Scientists reveal herbal medicines including

Scientists from Singapore and Taiwan have uncovered a definitive link between aristolochic acid (AA), a natural product of some plants used in herbal medicine, and liver cancer. Using mutational signature analysis, researchers found that liver tumors exposed to AA mutated many cancer-causing genes.

The team includes Professor Stephen Rosen of Duke-NUS School of Medicine (Duke-NUS), Professor Te Bin Tean of the National Cancer Center Singapore (NCCS), Professor Alex Chan of the Johns Hopkins University of Medicine, Singapore; The team is led by Professor Hsieh Seng-yong. For the first time, Taiwan’s Miya Memorial Hospital has analyzed the DNA sequences of 98 cases of liver cancer in Taiwan. Using mutational signature analysis, they found numerous AA-associated mutations in more than three-quarters of these cancers. A mutational signature is a pattern of changes in DNA caused by mutagens, which are cancer-causing compounds.

“We knew that there was exposure to AA in Taiwan, but we were very surprised that such a high proportion of liver cancer patients were exposed to AA,” Professor Xie said.

The team then looked at publicly available data on 1,400 liver cancer mutations from around the world. Although AA is found in plants used in traditional medicine around the world, the research team found that the prevalence of exposure was also high in other regions of East and Southeast Asia (see Figure 1).

Professor Rosen said: “This was another unexpected finding. We had no idea that exposure to AA was so prevalent in so many different regions.”

AA, a known mutagen, was previously implicated in kidney and urinary tract cancers in Taiwan. In this new study, researchers confirmed that AA mutations are also involved in the cause of liver cancer. “This was another surprising finding of this study,” Professor Rosen added.

Professor Teh from NCCS said: “This is a follow-up study to our 2013 paper, when our team made breakthrough progress in understanding the pro-cancer effects of AA in urinary tract cancer. “Our new study proves that AA is also involved in liver cancer.” . ”

AA is a natural compound found in plants of the genus Acerium and Asarum. These plants are commonly used in traditional Chinese medicine for various purposes such as weight loss and slimming. AA has been officially banned in Europe since 2001 and in Singapore since 2004. In Taiwan, some herbs containing AA have been banned since 2003, and in China, the use of some, but not all, herbs containing AA is restricted in traditional medicine. . The U.S. Food and Drug Administration has issued warnings about herbs containing AA, but does not restrict their sale unless they are properly labeled and make health claims.

However, such a ban could take years to take effect. Therefore, it may take many years for the incidence of AA-related cancers to decline. Additionally, herbs containing AA are easily available online. Complicating matters, herbs are often sold together in preparations rather than individually, and some preparations may contain herbs containing AA. In addition, herbs containing AA are sometimes inappropriately labeled, making it difficult for suppliers and consumers to be sure of the ingredients in multiherbal formulations.

Plants that may contain AA include the asarum plant (细心, xì xīn), and powered xì xīn products manufactured in Taiwan and China were banned in Singapore in 2014 for containing AA. Recalled. Other herbs that may contain AA are:铃 (mƎ dōu líng), Aoki Xiang (qīng mù xiāng), Tian Xian Tō (tiān xiān téng), 广defensei (guƎng fángjƐ), 关木通 (guān mù tōng), 寻子风 (xún gƔ fēng), 朱子莲 (zhō ) shā lián, also written as 朱沙莲).

As plants and treatments containing AA remain widely available, Professor Alex Chan said: “Public education and awareness are very important to avoid exposure.”

This study was published online on October 18, 2017 at 14:00 ET. scientific translational medicine, a high-impact scientific publication focused on practical medical advances. This study was supported by the Singapore Medical Research Council (NMRC/CIRG/1422/2015), the Singapore Ministry of Health through the Duke-NUS Signature Research Programmes, and the Chang Gung Medical Foundation of Taiwan.

Note to editor

Chinese glossary:

1. Duke NUS Medical School
   Du Ke – New Kapo National University School of Medicine
2. Professor Steven Rosen

Cancer and Stem Cell Biology Program
Duke NUS Center for Computational Biology Director
Professor Luomori
Cancer disease and desiccation biology
Chief Computational Biology Center



3. Professor The Binh Tian
   Deputy Director (Research) National Cancer Center Singapore
   Professor of Cancer and Stem Cell Program
   Professor Zheng Minnobu
   Deputy Director (Research), New Canada National Cancer Center




4. Professor Alex Y. Chan
   Johns Hopkins Singapore
   Professor Zheng Minnobu
   Deputy Director (Research), New Canada National Cancer Center




5. Professor Hsieh Seng-yong
Director of Gastroenterology/Hepatobiliary Department
Linkou Chang Gung Memorial Hospital
Professor Morinaga Xie
Chief of Gastrointestinal Hepatology Department Linkou Changgeng Memorial Hospital






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journal

scientific translational medicine