In vitro and in vivo chloroquine-potentiating action of Strychnos myrtoides alkaloids against chloroquine-resistant strains of Plasmodium malaria

Herbal Remedies to Treat Malaria in Madagascar: Hype and Hope

On the island of Madagascar, prior to the arrival of the Europeans, some pathologies including malaria, locally known as tazo (fever), were already described. As part of the Malagasy traditional knowledge, traditional medicine mainly based on the use of herbal remedies is part of the malaria treatment still today. Across the country, hundreds of plants are identified as antimalarial, and some compounds from plants show interesting in vitro activities against human Plasmodium. However, it has become clear that most of the antimalarial herbal remedies traditionally used are not efficient antimalarials. In order to identify authentic antimalarial herbal remedies, methodical approaches should range from plant selection to biological screening. In this paper, we share our point of view based on our experience on antimalarial plants in Madagascar.

Total synthesis of malagashanine: a chloroquine potentiating indole alkaloid with unusual stereochemistry

The first total synthesis of malagashanine, a chloroquine potentiating indole alkaloid, is presented. A highly stereoselective cascade annulation reaction was developed to generate the tetracyclic core of the Malagasy alkaloids. This chemistry is likely to be broadly applicable to the synthesis of other members of this stereochemically unique family of natural products.

Ethnopharmacology in the fight against Plasmodium parasites and brain disorders: In memoriam of Philippe Rasoanaivo

Prof. Philippe Rasoanaivo was a highly dedicated and brilliant scientist in the field of ethnopharmacology. He worked for the Institut Malgache de Recherches Appliquées and the University of Antananarivo, Madagascar. His research was mainly focused on the endemic medicinal and aromatic plants used by traditional healers in Madagascar against a range of parasites, with special reference to Plasmodium spp. In this Editorial, we resumed the key findings of his research activity, with special reference to the discovery of alkaloids that markedly enhance the action of chloroquine against malaria parasites.

Structural, Vibrational, and Electronic Properties of the Glucoalkaloid Strictosidine: A Combined Experimental and Theoretical Study

A detailed structural analysis and spectral behavior of the glucoalkaloid strictosidine, a precursor of all monoterpene indole alkaloids, are discussed. The experimental NMR, FTIR, and UV results were compared to the theoretical DFT spectra calculated by Becke using the three-parameter Lee-Yang-Parr (B3LYP) function with 6-31G(d) and 6-311++G(2d,p) basis sets. The theoretical geometry optimization data were compared with the X-ray data for precursors and similar structures in the associated literature. The similarity between the theoretical and experimental coupling constants values made it possible to affirm the values of dihedral angles and their configuration, reinforcing findings from previous stereochemical studies. Theoretical UV analysis agreed well with the measured experimental data, with bands assigned. Calculated HOMO/LUMO gaps show low excitation energy for strictosidine, justifying its stability and reaction kinetics. The molecular electrostatic potential map shows opposite potentials regions that form hydrogen bonds that stabilize the dimeric form, which were confirmed by excellent agreement of the dimeric form theoretical wavenumbers with the experimental IR spectrum. ESI-MS/MS data revealed patterns for the fragmentation of the protonated strictosidine molecule outlined by an NBO study.

Dietary supplementation of chloroquine with nigella sativa seed and oil extracts in the treatment of malaria induced in mice with plasmodium berghei

BACKGROUND

The aim of the study was to investigate the effects of dietary combination of Nigella sativa seed and oil extracts with chloroquine (CQ), and how these combinations enhance CQ efficacy in mice infected with Plasmodium berghei and their survival rates.

MATERIALS AND METHODS

Chloroquine sensitive P. berghei, NK65 strain was used for the study. This was passaged intraperitoneally into albino mice with a 0.2ml standard inoculum consisting of 10(6) parasitized erythrocyte suspension in phosphate buffer solution (PBS). Parasitaemia was ascertained by microscopical examination of blood films under oil immersion at X100 magnification.

RESULTS

Nigella sativa seed in feed (NSSF), NSSF + CQ on day 4, produced 86.1% and 86.0% suppression respectively, while Nigella sativa oil extract in feed (NSOF) and in combination with CQ had 86.0% and 99.9% suppression respectively. The degree of suppression with the combination was significantly higher compared to CQ alone (P < 0.001) (36.1%). Complete parasitaemia clearance was obtained on the 20(th) and 15(th) day of treatment for NSSF, NSSF + CQ respectively, while that for NSOF and NSOF + CQ was on days 26 and 12 respectively. For CQ parasite clearance was 12 days with treatment. Also, the combinastion of 10 mg/kg Nigella sativa oil treatment injected intraperitoneally with oral CQ produced very significant parasite suppression (P < 0.0001) (93%). Survival rate in NSSF and NSOF and in combination with CQ groups was 100 and 60.0% for CQ alone.

CONCLUSIONS

This study shows that the use of Nigella sativa seed and oil extract as dietary supplements in combination with CQ has a potential in enhancing the efficacy of CQ and could be of benefit in management of malaria.

Antiprotozoal activity of Khaya anthotheca, (Welv.) C.D.C. a plant used by chimpanzees for self-medication

ETHNOPHARMACOLOGICAL RELEVANCE

Khaya species, endemic to Africa and Madagascar, continues to be valuable in indigenous traditional medicine. Their bitter tasting barks are decocted to treat fevers, several febrile conditions, microbial infections and worm infestations. In the Budongo rain forest of Western Uganda, non-human primates, especially chimpanzees and baboons, have been observed to eat the bitter non-nutritious bark and occasionally the seed.

MATERIALS AND METHODS

Extracts were prepared by sequential fractionation with solvents of increasing polarities and assayed using standard procedures. Bioassay guided purification of the petroleum ether extract by column chromatography yielded three pure limonoids, Grandifolione (1), 7-deacetylkhivorin (2) and 1,3-deacetyldeoxyhavenensin (3). The antitrypanosomal, antileishmanial and antiplasmodial activities of pure compounds (1) and (2) were evaluated in vitro against Plasmodium falciparum K1, Trypanosoma brucei rhodesiense STIB 900, Trypanosoma cruzi trypomastigotes (Tulahuen C4), and axenic Leishmania donovani MHOMET-67/L82 and for cytotoxicity against L6 rat skeletal myoblast cells, in parallel with standard drugs.

RESULTS

Of the four extracts tested, the petroleum ether extract showed activity against Plasmodium falciparum (IC50 0.955 μg/ml) and Trypanosoma brucei rhodesiense (IC50 5.72 μg/ml). The pure compounds (1) and (2) demonstrated activity against Plasmodium falciparum (KI strain) and marginal activities against Trypanosoma brucei brucei, Trypanosoma brucei rhodesiense, Trypanosoma cruzi and Leishmania donovani.

CONCLUSION

The present study provides evidence justifying the use of Khaya preparations in traditional medicine to treat fevers and microbial infections. The observed antiprotozoal activity of grandifolione and 7-deacetylkhivorin from the seed of Khaya anthotheca further confirms the ethnomedicinal potential of this plant and supports the hypothesis that non-human hominids (chimpanzees and baboons) too, eat the bitter bark and seeds for self-medication and in general, the use of Khaya plant material for medication by humans in disease endemic tropical areas. The antiprotozoal activity of gradifolione, and, the antitrypanosomal and antileishmanial activities of 7-deacetylkhivorin are reported here for the first time.

Whole plant extracts versus single compounds for the treatment of malaria: synergy and positive interactions

Background

In traditional medicine whole plants or mixtures of plants are used rather than isolated compounds. There is evidence that crude plant extracts often have greater in vitro or/and in vivo antiplasmodial activity than isolated constituents at an equivalent dose. The aim of this paper is to review positive interactions between components of whole plant extracts, which may explain this.

Methods

Narrative review.

Results

There is evidence for several different types of positive interactions between different components of medicinal plants used in the treatment of malaria. Pharmacodynamic synergy has been demonstrated between the Cinchona alkaloids and between various plant extracts traditionally combined. Pharmacokinetic interactions occur, for example between constituents of Artemisia annua tea so that its artemisinin is more rapidly absorbed than the pure drug. Some plant extracts may have an immunomodulatory effect as well as a direct antiplasmodial effect. Several extracts contain multidrug resistance inhibitors, although none of these has been tested clinically in malaria. Some plant constituents are added mainly to attenuate the side-effects of others, for example ginger to prevent nausea.

Conclusions

More clinical research is needed on all types of interaction between plant constituents. This could include clinical trials of combinations of pure compounds (such as artemisinin + curcumin + piperine) and of combinations of herbal remedies (such as Artemisia annua leaves + Curcuma longa root + Piper nigum seeds). The former may enhance the activity of existing pharmaceutical preparations, and the latter may improve the effectiveness of existing herbal remedies for use in remote areas where modern drugs are unavailable.

Quinoline-resistance reversing agents for the malaria parasite Plasmodium falciparum

Resistance to quinoline antimalarials, especially to chloroquine and mefloquine has had a major impact on the treatment of malaria worldwide. In the period since 2000, significant progress has been made in understanding the origins of chloroquine resistance and to a lesser extent mefloquine resistance in Plasmodium falciparum. Chloroquine resistance correlates directly with mutations in the pfcrt gene of the parasite, while changes in another gene, pfmdr1, may also be related to chloroquine resistance in some strains. Mutations in pfcrt do not appear to correlate with mefloquine resistance, but some studies have implicated pfmdr1 in mefloquine resistance. Its involvement however, has not been definitively demonstrated. The protein products of these genes, PfCRT and Pgh-1 are both located in the food vacuole membrane of the parasite. Current evidence suggests that PfCRT is probably a transporter protein. Chloroquine appears to exit the food vacuole via this transporter in resistant PfCRT mutants. Pgh-1 on the other hand, resembles mammalian multi-drug resistance proteins and appears to be involved in expelling hydrophobic drugs from the food vacuole. Resistance reversing agents are believed to act by inhibiting these proteins. The currently known chloroquine- and mefloquine-resistance reversing agents are discussed in this review. This includes a discussion of structure-activity relationships in these compounds and hypotheses on their possible mechanisms of action. The status of current clinical applications is also briefly discussed.

Medicinal plants: traditions of yesterday and drugs of tomorrow

Plants have provided Man with all his needs in terms of shelter, clothing, food, flavours and fragrances as not the least, medicines. Plants have formed the basis of sophisticated traditional medicine systems among which are Ayurvedic, Unani, Chinese amongst others. These systems of medicine have given rise to some important drugs still in use today. Among the lesser-known systems of medicines are the African and Australian, Central and South American amongst others. The search for new molecules, nowadays, has taken a slightly different route where the science of ethnobotany and ethnopharmacognosy are being used as guide to lead the chemist towards different sources and classes of compounds. It is in this context that the flora of the tropics by virtue of its diversity has a significant role to play in being able to provide new leads. Nonetheless the issue of sovereignty and property rights should also be addressed in line with the Convention for Biological Diversity (CBD). This paper highlights the above, provides an overview of the classes of molecules present in plants and gives some examples of the types of molecules and secondary metabolites that have led to the development of these pharmacologically active extracts. The paper also presents some data on the use of plant products in the development of functional foods, addresses the needs for validation of plant extracts and always stressing on safety, efficacy and quality of phyto-medications.

Synthesis and chloroquine-enhancing activity of Na-deacetyl-ferrocenoyl-strychnobrasiline

Several strychnobrasiline derivatives have been synthesized to overcome the lack of in vivo reversal activity of the parent compound. In the present study, N(a)-deacetyl-ferrocenoyl-strychnobrasiline was synthesized by condensing N(a)-deacetyl-strychnobrasiline with ferrocenic acid previously treated with oxalyl chloride. While the in vitro antiplasmodial activity of the test compound (IC(50)=4.83 microg/mL) was increased 15-fold compared to that of strychnobrasiline, and the in vitro enhancing activity was found to be similar to that of the parent compound, the compound was devoid of any in vivo potentiating effect, and an antagonistic effect was even observed at higher doses. Based on the overall results on the hemisynthesis of strychnobrasiline derivatives for better reversal activity, this strategy has appeared to be of little value for useful drugs.

About the toxicity of some Strychnos species and their alkaloids

Poisons are widespread in plants and animals and humankind has often tried to turn them to its own advantage. Owing to their poisonous properties, some species of Strychnos genus have been employed mainly in hunting and fishing, as an adjunct to weapons used not only in the search of food and clothes, but also for preventing depredation by wild animals. They have been employed for martial and criminal purposes and also as a means of determining guilt or innocence. By their nature, poisons such as strychnine and curare affect the functioning of the victim's body; this also means that they have been, and are, an important source of pharmacological tools and medicines all over the world. With such potentially dangerous substances, care in medication is essential to avoid complications by overdose. All these points are approached in the present review.

A randomized comparison of chloroquine and chloroquine plus ketotifen in the treatment of acute, uncomplicated, Plasmodium falciparum malaria in children

The increasing resistance of Plasmodium falciparum to chloroquine (CQ) has created urgent needs for the evaluation of alternative antimalarial drugs that are effective, safe, readily available and affordable. Ketotifen, a histamine H(1)-receptor antagonist that reverses CQ resistance in P. falciparum in vitro, may potentially enhance the effects of CQ in vivo. The effects of oral treatment with CQ alone (30 mg/kg base given over 3 days) were compared with those of this CQ regimen combined with ketotifen fumarate (0.25 mg at presentation followed by 0.125 mg/kg every 8 h for 5 days). The subjects were 145 children aged 1-10 years who were suffering from acute, symptomatic, uncomplicated, P. falciparum malaria: 74 given CQ alone and 71 given CQ plus ketotifen (CQK). Although the mean fever-clearance time was significantly shorter following treatment with CQK than after treatment with CQ alone, all other therapeutic responses were similar in the two treatment groups. Among siblings in whom there was clustering of infections, the likelihood of cure was also similar in the two treatment groups. Retreatment of 17 CQ-treatment failures with CQK produced a cure in six children, and retreatment of 22 CQK-treatment failures with CQK produced a cure in eight children. Retreatment of all drug failures with a combination of amodiaquine plus pyrimethamine-sulfadoxine resulted in complete clearance of parasitaemia and symptoms within 2-3 days and a cure 'rate' of 100% on day 28. The prevalences and intensities of gametocytaemias on day 3 or days 3, 7 and/or 14 combined were similar in the two groups. Adverse drug reactions were always tolerable, and limited to pruritus, gastro-intestinal disturbances, drowsiness and weight gain; the latter two adverse effects were significantly more frequent in those treated with CQK than in those given CQ alone. Haematological and biochemical parameters were not adversely affected by either treatment regimen. The findings indicate that - at least at the dosing regimen used in the present study and among children with acute, uncomplicated, P. falciparum malaria from Ibadan - the addition of ketotifen to CQ produced little or no significant enhancement of the antimalarial effect of CQ.

People's perception of malaria in Mbarara, Uganda

To understand people's perceptions of malaria and their implications for control programmes, we held focus group discussions (FGDs) and conducted semi-structured interviews (SSIs) with community members in Mbarara, Uganda. Mosquitoes were perceived as the cause or transmitters of malaria but the causation/transmission model of people differed from biomedical facts. Convulsions, a common complication of malaria, were perceived as a supernatural ailment, best treated by traditional medicine, as was splenomegaly. More than 70% of the patients with malaria had treatment from non-public health sources. This included self-treatment (13%), use of traditional healers (12%) and use of private medical practitioners/pharmacists (69%). Although 26% (887/3309) used bednets to prevent malaria, only 7% of the nets were impregnated with insecticide. People who did not use bednets cited discomfort because of heat/humidity and their high cost as reasons. To improve malaria control in this area, people need to be educated on the connection between mosquitoes and malaria and on seeking biomedical treatment for convulsions. The malaria control programme could collaborate with traditional and private health care providers to increase promotion of insecticide-impregnated mosquito nets.

The co-occurrence of C(3) epimer Nb,C(21)-secocuran alkaloids in Strychnos diplotricha and Strychnos myrtoides

From the stem bark of Strychnos diplotricha, three Nb,C(21)-secocuran alkaloids, viz., 3-epi-myrtoidine, 11-demethoxy-3-epi-myrtoidine and 11-demethoxy-12-hydroxy-3-epi-myrtoidine, were isolated together with the known myrtoidine and 11-demethoxymyrtoidine. They also occur in different parts of S. myrtoides.

High-performance liquid chromatographic assay of malagashanine in rat plasma and urine and its pharmacokinetic application

A reversed-phase HPLC method was developed for quantitative analysis of malagashanine in rat plasma and urine. Malagashanine and internal standard were extracted from alkalinized rat plasma. Urine analysis was performed by direct injection onto the HPLC system. Acetonitrile-aqueous 25 mM sodium acetate solution at pH 6.25 (45:55, v/v) was used as the mobile phase. The eluate was monitored by using UV detection at 250 nm. The assay was linear within the concentration range of 10-1000 ng/ml. Both intra- and inter-day accuracy and precision were within acceptable limits. The method was applied to study the pharmacokinetics of malagashanine in rats.

Reversal activity of the naturally occurring chemosensitizer malagashanine in Plasmodium malaria

Malagashanine (MG) is the parent compound of a new type of indole alkaloids, the N(b)C(21)-secocuran, isolated so far from the Malagasy Strychnos species traditionally used as chloroquine adjuvants in the treatment of chronic malaria. Previously, it was shown to have weak in vitro intrinsic antiplasmodial activity (IC(50) = 146.5 +/- 0.2 microM), but did display marked in vitro chloroquine-potentiating action against the FcM29 chloroquine-resistant strain of Plasmodium falciparum. The purpose of the present study was to further investigate its reversal activity. Thus, the previous in vitro results were tested in vivo. The interaction of MG with several antimalarials against various strains of P. falciparum was also assessed. As expected, MG enhanced the effect of chloroquine against the resistant strain W2, but had no action on the susceptible strain 3D7 and two sensitive isolates. Interestingly, MG was found to exhibit significant chloroquine-potentiating action against the FcB1 strain formerly described as a resistant strain but one which has since lost its resistance for unknown reasons. One other relevant result that arose from our study was the observation of the selective enhancing action of MG on quinolines (chloroquine, quinine, and mefloquine), aminoacridines (quinacrine and pyronaridine), and a structurally unrelated drug (halofantrine), all of which are believed to exert their antimalarial effect by binding with haematin. MG was finally found to specifically act with chloroquine on the old trophozoite stage of the P. falciparum cycle. Similarities and differences between verapamil and MG reversal activity are briefly presented.

In vitro antimalarial activity of limonoids from Khaya grandifoliola C.D.C. (Meliaceae)

The crude extract from the bark and seeds of Khaya grandifoliola was active in vitro against Plasmodium falciparum with an IC50 value of 13.23 microg/ml. The extract was purified to obtain seven limonoids--methylangolensate (1), 6-methylhydroxyangolensate (2), gedunin (3), 7-deacetylkhivorin (5), 1-deacetylkhivorin (6), swietenolide (7), 6-acetylswietenolide (8)--and one flavonoid, catechin (4). Five limonoids (1, 3, 5, 6, 8) were active with IC50 values between 1.25 and 9.63 microg/ml. Catechin was practically devoid of activity. The most active limonoid, gedunin, exhibited an additive effect when combined with chloroquine.

Effects of the naturally-occurring chemosensitizer malagashanine and its combination with chloroquine on KB and P388 cell lines and isolated auricle

Besides the determination of its LD50 value, the cytotoxicity against KB and P388 cell lines and the toxicity on isolated guinea pig auricle of malagashanine and its combination with chloroquine were assessed. Malagashanine alone was devoid of cytotoxicity and cardiac effect on isolated auricle, and importantly, when combined to chloroquine, did not affect the inherent toxicity and cardiac toxicity of this antimalarial agent.

Enhanced efficacy of chloroquine-chlorpheniramine combination in acute uncomplicated falciparum malaria in children

Chlorpheniramine, a histamine H1 receptor antagonist, reverse chloroquine resistance in Plasmodium falciparum in vitro. However, the clinical significance of this remains unclear. We have evaluated the efficacy of chloroquine and a chloroquine-chlorpheniramine combination in 112 consecutive children with acute symptomatic uncomplicated falciparum malaria. There was no significant difference in the parasite and fever clearance times in the 2 treatment groups. However, the proportion of patients in whom parasitaemia increased 24 h after commencement of treatment was significantly higher in the chloroquine group than in the chloroquine-chlorpheniramine group (28.5% vs. 8.3%, chi 2 = 6.61, P < 0.01). There was also a higher proportion of children with RII and RIII responses to treatment in the chloroquine than in the chloroquine-chlorpheniramine group but the difference was not statistically significant. The cure rate on day 14 was higher in the chloroquine-chlorpheniramine group than in the chloroquine group. Chloroquine and its combination with chlorpheniramine were well tolerated, the only prominent adverse effect being pruritus, with equal incidence in both groups. Chlorpheniramine reversed chloroquine resistance in vitro in a similar manner to verapamil in isolates of P. falciparum obtained from the patients. Failure of a response in vivo to chloroquine correlated with resistance in vitro in patients treated with this drug. In contrast, all but one patient with isolates which were chloroquine resistant in vitro were successfully treated with chloroquine-chlorpheniramine combination. These data suggest the enhanced efficacy of chloroquine-chlorpheniramine combination in treating acute uncomplicated P. falciparum infection in children from an endemic area of Nigeria.

Medicinal plants and the control of protozoal disease, with particular reference to malaria

Malaria and other protozoal diseases continue to pose serious health problems world-wide. Resistance of the malaria parasites, Plasmodium spp., to drugs such as chloroquine (and, more lately, quinine) occurs with increasing frequency and underlies the necessity to develop new agents for malaria chemotherapy; in the case of diseases caused by species of Leishmania and Trypanosoma there has always been a marked paucity of effective drugs, particularly those with a wide safety margin and minimal or no undesirable side effects. Novel drugs, are required to help alleviate morbidity and mortality and to contribute to the world-wide control of these diseases, in part by helping to reduce the reservoirs of infection. Reliance upon plants for the treatment of disease is high in the developing world and such plants offer a source of new molecules. Research centered upon Plasmodium has produced a number of findings which now prompt the formulation of important questions which may influence and focus the direction of phytotherapy research in the future.