Aristolochic acid-associated cancers: a public health risk in need of global action

Aristolochic acids (AAs) are a group of naturally occurring compounds present in many plant species of the Aristolochiaceae family. Exposure to AA is a significant risk factor for severe nephropathy, and urological and hepatobiliary cancers (among others) that are often recurrent and characterized by the prominent mutational fingerprint of AA. However, herbal medicinal products that contain AA continue to be manufactured and marketed worldwide with inadequate regulation, and possible environmental exposure routes receive little attention. As the trade of food and dietary supplements becomes increasingly globalized, we propose that further inaction on curtailing AA exposure will have far-reaching negative effects on the disease trends of AA-associated cancers. Our Review aims to systematically present the historical and current evidence for the mutagenicity and carcinogenicity of AA, and the effect of removing sources of AA exposure on cancer incidence trends. We discuss the persisting challenges of assessing the scale of AA-related carcinogenicity, and the obstacles that must be overcome in curbing AA exposure and preventing associated cancers. Overall, this Review aims to strengthen the case for the implementation of prevention measures against AA's multifaceted, detrimental and potentially fully preventable effects on human cancer development. Environmental exposure to aristolochic acid-containing plant material and its use in traditional medicines have been linked to a wide range of cancers. In this Review, Das et al. describe the evidence for aristolochic acid as a potent carcinogen and explore the impact of public health measures on preventing aristolochic acid-linked cancers and nephropathy, with a call to action for the implementation of further preventative measures.

Automated summary

In this Review, Das et al. describe the evidence for aristolochic acid as a potent carcinogen and explore the impact of public health measures on preventing aristolochic acid-linked cancers and nephropathy, with a call to action for the implementation of further preventative measures.