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Current Topics in Medicinal Chemistry, 2013, 13, 000-000 1
1568-0266/13 $58.00+.00 © 2013 Bentham Science Publishers
Mycotherapy of Cancer: An Update on Cytotoxic and Antitumor Activities
of Mushrooms, Bioactive Principles and Molecular Mechanisms of their
Action
Vinja Popovi1, Jelena ivkovi2, Slobodan Davidovi3, Milena Stevanovi3 and Dejan Stojkovi4,*
1University of Belgrade - Faculty of Pharmacy, Department of Pharmacognozy, Vojvode Stepe 450, 11221 Belgrade,
Serbia; 2Institute for Medicinal Plant Research “Dr. Josif Pani”, Tadeua Kouka 3, 11000 Belgrade, Serbia;
3University of Belgrade, Institute of Molecular Genetics and Genetic Engineering, 11010 Belgrade, Serbia; 4University
of Belgrade, Institute for Biological Research “Sinia Stankovi”, Department of Plant Physiology, Bulevar Despota
Stefana 142, 11000 Belgrade, Serbia
Abstract: Mycotherapy is defined as the study of the use of extracts and compounds obtained from mushrooms as medi-
cines or health-promoting agents. The present review updates the recent findings on anticancer/antitumor agents derived
from mushroom extracts and their metabolites. The increasing number of studies in the past few years revealed mushroom
extracts as potent antitumor agents. Also, numerous studies were conducted on bioactive compounds isolated from mush-
rooms reporting the heteropolysaccharides, -glucans, -glucans, proteins, complexes of polysaccharides with proteins,
fatty acids, nucleoside antagonists, terpenoids, sesquiterpenes, lanostanoids, sterols and phenolic acids as promising anti-
tumor agents. Also, molecular mechanisms of cytotoxicity against different cancer cell lines are discussed in this review.
Findings with Antrodia camphorata and Ganoderma lucidium extracts and isolated compounds are presented, as being the
most deeply studied previously.
Keywords: Antitumor properties, compounds, extracts, molecular mechanisms, mushrooms.
INTRODUCTION
We defined the mycotherapy as the study of the use of
extracts and compounds obtained from mushrooms as medi-
cines or health-promoting agents. Mycotherapy of cancer is a
relatively novel and promising scientific field, which deals
with anticancerogenic agents derived from mushrooms. The
term “mushroom” will be used for a medicinal fruiting body
belonging to higher fungi.
Mushrooms are important dietary components in some
cultures, some of them being traditionally used for the treat-
ment of various conditions including cancer [1]. Identifica-
tion of active principles in extracts, i.e. isolation of new anti-
tumor substances from mushrooms became a matter of great
importance, taking into account the complexity and distribu-
tion of various cancer types in population worldwide [2]. A
great variety of compounds and complex fractions were iso-
lated and/or purified from medicinal as well as from some
edible mushrooms, with special importance regarding anti-
cancer and cancer preventive activity [1]. Amongst the broad
spectrum of constituents in medicinal and ed ible mushrooms,
these activities are mainly attributed to polysaccharides (3-
6), various polysaccharide-protein/peptide complexes [2],
lectins [4, 7] terpenoids [8, 9], sterols [10, 11], etc. Special
interest is devoted to polysaccharides from the fungal cell
walls because of their immunomodulatory activity, being
*Address correspondence to this author at the Institute for Biological Re-
search “Sinia Stankovi”, University of Belgrade, Bulevar Despota Stefana
142, 11000, Belgrade, Serbia; Tel: +381-11-2078419;
Fax: +381-11-276143; Email: dejanbio@yahoo.com
biological response modifiers (BRM) that prevent carcino-
genesis, but they also show direct anticancer effects and pre-
vent tumor metastasis [12].
MUSHROOM EXTRACTS
Mushroom extracts are increasingly consumed as dietary
supplements because of their properties, including the en-
hancement of immune function and antitumor activity [13].
It is well established that mushroom extracts contain a wide
variety of compounds such as polysaccharides, protein, fiber,
lectins and polyphenols, each of which may have pharma-
cological effects. More than 30 species of medicinal mush-
rooms are currently identified as sources of biologically ac-
tive metabolites with potential anti-cancer properties [14].
The properties and mechanisms of mushroom extracts that
have been recently evaluated are outlined in Table 1.
Ganoderma lucidum, commonly known as Lingzhi or
Reishi has been traditionally administered throughout Asia
for centuries as a cancer treatment [15]. The pharmacological
activities of G. lucidum, particularly its intrinsic immuno-
modulating and antitumor properties, have been well docu-
mented. Several studies have demonstrated that various G.
lucidum extracts interf ere with cell cycle progression, induce
apoptosis and suppress angiogenesis in human cancer cells
and thus act as antican cer agents [16-18]. Recently, Suarez-
Arrayo et al., [19] evaluated the antitumor effect of a com-
mercially available extract consisting of Reishi fruiting body
and cracked spores and elucidated its potential mechanism in
vivo. Mice injected with Inflammatory Breast Cancer (IBC)
cells treated with Reishi for 13 weeks show tumor growth
2 Current Topics in Medicinal Chemistry, 2013, Vo l. 13, No. 21 Popovi et al.
Table 1. Antitumo r Activity of Mushroom Extracts
Mushroom
species
Active compounds/
extracts/fractions Cell type Activity/results Mechanism of action Reference
Amauroderma
rude hot water extract
human breast cancer
cell lines MT-1, MDA-
MB231, 4T1, MDA-
MB468, MCF7
induction of apoptosis [32]
cold water extract
human breast cancer
cell lines MDA-MB-
453 and BT-474
IC50 values 220 and 240
μg/ml for MDA-MB-453
and BT-474 cells respec-
tively
inhibition of cell growth and induction of
apoptosis through the induction of ROS,
depletion of HER-2/neu, and disruption
of the PI3K/Akt signaling pathway
[23]
Antrodia
camphorata
fermentation culture human ovarian carci-
noma (SKOV-3) cells
at 240 μg/mL colony
formation was reduced by
over 90% compared to the
untreated control cells
modulation of HER-2/neu signaling
pathway [24]
Antrodia
cinnamonea ethanolic extract murine leukemia
WEHI-3 cells
inhibition of the proliferation and migra-
tion of WEHI-3 cells, MMP-9 protein
expression reduction
[20]
Clitocybe
alexandri ethanolic extract human non-small lung
cancer NCI-H460 S-phase cell cycle arrest [30]
Ganoderma
lucidum
commercialy avail-
able extract Reishi-
Max GLpTM
mice injected with IBC
cells
reduction of tumor growth
and weight by 45%
reduction in expression at both the gene
and protein level of important molecules
in the PI3K/Akt/mTOR and MAPK
signaling pathways
[19]
Hericium
erinaceus 50% ethanol extract CT-26 mouse colon
carcinoma cell
42% inhibition at 1
mg/mL
suppression of ERK and JNK activation,
inhibition of lung metastasis in vivo [31]
aqueous extract
human tumor cell lines
laryngeal carcinoma
(Hep-2), cervical ade-
nocarcinoma (HeLa)
IC50%=0.46-1.03 apoptosis induction [13]
Lentinula
edodes
ethanol extract HepG2 human hepato-
cellular carcinoma apoptosis induction through caspase-3
and -8 death receptor pathway [22]
human breast carci-
noma MCF-7 IC50=96.7 μg/mL
Lignosus
rhinocereus cold water extract
human lung carcinoma
A549 IC50=466.7 μg/mL
[23]
Pleurotus
pulmonarius hot water extract
human liver cancer cell
lines Huh7, Hep 3B,
SMMC-7721 and
HepG2
inhibition of VEGF-mediated autocrine
regulation of PI3K/AKT [1]
Pleurotus
sajor-caju aqueous extract
human tumor cell lines
laryngeal carcinoma
(Hep-2) and cervical
adenocarcinoma
(HeLa)
IC50(%)=0.25-0.78 apoptosis induction [13]
Ramaria flava ethanol extract BGC-803, NCI-H520,
MDA-MB-231
IC50 ranged from 66.54 to
743.99 μg/ml for the
MDA-MB-231 and BGC-
803 cell lines respectively
[20]
Suillus
collinitus methanolic extract MCF-7 human breast
cancer cell line increases p53 expression and causes
apoptosis [28]
Mycotherapy of Cancer Current Topics in Medicinal Chemistry, 2013, Vol. 13, No. 21 3
(Table 1) contd….
Mushroom
species
Active compounds/
extracts/fractions Cell type Activity/results Mechanism of action Reference
Suillus luteus methanolic extract
MCF-7 human breast
cancer cell line, NCI-
H460 human non-
small cell lung cancer,
AGS human gastric
cancer, HCT-15 hu-
man colon cancer
GI50 values ranged from
17.75 to 32.25 μg/ml for
the HCT-15 and MCF-7
cells, respectively
increases p53 expression and causes
apoptosis [29]
Tricholoma
giganteum 80% ethanol extract Ehrlich ascites
carcinoma apoptosis induction [27]
and weight reduced by 45%. Furthermore, reduced expres-
sion of E-cadherin, mammalian target of rapamycin
(mTOR), human eukaryotic translation initiation factor 4G
(eIF4G), p70 ribosomal protein S6 kinase (p70S6K) and
activity of extracellular regulated kinase (ERK 1/2) were
observed. These results confirmed that Reishi is a potential
natural th erapeutic for breast and other cancers that selec-
tively affects gene and protein expression and therefore, ac-
tivity of molecules involved in cancer cell function [19].
Lentinula edodes, the shitake mushroom, has been used
for traditional foods and medicine in Asia for over 2000
years and today it is also popular in many western countries
[20]. It is the second most popular edible mushroom in the
global market, and its importance being attributed to both
nutritional value and medical application [21]. L. edodes has
been extensively researched for their medicinal benefits,
most notably antitumor properties [21]. The low temperature
(<50°C) aqueous extract of this mushroom significantly de-
creased proliferation of the human tumor cell lines laryngeal
carcinoma (Hep-2) and cervical adenocarcinoma (HeLA),
with IC50% values ranging from 0.46% to 1.03% [13]. Yu-
kawa et al., [22] examined the antiproliferative eff ect of L.
edodes mycelia extract on HepG2 human hepatocellular car-
cinoma cells. The extract efficaciously induced apoptosis of
tested type of cells through the caspase -3 and -8 death re-
ceptor pathways [22].
Antrodia (camphor tree mushroom) is a genus of mush-
rooms in the family Fomitopsidaceae. These mushrooms are
highly valued in Taiwan [15]. The fermented culture broth of
A. camphorata has been shown to promote growth inhibition
and apoptotic induction of HER-2/neu-overexpressing hu-
man breast cancer cells MDA-MB-453 and BT-474 cells
with IC50 values of 220 and 240 μg/ml, respectively [23].
Among positive regulators of proliferation, HER-2/neu was
found to be a complement protooncogene that regulates tu-
mor progression in a variety of human cancers, including
breast cancer. Anti-HER-2/neu receptor therapy has been
increasingly recognized as a potential treatment of HER-
2/neu-overexpressing breast and ovarian cancer patients, as
supported by recent advances in this direction [24]. A. cam-
phorata extract significantly down-regulated the expression
of cyclin D1, cyclin E and cyclin-dependent kinase (CDK)
followed by the suppression of PI3K/Akt, and their down-
stream effectors GSK-3 and -catenin in tested cancer cell
lines. Additionally, A. camphorata extract efficiently inhib-
ited human ovarian carcinoma cell (SKOV-3) proliferation
(IC50=196 μg/ml) as a result from ROS (reactive oxygen
species) generation, loss of HER-2/neu activation and sup-
pression of its downstream signaling, including the PI3K/Akt
cascade [24]. A. camphorata induced apoptosis in SKOV-3
cells which was associated with internucleosomal DNA
fragmentation and caspase-3 and caspase-9 activation, down-
regulation of Bcl2 expression and up-regulation of Bax ex-
pression [24].
Ethanolic extract of A. cinnamomea significantly inhib-
ited the proliferation and migration of murine leukemia cell
line WEHI-3 through the reduction of p-ERK1/2, p-Akt and
MMP-9 protein expression and the upregulation of p21 and
p27 protein expression [20]. Using an allograft tumor model
in which BALB/c mice were injected with WEHI-3 leukemia
cells, Liu et al., [20] also found that this extract exhibited
antitumor activity by significantly decreasing the average
weights of liver, spleens and tumor.
Cultivation of the Pleurotus (oyster mushroom) species
has increased greatly throughout the world during the last
few decades. Today they represent the 3rd largest cultivated
mushroom in the world [25]. Xu et al., [1] reported that ex-
posure of liver cancer cells to hot water extract of Pleurotus
pulmonarius not only significantly reduced the in vitro and
in vivo cancer cell proliferation and invasion, but also en-
hanced the drug-sensitivity to the chemotherapeutic drug
Cisplatin [26]. The exhibited effect was mediated by the in-
hibition of autocrine vascular endothelial growth factor
(VEGF)-induced PI3K/AKT signaling pathway. Aqueous
extract of P. sajor-caju demonstrated inhibitory activity
against the proliferation of Hep-2 and HeLa cell lines with
IC50% values ranged from 0.23% to 1.21% depending on the
temperature used for extraction [13].
Tricholoma giganteum of the family Tricholomataceae, a
wild edible mushroom, is most conspicuous in the tropical
region during rainy season [27]. The 80% ethanol extract of
T. giganteum exhibited significant potency against Ehrlich’s
ascites carcinoma (EAC) through induction of apoptogenic
signal. It was observed that 80% ethanol extract enhanced
the levels of pro-apoptotic proteins p53 and p21. Addition-
ally, pro-apoptotic gene Bax was up-regulated, while no sig-
nificant change in the expression of Bcl-2 was observed en-
suing in decrease of the Bax/Bcl-2 ratio [27].
Suillus collinitus is an edible mycorrhizal mushroom
found in European pine forests, belonging to the genus Suil-
lus in the Suillaceae family. Vaz et al., [28] studied the effect
4 Current Topics in Medicinal Chemistry, 2013, Vo l. 13, No. 21 Popovi et al.
of S. collinitus methanolic, ethanolic and boiled water ex-
tracts on the growth of four human tumor cell lines: MCF-7
(breast), NCI-H460 (non-small cell lung cancer), AGS (gas-
tric) and HCT-15 (colon). The methanolic extract was the
most potent in tested cell lines with concentrations that
caused 50% of cell growth inhibition (GI50) ranging from
25.2 to 103.2 μg/ml for the MCF-7 and HCT-15 cells, re-
spectively. The boiled water extract did not show any effect
on the tested cell lines at the tested concentrations (up to 400
μg/ml). The results of flow cytometry showed that the
methanolic extract induced G1 arrest in MCF-7 cells, with a
concomitant decrease in the percentage of cells in the S
phase. The apoptotic machinery was associated with strong
increase in the levels of p53 and p21, decrease in the levels
of XIAP and Bcl-2 and a concentration dependent increase in
the levels of cleaved poly (ADP-ribose) polymerase (PARP).
Additionally, methanolic, ethanolic and boiled water extracts
of S. luteus were subjected to antitumor evaluation in the
same human tumor cell lines (NCI-H460, MCF-7, HCT-15
and AGS). The methanolic extract was the most potent with
GI50 values ranging from 17.75 to 32.25 μg/ml for HCT-15
and MCF-7 cells, respectively. In HCT-15 cells, an increase
in the levels of p53 was detected, but no alterations in some
of the proteins transactivated by p53 (p21 or Bax) were
found. Also, methanolic extract caused an increase in the
cellular levels of p-H2A.X, which suggests DNA damage
[29].
Lignosius rhinocerus, the tiger milk mushroom, belongs
to the Polyporaceae family and is one of the most important
medicinal mushrooms, used by natives in Southeast Asia and
southern China. The cold water extract of L. rhinocerus ex-
hibited significant antiproliferative activity against the breast
cancer cell line MCF-7 and lung cancer cell line A549 [23].
The high-molecular-weight fraction of the extract was the
one responsible for the observed activity against the two
cancer cell lines tested, while the low-molecular-weight frac-
tion was devoiced of antiproliferative activity. The mecha-
nism of growth inhibition was apoptosis induction [23].
Clitocybe alexandri is an edible saprophytic Basidiomy-
cotina mushroom belonging to the family of Tricholomata-
ceae [15]. Ethanolic extract of C. alexandri has been demon-
strated to possess cytotoxic and anti-proliferative activity
towards a lung human tumor cell line (NCI-H460 cells).
Flow cytometric analysis showed that the extract induced an
S-phase cell cycle arrest and increased the percentage of
apoptotic cells. Furthermore, an increase in the levels of
(PARP) cleavage, caspase-3 cleavage and p53 were observed
in the NCI-H460 cells treated with this extract [30].
The edible medicinal mushroom Hericium erinaceus
commonly known as Lion’s Mane has attracted great atten-
tion owing to its antitumor and immunomodulatory effects
[15]. Kim et al., [31] found that hot water and microwaved
50% ethanol extracts of
H. erinaceus effectively inhibited the proliferation and
invasion of CT-26 colon carcinoma cells, as well as the me-
tastasis and invasion of CT-26 cells to the lungs by 66 and
69%, respectively. Their anti-invasive and antimetastasis
activities might be ascribed to the suppression of extracellu-
lar matrix (ECM) degrading protease expression such as that
of matrix metalloproteinases MMP-2 and MMP-9 and
urokinase-type plasminogen activator (u-PA) via down-
regulating the upstream MAPK signaling pathway. Dietary
administration of H. erinaceus extracts in BALB/c mice
transplanted with CT-26 cancer cells reduced the formation
of tumor nodules in the lung by 50 and 55% respectively,
and prevented increase in lung weight caused by cancer cell
metastasis [31].
Amauroderma rude, or bloody mushroom, of the family
Ganodermataceae, is newly described and poorly studied
fungus. Jiao et al., [32] studied the effect of hot water extract
of A. rude on invasive and metastatic breast cancer cell lines
MT-1, MDA-MB231 and 4T1, less invasive breast cancer
cell line MDA-MB468 and benign breast cell line MCF7. No
cancer cells could survive after treatment with 600 μg/ml of
A. rude extract. Also, low concentration of this extract (50
μg/ml) exerted a significant activity in inducing cell apopto-
sis as compared with the control (29% vs. 1.8%). Further-
more, the antitumor effect of A. rude extract was assessed in
vivo in regular mice injected with 4T1 cells. Locally admini-
stration of extract significantly inhibited the growth of tumor
mass. Suppression of c-myc expression appeared to be asso-
ciated with these effects [32].
The reported results are mainly from in vitro studies and
as a hint of the potential therapeutic value they mark the very
first steps in preclinical screening. Often they are also used
as advertising arguments for traditional medicines [14].
BIOACTIVE PRINCIPLES OF MUSHROOMS
Polysaccharides
Polysaccharides are biopolymers, consisted of monosac-
charide units linked through glucoside bonds with high abil-
ity to carry biological information due to numerous structural
variations. Many of them are shown to exert in vitro antipro-
liferative/cytotoxic as well as antitumor activity in animal
models [2]. Polysaccharides are still mainly used as an adju-
vant therapy in cancer treatment [3]. Several structural fea-
tures are known to affect these biological activities, primar-
ily specific structural features, molecular weight, backbone
linkage, degree of branching, side-chain units, as well as
monosaccharide composition [6].
Various mechanisms may determine the mode of action
of polysaccharides on cancer cells, but these compounds
mainly induce activation and modification of different im-
mune responses in the host, rather than directly attacking
cancer cells [3, 33]. These polysaccharides bind to serum
specific proteins leading to activation of macrophages, T-
helper, natural killer (NK) cells, and other effector cells and
thereby increase the production of antibodies, interleukins
such as IL-1 and IL-2, and interferon [34]. Such activities
are strongly influenced by molecular mass, branching con-
figuration, conformation and chemical modification of the
polysaccharides [4]. Knowing that a specific pharmacologi-
cal effect is dependent on structural features, apart from
naturally occurring polysaccharides, many of the bioactive
polysaccharides are produced semi-synthetically via chemi-
cal or enzymatic modification of the parent molecules [2].
Most often, such modifications are carried out in order to
improve their water solubility by Smith degradation (oxydo-
reducto-hydrolysis), formolysis and carboxymethylation
[33].
Mycotherapy of Cancer Current Topics in Medicinal Chemistry, 2013, Vol. 13, No. 21 5
Mushroom polysaccharides that exert antitumor activities
have been isolated from fruiting bodies, cultured mycelia
and culture filtrates of Basidiomycetes [4]. Traditional isola-
tion of polysaccharides as active principles includes various
techniques of boiling water, alkali or acid extractions, alco-
hol precipitation, followed by fractionation on a sepharose
and usually sephadex column chromatography [3, 35]. By
various chemical modifications such as periodate oxidation,
Smith degradation, partial acid hydrolyzation and methyla-
tion analysis of a polysaccharide in combination with spec-
troscopic methods such as Fourier Transform Infrared (FT-
IR), and 1-D and 2-D Nuclear Magnetic Resonance (NMR)
techniques, it is possible to determine backbone structure
with specific configuration and/or linkage position [4, 34,
35].
Nowadays, considering backbone structure, it is known
that glucose residues linked by -(1 3)-glycosidic bonds
with attached -(1 6) branch points exhibit strong antitu-
mor and immunostimulating properties [4]. In the following
overview, besides well-known and commercially available
products of a polysaccharide source, such as schizopyhllan,
lentinan and grifolan, a brief report on other polysaccharides
that are currently investigated for their potential use in my-
cotherapy of cancer, will be given.
Heteropolysaccharides
Low molecu lar weight polysaccharide (LMW-ABP) iso-
lated from the fruiting bodies of Agaricus blazei (syn. A.
brasiliensis) inhibited tumor growth and angiogenesis in vivo
by down-regulating VEGF. It was further shown that this
polysaccharide inhibited tumor cell adhesion via depressing
E-selectin protein expression and also NF-B protein expres-
sion, so it may be a promising therapeutic agent against E-
selectin mediated neoplasm metastasis [36]. From the fruit-
ing bodies of the same species, an heteropolysaccharide
(MW 4.2 105 Da) consisting of glucose, mannose and ga-
lactose in a molar ratio 1:1:1 was purified, and cytotoxicity
was tested in osteosarcoma HOC as well as in normal human
osteoblast cells. This heteropolysaccharide showed signifi-
cant inhibitory effect in HOS cell line by induction of apop-
tosis, whilst showing no or little toxicity in a normal cell line
[37].
A heteroglucan polysaccharide isolated from Astraeus
hygrometricus induced tumor regression in Dalton lym-
phoma bearing mice, and the possible mechanism, the eleva-
tion of macrophage and NK cells activation, with increase in
Th1 cytokine production [38], was suggested.
Two heteropolysaccharides (MW 2 kDa and 40-70 kDa)
consisted mainly of glucose, mannose, xylose, and fructose,
were obtained by size-exclusion chromatography from me-
dicinal mushroom Agaricus bisporus, and tested in MTT (3-
(4,5-dimethyltiazol-2-yl)-2,5-diphenyltetrazoliumbromide)
assay for cytotoxic activity in four human cancer cell lines.
Both polysaccharide fractions were active in human breast
adenocarcinoma cell line MCF-7, while the activity in other
tested cell lines was low [39]. In the same study, Jeong et al.,
[39] exposed murine Sarcoma 180 cells to these polysaccha-
rides, and implanted subcutaneously those cells into mice. A
reduction in tumor growth compared to control group was
observed.
Apart from -glucans, from medicinal mushroom mai-
take (Grifola frondosa), a water-soluble heteropolysaccha-
ride consisting of galactose, mannose, fucose and glucose in
a molar ratio of 1.24:1:0.95:0.88 was purified. This polysac-
charide inhibited colon-26 tumor-growth in BALB/cA mice,
to a level achieved by the reference -glucan, and the effect
is thought to be associated with induced cell-mediated im-
munity [40].
An alkaline-soluble polysaccharide (MW 6.3 kDa) iso-
lated and purified from Inonotus obliquus consisted of rham-
nose, xylose, manose, galactose, glucose and galacturonic
acid in a molar ratio of 3.09:1.61:2.06:4.45:19.7:1, showed
excellent activity against solid tumor Sarcoma 180 formation
in mice, and the exerted activity was associated with potent
immunostimulating effect of this polysaccharide [41]. An-
other heteropolysaccharide (MW 93 kDa) was extracted and
purified from I. obliquus, but was water-soluble and con-
sisted of rhamnose, mannose and glucose in molar ratios of
1.0:2.3:1.7. For this polysaccharide, no significant in vitro
cytotoxic effect was observed, but exerted significant anti-
tumor effect in human gastric carcinoma SGC-7901-bearing
nude mice. Similar to other polysaccharides, authors sug-
gested possible mechanisms related to cancer-prev ention,
immuno-enhancement and direct tumor inhibition [42].
One of the polysaccharide fractions isolated from fruiting
bodies of Tricholoma matsutake, unlike other purified frac-
tions of this mushroom, was found to be consisted of glu-
cose, galactose and mannose with a molar ratio 5.9:1.1:1.0.
This fraction exerted strong antiproliferative activity on
HepG2 and A549 cell lines in MTT test [43].
Several investig ations revealed that water-solubility of
heteropolysaccharides could be one of the key features for
increased antitumor activity [4, 44].
Some previous investigation showed that carboxymethy-
lated derivatives of linear -(1 3)-D-glucans isolated from
Agrocybe cilindracea and Amanita muscaria exhibited high
potentiating effect on peritoneal murine macrophages, play-
ing an important role in tumor immunity [45]. Water insolu-
ble, alkali soluble -(1 3)-D-glucans isolated from fruit-
ing bodies of four fungal species: Laetiporus sulphureus,
Lentinus edodes, Pleurotus ostreatus and Piptoporus betu-
linus were converted into water soluble fractions by car-
boxymethylation [5]. After carboxymethylation, the obtained
derivatives were tested for their cytotoxic activities in MTT
and neural red uptake (NR) assays, and all carboxymethy-
lated -(1 3)-D-glucans exerted high cytotoxic activity on
human cervical carcinoma (HeLA) and human acute T-cell
leukemia cell line (IC50 values in range 0.53-2.45 g/ml),
with relatively low activity in cell line of normal human skin
fibroblasts (IC50 values >25 g/ml, or no activity at all) [5].
Water-insoluble, alkali-soluble polysaccharides that were
identified as -(1 3)-D-glucans isolated from three fruit-
ing bodies of the fungus Ganoderma lucidum, were car-
boxymethylated and tested for their cytotoxic activity in hu-
man cervical carcinoma HeLa cell line, as well as in two
normal human cell lines (colon myofibroblasts CCD-18Co
and epithelial cells CCD 841 CoTr). Tested carboxymethy-
lated glucans decreased cell metabolism after 24 h incuba-
tion in both carcinoma and normal cell lines, and exerted
inhibition of cell viability in normal cell lines while in HeLa
6 Current Topics in Medicinal Chemistry, 2013, Vo l. 13, No. 21 Popovi et al.
cell line did not induce cytotoxic effect [46]. Even though,
carboxymethylation, leading to increased water-solubility,
may be the suitable chemical modification for enhancing
cytotoxic activity. Wiater et al., [46] suggested that degree of
substitution in carboxymethylated products strongly affects
immunological parameters, whereas increased degree of sub-
stitution did not result in cytotoxic activity. Another study of
intracellular polysaccharides from submerged fermentation
of Ganoderma lucidum and their sulfated derivatives pointed
out the importance of the structure of derivatives and their
origin i.e. whether they are of intra- or extra-cellular origin
and implication of these facts on their anticancer properties.
Intracellular polysaccharides from mycelia of G. lucidum are
believed to be more active against cancer cell lines than ex-
tracellular polysaccharides. Still, in th e mentioned research,
the intracellular polysacch arides of G. lucidum inhibited hu-
man hepatocarcinoma cell line HepG2 in the first 48 h but
stimulated the cell growth after 72 h regardless the concen-
tration applied, whilst for other human hepatocarcinoma cell
lines, these polysaccharides showed dose- and time-
dependent inhibition. Also, intracellular polysaccharides
accelerated the growth of normal human liver cells. Sulfated
extracellular polysaccharides performed high inhibition on
HepG2 cell line, but also exerted certain toxicity in normal
liver cell line. Supplementing sulfated extracellular polysac-
charides with intracellular polysaccharides of G. lucidum
reduced the harm to normal liver cells [47].
Apart from carboxymethylation, it has been shown that
O-sulfonated derivatives of native water-insoluble (13)--
D-glucans, isolated from fruiting bodies of Lentinus edodes,
exert inhibition of growth of solid tumor Sarcoma 180 im-
planted in mice. Also, cytotoxic activity of O-sulfonated
glucans exerted cytotoxic activity in MTT assay on the same
cell line. O-Sulfonation increased antitumor and cytotoxic
activities of naturally occurring glucans, in both in vitro an d
in vivo tests [48].
Polysaccharides isolated from submerged fermentation
broth of G. lucidum SB1997 were sulfated and the effect of
this modification on the antitumor and cytotoxic properties
was estimated. The sulfated polysaccharides exhibited high
antiproliferative activity in MTT test on four human and one
rat carcinoma cell lines in concentration-dependent manner
and also remarkable but not dose-dependent antitumor activ-
ity in Heps hepatoma in mice. In comparison, naturally oc-
curring extracellular water-soluble polysaccharide isolated
from G. lucidum showed to lack antiproliferative activity in
these cell lines, but reduced Heps in rat models also in non-
dose-dependent manner [49].
Similarly, a sulfated polysaccharide from Grifola fron-
dosa was tested for antiproliferative activity in Hep2 cells.
This derivative concentration-dependently inhibited prolif-
eration of Hep2 cells and it was related to a potential mecha-
nism involving apoptosis through cell cycle arrest in S phase
[50].
-GLUCANS
-Glucans represent fundamental building blocks in
fungi, since their cell walls are composed of two polymers:
chitin and -glucan that are interlinked by covalent bonds
and hydrogen bridges, which makes strong foundation for
chitin fib ers network incorporated in glucan matrix. -
Glucans are polysaccharides where glucose is a sole mono-
mer unit, from tens to thousands of kilodaltons, more or less
soluble in water, which increases with temperature of the
solvent. Glucans that are isolated from mushrooms are
mainly -1,3-D-glucan or -1,6-D-glucans [44].
Even though chemical structure of -glucans of cell walls
of fungi has not been examined fully, it is known that
immunomodulating activity is mainly dependent on single
helix glucan structure capable to interact and/or link to
immunoglobulins present in blood serum. Several structural
features contribute to these effects such as higher degree of
substitution, presence of hydrophilic groups on the helix
surface and higher molecular weight. In the human body,
glucans are intensively oxidized, and formed metabolites are
temporarily and less effective than -glucans themselves
[44]. Basically, underlying mechanisms for antitumor
activities of -glucans such as lentinan, schizophyllan and
grifolan, include stimulation of hematopoietic stem cells,
activation of the alternative complement pathway, and
activation of immune cells such as lymphocytes,
macrophages, DC, NK cells, Th cells, Tc cells, and B cells
[5].
In order to define specific features that contribute to anti-
tumor activity, a series of tests were conducted on glucans
obtained from Grifola frondosa. The most active glucan ap-
peared to be branched -(1 3)-glucan, known as grifolan,
that exerted antitumor activity in Sarcoma 180 mice in a sin-
gle dose 20 μg/mice (daily dose 20 μg/mice three times a
day). Using specific solvents in extraction, may favour the
enriching of extracts of G. frondosa in grifolan, and for this
purpose the predominantly used solvent is sodium hydroxide
[32]. A soluble -(1 3)-(1 6)-D-glucan, purified also
from
G. frondosa, named maitake D-fraction, was proven to
exert antitumor activity after intraperitoneal injection, by
activating host immune system. The same fraction after oral
administration significantly inhibited tumor growth in mur-
ine tumor models [40]. A soluble homogeneous -glucan
(MW 300 kDa) was purified from the fraction of the fruit
bodies of G. frondosa. Its structure was determined to be a -
(1 3)-D linked glucan backbone with a single -(1 6)-
D linked glucopyranosyl residue branched at C-6 on every
third residue. This glucan inhibited Sarcoma-180 growth
allografted in ICR (Imprinting Control Region) mice but not
in immunodeficient BALB/c nu/nu mice and the effect was
partially associated with the activation of macrophages,
which suggested the molecule as promising biological re-
sponse modifier [51].
-(1 6)-D-glucan, major polysaccharide component
obtained from fruit bodies of Agaricus blazei (A. brasilien-
sis), a mushroom used for cancer prevention, exerted signifi-
cant antitumor activity in Sarcoma 180 mice, as demon-
strated in several tests [10].
Lentinan (MW 400-800 103 Da), the main -glucan of
L. edodes fruit bodies, is a right handed triple helix, with five
-(1 3)-glycose residues in a linear linkage and two -(1
6)-glucopyranoside branches in side chains. Due to the
specific conformation, it exerts specific immunomodulatory
and anti-cancer effects in tumor models, which are attrib-
uted, not directly to inhibition of cell growth in vitro, but to
Mycotherapy of Cancer Current Topics in Medicinal Chemistry, 2013, Vol. 13, No. 21 7
the activation of T-cell- or peritonealexudate-cell-mediated
immune responses [44, 52]. Lentinan is considered relatively
safe in doses used by i.v. administration (0.001-30 mg/kg)
for 5-6 weeks, but longer term use is not recommended due
to its toxicity. Also, taken orally, lentinan exerts little activ-
ity and may cause different gastro-intestinal disturbances and
allergic reactions [53].
Schizophyllan (MW 450 103 Da) is also -(1 3)-
glycan, with a side chain of -(1 6)-glucopyranosily
group and at each third glucose of main chain [44].
-(13)-D-Glucan with linked branches of primarily
single (16)-glucopyranosyl groups, two for every seven
residues in the main chain, was isolated from the fruiting
bodies of Amanita muscaria. For this -glucan, it was dem-
onstrated a high antitumor activity in Sarcoma 180 in mice,
and a mixture of this compound with mytomycin C, refer-
ence compound, increased the antitumor effect of mitomycin
[54].
-GLUCANS
Apart from -glucans, immunostimulatory and potential
anticancer activity of -glucans was also shown. A branched
-(14)-glucan (L10) purified from Lentinula edodes in-
duced a significant reducion of viability (66% to 37%) of
irradiated human lung adenocarcinoma A549 cells cocul-
tured with monocytes (THP-1) by Toll-like receptor 4 medi-
ated induction of THP-1 [6]. Lo et al., [6] stated that L10-
monocites have the potential to enhance the antitumor im-
mune response and antitumor effect of radiotherapy.
A low molecular complex of glucans (20 kDa) derived
from Agaricus blazei consisted of -(14)-glucan and -
(16)-glucan, and it showed in vitro selective cy totoxicity
in MethA tumor cells, without affecting normal cells [55].
Proteins
Mushrooms contain high amounts of proteins, which ac-
count 10-40% of dry body weight [3]. Normally, a protein or
peptide is not regarded as a drug candidate due to intensive
metabolism in alimentary tract and serum, and development
of corresponding antibodies by the immune system. How-
ever, there are few studies that support cytotoxic and antitu-
mor properties of proteins isolated from mushrooms [3, 56-
58]. Lectins are proteins of non-immune origin that reversi-
bly bind to mono- and oligosaccharides with high specificity;
through these processes they may be involved in biological
activities such as cell-to-cell interactions and innate immu-
nity [59]. Antitumor and cytotoxic properties of several lect-
ins isolated from mushrooms, have been demonstrated [7,
57, 59].
A water soluble component from Agrocybe aegerita (Yt),
consisting of 60% of proteins (two lectins, serine proteinase
and several unknown proteins), 40% of low molecular
weight substances and trace carbohydrates, was demon-
strated to induce significant cytotoxicity in six tumor cell
lines in concentration 50 μg/ml, while fibroblast cell line
NIH3T3 was not affected by the presence of Yt. Further-
more, this protein complex induced tumor rejection in hepa-
tocellular carcinoma H22 and sarcoma S180 tumor bearing
BALB/c mice in a low con centration (2.5 mg/kg) without
significant cytotoxicity. In a nude mouse H22 tumor model,
Yt did not produce significant changes, but prolonged the
lifespan. The contribution of a protein part of the molecule to
exerted activities was proven by weakening of tumor rejec-
tion properties when proteins were degraded by proteinase
K. Using the same isolation procedure from water extracts of
fungi Cordyceps militaris, Ganoderma lucidum and Lentinus
edodes, similar protein-low molecular weight compound
complexes were extracted and purified, and anti-cancer ac-
tivity was examined in H22 hepatocellular carcinoma bear-
ing mice, and those tumor rejection effects were similar to
those of Yt complex, pointing out that protein components,
at least in part, contribute to antitumor properties of these
mushrooms [3].
Agaricus bisporus lectin (ABL) has the remarkable prop-
erty of binding selectively and with high affinity to Thomas-
Friedereich antigen or T-antigen, a disaccharide hidden in
healthy cells but exposed in high percentage in human carci-
nomas [60]. In vitro tests of ABL showed that it causes con-
centration-dependent inhibition on proliferation of HT29
human colorectal carcinoma, Caco-2 human colorectal can-
cer cells, human breast cancer MCF-7 cells, as well as rat
mammary fibroblast Rama-27 cells via specific oligosaccha-
ride binding sites (TF antigens) on cell membranes [7]. Also,
from Boletus edulus, another lectin with similar structure to
ABL was isolated, and it was found that it selectively and
dose-dependently inhibits the growth of three cell lines, with
inhibition of colon cancer cell line HT29 being the most pro-
nounced [59]. A novel lectin marked as a BEL -trefoil, for
its structure of homodimer and each promoter folds as -
trefoil domain, was isolated and characterized from fruiting
bodies of the same Boletus species; furthermore, it was
shown to exert concentration-dependent cytotoxic effect in
four human cell lines by MTT assay [57].
An immunomodulatory recombinant protein Lz-8, that
was previously isolated and purified from the mycelia of
Ganoderma lucidum, induced endoplasmic reticulum stress-
mediated autophagic cell death in SGC-7901 human gastric
cancer cells. Described mechanism is neither a caspase de-
pendent cell death nor apoptosis, and may be a novel strat-
egy for cancer treatment [58].
Alkaline protease (MW 15 kDa) that was isolated from
fruiting bodies of Amanita farinosa was shown to inhibit
proliferation of HepG2 cells concentration-dependently (IC50
of about 25 μM) using MTT assay [56].
Complexes of Polysaccharides with Proteins
Biological effects of mushroom polysaccharides may be
promoted by the presence of a peptide or protein part com-
plexed to them [44, 52, 61]. In previous investigations it was
shown that highly active principals of Ganoderma lucidum
are immunostimulating glycoproteins called fungal immu-
nomodulatory proteins (FIMs) and Ganoderma polysaccha-
rides peptide (GPP). Proteoglucans polysaccharide peptide
(PSP) and polysaccharide-krestin (PSK) that are present in
Trametes versicolor or Schizophyllum commune are also
known to possess antitumor properties [61].
Krestin, polysaccharide protein complex purified from
Coriolus versicolor, is a -(1 4)-glycan with a -(1 3)-
and -(1 3)-glucosidic branches, containing about 25% of
8 Current Topics in Medicinal Chemistry, 2013, Vo l. 13, No. 21 Popovi et al.
protein that exert antitumor effects in various animal tumor
models and has been given orally to cancer patients. The
killer T cell activity was increased in tumor-bearing mice by
intraperitoneal or oral administration of krestin [52].
A specific heteroglycan-protein conjugate (LEM), known
to possess antitumor properties is extracted from L. endodes
mycelia before the cap and the stem grow and contains
24.6% of protein and 44.0% of sugars, comprising mostly
glucose, but also galactose, mannose and fructose. In much
lower quantity, it contains nucleic acid derivatives, vitamin
B complex, ergosterol and water-soluble lignins [53].
Soluble proteoglucan isolated from the fruit bodies of
Agaricus blazei Murill consists of (13)--D-glucan and
(16)--D-glucan in ratio 2:1 (MW 170 kDa), and small
amounts of proteins. This complex was shown to be able to
selectively supress tumor growth by both apoptotic process-
ing and host immune responses in solid tumor glioblastoma
cells, as well as by NK cells-mediated immune response and
related tumoricidal activity in Balb/c mice [62].
Furthermore, a complex RNA-glucoprotein complex
named FA-2-b--fraction, containing adenine, aminopurine,
chloropurine and other modified bases as nucleic acid base
components, 15.7% of protein and D-ribose as the major
constitutive sugar, was isolated from A. blazei and exerted
cytotoxic effect in HL-60 cells measured by MTT assay,
causing induction of apoptosis by combined effect of down-
regulation of telomerase activity and up-regulation of mRNA
expression of caspase-3 gene [63].
A 21-kDa heteropolysaccharide, coded as GFPS1b was
isolated from the cultured mycelia of Grifola frondosa
GF9801, is an acidic polysaccharide with approximately
16.60% protein and 4.3% uronic acid. Monosaccharide units
were found to be D-glucose, D-galactose, and L-arabinose in
a molar ratio of 4:2:1, forming a backbone consisting of -(1
4)-linked D-galacopyranosyl and -(1 3)-linked D-
glucopyranosyl residues substituted at O-6 with glycosyl
residues composed of -L-arabinose-(1 4)--D-glucose
(1 6) linked residues. This polysaccharide was shown to
induce strong antiproliferative effect in MCF-7 human breast
adenocarcinoma cells [35].
Ganoderan, a -glucan isolated from G. lucidum, is con-
sisted of glucose and 4% of protein, and induced antitumor
immunity in tumor-bearing mice [4].
Sixteen peptide polysaccharide complexes were isolated
from the mycelium of Ganoderma tsuage and tested for anti-
tumor properties on Sarcoma 180 mice. Amongst the com-
plexes tested, the most active were heteropolysaccharides
consisted of glucose, xylose and mannose with 9.3% of pro-
teins and two more glucan-protein complexes: one contain-
ing 25.8% of protein and other having glycan (protein ratio
of 42:58 w/w with the polysaccharide part consisting mainly
of glucose, associated with arabinose, mannose, xylose and
galactose). The three polysaccharide protein complexes ex-
erted the highest tumor inhibition, and the most prolonged
life span [64].
A protein bound polysaccharide composed mainly of
mannose, galactose and glucose in a molar ratio of
1:1.28:4.91 (MW 1013 kDa) was isolated from fruiting bod-
ies of Ganoderma atrum, a medicinal mushroom with a long
history of use in Asia, and shown to inhibit proliferation of
mouse colon cancer cell line (CT26) via activation of perito-
neal macrophages. Furthermore, this polysaccharide-protein
complex showed significant antitumor activity in CT26 tu-
mor bearing mice model, as well as inhibition of sarcoma
180 cells proliferation via macrophage activation and anti-
tumor activity in Sarcoma 180 bearing mouse model [65-66].
A polysaccharide peptide complex purified from the
fruiting bodies of the edible mushroom Plurotus abalonus,
that contains glucose, rhamnose, glucuronic acid and galac-
tose (molar ratio 22.4:1:1.7:1.6) demonstrated in vitro anti-
proliferative activity in hepatoma HepG2 and breast adeno-
carcinoma MCF 7 cell lines [67].
FATTY ACIDS
Ethanol extracts of spores of Ganoderma lucidum inhib-
ited tumor cell proliferation and induced apoptosis of HL-60
cells; the active constituents appeared to be long chain fatty
acids, particularly carbon-19 fatty acids. Nonadecanoic acid
and cis-9-nonadecanoic acid were pointed out as the active
components [68].
NUCLEOSIDE ANTAGONISTS
Amongst nucleoside antagonists, cordycepine i.e. 3’-
deoxyadenosine isolated originally from Cordyceps militaris,
is known to exert antitumor activity, mostly by interfering
with RNA synthesis [69]. Also its cytotoxic activity was
shown in several cancer cell lines, where it suppresses NF-
B signaling pathway [70]. It was shown that cordycepine
induced apoptosis and persistent cell cycle arrest in human
breast cancer cell lines, highly de-differentiated cell lines
being more affected by this compound than less aggressive
cell lines or non-malignant breast epithelial cells [69].
TERPENOIDS
Certain classes of terpenoid compounds were isolated
from some mushroom species; their structure was com-
pletely elucidated. The most important class is lanostane
triterpenes, isolated from species such as Ganoderma lu-
cidum, Poria cocos, Laetiporus suphureus, Inonotus
obliquus and Anthrodia camphorata that were investigated
for their cytotoxic or apoptotic effects [71]. In the following
chapter, a brief overview of terpenoid compounds is given
and some of the structures are provided in Table 2.
SESQUITERPENES
Three unusual sesquiterpenes namely cordycepol A-C of
spiro[4.5]decane type and one fumagillol analogue cordycol,
were isolated from the cultured mycelia of Cordiceps ophio-
glossoides and all the compounds were tested for their cyto-
toxic properties in HeLa, A549, HepG2 and MCF-7 cell
lines using MTT assay. Cordycepol C and cordycol (Table 2)
concentration- and time-dependently reduced the number of
carcinoma cells, with relatively low effect on normal liver
LO2 cell line. Results imply that these two molecules may be
promising lead compounds in treating human hepatic carci-
noma [72].
Sesquiterpene nambinone C (Table 2) and dimer ses-
quiterpenes aurisin A and aurisin K, isolated from
Mycotherapy of Cancer Current Topics in Medicinal Chemistry, 2013, Vol. 13, No. 21 9
Table 2. Some of the Compounds Isolated from Medicinal Mushrooms that Exert Cytotoxic or Apoptotic Effects
Compound Exerted activity Reference
H
OH
OH
Cordycepol C
H
O
Cordycol
Cytotoxic effects in HeLa, A549, HepG2 and
MCF 7 cell lines [72]
OH
HO O
Nambinone C
Cytotoxic effect in NCI/H187 cells [73]
O
O
O
O
O
O
OEt
O
26
Ethyl 3,7,11,12,15,23-hexaoxo-5-lanost-8-en-26-oate
Cytotoxic effect in B16F1, B16F10, Huh-7,
MCF 7 and A 2058 [74]
R
1
R
2
H
OH
O
R1=O; R2=OAc Astraodoric acid A
R1=O; R2=OH Astraodoric acid B
R1=-OH; R2=OAc Astraodoric acid D
Cytotoxic effect in KB, NCI-H187 and MCF
7 cell line [79]
O
H
O
O
HO
Ganoderic acid DM
Anti-prostate cancer activity and cytotoxic
effect in
MCF 7 cell line
[8]
10 Current Topics in Medicinal Chemis try, 2013, Vo l. 13, No. 21 Popovi et al.
(Table 2) contd….
Compound Exerted activity Reference
AcO
COOH
OAc
AcO
Ganoderic acid T
Three human carcinoma cell lines [9]
HO
O
Ergosterol peroxide
Induction of cell death of the miR-378-
transfected cells
Cytotoxic effects in human breast and prostate
cell lines
[11]
[81]
HO
HOOC
Trametenolic acid
Cytotoxic effects in human breast and prostate
cell lines [81]
OH
OH
4-(1-methoxyethyl)-5-methyl-2-[(2E,6E)-3,7,11-
trimethyldodec-2,6,10-trienyl]benzene-1,3-diol
Cytotoxic effect in human lung carcinoma and
human and mouse melanoma cell lines [82]
OH
OH
4-(1-ethoxyethyl)-5-methyl-2-[(2E,6E)-3,7,11-trimethyldodec-2,6,10-trienyl]benzene-1,3-
diol
Cytotoxic effect in human lung carcinoma and
human and mouse melanoma cell lines [82]
O
OH
(2R*,4R*)-3,4-dihydro-4,5-dimethyl-8-[(2E,6E)-3,7,11-trimethyldodec-2,6,10-trienyl]-
2H-[1]benzopyran-2,7-diol
Cytotoxic effect in human lung carcinoma and
human and mouse melanoma cell lines [82]
Mycotherapy of Cancer Current Topics in Medicinal Chemistry, 2013, Vol. 13, No. 21 11
luminiscent mushroom Neonothopanus nambi, exerted cyto-
toxic activity. All three compounds induced cytotoxicity in
human small cell lung cancer cells (NCI-H187), and aurisins
A and K additionally exerted cytotoxic activ ity in chloran-
giocarcinoma cell lines [73].
LANOSTANOIDS
Lanostanoids are a type of tetracyclic triterpenoids de-
rived from lanosterol that are being intensively investigated
for their an ticancer effects. Various mechanisms are believed
to support apoptotic effects of these compounds: modifica-
tion of transcriptional activities via nuclear factors or genes
and the activation or inhibition of pro- and antiapoptotic pro-
teins. Some data on cytotoxicity were reported, but mecha-
nisms of their action were not fully elucidated [71].
From fruiting bodies and mycelia of solid cultures of An-
trodia camphorata, a parasitic fungus on heartwood inner
wall of endemic and endangered Cinamomum kanehirai
Hay, six compounds: three lasnostane triterpenes, two sterols
and a stero id were isolated and elucidated. Cytotoxic activity
of these compounds was tested in seven cell lines: human
squamous cell carcinoma (HSC-3), murine melanoma
(B16F1 and B16F10), hepatocarcinoma Huh-7, ovarian car-
cinoma (SKOV3), human breast adenocarcinoma (MCF-7)
and human melanoma (A 2058). Even all the compounds
exerted moderate activity, there were differences in observed
effects; the presence of ethylester at position C-26, as in
ethyl 3,7,11,12,15,23-hexaoxo-5-lanost-8-en-26-oate (Ta-
ble 2), seemed to play a key role in mediating cytotoxicity
[74].
At least 31 triterpenoids were identified in Antrodia cin-
namomea, and some of them shown to possess anti-cancer
activity [75]. Three ergostane type triterpenes: methyl antici-
nate B, zhankuic acid A and C isolated from fruiting bodies
of this species, exerted cytotoxic activity in four human car-
cinoma cell lines [76]. Five triterpenoids, camphoratins B-F,
that were also isolated from the fruiting bodies of A. cinna-
momea showed moderate to potent cytotoxicity in KB and
KBVIN human nasopharingeal cancer cell lines [77]. Fur-
thermore, anticin K, anticin C, zhankuic acid C and zhankuic
acid A, isolated from the fruiting bodies of the same species
were also shown to inhibit three human leukemia cell lines
[78].
Four novel lanosane trirtpenes: astraodoric acids A-D,
and new 5-hydroxyhyphaporine, together with ergosterol,
astraodorol (artabotryols A), nicotinic acid and hypaphorine
were isolated and elucidated from Astraeus odoratus, a Thai
edible mushroom, and were tested for their in vitro cytotoxic
activity in three human carcinoma cell lines [79]. In the men-
tioned research, among the compounds tested, astraodoric
acid A, B and D (Table 2) exerted the highest cytotoxic ac-
tivity (IC50 values of 34.69, 19.99 and 31.55 μg/ml against
human epidermoid carcinoma cell line and 18.57, 48.35 and
34.15 μg/ml against human small cell lung cancer, respec-
tively, and IC50 value of astraodoric acid D against human
breast adenocarcinoma MCF-7 was 40.15 μg/ml).
A series of lanostane triterpens has been isolated from
Ganoderma lucidum, a species intensively used in Tradi-
tional Chinese Medicine [8]. Ganoderic acid DM (Table 2),
isolated from this species, exerted anti-prostate cancer activ-
ity via inhibiting 5-reductase activity. Furthermore, it inhib-
ited cell proliferation and colony formation in MCF-7 human
breast adenocarcinoma cell line via induction of G1 cell cy-
cle arrest and apoptosis [8]. Ganoderic acid Mk, isolated
from mycelia of G. lucidum dose-dependently inhibited pro-
liferation of HeLa cells via induction of apoptosis [80]. Gan-
oderic acid S, isolated from the same mushroom, caused cell
cycle arrest in S phase, whilst ganoderic acid Mf causes cell
cycle arrest in G1 phase [9]. Some of the lanostane triterpe-
noids served as model compounds for the synthesis of de-
rivatives with more pronounced cytotoxic and/or antitumor
activities. Ganoderic acid T (Table 2), a promising antican-
cer agent, was modified to obtain more potent derivatives
with cytotoxic and pro-apoptotic effects on three human car-
cinoma cell lines, with minimal effect on non-tumor cell line
[9].
STEROLS
Various ergosterol derivatives have been isolated from
mushrooms such as Lentinus edodes, Polyporus umbellatus
and Agaricus blazei, mainly from the lipid fraction [10].
Oral administration of ergosterol (400 and 800 mg/kg
during 20 days) to Sarcoma 180 bearing mice, significantly
reduced tumor growth without side effects, such as decreases
in body, epydidimal adipose tissue, thymus, spleen weight
and leukocyte numbers. Ergosterol did not induce cytotoxic
effects in tumor cells, but acted as antiangiogenic substance
in two in vivo models of tumor- and Matrigel-induced
neurovascularization [10].
Ergosterol peroxide induced death of the miR-378-
transfected cells; miR-378 are expressed in a number of can-
cer cell lines. This data point out that ergosterol peroxide
may be a new reagent for overcoming the problem of drug-
resistance in tumor cells [11].
Ergosterol peroxide and trametenolic acid (Table 2), iso-
lated from Inonotus obliquus exerted cytotoxic activity in
human prostate and breast carcinoma cell lines [81].
PHENOLIC COMPOUNDS
Three novel farnesyl phenols, grifolin derivatives (Table
2) isolated from the fresh wild mushroom Boletus pseudoca-
lopus showed high cytotoxic activity against two human and
one mouse cancer cell lines, using SRB assay [82].
Protocatechuic acid (phenolic acid) and a related com-
pound (cinnamic acid), detected as the main components in
Clitocybe alexandri ethanol extract induced significant cell
growth inhibition of human lung cancer cell line (NCI-
H460), by SRB assay; the effect of cinnamic acid being the
most pronounced. These compounds, at least partly contrib-
uted to cell cycle arrest and apoptosis in the lung cancer cell
line induced by C. alexandri extract [30].
Molecula r Mechanisms Of Action – A. camphorata and
G. lucidum
Antrodia camphorata and Ganoderma lucidum were the
most deeply studied mushrooms regarding their molecular
mode of action on anticarcinogenesis. Therefore, we focused
12 Current Topics in Medicinal Chemis try, 2013, Vo l. 13, No. 21 Popovi et al.
further on explaining the data concerning molecular mecha-
nisms of action of these mushrooms and their bioactive con-
stituents.
DNA Damage and Apoptosis Biomarkers Activation
Studies on Antrodia camphorata (AC) extracts showed
that they can promote immune responses by exhibiting an-
tileukemic activity in WEHI-3 leukemia BALB/c mice [83]
and can activate the immunomodulation of macrophages in a
human hepatoma cell model [84].
In numerous studies it has been shown that AC demon-
strates cell cycle inhibition and apoptotic cell death that are
both contributing to its antitumor effect. Tu and his team
[85] demonstrated that a purified compound from AC (4,7-
dimetohoxy-5-methyl-1,3-benzodioxole; SY-1) can be used
as apoptosis inducer in COLO-25 colon cancer cells. SY-1
also induced cell cycle arrest in G0/G1 phase through the
activation of p53-mediated cyclin-dependent kinase (CDK)
inhibitor expression. These findings showed that AC can be
used as adjuvant antitumor agent for T 29 human colon can-
cer cell xenograft tumors [86]. Tu et al., [85] demonstrated
that SY-1 isolated from dried fruiting bodies of AC inhibited
the growth of COLO-25 cell xenograft tumors through the
inhibition of p53-mediated cell cycle regulatory genes. SY-1
inhibited the cell growth in both COLON-205 and HepG2
cells that exhibits wild type p53 and cancer cell lines that
have mutant p53 in dose and time-dependent manner. But it
has to be pointed out that those cells with wild type p53 are
more sensitive to SY-1. SY-1 has its effect through increased
expression of p53, which leads to inhibition of cell cycle by
inducing p27/Kip1. P27/Kip1 is an important step, which
directly has effect on cell cycle that leads to cell growth cy-
cle arrest.
Apoptosis Induction (Up-Regulation of p21Waf1/Cip1
and K-ras)
Antroquinonol is a compound which is an ubiquinone de-
rivative isolated from AC. It has been shown that this com-
pound exhibits anticancer activity against hepatocellular car-
cinoma (HCC) through activation of 5'adenosine-
monophosphate-activated protein kinase (AMPK) and inhi-
bition of mTOR pathway [87]. The aberrant induction of
checkpoint arrest renders cells to apoptosis, which makes
this compound good anticarcinogenic. Antroquinonol inhib-
ited phosphorylation of mTOR at Ser2448 which is a site de-
pendent on mTOR kinase activity [87], but in AsPC-1 cell
line this is not the mechanism by which antroquinonol exhib-
its its effect. In this particular cell line, antroquinonol has
effect indirectly on mTOR by first blocking PI3-kinase/Akt
pathway by inhibiting the phosphorylation of Akt at Ser473.
This pathway is important upstream regulator of mTOR.
Antroquinonol also displays effect on other important pro-
teins by inhibiting phosphorylation of p70S6K, elF4E and
4E-BP1 thus blocking whole mTOR/p70S6K/4E-BP1 signal-
ing pathway.
Antroquinonol also down-regulated expression of other
cyclins that are important in cell cycle. This compound de-
creased expression of cyclins D1, E, A, B1 and CDK4 in a
time dependent fashion. Antroquinonol also induced signifi-
cant increase in K-ras expression and phosphorylation. This
protein belongs to Ras family that regulates a wide variety of
biological effects including cell proliferation, survival and
transformation [88]. This protein can also induce growth
arrest, apoptosis, senescence and autophagy. Ras displays
proapoptotic activity through a direct interaction with Bcl-2
or related family members. Bcl-2 regulates integrity of mito-
chondrial membrane and it is a well known fact that mito-
chondrion plays important role in apoptosis. So, increasing
level of K-ras antroquinonol causes down-regulation of Bcl-
2 family proteins (specifically Bcl-xL) that leads to loss of
mitochondrial integrity and programmed cell death through
apoptosis. Therefore, data reported by Yu et al., [89] suggest
that antroquinonol induces anticancer activity in human pan-
creatic cancer AsPC-1 cells through a sequential signaling
cascade. It induces an inhibitory effect on PI3-kinase/Akt
activities that in turn block mTOR/p70S6K/4E-BP1 signal-
ing pathways, leading to the down-regulation of cyclin pro-
teins and CDKs. The translational inhibition results in G1
arrest of the cell cycle and an ultimate mitochondria-
dependent apoptosis. The upregulated K-ras may also con-
tribute to apoptosis through the association with Bcl-xL.
Moreover, autophagic cell death and accelerated senescence
also explain, at least partly, the antroquinonol-mediated anti-
cancer effect in AsPC-1 cells [89].
Depletion of HER-2/neu, and Disruption of the PI3K/Akt
Signaling Pathway
Antrodia camphorata can also be used against human
breast cancer cell lines that exhibit high level of HER-2/neu
[90]. It mediates growth inhibition and apoptotic induction
through intercellular ROS generation, suppression of the
HER-2/neu signaling cascade, and disruption of the
PI3K/Akt-dependent pathway. Activation of the HER-2/neu
network leads to autophosphorylation of the C-terminal tyro-
sine and the recruitment to these sites of cytoplasmic signal
transducers that regulate cellular processes, such as prolifera-
tion, inhibition of apoptosis, and transformation [91]. Results
showed that AC reduces the basal tyrosine kinase phos-
phorylation and constitutive activation of HER-2/neu recep-
tors in HER-2/neu-overexpressing breast cancer cells. It
seems that AC mechanism of induction doesn't influence the
mRNA level in cells, in another words, it has no effect on
post-transcriptional mechanism. Since it has no effect at
post-transcriptional level, another way by which AC can
exert effect is by proteolysis, which was the case of the re-
sults presented by Lee et al. [90]. These authors demon-
strated that proteasomal activity was critically involved in
AC-induced HER-2/neu degradation in human breast cancer
MDA-MB-453 cells. Also incubation of cells with AC
caused a significant increase in ROS accumulation that leads
to cell death. Key mechanism by which HER-2/neu-
overexpression stimulates tumor cell growth and renders
cells chemoresistant involves the HER-2/neu receptor. This
mechanism involves the PI3K/Akt signaling pathway, and
human breast cancer cells with overexpression and amplifi-
cation of HER-2/neu, have been shown to make increased
use of the PI3K/Akt signaling pathway [90]. Results suggest
that AC treatment significantly inhibits the expression of the
Akt upstream kinase, PI3K, in MDA-MB-453 cells. AC
causes a similar dose-dependent reduction in Akt phosphory-
lation in BT-474 cells, whereas the levels of total Akt re-
Mycotherapy of Cancer Current Topics in Medicinal Chemistry, 2013, Vol. 13, No. 21 13
mains unaffected by AC under the same treatment condi-
tions. These data established that AC induced HER-2/neu
depletion and growth inhibition may be mediated by the in-
activation of PI3K/Akt activity in HER-2/neu-
overexpressing breast cancer cells.
When PI3K/Akt is active, a number of substrates are ac-
tivated that involve apoptosis, cell-cycle regulation, and pro-
tein synthesis [91]. PI3K/Akt could potentially regulate cell
cycle progression by phosphorylating and inactivating GSK-
3, thereby stabilizing nuclear translocation of -catenin and
increasing cyclin D1 and Cdk4 transcription [92]. So, it was
demonstrated that AC may inhibit cell proliferation and the
induction of cell death by suppressing GSK-3 and the -
catenin pathway in HER-2/neu-overexpressing breast cancer
cells. In this study it was also shown that AC treatment
causes dose dependent reduction of cyclin D1 and cyclin E
expression in HER-2/neu-overexpressing MDA-MB-453
cells. Cyclin D1 is regulatory subunit of CDK4 and contrib-
utes to its stability. In addition, Akt may contribute to the
induction of cell-cycle progression by regulating the CDK
inhibitors p27KIP and p21CIP [93]. Previous studies have
shown that the modulation of both p27KIP and p21CIP is
required for oncogenic growth driven by HER-2 [94]. Both
p27KIP and p21CIP protein levels increased dose-
dependently in response to AC treatment. A similar pattern
of results were also observed in BT-474 cells; AC down-
regulates cyclin D1 and upregulates p21CIP expression in a
dose dependent fashion.
AC significantly increased the release of cytochrome c
from mitochondrion, which is evidence that AC causes
membrane damage. It is a known fact that cytochrome c is
involved in triggering apoptosis [95]. AC induces cell apop-
tosis through another mechanism by disregulating Bax/Bcl-
2. So, induction of apoptosis could be a major mechanism of
AC-induced growth inhibition in HER-2/neu-overexpressing
breast cancer cells. One impo rtant feature of AC effect on
HER-2/neu-overexpressing breast cancer cell lines is that it
also suppresses their transformation ability.
Cell Cycle Arrest by G. lucidum
Among the active compounds in Ganoderma lucidum
(GL), triterpenoids have been demonstrated as one of the
main components responsible for the pharmacological activi-
ties including immunomodulation, anti-oxidative, anti-
metastasis, and anti-tumor effects [16-18]. In vitro and in
vivo assays have revealed that the mixtures of triterpenoids
from GL exerted antiproliferation effects by inducing apop-
tosis and cell cycle arrest [96, 97]. Ganoderic acid DM
(GADM) is a lanostane-type triterpenoid extracted from the
GL that inhibits osteoclastogenesis by regulation of c-Fos
and nuclear factor of activated T cells c1 [98] has been
shown to exert anti-proliferation effects on both androgen-
dependent and independent prostate cancer cell lines in a
concentration dependent manner [8]. One of the underlying
mechanisms is that GADM attenuates the conversion of tes-
tosterone to dihydrotestosterone by inhibition of the 5-
reductase activity and blocks DHT binding to the androgen
receptor by competitive inhibition in prostate cancer cells
[99]. Human breast cancer is another hormone sensitive ma-
lignancy. Wu et al., [8] used breast cancer cell lines MCF-7
(ER-positive) and MDA-MB-231 (ER-negative) to evaluate
anti-proliferative potential of GADM. GADM decreased the
percentage of adherent cells in a concentration-dependent
manner in MCF-7 cells. GADM also notably decreased the
viability of MCF-7 cells as detected by MTT assay. Wu et
al., [8] found out that MCF-7 cells were much more sensitive
to GADM compared with MDA-MB-231 cells. GADM ef-
fectively induced G1 cell cycle arrest and apoptosis in MCF-
7 cells. Consistently the cells distributed in S phase were
significantly reduced in affected cell line. Both CDK2 and
CDK6 are catalytic subunits of the cyclin-dependent kinase
complex are essential for the G1/S transition. Cyclin D is
one of the major cyclins and cyclin D-CDKs complex par-
tially phosphorylates Rb which is an important regulator of
genes responsible for progression through G1 phase. The
expression of CDK2, CDK6, cyclin D1 and p-Rb was down-
regulated after GADM treatment. These proteins are all im-
portant for G1 cell cycle progression [100], and might par-
tially be responsible for GADM-induced G1 cell cycle arrest.
It has been demonstrated that c-Myc promotes cell prolifera-
tion and many investigators have uncovered the target genes
that regulate the cell cycle such as CDKs and cyclins [101].
It's notable that the oncoprotein c-Myc, which is vital for
cells progressing into S phase [101], was also reduced after
GADM treatment. Thus, GADM mediated c-Myc down-
regulation may also contribute to the G1 cell cycle arrest.
These results indicate that GADM induced G1 cell cycle
arrest in MCF-7 cells may be partially due to modulating of
CDKs, cyclins and c-Myc. Results suggested that G1 cell
cycle arrest and apoptosis induction both contributed to the
anti-cancer activity of GADM. DNA damage is one of the
molecular events associated with cell cycle arrest and apop-
tosis and many anti-cancer reagents induce DNA damage
[102]. Incubation with GADM leads to internucleosomal
DNA fragmentation in time dependent manner. After
GADM treatment, apoptosis was observed by detecting a
cleavage fragment of PARP, indicating GADM indeed in-
duces apoptosis in MCF-7 cells. It has been known that all
organisms have the ability to restore genomic integrity
through DNA repair. If the repair is faulty or the cell is
overwhelmed by damage, chances are that the cell will de-
spair and be removed by apoptosis [103, 104]. Wu et al., [8]
found that GADM elicited DNA damage after 6-h treatment
measured by the comet assay and the up-regulated -H2AX
protein levels, so it can be supposed that the cell cycle arrest
and apoptosis may be attributed to GADM-induced DNA
damage.
CONCLUSION
Mycotherapy of cancer is promising discipline in current
scientific and medical battle against serious, widespread and
very frequent disease of nowadays. Studies to date have
identified a number of compounds and elucidated underlying
mechanisms. Further research focused on mycotherapy of
cancer, especially clinical trials, are needed to validate the
usefulness of mushrooms and their compounds, either alone
or in combination with existing therapies.
CONFLICT OF INTEREST
This research was supported by the Ministry of Educa-
tion, Science and Technological Development of the Repub-
lic of Serbia (173021 and 173032).
14 Current Topics in Medicinal Chemis try, 2013, Vo l. 13, No. 21 Popovi et al.
ACKNOWLEDGEMENT
All the authors equally contributed to this work, regard-
ing article structure, searching the literature, writing and re-
vising the paper.
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Received: August 29, 2013 Revised: September 09, 2013 Accepted: September 09, 2013
