A Scoping Review on Medicinal Properties of Piper betle (Sirih) Based on Malay Medical Manuscripts and Scientific Literatures.

Background: Malay medical manuscripts have deciphered the medicinal value of Piper betle (sirih) enormously. In this review, an effort was made to explore the medicinal use of P. betle and correlate this information with the scientific evidence. Methods: The information regarding the use of P. betle was retrieved from the books consisting of a Malay medical manuscript with an identification number MSS 2219 from the National Library of Malaysia. PubMed, ScienceDirect and Scopus databases were used to collect information regarding the scientific evidence for the medicinal use of P. betle. This review was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The keywords used for searching the articles included P. betle, antimicrobial, analgaesic, haepatic and gastric. Results: MSS 2219 showed that P. betle has varied medicinal uses and based on that, it can be grouped into six categories. P. betle application method was different in different conditions. In terms of the literature search, 226 articles were found, 75 articles were extracted for detailed analysis and only 23 met the inclusion criteria. The information was related to the chemical assays, in vivo and in vitro studies. Conclusion: In summary, P. betle has the potential to treat medical conditions in various types of categories as recorded in the Malay medical manuscripts and also based on scientific publications. For clinical purposes, more information is required, such as the specific mechanism involved, the best extraction method and the best dosage for treatment.

Prognostic significance of elongator protein 3 expression in endometrioid adenocarcinoma.

Elongator protein 3 (ELP3), the catalytic subunit of the elongator complex of RNA polymerase II, is involved in various functions, including transcriptional elongation, chromatin modification and cytoskeletal regulation. In this study, ELP3 expression was immunohistochemically examined in normal uterus tissue and uterine endometrioid adenocarcinoma tissue. ELP3 was abundantly expressed in both the proliferative and secretory phases of the endometrial cycle. However, ELP3 expression levels varied among cases of endometrioid adenocarcinoma. In patients with endometrioid adenocarcinoma, a low ELP3 expression was correlated to a high T-factor (p=0.036), tumor stage (p=0.001), lymph node metastasis (p<0.001), resistance to chemotherapy (p=0.045), recurrence (p=0.004) and poor prognosis (p=0.003). Univariate and multivariate analyses revealed that a low ELP3 expression was an independent factor for poor prognosis. In conclusion, this is the first study to examine the clinical implications of ELP3 expression in cancer.

Reactive oxygen species and aldehyde dehydrogenase activity in Hodgkin lymphoma cells.

Tumor cells with tumorigenic potential might be limited to a small population of cells, called cancer-initiating cells (CICs). CICs efficiently form colonies in vitro, yield both CIC and non-CIC populations, maintain reactive oxygen species (ROS) at low levels, show high aldehyde dehydrogenase (ALDH) activity, and are mostly in a quiescent state of the cell cycle. CICs of Hodgkin lymphoma (HL) are small in size, with low levels of ROS. The relationship between ROS level and ALDH activity in CICs was examined in HL cell lines. ROS-low and ALDH-high populations formed colonies in semi-solid cultures more efficiently than ROS-high and ALDH-low populations. ALDH-high populations yielded both ALDH-low and -high populations, whereas ALDH-low populations rarely yielded an ALDH-high population. The number of cells in a quiescent state was significantly greater in ROS-low than in ROS-high cells, whereas that of ALDH-high and ALDH-low cells was comparable to each other. These findings show that ALDH-high and ROS-low cells share CIC-like potential, but they differ in their cell cycle status, suggesting that CICs are comprised of cells with heterogeneous characteristics.

Role of leucine-rich pentatricopeptide repeat motif-containing protein (LRPPRC) for anti-apoptosis and tumourigenesis in cancers.

Due to accelerated energy consumption, enhanced function of mitochondria in tumour cells compared to normal cells is prerequisite for tumour development. Leucine-rich pentatricopeptide repeat motif-containing protein (LRPPRC) regulates the expression of all mitochondrial DNA-encoded mRNAs, thus plays an important role in the mitochondrial function. LRPPRC is abundantly expressed in the side population of lung adenocarcinoma cell lines, where cancer stem cells are enriched. However, the role of LRPPRC in tumour development remained to be clarified in detail. Here, the expression of LRPPRC was examined in various types of tumours, such as lung adenocarcinoma, oesophageal squamous cell carcinoma, stomach, colon, mammary and endometrial adenocarcinoma, and lymphoma. Immunohistochemistry revealed that all kinds of examined tumours abundantly expressed LRPPRC. In contrast, surrounding non-neoplastic cells hardly expressed LRPPRC. The knocked-down expression of LRPPRC in lung adenocarcinoma cells did not affect amount of side population and activity of aldehyde dehydrogenase 1, known to be highly expressed in cancer stem cells of the lung. However, the knocked-down expression of LRPPRC reduced the abilities for anti-apoptosis, invasion and in vitro colony formation in lung adenocarcinoma, as well as Hodgkin lymphoma cells. Double staining of LRPPRC with active caspase-3 in clinical samples of lung adenocarcinoma revealed that apoptotic cells were hardly observed in LRPPRC-expressing tumours. These findings indicate that LRPPRC played an important role in tumourigenesis through the resistance to apoptosis and high invasive activity.

Expression of aldehyde dehydrogenase 1 (ALDH1) in endometrioid adenocarcinoma and its clinical implications.

Aldehyde dehydrogenase 1 (ALDH1) is expressed in stem/progenitor cells, including cancer-initiating cells (CIC) of various organs. In the present study, ALDH1 expression was immunohistochemically examined in uterine endometrioid adenocarcinoma. The ALDH1 was expressed in a small portion of tumor cells, and these ALDH1-expressing cells were less mature than ALDH1-non-expressing cells. The ALDH1-expressing (ALDH1-hi) cells were more tumorigenic, resistant to anti-cancer agents and more invasive than ALDH1-lo cells. Culture of the sorted ALDH1-hi cells yielded both ALDH1-hi and ALDH1-lo cells, whereas ALDH1-lo cells yielded ALDH-lo cells alone. Clinically, a high-level of ALDH1 expression in tumor cells was correlated with T category, lymphatic invasion, recurrence and prognosis of patients. Patients with high ALDH1 expression showed poorer prognoses than those with low expression (P = 0.015 for disease-free survival [DFS] and P = 0.010 for overall survival [OS]), and high ALDH1 expression was an independent factor for poor prognosis. Aldehyde dehydrogenase 1 is a candidate for CIC marker for uterine endometrioid adenocarcinoma.

Transcriptional Regulation of Aldehyde Dehydrogenase 1A1 Gene by Alternative Spliced Forms of Nuclear Factor Y in Tumorigenic Population of Endometrial Adenocarcinoma.

High activity of aldehyde dehydrogenase (ALDH) is characteristic of normal and cancerous stem cells. Recently, high ALDH expression was shown to be associated with poor prognosis in uterine endometrial adenocarcinoma. The population with high ALDH activity (ALDH-hi) was more invasive, anti-apoptotic, and tumorigenic than that with low activity (ALDH-lo). Here, the transcriptional regulation of ALDH1A1 gene, which is responsible for ALDH activity, was examined in endometrial adenocarcinoma. The promoter region of ALDH1A1 contained CCAAT and octamer binding motifs, and their mutation diminished promoter activity. Among CCAAT-recognizing transcription factors, nuclear factor YA (NFYA) was involved in ALDH1A1 transcription. Two alternatively spliced isoforms of NFYA (NFYA-long and NFYA-short) have been reported. The sorted ALDH-hi population of endometrial adenocarcinoma preferentially expressed NFYA-short, whereas ALDH-lo dominantly expressed NFYA-long. NFYA-short possessed higher transactivation ability than did NFYA-long. In addition, an additive effect of NFYA with Oct-1, which recognizes octamer binding motif, was observed in ALDH1A1 transactivation. These results indicate that the alternatively spliced isoforms of NFYA, in cooperation with Oct-1, play an important role in ALDH1A1 expression in endometrial adenocarcinoma.

Tumorigenic potential of mononucleated small cells of Hodgkin lymphoma cell lines.

Tumor cells with tumorigenic potential are limited to a small cell population known as cancer stem cells (CSCs). CSCs yield both CSCs and non-CSCs, whereas non-CSCs do not yield CSCs. CSCs have not been identified in any malignant lymphomas. Hodgkin lymphoma (HL) is a mostly B-cell neoplasm that can be diagnosed by the presence of multinucleated (Reed-Sternberg; RS) cells admixed with Hodgkin cells with distinct nucleoli and various inflammatory cells. Here, the tumorigenic potential of cells with a single nucleus (S) and cells with multiple nuclei (M), which may be equivalent to Hodgkin and RS cells, respectively, was examined in HL cell lines L1236 and L428. Cultures of single S cells yielded both S and M cells, whereas M cell cultures yielded only M cells. When either cultured in methylcellulose or inoculated into NOD/SCID mice, the colony number and tumor size were both larger in S than in M cells. Concentrations of intracellular reactive oxygen species (ROS) were at low levels in a portion of S cells that abundantly expressed FoxO3a, a transcription factor that regulates ROS-degrading enzymes. In clinical samples of HL, FoxO3a was expressed in mononuclear Hodgkin cells but not in multinucleated RS cells. These findings suggest that smaller cells or Hodgkin cells that show low-ROS concentrations and high FoxO3a expression levels might be candidates for HL CSCs.

Prognostic significance of CUB domain containing protein expression in endometrioid adenocarcinoma.

CDCP1, a transmembrane protein with intracellular tyrosine residues which are phosphorylated upon activation, is supposed to be engaged in proliferative activities and resistance to apoptosis of cancer cells. High level of CDCP1 expression proved to be a poor prognosticator for lung adenocarcinoma. Here, expression level of CDCP1 was immunohistochemically examined in 110 cases (median age of 54.7 years) of endometrioid adenocarcinoma, and its clinical implications were evaluated. Tumor stage was stage I in 71 cases (64.5%), II in 5 (4.5%), III in 28 (25.5%), and IV in 6 (5.5%). Staining intensity of tumor cells was divided into two categories; tumor cells with no to weak and moderate to strong membrane staining. The intensity of CDCP1 expression in each case was defined by the staining of major population of cells as follows; cases with tumor cells showing no to weak and moderate to high membrane staining were categorized as CDCP1-low and CDCP1-high, respectively. Eighty-seven of 110 cases were categorized as CDCP1-high, and the remaining as CDCP1-low. Significant positive correlation was observed between low CDCP1 expression and stage (p=0.0091), relapse rate (p=0.0017), and poor prognosis (p=0.0009). Multivariate analysis revealed that low CDCP1 and advanced stage were independent poor prognostic factors for both OS and DFS. As compared to cancer cells, normal endometrium continuously expressed CDCP1. These suggested that the attitude of CDCP1 in cancers of lung and endometrium was different. Different role of CDCP1 by tissues and cancers is discussed.

Tumorigenic role of podoplanin in esophageal squamous-cell carcinoma.

BACKGROUND: Podoplanin, a mucin-type transmembrane glycoprotein, is thought to be one of the cancer stem cell markers for squamous-cell carcinoma of the vulva. The objectives of the present study were to examine the role of podoplanin in esophageal squamous-cell carcinoma (ESCC). METHODS: Expression of podoplanin was examined immunohistochemically in 61 cases of ESCC that had not been treated with chemotherapy or radiotherapy before surgery. Because cancer stem-cell quantities have been reported to increase with chemotherapy and radiotherapy, cases in patients who did not receive such prior therapies were included in this study. Cases with >10% tumor cells showing signals for podoplanin were categorized as podoplanin high, and the others were classified as podoplanin low. The effects of podoplanin on the behavior of cancer cells were evaluated in ESCC cell lines in which podoplanin expression was knocked down. RESULTS: To examine whether podoplanin could be used as a cancer stem cell marker for ESCC, podoplanin-positive and podoplanin-negative fractions were sorted separately from the ESCC cell line and cultured. Podoplanin-positive ESCC cells yielded both podoplanin-positive and podoplanin-negative cells, whereas few cells were obtained from podoplanin-negative ESCC cells. When podoplanin expression was knocked down, ESCC cell lines became vulnerable to anticancer drugs and showed defective invasion and tumorigenic activities. Nineteen (31.1%) of 61 cases were categorized as podoplanin high. Podoplanin-high cases were correlated with T category, stage of disease, lymphatic and vascular invasion, recurrence, and prognosis of patients. Podoplanin-low cases showed better overall and disease-free survival. CONCLUSIONS: There is a role for podoplanin in tumorigenesis and malignant progression in ESCC.