In this review, the composition, actions, and clinical applications of acemannan in medicine and its effectiveness as an adjunct in the treatment of diseases are presented. An electronic literature search was performed up to January 2014 for studies and research presenting data to validate the efficacy of acemannan. A total of 50 titles, abstracts and full-text studies were selected and reviewed. Acemannan has various medicinal properties like osteogenic, anti-inflammatory, and antibacterial, which accelerate healing of lesions. Also, acemannan is known to have antiviral and antitumor activities in vivo through activation of immune responses. It was concluded that Aloe vera has immense potential as a therapeutic agent. Even though the plant is a promising herb with various clinical applications in medicine and dentistry, more clinical research needs to be undertaken to validate and explain the action of acemannan in healing, so that it can be established in the field of medicine and a more precise understanding of the biological activities of these is required to develop Aloe vera as a pharmaceutical source.
SilvaS.S., CaridadeS.G., ManoJ.F., ReisR.L. (2013) Effect of crosslinking in chitosan/Aloe vera-based membranes for biomedical applications. Carbohydrate Polymers, 98, 581–588.
2.
(a) HammanJ.H. (2008) Composition and applications of Aloe vera leaf gel. Molecules, 13, 1599–1616; (b) Capasso R, Laudato M, Borrelli F. (2013) New perspectives in Aloe research: from basic science to clinical application. Natural Product Communications, 8, 1333–1334.
3.
SajjadA., SajjadS.S. (2014) Aloe vera: an ancient herb for modern dentistry. A literature review. Journal of Dental Surgery, Article ID 210463.
4.
SehgalI., WintersW.D., ScottM., DavidA., GillisG., StouffletT., NairA., KousoulasK. (2013) Toxicologic assessment of a commercial decolorized whole leaf Aloe vera juice, lily of the desert filtered whole leaf juice with aloesorb. Journal of Toxicology, 2013, 802453.
5.
VoglerB.K., ErnstE. (1999) Aloe vera: a systematic review of its clinical effectiveness. British Journal of General Practice, 49, 823–828.
6.
ReynoldsT., DweckA.C. (1999) Aloe vera leaf gel: a review update. Journal of Ethnopharmacoogy, 68, 3–37.
7.
PanelCire. (2007) Final report on the safety assessment of Aloe andongensis extract, Aloe andongensis leaf juice, Aloe arborescens leaf extract, Aloe arborescens leaf juice, Aloe arborescens leaf protoplasts, Aloe barbadensis flower extract, Aloe barbadensis leaf, Aloe barbadensis leaf extract, Aloe barbadensis leaf juice, Aloe barbadensis leaf polysaccharides, Aloe barbadensis leaf water, Aloe ferox leaf extract, Aloe ferox leaf juice, and Aloe ferox leaf juice extract. International Journal of Toxicology, 26 Suppl 2, 1–50.
8.
ChantarawaratitP., SangvanichP., BanlunaraW., SoontornvipartK., ThunyakitpisalP. (2014) Acemannan sponges stimulate alveolar bone, cementum and periodontal ligament regeneration in a canine class II furcation defect model. Journal of Periodontal Research, 49, 164–178
9.
TizardI. (1991) Use of immunomodulators as an aid to clinical management of feline leukemia virus-infected cats. Journal of the American Veterinary Medical Association, 199, 1482–1485.
10.
KingG.K., YatesK.M., GreenleeP.G., PierceK.R., FordC.R., McAnalleyB.H., TizardI.R. (1995) The effect of AcemannanImmunostimulant in combination with surgery and radiation therapy on spontaneous canine and feline fibrosarcomas. Journal of the American Animal Hospital Association, 31, 439–447.
11.
JettanacheawchankitS., SasithanasateS., SangvanichP., BanlunaraW., ThunyakitpisalP. (2009) Acemannan stimulates gingival fibroblast proliferation; expressions of keratinocyte growth factor-1, vascular endothelial growth factor, and type I collagen; and wound healing. Journal of Pharmacological Sciences, 109, 525–531.
12.
LoboR., PrabhuK.S., ShirwaikarA., BallalM., BalachandranC. (2010) A HPTLC densitometric method for the determination of aloeverose in Aloe vera gel. Fitoterapia, 81, 231–233.
13.
NiY., TurnerD., YatesK.M., TizardI. (2004) Isolation and characterization of structural components of Aloe vera L. leaf pulp. International Immunopharmacology, 4, 1745–1755.
14.
MannaS., McAnalleyB.H. (1993) Determination of the position of the O-acetyl group in a beta-(1–>4)-mannan (acemannan) from Aloe barbardensis Miller. Carbohydrate Research, 241, 317–319.
15.
AlonsoM., TámbaraY., LópezM., AguilarJ.C., MayoO., PrietoE., CremataJ., GerwigG., KamerlingH., HardyE. (2012) On the isolation of immunostimulatory active acemannan from Aloe barbadensis. Aislamiento de acemannano inmunoestimulador activo de Aloe barbadensis. Biotecnología Aplicada, 29, 87–101.
16.
BoonyagulS., BanlunaraW., SangvanichP., ThunyakitpisalP. (2013) Effect of acemannan, an extracted polysaccharide from Aloe vera, on BMSCs proliferation, differentiation, extracellular matrix synthesis, mineralization, and bone formation in a tooth extraction model. Odontology 2013.DOI10.1007/s10266-012-0101-2
17.
JittapiromsakN., JettanacheawchankitS., LardungdeeP., SangvanichP., ThunyakitpisalP. (2007) Effect of acemannan on BMP-2 expression in primary pulpal fibroblasts and periodontal fibroblasts, in vitro study. Journal of Oral Tissue Engineering, 4, 149–154.
18.
SahawatD., KanthasuwanS., SangvanichP., TakataT., KitagawaM., ThunyakitpisalP. (2012) Acemannan induces cementoblast proliferation, differentiation, extracellular matrix secretion, and mineral deposition. Journal of Medicinal Plants Research, 6, 4069–4076.
19.
JittapiromsakN., SahawatD., BanlunaraW., SangvanichP., ThunyakitpisalP. (2010) Acemannan, an extracted product from Aloe vera, stimulates dental pulp cell proliferation, differentiation, mineralization, and dentin formation. Tissue Engineering Part A, 16, 1997–2006
20.
BoonpaisansereeW., Jaru-AmpornpanK., KoontongkaewS., ThunyakitpisalP. (2012) Acemannan stimulated dentine sialophosphoprotein expression in human dental pulp cell via p38 mitogen activated protein kinase.Proceedings of International Conference: Innovative Research in a Changing and Challenging World.Australian Multicultural Interaction Institute, Thailand, 356–365.
21.
PoorM.R., HallJ.E., PoorA.S. (2002) Reduction in the incidence of alveolar osteitis in patients treated with the SaliCept patch, containing Acemannan hydrogel. Journal of Oral and Maxillofacial Surgery, 60, 374–379.
ChoiS., ChingM.H. (2003) A review on the relationship between Aloe vera components and their biologic effects. Seminars in Integrative Medicine, 1, 53–62.
24.
MaenthaisongR., ChaiyakunaprukN., NiruntrapornS., KongkaewC. (2007) The efficacy of Aloe vera used for burn wound healing: a systematic review. Burns, 33, 713–718.
25.
GarrastazuG., Staniscuaki, BalducciA., ColomboP., SonvicoF. (2014) Polymeric films loaded with vitamin E and Aloe vera for topical application in the treatment of burn wounds. BioMed Research International, Article ID 641590
26.
RodriguezM.B., CruzN., SuarezA. (1988) Comparative evaluation of Aloe vera in the management of burn wounds in Guinea pigs. Plastic and Reconstructive Surgery, 3, 386–389.
27.
AtibaA, NishimuraM., KakinumaS., HiraokaT., GoryoM., ShimadaY., UenoH., UzukaY. (2011) Aloe vera oral administration accelerates acute radiation-delayed wound healing by stimulating transforming growth factor-β and fibroblast growth factor production. American Journal of Surgery, 201, 809–818.
28.
RobertsD.B., TravisE.L. (1995) Acemannan-containing wound dressing gel reduces radiation-induced skin reactions in C3H mice. International Journal of Radiation Oncology Biology Physics, 32, 1047–1052.
29.
ZhangL., TizardI.R. (1996) Activation of a mouse macrophage cell line by acemannan: the major carbohydrate fraction from Aloe vera gel. Immunopharmacology, 35, 119–128.
30.
Tai-Nin ChowJ., WilliamsonD.A., YatesK.M., GouxW. (2005) Chemical characterization of the immunomodulating polysaccharide of Aloe vera L. Carbohydrate Research, 340, 1131–1142.
31.
RamamoorthyL., TizardI.R. (1998) Induction of apoptosis in a macrophage cell line RAW 264.7 by acemannan, a beta-(1, 4)-acetylated mannan. Molecular Pharmacology, 53, 415–421.
32.
TalmadgeJ., ChavezJ., JacobsL., MungerC., ChinnahT., ChowJ.T., WilliamsonD., YatesK. (2004) Fractionation of Aloe vera L. inner gel, purification and molecular profiling of activity. International Immunopharmacology, 4, 1757–1773.
33.
WombleD., HeldermanJ.H. (1992) The impact of acemannan on the generation and function of cytotoxic T-lymphocytes. Immunopharmacology and Immunotoxicology, 14, 63–77.
34.
LeeJ.K., LeeM.K., YunY.P., KimY., KimJ.S., KimY.S., KimK., HanS.S., LeeC.K. (2001) Acemannan purified from Aloe vera induces phenotypic and functional maturation of immature dendritic cells. International Immunopharmacology, 1, 1275–1284.
35.
KaracaK., SharmaJ.M., NordgrenR. (1995) Nitric oxide production by chicken macrophages activated by Acemannan, a complex carbohydrate extracted from Aloe vera. International Journal of Immunopharmacology, 17, 183–188.
36.
PughN., RossS.A., ElSohlyM.A., PascoD.S. (2001) Characterization of Aloeride, a new high-molecular-weight polysaccharide from Aloe vera with potent immunostimulatory activity. Journal of Agricultural and Food Chemistry, 49, 1030–1034.
37.
CastellanosE., Rodiguez-AcostaM. (2001) Efecto antiviral del extracto acuoso de Aloe barbadensis contra el virus de la hepatitis B. Revista Cubana de Plantas Medicinales, 6, 7–11.
38.
AzghaniA.O., WilliamsI., HolidayD.B., JohnsonA. (1995) A beta-linked mannan inhibits adherence of Pseudomonas aeruginosa to human lung epithelial cells. Glycobiology, 5, 39–44.
39.
StuartR.W., LefkowitzD.L., LincolnJ.A., HowardK., GeldermanM.P., LefkowitzS.S. (1997) Upregulation of phagocytosis and candidicidal activity of macrophages exposed to the immunostimulant acemannan. International Journal of Immunopharmacology, 19, 75–82.
40.
YatesK.M., RosenbergL.J., HarrisC.K., BronstadD.C., KingG.K., BiehleG.A., WalkerB., FordC.R., HallJ.E., TizardI.R. (1992) Pilot study of the effect of acemannan in cats infected with feline immunodeficiency virus. Veterinary Immunology and Immunopathology, 35, 177–189.
41.
HarlevE., NevoE., LanskyE.P. (2012) Anticancer potential of aloes: antioxidant, antiproliferative, and immunostimulatory attributes. Planta Medica, 78, 843–852
42.
HarrisC., PierceK., KingG., YatesK.M., HallJ., TizardI. (1991) Efficacy of acemannan in treatment of canine and feline spontaneous neoplasms. Molecular Biotherapy, 3, 207–213
43.
LiuC., LeungM.Y.K., KoonJ.C.M., ZhuL.F., HuY.Z., YuB., FungK.P. (2006) Macrophage activation by polysaccharide biological response modifier isolated from Aloe vera L. var. chinensis (Haw) Berg. International Immunopharmacology, 6, 1634–1641
44.
HuseiniF., KianbackhtS., HajiaghaeeR., Afkhami-ArdekaniM., BonakdaranA., Hashem DabaghianF. (2012) Aloe vera leaf gel in treatment of advanced type 2 diabetes mellitus needing insulin therapy: a randomized double-blind placebo-controlled clinical trial. Journal of Medicinal Plants, 11, 19–27
BhalangK., ThunyakitpisalP., RungsirisateanN. (2013) Acemannan, a polysaccharide extracted from Aloe vera, is effective in the treatment of oral aphthous ulceration. Journal of Alternative and Complementary Medicine, 19, 429–434.
47.
KayaG., YapiciG., SavaşZ., GüngörmüşM. (2011) Comparison of alvogyl, SaliCept patch, and low-level laser therapy in the management of alveolar osteitis. Journal of Oral and Maxillofacial Surgery, 69, 1571–1577.
48.
TelloC.G., FordP., IacopinoA.M. (1998) In vitro evaluation of complex carbohydrate denture adhesive formulations. Quintessence International, 29, 585–593.
49.
National Toxicology Program Report, “Toxicology and carcinogenesis studies of a non-decolorized whole leaf extract of Aloe barbadensis Miller (Aloe vera) in F344/N rats and B6C3F1 mice (drinking water study),” (2011) NTP Technical Report Series 577, NIH Publication.
50.
FoglemanR.W., ShellenbergerT.E., BalmerM.F., CarpenterR.H., McAnalleyB.H. (1992) Subchronic oral administration of acemannan in the rat and dog. Veterinary and Human Toxicology, 34, 144–147.
