Botanicals Show Promise for Sickle Cell Anemia Treatment
Researchers from Nigeria’s National Institute for Pharmaceutical Research and Development (NIPRD) have concluded after examining the evidence, that several herbs, and one particular combination of herbal extracts, provides evidence of being able to provide a potential treatment for sickle cell anemia.
The research, led by Dr. Sunday John Ameh and Dr. Benjamin Umar Ebeshi – a medical and chemistry professor at Nigeria’s Niger Delta University – delved into the clinical application and the phase I, II and III trials of traditionally-based herbal extracts used to treat sickle cell anemia.
An herbal combination extract called Niprisan – also called Nicosan – has shown significant success among the research. In a Phase IIb clinical trial, among the 30 sickle cell patients given the herbal formula, 73% had no sickle cell crisis during the twelve month testing period, while the remainder of the group – 27% – had fewer and less severe sickle cell crises.
In another trial, which included 82 patients, Nicosan was found again to be effective at significantly reducing sickle-cell crises among those given the herbal combination.
What are the herbs in Niprosan/Nicosan?
Based on a traditional African healing remedy for treating sickle cell-like symptoms, the primary constituents of Niprisan or Nicosan are derived from extracts of the following plants:
• Piper guineense seed: the West African pepper or Guinea pepper – a relative of the Ayurvedic long pepper – used to make black pepper.
• Pterocarpus osum stem: an African timber with many relatives.
• Eugenia caryophyllus: also known as cloves
• Sorghum bicolor: a grass also known as sorghum.
The central active constituents of these Niprisan/Nicosan herbs include piperine, chavicine, capsaicin and cubebin.
What is sickle cell disease?
Sickle cell disease – which can develop into anemia – is thought to be primarily a genetic (and possibly epigenetic) disease produced by abnormal hemoglobin production, which changes the shape of red blood cells into a crescent or sickle shape. These will transport less oxygen to the cells, and can reduce blood flow. It has been prominent among those of African or Middle Eastern descent, as well as South and Central America.
Symptoms of sickle cell include periods of intense pain, rapid heart rates, yellowing of skin – jaundice, vision issues, skin ulcers, confusion, infections of the urinary tract, lungs bones and/or gallbladder and others.
Sickle cell anemia is difficult to treat. Conventional medicine typically aims to manage and control symptoms, often with the drug hydroxycarbamide along with pain-killers. Hydroxycarbamide inhibits DNA replication, which can slow the production of sickle cells.
Hydroxycarbamide treatment also comes with a number of potential adverse and toxic side effects, including bone marrow toxicity, liver toxicity, nausea, vomiting, diarrhea, constipation, mucositis, hair loss, problems with blood urea and creatinine among others.
On the other hand, Niprisan has been shown to have no adverse side effects in its clinical trials.
Research finds other promising botanicals for sickle cell disease
Traditional healers have utilized other and similar herbs to combine into similar formulations to treat sickle, with clinical success. These include Piper cubeba and Aframomum melegueta. These two pungent pepper-like compounds have the ability to reduce pain, due to their capsicum and piperine content.
Another promising traditional anti-sickle cell herb gaining attention is Fagara (F. zanthoxyloides) a prickly-ash relative. Root bark from this plant have been shown to dramatically reduce sickle cell formation. Fagara constituents thought to inhibit sickle include burinabans A, B and C. Fargara has also gained notoriety as an anti-malaria medicine. Following is a clinical description written in the Journal Anemia:
“Doctors in Nigeria use fagara (F. zanthoxyloides) to reduce the painful crisis of the genetic disease, sickle cell anemia. This herb has a variety of unusual properties that reduce platelet and blood cell sticking. After reading the reports from Nigeria many years ago, I decided to try fagara’s relative prickly ash bark for the same indication. I made a simple tincture of 50% prickly ash bark and 50% ginkgo leaf, and gave it to a young African-American girl in the first grade who constantly missed school and needed to be hospitalized 3-4 times per year due to the painful sickle cell crisis. I gave her about 25 drops three times a day. She immediately stopped having serious problems, her thinking was no longer fuzzy, the frequency of her attacks went down to about one per year, and the severity of the attacks decreased appreciably. This success has continued through the years, as long as she takes her medicine. I saw her last year, and she has blossomed into a beautiful junior high school student, the sickle cell disease now only a bit-player in the background of her life. Another of my patients had lived with the disease his entire life, with almost constant pain, and bimonthly crisis. I gave him 35 drops three times per day, and he immediately improved in the same way as the young girl. This improvement in both frequency of attacks and level of pain has persisted in three of my long-term patients over many years. The wholesale cost of this medicine is less than $20 per month at full dosage. My biggest fear is that this knowledge will be co-opted by a pharmaceutical company, and made available to the many suffering children only at an exorbitant cost.”
Other promising sickle cell treatments include the green fruit or leaf of Carica papapa. After five days of fermentation, the green papaya resulted in 87% inhibition and 74% reversal in animal research. Garlic has also been mentioned in the research as a possible sickle cell treatment, along with Pigeon pea seed (Cajanus cajan).
As to the aforementioned – Cajanus cajan – University of Lagos researchers conducted a single-blind placebo-controlled study with 100 sickle cell patients. The group given the Cajanus cajan had fewer recall painful episodes (207 reduced to 191) while the placebo group had increased pain episodes (109 to 164) during the treatment period. Liver enlargement decreased from 55% to 33% of cases in the Cajanus group while the placebo groups liver enlargement count increased during the treatment period.
Why so many sickle cell studies from Nigeria?
Nigeria has the largest occurrence of sickle cell anemia as a percentage of the population. A study a few decades ago revealed that about 25% of adult Nigerians had the AS sickle cell trait, while about 6% of the Yoruba people many others had the Hemoglobin C trait according to the study.
According to the Sickle Cell Disease Association of America, between 45,000 and 90,000 infants are born with sickle cell each year – from a population of about 90 million. In the U.S., about 1,000 babies are born with sickle cell each year.
Ameh SJ, Tarfa FD, Ebeshi BU. Traditional herbal management of sickle cell anemia: lessons from Nigeria. Anemia. 2012;2012:607436. doi: 10.1155/2012/607436.
Perampaladas K, Masum H, Kapoor A, Shah R, Daar AS, Singer PA. The road to commercialization in Africa: lessons from developing the sickle-cell drug Niprisan. BMC Int Health Hum Rights. 2010 Dec 13;10 Suppl 1:S11.
Oniyangi O, Cohall DH. Phytomedicines (medicines derived from plants) for sickle cell disease. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD004448.
Ouattara B, Jansen O, Angenot L, Guissou IP, Frédérich M, Fondu P, Tits M. Antisickling properties of divanilloylquinic acids isolated from Fagara zanthoxyloides Lam. (Rutaceae). Phytomedicine. 2009 Mar;16(2-3):125-9.
Obodozie OO, Ameh SJ, Afolabi EK, Oyedele EO, Ache TA, Onanuga CE, Ibe MC, Inyang US. A Normative Study of the Components of Niprisan-an Herbal Medicine for Sickle Cell Anemia. J Diet Suppl. 2010 Mar;7(1):21-30.
Ataga KI. Novel therapies in sickle cell disease. Hematology Am Soc Hematol Educ Program. 2009:54-61.
Kotiah SD, Ballas SK. Investigational drugs in sickle cell anemia. Expert Opin Investig Drugs. 2009 Dec;18(12):1817-28.
Ogunyemi CM, Elujoba AA, Durosimi MA. Antisickling properties of Carica papaya Linn. Journal of Natural Products. 2008;1:56–66.
Imaga NO, Gbenle GO, Okochi VI, et al. Antisickling property of Carica papaya leaf extract. African Journal of Biochemistry Research. 2009;3(4):102–106.
Ohnishi ST, Ohnishi T, Ogunmola GB. Sickle cell anemia: a potential nutritional approach for a molecular disease. Nutrition. 2000 May;16(5):330-8.
Akinsulie AO, Temiye EO, Akanmu AS, Lesi FE, Whyte CO. Clinical evaluation of extract of Cajanus cajan (Ciklavit) in sickle cell anaemia. J Trop Pediatr. 2005 Aug;51(4):200-5.
Akinyanju OO. A profile of sickle cell disease in Nigeria. Ann N Y Acad Sci. 1989;565:126-36.
Sickle Cell Disease Association of America: http://www.sicklecelldisease.org