INTRODUCTION

The rose (Rosaceae) family genus Prunus comprises five subgenera and about 200 species.¹ Prunus is taxonomically complex, and different botanical authorities over the centuries have either split the genus into multiple genera or recognized a wider Prunus “sensu lato” (“in the broad sense”).² Prunus includes more than 30 species of trees with fruits considered to be types of cherries. Most of these are indigenous to Asia and Europe.³ Tart cherry (P. cerasus), also known as sour cherry, is a small tree, rarely exceeding eight meters (26.2 ft) tall, with dark red fruits that have a characteristic acidic taste.⁴ The seeds contain kernels that have an odor similar to that of bitter almonds (Prunus dulcis var. amara, Rosaceae).⁵ Some sources report the origin of P. cerasus in the area between the Caspian Sea and the north Anatolia mountain ranges (in Azerbaijan, Georgia, Armenia, and Turkey),⁶ while others report a somewhat wider geographic origin from western Asia (Anatolia to the Caucasus) and west to neighboring parts of eastern Europe (Bulgaria and Macedonia).^5,7

Prunus cerasus is among the first fruit trees known to be used by humans.⁸ Tart cherry is closely related to ground cherry (P. fruticosa)⁴ and sweet cherry (P. avium),⁹ and it is believed that P. cerasus originated from spontaneous hybridization between the two.⁸ The parental species (P. fruticosa and P. avium) have partially different geographic ranges of distribution, but the range of wild P. cerasus trees corresponds with the overlapping area where the ranges of the parents meet in southeastern Europe and southwestern Asia.¹⁰ Prunus avium is also a progenitor of Duke cherry (P. × gondouinii).⁹

Kütahya province in the Aegean region of Turkey is traditionally known for its diversity of tart cherry types. Studies performed on P. cerasus populations in the Aegean region and in Gaziantep in the Southeast Anatolia region found a rich variation among tart cherry types “in terms of fruit size, color, taste, shape (mostly round, and more rarely oblate, heart, and kidney shaped), juice color and yield, fruit/pit ratio, aroma, total soluble solids and total yield.”⁶ In the early 1990s, 115 different types of P. cerasus fruits collected from the Aegean, Central and Northern Anatolia, and Marmara regions of Turkey were analyzed, of which 13 accessions were selected as the most promising for commercial cultivation in Turkey and registered as new cultivars.¹¹

In 2019, about 53,540 metric tons (MT) of fresh tart cherries were exported globally.¹² The top five exporters in terms of volume were Serbia (14,250 MT), Hungary (10,322 MT), Poland (5,210 MT), the United States (3,176 MT), and Czechia (2,703 MT). The United States imported 4,583.3 MT of frozen tart cherries in 2019, mainly from Canada, with relatively minor amounts from Poland, Turkey, and a few other countries.¹³ The tart cherry crop in the United States is subject to marketing order regulations implemented by the US Department of Agriculture (USDA) for the purposes of providing stable markets and improving grower returns. The 2019–2020 crop year pursuant to the marketing order includes tart cherries grown in the states of Michigan, New York, Oregon, Pennsylvania, Utah, Washington, and Wisconsin.¹⁴ The tart cherry crop in the United States is also subject to extreme genetic vulnerability to pests, diseases, and unfavorable weather conditions. This is due to genetic uniformity and geographic concentration (most of the production has been concentrated in northwestern Michigan and northeastern Wisconsin using a single cultivar, “Montmorency”).³

Other Prunus species and plant parts also are used in food and medicine, such as black cherry (P. serotina), Chinese sour cherry (P. pseudocerasus), and sweet cherry. However, this article concerns mainly the fruit of P. cerasus.

HISTORY AND CULTURAL SIGNIFICANCE

In 1700, French botanist Joseph Pitton de Tournefort (1656–1708) named the genus Prunus in the publication Institutiones Rei Herbariae.¹⁵ Swedish botanist Carl Linnaeus (1707–1778) named the species P. cerasus in his 1753 work Species Plantarum.¹⁶ The Latin genus name Prunus derives from the Greek proumnon, meaning “wild plum.”¹⁷ The Latin species name cerasus was the common name used by the Romans,¹⁸ and some report that it was derived from the name of a city “Kerasus,” which is in the Black Sea region of Turkey and is known today as Giresun.⁶ However, some authors dispute that account and assert that the Latin cerasus and corresponding Greek kerasos were not derived from the name of the city Kerasus, but rather that the city was named after the cherry trees growing there.¹⁷

Preparations with tart cherry fruits were reportedly given to Roman army soldiers who suffered from mild to moderate pain on the battlefield.¹⁹ In the first century, naturalist Pliny the Elder (23 or 24–79) did not distinguish between sweet and tart cherries, but wrote that they were unknown in Italy before the time of late Roman Republic politician Lucius Lucullus (118–57 or 56 BCE), who was credited with bringing cherries from Pontus (in the eastern Black Sea region of Turkey) in 74 BCE. However, French-Swiss botanist Alphonse de Candolle (1806–1893), in his 1883 book Origin of Cultivated Plants, claimed that P. cerasus already had been naturalized in Europe at the start of the Greek civilization and was brought to Italy later but well before the time of Lucullus in 74 BCE. Prunus cerasus fruits were among the carbonized plant materials found at the base of the lararium (shrine to guardian spirits) at the House of the Garden of Hercules in Pompeii, which was preserved after the volcanic eruption of Mount Vesuvius in 79 CE.¹⁸ Greek physician Claudius Galenus (129–ca. 216 CE), also known as Galen of Pergamon, ascribed an astringent effect of P. cerasus fruit in book two of his treatise De alimentorum facultatibus (“On the Properties of Foodstuffs”).²⁰

The P. cerasus tree was brought to Germany during the occupation by the Roman Empire.⁷ Tart cherry has since become one of the more important stone fruit crops of Germany.²¹ Today, 39 registered varieties are approved for cultivation in Germany.²² A study investigating the mycobiome (fungal microbiome) of Prunus trees in Germany found that P. cerasus trees were host to 61 fungal species, some that could not be identified, meaning that tart cherry trees represent a habitat that harbors potentially new species, or even new genera, of fungi.²¹

Traditional Medicinal Uses

In the traditional Unani system of medicine, P. cerasus fruit, known as alu balu, is used in formulations to treat conditions such as urinary tract infections, nephrolithiasis (kidney stones), cystolithiasis (calculi [stones] in the urinary bladder), and dysuria (painful urination).²³ For example, alu balu is listed as a component of formulations monographed in the Government of India’s National Formulary of Unani Medicine for the treatment of renal and vesicle calculi.²⁴

In Iran, P. cerasus seeds have been used in confections and are considered to have nutritive and tonic properties. Tart cherry pits mixed with barley (Hordeum vulgare, Poaceae) awns (needle-like extensions from the top of lemmas of the florets) and cherry stems are prepared as an herbal tea infusion for treating gonorrhea.⁵

Villagers in the mountainous Peshkopia region of northeastern Albania, near the border with North Macedonia, prepare an herbal tea infusion of wild-collected P. cerasus fruit peduncles for medicinal use as a diuretic.²⁵ In western Europe, the fresh fruits with the pits traditionally were used to prepare Sirupus Cerasi (cherry syrup), which was used to treat fever and liver diseases.²⁶ Traditional European uses of P. cerasus fruit and peduncle of fruit, submitted to the European Food Safety Authority (EFSA) for an opinion, including “traditionally used to facilitate the digestion,” have not been accepted by the EFSA.²⁷

CURRENT AUTHORIZED USES IN COSMETICS, FOODS, AND MEDICINES

In the United States, tart cherries are used mainly as conventional food, as well as for food coloring and flavoring, but also as a component of dietary supplement products. Official quality standards monographs for Cherry Juice NF, the liquid expressed from the fresh ripe fruit of P. cerasus, containing not-less-than 1% malic acid, and Cherry Syrup NF (prepared from Cherry Juice NF) are available in the National Formulary, which is published by the United States Pharmacopeial Convention (USP).²⁸ USP recognizes the need to develop a corresponding monograph for the starting material, tart cherry fruit, as a dietary ingredient (Maria Monagas, PhD, scientific liaison for dietary supplements and herbal medicines at USP, email to T. Smith, October 16, 2020). There are also “United States Standards for Grades of Frozen Red Tart Pitted Cherries” (US Grade A or US Fancy; US Grade B or US Choice; US Grade C; and Substandard)²⁹ and “United States Standards for Grades of Red Sour Cherries for Manufacture” (US No. 1 and US No. 2).³⁰

Tart cherry pit is classified as Generally Recognized as Safe (GRAS) by the US Food and Drug Administration (FDA) for use as a natural flavoring substance in conventional foods with the limitation not-to-exceed 25 ppm prussic acid (also known as hydrogen cyanide).³¹ The FDA also provides specifications for canned fruit cocktail containing approximate halves or whole pitted P. cerasus cherries in the Code of Federal Regulations (21CFR Part 145).³² The USDA permits the use of nonorganically-produced cherry juice color, derived from P. cerasus, as an exempted ingredient in processed products that are labeled as certified organic, but only when organic cherry juice color pigment is not commercially available.³³ The US National Institutes of Health’s (NIH’s) Dietary Supplement Label Database lists 166 dietary supplement products containing cherry extract, but this includes extracts of both tart and sweet cherry.³⁴

In Canada, in addition to use as a conventional food, tart cherry fruit may also be used as an active ingredient of licensed natural health products (NHPs), which require pre-marketing authorization from the Natural and Non-prescription Health Products Directorate (NNHPD).³⁵ Licensed NHPs that contain a tart cherry preparation equivalent to 15 grams of dried tart cherry fruit or 100 grams of fresh tart cherry fruit may be labeled with a claim statement to the effect of “Provides antioxidants that help protect against cell damage caused by free radicals.”³⁶ Certain tart cherry ingredients also are permitted for use as non-medicinal components of licensed NHPs. For example, tart cherry fruit juice or fruit powder may be used as a flavor enhancer, and the dried juice may be used as a color additive and flavor enhancer.³⁵

In the European Union (EU), extract of P. cerasus fruit is authorized for use as an antioxidant and skin-conditioning component of cosmetic products. The fruit water (aqueous solution of the steam distillates obtained from the fruit) is authorized for use as a skin-conditioning emollient, and the juice expressed from the fruit as a skin conditioner.³⁷ In 2010, the EFSA issued an opinion that a cause-and-effect relationship has not been established between the consumption of P. cerasus fruit and/or peduncle of fruit and a beneficial physiological effect related to an “increase in renal water elimination (i.e., diuresis).”³⁸ Regarding proposed antioxidant health claims for preparations of P. cerasus such as fruit concentrate and freeze-dried extract, the EFSA issued an opinion that no evidence had been provided to establish that having antioxidant activity/content and/or antioxidant properties is a beneficial physiological effect.³⁹

MODERN RESEARCH

The biochemistry and pharmacology of tart cherry have only recently been reviewed.^40,41 Anthocyanins in tart cherry juice not only have shown significant antioxidant activity, but also have inhibited enzymes involved in diabetes in a dose-dependent manner. Additionally, anti-inflammatory effects have been demonstrated both in vitro and in vivo.

General health benefits,^42-44 pharmacokinetics and pharmacodynamics,⁴⁵ and clinical data on the effects of tart cherry on exercise-induced muscle damage,⁴⁶ exercise performance,^43,47,48 reduction of serum uric acid concentrations and gout,⁴⁹ vascular function,⁵⁰ blood pressure,⁵¹ and pain⁴¹ have been reviewed extensively and meta-analyzed. In various exercise protocols, exercise-related muscle damage was shown to be alleviated, and muscle contractility and endurance improved with tart cherry preparations. A positive trend was noted for efficacy in gout or hyperuricemia (elevated uric acid in the blood). However, variability in methods and metrics did not allow for an effective meta-analysis. Improvements in vascular health and blood pressure were found to be significant. Reductions in pain associated with chronic diseases such as fibromyalgia and osteoarthritis were reported but require larger trials for drawing firm conclusions. Some exploratory studies were not supported by confirmatory studies, likely due to heterogeneity in design, size, differences among test products, and duration.

More than 60 clinical trials on tart cherry with multiple designs, interventions, and outcomes have been identified. Many of these studies can be considered preliminary due to the low number of enrolled patients. Selected trials are summarized in Table 1.

None of the trials reviewed in Table 1 reported serious adverse reactions to any of the study preparations. The safety profile of tart cherry preparations is overall favorable, and compliance was good.

ADULTERATION

One study, published in 2016, found no cherry anthocyanins in a tart cherry fruit concentrate dietary supplement product (in capsule form) that was labeled as being standardized to contain 6.8 mg anthocyanins per serving.⁷⁵ Tart cherry juice can be adulterated with other less costly juices, and, conversely, tart cherry juice may be an adulterant of more costly fruit juices. Malic acid content can be used as an indicator of whether a juice is made from tart cherry or sweet cherry.⁷⁶

SUSTAINABILITY AND FUTURE OUTLOOK

The conservation status of P. cerasus has not yet been assessed using the International Union for Conservation of Nature (IUCN) Red List Categories and Criteria. The IUCN assigns wild sweet cherry to the conservation category of least concern (LC), meaning that the species is not considered to be threatened.⁹ In 2005, an estimated 3,689 hectares (14.2 square miles) were registered for certified organic wild collection of P. cerasus fruits globally.⁷⁷

Three institutions are responsible for the conservation maintenance of P. cerasus in Turkey: the Aegean Agricultural Research Institute (Izmir), the Horticultural Research Institute (Erzincan), and the Eğirdir Horticultural Research Institute (Isparta).¹¹ Both wild and cultivated sweet cherry and tart cherry trees once covered large areas in riverbank woodlands of Azerbaijan. However, their area is decreasing, which has been attributed to anthropogenic effects. Accessions are being maintained at the Genetic Resources Institute and the Research Institute of Horticulture and Subtropical Crops, both in Azerbaijan.⁷⁸ The Institute of Agriculture in Skopje, North Macedonia, carries out ex situ conservation of wild flora and maintains 14 varieties of P. cerasus.⁷⁹

Certified organic tart cherries are now produced on a commercial scale and exported into the global market by some Asian countries (especially Turkey, but also Georgia), European countries (especially Serbia), and South American countries (Chile and Bolivia).⁸⁰ The sustainability of the tart cherry raw material supply, especially from the growing number of certified organic operations, appears stable at this time. However, impacts of climate change on the tart cherry crop should be considered. According to Steele et al (2018), climate change data are showing that tart cherry trees are being exposed “to higher temperatures in summer, later onset of cold temperatures in fall, reduced chilling hours in winter, and earlier spring onset. These factors reduce yield, impair fruit quality, and, in the worst-case scenario, cause crop failure from freeze-induced blossom damage. Earlier spring onset is the most critical factor exposing growers to losses because it increases risk of bud exposure to a late hard frost or freeze event.”⁸¹

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