Malaria: treated with artemisinin

Price R, Van Vugt M, Phaipun F, Fuxemburger C, Simpson J, McGready R, Kuile FT, Khan A, Chongsuphajasiddhi T, White NJ, Nosten F. (1999) Adverse effects in patients with acute falciparum malaria treated with artemisinin derivatives. Am J Trop Med Hyg 60 547-555. 

Van Vugt M, Angus BJ, Price RN, Mann C, Simpson JA, Poletto C, Htoo SE, Looareesuwan S, White NJ, Nosten F. A case-control auditory evaluation of patients treated with artemisinin derivatives for multidrug-resistant Plasmodium falciparum malaria. Am J Trop Med Hyg 2000 62(l) 65-9. 

Iron(n) is known to decompose hydrogen and dialkyl peroxides to free radicals by reductive cleavage of the 0—0 bond and early investigations established the parasite s sensitivity to these species. When treated with radiolabelled C-artemisinin, the hemin-hemozoin fraction of the lysed malaria-infected erythrocytes was shown to contain a radiolabel, though the mechanism of incorporation is not clear. Meshnick and coworkers demonstrated that uninfected cells did not contain radiolabelled proteins whereas six radiolabelled proteins were isolated from cells infected with the Plasmodium falciparum (P. falciparum) strain of the parasite. It was suspected that one of the alkylated proteins was the Histidine Rich Protein (HRP) that was known to bind multiple heme monomers and therefore thought to be instrumental to the parasite s detoxification process. Moreover, iron chelators were found to inhibit the lethal effects of peroxides on the parasite. ... 

Qinghao (Sweet Wormwood) is the dried aerial parts of the herb Artemisia annua L. (Asteraceae family), which has been used in China for centuries to treat fever and malaria. Artemisinin (Nl) (Qing Hao Su) (128), the active principle, directly kills Plasmodium falciparum (malaria parasites) with little toxicity to animals and humans. Thus, it is a clinically effective, safe, and rapid antimalarial agent (129, 130). The novel endo-peroxide link is essential for the antimalarial activity. 

Prospects. Other indications for malaria for the artemisinin drugs are currently under investigations. Without a final proof, other erythrocyte persisting parasites like Babesia are maybe another interesting target parasite. But also Toxoplasma gondii, Pneumocystis carinii infections in mice have been treated successfully with artemisinin drugs [157-159],... 

How do traditional remedies fare in such trials Some perform quite well and prove to be highly effective, but others are no better than placebos. One striking success is an extract of sweet wormwood (Artemisia annua), which Chinese physicians have prescribed for the chills and fevers of malaria for more than two thousand years. About twenty-five years ago, Chinese chemists obtained from sweet wormwood its principal active component, a compound now called artemisinin. Clinical trials on malaria patients in Southeast Asia agreed with Chinese tradition on the value of artemisinin and also identified a few even more useful drugs prepared from it in the laboratory. These compounds are effective against the deadliest form of malaria and are now frequently the therapies of choice for treating it. 

FDA) for use in humans to treat malaria because this drug is considered a safe drug with few side effects.These features prompted various scientists around the world to evaluate the potential of artemisinin (1) and derivatives to control cancer cells proliferation. This chapter reviews the recent advances on analytical methods for extraction and quantification of artemisinin (1) from A. annua. Examples of artemisinin-derivatives with antiproliferative activities are listed, describing the structure-activity relationships of 96 compounds. This knowledge is essential for future development and use of artemisinin derivatives in cancer therapy. The mechanism of action of artemisinin and derivatives on cancer cells have been well reviewed in literature and therefore is not discussed in this chapter. 

The sesquiterpene lactone artemisinin (Fig. 1), in association with other medications, is used to treat malaria. Over-expression of the cotton... 

Chloroquine is the drug of choice in the treatment of nonfalciparum and sensitive falciparum malaria. It rapidly terminates fever (in 24-48 hours) and clears parasitemia (in 48-72 hours) caused by sensitive parasites. It is still used to treat falciparum malaria in some areas with widespread resistance, in particular much of Africa, owing to its safety, low cost, antipyretic properties, and partial activity, but continued use of chloroquine for this purpose is discouraged, especially in nonimmune individuals. Chloroquine has been replaced by other drugs, principally artemisinin-based combination therapies, as the standard therapy to treat falciparum malaria in most endemic countries. Chloroquine does not eliminate dormant liver forms of P vivax and P ovale, and for that reason primaquine must be added for the radical cure of these species. 

Mefloquine is effective in treating most falciparum malaria. The drug is not appropriate for treating individuals with severe or complicated malaria, since quinine, quinidine, and artemisinins are more rapidly active, and since drug resistance is less likely with those agents. The combination of artesunate plus mefloquine showed excellent antimalarial efficacy in regions of Southeast Asia with some resistance to mefloquine, and this regimen is now one of the combination therapies recommended by the WHO for the treatment of uncomplicated falciparum malaria (Table 52-4). Artesunate-mefloquine is the first-line therapy for uncomplicated malaria in a number of countries in Asia and South America. 

Artemisinin is used here as an example of a plant sesquiterpenoid with both traditional value as well as with medicinal and social value in the twenty-first century. Research on artemisinin has also established new benchmarks for biochemical engineering and functional genomics of plant terpenoids. Artemisinin is a functionalized sesquiterpene with a unique peroxide linkage from the sweet wormwood Artemisia annua). Chinese herbalists have used it since ancient times, and it is now used for its unique efficacy to treat multidrug-resistant strains of the malaria parasite Plasmodium falciparum. Its medicinal importance has prompted studies into its biosynthesis and its biochemical engineering so that cost-effective methods for producing it in large scale and in consistent quality may be realized. 

Malaria remains a parasitic scourge that is still extending in incidenoe. In 1972, the aotive principle from Artemisia annua, a plant used for centuries in Chinese traditional medioine to treat fevers and malaria, was established as a novel antimalarial ohemotype. This oompound, artemisinin ( qinghaosu in Chinese), is a sesquiterpene lactone with an endoperoxide group that is essential for activity, and it reacts with the iron in heme in the malarial parasite, Plasmodium falciparum (Fig. 1.3). Beoause this compound is poorly soluble in water, a number... 

Malaria and fever have been treated for over two mileniums with Artemisia annua, called green herb by Chinise people. Besides artemisinin. 

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