Deutsche Zeitschrift für Onkologie 2017; 49(04): 174-180
DOI: 10.1055/s-0043-117027
Forschung
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Artemisinin und seine Derivate – eine neue Option für die Krebstherapie?

Artemisinin and its derivatives – a promising option in cancer therapy?
Janine Naß
1   Institut für Pharmazie und Biochemie, Universität Mainz
,
Thomas Efferth
1   Institut für Pharmazie und Biochemie, Universität Mainz
› Author Affiliations
Further Information

Publication History

Publication Date:
11 December 2017 (online)

Zusammenfassung

Artemisinin und seine Derivate sind nicht nur hochwirksame Medikamente gegen Malaria. Zahlreiche präklinische und vorläufige klinische Daten deuten darauf hin, dass sie auch therapeutisches Potenzial für die Onkologie besitzen könnten. Artemisinin-basierte Medikamente induzieren oxidativen Stress und DNA-Schäden und hemmen die Angiogenese. Tumorzellen sterben durch diese Substanzen, indem sie verschiedene Formen des Zelltodes hervorrufen (Apoptose, Autophagie, Ferroptose). Zytostatika-resistente Tumorzellen werden durch Artemisinin und seine Derivate effektiv abgetötet. Artemisinin-Derivate zeigen mit verschiedenen Standard-Krebsmedikamenten, Radiotherapie und therapeutischen Antikörpern additive bis synergistische Therapieeffekte gegenüber Tumorzelllinien. Ergebnisse aus klinischen Studien zeigten positive Ergebnisse, jedoch sollte bedacht werden, dass die behandelten Gruppen bisher nur klein waren. Individuelle Heilversuche sollten nur von approbierten Ärzten vorgenommen werden. Bis zur routinemäßigen klinischen Anwendung von Artemisinin und seinen Derivaten in der Krebstherapie wird sicherlich noch einige Zeit vergehen. Die bisherigen Ergebnisse sind jedoch vielversprechend.

Abstract

Artemisinin and its derivatives are not only highly effective drugs against malaria. Numerous preclinical and preliminary clinical data suggest that they also may have therapeutic potential for oncology. Artemisinin-based drugs induce oxidative stress and DNA damage and inhibit angiogenesis. Tumor cells die through these substances by inducing various forms of cell death (apoptosis, autophagy, ferroptosis). Drug-resistant tumor cells are effectively killed by artemisinin and its derivatives. Artemisinin derivatives show additive to synergistic therapy effects against tumor cell lines with various standard cancer drugs, radiotherapy and therapeutic antibodies. Results from clinical trials showed positive results, but it should be borne in mind that the treated groups were only small. Individual healing attempts should only be undertaken by approved physicians. There will certainly be some time left, before the routine use of artemisinin and its derivatives will be established in cancer therapy. However, the results to date are promising.

 
  • Literatur

  • 1 Anfosso L, Efferth T, Albini A. et al. Microarray expression profiles of angiogenesis-related genes predict tumor cell response to artemisinins. Pharmacogenomics J 2006; 6: 269-278
  • 2 Berger TG, Dieckmann D, Efferth T. et al. Artesunate in the treatment of metastatic uveal melanoma--first experiences. Oncol Rep 2005; 14: 1599-1603
  • 3 Button RW, Lin F, Ercolano E. et al. Artesunate induces necrotic cell death in schwannoma cells. Cell Death Dis 2014; 5: 1466
  • 4 Cragg GM, Grothaus PG, Newman DJ. Impact of natural products on developing new anti-cancer agents. Chem Rev 2009; 109: 3012-3043
  • 5 Dell'Eva R, Pfeffer U, Vené R. et al. Inhibition of angiogenesis in vivo and growth of Kaposi's sarcoma xenograft tumors by the anti-malarial artesunate. Biochem Pharmacol 2004; 68: 2359-2366
  • 6 Efferth T, Rücker G, Falkenberg M. et al. Detection of apoptosis in KG-1a leukemic cells treated with investigational drugs. Arzneimittelforschung 1996; 46: 196-200
  • 7 Efferth T, Dunstan H, Sauerbrey A. et al. The anti-malarial artesunate is also active against cancer. Int J Oncol 2001; 18: 767-773
  • 8 Efferth T, Sauerbrey A, Olbrich A. et al. Molecular modes of action of artesunate in tumor cell lines. Mol Pharmacol 2003; 64: 382-394
  • 9 Efferth T, Benakis A, Romero MR. et al. Enhancement of cytotoxicity of artemisinins toward cancer cells by ferrous iron. Free Radic Biol Med 2004; 37: 998-1009
  • 10 Efferth T, Giaisi M, Merling A. et al. Artesunate induces ROS-mediated apoptosis in doxorubicin-resistant T leukemia cells. PLoS One 2007; 2: e693
  • 11 Efferth T, Romero MR, Wolf DG. et al. The antiviral activities of artemisinin and artesunate. Clin Infect Dis 2008; 47: 804-811
  • 12 Efferth T, Koch E. Complex interactions between phytochemicals. The multi-target therapeutic concept of phytotherapy. Curr Drug Targets 2011; 12: 122-132
  • 13 Efferth T. From ancient herb to modern drug: Artemisia annua and artemisinin for cancer therapy. Semin Cancer Biol 2017; 46: 65-83
  • 14 Efferth T. Cancer combination therapies with artemisinin-type drugs. Biochem Pharmacol 2017; 139: 56-70
  • 15 Efferth T, Schöttler U, Krishna S. et al. Hepatotoxicity by combination treatment of temozolomide, artesunate and Chinese herbs in a glioblastoma multiforme patient: case report review of the literature. Arch Toxicol 2017; 91: 1833-1846
  • 16 Jansen FH, Adoubi I. et al. First study of oral Artenimol-R in advanced cervical cancer: clinical benefit, tolerability and tumor markers. Anticancer Res 2011; 31: 4417-4422
  • 17 Jiang W, Cen Y, Song Y. et al. Artesunate attenuated progression of atherosclerosis lesion formation alone or combined with rosuvastatin through inhibition of pro-inflammatory cytokines and pro-inflammatory chemokines. Phytomedicine 2016; 23: 1259-1266
  • 18 Kelter G, Steinbach D, Konkimalla VB. et al Role of transferrin receptor and the ABC transporters ABCB6 and ABCB7 for resistance and differentiation of tumor cells towards artesunate. PLoS One 2007; 2: e798
  • 19 Krishna S, Ganapathi S, Ster IC. et al. A randomised, double blind, placebo-controlled pilot study of oral artesunate therapy for colorectal cancer. EBioMedicine 2015; 2: 82-90
  • 20 Li J, Casteels T, Frogne T. et al. Artemisinins target GABAA receptor signaling and impair alpha cell identity. Cell 2017; 168: 86-100. e15
  • 21 Michaelsen FW, Saeed ME, Schwarzkopf J. et al. Activity of Artemisia annua and artemisinin derivatives, in prostate carcinoma. Phytomedicine 2015; 22: 1223-1231
  • 22 Newman DJ, Cragg GM. Natural products as sources of new drugs from 1981 to 2014. J Nat Prod 2016; 79: 629-661
  • 23 Ooko E, Saeed ME, Kadioglu O. et al. Artemisinin derivatives induce iron-dependent cell death (ferroptosis) in tumor cells. Phytomedicine 2015; 22: 1045-1054
  • 24 Rutteman GR, Erich SA, Mol JA. et al. Safety and efficacy field study of artesunate for dogs with non-resectable tumours. Anticancer Res 2013; 33: 1819-1827
  • 25 Saeed ME, Krishna S, Greten HJ. et al. Antischistosomal activity of artemisinin derivatives in vivo and in patients. Pharmacol Res 2016; 110: 216-226
  • 26 Soomro S, Langenberg T, Mahringer A. et al. Design of novel artemisinin-like derivatives with cytotoxic and anti-angiogenic properties. J Cell Mol Med 2011; 15: 1122-1135
  • 27 Uhl M, Schwab S, Efferth T. Fatal liver and bone marrow toxicity by combination treatment of dichloroacetate and artesunate in a glioblastoma multiforme patient: Case report and review of the literature. Front Oncol 2016; 6: 204
  • 28 von Hagens C, Walter-Sack I, Goeckenjan M. et al. Prospective open uncontrolled phase I study to define a well-tolerated dose of oral artesunate as add-on therapy in patients with metastatic breast cancer (ARTIC M33/2). Breast Cancer Res Treat 2017; 164: 359-369
  • 29 Wang Z, Hu W, Zhang JL. et al. Dihydroartemisinin induces autophagy and inhibits the growth of iron-loaded human myeloid leukemia K562 cells via ROS toxicity. FEBS Open Bio 2012; 2: 103-112
  • 30 WHO. World Health Organization: WHO traditional medicine strategy 2014–2033. 2013; http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/ [cited 2017 June 15th]
  • 31 Youns M, Efferth T, Reichling J. et al. Gene expression profiling identifies novel key players involved in the cytotoxic effect of artesunate on pancreatic cancer cells. Biochem Pharmacol 2009; 78: 273-283
  • 32 Zhang ZY, Yu SQ, Miao LY. et al. Artesunate combined with vinorelbine plus cisplatin in treatment of advanced non-small cell lung cancer: a randomized controlled trial. Zhong Xi Yi Jie He Xue Bao 2008; 6: 134-138