Plants that prolong life in sickle celldisease

Sickle cell disease (SCD), a common inherited blood disorder, affects people from sub-Saharan Africa, the Middle East, Mediterranean basin, Indian subcontinent, Caribbeans and South America. Some 200,000 babies are born
every year in sub-Saharan Africa with sickle
cell disease, which is associated with
complications and a reduced life expectancy
People with sickle cell disease have red
blood cells that contain mostly Haemoglobin
S, an abnormal type of haemoglobin.
Sometimes these red blood cells become
sickle-shaped (crescent shaped) and have
difficulty passing through small blood
vessels.
When sickle-shaped cells block small blood
vessels, less blood can reach that part of the
body. Tissue that does not receive a normal
blood flow eventually becomes damaged.
This is what causes the complications of
sickle cell disease. There is currently no
universal cure for sickle cell disease.
People with SCD, as such, remain a
vulnerable group and could be at risk from
remedies that they may. These remedies
may include traditional medicines or herbal
remedies, which may have true benefits or
risks that might go unrecognised by the
classically-trained medical fraternity.
Laboratory work has long suggested that
these medicines may help to ease the
symptoms of sickle cell disease.
Unfortunately, there has not been any
systematic appraisal of the health benefits
of these medicines derived from herbs.
In filling up this gap, a new study published
in the 2010 Cochrane Database of
Systematic Reviews tried to review the
benefits and risks of common
phytomedicines used by people with sickle
cell disease, taking into consideration the
different sickle cell disease types and age of
people affected by the blood disorder.
The assessment was carried out by Oluseyi
Oniyangi from the Paediatrics Department,
National Hospital, Abuja in collaboration
with Damian Cohall from the Faculty of
Medical Sciences, University of the West
Indies, St Michael, Barbados. It was entitled,
“Phytomedicines (medicines derived from
plants) for sickle cell disease” and only two
phytomedicines met the stipulated
standards set for the review.
The safety and efficacy of all
phytomedicines is a challenge and its true
benefit and risks to the individual with SCD
need to be accurately reported.
One of these phytomedicines in this review
is known as Niprisan (also known as
Nicosan), a freeze-dried extract of Piper
guineenses seeds (black pepper, Iyere in
Yoruba or Uziza in Ibo), Pterocarpus stem
(osun in Yoruba), Eugenia caryophyllum
(clove) fruit and Sorghum leaves. Niprisan
has been investigated under different
laboratory conditions.
In addition, a Phase IIB (pivotal) clinical trial
was conducted on Niprisan by the National
Institute for Pharmaceutical Research and
Development (NIPRD) to compare the safety
and efficacy of a phytomedicine derived
from plants indigenous to Nigeria in people
with SCD.
Another phytomedicine, the review
considered was Ciklavit, an extract of
Cajanus cajan, an edible local bean. In 2005,
a randomised placebo-controlled single-
blind intervention trial compared its safety
and efficacy to placebo in people with SCD.
The anti-sickling property of the Cajanus
cajan (Pigeon pea in English, olele in Edo,
shingwazo in Gwari) extract has been
attributed to this amino acid. Zinc (400 ug)
and ascorbic acid (50 mg) were added as
preservatives.
In vitro studies with red cells from people
with SCD have shown potentially clinically
beneficial action of extracts of plants,
including Fagara xanthyloides(orin ata in
Yoruba), Khaya senegalensis (African
Mahogany, madachi in Hausa and ono in
Igbo) and Cajanus cajan.
They wrote: “While Niprisan appeared to be
safe and effective in reducing severe
painful crises over a six-month follow-up
period, further trials are required to assess
its role in the management of people with
SCD and the results of its multicentre trials
are awaited. “
They suggested that Ciklavit, which has
been reported to reduce painful crises in
people with SCD, deserved further study
before recommendations can be made
regarding its use.
According to the published results for
Niprisan and in view of the limitations in
data collection and analysis of both trials,
which indicated that phytomedicines may
have a potential beneficial effect in
reducing painful crises in SCD, they declared
that there was the need for it to be further
validated in future trials. Further research,
they indicated should also assess long-term
outcome measures of these phytomedicines
in treatment of sickle cell disease.
Finally, both trials only looked at those with
sickle cell anaemia (SS) and other genotypes
may benefit from phytomedicines. They
declared the need for future trials to
address this.