Potential of Moringa oleifera extract-incorporated with folic acid-conjugated gold nanoparticles as an oral squamous cell carcinoma therapy by modulating intrinsic apoptotic pathway: A narrative review

Background: Oral squamous cell carcinoma (OSCC) is the most common oral cancer worldwide. Surgery, radiotherapy and chemotherapy are the most common treatments, despite their side effects including toxicity, metastasis and multidrug resistance, thus evoking the need to develop safer treatment. Moringa oleifera (Mo) acts as anticancer agent but has poor bioavailability then incorporated with folic acid-conjugated gold nanoparticles (AuNPs) as drug carriers may enhance the action of Mo in OSCC treatment. Purpose: To describe the potential of Mo extract incorporated with folic acid-conjugated AuNPs as an OSCC therapy by modulating intrinsic apoptosis pathway. Review: Mo-AuNPs was injected to the body and reached the target cell. Folic acid in AuNPs bound to folic acid receptors in the cell membrane thus promoting endocytosis and encapsulation of Mo. AuNPs along with irradiation using near infrared light converted light into heat thus promoting pro-apoptotic protein release. This condition was also supported by Mo's ability to downregulate Akt thus upregulating Bad. Bad induces translocation of Bax into the outer mitochondrial membrane then induces the opening of mitochondrial pores. This condition manifests in formation of apoptosomes thus activating caspase-3 and inducing formation of apoptotic bodies. Conclusion: Mo extract-incorporated with folic acid-conjugated AuNPs may potential as an OSCC therapy by modulating intrinsic apoptosis pathway.