Recently, Science Translational Medicine pointed out that 78% of the 98 hepatocellular carcinoma (HCC) samples from Taiwan, China, showed distinctive signatures of aristolochic acids (AAs) exposure. In addition, 47% of the HCC samples from mainland China, 29% from Southeast Asia, 13% from Korea, and 2.7% from Japan showed AA signatures, which is much higher than those in North America and Europe, by searching for the AAs signature in 1,400 HCC samples from around the world. Researchers have suggested that there is a distinct relationship between AAs and HCC occurrence in Asia. As soon as the news comes out, the medical community is immediately triggered. Does AAs truly cause the occurrence of HCC?
AAs are not really just a compound and usually refer to several compounds from the aristolochiaceae plants that contain substituted phenanthrenes. There are over six hundreds of plants that contain AAs in the world, including sixty-five kinds of traditional Chinese medicine (TCM).
However, some experts in the industry have questioned the association between AAs and cancer. Firstly, are cancer-associated mutations caused by AAs themselves? The previous study failed to report when its patients began the treatment with AA-containing drugs and the amount of the administered dose. Secondly, this paper points out that AAs mutational signatures are mostly non-silent mutations in known oncogenic driver genes. However, HCC occurrences are caused by a variety of factors, and AAs-induced gene mutations may be only one such factor. Finally, if TCM is abused, heavy metal pollution of the TCM may be responsible for HCC occurrence, and therefore AAs would be related to the occurrence of HCC rather than have a direct causal relationship.
This special issue of cancer prevention and treatment will focus on the latest research on the effects of TCM in the prevention and treatment of cancer.