How Effective Can Artemisinin Be to Treat Malaria?
Remedial drugs for malaria have been the subject of many drug development research for several decades. And thanks to the dedicated work of drug researchers worldwide, we have several cures for malaria today, many of which are very effective, with near-to-instant results. One such drug is artemisinin.
According to research by Joaquín Pousibet-Puerto, et al., artemisinin-based combination therapy (ACT) has been adopted by the World Health Organization as the first-line treatment for uncomplicated Plasmodium falciparum malaria. In fact, in regions where the disease is endemic, especially sub-Saharan African countries, artemisinin antimalarial drugs have proven more effective in treating malaria and reducing its transmission.
In this article, we want to review the effectiveness of artemisinin in treating malaria based on studies previously conducted on the subject. However, before we delve deeper, let’s take a look at the importance of malaria along with a few stats known to date.
Malaria is the most important parasitic disease worldwide.
Each year, malaria has been calculated to be responsible for new episodes in more than 210 million patients associated with approximately 438,000 deaths. Unfortunately, most of these cases are children under 5 years of age and pregnant women. Unlike in Sub-Saharan Africa, where the disease is endemic, Malaria has continued to be an imported disease in most parts of Europe, apart from isolated cases in Greece, with about 11,000 cases recorded each year.
These statistics make malaria the most important tropical disease in the world. Roughly 90% of imported malaria cases are diagnosed in recently-arriving immigrants or resident immigrants visiting their home country, probably for business or visiting friends or family. Also, research has shown that 80% of declared imported malaria cases in Europe are Plasmodium falciparum.
Malaria treatment methods
Over the years, malaria treatment approaches have changed significantly. In the nineteenth century, the first chemically purified, effective treatment for malaria, quinine, and several other natural and synthetic compounds were developed. Since then, more advancements have been made in the study of malaria and the development of malaria drugs.
Artesunate was later developed and has even been proven to be superior to quinine in most situations where complicated malaria is treated. However, studies show that in uncomplicated malaria cases, a treatment known as artemisinin-based combination therapy (ACT) has greater efficacy in treating malaria, helps to reduce transmission of the disease in endemic regions, and produces lower levels of reinfection.
From this, researchers and drug development experts have seen that artemisinin is very effective in treating malaria. Artemisinin derivatives are currently recommended as a first-line medication for P. falciparum to treat malaria. Note that there are four different species of Plasmodium. Plasmodium falciparum is known to be the deadliest species of plasmodium, the causative organism responsible for malaria in humans.
The P. falciparum parasite is transmitted through the bite of a female Anopheles mosquito. Based on results from several studies, artemisinin has been shown to be the most effective treatment for malaria, including complicated and uncomplicated cases, whether in endemic or non-endemic areas.
How does artemisinin work?
Several researchers have shown that artemisinin kills the plasmodium parasite by indiscriminately binding to proteins in many of the organism’s key biochemical pathways.
Artemisinin was first isolated and developed in the 1970s by the Chinese. Despite its rapid effectiveness against malaria, the WHO and many Western researchers received the news with skepticism mostly because they were not sure how a natural remedy is so effective and also because Chinese medicine producers did not follow standard practices in developing the drug. So the question about how artemisinin works sparked a series of research in the West that ultimately uncovered how artemisinin works.
One of the works that shed more light on the mechanism of action of artemisinin is a team of researchers led by Qingsong Lin, Kevin S. W. Tan, and Jigang Wang of the National University of Singapore, who identified artemisinin binding partners in plasmodium by synthesizing an alkyne-tagged artemisinin analog. The team was able to identify all the protein units in the parasite to which artemisinin binds to be effective. In fact, they went ahead to isolate and purify the identified proteins with mass spectrometry.
According to further research, the mechanism of action of artemisinin was also shown to be dependent on the red blood cell compound, heme, for its activation. Although further investigation is needed to elucidate this properly, artemisinin is believed to act via a two-step mechanism. Once introduced, artemisinin is activated by intra-parasitic heme-iron that catalyzes the cleavage of this endoperoxide, giving a free radical intermediate. The resulting free radical intermediate then kills the parasite by alkylating and destroying one or more essential malarial proteins, as highlighted in the research of Qingsong Lin, et al.
Final thoughts
Generally, treatment of malaria with artemisinin brings about a reduction in average hospital stays, more rapid parasite clearance in comparison with any other anti-malarial, and complicated malaria, a lowering of the global mortality rate. Have more inquiries about artemisinin? Don’t hesitate to reach out to us today at Stanford Chemical Company or call us at 1-949-468-0555.
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