Dr. P. Pushpangadan Director, National Botanical Research Institute Lucknow, India Growing popularity 5 trillion $ 2020 2005 62 billion $ Business standard, 2005 ccessible ffordable ssured safety About 70% Indian population (60-70 crore) depends on alternative system of medicine. WHO Herbal drugs are cheaper than generic drugs !!?? Herbal drugs have been used in India for more than 4000 years. Allopathy or Modern Medicine Glamorized discipline Pursued by most (influenced and so called Literate) in India and, in western countries Backed by technological advances - investigations Based on sound scientific reasoning experimental evidence; not anecdotal Thus, Modern Medicine is an evidence- based, techno-savvy science that seems to provide ultimate care to sick patients Allopathy or Modern Medicine But???? The treatment is often symptomatic, costly, out of reach of most in developing countries Except for infective pathologies, we do not have much to offer except palliation Treatment of Chronic Lifestyle Disorders like neurodegenerative disorders is often very disappointing and limited by adverse events It treats the Disease (symptomatic) and not the patient as a whole (Holistic approach) Therapeutic Objective The ultimate goal of every physician is to CURE the disease. Has Allopathy achieved this goal for all ailments? No; Except for infective pathologies, we do not achieve CURE Most often the treatment is Symptomatic and Palliative. Effective & Safe Medicine Drug Discovery problems It is notoriously inefficient One in a hundred thousand or more compounds will enter the market as a drug Pharma majors have NO interest in higher plants extracts for screening for biological activity In NAPRALERT ethnomedical reports for 14,300 species (5.2% of all plant species) are there; But 58% of these species have never been examined biologically or chemically Of these 74% are used in a manner which parallels their ethnomedical use Traditional medicine Modern science Modern medicine Golden triangle Thus making cheaper affordable and safe medicine Mashelkar 2005 Compound
Plant Species
Acetyl digoxin
Digitalis lanata
Ajmalicine
Catharanthus roseus, Rauwolfia sp.
Ajmmaline
Rauvolfia serpentina
Andrographolide
Andrographis paniculata
Artemissine
Artemisia annua
Asiaticoside
Centella asiatica
Berberine
Berberis spp.
Caffeine
Camellia sinensis
Caffeine
Camellia sinensis
Cocaine
Erythroxylum cocoa
Codeine
Papaver spp.
Codiene
Papaver somniferum
Colchicine
Colchicum autumnale, Gloriosa superba
Curcumin
Curcuma longa
Digitoxin, Digoxin, Digitoxigenin
Digitalis spp.
Emetine
Cephaelis ipecacuanha
Ephedrine
Ephedra gerardiana
Ergometrine, Ergotamine, Ergotoxin
Claviceps purpurea on Rye plants
Glycyrrhizin, Glycyrrhizinic acid
Glycyrrhiza glabra
Hesperidin
Citrus spp. Mentha spp.
Examples of some important plant derived drugs Contd.. Hyoscine
Duboisia spp.
Hyoscyamine
Datura spp, Hyscyamus spp.
L-Dopa
Mucuna pruriens
Menthol
Mentha spp.
Morphine
Papaver spp.
Papain
Carica papaya
Podophyliotoxin
Podophyllum emodi
Quinine, Quinidine
Cinchona spp.
Reserpine & Deserpidine
Rauvolfia serpentina,
Rutin
Eucalyptus spp, Fagopyrum spp, Sophora japonica
Scopolamin
Datura sp.
Sennosides A&B
Cassia angustifolia, C. acutifolia
Silymarin
Silybum marianum
Strychnine
Strychnos nux-vomica
Taxol
Taxus baccata
Thymol
Thymus vulgaris
Vinblastine, Vincristine
Catharanthus roseus
Xanthotoxin
Ammi majus, Heracleum candicans
Chemical Intermediates
Citral
Lemon grass
Diosgenin
Dioscorea spp. Costus spp.
Phytosterols (Stigmasterol & Sitosterol)
Soya & Calabar Beans
Solasodine
Solanum
Hypercin, Hyperforin
Hypericum perforatum
Examples of some important plant derived drugs (Contd..) Traditional medicine Historical background Earliest recorded use of a medicinal plant has been mentioned in Rigveda one mentioned in the modern texts is that of the herb called Ma huang a species of Ephedra used medicinally in China for over 5000 years Cinchona was used by local south American tribes long before before the isolation of quinine for treating malaria Source of aspirin (Salix officinalis) was used as pain killer for long time before being identified Traditional medicines Middle of 19 th century, 80% of all medicines were herbal Even today 25% of drugs are derived from plant source Most of these drugs came from traditional lead, folk knowledge etc. Some of these still could not substituted despite the enormous advancement in synthetic chemistry eg. Reserpine, taxol, vincristine etc. Revival of herbal medicine widespread belief that green medicine is healthier than synthetic products leading to rapid spurt of demand for health products like herbal tea, ginseng and such products of traditional medicine So rapid sale of herbal products are staggering 100 billion dollars a year. After India and China, even the western world has started working on herbals NIH has set up CAM center and working on St. Johns wort and Gingko biloba Drug development based on traditional leads Survey of traditional remedies Choice of plant Identification, authentication Collection Traditional formulation Clinical trial Related species Extraction Biological screening Effective 1. Analytical standard 2. Safety 3. Modernise Technology 4. New Dosage Forms Active Bioassay Linked Fractionation Active Compound(s) Characterisation Pure Compound, Standardised Extracts Clinical Trials Commercial Production Marketing 1. Pharmacology 2. Toxicity 3. Clinical Pharmacology
Bio-availability Registration Pharmacokinetics/Pharmacodynamics Pilot Plant Production Reverse pharmacology What is required is Scientific evidence Answer lies in providing scientific validation for efficacy and safety Screening based on ethnomedical and ethnobotanical lead as chances of hitting the target is more
System biology The health triangle. The survival potential of all living systems, H, is expressed in the health triangle, structured with lifes common denominator: Intelligence, Energy and Organization. Synergy Most of the effective phytomedicine in market are as whole extracts of plants Practitioners believe that synergistic interactions between the components of individual or mixture of herbs are a vital part of therapeutic efficacy Mechanism of action of many phytomedicine is still unknown and there are several instance where total extract shows better activity than an equalent dose of isolated compound chemical and pharmacological evidence to demonstrate conclusively the concept of synergism Multi-target approach Combinations of herbs are normal and are based on empirical observation and reasoning based on a particular patient these herbal combinations may not be targeted to a particular organ (multi-targeted), cell, tissue or any biochemical system, making this synergy even more difficult to identify possibility of drug interactions and the adverse reactions arising out of these have to be checked before coming out with the drug Plant A Plant B Plant C Plant D Plant E Plant F Plant G Plant H
Pain, Cartilage Inflammation Oxidative stress Osteoporosis Anabolic CNS Immunomodulator Antistress Bioavailability Lubricant Multiple Targets Need A Combo Activity Matrix: Systems-Biology Approach Pharmacovigilance Any thing herbal is safe!!????? Adverse drug reactions (ADR) Drug-drug interactions Herb-Drug interactions Toxicity of the isolated ingredients Traditional process (Shodhana) Traditional Medicine: Threats Poor positioning on a global level Ignored by the global scientific community Very little scientific research validations Very little publications in peer-reviewed science Journals Deliberate negative propagandas Traditional medicine: Future Innovative, Effective and Aggressive use of Emerging Technologies without Compromising the Basic Principles will be the main key towards the bright future Pharmacological studies Extraction and fractionation Activity guided isolation of active copounds Traditional Approach
Selection of potential plants Formulation and Doasge studies
Toxicity stuides Standardization of the formulation(s) Clinical studies IPR Final Product