Polyherbal Combinations Used by Traditional Health Practitioners against Mental Illnesses in Bamako, Mali, West Africa.

This study explores the traditional knowledge of plants used by traditional health practitioners (THPs) in the treatment of symptoms or syndromes related to mental illnesses in the district of Bamako in Mali, along with the identification of affiliated traditional treating methods. An exploratory and cross-sectional ethnopharmacological survey was conducted in the district of Bamako. The Malian Federation of Associations of Therapists and Herbalists (FEMATH) assisted in the identification and inclusion of the THPs. Data sampling included semi-structured interviews, questionnaires, and in-depth interviews. Quantitative data were evaluated by analysing reports of the use of different medicinal plants and the number of participants. Fifteen THPs belonging to the district of Bamako participated. In total, 43 medicinal plants belonging to 22 plant families were used by the THPs. The most cited plant species was Securidaca longepedunculata (violet tree), followed by Khaya senegalensis (African mahogany) and Boscia integrifolia (rough-leaved shepherds tree). A great number of herbal combinations, preparation methods, and administration routes were used, often with honey as an adjuvant. To our knowledge, this is the first ethnobotanical survey on the use of medicinal plants in the treatment of all types of mental disorders in Bamako.

Inhibition of Seizure-Like Paroxysms and Toxicity Effects of Securidaca longepedunculata Extracts and Constituents in Zebrafish Danio rerio.

Plants used in traditional medicine in the management of epilepsy could potentially yield novel drug compounds with antiepileptic properties. The medicinal plant Securidaca longepedunculata is widely used in traditional medicine in the African continent, and epilepsy is among several indications. Limited knowledge is available on its toxicity and medicinal effects, such as anticonvulsant activities. This study explores the potential in vivo inhibition of seizure-like paroxysms and toxicity effects of dichloromethane (DCM) and ethanol (EtOH) extracts, as well as isolated xanthones and benzoates of S. longepedunculata. Ten phenolic compounds were isolated from the DCM extract. All of the substances were identified by nuclear magnetic resonance spectroscopy. Assays for toxicity and inhibition of pentylenetetrazole (PTZ)-induced seizure-like paroxysms were performed in zebrafish larvae. Among the compounds assessed in the assay for maximum tolerated concentration (MTC), benzyl-2-hydroxy-6-methoxy-benzoate (MTC 12.5 µM), 4,8-dihydroxy-1,2,3,5,6-pentamethoxyxanthone (MTC 25 µM), and 1,7-dihydroxy-4-methoxyxanthone (MTC 6.25 µM) were the most toxic. The DCM extract, 1,7-dihydroxy-4-methoxyxanthone and 2-hydroxy-1,7-dimethoxyxanthone displayed the most significant inhibition of paroxysms by altering the locomotor behavior in GABAA receptor antagonist, PTZ, which induced seizures in larval zebrafish. The EtOH extract, benzyl benzoate, and benzyl-2-hydroxy-6-methoxy-benzoate unexpectedly increased locomotor activity in treated larval zebrafish and decreased locomotor activity in nontreated larval zebrafish, seemingly due to paradoxical excitation. The results reveal promising medicinal activities of this plant, contributing to our understanding of its use as an antiepileptic drug. It also shows us the presence of potentially new lead compounds for future drug development.

Isolation, characterisation and complement fixation activity of acidic polysaccharides from Argemone mexicana used as antimalarials in Mali.

CONTEXT: Global studies on Argemone mexicana L. (Papaveraceae) traditionally used against malaria in Mali are limited to its low-mass compounds activities, and little information on its bioactive polysaccharides is available. OBJECTIVE: This study determines the structure and the immunomodulatory activity of polysaccharides from aerial parts of A. mexicana. MATERIALS AND METHODS: Acidic polysaccharides from this plant material named HMAmA1 and HMAmA2 were isolated from water extracts. Their monosaccharide composition was determined by gas chromatography. Glycosidic linkages were determined using GC-MS. NMR was also applied. The polymers were tested for effects on the human complement system in vitro at different doses. RESULTS: The monosaccharide composition showed that the two polysaccharides contained in different amounts the following monomers: arabinose, rhamnose, galactose, and galacturonic acid. Overall structural analysis showed the presence of a low ratio of 1,2-linked rhamnose compared to 1,4-linked galacturonic acid with arabinogalactans substituted on position 4 of rhamnose. NMR data showed the presence of galacturonans alternated by rhamnogalacturonans bearing arabinose and galactose units. α-Linkages were found for l-arabinose, l-rhamnose and d-galacturonic acid, while ß-linkages were found for d-galactose. The two polysaccharides exhibited strong complement fixation activities, with HMAmA1 being the highest potent fraction. ICH50 value of HMAmA1 was 5 µg/mL, compared to the control BPII being 15.9 µg/mL. DISCUSSION AND CONCLUSIONS: Polysaccharides form A. mexicana presented a complement fixation effect. The complement system is an important part of the immune defense, and compounds acting on the cascade are of interest. Therefore, these polymers may be useful as immunodulatory agents.

Anti-plasmodial Effects of Zanthoxylum zanthoxyloides.

Zanthoxylum zanthoxyloides, syn. Fagara zanthoxyloides, is a tree growing in West Africa and is used in traditional medicine against a variety of diseases, including malaria. In the work reported here, root bark and stem bark extracts of this tree, as well as compounds isolated from the extracts, have been investigated for activity in vitro against chloroquine-sensitive and chloroquine-resistant strains of Plasmodium falciparum. In addition, toxicity against nauplii of the brine shrimp Artemia salina has been studied. Dichloromethane extracts of the root bark and stem bark, and a methanol extract of the stem bark, showed anti-parasitic activity towards chloroquine-sensitive as well as chloroquine-resistant P. falciparum, with IC50 values between 1 and 10 µg/mL. Among the isolated compounds, bis-dihydrochelerythrinyl ether, buesgenine, chelerythrine, γ-fagarine, skimmianine, and pellitorine were the most active, with IC50 values of less than 5 µg/mL. The dichloromethane extracts were toxic to brine shrimp nauplii, with LC50 values of less than 1 µg/mL. Methanol extracts were much less toxic (LC50 between 50 and 100 µg/mL). Among the isolated substances, bis-dihydrochelethrinyl ether was the most toxic (LC50 ca. 2 µg/mL).

Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry.

BACKGROUND: Interventions to reduce child deaths in Africa have often underachieved, causing the Millennium Development Goal targets to be missed. We assessed whether a community enquiry into the circumstances of death could improve intervention effectiveness by identifying local avoidable factors and explaining implementation failures. METHODS: Deaths of children younger than 5 years were ascertained by community informants in two districts in Mali (762 deaths) and three districts in Uganda (442 deaths) in 2011-15. Deaths were investigated by interviewing parents and health workers. Investigation findings were reviewed by a panel of local health-care workers and community representatives, who formulated recommendations to address avoidable factors and, subsequently, oversaw their implementation. FINDINGS: At least one avoidable factor was identified in 97% (95% CI 96-98, 737 of 756) of deaths in children younger than 5 years in Mali and 95% (93-97, 389 of 409) in Uganda. Suboptimal newborn care was a factor in 76% (146 of 194) of neonatal deaths in Mali and 64% (134 of 194) in Uganda. The most frequent avoidable factor in postneonatal deaths was inadequate child protection (mainly child neglect) in Uganda (29%, 63 of 215) and malnutrition in Mali (22%, 124 of 562). 84% (618 of 736 in Mali, 328 of 391 in Uganda) of families had consulted a health-care provider for the fatal illness, but the quality of care was often inadequate. Even in official primary care clinics, danger signs were often missed (43% of cases in Mali [135 of 396], 39% in Uganda [30 of 78]), essential treatment was not given (39% in Mali [154 of 396], 35% in Uganda [27 of 78]), and patients who were seriously ill were not referred to a hospital in time (51% in Mali [202 of 396], 45% in Uganda [35 of 78]). Local recommendations focused on quality of care in health-care facilities and on community issues influencing treatment-seeking behaviour. INTERPRETATION: Local investigation and review of circumstances of death of children in sub-Saharan Africa is likely to lead to more effective interventions than simple consideration of the biomedical causes of death. This approach discerned local public health priorities and implementable solutions to address the avoidable factors identified. FUNDING: European Union's 7th Framework Programme for research and technological development.

Flavonoids, gallotannins and ellagitannins in Syzygium guineense and the traditional use among Malian healers.

ETHNOPHARMACOLOGICAL RELEVANCE: Syzygium guineense has been traditionally used in Mali in West Africa for the treatment of different diseases such as stomach problems, wounds, inflammations and various female disorders. AIMS OF THE STUDY: (1) To perform an ethnopharmacological survey on the traditional use of S. guineense among Malian healers. (2) To isolate and identify chemical constituents from S. guineense leaves and to study their radical scavenging and enzyme inhibitory effects. MATERIALS AND METHODS: In four different districts in Mali, 44 healers were interviewed about their medicinal use of S. guineense. A methanol extract of the leaves of this tree was prepared and further fractionated using different chromatographic methods. Isolated compounds were identified by 1D and 2D NMR spectroscopy. Extracts and isolated compounds were investigated as DPPH radical scavengers and as inhibitors of xanthine oxidase and 15-lipoxygenase, and the methanol extract was tested for toxicity towards Artemia salina nauplii. RESULTS: Major uses by Malian healers were against dermatosis, pain, malaria/fever and for wound healing. There was little consensus about the use in the different districts. Leaves were most commonly used. From the methanol leaf extract, the flavonoids gallocatechin (1), myricetin (2), myricetin-3-O-glucoside (3), myricetin-3-O-rhamnoside (4), myricetin-3-O-glucuronide (5) and myricetin-3-O-ß-D-(6″-galloyl)galactoside (6), the gallotannins 1,2,3,6-tetra-O-galloyl-ß-D-glucose (7) and 1,2,3,4,6-penta-O-galloyl-ß-D-glucose (8), and the ellagitannins casuarictin (9) and casuarinin (10) were isolated. These ten polyphenols are all new for the species. The crude methanol extract was active as a radical scavenger and as an inhibitor of xanthine oxidase and 15-lipoxygenase. Among the isolated compounds, pentagalloylglucose was the best enzyme inhibitor (IC50 25±4µM for 15-lipoxygenase, 8±1µM for xanthine oxidase), while casuarictin (IC50 3.9±0.1µM), casuarinin (IC50 4.5±0.3µM) and pentagalloylglucose (IC50 5±1µM) showed the highest radical scavenging activity. The methanol extract was non-toxic to Artemia salina nauplii. CONCLUSION: S. guineense leaves are commonly used among Malian healers, however the traditional practice varies a lot between different regions. The leaves of S. guineense are rich in polyphenols; several are galloylated, either as galloylated flavonoids, gallotannins or ellagitannins. The high content of biologically active polyphenols might be important for medicinal effects of this plant and might give a rationale for the widespread usage of S. guineense in Mali.

Antiplasmodial, anti-complement and anti-inflammatory in vitro effects of Biophytum umbraculum Welw. traditionally used against cerebral malaria in Mali.

ETHNOPHARMACOLOGICAL RELEVANCE: Biophytum umbraculum Welw. (Oxalidaceae) is a highly valued African medicinal plant used for treatment of cerebral malaria, a critical complication of falciparum malaria. AIM OF THE STUDY: To provide additional information about traditional use of B. umbraculum and to test plant extracts and isolated compounds for in vitro activities related to cerebral malaria. MATERIALS AND METHODS: The traditional practitioners were questioned about indication, mode of processing/application, dosage and local name of B. umbraculum. Organic extracts and some main constituents of the plant were investigated for anti-malaria, anti-complement activity and inhibition of NO secretion in a RAW 264.7 cell line. RESULTS: Treatment of cerebral malaria was the main use of B. umbraculum (fidelity level 56%). The ethyl acetate extract showed anti-complement activity (ICH50 5.7±1.6µg/ml), inhibition of macrophage activation (IC50 16.4±1.3µg/ml) and in vitro antiplasmodial activity (IC50 K1 5.6±0.13µg/ml, IC50 NF54 6.7±0.03µg/ml). The main constituents (flavone C-glycosides) did not contribute to the activity of the extract. CONCLUSION: Inhibition of complement activation and anti-inflammatory activity of B. umbraculum observed in this study might be possible targets for adjunctive therapy in cerebral malaria together with its antiplasmodial activity. However, clinical trials are necessary to evaluate the activity due to the complex pathogenesis of cerebral malaria.

Medicinal plants from Mali: Chemistry and biology.

ETHNOPHARMACOLOGICAL RELEVANCE: Mali is one of the countries in West Africa where the health system rely the most on traditional medicine. The healers are mainly using medicinal plants for their treatments. The studies performed being the basis for this review is of importance as they will contribute to sustaining the traditional knowledge. They contribute to evaluate and improve locally produced herbal remedies, and the review gives also an overview of the plant preparations that will have the most potential to be evaluated for new Improved Traditional Medicines. AIM OF THE REVIEW: The aim of this review is to give an overview of the studies performed related to medicinal plants from Mali in the period 1995-2015. These studies include ethnopharmacology, chemistry and biological studies of the plants that were chosen based on our interviews with the healers in different regions of Mali, and contribute to sustainable knowledge on the medicinal plants. The Department of Traditional Medicine, Bamako, Mali, is responsible for registering the knowledge of the traditional healers on their use of medicinal plants and also identifying compounds in the plants responsible for the bioactivities claimed. The studies reported aimed at getting information from the healers on the use of medicinal plants, and study the biology and chemistry of selected plants for the purpose of verifying the traditional use of the plants. These studies should form the basis for necessary knowledge for the development of registered Improved Traditional Medicines in Mali. MATERIALS AND METHODS: The healers were the ethnopharmacological informants. Questions asked initially were related to wound healing. This was because the immune system is involved when wounds are healed, and additionally the immune system is involved in the majority of the illnesses common in Mali. Based on the results of the interviews the plant material for studies was selected. Studies were performed on the plant parts the healers were using when treating their patients. Conventional chromatographic and spectroscopic methods were used for the isolation and structural elucidation of compounds. The compounds to study were selected based on the bioassays performed concomitant with the fractionation. RESULTS: Our results show that plants traditionally used as wound healing agents contain polysaccharides basically of pectin nature with immunomodulating activities. These pectins all have different and new structures. Several of the plants also contain compounds with effects related to antioxidant properties. These compounds are mainly of polyphenolic nature. Three of these are new compounds from Nature, while 32 was for the first time described from the plant they were isolated from. This review gives an overview of the most important results obtained during the 20 year long collaboration between Department of Traditional Medicine, Bamako, Mali, and Department of Pharmacognosy, School of Pharmacy, University of Oslo, Norway. CONCLUSION: Our studies showed that ethnopharmacological information is important for the determination of screening and chemical methods to be used for studies of plants used in traditional medicine.

Intellectual property rights, benefit-sharing and development of "improved traditional medicines": A new approach.

ETHNOPHARMACOLOGICAL RELEVANCE: Protection of intellectual property rights and benefit-sharing are key issues for all ethnopharmacological research. The International Society of Ethnobiology has produced helpful guidelines on access and benefit-sharing which are widely viewed as a "gold standard" but the question remains how best to apply these guidelines in practice. Difficult questions include ownership of traditional knowledge, making appropriate agreements, and how appropriately to share benefits. MATERIALS AND METHODS: We present the case study of the development of an "improved traditional medicine" for malaria in Mali and we report how benefit-sharing was applied in this case. RESULTS: The knowledge about the selected plant came independently from several families and traditional healers. The IPR approach was to recognise that this traditional knowledge belongs to the people of Mali and was used for their benefit in developing a new "improved traditional medicine" (ITM). The traditional healer whose method of preparation was used, and who collaborated in clinical trials, did not request any financial reward but asked for the ITM to be named after him. The most sustainable benefit for the community was sharing the results of which preparation of which medicinal plant seemed to be the most effective for treating malaria. Attempts at providing a health centre and training a health worker for the village did not prove to be sustainable. CONCLUSIONS: Respect for intellectual property rights and benefit-sharing are possible even in a context where the knowledge is not owned by a clearly identified person or group of people. The most sustainable benefits are intangible rather than material: namely recognition, improved knowledge about which traditional treatment is the best and how to prepare and take it.

Attitudes and use of medicinal plants during pregnancy among women at health care centers in three regions of Mali, West-Africa.

BACKGROUND: Although, medicinal plants have been important for women's health historically, the knowledge about such use during pregnancy in developing countries is limited. This is the first quantitative, ethnobotanical study on Malian women's use of and attitudes towards the use of medicinal plants during pregnancy. The aim of the study was to describe Malian women's use of medicinal plants during pregnancy according to indications and to evaluate the potentially safety of such use. The overall aim was to preserve valuable information about medicinal plants for women's reproductive health for the future. METHODS: Data was collected through structured interviews of 209 pregnant women or mothers in three health care centers in Mali. The women were interviewed about their uses of medicinal plants during pregnancy and their attitudes to such use. Nine specific medicinal plants commonly used in Mali and treatment of eleven common ailments in pregnancy were specifically queried about. RESULTS: In total, 79.9 % had used medicinal plants during pregnancy. Only 17 women (8.5 %) had received a recommendation from a traditional practitioner (TP). The most commonly used medicinal plants were Lippia chevalieri (55.5 %), Combretum micranthum (39.7 %), Parkia biglobosa (12.0 %) and Vepris heterophylla (8.1 %). The most common reasons for use were for well-being (37.7 %), symptoms of malaria (37.1 %) and "increased salt-elimination" (to reduce edema) (19.2 %). For treatment of symptoms of malaria and urinary tract infections during pregnancy, the women's choices of medicinal plants agreed with those previously reported from interviews with TPs. Almost 30 % believed that medicinal plants had no adverse effects for the mother. CONCLUSION: This study showed an extensive use and knowledge of medicinal plants during pregnancy in three regions in Mali. However, exclusive use of medicinal plants as treatment of malaria and urinary tract infections during pregnancy may pose a health risk for the mother and her unborn child. A wider collaboration with TPs, with local communities and conventional health workers of the health care centers, on the safe use of medicinal plants, is important to promote safer pregnancies and better health care for pregnant women and their unborn infants in Mali.

Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

BACKGROUND: The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. METHODS: This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. RESULTS: Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. CONCLUSION: There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa.

Ethnobotanical study of plants used against malaria in Sélingué subdistrict, Mali.

ETHNOPHARMACOLOGICAL RELEVANCE: Plants have contributed to food security and disease treatments to rural populations in sub Saharan Africa for many centuries. These plants occupy a significant place in the treatment of diseases, such as malaria. In Mali, malaria is the leading cause of medical consultation and death. This infection is particularly dangerous for pregnant women and children under 5 years. The general aim of this research was to collect data on the knowledge of traditional health practitioners on malaria in the Sélingué area; particularly to document how traditional healers conceptualize and diagnose malarial disease and to collect and identify medicinal plants or other substances used for their health and well-being. MATERIALS AND METHODS: An ethnobotanical survey was conducted on simple and complicated malaria in six villages in Sélingué subdistrict in a period of 2 months. The ethnobotanical data was collected by means of semi-structured interviews and questionnaires. In total 50 traditional healers were interviewed. RESULTS: Two concepts of malaria (simple and complicated malaria) were cited and 97 plants used to treat malaria were identified. Decoctions and bathing (whole body) proved to be the most commonly used mode of application. Food attitudes and mosquitoes are perceived to be the most important causes of the disease. Trichilia emetica, Mitragyna inermis, Sarcocephalus latifolius, Cassia sieberiana, Cochlospermum tinctorium, Anogeissus leiocarpa, Guiera senegalensis and Entada africana were quoted as the most used in the treatment of malaria. CONCLUSION: Knowledge about malaria and traditional treatment practices exist in Sélingué subdistrict. Herbal remedies are commonly used by people for the treatment of malaria because they are believed to be cost-effective and more accessible. Many of the plant species used for the treatment of malaria have not been well documented as well as their phytochemical and antimalarial activity.

Investigation of skin permeation, ex vivo inhibition of venom-induced tissue destruction, and wound healing of African plants used against snakebites.

ETHNOPHARMACOLOGICAL RELEVANCE: Snakebite envenomation causes 5000-10,000 mortalities and results in more than 5-15,000 amputations in sub-Saharan Africa alone every year. The inaccessibility of antiserum therapy is a vast problem, and only about 2.5% of the actual need for antiserum in Africa is covered. Numerous plants have shown in vitro inhibitory activity against one or more of the hydrolytic enzymes involved in snakebite-induced necrosis. However, a more thorough examination of the plant species in ex vivo and in vitro cell assay models is needed to test their ability to inhibit necrosis. MATERIALS AND METHODS: Extracts which had previously shown in vitro inhibitory activity against necrosis enzymes, were tested in an ex vivo air-liquid-interface model, and a wound healing scratch assay as well as for their ability to permeate the skin barrier and inhibit venom induced cell death. RESULTS: Of the 14 water extracts and 16 ethanol extracts tested at a concentration of 10 µg/mL, only the ethanol extracts of Tamarindus indica and Paullinia pinnata resulted in a small but significant increase in cell migration of around 10% compared to treatment with buffer after 24h treatment. The remaining extracts showed no effect, or they even delayed the cell migration compared to the treatment with buffer. After 48 h treatment, 10 of the tested extracts showed a decreased cell migration compared to no treatment. At a 100 µg/mL concentration all the extracts inhibited cell migration and five extracts killed some of the cells, while four extracts killed all the cells. Ten of the thirty extracts were tested in a Franz cell set-up but none of the extracts tested did permeate the skin barrier over a 48 h period, and will therefore be of very limited use topically in the initial treatment of snakebites in its present form. None of the extracts were able to directly interact with the enzyme to lower the cell toxicity of the venom. Two extracts, Dichrostachys cinerea and Grewia mollis, were tested in the ex vivo model, but none of them inhibited the tissue destruction caused by venom. CONCLUSION: On the basis of this study, topical treatment with plant extracts for snakebite-induced tissue necrosis cannot be recommended.

Home treatments alone or mixed with modern treatments for malaria in Finkolo AC, South Mali: reported use, outcomes and changes over 10 years.

BACKGROUND: In 2003, a study in Mali showed that 87% of episodes of uncomplicated malaria were first treated at home. We investigated whether treatment-seeking patterns in Mali had changed 10 years later. METHODS: In 2013, we repeated the retrospective treatment-outcome study on 400 children with presumed malaria in the same area. RESULTS: Most children with reported uncomplicated malaria were still first treated at home (76% [196/258] in 2013 vs 85% in 2003; p=0.006), rather than in modern health centres (20% [52/258] in 2013 vs 12% in 2003; p=0.01). Overall, 58% of children with uncomplicated malaria were treated with herbal medicine alone, a significant increase from 24% 10 years earlier (p<0.001). This was associated with an increase in use of Argemone mexicana decoction from 8% to 26% (p<0.001), with a reported cure or improvement in 100% of cases among those aged >5 years. For severe malaria, first treatment was sought less often from a traditional healer compared with 10 years earlier (4% vs 32%; p<0.001) and more often from a modern health centre (29% vs 17%; p=0.04). CONCLUSIONS: Two trends that emerged are that there is a greater use of modern health facilities for treatment of severe malaria, and a greater use of traditional medicine alone for treatment of uncomplicated malaria.

Immunomodulating pectins from root bark, stem bark, and leaves of the Malian medicinal tree Terminalia macroptera, structure activity relations.

The root bark, stem bark, and leaves of Terminalia macroptera were sequentially extracted with ethanol, 50% ethanol-water, and 50°C water using an accelerated solvent extractor (ASE). Six bioactive purified pectic polysaccharide fractions were obtained from the 50°C crude water extracts after anion exchange chromatography and gel filtration. The root bark, stem bark, and leaves of T. macroptera were all good sources for fractions containing bioactive polysaccharides. The high molecular weight fraction 50WTRBH-I-I, being the most active fraction in the complement fixation test, has a highly ramified rhamnogalacturonan type I (RG-I) region with arabinogalactan type II (AG-II) side chains. The most abundant fractions from each plant part, 50WTRBH-II-I, 50WTSBH-II-I, and 50WTLH-II-I, were chosen for pectinase degradation. The degradation with pectinase revealed that the main features of these fractions are that of pectic polysaccharides, with hairy regions (RG-I regions) and homogalacturonan regions. The activity of the fractions obtained after pectinase degradation and separation by gel filtration showed that the highest molecular weight fractions, 50WTRBH-II-Ia, 50WTSBH-II-Ia, and 50WTLH-II-Ia, had higher complement fixation activity than their respective native fractions. These results suggest that the complement fixation activities of these pectins are expressed mainly by their ramified regions.

Vernonia kotschyana roots: therapeutic potential via antioxidant activity.

The roots of Vernonia kotschyana Sch. Bip. ex Walp. (Asteraceae) are used in Malian traditional medicine in the treatment of gastroduodenal ulcers and gastritis. Since oxidative stress is involved in gastric ulceration, the aim of this study was to screen the root extracts for their in vitro antioxidant activity and phenolic content. The roots were extracted successively with chloroform, ethyl acetate, ethanol and water. The antioxidant activity of root extracts was evaluated in both cell-free and cell-based assays. Their chemical characterization was performed by Fourier transform infrared spectroscopy (FT-IR) whereas the total phenolic content was determined by the Folin-Ciocalteu method. The ethyl acetate extract displayed the highest phenolic content and was found to be the most active in the free radical scavenging and lipid peroxidation inhibition assays; it also showed a high antioxidant activity in MCF-12F cells. This study suggests a potential use of the ethyl acetate extract of Vernonia kotschyana not only as an antioxidant agent in gastroduodenal ulcers and gastritis, but also in other disorders characterized by high levels of oxidative stress.

Hyaluronidase, phospholipase A2 and protease inhibitory activity of plants used in traditional treatment of snakebite-induced tissue necrosis in Mali, DR Congo and South Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: Snakebite envenomation, every year, causes estimated 5-10,000 mortalities and results in more than 5-15,000 amputations in sub-Saharan Africa alone. Antiserum is not easily accessible in these regions or doctors are simply not available, thus more than 80% of all patients seek traditional practitioners as first-choice. Therefore it is important to investigate whether the plants used in traditional medicine systems contain compounds against the necrosis-inducing enzymes of snake venom. MATERIALS AND METHODS: Extracts from traditionally used plants from DR Congo, Mali and South Africa were tested in hyaluronidase, phospholipase A2 and protease enzyme bioassays using Bitis arietans and Naja nigricollis as enzyme source. RESULTS: A total of 226 extracts from 94 different plant species from the three countries, Mali, Democratic Republic of Congo and South Africa were tested in phospholipase A2, proteases and hyaluronidase enzyme assays. Forty plant species showed more than 90% inhibition in one or more assay. Fabaceae, Anacardiaceae and Malvaceae were the families with the highest number of active species, and the active compounds were distributed in different plant parts depending on plant species. Polyphenols were removed in the search for specific enzyme inhibitors against hyaluronidase, phospholipase A2 or proteases from extracts with IC50 values below 100µg/ml. Water extracts of Pupalia lappacea, Combretum molle, Strychnos innocua and Grewia mollis and ethanol extract of Lannea acida and Bauhinia thonningii still showed IC50 values below 100µg/ml in either the hyaluronidase or protease bioassay after removal of polyphenols. CONCLUSION: As four of the active plants are widely distributed in the areas where the snake species Bitis arietans and Naja nigricollis occur a potential inhibitor of the necrotic enzymes is accessible for many people in sub-Saharan Africa.

Pre-hospital risk factors for inpatient death from severe febrile illness in Malian children.

BACKGROUND: Inpatient case fatality from severe malaria remains high in much of sub-Saharan Africa. The majority of these deaths occur within 24 hours of admission, suggesting that pre-hospital management may have an impact on the risk of case fatality. METHODS: Prospective cohort study, including questionnaire about pre-hospital treatment, of all 437 patients admitted with severe febrile illness (presumed to be severe malaria) to the paediatric ward in Sikasso Regional Hospital, Mali, in a two-month period. FINDINGS: The case fatality rate was 17.4%. Coma, hypoglycaemia and respiratory distress at admission were associated with significantly higher mortality. In multiple logistic regression models and in a survival analysis to examine pre-admission risk factors for case fatality, the only consistent and significant risk factor was sex. Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08-3.70). There was a wide variety of pre-hospital treatments used, both modern and traditional. None had a consistent impact on the risk of death across different analyses. Reported use of traditional treatments was not associated with post-admission outcome. INTERPRETATION: Aside from well-recognised markers of severity, the main risk factor for death in this study was female sex, but this study cannot determine the reason why. Differences in pre-hospital treatments were not associated with case fatality.

Enzyme inhibition, antioxidant and immunomodulatory activities, and brine shrimp toxicity of extracts from the root bark, stem bark and leaves of Terminalia macroptera.

ETHNOPHARMACOLOGICAL RELEVANCE: The root bark, stem bark and leaves of Terminalia macroptera have been traditionally used against a variety of ailments such as wounds, hepatitis, malaria, fever, cough, and diarrhea as well as tuberculosis and skin diseases in African folk medicine. Boiling water extracts of Terminalia macroptera, administered orally, are the most common preparations of this plant used by the traditional healers in Mali. This study aimed to investigate the inhibition of the activities of α-glucosidase, 15-lipoxygenase and xanthine oxidase, DPPH scavenging activity, complement fixation activity and brine shrimp toxicity of different extracts obtained by boiling water extraction (BWE) and by ASE (accelerated solvent extraction) with ethanol, ethanol-water and water as extractants from different plant parts of Terminalia macroptera. MATERIALS AND METHODS: 27 different crude extracts were obtained by BWE and ASE from root bark, stem bark and leaves of Terminalia macroptera. The total phenolic and carbohydrate contents, enzyme inhibition activities (α-glucosidase, 15-lipoxygenase and xanthine oxidase), DPPH scavenging activity, complement fixation activity and brine shrimp toxicity of these extracts were evaluated. Principal component analysis (PCA) was applied for total biological activities evaluation. RESULTS: Several of the extracts from root bark, stem bark and leaves of Terminalia macroptera obtained by BWE and ASE showed potent enzyme inhibition activities, radical-scavenging properties and complement fixation activities. None of the extracts are toxic against brine shrimp larvae in the test concentration. Based on the results from PCA, the ASE ethanol extracts of root bark and stem bark and the low molecular weight fraction of the 50% ethanol-water extract of leaves showed the highest total biological activities. The boiling water extracts were less active, but the bark extracts showed activity as α-glucosidase inhibitors and radical scavengers, the leaf extract being less active. CONCLUSION: The observed enzyme inhibition activities, radical scavenging properties and complement fixation activities may explain some of the traditional uses of this medicinal tree, such as in wound healing and against diabetes.

Complement fixing polysaccharides from Terminalia macroptera root bark, stem bark and leaves.

The root bark, stem bark and leaves of Terminalia macroptera were sequentially extracted with ethanol, 50% ethanol-water, and 50 °C and 100 °C water using an accelerated solvent extractor. Ten bioactive purified polysaccharide fractions were obtained from those crude extracts after anion exchange chromatography and gel filtration. The polysaccharides and their native extracts were characterized with respect to molecular weight, chemical compositions and effects in the complement assay. The chemical compositions showed that the polysaccharides are of pectic nature. The results indicated that there was no great difference of the complement fixation activities in the crude extracts from the different plant parts when extracting with the accelerated solvent extraction system. The purified polysaccharide fractions 100WTSBH-I-I and 100WTRBH-I-I isolated from the 100 °C water extracts of stem and root bark respectively, showed the highest complement fixation activities. These two fractions have rhamnogalacturonan type I backbone, but only 100WTSBH-I-I contains side chains of both arabinogalactan type I and II. Based on the yield and activities of the fractions studied those from the root bark gave highest results, followed by those from leaves and stem bark. But in total, all plant materials are good sources for fractions containing bioactive polysaccharides.