Artemisinin represents a showcase example not only for the activity of medicinal herbs deriving from traditional chinese medicine, but for phytotherapy in general. Its isolation from Sweet Wormwood (qinhao, Artemisia annua L.) represents the starting point for an unprecedent success story in the treatment of malaria worldwide. Beyond the therapeutic value against Plasmodium parasites, it turned out in recent years that the bioactivity of artemisinin is not restricted to malaria. We and others found that this sesquiterpenoid also exerts profound anticancer activity in vitro and in vivo. Artemisinin-type drugs exert multi-factorial cellular and molecular actions in cancer cells. Ferrous iron reacts with artemisinin, which leads to the formation of reactive oxygen species and ultimately to a plethora anticancer effects of artemisinins, e.g. expression of antioxidant response genes, cell cycle arrest (G1 as well as G2 phase arrests), DNA damage that is repaird by base excision repair, homogous recombination and non-homologous end-joining, as well as different modes of cell death (intrinsic and extrinsic apoptosis, autophagy, necrosis, necroptosis, oncosis, and ferroptosis). Furthermore, artemisinins inhibit neoangiogenesis in tumors. The signaling of major transcription factors (NF-κB, MYC/MAX, AP-1, CREBP, mTOR etc.) and signaling pathways are affected by artemisinins (e.g. Wnt/β-catenin pathway, AMPK pathway, metastatic pathways, nitric oxide signaling, and others). Several case reports on the compassionate use of artemisinins as well as clinical Phase I/II pilot studies indicate the clinical activity of artemisinins in veterinary and human cancer patients. Larger scale of Phase II and III clinical studies are required now to further develop artemisinin-type compounds as novel anticancer drugs. Abbreviations: ABCB6, ATP-binding Cassette Transporter B6; ABCG2, ATP Binding Cassette Transporter G2; AIF, Apoptosis Inducing Factor; AKT, V-Akt Murine Thymoma Viral Oncogene Homologue; AMPK, AMP-Activated Protein Kinase; Ang-1, Angiotensin 1; ARE, Arteether; ARM, Artemether; ARS, Artemisinin; ART, Artesunate; ATF4, Activating Transcription Factor 4; Bak, Bcl2 Antagonist/Killer 1; Bax, Bcl2-Associated X Protein, Pro-Apoptotic BH3-Only Bcl-2 Family Member; Bcl-2, B-cell CLL/lymphoma 2; Bcl-xL, B-cell CLL/Lymphoma-x Long; BCR/ABL, Breakpoint Cluster Region/Abl Proto-Oncogene; Bid, BH3-Interacting Domain Death Agonist; Bim, Pro-Apoptotic Bcl2- Family Member; BSO, Buthionine Sulfoximine; C/EBP β, CCAAT/Enhancer Binding Protein β; CAM, Chorioallantoic Membrane; CD, Cluster of Differentiation; CDC25B; CDK, Cyclin-Dependent Kinase; CHOP/DDIT, DNA Damage-Inducible Transcript; CIP1/WAF1, CDK-Interacting Protein 1/Wild-Type p53-Activated Fragment 1; c-JUN, Jun Proto-Oncogene; COX2, Cyclooxygenase 2; CREB, Cyclic ATP Responsive Element Binding Protein; DHA, Dihydroartesunate; DNA-PK, DNA-Dependent Protein Kinase; DR5, Death Receptor 5; E2F1, E2F Transcription Factor 1; EA, Ethacrynic Acid; EGFR, Epidermal Growth Factor Receptor; EMT, Epithelial to Mesenchymal Transition; EndoG, Endonuclease G; ERK, Extracellular Signal-Regulated Kinase; FAK, Focal Adhesion Kinase; FAS, Fas Cell Surface Death Receptor; Flt-1, Fms- Related Tyrosine Kinase 1; GADD153, Growth Arrest and DNA Damage-Inducible 153; GRP78, Glucose-Regulated Protein; GSK3 β, Glycogen Synthase Kinase 3 β; HIF-1α, Hypoxia-Inducible Factor-1 α; HPV39, Human Papilloma Virus 39; HR, Homologous Repair; hTERT, Human Telomerase Reverse Transcriptase; hTR, Human Telomerase; HUVEC, Human Umbilical Vein Endothelial Cells; IFN, Interferon; IL, Interleukin; IκBβ, Inhibitor of Kappa B β; JNK, c-Jun N-Terminal Kinase; KDR/flk-1, Kinase Insert Domain Receptor; LC3, Microtubule- Associated Protein 1 Light Chain 3; MAPK, Nitogen-Activated Protein Kinase; MAX, MYC-Associated Factor X; Mcl-1, Myeloid Cell Leukemia 1; MDM2, Mouse Double Minute 2 Homologue; MEK, also known as MAPKK, Mitogen-Activated Protein Kinase Kinase; MMP, Matrix Metalloproteinase; MPNST, Malignant Peripheral Nerve Sheath Tumor; mTOR, Mammalian Target of Rapamycin; MYC, Avian Myelomastosis Viral Oncogene Homologue; NAC, N-Acetyl Cysteine; NFκB, Nuclear Factor Kappa B; NHEJ, Non-Homologous End-Joining; NO, Nitric Oxide; NOXA, Also Known As PMA/P1; Phorbol-12-Myristate-13-Acetate-Induced Protein 1; PARK7, Parkinson Disease Protein 7, Protein Deglycase DJ-1; PARP, Poly ADP Ribose Polymerase; PCNA, Proliferating Cell Nuclear Antigen; PGE2, Prostaglandine E2; PI3-K, Phospoinositide-3 Kinase; PMA, Phorbol-12-Myristate-13-Acetate; RAF, Ras-Associated Factor Proto-Oncogene; RAS, Rat Sarcoma Viral Oncogene Homologue; RKIP, Raf-1 Kinase Inhibitor Protein; ROS, Reactive Oxygen Species, SMAC/DIABLO, IAP-Binding Mitochondrial Protein; TCTP, Translationally Controlled Tumor Protein; TF, Transferrin; TFRC, Transferrin Receptor 1 Gene; TGB1, Triple Gene Block Protein β, TGF-beta, Tumor Growth Factor β, TIMP, Tissue Inhibitor of Metalloproteinase, TNF-α, Tumor Necrosis Factor α, TOPO2 A, DNA Topoisomerase 2 α, TRAIL, Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand, Treg, Regulatory T Cells, VDAC2, Voltage-Dependent Anion Channel 2, VEGF, Vascular Endothelial Growth Factor, VEGFR, Vascular Endothelial Growth Factor Receptor, XIAP, X-Linked Inhibitor of Apoptosis, YY1, Yin Yang 1
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