We present a case report of a patient with NF1 and optical glioma who had high-dose IVC treatment about three years after one year of conventional treatment (carboplatin and vincristine). To our knowledge it is the first case report of a NF1 patient with OPG treated intravenously by high-dose vitamin C, as an extensive literature review did not reveal cases of children with NF1 and OPG treated by IVC.The results of the MRI analysis during and at the end of chemotherapy showed the continued optic pathway tumor with a slight increase in size and degree of enhancement within the tumor centered in the hypothalamic/chiasmatic regions.Approximately 4 months after completion of chemotherapy, the patient started treatment at the Riordan Clinic with high-dose IVC (7.5–15 g) one time per week.As nutritional evaluation of vitamin levels demonstrated low vitamin D, a dose of vitamins D3/K2 5000 IU/50 µg per day was prescribed. At the end of the treatment, the patient’s level of vitamin D increased from 30 ng/mL to 120 ng/mL. Diet improvements were recommended with addition of fruits, vegetables, and a shake supplement with proteins, vitamins, and essential minerals.The improvement of the patient’s condition after 2.8 years of treatment at the clinic was described based on diagnostic MRI reports in Table 1 and Figures 3 and ​and4.4. There was shrinkage/stabilization of the tumors in the hypothalamus, optic chiasm, and left optic nerve according to radiographic imaging. The right optic nerve that showed initial enlargement demonstrated normal appearance according to the last two MRI reports made during IVC treatments.The patient was treated according to the Riordan Protocol, which involves the slow infusion of high-dose IVC [26]. This protocol is used by many integrative and orthomolecular practitioners for treating a variety of conditions, such as combating infections, treating chronic diseases, and in cancer care.Our clinic has treated thousands of cancer patients for more than forty years using this protocol. The rationales for using intravenous ascorbate infusions to treat cancer, based on our studies and experience, are summarized in reference 26. According to the studies, ascorbic acid is a key water-soluble antioxidant that, when administered in doses well above its recommended dietary allowance, may have preventative and therapeutic value against a number of pathologies. Ascorbic acid is essential for the formation of collagenase, a basic substance of connective tissue, which may be related to corneal wound healing and prevention of cerebral tissue degeneration [27,28].In one study, the anti-proliferative and apoptotic effects of ascorbic acid on T98G glioma cells through modulation of IGF-IR expression and consequent facilitation of programmed cell death were reported [29]. A previous study showed up-regulation of proteolipid protein (PLP) and myelin-associated glycoprotein (MAG) genes in ascorbic acid–treated rat glioma C6 cells [30].Our studies have demonstrated that IVC treatment of cancer patients has an anti-inflammatory effect and anti-angiogenic effects [31–33].It is now shown that ascorbic acid has much a broader impact on the critical stages of tumor cell proliferation and differentiation by shifting their epigenome and transcriptome. For example, nuclear factor erythroid 2-related factor 2 (Nrf2) is an essential component of cellular defense against a variety of endogenous and exogenous stresses. A marked increase in research over the past few decades focusing on Nrf2 and its role in regulating glioblastoma has revealed the potential value of Nrf2 in the treatment of glioblastoma and that ascorbic acid affects the regulation of this factor [34].Ascorbate plays an important role in regulation of hypoxia-inducible factor 1 (HIF-1α), the dramatic overexpression of which has been observed in common cancers, cancer cell lines, and metastases [35]. Ascorbate has been shown to assist prolyl and lysyl hydroxylases in the hydroxylation of HIF-1α, a transcription factor responsible for the cellular response to low oxygen conditions through activation of genes controlling several cellular transduction pathways, by regulating growth and apoptosis, cell migration, energy metabolism, angiogenesis, and transport of metal ions and glucose [36]. Because HIF-1α prolyl hydroxylase is stimulated by ascorbic acid, low vitamin C levels would reduce HIF-1α hydroxylation and thereby promote HIF-dependent gene transcription and tumor growth [37].Given the fact that IVC boosts immunity and collagen formation, inhibits hyaluronidase involved in metastasis, induces apoptosis to help program death of cancer cells without harm to normal cells, has anti-inflammatory and anti-angiogenic effects, and improves quality of life of cancer patients, this treatment can be considered as therapy in optic glioma.

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