**4.9 Zingiberaceae—***Zingiber officinale* **Roscoe**

The ginger *Z. officinale* (**Figure 10**) is presumably native to the Indian subcontinent and other Southern Asian regions. This plant was probably introduced in Suriname by Javanese indentured laborers around the beginning of the twentieth century [28, 38]. The rhizome is extensively used as a hot and fragrant kitchen spice in many cuisines and to prepare various hot and cold beverages. This part of the plant also has many long-standing traditional uses [43, 183]. The essential oil from the rhizomes is topically applied as an analgesic, while preparations from powdered fresh or dried rhizomes are orally or topically used for treating, among others, respiratory complaints; obesity; microbial infections; vertigo, travel sickness, morning sickness, as well as nausea and vomiting associated with surgery and chemotherapy; and cancer [43, 183].

 These claims are supported by the pharmacological activities displayed by particularly gingerols (such as zingerone and zingeberol) and shogaols in the rhizomes. Gingerols are the main compounds in the volatile oil of fresh ginger rhizomes and are responsible for their characteristic fragrance [184]. They are thermally labile and easily undergo dehydration reactions to form the corresponding shogaols, which convey the typical pungent taste of dried ginger during cooking [184]. Both gingerols and shogaols exhibited pharmacological activities which supported the traditional uses of *Z. officinale* [185, 186].

A host of data supports that gingerols and shogaols possess both anticancer and chemopreventive activities. Evidence for the former suggestion came from their inhibitory effects on the proliferation, cell cycle progression, and viability of human carcinoma cell lines [187–197] and tumors implanted into laboratory animal [198, 199]. Suggestions for chemopreventive activities of these compounds came from their inhibitory effects on the development of cancer in animals treated with laboratory carcinogens [199–203]. Both activities may be mediated by multiple mechanisms including inhibition of invasion through activation of the nuclear receptor peroxisome proliferator-activated receptor γ (PPAR-γ) [197]; downregulation of matrix metalloproteinase 9 transcription [204]; suppression of tumor angiogenesis [191, 194]; deactivation of aberrant cell cycle-regulating elements [189, 200]; and interference with microtubule integrity [190, 196].

**Figure 10.**  *The ginger Zingiber officinale Roscoe (Zingiberaceae) (from: https://goo.gl/images/Tr2fgV).* 

All these observations have led to the consideration of *Z. officinale* preparations for treating cancer as well as cancer-related complications such as chemotherapyinduced nausea and vomiting. So far, however, there is no scientific proof of clinical efficacy against either cancer [205] or nausea and vomiting resulting from chemotherapy or surgery [206].

## **5. Concluding remarks**

The nine plants addressed in this chapter have a long traditional use in Suriname against various conditions including neoplastic disease and indeed showed some evidence of anticancer activity. However, in all cases, the evidence was limited to preclinical models and was not sufficient to support claims of clinical efficacy. However, this does not necessarily mean that these plants and their active constituents should be discarded as failed compounds. Some may constitute useful parts of an integrative medical approach for treating or preventing cancer. Others—including many mentioned in this chapter—may boost the immune system or improve overall health, well-being, and quality of life. And still others may help relieve some of the symptoms of cancer such as fatigue or reduce the side effects of chemotherapy and radiotherapy.

 Converging lines of evidence lend support to these suppositions. Firstly, several phenolic compounds such as curcumin from the turmeric *Curcuma longa* L. (Zingiberaceae) and apigenin from the celery *Apium graveolens* L. (Apiaceae) may directly or indirectly exert cytotoxic and apoptotic effects by stimulating autophagy [207, 208]. Other plant phenols such as luteolin in celery, thyme, green peppers, and chamomile tea; epigallocatechin-3-gallate in Chinese green tea; and resveratrol in the skin of grapes, blueberries, raspberries, and mulberries have shown promise in the treatment and prevention of cancer [209–211]. These compounds are able to inactivate molecular signals and transcription pathways essential for cancer cells, scavenge harmful free radicals, and inhibit tumor angiogenesis, respectively [209–211].

 Secondly, mistletoe extracts may alleviate cancer-related fatigue [212]; preparations from the holy basil *Ocimum sanctum* L. (Lamiaceae) may avert radiation-induced clastogenesis [213]; those based on *A. vera* may prevent or treat radiation-induced oral mucositis [214]; and the gingerols and shogaols in *Z. officinale* may reduce the cardiotoxicity of doxorubicin [215]. These compounds may exercise their protective effects through their anti-inflammatory, immunemodulating, free radical-scavenging, antioxidant, and/or metal-chelating properties [212–215].

Furthermore, recent advances in analytical and computational techniques as well as the introduction of innovative technologies such as predictive computational software may help employ apparently "useless" anticancer compounds in novel ways. For instance, the rejected tubulin-binding maytansines from *Maytenus* species (Celastraceae) may have found a new use as "warheads" attached to specific antitumor monoclonal antibodies in order to precisely attack tumor tissues while causing little toxicity [216]. And the discarded topoisomerase I inhibitor lapachol from the stembark of the Surinam greenheart *Handroanthus serratifolius* (Vahl) S.O. Grose also known as *Tabebuia serratifolia* (Vahl) G. Nicholson (Bignoniaceae)—is attracting renewed attention following reports that its inhibitory effect on melanoma cell proliferation may involve interference with glycolysis and decreasing ATP levels [217].

Likewise, the therapeutic index of gingerols in the treatment of breast cancer may improve when formulated as a PEGylated nanoliposomal form, allowing for high specificity, improved bioavailability, slow release, and low systemic toxicity [218]. And structural modifications of quassinoids on the basis of, for instance,

*Anticancer Activity of Uncommon Medicinal Plants from the Republic of Suriname: Traditional… DOI: http://dx.doi.org/10.5772/intechopen.82280* 

(quantitative) structure-activity relationships, may produce more potent and less toxic analogues [219, 220]. These and many other examples support continued assessment of the plants and their bioactive compounds dealt with in the current chapter for their usefulness against cancer. If only one of these compounds would reach the clinic, the efforts invested in their evaluation would have been worthwhile.
