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Repurposing tranexamic acid as an anticancer drug: a systematic review and meta-analysis
Karoline Assifuah Kristjansen1,2, Nulvin Djebbara-Bozo3, Kumanan Rune Nanthan4
1Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. karoline_kristjansen@clin.au.dk.
Purpose:
Drug repurposing may be an efficient strategy for identifying new cancer treatments. Tranexamic acid (TXA), an antifibrinolytic agent that affects the plasminogen-plasmin pathway, may have potential anticancer effects by influencing tumor cell proliferation, angiogenesis, inflammation, immune response, and tissue remodeling-all crucial processes contributing to tumor progression and metastasis.
Objective:
Evaluate TXA's anticancer effects across in vitro, animal, and clinical studies to assess its potential as a repurposed cancer drug.
Methods:
The study was designed as a PRISMA-compliant systematic review and meta-analysis. The literature search was conducted in MEDLINE, EMBASE, Web of Science, and the Cochrane Library. In vitro, animal, and clinical studies investigating the anticancer effects of TXA or epsilon-aminocaproic acid (EACA) were included. Animal and clinical studies were critically appraised, and studies with a low risk of bias were included in the meta-analysis.
Results:
Of 4367 identified records, 38 articles were included, collectively reporting findings from 41 in vitro studies, 34 animal studies (n = 843 animals), and seven clinical studies (n = 91 patients). The meta-analysis included nine animal studies and showed a tumor growth reduction in animals treated with TXA compared to controls with a standardized mean difference of - 1.0 (95%CI - 1.5; - 0.4) (p = 0.0002). Equivalently, the majority of in vitro studies reported reduced proliferation, viability, and invasiveness in TXA-exposed tumor cell lines. The clinical studies were considerably susceptible to bias, rendering any conclusions futile.
Conclusions:
TXA shows promise as a repurposed cancer drug, revealing an overall reduction in tumor growth, viability, and invasiveness in animal and in vitro studies.
Insights
Drug repurposing offers new cancer treatments. Tranexamic acid (TXA) shows promise, reducing tumor growth, viability, and invasiveness in preclinical studies, suggesting potential as a repurposed cancer drug.
Area of Science:
- Oncology
- Pharmacology
- Drug Repurposing
Background:
- Drug repurposing is a viable strategy for discovering novel cancer therapeutics.
- Tranexamic acid (TXA), an antifibrinolytic agent, influences pathways critical to tumor progression, including proliferation, angiogenesis, and inflammation.
Purpose of the Study:
- To systematically evaluate the anticancer effects of Tranexamic acid (TXA).
- To assess TXA's potential as a repurposed cancer drug through in vitro, animal, and clinical studies.
Main Methods:
- A PRISMA-compliant systematic review and meta-analysis was conducted.
- Literature search across major databases (MEDLINE, EMBASE, Web of Science, Cochrane Library).
- Inclusion of in vitro, animal, and clinical studies on TXA or epsilon-aminocaproic acid (EACA); critical appraisal and meta-analysis of low-risk bias studies.
Main Results:
- 38 articles were included, encompassing 41 in vitro, 34 animal, and 7 clinical studies.
- Meta-analysis of 9 animal studies demonstrated a significant reduction in tumor growth with TXA treatment (SMD -1.0, p=0.0002).
- In vitro studies consistently showed reduced tumor cell proliferation, viability, and invasiveness upon TXA exposure; clinical studies had high bias.
Conclusions:
- Tranexamic acid (TXA) exhibits potential as a repurposed anticancer agent.
- Preclinical evidence (in vitro and animal models) indicates TXA reduces tumor growth, viability, and invasiveness.
- Further high-quality clinical trials are needed due to bias in existing human studies.
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