Conclusion: drawbacks, prospects and
A general overview of malaria
• A worldwide mosquito-transmitting infectious disease;
pathogenic agent: plasmodium1.
• Infectious mechanism: Infected mosquitos pierce
individuals’ skin for blood => sporozoites enter the liver
=> multiply rapidly => sporozoites enter the red blood
cells => several amplification cycles1.
• Symptoms: fever, tiredness, vomiting,
headaches, etc.2
Damage caused worldwide:
• 216 million cases, 731,000 deaths
worldwide; 90% cases and deaths
in Africa (reported 2016).3
• Hinder economic development:
extra 12 billion$ healthcare costs
in Africa (2014)4.
Leon
Kevin
Robby
Shirly ZJU-UoE INSTITUTE
Arteannuin in practice:
• Former antimalaria drug: Fansidar;
an average 36% treatment failure
rate9
• Current antimalaria drug: Coartem;
a drug therapy containing
arteannuin which is 100% effective
when used correctly9;
• A 2012 review: arteannuin -based remedies
are the most effective drugs for the
treatment of malaria10.
• Fundamentally improved the treatment of
parasitic diseases.
• reduced total death rates by at least 20
percent and child mortality by at least 30
percent.
• Even only in Africa arteannuin can save 100,
000 lives a year.
illumination
• Derivative: dihydroartemisinin
a. more stable; ten times more effective; much less
Discovery & Extraction method disease recurrence12. BXSB mice: alleviate lupus
• 1967 Chinese national Project 523 symptom13 • Derivative: Artesunate
• ≥ 2,000 Chinese herb preparations; identified 640 a. well tolerated; no serious side effects;
candidates. greatly reduces African children
evaluated ≥ 380 extracts from ≈200 Chinese herbs mortality with severe malaria5.
(mouse) b. Combinational usage
• Artemisia annua L. extract: inhibition to parasite • ACT; poor tolerance
growth. Contradictory
• Ge Hong’s A Handbook of Drawbacks
Introduction Prescriptions for Emergencies:
“A handful of qinghao
• Extracting:
Compounds, season,
to immersed with 2 liters of water, maturity, species,
wring out the juice and drink it
Arteannuin all”
processing & extracting
method
• heating => lower temperature Side effects; stability.
extraction
• 1971: acidic & neutral portions Resistance for
=> neutral 100% effective Artesunate:
(mice and monkey) (certain Resistance: slow
kinds of malaria) 5 parasite clearance,
reductions on
susceptibility.
Thai–Cambodian
Pharmacodynamics border; P. falciparum16.
• EM studies: artemisinin => parasite What to do?
membrane structure artemisinin Containment measures;
reacts with hemin => production of various drugs to
reactive oxygen species (ROS) => eliminate malaria in
oxidation damage8
Way to an effective drug
Greater Mekong
• Self-volunteering of extracts => patient in Hainan
subregion (GMS)17
=> isolation and purification => production: need
Artemisia high in artemisinin. Seek for => Sichuan
=> tablets => capsule5 References
1. Bledsoe GH. Malaria primer for clinicians in the United States. Southern Medical Journal. 2005; 98(12): 1197-204.
• Extract: quick reverses fever and blood parasite
2. Caraballo H. Emergency department management of mosquito-borne illness: Malaria, dengue, and west nile virus. Emergency
Medicine Practice. 2014; 16(5).
3. GBD 2015 Mortality and causes of death, collaborators. Global, regional, and national life expectancy, all-cause mortality, and
amount. Chloroquine failed to do this5.
cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. 2016;
388(10053): 1459-1544.
4. WHO. World malaria report 2014. Available from:
http://www.who.int/malaria/publications/world_malaria_report_2014/en/ [Accessed 16th April 2018]
• Capsule: satisfactory clinical efficacy5. ≥2,000
5. Tu Y. The discovery of artemisinin (qinghaosu) and gifts from Chinese medicine.. Nature Medicine, 2011, 17(10): 1217-1220.
6. Tu Y. A study on the authenticity of artemisia annua [in Chinese]. Chinese journal of Chinese medicine, 1987, 12(4).
7. Klayman D L. Qinghaosu (artemisinin): an antimalarial drug from China. Science, 1985, 228(4703): 1049-1055.
clinical successful recordings6. 8. Wang JY. Anti-malaria mechanism of artemisinin and its derivatives [in Chinese]. Chinese herbal medicine, 1994(3):152-155.
9 UN-OCHA. "Malaria Update", Focus on Ethiopia [online] Available from
http://ww-w.ocha-eth.org/Reports/downloadable/FocusonEthiopiaApril2005.pdf [Accessed 12/4/2018]
• Treating several thousand Chinese
10 Fairhurst RM, Nayyar GM, Breman JG, Hallett R, Vennerstrom JL, Duong S, Ri-ngwald P, Wellems TE, Plowe CV, Dondorp AM. Artemisinin-resistant
malaria: Rese-arch challenges, opportunities, and public health implications. The American Journal of Tropical Medicine and Hygiene. 2012. Available from:
http://www.ajtmh.org/content/journals/10.4269/ajtmh.2012.12-0025
[Accessed 12/4/2018]
malaria patients, regardless 11 Abolaji AO, Eteng MU, Ebong PE, Brisibe EA, Dar A, Kabir N, Choudhary MI . . A safety assessment of the antimalarial herb Artemisia annua during pregnancy in Wistar rats. Phytotherapy
Research. 2013. Available from:
of chloroquine
https://onlinelibrary.wiley.com/doi/abs/10.1002/ptr.4760 [Accessed 12/4/2018]
12. Li W, Dong Y, Tu Y, et al. Dihydroarteannuin ameliorates lupus symptom of BXSB mice by inhibiting production of TNF-alpha and blocking the signaling pathway NF-kappa B translocation..
International Immunopharmacology, 2006, 6(8): 1243-1250.
13. Dondorp A M, Fanello C I, Hendriksen I C, et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial..
resistance7.
The Lancet, 2010, 376(9753): 1647-1657.
14. Eziefula A C. Artesunate-mefloquine: a malaria treatment for African children?. Lancet Infectious Diseases, 2016, 16(10): 1086-1087.
15. Achan J, Talisuna A O, Erhart A, et al. Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria. Malaria Journal, 2011, 10(1): 144-144.
16.
Medicine, 2009, 361(5): 455-467
17.
Dondorp A M, Nosten F, Yi P, et al. Artemisinin Resistance in Plasmodium falciparum Malaria. The New England Journal of
WHO. Update on artemisinin resistance - September 2015 from the WHO Global Malaria Programme.. 2015.