Viscum album (mistletoe) as Medicine

Introduction

Mistletoe
In ancient times, mistletoe was considered both holy and healing; the druid priests honoured it as “all healing”. Mistletoe preparations were used medically for a range of different illnesses, for example liver problems, epilepsy or illnesses which today we would attribute to high blood pressure; but cancer was not among them. This indication is the result of work by Rudolf Steiner, PhD, the founder of anthroposophy (1861 – 1925). Together with Ita Wegman, MD, he developed the foundations of anthroposophically extended medicine, whose perhaps best known medication today is the mistletoe preparation Iscador®.
After almost 80 years of clinical experience with the medication Iscador®, mistletoe is now a permanent part of modern cancer therapy. A range of therapy schemes have been developed over the years which allow a rational, individual treatment. In modern mistletoe therapy, it is important to use all the potency of the plant and not to reduce it to a single active ingredient. New studies clearly demonstrate that several ingredients in mistletoe have immunomodulatory and cytotoxic properties. The knowledge of this variety allows mistletoe preparations to be used more sophisticated than is possible through the reduction of the plant to just one ingredient.

Mistletoe preparations are officially licensed for treating malign and pre-cancerous illnesses in various European countries and are used as adjuvant treatment alongside with conventional chemotherapy and radiation. The various effects of mistletoe preparations have been documented in numerous studies.

Ingredients and principles

Mistletoe extracts are characterised by two main substance classes: mistletoe lectins and viscotoxins. Both have cytotoxic and immunomodulatory qualities. These groups of substances are formed by the plant in summer and winter in varying compositions and quantities. A very extensive production process is required to capture all the pharmaceutical potency of the plant and thus to make it usable for therapy. Several investigations have shown that immunomodulatory effects can be achieved with practically lectin-free mistletoe preparations. For mistletoe therapy, therefore, it is important that preparations are used which contain and provide the entire potency of the plant.

Mistletoe
The three most important effects of mistletoe extracts are: induction of the apoptotic cell death, stimulation of the immune system and protection of the DNA against alkalising chemotherapies and radiation. The immunomodulatory and cancer preventing effects of Viscum album have been examined in vitro, ex vivo in vitro and in vivo. The effectiveness is based on the activation of Natural Killer (NK) Cells, macrophages and Large Granular Lymphocytes (LGL). Moreover, treatment with Viscum album causes cytokines IL-1, IL-6, IL-8, TNF-α and IFN-γ to be secreted.


The following immunomodulatory and gene reparatory qualities have been proven for Iscador®: In animal experiments, lymphocyte stimulation was increased by PHA and Con-A and thymus and splenic hyperplasia was shown; in humans, in vitro increased lymphocyte stimulation, in vivo increased cytokine secretion of Il-1, Il-6, IFN-α and TNF-γ, increased expression of Il-2-Receptor (CD25), increase in T-helper/T-suppressor cell ratios, increase in NK cells with enhanced activity, increase in leukocytes, neutrophilic granulocytes and in phagocytic capacity of the granulocytes was demonstrated. Furthermore, both in vitro and in vivo increase in DNS repair of lymphocytes after induction of DNS damage as a result of UV, gamma and photon radiation and chemotherapy have been shown. The mistletoe lectins are mainly considered responsible for the immunological effects of Iscador®, but polysaccharides and viscotoxins are also discussed.

Apart form these immunological effects, cytotoxic effects of Viscum album are also being considered, for which mistletoe lectins and viscotoxins are also responsible. The former prevent ribosomal protein synthesis while the latter damage the tumour cell membranes. As a result, viscum preparations cause dose-dependent cytotoxic effects against a range of tumour cell lines.
The topical application of Iscador®, even in higher doses have been tolerated well in the situations studied so far. This relates to the treatment of malign pleuracarcinosis with intrapleural Iscador® instillation and the intravesical treatment of the surface bladder carcinoma in pilot studies. For the intrapleural application, an immunological reaction with a considerable increase in eosinophilic granulocytes and lymphocytes, along with a significant increase in T-helper/T-suppressor ratios has been documented at the same time as the cytotoxic effect on tumour cells.

Side effects and counter indications

Mistletoe
Under treatment with Iscador®, there can be a temporary increase in body temperature by around 0.5°C, which is desirable as it shows that the body’s defence mechanisms are functioning well. In rare cases, dose-dependent flu-like symptoms are described, which disappear again after the dose has been reduced.
As the dose is increased from 0.1 mg to 1 mg or from 1 mg to 10 mg, there can be a local inflammatory reaction around the injection site, which results in rash, induration, slight heating and itching. This local reaction occurs 4 to 10 hours after subcutaneous injection and lasts for between 24 and 48 hours. Histological investigations of skin samples from the injection site have clearly shown that for local reactions this is a dose-dependent inflammatory reaction (lympho-monocytic infiltrate with active T-helper cells). These skin reactions are harmless and therapeutically desirable within a certain framework (diameter up to 5 cm). However, a lack of local reaction is not a criterion for an insufficient reaction by the patient’s organism as the human body can react differently to Iscador preparations of different host tree species.
With mistletoe treatment, there can very rarely be genuine allergic reactions, including shock, which can be generalised pruritus (itching), urticaria (hives), local or generalised exanthema to Quincke’s disease, shivering and shortness of breath. These symptoms can be differentiated immediately and clearly from the local inflammatory reaction and must be treated with emergency allergic treatment.

Mistletoe
Mistletoe preparations must not be used if the patient is suffering from an acute infection or untreated thyroid hyperfunction. Treatment with Iscador® for brain tumours or brain metastasis must be carefully considered by an experienced doctor and, if necessary, closely followed.



Mistletoe treatment is part of an overall treatment concept

It must be stressed that mistletoe treatment for cancer it not an alternative to conventional oncology (with the three pillars of operation, chemotherapy and radiation), but is an extension (“complementary” treatment). However, as part of an “integrated cancer treatment concept”, treatment with Iscador®, alongside with other complementary methods such as art therapy and therapeutic eurythmia, is effective, especially in improving quality of life with possible effects at the physical-functional, emotional, social and spiritual levels.

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