Subject: Aloe Vera/Acemannan Date: Tue, 13 Sep 1994 (262 lines) From: STARTHROWER@delphi.com &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& A R T I C L E S E N T T O U S &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Treatment Education Program 213.993-1482 Treatment Advocate AIDS Project Los Angeles 213.993-1483 Treatment Advocate 1313 North Vine Street 213.993-1484 Program Manager Los Angeles, California 90028 213.993-1529 Materials T R E A T M E N T E D U C A T I O N P R O J E C T Jon Greenburg Library of Alternative Therapies for HIV/AIDS Copyright 1994, AIDS Project Los Angeles. We encourage you to share these fact sheets with others. Permission is granted for reproduction in full, and copies must be provided free of charge. The information in these fact sheets is not medical advice. It is intended to help people with HIV/AIDS make informed choices. Please consult with a physician before making any decisions regarding treatment. ALOE VERA / ACEMANNAN Prepared by Martin A. Majchrowicz Spring 1994 Aloe vera is a plant that grows in subtropical and tropical regions. Most people are familiar with aloe vera through using it to treat burns, cuts, and as skin conditioner. Although there are over three hundred different species of aloe vera, the most commonly used are Aloe barbadensis (Miller), also known as aloe vera (Linne) Aloe ferrox (Miller), and Aloe perryi (Baker). Aloes and aloe vera extracts have been used medicinally for hundreds of years and are now being used in veterinary medicine and researched for possible use in humans. Acemannan, an aloe extract, is widely used and is currently being researched as a possible therapy for people with HIV/AIDS, cancer, ulcerative colitis, and wound healing. MECHANISM OF ACTION In vitro studies have shown that aloe vera has antibacterial, antifungal, antiviral, and anti-inflammatory properties. Additional studies suggest that acemannan, one of the many components of aloe vera, may have direct anti-HIV properties as well as enhancing the immune system. In vitro (test tube) studies suggest that acemannan may interfere with glycosylation, a step in the life cycle of HIV that is necessary for replication. In addition, acemannan reduces syncytia formation, the fusion and death of uninfected lymphocytes. As an immune modulator, in vitro studies indicate that acemannan regulates the activity of cytokines (proteins which regulate the immune system), and enhances the activity of cytotoxic T- Lymphocytes. STUDIES In vitro (test tube) studies demonstrate that acemannan can inhibit HIV replication alone and enhance the antiviral activity of AZT. Animal studies are of particular interest. One study demonstrated that acemannan had a beneficial effect on cats infected with feline leukemia virus (FLV) and feline immunodeficiency virus (FIV). Acemannan is currently approved for veterinary use as a vaccine adjuvant in Marek's disease, a virus-induced lymphoma that affects poultry, and for the treatment of fibrosarcoma, a type of cancer in cats and dogs. Human studies are fairly limited in their findings. One small safety study demonstrated that there is no additional toxicity when acemannan is used in combination with AZT. Other studies suggest that acemannan may increase CD4 cells. A study conducted by the Canadian HIV Trials Network presented at the IX International AIDS Conference in Berlin suggests that there may be a benefit in regards to the rate of decline of CD4 cells for those who received acemannan, however, that benefit may be limited. This study evaluated sixty-two patients with an average of 165 CD4 cells; in the placebo group and 144 CD4 cells in the acemannan group. Ninety percent of the patients were on AZT at entry with thirty percent switching to ddI. Ten patients in each arm discontinued the study but none due to serious adverse reactions. Seven patients in the acemannan group and five in the placebo group developed AIDS-defining illnesses. From weeks sixteen to forty-eight, there was a greater decline in CD4 cells in the placebo group than in the acemannan group. However, at forty-eight weeks, there was no difference in the decline of CD4 cells between the placebo and acemannan treated groups. This study also showed no effect on p24 levels or quantitative virology between the two groups. Another study sponsored by Carrington Laboratories suggests that acemannan may have a beneficial effect. Their study compares five long term survivors with ten deceased individuals. The five patients consumed a daily beverage containing 500-800 mg acemannan in addition to "existing medications," while the ten deceased patients all voluntarily stopped their treatment 18- 24 months prior to their deaths. The authors state that the "CD4 and CD8 levels and clinical status of these 5 patients and clinical deterioration of 10 deceased study patients closely paralleled their compliance for the daily intake of acemannan." The average CD4 cell count of the five long- term survivors remained fairly constant over the period of the study; increasing from 337 in 1986, to 346 in 1992. However, their CD8 cells significantly increased from 359 in 1986, to 1395 in 1992. The authors note that previous in vitro studies report that acemannan increases CD8 cells and may stimulate the production of cytokines such as Interleukin-1, IL-6, and Tumor Necrosis Factor-alpha (TNF). This report speculates that long- term survival may be associated with high CD8 cells and increased cytokine production, which may be induced by acemannan. One needs to keep in mind that this is only data on five people with no mention of other therapies used. Reports on long-term survivors have suggested that there may be an association with high CD8 cells. Studies of ex-vivo CD8 expansion as a therapeutic approach are attempting to answer that question. The big question here is whether the elevated CD8 cells in these five patients was a result of their acemannan use, another therapy, or just a natural occurrence in these five individuals. Another point of controversy is the increased production of specific cytokines. In vitro studies suggest that IL-1, IL-6, and TNF may stimulate the production of HIV and Kaposi's Sarcoma cells, which may lead to rapid disease progression. The role of these cytokines and the ability of acemannan to increase these cytokines may need further investigation. More recently there has been interest in using injectable acemannan in combination with dinitrochlorobenzene (DNCB), a chemical used in developing photographic film. When used topically, DNCB may induce a cellular immune response. Pathogenesis data suggests that a cellular immune response may be more beneficial than an antibody producing immune response (humoral). The rationale for this combination therapy is that DNCB will stimulate a cellular immune response and the acemannan will enhance or sustain that response. While no formal clinical studies have been done on this combination, anecdotal reports are very positive, particularly for people with Kaposi's Sarcoma. For more information on DNCB, please refer to DNCB fact sheet. AVAILABILITY While aloe vera is easily available, be warned that aloe vera juice from grocery or health food stores is mostly water. Although the bottle may say 99.9% natural aloe vera, it may contain very little aloe vera. Aloe vera which contains high concentrations of acemannan is available directly from some health food stores but is also available through distributors. It comes in a liquid form and is taken orally or can be mixed with beverages. Carrington Labs produces Carrisyn, their trade name for acemannan. Carrisyn contains 85-95% acemannan and is only available in injectable forms for veterinary use. However, Carrington produces the oral acemannan distributed by De Veras in a liquid form. Their product costs $160 for a twenty-seven day supply. Carrington Labs, Inc. (800) 438-3315 2001 Walnut Hill Lane Irving, TX 75038 DeVeras, Inc. (214) 823-4659 3404 Greenville Ave Dallas, TX 75206 Other distributors of aloe vera products are: Aloe Master (800) 424-2563 Kaire International (800) 524-7348 Other aloe vera concentrates are available at health food stores and farmers markets. However, be aware of the difference between aloe vera juice, which contains very little aloe vera, and aloe vera concentrate. High quality aloe vera is usually expensive and can cost as much as $80.00 for a one month supply. Aloe vera can be rated on the amount of active ingredients it contains. Be warned that there have never been any studies on the amount of active ingredients needed or how active these ingredients are in HIV-infected individuals. The most effective product, if any, remains unknown. Aloe vera can be processed through several different methods: distillation, freeze-dried, heat-processed, and cold- processed. The main purpose of processing is the removal of aloin, the portion of the plant that acts as a laxative. The question of what is the most efficient process is heavily debatable and has not been evaluated in any clinical study. REFERENCES Kahlon JB, Kemp, MC, Carpenter, RH, et al: Inhibition of AIDS virus replication in vitro. Molecular Biotherapy 3:127-135, 1991. Kahlon, JB, Kemp, MC, Yawei, N, et al: In Vitro evaluation of the synergistic antiviral effects of acemannan in combination with azidothymidine and acyclovir. Molecular Biotherapy 3:214- 23, 1991. Kemp, MC, Kahlon, JB, Carpenter, RH, et al: Concentration- dependent inhibition of AIDS virus replication and pathogenesis by acemannan in vitro. VI Int Conf on AIDS, San Francisco, Abs #1007, 1990. Klein, AD, Penneys, NS: Aloe vera. Journal of the American Academy of Dermatology 18(4):714-20, 1988. Korsia, S: Aloe vera: the plot thickens...but does the concentrate. I Heard It Through The Grapevine #5, December 1991. McDaniel, HR, Carpenter, R, Kemp, et al: HIV-2 infected patients respond favorably to oral acemannan. VI Int Confs on AIDS, San Francisco, Abs #493, 1990. McDaniel, HR. Rosenberg, LJ: CD4 and CD8 lymphocyte levels in acemannan (ACM)-treated HIV-1 infected long-term survivors. IX Int Conf on AIDS. Berlin, June 1993. #PO-B29-2179. Sheets, M., Unger, B., et al. Studies of the effect of acemannan on retrovirus infections: Clinical stabilization of feline leukemia virus- infected cats. Molecular Biotherapy 3:41-45, 1991. Singer, J, Gill, J, Arseneau, et al: A randomized placebo- controlled trial of oral acemannan as an adjunctive to anti- retroviral therapy in advanced HIV disease. IX Int Conf on AIDS. Berlin, June 1993. #PO-B28-2153. Womble, D, Helderman, JH: The impact of acemannan on the generation and function of cytotoxic T-lymphocytes. Immunpharmacology and Immuntoxicology 14:63-77, 1992. Yates, KM, Rosenberg, LJ, Harris, et al: Pilot study of the effect of acemannan in cats infected with feline immunodeficiency virus. Veterinary Immunology and Immunopathology 35:177- 189,1992. &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& End of display