Aloe vera is a cactus-like plant and the gel from its leaves and juice are used for a wide range of problems. In oncology, Aloe vera is applied topically for radiation-induced skin problems, oral submucosal fibrosis (a precancerous condition) and chemotherapy-/radiation-induced inflammation of the digestive tract.
- Radiation-induced skin problems: Two systematic reviews (n=7; n=4) and three additional randomized controlled trials (RCTs) have conflicting results and many limitations.
- Radiation-induced oral mucositis: Although systematic reviews are inconclusive, moderate evidence from three RCTs suggests that Aloe vera mouthwash is as beneficial as conventional mouthwash in head and neck cancer and paediatric leukaemia and chemotherapy-induced stomatitis in leukaemia.
- Radiation-induced proctitis: Evidence from two high-quality randomized clinical trials suggests that Aloe vera ointment may improve some symptoms compared to placebo.
- Oral submucosal fibrosis: Although topical Aloe vera has shown some positive results compared to conventional treatment, these findings are limited by the methodological limitations of the trials.
- Oral Aloe vera juice has been tested as an anti-cancer treatment, but studies are too preliminary to tell whether it is effective.
Numerous adverse events are on record but they are generally mild and reversible. Oral use might cause abortion.
Ava Lorenc, Edzard Ernst, CAM Cancer Consortium. Aloe vera [online document], December 12, 2020.
Latest update: December 2020
Next update due: December 2023
Aloe vera or “true aloe” is the most widely known species of around 500 species of the Aloe genus. It is a cactus-like plant belonging to the Asphodelaceae family. Originally native to the Arabian Peninsula, it grows in tropical and subtropical climates growing and is widely cultivated around the world. For medicinal purposes Aloe gel produced in the inner part of the plant leaves and Aloe latex produced just under the plant’s skin are used. Aloe vera has a long history of medicinal use; today Aloe vera products are available over-the-counter and very popular, particularly for self-treatment and cosmetic use.
Other Aloe species include: Aloe barbadensis, Aloe vulgaris, Aloe chinensis, Aloe indica, Aloe littoralis, Aloe lanzae.
Ingredients and quality requirements
Aloe vera gel is the mucilaginous tissue from the centre of the Aloe vera leaf and contains polysaccharides. Aloe vera latex (taken orally), is made of the peripheral bundle sheath cells and contains aloin, anthraquinones, barbaloine and glycosides (Ernst 2006). The International Aloe Science Council (IASC) advises that Aloe vera products: have been checked for potential contaminants (pathogens, lactic acid, general APC, mould, yeast, heavy metals and undeclared maltodextrin); contain aloin A&B ≤10ppm for juice and powders; contain 1% total aloe solids in aloe vera leaf juice and 0.5% total aloe solids for inner leaf juice; contain minimal malic acid and glucose (IASC 2020).
Application and dosage
Gel is applied topically as needed. Latex is taken orally at doses between 50 and 200mg daily (Ernst 2006).
Traditionally, Aloe vera has been used for a wide range of conditions. In oncology, the main claim is that topical application of the gel prevents or treats radiation-induced skin reactions (Ulbricht 2007). In the general population, Aloe vera is used by between 7 and 10% of adults in Australia, Italy, and Jamaica. In the USA, dietary supplements containing Aloe vera were used by 0.1% of adults in the past 30 days, and Aloe vera is the 20th best-selling dietary supplement, with sales of US$ 72million in 2011 (IARC 2016).
The notion that oral Aloe vera might prevent lung cancer was supported by a Japanese case-control study (Sakai 1989). A comparison of 44 pairs was analysed according to plant food intake. The results suggested that those study participants regularly consuming Aloe vera were associated with a reduced lung cancer-risk. Even though interesting, this small study cannot prove that the detected association is causal.
Mechanisms of action
A multitude of potential mechanisms of action has been identified by in vitro experiments (Ulbricht 2007). Aloe perryi flowers inhibit the growth of seven cancer cell lines (Al-Oqail 2016) and Aloe vera extract inhibits the growth of breast, cervical cancer and neuroblastoma cells, and increases the therapeutic efficacy of conventional drugs (Hussain 2015, Yonehara 2015). Regarding the constituents of Aloe vera, aloin/barbaloin exhibits anti-cancer effects through anti-angiogenic and cytotoxic activities (Cardenas 2006, Xiao 2007, Esmat 2006, Wang 2018, Li 2020), and aloe emodin inhibits the proliferation of cancer cells (including breast, pancreatic, prostate, colorectal, gastric, cervical, and lung cancers, glioma and melanoma (Wu 2018, Tabolacci 2015, Chihara 2015, Ismail 2013, Trybus 2018, Cheng 2018, Du 2019, Gao 2019, Hosseini 2020, Jiang 2020), induces the expression of genes involved in apoptosis (Haris 2014), induces cell differentiation (Tabolacci 2015), inhibits cancer metastasis (Ma 2016) and enhances the effect of radiation (Luo 2014), imatinib (Akev 2020) and tamoxifen (Tseng 2017). Photodynamic therapy with aloe-emodin causes cell death, induces autophagy, and inhibits adhesion, migration and invasion of cancer cells (Ismail 2013, Li 2016, Tu 2016, Chen 2018). Animal experiments have demonstrated detoxification of carcinogens (Singh 2000), reduced tumour angiogenesis (Kocik 2014, Arcella 2018) and reduction of papilloma growth in mice (Chaudhary 2007, Saini 2010) and chemopreventive effects (Chihara 2015, Im 2016, Shimpo 2014, Birari 2020) through modulating antioxidant and detoxification enzyme activity (El-Shemy 2010, Wang 2020).
Aloe vera latex is a powerful laxative. Aloe vera gel has antimicrobial, antioxidant, antiproliferative, chemo-preventive, anti-inflammatory, moisturising and antipuritic actions (Ernst 2006, Richardson 2005, Su 2004). Anthraquinones of Aloe vera latex also have cytotoxic, radioprotective as well as anti angiogenic effects and inhibit angiogenic and metastatic regulatory processes (Lissoni 1998, Suboj 2012). In addition, aloin may enhance cisplatin antineoplastic activity in B16-F10 melanoma cells (Tabolacci 2013).
Aloin-loaded tablets may be a useful drug delivery system as a coadjuvant of conventional chemotherapy/radiation therapy (De Caro 2014).
Legal issues and cost
Aloe vera products are sold as cosmetics or as herbal supplements. High quality products are widely available and usually inexpensive. A typical week’s supply of Aloe vera gel would cost less than €6.
Four systematic reviews (Richardson 2005, de Almeida 2020, Yu 2020, Worthington 2011) and 10 RCTs have investigated the use of Aloe vera for side effects of cancer radiotherapy treatment: skin problems (Rao 2017, Ahmadloo 2017, Sahebjamee 2015), oral mucositis (Puataweepong 2009, Sahebjamee 2015, Su 2004, Mansouri 2016, Alkhouli 2020), and proctitis (Sahebnasagh 2020, Sahebnasagh 2017). Four RCTs have investigated the use of Aloe vera for oral submucosal fibrosis (OSMF), a potentially malignant disorder of the oral mucosa (Sudarshan 2012, Patil 2014, Singh 2016, Anuradha 2016).
The results of the SRs and trials suggest:
- Evidence for Aloe vera for radiation-induced skin problems is poor quality and conflicting.
- Aloe vera may improve some symptoms of radiation-induced oral mucositis similarly to conventional mouthwashes, but this is based on only a few studies.
- Evidence from two well conducted studies suggests that Aloe vera improves some symptoms of radiation-induced proctitis compared to placebo.
- Oral Aloe vera juice has been tested as an anti-cancer treatment, but the two studies are too preliminary to tell whether it is effective.
- There is some moderate quality evidence (n=4) that Aloe vera may improve symptoms of oral submucosal fibrosis as well as conventional treatment.
Description of included studies
Radiation-induced skin problems
Richardson 2005 systematic review included seven randomized controlled trials (RCTs) of topical Aloe vera gel to treat radiation-induced skin problems. The quality of the studies and of reporting was frequently poor. Overall, the results failed to show the superiority of topical Aloe vera gel over various control treatments. The authors conclude that “there is no evidence from clinical trials to suggest that topical Aloe vera is effective in preventing or minimising radiation-induced skin reactions in cancer patients” (Richardson 2005). De Almeida et al conducted a systematic review of medicinal plants for treating side effects of cancer treatment, including four studies of Aloe vera(de Almeida 2020). They found conflicting evidence from two studies on the effect of Aloe vera on skin reactions to radiotherapy. Although the selection process seems thorough, this review may not have identified all relevant studies as they searched a small number of databases and used a limited range of keywords.
Three further trials of topical Aloe vera on radiation-induced skin problems were not included in either review (see evidence table for Aloe vera ) (Rao 2017, Sahebjamee 2015, Ahmadloo 2017). Topical Aloe vera may reduce the incidence of radiation-induced dermatitis in patients (n=60) with head and neck cancer (Rao 2017) although the study does have some limitations. One good quality (n=248) and one poor quality study (n=100) suggest no effect in breast cancer (Ahmadloo 2017, Hoopfer 2015).
A 2011 Cochrane review of interventions to prevent mucositis in cancer patients found “weak unreliable evidence that Aloe vera may be beneficial in the prevention of moderate to severe mucositis”, although this is now out of date (Worthington 2011). The more recent systematic review (de Almeida 2020) included one small (n=26) and possibly underpowered but well conducted RCT (Sahebjamee 2015). It reports similar effects of Aloe vera on mucositis to those of benzydamine mouthwash. A 2020 systematic review and network meta-analysis of 9 oral care solutions for preventing oral mucositis ranked Aloe vera lowest out of the 9 interventions (Yu 2020), however this was based on the one small study by Sahebjamee 2015.
Two subsequently published RCTs studied Aloe vera for radiation-induced oral mucositis in head and neck cancer (see Table 1) (Su 2004, Puataweepong 2009), and two in patients with leukaemia - one with children (Alkhouli 2020), one for chemotherapy-induced stomatitis (Mansouri 2016). There is moderate quality evidence that oral Aloe vera reduces the incidence but not duration of mucositis compared to placebo (n=61) (Puataweepong 2009), and may reduce onset, severity, intensity and pain better than or as well as conventional mouthwashes (n=26, n=64) (Mansouri 2016, Alkhouli 2020). However, Su 2004 (n=58) found no difference compared to placebo. Two of these studies had small sample sizes (Su 2004, Alkhouli 2020).
Two well conducted, powered and blinded RCTs investigated Aloe vera for proctitis in patients with pelvic cancer (n=42)(Sahebnasagh 2020); (n=20)(Sahebnasagh 2017). Both found that topical Aloe vera improves some symptoms of radiotherapy-induced proctitis (diarrhoea, faecal urgency, clinical presentation inflammation and lifestyle) and possibly rectal bleeding, compared to placebo (Sahebnasagh 2017, Sahebnagasgh 2020).
There is preliminary evidence from two RCTs (n=240) that oral Aloe vera in combination with chemotherapy (n=240) (Lissoni 2009) or melatonin (n=50) (Lissoni 1998) may improve stabilization of disease and survival in patients with advanced solid tumours, for whom no other standard effective therapy is available.
Oral Submucosal Fibrosis (OSMF)
Four trials tested Aloe vera for oral submucosal fibrosis (OSMF), three topical (gel) (n=20), (n=120), (n=40) (Sudarshan 2012, Patil 2014, Singh 2016) and one oral and topical (n=74) (Anuradha 2016) (see Table 1). OSMF is a potentially malignant disorder of the oral mucosa, frequently associated with chewing gutka and betel quid (Sudarshan 2012). There was some evidence that Aloe vera may improve symptoms (burning sensation, mouth opening, tongue protrusion and cheek flexibility) as well as conventional treatment, but all four trials have significant limitations in methodology and reporting
Numerous adverse effects are on record but, generally speaking, these are mild and reversible (Ulbricht 2007). Topical use: allergic reactions, delayed healing of deep wounds.
Oral use: irritation of and damage to intestinal mucosa, intestinal pain, vomiting, diarrhoea, cathartic colon, fluid and electrolyte loss, kidney failure, phototoxicity and hypersensitive reactions (Guo 2016).
Oral: pregnancy (oral administration can cause abortion), intestinal obstruction or inflammation.
Oral: increased effects of antiarrhythmics, cardiac glycosides, diuretics and steroids (Ulbricht 2007).
Based on animal studies, there is a suspicion that oral use of Aloe vera might promote colonic cancer (Yokohira 2009, Bodreau 2013, Peng 2019, Peng 2020) although a subsequent study using Aloe vera extract with the latex component removed (which removed some mutagenic components (Guo 2014)) had no toxicological findings after 13 weeks (Sehgal 2013). There is also suspicion that topical use might enhance the induction of skin cancer by ultraviolet light (Photocarcinogenesis study of aloe vera).
Ahmadloo N, Kadkhodaei B, Omidvari S, Mosalaei A, Ansari M, Nasrollahi H, et al. Lack of Prophylactic Effects of Aloe Vera Gel on Radiation Induced Dermatitis in Breast Cancer Patients. Asian Pacific journal of cancer prevention : APJCP. 2017;18(4):1139-43.
Akev, N., E. Candoken, and S. Erdem Kuruca. 2020. 'Comparative Study on the Anticancer Drug Potential of a Lectin Purified from Aloe Vera and Aloe-Emodin', Asian Pac J Cancer Prev, 21: 99-106.
Alkhouli, M., M. Laflouf, and M. Alhaddad. 2020. 'Efficacy of aloe-vera use for prevention of chemotherapy-induced oral mucositis in children with acute lymphoblastic leukemia: a randomized controlled clinical trial', Comprehensive child and adolescent nursing: 1‐14.
Al-Oqail MM, El-Shaibany A, Al-Jassas E, Al-Sheddi ES, Al-Massarani SM, Farshori NN. In vitro anti-proliferative activities of Aloe perryi flowers extract on human liver, colon, breast, lung, prostate and epithelial cancer cell lines. Pakistan journal of pharmaceutical sciences. 2016;29(2 Suppl):723-9.
Anuradha, A., B. Patil, and V. R. Asha. 2016. 'Evaluation of efficacy of aloe vera in the treatment of oral submucous fibrosis - a clinical study', J Oral Pathol Med, 46: 50-55.
Arcella, A., M. A. Oliva, S. Staffieri, M. Sanchez, M. Madonna, B. Riozzi, V. Esposito, F. Giangaspero, and L. Frati. 2018. 'Effects of aloe emodin on U87MG glioblastoma cell growth: In vitro and in vivo study', Environ Toxicol, 33: 1160-67.
Birari, Lalit, Shivani Wagh, Kalpesh R. Patil, Umesh B. Mahajan, Banappa Unger, Sateesh Belemkar, Sameer N. Goyal, Shreesh Ojha, and Chandragouda R. Patil. 2020. 'Aloin alleviates doxorubicin-induced cardiotoxicity in rats by abrogating oxidative stress and pro-inflammatory cytokines', Cancer chemotherapy and pharmacology, 86: 419-26.
Boudreau MD, Beland FA, Nichols JA, Pogribna M. Toxicology and carcinogenesis studies of a nondecolorized [corrected] whole leaf extract of Aloe barbadensis Miller (Aloe vera) in F344/N rats and B6C3F1 mice (drinking water study). National Toxicology Program technical report series. 2013(577):1-266.
Cardenas C, Quesada AR, Medina MA. Evaluation of the anti-angiogenic effect of aloe-emodin. Cellular and molecular life sciences : CMLS. 2006;63(24):3083-9.
Chaudhary G, Saini MR, Goyal PK. Chemopreventive potential of Aloe vera against 7,12-dimethylbenz(a)anthracene induced skin papillomagenesis in mice. Integrative cancer therapies. 2007;6(4):405-12.
Chen, Q., K. T. Li, S. Tian, T. H. Yu, L. H. Yu, H. D. Lin, and D. Q. Bai. 2018. 'Photodynamic Therapy Mediated by Aloe-Emodin Inhibited Angiogenesis and Cell Metastasis Through Activating MAPK Signaling Pathway on HUVECs', Technol Cancer Res Treat, 17: 1533033818785512.
Cheng, C., and W. Dong. 2018. 'Aloe-Emodin Induces Endoplasmic Reticulum Stress-Dependent Apoptosis in Colorectal Cancer Cells', Med Sci Monit, 24: 6331-39.
Chihara T, Shimpo K, Beppu H, Yamamoto N, Kaneko T, Wakamatsu K, et al. Effects of Aloe-emodin and Emodin on Proliferation of the MKN45 Human Gastric Cancer Cell Line. Asian Pacific journal of cancer prevention : APJCP. 2015;16(9):3887-91.
de Almeida, E. M., H. J. Ferreira, D. R. Alves, and W. M. B. da Silva. 2020. 'Therapeutic potential of medicinal plants indicated by the Brazilian public health system in treating the collateral effects induced by chemotherapy, radiotherapy, and chemoradiotherapy: A systematic review', Complement Ther Med, 49: 102293.
De Caro V, Scaturro AL, Di Prima G, Avellone G, Sutera FM, Di Fede O, et al. Aloin delivery on buccal mucosa: ex vivo studies and design of a new locoregional dosing system. Drug development and industrial pharmacy. 2014;41(9):1541-7.
Du, Y., J. Zhang, Z. Tao, C. Wang, S. Yan, X. Zhang, and M. Huang. 2019. 'Aloe emodin exerts potent anticancer effects in MIAPaCa-2 and PANC-1 human pancreatic adenocarcinoma cell lines through activation of both apoptotic and autophagic pathways, sub-G1 cell cycle arrest and disruption of mitochondrial membrane potential (LambdaPsim)', J buon, 24: 746-53.
El-Shemy HA, Aboul-Soud MA, Nassr-Allah AA, Aboul-Enein KM, Kabash A, Yagi A. Antitumor properties and modulation of antioxidant enzymes' activity by Aloe vera leaf active principles isolated via supercritical carbon dioxide extraction. Current medicinal chemistry. 2010;17(2):129-38.
Ernst E, Pittler M, Wider B, Boddy K. The Desktop Guide to Complementary and Alternative Medicine. 2nd edition ed. Edinburgh: Elsevier Mosby; 2006.
Esmat AY, Tomasetto C, Rio MC. Cytotoxicity of a natural anthraquinone (Aloin) against human breast cancer cell lines with and without ErbB-2: topoisomerase IIalpha coamplification. Cancer biology & therapy. 2006;5(1):97-103.
Gao, R., X. Wu, Z. Huang, B. Wang, F. Li, H. Xu, and L. Ran. 2019. 'Anti-tumor effect of aloe-emodin on cervical cancer cells was associated with human papillomavirus E6/E7 and glucose metabolism', Onco Targets Ther, 12: 3713-21.
Guo X, Mei N. Aloe vera: A review of toxicity and adverse clinical effects. Journal of environmental science and health Part C, Environmental carcinogenesis & ecotoxicology reviews. 2016;34(2):77-96.
Guo X, Zhang S, Dial SL, Boudreau MD, Xia Q, Fu PP, et al. In vitro investigation of the mutagenic potential of Aloe vera extracts. Toxicology Research. 2014;3(6):487-96.
Haddad P, Amouzgar-Hashemi F, Samsami S, Chinichian S, Oghabian MA. Aloe vera for prevention of radiation-induced dermatitis: a self-controlled clinical trial. Current oncology (Toronto, Ont). 2013;20(4):e345-8.
Haris K, Ismail S, Idris Z, Abdullah JM, Yusoff AA. Expression profile of genes modulated by Aloe emodin in human U87 glioblastoma cells. Asian Pacific journal of cancer prevention : APJCP. 2014;15(11):4499-505.
Hoopfer D, Holloway C, Gabos Z, Alidrisi M, Chafe S, Krause B, et al. Three-Arm Randomized Phase III Trial: Quality Aloe and Placebo Cream Versus Powder as Skin Treatment During Breast Cancer Radiation Therapy. Clinical breast cancer. 2015;15(3):181-90.e1-4.
Hosseini, M. S., F. Hosseini, A. Ahmadi, M. Mozafari, and I. Amjadi. 2020. 'Antiproliferative Activity of Hypericum perforatum, Achillea millefolium, and Aloe vera in Interaction with the Prostatic Activity of CD82', Rep Biochem Mol Biol, 8: 260-68.
Hussain A, Sharma C, Khan S, Shah K, Haque S. Aloe vera inhibits proliferation of human breast and cervical cancer cells and acts synergistically with cisplatin. Asian Pacific journal of cancer prevention : APJCP. 2015;16(7):2939-46.
IASC, The International Aloe Science Council. 'Aloe vera Quality Standard', Accessed 05/11/2020.
Im SA, Kim JW, Kim HS, Park CS, Shin E, Do SG, et al. Prevention of azoxymethane/dextran sodium sulfate-induced mouse colon carcinogenesis by processed Aloe vera gel. International immunopharmacology. 2016;40:428-35.
International Agency For Research On Cancer. Some Drugs And Herbal Products Volume 108: IARC Monographs On The Evaluation Of Carcinogenic Risks To Humans. Switzerland: WHO; 2016.
Ismail S, Haris K, Abdul Ghani AR, Abdullah JM, Johan MF, Mohamed Yusoff AA. Enhanced induction of cell cycle arrest and apoptosis via the mitochondrial membrane potential disruption in human U87 malignant glioma cells by aloe emodin. Journal of Asian natural products research. 2013;15(9):1003-12.
Jiang, X., Y. Liu, G. Zhang, S. Lin, J. Wu, X. Yan, Y. Ma, and M. Ma. 2020. 'Aloe-Emodin Induces Breast Tumor Cell Apoptosis through Upregulation of miR-15a/miR-16-1 That Suppresses BCL2', Evid Based Complement Alternat Med, 2020: 5108298.
Kocik J, Balan BJ, Zdanowski R, Jung L, Skopinska-Rozewska E, Skopinski P. Feeding mice with Aloe vera gel diminishes L-1 sarcoma-induced early neovascular response and tumor growth. Central-European journal of immunology. 2014;39(1):14-8.
Li KT, Chen Q, Wang DW, Duan QQ, Tian S, He JW, et al. Mitochondrial pathway and endoplasmic reticulum stress participate in the photosensitizing effectiveness of AE-PDT in MG63 cells. Cancer medicine. 2016;5(11):3186-93.
Li, P., K. Ren, Y. Y. Liang, J. K. Liu, Z. W. Liang, and Y. F. Zhang. 2020. 'Aloin promotes cell apoptosis by targeting HMGB1-TLR4-ERK axis in human melanoma cells', Excli j, 19: 641-51.
Lissoni P, Giani L, Zerbini S, Trabattoni P, Rovelli F. Biotherapy with the pineal immunomodulating hormone melatonin versus melatonin plus aloe vera in untreatable advanced solid neoplasms. Natural immunity. 1998;16(1):27-33.
Lissoni P, Rovelli F, Brivio F, Zago R, Colciago M, Messina G, et al. A randomized study of chemotherapy versus biochemotherapy with chemotherapy plus Aloe arborescens in patients with metastatic cancer. In vivo (Athens, Greece). 2009;23(1):171-5.
Luo J, Yuan Y, Chang P, Li D, Liu Z, Qu Y. Combination of aloe-emodin with radiation enhances radiation effects and improves differentiation in human cervical cancer cells. Molecular medicine reports. 2014;10(2):731-6.
Ma JW, Hung CM, Lin YC, Ho CT, Kao JY, Way TD. Aloe-emodin inhibits HER-2 expression through the downregulation of Y-box binding protein-1 in HER-2-overexpressing human breast cancer cells. Oncotarget. 2016;7(37):58915-30.
Mansouri P, Haghighi M, Beheshtipour N, Ramzi M. The Effect of Aloe Vera Solution on Chemotherapy-Induced Stomatitis in Clients with Lymphoma and Leukemia: A Randomized Controlled Clinical Trial. International journal of community based nursing and midwifery. 2016;4(2):119-26.
Mansouri, P., M. Haghighi, N. Beheshtipour, and M. Ramzi. 2016. 'The Effect of Aloe Vera Solution on Chemotherapy-Induced Stomatitis in Clients with Lymphoma and Leukemia: A Randomized Controlled Clinical Trial', Int J Community Based Nurs Midwifery, 4: 119-26.
Patil, S., V. Halgatti, S. Maheshwari, and B. S. Santosh. 2014. 'Comparative study of the efficacy of herbal antioxdants oxitard and aloe vera in the treatment of oral submucous fibrosis', J Clin Exp Dent, 6: e265-70.
Peng, C., W. Zhang, C. Dai, W. Li, X. Shen, Y. Yuan, L. Yan, W. Zhang, and M. Yao. 2019. 'Study of the aqueous extract of Aloe vera and its two active components on the Wnt/beta-catenin and Notch signaling pathways in colorectal cancer cells', J Ethnopharmacol, 243: 112092.
Peng, C., W. Zhang, X. Shen, Y. Yuan, Y. Li, W. Zhang, and M. Yao. 2020. 'Post-transcriptional regulation activity through alternative splicing involved in the effects of Aloe vera on the Wnt/beta-catenin and Notch pathways in colorectal cancer cells', J Pharmacol Sci, 143: 148-55.
Photocarcinogenesis study of aloe vera [CAS NO. 481-72-1(Aloe-emodin)] in SKH-1 mice (simulated solar light and topical application study). National Toxicology Program technical report series. 2010(553):7-33, 5-97, 9-103 passim.
Puataweepong P, Dhanachai M, Dangprasert S, Sithatani C, Sawangsilp T, Narkwong L, et al. The efficacy of oral Aloe vera juice for radiation induced mucositis in head and neck cancer patients: a double-blind placebo-controlled study. Asian Biomedicine. 2009;3(4):375-82.
Rao S, Hegde SK, Baliga-Rao MP, Palatty PL, George T, Baliga MS. An Aloe Vera-Based Cosmeceutical Cream Delays and Mitigates Ionizing Radiation-Induced Dermatitis in Head and Neck Cancer Patients Undergoing Curative Radiotherapy: A Clinical Study. Medicines (Basel, Switzerland). 2017;4(3).
Richardson J, Smith JE, McIntyre M, Thomas R, Pilkington K. Aloe Vera for Preventing Radiation-induced Skin Reactions: A Systematic Literature Review. Clinical Oncology. 2005;17(6):478-84.
Sahebjamee M, Mansourian A, Hajimirzamohammad M, Mohammad H, Zadeh M, Bekhradi R, et al. Comparative Efficacy of Aloe vera and Benzydamine Mouthwashes on Radiation-induced Oral Mucositis: a Triple-blind, Randomised, Controlled Clinical Trial. Oral health & preventive dentistry. 2015; 13(4):309-15.
Sahebnasagh A, Ghasemi A, Akbari J, Alipour A, Lashkardoost H, Ala S, et al. Successful Treatment of Acute Radiation Proctitis with Aloe Vera: A Preliminary Randomized Controlled Clinical Trial. Journal of alternative and complementary medicine (New York, NY). 2017;23(11):858-65.
Sahebnasagh, A., A. Ghasemi, J. Akbari, A. Alipour, H. Lashkardoost, S. Ala, S. J. Hosseinimehr, and E. Salehifar. 2020. 'Prevention of acute radiation-induced Proctitis by Aloe vera: a prospective randomized, double-blind, placebo controlled clinical trial in Pelvic Cancer patients', BMC Complement Med Ther, 20: 146.
Saini M, Goyal PK, Chaudhary G. Anti-tumor activity of Aloe vera against DMBA/croton oil-induced skin papillomagenesis in Swiss albino mice. Journal of environmental pathology, toxicology and oncology : official organ of the International Society for Environmental Toxicology and Cancer. 2010;29(2):127-35.
Sakai R. Epidemiologic survey on lung cancer with respect to cigarette smoking and plant diet. Japanese journal of cancer research : Gann. 1989;80(6):513-20.
Sehgal I, Winters WD, Scott M, David A, Gillis G, Stoufflet T, et al. Toxicologic assessment of a commercial decolorized whole leaf aloe vera juice, lily of the desert filtered whole leaf juice with aloesorb. Journal of toxicology. 2013;2013:802453.
Shimpo K, Chihara T, Kaneko T, Beppu H, Wakamatsu K, Shinzato M, et al. Inhibitory effects of low-dose aloe-emodin on the development of colorectal tumors in min mice. Asian Pacific journal of cancer prevention : APJCP. 2014;15(14):5587-92.
Singh N, Hebbale M, Mhapuskar A, Ul NS, Thopte S, Singh S. Effectiveness of aloe vera and antioxidant along with physiotherapy in the management of oral submucous fibrosis. Journal of contemporary dental practice [Internet]. 2016; 17(1):[78-84 pp.].
Singh RP, Dhanalakshmi S, Rao AR. Chemomodulatory action of Aloe vera on the profiles of enzymes associated with carcinogen metabolism and antioxidant status regulation in mice. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2000;7(3):209-19.
Singh, N., M. Hebbale, A. Mhapuskar, Nisa S. Ul, S. Thopte, and S. Singh. 2016. "Effectiveness of aloe vera and antioxidant along with physiotherapy in the management of oral submucous fibrosis." In Journal of contemporary dental practice, 78-84.
Su CK, Mehta V, Ravikumar L, Shah R, Pinto H, Halpern J, et al. Phase II double-blind randomized study comparing oral aloe vera versus placebo to prevent radiation-related mucositis in patients with head-and-neck neoplasms. International Journal of Radiation Oncology • Biology • Physics. 2004;60(1):171-7.
Suboj P, Babykutty S, Valiyaparambil Gopi DR, Nair RS, Srinivas P, Gopala S. Aloe emodin inhibits colon cancer cell migration/angiogenesis by downregulating MMP-2/9, RhoB and VEGF via reduced DNA binding activity of NF-kappaB. European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences. 2012;45(5):581-91.
Sudarshan, R., R. G. Annigeri, and G. Sree Vijayabala. 2012. 'Aloe vera in the treatment for oral submucous fibrosis - a preliminary study', J Oral Pathol Med, 41: 755-61.
Tabolacci C, Cordella M, Turcano L, Rossi S, Lentini A, Mariotti S, et al. Aloe-emodin exerts a potent anticancer and immunomodulatory activity on BRAF-mutated human melanoma cells. European journal of pharmacology. 2015;762:283-92.
Tabolacci C, Rossi S, Lentini A, Provenzano B, Turcano L, Facchiano F, et al. Aloin enhances cisplatin antineoplastic activity in B16-F10 melanoma cells by transglutaminase-induced differentiation. Amino acids. 2013;44(1):293-300.
Trybus W, Krol T, Trybus E, Stachurska A, Kopacz-Bednarska A, Krol G. Induction of Mitotic Catastrophe in Human Cervical Cancer Cells After Administration of Aloe-emodin. Anticancer research. 2018;38(4):2037-44.
Tseng HS, Wang YF, Tzeng YM, Chen DR, Liao YF, Chiu HY, et al. Aloe-Emodin Enhances Tamoxifen Cytotoxicity by Suppressing Ras/ERK and PI3K/mTOR in Breast Cancer Cells. The American journal of Chinese medicine. 2017;45(2):337-50.
Tu P, Huang Q, Ou Y, Du X, Li K, Tao Y, et al. Aloe-emodin-mediated photodynamic therapy induces autophagy and apoptosis in human osteosarcoma cell line MG63 through the ROS/JNK signaling pathway. Oncology reports. 2016;35(6):3209-15.
Ulbricht C, Armstrong J, Basch E, Basch S, Bent S, Dacey C, et al. An evidence-based systematic review of Aloe vera by the natural standard research collaboration. Journal of herbal pharmacotherapy. 2007;7(3-4):279-323.
Wang YR, Yang SY, Chen GX, Wei P. Barbaloin loaded polydopamine-polylactide-TPGS (PLA-TPGS) nanoparticles against gastric cancer as a targeted drug delivery system: Studies in vitro and in vivo. Biochemical and biophysical research communications. 2018;499(1):8-16.
Wang, S., W. W. Yan, M. He, D. Wei, Z. J. Long, and Y. M. Tao. 2020. 'Aloe emodin inhibits telomerase activity in breast cancer cells: transcriptional and enzymological mechanism', Pharmacol Rep.
Worthington HV, Clarkson JE, Bryan G, Furness S, Glenny AM, Littlewood A, et al. Interventions for preventing oral mucositis for patients with cancer receiving treatment. The Cochrane database of systematic reviews. 2011(4):Cd000978.
Wu YY, Zhang JH, Gao JH, Li YS. Aloe-emodin (AE) nanoparticles suppresses proliferation and induces apoptosis in human lung squamous carcinoma via ROS generation in vitro and in vivo. Biochemical and biophysical research communications. 2017;490(3):601-7.
Xiao B, Guo J, Liu D, Zhang S. Aloe-emodin induces in vitro G2/M arrest and alkaline phosphatase activation in human oral cancer KB cells. Oral oncology. 2007;43(9):905-10.
Yokohira M, Matsuda Y, Suzuki S, Hosokawa K, Yamakawa K, Hashimoto N, et al. Equivocal colonic carcinogenicity of Aloe arborescens Miller var. natalensis berger at high-dose level in a Wistar Hannover rat 2-y study. Journal of food science. 2009;74(2):T24-30.
Yonehara A, Tanaka Y, Kulkeaw K, Era T, Nakanishi Y, Sugiyama D. Aloe vera Extract Suppresses Proliferation of Neuroblastoma Cells In Vitro. Anticancer research. 2015;35(8):4479-85.
Yu, Y. Y., J. L. Deng, X. R. Jin, Z. Z. Zhang, X. H. Zhang, and X. Zhou. 2020. 'Effects of 9 oral care solutions on the prevention of oral mucositis: a network meta-analysis of randomized controlled trials', Medicine (Baltimore), 99: e19661.