Chemotherapeutic effects of Boswellic Acid against human glioblastoma multiform: A comprehensive review

Glioblastoma multiform (GBM) is a malignant subgroup of gliomas. Due to the natural resistance of GBM cells to radio-and chemotherapy usually, recurrence occurs 6-9 months after diagnosis. This paper reviewed the beneficial effects of Boswellic acid (BA) in adjacent therapy for GBM, based on its possible molecular mechanisms. In this review paper, all papers indexed in scientific databases, including PubMed, Scopus, Embase, Google Scholar, and Elsevier were searched during 2000 - 2021 using apoptosis, Boswellic acid, cancer, glioblastoma multiform, inflammation, oxidative stress as keywords. The most important compounds of BAs are alpha-boswellic acid, beta- boswellic acid, acetyl-beta- boswellic acid, acetyl-alpha- boswellic acid, and 11-keto-beta- boswellic acid (KBA). Anti-inflammation, reduction of the skin irritation, anti-tumor, anti-cancer, anxiolytic, and anti-phlogistic, are defined as the main properties of BAs. Boswellic acid is recognized as a chemopreventive agent. Boswellic acid exerts its effects mainly via various mechanisms such as induction of apoptosis and cytotoxic effects on malignant cells, activation of caspases, up-regulation of genes expression with potential anti-apoptotic and pro-survival properties, inhibition the signaling and activity pathway of nuclear factor-kappa B (NF-κB) and enhancing poly (ADP)-ribose polymerase (PARP) cleavage. Boswellic acid inhibits the signaling pathway of 5 and 12-lipoxygenase (5, 12 LOX), and cyclooxygenase-2 (COX-2) which are considered triggers in the production of inflammatory cytokines such as tumor necrosis factor (TNF-α), and interleukin-1β (IL-1β). Future clinical trials are needed to identify the interaction between Boswellic acid and the severity of GBM and to define the safe dose and effective duration of supplementation.