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A R T I C L E
I N F O
Article history:
Received 16 January 2015
Received in revised form 12 March 2015
Accepted 12 March 2015
Keywords:
Garcinia indica
Garcinol
Pharmacodynamics
Pharmacokinetics
Toxicology
A B S T R A C T
Garcinol is the main medicinal component of the dried fruit rind of Garcinia indica (G. indica), which has
traditionally been extensively used to treat gastric ailments and skin irritation. In vitro studies of garcinol
revealed its potential therapeutic effects, such as its anti-oxidative, anti-inflammatory and anti-cancer
properties. Similarly, in vivo studies in animal models also demonstrated the ecacy of garcinol for the
treatment of various inflammatory and cancerous conditions. Despite being well tolerated in preclinical studies, the toxicological profile of garcinol remains elusive. More importantly, systematic
pharmacokinetics (PK) studies of garcinol to establish an appropriate route of administration and its effective concentration range under physiological conditions have not yet been performed. PK studies play
an essential role in translating the preclinical findings of garcinol from cell line models and animal species
to humans, thereby facilitating dose selection, the characterization of the therapeutic index, identification of a metabolic pathway, and the determination of garcinols potency and tolerability. This paper reviews
the current studies of garcinol as a potential anti-oxidant, anti-inflammatory and anti-cancer agent and
highlights the importance of performing preclinical PK and toxicological studies on garcinol for its development pipeline.
2015 Elsevier Ireland Ltd. All rights reserved.
Introduction
Garcinia indica (G. indica, also known as kokum) is a small tropical evergreen tree that was first discovered in the Western Ghats
of India [1]. Natural compounds that have been isolated from the
Abbreviations: G. indica, Garcinia indica; PD, pharmacodynamics; PK, pharmacokinetics; ADME, absorption, distribution, metabolism and elimination; OH,
hydroxyl radical; ROS, reactive oxygen species; DPPH, 1,1-diphenyl-2-picrylhydrazyl;
NFB, nuclear factor-k B; iNOS, inducible nitric oxide synthase; NO, nitric oxide;
ERK1/2, extracellular signal-regulated kinase; MAPK, P38/Mitogen-activated protein
kinase; cPLA2, cytosolic phospholipases A2; PGs, prostaglandins; COX-2,
cyclooxygenase-2; 5-LOX, 5-Lipoxygenase; LTs, leukotrienes; PI3K, phosphoinositide
3-kinase; Akt, serine/threonine-specific protein kinase; CDKIs, cyclin-dependent
kinases inhibitors; HAT, histone acetyltransferase; p300/PCAF, P300/CBP-associated
factor; miRNAs, micro RNAs; MMPs, metalloproteinases; VEGFs, vascular endothelial growth factors; ACF, aberrant crypt foci; Cmax, maximum concentration; Tmax,
time to maximum concentration; t1/2, elimination half-life; HCC, hepatocarcinoma;
HNSCC, head and neck squamous cell carcinoma).
* Corresponding author. Tel.: +6565168925; fax: +6568739664.
E-mail addresses: csiwl@nus.edu.sg (L.Z. Wang).
** Corresponding author. Tel.: +6565168925; fax: +6568739664.
E-mail addresses: phcgbc@nus.edu.sg (B.C. Goh).
http://dx.doi.org/10.1016/j.canlet.2015.03.019
0304-3835/ 2015 Elsevier Ireland Ltd. All rights reserved.
Fig. 1. A: Chemical structure of garcinol extracted from Garcinia indica. B: Structure of cambogin extracted from Garcinia cambogia. C: Structure of xanthochymol extracted
from Garcinia xanthochymus [10].
10
from the bark of the willow tree and one of the most important antiinflammatory drugs in clinical use. Current studies have shown that
garcinol exhibits an anti-inflammatory effect by interfering with
various inflammatory cascades. First, garcinol was found to affect
the nuclear factor NFkB signaling pathway. A study showed that
garcinol suppressed inducible nitric oxide synthase (iNOS) synthesis most effectively at 5 M by inhibiting NFkB activation, leading
to reduced nitric oxide (NO) generation [19], a known physiologic
free radical believed to be elevated in neurodegenerative diseases,
diabetes and rheumatoid arthritis [20]. Moreover, extracellular signalregulated kinase 1/2 (ERK1/2), a protein kinase of the P38/Mitogenactivated protein kinase (MAPK) family, can also mediate the
inflammation process [21]. Under normal physiological conditions, phosphorylated ERK1/2 activates cytosolic phospholipases A2
(cPLA2) and leads to the formation of COX-2, an enzyme that produces prostaglandins (PGs) [22]. In lipopolysaccharide-activated
macrophages, 1 M garcinol inhibited the production of COX-2 and
PGs. The proposed mechanism of action involves interference with
the LPS-mediated phosphorylation of ERK1/2, which reduces the
level of COX-2 products in LPS-stimulated cells [23]. The third antiinflammatory pathway of garcinol was found to be related to
5-lipoxygenase (5-LOX) activation, which is responsible for producing inflammatory molecules, such as leukotrienes (LTs) [22].
Garcinol inhibited the activation of 5-LOX at IC50 values of 0.1 M
in in vitro cell-free assays and 1.9 M in cellular studies [24]. This
difference could be due to the lower activity of garcinol on intracellular 5-LOX [24]. Furthermore, garcinol inhibited isolated COX-1
activation with an IC50 of 12 M, but this effect was not observed
in human whole blood [24]. The loss of potency in human whole
blood could be due to the strong albumin-binding of garcinol [24].
Table 1
Summary of results from in vitro and in vivo studies to investigate mechanisms of action of garcinol in different cancer types.
Cancer type
Study type
Mechanisms
Reference
Breast
Breast
In vitro
In vitro
Apoptosis
Apoptosis and reduced angiogenesis
[26]
[27]
Breast
Breast
Colon
In vivo (p.o.)
In vitro
In vitro
In vitro
Lung
In vitro
In vivo (p.o.)
In vivo (p.o.)
In vitro
In vitro
In vitro
In vitro
In vitro
In vitro
In vivo (i.p.)
In vitro
Apoptosis
Anti-inflammatory
Anti-inflammatory
Apoptosis
Apoptosis
Apoptosis
Apoptosis
Apoptosis
Apoptosis and cell cycle arrest
Apoptosis
Cell cycle arrest
Lung
Pancreatic
In vitro
In vitro
HAT inhibition
Apoptosis and reduced angiogenesis
Pancreatic
In vitro
Pancreatic
In vitro
In vitro
In vivo (p.o.)
In vivo (topical)
In vivo (p.o.)
In vitro
In vivo (i.p.)
MDA-MB-231: 35 (IC50)
MDA-MB-231: 10
MCF-7: 20 (IC50)
Mice: 285.71
MCF7: 10
MDA-MB-231: 20
HT-29: 11.4 (IC50)
HCT-116: 12 (IC50)
HT-29: 20
Mice: 500 ppma
Rat: 6.53
HCT116: 15
U937, and K562: 20 (IC50)
HL-60: 9.42 (IC50)
HL-60: 16 (IC50)
Hep3B: 20 (IC50)
C3A: 25
Mice: 1
H460: 7.5 (IC50)
H1299: 7.5 (IC50)
A549: 12 (IC50)
BxPC-3: 20 (IC50)
Panc-1: 10 (IC50)
BxPC-3: 15 (IC50)
Panc-1: 7 (IC50)
BxPC-3: 5
Panc-1: 5
MDA-MB-231: 10
Mice: 285.71
Hamster: 0.5 mM
Rat: 26.05
CAL27 and UMSCC1: 10
Mice: 1
Colon
Colon
Colon
Colon
Leukaemia
Leukaemia
Leukaemia
Liver
Liver
Oral
Tongue
Head and neck
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
[36]
[10]
[37]
[38]
[39]
[40]
[41]
[42]
[43]
[44]
[45]
[46]
[47]
IC50 concentrations are given if reported in the respective paper. When not reported, the lowest concentration at which garcinol demonstrated observed activities in the
respective cell lines are reported.
a
Oral dose given to each animal could not be determined due to insucient information on dietary intake of garcinol.
i.p.: intraperitoneal injection; p.o.: oral gavage.
11
Fig. 2. Pharmacodynamic effects and mechanisms of action of garcinol reported in in vitro and in vivo studies.
target the key cell cycle checkpoint molecules CDKs, specifically the
CDK2 and CDK4/cyclin complex, to induce G1 cell cycle arrest and
inhibit cell division [54,55]. In p53-null H1299 lung cancer cells,
10 M garcinol was shown to cause cell cycle arrest at the G1 phase
by up-regulating p21Waf1/Cip1 gene expression [39]. Interestingly, p53
wild-type A549 cells treated with less than 4 M garcinol continued to divide, suggesting that garcinol may not be able to induce
cell cycle arrest in p53 wild-type cells or that the dose was insufficient to induce cell cycle arrest in this cell type [39]. A PK evaluation
of garcinol is critical to determine its effective dose for both in vitro
and/or in vivo studies.
Modulation of gene expression. Growing interest in histone
acetyltransferase (HAT) inhibitors as potential agents to treat cancer
has also led to anti-cancer studies of histone acetylation in response to garcinol [56]. Several members of the HAT family have
been implicated in hematological malignancies [57]. Specifically,
P300/CBP-associated factor (p300/PCAF) dysfunction in the HAT
family is associated with the onset of acute leukemia [58]. In vitro
studies showed that p300/PCAF is one of the molecular targets of
garcinol (IC50 7 M for p300 and IC50 5 M for PCAF) [8]. Recent functional studies of micro RNAs (miRNAs) revealed that the highly
conserved and non-protein-coding short RNA products may participate in carcinogenesis by acting as tumor suppressors or
oncogenes [59]. For instance, preclinical studies of breast cancer
tissues confirm the function of miRNA let-7 as a tumor suppressor gene [60]. In MDA-MB-231 and BT-549 breast cancer cells,
garcinol up-regulated the expression levels of let-7, further elucidating the mechanism by which it inhibits breast cancer [27].
Moreover, elevated oncogenic miRNA-21 levels are observed in
breast, colon and pancreatic cancers [6163]. Garcinol also downregulated the expression level of miRNA-21 in the human pancreatic
12
cancer cell lines BxPC-3 and Panc-1 [42]. Taken together, these novel
discoveries of garcinols ability to inhibit p300/PCAF and downregulate oncogenic miRNA make it an attractive agent to modulate
gene expression and affect downstream PD events in various cancer
types. Thus, these studies may serve as a motivation to study the
PK profile of garcinol in order to explore its effective tumor uptake
concentration in xenografted mouse models.
Reduction in tumor angiogenesis and metastasis. The role of matrix
metalloproteinases (MMPs) and vascular endothelial growth factors
(VEGFs) in promoting the metastatic potential of cancer cells is well
established in breast, pancreatic and colon cancer [64,65]. In
colorectal cancer, the expression levels of VEGF and MMP-7 strongly
correlate with metastatic potential [66]. Garcinol reduces the MMP-7
levels in HT-29 cells [45]. In addition to MMP-7, MMP-9 has recently been identified as a key regulator of angiogenesis in the
metastatic pancreatic islets of transgenic mice [57]. The ability of
garcinol to reduce MMP-9 levels in the pancreatic cancer cell models
BxPC-3 and Panc-1 indicates the potential effect of garcinol on the
function of MMPs [43].
Overall, the concentrations used in different cell culture assays
varied dramatically, from 5 M in pancreatic cancer cells to 35 M
in breast cancer cells [26,43]. Despite these differences, micromolar concentrations of garcinol were effective in almost all studies
conducted thus far [67]. However, this phenomenon is common for
most natural products, which require higher consumption in order
to observe beneficial effects [68]. Based on the reported IC50 values,
garcinol appears to be more effective in inducing apoptosis and cell
cycle arrest in pancreatic cancer, lung cancer and leukaemia cells
than in colon, liver and breast cancer cells. Thus, the use of garcinol
for the former malignancies should be explored further.
In vivo studies
Current in vivo anti-cancer studies of garcinol focused on its
chemoprevention and chemotherapeutic actions. First, the
chemopreventive effect of garcinol against inflammation-induced
cancer was explored in 4 in vivo studies, which examined varied
doses, administration frequencies and administration routes for
garcinol. The dietary administration of 6.53 mg/kg of garcinol to a
rat with inflammation-induced colonic aberrant crypt foci (ACF) (precursor lesions for colon carcinoma) for 5 weeks was found to reduce
the incidence of colon carcinogenesis by 40.2%. This effect could be
attributed to an increase in glutathione S-transferase and quinone
reductase detoxifying enzymes observed in the rat livers [33]. In addition, 22 weeks of dietary intake equivalent to 26.05 mg/kg garcinol
for a rat resulted in COX-2 suppression and cell cycle arrest at the
G1 phase. These effects decreased the incidence of inflammationinduced neoplastic tongue carcinoma by 44.4% [46]. In the third
study, a thrice weekly topical application of 0.5 mM garcinol for 25
weeks to the chemically treated cheeks of hamsters decreased the
occurrence of inflammation-induced oral carcinogenesis by 19.0%,
likely by down-regulating the 5-LOX enzyme and LTB4 [45]. Another
study showed a 44.4% reduction of inflammation-induced colorectal
tumor formation after feeding mice food supplemented with
500 ppm garcinol for 24 weeks. Garcinol was shown to interrupt
the MAPK/ERK, Pl3K/Akt and Wnt pathways in this study [32]. These
results reflect the beneficial effect of garcinol against inflammationinduced colon cancer.
Other in vivo evidence suggested that garcinol could reduce tumor
growth and metastasis. The oral administration of 285.71 mg/kg
garcinol to mice bearing MDA-MB-231 breast cancer xenografts at
a dosing frequency of 5 days per week for 4 weeks reduced breast
tumor weight by 42.9%. Garcinol was shown to interrupt the STAT-3
signaling cascade, which was also demonstrated in vitro by the same
group [26,44]. Moreover, the group used the same mouse model and
garcinol dose (285.71 mg/kg) but increased the frequency to 6 days
per week for 4 weeks. This regiment significantly decreased the level
of the tumor proliferation biomarker Ki-67, which indicated a reduction in breast tumor proliferation in garcinol-treated mice [44].
Furthermore, the relative level of miRNA let-7 was also found to be
1.11 times higher in the garcinol-treated group compared with the
control [27]. These studies further support the in vitro experiments conducted with MDA-MB-231 cells described in Section
Modulation of gene expression, which indicated that garcinol could
inhibit breast tumor proliferation. A 1 mg/kg dose of garcinol administered intraperitoneally (i.p.) 5 days per week for 3 weeks to
mice carrying hepatocarcinoma (HCC) xenografts reduced the liver
tumor volume by 200 mm3, at least in part by interrupting STAT-3
phosphorylation, reducing the level of the pro-survival protein Bcl-2
and activating cleaved-caspase-3 [38]. In another head and neck
squamous cell carcinoma (HNSCC) xenograft mouse model, 1 mg/kg
of garcinol administered i.p. 5 days per week for 4 weeks reduced
the tumor volume by 100 mm3 [47]. Garcinol also suppressed STAT-3
phosphorylation in mice in this study [47]. These results suggest
that garcinol inhibits cancers, such as HCC and HNSCC, via a STAT3-mediated pathway [69].
However, the lack of PK studies may call the reliability of data
collected from both in vitro and in vivo studies into question. Therefore, the effective concentration range of garcinol needs to be
determined with a PK analysis to complement existing ecacy
studies of garcinol against different types of cancer.
Acknowledgements
The study was sponsored by the National Research Foundation
of Singapore (Experimental Therapeutics Program/R-713-001-011271) and the National Medical Research Council of Singapore
(NMRC/CSA/021/2010). The authors thank the NUHS Medical
Publications Support Unit, Singapore, for assistance in the
preparation of this manuscript.
13
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