. Matough, F.A.; Budin, S.B.; Hamid, Z.A.; Alwahaibi, N.; Mohamed, J. The Role of Oxidative Stress and Antioxidants in Diabetic Complications. Sultan Qaboos Univ. Med. J. 2012, 12, 5–18. [Google Scholar] [CrossRef]
  82. Frijhoff, J.; Winyard, P.G.; Zarkovic, N.; Davies, S.S.; Stocker, R.; Cheng, D.; Knight, A.R.; Taylor, E.L.; Oettrich, J.; Ruskovska, T.; et al. Clinical Relevance of Biomarkers of Oxidative Stress. Antioxid. Redox Signal. 2015, 23, 1144–1170. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  83. Nuncio-Jáuregui, N.; Calín-Sánchez, Á.; Vázquez-Araújo, L.; Pérez-López, A.J.; Frutos-Fernández, M.J.; Carbonell-Barrachina, Á.A. Chapter 76—Processing Pomegranates for Juice and Impact on Bioactive Components. In Processing and Impact on Active Components in Food; Preedy, V., Ed.; Academic Press: San Diego, CA, USA, 2015; pp. 629–636. ISBN 978-0-12-404699-3. [Google Scholar]
  84. Dutta, T. Antioxidants and its effects. JERHP 2016, 2, 5. [Google Scholar]
  85. Althunibat, O.Y.; Al-Mustafa, A.H.; Tarawneh, K.; Khleifat, K.M.; Ridzwan, B.H.; Qaralleh, H.N. Protective Role of Punica granatum L. Peel Extract against Oxidative Damage in Experimental Diabetic Rats. Process Biochem. 2010, 45, 581–585. [Google Scholar] [CrossRef]
  86. Bedel, H.A.; Turgut, N.T.; Kurtoglu, A.U.; Usta, C. Effects of Nutraceutical Punicic Acid. Indian J. Pharm. Sci. 2017, 79, 328–334. [Google Scholar] [CrossRef]
  87. Merkeb Alamneh, Y.; Sume, B.W.; Abebaw Shiferaw, A. Musculoskeletal Disorders among the Population in Northwest Ethiopia. SAGE Open Med. 2022, 10, 20503121221085108. [Google Scholar] [CrossRef]
  88. O’Neill, T.W.; McCabe, P.S.; McBeth, J. Update on the Epidemiology, Risk Factors and Disease Outcomes of Osteoarthritis. Best Pract. Res. Clin. Rheumatol. 2018, 32, 312–326. [Google Scholar] [CrossRef]
  89. Grässel, S.; Muschter, D. Recent Advances in the Treatment of Osteoarthritis. F1000Research 2020, 9, 325. [Google Scholar] [CrossRef]
  90. Anandacoomarasamy, A.; March, L. Current Evidence for Osteoarthritis Treatments. Ther. Adv. Musculoskelet. Dis. 2010, 2, 17–28. [Google Scholar] [CrossRef]
  91. Anjum, A.; Akram, M.; Rashid, A. Epidemiology and herbal treatment of osteoarthritis. Pak. J. Med. Biol. Sci. 2017, 1, 48–57. [Google Scholar]
  92. Choi, B.-R.; Ku, S.-K.; Kang, S.-J.; Park, H.-R.; Sung, M.-S.; Lee, Y.-J.; Park, K.-M. Anti-Osteoarthritis Effects of Pomegranate, Eucommiae Cortex and Achyranthis Radix Extracts on the Primary Cultured Rat Articular Chondrocytes. J. Soc. Prev. Korean Med. 2017, 21, 87–98. [Google Scholar] [CrossRef]
  93. Liu, F.; Yang, H.; Li, D.; Wu, X.; Han, Q. Punicalagin Attenuates Osteoarthritis Progression via Regulating Foxo1/Prg4/HIF3α Axis. Bone 2021, 152, 116070. [Google Scholar] [CrossRef]
  94. Mahdavi, A.M.; Javadivala, Z. Systematic Review of the Effects of Pomegranate (Punica granatum) on Osteoarthritis. Health Promot. Perspect. 2021, 11, 411–425. [Google Scholar] [CrossRef] [PubMed]
  95. Hadipour-Jahromy, M.; Mozaffari-Kermani, R. Chondroprotective Effects of Pomegranate Juice on Monoiodoacetate-Induced Osteoarthritis of the Knee Joint of Mice. Phytother. Res. 2010, 24, 182–185. [Google Scholar] [CrossRef] [PubMed]
  96. Shimizu, T.; Marusawa, H.; Endo, Y.; Chiba, T. Inflammation-Mediated Genomic Instability: Roles of Activation-Induced Cytidine Deaminase in Carcinogenesis. Cancer Sci. 2012, 103, 1201–1206. [Google Scholar] [CrossRef] [PubMed]
  97. Okada, F. Inflammation-Related Carcinogenesis: Current Findings in Epidemiological Trends, Causes and Mechanisms. Yonago Acta Med. 2014, 57, 65–72. [Google Scholar]
  98. Kim, H.; Banerjee, N.; Sirven, M.A.; Minamoto, Y.; Markel, M.E.; Suchodolski, J.S.; Talcott, S.T.; Mertens-Talcott, S.U. Pomegranate Polyphenolics Reduce Inflammation and Ulceration in Intestinal Colitis—Involvement of the MiR-145/P70S6K1/HIF1α Axis in Vivo and in Vitro. J. Nutr. Biochem. 2017, 43, 107–115. [Google Scholar] [CrossRef]
  99. Lin, Z.; Lin, C.; Fu, C.; Lu, H.; Jin, H.; Chen, Q.; Pan, J. The Protective Effect of Ellagic Acid (EA) in Osteoarthritis: An in Vitro and in Vivo Study. Biomed. Pharmacother. 2020, 125, 109845. [Google Scholar] [CrossRef]
  100. Xu, J.; Zhao, Y.; Aisa, H.A. Anti-Inflammatory Effect of Pomegranate Flower in Lipopolysaccharide (LPS)-Stimulated RAW264.7 Macrophages. Pharm. Biol. 2017, 55, 2095–2101. [Google Scholar] [CrossRef] [Green Version]
  101. BenSaad, L.A.; Kim, K.H.; Quah, C.C.; Kim, W.R.; Shahimi, M. Anti-Inflammatory Potential of Ellagic Acid, Gallic Acid and Punicalagin A&B Isolated from Punica granatum. BMC Complement. Altern. Med. 2017, 17, 47. [Google Scholar] [CrossRef] [Green Version]
  102. Howell, A.B.; D’Souza, D.H. The Pomegranate: Effects on Bacteria and Viruses That Influence Human Health. Evid.-Based Complement. Altern. Med. 2013, 2013, 606212. [Google Scholar] [CrossRef] [Green Version]
  103. Moradi, M.-T.; Karimi, A.; Shahrani, M.; Hashemi, L.; Ghaffari-Goosheh, M.-S. Anti-Influenza Virus Activity and Phenolic Content of Pomegranate (Punica granatum L.) Peel Extract and Fractions. Avicenna J. Med. Biotechnol. 2019, 11, 285–291. [Google Scholar]
  104. Neurath, A.R.; Strick, N.; Li, Y.-Y.; Debnath, A.K. Punica granatum (Pomegranate) Juice Provides an HIV-1 Entry Inhibitor and Candidate Topical Microbicide. Ann. N. Y. Acad. Sci. 2005, 1056, 311–327. [Google Scholar] [CrossRef] [PubMed]
  105. Moradi, M.-T.; Karimi, A.; Rafieian-kopaei, M.; Rabiei-Faradonbeh, M.; Momtaz, H. Pomegranate Peel Extract Inhibits Internalization and Replication of the Influenza Virus: An in Vitro Study. Avicenna J. Phytomed. 2020, 10, 143–151. [Google Scholar] [PubMed]
  106. Salles, T.S.; Meneses, M.D.F.; Caldas, L.A.; Sá-Guimarães, T.E.; de Oliveira, D.M.; Ventura, J.A.; Azevedo, R.C.; Kuster, R.M.; Soares, M.R.; Ferreira, D.F. Virucidal and Antiviral Activities of Pomegranate (Punica granatum) Extract against the Mosquito-Borne Mayaro Virus. Parasit. Vectors 2021, 14, 443. [Google Scholar] [CrossRef]
  107. Karimi, A.; Moradi, M.-T.; Rabiei, M.; Alidadi, S. In Vitro Anti-Adenoviral Activities of Ethanol Extract, Fractions, and Main Phenolic Compounds of Pomegranate (Punica granatum L.) Peel. Antivir. Chem. Chemother. 2020, 28, 2040206620916571. [Google Scholar] [CrossRef] [Green Version]
  108. Bhandary, B.S.K.; Sharmila, K.P.; Kumari, N.S.; Bhat, S.V. Acute and subacute toxicity study of the ethanol extracts of Punica granatum (Linn). Whole fruit and seeds and synthetic ellagic acid in swiss albino mice. Asian J. Pharm. Clin. Res. 2013, 6, 192–198. [Google Scholar]
  109. Salwe, K.J.; Sachdev, D.O.; Bahurupi, Y.; Kumarappan, M. Evaluation of Antidiabetic, Hypolipedimic and Antioxidant Activity of Hydroalcoholic Extract of Leaves and Fruit Peel of Punica granatum in Male Wistar Albino Rats. J. Nat. Sci. Biol. Med. 2015, 6, 56–62. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  110. Bassiri Jahromi, S.; Pourshafie, M.R.; Mirabzadeh, E.; Tavasoli, A.; Katiraee, F.; Mostafavi, E.; Abbasian, S. Punica granatum Peel Extract Toxicity in Mice. Jundishapur J. Nat. Pharm. Prod. 2015, 10, e23770. [Google Scholar] [CrossRef]
  111. Setiadhi, R.; Sufiawati, I.; Zakiawati, D.; Nuraeny, N.; Hidayat, W.; Firman, D. Evaluation of Antibacterial Activity and Acute Toxicity of Pomegranate (Punica granatum L.) Seed Ethanolic Extracts in Swiss Webster Mice. J. Dentomaxillofacial Sci. 2017, 2, 119. [Google Scholar] [CrossRef]
  112. Madireddy, R.K.; Alluri, K.V.; Somepalli, V.; Golakoti, T.; Sengupta, K. Toxicological Assessments of a Proprietary Blend of Punica granatum Fruit Rind and Theobroma Cacao Seed Extracts: Acute, Subchronic, and Genetic Toxicity Studies. J. Toxicol. 2022, 2022, e3903943. [Google Scholar] [CrossRef]
  113. Elnawasany, S. Clinical Applications of Pomegranate; IntechOpen: London, UK, 2018; ISBN 978-1-78923-273-8. [Google Scholar]
  114. Bassiri-Jahromi, S. Punica granatum (Pomegranate) Activity in Health Promotion and Cancer Prevention. Oncol. Rev. 2018, 12, 345. [Google Scholar] [CrossRef] [Green Version]
  115. Ma, G.-Z.; Wang, C.-M.; Li, L.; Ding, N.; Gao, X.-L. Effect of Pomegranate Peel Polyphenols on Human Prostate Cancer PC-3 Cells in Vivo. Food Sci. Biotechnol. 2015, 24, 1887–1892. [Google Scholar] [CrossRef]
  116. Loizzo, M.R.; Aiello, F.; Tenuta, M.C.; Leporini, M.; Falco, T.; Tundis, R. Chapter 3.46—Pomegranate (Punica granatum L.). In Nonvitamin and Nonmineral Nutritional Supplements; Nabavi, S.M., Silva, A.S., Eds.; Academic Press: Cambridge, MA, USA, 2019; pp. 467–472. ISBN 978-0-12-812491-8. [Google Scholar]
Plants 11 02820 g001 550
Figure 1. A picture of the P. granatum plant.
Figure 1. A picture of the P. granatum plant.
Plants 11 02820 g001
Plants 11 02820 g002 550
Figure 2. Phytochemicals found in P. granatum and its therapeutic properties.
Figure 2. Phytochemicals found in P. granatum and its therapeutic properties.
Plants 11 02820 g002
Plants 11 02820 g003 550
Figure 3. Mechanism of action of ellagic acid from P. granatum extract on MCF-7 breast cancer cells. Superoxide dismutase (SOD), oxidase enzyme (NOX), molecular oxygen (O2), glutathione (GSH), oxidized glutathione (GSSG), hydrogen peroxide (H2O2), superoxide anion (O2•−), hydroxyl ion (OH•), NADPH (nicotinamide adenine dinucleotide phosphate), nicotinamide adenine dinucleotide phosphate coenzyme (NADP+), ferrous cation (Fe2+), ferric cation (Fe3+), and water (H2O).
Figure 3. Mechanism of action of ellagic acid from P. granatum extract on MCF-7 breast cancer cells. Superoxide dismutase (SOD), oxidase enzyme (NOX), molecular oxygen (O2), glutathione (GSH), oxidized glutathione (GSSG), hydrogen peroxide (H2O2), superoxide anion (O2•−), hydroxyl ion (OH•), NADPH (nicotinamide adenine dinucleotide phosphate), nicotinamide adenine dinucleotide phosphate coenzyme (NADP+), ferrous cation (Fe2+), ferric cation (Fe3+), and water (H2O).
Plants 11 02820 g003
Table
Table 1. Phytochemical components of P. granatum.
Table 1. Phytochemical components of P. granatum.
Plant PartsPhytochemicalsReference
BarkEllagitannins and Gallotannins: brevifolin, castalagin, carboxylic acid, punicalagin, galloylpunicalin castalagin;
Alkaloids: serine, hygrine, pseudopelletierine;
Sterols and Terpenoids: friedooleanan-3-one		[30,31]
PeelCatechin: gallocatechin;
Ellagitannins and Gallotannins: granatin b, pedunculagin, punicalagin; Flavonoids: delphinidin, pelargonidin, quercetin;
Tannins: Phenolic acid: ellagic, chlorogenic		[32,33]
FruitEllagic acid derivatives: ellagic acid;
Ellagitannins and Gallotannins: corilagin;
Flavonols: kaempferol, quercime, ritrin		[2,34]
SeedEllagic acid derivatives: ellagic acid;
Fatty Acids and Triglycerides: conjugated linolenic acid, tri-O-punicylglycerol, palmitic acid;
Sterols and Terpenoids: estrone, testosterone		[35,24,26,36,37]
JuiceCatechin and Procyanidins: catechin, procyanidin B1 and B2;
Anthocyanins and Anthocyanidins: anthocyanins, cyanidin, delphinidin;
Organic Acids: chlorogenic acid, citric acid, gallic acid;
Flavonoid: quercetin, rutin 		[26,38]
RootAlkaloids: norhygrine, isopelletierine, hygrine, pelletierine[39,40]
LeavesEllagitannins and Gallotannins: punicalin, tellimagrandin, punicafolin, tercatain;
Flavonols: apigenin-4′-o-β-d-glucoside, luteolin-3′-o-β-d-glucoside; Simple Gallyol Derivatives: brevifolin		[41,42]
Table
Table 2. Exemplary the Medicinal Plants and Its Bioactive Compounds.
Table 2. Exemplary the Medicinal Plants and Its Bioactive Compounds.
Plant NameBioactive CompoundsMechanism of ActionCancer Types Reference
Beta vulgaris L.Betaine, p-coumaric acid, rutin, kaempferol, rhamnocitrin, syringic acid, astragalin, oleanolic acid, β-carotene, caffeic acid, lutein, rhamnetin, betalains, ferulic acid Cytotoxicity activity is caused by methylation of DNA in cancer cells. These compounds also showed scavenging activities of free radicals, inhibition of NF-κB, and DNA intercalation.Skin and lung cancer [43,44,45]
Allium sativum L.Organosulfur, polysaccharides, saponins and
phenolic compounds		Blockage of G2/M phase of cell cycle and inhibition in tumor growth. Bone cancer[46,47,48]
Annona muricata L.Alkaloids, phenols, kauranes, flavonoids, lignans, megatigmanes, terpenoids, acetogenin, tannins, glycosides, cyclopeptides, and oils Reduced mitochondrial membrane integrity and ATP production and induction of apoptosis.Breast cancer [49,50]
Daucus carota L.Phenols, ascorbic acid (vitamin C), carotenoids, and polyacetylenes Blocking of cell proliferation by apoptosis and cell cycle cessation of cancer cells. Colorectal cancer [51,52]
Artemisia annual L. Arteannuin B, scopoletin, artemisinin and arteannic acidCell viability inhibition, activation of caspase 3 and fragmentation of DNA leads to apoptosis.Prostate, lung, and breast cancer[53,54]
Kigelia AfricanaTerpenoids, steroids, flavonoids, phenols, furanonaphthoquinoids, coumarins, fatty acids, caffeic acid norviburtinal, and iridoids Inhibition of cell viability and proliferation. Skin and renal carcinoma[55,56]
Opuntia spp.Ascorbate, flavonoids, carotenoids, phenolic acids, kaempferol, and betalains DNA fragmentation and cell arrest at the G2/M phaseProstrate and breast cancer[57,58]
Table
Table 3. Toxicity studies of P. granatum.
Table 3. Toxicity studies of P. granatum.
Research TopicsResults FoundReference
Acute and subacute toxicity study of the ethanol extracts of P. granatum (Linn) whole fruit and seeds and synthetic ellagic acid in Swiss albino miceNo adverse effects were found, and it was classified as non-toxic, and safe to utilize. The dosage used was 2000 mg/kg of body weight of the extracts.[108]
Evaluation of the antidiabetic, hypolipidemic, and antioxidant activity of hydroalcoholic extract of leaves and fruit peel of P. granatum in male Wistar albino ratsNo toxicity effects were found. The highest dose administered was 2000 mg/kg body weight of the extracts.[109]
P. granatum peel extract toxicity in miceNo adverse effects were found on the utilization of P. granatum in mice with a maximum oral dose of 7.5 mg/kg or intravenous amount of 224 mg/kg body weight.[110]
Evaluation of antibacterial activity and acute toxicity of pomegranate (P. granatum L.) seed ethanolic extracts in Swiss webster miceThe toxicity test showed a positive result. Results showed that only a high systemic dose would cause death, LD50 was assumed to be greater than 2000 mg.[111]
Toxicological assessments of a proprietary blend of P. granatum fruit rind and Theobroma cacao seed extracts: acute, subchronic, and genetic toxicity studiesNo toxicity was found during testing at 5000 mg/kg body weight of the extract.[112]
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Fakudze, N.T.; Aniogo, E.C.; George, B.P.; Abrahamse, H. The Therapeutic Efficacy of Punica granatum and Its Bioactive Constituents with Special Reference to Photodynamic Therapy. Plants 2022, 11, 2820. https://doi.org/10.3390/plants11212820

AMA Style

Fakudze NT, Aniogo EC, George BP, Abrahamse H. The Therapeutic Efficacy of Punica granatum and Its Bioactive Constituents with Special Reference to Photodynamic Therapy. Plants. 2022; 11(21):2820. https://doi.org/10.3390/plants11212820

Chicago/Turabian Style

Fakudze, Nosipho Thembekile, Eric Chekwube Aniogo, Blassan P. George, and Heidi Abrahamse. 2022. "The Therapeutic Efficacy of Punica granatum and Its Bioactive Constituents with Special Reference to Photodynamic Therapy" Plants 11, no. 21: 2820. https://doi.org/10.3390/plants11212820

APA Style

Fakudze, N. T., Aniogo, E. C., George, B. P., & Abrahamse, H. (2022). The Therapeutic Efficacy of Punica granatum and Its Bioactive Constituents with Special Reference to Photodynamic Therapy. Plants, 11(21), 2820. https://doi.org/10.3390/plants11212820

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop