Acemannan is a polysaccharide derived from Aloe vera. Aloe vera is a herb which gets recognition from all over the world due to its multiple health benefits. This herb is widely used to prevent or treat skin diseases, metabolic ailments, cardiovascular conditions and cancers as a natural remedy. Aloe vera leaves are usually used in medicinal purposes due to the high concentration of polysaccharides present. The different parts of the plant have immunomodulatory, anti-inflammatory, broad antimicrobial, antiviral, and anti-cancer properties.
Polysaccharide acetylation is derived from the biochemical alteration of polysaccharides and imparts functional changes of polysaccharides. Acemannan is chemically known as β-(1,4)-acetylated polymannose, which is a soluble form of Polysaccharide abundantly present in Aloe vera. Acemannan is used in veterinary medicine and treat animals with histiocytoma, squamous cell carcinoma, lymphoma, infiltrative lipoma, myxosarcoma, adenocarcinoma, and mast cell tumor.
Past few decades, medical and pharmaceutical industries recognized the health benefits of acemannan and started to use this natural ingredient to treat oral diseases, cardiovascular diseases, metabolic diseases, and tumor diseases. Currently, researchers are focused to use acemannan on dentistry and wound healing, and got approval from US Food and Drug Administration on the research protocol to continue the research. Acemannan become a promising medicinal ingredient and researchers paying attention to use this ingredient to formulate new medicinal product and introduce in drug delivery system.
Biological effects of Acemannan include its polysaccharide nature of acemannan obtainex from Aloe vera, activates macrophages and increases phagocytic activity. Phagocytic activity is a natural immune response, which is essential for preventing microbial infections including bacterial and fungal attack and protect the different organs from such infections. The broad antimicrobial property of acemannan also includes the antiviral effect.
It also provides immunomodulatory effect by producing interleukin-1a, Tumor necrosis factor-alpha (TNF-α), interleukin-6, nitric oxide and prostaglandin E2 due to macrophages activation obtained by administering acemannan. TNF-α accelerates wound healing and promotes angiogenesis.
Acemannan can suppress tumor by inducing tumor cell apoptosis or necrosis. Acemannan can do so may due to the release of TNF-α. It is well established that TNF-α acts as a cancer promoter, but actually, it has a dual role in cancer progression. TNF-α suppresses tumor by activating cytotoxic T-cell, natural killer cell, inducing tumor vascular damage and increase permeability, maturation of dendritic cells, regulate major histocompatibility complex expression. 
Acemannan is a Polysaccharide and its variety depends upon the molecular size of the polymer present in it. The immunomodulatory action depends upon the molecular size of acemannan. The unit of molecular size is “KDa”, which means thousands of Dalton.
Moderate molecular-sized acemannan: In this category, the molecular size of acemannan ranges between 5 and 400 KDa with maximum immunomodulatory action.
Low molecular-sized acemannan: In this category, the molecular size of acemannan is lower than the 400 KDa with potent immunomodulatory action.
High molecular-sized acemannan: In this category, the molecular size of acemannan is higher than the 400 KDa with limited immunomodulatory action.
Laboratory test report finds that acemannan extracted from Aloe vera leaves have multiple health benefits. It is effective against cancer and AIDS and also provides sun protection.  Following are some of the uses of Acemannan:
Acemannan help in oral ulcer
Aphthous ulceration is a type of oral ulcer that causes pain and discomfort. The recurrent appearance of this ulcer usually occurs due to immunological disorders, bacterial infection, hormonal imbalance, and sensitivity to certain diets. The treatment goal of this disorder is to reduce pain and inflammation. The recurrent attack of Aphthous ulceration leads to an increase in the size of ulceration. Acemannan attracts herbal researcher’s attention to treat such oral ulcers because of the standard treatments such as antimicrobial agents, steroidal treatment, topical analgesics, anti-inflammatory agents, immunosuppressive agents, and laser therapy have their limitation due to a variety of side effects.
Animal research reported that acemannan is a promising effect against aphthous ulceration by following mechanisms:
Protection against radiation
The immunomodulation action of acemannan is effective to protect radiation therapy. Acemannan increases the production of blood cells ( hematopoiesis) and up-regulate cytokines like TNF-α and IL-1. These physiological changes mitigate radiation damage. This health benefit has already proven through animal research.  These study findings indicate acemannan can be promising agent not only to protect against UV radiation but can also be used as a protective agent against cancer radiation therapy. The potent antioxidant property of acemannan inhibits free radicals burden due to its free radical scavenging property. 
Acemannan as prebiotic
The growth of gut friendly-bacterial growth is not only essential for digestion and absorption of nutrients but also gives protection from colon cancer. Recently, different prebiotic supplements are marketed to promote the growth of and Bifidobacterium species in the gut wall to improve the gut-friendly bacterial populations. Prebiotics also facilitate fermentation processes by producing short-chain fatty acids (SCFAs). These physiological processes reduce the risk of chronic illness including a certain type of cancers such as colorectal cancer. Researchers expected that acemannan could probably enhance the significant population of Bifidobacterium spp. But a research result confirmed that acemannan could increase the total SCFAs production during the stool fermentation process. Thus study results published in the Journal of Agricultural and Food Chemistry reported that acemannan is a very promising prebiotic. 
The immune regulation and antioxidant properties of acemannan attract the attention of this phytochemical as a neuroprotective effect. A placebo-controlled research study reported that acemannan improve the cognitive functioning of middle-aged study participants who had a complaint of mental fatigue. The exact mechanism of action of acemannan as a memory booster is not properly studied but performed study researchers reported it is different to blood glucose level enhancement. 
Acemannan as hepatoprotective
The antioxidant property of acemannan improves glutathione S-transferase enzyme activity, which detoxifies the products obtained from lipid peroxidation and improves liver functionality. 
Acemannan improves bone health
Numerous evidence insinuates that acemannan is capable of enhancing bone formation by stimulating primary rat bone marrow stromal cell (BMSC) proliferation, differentiation into osteoblasts, and extracellular matrix synthesis in vivo. 
Acemannan use in dentistry
The following are some remarkable changes that can be induced by acemannan treatment in dentistry.
These claims are not only theoretical, but the human trial result also showed positive result like papillary cells treated with acemannan can proliferate of dental pulp cells, increases of dental bone density. The clinical trial also reported that acemannan has alveolar bone healing property.
The dose is an important factor to avoid side effects associated with Acemannan. Dose alternation can cause pyrexia, anorexia, depression, diarrhea, syncope, temporary bradycardia and disorientation, tachycardia and/or tachypnea, and collapse and pain on injection site.