Boswellic acid formulations are not suitable for treatment of pediatric high-grade glioma due to tumor promoting potential

Boswellia serrata for the Management of Radiation-Induced Cerebral Edema and Necrosis: A Systematic Meta-Narrative Review of Clinical Evidence

Purpose

Stereotactic radiosurgery (SRS) yields excellent local control in patients with a limited number of brain metastases (BMs), but radiation-induced cerebral edema and radiation necrosis (RN) in particular may cause dose-limiting late toxicity, with the same holding true after fractionated radiation therapy for glioma. In symptomatic patients, the first-line standard of care includes corticosteroids, which may, however, be counterproductive in the evolving era of immunotherapy. Boswellic acid (BA), available as an over-the-counter dietary supplement, has been suggested as a potential corticosteroid-sparing alternative because of its anti-inflammatory and antiangiogenic effects.

Methods and Materials

We performed a comprehensive literature search of the MEDLINE, Embase, Scopus, and Cochrane databases, identifying publications reporting on the use of BA during or after brain irradiation in humans. Using the Realist and Meta-Narrative Evidence Syntheses: Evolving Standards framework, relevant data are summarized using a meta-narrative approach.

Results

Six records (3 for edema reduction in large irradiated volumes and 3 for RN after SRS) were identified, encompassing 130 patients. Roughly half of patients benefited from BA (radiographically or clinically) and about one third could successfully taper dexamethasone or prevent its long-term intake. Tolerability of BA was favorable, with mild gastrointestinal discomfort being reported most frequently. Current drawbacks include unknown optimal formulation as well as timing and dosing, a considerably large number of required daily capsules, and uncertain interactions with other drugs.

Conclusions

Overall, the clinical evidence on the use of BA for radiation-induced cerebral edema and RN is lacking and well-designed prospective trials are warranted to further investigate this potential low-cost corticosteroid-sparing option.

Qualitative and quantitative analyses of the changes in the chemical composition of frankincense before and after stir-frying using GC-MS and LC-MS

Frankincense is a resin drug used widely in the medical field. Comprehensive qualitative and quantitative analyses of the differences in the chemical composition of frankincense, stir-fried frankincense and vinegar frankincense were done by combining GC-MS and LC-MS. GC-MS revealed six chemical compositions with high content in frankincense: β-ocimene, 1-octanol, acetic acid, octyl ester, nerolidol, lauric acid and incensole acetate. LC-MS revealed eight more widely studied chemical compositions: 11-keto-β-boswellic acid, β-elemolic acid, acetyl-11-keto-β-boswellic acid, β-elemonic acid, α-boswellic acid, β-boswellic acid, 3-O-acetyl-α-boswellic acid and 3-O-acetyl-β-boswellic acid. In addition, the chemical composition of frankincense was identified by the fragmentation information afforded by LC-MS.

BA inhibits LPS-stimulated inflammatory response and apoptosis in human middle ear epithelial cells by regulating the Nf-Kb/Iκbα axis

Otitis media (OM) is a prevalent childhood ear disease characterized by inflammation of the middle ear cavity, which can lead to ear pain, fever, and hearing loss. The pathogenesis of OM is multifaceted, encompassing a variety of factors including bacterial or viral infections, host immune responses, and the function of middle ear epithelial cells. Boswellic acid (BA), a natural triterpene compound extracted from frankincense resin, has been proven to possess significant anti-inflammatory and immunomodulatory effects. This study aims to investigate the effects of BA on lipopolysaccharide (LPS)-stimulated inflammatory responses and apoptosis in human middle ear epithelial cells (HMEECs) and its potential mechanisms. Our findings demonstrated that BA enhances the proliferation of LPS-stimulated HMEECs and concurrently inhibits their apoptosis. In addition, BA blocked LPS-stimulated HMEEC inflammation. Mechanistically, BA suppressed the NF-κB/IκBα axis in LPS-stimulated HMEECs. In conclusion, BA effectively inhibits LPS-stimulated inflammation and apoptosis by mediating the NF-κB/IκBα axis, highlighting its potential as a therapeutic agent for OM.