Phytotherapy as part of complementary and alternative therapies in cancer care – protocol for a systematic review

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Abstract

Abstract. Objective: In cancer care, phytopharmaceuticals are used to treat cancer-related symptoms or side effects related to conventional cancer treatment. Herbal extracts are complex mixtures of several substances and therefore the safety and efficacy of an herbal extract is the sum of actions and interactions of all its ingredients. Phytotherapy may have a positive effect on cancer-related symptoms and side effects of conventional treatments. Effectiveness, efficacy, and safety of most herbal treatments remain uncertain. Material and methods: This review will consider studies that include adult patients with all types of cancer and all studies providing data on herbal medicine as intervention if used for medicinal purposes or taken as supplements. Control interventions eligible for the planned review will be all therapy options at the particular treatment stage. All outcomes chosen in the included studies will be discussed concerning their clinical relevance and their relevance to the patient. It will consider both experimental and epidemiological study designs. The search strategy aims to find evidence published in journals and grey literature. The reporting will follow the PRISMA statement. Results: Based on an initial search ~ 16,000 search results are estimated for title/abstract screening. A preliminary search for systematic reviews on the topic revealed that the essential questions of the suggested review, which specific phytotherapy interventions and methods of delivery are most effective in cancer treatment and what are the characteristics of patients who benefit the most, have not been answered by any review yet. Conclusion: Regarding biological-based complementary and alternative medicine (CAM) and especially phytotherapy, benefits as well as risks from side effects and interactions must be considered. With an abundance of phytotherapeuticals existing, systematic reviews for often-used botanicals in cancer care may summarize evidence for physicians and other healthcare providers engaged in counseling individuals with cancer. 

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Selenium, selenoproteins and human health: a review.

KM Brown, JR Arthur (2001)

Selenium is of fundamental importance to human health. It is an essential component of several major metabolic pathways, including thyroid hormone metabolism, antioxidant defence systems, and immune function. The decline in blood selenium concentration in the UK and other European Union countries has therefore several potential public health implications, particularly in relation to the chronic disease prevalence of the Western world such as cancer and cardiovascular disease. Ten years have elapsed since recommended dietary intakes of selenium were introduced on the basis of blood glutathione peroxidase activity. Since then 30 new selenoproteins have been identified, of which 15 have been purified to allow characterisation of their biological function. The long term health implications in relation to declining selenium intakes have not yet been thoroughly examined, yet the implicit importance of selenium to human health is recognised universally. Selenium is incorporated as selenocysteine at the active site of a wide range of selenoproteins. The four glutathione peroxidase enzymes (classical GPx1, gastrointestinal GPx2, plasma GPx3, phospholipid hydroperoxide GPx4)) which represent a major class of functionally important selenoproteins, were the first to be characterised. Thioredoxin reductase (TR) is a recently identified seleno-cysteine containing enzyme which catalyzes the NADPH dependent reduction of thioredoxin and therefore plays a regulatory role in its metabolic activity. Approximately 60% of Se in plasma is incorporated in selenoprotein P which contains 10 Se atoms per molecule as selenocysteine, and may serve as a transport protein for Se. However, selenoprotein-P is also expressed in many tissues which suggests that although it may facilitate whole body Se distribution, this may not be its sole function. A second major class of selenoproteins are the iodothyronine deiodinase enzymes which catalyse the 5'5-mono-deiodination of the prohormone thyroxine (T4) to the active thyroid hormone 3,3'5-triiodothyronine (T3). Sperm capsule selenoprotein is localised in the mid-peice portion of spermatozoa where it stabilises the integrity of the sperm flagella. Se intake effects tissue concentrations of selenoprotein W which is reported to be necessary for muscle metabolism. It is of great concern that the health implications of the decline in Se status in the UK over the past two decades have not been systematically investigated. It is well recognised that dietary selenium is important for a healthy immune response. There is also evidence that Se has a protective effect against some forms of cancer; that it may enhance male fertility; decrease cardiovascular disease mortality, and regulate the inflammatory mediators in asthma. The potential influence of Se on these chronic diseases within the European population are important considerations when assessing Se requirement.

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Zinc, copper, and blood pressure: Human population studies

William E. Carpenter, Derek Lam, Glenn M. Toney … (2013)

Summary Copper and zinc are essential trace biometals that regulate cardiovascular homeostasis, and dysregulation of these metals has been linked to vascular diseases, including hypertension. In this article, we review recent human population studies concerning this topic, focusing on: 1) the relationship between blood pressure and levels of zinc and copper; 2) correlations between trace metals, the renin-angiotensin system, obesity, and hypertension; 3) the relationship between environmental metal pollution and the development of hypertension; and 4) methods commonly employed to assay zinc and copper in human specimens. Moreover, based on the findings of these studies, we suggest the following topics as the basis for future investigations: 1) the potential role of environmental metal pollution as a causal factor for hypertension; 2) metal profiles within specific pathogenic subsets of patients with hypertension; 3) standardizing the experimental design so that the results between different studies are more comparable; and 4) the requirement for animal experiments as complementary approaches to address mechanistic insight that cannot be studied in human populations.

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The value of the chloride: sodium ratio in differentiating the aetiology of metabolic acidosis.

D. Taylor, A Durward, I Murdoch … (2001)

Stewart's physicochemical approach to acid-base balance defines the aetiology of a metabolic acidosis by quantifying anions of tissue acids (TA), which consist of unmeasured anions (UMA) and/or lactate. We hypothesised that an increase in TA during metabolic acidosis would lead to a compensatory fall in the plasma chloride (Cl) relative to sodium (Cl:Na ratio) in order to preserve electro-neutrality. Thus, the Cl:Na ratio could be used as a simple alternative to the anion gap in identifying raised TA. Two hundred and eighty two consecutive patients who were admitted to our Paediatric Intensive Care were enrolled in the study. We obtained 540 samples (admission n = 282, 24 h n = 258) for analysis of blood chemistry, lactate and quantification of TA and UMA. Samples were subgrouped into those with metabolic acidosis (standard bicarbonate 3 mEq/l). Metabolic acidosis occurred in 46% of samples, of which 52.3% (120/230) had increased UMA. The dominant component of TA was UMA rather than lactate, and these two components did not always rise in tandem. Our hypothesis of relative hypochloraemia was supported by a lower Cl:Na ratio (P 0.79) excluded TA (PPV 81%, LR 4.5). Base deficit (BD) and lactate performed poorly. In metabolic acidosis due to TA, plasma Cl concentration decreases relative to sodium. The Cl:Na ratio is a simple alternative to the AG for detecting TA in this setting.