Ellagic acid and Annona muricata in the chemoprevention of HPV-related pre-neoplastic lesions of the cervix

Ellagic acid is a phenolic compound naturally present in nuts and berries. Several studies have demonstrated that this bioactive compound has antioxidant, chemopreventive and antiviral activity. Annona muricata is a type of fruit tree with a long history of traditional use. A number of properties have been attributed to different parts of the plant, including anticancer and antioxidant activities. In the current study, a complex based on ellagic acid, Annona Muricata and antioxidant factors (an ellagic acid complex) was administered to a group of human papilloma virus (HPV) infected women with and without cervical lesions, for 12 months. Its effect on HPV clearance and cervical cytological outcomes was assessed and a group of women with the same clinical features who did not receive the ellagic acid complex served as a control. A positive correlation was observed between intake of ellagic acid complex and negative Pap test following 6 and 12 months of treatment (χ2 test: 0.041 and 0.014, respectively). Women treated with the ellagic acid complex were less likely to be diagnosed with an abnormal Pap smear at 6 months [Odds ratio (OR): 0.39; 95% confidence interval (CI) 0.14-1.06] and 12 months (OR: 0.35; 95% CI 0.13-0.89), compared with the control group. After adjusting for confounding factors including age and smoking habit, this association remained significant. No effect was observed on HPV clearance or viral integration. The data from the current study suggest a protective effect of the ellagic acid complex on cervical cells, possibly through apoptosis, cell cycle arrest and repair mechanisms.