Substitution between Aristolochia and Bryonia genus in North-Eastern Morocco: toxicological implications

Multiple sclerosis in Morocco: Epidemiological, clinical, and therapeutic profile

OBJECTIVE

This study aims to describe the clinical, therapeutic, and epidemiological profiles of MS patients in Morocco.

METHODS

This descriptive study involved 170 patients representing four Morocco regions. We collected the data using an electronic survey.

RESULTS

The results show female dominance in patients with MS. Besides, most patients present with relapsing-remitting MS (RRMS). The main clinical symptoms reported by patients are fatigue, cognitive issues, spasticity, bowel or bladder complaints, and visual issues. Furthermore, the findings show that almost half of the patients use Interferon bêta-1a and azathioprine as disease-modifying therapies; 60.5 % use traditional and complementary medicine, of which 30.6 % use cupping, 30 % recite the Holy Quran, and 28.2 % use apitherapy. The findings show that there is a statistically significant relationship between specific MS factors such as professional activity (p = 0.0071), degree of satisfaction with treatment (p = 0.005), stress (p = 0.014), and the frequency of relapses.

CONCLUSIONS

In addition to DMT, patients also use traditional and complementary medicine. There is also a relationship between some epidemiological characteristics and the frequency of relapses in patients with MS.

Phytochemical analysis, antioxidant, and antihyperlipidemic activities of Teucriumtakoumitense

Objective

The main purpose of the present work was to determine the chemical composition, safety, and antioxidant and antihyperlipidemic activities of an aqueous extract of Teucrium takoumitense.

Methods

Phytochemical analysis (total phenolic, total flavonoid, and total hydroxycinnamic acid contents), antioxidant activity (ferric-reducing antioxidant power, 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid, 2,2-diphenyl-1-picrylhydrazil, and total antioxidant capacity tests), acute toxicity, and antihyperlipidemic activity were evaluated according to established models. In addition, the phytochemical profile was determined by methylation followed by gas chromatography-mass spectrometry (GC/MS).

Results

The aqueous extract of T. takoumitense had a high content of total polyphenols (87.01 ± 0.31 mg gallic acid equivalent (GAE)/g extract) and hydroxycinnamic acid (2.28 ± 0.1 g/100 g Powdered Material) and a low content of total flavonoids (2.99 ± 0.16 mg GAE/g extract). In addition, the extract demonstrated remarkable antioxidant activity (DPPH IC50 = 76.67 ± 0.56 μg/mL, ABTS IC50 = 89.65 ± 0.27 μg/mL, FRAP EC50 = 296.32 ± 0.86 μg/mL, TAC value = 43 ± 0.27 mg EAA/g extract). The main compounds were identified as benzene, (hexyloxy)- (19.32%), 2,6a-methano-6aH-indeno[4,5-b]oxirene, octahedro-(1a.alpha., 2.beta., 3a.alpha., 6a.beta., 6b.alpha.)- (32.42%), d-fucose (5.47%), 5-hydroxymethylfurfural (5.47%) and guaiacol (3.19%). The LD50 was estimated to be between 500 and 2000 mg/kg. Furthermore, at 500 and 250 mg/kg, the aqueous extract of T. takoumitense exhibited good antihyperlipidemic activity in vivo.

Conclusion

T. takoumitense extract has significant pharmacological potential and a varied chemical composition.

Antioxidant activity, analgesic activity, and phytochemical analysis of Ammi majus (L.) extracts

Ammi majus (L.) is commonly used to cure many diseases in Moroccan folk medicine, especially vitiligo. This research tries to evaluate the phytochemical constituents of two aqueous extracts (E1; Maceration; 48 h) and (E2: Infusion; 1h) and three organic fractions (F1: Cyclohexane), (F2: Ethyl acetate (EtOAc)) and (F3: Ethanolic (EtOH)) of A. majus (L.) seeds, as well as to study the antioxidant and analgesic activity of the species. Phytochemical analysis, antioxidant activity (DPPH, FRAP, ABTS, and TAC tests), and analgesic activity (writhing and tail immersion were induced by Acetic acid tests) were analyzed according to the literature. A quantitative phytochemical study indicate that the E1 had the highest content of total polyphenols (26.95 ± 0.53 mg GAE/g extract) and flavonoids (37.92 ± 0.46 mg QE/g extract), while F3 showed a promising flavonol content (24.26±0.08 mg QE/g extract). Tannins were found to be high in F1 (59.27 ± 0.16 mg CE/g extract) and F2 (57.65 ± 1.18 mg CE/g extract). Antioxidant results reveals that DPPH (IC50 = 179.68 ± 0.47 μg/mL) and FRAP (EC50 = 367.03 ± 0.12 μg/mL) show to E1 a high antioxidant activity. Regarding the analgesic activity of the different studied extracts, it was found that E1 has a high peripheral analgesic effect with 62.32 % and a high central analgesic potential throughout the experimentation at 500 mg/kg. Our studies demonstrated for the first time that A. majus seeds extracts have high antioxidant and analgesic activities through different analysis techniques.

Smallholders' knowledge about healing goat gastrointestinal parasite infections with wild plants in southern DR Congo

Gastrointestinal parasite (GIP) infections control has an important role to play in increasing livestock production from a limited natural resource base and to improve animal health and welfare. This study aimed to collect indigenous knowledge and identify wild plants locally used by goat smallholders of three territories of Haut-Katanga province for treating signs of gastrointestinal parasitism. Ethnoveterinary surveys were conducted by semi-structured interviews and a bibliographic screening of the biological activities relating to cited plants was carried out. Our interviews showed that ethnosemantic diagnoses of GIP diseases are based on signs. Eighty-seven informants reported that 27 plant species from 15 families, dominated by Fabaceae (29.6%) and Lamiaceae (18.5%) were commonly used in their goats treatment. Among these plants, five species with palmately compound leaves were considerably more used. From those, we noted a substitution of Vitex congolensis De Wild. and T. Durand (Lamiaceae) by Oldfieldia dactylophylla (Welw. Ex Oliv.) J. Leonard (Picrodendraceae) and of Vitex mombassae Vatke by Vitex madiensis Oliv. Subsp. Milanjiensis (Britten) F. White. Roots (46.9%), leaves (28.0%) and seeds (12.5%) were the most frequently used plant organs, and maceration is applied for most of the medicinal preparations (62.2%). Recipes were administered by oral route, for GIP 1) prevention (33.3%), by macerating the ground plant material in drinking water for 2 weeks at the start of each season (dry and rainy); and 2) treatment (66.7%). According to the literature, some of these plants have few or no studies investigating their anthelmintic activity. The cited plants are worth investigating further as they could constitute an effective alternative strategy in maintaining animal productivity. Studies on the biological activity of these plants can also provide indications of promising leads for extracts that could be developed into commercial standardized medications.

Aristolochic acid I as an emerging biogenic contaminant involved in chronic kidney diseases: A comprehensive review on exposure pathways, environmental health issues and future challenges

Described in the 1950s, Balkan Endemic Nephropathy (BEN) has been recognized as a chronic kidney disease (CKD) with clinical peculiarities and multiple etiological factors. Environmental contaminants - aromatic compounds, mycotoxins and phytotoxins like aristolochic acids (AAs) - polluting food and drinking water sources, were incriminated in BEN, due to their nephrotoxic and carcinogenic properties. The implication of AAs in BEN etiology is currently a highly debated topic due to the fact that they are found within the Aristolochiaceae plants family, used around the globe as traditional medicine and they were also incriminated in Aristolochic Acid Nephropathy (AAN). Exposure pathways have been investigated, but it is unclear to what extent AAs are acting alone or in synergy with other cofactors (environmental, genetics) in triggering kidney damage. Experimental studies strengthen the hypothesis that AAI, the most studied compound in the AAs class, is a significant environmental contaminant and a most important causative factor of BEN. The aim of this review is to compile information about the natural exposure pathways to AAI, via traditional medicinal plants, soil, crop plants, water, food, air. Data that either supports or contradicts the AAI theory concerning BEN etiology was consolidated and available solutions to reduce human exposure were discussed. Because AAI is a phytotoxin with physicochemical properties that allow its transportation in environmental matrices from different types of areas (endemic, nonendemic), and induce CKDs (BEN, AAN) and urinary cancers through bioaccumulation, this review aims to shed a new light on this compound as a biogenic emerging pollutant.

Consumption of nephrotoxic plants among chronic hemodialysis patients in the Eastern region of Morocco: A multicentric cross-sectional study

ETHNOPHARMACOLOGICAL RELEVANCE

The consumption of nephrotoxic plants is quite frequent in Morocco and could explain the high prevalence of indeterminate nephropathy in patients with End-Stage Kidney Disease (ESKD).

AIM OF THE STUDY

to determine, in a population of chronic hemodialysis (CHD) patients and before the occurrence of ESKD, the prevalence of the use of nephrotoxic plants, in particular, Aristolochia longa L. (Bereztam) and the etiological role of plants in the rapid progression of known and unknown nephropathy toward the end stage of chronic hemodialysis.

MATERIALS AND METHODS

This was a multicentric cross-sectional study spread over 12 months (May 2019-May 2020), carried out in public hemodialysis centers in the eastern region of Morocco. Clinical data were collected from medical records. Herbal and sociodemographic data were collected from a detailed and precise interview with each enrolled CHD patient.

RESULTS

A total of 404 CHD patients participated in the study. 71.5%, had used medicinal plants before the occurrence of ESKD and 32.9% had indeterminate nephropathy. Among the plants consumed, we identified plants whose kidney toxicity was well demonstrated, mainly Rhamnus alaternus L. (Mlilas) in 66.7%, Artemisia herba alba Asso (Chih) in 54.32%, Aristolochia longa L.(Bereztam) in 52.6%, and Rubia tinctorum L. (Fowa) in 47.4%. 27.7% of CHD patients had presented complications following the use of the plants before the occurrence of ESKD. In multivariate analysis, the use of plants to treat digestive disorders (OR 9.57; 95%CI [4.49-20.37], P < 0.001) and asthenia associated with anemia (OR 8.59; 95%CI [3.92-18.81], P < 0.001), as well as side effects observed after taking the plants (OR 4; 95%CI [1.09, 14.7], P = 0.03), were identified as significant risk factors for the occurrence of severe indeterminate nephropathy.

CONCLUSIONS

This study showed the high prevalence of consumption of nephrotoxic herbs which may be the root cause of chronic renal failure in CHD patients.

Inventory of Medicinal Plants Used Traditionally to Manage Kidney Diseases in North-Eastern Morocco: Ethnobotanical Fieldwork and Pharmacological Evidence

Kidney disease is one of the most common health problems and kidney failure can be fatal. It is one of the health disorders associated with extreme pain and discomfort in patients. In developing countries, such as Morocco where socioeconomic and sanitary conditions are precarious, medicinal plants are considered the primary source of medication. In the present work an ethnobotanical survey was conducted in a remote area of North-Eastern Morocco and we focused on (1) establishing a record of medicinal plants used traditionally by local people to treat kidney diseases and (2) correlate the obtained ethnomedical use with well-studied pharmacological evidence. From February 2018 to January2020, information was gathered from 488 informants using semi-structured questionnaires. The data were analyzed using three quantitative indices: The use value (UV), family use value (FUV), and informant consensus factor (ICF). A total of 121 plant species belonging to 57 botanical families were identified to treat kidney diseases. The families most represented were Asteraceae (14 species), followed by Lamiaceae (12 species) and Apiaceae (10 species). The most commonly used plant parts were leaves, followed by the whole plant and they were most commonly prepared by decoction and infusion. The highest value of the (UV) index was attributed to Herniaria hirsuta L. (UV = 0.16), and the highest family use value (FUV) was assigned to Caryophyllaceae with (FUV = 0.163). Regarding the informant consensus factor (ICF), this index's highest values were recorded for kidney stones (ICF = 0.72). The use of 45% of the selected plants were validated based on literature review. This study helped document and preserve crucial traditional plant knowledge of 121 plant species used to treat kidney problems that can be used in the search for new biologically active compounds through more upcoming pharmacological studies.

Potential Toxicity of Medicinal Plants Inventoried in Northeastern Morocco: An Ethnobotanical Approach

Herbal medicine and its therapeutic applications are widely practiced in northeastern Morocco, and people are knowledgeable about it. Nonetheless, there is a significant knowledge gap regarding their safety. In this study, we reveal the toxic and potential toxic species used as medicines by people in northeastern Morocco in order to compile and document indigenous knowledge of those herbs. Structured and semi-structured interviews were used to collect data, and simple random sampling was used as a sampling technique. Based on this information, species were collected, identified, and herbarium sheets were created. The collected data were analyzed using two quantitative indices: informant consensus factor (ICF) and fidelity level (Fl), as the degree of these indices give an insight into the level of toxicity of a given plant. The results revealed the knowledge of 55 species belonging to 36 families. The most represented families were Apiaceae, Asteraceae, Solanaceae, and Fabaceae. Furthermore, the majority of the species cited were herbs (67%), and the most common toxic parts were seeds, followed by leaves and roots. According to the informant consensus factor, death (0.81%) had the highest agreement, followed by the urological (0.76%) and skin (0.75%) categories. The most significant plants in terms of fidelity level were Solanum sodomaeum L. and Nerium oleander L. for death, Arisarum vulgare O. Targ. Tozz., Mentha spicata L., and Morus alba L. for the digestive category, Petroselinum crispum (Mill.) Fuss. and Citrus x aurantium L. for cardiovascular category, Urtica dioica L. for skin category, Datura stramonium L, and Ephedra altissima Desf. for neurological category, and finally Crocus sativus L. for general and unspecified category. This work highlights a valuable traditional knowledge of poisonous and potential poisonous plants in northeastern Morocco. Further phytochemical and toxicological research is needed to determine the safety of these prized herbs.

An overview on ethnobotanico-pharmacological studies carried out in Morocco, from 1991 to 2015: Systematic review (part 1)

ETHNOPHARMACOLOGICAL RELEVANCE

The full bibliometric records of data retrieved from ethnobotanical field studies carried out in Morocco (1991-2015) was quali-quantitatively analysed. Despite the importance of traditional medicinal uses in Morocco, any comments about the methodologies and approaches adopted by reviewed studies have been undertaken. Include more data about the importance of traditional medicinal uses in Morocco.

AIM OF THE STUDY

Three key points were targeted in this review: (i) to contribute to original compilation of medicinal plants traditionally used by people at whole Morocco, by gathering and documenting the current status of these ancestral medical practices, (ii) to provide a novel insight into the relationship between local and biomedical disease concepts in Moroccan society, taking into account health-related beliefs, and their influences on medicinal plant uses, (iii) to figurout the weaknesses and the strengths of the conceptual approches and methods adopted by researchers in ethnobotanical field works.

MATERIALS AND METHODS

With the help of a computerized database querying, we conducted an extensive literature search respecting our integration criteria. We performed this bibliographic research by using the following search engines available over the Web: Google Scholar, PUBMED, Sciencedirect, Current Content Connect, SCOPUS, SPRINGER LINK, GLOBAL PLANTS, Cochrane Library and SCIRUS. The scientific names listed in the present paper have been validated according to the "The Plant List" and the African Plants Database in order to standardize ethnobotanical data on an international level. For the analysis of data gathered, quali-quantitative analyses have been performed.

RESULTS

A total of 905 medicinal plant species belonging to 116 families and 726 genera have been selected from 63 published articles. The dominant families were ASTERACEAE (111 species) followed by the FABACEAE (77 species), LAMIACEAE (75 species) and APIACEAE (46 species). The plant species listed are used to cure several public ailments. The digestive ailments represented the most important category (494 species) followed by dermatological diseases (407 species), diabetes (315 species) and urinary diseases (277 species). We assigned the importance of the plant species by several measures (including Frequency Cited (FC), Number of Uses (NU), Number of Respondents (NR) and Index of Performance (IP). The ICF (Informant Consensus Factor) calculated was important in all categories of diseases averaging 47%.

CONCLUSION

The results obtained, which cover the whole country, delineate the profile of rich wealth of indigenous knowledge on traditional uses of medicinal plants heald by Moroccan society. The total number of 905 plant species listed in this paper, are currently being utilized as medicines and the number is expected to grow as infrastructure allows greater access to unexplored parts of the country. Furthermore, the know how, regarding the plants used, is consistent because the ICF has recorded important values for most diseases treated. Furthermore, in the present paper, we suggested, for authors, some useful recommendations for ethnobotanical field works such as the respect of ethnobotanical standards including checklist of plants with international data base, the deposited voucher specimens, sampling and collection methods.

Anticancer medicinal plants used by Moroccan people: Ethnobotanical, preclinical, phytochemical and clinical evidence

ETHNOPHARMACOLOGICAL RELEVANCE

Cancer is a major health problem worldwide. Drugs' side effects and high cost of treatment remain the main limitations of conventional therapy. Nowadays, developing new therapeutic strategies is necessary. Therefore, medicinal plants can be used to promote novel, safe, and potent anticancer drugs through their natural compounds.

AIM OF THE STUDY

This review aims to provide scientific evidence related to the anticancer activities of medicinal plants used by Moroccan people as well as approving their efficiency as an alternative cancer therapy.

METHODS

An ethnopharmacological review approach was conducted by analyzing Moroccan published ethnobotanical surveys from 1991 to 2019 and consulting peer-reviewed articles worldwide to investigate the pharmacological, phytochemical, and clinical effects related to the anticancer activities. Plants with anticancer proprieties were classified into four groups: (a) plants only cited as anticancer, (b) plants pharmacologically investigated, (c) plants with bioactive compounds tested as anticancer, and (d) plants clinically investigated.

RESULTS

A total of 103 plant species belonging to 47 botanical families used by Moroccans to treat cancer have been recorded. Aristolochia fontanesii Boiss. & Reut, Marrubium vulgare L., and Allium sativum L. are the most referred species in Morocco. Medicinal plants used for cancer treatment were classified into four groups: 48 species were used traditionally as anticancer (group a), 41 species pharmacologically investigated for their anticancer activities (group b), 32 plants with bioactive compounds tested against cancer (group c), and eight plants were clinically investigated for their anticancer effects (group d). Out of 82 plants' extracts pharmacologically tested (from plants of group b), only 24 ones show a significant cytotoxic effect. A total of seventy-seven compounds are isolated from plants of group (c). However, only six ones were clinically evaluated, and most of them exhibit a beneficial effect on cancerous patients with few side effects.

CONCLUSION

Medicinal plants can be a promising candidate for alternative cancer therapy. Nevertheless, it is critical to increasing the clinical trials to confirm their beneficial effect on patients with cancer. Overall, this review can serve as a database for further studies.

Molecularly imprinted ratiometric fluorescent probe for visual and fluorescent determination of aristolochic acid I based on a Schiff-base fluorescent compound

A molecularly imprinted ratiometric fluorescent probe (MIRF probe) was synthesized for the determination of aristolochic acid I (AAI) based on the Schiff-base fluorescent compound N,N'-bis(o-carboxybenzylidene)-p-4,4'-diaminobiphenyl (BDDB). The BDDB was immobilized in the silica nanoparticle (BDDB@SiO₂) as an internal standard material. The blue-emitting BDDB@SiO₂ and the yellow-emitting carbon quantum dots (y-CDs) were wrapped in the molecularly imprinted polymer (MIP) to provide a reliable reference signal at 440 nm and a fluorescent response signal at 530 nm at the excitation wavelength of 365 nm, respectively. In the preparation of the MIP of the MIRF probe, 4-vinylbenzoic acid as the functional monomer and AAI as the template molecule were used. An imprinting factor of 2.25 was obtained. Under the optimum conditions, the fluorescent response signal at 530 nm was quenched gradually by AAI in the range 1.0 to 120.0 μmol/L, while the reference signal at 440 nm remained unchanged. The limit of detection was 0.45 μmol/L, and the fluorescent color of the MIRF probe changed gradually from yellow to green to blue, which illustrated that the developed probe had a specific AAI recognition ability, a good anti-interference ability, and a sensitively visual determination ability. The probe was successfully applied to the AAI determination in traditional Chinese medicine (TCM) Asarum. The results showed that it had satisfactory recoveries (95.5-107.3%) and low relative standard deviations (2.0%). Furthermore, this method has a potential for the onsite naked eye determination of AAI in TCM samples.Graphical abstract.

Acute and Subacute Toxicity Studies of the Aqueous Extract from Haloxylon scoparium Pomel (Hammada scoparia (Pomel)) by Oral Administration in Rodents

Materials and Methods

Acute toxicity test was performed on Swiss albino mice at a single oral dose of 1-10 g/kg for 14 consecutive days. General behavioral adverse effects, mortality, and latency of mortality were determined. In the subacute study, the Haloxylon scoparium Pomel extract was administered orally at doses of 500, 1000, and 2000 mg/kg daily for 30 days to Wistar rats. Body weight and selected biochemical and hematological parameters were determined at the end of the experiment. Sections of livers and kidneys were removed for histological studies.

Results

Acute toxicity study showed that the oral LD₅₀ value of Haloxylon scoparium Pomel extract was 5000 mg/kg. The subacute toxicity study of Haloxylon scoparium Pomel extract at doses 500, 1000, and 2000 mg/kg did not produce any observable symptoms of toxicity and no significant variation in body weight, organ weights, food, and water consumption or mortality in all treated rats. However, the administration of the Haloxylon scoparium Pomel extract to rats at 500 mg/kg and 1000 mg/kg showed a significant decrease in platelets. Moreover, only at the highest dose (2000 mg/kg), the extract caused a significant increase in red blood cells and hemoglobin. Our results showed that subacute treatments with Haloxylon scoparium Pomel extract at doses of 1000 mg/kg and 2000 mg/kg significantly elevated alkaline phosphatase and triglycerides. Histological studies showed that the subacute treatments of rats with Haloxylon scoparium Pomel extracts, at the doses 1000 and 2000 mg/kg, induced some histopathological changes in the livers but a slight changing in kidneys.

Conclusion

Our results indicated low acute toxicity of the aqueous extract of Haloxylon scoparium Pomel. Furthermore, daily oral administration of Haloxylon scoparium Pomel extract caused some damages to the livers of rats treated with high doses, expressed by an increase in some enzyme activities such as ALP. Regarding the renal function, we did not find remarkable toxicity in the subacute treatment with Haloxylon scoparium Pomel extracts at doses 1000 and 2000 mg/kg. However, further toxicity assessments should be done to ascertain the safety or the toxicity of this valuable plant species “Haloxylon scoparium pomel” in subchronic treatments.

Toxicity and developmental effect of cucurbitacin E from Citrullus colocynthis L. (Cucurbitales: Cucurbitaceae) against Spodoptera litura Fab. and a non-target earthworm Eisenia fetida Savigny

Pest management with natural botanical insecticides is a significant implementation for the sustainability of agroecosystem by reducing the unnecessary risk from the inputs of synthetic insecticides. In this research, we isolated the bioactive compound cucurbitacin E from Citrullus colocynthis (L.) Schrad, and their toxicological effects were screened against different larval instars of Spodoptera litura. The bioactive compound cucurbitacin E was chemically characterized through TLC, FT-IR, and NMR analyses. The larval mortality bioassay revealed that the larvae exposed to cucurbitacin E at the discriminating dose of 50 ppm display higher mortality rate against second (93.8%), third (86.4%), and fourth (73.2%) instar respectively. The lethal concentrations (LC₅₀ and LC₉₀) was detected as 15.84 and 67.60 ppm for third instar respectively. The sub-lethal concentration of cucurbitacin E (2, 4, and 6 ppm) intentionally altered the percentage of survival, pupation, fecundity, and egg hatchability of S. litura. Moreover, antifeedant activity of cucurbitacin E was analyzed using choice-based test. In addition, we found the toxic effects of cucurbitacin E (50 and 100 ppm) and chemical pesticides (cypermethrin and monocrotophos) against terrestrial beneficial earthworm Eisenia fetida, and the result revealed that cucurbitacin E has no harmful effect on non-target organism. Hence, the present study reveals that cucurbitacin E might be a part of a new biorational product alternative to synthetic pesticides.

Evaluation of the toxicity potential of acute and sub-acute exposure to the aqueous root extract of Aristolochia ringens Vahl. (Aristolochiaceae)

ETHNOPHARMACOLOGICAL RELEVANCE

Aristolochia ringens Vahl. (Aristolochiaceae) is used traditionally in Nigeria for managing a number of ailments including gastrointestinal disturbances, rheumatoid arthritis, pile, insomnia, oedema, and snake bite venom. Some studies in our laboratory have demonstrated a scientific justification for some of such uses. This study aims at investigating the toxicological actions of the aqueous root extract of Aristolochia ringens (AR).

MATERIALS AND METHODS

Brine shrimp lethality assay was carried out using 10, 100 and 1000 μg/ml of the extract. Oral and intraperitoneal acute toxicity tests were carried out using mice. The effect of sub-acute (30 days) repeated oral exposure to the extract at 10, 50 and 250 mg/kg in rats was also evaluated via weekly assessments of body weights and general observations as well as end of exposure haematological, biochemical and histological examinations of blood and tissue samples of treated rats. Phytochemical analyses to determine the presence of aristolochic acid I in the extract was also carried out using high performance liquid chromatography (HPLC).

RESULTS

The aqueous root extract of A. ringens showed potential for biological activity and cytotoxicity with an LC₅₀ of 175 μg/ml in brine shrimps. AR was found to be relatively safe on acute oral exposure with LD₅₀ estimated to be greater than 10 g/kg, while its LD₅₀ on intraperitoneal administration was 407.38 mg/kg. Upon 30 days sub-chronic exposure, AR induced significant weight loss in female rats, enlargement of male rats' stomach, oxidative stress in male and female rats' kidney and liver tissues and disruption of leukocytes level in female rats. It also showed evidence of kidney and liver injuries inducible by oxidative damage and the potential to cause male sterility. HPLC revealed the presence of 0.003 mg/1 g of aristolochic acid in AR.

CONCLUSION

These results show that AR contains detectible aristolochic acid I and has potential to induce toxic responses. Caution must therefore be exercised in its medicinal application especially when required for a prolonged use.

Prevalence of herbal medicine use among patients with kidney disease: A cross-sectional study from Morocco

INTRODUCTION

The objectives of this study were to determine the prevalence of herbal medicine use by patients hospitalized or consultant in the nephrology department of University Hospital center Hassan II Fez, the reasons of this use, to identify socio-demographic characteristics, and the etiology of kidney disease related to herbal medicine use, also the most used plants.

METHOD

Cross-sectional study on the use of herbal medicine conducted at the nephrology department of University Hospital Center Hassan II Fez, Morocco. During 6 months between August 2015 and February 2016. Patients older than 15 years (n=471) with varying degrees of kidney disease were included. The questionnaire contained questions related to socio-demographic data, the use of plants, knowledge about herbal medicine toxicity, and etiology of KD. Descriptive statistics were used to analyze socio-demographic characteristics related to herbal medicine use.

RESULTS

A total of 471 patients responded; the prevalence of herbal medicine use was 50.7%. Herbal medicine users were more likely to be males (OR 0.43; 95%CI 0.25-0.74); unemployed (OR 0.51; 95%CI 0.29-0.89), with unknown etiology (OR 0.43; 95%CI 0.22-0.84). Reasons of use were: belief in its efficacy (74%), easy access to medicinal herbal medicine (70%), and lower cost (48%). The most commonly used herbal medicine were Rosmarinus officinalis L.; Origanum compactum Benth; Artemisia herba-alba Asso and Mentha pulegium L. Potentially harmful herbal medicine included Aristolochia longa.

CONCLUSIONS

The prevalence of herbal medicine use is high among patients with kidney disease in nephrology department.

Ethnopharmacological Survey of Herbal Remedies Used for the Treatment of Cancer in the Greater Casablanca-Morocco

Medicinal plants played an important role in traditional medicine for the treatment of diseases since antiquities. The aim of the study is to carry out an ethnobotanical survey on medicinal plants used traditionally in cancer treatment in the region of Greater Casablanca-Morocco, and to enhance the traditional herbal medicine knowledge. 110 traditional healers in the study area were interviewed face to face to response a survey questionnaire including the names of plants used in cancer treatment, used parts, methods of preparation, and route of administration. Indices of Fidelity Level (FL), Use Value (UV), and Relative Frequency of Citation (RFC) were calculated to identify the most effective plants used for cancer treatment. Eight species were specified including Aristolochia baetica, Aristolochia paucinervis, Bryonia dioica, Aquilaria malaccensis, Marrubium vulgare, Lavandula maroccana, Ephedra alata, and Euphorbia resinifera belonging to 7 families. Aristolochiaceae, Aquilariaceae, and Cucurbitaceae were the most useful families in cancer treatment with high significant indices of UV, FL, and RFC with values of 1, 100%, and 1, respectively. Roots and leaves were the most commonly used plant parts. Decoction and powder mixed with honey were the frequently used method for remedies preparation. The present study showed that the people living in Morocco's economic capital are still highly dependent on traditional herbal medicine for the treatment of cancer. Therefore, it seems that herbal medicine still plays a crucial role in the primary healthcare system for the local population. During this survey, it was reported that even some plant families are highly toxic for humans like Aristolochiaceae that are frequently used in cancer treatment in the study area. As many people still rely on natural traditional medicine considering (it is safe with no side effects), so combined effort between all social categories including scientists and traditional healers should be established for involving the scientific validity of the used plants in the treatment of diseases.

Profile on medicinal plants used by the people of North Eastern Morocco: Toxicity concerns

In the North Eastern region of Morocco, many people are interested in medicinal plants and their uses. However, the rationale for the utilization of medicinal plants has remained largely underestimated with little or no scientific data on plant safety. In this paper we attempt to describe and establish a detailed list of current knowledge in relation to the toxicity of these plants and to evaluate the scientific data concerning the harmful effects of the selected natural products. Our approach consists of collecting published data from literature in specialized journals, books and website related to the toxic plants. This research revealed that 89 plant species, retrieved from 287 plants used as medicine in the North-Eastern region of Morocco, are considered toxic or present some kind of toxicity. Our data determines 55 compounds isolated from the plants which are dominated by five groups of toxic compounds: alkaloids followed by glucosides, terpenoids, protides and phenolics. The present work discusses toxicity-related issues arising from the use of medicinal plants by local people. We conclude that the database considered in this study could serve as an important source of information on the toxicity of medicinal plants used by this society.

North African Medicinal Plants Traditionally Used in Cancer Therapy

Background: Cancer is a major cause of mortality worldwide with increasing numbers by the years. In North Africa, the number of cancer patients is alarming. Also shocking is that a huge number of cancer patients only have access to traditional medicines due to several factors, e.g., economic difficulties. In fact, medicinal plants are widely used for the treatment of several pathologies, including cancer. Truthfully, herbalists and botanists in North African countries prescribe several plants for cancer treatment. Despite the popularity and the potential of medicinal plants for the treatment of cancer, scientific evidence on their anticancer effects are still scarce for most of the described plants.

Objective: Bearing in mind the lack of comprehensive and systematic studies, the aim of this review is to give an overview of studies, namely ethnobotanical surveys and experimental evidence of anticancer effects regarding medicinal plants used in North Africa for cancer therapy.

Method: The research was conducted on several popular search engines including PubMed, Science Direct, Scopus and Web of Science. The research focused primarily on English written papers published between the years 2000 and 2016.

Results: This review on plants traditionally used by herbalists in North Africa highlights that Morocco and Algeria are the countries with most surveys on the use of medicinal plants in folk medicine. Among the plethora of plants used, Nigella sativa and Trigonella foenum-graecum are the most referred ones by herbalists for the treatment of cancer. Moreover, a plethora of scientific evidence qualifies them as candidates for further drug development. Furthermore, we report on the underlying cellular and molecular mechanisms.

Conclusion: Overall, this review highlights the therapeutic potential of some medicinal plants as anticancer agents. The North African flora offers a rich source of medicinal plants for a wide array of diseases, including cancer. The elucidation of their modes of action represents an indispensable condition for the rational development of new drugs for cancer treatment. Furthermore, testing the anticancer activity in vivo and in clinical trials are warranted to explore the full therapeutic potential of North African plants for cancer therapy.

Lynch syndrome and exposure to aristolochic acid in upper-tract urothelial carcinoma: its clinical impact?

The purpose of the current review was to describe the clinical risk for Lynch syndrome (LS) after exposure to aristolochic acid (AA) in cases of upper urinary-tract urothelial carcinoma (UTUC). A systematic review of the scientific literature was performed using the Medline database (National Library of Medicine, PubMed) using the following keywords: epidemiology, risk factor, AA, Balkan nephropathy (BNe), LS, hereditary cancer, hereditary non-polyposis colorectal cancer (HNPCC), mismatch repair genes, urothelial carcinomas, upper urinary tract, renal pelvis, ureter, Amsterdam criteria, genetic counselling, mismatch repair genes, genetic instability, microsatellite, and Bethesda guidelines. LS is a specific risk for UTUC, which is the third most frequent cancer (in its tumor spectrum) after colon and uterine lesions. Mutation of the MSH2 gene is the most commonly described cause of UTUC in LS. Diagnosis is based on clinical suspicion and is guided by Bethesda and Amsterdam criteria. It is secondarily confirmed by immunohistochemical analyses of the tumor and a search for gene mutations. The presence of LS in patients with UTUC is a favorable prognosis factor for survival during follow-ups. AA is a specific environmental risk factor for UTUC and tubulo-interstitial nephropathy. It has been involved in the development of nephropathies in link with the Balkan disease and intake of Chinese herbal medicine. More broadly, the use of traditional plant medicines from the genus Aristolochia has created worldwide public-health concerns. UTUCs share common risk factors with other urothelial carcinomas such as tobacco or occupational exposure. However, these tumors have also specific risk factors such as AA exposure and LS that clinicians should be aware of because of their clinical implication in further management and follow-up.