SCIENTISTS VALIDATE MORE HERBAL ‘CURES’ FOR SICKLE CELL ANAE

[herbsandhelpers]

SCIENTISTS VALIDATE MORE HERBAL ‘CURES’ FOR SICKLE CELL ANAEMIA

Nigerians with sickle cell anaemia should no longer die or be limited by the condition because scientists have identified and validated herbal cures for the condition. CHUKWUMA MUANYA writes.

RECENT studies estimate that about 89 per cent of persons with sickle cell disorder (SCD) worldwide are in Africa, of which Nigeria alone constitutes 25 per cent. Europe has the least, 0.1 per cent, while the United States of America (USA), Asia and the Mediterranean have 3.5 per cent each.

However, most current works on the development of specific therapy for sickle cell anaemia include the discovery of Hemoglobin modifiers, membrane modifiers and genetic modifiers among others.

Several studies have shown that some of the orthodox modes of treatment of SCD include induction of fetal hemoglobin (HbF) using HydroxyUrea (HU), Butyrate or its derivatives, oral administration of Clotrimazole, which is a potent Gardos Channel inhibitor; blood transfusion and Haematopoetic cell Transplantation (HCT).

Although, the successful use of HU was reported in children, however, side effects or poor drug efficacy of some of these agents poses problems for many patients. In addition, the high cost of HCT is hardly affordable by most sickle-cell disease patients in Nigeria and other developing countries.

However, herbal medicines have come to the rescue. They are accessible and cheap. Nigerians were last year reassured by the Minister of State for Health, Prof. Muhammad Ali Pate, that the only Nigerian herbal drug that has received global acceptance and patents for treating sickle cell anaemia, NIPRISAN, developed by researchers at the Nigeria Institute of Pharmaceutical Research and Development (NIPRD), will be back into the market after almost 10 years of stopping production due to property right and financial issues.

Scientists especially those at NIPRD have continued to identify and validate new candidates.

According to a recent study published in the journal Anaemia, three new anti-sickling herbs: Entandrophragma utile; Chenopodium ambrosioides; and Petiveria alliacea were reported in May 2011. At NIPRD, where NIPRISAN was developed, three other recipes are currently awaiting development.

Entandrophragma utile is commonly called African cedar, Sapele mahogany, Ashanti cedar and is of the plant family Meliaceae.

Commonly called Indian wormseed, sweet pigweed, Mexican tea, Jesuit’s tea, Chenopodium ambrosioides belongs to the plant family Chenopodiaceae. It is called ewe imí (leaf of excreter) in Yoruba.

Petiveria alliacea is commonly called guinea-hen weed in English and ojú sajú in Yoruba.

The study raised the hope that the search in the Tropics for more effective herbal recipes for managing sickle cell anaemia will be more fruitful with time and effort.

The study is titled “Traditional Herbal Management of Sickle Cell Anemia: Lessons from Nigeria.”

The researchers from the Department of Medicinal Chemistry and Quality Control, NIPRD, Abuja, and Department of Pharmaceutics & Medicinal Chemistry, Niger Delta University, Wilberforce Island, Amassoma, wrote: “Among the Efik and Ibibio, Hausa, Igbo, Idoma, and Yoruba: clove (Eugenia caryophyllata or “kanunfari” in Hausa; Piper guineense (“eche” in Idoma or “akwa-ose” in Igbo); grains of paradise (Aframomum melegueta or “otuta” in Idoma); Sorghum bicolor (the leaf stalk yields an extract that looks like blood); Pterocarpus osun (common in the Yoruba state of Osun) are used in various health conditions, including sickle cell anemia.

“As stated earlier E. caryophyllata, P. guineense, P. osun, and S. bicolor are the herbal components of the Yoruba recipe upon which the anti-sickling drug Niprisan is based. Prior to the era of Niprisan these herbs were either extracted with “ogogoro” (ethanolic distillate of palm wine) or with an aqueous solution trona (sodium sesquicarbonate—a mineral used in Nigeria as tenderizer). Niprisan has passed phases IIA and IIB, and is widely used in Nigeria, and is known or popular in India and the United States of America (USA).”

In 2010, Swift of COSMID Corporation, USA, stated the following: “A dried extract of four plants has been used to treat patients with SCD in Nigeria for many years (NIPRISAN). It has been through multiple clinical trials in Nigeria and has been formally approved for use in that country since 2006 for the treatment of Sickle Cell Disease (SCD). The United States Food and Drug Administration (US FDA) has determined there is sufficient safety and efficacy data for NIPRISAN to start a Phase III clinical trial. The US FDA Botanical Review Team (BRT) suggested a simpler formulation of NIPRISAN, development of a chemical fingerprint for the formulation using LC/MS and elucidation of some of the anti-sickling compounds in the formulation would improve standardisation and increase the probability of obtaining FDA marketing approval.”

The researchers said that to the best of their knowledge phase III trial of Niprisan is yet to be reported. “We did however suggest in 2011 that phytocannabinoids and vanilloids in E. caryophyllata and P. guineense may account for some of the useful effects of Niprisan in sickle cell crisis. Some of these compounds, including shikimic acid derivatives (vanilloids) and cannabinoids are indicated, respectively,” they wrote.

This is the testimony of one of the American doctors: “Doctors in Nigeria use Fagara (Fagara zanthoxyloides) to reduce the painful crisis of the genetic disease, sickle cell anemia. This herb has a variety of unusual properties that reduce platelet and blood cell sticking. After reading the reports from Nigeria many years ago, I decided to try fagara’s relative prickly ash bark for the same indication.

“I made a simple tincture of 50 per cent prickly ash bark and 50 per cent ginkgo leaf, and gave it to a young African-American girl in the first grade who constantly missed school and needed to be hospitalized three to four times per year due to the painful sickle cell crisis. I gave her about 25 drops three times a day. She immediately stopped having serious problems, her thinking was no longer fuzzy, the frequency of her attacks went down to about one per year, and the severity of the attacks decreased appreciably. This success has continued through the years, as long as she takes her medicine. I saw her last year, and she has blossomed into a beautiful junior high school student, the sickle cell disease now only a bit-player in the background of her life.

“Another of my patients had lived with the disease his entire life, with almost constant pain, and bimonthly crisis. I gave him 35 drops three times per day, and he immediately improved in the same way as the young girl. This improvement in both frequency of attacks and level of pain has persisted in three of my long-term patients over many years. The wholesale cost of this medicine is less than $20 per month at full dosage. My biggest fear is that this knowledge will be co-opted by a pharmaceutical company, and made available to the many suffering children only at an exorbitant cost.”

Fagara znthoxyloides is called Chewing stick in English and orin ata in Yoruba.

Entandrophragma utile, Chenopodium ambrosioides, and Petiveria alliacea

The results of a study titled “Phytochemical and antisickling activities of Entandrophragma utile, Chenopodium ambrosioides and Petiveria alliacea” showed that they exhibited substantial anti-sickling activity. This may offer a rational explanation for the use of these plants in managing SCD by traditional healers.

Until now, the root, leaf and bark of Petiveria alliacea, Chenopodium ambrosioides and Entandrophragma utile respectively are used by traditional healers for the management of SCD in some parts of South West Nigeria.

The study published recently in Journal of Medicinal Plants Research by scientists from the Faculty of Pharmacy, Olabisi Onabanjo University, Sagamu; and Department of Microbiology, University of Agriculture, Abeokuta, evaluated the in-vitro anti-sickling activities of these plants’ parts using p- hydroxybenzoic acid and normal saline as positive and negative controls respectively.

Methodology involved the inhibition of sodium metabisulphite induced sickling of HbSS erythrocytes (sickled red blood cells), collected from a confirmed sickle-cell disease (SCD) volunteer in steady state using both crude methanol extract and its aqueous fractions.

The extracts/fractions of the three plants at 1.0 and 0.1 mg/ml were observed to exhibit significant anti-sickling activity while lysis of erythrocytes occurred at 10.0 mg/ml.

Phytochemical screening of the plant extracts revealed the presence of saponnins, tannins and alkaloids. “Therefore, the use of the plants by the traditional medical practitioners in the treatment of SCD is justified,” the researchers wrote.

Pawpaw and guinea corn

Nigerian researchers have achieved 93 per cent anti-sickling properties and 84 per cent reversal activities with Carica papaya (pawpaw) and Sorgum bicolor extract. Sorghum bicolor is commonly called guinea-corn or sweet sorghum. Guinea corn is called dawa in Hausa.

The study was published in African Journal of Pharmacy and Pharmacology by researchers from Adekunle Ajasin University, Akungba-Akoko, Ondo State and Obafemi Awolowo University, Ile-Ife, Osun-State.

Traditionally in Nigeria, S. bicolor is used as a blood builder and used in the treatment of sickle cell crisis. A four - five day cold infusion of a mixture of S. bicolor leaves and Carica papaya unripe fruit pulp is used by the Yorubas (western Nigeria) to alleviate bone pains.

The researchers wrote: “The anti-sickling properties of fermented mixture of dried unripe fruit pulp of Carica papaya and dried Sorghum bicolor leaves, mixed in equal proportions in distilled water, was carried out using sodium metabisulphite sickled red blood cells and the result presented. Equal weight of dried C. papaya fruit pulp and S. bicolor leaves were fermented together in distilled water at room temperature and the aqueous extract obtained and used for anti-sickling assays.

“The extract gotten from the materials incubated for five days indicated as SP5, was found to have the highest anti-sickling properties with 93 per cent inhibitory and 84 per cent reversal activities. The concentration of the day-five extract was further varied. 0.2 ml was found to be the optimum volume of the test extracts…

“C. papaya had been reported to possess anti-sickling properties suggesting that the active compound(s) preventing and reversing sickling could be organic acids, produced after hydrolysis of corresponding esters in the fruit. Also reported are amino acids, glycine, phenylalanine and tyrosine, which have been reported to possess anti-sickling properties.

“The combination of these two plants could have synergistic effect since one or more components of each have anti-sickling properties hence the high values for both the reversal and inhibitory activities.”

A herbal preparation made with Sorghum bicolor has been able to boost blood levels (treat anemia), stop pain and inflammation, reverse cell damage (antioxidant), and increase cellular immunity in Persons Living With HIV/AIDS (PLWHA) in animal and human models.

Sorghum bicolor belongs to the plant family Poaceae. It makes a refreshing non-alcoholic beverage, kunu-zaki (in Hausa), and tasty pap, akamu (in Ibo), and thick porridge or porage, tuwo dawa (in Hausa). It is fermented to make sorghum beer called burkutu or pito, or made into flour and mixed with bean flour then fried to make dawaki.

Researchers have also shown that unripe mature pawpaw seeds may provide a cheap and accessible treatment for kidney damage and sickle cell anaemia. They found that seed extracts of unripe mature fruits of pawpaw can protect the kidneys from damage and could offer hope for the treatment of poison-related kidney (renal) diseases.

The study titled “Nephroprotective activities of the aqueous seed extract of Carica papaya in carbon tetrachloride induced renal injured Wistar rats: A dose- and time-dependent study,” was published in Biology and Medicine.

Nigerian researchers have also shown the anti-sickling properties of crude juice extracts of the edible portions of three commonly consumed tropical fruits namely Persia Americana (avocado), Citrus sinensis (orange) and Carica papaya.

The study was published in African Journal of Traditional Complementary and Alternative Medicines.

Fagara zanthoxyloides and Cajanus cajan

Researchers have clearly demonstrated that plant-based antioxidants replete in Cajanus cajan (Pigeon pea in English, fio fio in Igbo), Fagara zanthoxyloides (Chewing stick in English, orin ata in Yoruba), fishes, fruits and vegetables, nuts and whole grains, and nutritional supplements can compensate for some inborn defect of sickle cell anaemia.

The studies suggest that for people with Sickle Cell Disorder (SCD), it means healthier red blood cells, less anaemia and pain, and other improvement in health.

Nigerian researchers have reported a randomised single-blind placebo controlled study, which showed that the extract of Cajanus cajan reduced the frequency of painful crises and possibly ameliorated the adverse effects of SCA on the liver in children aged one to15 years.

Cajanus cajan is a popular food in developing tropical countries and belongs to the plant family Fabaceae. Nutritious and wholesome, the green seeds (and pods) serve as vegetable.

The results of this study by researchers at the College of Medicine University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH), Idi-Araba, published in the Journal of Tropical Paediatrics, are encouraging when viewed in the light of increasing concern about the benefit of new conventional therapies like Hydroxyurea in an African setting where limited resources make widespread use, monitoring of side effects, and toxicities virtually impossible.

Considerable attention has thus been paid, particularly in Africa, to naturally occurring anti-sickling agents, which offer the potential of being relatively safer, easily administered and potentially less costly than Hydroxyurea.

In summary, evidence from this study shows that the extract of Cajanus cajan appears to be safe, easily administered and efficacious in reducing painful crises and may offer increased benefit to patients with SCA in future.

Roots of Fagara zanthoxyloides (orin ata in Yoruba), known as chewing sticks, are widely used for tooth cleaning in West Africa. The Nigerian Zanthoxylum is a common component of the rain forest vegetation of southern Nigeria.

According to a study on the Nigerian Fagara zanthoxyloides by S. K. Adesina of the Drug Research & Production Unit, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, traditional healers throughout Nigeria have used species of the Zanthoxylum for the treatment of a wide range of disorders, including toothache, urinary and venereal diseases, rheumatism and lumbago.

According to the study, which was published in the African Journal of Traditional, Complementary and Alternative Medicines preliminary assays carried out at the Universitty of Ibadan, Isaacs Sodeye noted that it seemed that zanthoxylol isolated from Fagara zanthoxyloides in 1966 possessed antisickling activity.

Alchornea laxiflora

Alchornea laxiflora has shown promise in a College of Medicine University of Lagos (CMUL), Idi-Araba, study in treating sickle cell anaemia.

Alchornea laxifora is called uwenuwen in Edo; ububo in Igbo; urievwu in Urhobo; and ijin, ijin funfun and ijindi in Yoruba.

Preclinical anti-sickling and haemolytic toxicity studies on the herbal product, Cellod-S, carried out by researchers at Natural Medicine and Molecular Pharmaco-Biotechnology Laboratories Faculty of Pharmacy, CMUL, indicated that the herbal preparation produced 85 per cent sickling inhibition and 69.1 per cent sickling reversal.

The study titled “Does re-hydration necessarily imply re-oxygenation in sickling reversal? The Gardos phenomenon - revisited. A case for cellod-S herbal remedy” was published in Journal of Pharmaceutical Sciences and Pharmacy Practice.

The researchers concluded: “The results of these pre-clinical evaluations indicate that Cellod-S has the acclaimed anti-sickling ethnomedicinal use, and thatbhaemolysis - a major mechanism-based toxicity of potential anti-sickling agents, and phenomenon most guided against in sickle cell sufferers- is not a problem with Cellod-S. We therefore recommend Cellod-S for extensive clinical evaluations in humans.”

Indian almond

Nigerian researchers have also studied the anti-sickling activity of Terminalia catappa leaves harvested at different stages of growth.

According to the study published in the Nigerian Journal of Natural Products and Medicine, the aqueous and ethanolic leaf extracts of Terminalia catappa, a fruit bearing tree, popular in folkloric medicine for the treatment of sickle cell anaemia disease were assessed for their in-vitro anti-sickling activities. Extracts were prepared from the reddish-brown freshly fallen leaves, reddish-brown leaves and green leaves of the plant by maceration in the solvents.

Indian almond is botanically called Terminalia catappa and belongs to the plant family combretaceae. It is found in almost every town and village in southern Nigeria.

Studies have shown that diabetes and its attendant complications (erectile dysfunction/premature ejaculation, leg ulcer/gangrene, liver/ kidney failure), lung cancer and sickle cell anaemia can be addressed with extracts of Indian almond.

Source: The Guardian Nigeria