aristolochic acid induced by insufficient evidence of liver cancer
recently, the United States in the journal science translational medicine published a research paper, think aristolochic acid can cause liver cancer. This paper, according to 78% of the Chinese Taiwan area and mainland 47% of liver cancer of liver cancer, may be associated with it. The news, immediately caused wide attention and heated debate. Aristolochic acid is high incidence of liver cancer in the Asian region? That contain aristolochic acid ingredients of traditional Chinese medicine, proprietary Chinese medicine, eat can lead to liver cancer? To counter the problem of public concern, the reporter interviewed leading experts.
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aristolochic acid has nephrotoxicity obviously, but cause of insufficient evidence of liver cancer
in order to assist the relevant state departments effectively cope with security issues, the Chinese medicine timely provide related clinical scientific research and information consulting, China academy of traditional Chinese medicine has a special organization held a panel discussion. The national center for drug approval, clinical pharmacy professional committee of China medicine institute also immediately led, combined liver disease branch of China association of Chinese medicine of traditional Chinese medicine (TCM), the world federation of Chinese medicine, the liver disease branch of Chinese pharmacological society drug-induced liver disease, liver disease at the Chinese academy of research hospital on professional committee, proprietary Chinese medicine branch of China association of Chinese medicine, the Chinese society of toxicology clinical toxicology, clubs and other academic institutions, in the people’s liberation army third second hospital, organization of Chinese and western medicine liver disease, cancer, kidney disease, diagnosis, pharmacology, toxicology and so on domestic well-known experts, & other; Aristolochic acid and the correlation of liver cancer and safe medication & throughout; Held a workshop.
it is understood that aristolochic acid exists in some Chinese herbal medicine, such as clearance also, wide acutum, radix aristolochiae, fairy cane, aristolochia, asarum, etc. The traditional Chinese medicine (TCM) is generally used to wind dampness, analgesic, anti-inflammatory, etc. A Chinese herbal medicine often have hundreds or even thousands of components, aristolochic acid is one of the thousands of components. Aristolochic acid exactly?
the people’s liberation army hospital of the 3rd they combine traditional Chinese and western medicine, the director of the center, and all the Chinese medicine institute, shaw river explained that aristolochic acid is a kind of plant secondary metabolites, which combined with the body’s DNA, forming & other; Aristolochic acid – DNA adduct & throughout; , may lead to renal tubular function damage, and may develop kidney failure, also can lead to upper tract urothelial carcinoma and bladder cancer. At present, the human gene mutation caused by aristolochic acid and urinary tract cancer, have been study at home and abroad, but the lack of evidence of liver cancer.
& other; In fact, this paper speculated that liver cancer is associated with aristolochic acid may, not sure aristolochic acid cause liver cancer, because of the lack of direct evidence. Throughout the &; China’s traditional Chinese medicine academy of sciences, explains zhang bl, what is the direct evidence? If the patient did eat traditional Chinese medicine (TCM) containing aristolochic acid, or inside the patient or liver cancer tissues, indeed detected aristolochic acid related components, such as & other Aristolochic acid – DNA adduct & throughout; , this is the direct evidence, but, but can’t find the evidence in this paper.
so, this paper is how to cancer of the liver with aristolochic acid linked? According to gabor king of army deputy director of the institute of Chinese medicine, the research by 98 cases of patients with liver cancer in Taiwan all exons sequencing, found that 78% of the patients exist aristolochic acid mutation spectrum related features. Through to the worldwide, other countries and regions further comparative study found that about 1400 cases of patients with cancer of the liver, 89 cases of liver cancer patient samples in mainland China, aristolochic acid in 47% of patients related gene mutation spectrum features. The study also found that aristolochic acid is widely involved in China and other Asian countries or regions of liver cancer, so may be a significant risk factor for liver cancer.
paper provide only indirect clues, special mutation is by no means unique aristolochic acid
xiao river, stressed that although the article suggests the aristolochic acid or risk factors for liver cancer, but because of the lack of conclusive evidence directly, and so, the correlation between aristolochic acid and liver cancer remains to be further confirmed.
at the same time, the xiao river, the study also exist the following problems: a history of medicine is the study of cases it is not clear, whether patients with relevant preparations containing aristolochic acid and its drugs type, component content, doses, time course, basic diseases, etc. It is not clear. 2 it is the key to the study the number of cases is less, sampling representativeness, objective authenticity is difficult to reflect different parts of the liver cancer. Three is related to the security of the signal is still lack of a complete chain of evidence, risk aristolochic acid and its derivatives and related gene mutation, the causal relationship between liver cancer remains to be further confirmed. And in Taiwan as early as in 2003, has banned the sale containing aristolochic acid preparations, but the paper compares the before and after 2003, containing aristolochic acid in proportion to the relevant characteristics of the mutation spectrum of liver cancer patients and no difference, although the paper points out that there is not yet fully the possibility of a ban on the sale, or liver cancer compared with aristolochic acid exposure lag, but still not enough to explain the state of no difference before and after the ban in 2003.
liang, a researcher at the Chinese academy of sciences institute of traditional Chinese medicine of traditional Chinese medicine, also said in the paper only provides an indirect clues. The study adopted the gene sequencing method for liver cancer samples collected for testing, the results found in the detection of liver samples, sample of Taiwan and the mainland are 78% and 47% respectively presents a special kind of mutation types, namely, & other A: T> T: A” Mutation, they call this mutation type & other Aristolochic acid fingerprint & throughout; . That is to say, they think that the mutation type, only by aristolochic acid can cause other carcinogens won’t have this kind of mutation. However, authoritative professional magazine “cancer” in 1994 published a paper, confirmed that the vinyl chloride can cause gene mutations, mutation type to & other; A: T→ T: A” Give priority to, and can cause liver hemangioma and liver cancer. That is to say, in addition to aristolochic acid, other carcinogens can also cause & other; A: T→ T: A” Mutation, is not a characteristic of aristolochic acid. Liang said, how can this be & other; Aristolochic acid fingerprint & throughout; ? What’s more, there are many other carcinogens, will produce what kind of mutation, there is no clear all research.
most liver cancer caused by hepatitis b virus (HBV) infection, deal with the general public science
the relevant person in charge of state food and drug supervision bureau said that according to epidemiological big sample, data analysis, liver cancer patients in our country is mainly caused by the hepatitis b virus infection. , said the state administration of traditional Chinese medicine, deputy director of the week is it to respond positively, and the social public to carry out the science popularization propaganda.
liang said, and some Asian countries and regions in our country, second liver is the main cause of liver cancer, this is the consensus of the medical profession. But according to the logic, the paper aristolochic acid has become the mainland and the main factors of liver cancer in Taiwan area, this is obviously contrary to the reality and medical knowledge. Moreover, published in science translational medicine, this paper mentioned Taiwan, 98 cases of liver cancer samples, only 10 cases of hepatitis b virus is negative, that is, the vast majority of the samples is positive for hepatitis, more about isn’t the liver cancer and hepatitis?
in addition, the current has certain carcinogenic factors are many, including the chemical material such as vinyl chloride, benzene; Drugs such as estrogen, ultraviolet, X-ray; Food carcinogenic ingredients such as bacon, nitrosamines in salted fish and pickled vegetables. Similarly, menopausal women moderate supplement estrogen does not cause cancer, but too much and take too long, may cause cancer. And excessively in the sunshine, can lead to skin cancer, but everyday bask in the sun, will not be getting skin cancer. Therefore, deputy director of the China institute of traditional Chinese medicine academy of sciences xiao-xin zhu believes that some Chinese medicine indeed there may be side effects, which is really alarming, but don’t panic, more do not need to isolate.
no drug can large doses for a long time, must be strictly prescribed
at present, countries have strict limitation on related drug content. For example, the regulation of asarum aristolochic acid content must be less than one over one hundred thousand. “Chinese pharmacopoeia” regulation, the dosage of the asarum is 2 g to 3 g a day. That is to say, asarum, amount of aristolochic acid a day can’t more than 30 micrograms, plus decoction is only part of the solution, when the patients take has extremely trace. & other; Traditional Chinese medicine instruction, of course, also need to further standardize and possible adverse reactions to give tips, pay attention to when to remind people to use. Throughout the &; Zhu Xiao shin.
the relevant person in charge of state food and drug supervision bureau also said that herbs containing aristolochic acid used in China for thousands of years of history. In the wei jin southern and northern dynasties period of the “medicinal theory”, it has a record of aristolochiaceae medicinal materials of medicine, such as aristolochic & other; Primary pulmonary gas on urgent, sit rates shall not, cough inverse repeatedly not & throughout; The efficacy. Currently, contains the Chinese pharmacopoeia, the customer standards and local standards for the discharge of medicinal aristolochiaceae herbs have 24 kinds, proprietary Chinese medicine oral preparations containing aristolochia genus medicinal materials have 47, both are available in the administration of the government website. Patients should be used in strict accordance with the doctors’ prescriptions and the doctor’s advice.