Investigation of the pathways and mechanisms of Sambucus nigra on different types of cancers: a review

What the paper says

Purpose This study aims to evaluate the anticancer potential of elderberry (Sambucus nigra L.) as a functional food ingredient, focusing on its bioactive compounds and their roles in oxidative stress regulation, apoptosis, immune modulation and chemotherapy support, alongside safety considerations and translational relevance. Design/methodology/approach A structured literature review was conducted using PubMed, Scopus, Web of Science, Google Scholar and ScienceDirect for studies published between January 2000 and May 2024. Peer-reviewed in vitro, in vivo, clinical studies and relevant reviews/meta-analyses were included. Extracted data covered study models, elderberry compounds and extracts, dosage, molecular mechanisms and reported biological outcomes. Findings Elderberry exhibits preventive and supportive anticancer effects through antioxidant, antiproliferative and pro-apoptotic mechanisms. Its phytochemicals may reduce chemotherapy-related toxicity and enhance tumor cell sensitivity to treatment. However, heterogeneity in extract preparation, dosage and experimental design, combined with limited human clinical evidence, restricts firm nutritional or therapeutic conclusions. Research limitations/implications Current evidence on S. nigra’s anticancer effects is predominantly preclinical, with limited in vivo and no clinical trial data. Variability in extract composition, lack of standardized dosing and inconsistent methodological quality hinder reproducibility and translational applicability. Safety concerns related to cyanogenic glycosides remain underexplored in long-term models. Regulatory classification of elderberry compounds varies across jurisdictions, complicating therapeutic integration. Future research should prioritize standardized formulations, mechanistic validation in human models and alignment with international regulatory frameworks to support clinical translation and safe use. Practical implications The findings support the integration of S. nigra as a complementary agent in cancer therapy, particularly for enhancing chemosensitivity and mitigating drug resistance. Its multitarget mechanisms offer potential for personalized treatment strategies. However, practical application requires standardized extract formulations, validated dosing protocols and regulatory oversight to ensure safety and efficacy. Healthcare professionals and researchers should consider elderberry’s pharmacological profile and toxicological risks when designing adjuvant therapies. The review provides a foundation for developing elderberry-based interventions aligned with clinical and regulatory standards. Social implications The growing interest in S. nigra as a natural anticancer agent reflects a broader societal shift toward plant-based and integrative therapies. Its potential use may empower communities with accessible, culturally accepted alternatives, especially in regions with limited access to conventional treatments. However, public awareness of safety concerns and regulatory oversight is essential to prevent misuse or overreliance on unstandardized products. This review encourages informed decision-making, bridging traditional knowledge with scientific validation and promoting equitable health-care innovation rooted in natural resources. Originality/value This review integrates mechanistic and nutritional evidence linking elderberry to cancer-related outcomes and identifies key research gaps. It emphasizes the need for standardized formulations, toxicological assessment and early-phase clinical trials to evaluate safety and efficacy, supporting elderberry’s potential role as an adjunct in oncology nutrition.