01 Chapter 1
01 Chapter 1
INTRODUCTION
1
1.10 Hypothesis………………………………………………………………..... 34
1.11 References…………………………………………………………..…….. 35
2
CHAPTER 1
INTRODUCTION
Throughout the ages, humans have relied on nature for their basic needs, for
the production of food, shelter, clothing, transportation, fertilizers, flavours and
fragrances, and medicines (Cragg and Newman, 2005). Plants have formed
the basis of sophisticated traditional medicine systems that have been in
existence for thousands of years and continue to provide mankind with new
remedies. Although some of the therapeutic properties attributed to plants
have proven to be erroneous, medicinal plant therapy is based on the
empirical findings of hundreds and probably thousands of years of use. The
first records, written on clay tablets in cuneiform, are from Mesopotamia and
date from about 2 600 BC (Heinrich et al., 2004). Among the substances that
were used are oils of Cedrus species (cedar) and Cupressus sempervirens
(cypress), Glycyrrhiza glabra (licorice), Commiphora species (myrrh) and
Papaver somniferum (poppy juice), all of which are still in use today for the
treatment of ailments ranging from coughs and colds to parasitic infections
and inflammation. In ancient Egypt, bishop’s weed (Ammi majus) was
reported to be used to treat vitiligo, a skin condition characterized by a loss of
pigmentation (Staniszewska, et al., 2003; Beissert and Schwarz, 2002). More
recently, a drug (β-methoxypsoralen) has been produced from this plant to
treat psoriasis and other skin disorders, as well as T-cell lymphoma (Beissert
and Schwarz, 2002).
3
(Pilocarpus spp.) in the Citrus family; two powerful anti-cancer agents from the
Rosy Periwinkle (Catharanthus roseus); laxative agents from Cassia sp. and a
cardiotonic agent to treat heart failure from Digitalis species (Newman et al.,
2000).
Approximately half (125 000) of the world’s flowering plant species are found
in the tropical forests. Tropical rain forests continue to support a vast reservoir
of potential drug species. They continue to provide natural product chemists
with invaluable compounds as starting points for the development of new
drugs. The potential for finding more compounds is enormous as to date only
about 1% of tropical species have been studied for their pharmaceutical
potential (Cragg and Newman, 2005). This proportion is even lower for
species confined to the tropical rain forests. To date about 50 drugs have
come from tropical plants. The probable undiscovered pharmaceuticals for
modern medicine has often been cited as one of the most important reasons
for protecting tropical forests. Therefore the high annual extinction rate is a
matter for concern.
4
Modern allopathic medicine has its roots in ancient medicine, and it is likely
that many important new remedies will be discovered and commercialized in
the future, as it has been till now, by following the leads provided by traditional
knowledge and experiences. While European traditions are particularly well
known and have had a strong influence on modern western pharmacognosy,
almost all societies have well-established herbal traditions, some of which
have hardly been studied at all. The study of these traditions will not only
provide an insight into how the field has developed but it is also a fascinating
example of our ability to develop a diversity of cultural practices.
African traditional medicine is ancient and perhaps the most diverse of all
medicinal systems. Africa is considered to be the cradle of humankind, with a
rich biological and cultural diversity and marked regional differences in healing
practices. Unfortunately, even today the systems of medicines are poorly
recorded. The documentation of medicinal uses of African plants is becoming
increasingly urgent because of the rapid loss of the natural habitats of these
plants due to human activities. The African continent is reported to have one
of the highest rates of deforestation in the world. This loss is all the greater
because the continent has a high rate of endemism, with Madagascar topping
the list at 82% (Green and Sussman, 1990).
5
African traditional medicine in its varied forms is holistic, involving both the
body and the mind. The healer typically diagnoses and treats the
psychological basis of an illness before prescribing medicines to treat the
symptoms. Well known African medicinal plants include Acacia senegal (gum
arabic), Agathosma betulina (buchu), Aloe ferox (Cape aloes), Aloe vera
(north African origin), Artemisia afra (African wormwood), Aspalanthus linearis
(rooibos tea), Boswellia sacra (frankincense), Catha edulis (khat),
Commiphora myrrha (myrrh), Harpagophytum procumbens (devil’s claw),
Hibiscus sabdariffa (hibiscus, roselle), Hypoxis hemerocallidea (African
potato), Prunus africana (African cherry). Madagascar has contributed
Catharanthus roseus (rosy periwinkle) and has the potential of contributing
more in view of the diversity of the flora and fauna (Newman et al., 2000;
Neuwinger, 2000).
In the USA, just like in many other cultures, the indigenous healer or Shaman
treated illnesses by addressing both the physical and spiritual dimension of
diseases. These Shamanistic ceremonies involve chanting, dancing and other
rituals aimed at expelling evil forces so that the patient or the community as a
whole can be healed (Fabricant and Farnsworth, 2001). Early settlers learnt
from native practices and they eventually adopted many of the herbal
remedies, which later formed the basis of the early United States
Pharmacopoeia. Among the well known medicinal plants of the United States
are Echinacea (Echinacea purpurea) and Goldenseal (Hydrastis canadensis).
During most of the 20th century, herbs or botanicals have been regarded with
skepticism and the practice of herbal medicine went into decline. Plants were
viewed mainly as a potential source of pure chemical compounds for the
development of medicine. In recent years, herbs and botanicals have become
very popular in the USA and Canada but they are still considered as
nutritional supplements rather than medicines in their own rights (Pieroni et
al., 2000; Heinrich et al., 2004; Gurib-Fakim, 2006).
6
1.2.2.2 Central and South America
Just like Africa, Central and South American countries have rich and diverse
healing cultures, which are poorly known and have not been properly
recorded. They will no doubt be a source of new herbal remedies in the years
to come. South and Central America have made enormous contributions to
agriculture and a large number of food crops such as maize, potatoes,
tomatoes, pumpkins, cassava, peanuts and sweet potato originate from there.
Traditional American Indian medicinal herbs are used extensively but the
influence of Spanish, European, East Asian and African medical systems is
obvious. Notable examples of medicinal plants are: Cinchona pubescens
(peruvian bark), Erythroxylum coca (coca), Ilex paraguariensis (maté),
Myroxylon balsamum (tolu balsam), Paullinia cupana (guarana), Peumus
boldus (boldo), Psidium guajava (guava), Spilanthes acmella (Brazilian cress),
Tabebuia impetiginosa (lapacho) and Uncaria tomentosa (cat’s claw)
(Fabricant and Farnsworth, 2001; Gurib-Fakim, 2006).
7
1.2.4 Ayurvedic medicine (Indian traditional medicine)
Ayurveda is derived from the Indian words ‘Ayar’ (life) and ‘veda’ (knowledge
or science) and hence means the science of life. Following the system would
help ensure a long life, which is considered to be the instrument for achieving
righteousness (dharma), wealth (artha) and happiness (sukha).
In India, knowledge and wisdom have been passed on from one generation to
the next through songs and poems, which scholars and physicians had to
learn and recite by heart. The Veda is an ancient text in four parts (Rig Veda,
Sama Veda, Yajur Veda and Atharva Veda), the earliest of which date back to
2 000 years BC. The principles of Ayurvedic medicine and the medicinal uses
of plants are contained in thousands of poetic hymns in the Rig Veda. The first
school to teach Ayurvedic medicine was at the University of Banaras in 500
BC where the great Samhita (or encyclopedia of medicine) was written.
Another great enclyclopedia was written 700 years later, and these two
together form the basis of the Ayurveda (Chopra, 2000).
8
Famous Ayurvedic medicinal plants include Azadirachta indica (neem),
Centella asiatica (gotu kola), Cinnamomum camphora (camphor), Elettaria
cardamomum (ela or cardamomum), Rauwolfia serpentina (Indian snake
root), Santalum album (sandalwood), Terminalia species (myrobolan) and
Withania somnifera (aswargandha) (Kapoor, 1990; Magner, 1992; Padua de,
1999; Gurib-Fakim, 2006).
The civilizations of China and India were flourishing when only modestly
sophisticated cultures were developing in Europe. Expectedly writings on
medicinal plants and the aesthetics of vegetation were numerous. This
ancient system of medicine, believed to be more than 5 000 years old, is
based on two separate theories about the natural laws that govern good
health and longevity, namely yin and yang, and the five elements (wu xing)
(Kapoor, 1990; Patwardhan, 2005).
The legendary emperor Shen Nung discussed medicinal herbs in his works—
which were probably written 2 500 years B.P. (Before Present) and not the
traditional date of 3 500 B.P. The Traditional Chinese medicine was
systematized and written between 100 and 200 BC (Before Christ). The most
complete reference to Chinese herbal prescription is the Modern Day
Encyclopedia of Chinese materia medica published in 1977. It lists nearly 6
000 medicines out of which 4 800 are of plant origin (Magner, 1992).
In common with Western and African traditional medicines, Chinese herbs are
usually given in fixed mixtures or formulas of up to 20 herbs, carefully
prepared according to traditional recipes. There are hundreds such recipes
being used alongside with Western medicines. As in other healing cultures,
9
traditional recipes are used preferentially against chronic illnesses while acute
or serious illnesses are cured by Western medicines.
Greek and Roman medicine was based on the belief that the world is
composed of four elements—earth, wind, fire and water. Each of these has its
corresponding humours, linked to the four vital fluids in the body. The four
humours—blood, phlegm, black bile and yellow bile, influence both health and
temperament (respectively sanguine, phlegmatic, melancholic and choleric).
In order to restore balance, drastic measures such as blood letting (reducing
excess blood) and purging (to remove excess black bile) was used. The four
10
humours were also associated with cold, heat, dampness and dryness and
each of these had a corresponding range of cold, hot, damp or dry herbs that
were supposedly able to restore imbalances. European tradition also had
many regional influences that influenced local folk practices and traditions
(Weiher et al., 1999).
One of the most powerful influences was the famous book De Materia Medica,
written by the Greek physician Dioscorides in the first century AD. It is
generally accepted to be the first European herbal and was the standard
reference in Europe for more than 1 000 years, providing the base for most of
the later herbals. As early as AD 800, medicinal plants were cultivated
according to a standardized layout in monasteries in Central Europe. One of
the famous healers of this era was Hildegard of Bingen (1098–1179). In later
years a Swiss alchemist known as Paracelsus (1493–1541) emphasized the
importance of the correct dosage for medical treatments (Gurib-Fakim, 2006).
Herbal medicine was part of everyday life in many countries in Europe and to
this day has remained a popular method of treating ailments but is often
considered to be supportive rather than curative. To date in several European
countries, the use of herbal tea is still very popular. In addition to these,
‘natural products’ taken in their crude form (unprocessed) as teas or
decoctions, more sophisticated phytomedicines (standardized and formulated
extracts of plants, often subject to rigorous testing in humans) remain a
popular alternative to medicinal products derived from pure synthetic
chemicals (Vicker and Zollman, 1999).
11
1.2.7 Classical Arabic and North African traditional medicine
The oldest written information in the Arabic traditions comes from the
Sumerians and Akkadians of Mesopotamia, thus originating from the same
areas as the archeological records of Shanidar IV (Heinrich et al., 2004). The
earliest documented record, which presumably relates to medicinal plants,
dates from 60 000 before the common era (BCE) found in the grave of the
Neanderthal man from Shanidar IV, an archeological site in Iraq. Pollen of
several species of plants, presumably used as medicines, was discovered
among which are: Centaurea solstitialis (Asteraceae), Ephedra altissima
(Ephedraceae), Althea sp. (Malvaceae) amongst others. Although this may
not be a finding with direct bearing on the culture of Shanidar, these species
or closely related ones from the same genus, are still important today in the
phytotherapy of Iraq and also known from other cultural traditions. These
species may well have been typical for the Neanderthal people and may also
be part of a tradition for which Shaidar IV represents the first available record
(Cragg and Newman, 2005).
The Middle East is known as the cradle of civilisation and many plants
cultivated nowadays were domesticated in this region. The Babylonians,
Assyrians and Sumerians recorded herbal remedies in cuneiform writing on
numerous clay tablets. Of special interest is the Code of Hammurabi (ca. 1
700 BC), a comprehensive set of civil laws carved in stone and commissioned
by the King of Babylon and which lists several medicinal herbs (Spiegel and
Springer, 1997).
12
Ebers published a facsimile edition (Ghalioungui, 1987). The Ebers Papyrus is
a medical handbook covering all sorts of illnesses and includes empirical as
well as symbolic forms of treatment. The diagnostic precision documented in
this text is impressive. During the Dark and Middle Ages (5–12th Centuries,
AD), the monasteries in countries such as England, Ireland, and Germany
were responsible for preserving the remains of Western knowledge. But it was
the Arabs who were responsible for the preservation of much of the Greco-
Roman expertise, and for expanding it to include the use of their own
resources, together with the Chinese and Indian herbs, till then unknown to
the Greco-Roman world. The Arabs were the first to establish privately owned
drug stores in the 8th century. The Persian pharmacist, physician, philosopher
and poet, Avicenna, contributed much to the sciences of pharmacy and
medicine throughout works such as Canon medicinae, regarded as the “final
codification of all Greco-Roman medicine”. Canon medicinae included
elements of other cultures healing system and forms the basis for a distinct
Islamic healing system known today as Unani-Tibb (Sheehan and Hussain,
2002).
Among the famous medicinal plants of the Middle East and Egypt are: Allium
cepa (onion), Astracantha gummifera (tragacanth), Carthamus tinctorius
(safflower), Carum carvi (caraway), Ferula assafoetida (asofoetida), Lawsonia
inermis (henna), Papaver somniferum (opium poppy), Peganum harmala
(syrian rue), Prunus dulcis (almond), Punica granatum (pomegranate), Rosa x
damascena (damask rose), Ricinus communis (castor oil plant), Salvadora
persica (toothbrush tree), Senna alexandrina (senna), Sesamum indicum
(sesame), Trachyspermum ammi (ajowan), Trigonella foenum-graecum
(fenugreek) and Vitis vinifera (grape) (Padua de, 1999; Neuwinger, 2000;
Gurib-Fakim, 2006). A list of some botanical drugs used in traditional
medicine, which have led to useful modern drugs are shown in Table 1.1.
However, it should be noted that concern has been raised on the toxicity of
Kava pyrones and that their anxiolytics have been positively reviewed
(Schulze et al., 2003).
13
Table 1.1: Botanical drugs used in traditional medicine which led to useful modern drugs (Gurib-Fakim 2006).
English
Botanical names Indigenous use Origin Uses in biomedicine Biologically active compounds
names
Antispasmodic,
antiseptic, Antispasmodic, oxytocic, Vasicin (lead molecule for Bromhexin and
Adhatoda vasica – India, Sri Lanka
insecticide, fish cough suppressant Ambroxol)
poison
Catharanthus roseus Periwinkle Diabetes, fever Madagascar Cancer chemotherapy Vincristine, Vinblastine
D-Tubocurarine
Condrodendron tomentosum – Arrow poison Brazil, Peru Muscular relaxation
Dementia, Ginkgolides
Asthma, anthelmintic
Gingko biloba Gingko Eastern China cerebral
(fruit)
deficiencies
Piper methysticum Kava Ritual stimulant, tonic Polynesia Anxiolytic, mild stimulant Kava pyrones
14
1.3 Drug discovery from medicinal plants
Drug discovery from medicinal plants has evolved to include numerous fields
of inquiry and various methods of analysis. The process typically begins with a
botanist, ethnobotanist, ethnopharmacologist, or plant ecologist who collects
and identifies the plant(s) of interest. Collection may involve species with
known biological activity for which active compound(s) have not been isolated
(i.e traditionally used herbal remedies) or may involve taxa collected randomly
for a large screening program. It is necessary to respect the intellectual
property rights of a given country where plant(s) of interest are collected
(Baker et al., 1995). Phytochemists (natural product chemists) prepare
extracts from the plant material, subject these extracts to biological screening
in pharmacologically relevant assays, and commence the process of isolation
and characterization of the active compound(s) through bioassay-guided
fractionation. Molecular biology has become essential to medicinal plant drug
discovery through the determination and implementation of appropriate
screening assays directed towards physiologically relevant molecular targets.
Pharmacognosy encapsulates all of these fields into a distinct interdisciplinary
science.
15
O O O O
O O
O O
O OCH2CH3
Artemisinin Arteether
16
Figure 1.2: Schematic representation of a typical medicinal plant drug
discovery process and development (Balunas and Kinghorn, 2005).
Drug discovery from medicinal plants has traditionally been lengthier and
more complicated than other drug discovery methods. Therefore, many
pharmaceutical companies have eliminated or scaled down their natural
product research (Butler, 2004; Koehn and Carter, 2005).
17
1.4 Synthesis and role of plant secondary metabolites
They have also provided an invaluable resource that has been used to find
new drug molecules (Gurib-Fakim, 2006).
18
1.4.1 Terpenes
CH3
H3C C CH CH3
Isoprene unit
19
1.4.1.1 Monoterpenes
OH
OH
O
OH
1.4.1.2 Sesquiterpenes
CH3
O CH3
CH3 O
α- Santonin
20
1.4.1.3 Diterpenes
Diterpenes are present in animals and plants and have some therapeutic
applications, for example, the famous taxol and its derivatives are anticancer
drugs. Other examples are forskolin, which has antihypertensive activity;
zoapatanol is an abortifacient while stevoside is a sweetening agent (Gurib-
Fakim, 2006).
1.4.1.4 Triterpenes
Triterpenes are C30 compounds arising from the cyclization of squalene. They
are comprised of a variety of structurally diverse compounds, which include
steroids. Tetracyclic terpenes and steroids have similar structures but have
different biosynthetic pathways (Taiz and Zeiger, 2006).
All phenolic compounds have an aromatic ring that contains various attached
substituent groups such as hydroxyl, and methoxy (-O-CH3) groups, and often
other non-aromatic ring structures.
OH
They range from simple structures with one aromatic ring to complex
polymers such as tannins and lignins. Phenolics differ from lipids in being
more soluble in water and less soluble in non-polar organic solvents. Some
phenolics, however, are rather soluble in ether, especially when the pH is low
enough to prevent ionization of any carboxyl and hydroxyl group present.
21
These properties greatly aid separation of phenolics from one another and
from other compounds (Taiz and Zeiger, 2006). Other classes of phenolic
compounds include coumarines, quinones and flavonoids.
Phenolic compounds are synthesised via the Shikimic acid or acetate pathway
(Fig 1.5) and subsequent reactions. They have a wide range of
pharmaceutical activities such as anti-inflammatory, analgesic, antitumour,
anti-HIV, anti-infective (antidiarrhoeal, antifungal), antihepatotoxic,
antilipolytic, antioxidant, vasodilatory, immunostimulant and antiulcerogenic. In
plants they serve as effective defence against herbivores (Wink, 1999 and
Gurib-Fakim, 2006).
1.4.2.1 Flavonoids
22
(Taiz and Zeiger, 2006). They are responsible for the colour of flowers, fruits
and sometimes leaves. Some may contribute to the colour by acting as a co-
pigment. The name ‘flavonoid’ refers to the Latin word ‘flavus’ meaning yellow.
H
H
O
O
OH
OH
O O O
O
O
OH
O
O O
Flavonoids protect the plant from UV-damaging effects and play a role in
pollination by attracting animals with their colours (Gurib-Fakim, 2006). The
basic structure of flavonoids is 2-phenyl chromane or an Ar–C3–Ar skeleton.
Biosynthetically they are derived from a combination of the Shikimic acid and
the acetate pathways. Small differences in basic substitution patterns give rise
to several sub-groups. In the plant, flavonoids can either occur as aglycones
or as O- or C-glycosides (Gurib-Fakim, 2006). Recently, flavonoids have
attracted interest due to the discovery of their pharmacological activities.
23
properties. Most nitrogenous secondary metabolites are biosynthesised from
common amino acids (Taiz and Zeiger, 2006).
1.4.3.1 Alkaloids
The term ‘alkaloid’ has been defined as a cyclic organic compound containing
nitrogen in a negative oxidation state, which has limited distribution in living
organisms (Taiz and Zeiger, 2006). Based on their structures, alkaloids are
divided into several subgroups: non-heterocyclic alkaloids and heterocyclic
alkaloids, which are again divided into 12 major groups according to their
basic ring structure. Mescaline is an example of a non-heterocyclic or pseudo-
alkaloid, tetrandrine is an example of a bisbenzylisoquinoline alkaloid while
solasodine is a triterpene alkaloid (GuribFakim, 2006) (Fig. 1.7).
H
H
N
H3CO H
O
H H
H3CO
H
NH2
H3CO HO
Mescaline Solasodine
OCH3 H3CO
N CH3
H3C N OCH3
O H
OCH3
Tetrandrine
24
Free alkaloids are soluble in organic solvents and react with acids to form
water-soluble salts. There are exceptions like berberine, which is a quartenary
ammonium alkaloid. Most alkaloids are solids except for nicotine, which is a
liquid.
25
Every year, more than half of the deaths associated with infectious diseases
continue to be attributed to three illnesses: HIV/AIDS, tuberculosis and
malaria. These diseases are present in epidemic proportion, profoundly
affecting and serving as major obstacles to the economic growth and
development in many of the poorest countries in the world (Mandell et al.,
2005). Urgent solutions are required if the poorest regions in the world is to
develop.
1.5.1 Malaria
26
Although the increasing prevalence of drug resistant P. falciparum has
hindered the ability to control/treat the disease, it has at the same time
intensified attempts to develop novel antimalaria drugs and agents to prolong
the clinical usefulness of the few currently available drugs (Singh and Puri,
2000). An increasing number of countries have been compelled to adopt a
different class of drug, the antifolates, as the first line of alternatives to
27
chloroquine. The most widely used combination of this type consist of
pyrimethamine (PYR) and sulfadoxine (SDX), known as fansider or SP, which
is cheap and, until recently, was effective against the chloroquine-resistant
parasites found in Africa. However, resistance to this formulation, long
established in parts of south-east Asia and South America (Wernsdorfer,
1994), now threatens to leave Africa with no affordable treatment. Further
combinations of antifolates with newer drugs such as the artemisinin
derivatives, or the development of alternative combinations, may be the only
way to limit the pace of the parasitic resistance to chemotherapy. For
example, the antifolate prodrug, proguanil, has now been formulated together
with a new type inhibitor, atovaquone, to yield malarone, recently licensed for
clinical use (Hyde, 2002).
The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World
Health Organisation (WHO), reported the number of people living with HIV at
the end of 2006 to be 39.5 million globally. Of the people infected worldwide,
64% reside in sub-Saharan Africa, 77% of which are women. The severity of
the epidemic has been associated with poverty, low status of women and
other socio-economic factors (Nicoll and Gill, 1999; NSP, 2000).
28
A number of documents have described the seriousness of HIV/AIDS in the
Southern Africa region with particular emphasis on Southern Africa being the
most affected (UNAIDS, 2000). The prevalent rate for South Africa is
estimated to be 12.5%, which is one of the highest national prevalent rates in
the world (James et al., 2006). Women are more hit by the epidemic of
HIV/AIDS. Of the 5.54 million people living with HIV in South Africa in 2005,
18.8% are adults aged 15-49 years of which women account for
approximately 55%. The infection is more pronounced in the age group 20-24
years and 25-29 where the HIV prevalence rates are 23.9% for women to 6%
for men and 33.3% for women and 12.2% for men respectively (NSP, 2007).
HIV was around 3% among children aged 2-14 year and nearly 4% for people
in their sixties (Dinkelman et al., 2007).
The increase in pregnancy and HIV infection in young school leaving people
has been linked with unemployment. The inability to secure a job plus
pressure from family members to make financial contributions for the
maintenance of their homes, predispose them to sex work as a way to make
ends meet (Dinkelman et al., 2007).
Children under the age of 18 comprise 40% of the population of South Africa.
In 2004, it was reported that 13% of them have lost either mother or father,
half of which was due to AIDS. Children from deeply impoverished
households were worst affected by the impact of AIDS (UNAIDS, 2004).
Children are exposed to HIV through sexual abuse, blood transfusion and
29
mother to child transmission (MTCT) which occurs mostly during birth and/or
breastfeeding (Nicoll and Gill, 1999).
Many countries in Africa and Asia have taken urgent steps to curb the
epidemic with varying degrees of success. In South Africa, despite the effort
invested, the HIV infection rate has increased significantly over the last 5
years (NSP, 2000). The country has the largest number of people enrolled on
antiretroviral therapy in the world. There are still many more people in need of
this and other related interventions to reduce the morbidity and mortality of
HIV/AIDS. In particular, more eligible adults than children have accessed
these services. There is need to develop more innovative strategies to
improve access for children in schools (primary and secondary) (NSP, 2007).
At the moment there is no cure for HIV. Single drug therapy is no longer
effective due the resistance developed by the virus. Combinational therapy is
now the method of choice in treatments (Spencer, 2005). The adverse side
effects of the available drugs or combination of drugs and non-compliance of
patients on treatment did not help the situation (Spencer, 2005). There is a
urgent need to develop drugs with less side effects for the treatment and a
cure for the disease. The only effective way to combat HIV infection at the
moment is in prevention-advocacy and the practice of abstinence, and safe
sexual practice (Nicoll and Gill, 1999).
1.5.3 Tuberculosis
30
strongest risk factor for progression to active disease: 46% of people in the
developing world with HIV are co-infected with tuberculosis (Nicoll and Gill,
1999; Anthony and Fauci, 2005). About 4 million people have active
tuberculosis at any time resulting in about 2 million deaths each year. Most of
the deaths occur in the developing countries predominantly in Africa and Asia
(Anthony and Fauci, 2005). The fatalities of this disease are worsened by the
development of resistance to the available antituberculosis drugs (Mandell et
al., 2005).
The human body has evolved with antioxidant systems to protect it against
free radicals. These systems include some antioxidants produced in the body
(endogenous), obtained from the diet (exogenous) and repair antioxidant
(proteases, lipase, transferases, and DNA repair enzymes). The ones
produced in the body are enzymatic defences, such as Se-glutathione
peroxidase, catalase, and superoxide dismutase, which metabolize
superoxide, hydrogen peroxide and lipid peroxides, thus preventing most of
the formation of the toxic hydroxyl radicals. Exogenous antioxidants consist of
non-enzymatic defenses, such as glutathione, histidine-peptides, the iron-
binding proteins transferring and ferritin, dihydrolipoic acid etc (Erkoç et al.,
2003; Brahmachari and Gorai, 2006). Owing to the incomplete efficiency of
our endogenous defence systems and the existence of some
physiopathological situations (cigarette smoking, air pollutants, UV radiation,
high polyunsaturated fatty acid diet, inflammation, ischemia/reperfusion, etc)
in which ROS are produce in excess and at the wrong time and place, dietary
antioxidants are needed for diminishing the cumulative effects of oxidative
31
damage over the life span. The antioxidants derived from diet are vitamins C,
E and A, and carotenoids. Other antioxidants of value to health derived from
plants include phenols, phenolic acids, flavonoids, tannins and lignans (Pietta,
2000).
32
further north into Africa. The main stem is much branched from the base, with
smoothish grey bark. The leaves are large, heart shaped, grey to olive-green
above, white beneath, with a pointed tip (Pooley, 1993; Prozesky, 2004).
1.8 Objectives
The isolation and identification of three flavonoids, two new diterpenes (with a
newly described skeleton) and one new indane is described in chapter two.
The isolation was performed using bioassay-guided fractionation (antibacterial
activity). The bio-activities (antiplasmodial, antibacterial and antioxidant, anti-
HIV and cytotoxicity of the isolated compounds are described in chapters 3, 4,
33
5 and 6 respectively. Chapter 7 consists of a general discussion and
conclusion.
1.10 Hypothesis
34
1.11 References
Anthony, S. and Fauci, M.D. 2005. Emerging and reemerging infectious diseases:
the perpetual challenge. Acad. Med. 80(12):1079-1085.
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