Abstract
Curcumin, a natural polyphenolic compound derived from the South Asian turmeric plant (Curcuma longa), has well-characterized antioxidant, anti-inflammatory, anti-protein-aggregate, and anticancer properties. Neuroblastoma (NB) is a cancer of the nervous system that arises primarily in pediatric patients. In order to reduce the multiple disadvantages and side effects of conventional oncologic modalities and to potentially overcome cancer drug resistance, natural substances such as curcumin are examined as complementary and supportive therapies against NB. In NB cell lines, curcumin by itself promotes apoptosis and cell cycle arrest through the suppression of serine–threonine kinase Akt and nuclear factor kappa of activated B-cells (NF-κB) signaling, induction of mitochondrial dysfunction, and upregulation of p53 and caspase signaling. While curcumin demonstrates anti-NB efficacy in vitro, cross-validation between NB cell types is currently lacking for many of its specific mechanistic activities. Furthermore, curcumin’s low bioavailability by oral administration, poor absorption, and relative insolubility in water pose challenges to its clinical introduction. Numerous curcumin formulations, including nanoparticles, nanocarriers, and microemulsions, have been developed, with these having some success in the treatment of NB. In the future, standardization and further basic and preclinical trials will be required to ensure the safety of curcumin formulations. While the administration of curcumin is clinically safe even at high doses, clinical trials are necessary to substantiate the practical efficacy of curcumin in the prevention and treatment of NB.
Highlights
Neuroblastoma (NB) is a solid pediatric tumor of the nervous system that arises from neural progenitor cells
Mitochondrial dysfunction leads to the release of cytochrome c, as observed in SK-N-SH cells treated with doxorubicin and B50 cells treated with cisplatin [94,96]
Epigenetic modifications that occur during tumor progression are potentially reversible, with consequent diminishment of the Warburg effect [118,119]. These results suggest that the Warburg effect, in which decreased vascularization, nutrient deprivation, and hypoxia lead to a tumor microenvironment with low pH, is a reversible process that may be targeted by curcumin
Summary
Neuroblastoma (NB) is a solid pediatric tumor of the nervous system that arises from neural progenitor cells. A treatment regimen for high-risk NB could include the following: (1) induction chemotherapy with cisplatin, carboplatin, etoposide, vincristine, and cyclophosphamide; (2) surgical removal of the primary tumor, with or without additional topotecan, vincristine, and doxorubicin therapy; (3) consolidation chemotherapy utilizing busulfan and melphalan, or carboplatin, etoposide, and melphalan; (4) stem cell rescue; (5) radiation therapy; and (6) maintenance chemotherapy, with or without immunotherapy [11]. These often complex and multifaceted conventional treatment regimens are clinically trialed and effective. P53-dependent cell death in various tumor cells can be and effectively activated by treatment with the naturally occurring polyphenol curcumin [41]
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