From Pharmacognosia to DNA-Based Medicinal Plant Authentication - Pharmacognosy through the Centuries

For centuries, pharmacognosy was essential for the identification, quality, purity, and, until the end of the 18th century, even for the efficacy of medicinal plants. Since the 19th century, it concentrated on authenticity, purity, quality and the analysis of active substances, and was established as an academic branch discipline within pharmacy and continuously developed into a modern, highly sophisticated science. Even though the paradigm in pharmacy changed in the 19th century with the discovery of morphine and concentrated on single substances that could be synthesized fast by the upcoming industry, medicinal plants always remained an important element of the Materia medica, and during the last decades, medicinal plants continue to be a source of remedies, and natural products are an inspiration for new medicine. In this research, pharmacognostic skills remain an essential element, both with regards to identity, quality assurance of botanicals (both herbal medicines and supplements), and the discovery and development of new medicines. Over the years, the specific pharmacognostical tools have changed dramatically, and most recently, DNA-based techniques have become another element of our spectrum of scientific methods.

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Missionary pharmacy developed as a special type of the European pharmacy from the 16th to the 18th centuries in the overseas missions in the context of the proclamation of the Christian faith, the European expansion and the beginning globalization. As this type of pharmacy was determined by the specific circumstances of the medical-pharmaceutical situation in the mission countries as well as by the knowledge of the missionaries themselves, it can be defined as missionary pharmacy. It followed principally the model of the medieval monastery pharmacy and paved the way for the Medical Mission at the beginning of the 19th century. Different lines of development on various levels of exchange, forming, documenting and transmission of knowledge shaped the concept of the missionary pharmacy. The activities in the context of the missionary pharmacy initiated a global transfer of drugs and the referring pharmaceutical knowledge, which was institutionalized by the pharmacies of the Jesuits and essentially influenced the development of the Materiae medicae and the development of modern pharmacy all around the globe. The trading routes of typical drugs like the Fever bark and compositions can reconstruct this international transfer of knowledge. Still nowadays, knowledge of the missionary pharmacy, especially about genuine plants of the non-European countries, can be interesting for the development of new phytotherapeutics and possibly active substances.

Forming, transfer and globalization of medical-pharmaceutical knowledge in South East Asian missions (17th to 18th c.) - historical dimensions and modern perspectives

From the 17th to the 18th centuries, missionaries in Southeast Asia dedicated themselves to providing and establishing a professional medical-pharmaceutical supply for the local population and therefore explored the genuine Materia medica for easily available and affordable remedies, especially medicinal plants. In characteristic medical-pharmaceutical compendia, which can be classified as missionary pharmacopoeias, they laid down their knowledge to advise others and to guarantee a professional health care. As their knowledge often resulted from an exchange with indigenous communities, these compendia provide essential information about traditional plant uses of Southeast Asian people. Individual missionaries such as the Jesuit Georg Joseph Kamel (1661-1706) not only strove to explore medicinal plants but performed botanical studies and even composed comprehensive herbals. The Jesuit missionaries in particular played roles in both the order's own global network of transfer of medicinal drugs and knowledge about the application, and within the contemporary local and European scientific networks which included, for example, the famous Royal Society of London. The results of their studies were distributed all over the world, were introduced into the practical Materia medica of other regions, and contributed significantly to the academization of knowledge. In our article we will explain the different intentions and methods of exploring, the resulting works and the consequences for the forming of the pharmaceutical and scientific knowledge. Finally, we will show the options which the works of the missionaries can offer for the saving of traditional ethnopharmacological knowledge and for the development of modern phytotherapeutics and pharmaceutical supply. The publication is based on a comprehensive study on the phenomenon of missionary pharmacy which has been published as a book in 2011 (Anagnostou, 2011a) and shows now the potential of historical medical-pharmaceutical works written in the Asian missions of the 17th to 18th century and influenced by ethnopharmaceutical knowledge and the relevance of historical studies for modern investigation in phytotherapy.

Comparison of the manual Mycobacteria Growth Indicator tube and the Etest with the method of proportion for susceptibility testing of Mycobacterium tuberculosis

BACKGROUND

Clinical microbiology laboratories should provide reliable results on susceptibility testing of Mycobacterium tuberculosis to different agents.

METHODS

The manual Mycobacteria Growth Indicator Tube (MGIT) and Etest were compared to the method of proportion (MOP) for susceptibility testing of 88 clinical isolates of M. tuberculosis against isoniazid (INH), rifampin (RIF), streptomycin (STR) and ethambutol (EMB). Isolates were recovered from different patients and were identified at species level by PCR and hybridization.

RESULTS

Resistance to INH was detected in 20.5, 29.5 and 12.5% of the isolates, followed by STR resistance (19.3, 26.1 and 1.1%), RIF (9.1, 4.5 and 5.7%) and EMB (2.3, 11.4 and 2.3%) by the MOP, MGIT and Etest, respectively. Sensitivity of the manual MGIT ranged from 37.5% for RIF resistance to 100% for EMB, while Etest sensitivity ranged from 5.9% for STR to 62.5% for RIF.

CONCLUSIONS

MOP remains the method of choice, with the manual MGIT showing superior sensitivity at detecting resistance to INH, STR and EMB compared to the Etest.

Resistance of Mycobacterium tuberculosis isolates in different populations in Greece during 1993-2002

OBJECTIVE

To document the prevalence of resistance of Mycobacterium tuberculosis to isoniazid (INH), rifampicin (RMP) and both combined (multidrug resistance [MDR]) in Greece from 1993 to 2002.

DESIGN

We studied a single sputum sample per patient from 4108 patients referred to the Greek National Referral Centre for Mycobacteria. Patients were divided into native Greeks, immigrants and repatriated Greeks originating from the former Soviet Union. Prior treatment status was not recorded.

RESULTS

A statistically significant increase in resistance to INH and RMP and MDR was noted comparing the years 1993-1997 to 1998-2002 (P < 0.0001). Resistance to INH and RMP and MDR rose from 5.6% to 7.71%, from 1.57% to 4.49% and from 1.23% to 3.98%, respectively, among native Greeks and from 23.63% to 32.91%, from 6.36% to 15.19% and from 6.36% to 13.92% among repatriated Greeks. Smaller changes were seen among immigrants (from 15.43% to 9.57% for INH, from 5.51% to 6.12% for RMP and from 5.71% to 5.32% for MDR).

CONCLUSION

We documented an increase in M. tuberculosis resistance to INH and RMP, and MDR. This was mainly limited to native and repatriated Greeks. Although this is likely the result of immigration and of mismanagement of index cases in Greece, molecular methods are needed to better describe the situation.

Multicenter evaluation of the fully automated bactec MGIT 960 system and three molecular methods for the isolation and the identification of mycobacteria from clinical specimens

A combination of Bactec MGIT 960 system, a PCR-based assay and a PCR-Restriction Analysis procedure (PRA) was assessed for the detection and identification of mycobacteria from clinical samples. The MGIT recovered 243 from 266 mycobacterial isolates. The PCR-based assay correctly identified all (234) Mycobacterium tuberculosis isolates, while 35 nontuberculous mycobacterial isolates were identified by PRA.

Detection of mycobacteria in clinical specimen using the mycobacteria growth indicator tube (MGIT) and the Lowenstein Jensen medium

The recovery rates of mycobacteria strains isolated from 1200 clinical specimens using the mycobacteria growth indicator tube (MGIT) system and the conventional Lowenstein Jensen medium (LJ) were assessed. Of the 87 mycobacterial isolates recovered, 54 belonged to the M. tuberculosis complex (MTB) and 33 to the non-tuberculosis complex (NTM). MGIT recovered 78 (89.65%) mycobacteria isolates (51 MTB (94.44%) and 27 NTM (81.81%) and LJ recovered 70 (80.46%) mycobacteria isolates (49 MTB (90.74%) and 21 NTM (63.63%). Sixty one (70.1%) of the total mycobacteria isolates were recovered with both systems (46 (85.2%) MTB and 15 (45.5%) NTM). No significant difference was found between MGIT and LJ (p > 0.05) in both MTB and NTM recoveries. The average detection time for MTB was significantly shorter with MGIT than with LJ, in both the smear-positive specimens (8 vs 30 days: p < 0.0001) and smear-negative specimens (15 vs 30 days: p < 0.001). The average detection time of NTM was also shorter for MGIT (15 vs 30 days: p < 0.0001). However, the contamination rate was higher in MGIT (8.5%) than in LJ (3%). The results suggest that the use of MGIT contributes to a more rapid and effective diagnosis of mycobacterial infections particularly when combined with the classical LJ.

Molecular markers for the investigation of Mycobacterium gordonae epidemics

Mycobacterium gordonae was isolated as a light growth from bronchoalveolar aspirates from nine patients over 12 months. All patients were in one hospital, and had been bronchoscoped for suspected malignancy. None of the patients had symptoms or radiographic findings of mycobacterial infection. The isolates were characterized by biochemical tests and molecular hybridization. Random amplified polymorphic DNA analysis (RAPD) was used to test whether the strains had a common origin. All the isolates generated four to eight fragments, and almost all presented distinct RAPD patterns. Antimicrobial resistance patterns to six agents confirmed that the isolates were unrelated. Thus epidemiologically unrelated strains of M. gordonae can exist as contaminants in the same department over a relatively short time frame. RAPD analysis is easy to perform, gives rapid results, and can be used for epidemiological analysis of M. gordonae isolates.

The effect of intraarticular hydrocortisone injection on the articular cartilage of rabbits

We investigated the effect of hydrocortisone on the articular cartilage of the knee in rabbits. 27 New Zealand white rabbits were injected intraarticularly with 25, 50 or 100 mg betamethasone acetate in 2 or 4 weekly intervals. Control animals were injected with normal saline and demonstrated no histological changes in the articular cartilage. Hydrocortisone administration was associated with increased cell size, as well as an increased stain density in the cytoplasm surrounding vacuoles. In addition, loss of cell organelles was also observed. High dose of hydrocortisone was associated with an obvious loss of cell shape and distortion of the cell membrane and nucleus. The magnitude of histological changes, found under light and electron microscopy, were proportional to the amount of hydrocortisone injected. Our findings strongly indicate that intraarticular injection of hydrocortisone alters the shape of articular cartilage chondrocytes, producing abnormal changes in the cytoplasm and nucleus and leading to cell degeneration.

Mid-palm replantation. Long-term results

16 patients with complete mid-palm amputations underwent replantation between 1987 and 1991. 14 were successful. Young patients with guillotine type mid-palm amputations who could be treated with end-to-end suturing of the tendons and nerves, presented with the highest degree of function when evaluated both objectively and subjectively. In contrast, less return of function was noted in patients with high energy or avulsion type injuries of the nerves.

Clinical assessment of primary digital nerve repair

We have carried out a retrospective study of 64 primary digital nerve repairs in 50 patients who presented to our department between 1988 and 1993. 45 of the patients were operated on within 6 hours of the injury using microscope (x 14). Normal two-point discrimination was regained in only 9 cases, while 6-10 mm two-point discrimination was achieved in 22, 11-15 mm in 15 and protective sensation in 18. A close correlation between age and recovery of sensation after repair was observed. Microsurgical repair of digital nerve gives satisfactory results, since a normal or good two-point discrimination can be obtained in about half of cases, while sensation improves in the rest. A high rate of complete recovery of sensation, however, is to be expected only in children.

Major amputation of the upper extremity. Functional results after replantation/revascularization in 47 cases

Over a 7 year period, 47 patients underwent replantation of complete (19) and revascularization of incomplete nonviable (28) amputations of the upper extremity. Revascularization of incomplete nonviable amputations had a success rate of 100 percent, where as replantation of complete amputations had a success rate of 74 percent. 37 of the 42 patients with successful replantations had satisfactory functional use of the replanted extremity.

Clinical analysis and evaluation of the function of replanted and revascularized parts of the upper limb

During the past four years, we have attempted to replant and revascularize 57 hands and fingers in 43 patients. The total success rate was 81%. Replantation of hands severed cleanly (guillotine type) and those with slight local crush injuries had the highest success rate. As for hand function, amputations at zones III and IV with end-to-end suturing of the tendons and nerves presented the highest degree of function when evaluated objectively and subjectively. All patients presented a high degree of satisfaction with the outcome of the operation.

Results after repair of traumatic arterial damage in the forearm

Eighty-three patients, with 96 instances of radial or ulnar arterial damage, were treated over a four-year period using microsurgical techniques. Thirty-one patients, with 43 arterial repairs, were available for evaluation. In the 14 patients with a single arterial repair, 4 resulted in thrombosis (71.5% success rate). When both arteries required repair, our success rate was 75.9%, with 7 thromboses. The overall success rate was 74.5%. We attribute the high patency rate to strict microsurgical technique, the repair of the vessels in the early stages after trauma, and the use of vein grafts after complete resection of the damaged portion of the vessel.