The role of edible mushrooms in health: Evaluation
of the evidence
, Jennifer Keogh
, Manny Noakes
, Christine Margetts
, Pennie Taylor
CSIRO Food and Nutritional Sciences, Werribee, Victoria, Australia
CSIRO Food and Nutritional Sciences, Adelaide, South Australia, Australia
Received 6 July 2011
Received in revised form
26 April 2012
Accepted 1 May 2012
Available online 27 May 2012
There have been relatively few direct intervention trials of mushroom consumption in
humans, although those that have been completed to date indicate that mushrooms and
their extracts are generally well-tolerated with few, if any, side-effects. Immunomodulating
and anti-tumor effects of mushrooms and their extracts appear to hold potential health
beneﬁts. These beneﬁts are primarily due to their polysaccharide content, either in the
form of beta-glucans or polysaccharide-protein complexes, which appear to exert their
anti-tumorigenic effects by enhancement of cellular immunity via effects on the balance
of T helper cell populations and induction of certain interleukins and interferon (IFN)-c.
This review summarizes the current knowledge on edible mushrooms and their compo-
nents on health outcomes, with a focus on the evaluation of the evidence from human tri-
als. Where information is available from such trials, the active compounds are identiﬁed
and their proposed mechanisms are discussed.
Crown Copyright Ó2012 Published by Elsevier Ltd. All rights reserved.
1. Introduction . . . ................................................................................ 688
2. Studies in humans . . . . . ......................................................................... 688
2.1. Anti-cancer studies . . . . . . .................................................................. 695
2.1.1. Breast cancer studies ................................................................ 695
2.1.2. Colorectal/colon cancer studies . . . ..................................................... 696
2.1.3. Cervical, ovarian, endometrial cancer studies . . . . . . ....................................... 696
2.1.4. Gastic cancer studies ................................................................ 697
2.1.5. Prostate cancer studies . . . ............................................................ 697
2.1.6. Pancreatic cancer/solid malignancies. . . . . . .............................................. 697
2.2. Immune function ......................................................................... 697
2.3. Diabetes. ................................................................................ 698
2.4. Brain health/cognition. . . . .................................................................. 699
2.5. Biomarkers for cardiovascular disease . . ....................................................... 699
2.6. Anti-microbial properties . .................................................................. 699
2.7. Anti-viral properties . . . . . .................................................................. 699
1756-4646/$ - see front matter Crown Copyright Ó2012 Published by Elsevier Ltd. All rights reserved.
*Corresponding author: Address: Pre-Clinical and Clinical Health Substantiation, CSIRO Food and Nutritional Sciences, Private Bag 16,
671 Sneydes Road, Werribee, 3030 Victoria, Australia.
E-mail address: email@example.com (P. Roupas).
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
Available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/jff
2.8. Asthma . . ............................................................................... 700
2.9. Hepatitis . ............................................................................... 700
2.10. Constipation . . . . ........................................................................ 700
3. Medical conditions with lower levels of evidence ...................................................... 700
3.1. Bladder cancer. . . . ........................................................................ 700
3.2. Leukemia . ............................................................................... 701
3.3. Liver cancer . . . . . . ........................................................................ 701
3.4. Lung cancer . . . . . . ........................................................................ 701
3.5. Skin cancer . . . . . . ........................................................................ 701
3.6. DNA damage . . . . . ........................................................................ 702
3.7. Rheumatoid arthritis . . . .................................................................... 702
3.8. Osteoporosis/bone mineral density. . . . . . ...................................................... 702
3.9. Effects on wound healing . . . . . . ............................................................. 703
3.10. Eye health . . . . . . ........................................................................ 703
4. Mushroom bioactive compounds and propo- sed mechanisms . . . . . . .................................... 703
5. Conclusions . . . . ............................................................................... 704
Acknowledgement . . . . . . ........................................................................ 704
References . . . . . ............................................................................... 704
Alongside the mushrooms’ long history as a food source is an
equally long history of beliefs about their curative abilities in
traditional medicine systems—both the folk medicine of the
western world and traditional medicine of the orient.
Although there are limited direct human intervention trials,
there is a rapidly growing volume of in vitro and in vivo animal
trials describing a range of possible health beneﬁts including
immunomodulatory, anti-tumor, anti-microbial effects and
Some of the more efﬁcacious compounds in mushrooms
are 1,6-branched 1,3-b-glucans which have been reported to
inhibit tumor growth by stimulating the immune system via
activation of macrophages, via balance of T helper cell popu-
lations and subsequent effects on natural killer (NK), cells and
also via cytokine production (Hetland, Johnson, Lyberg, &
Kvalheim, 2011). Other work has implicated polysaccharides
with varying sugars such as beta- and alpha-glucans.
(Borchers, Krishnamurthy, Keen, Meyers, & Gershwin, 2008).
Such mushroom polysaccharides are beginning to be evalu-
ated as adjuvant cancer therapy compounds alongside
conventional cancer treatments (Standish et al., 2008).
The mechanisms by which these polysaccharides exert
their immunomodulatory effects are not entirely clear,
although structure–function relationships have been de-
scribed between anti-tumor activities and structural charac-
teristics of b-D-glucans, these mushroom polysaccharides
generally do not exert cytotoxic effects on tumor cells, but
have been shown to enhance host-mediated immunomodu-
latory responses (reviewed by Wong, Lai, & Cheung, 2011).
A recent systematic review has also provided evidence for
immunomodulatory effects (increased NK cell activity, effects
on IgG, IgM, neutrophil and leukocyte counts) in humans
from oral ingestion of dietary polysaccharides (glucans) from
some varieties of mushrooms ( Ramberg, Nelson, & Sinnott,
2010), while inhibition of aromatase activity by mushroom ex-
tracts (Grube, Eng, Kao, Kwon, & Chen, 2001; Chen et al., 2006)
and subsequent reduction of estrogen, is a potential adjuvant
therapy for breast cancer patients with estrogen receptor po-
sitive tumors. While the effects and underlying mechanisms
of mushroom polysaccharides in health outcomes have been
more extensively evaluated, bioactive proteins from mush-
rooms (such as lectins, fungal immunomodulatory proteins
(FIP), ribosome inactivating proteins (RIP), ribonucleases and
other proteins have also been reported to possess similar
anti-tumor, anti-viral and immunomodulatory activities (re-
viewed by Xu, Yan, Chen, & Zhang, 2011).
This review evaluates published human trials on mush-
room consumption and health outcomes in order to identify
the levels of evidence, and to identify areas where future hu-
man dietary intervention trials are warranted to substantiate
the potential effects of mushroom consumption on human
health outcomes. While the review focusses on human stud-
ies, animal and in vitro studies that provide lower levels of evi-
dence are also discussed, particularly where they provide
insights into cellular mechanisms.
2. Studies in humans
The properties and mechanisms of extracts and bioactive
compounds from mushrooms that have been evaluated in a
human population or human cell lines are outlined in Table
1. The human trials carried out to date have primarily been
smaller observational studies, or studies without appropriate
placebo or other matched controls, and therefore larger, dou-
ble-blind, placebo controlled human studies are required be-
fore clear effects on human health outcomes can be
substantiated. In general, the growing data suggest that the
mushrooms and mushroom extracts tested are safe and gen-
erally well-tolerated. The most promising data appear to be
those indicating an inverse relationship between mushroom
consumption and breast cancer risk, although the data are
based on food frequency/diet recalls, which can be affected
by recall bias, and therefore, the effects need to be conﬁrmed
via intervention trials involving mushroom consumption.
688 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
Table 1 – Properties and mechanisms of bioactive compounds and mushroom extracts evaluated in a human population or
human cell lines.
Effect/disease state Bioactive or extract Mushroom variety Mechanism (in vitro/in vivo) Reference
Anti-cancer (breast) Ergosterol Unspeciﬁed variety Increase serum 25 (OH) vitamin D2
levels (in vivo-humans)
Aqueous extracts Agaricus bisporus Suppress aromatase activity and
proliferation of MCF-7aro cells-hence
suggesting a reduction in estrogen
production (breast cancer cell lines)
Grube et al. (2001)
Multiple varieties Downregulation of Akt/NF-kappaB
Jiang et al. (2008)
Polysaccharopeptides Ganerderma lucidum Apoptosis (human cell lines)
Suppress oxidative stress stimulated
phosphorylation of Erk1/2 resulting
in downregulation of expression of c-
fos and inhibition of transcription
factors AP-1 and NF-kappaB
Wan et al. (2008),
Thyagarajan et al.
Polysaccharide K (PSK)
(in adjunct with
Coriolus versicolor CM-10 Stimulate both innate and adaptive
immune pathways in curatively
resected colorectal cancer (in vivo)
Oba et al. (2007),
Sakamoto et al.
Agaricus sylvaticus Beneﬁts in hematological and
immunological parameters &
reduction in glycemic levels (in vivo)
Fortes et al. (2009)
Lectin Agarius bisporus (ABL) Inhibit the proliferation of HT29
human colonic cells (in vitro -in
Yu et al. (1993)
Ganoderma lucidum Apoptosis (induced by increase in
caspase-3 activity) & Anti-
inﬂammatory function in HT-29 in
human carcinoma cells (no toxicity
in HT-29 cells in doses <10 mg/ml)
Hong et al. (2004)
Aqueous extract Inonotus obliquus Apoptosis and inhibition of the
growth of HT-29 colonic cancer cells
via up-regulation of expression of
pro-apoptotic proteins and down-
regulation of anti-apoptotic proteins
Lee et al. (2009b)
Anti- cancer (cervical,
Unspeciﬁed extract Agaricus blazei Murill
Increase activity of natural killer cells
Improve chemotherapy side effects
(e.g. appetite, alopecia, emotional
stability & general weakness) (in vivo
Ahn et al. (2004)
Anti-proliferative effects via
induction of apoptosis
Chen et al. (2010), Liu
et al. (2009), Ren et al.
Anti-cancer (gastric) Polysaccharide K
Lentinan (in adjunct
Lentinus edodes Prolong survival; more effective in
patients with lymph-node metastasis
vs. non- node metastasis (in vivo)
Oba et al. (2009)
Anti-cancer (prostate) Ethanol extract of whole
Ganoderma lucidum Dose extract 6 mg per day improve
the total International Prostate
Symptom Score (IPSS) of men with
lower urinary tract symptoms via
strong 5-alphal-reductase inhibitory
activity (in vivo)
Noguchi et al. (2008a,
Ganoderma lucidum Inhibit proliferation and induce
apoptosis in PC-3 human prostate
cancer cells. Inhibition of prostate
cancer-dependent angiogenesis is
suggested to be due to modulation of
MAPK and Akt signaling
Jiang et al. (2004b),
Stanley et al. (2005)
(continued on next page)
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 689
Table 1 – (continued)
Effect/disease state Bioactive or extract Mushroom variety Mechanism (in vitro/in vivo) Reference
Anti-cancer (pancreatic –
Irofulven (cytotoxin) Omphalotus olearius.
Note: Not an edible
Daily dose of 10.64 mg/m2 as a
5 min i.v. infusion for 5 days every
4 weeks resulted in anti-tumor
activity; and intermittent dosing
schedules had positive pre-clinical
anti-tumor effects (in vivo)
Eckhardt et al. (2000)
Polysaccharide extract Grifola frondosa Immunologically stimulatory and
inhibitory measurable effects in
peripheral blood of patients free of
disease after 1st treatment (in vivo)
Deng et al. (2009)
AndosanäAgaricus blazei Murill
Grifolia frondosa 2.9%
Stimulation of whole blood ex vivo
with 0.5–5.0% of extract containing
AbM produced a dose-dependent
increase in all cytokines studied
from 2 to 399-fold (TNF-a). In vivo
there was a signiﬁcant reduction in
levels of IL-1-b(97%), TNF-a(84%),
IL-17 (50%) and IL-2 (46%).
Discrepancy in results associated
with antioxidant activity of AbM
in vivo and limited absorption of its
large beta-glucans across the
intestinal mucosa to the
reticuloendothelial system and
Johnson et al. (2009)
Alpha-glucans Agaricus bisporus Consumption of fruit juice
enriched with 5 g glucans/ day
induced TNFaproduction by 69%.
No effects on IL-1band IL-6 and
decreased production of IL-12 and
IL-10 was observed (in vivo).
Contrarily alpha glucans has been
observed to stimulate immune
response in an in vitro mouse
Volman et al. (2010a)
Glucan Trametes versicolor Improved survival and immune
function (in vivo)
Ramberg et al. (2010)
(variety of disease states)
Multiple variety Effects on natural killer cells,
macrophages, T cells and their
cytokine production; and via the
activation of Mitogen Activated
Protein Kinase (MAPK) pathways
Kim et al. (2007)
Diabetes (type II) AbM extract (in
Agaricus blazei Murill
Improve insulin resistance
potentially by the mechanism that
caused an increase in adiponectin
concentration after taking the
extract for 12 weeks (in vivo)
Hsu et al. (2007)
Signiﬁcant reduction in systolic
and diastolic blood pressure, blood
glucose, total cholesterol and
triglycerides (in vivo)
Khatun et al. (2007)
hypolipidemic effect via a
mechanism involving absorption
of cholesterol (in vivo)
Kweon et al. (2002)
690 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
Table 1 – (continued)
Effect/disease state Bioactive or extract Mushroom variety Mechanism (in vitro/in vivo) Reference
Brain health and
Increase in scores on cognitive
function scales in men and
women diagnosed with mild
cognitive impairment (in vivo)
Mori et al.
Hericium erinacium Protect against neuronal cell
death caused by beta-amyloid
peptide (A beta) toxicity,
endoplasmic reticulum (ER)
stress and oxidative
stressImproves the Functional
Independence Measure (FIM)
score or retard disease
progression in patients with
dementia (in vivo)
Hericenones C to H;
Erinacines A to I
Hericium erinacium Induce synthesis of nerve
growth factor (NGF) (in vitro and
Hepatitis B Agarius blazei Murill
Decrease levels aspartate
aminotransferase and alanine
normalizing liver function of
patients with Hepatitis B
(in vivo).To be noted: results
based on a sample of four
patients thus larger and
controlled studies are required
to conﬁrm the effects.
Hsu et al.
Ganoderma lucidum Hypoglycemic activity, anti-viral
and liver protective effects in
chronic hepatitis B (in vivo). To be
noted: authors indicated despite
clinical proof is lacking.
Zhou et al.
Anti-viral (HIV) 1. Farnesyl hydroquinone,
2. Ganomycin B
Ganoderma colossum Competitive inhibition of the
HIV-1 protease enzyme by
ganomycin B and docking with
the HIV-1 protease crystal
structure by both compounds
El Dine et al.
Polysaccharides Agarius brasiliensis
blazei ss Heinem)
Anti-viral activity when added
during poliovirus infection:
potentially acting at the initial
stage of viral replication
Faccin et al.
Asthma Unspeciﬁed bioactive
Inhibit proliferation and
differentiation of Th2 cells and
reduce the expression of
cytokines by down-regulating
the expression of GATA-3 mRNA
and up-regulating the
expression of Foxp3 mRNA in
peripheral blood mononuclear
cells. Alleviate chronic allergic
inﬂammation by increasing the
level of interleukin-10 (in vivo)
Sun et al.
Constipation Fiber Auricularia (ear
Fiber supplements using ear
constipation related symptoms
without serious side effects
Kim et al.
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 691
Table 2 – Properties and mechanisms of bioactive compounds and mushroom extracts evaluated in animal models or
animal cell lines.
Mushroom variety MECHANISM (in vitro/ in vivo) Reference
D fraction (in
Grifola frondosa Reduce growth in T24 bladder
cancer cells potentially by
triggering double-stranded DNA-
dependent protein kinase
activation that may act on the
cell cycle to cease cancer cell
growth (in vitro)
Louie et al. (2010)
Cordyceps militaris Inhibit growth during cell-cycle
progression of 5637 and T-24
bladder cancer cells largely due
to G2/M-phase arrest (in vitro)
Lee et al. (2009c)
Agaritine Agaricus blazei Murill Inhibit proliferation of leukemic
tumor cell lines (e.g. U937,
Endo et al. (2010)
Inhibit proliferation of HL-60
leukemia cells & other leukemia
human cell lines via induction of
cytotoxicity with no signiﬁcant
cytotoxic effects on normal cell
lines (in vitro)
Gao et al. (2007),
Jin et al. (2007), Bae
et al. (2009),
Mizumoto et al.
(2008), Hsu et al.
et al. (2010), Lau
et al. (2004)
Anti-cancer (liver) 1. Triterpenoids
Cordyceps sinensis and
Inhibit proliferation of HepG2
cytotoxicity (in vitro)
Weng et al. (2007),
Tao et al. (2006),
Wu et al. (2007),
Youn et al. (2008),
Lin et al. (2003)
Hepato-protective effects on
both chemically-induced liver
toxicity and hepato-
carcinogenesis in rodents
Barbisan et al.
et al. (2003),
Wasonga et al.
Anti-cancer (lung) Aqueous extract Hypsizigus marmoreus Intraperitoneal administration
exhibit inhibitory activity against
spontaneous tumor metastasis
and decreases number of
metastasised nodules in mice
with Lewis lung carcinoma
Saitoh et al. (1997)
Lucialdehydes A–C Ganoderma lucidum Cytotoxic against murine and
human tumor cells (Lewis lung
carcinoma, T-47D, Sarcoma 180,
Meth-A tumor cell lines) (in vivo)
Gao et al. (2002)
Phellinus linteus Mediate cell-cycle arrest at a low
concentration and apoptosis in
response to a high dose in mouse
and human lung cancer cell
(in vivo and in vitro)
Guo et al. (2007)
Blazein Agaricus blazei Murill
Induce cell death and
morphological change indicative
of apoptopic chromatin
condensation in human lung
cancer LU99 and stomach cancer
Itoh et al. (2008)
Pleurotus ferulae Exhibit cytotoxic effects on
human lung and cancer cell lines
(A549, SiHa and HeLa cells)
Choi et al. (2004)
692 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
Table 2 – Properties and mechanisms of bioactive compounds and mushroom extracts evaluated in animal models or
animal cell lines.
Mushroom variety MECHANISM (in vitro/ in vivo) Reference
Lentinula edodes Reduce cell proliferation and
induce apoptosis in CH72
mouse skin carcinoma cells
Gu and Belury
Methanol extract Coriolus versicolour Reduce B-16 melanoma cell
viability and the proliferation
of tumor cells (arrest in the
G-/G1 phase of the cell cycle)
followed by apoptotic and
secondary necrotic cell death
Harhaji et al.
Proﬂamin Flammulina velutipes Increase median survival
time of mice treated with B-
16 and Ca-744 (in vivo)
Ikekawa et al.
Phellinius linteus Inhibit melanoma cell
metastasis in mice
Directly inhibit cancer cell
adhesion to and invasion
through the extracellular
Increase macrophage NO
production (in vivo)
Han et al. (2006)
DNA damage Unspeciﬁed
Agaricus blazei Murill Reduce DNA damage in liver
diethylnitrosamine (DEN) in
adult male Wistar rats)
Barbisan et al.
Agaricus bisporus Protect Raji cells (human
lymphoma cell line) against
damage to cellular DNA
Shi et al. (2002)
1. Cold (20°) water
2. Hot (100°) water
Protective against H
induced oxidative damage to
cellular DNA (in vitro)
Rocha et al. (2002)
Inonotus obliquus Reduce DNA fragmentation Park et al. (2004)
Aqueous extract Agrocybe cylindracea
Protects DNA against OH-
mediated strand breaks
damage in HepG2 cells
Wang et al. (2004)
Beta-glucan Agaricus brasiliensis In the dose range 20–80 lg/
ml exhibited signiﬁcant
effect against damage
induced by hydrogen
peroxide and Trp-P-2
Angeli et al. (2006)
Beta-glucan Agaricus blazei Protective against DNA
damage caused by
mediated via binding to
benzo[a]pyrene or the
capture of free radicals
produced during its
Angeli et al. (2009)
4. Hot water
Ganoderma lucidum Protective against hydroxyl
radical-induced DNA strand
Kim and Kim
(continued on next page)
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 693
Table 2 – Properties and mechanisms of bioactive compounds and mushroom extracts evaluated in animal models or
animal cell lines.
Mushroom variety MECHANISM (in vitro/ in vivo) Reference
Aqueous extract Ganoderma lucidum Protection of radiation-
induced plasmid pBR322
DNA strand breaks and
inhibition of lipid
Pillai et al. (2006)
Strong protective effects
against oxidative damage
possibly associated with Se’s
role in increasing
antioxidant activities of
Protection of DNA from
hydroxyl radical oxidative
Zhao et al. (2004,
Pleurotus ostreatus Immuno-modulating effect
on all cytokine plasma levels
measured (in vivo)
Bauerova et al.
Bone health Ethanol extracts Ganoderma lucidum Improve bone density in rats Miyamoto et al.
Vitamin D2 and/
May improve bone
mineralization through a
direct effect on the bone and
by inducing the expression
of calcium absorbing genes
in the duodenum and kidney
Lee et al. (2009a)
Aqueous extract Grifola frondosa Increase alkaline
phosphatase activity of
hence acting as a bone-
Saif et al. (2007)
Pleurotus eryngii Alleviate the decrease in
trabecular bone mineral
density in ovariectomy-
induced osteporosis in rats
Kim et al. (2006)
Ethanol extract Pleurotus eryngii Protect against bone loss
caused by estrogen
Shimizu et al.
Wound healing Unspeciﬁed
Agaricus bisporus Dose-dependent inhibition
of proliferation and lattice
contraction in an in vitro
model of wound healing
(human ocular ﬁroblasts in
monolayers and in 3-D
Batterbury et al.
Sparassis crispa (SC) Accelerate wound healing in
diabetes mellitus via an
increase in the migration of
ﬁbroblasts, and beta-glucan
from SC directly increasing
the synthesis of type I
collagen (in vivo)
Kwon et al. (2009)
Ganoderma lucidum Active component with
healing efﬁcacy on acetic
acid-induced ulcers in rats
Gao et al. (2004)
694 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
However, in vitro and animal trials have reported an inhibition
of aromatase activity and subsequent reduction of estrogen
by mushroom extracts, which provide a physiologically-
relevant mechanism for effects on estrogen receptor positive
tumors. Preliminary new data showing protective effects of
mushrooms on beta-amyloid peptide toxicity in the brain
and mild cognitive impairment (both precursors to dementia)
are promising and warrant further research on the ability of
mushroom consumption to delay the onset of cognitive de-
cline/Alzheimer’s disease. In addition to the studies in human
population groups and human cell lines provided in Table 1,
the properties and mechanisms of bioactive compounds and
mushroom extracts evaluated in animal models or animal
cell lines are provided in Table 2.
2.1. Anti-cancer studies
Anti-tumor effects, primarily in human cell lines, have been
reported from polysaccharides extracted from various
mushrooms. The polysaccharides generally belong to the
beta-glucan family of compounds and appear to exert their
anti-tumorigenic effects via enhancement of cellular immu-
nity. Anti-tumor effects of proteoglycan fractions from a vari-
ety of mushrooms, including Agaricus bisporus, involve the
elevation of natural killer (NK) cell numbers and the stimula-
tion of inducible nitric oxide (NO) synthase gene expression,
which is then followed by NO production in macrophages
via activation of the transcription factor, NF-kappaB. Activa-
tion of NK cells is likely via interferon-gamma and interleukin
mediated pathways. While studies in human cell lines pro-
vide supporting evidence, well-designed human clinical trials
are required before anti-cancer health outcomes in humans
can be validated. In recent years, a number of human trials
have been undertaken and these are outlined below.
2.1.1. Breast cancer studies
An epidemiological study of women with histologically con-
ﬁrmed breast cancer has identiﬁed that daily intake and the
average consumption frequency of mushrooms were inversely
associated with breast cancer risk, and a strong inverse asso-
ciation was found in post-menopausal women, but not in pre-
menopausal women (Hong, Kim, Nam, Kong, & Kim, 2008),
which is in contrast to another epidemiological study that
has suggested a decreased risk of breast cancer from mush-
room consumption by pre-menopausal women (Shin et al.,
2010). In this latter study, greater mushroom intake was re-
lated to lower risk of breast cancers among premenopausal
women for the highest vs. the lowest quartile intake. The
association was stronger for premenopausal women with
estrogen receptor (ER)+/progesterone receptor (PR) + tumors
than those with ER/PRtumors, suggesting that this effect
may be more robust among women with hormone receptor
positive tumors. A possible mechanism for this effect may
be via an inhibition of aromatase activity, described in both
in vitro and animal trials (Grube et al., 2001; Chen et al.,
2006), and more recently in a human trial of postmenopausal
women diagnosed with breast cancer (Palomares et al., 2011)
for A. bisporus. A subsequent reduction in estrogen, affecting
estrogen receptor positive tumors was reported in animal tri-
als. Recent evidence suggests that the anti-aromatase com-
pound in A. bisporus is conjugated linoleic acid (CLA) (Kanaya
et al., 2011).
However, an in vitro study using water-based extracts of
Coprinellus sp., Coprinus comatus,Flammulina velutipes, signiﬁ-
cantly inhibited growth of both estrogen-receptor positive
(ER+) and estrogen-receptor negative (ER) breast cancer
cells, induction of rapid apoptosis on both ER+ and ERcells,
and signiﬁcantly inhibited MCF-7 tumor colony formation
in vitro. These activities were dose-dependent, regardless of
animal cell lines.
Mushroom variety MECHANISM (in vitro/ in vivo) Reference
Hericium erinaceus Reduce ulceration when
used in pre-treatment in
ulcers in rats (in vivo)
Mahmood et al.
Polysaccharide Lentinus edodes Increase activities of
decrease levels of
and TNF-ain rats
with oral ulceration
Yu et al. (2009b)
Eye health Unspeciﬁed
Pleurotus ostreatus In vitro: incubation of extract
lenses result in a decrease in
lens opaciﬁcation by
components at near normal
In vivo: extract prevents
cataracts in 75% of rats
Isai et al. (2009)
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 695
the hormone receptor status of the cancer cells (Gu & Leon-
Higher dietary intake of mushrooms decreased breast can-
cer risk in both pre- and post-menopausal women and an
additional decreased risk of breast cancer was observed from
a synergistic effect of mushrooms and green tea in a case–
controlled study (Zhang, Huang, Xie, & Holman, 2009).
Vitamin D2 could be one of the protective phytonutrients
against breast cancer as mushrooms are rich in ergosterol,
generating vitamin D2 when exposed to ultraviolet B (UVB)
light and ergocalciferol being bioavailable and increasing
serum 25(OH) vitamin D2 levels in humans (Furlanetto,
2009). While these human trials are promising, it should be
noted that they were not direct intervention trials and
mushroom consumption was assessed via quantitative food
frequency questionnaires, which can be affected by recall
Studies in animal models and human cell lines have pro-
vided insights into the possible mechanisms involved for the
effects of mushrooms and their components on breast cancer,
and several studies have shown that mushroom extracts are
able to suppress the proliferation of breast cancer cell lines,
without affecting the proliferation of normal (non-cancer) cell
lines (Israilides et al., 2008; Jedinak & Sliva, 2008). An in vitro
study using an aqueous extract of A. bisporus has identiﬁed
suppression of aromatase activity and estrogen production
as key mechanisms (Grube et al., 2001), which is supported
by an animal model study that has reported that the major ac-
tive compounds (in A. bisporus) are unsaturated fatty acids
such as linoleic acid, linolenic acid, and CLA which have been
shown to inhibit aromatase activity (Chen et al., 2006).Inhibi-
tion of proliferation of human breast cancer cell lines has also
been suggested to be mediated via downregulation of Akt/NF-
kappaB (transcription factor) signaling in several mushroom
varieties (Jiang, Slivova, Harvey, Valachovicova, & Sliva,
2004a; Jiang, Slivova, & Sliva, 2006; Jin, Kim, & Choi, 2008), with
a suggestion that the active components in mushrooms in
these effects may be hydroxylated triterpenes (Jiang, Grieb,
Thyagarajan, & Sliva, 2008). Suppression of the transcription
factors NF-kappaB and AP-1 has also been demonstrated by
Ganerderma lucidum (Thyagarajan, Jiang, Hopf, Adamec, &
Polysaccharide K (Krestin, PSK), extracted from Coriolus
versicolor strain CM-101, is a non-speciﬁc immunomodulatory
polysaccharide which induces interleukin 2 (IL-2) and inter-
feron (IFN)-c, thereby stimulating lymphokine activated killer
cells and enhancing natural killer cells (Sakamoto et al., 2006).
Oral administration of PSK has been shown to signiﬁcantly in-
hibit breast cancer growth in tumor-bearing neu transgenic
mice (Lu et al., 2011), with the indication that PSK is a speciﬁc
toll-like receptor 2 (TLR2) agonist and exerts its anti-tumor ef-
fects via stimulation of both innate and adaptive immune
pathways. Mushroom polysaccharopeptides have also been
implicated in apoptopic effects in human breast cancer cell
lines (Wan, Sit, & Louie, 2008).
2.1.2. Colorectal/colon cancer studies
Two meta-analyses of randomised clinical trials have sug-
gested that adjuvant immunochemotherapy with polysac-
charide K from mushrooms can improve the survival of and
disease-free survival of patients with curatively resected
colorectal cancer (Oba et al., 2007; Sakamoto et al., 2006).
The reduction of death rate by 29% and of recurrence by
28% by PSK immunochemotherapy over standard oral ﬂuori-
nated pyrimidine based chemotherapy may have been due to
restoration of immunity in patients who could have been
immunosuppressed due to surgery and chemotherapy
(Sakamoto et al., 2006). The mechanism of this effect is pos-
sibly via action of PSK on a toll-like receptor initiating a sig-
naling cascade involving T helper 1 cells which induce IL-2
and IFN-cand then activate natural killer cells. This sequence
of signaling cascades has recently been described in the mod-
ulation of innate immunity of Agaricus blazei (Ab) (Hetland
et al., 2011), although intake of 5% Ab over 4 weeks by male
Wistar rats did not conﬁrm chemopreventive activity on the
initiation stage of rat colon carcinogenesis (Ziliotto, Barbisan,
& Rodrigues, 2008; Ziliotto, Pinheiro, Barbisan, & Rodrigues,
A clinical study of healthy volunteers reported that G. luci-
dum did not affect their immune functions, but a subsequent
open-labeled study (i.e. not double-blind or placebo con-
trolled) evaluating water-soluble G. lucidum polysaccharides
) in patients with advanced colorectal cancer re-
ported that treatment with Ganopoly
tended to increase
mitogenic reactivity to phytohemagglutinin. Larger double-
blind trials are required to validate this effect and further
studies are needed to determine the mechanism of action,
efﬁcacy, and safety of the water-soluble G. lucidum polysac-
charides in cancer patients (Gao et al., 2005). A randomized,
placebo-controlled, double-blind clinical trial in which pa-
tients with colorectal cancer were supplemented with Agari-
cus sylvaticus mushroom, orally, twice daily (30 mg/kg/day),
for 6 months also suggested beneﬁts in hematological and
immunological parameters and reduced glycemic levels in
patients with colorectal cancer (Fortes, Novaes, Recova, &
Melo, 2009). These data suggest that mushrooms may have
an immunostimulatory effect on immunocompromised pa-
tients, but not in a normal, healthy population.
Several in vitro studies in HT-29 human colonic carcinoma
cells with extracts from G. lucidum (Hong, Dunn, Shen, &
Pence, 2004), A. bisporus lectin (ABL) (Yu, Fernig, Smith, Milton,
& Rhodes, 1993) and other mushrooms have reported pro-
apoptotic effects with no associated cytoxicity. It has been
suggested that the pro-apoptotic effects in HT-29 cells is in-
duced by an increase in the activity of caspase-3 (Hong
et al., 2004). More recent studies have suggested the pro-apop-
totic effects and inhibition of the growth of HT-29 colonic can-
cer cells is mediated through up-regulation of the expression
of pro-apoptotic proteins and down-regulation of anti-apop-
totic proteins (Lee, Hwang, & Yun, 2009b). The inhibition of
proliferation has been shown to be reversible after removal
of (A. bisporus) lectin (Yu et al., 1993) and the reversibility of
the anti-proliferative effect was associated with the release
of the lectin from cancer cells after internalization (Yu, Fernig,
& Rhodes, 2000).
2.1.3. Cervical, ovarian, endometrial cancer studies
The effect of consumption of an extract from A. blazei Murill
Kyowa (ABMK), on immunological status and quality of life
696 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
has been studied in cancer patients undergoing chemother-
apy. One hundred cervical, ovarian, and endometrial cancer
patients were treated either with carboplatin plus VP16 or
with carboplatin plus taxol every 3 weeks for at least three
cycles, with or without oral consumption of ABMK. The
authors observed that natural killer cell activity was signiﬁ-
cantly higher in the ABMK-treated group compared to the
non-treated placebo group (n= 61). However, no signiﬁcant
difference in lymphokine-activated killer and monocyte activ-
ities was observed. Chemotherapy-associated side effects
such as appetite loss, alopecia, emotional instability, and gen-
eral weakness were all reported to be improved by ABMK treat-
ment (Ahn et al., 2004).Very little is known about the
mechanisms involved in the effects of mushrooms or mush-
room extracts in cervical, ovarian and endometrial cancers,
with only a small number of reports suggesting anti-prolifera-
tive effects (Liu, Ning, Cao, & Huang, 2009; Chen et al., 2010) via
an induction of apoptosis (Ren, Zhao, Yang, & Fu, 2008).
2.1.4. Gastic cancer studies
A meta-analysis of the effect of immunochemotherapy with
lentinan compared to chemotherapy alone has been evalu-
ated in patients with advanced gastric cancer across ﬁve ran-
domised controlled trials. Lentinan signiﬁcantly prolonged
overall survival but was possibly more effective in patients
with lymph-node metastasis than in non-node metastasis
patients (Oba, Kobayashi, Matsui, Kodera, & Sakamoto, 2009).
Natural polysaccharides isolated from Phellinus gilvus (PG)
have been shown to decrease cell proliferation and increase
cell apoptosis in a dose-dependent manner in vitro in a model
of human gastric adenocarcinoma and also to lead to a marked
inhibition of tumor growth and a signiﬁcant decrease in the
incidence of peritoneal carcinomatosis (Bae, Jang, & Jin,
2006). Anti-proliferative (Chen, Zhao, Chen, & Li, 2008) and
pro-apoptotic effects (Shomori, Yamamoto, Arifuku, Tera-
machi, & Ito, 2009) in human gastric cell lines also were
reported for several mushroom extracts with both caspase-3
– dependent (Jin et al., 2006)(Shomori et al., 2009) and indepen-
dent signaling cascades being implicated (Shomori et al., 2009).
2.1.5. Prostate cancer studies
Human trials to date have shown that mushrooms and their
extracts to be ineffective in the treatment of clinical prostate
cancer, although the treatments have been well-tolerated.
Trials with G. lucidum (Noguchi et al., 2008a, 2008b) and with
a polysaccharide/oligosaccharide complex obtained from a
Shiitake mushroom extract (White, Hackman, Soares, Beck-
ett, & Sun, 2002) showed no effect on prostate-speciﬁc antigen
levels in patients with either lower urinary tract symptoms or
patients with prostate cancer, respectively.
In other human trials, treatment with Senseiro (containing
extracts from A. blazei Murill) and Rokkaku Reishi (containing
the G. lucidum mushroom) for 6 months in patients with pros-
tate cancer also failed to show a response in terms of serum
prostate-speciﬁc antigen (Yoshimura et al., 2010), while a
Phase II human trial of 74 early prostate cancer patients re-
ported a mushroom mycelium extract to be ineffective in
reducing by 50% or more the patient prostate speciﬁc antigen
values (Sumiyoshi et al., 2010).
These human trial outcomes do not support in vitro mech-
anistic studies, where several mushrooms and their extracts
have been reported to inhibit proliferation of human prostate
cancer cell lines. An A. blazei extract (with a high ratio of beta-
glucan) inhibited cell proliferation in both androgen-depen-
dent and androgen-independent prostate cancer cell lines
via an apoptotic pathway, with activities of caspase 3 and
DNA fragmentation being enhanced the most in androgen-
independent PC3 cells (Yu et al., 2009a). Beta-glucan from
Grifola frondosa (Maitake) has a cytotoxic effect on human
androgen-independent prostatic cancer PC-3 cells in vitro,
leading to apoptosis (Fullerton et al., 2000), while a recent
study has also suggested that a Phellinus linteus extract is able
to sensitize advanced prostate cancer cells to apoptosis in
athymic nude mice (Tsuji et al., 2010).
Inhibition of proliferation in a dose- and time-dependent
manner and induction of apoptosis in PC-3 human prostate
cancer cells by G. lucidum (Jiang et al., 2004b) has been deter-
mined to be caused by the inhibition of constitutively active
AP-1 in prostate cancer cells, resulting in the down-regulation
of secretion of vascular endothelial growth factor and trans-
forming growth factor beta (TGF-beta1) from PC-3 cells, and
G. lucidum inhibits prostate cancer-dependent angiogenesis
by modulation of MAPK (mitogen activated protein kinase)
and Akt signaling (Stanley, Harvey, Slivova, Jiang, & Sliva,
2005). The mechanisms by which mushrooms and their ex-
tracts affect prostate cancer cells appear to be multi-modal
with gene network analysis of studies with A. bisporus identi-
fying alterations in networks involved in apoptosis, growth
and proliferation, lipid metabolism, the TCA cycle and im-
mune responses (Adams, Phung, Wu, Ki, & Chen, 2008).
2.1.6. Pancreatic cancer/solid malignancies
Only one single trial on the effects of a mushroom-derived
compound on pancreatic cancer in humans has been
reported. A phase I trial and pharmacokinetic study of iroful-
ven, a mushroom-derived cytotoxin has been carried out in 46
patients with advanced solid malignancies. While the highest
dose used was not well tolerated (grade 4 neutropenia and
renal toxicity), the authors recommended a lower dose of iro-
fulven (10.64 mg/m
) as a 5-min intravenous infusion daily for
5 days every 4 weeks. The preliminary anti-tumor activity
documented in a patient with advanced pancreatic cancer
and the positive pre-clinical anti-tumor effects observed on
intermittent dosing schedules support a need for further tri-
als on irofulven. It should be noted that the source of this
compound (Omphalotus olearius) is not an edible mushroom
(Eckhardt et al., 2000).
2.2. Immune function
Numerous studies have described the effects of mushrooms
and mushroom extracts on immune function with implica-
tions for inhibiting tumor growth. Some of the more efﬁcacious
compounds reported are the 1,6-branched 1,3-b-glucans,
thought to inhibit tumor growth by stimulating the immune
system via effects on NK cells, macrophages and via T cells
and their cytokine production. More recent work has impli-
cated polysaccharides with varying sugars and some are
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 697
alpha- rather than beta-glucans. Furthermore, mushroom
proteins, terpenes and furans have also been implicated in
immune function. While considerable in vitro data exists,
in vivo studies are few and the limited clinical studies that have
been carried out have been with small numbers of patients and
have often been poorly controlled.
A polysaccharide extract from G. frondosa (Maitake extract)
has shown immunomodulatory effects in a phase I/II dose
escalation trial in post-menopausal breast cancer patients
(n= 34). No dose-limiting toxicity was encountered and there
was a statistically signiﬁcant association between Maitake
and immunologic function. The dose–response curves for
many endpoints were non-monotonic with intermediate
doses having either immune enhancing or immune suppress-
ing effects in peripheral blood compared with both high and
low doses (Deng et al., 2009). Another clinical trial in breast
cancer patients (n= 82) evaluating the immunomodulatory
effects of Yunzhi–Danshen capsules (Yunzhi ( C. versicolor);
Danshen (Salvia miltiorrhiza)) showed signiﬁcantly elevated
B-lymphocytes in patients with breast cancer after taking
Yunzhi–Danshen capsules, while plasma sIL-2R concentra-
tion was signiﬁcantly decreased (Wong et al., 2005).
Discrepancies in results have been reported between ex-
vivo and in vivo studies. After stimulation of whole blood from
healthy volunteers ex vivo with 0.5–5.0% of a mushroom
extract, mainly containing A. blazei Murill (AbM), a dose-
dependent increase in all the cytokines studied was seen,
ranging from two to 399-fold (TNFa). However, in vivo, in eight
volunteers who completed the daily intake (60 ml) of the AbM
extract for 12 days, a signiﬁcant reduction was observed in lev-
els of IL-1-b(97%), TNF-a(84%), IL-17 (50%) and IL-2 (46%). An-
other nine cytokines remained unaltered (Johnson et al., 2009).
The discrepancy in cytokine release ex vivo and in vivo may
partly be explained by the antioxidant activity of AbM in vivo
and limited absorption of its large beta-glucans across the
intestinal mucosa to the reticuloendothelial system and blood.
A double-blind randomized trial undertaken in mildly
hypercholesterolemic subjects (n= 56) to examine the effects
of alpha-glucans from A. bisporus reported that consumption
of A. bisporus alpha-glucans lowered lipopolysaccharide-in-
duced TNFaproduction by 69% compared to the control group,
whereas no effect on IL-1band IL-6 was observed. The authors
suggested that in vivo, alpha-glucans had lost their efﬁcacy to
stimulate the immune response as observed in an in vitro
mouse model (Volman, Mensink, van Griensven, & Plat, 2010a).
Reviews have been carried out on the immunobiology of
mushrooms (Borchers et al., 2008), on the immunomodula-
tory activities of mushroom polysaccharides (Cheung, Wong,
& Lai, 2011), and on the health effects of beta-glucans in
mushrooms (Rop, Mlcek, & Jurikova, 2009; Rondanelli, Opizzi,
& Monteferrario, 2009). A recent systematic review of immu-
nomodulatory dietary polysaccharides concluded that glucan
extracts from Trametes versicolor improved survival and im-
mune function in human randomised controlled trials of can-
cer patients (Ramberg et al., 2010). Many of the potential
therapeutic effects of mushrooms and mushroom compo-
nents on a variety of diseases appear to be directly or indi-
rectly mediated by enhancing natural immunity of the host
via effects on natural killer (NK) cells, macrophages, via bal-
ance of T cells and their cytokine production, and via the acti-
vation of Mitogen Activated Protein Kinase (MAPK) pathways
(Kim et al., 2007; Lin et al., 2009). A recent study has also sug-
gested that branching of the beta-glucan chain is a require-
ment for immunostimulatory activity (Volman et al., 2010b).
A large number of animal studies, using both normal and dia-
betic animals, have demonstrated a hypoglycemic effect of
mushrooms and mushroom components. This effect appears
to be mediated via mushroom polysaccharides (possibly both
alpha- and beta-glucans) via a direct interaction with insulin
receptors on target tissues, although this mechanism remains
to be conﬁrmed.
A randomized, double-blinded, and placebo-controlled
clinical trial (n= 72) showed that A. blazei Murill supplementa-
tion in combination with metformin and gliclazide improved
insulin resistance in these subjects. An increase in adiponec-
tin concentration after A. blazei Murill extract consumption
for 12 weeks may be the mechanism that resulted in the re-
ported effect (Hsu, Liao, Lin, Hwang, & Chou, 2007). Clinical
investigation in diabetic patients (n= 89) has also shown that
Oyster mushroom consumption signiﬁcantly reduced systolic
and diastolic blood pressure, lowered plasma glucose, total
cholesterol and triglycerides signiﬁcantly, with no signiﬁcant
change in body weight, and no deleterious effects on liver or
kidney function (Khatun, Mahtab, Khanam, Sayeed, & Khan,
2007). These results in humans mirror the decreases in plasma
glucose, cholesterol and triglyceride concentrations following
A. bisporus consumption observed in rats (Jeong et al., 2010)
and the reduction in blood pressure in Zucker fattyrats follow-
ing oral administration of Maitake mushroom fractions (Tal-
pur et al., 2002).
Aqueous extracts of various mushrooms have been shown
to possess hypoglycemic activity and anti-hyperglycemic
activity against diabetes-inducing compounds in obese and
diabetic animal models. An aqueous extract of G. lucidum
(0.03 and 0.3 g/kg) lowered the serum glucose level in obese/
diabetic (+db/+db) mice after one week of treatment through
the suppression of hepatic PEPCK gene expression (Seto
et al., 2009). Aqueous extracts of Pleurotus pulmonarius also
have been shown to possess hypoglycemic activity (Badole,
Shah, Patel, Thakurdesai, & Bodhankar, 2006), as well as hav-
ing synergistic anti-hyperglycemic effects with acarbose
(Badole & Bodhankar, 2007) in alloxan-induced diabetic mice.
A similar anti-hyperglycemic effect has been reported by G.
frondosa (Cui, Han, Qu, & Lv, 2009) and C. comatus (Han &
Liu, 2009) on an adrenaline-induced increase in blood glucose
in mice, although in this study, the same result was not
observed with G. lucidum and G. frondosa.
An alpha-glucan fromG. frondosa was shown to affect a ser-
ies of diabetes markers in KK-Ay mice, which may be related
to an effect on insulin receptors by increasing insulin sensitiv-
ity and ameliorating insulin resistance of peripheral target
tissues (Lei, Ma, & Wu, 2007). Beta-glucans and their enzymat-
ically hydrolyzed oligosaccharides from A. blazei have
anti-hyperglycemic, anti-hypertriglyceridemic, anti-hyper-
cholesterolemic, and anti-arteriosclerotic activity indicating
overall anti-diabetic activity in diabetic rats. However, the
enzymatically hydrolyzed oligosaccharides have been shown
698 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
to have around twice the activity of beta-glucans with respect
to anti-diabetogenic activity (Kim, Kim, Choi, & Lee, 2005).
Semi-puriﬁed fractions of a submerged-culture broth of A.
blazei Murill were also reported to reduce blood glucose levels
in streptozotocin-induced diabetic rats (Oh et al., 2010).
Extracellular polysaccharides (EPS) from Laetiporus sulphu-
reus var. miniatus have been shown to both stimulate insulin
secretion (Hwang et al., 2008) and insulin sensitivity possibly
via regulation of lipid metabolism (Cho et al., 2007) in diabetic
mouse models. A polysaccharide isolated from P. linteus
reportedly inhibited the development of autoimmune diabe-
tes by regulating cytokine expression in non-obese diabetic
mice (Kim et al., 2010). The hypoglycemic potential of EPS
was also conﬁrmed by histopathological examination that
showed that EPS administration is able to restore impaired
kidneys to almost normal architecture (Hye-Jin et al., 2007)
as well as pancreatic islets of Langerhans (Yamac et al.,
2008) in streptozotocin-induced rats.
The consistency between the effects of the mushroom ex-
tracts in diabetic animal models described above and preli-
minary data from human trials, which mirror decreases in
plasma glucose, blood pressure, cholesterol and triglyceride
concentrations, strengthens the level of evidence for anti-dia-
betogenic effects of the studied mushrooms and theirextracts.
2.4. Brain health/cognition
Although very preliminary, data showing protective effects of
mushrooms (Hericium erinaceum) on beta-amyloid peptide tox-
icity (Kawagishi & Zhuang, 2008) in the brain and mild cogni-
tive impairment (both precursors to dementia) are promising.
Preliminary human trials with H. erinaceum derivatives
showed efﬁcacy in patients with dementia in improving the
Functional Independence Measure (FIM) score or retarding
disease progression (Kawagishi & Zhuang, 2008), while a dou-
ble-blind, parallel-group, placebo-controlled trial with oral
administration of Yamabushitake (Hericium erinaceus)to50
to 80-year-old Japanese men and women diagnosed with mild
cognitive impairment reported signiﬁcantly increased cogni-
tive function scores compared to placebo during intake, but
the scores decreased signiﬁcantly following termination of
the intake (Mori, Inatomi, Ouchi, Azumi, & Tuchida, 2009).
2.5. Biomarkers for cardiovascular disease
Oyster mushroom consumption by 89 diabetic patients signif-
icantly reduced systolic and diastolic blood pressure, total
cholesterol and triglycerides, with no signiﬁcant change in
body weight and no deleterious effects on liver or kidney
function (Khatun et al., 2007). Another study in 90 female vol-
unteers demonstrated a weight-controlling and hypolipidem-
ic effect of protein-bound polysaccharides from the mycelia
of A. blazei and Lentinus edodes, via a mechanism involving
absorption of cholesterol (Kweon, Kwon, Kwon, Ma, & Park,
2002). However, a double-blind, placebo-controlled, cross-over
intervention study in adults (n= 18; ages 22–52 years) of a
commercially available encapsulated Lingzhi preparation
(equivalent to 13.2 g fresh mushroom/d) over 4 weeks failed
to show any change in biomarkers for coronary heart disease
risk (Wachtel-Galor, Tomlinson, & Benzie, 2004).
2.6. Anti-microbial properties
Anti-microbial effects of a large number of mushroom varie-
ties and mushroom components on both gram-positive and
gram-negative bacteria have been conﬁrmed via in vitro stud-
ies. A small number of animal studies have been undertaken
and the data suggest that the anti-microbial effects in vivo
may be mediated by effects on the immune system. Initial
studies in humans suggested anti-microbial properties of ex-
tracts from A. blazei Murill and G. lucidum, although these
studies did not have adequate controls in the experimental
design, and therefore such effects have not yet been scientif-
ically validated in humans.
A very small one-year open-label (not double-blind or pla-
cebo-controlled) pilot study reported that intake of A. blazei
Murill (AbM) extract (1500 mg daily) over 12 months improved
liver function in patients with hepatitis B, determined by a de-
crease in the mean level of aspartate aminotransferase and
alanine aminotransferase decreased from 246.0 to 61.3 IU/L
and 151.0 to 46.1 IU/L, respectively (Hsu, Hwang, Chiang, &
Chou, 2008a). The initial observation seems to indicate a po-
tential beneﬁt of AbM extract in normalizing liver function
of patients with hepatitis B, although clearly larger and con-
trolled studies are required to conﬁrm such effects.
Model studies have demonstrated anti-bacterial effects of
A. blazei Murill (AbM) extract against systemic Streptococcus
pneumoniae 6B infection in mice. The lack of an antibiotic ef-
fect on pneumococci in vitro and increased levels of cytokines
MIP-2 and TNF in the serum of mice receiving AbM extract,
indicated that its protective effect may be due to the involve-
ment of the native immune system (Bernardshaw, Hetland,
Ellertsen, Tryggestad, & Johnson, 2005a; Bernardshaw et al.,
2005b). This group’s subsequent study showed that an extract
of A. blazei Murill can protect against lethal bacterial septice-
mia in a mouse model of fecal peritonitis. Mice (BALB/c) that
were orally treated with AbM extract before bacterial chal-
lenge showed signiﬁcantly lower levels of septicemia, as mea-
sured by the number of colony-forming units of bacteria in
blood and by the survival rate of the animals (Bernardshaw,
Hetland, Grinde, & Johnson, 2006).
Numerous in vitro studies have clearly demonstrated activ-
ities against gram-positive and gram-negative bacteria, yeasts
and mycelial fungi, including dermatophytes and phytopath-
ogens (Jagadish, Krishnan, Shenbhagaraman, & Kaviyarasan,
2009; Soboleva, Krasnopol’Skaia, Fedorova, & Katrukha,
2006; Hearst et al., 2009), including several foodborne patho-
genic bacterial strains (Venturini, Rivera, Gonzalez, & Blanco,
2008). It has been suggested that such antimicrobial effects of
mushroom extracts may be indirect, with a polysaccharide-
rich fraction of Agaricus brasiliensis being shown to increase
host resistance against some infectious agents through stim-
ulation of the microbicidal activity of macrophages (Martins
et al., 2008).
2.7. Anti-viral properties
Proteins, peptides and polysaccharopeptides from mush-
rooms have been reported to inhibit human immunodeﬁ-
ciency virus type 1 (HIV-1) reverse transcriptase and
protease, the two enzymes of importance to the life cycle of
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 699
HIV. Inhibitory effects on hepatitis B and herpes simplex virus
type 1 have also been reported. The anti-viral effects of mush-
rooms do not seem to be related to viral adsorption or viru-
cidal effects (i.e. they do not kill the virus), however a
number of studies have reported inhibitory effects at the ini-
tial stage of virus replication (Faccin et al., 2007).
Two phase I/II placebo-controlled trials in 98 HIV-positive
patients were completed using lentinan, a beta-glucan iso-
lated from L. edodes (Shiitake mushroom) (Gordon et al.,
1998). The studies reported generally good tolerability of lent-
inan with observed side effects being mainly mild, particu-
larly when infusion was carried out over a 30 min period. In
the ﬁrst study, where administration was over a 10 min peri-
od, there were nine side effects severe enough to be reported
to the FDA (one case each of anaphylactoid reaction, back
pain, leg pain, depression, rigor, fever, chills, granulocytope-
nia and elevated liver enzymes) with four patients discon-
tinuing therapy because of side effects. In the second study,
where infusion was over a 30 min period, there were no side
effects reportable to the FDA but there were four drop-outs
due to side effects or personal preference. Most side effects
resolved promptly after the discontinuation of medication,
and all of them were relieved within 24 h. The small number
of patients in the study groups meant the data on possible in-
creases in CD4 cell and neutrophil activity were inconclusive
(Gordon et al., 1998).
Extracts of G. frondosa (Maitake) have shown activity
against hepatitis B virus (Gu, Li, & Chao, 2006), herpes simplex
virus type 1 (HSV-1) replication in vitro (Gu et al., 2007) and
against the growth of inﬂuenza A/Aichi/2/68 virus (Obi et al.,
2008). The effects of a mushroom-derived active hexose cor-
related compound (AHCC) on the immune response to inﬂu-
enza A virus (H1N1, PR8) infection were shown to be dose
dependent with low-dose AHCC supplementation improving
the response to inﬂuenza infection despite no effect on total
NK cell cytotoxicity (Nogusa, Gerbino, & Ritz, 2009). Extracts
from P. linteus also provided protection against variant H5N1
inﬂuenza viruses (Ichinohe et al., 2010).
Anti-viral activity of several mushroom extracts has been
demonstated in vitro and in vivo in animal models. A poly-
saccharopeptide from the Turkey Tail mushroom T. (=Corio-
lus) versicolor was reported to inhibit HIV-1 reverse
transcriptase and protease, the two enzymes of paramount
importance to the life cycle of the HIV (Tzi, Wang, & Wan,
2006). Anti-HIV-1 protease activity was also reported for lan-
ostane triterpenes from Ganoderma colossum (el Dine, el
Halawany, Ma, & Hattori, 2008) and from Ganoderma sinense
(Sato, Zhang, Ma, & Hattori, 2009), while nebrodeolysin from
Pleurotus nebrodensis has been shown to possess anti-HIV-1
activity in vitro (Lv et al., 2009). Lectins from A. bisporus,Phase-
olus vulgaris,Momordica charantia,Ricinus communis and its con-
stituent chains have been shown to inhibit HIV-1 reverse
transcriptase (Wang & Ng, 2001). A ubiquitin-like protein from
Pleurotus ostreatus has also demonstrated inhibitory activity
toward HIV-1 reverse transcriptase, which could be enhanced
by succinylation (Wang & Ng, 2000). The evidence for an anti-
viral effect of several mushroom extracts via inhibition of
HIV-1 reverse transcriptase and protease appears strong. A
farnesyl hydroquinone, ganomycin I, isolated along with
ganomycin B, from G. colossum has been reported to inhibit
HIV-1 protease with IC
values of 7.5 and 1.0 lg/ml, respec-
tively (el Dine, el Halawany, Ma, & Hattori, 2009). Ganomycin
B competitively inhibited the active site of the enzyme, with
both compounds docking with the HIV-1 protease crystal
ACordyceps extract has recently been evaluated in asthmatic
children during remission stage (Sun et al., 2010). The Cordy-
ceps extract inhibited the proliferation and differentiation of
Th2 cells and reduced the expression of related cytokines by
down-regulating the expression of GATA-3 mRNA and up-reg-
ulating the expression of Foxp3 mRNA in peripheral blood
mononuclear cells. The extract was able to alleviate the
chronic allergic inﬂammation by increasing the level of inter-
Clinical effects and safety evaluation of A. blazei condensed li-
quid (Agaricus Mushroom Extract; ABCL) administered to hu-
man volunteers (10 male, 10 female) with chronic C-type
hepatitis orally twice per day for 8 weeks reported no toxico-
logical or other side effects (Inuzuka & Yoshida, 2002). A series
of trials have evaluated G. lucidum on cancer, Type II diabetes,
coronary heart disease, chronic hepatitis B, and neurasthenia.
Treatment with Ganopoly
for 12 weeks showed hypoglyce-
mic activity and produced some anti-viral and liver protective
effects in patients with chronic hepatitis B infection. However,
the same treatment regimen did not result in any objective re-
sponse in late-stage cancer patients (Zhou, Gao, & Chan, 2005).
Overall, the ﬁndings suggest that Ganopoly
may have some
pharmacological activities, although clinical proof is lacking.
Constipation is one of the most prevalent gastrointestinal
complaints and high ﬁber intake is recommended as an initial
therapy for constipation. Ear mushrooms (Auricularia) are
known to have higher ﬁber contents (by 50%) than other
mushroom varieties. In patients with functional constipation,
ﬁber supplements using ear mushrooms have been shown to
signiﬁcantly improve constipation related symptoms without
serious side effects (Kim, Park, Choi, Lee, & Kim, 2004).
3. Medical conditions with lower levels of
There are currently no published human clinical trials on
mushrooms and the following medical conditions, and hence
a summary of in vitro studies and in vivo animal trials is
provided in Table 2 and brieﬂy summarized below. Without
conﬁrmation of efﬁcacy in humans, these studies provide a
lower level of evidence.
3.1. Bladder cancer
The synergistic potentiation of interferon activity with Maitake
mushroom on bladder cancer cells has recently been reported
700 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
(Louie, Rajamahanty, Won, Choudhury, & Konno, 2010). The
combination of interferon-alpha2b (10,000 IU/ml) and Maitake
mushroom D fraction (200 g/ml) reduced growth by 75% in
T24 bladder cancer cells. This effect may be due to triggering
double-stranded DNA-dependent protein kinase activation
that may act on the cell cycle to cease cancer cell growth.
Cordycepin (30-deoxyadenosine), from Cordyceps militaris,
has been shown to have anti-tumor effects in two different
bladder cancer cell lines, 5637 and T-24 cells. Cordycepin
treatment, at a dose of 200 lM (IC
) during cell-cycle progres-
sion resulted in a signiﬁcant and dose-dependent growth
inhibition, which was largely due to G2/M-phase arrest (Lee,
Kim, Choi, Kim, & Moon, 2009c).
A recent study demonstrated that agaritine puriﬁed from
A. blazei Murrill exerts anti-tumor activity against leukemic
cells in vitro (Endo et al., 2010). Agaritine inhibited the prolif-
eration of leukemic cell lines U937, MOLT4, HL60 and K562,
but showed no signiﬁcant effect on normal lymphatic cells.
The data also showed that this activity was distinct from that
of beta-glucan, which indirectly suppresses proliferation of
tumor cells. This conclusion of direct anti-tumor activity by
agaritine against leukemic tumor cells in vitro contrasts to
the carcinogenic activity previously ascribed to it in animal
studies carried out around 20–30 years ago. Agaritine, a natu-
rally occurring phenylhydrazine derivative present in Agaricus
mushroom species, had been described as potentially carcin-
ogenic in some studies, although the scientiﬁc validity of the
experimental designs and rat models from which this conclu-
sion was drawn have now been challenged. These newer
studies, animal models, and human food safety studies with
Agaricus mushrooms have been evaluated recently with the
conclusion that agaritine from consumption of cultivated A.
bisporus mushrooms poses no known toxicological risk to
healthy humans (Roupas, Keogh, Noakes, Margetts, & Taylor,
Extracts from A. bisporus (Jagadish et al., 2009), A. blazei (Gao
et al., 2007), Hypsizigus marmoreus (Mizumoto et al., 2008) and
other mushrooms have been shown to inhibit cell proliferation
of HL-60 leukemia cells and other leukemia human cell lines
via the induction of apoptosis. Mechanisms by which apopto-
sis is induced include down-regulation of telomerase activity
and up-regulation of mRNA expression of the caspase-3 gene
(Gao et al., 2007), regulation of Bcl-2 and caspase-3 (Jin, Moon,
Choi, Lee, & Kim, 2007), cleavage of poly (ADP-ribose) polymer-
ase and pro-caspase 3 (Bae et al., 2009), mitochondrial mem-
brane potential loss and caspase activation (Mizumoto et al.,
2008), release of mitochondrial cytochrome c and subsequent
activation of caspase-9 and caspase-3 (Hsu, Yu, & Yen, 2008b)
and via the signal transduction kinases Akt and Erk (Calvino
et al., 2010). These extracts appear to exert tumor-selective
cytotoxicity, with studies reporting no signiﬁcant cytotoxic ef-
fects on normal cell lines (Lau et al., 2004).
3.3. Liver cancer
Lucidenic acids (triterpenoids) isolated from G. lucidum (Weng,
Chau, Chen, Chen, & Yen, 2007), hyperbranched beta-glucan,
extracted from Pleurotus tuberregium (Tao, Zhang, & Cheung,
2006) and extracts from Cordyceps sinensis (Wu, Zhang, & Leu-
ng, 2007) and Chaga (Inonotus obliquus) mushrooms (Youn
et al., 2008) have been shown to inhibit the proliferation of
HepG2 human hepatocellular carcinomas. As reported above
for human leukemia cell lines, such extracts appear to be
have tumor-selective cytotoxicity, without signiﬁcant effects
on normal human liver cell lines (Lin, Li, Lee, & Kan, 2003).
In vivo rodent studies have also reported hepato-protective ef-
fects on both chemically-induced liver toxicity and hepato-
carcinogenesis by extracts from A. blazei (Barbisan et al.,
2002; Pinheiro et al., 2003) andP. pulmonarius (Wasonga, Okoth,
Mukuria, & Omwandho, 2008).
3.4. Lung cancer
An in vivo study in mice with Lewis lung carcinoma treated
with an aqueous extract of H. marmoreus showed a signiﬁcant
increase in life span when given it by intraperitoneal admin-
istration, but not as much by oral administration. The extract
inhibited spontaneous tumor metastasis in mice bearing the
carcinoma and signiﬁcantly decreased the number of metas-
tasized nodules (Saitoh, Feng, Matsuzawa, & Ikekawa, 1997).
In vitro studies have shown that three triterpene aldehydes,
lucialdehydes A–C, from the fruiting bodies of G. lucidum, pos-
sess cytotoxicity against murine and human tumor cells
(Lewis lung carcinoma (LLC), T-47D, Sarcoma 180, and Meth-
A tumor cell lines) (Gao et al., 2002), while P. linteus has been
shown to mediate cell-cycle arrest at a low concentration
and apoptosis in response to a high dose in mouse and
human lung cancer cells (Guo et al., 2007). Blazein, a steroid
isolated from A. blazei Murrill (Himematsutake), has also been
reported to induce cell death and morphological change
indicative of apoptotic chromatin condensation in human
lung cancer LU99 and stomach cancer KATO III cells (Itoh,
Ito, & Hibasami, 2008), and an extract from Pleurotus ferulae
has been reported to have cytotoxic effects on human lung
cancer and cervical cancer cell lines (A549, SiHa and HeLa
cells) (Choi, Cha, Kang, & Lee, 2004).
3.5. Skin cancer
L. edodes has been shown to reduce cell proliferation and in-
duce apoptosis in CH72 mouse skin carcinoma cells via an
induction of a transient G1 arrest with no effect in non-
tumorigenic (C50) cells (Gu & Belury, 2005). Similarly, reduc-
tion of cell proliferation of B-16 melanoma cells by arrest in
the G0/G1 phase of the cell cycle, followed by both apoptotic
and secondary necrotic cell death has been demonstrated
for a methanol extract of C. versicolor (Harhaji et al., 2008).
In contrast, proﬂamin, isolated from F. velutipes, exhibited
no cytotoxic effects against B-16 melanoma (B-16) and adeno-
carcinoma 755 (Ca-755) cultured cell lines in vitro, but in-
creased the median survival time of mice treated with B-16
and Ca-755 by 86% and 84%, respectively, with no apparent
adverse effects (Ikekawa et al., 1985).
An acidic polysaccharide from P. linteus has been shown to
markedly inhibit melanoma cell metastasis in mice, and di-
rectly inhibit cancer cell adhesion to, and invasion through,
the extracellular matrix, with an increase in macrophage
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 701
NO production but to have no direct effect on cancer cell
growth. These results suggest that P. linteus has two anti-met-
astatic functions—it acts as an immunopotentiator and as a
direct inhibitor of cancer cell adhesion (Han et al., 2006).
3.6. DNA damage
In vitro studies have shown that a heat-labile protein from
A. bisporus protects Raji cells (a human lymphoma cell line)
-induced oxidative damage to cellular DNA (Shi,
Benzie, & Buswell, 2002). Similar protective effects against
-induced oxidative damage to cellular DNA have been
demonstrated with cold (20 °C) and hot (100 °C) water extracts
of A. bisporus and G. lucidum fruit bodies, respectively. No
protective effects were observed with mushroom derived
preparations from F. velutipes,Auricularia auricula,H. marmore-
us,L. edodes,Pleurotus sajor-caju,orVolvariella volvacea (Rocha,
Barbisan, de Oliveira, & de Camargo, 2002). Similar reductions
in DNA fragmentation (Comet assay), compared with H
a positive control, have been reported from Chaga mushroom
(I. obliquus)(Park, Lee, Jeon, Jung, & Kang, 2004), while an
aqueous extract from Agrocybe cylindracea strain B has also
been shown to protect against DNA damage in HepG2 cells
(Wang, Tsai, & Lin, 2004). Some edible mushrooms therefore
represent a valuable source of biologically active compounds
with potential for protecting cellular DNA from oxidative
damage, while other mushroom varieties do not.
Beta-glucan from A. brasiliensis has been reported to be de-
void of mutagenic activity and to provide a signiﬁcant dose-
dependent protective effect against DNA damage in the dose
range 20–80 lg/ml (Angeli et al., 2006). Furthermore, a possible
chemoprotective effect of beta-glucan extracted from A. blazei
against DNA damage induced by benzo[a]pyrene, using the
comet assay (genotoxicity) and micronucleus assay with cyto-
kinesis block (mutagenicity) in a human hepatoma cell line
(HepG2) has suggested that beta-glucan did not exert a geno-
toxic or mutagenic effect, but that it did protect against DNA
damage via binding to benzo[a]pyrene or by the capture of
free radicals produced during its activation (Angeli, Ribeiro,
Bellini, & Mantovani, 2009).
It has been suggested that synthetic agaritine (i.e. not ex-
tracted from mushrooms) is quickly metabolized in mice
and disappears in the plasma, whereas DNA damage after a
single administration of synthetic agaritine lasts for a longer
time (Kondo, Watanabe, Akiyama, & Maitani, 2008). The infer-
ence for DNA damage in this study was from a result of a sep-
arate in vitro test. While data with a particular marker of
oxidative stress showed this effect, a similar experiment with
a different marker of oxidative stress did not, thus the
authors made these comments based on their results with
one particular marker only. In contrast, recent research (Endo
et al., 2010) has ascribed anti-tumor activity of agaritine (from
mushrooms) against leukemic cells, and a recent review (Rou-
pas et al., 2010) also concluded that agaritine from consump-
tion of cultivated A. bisporus mushrooms poses no known
toxicological risk to healthy humans. Another in vivo study
demonstrated that crude extracts of A. blazei Murrill signiﬁ-
cantly reduced DNA damage in liver induced by diethylnitros-
amine in adult male Wistar rats (Barbisan et al., 2003), while
DNA strand breaking by the carbon-centered radical gener-
ated from 4-(hydroxymethyl) benzenediazonium salt from
A. bisporus has been reported in the mouse (Hiramoto, Kaku,
Kato, & Kikugawa, 1995).
Strong DNA protective effects from oxidative damage have
been reported for protein extracts from selenium-enriched G.
lucidum (Se-GLPr), and this effect increased with increasing Se
content (Zhao et al., 2004). Polysaccharide extracts from Se-
enriched G. lucidum have also been shown to protect DNA
from hydroxyl radical oxidative damage in a dose dependent
manner (Zhao et al., 2008). A water-soluble polysaccharide
from G. lucidum was protective against hydroxyl radical-in-
duced DNA strand breaks (Kim & Kim, 1999), and radioprotec-
tive properties of an aqueous extract of G. lucidum against
radiation-induced plasmid pBR322 DNA strand breaks
have been demonstrated that may be due to inhibition of lipid
peroxidation (Pillai, Salvi, Maurya, Nair, & Janardhanan, 2006).
3.7. Rheumatoid arthritis
A polysaccharide–protein complex, isolated from Phellinus
rimosus (Berk.), signiﬁcantly increased lipid-peroxide levels in
the plasma of adjuvant-induced arthritic rats. The antioxidant
enzymes superoxide dismutase and glutathione peroxidase
were elevated in adjuvant-induced rats, and reduced blood
glutathione was decreased. Treatments with various concen-
trations of the polysaccharide–protein complex modulated
the alterations produced in arthritic animals in a dose-depen-
dent manner (Meera, Smina, Balan, Mathew, & Janardhanan,
2009). Anti-arthritic activity of a beta-(1,3/1,6)-D-glucan from
P. ostreatus has been reported (Bauerova, Paulovicova, Mihal-
ova, Svik, & Ponist, 2009; Rovensky, Stancikova, Svik, Bauerova,
& Jurcovicova, 2011) in a rat model which involved an immuno-
modulating effect on cytokine plasma levels that changed
markedly with arthritis progression.
3.8. Osteoporosis/bone mineral density
Ethanol extracts of G. lucidum have been evaluated against
ovariectomized (Ovx)-induced deterioration of bone density
in 11-week-old female Sprague Dawley (SD) rats (Miyamoto
et al., 2009) with the treated rats showing improved bone den-
sity. L. edodes that are exposed to UV radiation contain en-
hanced vitamin D2 and have a much higher calcium
content than non-irradiated mushrooms. A study in 4-week
old mice fed low calcium and a vitamin D deﬁcient diet
showed signiﬁcantly increased femur density and tibia thick-
ness in mice fed calcium plus vitamin D2-enhanced mush-
rooms, and the expression of duodenal and renal calcium
transport genes was signiﬁcantly induced. The results indi-
cated that in mice, vitamin D2 and/or calcium derived from
irradiated L. edodes may improve bone mineralization directly
and by inducing the expression of calcium-absorbing genes in
the duodenum and kidney (Lee et al., 2009a). A recent ran-
domized controlled trial has also demonstrated that the bio-
availability of vitamin D2 from vitamin D2-enhanced
mushrooms via UV-B irradiation improved vitamin D status
in humans to a level similar to that of a vitamin D2 supple-
ment (Urbain, Singler, Ihorst, Biesalski, & Bertz, 2011).
It has been suggested that the mechanisms for these ef-
fects is an increase in the alkaline phosphatase activity of
702 JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709
osteoblasts. The cultivation of human osteosarcoma cells
HOS58 in the presence of an aqueous extract of G. frondosa re-
sulted in a signiﬁcant elevation of alkaline phosphatase activ-
ity of the cells in comparison to untreated cells. In another
osteoblastic cell line (SaOS-2) cells incubated with G. frondosa
for 21 days, showed a nearly 2-fold higher mineralization than
cells cultured with a positive control, demonstrating the activ-
ity of G. frondosa extract as a bone-inducing agent (Saif, Linde-
quist, & Wende, 2007). Pleurotus eryngii extracts (PEX) have also
been shown to increase alkaline phosphatase activity of oste-
oblasts and in the osteocalcin mRNA expression from primary
osteoblasts. In vivo studies, using rats with ovariectomy-in-
duced osteoporosis revealed that PEX alleviated a decrease
in the trabecular bone mineral density (Kim et al., 2006). An
ethanol extract of P. eryngii was also reported to help protect
against bone loss caused by estrogen deﬁciency, without hav-
ing a substantial effect on the uterus (Shimizu et al., 2006), and
osteoclast forming suppressive compounds have been iso-
lated from the mushroom Agrocybe chaxingu (Abel et al., 2007).
3.9. Effects on wound healing
Impaired wound healing in diabetes mellitus is a major clini-
cal problem. Wound closure in streptozotocin-induced dia-
betic rats has been shown to be signiﬁcantly accelerated by
oral administration of Sparassis crispa (SC) a mushroom with
a beta-glucan content of more than 40%, via a mechanism
that may involve an increase in the migration of macrophages
and ﬁbroblasts, with beta-glucan from SC directly increasing
the synthesis of type I collagen (Kwon, Qiu, Hashimoto,
Yamamoto, & Kimura, 2009).
A dose-dependent inhibition of proliferation and lattice
contraction without signiﬁcant toxicity in an in vitro model
of wound healing (human ocular ﬁbroblasts in monolayers
and in three-dimensional collagen lattices) by A. bisporus
(0–100 lg/ml) has been shown (Batterbury, Tebbs, Rhodes, &
Grierson, 2002), while H. erinaceus (Bull.: Fr.) Pers. (Aphyllo-
phoromycetideae) (Mahmood et al., 2008), and polysaccharide
fractions from both G. lucidum (Gao et al., 2004) and L. edodes
(Yu, Yin, Qian, & Yan, 2009b) have demonstrated efﬁcacy in
treatment of ulceration in rats via mechanisms which
involved raised activities of serum antioxidant enzymes and
decreased levels of serum, mucosal interleukin-2 (IL-2) and
TNF-a(Yu et al., 2009b).
3.10. Eye health
A recent study has evaluated the efﬁcacy of P. ostreatus extract
in preventing selenite-induced cataractogenesis. In vitro,
simultaneous incubation of extract with selenite-challenged
lenses caused a decrease in lens opaciﬁcation by maintaining
antioxidant components at near normal levels. In vivo,P. ostre-
atus prevented cataracts in 75% of rats (Isai et al., 2009).
4. Mushroom bioactive compounds and propo-
Recent studies on mushrooms and their extracts (Tables 1 and
2), have identiﬁed roles involving host-mediated immuno-
modulatory responses, via stimulation of both innate and
adaptive immune pathways, with implications for inhibition
of tumor growth via anti-proliferative effects and induction
of apoptosis in human cancer cells.
Polysaccharides from mushrooms, generally belonging to
the beta-glucan family appear to inhibit tumor growth by
stimulating the immune system. Some of the more efﬁca-
cious compounds in mushrooms are 1,6-branched 1,3-b-glu-
cans, which are recognized by pattern-recognition receptors
on immune cells such as monocytes, granulocytes and
dendritic cells. Beta-glucans in mushrooms are also known
to exert immunomodulatory effects via activation of macro-
phages, balance of T helper cell (TH1 and TH2 in particular)
populations and subsequent effects on natural killer (NK),
cells and also via cytokine production (Hetland et al., 2011).
In addition to beta-glucans, polysaccharides with other sugar
moieties such as alpha-glucans have also been implicated
(Borchers et al., 2008) while other studies with non-medicinal
mushrooms containing 1,4-glucans have not shown similar
effects suggesting that branching of the beta-glucans may
provide speciﬁcity to the binding of these compounds to im-
mune cells. While the majority of these mechanisms have
been determined in in vitro or in vivo animal studies, some
recent data have also provided evidence for such immuno-
modulatory effects (increased NK cell activity, effects on IgG,
IgM, neutrophil and leukocyte counts) in humans from oral
ingestion of dietary polysaccharides (glucans) from some
varieties of mushrooms (Ramberg et al., 2010), which further
strengthens this evidence.
Apoptosis and/or anti-proliferative effects on carcinomas
and cell lines is a mechanism shared by several mushrooms
and their extracts in studies of anti-cancer effects. The anti-
tumor effects of proteoglycan fractions of mushrooms involve
the elevation of natural killer (NK) cell numbers and the stim-
ulation of inducible NO synthase gene expression, which is
then followed by NO production in macrophages via activa-
tion of the transcription factor, NF-kappaB. Activation of NK
cells is likely via interferon-gamma and interleukin mediated
pathways. In addition to the apoptotic and anti-proliferative
effects, the anti-inﬂammatory and anti-microbial/viral effects
outlined may also contribute to the anti-carcinogenic effects
of mushrooms and their extracts, although such direct links
have not been established to date. As mentioned above, while
the majority of such mechanisms have been determined in
in vitro or in vivo animal studies, mushroom polysaccharides
in particular are beginning to be evaluated as adjuvant cancer
therapy compounds alongside conventional cancer treat-
ments (Standish et al., 2008), particularly in breast cancer pa-
tients with estrogen receptor positive tumors where
mushroom extracts have been shown to inhibit aromatase
activity (Grube et al., 2001; Chen et al., 2006) and subsequent
reduction of estrogen.
While the effects and underlying mechanisms of mush-
room polysaccharides in health outcomes have been more
extensively evaluated, bioactive proteins from mushrooms
(such as lectins, fungal immunomodulatory proteins (FIP),
ribosome inactivating proteins (RIP), ribonucleases and other
proteins have also been reported to possess anti-tumor,
anti-viral and immunomodulatory activities. Furthermore,
ergosterol and agaritine, present in mushrooms of the
Agaricus family, have been reported to inhibit proliferation
JOURNAL OF FUNCTIONAL FOODS 4 (2012) 687–709 703
of leukemic cells without effects on normal lymphatic cells
and that this activity was distinct from that of beta-glucan
(Endo et al., 2010).
Although there have been relatively few direct intervention
trials of mushroom consumption in humans, those that have
been completed to date indicate that mushrooms and their ex-
tracts are generally well-tolerated with few, if any, side-
effects. The most promising data appear to be those indicating
an inverse relationship between mushroom consumption and
breast cancer risk, although the data are generally based on
food frequency questionnaires, which can be affected by recall
bias, and therefore these effects need to be conﬁrmed via di-
rect intervention trials involving mushroom consumption.
Although preliminary, new studies reporting protective effects
of mushrooms on beta-amyloid peptide toxicity and mild cog-
nitive impairment (both precursors to dementia) appear
promising and warrant further research. Studies in humans
have shown an increase in the antioxidant capacity in urine
and no evidence of liver, renal or DNA toxicity, and no clinical
problems with regard to blood test results, liver and renal
function, glucose and lipid metabolism, or blood pressure.
Mushroom components/extracts have been reported to have
stronger health effects/beneﬁts than whole mushrooms in
the limited number of direct human trials to date.
Mushrooms and mushroom components have been
reported to have a myriad of positive health beneﬁts, mainly
on the basis of in vitro and in vivo animal trials. However, the
majority of these effects are indirect in that they are due to a
stimulation or modulation of natural cellular immunity. Mush-
rooms and mushroom components exert many of their positive
effects on health via a balance of T helper cells,the induction of
interferon-gamma and certain interleukins or NO-mediated
mechanisms. Many of these immunomodulating effects are
due to the polysaccharide content of mushrooms, either from
beta-glucans or from polysaccharide–protein complexes.
The authors acknowledge the Mushroom and Health Global
Initiative (MHGI) for the ﬁnancial contribution in undertaking
this scientiﬁc review.
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