Improved traditional medicines in Mali

The genus Cassia L.: Ethnopharmacological and phytochemical overview

Nature gifts medicinal plants with the untapped and boundless treasure of active chemical constituents with significant therapeutic potential that makes these plants a beneficial source in the development of phytomedicines. Genus Cassia, with approximately 500 species, is a large group of flowering plants in the family Fabaceae. Cassia species are widely distributed throughout different regions mainly tropical Asia, North America, and East Africa. In the folk medicinal history, these plants are used as laxative and purgative agents. In the Ayurveda system of medicine, they are used to cure headache and fever. Cassia plants exhibit pharmacological activities at large scales such as antimicrobial, anticancer, antiinflammatory, antioxidant, hypoglycemic, hyperglycemic, antimutagenic, and antivirals. The phytochemical investigations of genus Cassia demonstrate the presence of more than 200 chemical compounds, including piperidine alkaloids, anthracene derivatives (anthraquinones), flavonoids, pentacyclic triterpenoids, sterols, phenylpropanoids, and γ-naphthopyrones. The literature illustrated anthraquinones and flavonoids as major secondary metabolites from this genus. However, some Cassia plants, with rich contents of anthraquinones, still show toxicology properties. As Cassia plants are used extensively in the herbal system of medicine, but only senna dosage forms have achieved the status of the pharmaceutical market as standard laxative agents. In conclusion, further investigations on isolating newer biologically active constituents, unknown underlying mechanisms, toxicology profiles, and clinical studies of Cassia species are needed to be explored. This review article specifies the systematic breach existing between the current scientific knowledge and the fundamentals for the marketization of genus Cassia products.

A review of ethnomedicinal uses of shea butter for dermatoses in Sub-Saharan Africa

Indigenous therapies, or traditional medicines (TMs), constitute a highly accessible and continuously growing health system in many parts of the world, including Sub-Saharan Africa (SSA). Shea butter, a fat produced from the kernels of the shea tree, has historically been used as an indigenous therapy for dermatologic ailments in SSA. Characterizing traditional therapeutic applications for shea butter is important to inform the continued development of TM in SSA. We conducted a literature review aimed at identifying all available publications on the use of shea butter to treat dermatoses within SSA and evaluating patterns of use. We found 24 dermatologic uses across 30 references. The most common study design was descriptive cross-sectional analysis (46.7%), often relying on the use of in-depth interviews, focus groups, and surveys. Eight SSA countries were represented and there were disparities in availability of information across SSA with the eastern and southern regions less likely to be represented. The most frequently investigated conditions were scabies, wound healing, and umbilical cord care. Shea butter was most commonly used in combination with other ingredients to produce a medical treatment with the most frequent adjuvant being Elaeis guineensis, African oil palm. Broad use of TM to treat varied skin diseases throughout SSA warrants increased investigations into this field in order to further develop the capacity of TM as a source of healthcare.

Modulation of Cytochrome P450, P-glycoprotein and Pregnane X Receptor by Selected Antimalarial Herbs-Implication for Herb-Drug Interaction

Seven medicinal plants popularly used for treating malaria in West Africa were selected to assess herb-drug interaction potential through a series of in vitro methods. Fluorescent cytochrome P450 (CYP) assays were conducted using the recombinant CYP enzymes for CYP1A2, CYP2A6, CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 to assess the effect of the methanolic extracts on the metabolic activity of CYPs. Secondly, the inhibitory effect of the extracts was evaluated on P-glycoproteins (P-gp) using calcein-AM, a fluorescent substrate, in MDCK-II and hMDR1-MDCK-II cells. The inhibition of P-gp activity was determined as a reflection of increase in calcein-AM uptake. Additionally, the enzyme induction potential of the extracts was assessed through the modulation of PXR activity in HepG2 cells transiently transfected with pSG5-PXR and PCR5 plasmid DNA. Significant inhibition of CYP activity (IC₅₀ < 10 µg/mL) was observed with the following herbs: A. muricata [CYP2C9, 3A4 and CYP2D6]; M. indica [CYP2C9]; M. charantia [CYP2C9 and CYP2C19]; P. amarus [CYP2C19, CYP2C9 and CYP3A4]; T. diversifolia [CYP2C19 and CYP3A4]. Extracts of four herbs (P. amarus, M. charantia, T. diversifolia and A. muricata) exhibited significant inhibition of P-gp with IC₅₀ values (µg/mL) of 17 ± 1, 16 ± 0.4, 26 ± 1, and 24 ± 1, respectively. In addition, four herbs (A. mexicana, M. charantia, P. amarus and T. diversifolia) showed a >two-fold increase in induction in PXR activity. These findings suggest that these herbs may be capable of eliciting herb-drug interactions if consumed in high quantities with concomitant use of conventional therapies.

Antiplasmodial activity of Mezoneuron benthamianum leaves and identification of its active constituents

ETHNOPHARMACOLOGICAL RELEVANCE

Decoctions of the leaves of M. benthamianum Baill. are used by traditional healers in Guinea to treat malaria and this use was validated by a preliminary clinical assay.

AIM OF THE STUDY

To evaluate the in vitro antiplasmodial activity and to identify active compounds from extracts of M. benthamianum leaves.

MATERIAL AND METHODS

Antiplasmodial activity of extracts, fractions and pure compounds was evaluated in vitro against a chloroquine-sensitive strain of Plasmodium falciparum (3D7) using the measurement of the plasmodial lactate dehydrogenase activity. Selectivity of extracts and purified compounds for Plasmodium parasites was evaluated by using WST-1 test on HeLa human cells. Compounds were isolated using normal phase silica gel column chromatography and prepHPLC and their structures elucidated using extensive spectroscopic analysis.

RESULTS

Hydroethanolic extracts (70% v/v) of M. benthamianum leaves showed a moderate in vitro activity against P. falciparum 3D7, with IC₅₀ in the range 22.5 - 32.6µg/mL, depending on the batch; while a dark precipitate formed during ethanol evaporation showed higher activity (IC₅₀ =6.5µg/mL). The fractionation was performed on this most active fraction and was followed by in vitro antiplasmodial assay. Active compounds (5, 7, 8) belong to several phytochemical classes, contributing together to the global antiplasmodial activity of the hydroethanolic extract against P. falciparum parasite. This study finally allowed the isolation of three diterpenes including two new compounds named Mezobenthamic acids A (1) and B (2) and neocaesalpin H (3), as well as quercetin (4), kaempferol (7), resveratrol (6), gallic acid (9) and its ethylester (5), β-sitosterol glucoside (10) and 13b-hydroxy-pheophorbide a (8).

CONCLUSION

This study gives some concrete evidence to support the ethnopharmacological use of Mezoneuron benthamianum leaves extract in the management of malaria. The active compounds can be further studied for their antiplasmodial potential, as well as their suitability to be used as quality markers for the standardization of this herbal drug from the Guinean traditional pharmacopeia.

Ethnopharmacology, Chemistry and Biological Properties of Four Malian Medicinal Plants

The ethnopharmacology, chemistry and pharmacology of four Malian medicinal plants, Biophytum umbraculum, Burkea africana, Lannea velutina and Terminalia macroptera are reviewed. These plants are used by traditional healers against numerous ailments: malaria, gastrointestinal diseases, wounds, sexually transmitted diseases, insect bites and snake bites, etc. The scientific evidence for these uses is, however, limited. From the chemical and pharmacological evidence presented here, it seems possible that the use in traditional medicine of these plants may have a rational basis, although more clinical studies are needed.

Intellectual property rights, benefit-sharing and development of "improved traditional medicines": A new approach

ETHNOPHARMACOLOGICAL RELEVANCE

Protection of intellectual property rights and benefit-sharing are key issues for all ethnopharmacological research. The International Society of Ethnobiology has produced helpful guidelines on access and benefit-sharing which are widely viewed as a "gold standard" but the question remains how best to apply these guidelines in practice. Difficult questions include ownership of traditional knowledge, making appropriate agreements, and how appropriately to share benefits.

MATERIALS AND METHODS

We present the case study of the development of an "improved traditional medicine" for malaria in Mali and we report how benefit-sharing was applied in this case.

RESULTS

The knowledge about the selected plant came independently from several families and traditional healers. The IPR approach was to recognise that this traditional knowledge belongs to the people of Mali and was used for their benefit in developing a new "improved traditional medicine" (ITM). The traditional healer whose method of preparation was used, and who collaborated in clinical trials, did not request any financial reward but asked for the ITM to be named after him. The most sustainable benefit for the community was sharing the results of which preparation of which medicinal plant seemed to be the most effective for treating malaria. Attempts at providing a health centre and training a health worker for the village did not prove to be sustainable.

CONCLUSIONS

Respect for intellectual property rights and benefit-sharing are possible even in a context where the knowledge is not owned by a clearly identified person or group of people. The most sustainable benefits are intangible rather than material: namely recognition, improved knowledge about which traditional treatment is the best and how to prepare and take it.

Medicinal plants from Mali: Chemistry and biology

ETHNOPHARMACOLOGICAL RELEVANCE

Mali is one of the countries in West Africa where the health system rely the most on traditional medicine. The healers are mainly using medicinal plants for their treatments. The studies performed being the basis for this review is of importance as they will contribute to sustaining the traditional knowledge. They contribute to evaluate and improve locally produced herbal remedies, and the review gives also an overview of the plant preparations that will have the most potential to be evaluated for new Improved Traditional Medicines.

AIM OF THE REVIEW

The aim of this review is to give an overview of the studies performed related to medicinal plants from Mali in the period 1995-2015. These studies include ethnopharmacology, chemistry and biological studies of the plants that were chosen based on our interviews with the healers in different regions of Mali, and contribute to sustainable knowledge on the medicinal plants. The Department of Traditional Medicine, Bamako, Mali, is responsible for registering the knowledge of the traditional healers on their use of medicinal plants and also identifying compounds in the plants responsible for the bioactivities claimed. The studies reported aimed at getting information from the healers on the use of medicinal plants, and study the biology and chemistry of selected plants for the purpose of verifying the traditional use of the plants. These studies should form the basis for necessary knowledge for the development of registered Improved Traditional Medicines in Mali.

MATERIALS AND METHODS

The healers were the ethnopharmacological informants. Questions asked initially were related to wound healing. This was because the immune system is involved when wounds are healed, and additionally the immune system is involved in the majority of the illnesses common in Mali. Based on the results of the interviews the plant material for studies was selected. Studies were performed on the plant parts the healers were using when treating their patients. Conventional chromatographic and spectroscopic methods were used for the isolation and structural elucidation of compounds. The compounds to study were selected based on the bioassays performed concomitant with the fractionation.

RESULTS

Our results show that plants traditionally used as wound healing agents contain polysaccharides basically of pectin nature with immunomodulating activities. These pectins all have different and new structures. Several of the plants also contain compounds with effects related to antioxidant properties. These compounds are mainly of polyphenolic nature. Three of these are new compounds from Nature, while 32 was for the first time described from the plant they were isolated from. This review gives an overview of the most important results obtained during the 20 year long collaboration between Department of Traditional Medicine, Bamako, Mali, and Department of Pharmacognosy, School of Pharmacy, University of Oslo, Norway.

CONCLUSION

Our studies showed that ethnopharmacological information is important for the determination of screening and chemical methods to be used for studies of plants used in traditional medicine.

Ethnobotanical study of plants used against malaria in Sélingué subdistrict, Mali

ETHNOPHARMACOLOGICAL RELEVANCE

Plants have contributed to food security and disease treatments to rural populations in sub Saharan Africa for many centuries. These plants occupy a significant place in the treatment of diseases, such as malaria. In Mali, malaria is the leading cause of medical consultation and death. This infection is particularly dangerous for pregnant women and children under 5 years. The general aim of this research was to collect data on the knowledge of traditional health practitioners on malaria in the Sélingué area; particularly to document how traditional healers conceptualize and diagnose malarial disease and to collect and identify medicinal plants or other substances used for their health and well-being.

MATERIALS AND METHODS

An ethnobotanical survey was conducted on simple and complicated malaria in six villages in Sélingué subdistrict in a period of 2 months. The ethnobotanical data was collected by means of semi-structured interviews and questionnaires. In total 50 traditional healers were interviewed.

RESULTS

Two concepts of malaria (simple and complicated malaria) were cited and 97 plants used to treat malaria were identified. Decoctions and bathing (whole body) proved to be the most commonly used mode of application. Food attitudes and mosquitoes are perceived to be the most important causes of the disease. Trichilia emetica, Mitragyna inermis, Sarcocephalus latifolius, Cassia sieberiana, Cochlospermum tinctorium, Anogeissus leiocarpa, Guiera senegalensis and Entada africana were quoted as the most used in the treatment of malaria.

CONCLUSION

Knowledge about malaria and traditional treatment practices exist in Sélingué subdistrict. Herbal remedies are commonly used by people for the treatment of malaria because they are believed to be cost-effective and more accessible. Many of the plant species used for the treatment of malaria have not been well documented as well as their phytochemical and antimalarial activity.

Medicinal plants used by traditional healers for the treatment of malaria in the Chipinge district in Zimbabwe

ETHNOPHARMACOLOGICAL RELEVANCE

Because about 50% of the Zimbabwean population is at risk of contracting malaria each year, the majority of people, especially in rural areas, use traditional plant-based medicines to combat malaria. This explorative ethnobotanical survey was undertaken to document how malaria is conceptualized and diagnosed by traditional healers, and to record the medicinal plants used in the prevention and treatment of malaria, their mode of preparation and administration.

MATERIALS AND METHODS

The research was conducted in three villages in Headman Muzite׳s area and in Chiriga village. These villages are located in the Chipinge district in the Manicaland Province in Zimbabwe.Traditional healers were selected with the assistance of the headman of the Muzite area and a representative of the Zimbabwe National Traditional Healers Association. Semi-structured interviews were conducted with 14 traditional healers from four villages in the Chipinge district in Zimbabwe.

RESULTS

In total, 28 plants from 16 plant families are used by the healers who manage malaria with medicinal plants. The most cited plant is Cassia abbreviata Oliv. (Leguminosae) followed by Aristolochia albida Duch (Aristolociaceae) and Toddalia asiatica (L.) Lam. (Rutaceae). Roots (55.3%) are the most common part used. Most of the plant parts used to treat malaria are stored as dried powders in closed bottles. The powders are soaked in hot or cold water and the water extract is taken as the active medicine. The healers consider their medicinal knowledge as a spiritual family heritage. Only 25% of the healers refer the malaria patients that do not respond to their treatment to hospital - they believe evil spirits cause their remedies to failure and they would rather try a different plant or perform a cleansing ceremony.

CONCLUSIONS

Local knowledge of medicinal plants in the treatment of malaria still exists in all four villages surveyed and traditional healers appear to play an important role in primary health care services in this remote rural area in Zimbabwe. This explorative survey underscores the need to preserve and document traditional healing for managing malaria and for more future scientific research on the plants to determine their efficacy and their safety. This could improve their traditional anti-malarial recipes and might contribute to a better integration of Zimbabwean traditional medicine into the national health system in the future.

Inulin-rich fractions from Vernonia kotschyana roots have anti-ulcer activity

ETHNOPHARMACOLOGICAL RELEVANCE

Roots from Vernonia kotschyana are on the national list of essential drugs in Mali (West-Africa). It is sold under the name Gastrosedal and it used against ailments like gastritis and gastric ulcer. To evaluate the anti-ulcer, immunomodulating activities and toxicity of 50 and 100 °C water extracts, Vk50-I and Vk100-I respectively, from the roots of Vernonia kotschyana.

MATERIALS AND METHODS

Characterization of extracts was carried out by GC, colorimetric and biological methods. Vk50-I and Vk100-I were administrated 50 min before induction of gastric ulcers in mice with 0.3 M HCl-60% EtOH. Inhibition of ulcer formation was calculated based on lesion index. Immunological activities were measured by complement fixation and macrophage activation. Toxicity assay was carried out on brine shrimps.

RESULTS

Vk50-I (98% inulin) and Vk100-I (83% inulin) from Vernonia kotschyana significantly inhibited the formation of gastric lesions in mice (100 mg/kg). No immunomodulating activities or toxicity were found.

CONCLUSIONS

Our results show that inulin is probably partly responsible for the anti-ulcer activity of Gastrosedal. In addition, it is possible that water soluble polysaccharides (mainly inulin) have an indirect impact on the general health of the GI.