title: Review of Ginkgo biloba-induced toxicity, from experimental studies to human case reports.
abstract: Ginkgo biloba seeds and leaves have been used as a traditional herbal remedy for thousands of years, and its leaf extract has been consumed as a botanical dietary supplement for decades. Ginkgo biloba extract is a complex mixture with numerous components, including flavonol glycosides and terpene lactones, and is one of the most widely sold botanical dietary supplements worldwide. Concerns about potential health risks for the general population have been raised because of the widespread human exposure to Ginkgo biloba and its potential toxic and carcinogenic activities in rodents. The National Toxicology Program conducted 2-year gavage studies on one Ginkgo biloba leaf extract and concluded that there was clear evidence of carcinogenic activity of this extract in mice based on an increased incidence of hepatocellular carcinoma and hepatoblastoma. Recently, Ginkgo biloba leaf extract has been classified as a possible human carcinogen (Group 2B) by the International Agency for Research on Cancer. This review presents updated information on the toxicological effects from experimental studies both in vitro and in vivo to human case reports (caused by ginkgo seeds or leaves), and also summarizes the negative results from relatively large clinical trials.
authors.affiliation: a Division of Genetic and Molecular Toxicology , National Center for Toxicological Research , Jefferson , Arkansas , USA.
authors.forename: Nan
authors.initials: N
authors.lastname: Mei
authors.affiliation: a Division of Genetic and Molecular Toxicology , National Center for Toxicological Research , Jefferson , Arkansas , USA.
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Guo
authors.affiliation: b Division of Biochemical Toxicology , National Center for Toxicological Research , Jefferson , Arkansas , USA.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Ren
authors.affiliation: c Department of Food and Chemical Toxicology , Faculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido , Hokkaido , Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: c Department of Food and Chemical Toxicology , Faculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido , Hokkaido , Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Wada
authors.affiliation: b Division of Biochemical Toxicology , National Center for Toxicological Research , Jefferson , Arkansas , USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Guo
mesh_terms: D019587:Dietary Supplements / Q000633:toxicity; D020441:Ginkgo biloba / Q000633:toxicity*; D006801:Humans; D010936:Plant Extracts / Q000633:toxicity*; D013729:Terpenes
chemical_list: D010936:Plant Extracts; D013729:Terpenes
keywords: Case report; Ginkgo biloba leaf extract; clinical trial; genotoxicity; ginkgo seeds; toxicity