Unlocking the anti-prostate cancer potential of some tropical and sub-tropical plants

Prostate cancer is the third leading cause of cancer death among men worldwide and is the leading cause of cancer mortality in males greater than 60 years in Trinidad and Tobago. Although there are some treatment options for the metastatic disease, the impact on overall survival rate has not improved in the last two decades. In particular, the mortality rate from prostate cancer is high among men of African descent in Trinidad and Tobago and the Americas. These groups manifest aggressive cancers that are often less responsive to available therapies. We hypothesize that phytochemical screening of tropical plants, coupled to cell culture studies would identify other potential treatments for prostate cancer. In separate experiments, the roots or leaves of five plants indigenous to the Caribbean and the skin of the muscadine grape, indigenous to North America were dried, crushed and suspended in 100% methanol. The respective methanol extracts were fractionated and the fractions dried. Next the ability of the extracts to halt the growth of or kill PC-3 prostate cancer cells was assessed by MTT assays. Colony formation, cell migration studies, cell cycle studies and western blots were performed to determine probable mechanism of action. The categories of chemical compounds present in the extracts were determined by Thin Layer chromatography (TLC). Results from MTT assays showed that compared to the control cells (ie those treated with DMSO only), treatment with at least four plant extracts significantly (p<0.05) inhibited the growth of the cancer cells; decreases as large as 95 % were observed. On the other hand these extracts had a limited or delayed effect on the "normal" PNT1A cells. Results from the cell cycle assay demonstrated that one extract, now identified as plant-A extract, caused the arrest of the G1/S phase of PC-3 cells i.e. leading to an increase in the number of cells that remained in the growth phase. On the other hand the total ethanol extract of muscadine grape skin decreased the expression of heat shock protein-40, possibly causing deactivation of the androgen receptor. This suggests that extracts prepared from Plant A and the muscadine grape have the potential for use as anticancer drugs.

Prevalence and profile of herbal medicine use in persons with diabetes and hypertension: data from the Barbados risk factor survey 2007

BACKGROUND: This paper seeks to determine the prevalence of herbal medicine use in persons with diabetes and hypertension; and to identify the demographic and socioeconomic profile of persons using such therapies. DESIGN AND METHODS: Secondary data analysis was done using the Barbados Behaviour Risk Factor Survey 2007. The prevalence of herbal medicine use was determined. Crude and adjusted odds ratios were generated for the relationship between these outcomes and age, sex, employment status; marital status; educational level and ethnicity. RESULTS: Herbal use was found to be 7.4% (2.9% to 11.9%) among diabetics, 4.5% (2.3% to 6.7%) among hypertensive persons, and 5.5% (3.2% to 7.8%) among all persons who were either diabetic and or hypertensive. A statistically significant association was seen between herbal use and age only (age 60 years and over compared to age < 60 years adjusted OR 4.0 95%CI 1.3 to 12.3). CONCLUSIONS: Though older persons were more likely to use herbal medicines, this study suggests a rather low prevalence of such practices. A more comprehensive assessment of socioeconomic status and of herbal medicine use is warranted.

Factors affecting the pharmacokinetics of herbal preparations and their impact on the outcome of clinical trials

This paper summarizes research on the pharmacokinetic characteristics of popular herbal medicines (such as Hypericum perforatum, Echinacea, Camellia sinensis, Tanacetum parthenium and Ginkgo biloba) in human studies, and in in vitro and in vivo systems. The effects of extract formulation, dosing frequency and biotransformation on the absorption and bioavailability of herbal drugs are briefly discussed.

Herbal self-medication at primary health care facilities in Trinidad

A letter to the editor is presented in response to the article regarding herbal self-medication at Primary Health Care Facilities in Trinidad, which appeared in previous issue.

Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad

BACKGROUND: The increasing global popularity of herbal remedies requires further investigation to determine the probable factors driving this burgeoning phenomenon. We propose that the users' perception of efficacy is an important factor and assessed the perceived efficacy of herbal remedies by users accessing primary health facilities throughout Trinidad. Additionally, we determined how these users rated herbal remedies compared to conventional allopathic medicines as being less, equally or more efficacious. METHODS: A descriptive cross-sectional study was undertaken at 16 randomly selected primary healthcare facilities throughout Trinidad during June-August 2005. A de novo, pilot-tested questionnaire was interviewer-administered to confirmed herbal users (previous or current). Stepwise multiple regression analysis was done to determine the influence of predictor variables on perceived efficacy and comparative efficacy with conventional medicines. RESULTS: 265 herbal users entered the study and cited over 100 herbs for the promotion of health/wellness and the management of specific health concerns. Garlic was the most popular herb (in 48.3% of the sample) and was used for the common cold, cough, fever, as 'blood cleansers' and carminatives. It was also used in 20% of hypertension patients. 230 users (86.8%) indicated that herbs were efficacious and perceived that they had equal or greater efficacy than conventional allopathic medicines. Gender, ethnicity, income and years of formal education did not influence patients' perception of herb efficacy; however, age did (p = 0.036). Concomitant use of herbs and allopathic medicines was relatively high at 30%; and most users did not inform their attending physician. CONCLUSION: Most users perceived that herbs were efficacious, and in some instances, more efficacious than conventional medicines. We suggest that this perception may be a major contributing factor influencing the sustained and increasing popularity of herbs. Evidence-based research in the form of randomized controlled clinical trials should direct the proper use of herbs to validate (or otherwise) efficacy and determine safety. In the Caribbean, most indigenous herbs are not well investigated and this points to the urgent need for biomedical investigations to assess the safety profile and efficacy of our popular medicinal herbs.

Comparison of plants used for skin and stomach problems in Trinidad and Tobago with Asian ethnomedicine

This paper provides a preliminary evaluation of fifty-eight ethnomedicinal plants used in Trinidad and Tobago for skin problems, stomach problems, pain and internal parasites for safety and possible efficacy. Thirty respondents, ten of whom were male were interviewed from September 1996 toSeptember 2000 on medicinal plant use for health problems. The respondents were obtained by snowball sampling, and were found in thirteen different sites, 12 in Trinidad and one in Tobago. The uses are compared to those current in Asia. Bambusa vulgaris, Bidens alba, Jatropha curcas, Neurolaena lobata, Peperomia rotundifolia and Phyllanthus urinaria are possibly efficacous for stomach problems, pain and internal parasites. Further scientific study of these plants is warranted.

Ethnomedicines used in Trinidad and Tobago for urinary problems and diabetes mellitus

BACKGROUND: This paper is based on ethnobotanical interviews conducted from 1996-2000 in Trinidad and Tobago with thirty male and female respondents. METHODS: A non-experimental validation was conducted on the plants used for urinary problems and diabetes mellitus: This is a preliminary step to establish that the plants used are safe or effective, to help direct clinical trials, and to inform Caribbean physicians of the plants' known properties to avoid counter-prescribing. RESULTS: The following plants are used to treat diabetes: Antigonon leptopus, Bidens alba, Bidens pilosa, Bixa orellana, Bontia daphnoides, Carica papaya, Catharanthus roseus, Cocos nucifera, Gomphrena globosa, Laportea aestuans, Momordica charantia, Morus alba, Phyllanthus urinaria and Spiranthes acaulis. Apium graviolens is used as a heart tonic and for low blood pressure. Bixa orellana, Bontia daphnoides, Cuscuta americana and Gomphrena globosa are used for jaundice. The following plants are used for hypertension: Aloe vera, Annona muricata, Artocarpus altilis, Bixa orellana, Bidens alba, Bidens pilosa, Bonta daphnoides, Carica papaya, Cecropia peltata, Citrus paradisi, Cola nitida, Crescentia cujete, Gomphrena globosa, Hibiscus sabdariffa, Kalanchoe pinnata, Morus alba, Nopalea cochinellifera, Ocimum campechianum, Passiflora quadrangularis, Persea americana and Tamarindus indicus. The plants used for kidney problems are Theobroma cacao, Chamaesyce hirta, Flemingia strobilifera, Peperomia rotundifolia, Petiveria alliacea, Nopalea cochinellifera, Apium graveolens, Cynodon dactylon, Eleusine indica, Gomphrena globosa, Pityrogramma calomelanos and Vetiveria zizanioides. Plants are also used for gall stones and for cooling. CONCLUSION: Chamaesyce hirta, Cissus verticillata, Kalanchoe pinnata, Peperomia spp., Portulaca oleraceae, Scoparia dulcis, and Zea mays have sufficient evidence to support their traditional use for urinary problems, "cooling" and high cholesterol...

Advancing Caribbean herbs in the 21st century

The conference was the second in the series on "Advancing Caribbean herbs in the 21st Century". It was organised as the 7th workshop held since 1998 by the Caribbean Association of Researchers and Herbal Practitioners (CARAPA). It was held in conjunction with the 2nd Annual General Meeting and Display of Exhibits of the Caribbean Herbal Business Association (CHBA), with much support from the Inter-American Institute for Cooperation on Agriculture (IICA)

A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention

BACKGROUND: The unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. METHODS: A cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May–July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests. RESULTS: Of 192 physicians interviewed, most (60.4 per cent) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 ñ 0.29 points or 40 per cent of total possible score) and poor knowledge (mean = 7.77 ñ 0.56 points or 15 per cent of total possible score). Seventy-eight physicians (40.6 per cent) admitted having used herbs in the past, and 60 of these (76.9 per cent) were satisfied with the outcome. Although 52 physicians (27.1 per cent) recommended the use of herbs to their patients only 29 (15.1 per cent) were able to identify at least one known herb-drug interaction. CONCLUSION: Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

Advancing Caribbean herbs in the 21st century

Just as elsewhere in the tropics, most plants used in traditional medicine in the Caribbean region have never been evaluated systematically for their theraputic qualities. It is recognized that some of them can become the raw materials for a future Caribbean herbal industry; and these are issues, which concern the Caribbean Association of Researchers and Herbal Practitioners (CARAPA). These were among the issues considered under the theme "Advancing Caribbean herbs in the 21st century" at the Sixth International conference of CARAPA on "Herbal medicine in the Caribbean". Over the three-day period, about one hundred and fifty registered participants attended the conference, including eight residents coming from Tobago, and twenty-six persons from fourteen countries outside the Republic of Trinidad and Tobago. Their valuable contributions are reflected in this document, which contains over thirty papers distributed across the following sections: Science and the Commercialization of Herbs; Scientific evaluation of medicinal plant extracts; Issues for a Caribbean herbal industry and Continuing education in herbal medicine .... (AU)

Herbal remedies today [abstract]

Over the last two decades, phytotherapy, or botanical medicine, and other "non-conventional" therapies have become increasingly prevalent in many countries around the world. Many actions involving WHO and other official agencies have been initiated concerning the regulatory situation, especially for herbal products, to provide reliable information and, further, to break down the barriers between western conventional medicine and complementary/alternative therapies. Alternative models of healthcare have been evolving quite rapidly, and research activity has been directed to the issues of quality, safety and efficacy of the traditional herbal remedies, modern phytomedicinals and the nutraceuticals. In this paper, a critical review has been undertaken of recent scientific and clinical studies which describe a variety of herbal medicinal preparations. An evaluation has been made of reports describing the knowledge, attitudes and practices of healthcare professionals towards herbal medicine. The findings have been translated into suggestions intended to encourage, and to enable, healthcare professionals to raise their awareness, and to improve their knowledge of, the established limitations and benefits of various formulations of herbal medicinal products in current use. (AU)

Herbal remedies today

In this paper, a critical review has been undertaken of recent scientific and clinical studies which describe a variety of herbal medicinal preparations. An evaluation also has been made of reports describing the knowledge, attitudes and practices of healthcare professionals towards herbal medicine. The findings have been translated into suggestions intended to encourage, and, to enable healthcare professionals to raise their awareness, and, to improve their knowledge of the established limitations and benefits of the various formulations of herbal medicinal products in current use (AU)

Jamaica's ethnomedicine: its potential in the healthcare system

Herbal remedies have always been used by Jamaicans for treating a variety of illnesses. However, although many of these medicinal herbs contain beneficial bioactive ingredients, not all of them are safe! Some have toxic components while others, if taken inappropriately, can harm the body's organs and even mask the symptoms of more serious conditions. The authors propose integrating these "alternative" medicinal practices into the healthcare delivery system, beginning with a systematic testing of the remedies used, so that their bioactive ingredients can be identified and dosages standardized

The use of herbal teas and remedies in Jamaica

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural area; among the adults and among caretakers of young children. From over 90 percent of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6ñ3 (mean ñ standard deviation) by the urban adults, and 10ñ6 by the rural adults (t-test, p < 0.001). Almost 100 percent of respondents had at some time used herbs for teas or for treating illnesses. The most common methods of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretakers factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibilty that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.(Au)

Medicine and its alternatives: health care priorities in the Caribbean

In the Caribbean as as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.(Au)