A Systematic Review of Cassia alata Extract as an Anticancer Agent in Human Breast Cancer Cell Lines from In Vitro Studies

Fasha Putri Arkhan, Faithu Arthuvachivo, Siti Munawaroh

Abstract

Introduction: As one of the leading causes of cancer-related deaths in women, breast cancer still poses major treatment challenges. Chemotherapy often causes toxicity and resistance, emphasizing the need for safer options. Cassia alata, rich in flavonoids like kaempferol shows potential anticancer effects through apoptosis induction. This review evaluated the in vitro evidence of C. alata against human breast cancer cell lines.

Methods: This review followed the PRISMA 2020 guidelines. A total of 1,183 records were retrieved from six databases (PubMed, Scopus, ScienceDirect, ProQuest, EBSCOhost, and Google Scholar). After screening records, eight studies met the eligibility criteria. Eligible studies were in vitro experiments evaluating C. alata crude extracts, fractions, or derived formulations on human breast cancer cell lines (MCF-7, T47D, MDA-MB-231, and others). Data on interventions, concentrations, cytotoxicity assays, and molecular mechanisms were extracted. Quality assessment was performed independently by two reviewers using the ToxRTool, with discrepancies resolved through consensus. Inter-rater reliability was not applied due to small sample size and consensus scoring.

Results: C. alata consistently reduced breast cancer cell viability, with reported IC₅₀ values ranging from 0.013 to 456 µg/mL depending on extract and cell line. Most studies showed dose-dependent cytotoxicity and apoptosis via caspase activation, nuclear fragmentation, and PI3K/AKT inhibition. Variations in extraction methods and assay conditions explained inter-study heterogeneity.

Conclusion: Evidence from studies indicates that C. alata reduces breast cancer cell viability and promotes apoptosis. Further in vivo and clinical studies are required to validate efficacy and safety.

Keywords

apoptosis; breast cancer; cassia alata; cytotoxicity; in vitro

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References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.
  2. Huang J, Chan PS, Lok V, Chen X, Ding H, Jin Y, et al. Global incidence and mortality of breast cancer: a trend analysis. Aging (Albany NY). 2021 Feb 11;13(4):5748-5803. doi:10.18632/aging.202502. PMID:33592581; PMCID:PMC7950292.
  3. Atanasov AG, Zotchev SB, Dirsch VM, Supuran CT. Natural products in drug discovery: advances and opportunities. Nat Rev Drug Discov. 2021 Mar;20(3):200-216. doi:10.1038/s41573-020-00114-z.
  4. Cragg GM, Pezzuto JM. Natural products as a vital source for the discovery of cancer chemotherapeutic and chemopreventive agents. Med Princ Pract. 2016;25(Suppl 2):41-59. doi:10.1159/000443404.
  5. Greenwell M, Rahman PKSM. Medicinal plants: their use in anticancer treatment. Int J Pharm Sci Res. 2015 Oct;6(10):4103-12. doi:10.13040/IJPSR.0975-8232.6(10).4103-12.
  6. Yuan H, Ma Q, Ye L, Piao G. The traditional medicine and modern medicine from natural products. Molecules. 2016 May;21(5):559. doi:10.3390/molecules21050559.
  7. Dai X, Xiang L, Li T, Bai Z. Cancer hallmarks, biomarkers and breast cancer molecular subtypes. J Cancer. 2016;7(10):1281-94. doi:10.7150/jca.13141.
  8. Kotecha R, Takami A, Espinoza JL. Dietary phytochemicals and cancer chemoprevention: a review. Antioxidants (Basel). 2016 Dec;5(4):88. doi:10.3390/antiox5040088.
  9. Fatmawati S, Ersam T, Yu H, Zhang C. Cassia alata: a review of ethnomedicinal uses, phytochemistry, and pharmacological activities. Phytother Res. 2020 Aug;34(8):1549-75. doi:10.1002/ptr.6622.
  10. Imran M, Salehi B, Sharifi-Rad J, Aslam Gondal T, Saeed F, Imran A, et al. Kaempferol: A key emphasis to its anticancer potential. Molecules. 2019;24(12):2277. doi:10.3390/molecules24122277.
  11. Qattan MY, Khan MI, Alharbi SH, Verma AK, Al-Saeed FA, Abduallah AM, et al. Therapeutic importance of kaempferol in the treatment of cancer through the modulation of cell signalling pathways. Molecules. 2022 Dec 13;27(24):8864. doi:10.3390/molecules27248864. PMID:36557997; PMCID:PMC9788613.
  12. Jiang X, Liu Y, Zhang G, Lin S, Wu J, Yan X, et al. Aloe-emodin induces breast tumor cell apoptosis through upregulation of miR-15a/miR-16-1 that suppresses BCL2. Evid Based Complement Alternat Med. 2020 Mar 3;2020:5108298. doi:10.1155/2020/5108298. PMID:32190086; PMCID:PMC7073502.
  13. Xu D, Hu MJ, Wang YQ, Cui YL. Antioxidant activities of quercetin and its complexes for medicinal application. Molecules. 2019 Mar 21;24(6):1123. doi:10.3390/molecules24061123. PMID:30901869; PMCID:PMC6470739.
  14. Dong X, Fu J, Yin X, Cao S, Li X, Lin L, et al. Emodin: a review of its pharmacology, toxicity and pharmacokinetics. Phytother Res. 2016 Aug;30(8):1207-18. doi:10.1002/ptr.5631. PMID:27188216; PMCID:PMC7168079.
  15. Shahali A, Ghanadian M, Jafari SM, Aghaei M. Mitochondrial and caspase pathways are involved in the induction of apoptosis by nardosinen in MCF-7 breast cancer cell line. Res Pharm Sci. 2018 Feb;13(1):12-21. doi:10.4103/1735-5362.220963. PMID:29387107; PMCID:PMC5772077.
  16. Khoerunisah M, Angelina M, Kasiyati K. Cytotoxic Test of Cassia alata L. Leaves Ethanol Extracts, Fractions, and Main Compounds against MCF-7 Cells. Indonesian Journal of Cancer Chemoprevention. 2022;13(3):144-151. doi:10.14499/indonesianjcanchemoprev13iss3pp144-151.
  17. Wiedagdo SA, Arkhani FP, et al. In silico and in vitro evaluation of chitosan–folate coated nanoliposomes loaded with Cassia alata leaf extract for targeted breast cancer therapy. Chem Biodivers. 2025; (advance online). doi:10.1002/cbdv.202500276.
  18. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
  19. Fernand V, Losso JN, Truax R, Villar EE, Bwambok D, Fakayode SO, et al. Rhein inhibits angiogenesis and the viability of hormone-dependent and -independent cancer cells under normoxic or hypoxic conditions in vitro. Chem Biol Interact. 2011;192(3):220–32.
  20. Onyegeme-Okerenta BM, Essien EB, Ajuzie CU. Evaluation of the anti-cancer potential of Senna alata leaf extract on human breast cancer cell line (MCF-7). J Adv Med Pharm Sci. 2018;19(2):1–8.
  21. Bhadusha NA, Jayachitra A, Suganya D. Evaluation of anticancer activity of hydroalcoholic extract of Cassia alata Linn. against MCF-7 and PC-3 cancer cell lines. Int J Pharm Sci Res. 2019;10(5):2361–5.
  22. Chahardeh SG, Ali MA, Othman S, Goh BH, Jantan I. Cytotoxic activity of fractions from Senna alata leaves on human breast cancer cell line (MCF-7). Trop J Nat Prod Res. 2021;5(1):128–34.
  23. Olarte El, Herrera A, Villasenor I. In Vitro Antitumor Properties of an Isolate from Leaves of Cassia alata L. Asian Pacific Journal of Cancer Prevention. 2013;14(5):3191–3196.
  24. Saravanan M, Shankar S, Mariadoss AVA, Sathiyaseelan A, Wang MH. Green synthesis of silver nanoparticles using Senna alata leaf extract and evaluation of their anticancer activity against MCF-7 cells. Biocatal Agric Biotechnol. 2022;42:102328.
  25. Prasad S, Gupta SC, Tyagi AK. Reactive oxygen species (ROS) and cancer: role of antioxidative nutraceuticals. Cancer Lett. 2017;387:95–105.
  26. Bianchini G, Balko JM, Mayer IA, Sanders ME, Gianni L. Triple-negative breast cancer: challenges and opportunities of a heterogeneous disease. Nat Rev Clin Oncol. 2016;13(11):674–90.

DOI: https://doi.org/10.13057/smj.v8i3.109304

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