Anticancer Activity of Atractylodes lancea (Thunb.) DC. in a Hamster Model and the Use of PET-CT for Early Detection and Monitoring of Cholangiocarcinoma Progression

Background: Opisthorchis viverrini (OV)-induced cholangiocarcinoma (CCA) is a significant public health issue in the Great Mekong region, particularly in Thailand. Current treatment options are limited, and early detection remains challenging, hindering effective management of CCA. This study aimed to evaluate the anti-CCA potential of the ethanolic extract of Atractylodes lancea (Thunb.) DC. and assess the applicability of positron emission tomography-computed tomography (PET-CT) as a diagnostic and monitoring tool for CCA in an OV/dimethylnitrosamine (DMN)-induced hamster model.

Aim: This study aimed to evaluate the anticancer activity of Atractylodes lancea (Thunb.) DC. in an OV/DMN-induced hamster model of cholangiocarcinoma (CCA) and to assess the potential of PET-CT for early detection and monitoring the progression of CCA.

Methods: Male Syrian hamsters were used to assess the toxicity and anti-CCA effects of Atractylodes lancea ethanolic extract. CCA was induced in male Syrian hamsters using a combination of OV infection and DMN exposure. The ethanolic extract of A. lancea was administered orally for 30 days. PET-CT imaging using 18F-FDG was conducted every 4 weeks after the initiation of CCA.

Results: The ethanolic extract of A. lancea demonstrated promising anti-CCA activity and a favorable safety profile in the OV/DMN-induced hamster model. PET-CT imaging successfully detected tumor formation and progression, although modifications to the radiolabeling approach are needed to enhance specificity for CCA cells. The median (95% CI) tumor 18F-FDG uptake (percentage of baseline) in CCA-baring and normal control hamsters at weeks 4, 8, 12, and 16 after OV infection were comparable (90 vs 100, 130 vs 140, 170 vs 175, and 200 vs 205 at week 4, 8, 12, and 16 after OV-infection, respectively).

Conclusion: The ethanolic extract of Atractylodes lancea (Thunb.) DC. demonstrates significant potential as a therapeutic agent against cholangiocarcinoma (CCA), showing both potent anticancer activity and a safe profile in the hamster model. Additionally, while PET-CT proves to be a feasible tool for monitoring tumor development and progression, enhancements in radiolabeling techniques are essential to improve the specificity for detecting CCA cells and ensure more accurate early detection and assessment of treatment efficacy. While PET-CT successfully detected tumor development, further optimization of the radiolabeling technique is needed to improve its selectivity for CCA cells.