Artemisinin-resistant Plasmodium falciparum: can the genie be put back in the bottle?

Ethnobotanical survey on medicinal plants used by Guinean traditional healers in the treatment of malaria

ETHNOPHARMACOLOGICAL RELEVANCE

The objective of the present study was to collect and document information on herbal remedies traditionally used for the treatment of malaria in Guinea.

MATERIALS AND METHODS

The survey was carried out from May 2008 to September 2010 and targeted traditional medical practitioners and herbalists. The questionnaire and oral interviews were based on the standardized model which was prepared by the "Centre de Recherche et de Valorisation des Plantes Médicinales (CRVPM) - Dubréka".

RESULTS AND DISCUSSION

A total of 258 people (141 males and 117 females) from which 150 traditional healers and 108 herbalists were interviewed. The age of informants ranged from 28 to 82 years old. 57% (149/258) of the interviewees were more than 50 years old. The respondents had good knowledge of the symptoms of malaria, and a fairly good understanding of the causes. One hundred thirteen plant species were recorded, out of which 109 were identified. They belonged to 84 genera and 46 families. The most frequently cited plants were Vismia guineensis, Parkia biglobosa, Nauclea latifolia, Harungana madagascariensis, Terminalia macroptera, Crossopteryx febrifuga, Terminalia albida, Annona senegalensis, and Nauclea pobeguinii. The leaves were most frequently used (80/113 species), followed by stem bark (38/113 species) and roots (4/113 species). The remedies were mostly prepared by decoction (111 species), followed by maceration (seven species). Only one species was prepared by infusion.

CONCLUSION

The present study showed that traditional healers in Guinea have a consistent knowledge of antimalarial plants. Further research should be carried out to compare the anti-malarial activity of the different species, and to check if their use against malaria can be scientifically validated.

Anti-plasmodial activity of Dicoma tomentosa (Asteraceae) and identification of urospermal A-15-O-acetate as the main active compound

Background

Natural products could play an important role in the challenge to discover new anti-malarial drugs. In a previous study, Dicoma tomentosa (Asteraceae) was selected for its promising anti-plasmodial activity after a preliminary screening of several plants traditionally used in Burkina Faso to treat malaria. The aim of the present study was to further investigate the anti-plasmodial properties of this plant and to isolate the active anti-plasmodial compounds.

Methods

Eight crude extracts obtained from D. tomentosa whole plant were tested in vitro against two Plasmodium falciparum strains (3D7 and W2) using the p-LDH assay (colorimetric method). The Peters’ four-days suppressive test model (Plasmodium berghei-infected mice) was used to evaluate the in vivo anti-plasmodial activity. An in vitro bioguided fractionation was undertaken on a dichloromethane extract, using preparative HPLC and TLC techniques. The identity of the pure compound was assessed using UV, MS and NMR spectroscopic analysis. In vitro cytotoxicity against WI38 human fibroblasts (WST-1 assay) and haemolytic activity were also evaluated for extracts and pure compounds in order to check selectivity.

Results

The best in vitro anti-plasmodial results were obtained with the dichloromethane, diethylether, ethylacetate and methanol extracts, which exhibited a high activity (IC₅₀ ≤ 5 μg/ml). Hot water and hydroethanolic extracts also showed a good activity (IC₅₀ ≤ 15 μg/ml), which confirmed the traditional use and the promising anti-malarial potential of the plant. The activity was also confirmed in vivo for all tested extracts. However, most of the active extracts also exhibited cytotoxic activity, but no extract was found to display any haemolytic activity. The bioguided fractionation process allowed to isolate and identify a sesquiterpene lactone (urospermal A-15-O-acetate) as the major anti-plasmodial compound of the plant (IC₅₀ < 1 μg/ml against both 3D7 and W2 strains). This was also found to be the main cytotoxic compound (SI = 3.3). While this melampolide has already been described in the plant, this paper is the first report on the biological properties of this compound.

Conclusions

The present study highlighted the very promising anti-plasmodial activity of D. tomentosa and enabled to identify its main active compound, urospermal A-15-O-acetate. The high anti-plasmodial activity of this compound merits further study about its anti-plasmodial mechanism of action. The active extracts of D. tomentosa, as well as urospermal A 15-O-acetate, displayed only a moderate selectivity, and further studies are needed to assess the safety of the use of the plant by the local population.

Brazilian Plasmodium falciparum isolates: investigation of candidate polymorphisms for artemisinin resistance before introduction of artemisinin-based combination therapy

Background

This study was performed to better understand the genetic diversity of known polymorphisms in pfatpase6 and pfmdr1 genes before the introduction of ACT in Brazil, in order to get a genotypic snapshot of Plasmodium falciparum parasites that may be used as baseline reference for future studies.

Methods

Parasites from P. falciparum samples collected in 2002, 2004 and 2006-2007 were genotyped using PCR and DNA sequencing at codons 86, 130, 184, 1034, 1042, 1109 and 1246 for pfmdr1 gene, and 243, 263, 402, 431, 623, 630, 639, 683, 716, 776, 769 and 771 for pfatpase6 gene.

Results

A pfmdr1 haplotype NEF/CDVY was found in 97% of the samples. In the case of pfatpase6, four haplotypes, wild-type (37%), 630 S (35%), 402 V (5%) and double-mutant 630 S + 402 V (23%), were detected.

Conclusion

Although some polymorphism in pfmdr1 and pfatpase6 were verified, no reported haplotypes in both genes that may mediate altered response to ACT was detected before the introduction of this therapy in Brazil. Thus, the haplotypes herein described can be very useful as a baseline reference of P. falciparum populations without ACT drug pressure.

Artemisone effective against murine cerebral malaria

Background

Artemisinins are the newest class of drug approved for malaria treatment. Due to their unique mechanism of action, rapid effect on Plasmodium, and high efficacy in vivo, artemisinins have become essential components of malaria treatment. Administration of artemisinin derivatives in combination with other anti-plasmodials has become the first-line treatment for uncomplicated falciparum malaria. However, their efficiency in cases of cerebral malaria (CM) remains to be determined.

Methods

The efficacy of several artemisinin derivatives for treatment of experimental CM was evaluated in ICR or C57BL/6 mice infected by Plasmodium berghei ANKA. Both mouse strains serve as murine models for CM.

Results

Artemisone was the most efficient drug tested, and could prevent death even when administered at relatively late stages of cerebral pathogenesis. No parasite resistance to artemisone was detected in recrudescence. Co-administration of artemisone together with chloroquine was more effective than monotherapy with either drug, and led to complete cure. Artemiside was even more effective than artemisone, but this substance has yet to be submitted to preclinical toxicological evaluation.

Conclusions

Altogether, the results support the use of artemisone for combined therapy of CM.

Evaluation of 13 selected medicinal plants from Burkina Faso for their antiplasmodial properties

AIM OF THE STUDY

The aim of this study was to evaluate the antiplasmodial properties of 13 plants used against malaria in traditional medicine in Burkina Faso.

MATERIALS AND METHODS

In vitro antiplasmodial activity of dichloromethane, methanol and aqueous crude extracts obtained from vegetal samples collected in Burkina Faso was first evaluated on the Plasmodium falciparum 3D7 chloroquine-sensitive strain using a colorimetric method.

RESULTS

Thirteen extracts obtained from 8 different species were found to exhibit antiplasmodial activity (IC(50)<50 microg/ml). Five species demonstrated a moderate activity (15 microg/ml<IC(50)<50 microg/ml): Boswellia dalzielii (leaves), Waltheria indica (roots and aerial parts), Bergia suffruticosa (whole plant), Vitellaria paradoxa (bark) and Jatropha gossypiifolia (leaves). The best results were obtained with extracts from the Dicoma tomentosa whole plant, from Psorospermum senegalense leaves and from Gardenia sokotensis leaves. These extracts found to display promising antiplasmodial activity, with IC(50) values ranging from 7.0 to 14.0 microg/ml. The most active plant extracts were then tested for in vitro activity on the Plasmodium falciparum W2 chloroquine-resistant strain and also for in vitro cytotoxicity on normal human fibroblasts (WI-38) in order to determine the selectivity index.

CONCLUSIONS

Dicoma tomentosa (Asteraceae) and Psorospermum senegalense (Clusiaceae) appeared to be the best candidates for further investigation of their antiplasmodial properties, reported for the first time by this study.