Lessertia frutescens

Cancer Bush - Lessertia frutescens

Plant Uses & Benefits: birds, flavouring, medicine, pot plant, rattle, small garden, tea

Names

Common names: cancer bush, sutherlandia, balloon pea (English); umnwele, insiswa (Xhosa); umnwele (Zulu); kankerbos, blaasbossie, blaas-ertjie, eendjies, gansiekeurtjie, klappers (Afrikaans). 
Botanical name: Lessertia frutescens
Previously known as: Sutherlandia frutescens, Colutea frutescens
Family: Fabaceae

• Etymology – Unwele means ‘hair’ referring to usefulness to stop people ‘pulling out their hair’ with distress.
• Confusers – six species in South Africa difficult to distinguish
• Other species in the genus

• Six species can be tricky to distinguish

phetola (“it changes”) in seTswana

insiswa (“the one that drives away the darkness”)


Nature

Type: shrub
Vegetation type:  
Flower colour: orange, red
Flowering season: Spring, Summer
Plant-animal interactions: birds
Red list status: Least Concern

• Indigenous to South Africa, throughout drier regions of Western Cape, Karoo, Northern Cape and Eastern Cape.
• Shrub up to 1.5m high
• Leaves – deep grey-green. pinnately compound leaves.
• Flowers – red-orange flowers (unlike typical Fabaceae ‘pea flower’), Spring to Summer, pollinated by sunbirds
• Fruit – papery, transparent, balloon pod, containing seeds,
• Seeds – distributed by wind.
• Symbiotic, nitrogen-fixing bacteria in root nodules. Legumes are well known for fixing nitrogen in the soil through a symbiotic (mutual) relationship with bacteria that infect the roots (plant supplies sugars to the bacteria and the bacteria supplies nitrogen to the plant).
• Pollinated by sunbirds

• No concerns, widespread, cultivated widely, popular garden plant.


Use as Medicine

Herbal traditions: Cape Herbal Medicine, Khoi & San
Plant parts used: above ground parts, leaves, roots

Traditional knowledge drawn from the initial populations of the Cape – the Khoi, San and Nama people, who used it for washing of wounds as a tea to treat fever related illnesses (Oloyede, 2010).
• Well-known traditional remedy, wide application
• Khoi & San used as tea for fevers, wash for wounds
• Colonists used for chicken pox, digestive upsets, internal cancers, eye wash
• Recent reputation as an immune booster in the treatment of HIV/AIDS
Plant Parts Used
• Leaves
• Arial parts

Safety & Toxicity

Safety: caution in long-term use, herb-drug interactions

• A randomized, double-blind, placebo-controlled trial of L. frutescens leaf powder (800mg/day) in healthy adults showed no significant differences in general adverse events or physical, vital, blood, and biomarker indices between the treatment and placebo groups. Although not to significant levels, participants consuming L. frutescens also reported improved appetite, had lower respiration rate, higher platelet count, higher albumin and total protein than the placebo group.155
• In vitro study that suggests L. frutescens may exacerbate neuroinflammation post-HIV infection by promoting monocyte infiltration across the blood-brain barrier.156
• In vivo study demonstrated possible herb-drug interactions due to inhibition of cytochrome P450 isozymes by L. frutescens crude extracts.157
• In vitro study demonstrated L. frutescens extracts may interact with protease inhibitor class of antiretrovirals (atazanavir) affecting bioavailability.158
• Possible interaction with isoniazid preventive therapy (IPT) taken by tuberculosis patients.159
• A study in rats suggests L. frutescens should not be used concurrently with isoniazid in treating pulmonary or cerebral TB as antioxidant effect can interfere with activation of isoniazid.160
• A study in rats suggests possible herb-drug interaction between L. frutescens and antiretroviral agent, nevirapine, used in AIDS treatment.161
• In vivo study of powdered L. frutescens significantly reduced the bioavailability of atazanavir. This may potentially result in subtherapeutic plasma concentrations and thus reduced anti-HIV efficacy of atazanavir.162
• A population pharmacokinetic model suggested that the mechanism by which L. frutescens reduced the overall bioavailability of atazanavir may be modulated via the inhibition of the “active” absorption process.163
• May reduce fertility in women with chronic use.
• Chronic use may have cardiotoxic effects.
• May induce hypoglycaemia if combined with insulin in diabetic patients – take care to monitor glucose levels.
• Give lower concentration to the children and elderly.

Qualities & Phytochemistry

Plant qualities: bitter, calming, cleansing, cooling, relaxing
Phytochemical constituents: GABA, alkaloids, amino acids, arginine, canavanine, cardiac glycosides, flavonoids, kaempferol, pinitol, polysaccharides, quercetin, saponins, sutherlandioside, tannins, triterpene saponins

• L. frutescens is chemically, genetically, and geographically extremely variable164,165

Anti-oxidant effects – high in plants from South Coast, low in plants from Northern Cape.
Colon cancer cell cytotoxicity – highest in plants from Northern Cape

Leaves164
• Bitter taste
• Not aromatic
• Triterpene saponins (cycloartane glycosides)
○ Sutherlandioside A, B, C, D
• Flavonoids (quercetin and kaempferol glycosides)
○ Sutherlandins A, B, C, D
• Phenolics
• Alkaloids
• Tannins, phlobatannins
• Cardiac glycosides
• Canavanine – L-canavanine
• Arginine – L-arginine
• Pinitol – D-pinitol
• GABA
• Polysaccharides

Root
• No information found

Actions & Pharmacology

Plant actions: adaptogen, analgesic / anodyne, anti-HIV, anti-TB, anti-cancer, anti-inflammatory, antibacterial, anticonvulsant / anti-epileptic, antioxidant, antithrombotic, anxiolytic / nervine-relaxant, contraceptive, diuretic, general tonic, hypoglycaemic / anti-diabetic, immune stimulant, immunomodulator

Bitter Tonic
Antibacterial
• In vitro study showed use of L. frutescens for topical staphylococcal infections, when formulated in an oily base appears to have a rational basis.166

Antioxidant
• Study showed L. frutescens extract possesses superoxide as well as hydrogen peroxide scavenging activities contributing to anti-inflammatory action.167
• In vitro study shows that L. frutescens ethanol extracts inhibit oxidative stress and inflammatory responses in neurons and microglial cells.168
• In vitro study of L. frutescens extracts showed antioxidant effects by scavenging ROS and preserving intracellular GSH/GSSG protecting cells against oxidative stress.169
• In vivo study in mice showed L. frutescens extracts have neuroprotective effects against oxidative and inflammatory responses to cerebral ischaemia and reperfusion.170

Anxiolytic, Anti-stress
• Study showed L. frutescens extracts in vitro inhibit steroidogenic enzymes and modulate adrenal hormone biosynthesis that may underlie anti-stress, anti-inflammatory and anti-hypertensive effects.171
• In vivo study in rats showed mobilization stress resulted in increased corticosterone levels in the control group while rats receiving L. frutescens extract showed significantly decreased corticosterone levels.172
• In vitro study showed L. frutescens extract can reduce glucocorticoid levels and alleviate symptoms associated with stress through attenuation of adrenal P450 enzymes which catalyse key reactions in glucocorticoid biosynthesis.173
• In vivo study in rats and mice showed L. frutescens extracts possesses analgesic, anti-inflammatory, and hypoglycemic actions.174
• In vivo study in mice with a low-dose aqueous extract of L. frutescens supported use as a non-sedative, anxiolytic in chronic stress-associated diseases.175
• In vitro study in rats showed L. frutescens extracts inhibited atrophy and apoptosis of skeletal muscle caused by daily brief restraint stress.176

Anticonvulsant
• In vivo study in mice supported use of aqueous extracts of L. frutescens for convulsions and seizures by acting like GABA, or by enhancing GABAergic neurotransmission and/or action in the brain.177

Anti-Inflammatory
• Study showed L. frutescens extracts in vitro inhibit steroidogenic enzymes and modulate adrenal hormone biosynthesis that may underlie anti-stress, anti-inflammatory and anti-hypertensive effects.171
• In vivo study in rats and mice showed L. frutescens extracts possesses analgesic, anti-inflammatory, and hypoglycemic actions.174
Anti-diabetic
• In vitro study showing aqueous extract of L. frutescens prevents development of insulin resistance (precursor of type 2 diabetes) in hepatic cell culture.178
• An in vivo study in rats showed an aqueous extract of L. frutescens can normalise insulin levels, decrease glucose uptake from the intestine, increase glucose uptake by peripheral tissues.179
• An in vivo study showed L. frutescens extract reduces plasma free fatty acid levels in rats fed a high fat diet, preventing the development of insulin resistance, reduced total cholesterol levels.180
• An in vivo study in rats fed a high fat diet showed treatment with L. frutescens significantly lowered body weight, and decreased plasma insulin, free fatty acids, and triglycerides levels.181
• In vivo study in rats and mice showed L. frutescens extracts possesses analgesic, anti-inflammatory, and hypoglycemic actions.174

Analgesic
• In vivo study in rats and mice showed L. frutescens extracts possesses analgesic, anti-inflammatory, and hypoglycemic actions.174
Immune Stimulant / Immune Modulating
• Polysaccharides present in the aqueous extracts of L. frutescens confirmed to have immune modulating effects in an in vitro study.182
• An in vitro study showed polysaccharide-enriched L. frutescens extract exhibited potent immune-stimulatory activity by macrophages, with increased production of reactive oxygen species (ROS), nitric oxide (NO), and inflammatory cytokines.183
• In vitro study showed L. frutescens ethanol extracts can modulate cytokine secretion by peripheral blood mononuclear cells, a critical component of the immune response.184

Anti-HIV
• In vitro study showed that L. frutescens extracts contain inhibitory compounds active against HIV target enzymes.185

Anti-TB
• In vitro study demonstrated that alpha-linolenic acid from L. frustescens is an inhibitor of shikimate kinase a good drug target for Mycobacterium tuberculosis.

Anti-cancer
• In vitro study showed L. frutescens aqueous extract had positive effect in colorectal cancer model.186
• In vitro study showed aqueous extract of L. frutescens induced apoptosis in cervical carcinoma cell lines.187
• In vitro study showed aqueous extracts of L. frutescens affect immune system by supressing the expression of IL-6, IL-10 and TNFα.188
• In vitro study showed L. frutescens ethanolic extract has concentration dependent antiproliferative effect on several human tumour cell lines.189
• An ethnobotanical study found L. frutescens was one of most mentioned by the traditional healers for lung, and skin cancer treatment. The most treated cancers in order: skin cancer > lung cancer > breast cancer > prostate cancer > cervical cancer. The method of preparation included decoction (32.3%), infusion (29%), paste (16.1%) and maceration (22.6%).190
• In vitro study showed L. frutescens extract is effective in inducing apoptosis in malignant melanoma cells.191
• In vitro study suggests L. frutescens may exert anti-cancer effect on prostate cancer cell growth by the inhibition of the Gli/hedgehog (Gli/Hh) signalling pathway.192
• In vitro study showed ethanol extracts of L. frutescens have effects on human breast adenocarcinoma cell line.193
• In vitro study of L. frutescens showed apoptosis inducing effects on an oesophageal cancer cell line.194

Antithrombotic

Diuretic

Other
• Adaptogen
• “Langbeen” cancer bush consumed daily as a contraceptive.

Preparations

Plant preparations: balm, capsules, compress, decoction, dried, fresh, infusion - aqueous, tincture, wash

• Infusion
• Decoction
• Balm
• Wash
• Tincture

First-Aid Indications

First-aid use: anxiety, arthritis, asthma, backache, colds & 'flu, depression, diarrhoea, fever, haemorrhoids, heartburn, indigestion, irritability, poor appetite, stress, wounds 

General wellbeing

Skin
• Wounds
Respiratory
• Cold & ‘flu
• Fever
• Asthma
Musculoskeletal
• Rheumatism
• Osteoarthritis
• Backache
Digestion
• Poor appetite
• Indigestion
• Diarrhoea
• Heartburn
• Haemorrhoids
Psychiatric
• Emotional and mental stress & tension
• Irritability
• Anxiety
• Depression

Medical Indications

Medical use:  

Respiratory
• Tuberculosis
• Bronchitis
Digestion
• Dysentery
• Peptic ulcers
• Diabetes
• Liver problems
Musculoskeletal
• Rheumatoid arthritis
Urogenital
• Urinary tract infections
• Uterus & women’s complaints
Cardiovascular
• Heart failure
• Dropsy
Other
• Chicken pox
• Internal cancers
• Conjunctivitis
• Immune booster in the treatment of HIV/AIDS
• Varicose veins

Veterinary Indications

Medical use:  

Dosage

Research

Review Articles
1. Van Wyk BE, Albrecht C. A review of the taxonomy, ethnobotany, chemistry and pharmacology of Sutherlandia frutescens (Fabaceae). J Ethnopharmacol. 2008 Oct 28;119(3):620-9. doi: 10.1016/j.jep.2008.08.003. Epub 2008 Aug 9. PMID: 18761068.
2. Folk WR, Smith A, Song H, Chuang D, Cheng J, Gu Z, Sun G. Does Concurrent Use of Some Botanicals Interfere with Treatment of Tuberculosis? Neuromolecular Med. 2016 Sep;18(3):483-6. doi: 10.1007/s12017-016-8402-1. Epub 2016 May 7. PMID: 27155670; PMCID: PMC4985487.
3. Van Wyk BE. A review of commercially important African medicinal plants. J Ethnopharmacol. 2015 Dec 24;176:118-34. doi: 10.1016/j.jep.2015.10.031. Epub 2015 Oct 22. PMID: 26498493.
4. Cordier W, Steenkamp V. Drug interactions in African herbal remedies. Drug Metabol Drug Interact. 2011;26(2):53-63. doi: 10.1515/DMDI.2011.011. Epub 2011 Jul 15. PMID: 21756221.
5. Laila U, Akram M, Shariati MA, Hashmi AM, Akhtar N, Tahir IM, Ghauri AO, Munir N, Riaz M, Akhter N, Shaheen G, Ullah Q, Zahid R, Ahmad S. Role of medicinal plants in HIV/AIDS therapy. Clin Exp Pharmacol Physiol. 2019 Dec;46(12):1063-1073. doi: 10.1111/1440-1681.13151. Epub 2019 Aug 22. PMID: 31365763.
6. Müller AC, Kanfer I. Potential pharmacokinetic interactions between antiretrovirals and medicinal plants used as complementary and African traditional medicines. Biopharm Drug Dispos. 2011 Nov;32(8):458-70. doi: 10.1002/bdd.775. PMID: 22024968.
7. Van Wyk BE. A broad review of commercially important southern African medicinal plants. J Ethnopharmacol. 2008 Oct 28;119(3):342-55. doi: 10.1016/j.jep.2008.05.029. Epub 2008 Jun 3. PMID: 18577439.
Clinical Research
Clinical Trials
Randomised Controlled Trials
1. Wilson D, Goggin K, Williams K, Gerkovich MM, Gqaleni N, Syce J, Bartman P, Johnson Q, Folk WR. Consumption of Sutherlandia frutescens by HIV-Seropositive South African Adults: An Adaptive Double-Blind Randomized Placebo Controlled Trial. PLoS One. 2015 Jul 17;10(7):e0128522. doi: 10.1371/journal.pone.0128522. PMID: 26186450; PMCID: PMC4506018.
Meta-Analyses – none
Systematic Reviews – none


Other Uses

Uses & Benefits: birds, flavouring, medicine, pot plant, rattle, small garden, tea

• Dried seed pods used as a rattle

Use as Food
Plant Parts Used
• Leaves
Preparations
• Tea
• Bitters


Cultivation & Harvest

Light-level: full sun
Soil type: clay, loamy, sandy, well-composted, well-drained
Soil pH: Neutral
Propagation: cuttings, seed

• Easy to grow
• Fast growing
• Light – full sun
• Soil – all types, well-drained, pH 6-8
• Water – reasonably drought tolerant, do not over-water
• Seeds easily
• Not long lived, remove when no longer looking good
• Does well in containers
• Pioneers in new gardens
• Plant in 2-5’s for fuller bush
• Prefer a west facing slope

Propagation
• Seed – Autumn and Spring in a well-drained
• Cuttings – stem cuttings


Resources

Websites