Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 14;27(12):3818.
doi: 10.3390/molecules27123818.

Ascorbate as a Bioactive Compound in Cancer Therapy: The Old Classic Strikes Back

Affiliations
Review

Ascorbate as a Bioactive Compound in Cancer Therapy: The Old Classic Strikes Back

Jaime González-Montero et al. Molecules. .

Abstract

Cancer is a disease of high mortality, and its prevalence has increased steadily in the last few years. However, during the last decade, the development of modern chemotherapy schemes, new radiotherapy techniques, targeted therapies and immunotherapy has brought new hope in the treatment of these diseases. Unfortunately, cancer therapies are also associated with frequent and, sometimes, severe adverse events. Ascorbate (ascorbic acid or vitamin C) is a potent water-soluble antioxidant that is produced in most mammals but is not synthesised endogenously in humans, which lack enzymes for its synthesis. Ascorbate has antioxidant effects that correspond closely to the dose administered. Interestingly, this natural antioxidant induces oxidative stress when given intravenously at a high dose, a paradoxical effect due to its interactions with iron. Importantly, this deleterious property of ascorbate can result in increased cell death. Although, historically, ascorbate has been reported to exhibit anti-tumour properties, this effect has been questioned due to the lack of available mechanistic detail. Recently, new evidence has emerged implicating ferroptosis in several types of oxidative stress-mediated cell death, such as those associated with ischemia-reperfusion. This effect could be positively modulated by the interaction of iron and high ascorbate dosing, particularly in cell systems having a high mitotic index. In addition, it has been reported that ascorbate may behave as an adjuvant of favourable anti-tumour effects in cancer therapies such as radiotherapy, radio-chemotherapy, chemotherapy, immunotherapy, or even in monotherapy, as it facilitates tumour cell death through the generation of reactive oxygen species and ferroptosis. In this review, we provide evidence supporting the view that ascorbate should be revisited to develop novel, safe strategies in the treatment of cancer to achieve their application in human medicine.

Keywords: ascorbate; cancer; ferroptosis; iron; oxidative stress.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Timeline summarising the various uses of ascorbate in human medicine throughout history.
Figure 2
Figure 2
Pro-oxidant effect of ascorbate when it interacts with free iron.
Figure 3
Figure 3
Scheme of the possible effect of high doses of ascorbate on tumour cells. AscH-: High-dose ascorbate. DHA: Dehydroascorbic acid.

Similar articles

Cited by

References

    1. van Gorkom G.N.Y., Lookermans E.L., Van Elssen C.H.M.J., Bos G.M.J. The Effect of Vitamin C (Ascorbic Acid) in the Treatment of Patients with Cancer: A Systematic Review. Nutrients. 2019;11:977. doi: 10.3390/nu11050977. - DOI - PMC - PubMed
    1. Siegel R.L., Miller K.D., Fuchs H.E., Jemal A. Cancer Statistics, 2021. CA Cancer J. Clin. 2021;71:7–33. doi: 10.3322/caac.21654. - DOI - PubMed
    1. Ngo B., Van Riper J.M., Cantley L.C., Yun J. Targeting cancer vulnerabilities with high-dose vitamin C. Nat. Rev. Cancer. 2019;19:271–282. doi: 10.1038/s41568-019-0135-7. - DOI - PMC - PubMed
    1. Manzie T., Celine G., Kakulas E. Scurvy: The almost forgotten disease—A case report. Aust. Dent. J. 2022;67:100–103. doi: 10.1111/adj.12889. - DOI - PubMed
    1. Packer L., Fuchs J. Vitamin C in Health and Disease. Marcel Dekker Inc.; New York, NY, USA: 1997.

Grants and funding

This research received no external funding.