The Potential of Chinese Herbal Medicines in the Treatment of Cervical Cancer

Cervical cancer is a pertinent global health issue as it is the fourth most common cancer in women worldwide and causes more than one quarter of a million deaths per year [1] and no standard therapy is available for patients with metastatic cervical cancer [2]. Several treatment options are currently available for treating patients with cervical cancer, such as chemoradiation and neoadjuvant or adjuvant chemotherapy, more aggressive systemic therapies and newer therapeutic agents are under investigation. Medicinal herbs have long been used to treat diseases. A review by Hsiao et al., (2019) [3] summarises studies analysing the anti-tumour effects and underlying mechanisms of Chinese herbal medicines, including the effects of crude extracts and compounds in vitro or in animal models for inducing apoptosis and inhibiting invasion or metastasis.

Chinese herbal medicines with therapeutic targeting, such as those that interfere with tumour growth and progression in cervical cancer, have been widely investigated.

 

Effects of Chinese Herbal Medicines on Cervical Cancer Cells

Crude Extracts of Chinese Herbal Medicines with Anti-Cervical Cancer Effects

 

Antrodia cinnamomea. Antrodia cinnamomea, also called Antrodia camphorata, is a food source used in traditional Chinese medicine [4]. Crude extracts of A camphorata exhibit a wide range of biological activities, with several studies having focused on its anticancer effects. The hepatoprotective activities and activities against liver injury of A camphorata have also been reported [5,6].

The apoptotic effect of the crude extract of A camphorata on cervical cancer cells, HeLa and C-33A, has been reported. A camphorata extract increased the activity of caspase-3, -8, and -9 as well as the cytosolic level of cytochrome c in HeLa and C-33A cell lines. The expressions of Bad, Bak, and Bim were increased, and the expressions of Bcl-2 family proteins were decreased. The expressions of inhibitor of apoptosis proteins (IAPs) and X-linked IAP protein also decreased, as did cell survival. Thus, the cytotoxic effect of A camphorata extract on cervical cancer cells through both extrinsic and intrinsic apoptotic pathways was demonstrated [6].

 

Chelidonium majus, commonly known as greater celandine, has been shown to contain several iso-quinoline alkaloids, such as sanguinarine, chelidonine, chelerythrine, berberine, and coptisisine, in the crude extract of its roots, shoots, and leaves. Both C majus and its main alkaloid chelidonine have cytotoxic effects against cancer cells, such as leukaemia, PANC-1 (pancreatic cancer), and HT-29 (colon cancer) cells [7,8].

Baicalein is the active ingredient extracted from the root of Scutellaria baicalensis, which is used in traditional Chinese medicine. It has multiple effects, such as anti-inflammatory, anti-allergic, antioxidative, and antitu-morigenic activities. Baicalein is involved in inhibiting various cancers, such as breast, bladder, and ovarian cancers [9,10].

 

Recent studies have reported that baicalein inhibits prostate cancer cell growth and metastasis via the caveolin-1/ AKT/mTOR pathway [11]. Furthermore, the restraining effect of baicalein on human cervical cancer cell line HeLa has been demonstrated [9]. Baicalein induced HeLa cell apoptosis and significantly inhibited HeLa cell migration. Baicalein markedly down-regulated extracellular signal–regulated kinase 1/2, MMP- 2, and MMP-9 levels both in mRNA and protein [9].

 

Matrine has been shown to have antitumour effects for numerous types of cancer, such as breast, lung, and prostate cancer [12-14. The molecular mechanisms of matrine in terms of its antitumour effects implicate the regulation of oncogene expression, the blockade of cell cycle progression, the inhibition of cytokine production, the induction of apoptosis, and the modulation of signalling pathways [14]. The antitumour effects of matrine on cervical cancer cells were evaluated in a recent study [15]. Matrine inhibited the cell growth and invasive and metastatic ability of HeLa and C33A cervical cancer cells in vitro; moreover, matrine inhibited tumour growth in vivo in a xenograft nude mouse model.

Concerning the mechanism of matrine, induction of apoptosis, suppression of MMP-2 and MMP-9 expression, and inhibition of cervical cancer cell invasion were all achieved through the suppression of the p38 signalling pathway [16].

 

Chinese Herbal Medicine	Cell Lines/Animal Models	Action	References
Antrodia camphorata	HeLa and C-33A cells	Cytotoxic to cervical cancer cells through both extrinsic and intrinsic apoptotic mechanisms	17
Terminalia catappa	HeLa and SiHa cells	Antimetastatic effects through the inhibition of matrix metalloprotein-9 and MAPK pathway	18
Chelidonium majus	HeLa cells	Promoting apoptosis in HeLa cells through p38-p53 and PI3K/ AKT signalling pathways	19
Lycopodium clavatum	HeLa cells	Inhibiting proliferation of HeLa cells through induction of apoptosis via caspase-3 activation	20
Myrica cerifera	HeLa and PC3 cells	Inducing apoptosis in cancer cells by triggering caspase activation	22

 

References

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3. The Potential of Chinese Herbal Medicines in the Treatment of Cervical Cancer. Integrative Cancer Therapies Volume 18: 1–9 DOI: 10.1177/1534735419861693
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