pharmacokinetic data indicate that intravenous administration of ascorbate can bypass this tight control resulting in highly elevated plasma levels
ascorbate readily oxidizes to produce H2O2, pharmacological ascorbate has been proposed as a prodrug for the delivery of H2O2 to tumors
Ascorbate is an excellent reducing agent and readily undergoes two consecutive, one-electron oxidations to form ascorbate radical (Asc•−) and dehydroascorbic acid (DHA)
Ascorbate oxidizes readily. The rate of oxidation is dependent on pH and is accelerated by catalytic metals
In near-neutral buffers with contaminating metals, the oxidation and subsequent loss of ascorbate can be very rapid
Ascorbate is required for maintaining iron in the ferrous state
In the presence of catalytic metal ions, ascorbate can also exert pro-oxidant effects
Ascorbate is an excellent one-electron reducing agent that can reduce ferric (Fe3+) to ferrous (Fe2+) iron, while being oxidized to ascorbate radical
In a classic Fenton reaction, Fe2+ reacts with H2O2 to generate Fe3+ and the very oxidizing hydroxyl radical
e presence of ascorbate can allow the recycling of Fe3+ back to Fe2+, which in turn will catalyze the formation of highly reactive oxidants from H2O2
Depending on concentrations, the effects of ascorbate on models of lipid peroxidation can be pro- or antioxidant
ferritin released enhanced pharmacologic ascorbate induced-cytotoxicity, indicating that ferritin with high iron-saturation could be a source of catalytic iron. Consistent with this, ascorbate has also been shown to be capable of releasing iron from cellular ferritin
metabolic activity, oxygen transport, and DNA synthesis
Iron is found in the human body in the form of haemoglobin in red blood cells and growing erythroid cells.
macrophages contain considerable quantities of iron
iron is taken up by the majority of cells in the form of a transferrin (Tf)-Fe(III) complex that binds to the cell surface receptor transferrin receptor 1 (TfR1)
excess iron is retained in the liver cells
the endosomal six transmembrane epithelial antigen of the prostate 3 (STEAP3) reduces Fe(III) (ferric ion) to Fe(II) (ferrous ion), which is subsequently transferred across the endosomal membrane by divalent metal transporter 1 (DMT1)
labile iron pool (LIP)
LIP is toxic to the cells owing to the production of massive amounts of ROS.
DHA is quickly converted to Vit-C within the cell, by interacting with reduced glutathione (GSH) [45,46,47]. NADPH then recycles the oxidized glutathione (glutathione disulfide (GSSG)) and converts it back into GSH
Fe(II) catalyzes the formation of OH• and OH− during the interaction between H2O2 and O2•− (Haber–Weiss reaction)
Ascorbate can efficiently reduce free iron, thus recycling the cellular Fe(II)/Fe(III) to produce more OH• from H2O2 than can be generated during the Fenton reaction, which ultimately leads to lipid, protein, and DNA oxidation
Vit-C-stimulated iron absorption
reduce cellular iron efflux
high-dose Vit-C may elevate cellular LIP concentrations
ascorbate enhanced cancer cell LIP specifically by generating H2O2
Vit-C produces H2O2 extracellularly, which in turn inhibits tumor cells immediately
tumor cells have a need for readily available Fe(II) to survive and proliferate.
Tf has been recognized to sequester most labile Fe(II) in vivo
Asc•− and H2O2 were generated in vivo upon i.v Vit-C administration of around 0.5 g/kg of body weight and that the generation was Vit-C-dose reliant
free irons, especially Fe(II), increase Vit-C autoxidation, leading to H2O2 production
iron metabolism is altered in malignancies
increase in the expression of various iron-intake pathways or the downregulation of iron exporter proteins and storage pathways
Fe(II) ion in breast cancer cells is almost double that in normal breast tissues
macrophages in the cancer microenvironment have been revealed to increase iron shedding
Advanced breast tumor patients had substantially greater Fe(II) levels in their blood than the control groups without the disease
increased the amount of LIP inside the cells through transferrin receptor (TfR)
Warburg effect, or metabolic reprogramming,
Warburg effect is aided by KRAS or BRAF mutations
Vit-C is supplied, it oxidizes to DHA, and then is readily transported by GLUT-1 in mutant cells of KRAS or BRAF competing with glucose [46]. DHA is quickly converted into ascorbate inside the cell by NADPH and GSH [46,107]. This decrease reduces the concentration of cytosolic antioxidants and raises the intracellular ROS amounts
ROS activates poly (ADP-ribose) polymerase (PARP), which depletes NAD+ (a critical co-factor of GAPDH); thus, further reducing the GAPDH associated with a multifaceted metabolic rewiring
Hindering GAPDH can result in an “energy crisis”, due to the decrease in ATP production
high-dose Vit-C recruited metabolites and increased the enzymatic activity in the pentose phosphate pathway (PPP), blocked the tri-carboxylic acid (TCA) cycle, and increased oxygen uptake, disrupting the intracellular metabolic balance and resulting in irreversible cell death, due to an energy crisis
mega-dose Vit-C influences energy metabolism by producing tremendous amounts of H2O2
Due to its great volatility at neutral pH [76], bolus therapy with mega-dose DHA has only transitory effects on tumor cells, both in vitro and in vivo.
Hydroxyl radicals cause oxidative damage to cells because they unspecifically attack biomolecules [22] located less than a few nanometres from its site of generation and are involved in cellular disorders such as neurodegeneration [23, 24], cardiovascular disease [25], and cancer [26, 27].
It is generally assumed that in biological systems is formed through redox cycling by Fenton reaction, where free iron (Fe2+) reacts with hydrogen peroxide (H2O2) and the Haber-Weiss reaction that results in the production of Fe2+ when superoxide reacts with ferric iron (Fe3+)
other transition-metal including Cu, Ni, Co, and V can be responsible for formation in living cells
The hydroperoxyl radical () plays an important role in the chemistry of lipid peroxidation
The is a much stronger oxidant than superoxide anion-radical
Lipid peroxidation can be described generally as a process under which oxidants such as free radicals or nonradical species attack lipids containing carbon-carbon double bond(s), especially polyunsaturated fatty acids (PUFAs) that involve hydrogen abstraction from a carbon, with oxygen insertion resulting in lipid peroxyl radicals and hydroperoxides as described previously
under medium or high lipid peroxidation rates (toxic conditions) the extent of oxidative damage overwhelms repair capacity, and the cells induce apoptosis or necrosis programmed cell death
The overall process of lipid peroxidation consists of three steps: initiation, propagation, and termination
Once lipid peroxidation is initiated, a propagation of chain reactions will take place until termination products are produced.
The main primary products of lipid peroxidation are lipid hydroperoxides (LOOH)
Among the many different aldehydes which can be formed as secondary products during lipid peroxidation, malondialdehyde (MDA), propanal, hexanal, and 4-hydroxynonenal (4-HNE) have been extensively studied
MDA has been widely used for many years as a convenient biomarker for lipid peroxidation of omega-3 and omega-6 fatty acids because of its facile reaction with thiobarbituric acid (TBA)
MDA is one of the most popular and reliable markers that determine oxidative stress in clinical situations [53], and due to MDA’s high reactivity and toxicity underlying the fact that this molecule is very relevant to biomedical research community
4-HNE is considered as “second toxic messengers of free radicals,” and also as “one of the most physiologically active lipid peroxides,” “one of major generators of oxidative stress,” “a chemotactic aldehydic end-product of lipid peroxidation,” and a “major lipid peroxidation product”
MDA is an end-product generated by decomposition of arachidonic acid and larger PUFAs
Identifying in vivo MDA production and its role in biology is important as indicated by the extensive literature on the compound (over 15 800 articles in the PubMed database using the keyword “malondialdehyde lipid peroxidation” in December 2013)
MDA reactivity is pH-dependent
When pH decreases MDA exists as beta-hydroxyacrolein and its reactivity increases
MAA adducts are shown to be highly immunogenic [177–181]. MDA adducts are biologically important because they can participate in secondary deleterious reactions (e.g., crosslinking) by promoting intramolecular or intermolecular protein/DNA crosslinking that may induce profound alteration in the biochemical properties of biomolecules and accumulate during aging and in chronic diseases
MDA is an important contributor to DNA damage and mutation
This MDA-induced DNA alteration may contribute significantly to cancer and other genetic diseases.
Dietary intake of certain antioxidants such as vitamins was associated with reduced levels of markers of DNA oxidation (M1dG and 8-oxodG) measured in peripheral white blood cells of healthy subjects, which could contribute to the protective role of vitamins on cancer risk
Study finds that vitamin C inhibits pro-oxidant effects of artesunate at doses of 400 microM/L; Same with doxycycline. The problem here is that that translates to 5 mg/dL of vitamin C. Studies have shown that vitamin C's effect in cancer is attributable in part to its dose and the presence of metals.
Conclusion: the data presented in this review show synergistically increased DNA damage with combination treatment of RT and P-AscH−, associated with H2O2 formation