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Environ Toxicol. 2017 Nov;32(11):2379-2391. doi: 10.1002/tox.22451. Epub 2017 Jul 19.

Auramine O, an incense smoke ingredient, promotes lung cancer malignancy.

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Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
Center for Molecular Medicine, China Medical University Hospital, Taichung, Taiwan.
Department of Biotechnology, Asia University, Taichung, Taiwan.
School of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan.
Chinese Medicine Research and Development Center, China Medical University Hospital, Taichung, Taiwan.
Department of Superintendent Office, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsinchu, Taiwan.
Research Center for Environmental Changes, Academia Sinica, Taipei, Taiwan.


Burning incense to worship deities is a popular religious ritual in large parts of Asia, and is a popular custom affecting more than 1.5 billion adherents. Due to incomplete combustion, burning incense has been well recognized to generate airborne hazards to human health. However, the correlation between burning incense and lung cancer in epidemiological studies remains controversy. Therefore, we speculated that some unknown materials in incense smoke are involved in the initiation or progression of lung cancer. Based on this hypothesis, we identified a major compound auramine O (AuO) from the water-soluble fraction of incense burned condensate using mass spectrometry. AuO is commonly used in incense manufacture as a colorant. Due to thermostable, AuO released from burned incenses becomes an unexpected air pollutant. AuO is classified as a Group 2B chemical by the International Agency of Research on Cancer (IARC), however, the damage of AuO to the respiratory system remains elusive. Our study revealed that AuO has no apparent effect on malignant transformation; but, it dramatically promotes lung cancer malignancy. AuO accumulates in the nucleus and induces the autophagy activity in lung tumor cells. AuO significantly enhances migration and invasive abilities and the in vitro and in vivo stemness features of lung tumor cells through activating the expression of aldehyde dehydrogenase family 1 member A1 (ALDH1A1), and ALDH1A1 knockdown attenuates AuO-induced autophagy activity and blocks AuO-induced lung tumor malignancy. In conclusion, we found that AuO, an ingredient of incense smoke, significantly increases the metastatic abilities and stemness characters of lung tumor cells through the activation of ALDH1A1, which is known to be associated with poor outcome and progression of lung cancer. For public health, reducing or avoiding the use of AuO in incense is recommended.


ALDH1A1; auramine O; incense; lung cancer; mass spectrometry

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