Plantas Anticancer
Plantas Anticancer
Plantas Anticancer
Review
Anticancer Plants: A Review of the Active
Phytochemicals, Applications in Animal Models,
and Regulatory Aspects
Tariq Khan 1,*, Muhammad Ali 2,*, Ajmal Khan 3, Parveen Nisar 2, Sohail Ahmad Jan 4,
Shakeeb Afridi 2 and Zabta Khan Shinwari 2,5
1 Department of Biotechnology, University of Malakand, Chakdara 18800, Pakistan
2 Department of Biotechnology, Quaid‐i‐Azam University, Islamabad 45320, Pakistan;
[email protected] (P.N.); [email protected] (S.A.); [email protected] (Z.K.S.)
3 Department of Zoology, University of Buner, Sowari 17290, Pakistan; [email protected]
4 Department of Biotechnology, Hazara University, Mansehra 21120, Pakistan; [email protected]
5 National Council for Tibb, Islamabad, Pakistan
* Correspondence: [email protected] (T.K.); [email protected] (M.A.);
Tel.: +92‐51‐90644133 (M.A.)
Received: 15 November 2019; Accepted: 25 December 2019; Published: 27 December 2019
Abstract: The rising burden of cancer worldwide calls for an alternative treatment solution. Herbal
medicine provides a very feasible alternative to western medicine against cancer. This article
reviews the selected plant species with active phytochemicals, the animal models used for these
studies, and their regulatory aspects. This study is based on a meticulous literature review
conducted through the search of relevant keywords in databases, Web of Science, Scopus,
PubMed, and Google Scholar. Twenty plants were selected based on defined selection criteria for
their potent anticancer compounds. The detailed analysis of the research studies revealed that
plants play an indispensable role in fighting different cancers such as breast, stomach, oral, colon,
lung, hepatic, cervical, and blood cancer cell lines. The in vitro studies showed cancer cell
inhibition through DNA damage and activation of apoptosis‐inducing enzymes by the secondary
metabolites in the plant extracts. Studies that reported in vivo activities of these plants showed
remarkable results in the inhibition of cancer in animal models. Further studies should be
performed on exploring more plants, their active compounds, and the mechanism of anticancer
actions for use as standard herbal medicine.
Keywords: cancer; apoptosis; herbs; cell lines; in vivo
1. Introduction
The burden of cancer rose to 18.1 million new cases and 9.6 million deaths in 2018. With 36
different types, cancer mainly affects men in the form of colorectal, liver, lung, prostate, and
stomach cancer and women in the form of breast, cervix, colorectal, lung, and thyroid cancer [1].
Treating cancer has become a whole new area of research. There are conventional as well as very
modern techniques applied against cancers. A variety of techniques i.e., chemotherapy, radiation
therapy, or surgery are used for treating cancer. However, all of them have some disadvantages [2].
The use of conventional chemicals bears side effects and toxicities [3]. But as the problem persists,
new approaches are needed for the control of diseases, especially, because of the failure of
conventional chemotherapeutic approaches. Therefore, there is a need for new strategies for the
prevention and cure of cancer to control the death rate because of this disease.
Biomolecules 2020, 10, 47; doi:10.3390/biom10010047 www.mdpi.com/journal/biomolecules
Biomolecules 2020, 10, 47 2 of 31
Herbal medicine has become a very safe, non‐toxic, and easily available source of cancer‐
treating compounds. Herbs are believed to neutralize the effects of diseases in a body because of
various characteristics they possess [4]. For instance, among the many anticancer medicinal plants,
Phaleria macrocarpa (local name: Mahkota dewa) and Fagonia indica (local name: Dhamasa) have been
used traditionally for the anticancer properties of their active ingredients [5,6]. Metabolites
extracted from the plant material are used to induce apoptosis in cancer cells. Gallic acid as the
active component was purified from the fruit extract of P. macrocarpa and has demonstrated a role
in the induction of apoptosis in lung cancer, leukemia, and colon adenocarcinoma cell lines [7,8]. It
is a polyhydroxy phenolic compound and a natural antioxidant that can be obtained from a variety
of natural products i.e., grapes, strawberries, bananas, green tea, and vegetables [9]. It also plays a
critical role in preventing malignancy transformation and the development of cancer [10]. Similarly,
other compounds such as vinca alkaloids, podophyllotoxin, and camptothecin obtained from
various plants are used for the treatment of cancer.
With the advancement in the industrial sector and industrial medicine, the use of herbs was
forgotten for a long period of time [11]. Hurdles regarding natural compounds are reduced because
of the advent of new techniques and interest has been developed in the use of such natural
ingredients in the pharmaceutical industry [12,13]. It has been estimated by the world health
organization that 80% of the world is using traditional treatment methods [14]. Understanding of
the effects or actions of herbs on various targets comes with the help of modern biomolecular
science which recognizes some important properties i.e., anticancer, anti‐inflammatory, and anti‐
virus. With the increasing understanding of the effects of such herbal medicine, their effects against
different types of cancers have also been identified. For instance, hepatocellular carcinomas (HCC)
are considered as the fifth most common malignancy in the world with increasing incidence [15,16].
Many studies have been performed on the treatment and prevention of using herbal medicine
against HCC in which it is shown that all phases of HCC such as initiation, promotion, and
progression could be affected by components of herbs [17,18].
However, as far as herbal compounds are considered as drugs, it is erroneously believed that
they have no issues in terms of safety and side effects. There are hundreds of species of plants that
are toxic to health. In the same way, there are many compounds in otherwise friendly plants that
cause cytotoxicity. Based upon testing it has been proved that even anticancer plants result in
cytotoxic effects [19].
Herbs are regulated under the “dietary supplement health and education act” as a dietary
supplement in the United States of America. This review highlights the mechanism of some very
important anticancer plants, the research related to their mechanism of action, their active
ingredients, and the guidelines in place for their regulations.
2. Sources and Methodology
The most relevant literature was retrieved through a meticulous search on the electronic
databases, Web of Science, Scopus, PubMed, and Google Scholar. The keywords and phrases used
during the search were “Medicinal plants,” “Anticancer activity,” “Anticancer herbs,” “Anticancer
plants,” “Mechanism of action,” “Animal models,” “in vitro activity,” and “in vivo activity.” The
number of relevant articles finalized after extraction and analysis through the combination of the
above keywords/phrases and the inclusion criteria was 200. The inclusion was based on two sets of
criteria. According to the first set, i.e., “general criteria,” articles selected for this manuscript had (i)
reported the traditional anticancer activity of plants and their parts, (ii) reported the anticancer role
of extract or pure compounds from plants.
The second set of criteria was used for selecting specific anticancer plants whose
phytochemicals are discussed in detail. For this purpose, twenty plants were selected for which
recent articles were available that (a) studied in vitro and in vivo anticancer activities of herbal
products, (b) reported the anticancer/antitumor activity of active compounds from the plants, and
(c) assessed the in vivo anticancer activity of the herbal anticancer products.
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All the data were extracted in a table and the mechanisms of action were explained in
respective subheadings and demonstrated through different figures.
3. Selected Plants and Their Anticancer Activity
Research so far has tested the anticancer activity of a plethora of plants and plant‐based
compounds. Some of these plants and their compounds prove to be very effective against one or
more types of cancers. Based on their activities, the following plants are selected for the in vitro and
in vivo anticancer activities of their compounds. The rest of the important plants shortlisted for
their activities are presented in Table 1 along with their activities.
3.1. Artemisia annua
The genus Artemisia, widespread in Europe, Asia, North America, and South Africa has
approximately 400 species worldwide [20]. Plants of the genus were used for centuries in classical
medicine [21]. Artemisia annua is an annual short‐day plant that belongs to family Asteraceae,
having a brownish rigid stem. A. annua is known as sweet wormwood (Chinese: qīnghāo) and
“dona” in the Urdu language in India and Pakistan [8]. A. annua was used by old Chinese for the
preparation of anti‐malarial drugs known as artemisinin (Figure 1). Having a unique ability of
environmental adaptation it consistently resists insects and pathogens [22].
A. annua also synthesize scopoletin and 1,8‐cineole compounds. Similarly, semi‐synthetic
derivatives of artemisinin are also generated such as arteether, artemether, and artesunate.
Artesunate has been studied to be a very effective anticancer compound. Efferth [23] studied the
effect of artesunate on 55 different cancer cell lines including leukemia, melanoma, lung cancer,
colon cancer, renal cancer, ovarian cancer, and tumors of the central nervous system. They
suggested that artesunate was most effective against leukemia and colon cancers. Furthermore, it
was observed through these studies that the artesunate was more active than the drugs used for
such cancers.
The stem and leaves A. annua were subject to extraction with the help of 80% ethanol and
water. Several quantitative phenolic compounds from A. annua were identified using high‐
performance liquid chromatography (HPLC). The extracts were tested against HeLa and AGS cell
lines. The cell growth inhibition activity of stem extracts was lower compared to leaf extracts. The
ethanolic extracts of leaves lead to growth inhibitions (57.24% and 67.07%) in HeLa and AGS cells,
respectively at a concentration of 500 mg/mL. HPLC analysis showed that the amount of phenolic
acids was lower in stem extract than in leaves extract of A. annua. It was concluded from the data
that the antioxidant and anticancer capacity was the result of phenolic compounds as well as
unidentified compounds within A. annua [24].
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Figure 1. Structural representation of important anticancer secondary metabolites from plants. The
structures are adapted from NCBI cited as National Center for Biotechnology Information.
PubChem Database. (a) 2‐Methylanthraquinone, Compound identification number (CID) = 6773; (b)
albanol A, CID = 44567218; (c) artemisinin, CID = 68827; (d) baicalein, CID = 5281605; (e) berberine,
CID = 2353; (f) curcumin, CID = 969516; (g) D‐amygdalin, CID = 656516; (h) garcinol, CID = 5281560;
(i) oblongifolin A CID = 53364454; (j) oridonin, CID = 5321010; (k) platycodin D, CID = 162859; (l)
polyphyllin C, CID = 44429637; (m) scutellarein, CID = 5281697, and (n) triptolide, CID = 107985. (o)
isoegomaketone, CID = 5318556; https://pubchem.ncbi.nlm.nih.gov/compound/ (accessed on 18 July
2019).
3.2. Coptis chinensis
Coptis chinensis, the Chinese goldthread, is a herb used as a traditional medicine in China thus
officially enlisted in the Chinese pharmacopeia [25]. It is widely known for its traditional use
against various diseases like diarrhea, dysentery, acute febrile, and supportive infections. The
organic extract of C. chinensis possesses anti‐inflammatory and anti‐oxidant properties [26,27]. C.
chinensis extract has wide use in the treatment of cholera, dysentery, diabetes, blood and lung
cancer because of its strong antibacterial activity [28]. Coptis genus contains the most important and
active components, such as an alkaloid i.e., berberine (Figure 1). Berberines alkaloids are used
frequently as criteria in the quality control of Rhizoma coptidis (Huang Lian) products and lead to the
apoptosis of human leukemia HL‐60 cells by down regulating nucleophosmin/B23 and telomerase
activity.
3.3. Curcuma longa
Curcuma longa (Turmeric) belongs to the ginger family Zingiberaceae. It is a rhizomatous
herbaceous perennial plant [29]. It is naturally found in Southeast Asia and the Indian subcontinent.
These plants are annually collected for their rhizomes and are then propagated from some of those
rhizomes [30]. C. longa possesses a broad range of pharmacological activities including anti‐ HIC
(human immunodeficiency virus), anti‐inflammatory, antioxidant effects, nematocidal and anti‐
bacterial activities.
Curcumin, the main component of C. longa, plays an important role in the therapeutic activities
of C. longa [31]. Curcumin shows anticancer and anti‐inflammatory activities as reported by many
different studies. Cyclooxygenase (COX)‐2 plays a vital role in the formation of colon cancer. In a
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study conducted by Goel et al. [32], the HT‐29 colon cancer cells of humans were treated with
different concentrations of curcumin to study the effect of curcumin on the expression of COX‐2.
The cell growth of HT‐29 cells was inhibited by curcumin in a concentration‐ and time‐dependent
manner. Curcumin affected COX‐2 by inhibiting its mRNA and protein expression, but no such
inhibitory effect was found against COX‐1. From this data, it can be suggested that the in vitro
growth of HT‐29 cells is significantly affected by a non‐toxic concentration of curcumin. Curcumin
may thus play an important role in the prevention of colon cancer. Furthermore, the anticancer
effects of curcumin on human breast cancer cell lines (MCF‐7) were assessed through lactate
dehydrogenase and 3‐(4,5‐dimethyl‐2‐thiazolyl)‐2, 5‐diphenyl‐2H‐tetrazolium bromide assays to
assess cytotoxicity and cell viability, respectively. The results showed that curcumin induced
cytotoxicity and inhibited cells in a time‐ and concentration‐dependent manner. This was observed
through increased caspase 3/9 activity and induction of apoptosis. The results also indicated that
curcumin downregulated miR‐21 the expression of miR‐21 in MCF‐7 cells by upregulating the
PTEN/Akt signaling pathway [33].
3.4. Fagonia indica
Fagonia indica, locally known as “dhamasa” is a flowering plant and belongs to the family of
caltrop, Zygophyllaceae [34]. Members of Fagonia genus are known for their use as traditional
medicine and are found effective in the treatment of many skin problems [35]. Traditionally, it was
also used as a medicine for curing cancer as well as ailments resulting from poisons [5]. Amino
acids and proteins [36], flavonoids [37], alkaloids [38], saponins [39], and terpenoid [40] are the
phytochemicals found in the Fagonia species. F. indica is found to have liver protective [41] and
antioxidant properties as well [42].
The aqueous extracts of F. indica have been found very effective against different types of
cancer specifically breast cancers. For instance, Waheed et al. [43] performed bioactivity‐guided
fractionation to isolate the active and potent fraction of the F. indica extract. The activity was
assessed against three cancer cell lines: MCF‐7 estrogen‐dependent breast cancer, MDA‐MB‐468
estrogen‐independent breast cancer, and Caco‐2 colon cancer cells (Figure 2). The results through
different pieces of evidence such as the activity of pan‐caspase inhibitor Z‐VAD‐fmk, caspase‐3
cleavage, and DNA ladder assays suggested that apoptosis was stimulated in MDA‐MB‐468 and
Caco‐2 cells. Furthermore, a new steroidal saponin glycoside caused necrosis through cell lysis in
MCF‐7 cells. Similarly, Lam et al. [44] also demonstrated significant activity against breast cancer
cells line MCF‐7 through an aqueous extract of F. indica.
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Figure 2. Illustration of activity of plants against several types of cancers. The icons were taken from
Biorender illustrator and constructed through ChemBiodraw v14.0.
3.5. Garcinia oblongifolia
Garcinia oblongifolia (Lingnan Garcinia) belongs to the family of Clusiaceae and has a wide
range of pharmaceutical activities. The important metabolites of the G. oblongifolia species;
polyisoprenylated benzophenones and xanthones have anticancer, antioxidant, antifungal,
apoptotic, and anti‐pathogenic properties [45,46]. In vitro study showed that the bark of G.
oblongifolia contains important secondary metabolites including oblongifolin A–G,
oblongixanthones A–C along with other important compounds. These metabolites showed
maximum apoptotic activities in HeLa‐C3 cell lines and cytotoxic properties in the cervical cancer
cells [47,48]. Li et al. [49] isolated about 40 different compounds from fruit, leaves, branches, and
other parts of G. oblongifolia. They noted very high cytotoxic activities of these metabolites in the
tested MCF‐7 breast cancer cell line. However, they found the higher anti‐cytotoxic activity of
branch as compared to other plant parts. A small vacuole body formation was found at a low bark
concentration of 0.250 g/mL. The vacuole size was increased at high concentrations of 500 g/mL and
1000 g/mL. The leaf part showed mild vacuole formation at a high concentration of 500 g/mL.
Similarly, Feng, Huang, Gao, Xu and Luo [48] tested the pro‐apoptotic activities of twenty different
isolated compounds from G. oblongifolia in cervical cancer HeLa cells. Among all tested compounds
the oblongifolins F and G, xanthone, nigrolineaxanthone T, and garcicowin B gave high pro‐
apoptotic properties at 10 μM concentration.
3.6. Garcinia indica
Garcinia indica, commonly known as kokum, is also an important medicinal plant that belongs
to the Garcinia genus. The garcinol of G. indica shows positive activities in the experimental HT‐29
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and HCT‐116 colon cancer cells along with normal immortalized intestinal cells (IEC‐6 and INT‐
407). In another study, the fruit extract of G. indica was used for the isolation of garcinol. The
garcinol at IC50 values (3.2–21.4 μM) for 72 h treatment shows strong inhibitory properties in all
intestinal cells. The anticancer properties were higher in the cancer cells as compared to normal
immortalized cells [50].
Similarly, Liao et al. [51] also observed a high tumor‐inhibiting activity of G. indica in a human
colorectal cancer cell line (HT‐29). The garcinol at 10 μM concentration retarded the cell invasion
activities several folds. The fruit extracts of G. indica has been shown very effective in the activation
of caspase‐3/CPP32 and the breakdown poly (ADP‐ribose) polymerase (PARP) protein to inhibit
leukemia in humans in the HL‐60 cells [52]. These results indicated that garcinol (IC50 = 9.42 μM)
shows strong growth inhibitory effects against human leukemia HL‐60 cells.
3.7. Hedyotis diffusa
Hedyotis diffusa (Chinese: sheshecao) is a member of the family Rubiaceae. It is spread over the
northeast regions of Asia. H. diffusa has been commonly used to cure inflammatory diseases i.e.,
urethritis, bronchitis, and appendicitis [53,54].
Because of the recent advances in pharmacological practices, this herb received importance for
having antitumor properties and showed effective results in treating cancers of the liver, colon,
lungs, brain, and pancreas [55]. H. diffusa contains important bioactive derivatives of
polysaccharides, triterpenes, and anthraquinones [56,57].
Methyl anthraquinonesare, one of the bioactive compounds in H. diffusa, is responsible for
apoptosis of many cancers. It shows apoptosis and inhibitory effect on the MCF‐7 cell line of breast
cancer via activation of the caspase‐4/Ca2+/calpain pathway when applied in a concentration of
18.62 μM for 24 h. It was observed that the S phase of the cell cycle and the percentage of the
apoptotic cells were markedly increased when methyl anthraquinone was applied to MCF‐7 cells
[58]. Similarly, a concentrated extract of H. diffusa cause an inhibitory effect on the cervical cancer
proliferation and induces apoptosis of Hela cells. Studies on the effect of H. diffusa ethanolic
extracts on anti‐colorectal cancer showed that these extracts cause an inhibitory effect on the Ct‐
26 cells by applying different concentrations (0.06 mg/mL, 0.08 mg/mL, 0.10 mg/mL and 0.12
mg/mL) with the rate of 35.46% to 71.84% [59].
3.8. Loranthus parasiticus and Scurrulus parasitica
Loranthus parasiticus, also known as Sang Ji Sheng (in Chinese), is a member of the
Loranthaceae family and is widely distributed in the Southwestern regions of China. L. parasiticus is
a semiparasitic plant, historically used as traditional folk medicine in China and Japan [60]. Since
they are parasitic in nature, their biological activities including phytoconstituents are highly
dependent on the host trees [61,62]. In fact, certain studies indicated the reverse effects of L.
parasiticus on a host tree in decreasing sugar and chlorophyll content [63]. In vitro and in vivo
studies have been conducted to evaluate the possible anticancer and antitumor potential of L.
parasiticus. Cytotoxicity analysis of aqueous extracts of L. parasiticus has shown positive activity
against ovarian cancer cell lines; SKOV3, CAOV3, and OVCAR‐3 [64].
A comparative study conducted by Xiao et al. [65] on flavonoids extracted in 80% ethanol from
Scurrulus parasitica harvested from different hosts showed a good anticancer potential on acute
myeloid leukemia cell line HL‐60. Flavonoids from S. parasitica on N. indicum induced apoptosis
and inhibited cell proliferation with an IC50 value of 0.60 mg/L on HL‐60 cells and arrested cell cycle
at G0–G1 phase. S. parasitica parasitizing on Morus alba also showed an IC50 value of 2.49 mg/L.
Similarly, Xiao et al. [66] isolated a polysaccharide in aqueous and ethanol extract from the leaves of
S. parasitica and conducted proliferation inhibition assay on S180, K562, HL‐60 cell lines. They
observed inhibition in sarcoma S180 growth in mice with a 54% tumor inhibition rate Loranthus
parasiticus on the optimal dose of 100 mg kg−1 d−1. S. parasitica downregulate expression of
CyclinD1, Bcl‐2, and Ki‐67 protein, and upregulate the expression of Bax protein which helps in the
inhibition of cancer cell line and apoptosis of cancer cell in vivo.
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3.9. Morus alba
M. alba, commonly called white mulberry, is native to China, Japan, India and is cultivated
throughout the world where silkworm is raised. Their leaves are the main source of food for
silkworms. Extracts from M. alba are traditionally used to cure cough, edema, insomnia, bronchitis,
asthma, nose bleeding, wound healing, eye infections, and diabetes [67]. M. alba contains many
pharmaceutically important compounds like kuwanol, hydroxymoricin, moranoline, morusin,
calystegin, albafuran, and albanol. The leaves of M. alba contain some active compounds such as
quercetin, rutin, apigenin, 1‐deoxynojirimycin [67].
A study by Chon et al. [68] on methanolic extract of M. alba leaves showed anti‐proliferative
effects on different human cell lines like pulmonary carcinoma (Calu‐6), colon carcinoma (HCT‐116)
and breast adenocarcinoma (MCF‐7). These results showed a strong link to the concentrations of the
investigated extracts. Anti‐proliferative activity in the methanolic extract of M. alba leaves was
observed on the human cell line of gastric carcinoma (SNU‐601) in a concentration of 1000 mg/mL.
In another study on albanol A, isolated from M. alba root extract, Kikuchi et al. [69] showed
apoptosis‐inducing, cytotoxic activity (IC50 = 1.7 μM) in HL‐60 cell line. It induced topoisomerase II
(IC50 = 22.8 μM), clearly reduced the levels of pro‐caspases 3, 8, and 9. Furthermore, the Bax/Bcl‐2
ratio also increased and induced HL‐60 apoptotic cell death through stimulation of the death
receptor. The results of a study conducted on M. alba leaves in different extracts on human cell line
hepatoma (HepG2) showed that methanolic leaf extract also showed inhibition (IC50 = 33.1 μg/mL)
of HepG2 cell. It was concluded that M. alba leaves extract contains different phenolic compounds
in different solvents which showed an anti‐proliferative effect on the HepG2 cell line through the
arrest of the cell cycle in G2/M phase. This was achieved with p27Kip1 protein expression, activated
caspases to induced cell apoptosis and inhibited topoisomerase IIα activity [70].
Furthermore, lectin was isolated from the leaves of M. alba which showed anti‐proliferative
activity on the human breast cell line (MCF‐7) at a concentration of 8.5 μg/mL. This compound also
showed cell cycle arrest and cytotoxicity in a human colorectal cell line (HCT‐15) with inhibiting
concentration of 16 μg/mL. The mechanism of inhibition of cancer cell lines was linked to the
induction of apoptosis through activation and release of caspase‐3 [71].
Methanolic extracts of M. alba showed significant anti‐proliferative activity on the HepG2 cell
line. These extracts showed significant inhibition of cells reducing cleared viable cell count. The cell
growth was inhibited by suppressing the activity of NF‐kB gene expression and biochemical marker
modulation [72].
Further, Qin et al. [73] isolated 15 compounds from the root bark of M. alba which contain six
diels‐alder adducts and nine prenylated flavanones. The study observed that two new compounds,
soroceal B and sanggenol Q showed cytotoxic activity. One of the isolated compounds showed
selective cytotoxic activity in cells (HL‐60 and AGS) at inhibiting concentrations of 3.4 μM.
3.10. Paris polyphylla
Paris polyphylla (called “Love Apple”) belongs to family Liliaceae and contains 24 species
throughout the world [74]. P. polyphylla is mostly used by Indian and Chinese traditional medicine
system for having potential anticancer properties. P. polyphylla consists of important secondary
metabolites such as polyphyllin D, formosanin C, β‐ecdysterone, dioscin, daucosterol
heptasaccharide, oligosaccharides, octasaccharide, protogracillin, trigofoenoside A,yunnanosides G‐
J, padelaoside B, pinnatasterone, and other saponins [75]. Steroidal saponins are the main active
components because of its structural diversity and bio‐activities such as antitumor, immune‐
stimulator, analgesic, and hemostatic properties [76–81].
Aqueous and ethanol extracts of P. polyphylla showed potential antitumor activity against
human liver carcinoma (HepG2 and SMMC‐7721) cell line, human gastric (BGC‐823) cell line,
human colon adenocarcinoma (LoVo and SW‐116) cell line, and human esophagus adenocarcinoma
(CaEs‐17) cell lines. Ethanolic extract showed a strong inhibitory effect with IC50 values ranging
from 10 μg/mL to 30 μg/mL [82]. Extract of P. polyphylla also showed an antitumor effect in
esophageal cancer ECA109 cells by increasing the connexin26 mRNA and protein expression.
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Studies reported that P. polyphylla extracts increased the Bad genes expression and decreased the
expression of Bcl‐2 genes, inhibiting the growth of ECA109 cells by proliferation and inducing cell
apoptosis [83].
3.11. Perilla frutescens
Perilla frutescens, commonly called perilla or Korean perilla or Beefsteak plant, is widely
distributed in Vietnam, China, Japan, and most Asian regions belong to the Labiatae family [84,85].
Economically, one of the most significant crops, cultivation of P. frutescens in China and some other
Asian countries is more than 2000 years old [86,87]. Stem, seed, and leaf parts of P. frutescens have
been used to treat poisoning, cold, bloating, and headache [74,88]). Multiple in vivo and in vitro
studies have been conducted to evaluate the anticancer and antitumor potential of P. frutescens. Leaf
extract of P. frutescens showed the highest anticancer activity in HepG2 cells through cell
proliferation inhibition and upregulation of apoptosis‐related gene expression [89]. Other studies
revealed that ethanolic leaf extract of P. frutescens promoted apoptotic induction and tumorigenesis
through death‐mediated receptors and scavenging the reactive oxygen species (ROS) [90,91]
Similarly, Lin, Kuo, Wang, Cheng, Huang and Chen [89] used leaf extract of P. frutescens to
evaluate the proliferation and apoptosis in HepG2 cells. Anti‐proliferation activity was observed in
HepG2 cells treated with P. frutescens leaf extract at a concentration of 105 μg/mL. The study
reported that significant apoptosis was observed through flow cytometry. Furthermore, microarray
results showed apoptosis‐related gene expression in a time‐dependent manner. The activity of P.
frutescens leaf extract was compared to the activity of rosmarinic acid which showed less effective
results in apoptosis‐related gene expression and apoptosis induction in HepG2 cells.
The essential oil component “isoegomaketone” isolated from P. frutescens also induced
apoptosis in human colon cancer (DLD1) cells. A study by Cho et al. [92] reported the inhibition of
cell growth by isoegomaketone when treated for over 24 h, cleaved caspase‐3, 8, and 9 in a time‐
dependent and dose‐dependent manner. Isoegomaketone treatment triggered PARP cleavage,
translocation of the protein Bax, cleaved Bid protein and the release of cytochrome c to the
cytoplasm from mitochondria, induced apoptosis and translocation of apoptosis‐inducing factor
from mitochondria into the nucleus. It was suggested that isoegomaketone from P. frutescens
induced apoptosis in DLD1 cells via both caspase‐dependent and caspase‐independent pathways.
3.12. Platycodon grandiflorus
Platycodon grandifloras, commonly known as balloon flower, or Chinese bellflower, belongs to
the family Campanulaceae, which is distributed through Northeast Asia. The rhizomes of P.
grandiflorus are very effective and are used as a traditional medicine in China, North Korea, and
Japan for treatment of different diseases like cough, sore throat, phlegm, and other ailments [93]. P.
grandiflorus contains many biologically active compounds which include saponins, flavonoids,
anthocyanins, phenolics, and polysaccharide. These compounds have significant immune‐
stimulatory [94], anti‐inflammatory [95], hepatoprotective [96], and antitumor activities. The
antitumor activity of P. grandifloras was shown in a dose‐dependent manner by reducing PKC
enhancement of matrix metallopeptidases (MmP‐9 and MmP‐2), which caused the death of HT‐80
cells [97]. Yu and Kim [98] isolated platycodin D from the root of P. grandiflorus and treated MCF‐7
cells with a concentration of 5–100 μM which reduce cell viability and proliferation in a dose‐
dependent and time‐dependent manner as compared with controlled cells. Induction of anticancer
activity was observed because of caspase 8 and 9 activation and PARP cleavage. In addition,
platycodin D upregulate cellular levels of protein Bax and Bcl‐2 and downregulate the activation of
caspase‐9. Further, it also induces proteolytic activation of Bid (a protein of the proapoptotic Bcl‐2
family).
Platycodin D is a triterpene saponin isolated from the roots of P. grandiflorus shows cytotoxic
effects on the human leukemia cells. It inhibited telomerase activity and showed a cytotoxic effect in
a dose‐dependent manner with a concentration of 10–20 μM. This was shown to be achieved
through downregulating the expression of human telomerase reverse transcriptase (hTERT). The
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results of the study by Kim et al. [99] showed that suppression of telomerase activity and cytotoxic
effect on leukemia cells by platycodin D was through post‐translational and transcriptional
inhibition of hTERT. Platycodin D induced apoptosis and cell death of human leukemia (U937) cell
by inducing the production of ROS through Egr‐1 gene activation and as a result, decreased in
mitochondrial membrane potential, activating caspase‐3 and PARP cleavage [100].
The extract of P. grandiflorus also showed antitumor effects on ovarian (SKOV3) cancer cells.
Results showed that induced apoptosis occurs through the downregulation of Bcl‐2 expression,
upregulation of Bax expression, activation of caspase (3, 8, 9), and mitochondrial cytochrome c
released to the cytosol [101].
3.13. Prunus armeniaca
Prunus armeniaca (Armenian plum) belongs to an important plant family Rosacea. Various
parts of the plant are used as the major source of some important antioxidant substances and are
commonly used against cancer and some other cardiovascular diseases [102]. The fruit part of P.
armeniaca contains various important secondary metabolites like β‐carotene, flavonoids, organic
acids, thiamine, minerals, and oils [103]. The seeds of P. armeniaca contains plenty of cyanogenic
glycosides, used against different types of cancers [104]. Amygdalin is one of the important
glycosides of P. armeniaca, used for the treatment of prostate cancer [105]. Gomaa [106] reported the
antioxidant and anticancer activities of P. armeniaca at different combinations of methanolic and
ethanolic extracts with water. The study concluded that kernels of P. armeniaca have better
antioxidant capacity compared to almonds that belong to the same genus. The study showed the
highest antioxidant activity (67%), total lycopene content (4.70 mg/mL), and total phenolic content
(3.290 mg/g of dry extract) in P. armeniaca kernels. Furthermore, P. armeniaca kernels were also
found active in the inhibition of certain cancers when tested on the colon (HCT‐116), human breast
(MCF‐7), and HepG2 cell lines in different concentrations and combinations. The highest
cytotoxicity was observed from methanolic extract (IC50 = 10.1 μg) against HepG2 cells. According
to Madrau et al. [107], the fruit part contains a large amount of phenolic compound that shows
strong antioxidant and immune‐stimulant properties. Similarly, the study conducted by Liu et al.
[108] found low anti‐scavenging activity against DPPH of dry seed extract of apricot. Vardi et al.
[109] reported the strong protective activity of apricot against intestinal oxidative damage in the rat
model experiment.
3.14. Rabdosiae rubescens
Rabdosiae rubescens (Chinese: Dong Ling Cao) is a Chinese medicinal herb that belongs to the
family Lamiaceae. It possesses multiple biological activities like antibacterial, anti‐inflammatory,
anti‐parasitic, and anticancer [110]. R. rubescens contain important chemical compounds including
monoterpenes, sesquiterpene, diterpene, and terpenoids. Oridonin, a tetracyclic terpenoid, is the
main active compound in R. rubescens [111]. Oridonin gained its attention because of the remarkable
properties of growth inhibition and the induction of apoptosis in cancer cells. In vitro and in vivo
studies showed the induction of apoptosis in a variety of cancer cells by oridonin as in
hepatocellular carcinoma, breast, gastric, skin, colorectal, gallbladder, and pancreatic cancers [112].
Bao et al. [113] isolated oridonin from R. rubescens which showed a potent anticancer potential
in gallbladder both in vitro and in vivo. SGC996 and NOZ cells treated with oridonin results in
inhibition of colony formation and growth of tumor cells in S‐phase and induced apoptosis. Wang,
et al. [114] showed the molecular mechanism of oridonin as an anticancer compound in HepG2
cancer cells. Oridonin in a concentration of 41.77 μM inhibited the growth of HepG2 cells while in a
concentration of 44 μM, it induced G2/cell cycle arrest and apoptosis when applied for 24 h. The
expression of nine different proteins was observed through proteomic analysis. Eight out of the
nine proteins are already reported to be involved in anticancer activity. Oridonin up‐regulate
STRAP, Hsp70.1, Sti1, TCTP, and PPase, downregulate hnRNP‐E1 which are significantly involved
in the G2/M cell cycle arrest and apoptosis. The upregulation of HP1 beta and GlyRS by oridonin
are responsible for the inhibitory effects on tyrosine kinase and telomerase.
Biomolecules 2020, 10, 47 11 of 31
Wang et al. [115] also reported that oridonin from R. rubescens is a potent cytotoxic agent that
inhibited the growth and migration of highly metastatic human breast cancer cell lines (MCF‐7 and
MDA‐MB‐231). Oridonin significantly inhibited the growth of human breast cancer cells in a dose‐
and time‐dependent manner, by arresting the cell cycle in the G2/M phase and accumulated cells to
SUB‐G1 phase. Results from the study also showed that oridonin triggered apoptosis by reducing
Bcl‐2/Bax ratio, NF‐κB (p65), caspase‐8, phospho‐mTOR, IKKβ, IKKα and increasing the expression
level of PPARγ, PARP, and Fas cleaving in a time‐dependent manner. Oridonin significantly
suppressed MDA‐MB‐231 cell invasion and migration through decreasing MmPs expression and
regulation of integrin β1/FAK pathway and inhibited the growth and apoptosis via DNA damage
and activated the extrinsic and intrinsic apoptotic pathway in breast cancer cells.
3.15. Scutellaria baicalensis
Scutellaria baicalensis is one of the important medicinal plants species of family Lamiaceae. It is
commonly known as Baikal skullcap or Chinese skullcap and is found in different regions of the
world including East Asia, Europe, and the Russian Federation. Its root part is known as Scutellariae
radix and used as traditional Chinese medicine for the treatment of hepatitis, respiratory, and
gastrointestinal diseases [116]. The root parts have maximum flavonoid content having multiple
pharmacological properties [117].
About 60 different flavonoids have been identified in S. baicalensis which showed maximum
antioxidant activities [116,118]. The four flavones metabolites also showed antimutagenic properties
[119]. Woźniak et al. [120] studied the antioxidant potentials of four flavones: baicalein, baicalin,
wogonin, and their glucuronides compounds and wogonoside. These flavones have different
antioxidant capacity depending on the chemical structure and mechanisms of activity. However,
among these, baicalein showed maximum antioxidant activities while the wogonin provided high
protection to the linoleic acid from oxidation but did not show any antioxidant activity [121].
The S. baicalensis extract is useful against a wide range of cancer cells like brain tumor cells
[122], prostate cancer cells [123], and head and neck squamous cell carcinoma (HNSCC) cell lines
[124]. The aqueous extracts of roots led to programmed cell death, and thus inhibit the growth and
development of apoptosis. They suppressed the growth of lymphoma and myeloma cell lines via
disturbing normal expression level of Bcl and c‐myc genes, while increased the expression level of
cyclin‐dependent kinase inhibitor p27 (KIP1) [121]. Hongwei et al. [125] used three different
concentrations (80, 120, and 160 μmol/L) of baicalin for 2 days against BGC‐823 and MGC‐803
gastric cancer cells. The results of 3‐(4,5‐dimethyl‐2‐thiazolyl)‐2,5‐diphenyl‐2‐H‐tetrazolium
bromide assay showed a lower rate at different doses. Flow cytometric analysis showed that
baicalin induces apoptosis in a dose‐dependent way. Also, it was found that baicalin increase the
gene expression of caspase‐3, caspase‐9, and other B cell lymphoma (Bcl‐2)‐associated X protein but
lowers the expression of the Bcl‐2 gene.
A recent study reported the angiogenic properties of baicalin by using chick embryo
chorioallantoic membrane [126]. The aqueous extract of baicalin showed both inhibitory and
angiogenic activities while the baicalein showed only anti‐proliferative property. Quantitative PCR
results showed the expression of 84 different angiogenesis‐related genes at different doses of
baicalin and baicalein. The low dose significantly increases angiogenic genes expression while the
high concentration showed the opposite activity by decreasing angiogenesis and increasing the
lethality. The low to high levels of baicalein decrease the level of gene expression of multiple
angiogenic genes and decreased cell proliferation.
Sato et al. [127] studied the anticancer potential of the root extract of S. baicalensis by using
human oral squamous cell carcinoma (OSCC) cell line. The findings of the study showed 100 μg/mL
root extract retard the monolayer and anchorage‐independent growth rate many times but do not
affect the cell adhering ability. Downregulated expression of cyclin‐dependent kinase 4 cyclin D1,
G1 phase arrest, and PARP cleavage was observed with the application of the root extract of S.
baicalensis.
Biomolecules 2020, 10, 47 12 of 31
3.16. Scutellaria barbata
Scutellaria barbata, the barbed skullcap is a key medicinal plant species of family Lamiaceae,
used to treat inflammatory and cancer diseases [128]. It is rich in important secondary metabolites
like alkaloids, flavones, steroids, and polysaccharides [129,130]. In vitro studies showed positive
activities against a vast range of cancers i.e., colon cancer, lung cancer, hepatoma, and skin cancer
[128].
The apigenin and luteolin isolated from S. barbata gave cytotoxic activity against both human
breast cancer cell line MDA‐MB‐231 and non‐transformed breast cell line (MCF10A) [131].
Similarly, scutellarein was found to possess strong anti‐breast cancer activity demonstrated in
MDA‐MB‐468 cell lines [132]. Scutellarein increased the concentration of mitochondrial superoxide
and peroxide while decreasing the level of glycolysis, retarding the growth of cancer cells by
lowering ATP synthesis. Other secondary metabolites of S. barbata showed cytotoxic properties by
leading ROX and DNA damage [131]. The other important alkaloid of S. barbata, scutebarbatine A
(SBT‐A) also resulted in high antitumor and apoptosis activities in experimental A549 cells.
3.17. Tripterygium wilfordii
Tripterygium wilfordii of the family Celastraceae is also known as “Thunder God Vine,” and is
native to Korea, China, and Japan. It is commonly used for the treatment of multiple diseases such
as rheumatoid arthritis, systemic lupus erythematosus, nephritis, asthma, and cancers [133–135]. T.
wilfordii produces important bioactive compound triptolide which is used as an
immunosuppressive and anti‐proliferative agent [134]. It has a five‐membered unsaturated lactone
ring and is used against different breast cancer cells by activation of pro‐apoptotic compounds by
modulating several signaling pathways [136].
In vitro studies showed anti‐proliferative and pro‐apoptotic activities against tumor cell lines
[137–139]. He et al. [140] studied the in vitro properties of triptolide of T. wilfordii activity by using
human umbilical vein endothelial cells (HUVECs). The IC50 value for HUVECs proliferation was 45
nM. The results of semi‐quantitative RT‐PCR and Western blot analysis in human umbilical vein
endothelial cells showed that triptolide cause downregulation of proangiogenic Tie2 and VEGFR‐2
expression after 24 h at 50 nM concentration. At high concentration (100 nM), the VEGFR‐2 mRNA
expression was completely blocked. But on the other hand, the knockdown of Tie2 decreases the
inhibitory activities of triptolide on endothelial network formation. The overall results showed that
anticancer properties of triptolide are directly correlated with the blockage of two endothelial
receptor‐mediated signaling pathways. Triptolide showed more antagonistic activities against the
proliferation of HUVECs as compared to normal cells like skin keratinocytes HaCaT cells and other
liver cells L‐02 [141].
Celastrol is another important compound of T. wilfordii, having cytotoxic activity against a
broad range of cancer cells [142]. It demonstrates its anticancer activities by blocking the NF‐κB via
targeting IκB kinase and TAK1‐induced NF‐κB activation [143,144]. Other studies showed that
triptolide of T. wilfordii has anticancer properties in many model systems such as experiments have
also demonstrated triptolide’s therapeutic efficacy in several model systems including
neuroblastoma in nude mice model [145], other xenografts of human melanoma, breast cancer,
bladder cancer, gastric carcinoma [146].
3.18. Tussilago farfara
Tussilago farfara (commonly called coltsfoot) is one of the important medicinal plants, grown in
Europe and various regions of western and central Asia, commonly used against cancer. It
possesses a high quantity of flavonoids and other phenolic compounds and some trace elements
(Zn, Mg, and Se). The presence of these substances plays a key role in the anticancer activities of
this plant. Maximum scavenging activity was recorded in water extract as compared to ethanol
extract. It shows a 20.9% antioxidant activity. Further, this plant showed maximum antioxidant
activity both using DPPH and yeast model [147]. The quercetin‐glycosides isolated from the flower
Biomolecules 2020, 10, 47 13 of 31
bud of T. farfara shows the highest antioxidant activity [148]. Lee et al. [149] reported the (TF)‐
induced cytotoxic and apoptotic activities of the flower part of T. farfara in human colon cancer cell
line (HT‐29) by using a methanolic extract. Fatykhova et al. [150] showed the genotoxic activity of T.
farfara herb juice against known genotoxic compounds like nalidixic acid in SOS chromotest and
furacilin in Rec assay. Their findings showed that dilution of the herb juice gave maximum
antimutagenic properties in SOS chromotest as compared to furacilin in Rec assay.
Lee et al. [151] reported the activity of T. farfara as the TNF‐related apoptosis‐inducing ligand
(TRAIL)‐induced apoptosis via MKK7/JNK activation by inhibition of mitogen protein kinase‐TOR
signaling pathway regulator‐like protein (MKK7‐TIPRL) in human hepatocellular carcinoma cells.
The T. farfara extract decreases 50% interaction between MKK7‐TIPRL. HPLC data further verified
the presence of many important phenolic compounds that decrease MKK7‐TIPRL interaction and
also examined the activation of MKK7/JNK.
3.19. Wedelia chinensis
Wedelia chinensis (Chinese: Peng qi ju), indigenous to India, South‐East Asia, and China, is one
of the important anticancer plants belonging to family Asteraceae which is rich in many important
secondary metabolites like phenol, flavonoids, and tannin [152].
The essential oils of W. chinensis give a positive effect on lung cancer during the in vitro study.
The GC‐MS analysis recorded the presence of two important compounds carvacrol and trans‐
caryophyllene. High anti‐scavenging activities were found at different levels of dose. The study of
B16F‐10 melanoma metastatic cell line showed that the concentrations of some important
antioxidant enzymes (including catalase, superoxide dismutase, and glutathione peroxidase)
increased many folds in the treatment groups. Similarly, the amount of glutathione also increased
while the concentrations of other compounds such as lipid peroxidation and nitric oxide were
decreased. The histopathology studies further verified that these essential oils show negative effects
on cancer development [153].
4. In Vivo Studies of Anticancer Herbal Medicine: An Overview
The herbal medicines are tested both in vitro and in vivo. The anticancer activities of the
various medicinal plants have been tested in vivo using different animal models (Figure 3). There
are many studies available on in vivo experiments of the many different anticancer plants in mice
models. For instance, dihydroartemisinin was reported to inhibit tumor tissue, increase the level of
interferon‐gamma (IFN‐γ), and decrease interleukin 4 (IL‐4) in tumor‐bearing mice [154]. Similarly,
artesunate, a derivative of artemisinin is also reported to be a promising drug against angiogenic
Kaposi′s sarcoma [155], growth inhibition of A549 and H1299 lung tumors by 100 mg/kg dose [156],
the suppression of human prostate cancer xenograft [157] and the inhibition of leukemia growth in
mice [158].
Biomolecules 2020, 10, 47 14 of 31
Figure 3. A depiction of general strategies applied for assaying extracts/phytochemicals from
important medicinal plants for their anticancer activity both in vitro and in vivo.
Irradiation of C57BL/6 mice combined with a dose of 2 mg/kg twice a week was proved
effective against lung carcinoma [159]. The effectiveness of berberine was enhanced when it was
used in combination with other agents. Coptisine, another alkaloid of Coptidis rhizoma is proved to
have anticancer effects when used in concentrations of 150 mg/kg against BALB/c nude mice by
suppressing tumor growth and reducing cancer metastasis. The inhibition of the RAS‐ERK pathway
was suggested as the mechanism for this activity [160]. Another study was also performed on the
nude mice on the HepG2 cells by applying the aqueous extract of H. diffusa which inhibits
proliferation of cells in a dose‐dependent manner, also delay S phase and arrest cells in G0/G1 phase
[161].
Similarly, a high anticancer activity of SBT‐A was found in transplanted tumor nude mice.
Yang et al. [162] reported the anticancer activity of the polysaccharides isolated from S. barbata by
95‐D Xenograft model. The results showed that polysaccharides give strong anti‐proliferative
activities against a 95‐D cell line. It also lowered the expression of phospho‐c‐Met and other
signaling elements like phospho‐Erk and phospho‐Akt. In vivo study also gave maximum
antitumor activity by using a 95‐D subcutaneous xenograft model. After one daily intraperitoneal
injection for 3 weeks, the tumor growth was significantly decreased (47.72 % and 13.6%) at 100 and
200 mg/kg treatments. The ex vivo studies also showed that polysaccharides of S. barbata inhibit the
phosphorylation of c‐Met signaling pathway.
Furthermore, Li et al. [163] isolated a steroidal saponin from P. polyphylla which inhibited
tumor growth in Lewis bearing‐C57BL/6 mice and induced apoptosis in A549 cells. Results showed
that steroidal saponin in concentration of 2.5, 5.0, and 7.5 mg/kg showed significant inhibition rate
of 26.49 ± 17.30%, 40.32 ± 18.91%, and 54.94 ± 16.48%, remarkably increased thymus and sleep
indices, decreased inflammatory cytokines (TNF‐α, IL‐8, and IL‐10). This in turn inhibited the
tumor growth in C57BL/6 mice by reduced volume and weight of tumor. Nuclear changes, DNA
condensation, chromatin fragmentation, and apoptosis are induced in A549 cells with a
concentration of 0.25, 0.50, and 0.75 mg/mL steroidal saponin. Tumor growth inhibited by
steroidal saponin was associated with decreased ROS, inflammatory response, and induction of
apoptosis.
Furthermore, Wanga et al. [164] reported the effect of isoegomaketone from P. frutescens on
Huh‐7 hepatoma cell carcinoma and tumor‐xenograft nude mice. Results showed that
Biomolecules 2020, 10, 47 15 of 31
isoegomaketone inhibited cells and decreased tumor weight and volume. Isoegomaketone in the
concentration of 10 nM/L decreased pAkt without affecting Akt. Hepatoma cell carcinoma tumor
growth was suppressed by isoegomaketone from P. frutescens through PI3K/Akt signaling pathway
blocking. R. coptidis is also showed anticancer activity in rats as suggested by the inhibition of
cyclooxygenase 2 activity. The number of aberrant crypt foci in the rat colon was decreased by 54%
after the administration of R. coptidis extracts [165].
Manjamalai and Grace [166] reported the apoptosis along with lowering angiogenesis and lung
metastasis activities of the essential oils of W. chinensis by using B16F‐10 melanoma cell line in
C57BL/6 mice. The mice were injected with B16F‐10 melanoma cells through the tail vein and
treated with different doses of essential oil. A 50‐μg essential oil concentration showed maximum
cytotoxic activities with 65.17% lethality within 24 h. The numbers of apoptotic cells increased
many times in experimental samples as compared to the control group. They also recorded high
levels of important proteins like p53 and caspase‐3 in essential oil‐treated samples compared to
other non‐treated samples. They recommended this plant for the treatment and control of cancer.
In vivo activities of oridonin from R. rubescens showed a potent anticancer potential in the
gallbladder [113]. When injected intra‐peritoneally with a concentration of 5, 10, 15 mg/kg for 3
weeks to athymic nude mice, oridonin significantly inhibited NOZ xenografts growth. Oridonin
also inhibited NF‐κB nuclear translocation, increased Bax/Bcl‐2 ratio, activated caspase‐3, caspase‐9,
and PARP‐1 which showed that the mitochondrial pathway is concerned with apoptosis mediated
by oridonin.
Studies have reported anticancer activities of two artemisinin dimer, dimer‐hydrazone (dimer‐
Sal) and dimer‐alcohol (dimer‐OH) and one monomer dihydroartemisinin (DHA) compared to the
control against MTLn3 breast tumors in rats. Results of the study reported that dimer‐Sal, dimer‐
OH, and DHA significantly suppressed tumors in rats compared to the control group. It was also
observed that the dimers were more potent as compared to the monomers [167].
It is also reported that artemisinin is responsible for preventing breast cancer in rats treated
with a single oral dose (50 mg/kg) of 7,12‐dimethalbenz anthracene (DMBA) which is known for
rapidly inhibiting the multiple breast tumors. After the feeding DMBA with 0–2% artemisinin to the
target group and plain food in powdered form to the control group, both groups of experimental
rats were monitored for breast tumors for 40 weeks. Oral artemisinin significantly reduced the
development of breast tumors (57%) as compared to control fed (96%). The research indicates that
artemisinin might be a potent cancer chemoprevention agent, having lesser side effects [168].
Similarly, oral administration of curcumin to rats reduced the level of Gp A72 (glycoprotein) by
73% hence lowering paw inflammation [169].
Tanaka et al. [170] observed activities of fruit extracts of G. indica in the azoxymethane (AOM)‐
induced colonic aberrant crypt foci in male model rats (F344). They found lower proliferating cell
nuclear antigen index and high concentrations of glutathione S‐transferase and quinone reductase.
They also observed the maximum chemo‐preventive activities of garcinol.
Besides mice and rats, there are many other animal models employed for studying anticancer
activities. Zebrafish models are also employed for technical advantages including the ease of
advanced genetic studies, expression of tumor in any organ and the striking resemblance to human
malignancies [171]. Zhu et al. [172] used furanodiene which is a terpenoid isolated from Rhizoma
curcumae, for their anticancer effects in zebrafish models. They observed that furanodiene showed
anticancer effects in a pancreatic cell line (JF 305) and human breast cancer cells (MCF‐7)
transplanted into zebrafish. Furanodiene showed effective results through ROS production, anti‐
angiogenesis, apoptosis induction, and DNA strand breaks.
Similarly, the artemisinin type compound can have anticancer activities against different types
of tumors including leukemia, carcinomas of breast, kidneys, lungs, and ovaries, lymphoma,
melanoma, and brain tumors [23,173,174]. Currently, reports of in vivo activities of A. annua are
accumulating. One study reported anticancer activities of A. annua against four animal models aged
10 including a male cat with malignant fibrosarcoma, a male dog with malignant mesenchymal
neoplasia, a female dog with breast cancer and another male dog with a malignant fibrosarcoma.
Biomolecules 2020, 10, 47 16 of 31
The animals were treated with various doses of 150 mg/day (3 capsules), 450 mg/day (2 capsules),
450 mg/day (3 capsules), and 450 mg/day (2 capsules). All the animals showed complete reduction
with no tumor relapse [175].
5. Regulatory Aspects of Herbal Anticancer Drugs
It is generally established that the drugs including the anticancer compounds require phase III
clinical research trials for marketing permissions. The Food and Drug Administration (FDA) and
European Medicines Agency (EMA) guidelines require at least one controlled trial in Phase III with
statistically significant results for the green signal to market them [176]. Except for exceptional
circumstances, all the drugs need to go through all the phases of trials according to the guidelines of
international agencies such as the FDA and EMA. However, it has been observed that
pharmaceutical companies deviate from the standard protocol and start testing new compounds on
human subjects earlier than the defined timeline. The reason for such practices is to accelerate the
approval of these compounds under the pressure of investors [176]. This means that the drug is
presented for approval with insufficient data on its quality, safety, and efficacy.
Although plant‐based compounds have shown be less toxic compared to conventional
synthetic compounds, there is growing evidence on the side effects of the unregulated use of these
plants against different diseases. The problem is that there is insufficient data available regarding
the quality, safety, and efficacy of herbal drugs. F. indica, for instance, has shown potent activity
against breast cancer when tested in the MDA‐MB‐231 cell line [44]. F. indica is used traditionally to
treat many disorders and people have even started the use of its herbal tea against breast cancer.
However, the question remains that there are only a few reports available on the anticancer activity
of the plant. Globally, the process of oncology drug development and marketing is regulated
through the involvement of experts and an advisory process mediated by regulatory authorities
[177].
There are several regulatory framework models available for prescribing such drugs but there
is a need for harmony among regulating agencies and improvement in the regulation process. For
instance, the FDA has recently adopted the questions and answers guidelines of the International
Council for Harmonization on the nonclinical evaluation of drugs intended to treat cancer. These
guidelines include 41 questions and answers which provide additional information about
anticancer drug development and are aimed at bringing harmonization in the process of anticancer
drug development [178]. It is, however, suggested that regulatory authorities, while bringing
harmony with other agencies working for regulating anticancer herbal compounds, should increase
the focus on combining information from traditional knowledge about that drug and the scientific
studies on it [179].
Moreover, it is evident that plants of the same species grown in different areas vary in their
profile of medicinal compounds [180]. This calls for the need to focus on the production of uniform
and high‐quality plants with a uniform metabolite profile that once tested is declared safe or unsafe
once and for all. This might be achieved through the help of in vitro growth and biotechnological
and genetic studies on these anticancer plants [181,182].
6. Modern Trends in Traditional Medicine Informatics and Opportunities for Anticancer Plant
Products
With the advancement of information technology and bioinformatics, there is an increasing
trend to build resources and databases that report herbal formulations, active components of the
herb, and related information. There are several efforts like Chinese Medicine Integrated Database
(TCMID) [183], Collective Molecular Activities of Useful Plants (CMAUP) [184], SymMap [185],
encyclopedia of traditional Chinese medicine (ETCM) [186] etc. In addition, several researchers
have developed strategies for in silico pharmacokinetic properties of molecules/drugs [187–191].
Such approaches are also applicable to phytochemicals and plant‐based active drug components for
their virtual screening, possible mode of action, and advanced drug discovery [192–195]. Several
plant‐based anticancer compounds have been evaluated using in silico and systems pharmacology
Biomolecules 2020, 10, 47 17 of 31
tools [196–201]. The current study encourages further studies on anticancer active ingredients (of
plant origin) for their in silico screening and pharmacokinetic activities. Considering the fact that
plant‐based drug formulations usually consists of several phytochemicals or even more than one
plants. The major challenge on this direction would be to predict the role of phytochemicals other
than active compounds and are present in the traditional medicine.
7. Conclusions
This detailed analysis of different plants showed that medicinal herbs promise a huge
anticancer potential. This article comprehensively highlights the mechanism of antitumor action of
some of the important plants. This is generally done through regulating signaling pathways. Many
studies have reported inhibition of enzymes that stops tumor growth. These studies are mainly
performed in human cell lines. It is highlighted that these plants play an important anticancer role
through their different classes of secondary metabolites (Table 1). However, the study of these
plants should not limit the study of a plethora of anticancer plants some of which are still
unexplored. Studies are needed to highlight the mechanism of anticancer action of many already
explored and many unexplored plants.
Biomolecules 2020, 10, 47 18 of 31
Table 1. Some of the important anticancer medicinal plants, their active components, and in vitro and in vivo activity.
Extract Used
Active Components Dose Cancer Cell Line Animal Models
S.No. Plant Name Common Name Parts Used (Aqueous/Methanolic References
Used Concentration Applied To Applied To
etc.)
Allium Allicin, flavonoids, and 20 mg/kg/0.2 Wehi‐164 tumor
1 Garlic Leaves Aqueous extracts Balb/c mice [202]
sativum phenolic components mL cells
Murine daltons
Lengkuas, greater lymphoma ascite
Alpinia
2 galangal, and blue Rhizomes Ethyl acetate extract Chrysin 1.3 mg/kg (dla) and human Balb/c mice [203]
galangal
ginger lung cancer (a549)
cells
Alstonia Blackboard or devil’s
3 Stem bark Ethyl Alcohol extract ‐‐ 210 mg/kg Hela cells lines Swiss Albino mice [204]
scholaris tree
Andrographis Aerial Cancer cell lines
4 Creat or green chireta Methanolic extract Diterpenes 10 μg/mL Swiss Albino mice [205]
paniculata parts sw620 and a498
Garden angelica,
Angelica Root and Mcf7 and 4t1 cell
5 wild celery, and Ethanolic extract Angelicin 500 mg/kg Female balb/c mice [206]
archangelica rhizome lines
Norwegian angelica
Chinese angelica‐tree,
Japanese angelica‐ Tumor bearing‐
6 Aralia elata Leaves Ethanol extract ‐‐ 300 mg/kg Mcf‐7 cells [207]
tree, and Korean nude mice
angelica‐tree
Sweet wormwood,
Artemisia
7 sweet annie, and ‐‐ ‐‐ Artemisinin 0.02% Breast cancer Rats [168]
annua
sweet sagewort
Shade Human colo 320 dm
Asclepia Ethyl acetate and 10‐20 mg/kg
8 Tropical milkweed dried Β‐sitosterol and monkey vero Male wistar rats [208]
scurassavica methanolextract b.w.
leaves cell lines
H22
Astragalus hepatocarcinoma
9 Mongolian milkvetch ‐‐ ‐‐ Polysaccharide 400 mg/kg Liver cancer [209]
membranaceus transplanted balb/c
mice
Copaifera Trunk of Clerodane B16f10 melanoma Male C57/black
10 Hayne oil, Copaiba Oil resin 2 g/Kg [210]
multijuga the tree Diterpenes cells mice
Human hepatic
Coptidis Huanglian, Copaiba, 200 μM and carcinoma cell lines
11 ‐‐ ‐‐ Berberine ‐‐ [211]
rhizoma and Copaibera 400 μM HepG2 and mhcc97‐
l.
Ht‐29 colon cancer
12 Curcuma longa Turmeric ‐‐ ‐‐ Curcumin 75 μM ‐‐ [32]
cells of human
Biomolecules 2020, 10, 47 19 of 31
Murine ehrlich
Elephantopus Dimethyl sulfoxide Deoxyelephantopin Male swiss albino
13 Elephant′s Foot ‐‐ 25 mg/kg ascites carcinoma [212]
scaber extract (doe) mice
(eac)
Fagonia Whole Carbon tetrachloride
14 bush candle Ethanolic extract 200 μg/mL HepG2 cell line Male albino rats [213]
schweinfurthii plant (ccl4)
Ht‐29 and hct‐116
15 Garcinia indica Kokum Fruits Ethanol extract Garcinol <1 μM ‐‐ [50]
colon cancer cells
Garcinia Mcf‐7 breast cancer
16 Lingnan garcinia Branch Methanol extract Xanthone 1000 μg/mL ‐‐ [49]
oblongifolia cell line
Garcinia Fruits and Du145, hela, ht‐29,
17 ‐‐ Meohextract Benzophenones ‐‐ [214]
preussii leaves and a431 cell lines
Hedyotis Nude mice
18 Snake‐needle grass ‐‐ ‐‐ Hela cells [215]
diffusa xenograft
Aerial
19 Hedyotis spp. ‐‐ parts, stem Methanol extract ‐‐ 20 μM Cem‐ss cell line ‐‐ [54]
and leaves
Kaempferia Ovarian cancer cell
20 Black ginger Rhizomes Ethanolic extract ‐‐ 1 mg/mL ‐‐ [216]
parviflora line, skov3
Human smmc‐7721
Litchi Fruit Polyphenolic hepatocellular Murine hepatoma
21 litchi or lychee Ethanolic extract 0.3 mg/mL [217]
chinensis pericarp compounds carcinoma cell bearing‐mice
Line
Polyphenolic
Menyanthes Bogbean, Buckbean, Aerial part Aqueous methanol Grade iv glioma
22 compounds 1.5 mg/mL ‐‐ [218]
trifoliata and Marsh Trefoil and root extract cells
HL‐60 (human
N‐hexane and leukemia) and
23 Morus alba white mulberry Root Albanol a 30 μM ‐‐ [69]
methanolextracts. Crl1579 (human
melanoma) cell lines
Phenolic compounds
human prostate
Black mulberry or Aerial dimethyl sulfoxide especially Ascorbic
24 Morus nigra 1000 μg/mL adenocarcinoma ‐‐ [219]
blackberry parts extract acid and chlorogenic
(PC‐3)
acid
Salt tree or Nitre Β‐sitosterol and
25 Nitraria retusa Leaves Chloroform extract 50 mg/Kg b.w B16‐f10 cells lines Balb/c mice [220]
bush palmitic acid
Human hepatoma
Paeonia
26 Chinese Peony Root Aqueous extract ‐‐ 15 mg/mL cell lines (HepG2 ‐‐ [221]
lactiflora
and hep3b)
Paris Tumor‐bearing
27 Herb Paris Rhizomes Methanol extract Steroidal saponins 7.5 mg/kg A549 cell line [163]
polyphylla c57bl/6 mice
Perilla Huh‐7 hepatoma Tumor‐xenograft
28 Beafsteak plant Leaves Meoh extract Isoegomaketone 10nmol/l [164]
frutescens cell carcinoma nude mice
Biomolecules 2020, 10, 47 20 of 31
Perilla Human hepatoma
29 Beafsteak plant Leaf ‐‐ Rosmarinic acid 105 μg/mL ‐‐ [89]
frutescens (HepG2) cells
Platycodin d was
Human breast
Platycodon dissolved in
30 balloon‐flower Root Platycodin D 8 μg/mL cancer cell line, mcf‐ ‐‐ [98]
grandiflorus Phosphate‐buffered
7
saline
Indian Oyster, Italian
Pleurotus Oyster, Phoenix Edible Huh7 liver cancer
31 Aqueous extract ‐‐ 20 mg/kg Nude mice [222]
pulmonarius Mushroom, or the part cells
Lung Oyster
Bing Ling Cao, Human gallbladder
Rabdosia Athymic nude
32 BlushredRabdosia, ‐‐ ‐‐ Oridonin 30 μmol/L cancer cell lines [113]
rubescens mice
and Isodonrubescens sgc996 and noz
Scrub stringybark, Human breast (mcf‐
Rhodamnia Tetracycline
33 brush turpentine, or ‐‐ ‐‐ 50 μM 7 and mda‐mb‐231) ‐‐ [115]
rubescens diterpenoidoridonin
brown malletwood cancer cells
Scutellaria
34 Barbed Skullcap ‐‐ ‐‐ Polysaccharides 40 μg/mL 95‐d cell line Xenograft model [162]
barbata
Human oral
Scutellaria squamous cell
35 Baikal skullcap Root Aqueous extract Baicalin 100 μg/mL ‐‐ [127]
baicalensis carcinoma (oscc) cell
line
Neuroblastoma cell
Tripterygium Neuroblastoma
36 Thunder god vine ‐‐ ‐‐ Triptolide 250 nmol/L lines (n2a and [145]
wilfordii (nude mice model)
sknsh)
Tussilago Flower Ht‐29 human colon
37 Coltsfoot Methanol extract Quercetin‐glycosides ‐‐ [149]
farfara buds cancer cells
Wedelia Carvocrol and trans‐ B16f‐10 melanoma
38 Chinese Wedelia Leaves Essential oils C57bl/6 mice [153]
chinensis caryophyllene metastatic cell line
Palmatine, berberine,
Chinese kunming
39 Zuojin wan ‐‐ Aqueous extract epiberberine, and 10 mg/mL S180 tumor cells [223]
(km) mice
coptisine
Biomolecules 2020, 10, 47 21 of 31
Authors Contributions: Conceptualization, T.K., and M.A.; methodology, T.K. and M.A.; software, T.K.;
investigation, T.K.; resources, S.A.J. and A.K.; data curation, P.N.; writing—original draft preparation, T.K.,
P.N., S.A. and A.K.; writing—review and editing, T.K. and M.A.; visualization, T.K.; supervision, Z.K.S. and
M.A.; project administration, M.A.
Funding: This research received no external funding.
Acknowledgments: The authors acknowledge the efforts of all researchers working in the area of traditional
medicine against cancer. The authors apologize to all scientists whose work has not been cited because of space
limitation or unknowingly due to the great amount of literature in the field of anticancer phytochemicals.
Conflicts of Interest: The authors declare no conflict of interest.
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