Artemisinin
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Artemisinin

Artemisinin is a drug used to treat multi-drug resistant strains of falciparum malaria. The compound (a sesquiterpene lactone) is isolated from the shrub Artemisia annua long-used in Traditional Chinese Medicine. Not all shrubs of this species contain artemisinin. Apparently it is only produced when the plant is subjected to certain conditions. more...

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Cancer Treatment

Artemisinin is also under early research and testing for treatment of cancer. Artemisinin has a peroxide lactone group in its structure. It is thought that when the peroxide comes into contact with high iron concentrations (common in cancerous cells), the molecule becomes unstable and releases reactive oxygen species. It has been shown to reduce angiogenesis and the expression of vascular endothelial growth factor in some tissue cultures.

History

Artemisia has been used by Chinese herbalists for more than a thousand years in the treatment of many illnesses, such as skin diseases and malaria. In the 1960s a research program was set up by the Chinese army to find an adequate treatment of malaria. In 1972, in the course of this research, Tu Youyou discovered artemsinin in the leaves of Artemisia annua. The drug is named qinghaosu (青蒿素) in Chinese. It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria. It was the only one that was effective.

It remained largely unknown to the rest of the world for about 10 years, due to the Communist Chinese government at the time. The rest of the world finally found out about the drug from an article in a Chinese medical journal. People were sceptical at first, because the Chinese had made unsubstantiated statements about having found treatments of malaria before. Another reason was the peroxide part of the molecule. It was thought unlikely this would be a stable molecule, and so would not last long enough to be effective. This turned out not to be the case.

The Chinese government at the time, however, was very wary of western scientists, and would not give anyone either the plant or the refined drug. People around the world now started looking for the shrub themselves, to see if they could find it. They finally found it along the Potomac river, in Washington, D.C. Apparently it was a very common shrub, found in many parts of the world--In fact, it was often treated as a garden weed. It took another 10 years of research before the drug finally became commercially available. By this time relations between Communist China and the rest of the world had improved, and scientific information could be exchanged.

The drug is used these days in China and Vietnam without much regard to taking precautions against creating resistance of the malaria parasite to this drug as well, but nevertheless no resistance has been encountered in these parts of the world. Because ot the method of action, it is unlikely that resistance to artemisinine and derivatives will become a problem in the near future.

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Malaria's terrible toll
From Environment, 7/1/05

Despite recent efforts to combat malaria, the disease still kills one million people per year, most of them in Africa, according to a joint report by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). The 2005 World Malaria Report, released in early May, found that since 2000, more countries have been introducing new medicines and more people have been receiving pesticide-treated mosquito nets, which could be a sign that the disease will decline. However, insufficient funding and problems with the supply of the new medications leave the battle's outcome in doubt in the near term.

Because some of the protozoans that cause malaria have developed resistance to established medicines like chloroquine, many countries are seeking a second-line medicine that is derived from a chemical, artemisinin, produced by a Chinese herb. However, according to BBC News, producing the drug takes a long time: six months to grow the herb and an additional three to five months to process it.

WHO announced a shortage of the artemisinin-derived drugs late last year. According to the recently released report, various agencies have come together to try to help alleviate the shortage by the end of this year. The main challenge--for everything from mosquito netting distribution to new medicines and other technology and support--has been funding: WHO and UNICEF estimate that US$3.2 billion will be needed each year to reach their goal of halving the incidence of malaria by 2010. This year, only $600 million has been made available for malaria control. However, according to a joint WHO and UNICEF press release in early May, the World Bank will commit between $500 million and $1 billion over the next five years. In mid-May, the Bill and Melinda Gates Foundation announced it would be contributing $250 million toward vaccine research, including research on a vaccine for malaria that will not need refrigeration.

--BBC News, 11 September 2004; Reuters, 3 May; WHO/UNICEF joint press release, 3 May; and Detroit Free Press, 24 May. (D.H.)

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