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REVIEW ARTICLE
been studied for biological activity as shown in Table 1. biting the growth of Tinea rubrum30. In vitro, it can
The structure of some of these bioactive compounds has completely inhibit the growth of Mycobacterium tuber-
been presented in Figure 1. culosis and was also found to be bactericidal30. Diuretic
Nimbidin, a major crude bitter principle extracted from activity was also reported for sodium nimbidinate in
the oil of seed kernels of A. indica demonstrated several dogs31. Nimbolide (2) has been shown to exert anti-
biological activities. From this crude principle some malarial activity by inhibiting the growth of Plasmodium
tetranortriterpenes, including nimbin, nimbinin, nimbidi- falciparum32,33. Nimbolide also shows antibacterial acti-
nin, nimbolide and nimbidic acid have been isolated12,20. vity against S. aureus and S. coagulase34.
Nimbidin and sodium nimbidate possess significant dose- Gedunin (3), isolated from neem seed oil has been
dependent anti-inflammatory activity against carrageenin- reported to possess both antifungal35 and antimalarial33
induced acute paw oedema in rats and formalin-induced activities. Azadirachtin (4), highly oxygenated C-seco-
arthritis21,22. Antipyretic activity has also been reported meliacins isolated from neem seed and having strong
and confirmed in nimbidin23. Oral administration of antifeedant activity17,19,36, has been demonstrated to have
nimbidin demonstrated significant hypoglycaemic effect antimalarial property as well. It is inhibitory to the deve-
in fasting rabbits24. A significant antiulcer effect was lopment of malarial parasites37. Mahmoodin (5), a deoxy-
observed with nimbidin in preventing acetylsalicylic gedunin isolated from seed oil, has been shown to possess
acid, indomethacin, stress or serotonin-induced gastric moderate antibacterial action against some strains of
lesions as well as histamine or cysteamine-induced duo- human pathogenic bacteria18. Condensed tannins from the
denal ulcers25,26. Nimbidin can also suppress basal as bark contain gallic acid, (+) gallocatechin, (–) epicate-
well as histamine and carbachol-stimulated gastric acid chin, (+) catechin and epigallocatechin, of which gallic
output and may act as an antihistamine by blocking H2 acid (6), (–) epicatechin (7) and catechin (8) are primarily
receptors, thereby helping as an antiulcer agent27. The responsible for inhibiting the generation of chemilumine-
spermicidal activity of nimbidin and nimbin (1) was scence by activated human polymorphonuclear neutrophil
reported in rats and human as early as 1959 (refs 28, 29). (PMN)38, indicating that these compounds inhibit oxi-
Nimbidin also demonstrated antifungal activity by inhi- dative burst of PMN during inflammation. Three tricyclic
Nimbidin Anti-inflammatory 21
Antiarthritic 22
Antipyretic 23
Hypoglycaemic 24
Antigastric ulcer 25, 26
Spermicidal 29
Antifungal 30
Antibacterial 30
Diuretic 31
Sodium nimbidate Anti-inflammatory 21, 22
Nimbin (1) Seed oil Spermicidal 28
Nimbolide (2) Seed oil Antibacterial 32, 33
Antimalarial 34
Gedunin (3) Seed oil Antifungal 35
Antimalarial 33
Azadirachtin (4) Seed Antimalarial 37
Mahmoodin (5) Seed oil Antibacterial 18
Gallic acid (6), (–) epicatechin (7) Bark Anti-inflammatory and 38
and catechin (8) immunomodulatory
Margolone (9), margolonone (10) Bark Antibacterial 39
and isomargolonone (11)
Cyclic trisulphide (12) and Leaf Antifungal 40
cyclic tetrasulphide (13)
Polysaccharides Anti-inflammatory 41
Polysaccharides GIa (14), GIb Bark Antitumour 42
Polysaccharides GIIa (15), GIIIa (16) Bark Anti-inflammatory 43
NB-II peptidoglycan Bark Immunomodulatory 44, 45
diterpenoids, margolone (9), margolonone (10) and iso- of the tumours, when administered in mice at a daily dose
margolonone (11) isolated from neem stem bark are of 50 mg/kg for four days from 24 h after subcutaneous
active against Klebsiella, Staphylococcus and Serratia inoculation of Sarcoma-180 cells42. Two more poly-
species39. Sulphur-containing compounds such as cyclic saccharides, GIIa (15) and GIIIa (16) isolated from M.
trisulphide (12) and tetrasulphide (13) isolated from the azadirachta bark also showed significant anti-inflam-
steam distillate of fresh, matured neem leaves have matory effect on carrageenin-induced oedema in mice43.
antifungal activity against Trichophyton mentagrophy- Two polymers isolated from an aqueous extract of neem
tes40. Several polysaccharides from neem exhibit various bark possess anticomplement activity, amongst which the
biological effects. A polysaccharide extracted from bark compound NB-II, a peptidoglycan of lower molecular
inhibits carrageenin-induced inflammation in mouse41. weight was found to be more potent44,45. Some active
Two water-soluble polysaccharides GIa (14) and GIb ingredients (phytosterol fraction) isolated from the lipid
isolated from the bark of Melia azadirachta, demon- part of neem fruits, exhibit antiulcer activity in stress-
strated strong antitumour effect with complete regression induced gastric lesions46.
Pharmacological actions of neem extract cured by the bark extract52. Antipyretic activity has been
reported in neem oil30,53. A methanol extract of the leaves
Several pharmacological activities and medicinal appli- exerts antipyretic effect in male rabbits54. The plant also
cations of various parts of neem are well known16,47. possesses analgesic activity mediated through opioid
Biological activity of neem is reported with the crude receptors in laboratory animals55. Anti-inflammatory and
extracts and their different fractions from leaf, bark, root, antipyretic activities in various extracts have been
seed and oil. However, crude extract of different parts of reviewed56.
neem have been used as traditional medicine for the
treatment of various diseases. Immunostimulant activity: The aqueous extract of neem
bark possesses anticomplement activity, acting both on
the alternative as well as the classical pathway of com-
Medicinal use of various parts of neem plement activation in human serum44. Recently, an
aqueous extract of stem bark has been shown to enhance
Various parts of the neem tree have been used as tradi-
the immune response of Balb-c mice to sheep red blood
tional ayurvedic medicine in India from time imme-
cells in vivo57. The aqueous extract of leaf also possesses
morial48. The medicinal utilities have been described,
potent immunostimulant activity as evidenced by both
especially for leaf, fruit and bark4. Neem oil and the bark
humoral and cell-mediated responses58,59. Leaf extract at
and leaf extracts have been therapeutically used as folk
100 mg/kg after three weeks of oral administration causes
medicine to control leprosy, intestinal helminthiasis,
higher IgM and IgG levels along with increased titer of
respiratory disorders, constipation and also as a general
antiovalbumin antibody59. Neem oil has been shown to
health promoter49. Its use for the treatment of rheu-
possess immunostimulant activity by selectively acti-
matism, chronic syphilitic sores and indolent ulcer has
vating the cell-mediated immune mechanisms to elicit an
also been evident3. Neem oil finds use to control various
enhanced response to subsequent mitogenic or antigenic
skin infections1. Bark, leaf, root, flower and fruit together
challenge60.
cure blood morbidity, biliary afflictions, itching, skin
ulcers, burning sensations and pthysis13. Some of the medi-
Hypoglycaemic activity: Aqueous extract of neem leaves
cinal attributes of various parts of neem50 as mentioned
significantly decreases blood sugar level and prevents
in ayurveda13,48 have been summarized in Table 2.
adrenaline as well as glucose-induced hyperglycaemia61.
However, apart from these uses, there are several reports
The aqueous leaf extract when orally fed, also produces
on the biological activities and pharmacological actions
hypoglycaemia in normal rats and decreased blood glu-
of neem based on modern scientific investigations.
cose levels in experimentally-induced diabetes in rats62.
Aqueous leaf extract also reduces hyperglycaemia in
Anti-inflammatory, antipyretic and analgesic activities:
streptozotocin diabetes and the effect is possibly due to
The chloroform extract of stem bark is effective against
presence of a flavonoid, quercetin63. A significant hypo-
carrageenin-induced paw oedema in rat and mouse ear
glycaemic effect was also observed by feeding neem oil
inflammation51. Inflammatory stomatitis in children is
to fasting rabbits24. Recently, hypoglycaemic effect was
observed with leaf extract and seed oil, in normal as well
Table 2. Some medicinal uses of neem as mentioned in ayurveda as alloxan-induced diabetic rabbits64. The possible mecha-
Part Medicinal use
nisms underlying the hypoglycaemic activity of the aque-
ous leaf extract have also been discussed65,66.
Leaf Leprosy, eye problem, epistaxis, intestinal
worms, anorexia, biliousness, skin ulcers.
Antiulcer effect: Neem leaf aqueous extract produces
Bark Analgesic, alternative and curative of fever. antiulcer effect in rats exposed to restraint – cold stress
Flower Bile suppression, elimination of intestinal or ethanol orally by preventing mucus depletion and mast
worms and phlegm.
cell degranulation67. An aqueous extract of neem bark
Fruit Relieves piles, intestinal worms, urinary dis-
order, epistaxis, phlegm, eye problem, diabe-
has been shown from our laboratory to possess highly
tes, wounds and leprosy. potent antiacid secretory and antiulcer activity and the
Twig Relieves cough, asthma, piles, phantom bioactive compound has been attributed to a glycoside68.
tumour, intestinal worms, spermatorrhoea,
obstinate urinary disorder, diabetes. Antifertility effect: Neem oil proved spermicidal against
Gum Effective against skin diseases like ring- rhesus monkey and human spermatozoa in vitro69. In vivo
worms, scabies, wounds and ulcers.
studies showed that intravaginal application of neem oil
Seed pulp Leprosy and intestinal worms.
prior to coitus can prevent pregnancy69. Antifertility
Oil Leprosy and intestinal worms. effect of neem oil has also been studied and suggested to
Root, bark, leaf, flower Blood morbidity, biliary afflictions, itching, be a novel method of contraception70–72. Oral adminis-
and fruit together skin ulcer, burning sensation and leprosy.
tration of aqueous extract of neem leaf also shows
CURRENT SCIENCE, VOL. 82, NO. 11, 10 JUNE 2002 1339
REVIEW ARTICLE
antifertility effect in mice73. Purified neem seed extract Anticarcinogenic activity: Neem leaf aqueous extract
(Praneem) has also been demonstrated to abrogate effectively suppresses oral squamous cell carcinoma
pregnancy in both baboons and bonnet monkeys, when induced by 7,12-dimethylbenz[a]anthracene (DMBA), as
administered orally74. From the hexane extract of neem revealed by reduced incidence of neoplasm88. Neem may
seed, an active fraction containing six components has exert its chemopreventive effect in the oral mucosa by
been found to completely abrogate pregnancy in rodents modulation of glutathione and its metabolizing enzymes.
when given orally up to a concentration of 10%, with no That neem leaf extract exerts its protective effect in N-
apparent side effect75. The effect is possibly due to methyl-N′-nitro-N-nitrosoguanidine (MNNG) (a carcino-
activation of cell-mediated immune reaction. The mecha- genic material)-induced oxidative stress has also been
nism of action of neem oil appears to be non-hormonal, demonstrated by the reduced formation of lipid peroxides
probably mediated through its spermicidal effect and may and enhanced level of antioxidants and detoxifying
have less side effects than steroidal contraceptives. enzymes in the stomach, a primary target organ for
MNNG as well as in the liver and in circulation89,90.
Antimalarial activity: Neem seed and leaf extracts are
Hepatoprotective activity: The aqueous extract of neem
effective against malarial parasites33,76. Components of
leaf was found to offer protection against paracetamol-
the alcoholic extracts of leaves and seeds are effective
induced liver necrosis in rats91. The elevated levels of
against both chloroquin-resistant and sensitive strains of
serum aspartate aminotransferase (AST), alanine amino-
malarial parasite77. Recently, neem seed extract and its
transferase (ALT) and gamma glutamyl transpeptidase
purified fractions have been shown to inhibit growth
(GGT) indicative of liver damage, were found to be sig-
and development of asexual and sexual stages of drug-
nificantly reduced on administration of the neem leaf
sensitive and resistant strains of the human malarial
aqueous extract.
parasite P. falciparum78.
Antioxidant activity: The antioxidant activity of neem
Antifungal activity: Extracts of neem leaf, neem oil and seed extract has been demonstrated in vivo during horse-
seed kernels are effective against certain human fungi, grain germination, which is associated with low levels of
including Trichophyton, Epidermophyton, Microsporum, lipooxygenase activity and lipid peroxides92. An antioxi-
Trichosporon, Geotricum and Candida79. High anti- dant principle has also been isolated, which is a potent
mycotic activity with extracts of different parts of neem inhibitor of plant lipooxygenases.
has already been reported56.
Effect on central nervous system: Varying degrees of
Antibacterial activity: Oil from the leaves, seeds central nervous system (CNS) depressant activity in mice
and bark possesses a wide spectrum of antibacterial was observed with the leaf extract93. Fractions of acetone
action against Gram-negative and Gram-positive micro- extract of leaf showed significant CNS depressant acti-
organisms, including M. tuberculosis and streptomycin- vity94. Leaf extract up to a dose of 200 mg/kg body weight
resistant strains80. In vitro, it inhibits Vibrio cholerae, produces significant anxiolytic activity in rats95. The
Klebsiella pneumoniae, M. tuberculosis and M. pyo- crude ethanolic extract of stem bark and root bark showed
genes81. Antimicrobial effects of neem extract have been hypotensive, spasmolytic and diuretic activities96,97.
demonstrated against Streptococcus mutans and S. fae-
calis82. NIM-76, a new vaginal contraceptive from neem
Clinical studies and plausible medicinal
oil showed inhibitory effect on the growth of various
applications of neem
pathogens, including bacteria, fungi and virus83. Recently,
the antibacterial activity of neem seed oil was assessed
Although a large number of studies have been carried out
in vitro against 14 strains of pathogenic bacteria84.
on various biological activities of neem extracts and
some of the isolated compounds in several animal models,
Antiviral activity: Aqueous leaf extract offers antiviral
a few reports are available on clinical studies with
activity against Vaccinia virus85, Chikungemya and mea-
the extracts or the compounds and their medicinal
sles virus in vitro86. The antiviral and virucidal effects of
applications.
the methanolic extract of neem leaves (NCL-11) have
recently been demonstrated against group-B Coxsackie
viruses87. NCL-11 inhibits plaque formation in different Neem extract
antigenic types of Coxsackie virus B at a concentration of
1 mg/ml at 96 h in vitro. Further studies indicated that Clinical studies with the dried neem leaf extract indicated
NCL-11 is most effective in Coxsackie virus B-4 as a its effectiveness to cure ringworm, eczema and scabies.
virusidal agent, in addition to its interference at the early Lotion derived from neem leaf, when locally applied, can
events of its replication. cure these dermatological diseases within 3–4 days in
1340 CURRENT SCIENCE, VOL. 82, NO. 11, 10 JUNE 2002
REVIEW ARTICLE
acute stage or a fortnight in chronic case98,99. A paste has antimicrobial activity. Phase I clinical trials have
prepared with neem and turmeric was found to be been completed in India, Egypt and the Dominician
effective in the treatment of scabies in nearly 814 Republic. These indicate the safety of its use with bene-
people100. In 97% of cases, the paste was found to cure ficial action in invaginosis due to microbial infection106.
scabies within 3–15 days of treatment without any In most women, the pessary also prevented migration of
adverse effect. Neem leaf extract has been prescribed for sperm into the cervical mucus107. Praneem pessary has
oral use for the treatment of malaria by Indian ayurvedic thus potential for the development of contraceptive devices.
practitioners from time immemorial. Dried neem leaves
in the form of tea are used by the people of Nigeria and Neem compound
Haiti to treat this disease101. Recently, a clinical trial has
been carried out to see the efficacy of neem extract to There have been very few reports on the clinical trials
control hyperlipidemia in a group of malarial patients done with bioactive compounds isolated from neem.
severely infected with P. falciparum102. The lipid level, Sodium nimbidinate, the sodium salt of nimbidin, the
especially cholesterol, was found to be lower during main bitter principle isolated from neem seed oil, has
therapy when compared to non-malaria patients. This is a been shown to act as a potent diuretic under various clini-
report on malaria patients being treated with the neem cal conditions108. In a limited clinical trial, oral admin-
extract on plasma lipid level during infection. Several istration of 100 mg nimbidin three times daily for 10
clinical studies have been reported with the neem oil. consecutive days to tropical eosinophilia patients, caused
Application of neem oil on the hair has been shown to 25% reduction in total eosinophil count with a marked
kill head lice101. Reports are available regarding the use symptomatic relief109.
of neem to treat patients suffering from various forms of
cancer103. One patient with parotid tumour and another
with epidermoid carcinoma have responded successfully
Safety evaluation with various parts of neem and
when treated with neem seed oil104. Although in trials
neem products
neem oil has been shown to have antimicrobial effect to
Various studies have been reported on the safety evalu-
inhibit many species of pathogenic bacteria, including S.
ation of different parts of neem as well as its various
aureus and Salmonella typhora, it has not been consi-
biologically active products98,110–112. As the details of
dered as antibiotic due to some limitations101. Conside-
these studies are beyond the scope of this review, only
rable clinical trials have been done on the antifertility
the major findings have been presented.
effect of neem oil. NIM-76, a refined product from neem
oil, was studied in 10 human volunteers, where intra-
vaginal application before sexual intercourse could prevent Neem bark
pregnancy with no adverse effect on vagina, cervix and Neem stem bark extract shows lethal effect in three com-
uterus101. After demonstrating the antifertility effect of mon snail species Biomphalaria pfeifferi, Bulinus trunca-
intrauterine neem oil treatment (IUNT) in bonnet monkeys tus and Lymnaea natalensis and against fish, Aphyosemon
with no apparent side effects71, phase I clinical trials giardneri113. Methanolic extract of neem bark demonstra-
were conducted on Praneem Vilci (PV)105, a purified ted oral LD50 at about 13 g/kg in acute toxicity studies on
neem oil preparation on eighteen healthy tubectomized mice98. Detailed toxicity studies have recently been
women to evaluate the safety after a single intrauterine conducted in rats with the neem bark aqueous extract114
instillation of PV and to determine the effects of its as an extension of our studies showing antiacidsecretory–
coadministration on anti-hCG response to the hetero- antiulcer activity of the bark extract68. In 14-day oral
species dimer (HSD) hCG vaccine. Haematological and toxicity studies with 2 g/kg body weight, no lethal effect
biochemical profiles, mid-luteal serum progesterone level was observed, with no apparent change in relative organ
and ovulatory status were determined before and after weight, hematological parameters, enzyme levels and
intrauterine treatment with PV. Except one woman show- histopathology of several organs. The subacute (28 days)
ing nonspecific endometritis, no significant adverse effect oral toxicity studies with both 0.05 and 0.1 g/kg body
was observed in other women and all women receiving weight also revealed no abnormalities in the above-
PV and HSD vaccine produced antibodies against hCG. mentioned parameters. Acute and subacute (14 days)
The data suggested that intrauterine treatment of PV is toxicity studies in the authors’ laboratory on mice with 1
safe. The authors are unaware whether phase II and phase g/kg and 0.6 g/kg body weight respectively also showed
III clinical trials have been carried out. A polyherbal no lethal effect with the bark extract.
pessary (Praneem polyherbal pessary) has been deve-
loped using some purified ingredients from neem leaves, Neem seed
Sapindus mukerossi and Mencitrata oil, which shows
spermicidal action in vitro on human sperm and in vivo Various neem seed preparations such as aqueous neem
on post-coital tests in women106,107. The formulation also seed kernel extract demonstrated toxicity to Oreochromis
CURRENT SCIENCE, VOL. 82, NO. 11, 10 JUNE 2002 1341
REVIEW ARTICLE
niloticus (tilapia) and Cyprinus carpio (carp)110. Nearly oil produces toxic effect in humans in several isolated
60% mortality was observed in white leghorn chicks cases98,110,118. Neem oil intoxication by humans produces
within a day of feeding powdered ripe neem berry aque- diarrhoea, nausea, vomiting, acidosis, encephalopathy,
ous extract110,115. Another feeding trial with neem seed etc.110,118. These toxic effects might be due to presence of
meal (2.5%) on chicks110 indicated mild to severe changes aflatoxin and other toxic compounds present in neem oil.
in kidney, liver, spleen, intestine and heart. An aqueous Mechanistic investigations indicate that neem oil un-
extract of neem seed kernel (1 ml/100 g body weight couples mitochondrial oxidative phosphorylation, thus
daily of a 50 g/l solution) produces trypsin inhibitory inhibiting the respiratory chain. It also decreases intra-
activity in weanling rats110,116. Retardation of spermato- mitochondrial levels of acetyl CoA and acid-soluble CoA
genesis was observed by feeding neem seed cake to esters and reduces the mitochondrial ATP content98,110,119.
rats110. Calves fed with neem seed cake showed reduced
haemoglobin content in the blood, along with dep-
ression110.
Neem leaves