Artemisinin in Cancer Treatment

Dr. Narendra P. Singh

Department of Bioengineering
University of Washington
Seattle
What is Artemisinin?
Artemisinin is a sesquiterpene lactone
isolated from the plant Artemesia
annua L. (has been used for the
treatment of malaria).
Dr. Zhenxing Wei was first to isolate
artemisinin in 1970.
The artemisinin molecule contains an
endoperoxide bridge that reacts with a
ferrous iron to form free radicals
There are several analogs of
artemisinin including artesunate and
artemether.
 How does Artemisinin work?
Artemisinin causes the cancer cell to
commit suicide.
The artemisinin molecule contains an
endoperoxide bridge that reacts with a
ferrous iron atom to form free radicals
Generation of free radicals leads to
macromolecular damages and cell death.
Cancer cells have a very high iron uptake
and thus they are more susceptible.
 Research on Artemisinin:
MOLT-4 (Leukemia Cell Line) Studies
First study on artemisinin (1995) was done
in cell culture (MOLT-4 lymphoblastoid
leukemia cell line).
Results show all MOLT-4 cells were killed
in 8 hours by 200 micromolar of
dihydroartemisinin.
The drug is 100 times less toxic to human
lymphocytes in culture.
Research on Artemisinin: Leukemia Cell Line
APOPTOSIS IN MOLT-4 LEUKEMIA CELLS
(dihydro) Artemisinin (8 hours only)
Control 0%
200 M 100 %
Hyperthermia (24 hr incubation)
Control 3.26 %
44C for 1 hr 5.01 %
Hydrogen Peroxide (24 hr incubation)
Control 3.52 %
176 M 40.09 %
Mitoxantrone (24 hr incubation)
Control 3.51 %
0.5 M 55.02 %
Novobiocin (24 hr incubation)
Control 3.75 %
800 M 22.68 %
Sodium Ascorbate (24 hr incubation)
Control 3.47 %
2000 M 62.59 %
X-ray (24 hr incubation)
Control 3.2 %
100 rads 9.5 %
Research on Artemisinin: Trials in Dogs
Dog trials were begun soon after encouraging
results in MOLT-4 experiments (1994-1995).
Dogs of different breeds (male and female)
having various types of cancers
(lymphosarcoma, breast adenocarcinoma,
osteosarcoma, ETC) were treated.
Results: Specific results varied with dogs, but
generally positive. Tumor sizes were
drastically reduced. No reoccurrence of cancer
in 5 dogs operated and given artemisinin.
 Research on Artemisinin:
Human Breast Cancer Cells
in vitro
Most recent research was published (2001)
on a breast cancer cell line (HB 27) in vitro.
Breast cancer cells treated with
dihydroartemisinin and holotransferrin were
almost completely eliminated (after 16 hrs
of treatment cell count was only 2% of that
at time zero).
 Research on Artemisinin:
Human Breast Cancer Cells
in vitro
A morphological examination of breast
cancer cells treated with dihydroartemisinin
and holotransferrin showed that they were
undergoing apoptosis and necrosis.
Drug had no effect on normal breast cells.
 FIGURE 1

Breast cancer cells (HTB 27)

150

Percent of cell count from time zero

100

50

Research on Artemisinin: 0
0 4 8 12 16
Time (hr)

Breast Cancer Cells in vitro

undergo rapid and almost Normal breast cells (HTB125)

Percent of cell count from time zero

150

complete cell death (98%) 100

after treatment with dihydro-

artemisinin and 50

holotransferrin. 0
0 4 8 12 16
Time (hr)

Control
holotransferrin
dihydroartemisinin
dihydroartemisinin + holotransferrin
 FIGURE 2

Research on Artemisinin: BREAST CANCER CELLS (HTB 27)

24 hrs after
replating
Breast cancer cells were 200

Perecnt of cell count from time zero

8 hrs and
replating
time zero
completely non-viable after 8 150

hours of treatment with

holotransferrin
100
dihydroartemisinin +
holotransferrin

holotransferrin and 50

dihydroartemisinin, as proved 0

by replating.
NORMAL BREAST CELLS (HTB 125)

Normal breast cell counts

24 hrs after
Percent of cell count from time zero
150

8 hrs and
replating

replating
time zero
slightly decreased with the 100

same treatment, suggesting holotransferrin

dihydroartemisinin +
holotransferrin

some damage to cells. 50

0
Case report:
Archive of Oncology, Volume 10 (In press)

Artesunate Treatment for Larynx

Cancer in man
1Narendra P. Singh, 2Krishna B. Verma, 1Henry Lai

Artesunate injections and tablets were administered

to the patient over a period of nine months. The
tumor was significantly reduced (by approximately
70%) after two months of treatment. Treatment
reduced the sufferings and prolonged the life of the
patient
Principles of Artemisinin Therapy:
How to kill cancer cells
Starvation by depletion of nutrients
Exercise by generating H2O2
Drugs including vitamin C, vitamin D
and artemisinin and analogs
Alkaline pH in body
 Benefits of Exercise
For killing of Cancer Cells:
Generates Hydrogen Peroxide.
Results in high concentrations of oxygen in the body.
With the help of vitamin D, puts calcium in bones.
Increases circulation allowing immune cells to reach
cancer
General Benefits:
Feeling of well-being (increased appetite)
Increased excretory processes
Raises Pain Threshold
 Common Characteristics Observed among
Cancer Patients (all of the following decrease calcium):

Lack of sunshine in environment or aversion to

going out in sun.
Avoidance of physical activity or generally more
sedentary lifestyle.
Abnormal sleep habits (excessive sleeping,
napping during the day etc.)
Very limited consumption of/dislike of milk
Eating late dinners and immediately retiring for
the night
 Conclusion

Artemisinin can be used to treat

various types of cancer.
Side effects are minimal and it
can be taken orally.
 Frequently Asked Questions
Q. How often and when should the drug be
administered?
A. Ideally, just once at bedtime as the
immune system is at the lowest during the
night and bacterial and cancer cells
proliferate faster.
Q. Is exercise essential?
A. Yes. Importance-wise ranking: exercise,
diet and drug.
 Frequently Asked Questions
Q. What is the half life of artemisinin
A. Study in rats,
artemisinin 3-4 hr
artemether 12 hr
artesunate 40 min (human)
Blood levels are higher in females
 Frequently Asked Questions
Q. Does artemisinin cross blood brain
barrier?
A. Yes
Q. What is peak plasma level time
A Artemisinin and analogs are rapidly
absorbed and peak in plasma within 1-2 hr
 Frequently Asked Questions
Q. Can Artemisinin be taken soon after
or during radiation?
A. No. Irradiated normal cells increase
their transferrin receptors, allowing more
uptake of iron and thus become sensitive
to artemisinin. Artemisinin therapy can
be started a minimum of two weeks after
radiation (preferably more).
 Frequently Asked Questions
Q. Can artemisinin be given to smokers for the
treatment of cancer?
A. No, patients should have ceased smoking for at
least two months before starting artemisinin.
Research indicates that cells exposed to
Benzo(a)Pyrene (primary carcinogen in cigarette
smoke) have greater free iron content which makes
even normal cells sensitive to killing by artemisinin.
 Frequently Asked Questions
Q. Do we need Holotransferrin?
A. No we do not need Holotransferrin.
Enough iron can be found in our daily diet.
Q. What form of iron works with artemisinin?
A. Artemisinin reacts with ferrous iron (Fe2+).
Transferrin carries ferric iron (Fe3+) to the cell
surface, the ferric iron is then converted to the
ferrous form (Vitamin C can do this) and reacts
with artemisinin.
 Frequently Asked Questions
Q. Should an iron supplement be taken along
with artemisinin?
A. No. This is not necessary. Iron is abundant
in our diet in two forms: heme iron (found in
animal products) and non-heme iron (found in
plant products). Vitamin C helps in the
absorption of non-heme iron, which is generally
harder to absorb.
 Frequently Asked Questions

Q. Is a combination of Artemisinin
derivatives better?
A. A mixture of artemisinin,
artesunate and artemether and is
slightly better than individual
components.
 Frequently Asked Questions

Q. How does Vitamin C affect the results?

A. If taken after breakfast and after lunch,
it enhances the iron absorption from the
stomach. Iron is taken up more by cancer
cells and thus Vitamin C makes cancer cells
more susceptible for killing by artemisinin.
Frequently Asked Questions:
Vitamin C
Vitamin C also kills
cancer cells in low doses
without damaging normal
cells.
In Molt-4 cultures, a cell
loss of approximately
4050% was observed
after 8 hours of treatment
with Vitamin C (50 M).
 Frequently Asked Questions
Q. How do other vitamins and antioxidants
affect the results?
A. Different studies show different results with
vitamin E. Our own work shows glutathione
enhances cancer cell growth and reduces the
efficacy of artemisinin.
 Frequently Asked Questions
Q. What are toxic effects?
A. In general, artemisinin and its analogs are relatively
safe drugs with no obvious adverse reactions or
noticeable side effects. Some patients complain of skin
irritation and scratching in 1 to 2mg/kg/day doses.
Anemia and weakness is reported by several patients
on artemether but not by those on artesunate and
artemisinin. Artemisinin does not have affinity to
normal RBC unlike artemether
 Frequently Asked Questions
Q. How long the treatment should last?
A. We have a very short experience, one
pancreatic cancer patient is taking
artesunate injections for last 22 months and
a brain cancer patient taking artemisinin
capsules for last 11 months. Artemisinin in
low doses for a long duration may be safer
anticancer treatment.
 Frequently Asked Questions
Q. Are there some on going clinical trial.
A. No official clinical trial, but Dr. Joy
Craddick MD ([email protected]) and
Dr. Dwight McKee MD
([email protected]) are conducting a
clinical trial started 3 months ago on 30
cancer patients in Portland area. FDA
approved a canine trial in DC area.