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   Mar 11

Mixed results for local herbal ‘cures’ for TB

Malaria plant, turmeric, garlic top herbal ‘cures’ for multi-drug resistant tuberculosis

There are mixed results for local plants used in the treatment of tuberculosis (TB) and multi-drug-resistant strains especially in Human Immuno-deficiency Virus (HIV) patients in Nigeria.

While some plants such as the malaria plant, Artemisia annua, turmeric and garlic showed great promise against multi-drug resistant strains of TB, some other local plants have failed in clinical tests.

Indeed, the emergence of multi-drug resistant (MDR) and extensively-drug resistant (XDR) strains of Mycobacterium tuberculosis has further complicated the problem of TB control.

In one study, researchers could not validate the anti- tuberculosis activities of some medicinal plants used in the treatment of tuberculosis in HIV patients.

The team of researchers from Nigeria, United Kingdom (U.K.), India and Colombia evaluated claims by local herbalists in Nigeria that extracts of certain parts, that is, stem and seeds obtained from Crinum glaucum, Treculia africana, Erythrina mildbaedi, Ficus thonningii and Xylopis aethiopica are used to treat tuberculosis patients.

The researchers conducted a laboratory-based study of this claim scientifically using the procedures employed by the local herbalists. They said the Mycobacterium tuberculosis (causative organism for TB) strain used in this study was obtained locally and characterized based on cultural and biochemical tests on isolates of bacteriologically proven tuberculosis positive patients.

The researchers found the M. tuberculosis strains were resistant to all the extracts. There was no growth on the isoniazid drug containing medium which was used as control. There was growth on all the LJ medium containing the extracts.

According to the researchers, the results of these findings showed that the extracts of these plants exhibited no significant anti-microbial activity against M. tuberculosis and therefore not recommendable for clinical use as an anti-tuberculosis drug.

The study was published in the African Journal of Microbiology Research.

The researchers include: Anochie P. I., Onyejepu N., Adetunji M. A., and Efere L. O. from the Nigerian Institute of Medical Research (NIMR), Yaba, Lagos;
Ogu A. C. from the Department of Medicine, University of Sheffield, United Kingdom (U.K.); Onyeozirila A. C. from the Department of Medicine, Madonna University, Elele, Rivers State; Onyeneke E. C. from the Federal Medical Center, Owerri, Imo State; Onyeneke, C. N. from the Department of Microbiology, Abia State University, Abia State; Obinna J. U. from Ogun State University Teaching Hospital, Ogun State; Srikanth A. from the School of Biosciences Technology, VIT University, India; and Bueno, J. from the Grupo de Micobacterias, Instituto Nacional de Salud, Bogota, D.C, Colombia.

Crinum glaucum A.Chev (Amaryllidaceae) is a bulbous plant widely used in folk medicine in West Africa. The common English names are river lily, String-lily, swamp-lily, Crinum lily and Spider lily. In Zulu tribe it’s known as “umNduze”. In Nigeria, it’s known as “Isumeri” in the Yoruba speaking regions, Ede chukwu or Ede mmo (God’s cocoyam) in Igbo speaking regions and Albasar kwa’adi (Frog’s onion) in Hausa speaking regions.

The bulbs of Crinum glaucum is used in Southwestern Nigeria as an effective remedy in the relief of cough, asthma and convulsions by traditional medicine practitioners.

Commonly called African pepper or Guinea pepper, Xylopia aethiopica, belongs to the family Annonaceae. In Nigerian Arabic, it is called kyimba in, kumba in Arabic-Shuwa, kenya in Bokyi, akada in Degema, unie in Edo, ata in Efik, kimbaahre in Fula-Fulfulde, kimbaa in Hausa, ata in Ibibio, uda in Ibo, tsunfyanya in Nupe, kimbill in Tera, eeru in Yoruba.

The African breadfruit is botanically called Treculia africana. It is a tropical tree crop also belonging to the taxonomic family Moraceae. It is also called wild jackfruit or African-boxwood. In Nigeria, it is called ukwa in Ibo. It is afon in Yoruba; ize in Benin, Jekri in Sobo; izea in Ijaw; and ediang in Efik.

Erythrina mildbraedii belongs to the plant family Leguminosae-papilionoideae.

Ficus thonningii belongs to the plant family Moraceae.

Also, another study published in African Journal of Infectious Diseases evaluated crude extracts of twelve medicinal plants and “wonder-cure” concoction used in Nigeria unorthodox medicine activity against Mycobacterium tuberculosis isolated from tuberculosis patients sputum and the control strains of M. tuberculosis (H37RV).

The researchers found that both ethanolic and aqueous solution of the extract of Allium ascalonicum, Terminalia glaucescens, Allium cepa and Securidaca longepedunculata (ethanolic extract only) at 0.05g/ml as well as aqueous solution of “wonder cure” concoction at same concentration inhibited the growth of M. tuberculosis.

They, however, said at lower concentration of 0.2 µg/ml (critical proportion level of the control drug (isoniazide), M. tuberculosis was resistant to both aqueous and ethanolic extracts of the plants as well as the aqueous solution of the wonder-cure concoction.

The phytochemical analysis of the plant extract and the Epa-Ijebu showed the presence of bioactive compounds: tannin, flavonoid, alkaloids, phlobatannin, anthocyanin, reducing sugar, saponin and anthraquinone.

The researchers concluded: “Our results offer a scientific basis for the traditional use of aqueous and ethanolic extracts of Allium ascalonicum, Terminalia glaucescens, Allium cepa, Securidaca longepeducunlata (ethanolic extract only) and aqueous solution of the ‘wonder cure’ concoction at higher concentration against M. tuberculosis.

“However local herbs such as Nicotiana tabacum, Allium sativum, Aframomum melegueta, Aprus precatorius, Xylopia aethiopica, Tetrapleura tetraptera, Crinium jagus, and Garcinia kola were ineffective.”

Meanwhile, scientists have demonstrated the efficacy of the malaria plant, Artemisia annua, turmeric (Cucuma longa) and garlic in the treatment of the multi-drug resistant TB.

The Chinese plant, Artemisia annua, which is being grown in commercial quantities in Nigeria, has joined the league of plant validated for the treatment of TB and multi-drug resistant TB (MDR TB).

The drug-of-choice for malaria and the WHO-recommended drug, Artemisinin-based Combination Therapy (ACT), is derived from this plant. According to a new study published in the journal Nature Chemical Biology, the plant has been found to potentially aid in the treatment of tuberculosis and may slow the evolution of drug resistance.

In a promising study led by Robert Abramovitch, a Michigan State University, United States (U.S.), microbiologist and TB expert, the ancient remedy artemisinin stopped the ability of TB-causing bacteria, known as Mycobacterium tuberculosis, to become dormant. This stage of the disease often makes the use of antibiotics ineffective.

Abramovitch, an assistant professor in the College of Veterinary Medicine, said: “When TB bacteria are dormant, they become highly tolerant to antibiotics. Blocking dormancy makes the TB bacteria more sensitive to these drugs and could shorten treatment times.”

Mycobacterium tuberculosis, or Mtb, needs oxygen to thrive in the body. The immune system starves this bacterium of oxygen to control the infection. Abramovitch and his team found that artemisinin attacks a molecule called heme, which is found in the Mtb oxygen sensor. By disrupting this sensor and essentially turning it off, the artemisinin stopped the disease’s ability to sense how much oxygen it was getting.

Also, new research published in Respirology indicated that curcumin – a substance in turmeric that is best known as one of the main components of curry powder – may help fight drug-resistant tuberculosis.

Turmeric is a spice that comes from the root of Curcuma longa, a member of the ginger family, Zingaberaceae. In traditional medicine, turmeric has been used for its medicinal properties for various indications and through different routes of administration, including topically, orally, and by inhalation.

In Nigeria, it is called atale pupa in Yoruba; gangamau in Hausa; nwandumo in Ebonyi; ohu boboch in Enugu (Nkanu East); gigir in Tiv; magina in Kaduna; turi in Niger State; onjonigho in Cross River (Meo tribe).

Turmeric, also known as curcuma, produces a root that is used to produce the vibrant yellow spice used as a culinary spice so often used in curry dishes. Though native to India and parts of Asia, and is a relative of cardamom and ginger, turmeric has been domesticated in Nigeria. In Asia, turmeric is used to treat many health conditions and it has anti-inflammatory, antioxidant, and perhaps even anticancer properties.

Investigators found that by stimulating human immune cells called macrophages, curcumin was able to successfully remove Mycobacterium tuberculosis from experimentally infected cells in culture. The process relied on inhibiting the activation of a cellular molecule called nuclear factor-kappa B.

The ability of curcumin to modulate the immune response to Mycobacterium tuberculosis points to a potential new tuberculosis treatment that would be less prone to the development of drug resistance.

Lead author of the Respirology study, Dr. Xiyuan Bai, said: “Our study has provided basic evidence that curcumin protects against Mycobacterium tuberculosis infection in human cells.

“The protective role of curcumin to fight drug-resistant tuberculosis still needs confirmation, but if validated, curcumin may become a novel treatment to modulate the host immune response to overcome drug-resistant tuberculosis.”

Another study published in the International Journal of Applied Research investigated the in vitro anti-tubercular activity of garlic against MDR, XDR and reference strain of M. tuberculosis H37Rv.

The researchers concluded: “Ethanolic extract of garlic was set by maceration method. Minimum inhibitory concentration (MIC) was performed by using 7H9 middle brook broth dilution technique on 48 MDR isolates out of total 230 clinical isolates of MTB and reference strain of M. tuberculosis H37Rv. Minimum Inhibition Concentration (MIC) of garlic extract was ranged from 0.5 to 2 mg/ml, showing inhibitory effects of garlic against both MDR and XDR M. tuberculosis isolates.

“Alternate medicine practices with plant extracts including garlic should be considered to decrease the burden of drug resistance and cost in the management of diseases. The use of garlic against MDR-TB may be of great significance regarding to public health.”

Also, herbal preparation made with local plants: Seamus indica (sesame), Saccharum officinarum (sugar cane), Vernonia amygdalina (bitter leaf); and Aloe barbadensis (Aloe vera) has been shown to boost the body’s immunity against HIV/Acquired Immune Deficiency Syndrome (AIDS), tuberculosis, malaria, infertility, cancer, pain, stomach ulcer and sickle cell disease.

The researchers of the African Journal of Microbiology Research explained: “The resistance shown by the organism on the extracts means that the extracts were not able to inhibit the M. tuberculosis strains. Extracts from these herbs are therefore not recommendable for clinical use as an anti-tuberculosis drug until further work has been done in them like in other herbs.

“Patients that take these extracts as a way of treatment of TB may be doing so out of ignorance of the availability of better treatment or they could not afford the long treatment period of two to eight months needed to treat TB for proper cure or they cannot afford the money to buy the drugs that they will use for that long period but with the advent of the directly observed therapy short course (DOTS) programme which provides free diagnosis and treatment of TB (recognized as efficient by the World Health Organisation (WHO), if these patients are aware of this, it will be helpful to them. For those that are aware of the programme, treatment failures can mislead them into taking these extracts as a curative measure.

“Most of the herbal practitioners claim that their herbal extracts can cure a lot of diseases including TB. The result of this study has proved otherwise. Most of the patients they claim to have treated were not subjected to X-ray or laboratory investigations to prove their case. They may be suffering from other respiratory infections. It is only when more work has been done like in other herbs that this claim may be valid. Laboratory studies should be carried out on other herbs that are used by local traditional healers for the treatment of various infections.

“The disease which the local herbalist ‘cure’ or manage with the herbs used in this study could even be pneumonia, ordinary cough or could even be due to any other opportunistic respiratory tract infection other than M. tuberculosis.”

Source: Nigerian Guardian

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