A review on traditionally used South African medicinal plants, their secondary metabolites and their into anticancer

Ethnopharmacological relevance: Approximately 70% of anticancer drugs were developed or derived from natural products or plants. Southern Africa boasts an enormous floral diversity with approximately 22,755 plant species with an estimated 3000 used as traditional medicines. In South Africa more than 27 million individuals rely on traditional medicine for healthcare. The use of South African plants for the treatment of cancer is poorly documented, however there is potential to develop anticancer agents from these plants. Limited ethnobotanical studies report the use of plants for cancer treatment in traditional medicine. Plants growing in tropical or subtropical regions, such as in South Africa, produce important secondary metabolites as a protective mechanism, which could be used to target various factors that play a key role in carcinogenesis. Aims: The aim was to collate information from primary ethnobotanical studies on South African plants traditionally used for the treatment of cancer. Evaluation of literature focused on traditionally used plants that have been tested for their in vitro activity against cancer cells. Secondary metabolites, previously identified within these plant species, were also included for discussion regarding their activity against cancer. The toxicity was evaluated to ascertain the therapeutic potential in further studies. Additionally, the aim was to highlight where a lack of reports were found regarding plant species with potential activity and to substantiate the need for further testing. Materials and methods: A review of ethnobotanical surveys conducted in South Africa for plants used in the treatment of cancer was performed. Databases such as Science Direct, PubMed and Google Scholar, university repositories of master's dissertations and PhD theses, patents and books were used. Plant species showing significant to moderate activity were discussed regarding their toxicity. Compounds identified within these species were discussed for their activity against cancer cells and toxicity. Traditionally used plants which have not been scientifically validated for their activity against cancer were excluded. Results: Twenty plants were documented in ethnobotanical surveys as cancer treatments. Numerous scientific reports on the potential in vitro activity against cancer of these plants and the identification of secondary metabolites were found. Many of the secondary metabolites have not been tested for their activity against cancer cells or mode of action and should be considered for future studies. Lead candidates, such as the sutherlandiosides, sutherlandins, hypoxoside and pittoviridoside, were identified and should be further assessed. Toxicity studies should be included when testing plant extracts and/or secondary metabolites for their potential against cancer cells to give an indication of whether further analysis should be conducted. Conclusion: There is a need to document plants used traditionally in South Africa for the treatment of cancer and to assess their safety and efficacy. Traditionally used plants have shown promising activity highlighting the importance of ethnobotanical studies and traditional knowledge. There are many opportunities to further assess these plants and secondary metabolites for their activity against cancer and their toxic effects. Pharmacokinetic studies are also not well documented within these plant extracts and should be included in studies when a lead candidate is identified.