Wednesday, 12 February 2014

Prostate Cancer in Herbs' Points of View

By Kyle J. Norton 

The widespread of prostate cancer, once considered as a disease of aging male, now have become major concerns of governments and scientific community in South East Asian with tendency to spread to younger age population. Suggestions emerged of over consuming bad fats in any time in history accompanied with unhealthy diet and life style may be the possible causes of the disease, linking to the economic prosperity over 2 decades. Herbal medicine for diseases' management have been prescribed in folk medicine over thousands of year as one of best medicine of nature in preventing and treating diseases, including prostate cancer.
Prostate cancer is defined as a condition in which the cells of prostate has become cancerous, causing abnormal cell growth with possibility of spreading to the distant parts of the body. Most prostate cancers are slow growing and enlarged prostate and prostate cancer may be detected during physical (rectum) exams.
1. Aloe vera
Aloe Vera is species of succulent plant in the genus Aloe, belonging to the Family Xanthorrhoeaceae, native to Sudan. It has become very popular for commercial cultivation due to its health benefits. Aloe vera has been used in herbal medicine in treating many kinds of disease, including wound, burn healing, minor skin infections, sebaceous cysts, diabetes, and elevated of cholesterol, etc. It is also one of many popular herb studied in scientific ways with some conflicted results.
Aloe-emodin, a chemical constituent in Aloe vera, inhibited both proliferation and anchorage-independent growth of PC3 cells through activation of the downstream substrates of mTORC2, Akt and PKCα causes of apoptosis, cell proliferation(1). prostate cancer, LNCaP expression of N-acetylated by cytosolic N-acetyltransferase (NAT) activity and mRNA inhibited by aloe-emodin in doses depending manner through its kinase activity in cellular transformation(2)(3).

2. Cascara sagrada
Cascara sagrada is a species of buckthorn, genus Rhamnus, belonging to the family Rhamnaceae, native to western North America, it's bark has been used in traditional medicine for gastrointestinal support. and it is thought to have a laxative and natural cleansing, etc., effect.
Emodin, a cemical compoubd found in Cascara sagrada, inhibited cellular migration and invasion in prostate cancer through downregulate CXCR4 expression which is involved in promoting invasion and metastasis in tumors(4). In human prostate cancer cell LNCaP, amodin increased apoptosis and  decreased in cell proliferation through down regualting the expression of expression of androgen receptor (AR) and prostate specific antigen (PSA) and upregulating the expression of p53(Anti tumor antigen) and p21(( regulator of cell cycle progression at G1 and S phase)(5), In other study, Emodin enhanced the  cytotoxic effectiveness of chemotherapeutic drugs in prostate cancer cells through ROS(reactive oxygen spiecies)-mediated suppression of multidrug resistance and hypoxia inducible factor-1(influence cell metabolism, cell survival and angiogenesis to maintain biological homeostasis)(6).

3. Green tea
Green tea contains more amount of antioxidants than any drinks or food with the same volume, and is the leaves of Camellia sinensis, undergone minimal oxidation during processing, originated from China. Green tea has been a precious drink in traditional Chinese culture and used exceptional in socialization for more than 4000 thousand years. Because of their health benefits, they have been cultivated for commercial purposes all over the world.
Epigallocatechin-3-gallate (Chit-nanoEGCG), a phytochemical in green tea, exerted a significant inhibition of tumor growth and secreted prostate-specific antigen levels compared with EGCG and control groups, trough induction of poly (ADP-ribose) polymerases cleavage, increase in the protein expression of Bax(involved in p53-mediated apoptosis)  with accompanied decrease in Bcl-2(family of regulator proteins that regulate cell death), and activation of caspases(mechanisms of apoptosis) and reduction in Ki-67 and proliferating cell nuclear antigen(7). In androgen-independent prostate cancer, synthetic derivative, EGCG (EGCG-P) and EGCG treatment suppressed the growth of the tumor correlated with the decrease of serum PSA level together with the reduction in tumor angiogenesis and an increase in apoptosis on prostate cancer cells(8). In anticancer drug cisplatin, EGCG ehnaced the effectiveness of the chemo agent in reduction of cell survival of prostate cancer cell line PC3 and induced apoptosis(9).

4. Pomegranate
Pomegranates is a fruit-bearing small tree, genus Punica, belonging to family Lythraceae, native to Iran but has been cultivated in Asian since ancient time.
POMx, a pomegranate extract (PE) formula, exhibited potent in vitro cytotoxicity in metastatic castration-resistant PCa cells through inhibition of survivin, induced apoptosis, retarded C4-2 tumor growth in skeleton and significantly enhanced the efficacy of docetaxel(Chemodrug) in athymic nude mice(10). Ellagic acid (EA) converted from Ellagitannins (ETs) found in from pomegranate juice (PJ) showed to induce apoptosis in both cell lines, DU-145 and PC-3 through induced  cell cycle arrest in S phase associated with decreased cyclin B1 and cyclin D1 levels in regulation of cell cycle progression(11). Pomegranate juice (PJ) PJ components luteolin, ellagic acid, and punicic acid together found to inhibit growth of hormone-dependent and hormone-refractory prostate cancer cells and their migration, increase the expression of cell adhesion genes and decrease expression of genes involved in cell cycle control through suppression microRNAs (miRNAs), decrease several oncogenic miRNAs, and inhibit the chemokines receptor type 4 (CXCR4)/SDF1α chemotaxis axis(decreased PSA cell migration)(12).

6. Garlic
Garlic (Allium sativum) is a species in the onion genus, belonging to family Amaryllidaceae, native to central Asia. It has been used popularly in traditional and Chinese medicine in treating common cold and flu to the Plague, blood pressure cholesterol levels, natural antibiotic, etc.
In androgen-independent prostate cancer, garlic-derived organosulfur compound S-allylmercaptocysteinesuppresses invasion and cell motility of androgen-independent prostate cancer cells via the up-regulation of cell-adhesion molecule E-cadherin(Loss of E-cadherin expression has been implicated in cancer progression and metastasis)(16). Garlic compound diallyl disulfid,a oil soluble organosulfur compound of garlic, exerted its antiproliferative and inhibited effect on prostate cancer cells, through induction of DNA damage in a dose dependent manner(17). Garlic constituent diallyl trisulfide (DATS), induced apoptosis in prostate cancer cells is mediated in part by suppression of XIAP(a protein that stops apoptotic cell death) protein expression(18).

7. Chamomile
Chamomile is also known as camomile, common name of many species daisy-like plants in the family Asteraceae. The herb has been used in traditional medicine as antispasmodic and anti-inflammatory constituents and to treat menstrual cramps and sleep disorders, reduce cramping and spastic pain in the bowels, relieve excessive gas and bloating in the intestine, etc.
Phenolic profile of chamomile showed to inhibited the cell proliferation and to reduce IL-8 (an important mediator of the immune reaction in the innate immune system response) levels in PC3 prostate cancer cells(19). Traditional Botanical Supplement-101 (TBS-101), including the extracts of Panax ginseng, cranberry, green tea, grape skin, grape seed, Ganoderma lucidum and chamomile, showed to inhibit in hormone-refractory PC-3 cells and large aggressive PC-3 tumors cell growth in a dose-dependent manner(20). In human cancer cell lines PC-3, A-549 and MCF-7, Chamomile's essential oils, induced cytotoxicity of prostate carcinoma cell (PC-3), significantly stronger than on human lung carcinoma (A549) and human breast cancer (MCF-7) cell lines(21).

8. Onion
The onion is a close relation of garlic plant in the genus Allium, belonging to the family Alliaceae.  It is often called the "king of vegetables" because of its pungent taste and found in a large number of recipes and preparations, spanning almost the totality of the world's cultures. Depending on the variety, an onion can be sharp, spicy, tangy, pungent, mild or sweet.
Data from southern European populations showed intake of allium vegetables, including onion are  inversely associated reduced  risk of several common cancers, including prostate cancer(22).
 Fisetin, a chemical constituent found in Onion, in prostate cancer, it exerted anti cell profilerative effect as a dual inhibitor of the PI3K/Akt (anti-apoptosis and increased cell proliferation) and the mTOR(regulates cell growth, cell proliferation, cell motility, cell survival, protein synthesis, and transcription) pathways(23). Quercetin, also found in onion, inhibited the prostate cancer line PC-3 through DNA fragmentation and protein expressions of Bcl-2, Bcl-xL, Bax and caspase-3 (cell apoptosis) pathways(24).

9. Turmeric
Turmeric is a perennial plant in the genus Curcuma, belonging to the family Zingiberaceae, native to tropical South Asia. The herb has been used in traditional medicine as anti-oxidant, hypoglycemic, colorant, antiseptic, wound healing agent, and to treat flatulence, bloating, and appetite loss, ulcers, eczema, inflammations, etc.
In PC-3M prostate cancer cell line, extract from turmeric, showed significant inhibitory effects on anti profilerative ability in PC-3M in clonogenic assays(25). Demethoxycurcumin (DMC), one of mjor chemical constituents found in turmeric, exerted it antitumor effects on prostate cancer cells via AMPK((cellular energy homeostasis))-induced down-regulation of HSP70 (upregulated by and toxic chemicals, particularly heavy metals) and EGFR(over expression of epidermal growth factor receptor  have been associated with a number of cancers)(26)(27). Curcumin, a non-nutritive yellow pigment derived from the turmeric showed a inhibitory effects on the expression of  NF-κB (a transcription factor that has crucial roles in inflammation, immunity, cell proliferation and apoptosis)correlated with their effects on growth inhibition and apoptosis stimulation in PC-3 cells(28).

10. Ginseng
Ginseng is a slow-growing perennial plants with fleshy roots, the genus Panax, belonging to the family Araliaceae. Depending to the climate where it grows, ginseng can be classified mainly into Panax ginseng Asian ginseng (root), Red ginseng, wild ginseng, American ginseng (root).
In a highly metastatic PC-3M prostate cancer cell line,  Ginsenoside Rg3 (Rg3), a bioactive extract from ginseng, suppressed migration of PC-3M cells by down-regulating AQP1(a molecular water channel protein) expression through p38 (highly expressed in aggressive and invasive cancers)MAPK(Increased MAPK expression and activity in primary human carcinoma) pathway and some transcription factors acting on the AQP1 promoter(29). Ginsenoside 20(S)-Rh2  of Ginsenosides, a main component of ginseng, found to be effective in proliferative inhibition on androgen-dependent and -independent prostate cancer cells(30). Formula of Botanical Supplement-101 (TBS-101), containing Panax ginseng, cranberry, green tea, grape skin, grape seed, Ganoderma lucidum and chamomile showed a significant inhibition of tumor growth and invasion in a dose-dependent manner(31).

11. Grape Seed Extract
Grape Seed Extract is the commercial extracts from whole grape seeds containing many concentrations, including vitamin E, flavonoids, linoleic acid, oligomeric proanthocyanidins(OPCs), etc.. The herb has been used in traditional medicine as antioxidant, anti-inflammatory agents and to treat skin wounds with less scarring, allergies, macular degeneration, arthritis, enhance circulation of blood vessels, lower cholesterol, etc.
Grape seed extract (GSE), inhibited HAT(HAT mutations are associated to certain cancers), leading to decreased AR(plays roles in prostate development and cancer (PCa))-mediated transcription and cancer cell growth, and implicate GSE as a novel candidate for therapeutic activity against prostate cancer(32). B2G2 from total GSE, derived from Procyanidin B2 3,3″-di-O-gallate, a Biologically Active Constituent of Grape Seed Extract inhibited cell growth, decreased clonogenicity(colony expansion), and induced cell cycle arrest and apoptotic death, in various human PCa cell lines(33).
In a highly metastatic androgen-independent PC3 prostate cancer, Grape seed extract (GSE),  inhibited DNA-binding activity of the transcription factor nuclear factor kappa B (NFkappaB)(a transcription factor that has crucial roles in inflammation, immunity, cell proliferation and apoptosis), which in turn decreased NFkappaB-dependent uPA(in tumor invasion and metastasis) transcription(33).

12. Danshen (Salvia miltiorrhiza Bunge)
Dan Shen is also known as Red Sage Root. The bitter and slightly cold herb has been used in TCM as antithrombotic, antihypertonic (lowering blood pressure), antimicrobial, antipyretic, anti-inflammatory, sedative agent and to treat dysmenorrhea, amenorrhea, palpable tumors, angina,restlessness, insomnia, irritability, etc., by enhancing the functions of heart and liver channels.
Tanshinones, a chemical constituent found in Chinese herb Dan Shen, was found to be effective in inhibition of the growth of prostate cancer sell lines, in a dose-dependent manner through cell cycle arrest and apoptosis induction(34) specially in LNCaP cells and several androgen-independent PCa cell, through suppression of  prostate cancer growth and androgen receptor(AR) signaling.(35) or through induction of  G1 arrest via activation of p53(tumor antigen) signaling and inhibition of AR in LNCaP cells(36).

13. Ginkgo biloba
Ginkgo biloba is oldest living tree species, genus Ginkgo, belonging to the family Ginkgoaceae, native to China, from temperate zone to subtropical zone and some parts of north America. It has been used in traditional herbal medicine in treating impotence, memory loss,respiratory diseases, circulatory disorders and deafness as well as preventing drunkenness, and bedwetting.
Ginkgetin, isolated from leaves of Ginkgo biloba L, inhibited PC-3 cells in a concentration-dependent manner, through significantly increased the sub-G1(detection of cumulative apoptosis)  DNA contents of cell cycle by activated caspase-3 (mechanisms of apoptosis) and weakened  the expression of survival genes such as Bcl-2, Bcl-xL,(family of regulator proteins that regulate cell death) Survivin (baculoviral inhibitor), and Cyclin D1(regulating cell cycle progression) at protein and mRNA levels(37). Unfortunately, Some reseachers suggested that there were no associations for use of  ginkgo biloba in reduced risk of prostate cabcer(38)(39)

14. Licorice (Glycyrrhiza Glabra)
Licorice (Glycyrrhiza Glabra) also known as sweetwood, is the genus Glycyrrhiza, belonging to the family Fabaceae, native to the Mediterranean and certain areas of Asia. The herb has been used in traditional medicine to treat skin diseases, coughs, constipation, bronchitis, inflammation.
Licochalcone-A, isolated from licorice, induced modest level of apoptosis of androgen-independent PC-3 prostate cancer cells through the cell cycle progression arresting cells in G2/M, accompanied by suppression of cyclin B1 and cdc2(cell division cycle 2)(40). Isoangustone A (IAA) in licorice,  attenuated the growth of prostate cancer cell cultures and xenograft tumors attributed to inhibition of the G1/S phase cell cycle transition and the accumulation of p27(cell cycle inhibitor)(41). Other chemical compound such as Glycyrrhetinic acid found in licorice, in the experiment of prostate cancer cell line DU-145, inhibited proliferation and growth of these cells by inducing apoptosis, through down regulated expression of NF-κB (p65). (42).

15. Peppermint
Peppermint is a hybrid mint with small purple or white flowers and downy leaves, in the genus Mentha, belonging to the family Lamiaceae, native to  Europe. The herb has been used in folk medicine as analgesic, antiseptic, antispasmodic, decongestant, agent and to relieve gas, nausea, and stomach pain due to an irritable bowel, intestinal cramps, or indigestion, infecttion, etc.
Essential oils of peppermint exerted its cytotoxic effect against of  prostate cancer (LNCaP) cell lines(43). Menthol, a naturally isolated from peppermint oil, induced cell death in PC-3 cells independent to Ca(2+) influx pathways(44). When combined with 1alpha,25-dihydroxyvitamin D(3) [1alpha,25(OH)(2)D(3)], the most active form of vitamin D(3), menthol increased an anti-proliferation activity of 1alpha,25(OH)(2)D(3) in LNCaP prostate cancer cells, through evoking the increase in [Ca(2+)](45).

16. Wolfberry
Wolfberry is the common name for the fruit of two very closely related species, the genus of Lycium, belong to family Solanaceae, native to native to southeastern Europe and Asia.
Lycium barbarum polysaccharides (LBPs) in dose and time-dependently inhibited the growth of both PC-3 and DU-145 cells through exhibiting  the breakage of DNA strands of PC-3 and DU-145 cells and induced apoptosis(46). Extract from Lycium barbarum. showed an inhibited effect against  PC3 cell proliferation(47).

18. Rosemary 
Rosemary is a perennial herb with fragrant, evergreen, needle-like leaves, the genus Rosmarinus, belonging to the family Lamiaceae. Its fresh and dried leaves has been used frequently in traditional Mediterranean cuisine and as flavor foods while barbecuing.
Polyphenols isolated from rosemary, inhibited prostate cancer cell through targeting multiple signaling pathways involved in cell cycle modulation and apoptosis(48). Carnosic acid (CA), a polyphenolic diterpene, isolated from rosemary, induced apoptosis of PC-3 cells, by activation of PP2A(play critical roles in cell cycle and apoptosis) through modulation of Akt/IKK/NF-κB pathway(49).

Taking altogether, The above herbs have shown effectively in reduced risk and treatments of prostate cancer, through induced apoptosis, exhibited anti proliferation of prostate cancer cell line in cell cycle arrest, down regulation of pro cell growth pathways, etc.. Please consult with your doctor or related field specialist before applying.



Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months 


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References
(1) Aloe-emodin suppresses prostate cancer by targeting the mTOR complex 2 by Liu K, Park C, Li S, Lee KW, Liu H, He L, Soung NK, Ahn JS, Bode AM, Dong Z, Kim BY, Dong Z.(PubMed)
(2) Effect of inhibition of aloe-emodin on N-acetyltransferase activity and gene expression in human malignant melanoma cells (A375.S2) by Lin SY, Yang JH, Hsia TC, Lee JH, Chiu TH, Wei YH, Chung JG.(PubMed)
(3) Aloe-emodin suppresses prostate cancer by targeting the mTOR complex 2 by Liu K, Park C, Li S, Lee KW, Liu H, He L, Soung NK, Ahn JS, Bode AM, Dong Z, Kim BY, Dong Z.(PubMed)
(4) Emodin inhibits invasion and migration of prostate and lung cancer cells by downregulating the expression of chemokine receptor CXCR4 by Ok S, Kim SM, Kim C, Nam D, Shim BS, Kim SH, Ahn KS, Choi SH, Ahn KS.(PubMed)
(5) Emodin induces apoptosis in human prostate cancer cell LNCaP by Yu CX, Zhang XQ, Kang LD, Zhang PJ, Chen WW, Liu WW, Liu QW, Zhang JY.(PubMed)
(6) Chemosensitization by emodin, a plant-derived anti-cancer agent: mechanism of action by Sun Y.(PubMed)
(7) Oral administration of naturally occurring chitosan-based nanoformulated green tea polyphenol EGCG effectively inhibits prostate cancer cell growth in a xenograft model by Khan N, Bharali DJ, Adhami VM, Siddiqui IA, Cui H, Shabana SM, Mousa SA, Mukhtar H.(PubMed)
(8) Effect of a prodrug of the green tea polyphenol (-)-epigallocatechin-3-gallate on the growth of androgen-independent prostate cancer in vivo by Lee SC, Chan WK, Lee TW, Lam WH, Wang X, Chan TH, Wong YC.(PubMed)
(9) Epigallocatechin-3-gallate promotes apoptosis and expression of the caspase 9a splice variant in PC3 prostate cancer cells by Hagen RM, Chedea VS, Mintoff CP, Bowler E, Morse HR, Ladomery MR.(PubMed)
(10) Pomegranate extract inhibits the bone metastatic growth of human prostate cancer cells and enhances the in vivo efficacy of docetaxel chemotherapy by Wang Y, Zhang S, Iqbal S, Chen Z, Wang X, Wang YA, Liu D, Bai K, Ritenour C, Kucuk O, Wu D.(PubMed)
(11) Pomegranate Juice Metabolites, Ellagic Acid and Urolithin A, Synergistically Inhibit Androgen-Independent Prostate Cancer Cell Growth via Distinct Effects on Cell Cycle Control and Apoptosis by Vicinanza R, Zhang Y, Henning SM, Heber D.(PubMed)
(12) Specific pomegranate juice components as potential inhibitors of prostate cancer metastasis by Wang L, Ho J, Glackin C, Martins-Green M.(PubMed)
(13) Cytotoxic effect of the pentacyclic oxindole alkaloid mitraphylline isolated from Uncaria tomentosa bark on human Ewing's sarcoma and breast cancer cell lines by García Giménez D, García Prado E, Sáenz Rodríguez T, Fernández Arche A, De la Puerta R.(PubMed)
(14) The antiproliferative effects of Uncaria tomentosa extracts and fractions on the growth of breast cancer cell line by Riva L, Coradini D, Di Fronzo G, De Feo V, De Tommasi N, De Simone F, Pizza C.(PubMed)
(15) Anticancer activity of the Uncaria tomentosa (Willd.) DC. preparations with different oxindole alkaloid composition by Pilarski R, Filip B, Wietrzyk J, Kuraś M, Gulewicz K.(PubMed)
(16) Garlic-derived S-allylmercaptocysteine is a novel in vivo antimetastatic agent for androgen-independent prostate cancer by Howard EW, Ling MT, Chua CW, Cheung HW, Wang X, Wong YC.(PubMed)
(17) Growth suppressing effect of garlic compound diallyl disulfide on prostate cancer cell line (PC-3) in vitro by Arunkumar A, Vijayababu MR, Kanagaraj P, Balasubramanian K, Aruldhas MM, Arunakaran J.(PubMed)
(18) Garlic constituent diallyl trisulfide suppresses x-linked inhibitor of apoptosis protein in prostate cancer cells in culture and in vivo by Kim SH, Bommareddy A, Singh SV.(PubMed)
(19) Herbal infusions; their phenolic profile, antioxidant and anti-inflammatory effects in HT29 and PC3 cells by Kogiannou DA, Kalogeropoulos N, Kefalas P, Polissiou MG, Kaliora AC.(PubMed)
(20)The effect of a novel botanical agent TBS-101 on invasive prostate cancer in animal models by Evans S, Dizeyi N, Abrahamsson PA, Persson J.(PubMed)
(21) Activities of ten essential oils towards Propionibacterium acnes and PC-3, A-549 and MCF-7 cancer cells by Zu Y, Yu H, Liang L, Fu Y, Efferth T, Liu X, Wu N.(PubMed)
(22) Onion and garlic use and human cancer by Galeone C, Pelucchi C, Levi F, Negri E, Franceschi S, Talamini R, Giacosa A, La Vecchia C.(PubMed)
(23) Dietary flavonoid fisetin: a novel dual inhibitor of PI3K/Akt and mTOR for prostate cancer management by Adhami VM, Syed DN, Khan N, Mukhtar H.(PubMed)
(24) Effects of quercetin on insulin-like growth factors (IGFs) and their binding protein-3 (IGFBP-3) secretion and induction of apoptosis in human  prostate cancer cells by J. Vijayababu MR, Arunkumar A, Kanagaraj P, Arunakaran (PubMed)
(25) Combinatorial cytotoxic effects of Curcuma longa and Zingiber officinale on the PC-3M prostate cancer cell line by Kurapati KR, Samikkannu T, Kadiyala DB, Zainulabedin SM, Gandhi N, Sathaye SS, Indap MA, Boukli N, Rodriguez JW, Nair MP.(PubMed)
(26) Demethoxycurcumin Modulates Prostate Cancer Cell Proliferation via AMPK-Induced Down-regulation of HSP70 and EGFR by Hung CM, Su YH, Lin HY, Lin JN, Liu LC, Ho CT, Way TD.(PubMed)
(27) Growth factor receptor expression in anal squamous lesions: modifications associated with oncogenic human papillomavirus and human immunodeficiency virus(Human Patholog)
(28) Effects of cyclohexanone analogues of curcumin on growth, apoptosis and NF-κB activity in PC-3 human prostate cancer cells by Wei X, DU ZY, Cui XX, Verano M, Mo RQ, Tang ZK, Conney AH, Zheng X, Zhang K.(PubMed)
(29) Ginsenoside Rg3 attenuates cell migration via inhibition of aquaporin 1 expression in PC-3M prostate cancer cells by Pan XY, Guo H, Han J, Hao F, An Y, Xu Y, Xiaokaiti Y, Pan Y, Li XJ.(PubMed)
(30) Stereospecificity of hydroxyl group at C-20 in antiproliferative action of ginsenoside Rh2 on prostate cancer cells by Liu J, Shimizu K, Yu H, Zhang C, Jin F, Kondo R.(PubMed)
(31) The effect of a novel botanical agent TBS-101 on invasive prostate cancer in animal models by Evans S, Dizeyi N, Abrahamsson PA, Persson J.(PubMed)
(32) Grape seed extract regulates androgen receptor-mediated transcription in prostate cancer cells through potent anti-histone acetyltransferase activity by Park SY, Lee YH, Choi KC, Seong AR, Choi HK, Lee OH, Hwang HJ, Yoon HG.(PubMed)
(32) Procyanidin B2 3,3″-di-O-gallate, a Biologically Active Constituent of Grape Seed Extract, Induces Apoptosis in Human Prostate Cancer Cells Via Targeting NF-κB, Stat3, and AP1 Transcription Factors by Tyagi A, Raina K, Shrestha SP, Miller B, Thompson JA, Wempe MF, Agarwal R, Agarwal C.(PubMed)
(33) NFkappaB-dependent regulation of urokinase plasminogen activator by proanthocyanidin-rich grape seed extract: effect on invasion by prostate cancer cells by Uchino R, Madhyastha R, Madhyastha H, Dhungana S, Nakajima Y, Omura S, Maruyama M.(PubMed)
(34) Bioactive tanshinones in Salvia miltiorrhiza inhibit the growth of prostate cancer cells in vitro and in mice by Gong Y, Li Y, Lu Y, Li L, Abdolmaleky H, Blackburn GL, Zhou JR.(PubMed)
(35) Tanshinones from Chinese medicinal herb Danshen (Salvia miltiorrhiza Bunge) suppress prostate cancer growth and androgen receptor signaling by Zhang Y, Won SH, Jiang C, Lee HJ, Jeong SJ, Lee EO, Zhang J, Ye M, Kim SH, Lü J.(PubMed)
(36) Activation of p53 signaling and inhibition of androgen receptor mediate tanshinone IIA induced G1 arrest in LNCaP prostate cancer cells by Won SH, Lee HJ, Jeong SJ, Lü J, Kim SH.(PubMed)
(37) Ginkgetin induces apoptosis via activation of caspase and inhibition of survival genes in PC-3 prostate cancer cells by You OH, Kim SH, Kim B, Sohn EJ, Lee HJ, Shim BS, Yun M, Kwon BM, Kim SH.(PubMed)
(38) Specialty supplements and prostate cancer risk in the VITamins and Lifestyle (VITAL) cohort by Brasky TM, Kristal AR, Navarro SL, Lampe JW, Peters U, Patterson RE, White E.(PubMed)
(39) Ginkgo biloba and risk of cancer: secondary analysis of the Ginkgo Evaluation of Memory (GEM) Study by Biggs ML, Sorkin BC, Nahin RL, Kuller LH, Fitzpatrick AL.(PubMed)
(40) Licochalcone-A, a novel flavonoid isolated from licorice root (Glycyrrhiza glabra), causes G2 and late-G1 arrests in androgen-independent PC-3 prostate cancer cells by Fu Y, Hsieh TC, Guo J, Kunicki J, Lee MY, Darzynkiewicz Z, Wu JM.(PubMed)
(41) CDK2 and mTOR are direct molecular targets of isoangustone A in the suppression of human prostate cancer cell growth by Lee E, Son JE, Byun S, Lee SJ, Kim YA, Liu K, Kim J, Lim SS, Park JH, Dong Z, Lee KW, Lee HJ.(PubMed)
(42) 18α-glycyrrhetinic acid targets prostate cancer cells by down-regulating inflammation-related genes by Shetty AV, Thirugnanam S, Dakshinamoorthy G, Samykutty A, Zheng G, Chen A, Bosland MC, Kajdacsy-Balla A, Gnanasekar M.(PubMed)
(43) Seasonal variation in content, chemical composition and antimicrobial and cytotoxic activities of essential oils from four Mentha species by Hussain AI, Anwar F, Nigam PS, Ashraf M, Gilani AH.(PubMed)
(44) Menthol regulates TRPM8-independent processes in PC-3 prostate cancer cells by Kim SH, Nam JH, Park EJ, Kim BJ, Kim SJ, So I, Jeon JH.(PubMed)
(45) Menthol Enhances an Antiproliferative Activity of 1alpha,25-Dihydroxyvitamin D(3) in LNCaP Cells by Park EJ, Kim SH, Kim BJ, Kim SY, So I, Jeon JH.(PubMed)
(46) Lycium barbarum polysaccharides induce apoptosis in human prostate cancer cells and inhibits prostate cancer growth in a xenograft mouse model of human prostate cancer by Luo Q, Li Z, Yan J, Zhu F, Xu RJ, Cai YZ.(PubMed)
(47) [Extraction and isolation of active component for inhibiting PC3 cell proliferation in vitro from the fruit of Lycium barbarum L].[Article in Chinese] by Liu XL, Sun JY, Li HY, Zhang L, Qian BC.(PubMed)
(48) Polyphenols from the Mediterranean herb rosemary (Rosmarinus officinalis) for prostate cancer. by Petiwala SM, Puthenveetil AG, Johnson JJ.(PubMed)
(49) Carnosic acid modulates Akt/IKK/NF-κB signaling by PP2A and induces intrinsic and extrinsic pathway mediated apoptosis in human prostate carcinoma PC-3 cells by Kar S, Palit S, Ball WB, Das PK.(PubMed)

Tuesday, 11 February 2014

Breast cancer in Vitamin E's Points of View


By Kyle J. Norton

Epidemiological studies, linking vitamin E in reduced risk of breast cancer focused on variant α-tocopherol with inconsistent results. In recent study, research in γ-tocopherol,  δ-tocopherol, have shown a promising potential as the vaiants exerted  a greater ability in reducing inflammation, cell proliferation, and inhibiting the development of mammary hyperplasia and tumorigenesis(1)(1a)(1b)

 Vitamin E,  a fat soluble vitamin, consisting eight different variants (alpha-, beta-, gamma-, and delta-tocopherol and alpha-, beta-, gamma-, and delta-tocotrienol) with varying levels of biological activity(2), found abundantly in corn oil, soybean oil, margarine, wheat germ oil, sunflower,safflower oils, etc. plays an important role in neurological functions and inhibition of platelet aggregation, regulation of enzymatic activity, free radical scavenger, etc..

A  cohort study from the Breast Cancer Serum Bank in Columbia, free of cancer sample blood donated  to the bank did not found any evidence for protective effects of  alpha-tocopherol in breast cancer(3). Observation of her-2/neu indicated the correlation with Her2/neu receptor and reduced TAP expression found in  breast cancer stage and nodal stage in paired normal and cancerous breast tissue samples, α-tocopheryl succinate (α-TOS), a synthetic derivative of α-tocopherol, enhanced the efficacy of doxorubicin resulting in a reduction in cell viability in breast cancers(3a). In MCF-7 breast cancer cell line, dl-alpha-tocopherol showed evidence of a general inhibition of cell proliferation(3b). In HER-2/neu breast cancer cells and in comparison of the  anticancer effect of alpha-, gamma-, and delta-tocotrienols with alpha-tocopheryl succinate (alpha-TOS), the non-alpha form of T3 is more potent in inhibition of cancer activity than the synthetic VE-derivative alpha-TOS, possibly through the mitochondrial pathway, and the expression of senescent-like growth arrest markers(which provides a possible marker for the process) as p53tumor antigen), p21(regulator of cell cycle progression at G1 and S phase), , and p16(multiple tumor suppressor 1)(3c). Delta-tocotrienol, isolated from the tocotrienol-rich fraction of palm oil, showed a positive effective against metastatic breast cancers(3d). Other in the study of estrogen-responsive MCF7 cells and the estrogen-nonresponsive MDA-MB-435 cells, RRR-alpha-, beta-, gamma-and delta-tocotrienols and and RRR-delta-tocopherol induced MDA-MB-435 cells to undergo apoptosis, with the exception of RRR-delta-tocopherol, the tocopherols (alpha, beta, and gamma) and the acetate derivative of RRR-alpha-tocopherol (RRR-alpha-tocopheryl acetate)(3e).

In aggressive triple negative MDA-MB-231 cells and oestrogen-dependent MCF-7 cells, tocotrienol-rich fraction (TRF) and a tocotrienol-enriched fraction (TEF) isolated from palm oil showed a positive effect in induction of anti-proliferation and apoptosis through DNA repair protein and NF-κB, an apoptotic cell death signalling pathway(4). In HER-2/neu-overexpressing human SKBR3 and murine TUBO breast cancer cells, vitamin E form δ-tocotrienol (δ-T3) possessed significantly high cytotoxic and apoptotic activity in SKBR3 cells than other facttions of vitamin E, through  mitochondrial destabilization, energy failure, and unbalanced activity of stress/survival MAPKs, namely p38 ((highly expressed in aggressive and invasive breast cancers) and ERK1/2(cell regulation) pathways(5). In human MDA-mB-231 breast cancer cells, delta-tocotrienol exerted its anti cancer effect trough suppression of site-specific Rb phosphorylation and mediation of  by the loss of cyclin D1(6). In estrogen-nonresponsive MDA-MB-435 and estrogen-responsive MCF-7 human breast cancer cells, vitamin E succinate (VES) or dl-alpha-tocopherol (refers to eight naturally occurring and synthetic tocopherols and tocotrienols and their acetate and succinate derivatives), induced apoptosis involving up-regulation of TGF-beta receptor II (tumor suppressor gene) expression and TGF-beta-(cell prcess), Fas- (associated with the induction of apoptosis) and JNK- (cellular apoptosis) signaling pathways(7). These results indicated that tocotrienols exerted directly inhibitory effects on the growth of breast cancer cells irrespective of estrogen receptor status, not via an estrogen receptor-mediated pathway(8).
Also in  human (MCF-7 and MDA-MD-231) mammary tumor cells lines, γ-tocotrienol induced apoptosis through induction of autophagy with evidences of the presence of relatively large increase in the accumulation of monodansylcadaverine (MDC)-labeled vacuoles, a marker of autophagosome formation(9). In neoplastic(gene modification)  +SA(high malignance) mammary epithelial cells, treatment with 4 microM gamma-tocotrienol, a dose that inhibited +SA cell growth by more than 50% compared with that of untreated control cells, decreased intracellular levels of activated PI3K/Akt (anti-apoptosis and increased cell proliferation) pathway(10). On mouse (+SA) and human (MCF-7, and MDA-MB-231) mammary cancer cell lines, Combined γ-tocotrienol and SU11274 (Met inhibitor) treatment resulted in synergistic inhibition through reduction in Akt (multiple cellular processes) STAT1/5 (activator of transcription 1,5 )and NFκB(a transcription factor that has crucial roles in inflammation, immunity, cell proliferation and apoptosis) activation and corresponding blockade in epithelial-to-mesenchymal transition( a process by which epithelial cells lose their cell polarity and cell-cell adhesion and start a the initiation of metastasis for cancer progression.), as indicated by increased expression of E-cadherin, β-catenin, and cytokeratins 8/18 (epithelial markers) and corresponding reduction in vimentin (mesenchymal marker) and reduction in cancer cell motility(11). In other study, treatment of gamma-tocopherol (γT) and gamma-tocotrienol (γT3) in human breast cancer cell lines, induced apoptosis via de novo ceramide synthesis(key molecules in cellular life and death decisions and the precursors to complex sphingolipids found in membranes) dependent activation of JNK/CHOP((C/EBP homologous protein)/DR5 pro-apoptotic signaling(12) and in γ-tocopherol (γT) alone,  the variant showed to suppress inflammatory markers, inhibited E2 -induced cell proliferation, and up regulated PPARγ(regulation of cellular differentiation, development, and metabolism) and Nrf2 (antioxidant response pathway)expression in mammary hyperplasia(13) or  modulated ER stress signaling targeting ATF3(activating transcription factor 3, involved in the complex process of cellular stress response)  in breast cancer cells(14). In HER2/neu, vitamin E analog namely alpha-tocopheryloxyacetic acid, inhibited the proliferation of kills both HER2/neu positive and HER2/neu negative breast cancer cells with less toxic than existing chemotherapeutic drugs when used in combination with HER2/neu antibody(15).

Taken the evidences of the effects of tocotrienols, dietary vitamin E or vitamin E supplement may provide significant health benefits in the reduced risk and prevention and/or treatment of breast cancer when used either alone or in combination with other anticancer agents(16).


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References
(1) Chemopreventive activity of vitamin E in breast cancer: a focus on γ- and δ-tocopherol by Smolarek AK, Suh N.(PubMed)
(1a) Mechanisms mediating the antiproliferative and apoptotic effects of vitamin E in mammary cancer cells by Sylvester PW, Shah SJ.(PubMed)
(1b) Dietary administration of δ- and γ-tocopherol inhibits tumorigenesis in the animal model of estrogen receptor-positive, but not HER-2 breast cancer by Smolarek AK, So JY, Burgess B, Kong AN, Reuhl K, Lin Y, Shih WJ, Li G, Lee MJ, Chen YK, Yang CS, Suh N.(PubMed)
(2) Traber MG. Vitamin E. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins R, eds. Modern Nutrition in Health and Disease. 10th ed. Baltimore, MD: Lippincott Williams & Wilkins, 2006;396-411.
(3) Relationships of serum carotenoids, retinol, alpha-tocopherol, and selenium with breast cancer risk: results from a prospective study in Columbia, Missouri (United States) by Dorgan JF, Sowell A, Swanson CA, Potischman N, Miller R, Schussler N, Stephenson HE Jr(PubMed)
(3a) Alteration of α-tocopherol-associated protein (TAP) expression in human breast epithelial cells during breast cancer development by Tam KW, Ho CT, Lee WJ, Tu SH, Huang CS, Chen CS, Lee CH, Wu CH, Ho YS.(PubMed)
(3b) dl-alpha-tocopherol induces apoptosis in erythroleukemia, prostate, and breast cancer cells by Sigounas G, Anagnostou A, Steiner M.(PubMed)
(3c) Gamma- and delta-tocotrienols exert a more potent anticancer effect than alpha-tocopheryl succinate on breast cancer cell lines irrespective of HER-2/neu expression by Pierpaoli E, Viola V, Pilolli F, Piroddi M, Galli F, Provinciali M.(PubMed)
(3d) Synthesis of fluorescent analogues of the anticancer natural products 4-hydroxyphenylmethylene hydantoin and delta-tocotrienol by Mudit M, Behery FA, Wali VB, Sylvester PW, El Sayed KA.(PubMed)
(3e) Induction of apoptosis in human breast cancer cells by tocopherols and tocotrienols by Yu W, Simmons-Menchaca M, Gapor A, Sanders BG, Kline K.(PubMed).
(4) Tocotrienols promote apoptosis in human breast cancer cells by inducing poly(ADP-ribose) polymerase cleavage and inhibiting nuclear factor kappa-B activity by Loganathan R, Selvaduray KR, Nesaretnam K, Radhakrishnan AK.(PubMed)
(5) Mitochondrial-dependent anticancer activity of δ-tocotrienol and its synthetic derivatives in HER-2/neu overexpressing breast adenocarcinoma cells by Viola V, Ciffolilli S, Legnaioli S, Piroddi M, Betti M, Mazzini F, Pierpaoli E, Provinciali M, Galli F.(PubMed)
(6) Growth inhibition of human MDA-mB-231 breast cancer cells by delta-tocotrienol is associated with loss of cyclin D1/CDK4 expression and accompanying changes in the state of phosphorylation of the retinoblastoma tumor suppressor gene product by Elangovan S, Hsieh TC, Wu JM.(PubMed)
(7) Pro-apoptotic mechanisms of action of a novel vitamin E analog (alpha-TEA) and a naturally occurring form of vitamin E (delta-tocotrienol) in MDA-MB-435 human breast cancer cells by Shun MC, Yu W, Gapor A, Parsons R, Atkinson J, Sanders BG, Kline K.(PubMed)
(8) Tocotrienols inhibit the growth of human breast cancer cells irrespective of estrogen receptor status by Nesaretnam K, Stephen R, Dils R, Darbre P.(PubMed)
(9)γ-Tocotrienol-induced autophagy in malignant mammary cancer cells by Tiwari RV, Parajuli P, Sylvester PW.(PubMed)
(10) Gamma-tocotrienol inhibits neoplastic mammary epithelial cell proliferation by decreasing Akt and nuclear factor kappaB activity by Shah SJ, Sylvester PW.(PubMed)
(11) Combined γ-tocotrienol and Met inhibitor treatment suppresses mammary cancer cell proliferation, epithelial-to-mesenchymal transition and migration by Ayoub NM, Akl MR, Sylvester PW.(PubMed)
(12) Involvement of de novo ceramide synthesis in gamma-tocopherol and gamma-tocotrienol-induced apoptosis in human breast cancer cells by Gopalan A, Yu W, Jiang Q, Jang Y, Sanders BG, Kline K.(12)
(13) Dietary tocopherols inhibit cell proliferation, regulate expression of ERα, PPARγ, and Nrf2, and decrease serum inflammatory markers during the development of mammary hyperplasia by Smolarek AK, So JY, Thomas PE, Lee HJ, Paul S, Dombrowski A, Wang CX, Saw CL, Khor TO, Kong AN, Reuhl K, Lee MJ, Yang CS, Suh N.(PubMed)
(14) Gamma-tocotrienol induced apoptosis is associated with unfolded protein response in human breast cancer cells by Patacsil D, Tran AT, Cho YS, Suy S, Saenz F, Malyukova I, Ressom H, Collins SP, Clarke R, Kumar D.(PubMed)
(15) The vitamin E analog, alpha-tocopheryloxyacetic acid enhances the anti-tumor activity of trastuzumab against HER2/neu-expressing breast cancer by Hahn T, Bradley-Dunlop DJ, Hurley LH, Von-Hoff D, Gately S, Mary DL, Lu H, Penichet ML, Besselsen DG, Cole BB, Meeuwsen T, Walker E, Akporiaye ET.(PubMed)
(16) Potential role of tocotrienols in the treatment and prevention of breast cancer by Sylvester PW, Akl MR, Malaviya A, Parajuli P, Ananthula S, Tiwari RV, Ayoub NM.(PubMed)

Monday, 10 February 2014

Polycystic Ovarian Syndrome (PCOs) Diets

By Kyle J. Norton

Approximately half of women with polycystic ovary syndrome (PCOs) are either obese or overweight. Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5% to 10% of women worldwide.
1. High Protein Diet with Low-Glycemic-Load Hypocaloric Diet
Diet with 30% of protein is now considered reasonable, high protein diet is the term reserved for consumption of 50% or more.
Suggestions in linking High Protein Diet with Low-Glycemic-Load Hypocaloric Diet to control and combat polycystic ovary syndrome (PCOS) have drawn attention in scientific community over last decade. It may be due to its effect in reduced appetites and calorie intake. But epidemiological studies focusing the benefit of diets in treating obese and overweight patients have produced an inclusive results. The National Nutrition and Food Technology Research Institute showed that both composition of hypocaloric and hypocaloric diet lead to significantly  reduced body weight and androgen levels.  Compared with a conventional diet, the combination of high-protein and low-glycemic-load foods and Hypocaloric diett also found to be effective in enhanced insulin sensitivity and decreased hsCRP level (1). But the alternation of metabolic rate of hypocaloric diet  in glucose utilization and decreased antioxidant defenses, in some cases may result in life-threatening(8a).

2. Hypocaloric diet
 Comparison with Metformin in the same subjects, hypocaloric(low calories) diet showed a reduction of 5-10% of weight on markers of insulin resistance with  equal efficacy with Metformin in decreasing serum hs-CRP levels(2) and improving inflammatory biomarkers and adipokines independently of dietary composition(3). In a 20 weeks of a high-protein energy-restricted diet to evaluate the Markers of endothelial dysfunction, including elevated markers of endothelial dysfunction, presented in overweight and obese women with polycystic ovary syndrome, showed an significant weight loss, improved testosterone, sex hormone-binding globulin and the free androgen index (FAI) and insulin resistance(4). Sibutramine(the hydrochloride monohydrate salt) removed from the market because of the concerns of risk of heart attack and stroke, in a comparison test with hypocaloric diet, showed a significant weight loss in overweight and obese women with PCOS and improvement in hyperandrogenemia and insulin sensitivity after 6 months of treatment(5). Clomiphene citrate (CC) used conjunction with hypocaloric diet with structured exercise training (SET) after 6 weeks in overweight and obese CC-resistant PCOS patients, enhanced the probability of ovulation under CC treatment, through a significant improvement in clinical and biochemical androgen and insulin sensitivity indexes(6).
Comparison of  a hypocaloric low-fat diet with those of a very low carbohydrate diet, showed the positive effects in both diets in significant improvements in BMI, WC, and menstrual function and induced weight loss through targeting both the menstrual dysfunction and risk factors for long-term morbidity associated with PCOS in adolescents(7). Short-term hypocaloric diet including high protein (HP: 30% protein, 40% carbohydrate, and 30% fat) or high carbohydrate (HC: 15% protein, 55% carbohydrate, and 30% fat) showed a significant weight loss reduction and  improvement in their reproductive and metabolic abnormalities with no increased benefit to a high-protein diet(8).
Some researchers suggested that Hypocaloric (low-calorie) diets can alter your metabolic rate in glucose utilization and decreased antioxidant defenses, in some case may result in life-threatening(8a).

3. Low-carbohydrate diet
  A high-fat, adequate-protein, low-carbohydrate diet has been used in medicine primarily to treat difficult-to-control (refractory) epilepsy in children with purpose to induce the body to burn fat other than carbohydrate. In a women 24 weeks study with  limit carbohydrate intake to 20 grams or less per day for women diagnosed with PCOs, showed non-significant decreases in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body hair but improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity(9). According to the University of Padova study, "Epidemiological studies over last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors"(10). Some researchers insisted that the presence of high levels of insulin in the blood causes unnecessary water retention in the body(10a), the diet may produce a short term effect through eliminating excess body fat but may cause dehydration as an early-onset complication(10b)

4. Low glycemic index diet
Glycemic index diet originally is developed to help improve blood sugar control in diabetes by choosing foods Low-GI foods (55 and under) for steadier rise in blood sugar. In a Twenty-six participants recruited at baseline, 22 commenced and 21 participants completed the low-GI dietary intervention phase, low glycemic diet improved insulin sensitivity, changes of lipids(11). Comparison of low glycemic index with a conventional healthy diet in overweight and obese premenopausal women, low glycemic index attendants showed to improve more in glucose tolerance through oral-glucose-tolerance test (ISI(OGTT)), menstrual cyclicity, with serum fibrinogen concentrations significant differences between diets(12). Researchers also suggested that longer term compliance needs more evaluation in subsequent studies to reduced long term health risks to women with PCOS on a low GI diet(13). In comparison of low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus, some researchers suggested that the diet containing fewer carbohydrates, the low-carbohydrate, ketogenic diet, was more effective for improving glycemic control than the low glycemic diet(12a).

5. High-protein diet
High-protein diet is a diet mostly recommended for people who want to build muscle and lose fat. A comparison of a high protein (HP) and a normal protein (NP) diet on patients with polycystic ovary syndrome (PCOS) in 8-week randomized trial, showed a significantly reduced body weight, body mass index (BMI), waist circumference, percent of body fat,  decreased total testosterone in PCOs(14).  In fact, increased dietary protein-to-carbohydrate ratios showed no differences in testosterone, sex hormone-binding globulin, and blood lipids between the groups after 6 months, but adjustment for weight changes led to significantly lower testosterone concentrations in the standard-protein (SP) diet group, according to the University of Copenhagen(15). Unfortunately, some studies showed that consumption of HP diets may cause alterations in renal health status and some metabolic parameters(15a) and reduce the level of osteocalcin(15b)

7. High monounsaturated fat diet
High monounsaturated fat diet is a diet high in monounsaturated fatty acids (HMUFA)  for  a replacment of daily intake of bad fat. In a comparison of Carbohydrate-restricted diets high in either monounsaturated fat or protein, showed that magnitude of weight loss was smaller in the LF-HP group than in the HF-SP(16). The Mediterranean diet, a High monounsaturated fat diet is characterized by a high intake of olive oil, plant products, fish and seafood; a low intake of dairies, meat and meat products; and a moderate ethanol intake, but unfortunately, exploring the relationship between the Mediterranean diet and overweight/obesity is complex with inclusive results. Some studies indicated a significantly related to less overweight/obesity or more weight loss but many found no evidence of this association(16a).

8. Low fat diet 
Low fat diet restricts consumption of fat and stresses foods high in carbohydrates, mostly recommended to patients with some gallbladder conditions. Comparison of hormonal and metabolic markers after a high-fat, Western meal versus a low-fat, high-fiber meal in women with polycystic ovary syndrome, showed a reduction of free testosterone within 2 hours after both meals, however, the levels of testosterone remained below premeal values for 4 hours after the isocaloric low-fat, high-fiber meal (HIFIB) meal and 6 hours after the a high-fat, Western meal (HIFAT) meal. Levels of glucose was higher for 1 hour after the HIFIB meal compared with the HIFAT meal. DHEAS decreased 8%-10% within 2-3 hours after both meals, then increased during the remainder of the study period. Cortisol decreased during the 6-hour period after both meals(17). Suggestion of individuals on a low-fat vegan must ensure adequate intakes of  of vitamin D, vitamin K, folic acid, calcium, magnesium, zinc, vitamin B12, phosphorous, and selenium(17a).

Taking all together, there are subtle differences but correlation between diets, a monounsaturated fat-enriched diet induced greater weight loss, a low-glycemic index diet enhanced menstrual regularity, a high-carbohydrate diet increased free androgen index, a low-carbohydrate or low-glycemic index dietgreater reductions in insulin resistance, fibrinogen, total testosterone, and high-density lipoprotein cholesterol, a low-glycemic index diet improved quality of life, a high-protein diet.improved depression and self-esteem for a high-protein diet. Maximize weight loss control is important for women with PCOS regardless of dietary composition which should target all overweight women with PCOS through reducing calories with adequate nutritional intake and healthy food choices irrespective of diet composition(18).


Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months 


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References
(1) Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study by Mehrabani HH, Salehpour S, Amiri Z, Farahani SJ, Meyer BJ, Tahbaz F.(PubMed)
(2) Effect of metformin compared with hypocaloric diet on serum C-reactive protein level and insulin resistance in obese and overweight women with polycystic ovary syndrome by Esfahanian F, Zamani MM, Heshmat R, Moini nia F.(PubMed)
(3) Effect of a low-fat versus a low-gycemic-load diet on inflammatory biomarker and adipokine concentrations by Heggen E, Klemsdal TO, Haugen F, Holme I, Tonstad S.(PubMed)
(4) The effect of diet and exercise on markers of endothelial function in overweight and obese women with polycystic ovary eby Thomson RL, Brinkworth GD, Noakes M, Clifton PM, Norman RJ, Buckley JD.(PubMed)
(5) Effect of hypocaloric diet plus sibutramine treatment on hormonal and metabolic features in overweight and obese women with polycystic ovary syndrome: a randomized, 24-week study by Florakis D, Diamanti-Kandarakis E, Katsikis I, Nassis GP, Karkanaki A, Georgopoulos N, Panidis D.(PubMed)
(6) Six weeks of structured exercise training and hypocaloric diet increases the probability of ovulation after clomiphene citrate in overweight and obese patients with polycystic ovary syndrome: a randomized controlled trial by Palomba S, Falbo A, Giallauria F, Russo T, Rocca M, Tolino A, Zullo F, Orio F.(PubMed)
(7) Effect of weight loss on menstrual function in adolescents with polycystic ovary syndrome by Ornstein RM, Copperman NM, Jacobson MS.(PubMed)
(8) A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome by Stamets K, Taylor DS, Kunselman A, Demers LM, Pelkman CL, Legro RS.(PubMed)
(8a) Toxicity of hypercaloric diet and monosodium glutamate: oxidative stress and metabolic shifting in hepatic tissue by Diniz YS, Fernandes AA, Campos KE, Mani F, Ribas BO, Novelli EL.(PubMed)
(9) The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study by Mavropoulos JC, Yancy WS, Hepburn J, Westman EC.(PubMed)
(10) Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets by Paoli A, Rubini A, Volek JS, Grimaldi KA.(PubMed)
(1a) Eades, M. (1995) The Protein Power Lifeplan, Warner Books.
(1b) Early- and Late-onset Complications of the Ketogenic Diet for Intractable Epilepsy by Hoon Chul Kang1, Da Eun Chung1, Dong Wook Kim2, Heung Dong Kim (Wily online library)(11) An isocaloric low glycemic index diet improves insulin sensitivity in women with polycystic ovary syndrome by Barr S, Reeves S, Sharp K, Jeanes YM.(PubMed)
(12) Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome by Marsh KA, Steinbeck KS, Atkinson FS, Petocz P, Brand-Miller JC.(PubMed)
(12a) The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus by Eric C Westman1*, William S Yancy12, John C Mavropoulos1, Megan Marquart1 and Jennifer R McDuffie(Nutrition&Metabolism)
(13) Evaluating compliance to a low glycaemic index (GI) diet in women with polycystic ovary syndrome (PCOS) by Egan N, Read A, Riley P, Atiomo W.(PubMed)
(14) Effect of high-protein or normal-protein diet on weight loss, body composition, hormone, and metabolic profile in southern Brazilian women with polycystic ovary syndrome: a randomized study by Toscani MK, Mario FM, Radavelli-Bagatini S, Wiltgen D, Matos MC, Spritzer PM.(PubMed)
(15) Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids by Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster P, Clifton PM.(PubMed)
(15a) Effects of high-whey-protein intake and resistance training on renal, bone and metabolic parameters in rats by Aparicio VA, Nebot E, Porres JM, Ortega FB, Heredia JM, López-Jurado M, Ramírez PA.(PubMed)
(15b) Effects of dietary protein and glycaemic index on biomarkers of bone turnover in children by Dalskov SM1, Müller M2, Ritz C1, Damsgaard CT1, Papadaki A3, Saris WH4, Astrup A1, Michaelsen KF1, Mølgaard C1; on behalf of DiOGenes(PubMed)
(16) Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids by Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster P, Clifton PM.(PubMed)
(16a) Obesity and the Mediterranean diet: a systematic review of observational and intervention studies by Buckland G, Bach A, Serra-Majem L.(PubMed)

(17) Comparison of hormonal and metabolic markers after a high-fat, Western meal versus a low-fat, high-fiber meal in women with polycystic ovary syndrome by Katcher HI, Kunselman AR, Dmitrovic R, Demers LM, Gnatuk CL, Kris-Etherton PM, Legro RS.(PubMed)
(17a) Effects of a low-fat vegan diet and a Step II diet on macro- and micronutrient intakes in overweight postmenopausal women by Turner-McGrievy GM, Barnard ND, Scialli AR, Lanou AJ.(PubMed)

(18) Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines by Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, Frearson M, Thondan M, Stepto N, Teede HJ.(PubMed)

Sunday, 9 February 2014

Breast cancer in Vitamin B3's Points of view

By Kyle J. Norton

Niacin, is also known as vitamin B3, nicotinic acid, an organic compound with the formula
C6H5NO2, found abundantly in chicken, beef, fish, cereal, peanuts and legumes. It is best known for its effects in lowering cholesterol and triglycerides and removing toxic from our body and promoting production of steroid hormones.

Epidemiological studies, focused in niacin in reduced risk of breast cancer have produced conflict results. In human breast cancer cell, combination of niacin and butyrate induced apoptosis, through activation of GPR109A, a G-protein-coupled receptor in inhibition of genes, involved in cell survival and anti-apoptotic signaling(1). But in the study of breast cancer risk among Chinese women, niacin was found to be associated with ER+/PR+ breast cancer risk depending to the highest vs. lowest quartile of intake in premenopausal women(2). Unfortunately, some researchers indicated that regardless to the doses, even Mega-dose vitamins and minerals did not improve the breast cancer-specific survival and disease-free survival times in breast cancer patients(2a).

The study of potent antioxidant Niacin (CoRN), co administration with Tamoxifen (TAM) showed favorable impact on various blood chemistry profiles and may be considered as a co-administrating antioxidants with conventional chemotherapy but large scale randomized studies over a longer time span are required to ascertain the safety and efficacy(3).
In tumour angiogenesis, the co administrations also decreased the levels of pro-angiogenic factors which reduced the tumor burden in protection from cancer metastases and recurrence(4). Oral administration of daily supplement of 100 mg co-enzyme Q10, 10 mg riboflavin and 50 mg niacin (CoRN), one dosage per d along with 10 mg tamoxifen twice per day in breast caner patients showed to reduce tumor burden  by significant increase in poly(ADP-ribose polymerase levels(Differentiation, proliferation, and tumor transformation and Normal or abnormal recovery from DNA damage) and disappearance of RASSF1A(involved in early tumorigenesis) DNA methylation patterns(5). In postmenopausal women with breast cancer, the above combination significantly increased the AO(antioxidants) status, while decreasing lipid and lipid peroxides(free radical)(6).

Niacin is found effectively in reduced risk of breast cancer when co administrated. Combination with other vitamins and Tamoxifen (TAM) showed to provide protection and management in the process of breast cancer treatments, through exhibition of antioxidants status and decreased free radical expression. Please make sure to follow the guideline of the Institute of Medicine of the National Academies. Overdoses of vitamin B3 may induce symptoms of severe skin flushing combined with dizziness, rapid heartbeat, itching, nausea, vomiting, abdominal pain, etc.


Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months 


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References
(1) The niacin/butyrate receptor GPR109A suppresses mammary tumorigenesis by inhibiting cell survival by Elangovan S, Pathania R, Ramachandran S, Ananth S, Padia RN, Lan L, Singh N, Martin PM, Hawthorn L, Prasad PD, Ganapathy V, Thangaraju M.(PubMed)
(2) Dietary B vitamin and methionine intakes and breast cancer risk among Chinese women by Shrubsole MJ, Shu XO, Li HL, Cai H, Yang G, Gao YT, Gao J, Zheng W.(PubMed)
(2a) Mega-dose vitamins and minerals in the treatment of non-metastatic breast cancer: an historical cohort study by Lesperance ML, Olivotto IA, Forde N, Zhao Y, Speers C, Foster H, Tsao M, MacPherson N, Hoffer A.(PubMed)
(3) Effect of Coenzyme Q(10), Riboflavin and Niacin on Tamoxifen treated postmenopausal breast cancer women with special reference to blood chemistry profiles by Yuvaraj S, Premkumar VG, Shanthi P, Vijayasarathy K, Gangadaran SG, Sachdanandam P.(PubMed)
(4) Anti-angiogenic potential of CoenzymeQ10, riboflavin and niacin in breast cancer patients undergoing tamoxifen therapy by Premkumar VG, Yuvaraj S, Sathish S, Shanthi P, Sachdanandam P.(PubMed)
(5) Co-enzyme Q10, riboflavin and niacin supplementation on alteration of DNA repair enzyme and DNA methylation in breast cancer patients undergoing tamoxifen therapy by Premkumar VG, Yuvaraj S, Shanthi P, Sachdanandam P.(PubMed)
(6) Augmented antioxidant status in Tamoxifen treated postmenopausal women with breast cancer on co-administration with Coenzyme Q10, Niacin and Riboflavin by Yuvaraj S, Premkumar VG, Vijayasarathy K, Gangadaran SG, Sachdanandam P.(PubMed)

Saturday, 8 February 2014

Breast cancer in Vitamin B2's Points of view

 Kyle J. Norton

Vitamin B2 also known as  Riboflavin, is a water-soluble, yellow-orange organic compound found abundantly in milk, meat, eggs, nuts, enriched flour, green vegetables, etc. The vitamin is essential for normal cellular growth and function and best known for converting energy from protein, fat, and carbohydrates during metabolism and its antioxidant effects in oxidation-reduction reactions.
Breast cancer (malignant breast neoplasm) is a cancer that starts in the tissues of the breast either from the inner lining of milk ducts (Ductal carcinoma) or the lobules (Lobular carcinoma) suppled the ducts with milk. There is also rare cases that breast cancer starts in other areas of the breast. In 2010, over 250,000 new cases of breast cancer were expected to be diagnosed in women in the U.S. alone and the risk of getting invasive breast cancer during life time of a women is 1/8.

Epidemiological studies, focusing in the benefits of vitamin B2 in reduced risk and treatment of breast cancer have produced inconclusive results. Serum levels of riboflavin (RF) was found significantly be decreased in over-expressed of RF carrier protein women with breast cancer. Administration of RF-targeted MMC-conjugate (mitomycin C (MMC)-conjugated N-(2-hydroxypropyl) methacrylamide (HPMA) [used as macromolecular carriers to enhance therapeutic efficacy and limit side effects of anti-cancer chemotherapeutic agents] enabled an increase in MMC uptake and nuclear localization in cell cyle to induce cytotoxic activity in in both MCF-7 and SKBR-3 cells(1).  In a follow-up of 20,756 women from the Melbourne Collaborative Cohort Study, including modification by age, hormone receptor status and alcohol consumption showed a insignificant evidence for an inverse association between breast cancer risk and riboflavin intake(2). Other in breast cancer risk among Japanese women, found no correlation of vitamin B2 intake and no overall association with breast cancer risk(3)(3a). Unfortunately, a 5-year survival rate study for in ER-/PR- breast cancers among Korean women, showed that a high intake of vitamin B2 and folate statistically elevated the HR of breast cancer progression compared to a low intake(4).

In postmenopausal women with breast cancer, Tamoxifen (TAM) co administration with Coenzyme Q(10), Riboflavin and Niacin (CoRN)  exhibited a favorable impact on various blood chemistry profiles in reducing side effect of Tamoxifen causes of oxidative stress with various biochemical derangements(5), through increased the antioxidants status, while decreasing lipid and lipid peroxides(6)(7). In an 84 breast cancer patients randomized to receive a daily supplement of CoQ(10) 100 mg, riboflavin 10 mg and niacin 50 mg (CoRN), one dosage per day along with tamoxifen (TAM) 10 mg twice a day, supplementing CoRN  decreased the levels of pro-angiogenic factors, increased the levels of anti-angiogenic factors and enhanced the efficacy of the treatment and might even offer protection from cancer metastases and recurrence(8)(9)(10). Energy-modulating vitamins, riboflavin (45 mg/kg body weight per d), niacin (100 mg/kg body weight per d) and coenzyme Q10 (40 mg/kg body weight per d) for 28 days in the experiment against mammary carcinoma induced by the oral administration of 7,12-dimethylbenz[a]anthracene (25 mg/kg body weight), showed an decreasing of the Krebs cycle and oxidative phosphorylation enzymes and may be considered as a major therapeutic value in breast cancer(11).

Taking altogether, vitamin B2 used conjunction with other energy vitamins and in co administration with Tamixofen showed to enhance the efficacy of the chemo-agent by exerting its antioxidant effects. In fact, risk of breast cancer are associated to nutrient deficiency of vitamin B-12, thiamin, folacin, iron, and riboflavin(12). Over doses for a prolong period may cause symptoms of skin rashes, hypersensitivity, high blood pressure etc., please make sure you follow the guideline of the Institute of Medicine of the National Academies.



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References
(1) Riboflavin-targeted polymer conjugates for breast tumor delivery by Bareford LM, Avaritt BR, Ghandehari H, Nan A, Swaan PW.(PubMed)
(2) Dietary intake of B vitamins and methionine and breast cancer risk by Bassett JK, Baglietto L, Hodge AM, Severi G, Hopper JL, English DR, Giles GG.(PubMed)
(3) Dietary intake of folate, vitamin B2, vitamin B6, vitamin B12, genetic polymorphism of related enzymes, and risk of breast cancer: a case-control study in Japan by Ma E, Iwasaki M, Kobayashi M, Kasuga Y, Yokoyama S, Onuma H, Nishimura H, Kusama R, Tsugane S.(PubMed)
(3a) Folate, vitamin B12 and postmenopausal breast cancer in a prospective study of French women by Lajous M, Romieu I, Sabia S, Boutron-Ruault MC, Clavel-Chapelon F.(PubMed)
(4) Prognosis of breast cancer is associated with one-carbon metabolism related nutrients among Korean women by Lee Y, Lee SA, Choi JY, Song M, Sung H, Jeon S, Park SK, Yoo KY, Noh DY, Ahn SH, Kang D.(PubMed)
(5) Effect of Coenzyme Q(10), Riboflavin and Niacin on Tamoxifen treated postmenopausal breast cancer women with special reference to blood chemistry profiles by Yuvaraj S, Premkumar VG, Shanthi P, Vijayasarathy K, Gangadaran SG, Sachdanandam P.(PubMed)
(6) Augmented antioxidant status in Tamoxifen treated postmenopausal women with breast cancer on co-administration with Coenzyme Q10, Niacin and Riboflavin by Yuvaraj S, Premkumar VG, Vijayasarathy K, Gangadaran SG, Sachdanandam P.(PubMed)
(7) Augmented efficacy of tamoxifen in rat breast tumorigenesis when gavaged along with riboflavin, niacin, and CoQ10: effects on lipid peroxidation and antioxidants in mitochondria by Perumal SS, Shanthi P, Sachdanandam P.(PubMed)
(8) Anti-angiogenic potential of CoenzymeQ10, riboflavin and niacin in breast cancer patients undergoing tamoxifen therapy by Premkumar VG, Yuvaraj S, Sathish S, Shanthi P, Sachdanandam P.(PubMed)
(9) Serum cytokine levels of interleukin-1beta, -6, -8, tumour necrosis factor-alpha and vascular endothelial growth factor in breast cancer patients treated with tamoxifen and supplemented with co-enzyme Q(10), riboflavin and niacin by Premkumar VG, Yuvaraj S, Vijayasarathy K, Gangadaran SG, Sachdanandam P.(PubMed)
(10) Effect of coenzyme Q10, riboflavin and niacin on serum CEA and CA 15-3 levels in breast cancer patients undergoing tamoxifen therapy by Premkumar VG, Yuvaraj S, Vijayasarathy K, Gangadaran SG, Sachdanandam P.(PubNMed)
(11) Energy-modulating vitamins--a new combinatorial therapy prevents cancer cachexia in rat mammary carcinoma by Perumal SS, Shanthi P, Sachdanandam P.(PubMed)
(12) Taste perception and breast cancer: evidence of a role for diet by Ames HG, Gee MI, Hawrysh ZJ.(PubMed)

Thursday, 6 February 2014

Breast cancer in Vitamin K's Points of View

By Kyle J. Norton

Vitamin K(K1, phylloquinone; K2, menaquinones), is a fat soluble vitamin, found abundantly in leafy green vegetables, broccoli, and Brussels sprouts, etc. It is best known for promotion of coagulation and bone health.
Epidemiological studies focused in the synthetic version of vitamin K(Vk3) in reduced risk and treatment of breast cancer have proven successful in certain extents. In comparison of the anti cancer effects of Vitamin K (VK) congeners, vitamin K3(Menadione ), a synthetic analogue with the same properties as provitaminis was found to be most potent in treating various types of cancer, including breast cancer(1) In comparison the inhibition effects of vitamin K, K3 and warfarin in human cancer cell lines, the combination of 3 Completely inhibited of L1210 growth in flask culture at concentrations of 200 micrograms/ml of warfarin, 75 micrograms/ml of vitamin K1, and 4 micrograms/ml of vitamin K3. The combination K3 and warfarin enhanced cytotoxicity at doses depending manner. Vitamin K3 alone was also cytotoxic in a concentration of 1 micrograms/ml, including breast cancers(1a). Synthesized VK2 derivatives (MQ-1, MQ-2 and MQ-3, also in the comparison of the antitumor activities of vitamin K1, K2, and K3 against a panel of human cancer cell lines, vitamin K3 showed inhibition of various cancers and radioresistant cancers including breast cancer cell lines (BC-M1)( in doeses of 26, 15, 25, and 33 microM: VK1 ranged from 6 to 9 mM, and VK2 ranged from 1 to 2 mM in ID50 values(1b).

In breast cancer, vitamin K3 analogue plumbagin exerted its inhibitor effect in osteoclastogenesis induced by tumor cells and breast cancer-induced osteolytic metastasis through suppression of RANKL signaling to alter tumor progression(2). In breast cancer cell line MCF-7, VK(3), it exhibited cytotoxicity through DNA fragmentation (separation or breaking of DNA strands into pieces) and mitochondrial dysfunction(3).
In MCF-7, estrogen receptor-positive breast cancer cells, vitamin K3 (menadione) inhibited the transcriptional activity of 17beta-estradiol in a reporter gene assay(4). CR108, a novel vitamin K3 derivative, (S)-2-(2-hydroxy-3-methylbutylthio)naphthalene-1,4-dione, exhibited apoptosis in both the non-HER-2-overexpressed MCF-7 and HER-2-overexpressed BT-474 breast cancer cells, through induced the loss of mitochondrial membrane potential, leading to cytochrome c released from mitochondria to cytosol and and cleaved PARP(activate CNS immune responses) proteins(5). Menadione, also known as VK3, its reduction-oxidation, generated by ascorbate-driven menadione redox cycling inhibited MCF7 breast cancer cells, through glycolysis(metabolic pathway for generation of energy) inhibition, loss of calcium homeostasis(maintains adequate calcium levels), DNA damage and changes in mitogen activated protein kinases (MAPK)(regulate proliferation, gene expression, differentiation, mitosis, cell survival, and apoptosis ) activities(6). Also, in MCF 7 breast cancer cells, Fluorinated Cpd 5, an arylating K-vitamin derivative, showed growth inhibition probably via conjugation of cellular thiols, by suppressing the activity of thiol containing cellular protein tyrosine phosphatase (PTP) enzyme(play critical roles in fundamental biological processes), with consequent induction of various tyrosine phosphoproteins(involved in a number of metabolic and signalling pathways) in promoting mutation cell proliferation(7).

Vitamin K although was found effectively in decreased risk and treatment for breast cancers by exhibition of its effects in cytotoxicity, apoptosis and anti proliferation through DNA fragmentation, mitochondrial dysfunction, cell death pathway, overdoses can induce symptoms of Skin rash,  Diarrhea, Nausea, Vomiting, Anemia, etc. Please make sure you follow the guideline of the Institute of Medicine of the National Academies.

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References
(1) Comparison of antitumor activity of vitamins K1, K2 and K3 on human tumor cells by two (MTT and SRB) cell viability assays by Wu FY, Liao WC, Chang HM.(PubMed)
(1a) Vitamin K3 inhibition of malignant murine cell growth and human tumor colony formation. by Chlebowski RT, Dietrich M, Akman S, Block JB.(PubMed)
(1b) Vitamin K2-derived compounds induce growth inhibition in radioresistant cancer cells by Amalia H, Sasaki R, Suzuki Y, Demizu Y, Bito T, Nishimura H, Okamoto Y, Yoshida K, Miyawaki D, Kawabe T, Mizushina Y, Sugimura K(PubMed).
(2) Plumbagin inhibits osteoclastogenesis and reduces human breast cancer-induced osteolytic bone metastasis in mice through suppression of RANKL signaling by Sung B, Oyajobi B, Aggarwal BB.(PubMed)
(3) The potential of vitamin K3 as an anticancer agent against breast cancer that acts via the mitochondria-related apoptotic pathway by Akiyoshi T, Matzno S, Sakai M, Okamura N, Matsuyama K.(PubMed)
(4) Anti-estrogenic activity of fifty chemicals evaluated by in vitro assays by Jung J, Ishida K, Nishihara T.(PubMed)
(5) CR108, a novel vitamin K3 derivative induces apoptosis and breast tumor inhibition by reactive oxygen species and mitochondrial dysfunction by Yang CR, Liao WS, Wu YH, Murugan K, Chen C, Chao JI.(PubMed)
(6) Menadione reduction by pharmacological doses of ascorbate induces an oxidative stress that kills breast cancer cells by Beck R, Verrax J, Dejeans N, Taper H, Calderon PB.(PubMed)
(7) Growth inhibition and protein tyrosine phosphorylation in MCF 7 breast cancer cells by a novel K vitamin by Kar S, Carr BI.(PubMed)