Ficus septica exudate, a traditional medicine used in Papua New Guinea for treating infected cutaneous ulcers: in vitro evaluation and clinical efficacy assessment by cluster randomised trial.

BACKGROUND AND OBJECTIVES: Infected cutaneous ulcers are major health problems for children living in rural areas of Papua New Guinea. The inaccessibility of affected populations and lack of access to basic healthcare, make a local plant-based therapy an attractive treatment option. We assessed Ficus septica exudate in biological assays relevant to wound healing. We then carried out a clinical trial to determine the exudate's efficacy in healing small cutaneous ulcers compared with Savlon antiseptic cream, and soap and water washing. METHODS: Pre-clinical in vitro assessment of the exudate was carried out using assays to monitor the pro-inflammatory responses of M1 macrophages and neutrophils, antibacterial assays using known ulcer pathogens, an Ames test for mutagenicity and LC-MS chemical analysis of the exudate. An open label cluster-randomised clinical trial was performed, enrolling participants from three different clusters with skin lesions less than 1 cm in diameter. Each cluster comprising 50 participants was randomly assigned to one of three treatment arms namely topical exudate, topical Savlon antiseptic cream, and standard care (soap and water treatment), all administered daily for 2 days. The primary outcome was clinical healing/improvement measured at days 7 and 14, assessed by three dermatologists using blinded photographs. The primary analysis was assessed as non-inferiority of F. septica treatment based on the risk difference for healing/improvement. RESULTS: In vitro, the exudate which is rich in the alkaloid ficuseptine, was found to be non-mutagenic whilst also inhibiting pro-inflammatory responses and exhibiting antibacterial activity. When administered to participants enrolled in the clinical trial, no significant differences were observed between the healing efficacy of F. septica exudate and the two comparator treatments (Savlon antiseptic cream and soap/water treatment). At day 14, but not at day 7, the efficacy of F. septica exudate for healing/improving the ulcers was non-inferior to Savlon antiseptic cream or water/soap treatment. CONCLUSIONS: F. septica exudate is non-mutagenic and has both bactericidal and anti-inflammatory properties. When applied topically to small cutaneous ulcers, the exudate has a healing effect that is non-inferior to Savlon antiseptic cream and standard treatment with soap and water at day 14. Our findings, which should be confirmed in larger clinical trials, have important public health implications.

Evaluation of Cypholophus macrocephalus sap as a treatment for infected cutaneous ulcers in Papua New Guinea.

Cypholophus macrocephalus sap is used to treat bacterially infected cutaneous leg ulcers in Papua New Guinea. High resolution LC-MS analysis of the sap revealed it to be rich in sulphated flavonoids. We assessed the effects of the sap on the differentiation and pro-inflammatory anti-microbial responses of M1 macrophages using IL-6 and TNF-α ELISAs and found significant increases in M1 macrophage IL-6 expression with concentrations as low as 243 ng/ml sap. Neutrophil IL-6 and TNF-α expression was also significantly increased but to a lesser degree. Matrix metalloproteinases (MMPs) 1, 2, 8 and 9 which are known to contribute to the toxic nature of wound exudates were inhibited by the sap at 24 µg/ml. The sap was tested with several bacterial species known to colonize cutaneous ulcers in Papua New Guinea but proved not to be active. Cypholophus sap stimulates pro-inflammatory, anti-microbial M1 macrophage and neutrophil responses at very low concentrations, whilst also inhibiting MMPs. The combination of an enhanced innate immune response and inhibition of MMPs in ulcer exudate, may contribute to the eradication of bacteria and healing of these infected ulcers. The sap concentrations used in these assays are readily achievable in an in vivo context.

Lepiniopsis ternatensis sap stimulates fibroblast proliferation and down regulates macrophage TNF-α secretion.

The sap of the tree Lepiniopsis ternatensis is used as a topical treatment for cutaneous leg ulcers in Papua New Guinea. This study, which is the first investigation of this medicinal plant, examines the effect of the sap on wound healing biology using human-derived primary cell lines. NMR spectra from 1D and 2D experiments revealed the sap to contain a single major component, identified as the polyphenol, trifucol. The sap significantly increased the proliferation of dermal fibroblasts at just 1.3 µg/ml, without influencing keratinocytes, suggesting a fibroblast-specific mechanism of stimulation. It also significantly inhibited TNF-α secretion by pro-inflammatory M1 macrophages, but not from neutrophils, at 130 µg/ml. The low toxicity of the sap towards dermal cells along with its fibroblast stimulation activity and downregulation of macrophage TNF-α makes it a potentially attractive agent to promote dermal wound healing in chronic non-healing ulcers.

Tropical ulcer plant treatments used by Papua New Guinea's Apsokok nomads.

ETHNOPHARMACOLOGICAL RELEVANCE: The tropical ulcer is a debilitating bacterial infection that is common in Papua New Guinea. Deploying healthcare infrastructure to remote and inaccessible rainforest locations is not practical, therefore local plants may be the best treatment option. Here we present an ethnobotanical survey of the tropical ulcer plant medicines used by the semi-nomadic Apsokok who roam the remote central mountains of Papua New Guinea's West New Britain Province. In vitro biological activity in assays relevant to tropical ulcer wound healing is also presented. MATERIALS AND METHODS: Focus groups and semi-structured interviews were used to acquire information on the uses of plants, vouchers of which were identified by comparison with authentic herbarium specimens. Antibacterial disc diffusion assays with Staphylococcus aureus and Fusobacterium ulcerans, MMP-9 enzyme inhibition and dermal fibroblast stimulation assays were carried out on plant saps and aqueous extracts of plant material. LC-MS was used to identify known plant metabolites. RESULTS: The ethnobotanical survey identified sixteen species that were used to treat tropical ulcers, all of which were applied topically. A subset of twelve species were investigated further in vitro. Four species produced zones of inhibition with S. aureus, all 12 species provided low level inhibition of MMP-9 and 8 species stimulated dermal fibroblast proliferation, although cytotoxicity occurred at higher concentrations. The extract of Homalium foetidum Benth. inhibited S. aureus and MMP-9 while at lower sub-cytotoxic concentrations stimulated fibroblast proliferation. Trans-3-O-p-coumaroylquinic acid cis-3-O-p-coumaroylquinic acid were detected in the aqueous extract of H. foetidum. CONCLUSIONS: Topical application of plant saps to wounds results in very high localised concentrations of plant metabolites which is likely to result in inhibition of MMP proteases. H. foetidum is a candidate plant for tropical ulcer treatment in remote areas.

Medicinal plants of Papua New Guinea's Miu speaking population and a focus on their use of plant-slaked lime mixtures.

ETHNOPHARMACOLOGICAL RELEVANCE: Here we present the results of an ethnobotanical survey of the medicinal plants used by the Miu, a virtually unresearched ethnolinguistic group who live in the mountainous interior of Papua New Guinea's West New Britain Province. We compare the findings for those previously reported for the neighbouring inland Kaulong speaking population. Three species, Trema orientalis, Spondias dulcis and Ficus botryocarpa are used in combination with locally prepared slaked lime to produce intensely coloured mixtures which are applied to dermatological infections. Their effects on dermal fibroblast viability with and without slaked lime are examined. The sap of F. botryocarpa which is used to treat tropical ulcers was examined further with assays relevant to wound healing. MATERIALS AND METHODS: Focus groups and semi-structured interviews were used to acquire information on the uses of plants, vouchers of which were collected and identified by comparison with authentic herbarium specimens. LC-MS and NMR were used to identify chemical components. Cell viability assays were used to examine the effects of added slaked lime on dermal fibroblasts. For the sap of F. botryocarpa, fibroblast stimulation assays and antibacterial growth inhibition with Bacillus subtilis were carried out. RESULTS: The survey identified 33 plants and one fungal species, and clear differences with the inland Kaulong group despite their close proximity. Added slaked lime does not greatly increase the cytotoxicity of plant material towards dermal fibroblasts. The sap of F. botryocarpa contains the alkaloid ficuseptine as a single major component and displays antibacterial activity. CONCLUSIONS: The results demonstrate the potential for variation in medicinal plant use amongst Papua New Guinea's numerous language groups. The addition of slaked lime to plant material does not appear to present a concern for wound healing in the amounts used. The sap of F. botryocarpa displays antibacterial activity at concentrations that would occur at the wound surface and could be used as a highly accessible alternative to conventional antiseptics for remote communities in Papua New Guinea.

Myristicyclins A and B: antimalarial procyanidins from Horsfieldia spicata from Papua New Guinea.

An antimalarial screen for plants collected from Papua New Guinea identified an extract of Horsfieldia spicata as having activity. Isolation of the active constituents led to the identification of two new compounds: myristicyclins A (1) and B (2). Both compounds are procyanidin-like congeners of myristinins lacking a pendant aromatic ring. Myristicyclin A was found to inhibit the ring, trophozoite, and schizont stages of Plasmodium falciparum at similar concentrations in the mid-µM range.

Ampelocissus asekii J. Wen, R. Kiapranis & M. Lovave, a new species of Vitaceae from Papua New Guinea.

A new species Ampelocissus asekii J.Wen, R.Kiapranis & M.Lovave of Vitaceae is described from Morobe Province of Papua New Guinea. It is a close relative of Ampelocissus muelleriana Planch., another endemic of New Guinea and differs from the latter by its densely woolly tomentose lower leaflet surface and much thicker leaflets. The new species is from the mid montane forests, whereas Ampelocissus muelleriana occurs in the lowland rain forests.

Comparative ethnobotany and in-the-field antibacterial testing of medicinal plants used by the Bulu and inland Kaulong of Papua New Guinea.

ETHNOPHARMACOLOGICAL RELEVANCE: The island of New Britain in Papua New Guinea is an area of great floristic and cultural diversity that has received little attention from ethnobotanists. Here we present the results of a comparative medicinal ethnobotanical survey of the Bulu and inland Kaulong; two distinct people groups inhabiting lowland rainforest on different sides of the island. A high proportion of species are used in the treatment of bacterial infections and plants with antibacterial activity were identified in the field using a specially developed antibacterial assay kit. Follow up testing with human pathogens was used to evaluate active plant material in more detail. MATERIALS AND METHODS: Rapid appraisal techniques were used to survey both people groups with all data corroborated by three or more separate sources. Plants from both groups were tested in-the-field with a portable antibacterial test kit based on the agar diffusion assay, using a pressure cooker to sterilise glassware and media. Follow up laboratory based tests were carried out using standardised agar dilution protocols for drug resistant and drug sensitive strains of Staphylococcus aureus and Streptococcus pneumoniae. RESULTS: We find surprisingly little overlap in the plant species used by the two people groups with only 1 out of 70 species used for the same purpose. There is also a difference in emphasis in the conditions treated with 53% of Kaulong medicinal plants dedicated to treating tropical ulcers compared with only 8% of in the Bulu group. In-the-field testing identified Garcinia dulcis bark (a Kaulong tropical ulcer treatment) to have antibacterial activity and follow up tests against a drug resistant strain of Staphylococcus aureus (a pathogen implicated in tropical ulcer pathogenesis) revealed the crude bark extract to be potently active with an MIC of just 1 mg/ml. CONCLUSIONS: The results demonstrate extreme differences in medicinal plant use between two people groups living a mere 100 km apart and suggests the two medicinal plant systems have developed in isolation from one another. In-the-field antibacterial testing of plant extracts was found to be a valuable technique that enabled early identification of active plant material.

Lunacridine from Lunasia amara is a DNA intercalating topoisomerase II inhibitor.

An ethnobotanical survey of plants used to treat tropical ulcers in Papua New Guinea identified Lunasia amara as possessing anti-Staphylococcus aureus activity. Activity-guided fractionation of the aqueous bark extract resulted in the identification of the quinoline alkaloid lunacridine as the active principle. Lunacridine tends to cyslise at room temperature but the 2'-O-trifluoroacetyl derivative was found to be stable and therefore more suitable for biological assays. The compound exhibited a minimal inhibitory concentration (MIC) of 64 micro g/ml against Staphylococcus aureus NCTC 6571 and activity in the low micromolar range against HeLa and H226 cells; the latter showing signs of caspase-3/7 mediated apoptotic cell death. Experiments with drug resistant strains of Streptococcus pneumoniae suggested topoisomerase as a likely target for the drug in bacteria whilst decatenation assays with human topoisomerase II showed the compound to be a potent inhibitor of this isoform (IC(50)<5 micro M) thus explaining the drug's activity against human cell lines. Both lunacridine and 2'-O-trifluoroacetyl lunacridine exhibited mild DNA intercalation activity giving 50% decrease in ethidium DNA fluorescence at 0.22 and 0.6 mM, respectively, placing the drug amongst the DNA intercalating class of topoisomerase II inhibitors.