Elsevier

Food and Chemical Toxicology

Volume 145, November 2020, 111699
Food and Chemical Toxicology

Review
Curcumin as a preventive or therapeutic measure for chemotherapy and radiotherapy induced adverse reaction: A comprehensive review

https://doi.org/10.1016/j.fct.2020.111699 Get rights and content

Highlights

  • Curcumin prevents the chemotherapy and radiotherapy induced adverse reactions.

  • Antioxidative and anti-inflammation are the main proposed mechanism of action.

  • Curcumin has wide tolerable therapeutic range of dose with minimal side effects.

Abstract

Curcumin has attracted much attention for medicinal purposes in wide range of illnesses including cancer. In some studies, its efficacy is evaluated against chemotherapy and radiotherapy induced adverse reaction and also as adjuvant to cancer treatment. Here we have tried to present a comprehensive review on protective and therapeutic effect of curcumin against these side effects.

Method

The data were collected by searching Scopus, PubMed, Medline, and Cochrane database systematic reviews, using key words “nephrotoxicity”, “cardiotoxicity”, “genotoxicity”, “ototoxicity”, “hepatotoxicity”, “reproductive toxicity”, “myelosuppression”, “pulmonary toxicity”, “radiotherapy induced side effect” with “turmeric” and “curcumin”.

Although curcumin has low bioavailability, it has shown brilliant profile on prevention and management of chemotherapy and radiotherapy induced adverse reactions, particularly based on in vitro and in vivo studies and limited number of human studies on radiotherapy adverse reactions. Antioxidant and anti-inflammatory properties of the curcumin are the main proposed mechanism of action for management and prevention of adverse reactions.

One of the major points regarding the protective effect of curcumin is its wide tolerable therapeutic range of dose with minimal side effects. Furthermore, new nano-formulations help to improve the bioavailability, increase in efficacy and lower the adverse effects.

In conclusion, based on the present knowledge, curcumin has significant supportive potential in patients receiving chemotherapy or radiotherapy and may be suggested as adjutant with cancer treatments. Further well-designed human studies are recommended.

Introduction

Cancer is the first leading cause of mortality in economically developed countries and the second one in developing countries. Cancer dramatically affects human life expectancy and quality of life. There are many therapeutic options for cancer but their adverse reactions have limited their efficacy. Actually, treatment is associated with both acute and long-term complications for the cancer survivor. The frequency and severity of these side effects vary according to the medication type, dose and rout of administration. Because of possible negative effect on outcome it can interrupt the treatment in severe cases or result in dose reduction (Hymes et al., 2006). Herbal medicines and phytocompounds have gained much attention as remedies for management of chemotherapy and radiotherapy induced adverse reaction. In this review we focused on turmeric and its main active compound, curcumin as a useful remedy for management of chemotherapy and radiotherapy induced adverse reactions.

Section snippets

Method

The data were collected by searching PubMed, Scopus, Google Scholar and Medline databases from commencement to July 2020. Keywords included “nephrotoxicity”, “cardiotoxicity”, “genotoxicity”, “ototoxicity”, “hepatotoxicity”, “reproductive toxicity”, “myelosuppression”, “pulmonary toxicity”, “radiotherapy induced side effect”, “cancer”, “ovarian failure”, “bone marrow suppression”, “radiodermatitis”, “radiation induced mucositis”, “radiation induced dermatitis” with “turmeric” and “curcumin”.

Turmeric and curcumin: description and phytochemical

Turmeric, Curcuma longa Linn, is a rhizomatus mono-cotyledonous perennial plant from the family, Zingiberaceae, and is generally grown in south and southeast tropical Asia. Since 1280 it has been known as a remedy, dye and spice. Curcuma contains 8. 6% protein, 60–70% carbohydrate, 2–7% fiber, 5–10% fat, 3–5% curcuminoids (50–70% curcumin) and up to 5% essential oils and resins. The compound of curcuminoids is consisting of nearly 70% curcumin (curcumin I), 17% demethoxycurcumin (curcumin II),

Main protective mechanism of action

Curcumin activates anti-inflammatory process by modulating different signaling molecules. It can inhibit the activation of prostaglandin biosynthesis, c-Jun/AP-1, protein kinases and cyclooxygenase (COX)-2 expression and activity. Curcumin is an oxygen scavenger and inhibits lipid peroxidation likewise DNA damage induce by peroxide (Fig. 1) (Zhou et al., 2011).

This review provides a summary about radio- and chemoprotective features of turmeric and its main component's curcumin in various organs

Radio protective effect

Radiotherapy (RT) is a widely used modality in various cancers beside chemotherapy and surgery. Radiation-induced skin reactions (RISRs) are one of the Oxidative stress (OS) and Inflammation related issues which can occur in up to 95% of patients. It especially happens in patients with skin cancer, breast cancer, head and neck cancer, lung cancer, or sarcoma. Acute and chronic reactions are the subtypes of RISRs (Wei et al., 2019).

Radiation-induced epidermal damage can be prevented by curcumin

Adverse effects of curcumin

Although the use of curcumin as culinary agent date back to ancient times and its safety has been documented in clinical trials on healthy subjects, some minor side effects have been reported. The Allowable Daily Intake (ADI) value of curcumin has been reported 0–3 mg/kg body weight. Up to 12 g/day of oral dose has shown to be tolerated without obvious adverse effects (Nelson et al., 2017). Diarrhea, headache, rash, and yellow stool were the main adverse events reported in 7 subjects receiving

Pharmacokinetic

Curcumin showed poor systemic bioavailability following oral dosing, in animal models and phase I clinical studies on healthy volunteers and also patients with cancer. Some degree of intestinal and hepatic first-pass metabolism, exclusively sulfation and glucuronidation of curcumin, can result in low systemic bioavailability after oral administration (Sharma et al., 2007; Vareed et al., 2008). Even high dose of curcumin has been well tolerated but totally the absorption of the compound is

Conclusion

There are lots in vitro and in vivo evidence suggesting that use of curcumin is potentially beneficial and safe in most of the chemotherapy or radiotherapy associated adverse effect management or prevention especially for nephrotoxicity and cardiotoxicity; however, most of them are animal studies. Just for management and prevention of radiotherapy induced dermatitis and mucositis some human studies with promising findings are available which they used oral or topical form of curcumin.

Thus,

Funding

This work has been supported by Research Affairs of Mashhad University of Medical Sciences. Mashhad, Iran.

Conflict of interest

None.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

This study was performed in Mashhad University of Medical Sciences, Mashhad, Iran.

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