Arsenic as Traditional Chinese Medicine Provides New Hope for Overcoming High Treatment Costs of Acute Promyelocytic Leukemia

Zhu, Hong‐Hu; Hu, Jiong; Gu, Xuefei

doi:10.1200/jgo.2016.005405

Cited by 8 publications

(4 citation statements)

References 8 publications

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“…In this study, the inpatient days for induction and consolidation treatment were significantly reduced in the RIF group compared with the ATRA group, and the costs of hospitalization decreased accordingly, which could reduce the financial burden for patients. The total medical costs reported for the home treatment model of RIF + ATRA was significantly lower than the costs for the intravenous ATO group [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Oral Realgar-Indigo Naturalis Formula Treatment for Acute Promyelocytic Leukemia in Children: A Randomized, Control Clinical Trial

Luo

Tian

Sun

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To analyze the efficacy, safety, and economy of RIF compared with intravenous arsenic trioxide (ATO) for the induction and consolidation therapy of pediatric APL. Materials and Methods. In this randomized control clinical trial (NCT02200978), children with newly diagnosed APL from June 2013 to December 2017 were randomly divided into RIF and ATO groups. The groups were treated with RIF or ATO in combination with all-trans retinoic acid (ARTA) and conventional chemotherapeutic drugs during induction and consolidation therapy. Results. Ninteen patients were enrolled, including eight in the RIF group and 11 in the ATO group. After induction therapy, the bone marrow morphologic complete remission (CR) rate, the median time to CR, and molecular remission (promyelocytic leukemia protein (PML)/retinoic acid receptor α (RARα) conversion) rates showed no significant differences between patients in the RIF versus ATO groups (100% vs. 100%, p = 1.000 ; 22 vs. 24 days, p = 0.395 ; 28.5% vs. 54.5%, p = 0.367 , resp.). After consolidation therapy, the molecular remission rate was 100% in both groups. At the end of more than two years of follow-up, the disease-free survival (DFS) rate was 100% in both groups. Conclusion. Oral RIF can achieve similar efficacy to intravenous ATO for APL in children with good safety, less toxicity, fewer side effects, and fewer inpatient days. Therefore, oral RIF can be used as an alternative to intravenous ATO for the treatment of APL in children.

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Section: Discussionmentioning

confidence: 99%

Oral Realgar-Indigo Naturalis Formula Treatment for Acute Promyelocytic Leukemia in Children: A Randomized, Control Clinical Trial

Luo

Tian

Sun

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…More detailed clinical trials have shown that RIF is also safe and effective in newly diagnosed pediatric APL patients [81]. Furthermore, compared with ATO plus all-trans retinoic acid (ATRA), simultaneous use of oral RIF plus ATRA greatly reduces the clinical expenses [82,83] and hospital stays [84][85][86][87] of APL patients during induction and remission therapy. According to long-termfollow-up results, RIF provides excellent long-term survival advantages [88].…”

Section: Research On Realgar Formulasmentioning

confidence: 99%

Pharmacology, Toxicology, and Rational Application of Cinnabar, Realgar, and Their Formulations

Guan

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Ethnopharmacological Relevance. Mineral medicines are widely used traditional Chinese medicines with curative effects. These medicines are used for many refractory diseases. Aim of the Review. In this review, cinnabar (HgS) and realgar (As₂S₂) serve as examples of mineral medicines, and their pharmacology, therapeutic toxicity, use in traditional medicine mixtures, and research perspectives are discussed. Materials and Methods. A search was performed for the literature on cinnabar and realgar in PubMed, the Chinese Pharmacopeia, Google, and other sources. The search included studies using single herbs, traditional formulations, or novel dosage forms. Results. Cinnabar and cinnabar formulas exhibit good efficacy for sedation, sleep improvement, anxiety alleviation, and brain protection. However, previous studies on neurotransmitters have reached different conclusions, and detailed pharmacological mechanisms are lacking. Realgar and its formulas exert promising antitumor activity through regulation of cell cycle arrest, intrinsic and extrinsic apoptosis, induction of differentiation, autophagy, metabolic reprogramming, matrix metalloproteinase-9 (MMP-9) signaling, and reactive oxygen species (ROS) generation. In addition, realgar can be used to treat a variety of refractory diseases by regulating immunity and exerting antibacterial, antiviral, and other effects. However, the existing pharmacological research on the use of realgar for epidemic prevention is insufficient, and animal experiments and research at the cellular level are lacking. Inappropriate applications of cinnabar and realgar can cause toxicity, including neurotoxicity, liver toxicity, kidney toxicity, and genotoxicity. The toxicological mechanism is complex, and molecular-level research is limited. For clinical applications, theory and clinical experience must be combined to guide scientific and rational drug use and to achieve reduced toxicity and increased efficacy through the use of modern preparation methods or combined drugs. Notably, when cinnabar and realgar are used to treat targeted diseases, these agents have a bidirectional effect of “treatment” and “toxicity” on the central nervous system in pathological and normal states. The pharmacological and toxicological mechanisms need to be elucidated in greater detail in the future. Overall, systematic research is needed to provide a basis for better promotion of the rational use of cinnabar and realgar in the clinic. Conclusion. Mineral medicines are multicomponent, multiactivity, and multitargeted substances. The pharmacology and mechanisms of the toxicity and action of realgar and cinnabar are extremely complex. A number of Chinese medicinal preparations of realgar and cinnabar have demonstrated unique efficacy in the treatment of refractory diseases.

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“…[ 2 ] In fact, the most recent National Comprehensive Cancer Network guidelines recommend the combined use of ATO and ATRA as first-line treatment for APL. [ 3 ] However, some studies have indicated that the extensive use of ATO and ATRA may lead to side effects, including systemic infections, disorders of coagulation and fibrinolysis, hyperleukocytosis, and secondary leukemia. [ 4 ] Therefore, the need for a minimally toxic and highly targeted treatment for APL is urgent, and the search for new therapeutic agents and new therapeutic targets is crucial.…”

Section: Introductionmentioning

confidence: 99%

Integrated bioinformatics analysis and network pharmacology to explore the potential mechanism of Patrinia heterophylla Bunge against acute promyelocytic leukemia

Feng,

Zhu,

et al. 2023

Medicine

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Introduction: Current treatment with arsenic trioxide and all-trans retinoic acid has greatly improved the therapeutic efficacy and prognosis of acute promyelocytic leukemia (APL), but may cause numerous adverse effects. Patrinia heterophylla Bunge (PHEB), commonly known as “Mu-Tou-Hui” in China, is effective in treating leukemia. However, no studies have reported the use of PHEB for APL treatment. In this study, we aimed to investigate the potential anticancer mechanism of PHEB against APL. Methods: Public databases were used to search for bioactive compounds in PHEB, their potential targets, differentially expressed genes associated with APL, and therapeutic targets for APL. The core targets and signaling pathways of PHEB against APL were identified by the protein–protein interaction network, Kaplan–Meier curves, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway enrichment, and compound-target-pathway network analysis. Molecular docking was performed to predict the binding activity between the most active compounds and the key targets. Results: Quercetin and 2 other active components of PHEB may exert anti-APL effects through proteoglycans in cancer, estrogen signaling, and acute myeloid leukemia pathways. We also identified 6 core targets of the bioactive compounds of PHEB, including protein tyrosine phosphatase receptor type C, proto-oncogene tyrosine-protein kinase Src, mitogen-activated protein kinase phosphatase 3 (MAPK3), matrix metalloproteinase-9, vascular endothelial growth factor receptor-2, and myeloperoxidase, most of which were validated to improve the 5-year survival of patients. Molecular docking results showed that the active compound bound well to key targets. Conclusion: The results not only predict the active ingredients and potential molecular mechanisms of PHEB against APL, but also help to guide further investigation into the anti-APL application of PHEB.

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Arsenic as Traditional Chinese Medicine Provides New Hope for Overcoming High Treatment Costs of Acute Promyelocytic Leukemia

Cited by 8 publications

References 8 publications

Oral Realgar-Indigo Naturalis Formula Treatment for Acute Promyelocytic Leukemia in Children: A Randomized, Control Clinical Trial

Oral Realgar-Indigo Naturalis Formula Treatment for Acute Promyelocytic Leukemia in Children: A Randomized, Control Clinical Trial

Pharmacology, Toxicology, and Rational Application of Cinnabar, Realgar, and Their Formulations

Integrated bioinformatics analysis and network pharmacology to explore the potential mechanism of Patrinia heterophylla Bunge against acute promyelocytic leukemia

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