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   Dec 20

Work on Malaria brought recognition, eventually

Following up on my Dec. 5 column, a medicine that worked for malaria was known in China as early as 340 A.D. by practitioners of herbal medicine. It was unknown in the West until the 1980s when Deng Xiaoping opened China to the world. It was produced from an herb called sweet wormwood (Chinese name, Qinghao; Latin name, Artemisia annua).

The active chemical compound (Chinese name, Qinghaosu; Latin name, Artemisinin) was first identified by a phytochemist, Tu Youyou, in 1972. Born in 1930, she managed to develop a strong knowledge of both Chinese traditional medicine and modern western medicine during Mao Tse-tung’s regime. Malaria is not a health problem in most of China, but during the Vietnam War, the Vietnamese appealed to China for assistance because western medicines were losing their effectiveness against malaria in Vietnam.

Mao launched the 523 research program “which not only lead to the discovery of artemisinin but also new quinoleine derivatives that are now used as partner molecules to what is known as ‘Artemisinin based Combination Therapy’ or ACT,” (C. Faurant, “From bark to weed: The history of artemisinin,” in the journal, “Parasite,” Aug. 2011).

In the 1990s, several western university departments and pharmaceutical firms began to develop artemisinin medicines for malaria. Plantations of the sweet wormwood herb were started in several parts of the world. But there have been serious supply and demand issues. Only a few ounces of artemisinin can be produced from a ton of the leaves of the plant. Also, the amount varies greatly according to several little-understood factors including weather conditions, soil, moisture, even lighting conditions.

The process of separating out the desired compounds is quite lengthy and expensive (the cost per dose is often ten times or more than for other malaria medicines). However, the effectiveness of artemisinin is often as high as 97 percent compared to 30 percent to 50 percent for many of the other medicines to which the mosquitoes and their parasites have become resistant. There is variation in which medicines work best in various localities, so health workers must be very knowledgeable about what works best in their particular communities.

About 95 percent of the deaths from malaria are children in Africa less than five years old. Many of the adults who carry the malaria parasites are unaware that they carry the disease, and so it is difficult to convince them to take medicines for sickness they don’t know they have. But the eradication of malaria depends on killing off all the parasites that cause the illness. Most of the medicines are effective for a very limited time and during a particular phase of life of the parasites.

Like butterflies that have different life phases, living at first as worms, then making a cocoon from which they emerge as butterflies, the malaria parasites live through as many as six phases of life featuring both asexual and sexual reproduction and the time they spend in each phase can vary. More than one anti-malarial compound has to be included in medicine for it to be effective. That is why artemisinin is administered as part of “Artemisinin based Compound Therapy (ACT).”

When Tu Youyou and her team identified artemisinin as the active element in medicine from the sweet wormwood herb, they had to work secretly. It was during the Cultural Revolution, when many educated people were being violently abused by the Red Guard gangs that Mao had turned loose on them. For decades, very few knew about her work and she was unknown even among Chinese medical leaders, until well after the World Health Organization made ACT the preferred treatment for malaria.

Finally, in 2011, she was honored with the Lasker-DeBakey Clinical Medical Research Award, which in medical circles, is often referred to as “the American Nobel Prize.” (Until 2008, the award was known as the Lasker Clinical Medical Research Award; in 2008, in recognition of his great achievements, DeBakey’s name was added; see “Chinese scientist presented ‘America’s Nobel’ for anti-malaria drug,” Sina English; also, see Lasker Foundation, 2011 awards, for a 7 minute video).

On a personal note: Dr. Michael E. DeBakey (1908-2008) was the world-renowned cardiac surgeon still active until he was 98 as chancellor emeritus of Baylor College of Medicine in Houston, Texas. When I first met her in 1953, my future wife, Oralie Quintanilla, worked as a medical technician at M.D. Anderson Hospital where she was responsible one day each week for ensuring that all preparations were properly made for a demonstration surgical procedure by Dr. DeBakey. It was stressful work because DeBakey was a workaholic and perfectionist.

Source: The Reporter

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