Toxicology of a Peruvian botanical remedy to support healthy liver function

J Complement Integr Med. 2016 Jun 1;13(2):163-73. doi: 10.1515/jcim-2015-0054.


Background: The purpose of these studies was to determine the safety of a botanical treatment for supporting healthy liver function developed in Peru. The formulation, A4+, contains extracts of Curcuma longa L. rhizome (A4R), Cordia lutea Lam. flower (A4F) and Annona muricata L. leaf (A4L). The tests were used to support an application for a non-traditional Natural Health Product Licence from the Natural Health Product Directorate of Health Canada and future clinical trials.

Methods: Besides reviewing the scientific and clinical information from Peru on the ingredients and conducting an initial Ames test for mutagenicity, we analysed A4+ for its chemical profile and tested genotoxicity (micronucleus test) and general toxicity (28-day repeated dose).

Results: A4+ and extracts from the three plants provided distinctive chemical fingerprints. A4L contained acetogenins, requiring a second chromatographic method to produce a specific fingerprint. The Ames test proved positive at the highest concentration (5,000 μg/mL) but A4+ showed no evidence of genotoxicity in the more specific mouse micronucleus test. The 28-day repeated dose (general toxicity) study in rats showed no toxicity at 2,000 mg/kg.

Conclusions: We conclude that under the conditions of these studies, A4+ shows no evidence of toxicity at the levels indicated. A no observed adverse effect level (NOAEL) of 2,000 mg/kg was assigned.

MeSH terms

  • Animals
  • Annona / toxicity*
  • Cordia / toxicity*
  • Curcuma / toxicity*
  • Ethnopharmacology
  • Liver / drug effects*
  • Mice
  • No-Observed-Adverse-Effect Level
  • Peru
  • Plant Extracts / toxicity*
  • Rats


  • Plant Extracts
  • turmeric extract