A phase I/II trial of a polysaccharide extract from Grifola frondosa (Maitake mushroom) in breast cancer patients: immunological effects

Abstract

Background: Cancer patients commonly use dietary supplements to "boost immune function". A polysaccharide extract from Grifola frondosa (Maitake extract) showed immunomodulatory effects in preclinical studies and therefore the potential for clinical use. Whether oral administration in human produces measurable immunologic effects, however, is unknown.

Methods: In a phase I/II dose escalation trial, 34 postmenopausal breast cancer patients, free of disease after initial treatment, were enrolled sequentially in five cohorts. Maitake liquid extract was taken orally at 0.1, 0.5, 1.5, 3, or 5 mg/kg twice daily for 3 weeks. Peripheral blood was collected at days -7, 0 (prior to the first dosing), 7, 14, and 21 for ex vivo analyses. The primary endpoints were safety and tolerability.

Results: No dose-limiting toxicity was encountered. Two patients withdrew prior to completion of the study due to grade I possibly related side effects: nausea and joint swelling in one patient; rash and pruritus in the second. There was a statistically significant association between Maitake and immunologic function (p < 0.0005). Increasing doses of Maitake increased some immunologic parameters and depressed others; the dose-response curves for many endpoints were non-monotonic with intermediate doses having either immune enhancing or immune suppressant effects compared with both high and low doses.

Conclusions: Oral administration of a polysaccharide extract from Maitake mushroom is associated with both immunologically stimulatory and inhibitory measurable effects in peripheral blood. Cancer patients should be made aware of the fact that botanical agents produce more complex effects than assumed, and may depress as well as enhance immune function.

Fig. 1

Study participants flow chart (description and number of participants)

Fig. 2

Maitake dose (g/kg per day) versus immune factor change from baseline (%). Numbered 1 to 5: 1 geometric mean of granulocytes response to fMLP, 2 granulocytes response to fMLP, 3 IFN-γ production from CD45RO+ CD4+ cells unstimulated, 4 granulocytes response stimulated by PMA, 5 IFN-γ production from CD45RA+ CD4+ cells stimulated by PMA

Fig. 3

Maitake dose (g/kg per day) versus immune factor change from baseline (%). Numbered 1 to 7: 1 granulocytes response to PMA, 2 IL-10 production from CD14+ cells stimulated by PMA, 3 IL-10 production from CD3+ cells stimulated by PMA, 4 IL-2 production from CD56+ CD3+ cells unstimulated, 5 TNF-α production from CD3+ cells stimulated by LPS, 6 monocytes response stimulated by fMLP, 7 TNF-α production from unstimulated CD3+ cells

Fig. 4

Maitake dose (g/kg per day) versus immune factor change from baseline (%). Numbered 1 to 4: 1 CD3+ CD56+ NK T cells, 2 CD3+ T cells, 3 CD3+ CD161+ NK T cells, 4 CD3–CD19+ B cells

Fig. 5

Maitake dose (g/kg per day) versus immune factor change from baseline (%). Numbered 1 to 4: 1 CD4+ CD25+ T cells, 2 CD3+ CD25+ T cells, 3 CD45RA+ CD4+ cells, 4 CD45RO+ CD8+ cells