May 23 2022

Medicinal uses of Aloe vera (Aloe Barbadensis))

Description     

Aloe Vera(<em>Aloe Barbadensis</em>)

Aloe vera, also called Aloe barbadensis is a succulent plant of the lily family, native to northeast Africa, though with some endemism in the Canary Islands and Cape Verde, which has spread in warm areas of all continents, especially in Mexico where it is very popular as a medicinal remedy.

This plant is used as a therapeutic resource popular since ancient times. There is evidence of its use in Sumerian tablets over 2000 years before the Christian era. 100 years before Christ, in China, is used to treat seizures, fever, skin diseases and sinusitis. In times of Dioscorides, the plant was used to treat boils, skin diseases, itching and inflammation in local application. Internally, used for infections and gastric disorders.

It is a perennial, succulent leaves, radial arrangement. Leaves, elongate tapered at its free end, can reach up to 45-50 cm. long and 6-7 cm. thick. Its structure comprises the outer protective layer and sturdy, is concealed under another fibrous, resulting in the yellow bitter substance with laxative properties and the central mass gel rich in water and polymers. When the plant is young, the trunk is virtually nonexistent. As the years go by, we may trace a short trunk, barely visible. The flowers, small, are yellow and have less importance for medical applications.

Ssynonymy     

Scientific names of aloe vera include:

Aloe chinensis, Aloe elongata, Aloe flava, Aloe indica,Aloe lanzae, Aloe littoralis, Aloe maculata, Aloe perfoliata,Aloe rubescens, Aloe variegata y Aloe vulgaris.

Composition     

The content of the leaves of Aloe Vera substance comprises two types: the one hand, the bitter yellow exudate, used for its laxative effects and from the fibrous layer beneath the bark. On the other, the mucilaginous gel, containing several carbohydrate polymers, among which are glucomannans and pectic acid, and other substances such as alkaloids, triterpenes cyanidins, proanthocyanidins, tannins and saponins[1].

The separation of various components from the pulp by centrifugation sequentially allowed to differentiate three distinct components: thin sheets, microparticles and viscous gel in the following proportions: 16.2%, 0.70% and 83.1%. The gel contains mainly mannan, mannose polymers, of which the main one is the acemannan. Microparticles containing galactose rich polysaccharide and polysaccharide thin films with a high content of galacturonic acid [2] [3] [4].

The gel also contains aloeverosa, a substance of unknown therapeutic properties. Under the same circumstances is a derivative triglycosilated naphthalene, the aloeverósido [5]. The major phytosterols are lofenol gel, 24 lofenol methyl, ethyl lofenol 24, cycloartanol and 24-methylene cycloartanol [6]. Furthermore, aloe vera contains glycoproteins, enzymes, amino acids, vitamins and minerals [2]. It is known only fragmentarily the possible role of each component in the physiological properties of the plant [7].

Aloin (10-glucopyranosyl-1 ,8-dihydroxy-3-hydroxymethyl-9 (10H)-anthracenone), is a bioactive component of the plant [8]. In industrial processes, to evaluate the quality of aloe is measured the content of this substance[9][10]. Other components are the aloe-emodin (5.13 mg / g), methyl p-coumarato (0.768 mg / g) and 3,4-dihydro-6 ,8-dihydroxyl-[(3s)-2'-acetyl-3'-hydroxyl-5'-methoxy-benzyl]-isocoumarin (1.30 mg / g), the proportions in the plant are given in brackets [11]. Other components are the aloesin and alomanano, attributed to anti-inflammatory properties [12].

Aloe dried flowers contain phenolic type antioxidants such as chlorogenic acid, caffeic acid, 5-P-coumaroylquinic, caffeoilshiquinico, 5-feruloylquinic, 5-P-CIS-coumaroylquinic, p-coumaric and ferulic as well as luteolin, apigenin , quercetin, kaempferol, isoorientina, isovitexin and 7-O-glucoside, and lutonarina saponarina. They have also identified the anthranoid aloe-emodin and glucosilcromona aloeresina B, but have not been able to find laxatives Aloina A and B in the dried flowers. The polyphenol content is around 1% and flavonoids approximately 0.3% [13].

An experimental study describes three derivatives malonilglucanos (veracilglucanos A, B and C) as well as some of their properties. Veracilglucano B shows the potent anti-inflammatory and antiproliferative cell [14], while the veracilglucano C has an antiinflammatory effect but opposite to the derivative cellular proliferation B. The scarce veracilglucano obtained from A, and its instability prevented researchers a deeper understanding of the properties of the substance.

Have been isolated two dihidrocumarínicos derivatives, which have shown experimentally antioxidant and immunomodulatory properties [15]. It has also been identified chromone cinnamoyl-C-glycoside chromone that as the entire group of related substances have anti-inflammatory properties and antityrosinase [16].

Possibly, the beta-sitosterol content in the plant is an agent stimulating the formation of new blood vessels (angiogenesis factor), which would have potentially pharmaceutical applications in the treatment of chronic wounds [17].

Aloesin derivatives between the isorabaicromona have potent antioxidant activity together with feruloilaloesina and p-cumarinaloesina. At least the first component, this activity is due to the caffeoyl group [18].

The aloerid, a polysaccharide of high molecular weight (4-7 million Da), glycosidic whose components include glucose (37.2%), galactose (23.9%), mannose (19.5%) and arabinose (10.3%) possesses in vitro immunostimulatory properties. Despite its low concentration (0.015%) is the substance responsible for the activating effect of the whole juice of the plant [19].

Glycoprotein lectins are structures containing 5% sugar. Aloctina are identified I and II [20]. No therapeutic properties have been described for these substances, nor for aloenina, barbaloin, isobarbaloina and isoaloesina [21] [22].

The presence of arachidonic acid in Aloe Vera, a precursor of various biologically important substances, some authors do venture to the possibility that this plant contains some prostanoids, without these substances have been identified yet [23].

100 grams of fresh aloe vera containing 96.3 mg of citrate and tartrate 158.9. These data suggest to some researchers the ability to use the plant for the treatment and prevention of kidney stones, although no clinical observation supports for now, this application [24].

Properties and traditional applications     

This plant is a medicinal remedy very popular in countries as diverse as Turkey, the United Kingdom, India, United States or Mexico, the latter country where the plant was introduced in the sixteenth century [25] [26] [27 [28] [29] [30] [31] [32] [33] [34] [35] [36].

Many of the benefits attributed to this plant are due to the polysaccharides contained in the gel of the leaves. Its biological activity include the healing of wounds and burns, treatment and prevention of fungal infections, an antidiabetic effect, anti-inflammatory, anti-tumor, immunomodulatory gastric protective. Aloe is considered a stimulator of gastrointestinal and dermal absorption of some agents, as well as a good vehicle for various dermatological preparations [37] [38]. In some countries is used for the treatment of hypertension and for the treatment of diabetes mellitus [39] [40] [41] [42].

some derived from the Aloe are also used at low concentration as cosmetic ingredients, whose function would be to skin conditioners [43].

Other popular uses include local treatment of abscesses, fairly common practice in America in general and Mexico in particular [44], stomach ulcers [45], psoriasis [46], ulcerative colitis [47] and cancer [48].

The yellow area located just under the skin of the plant has purgative properties, used in some countries such as Trinidad and Tobago as a purgative of birds, among other uses [49] [50]. In parts of Canada, is used to treat digestive diseases for pets and livestock [51].

In situations of poverty, aloe is used by HIV-positive subjects to treat various ailments. Aloe is also one of the plants used by physicians more consumers of this type of resources [52].

On a popular level, the aloe is considered purgative (the yellow stuff under the skin it is), emmenagogue, locally antiinflammatory and antimicrobial emollient, so it is used on burns and wounds. According to the German Commission E, aloe is contraindicated in intestinal obstruction, inflammatory bowel disease, ulcerative colitis and appendicitis. Aloin an anthraquinone glycoside from the plant acts as a tonic in small doses, but at more is a drastic purgative. Aloe is also used for uterine disorders. Aloe pulp is used in menstrual suppression.

In Ayurvedic medicine, it is recommended to use the dried juice of aloe leaves in dysmenorrhea and liver disease. Also as an anthelmintic, antiasthmatic, for bronchitis, for dermatitis, erysipelas, fever, tumors, eye lesions and splenomegaly.

Aloe dried powder is used as pulp, also as juice, as decoction and extract. Topically, joins the dried powder or jelly to different carrier vehicles.

The applications of aloe vary depending on where used. Thus, the Arabs used the fresh leaves and the juice for fever. In the Caribbean region, is used in the form of gel for constipation, cough and sore throat. In Curaçao is used for gallbladder problems. In Haiti, using an aqueous extract of aloe as antidiabetic, purgative and vermifuge, while in Jamaica and elsewhere in America take a decoction of aloe for colds and biliary disorders. In Peru the gel is applied to burns, conjunctivitis, erysipelas and various inflammations. In the Gulf of Oman is frequently used for swelling of eyelids.

Traditionally, aloe vera flowers are used to treat gastrointestinal disorders (ulcerative colitis, peptic ulcers, constipation, colitis), musculoskeletal complaints (osteoarthritis, bursitis), herpes simplex, diabetes, asthma, post-irradiation mucositis, epilepsy, bleeding, amenorrhea , depression, glaucoma, multiple sclerosis, hemorrhoids, varicose veins, burns, wound healing, psoriasis, sunburn and frostbite.

Clinical Studies     

Burns, ulcers and wounds

In an open study in 30 patients with at least two areas of burn 2nd degree in the body, one of which was treated with silver sulfadiazine and the other with aloe, the rate of re-epithelialization and healing was significantly faster in the treated areas aloe (15.9 + / - 2 vs. 18.73 + / - 2.65 days, respectively, P <0.0001) [53].

The authors of a Cochrane review argue that there is no evidence to support the use of a particular solution for washing wounds over other options [54]. The authors of another systematic review on washing pressure ulcers, claim that there is little evidence to support the use of any particular cleaning solution for this purpose, so you can not make any recommendations about relevant [55 ]. In this sense, a hydrogel of acemannan gave similar results to the use of saline-moistened gauze in the treatment of pressure ulcers [56].

A comparative trial dividing an area of dermabrasion into two: one with and other without aloe vera produced intense vasoconstriction and reduction of edema at the site treated with aloe within 24-48 hours. On the third or fourth day there was less exudate and crusting lower in the treated with aloe. Collectively, these lesions healed 72 hours before. The mechanism of this accelerationis unknown[57]. However, in another clinical trial was a significant delay in healing wounds in the group treated with Aloe vera gel (83 + / - 28 days vs 53 + / - 24 days, P = 0.003)[58]. In a third study, involving 27 patients, the healing time of wounds in patients treated with aloe vera gel was 11.89 days, while those wounds treated with Vaseline gauze was 18.19 days (P <0.002) [59].

A review of the treatment of wounds healed by secondary intention indicates that there is insufficient documentation to support the choice of a topical agent over another to accelerate the healing of wounds [60].

An excellent systematic review on burns, included four trials in the analysis, comprising a total of 371 patients. The average difference in healing time was 8.79 days shorter in the group treated with aloe than the control group (P = 0.006). The authors caution that, due to the difference of products used in the tests, there are no data to establish specific conclusions regarding the aloe vera. However, the cumulative evidence seems to support that this plant can be effective on burns of first and second degree [61].

The results of a non-systematic review, which included experimental studies suggest that administration of oral aloe vera in laboratory mice is effective in wound healing and can decrease the number and size of papillomas, reduce tumor incidence and leshmanias parasitemia of more than 90% in the liver, spleen and bone marrow, but also states that it is not effective in preventing radiation injuries or sunburn. According to the authors, aloe may be effective for the treatment of genital herpes, psoriasis, human papilloma virus, seborrheic dermatitis, aphthous stomatitis, xerosis, lichen planus, frostbite, burns, wound healing and inflammation.

A randomized, comparative trial versus placebo for 4 weeks duration in 49 patients who were removed hemorrhoids and were treated postoperatively with a cream containing aloe vera or placebo record less postoperative pain at 12, 24, 48 hours and 2 weeks, higher degree of healing and less need for analgesics in the group treated with the cream of aloe vera [62].

Radiation injuries

A clinical trial in order to treat radioepitelitis (a disorder caused by radiation) with aloe vera has shown no benefit in the prevention of such disorders[63]. Similarly, other authors are pronounced in a systematic review[64]. The aloe vera does not improve tolerance to head and neck irradiation or decrease mucositis neither seems to improve the welfare of the patient, as indicated by the findings of a controlled clinical trial of phase II in malignant tumors of head and neck[65]. Another phase III trial also concluded that aloe vera does not prevent dermatitis caused by radiation therapy[66].

Aloe vera association with dexpanthenol not offered favorable results in the prevention of mucositis post irradiation [67].

A comparative study on 40 volunteers exposed to ultraviolet radiation showed a greater reduction in erythema aloe-treated group than in patients treated with 1% hydrocortisone. [68] By contrast, a phase III trial in 44 children provides better results in radiation dermatitis with a cream anionic phospholipids [69]. Another study about using aloe on sunburn in 20 volunteers showed comparatively higher efficacy than placebo [70].

Lichens, psoriasis and other dermatoses

Thirty four women suffering vulvar lichen planus were randomly distributed into two groups [71], which were treated for eight weeks with placebo gel and aloe, respectively. Fourteen of the seventeen patients treated with aloe had a good response to treatment, whereas in the placebo group only one patient improved.

Twenty-two patients with oral lichen planus experienced clinical improvement when treated the condition with aloe vera gel, while only 1 of 27 treated with placebo improved [72]. Was published a case involving complete healing with aloe vera for a patient suffering from lichen planus [73].

In another double-blind randomized clinical trial, the cream of aloe vera was more effective than other containing 0.1% triamcinolone in alleviating the symptoms of patients with plaque psoriasis, although the improvement of quality of life was similar [74] . In contrast to this study, another randomized, double-blind placebo controlled indicates that aloe was not superior to placebo in the treatment of psoriasis vulgaris of moderate intensity[75]. Another randomized, double-blind, placebo-controlled study suggests that topical application of aloe vera extract 0.5% in a hydrophilic cream is more effective than placebo[76].

A study on patients with dry skin and contact dermatitis of occupational origin who were applied gloves with topical extended release aloe experienced clinical improvement while maintaining the integrity of the skin with reduction of small wrinkles and erythema[77]. After ten days of topical application, formulations containing 0.10%, 0.25% and 0.50% aloe increase the water content of the stratum corneum compared to only topical vehicle, so that the authors of the study conclude that the plant can be a useful ingredient to improve skin hydration and treating dry skin[78].

In a phase III clinical trial, including 255 patients with breast cancer, an aqueous cream was significantly better than aloe vera gel applied topically to reduce dry desquamation and postintervention pain after lumpectomy or partial mastectomy [79].

Digestive disorders

A clinical trial of aloe vera for 4 weeks in patients with active ulcerative colitis concluded that this plant produces clinical improvement higher than placebo, also reducing histological activity [80]. However, these data are not conclusive, given the short duration of the study and the small number of patients. By contrast, a clinical trial with aloe in patients with irritable bowel syndrome revealed no benefits of its use [81].

Other applications

An open trial with aloe (n = 16) and benzyl benzoate lotion (n = 14) in the treatment of scabies, showed no difference between the two agents [82]. The low power of the study does not permit extrapolate the results.

A study conducted in 30 patients by analyzing the effect of the application of two different doses of aloe gel on facial wrinkles for 90 days showed an improvement in wrinkles in both groups of patients, also improving facial elasticity in patients received lower doses [83].

Aloe vera containing toothpastes have no effect on the control of gingivitis and plaque compared with fluoride toothpaste[84].

Other authors believe that the use of a hydrophilic substance such as aloe or a vegetable oil rich in vegetable fatty acids is as effective as soft creams with corticosteroids such as hydrocortisone 1% for the treatment of skin reactions [85].

A study of alveolar osteitis in patients treated with a commercial preparation containing a derivative of aloe, the acemannan, appears to reduce the incidence of this type of osteitis compared with foam clindamycin gel[86].

A preliminary study in solid tumors, aloe vera jointly administered with melatonin, suggests that the combination of both agents in untreatable tumors could produce some benefits in terms of survival or stabilization, when no other alternatives are available [87].

Pharmacology and toxicology     

Toxicology

The aloe vera has not shown significant toxicity after acute oral administration, with LD (50) in mice> 200 mg / kg. IV administration required a DL (50) in mice> 80 mg / kg. Subacute administration data were similar. 3 months administration of 100 mg / Kg of ethanol extract of aloe vera caused reproductive damage, inflammation and increased mortality in control animals. Although is proved phototoxicity of anthraquinone derivatives produced by aloe, several studies have shown no signs of it, indicating that the concentration of these substances is too low to induce photoreactions[43]. Moreover, a UV photo-irradiation induces the formation of free radicals, superoxide and induction of lipid peroxidation, which suggests that intake of aloe products may increase sensitivity to ultraviolet light [88].

Aloe vera gel contains cytotoxic compounds of low molecular weight comparable to the aleoe-emodin and aloin[89].

Acute administration produced only logical acemanan discomfort of an injection [90]. Subchronic administration did not produce significant alterations in experimental animals [91].

Side effects

Diarrhea was the only common side effect in patients using aloe to treat asthma, diabetes, heart disease, ulcers, skin diseases or cancer. Have been isolated cases of eczema, contact urticaria and dermatitis in patients treated with aloe topically [43][92].

It was published a case involving severe hepatitis by consumption of aloe in a male of 26 years who was consuming aloe infusion 2-4 weeks before symptoms [93]. Another possible case of hepatitis in a woman aged 73, admitted to hospital for acute hepatitis, which doctors consider possibly caused by capsules of aloe that the patient was taking to relieve constipation [94]. It was published a third case of acute hepatitis associated with taking aloe in a woman of 57, who was cured after stop taking[95].

Another case, in a woman of 72 years, started by dermatitis on the legs, followed by an eruption of the eyelids. The patient prepared aloe juice of homemade form that was applied to the legs for relieving the discomfort of peripheral venous insufficiency. Patch tests showed allergy to sheet and aloe jelly, as well as nickel sulfate [96].

It was published a case of Schoenlein-Henoch purpura in an adult who received aloe vera [97].

Three women and a man between 40 and 60 years had an intense burning sensation after topical application of aloe vera or vitamin E in an area of ??skin that underwent dermabrasion. One patient with severe dermatitis required hospitalization and corticoids. Full recovery took about three months. One patient reapplied Vitamin E two years later without any adverse effects [98].

Interactions

The test results indicate that the aloe improves absorption of vitamins E and C. Aloe slows the absorption process, which ensures that the vitamins remain longer in the plasma [99].

It has been published a case of possible interaction between sevoflurane and aloe. As it is known, aloe produces a reduction in prostaglandin synthesis, which in turn inhibits platelet aggregation, basic phenomenon in the process of blood coagulation. Sevoflurane inhibits thromboxane formation, which, on another level, is also involved in the clotting process. A 35 year old patient, operated on a hemangioma, suffered the loss of five liters of blood during surgery by the concurrence of taking aloe, sevoflurane and conditions of the tumor[100].

Experimental studies     

Antioxidant effects

Numerous experimental observations have described the antioxidant effect of aloe vera, relating even to the ancient use of the plant [101] [102] [103].

The antioxidant effect is tied to certain compounds, such as tocopherol, flavonoids, carotenoids, total phenolic content and ascorbic acid. While the extract shows significant antioxidant capacity, the inner part of the blade has no [104]. Aloe essential oil has the highest lipoxygenase inhibitory activity (95%) [105]. The glycoprotein fraction of aloe vera shows a free radical scavenger action caused by the xanthine-xanthine oxidase system as well as inhibition of COX-2 and a reduction of thromboxane A2 synthetase in vitro [106]. The antioxidant capacity is related to the content of polysaccharides and flavonoids, which in turn are with the age of the plant, being maximum at 3 or 4 years of the plant [107].

Effects on the nervous system

Some experimental studies suggest a protective effect of Aloe Vera on the cells of the nervous system [108] or a positive influence on animal models of human neurological diseases such as multiple sclerosis [109].

Immunological Effects

Have been published several scientific papers on the stimulatory activity of the defenses from the aloe vera in experimental animals [110] [111]. Some authors see in this property potential applications in inflammatory and infectious processes or tumors[112].

have been identified some of the substances responsible for these effects, such as acemannan and other polysaccharides, which stimulate the phagocytic activity of macrophages in the laboratory animal, plus lymphocyte response to antigenic stimuli and anticandidiasis effects[113][114][115][116].

Yellow juice of aloe vera stimulates or restores the cellular immune response and phagocytosis, both immunosuppressed and normal animals. The Aloctine A is another substance with immunostimulatory properties of Aloe vera[29].

Angiogenic effect

It has been identified in various experimental studies an angiogenic agent(beta-sitosterol) in Aloe vera plant, which could be applied, at least in theory, in the repair of damaged blood vessels and in wound healing[17][117][118]. Angigenic effect would result in a decrease in primary ovarian follicles and increase in secondary follicles. Aloe vera behave also as FSH [119]. In contrast, has been described an antiangiogenic aloe-emodin component[120].

Antiulcer effect

It has been described antiulcer effect of aloe vera in experimental models. According to the findings of one study, Aloe vera reduces the level of TNF-alpha, increases IL-10 and promotes healing of gastric ulcers in experimental animals [121]. According to the observations of another experimental study, AV has gastric antisecretory activity, which protect the gastric mucosa against mild to moderate aggressions[122].

Hepatoprotective effect

The aloe hepatoprotective effect has been analyzed in some studies [123] [124] [125] [126] [127]. In general, the results of animal experiments are encouraging, both in prevention and treatment of liver injury, and could result in lines of work in clinical trials.

Protective effect against radiation

Aloe may be protected, at least in part, against ionizing radiation and UV-B type [128] [129].

Effect on wounds and burns

There is a considerable number of publications about the healing of wounds and burns through aloe vera, alone or combined with other healing medium [130][131][132][133][134] [135][136][137].

For some authors in experimental animal diabetes, healing stimulation is due to the improvement of the plant induced diabetes [138]. For others, the substance responsible for the stimulatory effect of wound healing is a glycoprotein[139]. Furthermore, the acemannan stimulates the growth of fibroblasts, basic cells in healing processes, especially in the oral cavity[37].

Compared to sulfadiazine cream, aloe increase significantly the degree of re-epithelialization of burns in laboratory animals[140][141]. Other observations indicate similar results compared to different methods of treatment [142]. Furthermore, the aloe vera may offset the delayed wound healing caused by sulfadiazine [143].

Anti-inflammatory effect

Several publications indicate the anti-inflammatory effect of aloe vera, either applied locally or internal use[144][145][146][147][148]. Plant inhibit bacterial cytokines that would trigger the inflammation process [149], either by inhibiting the adhesion of leukocytes or leukocyte-endothelium interactions[150][151] or by the effect antilipoxigenasa [152] or by a effect on arachidonic acid synthesis via COX[153].

Some authors hypothesize that there are specific anti-inflammatory substances, perhaps in the supernatant of the extract of the plant[154]. Aloe vera has been effective in vitro for the treatment of inflamed colorectal mucosa[155].

Antimicrobial effect

It has been described an effect against multidrug resistant Mycobacterium tuberculosis[2]. Other studies have investigated the susceptibility of various strains of bacteria to aloe vera, including Shigella flexneri, methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes and Escherichia coli[156][157][158][159].

Regarding the oral bacterial flora, a preliminary study indicates that the toothpaste with or without aloe have similar effectiveness [160]. Nor have demonstrated superior antibacterial action soaps to which has been added aloe vera[161].

Aloe protect against experimental systemic infection, but rather by affecting certain mediators (TNF, IL) with a direct action on the germs. [162]

The aloe has shown remarkable activity against various classes of Leishmania, as L.Donovani, Leishmania braziliensis, Leishmania mexicana, Leishmania tropica, Leishmania major and Leishmania infantum[163][164][165].

Antidiabetic effect

Aloe oral administration seems to prevent the progression of mouse experimental diabetes mellitus[166]. The continuous administration of high doses of aloe in mice with experimental diabetes caused by streptozotocin normalizes enzymatic parameters, glucose, lipids and insulin levels [167][168].

Aloe extracts rich in polyphenols decreased the weight of laboratory animals, the levels of glucose and insulin resistance[169].

Several data are suggestive of the existence of one or more substances with antidiabetic properties in aloe gel[170]. Some researchers link the antidiabetic effect with a fraction of 10 kDa [171]. Five phytosterols of aloe vera (lofenol 24 lofenol methyl, ethyl lofenol 24, cycloartanol and 24-methylene-cycloartanol) have demonstrated a remarkable antidiabetic effect, reducing the glycemic values until?less than half of the values in the controls in almost all cases[6]. Some researchers suggest that the antidiabetic effect could be due to an action on the enzymes that catalyze carbohydrate and not on insulin secretion[172].

Aloe not only have the property to normalize blood glucose in laboratory animals but also prevent renal and hepatic lesions caused by diabetes[173][174]. Interestingly, a study shows that the gel leaf extract have a hyperglycemic effect, while the pulp would have, on the contrary, an antidiabetic effect[175].

The aloe-emodin would have an antiangiogenic effect, which depend on their antitumor effect [119] Other authors relate the antitumor effect of this substance with the suppression of c-myc[176].

Antitumoral effect

It has been demonstrated chemopreventive effect of aloe against skin papilloma caused by 7,12-dimethylbenz (a) anthracene. The aloe leaf extract would decrease the number and size of papillomas[177]. Aloe vera would exert a preventative effect on the liver carcinogenesis[178].

aloin, a natural anthracycline obtained from aloe vera, would have an antitumor effect due to the normalization of antioxidant enzyme function[179]. The aloctin I, a lectin of the pulp of aloe, act preventively on mouse Ehrlich tumor, possibly due to its immunomodulatory action[180][181]. Aloe-emodin induce cell death in certain human gastric, nervous and bladder cancer[182][183][184][185][186][187]. A similar effect of this substance would have the substance diethylhexylphthalate, an agent isolated from aloe vera on certain human leukemia cell lines[188][189].

Some authors have speculated that the optimum size of the polysaccharides with antitumoral and immunomodulatory effect would be between 400 and 5 kDa[190].

Other effects

Aloe vera may be beneficial for the protection of the epithelial cells, promoting progression and maturation of the integument[191]. The acemannan, a polysaccharide from Aloe vera may also exert an effect on ripening immature dendritic cells[192]. Complementarily, aloe extract increase the proliferation and collagen synthesis in human skin cells[193].

A study has shown that aloe gel contains small molecules that could prevent skin immunosuppression induced by UV type B, which may have a restorative effect[194] In contrast, aloe-emodin could have a phototoxic effect[195].

The aloe may have thyroid-slowing effects, although it is premature to speak of well defined antithyroid effects[196]. Other possible local effects suggest a positive influence on allergic rhinitis[197]. Laboratory animals treated with a dietary supplement of aloe reduced their cholesterol levels [198]. None of these effects has been well documented to induce people design trials.

A polymer derived from aloe increase survival in animals with lethal hemorrhagic shock[199][200]. A similar effect has been observed in rats with acute myocardial infarction [201].

Acemannan in experimental animals stimulates proliferation of dental pulp cells and mineralization and the formation of dentine[202].

Pretreatment with aloe vera juice does not improve ketoprofen penetration through the skin[203]. Other observations have opposite sign. So, for oxybutynin, colchicine and quinine, there would be a noticeable increase skin absorption[204]. Other experimental data suggest that the aloe vera intestinal increases penetration of various substances, which may lead to adverse effects caused by the increase in bioavailability of these agents[205].

Conclusions     

There is available a considerable number of observations, open trials and clinical trials of good methodology that seem to support the efficacy and safety of aloe vera. However, most experts believe that the information available in the various fields of application is insufficient to establish beyond any doubt the efficacy and safety of using this plant and clarify the myth that exists around it[1][2][206][207]. It is necessary to deepen the knowledge of its therapeutic properties[208].

References     

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