Research ArticleCancer

Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia

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Science Translational Medicine  18 Oct 2017:
Vol. 9, Issue 412, eaan6446
DOI: 10.1126/scitranslmed.aan6446

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  • Toxicity of Aristolochic Acid in Traditional Chinese Herbal Medicine: the Tip of the Iceberg?
    • YanLing Ai, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine
    • Other Contributors:
      • ZongMing Yu, School of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
      • HuiZe Zhang, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine
      • Yu Lai, School of Basic Medicine, Chengdu University of Traditional Chinese Medicine

    Traditional Chinese medicine (TCM) has been nationally and locally integrated into the Chinese health system with more than 2,000 years. It comprises traditional Chinese herbal medicine (TCHM), acupuncture, energy therapy (qi gong), massage (tui na) and other practices. TCHM is commonly used for various diseases in China and treated as the conventional medicine; while acupuncture is more widely used in western countries due to the advantages of non-pharmacological therapy. From the "aristolochic acid nephropathy" in Belgium in the 1990s to the liver cancer induced by aristolochic acid containing herbs in Asia, studies on the toxicology of TCHM have been repeatedly emphasized in recent years (1).
    In the current Chinese Pharmacopoeia (ChP), toxicity classification is rough and mostly based on ancient books rather than laboratories (2). The latest ChP includes 618 kinds of herbs and decoction pieces, of which only 83 are labeled "toxic". Most are considered as "non-toxic". The lack of rigorous toxicological information indicates the uncertain safety of herbs and decoction pieces. For example, Houttuynia cordata Thunb, a homogeny of medicine and food, is widely eaten in southwest China, but it acontains aristolactams which are the immediate mutagenic metabolites of aristolochic acids that interact directly with DNA (3, 4).
    To this end, a set of TCM toxicity evaluation system is proposed to construct and regulate TCM trials and localize...

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    Competing Interests: None declared.

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