Cissampelos capensis L.f. (Menispermaceae): Review of its medicinal uses, phytochemical and pharmacological properties

Cissampelos capensis L.f. is a perennial climber widely used as a traditional medicine in SouthAfrica. This studywasaimedat providing a critical reviewof medicinal uses, phytochemical and pharmacological properties of C. capensis. Documented information on the pharmacological properties, phytochemistry and medicinal uses of C. capensis was collected from several online sources such as Scopus, Google Scholar, PubMed and ScienceDirect, andpre-electronic sources such as book chapters, books, journal articles and scienti ic publications obtained from the university library. This study revealed that leaf, rhizome and root infusions and decoctions of C. capensis are mainly used as a blood puri ier, and traditional medicines for respiratory problems, ulcers, sores and wounds, skin and stomach cancers, snakebite, sexually transmitted infections, skin diseases, diabetes and gastrointestinal problems. Phytochemical compounds identi ied from the species include alkaloids, essential oils, lavonoids, phenolics, saponins and tannins. Pharmacological research revealed that C. capensis extracts and compounds isolated from the species have anthelmintic, antibacterial, antifungal, antidiabetic, antimalarial, hepatotoxicity, spermatozoa and cytotoxicity activities. Documentation of themedicinal uses, phytochemistry and pharmacological properties of C. capensis is vital as this information provides baseline data required for future research and development of health-promoting and pharmaceutical products. There is a need for extensive toxicological evaluations of crude extracts and compounds isolated from the species since C. capensis contains potentially toxic compounds.

Cissampelos capensis is an evergreen, dioecious, sprawling or climber with twining stems and can grow up to two meters in height (Germishuizen and Meyer, 2003). The stems grow from a woody root stock below the ground, and the plant supports itself by twining around the stems of other plants. The leaves are arranged spirally, heart-shaped and sometimes rounded, bright green in color, with entire to slightly undulating leaf margins. The in lorescence is axillary, umbel-like cyme, usually solitary or clustered. The male in lorescence is usually solitary or paired while female in lorescence is usually arranged in a short false raceme. Cissampelos capensis has been recorded in sandy slopes, among rocks and scrub of the Northern, Western and Eastern Cape provinces in South Africa and northwards into Namibia at an altitude ranging from sea level to 1900 m above sea level (Botha, 1980;Germishuizen and Meyer, 2003).
Rhizome and roots of C. capensis are sold as traditional medicines in informal herbal medicine markets in the Eastern Cape and Western Cape provinces in South Africa (Dold and Cocks, 2002;Philander et al., 2014). In Cape Town in South Africa, C. capensis is sold as herbal medicine in combination with Alepidea longifolia E. Mey., Glycyrrhiza glabra L., Stoebe fusca (L.) Thunb. and Tulbaghia violacea Harv. (Zonyane et al., 2013). The compound cissampareine isolated from C. capensis, which is characterized by sedative, anti-spasmodic and anti-tumour properties has potential for commercialization as a vital source of pharmaceutical products (George et al., 2001).
Cissampelos capensis is included in the book "medicinal plants of South Africa", a photographic guide to the most commonly used plant medicines in the country, including their botany, main traditional uses and active ingredients (Wyk et al., 2013). Cissampelos capensis is also included in two monographs focusing on poisonous plants, "mind-altering and poisonous plants of the world" and "poisonous plants of South Africa" (Wyk et al., 2005;Wink and Wyk, 2008).
In these two monographs, (Wyk et al., 2005;Wink and Wyk, 2008) provide necessary information about the poisonous ingredients, the pharmacological effects and associated symptoms of human and animal poisoning as a result of ingesting documented plant species. It is, therefore, within this context that this review was undertaken aimed at reviewing the ethnomedicinal uses, phytochemical and pharmacological properties of C. capensis to provide baseline data required in evaluating the therapeutic potential of the species.

MATERIALS AND METHODS
Results of the current study are based on a literature search on the phytochemistry, pharmacological properties and medicinal uses of C. capensis using information derived from several internet databases. The databases included Scopus, Google Scholar, PubMed and Science Direct. Other sources of information used included pre-electronic sources such as journal articles, theses, books, book chapters and other scienti ic articles obtained from the university library.

Medicinal uses of Cissampelos capensis
The leaf, rhizome and root infusions and decoctions of C. capensis are mainly used as a blood puriier, and traditional medicines for respiratory problems, ulcers, sores and wounds, skin and stomach cancers, snakebite, sexually transmitted infections, skin diseases, diabetes and gastrointestinal problems (Table 1, Figure 1). Other medicinal applications supported by at least ive literature reports include the use of leaves, rhizomes and roots as colic, protective charm and purgative, and traditional medicine against bladder problems, blood pressure, fever, glandular and gravel swelling, menstrual problems and pregnancy problems ( Table 1).
The roots of C. capensis are taken as a brandy tincture or mixed with roots of Pentzia incana (Thunb.) Kuntze and Pentzia globosa Less. As traditional medicine for erysipelas (Watt and Breyer-Brandwijk, 1962;Wet and Wyk, 2008).

Pharmacological properties of Cissampelos capensis
The following pharmacological activities have been documented from the leaves and roots of C. capensis and phytochemical compounds isolated from the species: anthelmintic, antibacterial, antifungal, antidiabetic, antimalarial, hepatotoxicity, spermatozoa, cytotoxicity and toxicity activities.
Anthelmintic activities (Ayers et al., 2007) evaluated the anthelmintic activities of aporphine alkaloids, (S)-dicentrine and (S)neolitsine isolated from the aerial parts of C. capensis using an in vitro assay using Haemonchus contortus with ivermectin as a positive control. The compounds (S)-dicentrine and (S)-neolitsine exhibited activities with EC 90 values (concentration at which 90% loss of larval motility observed) of 6.3 µg/mL and 6.4 µm/mL, respectively which were higher than the potent control with an EC 90 value of 0.2 µm/mL. The compounds were evaluated for in vivo activities in Swiss Webster mice using Heligmosomoides polygyrus. At a concentration of 25.0 mg/kg, the compound (S)-dicentrine exhibited 67.0% reduction in worm count when the mice were dosed orally 40.0% when dosed intramuscularly against 99.0% reduction exhibited by the positive control (Ayers et al., 2007).
Antibacterial activities (Babajide et al., 2010(Babajide et al., , 2015 evaluated antibacterial activities of aqueous, dichloromethane, ethyl acetate, n-hexane and methanol extracts of C. capensis aerial parts and roots against Pseudomonas aeruginosa, Proteus Vulgaris, Escherichia coli, Bacillus subtilis, Staphylococcus aureus and Bacillus licheniformis using the disc diffusion assay with amoxicillin (40 µg/ml) as a positive control.

CONCLUSIONS
Cissampelos capensis is a known poisonous plant and there is need for detailed clinical and toxicological evaluations of crude extracts and compounds isolated from the species. Although the leaves of C. capensis are known to be toxic to cattle, there is no information on human poisoning. Therefore, the widespread use of C. capensis in South Africa as traditional medicine suggest that the species is not taken at toxic dosages. But the use of C. capensis for the treatment of human diseases and ailments should be treated with caution and rigorous toxicological and clinical studies of the leaves, rhizomes, roots, stems and compounds isolated from the species are necessary.

ACKNOWLEDGEMENT
I am grateful to the reviewers who kindly commented on my manuscript.