Chemopreventive Potential and Safety Profile of a Curcuma longa Extract in Women with Cervical Low-Grade Squamous Intraepithelial Neoplasia

Joshi, JV;Paradkar, PH;Jagtap, SS;Agashe, SV;Soman, G;Vaidya, AB

  • Published : 20111200

Abstract

Objective: To determine whether Curcuma longa Linn extract, NBFR-03, can arrest low-grade squamous intraepithelial neoplasia (LSIL) a 12 week intervention study was performed. Methods: Of a total of 1473 women undergoing Pap smear screening, 88 cases had LSIL. Only those with persistent LSIL subsequent to antimicrobial therapy, and willing to follow the protocol (N=21), were included for clinical examination, Pap smears, colposcopy, clinical biochemistry, urinalysis and assessment of serum IL-6, being condcuted before and after treatment. Standardised NBFR-03 (0.2gm) capsules were administered, twice daily, for 12 weeks. Results: None progressed to higher grade lesion as assessed by Pap smears and colposcopy. Sixteen cases regressed to atypia, ASCUS or inflammatory pattern; 3 persisted as LSIL, 1 discontinued early because of itching, and 1 did not start. None developed any significant abnormality clinically or biochemically. Micrometry showed a significant reduction in nuclear diameter and nucleocytoplasmic ratio after treatment (p<0.02, and <0.05 respectively). Serum IL-6 levels showed a significant decline (mean $248{\pm}156$ (SEM) vs $27.7{\pm}10.5$ (SEM) pg/ml; p<0.05). Conclusion: Use of NBFR-03 for 12 weeks was associated with an arrest or regression of LSIL in Pap smears and colposcopy, with reduction in the circulating IL-6 levels.

Keywords

References

  1. Abu J, Batuwangala M, Herbert K, Symonds P (2005). Retinoic acid and retinoid receptors: potential chemopreventive and therapeutic role in cervical cancer. Lancet Oncol, 6, 712-20. https://doi.org/10.1016/S1470-2045(05)70319-3
  2. Aggarwal BB, Sung B (2009). Pharmacological basis for the role of curcumin in chronic diseases: an age-old spice with modern targets. Trends Pharmacol Sci 30,85-94. https://doi.org/10.1016/j.tips.2008.11.002
  3. Aratanechemuge Y, Komiya T, Moteki H et al (2002). Selective induction of apoptosis by ar-turmerone isolated from turmeric (Curcuma longa L) in two human leukemia cell lines, but not in human stomach cancer cell line. Int J Mol Med, 9, 481-4.
  4. Bar-Sela G, Epelbaum R, Schaffer M (2010). Curcumin as an anti-cancer agent: review of the gap between basic and clinical applications. Curr Med Chem, 17, 190-7. https://doi.org/10.2174/092986710790149738
  5. Basu P, Chandna P, Bamezai RN et al (2011). MassARRAY spectrometry is more sensitive than PreTect HPV-Proofer and consensus PCR for type-specific detection of high-risk oncogenic human papillomavirus genotypes in cervical cancer. J Clin Microbiol, 49, 3537-44. https://doi.org/10.1128/JCM.00354-11
  6. Bell MC, Crowley-Nowick P, Bradlow HL et al (2000). Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecol Oncol, 78, 123-9. https://doi.org/10.1006/gyno.2000.5847
  7. Bhide SV, Jakhi SD (1994). Clinical studies on turmeric treatment of precancerous oral lesions. Proceedings of XVI. International Cancer Congress. Abstract 351.
  8. Bollmann R, Bollmann M, Henson DE et al (2001). DNA cytometry confirms the utility of the Bethesda system for the classification of papanicolaou smears. Cancer, 93, 222-8. https://doi.org/10.1002/cncr.9033
  9. Bustamam A, Ibrahim N, Devi N et al (2008).The Establishment and Use of an in vivo Animal Model for Cervical Intra-Epithelial Neoplasia. International Journal of Cancer Research, 4, 61-70. https://doi.org/10.3923/ijcr.2008.61.70
  10. Center for Disease Control (CDC) (2006) . Sexually Transmitted Diseases Treatment Guidelines. MMWR August 4, 2006 / 55(RR11);1-94.
  11. Central Council for Research in Ayurveda & Siddha. Guidelines for formulation development. http://www.ccras.nic.in/Training_Modules/20081103_DrugStandardization2.htm
  12. Chen W, Lu Y, Gao M et al (2011). Anti-angiogenesis effect of essential oil from Curcuma zedoaria in vitro and in vivo. J Ethnopharmacol, 7, 220-6.
  13. Cuzick J, Castanon A, Sasieni P (2010). Predicted impact of vaccination against human papillomavirus 16/18 on cancer incidence and cervical abnormalities in women aged 20-29 in the UK. Br J Cancer, 102, 933-9. https://doi.org/10.1038/sj.bjc.6605528
  14. Divya CS, Pillai MR (2006). Antitumor action of curcumin in human papillomavirus associated cells involves downregulation of viral oncogenes, prevention of NFkB and AP-1 translocation, and modulation of apoptosis. Mol Carcino, 45, 320-32 https://doi.org/10.1002/mc.20170
  15. Gangawar R, Mittal B, Mittal RD (2009). Association of interleukin-6 -174G>C promoter polymorphism with risk of cervical cancer. Int J Biol Markers, 24, 11-6.
  16. Garg R, Gupta S, Maru GB (2008). Dietary curcumin modulates transcriptional regulators of phase I and phase II enzymes in benzo[a]pyrene-treated mice: mechanism of its anti-initiating action. Carcinogenesis, 29, 1022-32. https://doi.org/10.1093/carcin/bgn064
  17. Gullett NP, Ruhul Amin AR, Bayraktar S et al (2010). Cancer prevention with natural compounds. Semin Onco, 37, 258-8. https://doi.org/10.1053/j.seminoncol.2010.06.014
  18. Hastak KA, Lubri N, Jakhi SD et al (1997). Effect of turmeric oil and turmeric oleoresin on cytogenetic damage in patients suffering from oral submucous fibrosis. Cancer Letters, 116, 265-269. https://doi.org/10.1016/S0304-3835(97)00205-X
  19. Hefler LA, Grimm C, Speiser P et al (2006) . The cyclooxygenase-2 inhibitor rofecoxib (Vioxx) in the treatment of cervical dysplasia grade II-III: A phase II trial. Eur J Obstet Gynecol Reprod Biol, 125, 251-4. https://doi.org/10.1016/j.ejogrb.2005.08.019
  20. Heikkila, Ebrahim S, Lawlor DA (2008). Systematic review of the association between circulating interleukin-6 (IL-6) and cancer. Eur J Cancer, 44, 937-45. https://doi.org/10.1016/j.ejca.2008.02.047
  21. Jayaprakasha GK, Jena BS, Negi PS, Sakariah KK (2002). Evaluation of antioxidant activities and antimutagenicity of turmeric oil: a byproduct from curcumin production. Z Naturforsch [C], 57, 828-35.
  22. Jayaprakasha GK, Negi PS, Anandharamakrishnan C, Sakariah KK (2001). Chemical composition of turmeric oil--a byproduct from turmeric oleoresin industry and its inhibitory activity against different fungi. Z Naturforsch [C], 56, 40-4.
  23. Jin L, QiM, Chen DZ, Anderson, et al (1999) . Indole 3-carbinol prevents cervical cancer in human papilloma virus type 16 (HPV 16) transgenic mice. Cancer Res, 59, 3991-3997.
  24. Joshi JV, Affandi MZ, Amin P et al (2010). Persistence of cytologic abnormality after treatment of bacterial, parasitic and fungal infections in older women with low grade squamous intraepithelial lesion. Acta Cytol, 54, 242-3. https://doi.org/10.1159/000325023
  25. Joshi JV, Ghaisas SD, Vaidya RA et al (2003). Early clinical safety study with turmeric oil (Curcuma longa oil) in human volunteers. J Med Assoc Ind, 51,1055-1060.
  26. Joshi JV, Mali BN , Bhave G, Wagle U (1993). Cervical neoplasia and cytological manifestations of sexually transmitted infections in HIV seropositive prostitutes. Diagnostic Cytopathology, 4, 63-64. https://doi.org/10.1111/j.1365-2303.1993.tb00076.x
  27. Joshi JV. Detecting Chlamydia trachomatis infection in women (2001). Acta Cytologica, 46, 890-891.
  28. Kim HG, Yamal JM, Xu XC et al (2005). Cervical chromosome 9 polysomy: validation and use as a surrogate endpoint biomarker in a 4-HPR chemoprevention trial. Gynecol Oncol, 99(3 Suppl 1), S32-7. https://doi.org/10.1016/j.ygyno.2005.07.039
  29. Kuttan R, Bhanumathy P, Nirmala K, George MC (1985). Potential anticancer activity of turmeric (Curcuma longa). Cancer Letters, 29,197-202. https://doi.org/10.1016/0304-3835(85)90159-4
  30. Li Y, Wo JM, Liu Q et al (2009). Chemoprotective effects of Curcuma aromatica on esophageal carcinogenesis. Ann Surg Oncol, 16, 515-23. https://doi.org/10.1245/s10434-008-0228-0
  31. Lim CB, Ky N, Ng HM et al (2010). Curcuma wenyujin extract induces apoptosis and inhibits proliferation of human cervical cancer cells in vitro and in vivo. Integr Cancer Ther, 9, 36-49. https://doi.org/10.1177/1534735409359773
  32. Melnikow J, McGahan C, Sawaya GF et al (2009). Cervical intraepithelial neoplasia outcomes after treatment: long-term follow-up from the British Columbia Cohort Study. J Natl Cancer Inst, 101, 721-8. https://doi.org/10.1093/jnci/djp089
  33. Moore MA, Ariyar Y, Badar F et al (2010). Cancer epidemiology in South Asia - past, present and future. Asian Pac J Cancer Prev, 11 (Suppl 2), 49-66.
  34. Murooka TT, Ward SE, Fish EN. Chemokines and Cancer (2005). Chapter 2. In: Cytokines and Cancer, Ed; Platanias LC, Springer, pp 15-44.
  35. Nagabhushan M, Bhide SV (1987). Antimutagenicity and anticarcinogenicity of turmeric (Curcuma longa Linn). J of Nutrition Growth & Cancer, 4, 83-89.
  36. National Institute of Research in Reproductive Health (2006). National Guidelines for Diagnosis and Treatment and Management of Reproductive Tract Infections/ Sexually Transmitted Infections in Primary Health Care, Indian Council of Medical Research, 2006.
  37. National Institutes of Health (NIH), Bethesda Workshop Proceedings (2001). Bethesda system for reporting cervical\vaginal cytologic diagnosis . Acta Cytol, 37, 115-24.
  38. Negi PS, Jayaprakasha GK, Jagan Mohan Rao L, Sakariah KK (1999). Antibacterial activity of turmeric oil: a byproduct from curcumin manufacture. J Agric Food Chem, 47, 4297-300. https://doi.org/10.1021/jf990308d
  39. Paradkar PH, Agashe S, Joshi JV et al (2010a). Serum Cytokine levels and micrometry of Pap smears in women with leucorrhoea and with Low Grade Cervical Intraepithelial Lesions (LGSIL). Asia Pac J of Cancer Prev, 11, 989-992.
  40. Paradkar PH, Godse CG, Joshi JV et al (2010b). Use of mobile camera photography for quick scientific communication for early diagnosis and prevention of cervical cancer. J MGIMS,15, 41-44.
  41. Pardo-Govea T, Callejas D, Núñez-Troconis J et al (2005). Gamma interferon (IFN-gamma), tumor necrosis factor alpha (TNF-alpha) and interleukins 2, 4 and 6 (IL-2, IL-4, IL-6) in cervical-uterine cells of intraepithelial neoplasia: a preliminary report. Invest Clin, 46, 5-13.
  42. Prusty BK and Das BC (2005). Constitutive activation of transcription factor AP-1 in cervical cancer and suppression of human papillomavirus (HPV) transcription and AP-1 activity in HeLa cells by curcumin. Int J Cancer, 113, 951-960. https://doi.org/10.1002/ijc.20668
  43. Ramachandran Rejina (2000). Study of Turmeric oil: Organ Specific Safety and Activities. M. Sc. Dissertation University of Mumbai.
  44. Ramos MC, Pizarro De Lorenzo BH et al (2008). High-grade cervical intraepithelial neoplasia, human papillomavirus and factors connected with recurrence following surgical treatment. Clin Exp Obstet Gynecol, 35, 242-7.
  45. Sankaranarayanan R, Boffetta P (2010). Research on cancer prevention, detection and management in low- and medium-income countries. Ann Oncol, 21,1935-43. https://doi.org/10.1093/annonc/mdq049
  46. Sasieni P (2006). Chemoprevention of cervical cancer. Best Pract Res Clin Obstet Gynaecol, 20, 295-305. https://doi.org/10.1016/j.bpobgyn.2005.11.002
  47. Steinman S, Smith D, Chandler N et al (2008). Morphologic, patient and interpreter profiles of high-risk human papillomavirus-positive vs.-negative cases of atypical squamous cells of undetermined significance. Acta Cytolo, 52, 279-85. https://doi.org/10.1159/000325507
  48. Tjiong MY, van der Vange N, ten Kate FJ et al (1999). Increased IL-6 and IL-8 levels in cervicovaginal secretions of patients with cervical cancer. Gynecol Oncol, 73, 285-91. https://doi.org/10.1006/gyno.1999.5358
  49. Vaidya ADB, Amonkar AJ, Bhatt NS, Parikh PM (2010a). Complementary and Alternative Medicine for Cancer Care in India: Basic and Clinical Perspective . Chapter3. In: Alternative & Complementary Therapies for Cancer: Integrative Approaches and Discovery of Conventional Drugs. Ed. Moulay Alaoui-Jamali, Springer, 31-82.
  50. Vaidya AB, Vaidya RA (2010b). Roots of modern drugs in Reverse Pharmacology. In: Medicine Update, Ed. M. S. RAo, Association of Physicians of India(API), 2010, 871-879.
  51. Weinberg Robert A (2007). Multistep tumorigenesis. Chapter 11. In: The Biology of Cancer. Garland Science, 399-462.
  52. World Health Organisation (2007). WHO guidelines for assessing quality of herbal medicines with reference to contaminants and residues. WHO, Geneva, 2007.
  53. Yue GG, Chan BC, Hon PM et al (2010). Evaluation of in vitro anti-proliferative and immunomodulatory activities of compounds isolated from Curcuma longa. Food Chem Toxicol, 48, 2011-20. https://doi.org/10.1016/j.fct.2010.04.039