Chemotherapeutic Effects of Boswellic Acid Against Human Glioblastoma Multiform: A Comprehensive Review

Background: 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. Objective: This paper reviewed the beneficial effects of Boswellic acid (BA) in adjacent therapy for GBM, based on its possible molecular mechanisms. Methods: 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. Results: The most important compounds of BAs are alpha-boswellic acid, beta- boswellic acid, acetylbeta- boswellic acid, acetyl-alpha- boswellic acid, and 11-keto-beta- boswellic acid (KBA). Antiinflammation, reduction of skin irritation, anti-tumor, anti-cancer, anxiolytic, and anti-phlogistic are 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 antiapoptotic and pro-survival properties, inhibition the signaling and activity pathway of nuclear factorkappa 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). Conclusion: 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.