Mistletoe (Viscum album)

Scientific name / brand name / common name

Mistletoe (Viscum album) is a semiparasitic plant that grows throughout Europe, Asia and North Africa (North American mistletoe is a different species), most commonly on oak, chestnut, black poplar, and fruit trees. 1 It is also known as Birdlime, All-heal, or Viscum.

Brand names of various forms of mistletoe extract are ABNOBAViscum, Cephalektin, Eurixor®, Helixor®, Iscador®, Isorel, Lektinol™.

Ingredients

Mistletoe extracts contain pharmacologically active proteins (lectins). The composition of an extract may vary according to season, host tree, parts of the plant used and extraction method. Mistletoe extracts induce macrophage cytotoxicity, stimulate phagocytosis of immune cells, increase cytokine secretion and enhance cytotoxicity effects on various cell lines in vitro. 2-3 The plant also contains a host of other ingredients such as acids, alkaloids, amines, flavonoids, terpenoids and viscotoxins.

History / providers

Mistletoe has been used medicinally for centuries and has been employed to treat cancer, epilepsy, infertility, menopausal symptoms, nervous tension, asthma, hypertension, headache, and dermatitis. Recent interest in mistletoe began in the 1920s after it was first proposed for the treatment of cancer by Rudolf Steiner, the founder of anthroposophy and anthroposophical medicine. Since the 1980s, mistletoe therapy has been researched systematically. A number of German phyto-pharmacological providers like WELEDA, ABNOBA HEILMITTEL, HELIXOR HEILMITTEL, NOVIPHARM and MADAUS market a range of different misteltoe preparations. Some products, e.g. those from WELEDA are anthroposophical, i.e. fermented and diluted preparations, others are herbal extracts. Indications within the anthroposophical approach depend on the host tree of the misteltoe plant.

Description of treatment method

Mistletoe is usually injected subcutaneously, but other routes of administration (e.g. intravenous, peritumoural, or intrapleural) also exist. The dosing regimens vary according to extract type and either follow a constant or a variable dose.

Claims of efficacy / mechanisms of action / alleged indication

Proponents claim that mistletoe treatment improves quality of life, strengthens the immune system and enhances cancer remission and survival rates. These actions are thought to be caused by lectin which are believed to induce macrophage cytotoxology, stimulate phagocytosis and increase cytokine secretion.

Prevalence of use

Mistletoe is popular in continental Europe, particularly in Germany. A recent study for Germany, for instance, showed that 15% of lung cancer patients used misteltoe preparations, most in order to "support the tumor treatment". 4 For other cancers, the prevalence figures may be even higher. The prevalence of usage shows important national differences.

Legal issues

In Germany, Switzerland and Austria, mistletoe preparations are licensed medicines that are partly reimbursable through the official healthcare system. In other European countries, they have no license. In the United States, Iscador is the only mistletoe product approved for distribution by the FDA in accordance with its requirements for homeopathic medicines. At present, at least two U.S. investigators have IND approval to study misteltoe as a treatment for cancer. 5-6 The FDA has not approved the use of mistletoe as a cancer treatment.

The Medicines and Healthcare Regulatory Agency in the UK states that, if a company places a manufactured herbal remedy on the market and supplies the product to herbalists, then such a product would need to have either a marketing authorisation or traditional use registration (http://www.mhra.gov.uk/). This is in accordance with the European Directives and Regulation of herbs.

Costs and expenditures

The costs of extracts varies. In Germany, a course of treatment lasting 2-3 weeks would typically cost around 40 Euros.