Mechanism research on combination of decoction for reinforcing lung Qi and argon helium lancet in treatment of non-small cell lung cancer

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1 Online Submissions: J Tradit Chin Med 2013 June 15; 33(3): info@journaltcm.com ISSN JTCM. All rights reserved. CLINICAL STUDY TOPIC Mechanism research on combination of decoction for reinforcing lung Qi and argon helium lancet in treatment of non-small cell lung cancer Yin Zhang, Shaodan Li, Ke Cao, Yu Feng, Xiao Zhang, Yueyong Xiao, Jie Li aa Yin Zhang, Shaodan Li, Ke Cao, Yu Feng, Department of Traditional Chinese Medicine, General Hospital of People's Liberation Army, Beijing , China Xiao Zhang, Yueyong Xiao, Jie Li, Department of Radiology, General Hospital of People's Liberation Army, Beijing , China Supported by Special Project on Scientific Research into Traditional Chinese Medicine in People's Liberation Army (10ZYZ241) Correspondence to: Prof. Shaodan Li, Department of Traditional Chinese Medicine, General Hospital of People's Liberation Army, Beijing , China. lsd301@126.com Telephone: Accepted: March 3, 2013 METHODS: A total of 76 patients suffering from non-small cell lung cancer without surgical indication were randomly divided into a treatment group treated with decoction for reinforcing lung Qi and argon helium lancet and a control group treated with argon helium lancet only to observe lymphocytic proliferation, detect the percentage of positive cells in the T-lymphocyte CD 28 with flow cytometry and detect the expression of IL-2 and TNF-α in peripheral blood with enzyme linked immunosorbent assay. RESULTS: Proliferation of T-lymphocytes and expression of CD 28, IL-2 and TNF-α in peripheral blood after treatment in the treatment group were more obviously strengthened than those before treatment and those in the control group (all P<0.05). CONCLUSION: The mechanism of using decoction for reinforcing lung Qi and argon helium lancet to treat lung cancer may be realized through promoting T-lymphocytic proliferation, up-regulating expression of CD 28, IL-2 and TNF-α, and activating T-cells. Abstract OBJECTIVE: To observe the effect of decoction for reinforcing lung Qi on T-lymphocytic function, interleukin-2 (IL-2) and tumor necrosis factor-α (TNF-α) in peripheral blood of patients with non-small cell lung cancer after operation with argon helium lancet in order to explore its mechanism JTCM. All rights reserved. Key words: Reinforcing lung; Carcinoma, non-small-cell lung; Molecular mechanisms of pharmacological action; Argon helium lancet INTRODUCTION Non-small cell lung cancer is one of the lung cancers commonly seen in clinical practice. Patients without surgical indication are often treated with chemotherapy, radiotherapy, target therapy and micro-traumatic operation. Argon helium lancet, a new technique of micro-traumatic surgery, under ultralow temperature, can cause necrosis of cancerous cells, lighten tumor load and control progress of local tumor. 1,2 The mechanism of cell death in target area lies in hypoxia jointly caused by formation of icy crystal inside and outside cells, cell dehydration, concentration of electrolytic toxicity and rupture of micrangium. 3 The curative effect of Chinese herbs on lung cancer has been widely accepted. 4-6 JTCM www. journaltcm. com 307 June15, 2013 Volume 33 Issue 3

2 When using Chinese herb and argon helium lancet to treat patients with non-small cell lung cancer, we have discovered that their symptoms are obviously improved and their survival quality is noticeably enhanced. 7 Researches have shown that the generation and development of malignant tumor are closely related to the immune function of cells Our previous clinical researches have also confirmed that Chinese herbs can enhance the immunity of lung cancer patients. 11 In this study, through using Chinese herb and argon helium lancet to treat inpatients with non-small cell lung cancer that can not be treated with surgical operation, we observed changes in T-cell function, IL-2 and TNF-α in peripheral blood after treatment and investigated the therapeutic mechanism of Chinese herb and argon helium lancet in patients with non-small cell lung cancer. MATERIALS AND METHODS Diagnosis criteria Diagnosis Criteria in Western Medicine: non-small cell lung cancer is pathologically diagnosed in biopsy with tracheoscopy or with pneumocentesis guided by CT. Diagnosis criteria in Traditional Chinese Medicine: In reference to the criteria for diagnosing deficiency of lung Qi in the Principle on Directing Clinical Researches into New Chinese Herbs issued in 2002, 12 major symptoms are cough with weak voice, asthma, short breath and common cold, and minor symptoms are lingering cough, spontaneous perspiration, aversion to wind, lassitude, unwillingness to talk, pale tongue and weak pulse. Patients with 2 major symptoms and 2 minor symptoms or with 1 symptom and 3 minor symptoms can be diagnosed as suffering from non-small cell lung cancer. Inclusion and exclusion criteria Inclusion criteria: (a) Patients conform to the above-mentioned criteria of diagnosis in Western medicine and in traditional Chinese medicine. (b) Patients are years old. (c) Karpofsky (KPS) score 60 in reference to the score-evaluating criteria in medical manual of clinical lung cancer (5th edition). 13 (d) Natural survival time is expected to be more than 3 months. Exclusion criteria: (a) Patients have undergone excision. (b) Patients have serious dysfunction of the heart, lung, liver or kidney. (c) Patients suffer from accumulated liquid in the chest or cancerous lymphangitis. (d) Patients have accepted radiotherapy and chemotherapy in the latest month or are orally taking immune-regulating herb. (e) Patients took part in other clinical research within 3 months before inclusion. Rejection and dropout criteria Rejection criteria: (a) Patients who do not conform to criteria of inclusion are erroneously included. (b) Patients are not treated with this therapy. Dropout criteria: (a) Patients with serious adverse incident are unsuitable for continuing this therapy. (b) Patients with sudden serious diseases or complications are unsuitable for continuing this therapy. (c) Testees with poor obedience can not guarantee to complete the research. Patients and groupings A total of 76 inpatients with non-small cell lung cancer at our department from July 2008 to June 2012 were randomly divided into a treatment group treated with Chinese herb and argon helium lancet and a control group treated with argon helium lancet only, with each cases. In the treatment group 22 males and 16 females aged years, (56±8) years on average were included, while in the control group 24 males and 14 females aged years, (57 ± 8) years on average. There was no statistically significant difference (P> 0.05) in sex, age and KPS score between the 2 groups. Patients in the control group were treated with argon helium lancet (Galil Medical Ltd., Yokneam, Israel) under ultralow temperature. After the skin had been locally anaesthetized, the puncture needle monitored by CT (Koninklijke Philips N. V., Amsterdam, Netherlands) was thrust into scheduled site, and then argon helium lancet was inserted. The freezing system was started to make the temperature at the lancet tip rapidly reduce to below zero, and the refrigeration was kept for min according to the size of tumor and its sensitivity to temperature. Monitored by CT, the size of icy balls was controlled through the control of flow. Helium (Beijing Praxair Application Gas Co. Ltd., Beijing, China) was started to raise the temperature to 0 to melt icy balls. Then, refrigeration and raising temperature were repeated once again. When the temperature rose to 15, withdrawal of knife was followed by disinfection, hemostasis and bandaging at puncture site. While the operation was being carried out, life signs, electrocardiogram and saturation of blood oxygen were monitored. The treatment group was treated with Chinese herb and argon helium lancet. Three days before operation with argon helium lancet, patients began orally taking the decoction for reinforcing lung Qi. Its recipe consists of Sheng Huangqi (Radix Astragali seu Hedysari) 20 g, Dangshen (Radix Codonopsis Pilosulae) 15 g, Maidong (Radix Ophiopogonis) 15 g, Wuweizi (Fructus Schisandrae) 8 g, Fuling (Poria) 15 g, Chaobaizhu (Rhizoma Atractylodis Macrocephalae) 15 g, Zhigancao (Radix Glycyrrhizae Praeparata) 6 g, Zhebeimu (Bulbus Fritillariae Thunbergii) 10 g and Baihe (Bulbus lilii) 10 g. The decoction was orally taken, one dose a day in 2 times, for 10 days. This research was approved by the ethical committee of General Hospital of People's Liberation Army. All the patients have signed informed consent. Outcome measures In reference to the method in the article, 14 3 days be- JTCM www. journaltcm. com 308

3 fore treatment with argon helium lancet and 7 days after the operation, blood samples were collected respectively from peripheral vein. Absorbent cotton column was used to separate, purify and culture T-lymphocytes in peripheral blood. After culture fluid had been processed with anti-human CD 28mAb (Sigma-Aldrich Co. LLc., St. Louis, MO, USA), flow cytometry (Becton, Dickinson and Company, Franklin Lakes, NJ, USA) was used to detect the expressive rate of positive CD 28. According to the manipulation in manual of kit (Beijing North Institute of Biological Technology, Beijing, China), the expression of IL-2 and TNF-α in peripheral blood was determined. Safety indices include heart rate, blood pressure, blood routine, urine routine, function of liver and kidney, blood sugar and electrocardiogram of patients before and after treatment. Adverse incident was observed during treatment and in one month of follow-up visit. Statistical analysis SPSS 12.0 software (SPSS Inc., Chicago, IL, USA) is used. Measurement data is expressed with mean±standard deviation ( xˉ ±s) between the 2 groups. Paired t test is used for comparison inside a group. Grouping t test is used for comparison between the 2 groups. P<0.05 means having statistical significance. RESULTS Peripheral blood T-lymphocytic proliferation, CD 28 positive rate, and IL-2 and TNF-α expressions All the 76 patients in the 2 groups completed the treatment with argon helium lancet or Chinese herb without rejection or dropout. The T-lymphocytic proliferation index was 0.57±0.24, CD 28 positive rate 70.4%± 11.3%, IL-2 (91.8 ± 16.0) ng/l and TNF-α (128.2 ± 24.3) ng/l after treatment in the treatment group with significant difference (P<0.05) from those before treatment and in the control group (Table 1). Safety and adverse reaction evaluation Before and after treatment, patients in the 2 groups had normal heart rate and blood pressure, normal indexes of blood routine, urine routine, hepatic and renal function, blood sugar and electrocardiogram, without Zhang Y et al. / Clinical Study palpitation, chest pain and other uncomfortable sensations. Patients in the 2 groups had no adverse reaction during treatment and in one month of follow-up visit. DISCUSSION Researches have shown that the generation of lung cancer is closely related to the immune function of the body. 15,16 Argon helium lancet is a new micro-traumatic surgical operation used to treat lung cancer patients without surgical indication. Specific antigens produced by tumor cells destroyed by refrigeration can stimulate the proliferation of CTL and DC cells and make the body produce specific anti-tumor immunity to further inhibit tumor. 17 In recent years, great progress has been made in the researches into mechanism of using traditional Chinese medicine to treat lung cancer. Especially, the regulation of human immune function has involved changes in activation of immune cells (including T-lymphocytes, red cells and NK cells) and in the expression of immune cell factors (such as IL-1, IL-2 and TNF-α) and tumor antigens So far, there have been some researches into using Chinese herb and argon helium lancet to treat lung cancer, and few articles on research into the effect of Chinese herb on immune function of patients treated with argon helium lancet. According to theory of Traditional Chinese Medicine, we believe that after surgical operation or micro-traumatic operation on lung cancer, damage to the lung and deficiency of the lung Qi are the most fundamental pathogenesis, and patients mainly have cough, oppressed feeling in the chest, lassitude, short breath and other clinical symptoms. Therefore, according to the fundamental pathogenesis, we have treated patients with method for reinforcing the lung Qi. In the recipe, Shenghuangqi (Radix Astragali seu Hedysari) for greatly reinforcing primordial Qi is the monarch herb. Dangshen (Radix Codonopsis Pilosulae), Baizhu (Rhizoma Atractylodis Macrocephalae) and Fuling (Poria) for strengthening the spleen and reinforcing Qi are minister herbs. Maidong (Radix Ophiopogonis), Baihe (Bulbus lilii), Zhebeimu (Bulbus Fritillariae Thunbergii) and Wuweizi (Fructus Schisandrae) for nourishing the lung-yin and stopping cough are adjuvant herbs. Zhigancao (Radix Glycyrrhizae Praeparata) Table 1 Comparison of peripheral blood T-lymphocytic proliferation, CD28 positive rate, and IL-2 and TNF-α expressions between the 2 groups ( xˉ ± s ) Group n Cell proliferation index IL-2 (ng/l) CD 28(%) TNF-α (ng/l) Control group Before treatment 0.2± ± ± ±16.9 After treatment 0.4±0.2 a 56.5±10.6 a 61.8±12.7 a 112.3±20.4 a Treatment group Before treatment 0.2± ± ± ±16.5 After treatment 0.6±0.2 ab 70.4±11.3 ab 91.8±16.0 ab 128.2±24.3 ab Notes: Control group: treated by Argon Helium Cryoablation; Treatment group: treated by decoction for reinforcing lung Qi combined with Argon Helium Cryoablation. IL-2: interleukin-2; TNF-α: tumor necrosis factor-α. a P<0.05, as compared with the same group before treatment; b P<0.05, as compared with the control group after treatment. JTCM www. journaltcm. com 309

4 for regulating the other herbs is conductant herb. The whole recipe has the effect of reinforcing the lung Qi and stopping cough. Modern pharmacology has also confirmed that Huangqi (Radix Astragali seu Hedysari), Dangshen (Radix Codonopsis Pilosulae) and other herbs can obviously strengthen the immune function of patients to take effect of strengthening the body resistance to resist cancer Previous researches have shown that T-lymphocytic proliferation can kill tumor. 24 The combination of CD 28 with B7-1 or B7-2 can provide coordinated stimulant signal for the activation of T-lymphocytes. Without coordinated stimulant signal, T-lymphocytes may wither or enter the state of no inducing ability. 25 IL-2 mainly produced by activated TH1 cells can promote T-lymphocytic proliferation, induce Lak cells, promote the killing effect of T-lymphocytes and strengthen the activation of NK cells. IL-2 and its receptor system, an important index reflecting the immune function of the body, 26 play an important role in resisting tumor. TNF-α, a multi-functional cell factor mainly secreted by TH1 cells and an important tumor-killing medium of mononuclear cells and macrophages, can directly kill and inhibit tumor cells. 27,28 This research shows that decoction for reinforcing lung Qi and argon helium lancet can more obviously strengthen T-lymphocytic proliferation and increase the expression of CD 28 molecules on the surface and IL-2 and TNF-α in peripheral blood of patients with non-small cell lung cancer than argon helium lancet alone. The anticancer effect of this method may be caused by strengthening the coordinated stimulant signal of T-lymphocytes, increasing the coordinated stimulant signal of antigen cells and T-lymphocytes, enhancing the activation of T-lymphocytes, secreting more cell factors with anti-tumor effect, and giving play to the network effect of cell factors and the toxic effect of T-lymphocytes. REFERENCES 1 Wang HW, Liu J, Zhou YX, et al. Basic research into and clinical practice of argon helium target treatment of lung cancer. Hai Jun Yi Xue Za Zhi 2003; 24(1): Hu KW, Jiang M, Li ZD, et al. Clinical observations on using argon helium lancet and Chinese herb to treat 65 lung cancer patients. Zhong Hua Zhong Yi Yao Za Zhi, 2005; 20(5): Yi FT. Application of argon helium lancet to liver cancer. Zhong Liu Fang Zhi Yan Jiu 2003; 30(1): Yang HL. To analyze cost and effect of using combination of Traditional Chinese Medicine with Western Medicine to treat non-small cell lung cancer at late stage. Zhong Yi Za Zhi 2007; 48(3): Li XJ, Jia YJ, Zhang WZ, et al. Survey of researches into intervening effect of traditional Chinese medicine on stem cells of lung cancer. Zhong Yi Za Zhi 2012; 53(8): Jiang M, Chen XY, Hou L, Li Z, Hua BJ. Retrospective research into clinical curative effect on 203 patients with non-small cell lung cancer at late stage. Zhong Yi Za Zhi 2005; 46(6): Liu SR, Xiao YY, Wu B, Zhang X, Ma XY, Ren C. The clinical study of CT-guided percutaneous conformal argon-helium cryoablation for non-small cell lung carcinoma. Zhong Hua Lin Chuang Yi Shi Za Zhi 2012; 6(2): Peng JP, Feng XL, Xu L, Liu GZ, Xie ZR, Huang JM. Immunity-regulating effect of lentinan on patients with tumor at intermediate or late stage. Shi Yong Ai Zheng Za Zhi, 1997; 12(1): Wu GC, Yang ZG. Status quo of researches into naturally killing cells. Guangdong Yi Xue Yuan Xue Bao 2010; 28 (2): Zhang LH, Wang QQ. Current situation in and prospect for immune treatment of malignant tumor. Zhejiang Da Xue Xue Bao (medical edition) 2010; 39(4): Zhang Y, Guo JG. Influence of Chinese herb Bao Yuan Dan on T-lymphocytic function of lung cancer patients after chemotherapy. Di Si Jun Yi Da Xue Xue Bao 2005; 26 (13): Zheng XY. Principle on directing clinical research into new chinese herbs. Beijing: China Press of Medical Science and Technology, 2002: Sun Y, Shi YK, Clinical manual for medical department of lung cancer. 5th edition. Beijing: People's Health Press, 2007: Xie KJ, Chen XH. Experimental exploration of using absorbent cotton column to separate and purify human T-lymphocytes in peripheral blood. Zhong Hua Wei Sheng Wu Xue He Mian Yi Xue Za Zhi 2004; 24(2): Li YQ, Wu YL. Specific T-lymphocytic immunity and lung cancer. Ai Zheng Jin Zhan 2010; 8(1): Wulan TY, Wang SY, Du WL, et al. Systematic evaluation and clinical significance of immune function of patients with lung cancer at late stage. Zhong Guo Fei Ai Za Zhi 2010; 13(4): Duan YY, Wang HW, Huang YZ, Yang PD. Immune effect of frozen cancer cells melted by argon helium lancet on stimulating dendritic cells of bone marrow. Zhong Hua Wei Sheng Wu Xue He Mian Yi Xue Za Zhi 2003; 23 (12): Liu JX, Niu HM. Influence of recipe for reinforcing qi, replenishing yin and eliminating toxin on vascular endotheliocyte growth factor and immune function of lung cancer patients. Zhong Yi Za Zhi 2006; 47(3): Deng HB, Xu ZY, Wang ZQ, Zou HB. Short-term curative effect of recipe for resisting tumor and enhancing effect on non-small cell lung cancer patients accepting chemotherapy and its influence on immune function. Zhong Yi Za Zhi 2011; 52(10): Zhao XZ, Xu ZY, Wu ZH. Influence of recipe for treating lung cancer on expression of epithelial marker factor of mice with metastatic lung cancer. Zhong Yi Za Zhi 2008; 49(9): Leng YQ, Yang ZL, Xiao YS, et al. Clinical research into immune-regulating effect of decoction of Huangqi, Dang- JTCM www. journaltcm. com 310

5 shen and Mogu on chemotherapy of esophageal carcinoma and stomach cancer at late stage. Shizhen Guo Yi Guo Yao 2008; 19(6): Sun YX, Liu JC. Structural characterization of a water-soluble polysaccharide from the roots of Codonopsis pilosula and its immunity activity. Int J Biol Macromol 2008; 43 (3): Ding RH, Liao YH. Research into anti-oxidation of Huangqi. Zhong Yi Za Zhi 2010; 51(S1): Bu P, Zhou RQ, Chen QM. Effect of recipe for strengthening body resistance and removing blood stasis on inhibiting metastasis of stomach cancer after operation on patients and its influence on T-lymphocytic subgroup. Zhong Yi Za Zhi 2001; 42(4): Salomon B, Bluestone JA. Complexities of CD28/B7: CTLA-4 costimulatory pathways in autoimmunity and transplantation. Annu Rev Immunol 2001; 19: Kasprzak A, Przewozna M, Zabel M, Pankowski J, Surdyk-Zasada J. Immunocytochemical analysis of the tissue location of cytokines (IL-2 and IL-12) in neuroendocrine lung cancer. Folia Morphol (Warsz) 2003; 62(3): Li W, Liu J, Bai JY, et al. Progress in research into α tumour necrosis factor. Dongwu Yi Xue Jin Zhan 2010; 31 (12): Balkwill F. Tumour necrosis factor and cancer. Nat Rev Cancer 2009; 9(5): JTCM www. journaltcm. com 311