Potential therapeutic applications of medical gases in cancer treatment

Abbas Al Bazzal, Bassel H. Hoteit, Mariam Chokor, Abdallah Safawi, Zahraa Zibara, Fatima Rizk, Aya Kawssan, Naseeb Danaf, Layal Msheik, Hiba Hamdar

¹Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon²Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon³Research Department, Plovdiv Medical University, Plovdiv, Bulgaria⁴Research Department, Medical Learning Skills Academy, Beirut, Lebanon

Abstract

Medical gases were primarily used for respiratory therapy and anesthesia, which showed promising potential in the cancer therapy. Several physiological and pathological processes were affected by the key gases, such as oxygen, carbon dioxide, nitric oxide, hydrogen sulfide, and carbon monoxide. Oxygen targets shrinking the tumor via hyperbaric oxygen therapy, and once combined with radiation therapy it enhances its effect. Nitric oxide has both anti- and pro-tumor effects depending on its level; at high doses, it triggers cell death while at low doses it supports cancer growth. The same concept is applied to hydrogen sulfide which promotes cancer growth by enhancing mitochondrial bioenergetics and supporting angiogenesis at low concentrations, while at high concentrations it induces cancer cell death while sparing normal cells. Furthermore, carbon dioxide helps induce apoptosis and improve oxygenation for cancer treatments by increasing the release of oxygen from hemoglobin. Moreover, high-dose carbon monoxide gas therapy has demonstrated significant tumor reductions in vivo and is supported by nanomedicine and specialized medicines to boost its delivery to tumor cells and the availability of hydrogen peroxide. Despite the promising potentials of these gases, several challenges remain. Gas concentrations should be regulated to balance pro-tumor and anti-tumor effects for gases such as nitric oxide and hydrogen sulfide. Furthermore, effective delivery systems, such as nanoparticles, should be developed for targeted therapy.

摘要：医用气体主要用于呼吸治疗和麻醉，在癌症治疗中显示出良好的潜力。一些生理和病理过程受到关键气体的影响，如氧气、二氧化碳、一氧化氮、硫化氢和一氧化碳。通过高压氧治疗，氧气的目标是缩小肿瘤，一旦与放射治疗结合，它会增强其效果。一氧化氮具有抗肿瘤和促肿瘤作用，这取决于它的水平；在高剂量下，它会引发细胞死亡，而在低剂量下，它会促进癌症的生长。同样的概念也适用于硫化氢，在低浓度下，硫化氢通过增强线粒体生物能量和支持血管生成来促进癌症的生长，而在高浓度下，它会诱导癌细胞死亡，同时保留正常细胞。此外，二氧化碳有助于诱导细胞凋亡，并通过增加血红蛋白中氧气的释放来改善癌症治疗的氧合。此外，高剂量一氧化碳气体治疗在体内已显示出显著的肿瘤减少，并得到纳米医学和专门药物的支持，以促进其向肿瘤细胞的递送和过氧化氢的可用性。尽管这些气体潜力巨大，但仍存在一些挑战。应调节气体浓度，以平衡一氧化氮和硫化氢等气体的促肿瘤和抗肿瘤作用。此外，应该开发有效的递送系统，如纳米颗粒，用于靶向治疗。