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Chapter 8 Mushroom: A True Super Food

July 2021

July 2021

In book: Comprehensive Insights in Vegetables of Nepal (pp.201-234)
Publisher: Nepal Academy of Science & Technology (NAST)

Authors:

Jay Kant Raut

Nepal Academy of Science and Technology (NAST)

Mahesh Kumar Adhikari

Mushrooms have been consumed by humans since antiquity and considered as a culinary wonder due to their organoleptic merits. In the era of healthy eating by cutting down the calories, saturated fat and cholesterol, mushrooms are bound to attract the public attention a lot. At present they are widely used across the globe not only as food but also in the area of pharmaceuticals, nutraceuticals and cosmeceuticals. In this chapter an attempt has been made to provide the up to date insight on the nutritional and medicinal properties of mushrooms. Mushroom proteins are considered of higher nutritional quality than those of vegetables, being comparable to proteins of animal origin such as meat, eggs and milk. Furthermore, modern mushroom culture produces more protein per unit area of land than any other kind of agricultural technology at present available. Food and Agriculture Organization (FAO) has recommended mushrooms as a food item contributing significantly to the protein nutrition of the developing countries like Nepal, which depend heavily on the cereal diets. In the recent years, a lot of research has been done on the chemical composition of mushrooms around the globe including Nepal which revealed their several nutritional and medicinal attributes. Contemporary researches have also validated and documented much of the ancient knowledge on the mushrooms and recognized them as functional foods as well as a vital natural source for the development of pharmaceuticals, cosmeceuticals and nutraceuticals in the 21 st century.

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Chapter 8

Mushroom: A True Super Food

Jay Kant Raut* and Mahesh Kumar Adhikari1

Nepal Academy of Science and Technology (NAST), Khumaltar, Lalitpur, Nepal

*Email: raut_jk2000@yahoo.com

Mushrooms have been consumed by humans since antiquity and considered as a culinary

wonder due to their organoleptic merits. In the era of healthy eating by cutting down the

calories, saturated fat and cholesterol, mushrooms are bound to attract the public

attention a lot. At present they are widely used across the globe not only as food but also

in the area of pharmaceuticals, nutraceuticals and cosmeceuticals. In this chapter an

attempt has been made to provide the up to date insight on the nutritional and medicinal

properties of mushrooms. Mushroom proteins are considered of higher nutritional quality

than those of vegetables, being comparable to proteins of animal origin such as meat,

eggs and milk. Furthermore, modern mushroom culture produces more protein per unit

area of land than any other kind of agricultural technology at present available. Food

and Agriculture Organization (FAO) has recommended mushrooms as a food item

contributing significantly to the protein nutrition of the developing countries like Nepal,

which depend heavily on the cereal diets. In the recent years, a lot of research has been

done on the chemical composition of mushrooms around the globe including Nepal which

revealed their several nutritional and medicinal attributes. Contemporary researches

have also validated and documented much of the ancient knowledge on the mushrooms

and recognized them as functional foods as well as a vital natural source for the

development of pharmaceuticals, cosmeceuticals and nutraceuticals in the 21st century.

Keywords: Anti-aging; anti-allergic; dietary supplement; fungi; white vegetables;

vegetarian meat.

Introduction

Mushrooms are higher fungi that are biologically distinct from plant and animal

belonging to divisions Basidiomycota and Ascomycota (Hawksworth et al., 2008). They

have been informally categorized among the ‘White vegetables’ and described as the

forgotten source of nutrients (Feeney et al., 2014; Weaver & Marr, 2013). Mushrooms are

widely consumed across the globe; especially for their organoleptic properties and have

been praised by humankind as a culinary wonder (Ergönül et al., 2013; Valverde et al.,

1 Comprehensive Insights in Vegetables of Nepal

Sajan Lal Shyaula, Gan B. Bajracharya, Gopal K.C., Shanta Man Shakya and Dilip Subba (Editors)

ISBN: 978-9937-0-9153-4

J. K. Raut and M. K. Adhikari / Comprehensive Insights in Vegetables of Nepal

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2015). In the era of healthy eating by cutting down the calories, saturated fat and

cholesterol, mushrooms are bound to attract the public attention a lot (Zhang et al., 2014).

Mushroom proteins are considered of higher nutritional quality than those of vegetables,

being comparable to proteins of animal origin such as meat, eggs and milk (Wang et al.,

2014). Furthermore, modern mushroom culture produces more protein per unit area of

land than any other kind of agricultural technology available at present (Aneja, 2001).

Health awareness and demand for meat substitutes have prompted global mushroom

consumption. Currently, the usage of mushrooms has expanded up to a wider extent not

only as food but also in the area of pharmaceuticals, nutraceuticals and cosmeceuticals for

the mankind. In the recent years, a lot of researches have been done on the chemical

composition of mushrooms around the globe which revealed their several nutritional and

medicinal attributes. Contemporary researches have validated and documented much of

the ancient knowledge on the mushrooms and recognized them as functional foods as well

as a vital natural source for the development of pharmaceuticals, cosmeceuticals and

nutraceuticals in the 21st century (Kostić et al., 2017; Reis et al., 2014; Soković et al.,

2016). In this chapter, the nutritional and medicinal attributes of mushrooms, with an

emphasis on as a functional as well as a true super food are reviewed and highlighted.

Mushroom in Folklore

Mushrooms have been used as both food and medicine since prehistoric time (Chang &

Miles, 2004; O’Neil et al., 2013). It is known from the fossil record that mushrooms have

existed since the lower cretaceous period (130 million years ago), long before human

beings evolved on this planet. It is assumed that the primitive man also consumed

mushrooms (Miles & Chang, 1997). Mushroom has got a place in the scriptures of many

ancient civilizations. Theophrastus (372–227 BC), the great Greek philosopher, wrote

about food value of mushroom and treated them as the royal dishes, a part of vegetable

kingdom. The Egyptians regarded them as a food for Pharaohs (King of ancient Egypt).

The Greek and Romans described them as ‘Food for the Gods’ and were served only on

festive occasions. Chinese treasured mushroom as elixir of life (Kotowski, 2019).

Reference to mushroom is also found in the Vedas (Wasson, 1971). Mushroom is a dish

of Jannat for Islamic people (Marwat et al., 2009). Recently, the importance of the role of

mushrooms in history was evidenced by the fact that the desert truffle, Terfezia arnenari,

was described in the Bible as ‘Bread from Heaven’ and ‘Manna of the Israelites’ (Pegler,

2002). Moreover, various mushroom rituals were practiced in various civilizations of

Russia, China, Greece, Mexico and Latin America throughout the world. Many believed

that mushrooms had properties that could produce super-human strength, help in finding

lost objects and lead the soul to the realm of the gods (Chang & Miles, 2004). In the past,

they were often considered as exotic and luxurious food reserved for the rich only. But

today mushrooms have become food for both the rich and the poor (Aneja, 2001).

Wild versus Cultivated

Mushrooms belong to the kingdom Fungi, which constitutes the most diverse group of

organisms after insects on this biosphere. They are found all around the world and grow

in a wide range of habitats (desert, grassland, roadway and forest). The number of

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mushroom species on the earth is currently estimated at 150,000–160,000. Out of these,

only 16,000 species are described so far which is only around 10% of the estimated

mushroom species (Hawksworth et al., 2008; Hawksworth & Lücking, 2018). Due to

many reasons (such as habitat, environmental factors, etc.), the availability of mushrooms

in the wild is uncertain and seasonal. The need and greed to ensure the regular availability

of mushrooms impelled the mankind to domesticate wild delicious mushrooms. For the

first time Auricularia auricula-judae in 600 AD, Flammulina velutips in 800 AD and

Lentinula edodes in 1000 AD were domesticated in China, but the real commercial

ventures started with the cultivation of the common white button mushroom (Agaricus

bisporus) in the limestone caves in France, in late eighteenth century, which can be truly

termed as biggest milestone in the history of artificial mushroom production (Figure 8.1).

In the late l8th century, mushroom production made its way across the Atlantic to the

United States, where curious home gardeners in the East tried their luck at growing this

new and unknown crop (Miles & Chang, 2004). Since then, more than 20 species of

edible and medicinal mushrooms have been domesticated, and technologies have been

improved to the commercial level.

Caesar’s mushroom

(Amanita caesarea)

Morel mushroom

(Morchella elata)

Chicken of the woods

(Laetiporus sulphureus)

White button mushroom

(Agaricus bisporus)

Oyster mushroom

(Pleurotus ostreatus)

Shitake mushroom

(Lentinula edodes)

Figure 8.1. Some popular wild edible mushrooms (upper row) and

cultivated mushrooms (butttom row) in Nepal.

Mushroom Production and Consumption in Nepal

The tradition of collection and consumption of wild edible mushrooms by the various

ethnic groups in Nepal have been very popular since ancient times (Adhikari & Adhikari,

1996; Adhikari, 2000). Some ethnic groups (Chepang, Danuwar, Tamang, Tharu, Raute,

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etc.) found to be heavily depend on collection and consumption of wild mushrooms for

their food and medicine (Adhikari, 2014; Pandey & Budhathoki, 1970). Some wild

mushroom are being used in the Newar community during their ethnic festival (Adhikari

& Adhikari, 2011). The country is very rich in mushroom diversity due to its complex

geomorphology, diversity in altitude and climatic conditions. However, to date, very little

number of mushroom species has been unveiled and exploited scientifically. There are

altogether 1291 mushroom species, among them, 159 are edible, 100 are poisonous, 74

are medicinal and 25 are using in other purposes (Devkota & Aryal, 2020). There is also

significant trade and revenue from the collection of some wild mushrooms such as

Ophiocordyceps sinensis (yarsagumba), Morchella spp. (guchhi-chyau) and Ganoderma

spp. (rato-chyau) (Adhikari, 2008; Adhikari, 2009). They play an important role in the

national bio-economy (Raut, 2019; Raut et al., 2019). In addition of wild collection, the

artificial farming started in 1974 with button mushroom. Oyster (Pleurotus spp.), button

mushroom (A. bisporus), shitake (L. edodes) and milky mushroom (Calocybe indica) are

the most popular mushrooms in Nepal which have been farming on commercial scale (see

Figure 8.1). However, all these cultivars are exotic. None of native species is in the

cropping system yet. The production follows the upward trend. Total national output of

mushroom was only 30 kg in 1974 that reached 9300 tonnes in the year 2016 (Raut,

2019). In the last few years, with the change in the food habit and the recognition of its

nutritional and medicinal values, domestic market is increasing rapidly. The per capita

consumption/year reached 115 g in 2015 from 4 g in 2000 (Raut, 2019). Several

mushrooms both wild as well as cultivated from different parts of the country have been

chemically characterized (Adhikari et al., 2019; Adhikari, 2000; Adhikari et al., 2018;

Adhikari et al., 1996; Aryal et al., 2017; Aryal & Budhathoki, 2015; Gautam & Adhikari,

2007; Giri & Rana, 2009; Bang et al., 2014; Jha & Tripathi, 2012; Mishra & Mishra,

2017; Pandey & Budhathoki, 1970; Tamrakar et al., 2016, 2017, 2019; Upadhyaya et al.,

2017; Upadhyaya et al., 2018). These studies indicate the researches on the nutritional and

nutraceutical values of the Nepalese mushrooms are getting momentum in the recent

years making Nepalese peoples more aware on their food and medicinal value.

Nutritional Attribute

Proteins

Mushrooms offer high quality protein. The protein present in mushrooms contains all nine

essential amino acids (EAAs) essential for humans, in contrast to most other plant-based

protein options which are typically missing one or more EAAs. Moreover, mushrooms

have a high branched-chain amino acid composition, which is usually only found in

animal-based protein sources. In fact, mushroom proteins are nearly equivalent to the

animal protein. It is also known as White vegetables or Boneless vegetarian meat (Kakon

et al., 2012). Greeshma et al. (2018) found in a study that the amino acid content in

mushrooms is comparable to that of ovalbumin and surpasses soybean and wheat scores

(WHO/FAO reference standards). In a study that assessed the difference in satiety levels

between mushrooms and meat, participants expressed significantly less hunger, a greater

sense of fullness, and reduced prospective consumption after consuming the mushroom

meal compared with those participants given meat (Hess et al., 2017).

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The crude protein content of edible mushrooms is usually high, but varies greatly and

is affected by factors such as species, developmental stage, environment and substrate

(Cheung, 2010; Ferreira et al., 2017; Kakon et al., 2012). It contains 20–35% protein dry

weight basis (DW) as compared to 7.3% in rice, 13.2% in wheat, 39.1% in soybean and

25.2% in milk. This shows that protein content in mushrooms ranks below animal meats

but well above most other foods including milk (Chang & Miles, 2004; Kakon et al.,

2012; Rahi & Malik, 2016). On a fresh weight basis, an average value of protein content

in mushroom is 3.5–4% which is, in general, about twice that of asparagus and cabbage,

and 4 times and 12 times those of oranges and apples, respectively (Chang & Miles,

2004). In fact, in populations who do not consume animal proteins (either due to lack of

availability or religious beliefs), mushrooms can be used to combat protein deficiency and

as a supplement to cereal grains. The complete protein composition found in mushrooms

is a great alternative to bridge the gap for vegans and vegetarians who may be burnt out

on other traditional plant-based protein sources such as pea, rice, and other grains and

legumes (Jayachandran et al., 2017).

Carbohydrates and Fiber

Arabinose, fructose, rhamnose, xylose, fucose, mannose, mannitol, glucose, trehalose,

sucrose and melezitose are some carbohydrates of mushroom. The carbohydrate content

of edible mushrooms varies with species and ranges from 35 to 70% DW (Ooi, 2009).

Mannitol and trehalose are the major sugars reported in mushrooms that varies from

species to species. Mannitol is mainly responsible for the growth and firmness of the fruit

body and the most abundant sugar in the wild species (Ferreira et al., 2017). Pleurotus

species contain carbohydrates ranging from 46.6 to 81.8% as compared to 60% in A.

bisporus on dry weight basis (Rahi & Malik, 2016).

Mushrooms are also a good source of fiber, particularly the soluble fiber β-glucan.

Most of the active polysaccharides, water soluble or insoluble, isolated from mushrooms

can be classified as dietary fibers. Dietary fibre is a type of carbohydrate that cannot be

digested by gastrointestinal enzymes. Mushrooms contain 10–50% dietary fibers in dried

matter (Rahi & Malik, 2016). The soluble fiber is mainly β-glucans, a polysaccharide.

Soluble fiber helps to lower total and low-density lipoprotein (LDL) cholesterol levels. It

also helps regulate blood sugar levels (Kakon et al., 2012). The fiber content ranges from

7.4 to 27.6% in Pleurotus species as compared to 10.4% in A. bisporus and 4 to 20% in

Volvariella volvacea (Rahi & Malik, 2016).

Fat

Mushrooms contain extremely small amount of fat usually ranging from 0.1 to 16.3%,

most of which are polyunsaturated fat (Sande et al., 2019). As a result, they are

considered as a low caloric heart-healthy food choice without cholesterol. Instead, they

have ergosterol that acts as a precursor for vitamin D synthesis in human body. Similarly,

ergosterol in button mushroom is converted into vitamin D2 when exposed to UV

radiation or sunlight. It has been observed that a diet rich in sterols is important in the

prevention of cardiovascular diseases (Valverde et al., 2015). In general, the crude fat of

mushrooms represents all classes of lipid compounds including free fatty acids,

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monoglycerides, diglycerides, triglycerides, sterols, sterol esters, and phospholipids

(Chang & Miles, 2004). Linoleic acid, oleic acid and linolenic acid are the major

constituents in their lipid profiles and, in general, unsaturated fatty acids predominate

over saturated fatty acids. Therefore, compared to other food of vegetable and animal

origin, mushrooms have the advantage of possessing high levels of polyunsaturated fatty

acids. Percentage of these fatty acids (in 100 g of total fatty acids) in mushrooms varies

greatly: linoleic acid ranges from 0.0–81.1%, oleic acid between 1.0 and 60.3%, and

linolenic acid from 0.0–28.8% (Sande et al., 2019). Unsaturated fatty acids are essential to

human body while saturated fatty acids, which are present in high amounts in animal fats,

may be harmful to human health (Rahi & Malik, 2016). The high content of unsaturated

fatty acids in mushrooms make them a healthy food. Unsaturated fatty acids are useful for

a wide range human physiology such as in management of cardiovascular diseases,

triglyceride levels, blood pressure and arthritis (Ferreira et al., 2009; Heleno et al., 2012;

Reis et al., 2012; Valverde et al., 2015).

Vitamins

Mushroom is an excellent source of vitamins especially C and B (folic acid, thiamine,

riboflavin and niacin). The riboflavin (vitamin B2) content in mushrooms is higher than

that generally found in vegetables, and some varieties of A. bisporus even have a level of

vitamin B2 as high as that found in egg and cheese (Mattila et al., 2000). The content of

riboflavin (vitamin B2), niacin and folates, varies within the range of 1.8–5.1, 31–65 and

0.30–0.64 mg/100 g DW, respectively, depending on the species. In addition to riboflavin,

niacin and folates, cultivated mushrooms also contain small amounts of vitamin C and

vitamin B1, and traces of vitamins B12 and D2. Folic acid and vitamin B12, which are

normally absent in vegetative foods, are present in mushrooms. Vitamin A is uncommon,

although several mushrooms contain detectable amounts of pro-vitamin A measured as

the β-carotene equivalent. Most cultivated mushrooms are believed to contain low

amounts of the fat-soluble vitamins, K and E, and only a small contribution to the daily

requirement of vitamin C (Mattila et al., 2001). Vitamin C content has been reported to

be highest in L. edodes (9.4 mg/100 g dry sample) followed by Pleurotus sajor-caju, A.

bisporus and V. volvacea with 7.4, 1.8 and 1.4 mg/100 g DW, respectively (Chang &

Miles, 2004).

It has been reported that the vitamin D2 content in A. bisporus (0.21 µg/100 g DW)

cultivated in the dark is lower than that of L. edodes (22.0–110 µg/100 g DW) cultivated

in natural climatic conditions (Takamura et al., 1991), which is mainly due to the

influence of illumination on the conversion of ergocalciferol (provitamin D) to vitamin D

(Mattila et al., 2002). Unfortunately, few foodstuffs naturally contain significant levels of

vitamin D. Mushrooms are the only non-animal-based food containing vitamin D, and

hence they are the only natural vitamin D source for vegetarians. Mushrooms cultivated in

indoors contain lower levels of vitamin D2 than those cultivated at outdoors because the

metabolic route from ergosterol to ergocalciferol (vitamin D2) requires sunlight or

artificial ultraviolet (UV) light. Common cultivated mushrooms could be remarkably

enriched with vitamin D2 by UV- irradiation after harvest (Mau et al., 1998). This easy

way to improve the nutritional value of common mushrooms and make them more

functional as a source of vitamin D is worth noting (Mattila et al., 2000).

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Ash and Minerals

The ash content gives us a general idea about the mineral content of mushrooms and

usually ranges from 6 to 10.9% on dry weight basis (Cheung, 2010). Mushrooms are a

good source of wide variety of minerals, containing macro-elements such as calcium (Ca),

magnesium (Mg), sodium (Na), potassium (K), phosphorus (P) and micro-elements such

as copper (Cu), iron (Fe), manganese (Mn), and zinc (Zn). The amount of K, P, Na, Ca,

and Mg accounts about 56 to 70% of the total ash content, while potassium, an extremely

important mineral that regulates blood pressure, alone forms 45% of the total ash (Li &

Chang, 1982; Rahi & Malik, 2016). Mushrooms in general are rich in selenium (Se), an

essential trace mineral (Cocchi et al., 2006). Se is a powerful antioxidant that fights

oxidative stress and helps defend human body from chronic conditions, such as heart

disease and cancer. Mushrooms contain more Se than any other form of produce and are

one of the richest, natural sources of Se (Rahi & Malik, 2016). Mushrooms can also have

low contents of toxic elements, such as arsenic (As), cadmium (Cd) and lead (Pb)

(Ferreira et al., 2017). These toxic elements are not found or are very low in the cultivated

species (Mallikarjuna et al., 2013). The mineral content in mushrooms are greatly vary

with mushroom species, types of substrate and the environmental factors (Liu et al.,

2012).

Moisture

Generally, mushrooms comprise a high moisture content that ranges about 85 to 95% of

their fresh weight. Freshly harvested mushrooms are highly perishable because of high

moisture content metabolism and susceptible to enzymatic browning. Water content in

mushroom greatly varies depending on the time of cropping, watering condition during

cultivation, postharvest period, and temperature and relative humidity during growth

(Cheung, 2010). The moisture is easily lost after harvest, due to evaporation;

consequently, the chemical composition of mushrooms varies within and between species,

and corresponding maturation. Therefore, the dry matter content of mushrooms is

relatively low, about 10–30% on fresh weight basis and it is mainly formed by

carbohydrates, lipids, proteins and ash; low lipid concentrations result in low energy value

(Ferreira et al., 2017).

Energy

Due to low energy content (generally 25.08-50 cal/100 g of fresh weight), edible

mushrooms should be regarded as dietetic food. Cultivated species, such as A. bisporus

and Pleurotus ostreatus are characterized by a medium calorific value of 30 and 36

cal/100 of the edible part, respectively (Bernas et al., 2006; Manzi et al., 2001). Wild

species, Suillus luteus, Morchella esculenta, Cantharellus cibarius, Lactarius deliciosus

and Leccinum scabrum show low calorific values varying from 11 to 14 cal/100 g fresh

matter; a medium one was found for Boletus edulis (17 cal/100 g) and the highest one for

Tuber melanosporum (56 cal/100 g) (Aletor, 1995). A serving of 100 g of fresh edible

mushrooms provides only 1.4–4.4% of the daily energy requirement for a 70 kg adult

male who engages in moderate physical activity (Cheung, 2010).

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Medicinal Attribute

Antioxidants in Mushrooms

Oxidation is essential to many living organisms for the production of energy to fuel

biological processes. Free radicals are produced in the normal natural metabolism of

aerobic cells. A free radical is defined as any atom or molecule possessing unpaired

electrons in the outer orbit (Halliwell & Gutteridge, 1984). They are generally unstable

and very reactive. Free radicals derived from molecular oxygen (O2) are usually known

by reactive oxygen species (ROS) and represent the most important class of radical

species generated in living systems (Miller et al., 1990). Once produced, most of the free

radicals are neutralized by cellular antioxidant defenses (enzymes and non-enzymatic

molecules). Maintenance of equilibrium between free radical production and antioxidant

defenses (enzymatic and non-enzymatic) is an essential condition for normal organism

functioning. Due to either by the over-production of ROS or by the loss of the cell

antioxidant defenses, a disequilibrium occurs which is known as oxidative stress

(Machelin & Bendich, 1987). The excess ROS may oxidize and damage cellular lipids,

proteins and DNA leading to abnormal function (Ferreira et al., 2009; Fu et al., 1998;

Valko et al., 2007). In fact, the uncontrolled production of oxygen-derived free radicals is

involved in the onset of more than one hundred diseases including several kinds of

cancers (Valko et al., 2006), diabetes (Valko et al., 2007), cardiovascular diseases (Shah

& Channon, 2004), neurological disorders (Perry et al., 2008), among others (Valko et al.,

2007). The over-production of ROS has also been related to the aging process (Halliwell

& Gutteridge, 1984; Halliwell, 1996). Therefore, it becomes very important for many to

supplement their diet with good levels of antioxidants and free radicals scavengers to

protect themselves from the oxidative damage. Recently, many studies have found that

edible mushrooms possess potent antioxidants (Adhikari et al., 2019; Barros et al., 2007;

Boonsong et al., 2016; Elmastas et al., 2007; Ferreira et al., 2009; Gursoy et al., 2009;

Bang et al., 2014; Kalaras et al., 2017; Kalyoncu et al., 2010; Kozarski et al., 2015; Keleş

et al., 2011; Mau et al., 2004; Srikram & Supapvanich, 2016; Strapáč et al., 2016;

Unekwu et al., 2014; Wani et al., 2010). Phenolics, tocopherol, ascorbic acid and

caretenoids are the responsible compounds which has been isolated from the different

species of mushrooms. They are reported to boost the immune system; have

anticancerous, anti-hypercholesterolaemic and antiviral activities; and ameliorate the

toxic effect of chemo- and radiotherapies (Chang & Miles, 2004; Rathore et al., 2017).

Also, mushrooms might be used directly in diet and promote health taking advantage of

the additive and synergistic effects of all the bioactive compounds present.

Hypocholesterolemic/Antiatherogenic Effects

Increasing incidence of cardiovascular diseases in the globe leads to search for natural

substances as hypocholesterolemic agents that can lower blood cholesterol. In this regard,

mushrooms contain variety of such bioagents with promising effects on several

cardiovascular risk biomarkers (Murugan et al., 2018). Edible mushrooms as a natural

hypocholesterolemic and antisclerotic diet are often prescribed in Oriental medicine

(Ishikawa et al., 1984). Elevated serum cholesterol levels are widely recognized as a

contributing risk factor for the development of cardiovascular diseases, such as

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atherosclerosis, coronary heart disease and stroke. Atherosclerosis, a progressive disease

characterized by the accumulation of lipids and fibrous elements in the large arteries,

constitutes the single most important contributor to the growing burden of cardiovascular

diseases (Libby, 2012). Intake of mushrooms with hypocholesterolemic properties

reduces the cardiovascular risk (Bobek & Galbavý, 1999; Kaneda & Tokuda, 1966; Mori

et al., 2008; Yamada et al., 2002). In general, the hypocholesterolemic effects, including

the lowering of plasma triglycerides, and hepatic total cholesterol and triglycerides, of

edible mushrooms e.g., A. auricula-judae, A. bisporus, P. ostreatus, and Tremella

fuciformis have been mainly attributed to dietary fiber (Caz et al., 2015; Guillamón et al.,

2010).

Based on the capacity of the reduction of cholesterol absorption, the European

Food Safety Authority (EFSA) recognizes two types of functional food that can

reduce the risk of cardiovascular diseases (EFSA, 2009, 2010, 2012). One that contains

sterols (phytosterols) or derivatives (sitostanol esters) and another type contains

β-glucanspolysacharides. These compounds can reduce LDL-cholesterol in

hypercholesterolaemic patients by 10–15% within 3–4 weeks with the intake of 1.5 g/day

(Chen & Huang, 2009; Miettinen et al., 1995). Edible mushrooms are good sources of

phytosterol-like structures such as ergosterol, fungisterol and many other derivatives. The

major fungal sterol, ergosterol (9.61–1.28 mg/g DW), is abundant in all mushrooms

species since it is a constitutive compound of the hyphae membranes and it is known as a

vitamin D2 (ergocalciferol) precursor (Kalač, 2009; Mattila et al., 2002; Teichmann et al.,

2007). According to the reports, several oyster mushroom strains showed lovastatin

(mevinolin), a compound able to lower cholesterol levels by inhibiting the 3-hydroxy-3-

methyl-glutaryl CoA (HMG-CoA) reductase, a key-enzyme in the cholesterol metabolism

(Gunde-Cimerman & Cimerman, 1995). However, other compounds, such as

lanosteroids, ganoderols, etc., obtained from other mushrooms are also able to perform

such an inhibition (Berger et al., 2004; Gil-Ramirez et al., 2011). Mushroom intake

clearly has a cholesterol-lowering effect or hypocholesterolemic effect by different

mechanisms such as decreasing very-low-density lipoproteins, improving lipid

metabolism, inhibiting of activity of HMG-CoA reductase, and consequently preventing

the development of atherosclerosis (Guillamón et al., 2010). According to current dietary

recommendations for preventing and treating for cardiovascular diseases, edible

mushroom presents an appropriate nutritional value and its consumption can affect some

known cardiovascular risk biomarkers.

Hypoglycaemic/Antidiabetic Effects

Diabetes mellitus (DM) is a multifactorial metabolic disorder characterized by chronic

hyperglycemia due to defects in insulin secretion, insulin action, or both (American

Diabetic Association, 2014). The increasing worldwide incidence of DM with the number

of DM patients estimated to be doubled from 171 million in 2000 to 366 million in 2030

is creating a global public health burden (WHO, 2005). Management of diabetes basically

initiates with a modification in diet and exercise. Currently, available therapy for diabetes

includes insulin and various oral antidiabetic agents such as sulphonylurea, biguanide,

metformin, α-glucosidase inhibitors and troglitazone, but these are known to have a

number of serious adverse effects in patients (Berger, 1985; Sukalingam et al., 2015).

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Thus, there is an urgent requirement for effective substitutions to reduce the

complications of diabetes with lower side-effects. In recent years, the search for alternate

medications has drawn great attention to combat diabetes (Ganesan & Xu, 2019).

Therefore, development of safe and effective oral hypoglycemic agents from natural

sources to manage DM without side effects is of great interest recently and is strongly

recommended by The World Health Organization (WHO) (Singh et al., 2007).

Several mushrooms species such as Tremella aurantia, O. sinensis, Ganoderma

lucidum, A. auricula-judae, L. edodes, P. ostreatus, Phellinus linteus and others have

been shown to decrease blood glucose and triglyceride levels. Such results strongly

suggest that these mushrooms have potential preventive and therapeutic actions in DM

(type I and II) (Shamtsyan, 2016). The hypoglycemic activity of mushrooms has been

recorded on fruit bodies and on bioactive compounds isolated from the fruit bodies, such

as polysaccharides (Kiho et al., 1994; Kiho et al., 1994, 2000; Kurushima et al., 2000;

Mori et al., 1998) and lectin (Ewart et al., 1975). Furthermore, endo and exopolymers

produced in submerged mycelial cultures have also been found to have a hypoglycemic

effect (Kim et al., 2001; Kim et al., 1997). The most common animal models used for the

study of the hypoglycemic effects of mushrooms are rats and mice with insulin-dependent

diabetes mellitus (IDDM) induced by streptozotocin (STZ), and genetically diabetic mice

with non-insulin-dependent diabetes mellitus (NIDDM) (Beattie et al., 1980; Cheung,

2010; Kiho et al., 2001; Swanston-Flatt et al., 1989). In conclusion, mushrooms have

been recognized as an ideal food for the dietetic prevention of hyperglycemia because of

their high dietary fiber and protein, and low fat content.

Antiviral Effect

Mushroom can be considered as a powerhouse of antiviral agent. Cochran was the first to

report the antiviral substances in mushrooms (Goulet et al., 1960). They have shown

potential activity against prominent viruses such as human immunodeficiency virus

(HIV), influenza, herpes simplex virus (HSV), hepatitis B and C viruses, etc. The antiviral

activity of these mushrooms is associated mainly to the presence of polysaccharides in

mycelium and fruiting bodies, and synthesis of triterpenoid secondary metabolites (Chen

et al., 2012; Linnakoski et al., 2018; Rincão et al., 2012). Antiviral agents in mushrooms

can be divided into two major groups of molecules; the high-molecular weight

compounds such as polysaccharides, proteins and lignin-derivatives from the fruiting

bodies exhibiting their effect indirectly through immunostimulating activity; and the low-

molecular weight compounds, small organic molecules excreted by mushrooms in a liquid

culturing (fermentation) setups that directly inhibits viral enzymes, synthesis of viral

nucleic acids or adsorption and uptake of viruses into cells. High molecular weight

polysaccharides (such as glucan, chitin, mannan, polysaccharide krestin (PSK) or

lentinan) extracted from fruiting bodies and fungal mycelia have been reported to present

antiviral activities (Cardozo et al., 2011; Rincão et al., 2012; Tochikura et al., 1987).

Antiviral activity against HIV has shown by various types of mushroom. Several

triterpenes from G. lucidum i.e. ganoderiol F, ganodermanontriol and ganoderic acid B

are active antiviral agents against human immunodeficiency virus type 1 (HIV-1). A low

molecular weight laccase (LAC), from the dried fruiting body of Hericium erinaceus

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(Wang & Ng, 2004a, 2004b), fruiting body of Pleurotus eryngii (Wang & Ng, 2006b),

Lentinus edodes and G. lucidum (Sun et al., 2011; Wang & Ng, 2006a, 2006b) possess the

strong antiviral activities against HIV. Lanostane-type triterpenoid derived from

Scleroderma citrinum was also shown to have antiviral response against HSV

(Kanokmedhakul et al., 2003). Acidic protein-bound polysaccharide isolated from water-

soluble extracts of G. lucidum showed potent antiviral activity against both HSV-1 and

HSV-2 (Eo et al., 2000). P. ostreatus, Fomes fomentarius, Auriporia aurea and Trametes

versicolor were promising in blocking HSV in RK-13 cells (Krupodorova et al., 2014). A.

aurea, F. velutipes, F. fomentarius, G. lucidum, Lentinus edodes, Lyophyllum shimeji, P.

eryngii, P. ostreatus, Schizophyllum commune and T. versicolor extracts were tested for

inhibition against influenza A H1N1 virus (Krupodorova et al., 2014). Two phenolic

compounds from Inonotus hispidus showed antiviral action against influenza A and B

viruses (Ali et al., 2003). Datronia mollis, Daedaleopsis confragosa, Ischnoderma

benzoinum, T. versicolor, Trametes gibbosa, Laricifomes officinalis and Lenzites betulina

as promising antivirals against H5N1 and H3N2 (Teplyakova et al., 2012). Inonotus

obliquus polysaccharides were tested for their antiviral activity against a number of feline

viruses and found to be active against feline influenza H3N2 and H5N6 (Tian et al.,

2017).

The need for natural antiviral compounds arises from the issues of side effects and

development of drug-resistant mutant viruses (De Clercq, 1997). Mushrooms having

antiviral activity with no side effects and being readily available make it an effective source

of foods and therapeutics. Different compounds extracted from mushrooms include lectins

(Hassan et al., 2015), polysaccharides (Friedman, 2016), polysaccharopeptides (Ng, 1998),

enzymes and other molecular compounds (Lindequist et al., 2005), which possess

antiviral activity against HIV, herpes virus, influenza virus, Epstein-Barr virus, coxsackie

virus, etc. Medicinal mushrooms having different components each of which showing

antiviral action against different viruses make them more interesting for pharmacological

exploration. Isolated and extracted compounds can be formulated into tablets, capsules

and teas depending on the source. Usage of mushrooms as dietary supplements should

further be encouraged. The ease of mushroom cultivation could provide a ubiquitous

supply of antiviral compounds, once large-scale production is formulated for these

compounds.

Antitumour/Anticancer Effects

There are many reports on mushroom polysaccharides as antitumour and immune-

stimulating agents (Cheung, 2010; Ooi, 2009; Zhang et al., 2007). They show their

antitumour activity by stimulating the host immune system rather than direct killing the

tumour cells. The use of mushrooms as an anticarcinogenic agent is known for a very long

time in Korea, China, Japan, Russia, USA and Canada (Daba & Ezeronye, 2003). A variety

of polysaccharides from a number of mushroom varieties have been demonstrated to

enhance the immune system. Naturally-occurring substances having immunotherapeutic

effects are termed as immunoceuticals which can be included in the general category of

nutraceuticals, or dietary supplements. Immunoceutical has become a tool for

immunotherapy, a new dimension of anticancer therapy by which the body’s immune

defenses, beaten down by the cancer and by toxic therapies used against the cancer, can

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be revitalized to carry out their natural functions of eliminating abnormal tissues from the

body (Kidd, 2000).

More than 50 mushrooms species have yielded potential immunoceuticals that

exhibit anticancer activity in vitro or in animal models. Six of these carcinostatic

(immunotherapeutic) agents that have been investigated in human cancers include

lentinan, schizophyllan, active hexose correlated compounds (AHCC), maitake D-

fraction, polysaccharide-K and polysaccharide-P (Daba & Ezeronye, 2003). G. lucidum,

Lentinus edodes, T. fuciformis, Griflola, H. erinaceus, Agaricus blazei, F. velutipes,

Coriolus versicolor, I. obliquus, P. ostreatus, Sparassis crispa, Poria cocos and

Cordyceps militaris are some major mushroom species have been used as carcinostatic

agents (Meng et al., 2016). These mushrooms are associated with the treatment of various

cancers including breast, colorectal, cervical, skin, liver, ovarian, bladder, prostate,

gastric, skin, lung, leukemia and stomach cancers (Ayeka, 2018; Wasser, 2002). There are

many mushroom based commercial anticancer products in the global market and some

have been patented (Pandya et al., 2019). Despite the discovery of many antitumor

components of mushrooms, still, there is a need to increase the range of available

compounds, find more effective and less toxic molecules and to understand deeply single

and/or multiple targets, so as to battle cancer more precisely.

Antimicrobial Effect

Antimicrobial agents are substances used to treat infections caused by pathogenic

microorganisms. They have been in widespread and largely effective therapeutic use since

their discovery in the 20th century (Glamoclija & Sokovic, 2017). However, the

emergence of multi-drug resistant pathogens now presents an increasing global challenge

to both human and veterinary medicine (WHO, 2014). Mushrooms need antimicrobial

compounds to survive in their natural environment. Hence mushrooms must have strong

antimicrobial properties to fight such microbes to survive (Lindequist et al., 2005).

Antimicrobial compounds with more or less strong activities could be isolated from many

mushrooms and that could be very useful in the treatment of human infections

(Glamoclija & Sokovic, 2017). Only a handful mushrooms species have been studied for

antibacterial, antifungal, antiviral and /or antiprotozoal properties. During recent years

many investigations confirmed antimicrobial activity of numerous edible and inedible

mushrooms (Balakumar et al., 2011; Chowdhury et al., 2015; Gebreyohannes et al., 2019;

Hearst et al., 2009; Imtiaj et al., 2007; Klaus et al., 2016; Liu et al., 2010; Nikolovska-

Nedelkoska et al., 2013; Ren et al., 2014; Sharma et al., 2014; Singh, 2017; Tamrakar et

al., 2017; Venturini et al., 2008). Primary and secondary metabolites such as oxalic acid,

peptides or proteins, terpenes, steroids or benzoic acid derivatives from mushrooms have

been associated with their antimicrobial properties (Alves et al., 2012). The antimicrobial

potential of mushroom species depends on sample’s origin, type of extract, assays

applied, and bacterial and fungal species investigated, as well as the numerical values of

the results are presented (Alves et al., 2012; Barros et al., 2007; Glamoclija & Sokovic,

2017; Harikrishnan et al., 2012). One of the first antimicrobial compounds ever isolated

from a polypore was biformin, a poly acetylenic carbinol. Biformin is produced by

Trichaptum biforme (Polyporus biformis) and is active against a wide variety of bacteria

and fungi (Robbins et al., 1947). Ethanolic mycelial extracts from Lentinus edodes

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possess antiprotozoal activity against Paramecium caudatum (Lindequist et al., 2005).

Trehalose present in the extract of L. edodes is considered to be an important factor to

improve the beneficial intestinal bacterial flora of the gut. It is also effective to reduce the

harmful effects of certain bacterial enzymes such as α-glucosidase, α-glucuronidase and

tryptophanase preventing colon cancer formation (Wasser & Weis, 1999). Some

mushroom extracts, particularly obtained from L. edodes and P. linteus, have been

reported as effective even against highly resistant bacteria, such as methicillin-resistant

Staphylococcus aureus (MRSA) (Hearst et al., 2009; Hur et al., 2004). Agaricus genus

represents the most important cultivated edible mushroom. Antimicrobial activity of three

Agaricus species was published by Öztürk et al. (2011), who have described effects of

methanolic extracts against six species of Gram-positive bacteria and seven species of

Gram-negative bacteria. Giri et al. (2012) have described that a methanolic extract of A.

campestris from India showed antimicrobial activity against seven bacterial species.

Glamočlija et al. (2015) have investigated biological activity of the methanolic and

ethanolic extracts of Agaricus bisporus, A. bitorquis, A. campestris and A. macrosporus.

All the extracts showed antibacterial potential.

Some Ascomycestes such as M. esculenta and Tirmania pinoyi also demonstrated

excellent antibacterial activity. The methanolic extracts of M. esculenta exhibited very

good activity against five bacteria (Heleno et al., 2013). Coprinol, a new antibacterial

cuparane‐type terpenoid from cultures of a Coprinus sp., exhibited activity against

multidrug‐resistant Gram‐positive bacteria (Johansson et al., 2001). Cordycepin,

a derivative of the nucleoside adenosine, the main active constituent of C. militaris,

has antibacterial property, which is now being produced synthetically (Paterson, 2008).

Liu et al. (2010) have isolated novel compounds with effective antimicrobials from

two American mushroom species, Jahnoporus hirtus and Albatrellus flettii:

3,11‐dioxolanosta‐8,24(Z)‐diene‐26‐oic acid, a new lanostane type triterpene from

J. hirtus, and confluentin, grifolin, and neogrifolin from A. flettii. Grifolin showed

promising activity against Bacillus cereus (10 μg/mL) and Enterococcus faecalis

(0.5 μg/mL). Menaga et al. (2012) have found that bioactive compounds from Pleurotus

florida mushroom extracts could be used as an alternate therapeutics as antibiotics. Alves

et al. (2012) have reported that Fistulina hepatica, Russula botrytis and Russula delica are

the most promising species as antimicrobial agents.

Antiobesity Effect

Obesity is an excessive accumulation of fat in adipose tissue caused by an imbalance

between the intake and expenditure of energy (WHO, 2000; Hofbauer, 2002; Leslie et al.,

2007). It is a serious and growing worldwide health challenge that increases the risk of

other diseases and health problems, such as heart disease, diabetes, high blood pressure

and certain cancers (WHO, 2000). WHO considers obesity as one of the most obvious and

neglected public health issue. It has become a global epidemic, affecting not only

developed but also developing countries and among all the segments of society (WHO,

2000; Gortmaker et al., 2011). It is estimated that 1.12 billion people will be obese around

the world in 2030. Once considered a high-income country problem, overweight and

obesity are now on the rise in low- and middle-income countries, particularly in urban

settings (WHO, 2020b).

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To prevent or reduce obesity, the imbalance between energy intake and expenditure

needs to be addressed by improving dietary habits and/or increasing physical activity,

though this is difficult to achieve in modern society. Antiobesity drugs, as an alternative

option, have side effects and are expensive (Enzi et al., 1976; Kang & Park, 2012).

Conversely, the habitual consumption of foods with antiobesity effects may be a cost-

effective and manageable way to overcome obesity. Natural products can be an

outstanding, effective and safe strategy for the prevention of obesity (Bessesen & Van

Gaal, 2018). Recently, many studies have reported anti-obesity effects of mushrooms.

The antiobesity activity of maitake mushroom (Grifola frondosa) has been demonstrated

in both animals and humans (Mayell, 2001; Shamtsyan, 2016). Antiobesity and

triglyceride lowering effect has been reported for fermented milk product containing

edible mushroom water extracts (mushroom yogurt) (Jeon et al., 2005). Flammulina

velutipes (Enokitake), Hypsizygus marmoreus (Bunashimeji), Lentinus edodes (Shiitake),

G. frondosa (Maitake) and Pleurotus eryngii (Eringi or King oyster mushroom) contain

many nutritional components such as dietary fiber, vitamin B1, vitamin B2, niacin, vitamin

B6, vitamin D and folic acid (Valverde et al., 2015), and are reported to have antiobesity

effects (Handayani et al., 2011; Mizutani et al., 2010; Yeh et al., 2014), immunomodulatory

effects (Vetvicka & Vetvickova, 2014), antitumor effects (Masuda et al., 2013),

antiatherosclerotic effects (Mori et al., 2008) and antidiabetes effects (Hong et al., 2007).

Dried powder of A. auricula‐judae, suspension of Coprinus comatus, α‐glucan of G.

frondosa, and ethanol extract of P. ostreatus inhibited body weight increase in healthy and

diabetic patients (Soković et al., 2016).

Mushroom intake suppressed fat accumulation by inhibiting fatty acid synthesis and

promoting lipolysis of visceral fat. Mushroom intake also suppressed adipocyte

enlargement and promoted adiponectin production. Moreover, mushroom intake caused

some lactic acid- and short chain fatty acid (SCFA)-producing bacteria to proliferate,

possibly because of the dietary fiber content of the mushrooms, which promote energy

metabolism in the host and play a role in suppressing fat accumulation. Thus, the regular

mushroom intake results in synergistic and improved effects, and can be an effective

strategy for the prevention of obesity (Shimizu et al., 2018).

Immunosuppressive, Anti-inflammatory and Antiallergic Effects

Inflammation is the body’s natural reaction against injury and infection. It is a vital part of

the immune system’s response to injury and infection through which body signals the

immune system to heal and repair damaged tissue, as well as defend itself against foreign

invaders. An abnormal inflammation can occasionally be triggered by non-infectious/

harmless environmental agents or by an autoimmune process, as in rheumatoid arthritis

(Jayasuriya et al., 2020). An abnormal severe immune response to non-infectious

elements, also called antigens or allergens is known as hypersensitivity or allergy.

Allergies can be subdivided into type I–IV depending upon the antigens, cells and

symptoms that trigger the hypersensitivity reaction (Chinen & Shearer, 2008). Type I

allergy, the most frequent type of a pathogenic immune reaction, is caused by IgE-

mediated reactions, which result in the release of vasoactive substances, e.g. histamine

from mast cells. Although many mushrooms can stimulate the immune system, some

suppress immune responses that are useful for the treatment of allergic diseases, which

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are increasing worldwide. The pharmacological treatment of allergy consists mainly of

administration of immunosuppressants, antiphlogistic, and/or antiallergic drugs.

Some mushroom species are known to provide significant anti-inflammatory

properties (Jose et al., 2004; Kim et al., 2004; Lull et al., 2005; Tamrakar et al., 2019). It

has been reported that ergosterol and ergosterol peroxide from the edible mushroom H.

marmoreus can inhibit inflammatory processes (Yasukawa et al., 1994). Some mushrooms

were investigated for possible treatments of allergic diseases like allergic asthma (Li et al.,

2000; Liu et al., 2003), food allergy (Hsieh et al., 2003), atopic dermatitis (Kuo et al., 2002),

inflammation (Jose et al., 2004; Kim et al., 2004), autoimmune joint inflammation such as

rheumatoid arthritis (Kim et al., 2003). Agaricus subrufescens, Armillaria ostoyae,

Flammulina velutipes, Ganoderma lucidum and G. tsugae, Innonotus obliquus, Phellinus

linteus, Pleurotus ostreatus, P. pulmonarius, Tricholoma populinum are some mushrooms

with promising antiallergic property, which have been detected only in vitro and/or in

animal assays, and necessary to verify the results in further test systems, to elucidate the

mode of action, to conduct clinical trials, to identify the responsible bioactive compounds,

and to ensure safety and quality of resulting products (Merdivan & Lindequist, 2017).

Antihypertensive Effect

Hypertension is characterised by elevated arterial blood pressure and also known as the

‘silent killer’ as it raises the risk of cardiovascular diseases (CVDs), strokes, kidney

dysfunction, premature mortality and disability while remaining asymptomatic (WHO,

2005). It has become an epidemic and a global challenge. WHO has estimated that

hypertension causes one in every eight deaths, making it the third leading killer in the

world (Haldar, 2013). A review of current trends shows that the number of adults with

hypertension increased from 594 million in 1975 to 1.13 billion in 2015, with the increase

seen largely in low- and middle-income countries (WHO, 2020a). Hypertension alone

does not pose the threat; rather, it is correlated to hypercholesterolaemia, obesity and

atherosclerosis that makes a person vulnerable to vascular dysfunctions (Ariyo et al.,

2000; Egan & Zhao, 2013; Kearney et al., 2005).

Renin angiotensin aldosterone system (RAAS) is one of the key regulators of blood

pressure, which involves a series of enzymatic reactions. Angiotensin-converting enzyme

(ACE) in RAAS is one of the enzymes that controls blood pressure by converting inactive

angiotensin I to the potent vasoconstrictor angiotensin II (Atlas, 2007). Exploiting the

inhibitor of ACE as one curative means for hypertension is therefore paramount. ACE

inhibitors such as captopril, enalapril and lisinopril are the first-line synthetic drugs used

as clinical antihypertensive medications (Wong et al., 2004). Adverse side effects of these

synthetic antihypertensive drugs compel to find the natural, safe and alternative

therapeutic approaches. In this regard, mushrooms have been suggested to lower blood

pressure by improving lipid metabolism and kidney function and hindering angiotensin

converting enzymes (Miyazawa et al., 2008). The low concentration of sodium and the

presence of a great amount of potassium (182–395 mg/100 g) supports the utilization of

mushroom within an antihypertensive diet. Potassium-rich food helps to reduce blood

pressure (WHO, 2012). WHO recommends that adults should consume at least 3,510 mg

of potassium per day. ACE inhibitory peptides present in mushrooms lowered blood

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pressure with no adverse effect (Abdullah et al., 2012; Hong et al., 2008; Jao et al., 2012).

Several studies have investigated the antihypertensive effects of some edible mushroom

species such as Ganoderma lucidum, Grifola frondosa, Tricholoma giganteum, Marasmius

androsaceus, Pleurotus species, Lentinula edodes, Sparassis crispa, Pholiota adipose,

Sarcodon aspratus, H. marmoreus, Flammulina velutipes, Hericium erinaceus, Phlebia

tremellosa and Agaricus bisporus (Guillamón et al., 2010; Bang et al., 2014; Kabir et al.,

1987, 1988; Miyazawa et al., 2008; Mizuno & Zhuang, 1995; Yahaya et al., 2014). These

studies have attracted scientists of all over the world to focus further studies on mushroom.

Antihepatotoxic Effect

Hepatotoxicity is liver dysfunction or liver damage that is associated with an overload of

drugs or xenobiotics (Navarro & Senior, 2006). Liver is the largest organ of the human

body weighing approximately 1,500 g, and performs more than 500 vital metabolic

functions (Naruse et al., 2007). The chemicals that cause liver injury are called

hepatotoxins or hepatotoxicants. Hepatotoxicity can be caused by a wide variety of

pharmaceutical agents, natural products, chemicals or environmental pollutants and

dietary constituents.

Exposure to these hepatotoxic agents is usually accidental, through contaminated

food, water or air, or from unanticipated side effects of therapeutic agents. Severe

intoxication with hepatotoxic agents can lead to liver necrosis and death of the organism

if left untreated (Singh et al., 2011). Drug-induced hepatotoxicity is the most important

cause of acute liver failure in many countries (Andrade et al., 2019; Deng et al., 2009).

Mushrooms are considered to be beneficial for a wide range of hepatic disorders,

including hepatitis. Many mushroom extracts possess hepatoprotective property against

liver injury caused by toxic chemicals (Soares et al., 2013). Ethanolic extract of Calocybe

indica protects carbon tetrachloride (CCl4)-induced chronic hepatotoxicity in mice by

restoring the liver antioxidant status (Chatterjee et al., 2011). Sumy et al. (2014) found the

hepatoprotective effect of oyster mushroom (P. florida) against paracetamol-induced liver

damage in Wistar albino rats. G. lucidum aqueous extracts induce hepatoprotective effects

on acute liver injury induced by α-amanitin (α-AMA) (Wu et al., 2013). A significant

hepatoprotective effect on cirrhosis of the liver and chronic hepatitis B with the extracts

or polysaccharides from Dendropolyprus umbellatus, Schizophyllum commune, Trametes

versicolor, Pseudoepicoccum cocos, T. fuciformis and others has been reported

(Shamtsyan, 2016). Several bioactive agents isolated from the fruit body, mycelia and

spores of G. lucidum, such as ganoderic acids and ganosporeric acid A, are shown to have

strong antihepatotoxic activity. A polysaccharide fraction from Lentinula edodes

demonstrated liver protective action in animals together with improved liver function and

an increased production of antibodies to hepatitis B (Mizuno et al., 1995). Aqueous

extracts of Volvariella volvacea, Lentinula edodes, F. velutipes, Auricularia auricular-

judae, Tramella fuciformis, Grifola frondosa and Tricholoma lobayense are screened for

their hepatoprotective activity using paracetamol-induced liver injury (doses of 1.0 g/kg

body weight) in rats as the model of chemical hepatitis (Ooi, 1996; Soares et al., 2013).

Phenolics, triterpenes, polysaccharides and peptides are the main classes of compounds

which could be responsible for the hepatoprotective activity of the mushroom extracts.

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Anti‑aging Effect

Aging is a natural process that involves progressive physiological changes in an organism

leading to senescence, or a decline of biological functions and of the organism’s ability to

adapt to metabolic stress (Zhou et al., 2014). Among the numerous theories associated with

aging, the oxidative stress and free radical accumulation theories stand out the most that

states ROS generated inside the cell will lead to aging (Kim et al., 2016; Wang et al., 2017).

Oxidative stress is a result of imbalance between the antioxidant defense system and the

formation of ROS, which has been considered deleterious because of the damage to cell

membranes and DNA (Sies, 1997). Post-mitotic tissues such as brain, heart and skeleton

muscle are more susceptible to aging, compared with other organs (Kayali et al., 2006). In

brain, the accumulation of free radicals and attenuation of respiratory chain enzyme

complex activity cause damage to cerebral mitochondria (Trushina & McMurray, 2007),

wherein their dysfunction can induce the onset of some neurodegenerative diseases, such

as Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, among others (Islam,

2017). Besides oxidative stress, aging is also closely associated with bringing about

structural and functional defects in the immune system (Vulevic et al., 2008).

Immunological dysfunction could be the cause of the increased susceptibility of the aged

population to bacterial and virus infections, which are commonly seen in the elderly.

Human body’s natural antioxidant systems are not sufficient to repair oxidative damage

entirely (Zheng et al., 2015) and lead to the severe damage of cell functions eventually

aging and death (Harman, 2006). In order to reduce the oxidative damage of free radicals,

a lot of synthetic antioxidants are widely used, such as butylatedhydroxyanisole,

butylatedhydroxytoluene, tert-butylhydroquinone and propyl gallate (Sun & Kennedy,

2010). In recent years, researches have shown that synthetic antioxidants are restricted

due to their potential hazards related to health, such as liver damage and carcinogenesis

(Yuan et al., 2008).

In view of this, several mushrooms have been investigated for anti-aging property.

Extracted polysaccharide TLH-3, isolated from the fresh fruiting body of Tricholo

mamalobayense, shows anti-aging capability when measured in D-galactose-induced aged

mice model (Ding et al., 2016). Many anti-aging cosmeceuticals have been developed

from several types of mushrooms that are used in topical creams, serums and facial

preparations as anti-aging ingredients (Wu et al., 2016). Anti-aging patented product from

G. lucidum spores is available (Chung & Tong, 2005). Two novel anti-aging ergosterols,

ganodermasidase A and B are found in the methanolic extract of G. lucidum (Weng et al.,

2010). Water-soluble polysaccharide (AAP I-a), isolated from Auricularia auricular-

judae, prevents oxidative stress in D-galactose-induced aged mice. A paste of

polysaccharides is used for the production of anti-aging creams or lotions and other skin-

related cosmetics in the industry (Zhang et al., 2011). These polysaccharides (AAP I-a)

have the ability to delay aging as they result in the inhibition of the functional enzymes

responsible for skin aging, such as elastase, tyrosinase, hyaluronidase and MMP-1

enzymes (Chaturvedi et al., 2018). Many extracted ingredients from the fruiting body of

medicinal mushroom such as polysaccharides, polyphenolic, phenolics, terpenoids,

selenium, vitamins and volatile organic compounds show tremendous antioxidant,

anti-aging, anti-wrinkle, skin whitening and moisturizing effects (Hyde et al., 2010;

Wu et al., 2016).

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Conclusion

Mushrooms are beneficial to the humankind not only in terms of nutrition but also for

improved health. They are appropriate for inclusion in low calorie diets. Thus, mushrooms

are not only food but are the raw material for development of functional food and dietary

supplements (nutraceuticals). Furthermore, mushrooms as functional food can help in the

early intervention of sub-healthy states and may prevent the consequences of several

life‐threatening diseases. Nevertheless, more scientific efforts are needed in order to

elucidate the mechanisms and to identify and characterize the responsible and novel

bioactive compounds from mushrooms around the globe, in addition to long term clinical

trials.

Abbreviations: DM = diabetes mellitus; EFSA = European Food Safety Authority; FAO = Food

and Agriculture Organization; HIV = human immunodeficiency virus; HSV = herpes simplex virus;

LDL = low-density lipoprotein; ROS = reactive oxygen species; WHO = The World Health Organization.

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Author’s Biography

Dr. Jay Kant Raut is currently working as a Senior Scientist at Nepal

Academy of Science and Technology (NAST), Khumaltar, Lalitpur. He is

curator of Nepal Fungal Database (NFD) and Editor of NFD newsletter.

He has graduated his PhD degree in Mushroom Science in 2011 AD from

Graduate School of Horticulture, Chiba University, Japan. After

completing his Master Degree with Botany in 1997 from Tribhuvan

University, he has been actively working in the field of mycology. He is a

founder member of International Society for Fungal Conservation and

member of several other national and international professional societies.

At present, he is serving as regional representative in Asian Mycological

Association Executive Committee (2019-2023). Dr. Raut has authored/co-

authored about three dozens of research articles in national and

international journals, about dozen of op-eds and a mushroom book. He

has more than two decades of teaching and research experiences in Nepal

and Japan. Mushroom systematic and nomenclature, mushroom

biotechnology, mushroom cultivation, mycorrhiza, mushroom diversity

and conservation are the research areas of his interest. He is a prominent

crusader for mushroom science and non-green revolution in Nepal. He is

recipient of National Research Scientist Award 2019, Nepal Bidhya

Bhushan Padak ‘Ka’ and others.

Dr. Mahesh Kumar Adhikari is an eminent mycologist and currently

serving as the Secretary of Nepal Academy of Science and Technology

(NAST), Khumaltar, Lalitpur. He received MSc in Botany (in 1973) from

Tribhuvan University, Kathmandu Nepal, and PhD in 1996 from

University Paul Sabatier, Toulouse, France. Since 1976, he has been

working on the systematics and biodiversity of fungi and published

around 200 fungal related articles and seven books. He has discovered 16

fungal species from the territory of Nepal which are new to science. Two

newly discovered fungi have been named as Puccinia adhikarii Ono and

Suillus adhikarii Das, Chakraborty & Cotter after him. The mushrooms

Russula nepalensis Adhikari and Russula kathmanduensis Adhikari

described by him, were released as postage stamp by Government of

Nepal, Department of Postal Services. Dr. Adhikari has edited several

books, proceedings and bulletins.

He is the Life member/member of Nepal Botanical Society, Natural

History Society of Nepal, Ecological Society of Nepal and other

professional societies. He has already served as the Vice-President of

Nepal Botanical Society, and Mycological and Phytopathological Society

of Nepal. He has also served as Member Secretary of APINMAP/

SCAMAP committee, Nepal National commission for UNESCO,

Ministry of Education and Culture, and IUFRO committees.

Dr. Adhikari is decorated with Young Scientist Traveling Fellowship

Award, Janpad Sewa Padak, Shree Panch Birendra Rajyarohan Rajat

Mahotsav Padak, Mahendra Vidhya Bhushan Padak (A grade), Nepal

Science and Technology Award, National Plant Resource Award, etc.

Scope and challenges of mushroom production and their mitigations in Nepal: A review

Article

Full-text available

Jun 2022

This review paper aims to discuss and compile information regarding various scopes, challenges , and mitigating measures of mushroom cultivation in Nepal. Overall information on mushroom cultivation comprising its status, scope, and problems is vital for bringing positive change in this sector. Different secondary sources of information were reviewed and analyzed including journals like Elsevier and Springer. In Nepal, the production of mushrooms has increased about 8.23 times over a decade until 2020. Nepal is blessed with a range of ecosystems that really are ideal for mushroom production. Different mushroom species have been commercially cultivated in different parts of Nepal. Mushroom production can be used as an alternative source to overcome food and nutrition security problems and eventually leads to the livelihood improvement of people in developing countries like Nepal. The study revealed that mushrooms can be used to fight several diseases with their nutritional and medicinal properties. The demand for mushrooms is increasing nowadays more than ever. With the implementation of various measures with proper coordination and planning, mushroom cultivation can be proliferated. As a result, the mushroom industry has a lot of potentials to help the country's socioeconomic transition. Nepal can capitalize on this opportunity by enacting appropriate and concrete national mushroom policies and programs.

Economically Important Plants in Nepal

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Apr 2024

Nepal is home to many commercially significant plants that are used to meet everyday needs and have always been present in Nepal. The facts on commercially significant plants, their state of conservation, and future conservation requirements are provided in this chapter. This chapter highlights the need for more data on commercially important plants that will aid in creating the management strategies required for conservation.

Potential antioxidant activity of some mushrooms growing in Kashmir Valley

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Full-text available

Jan 2010

In the present study some mushrooms were collected from different sites/forest areas of south Kashmir and then were evaluated for antioxidant activity. It was revealed from the study the all the concentrations of tested mushrooms showed antioxidant activity. However, the highest antioxidant activity was observed at highest concentration of mushroom extracts. It was followed by lower concentrations of mushroom extract. Sarcoscypha coccinia showed highest antioxidant activity followed by Cantharella cibarius, Bovista plumbea, Coprinus comatus and C. atramentarius respectively. All the extracts of mushrooms showed positive correlation with standard oxidant, catechol. The antioxidant activity of mushroom extracts was either lower or higher than the antioxidant activity of catechol.

Anti-Inflammatory Activity of Pleurotus ostreatus , a Culinary Medicinal Mushroom, in Wistar Rats

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Mar 2020
EVID-BASED COMPL ALT

Context . Pleurotus ostreatus ( P.o ) is a culinary mushroom which is commonly called as “oyster mushroom” belonging to the Basidiomycetous fungi of the order Agaricales and family Pleurotaceae. Objectives . The present study investigates the anti-inflammatory potential of P.o and the underlying mechanisms of activity. Materials and Methods . Anti-inflammatory activity was evaluated using suspensions of freeze-dried and powdered (SFDP) P.o and acetone extract (AE) of P.o in normal and alloxan-induced diabetic rats using the carrageenan-induced rat paw oedema model. The mechanisms by which P.o is mediating the anti-inflammatory activity were studied using in vivo and in vitro assays. Results . At doses of 500–1000 mg/kg, the SFDP of P.o showed long-lasting activity at both early and late phases of carrageenan-induced rat paw oedema. The dose of 750 mg/kg showed the most potent inhibitory activity (92% inhibition) in healthy rats. The AE of P.o showed maximum inhibition of oedema of 87%. P.o exerted protective effects on the inflammatory pathologies in rats with diabetes. The possible mechanisms by which P.o mediates the anti-inflammatory activity were antihistamine activity (52.1%), inhibition of cell migration to the site of inflammation (45.4%), in vitro membrane stabilizing activity (52.6%), and inhibition of nitric oxide (NO) production (91.2%) ( P < 0.05 ). Dose-dependent inhibition of NO production was seen with in vitro treatment of rat peritoneal cells with AE of P.o ( r = 0.95; P < 0.05 ). Discussion and Conclusion. The promising activity of culinary mushroom P.o against inflammation suggests its potential application as a functional food during inflammatory conditions.

Fungal Diversity Revisited: 2.2 to 3.8 Million Species

Chapter

Full-text available

Sep 2017

Determination of Antimicrobial Activity of Extracts of Indigenous Wild Mushrooms against Pathogenic Organisms

Article

Full-text available

Feb 2019
EVID-BASED COMPL ALT

Objective: This study has investigated the antimicrobial activity of extracts of indigenous wild mushrooms against selected organisms. Methods: Thirty-five (35) indigenous wild mushrooms were collected from Arabuko-Sokoke and Kakamega National Reserve Forests, Kenya. All mushrooms were identified and their contents were extracted and screened for their antimicrobial activities against Escherichia coli (clinical isolate), Klebsiella pneumoniae (ATCC 13883), Pseudomonas aeruginosa (clinical isolate), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 25923), MRSA (ATCC 33591), Candida albicans (clinical isolate), and Candida parapsilosis (ATCC 90018) using tetrazolium microtiter plate bioassay method. Results: Of the 35 tested mushroom extracts, extracts of three (3) mushrooms, namely, Trametes spp. (Arabuko-Sokoke forest), Trametes, and Microporus spp. (Kakamega forest), have shown promising antimicrobial activities against the tested organisms. The S. aureus (ATCC 25923), P. aeruginosa (ATCC 27853), and Methicillin-Resistant Staphylococcus aureus (MRSA) (ATCC 33591) were the most susceptible to chloroform extract of Trametes spp. collected from Arabuko-Sokoke forest. Of the tested organisms, S. aureus (ATCC 25923) was the most susceptible whereas E. coli was the most resistant organism to the hot water extract of Trametes spp. collected from Arabuko-Sokoke forest. Chloroform extract of Microporus spp. has shown the highest antibacterial activity against S. aureus (ATCC 25923), MRSA (ATCC 33591), and K. pneumoniae (ATCC 13883) but limited activity against E.coli. All extracts of the three wild mushrooms have shown the most antibacterial activities against S. aureus (ATCC 25923). Conclusion: The present study has shown that the extracts of the three wild mushrooms have shown promising antimicrobial activities against the tested organisms.

History of mushroom consumption and its impact on traditional view on mycobiota -an example from Poland

Article

Full-text available

Dec 2019

Marcin Kotowski

For millennia, fungi have been known by various communities as a valuable source of nutrition and medicines, however traditional view on mycobiota has changed throughout the history. A major role in this context played past scholars and scientists whose impact on attitude towards mushroom collection is also seen in our times. Their confrontation with traditional folk knowledge on mycobiota could be the cause of current division between mycophobic and mycophillic nations. The aim of this article is to present these changes from the perspective of Polish nation, which is currently considered as highly mycophillic. The visible change in scholars' attitude towards fungi and acceptance of folk view on mushrooms took place not earlier than at the turn of XVIII th and XIX th century. Long scientific reluctance to fungal kingdom has caused that knowledge about wild edible fungi is still limited and we still have broadly explore the world of fungi. With the right approach, mushrooms are able to provide us with many, possibly yet unknown benefits.

Trade and Conservation of Morel Mushrooms in Nepal

Article

Full-text available

Nov 2019

In Nepal morel mushroom is one of the most important wild edible fungi, which is exported, in larger quantities. They have been collected, consumed and traded for more than two decades. The morel mushroom trade is worth a multi-billion dollar industry worldwide. This study was carried out to elucidate the current harvest and trade of morel mushrooms, the prospects for commercial morel industry development and the resource management in Nepal. Wild morels are harvested commercially and exported extensively from west Nepal especially from Karnali and Far West Province which share 58% and 29% of total national output respectively. Most commonly found and traded species are Morchella conica and M. esculenta. In most cases, the collectors sell morels in fresh form to the local dealers or in the local markets from where they are exported to different parts of the world. A bulk of morel mushrooms is traded via Nepalgunj and Mahendranagar routes. The local collectors get nominal benefits as prices are very low in the local area as compared to international markets. The price of M. conica is always higher than other morel species. There is neither processing nor any kind of value addition works currently being done in Nepal except drying, grading and packaging. The present study reveals that Nepal has a huge potential to become a major global producer of high quality morels. There is no serious concern about the overexploitation of the resource at the moment. However, a reliable local monitoring system and a scientific intervention for the artificial cultivation are inevitable for the sustainable management.

Analysis of Nutritional and Nutraceutical Properties of Wild-Grown Mushrooms of Nepal

Article

Full-text available

Jan 2017

The present study was conducted to evaluate nutritional properties of wild grown mushrooms collected from Far western regions of Nepal, mainly from two districts Darchula and Baitadi. Herein, it was reported and compared the nutritional value and nutraceutical values of the wild mushroom species; Laetiporus sulphureus (chicken of the woods), Polypore sp., Trametes elegans, Trichaptum biforme, Lenzites betulina, Stereum complicatum, Trametes versicolor, Trichaptum subchartaceum, and Ganoderma Lucidium. These mushrooms were found to be rich in proteins (6.8 - 60.23%), fibres ranging from 0.174 - 36.38% and also contained fat ranging from 3.642 - 14.6%. The carbohydrate contents ranged from 7.058 to 59% (on the basis of dry weight). Similarly; ash content and moisture content ranged from 10 - 19% and 10 - 16% respectively. The protein content was highest in Ganoderma lucidium (G. lucidium) and lowest in Trametes elegans (T. elegans). The fat content was highest in L. sulphureus and lowest in G. lucidium. Total phenolic content was estimated spectrophotometrically according to the Folin-Ciocalteus method. The analysis revealed that the total phenolic contents ranged from 3.95 to 10.05 mg ml-1. Similarly, the total flavonoid contents ranged from 2.149 to 11.36 mg ml-1. Our result indicated the high levels of antioxidants activity thus making mushrooms suitable to be used as functional foods or nutraceutical sources. Therefore, this study provides new information regarding chemical properties of wild mushrooms, which is very important for the biodiversity characterization.

Scientific Opinion on the substantiation of a health claim related to oat beta glucan and lowering blood cholesterol and reduced risk of (coronary) heart disease pursuant to Article 14 of Regulation (EC) No 1924/2006

Article

Dec 2010

Nutrition and Allergies (NDA) EFSA Panel on Dietetic Products

Following an application from CreaNutrition AG submitted pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of the United Kingdom, the Panel on Dietetic Products, Nutrition and Allergies was asked to deliver an opinion on the scientific substantiation of a health claim related to oat beta glucan and lowering of blood LDL and total cholesterol. Oat beta-glucan is sufficiently characterised. Lowering blood LDL-cholesterol concentrations is a beneficial physiological effect by decreasing the risk of coronary heart disease. The applicant identified a total of 22 references, which included three meta-analyses and 19 randomised controlled trials, as being pertinent to the health claim. In weighing the evidence, the Panel took into account that most of the trials investigating the effects of oat beta-glucan at doses of at least 3 g/d have shown a statistically significant decrease in LDL-cholesterol concentrations, and that there was strong evidence supporting the biological plausibility of the effect. The Panel concludes that a cause and effect relationship has been established between the consumption of oat beta-glucan and lowering of blood LDL-cholesterol concentrations. The following wording reflects the scientific evidence: “Oat beta-glucan has been shown to lower/reduce blood cholesterol. Blood cholesterol lowering may reduce the risk of (coronary) heart disease”. The Panel considers that, in order to bear the claim, foods should provide at least 3 g of oat beta-glucan per day. This amount can reasonably be consumed as part of a balanced diet. The target population is adults who want to lower their blood cholesterol concentrations.

In search of a selective antiviral chemotherapy.

Article

Oct 1997

Erik De Clercq

This article describes several approaches to a selective therapy of virus infections: (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU [brivudin]) for the therapy of herpes simplex virus type 1 and varicella-zoster virus infections: (S)-9-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine (HPMPC [cidofovir]) for the therapy of various DNA virus (i.e., herpesvirus, adenovirus, papillomavirus, polyomavirus, and poxvirus) infections; 9-(2-phosphonylmethoxyethyl)adenine (PMEA [adefovir]) for the therapy of retrovirus, hepadnavirus, and herpesvirus infections; (R)-9-(2-phosphonylmethoxypropyl)adenine (PMPA) for the therapy and prophylaxis of retrovirus and hepadnavirus infections; and nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as tetrahydroimidazo[4,5,1-jk][1,4]-benzodiazepin-2(IH)-one and -thione (TIBO), 1-[(2-hydroxyethoxy)methyl]-6-(phenylthio)thymine (HEPT), alpha-anilinophenylacetamide (alpha-APA), and 2',5'bis-O-(tert-butyldimethylsilyl)-3'-spiro-5"-(4"-amino-1",2"-oxat hiole- 2",2"-dioxide)pyrimidine (TSAO) derivatives, and thiocarboxanilides for the treatment of human immunodeficiency virus type 1 (HIV-1) infections. For the clinical use of NNRTIs, some guidelines have been elaborated, such as starting treatment with combinations of different compounds at sufficiently high concentrations to effect a pronounced and sustained suppression of the virus. Despite the diversity of the compounds described here and the different viruses at which they are targeted, they have a number of characteristics in common. As they interact with specific viral proteins, the compounds achieve a selective inhibition of the replication of the virus, which, in turn, should be able to develop resistance to the compounds. However, as has been established for the NNRTIs, the problem of viral resistance may be overcome if the compounds are used from the start at sufficiently high doses, which could be reduced if different compounds are combined. For HIV infections, drug treatment regimens should be aimed at reducing the viral load to such an extent that the risk for progression to AIDS will be minimized, if not avoided entirely. This may result in a real "cure" of the disease but not necessarily of the virus infection, and in this sense, HIV disease may be reduced to a dormant infection, reminiscent of the latent herpesvirus infections. Should virus replication resume after a certain time, the armamentarium of effective anti-HIV and anti-herpesvirus compounds now available, if applied at the appropriate dosage regimens, should make the virus return to its dormant state before it has any chance to damage the host. It is unlikely that this strategy would eradicate the virus and thus "cure" the viral infection, but it definitely qualifies as a cure of the disease.

Drug-induced liver injury

Article

Dec 2019

Drug-induced liver injury (DILI) is an adverse reaction to drugs or other xenobiotics that occurs either as a predictable event when an individual is exposed to toxic doses of some compounds or as an unpredictable event with many drugs in common use. Drugs can be harmful to the liver in susceptible individuals owing to genetic and environmental risk factors. These risk factors modify hepatic metabolism and excretion of the DILI-causative agent leading to cellular stress, cell death, activation of an adaptive immune response and a failure to adapt, with progression to overt liver injury. Idiosyncratic DILI is a relative rare hepatic disorder but can be severe and, in some cases, fatal, presenting with a variety of phenotypes, which mimic other hepatic diseases. The diagnosis of DILI relies on the exclusion of other aetiologies of liver disease as specific biomarkers are still lacking. Clinical scales such as CIOMS/RUCAM can support the diagnostic process but need refinement. A number of clinical variables, validated in prospective cohorts, can be used to predict a more severe DILI outcome. Although no pharmacological therapy has been adequately tested in randomized clinical trials, corticosteroids can be useful, particularly in the emergent form of DILI related to immune-checkpoint inhibitors in patients with cancer. This Primer discusses the cause, mechanisms, diagnosis and treatment of drug-induced liver injury — an adverse reaction to supplements, herbal medicines and commonly used pharmaceuticals.

Chapter 8 Mushroom: A True Super Food

Abstract

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