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Osteoporosis is an important public health challenge. Several medicinal mushrooms are able to improve bone stability by influencing different steps of bone formation, mineralization, or resorption. In nearly all investigations, the effects have been shown in vitro or in animal assays and only very few in clinical studies. Positive results exist for medicinal mushrooms of the genera Cordyceps/Ophiocordyceps, Ganoderma, Grifola, Lentinula, Phellinus, Pleurotus, Taiwanofungus, Trametes, and Wolfiporia. The results for Hericium are not consistent. This article critically reviews these investigations and describes challenges for the future.

Medicinal mushrooms contain highly valuable substances with proven positive effects on human health. To extract these components, different methods are available. Most of them suffer from individual disadvantages, therefore making them economically unviable. Pulsed electric fields (PEFs) could provide an opportunity to improve these processes. PEFs cause pore formation of cell membranes, facilitating substance transport out of cells. Thus, the influence of this technique on the extraction yield of medicinal mushrooms was studied for the first time. Lentinus edodes was used as model case and PEF treatment was compared with standard Soxhlet extraction alone. A square pulse generator (Electro Square Porator™ ECM 830) with a voltage of 3 kV and pulse length of 100 μs was used for PEF treatment. Extraction was studied for fresh and dried fruiting bodies, and dichloromethane and hot water extracts were analyzed. Extracts were quantified gravimetrically, and carbohydrate yields were also determined qualitatively with GC-MS and quantitatively with anthrone method. PEFs could increase in particular the yield of water-soluble compounds of fresh mushroom material. However, the lipid fraction was not affected by PEF in neither fresh nor dried material.

Several medicinal mushrooms exhibit hypoglycaemic activities in vitro and in animal studies. In contrast to the high number of experimental results, only a few clinical trials and/or case reports have been published. They exist for mushrooms of the genera Agaricus, Coprinus, Ganoderma, Grifola, and Pleurotus. This article critically reviews these clinical investigations and describes which tasks need to be done to explore the potential of mushrooms for supportive treatment of type 2 diabetes.

Piptoporus betulinus, the mushroom that has been carried by Ötzi the "Iceman", has a long tradition of use in medicinal practice for its antiseptic, anticancer, and immune-enhancing properties. With this study, we aimed to investigate the immunomodulatory effects of P. betulinus on primary human immunocompetent cells. The influence of P. betulinus water and methanol extract on apoptosis and necrosis induction of T cells and monocytes was analyzed using annexin V/propidium iodide staining and proliferation of T cells by carboxyfluorescein diacetate succinimidyl ester staining using flow cytometry. The effects on T-cell activation (CD69/CD25) and dendritic cell maturation (CD83, CD86, and CD14) were assessed using flow cytometric analysis of distinct marker expression. Alterations of the secretion of effector mediators interferon (IFN)-γ by T cells and interleukin (IL)-8 by monocytes and dendritic cells were detected by enzyme-linked immunosorbent assay. None of the P. betulinus extracts had a significant influence on apoptosis and necrosis induction, T-cell proliferation, or T-cell activation status, but P. betulinus water extract caused a strong increase in IFN-γ release. The same extract was slightly protective against apoptosis of monocytes and further triggered IL-8 secretion by monocytes and dendritic cells. Moreover, P. betulinus water extract induced dendritic cell maturation. Our results demonstrate the immune-enhancing properties of P. betulinus.

Ergosterol peroxide (EP; 5α,8α-epidioxy-22E-ergosta-6,22-dien-3β-ol) is a C28-sterol and a component of many medicinal mushrooms. Since its discovery nearly a century ago, many sources and biological effects of this compound have been described. Effects range from antimicrobial to cytotoxic to immunosuppressive and other activities. This review covers biological investigations of EP, its activities, and possible mechanisms of action. EP is a promising candidate for drug development and contributes to the health-promoting effects of medicinal mushrooms.

Agaritine, an aromatic hydrazine, is found as a secondary metabolite in mushroom species. It is among others suspected to exhibit genotoxic activity. This publication describes the validation of a method for the quantification of agaritine in mushrooms (i.e., extraction and purification by solid phase extraction) and measurement by liquid chromatography with tandem mass spectrometry detection in positive ionization mode. The results show this method to be selective, accurate, and precise. This method could be used for the quality control of pharmaceutical preparations containing mushrooms.

Whereas pharmaceuticals prepared by extraction of medicinal plants constitute an important part of evidence-based medicine also in the Western Hemisphere, medicinal mushrooms are mainly used as dietary supplements without declaration of a medical indication. Scientific investigations and case studies from Asian medicine show that fungi have very promising pharmacological potential. This article provides an overview of the principles of authorization and market access of herbal drugs in Europe, with special reference to Germany. The current status regarding mushrooms is reported, with an aim toward supporting the development of legalized pharmaceutical preparations of medicinal mushrooms in Europe.