A safe, effective, herbal antischistosomal therapy derived from myrrh.

ZAKI SHEIR 0 1 2 AMIRA A. NASR 0 1 2 AHMED MASSOUD 0 1 2 OSAMA SALAMA 0 1 2 GAMAL A. BADRA 0 1 2 HASSAN EL-SHENNAWY 0 1 2 NABIL HASSAN 0 1 2 SABRY M. HAMMAD 0 1 2 0 This study was carried out at the Urology and Nephrology Center at Mansoura University in Mansoura , Egypt between 1 Department of Internal Medicine, Faculty of Medicine, Department of Pharmacology, Faculty of Pharmacy, Students' University Hospital, Urology and Nephrology Center, and Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Department of Tropical Medicine, Faculty of Medicine, Al Azhar University, Cairo, Egypt; Faculty of Medicine, Menoufeya Hepatology Institute , Shebine El-Kom, Menoufeya , Egypt 2 Reprint requests: Zaki Sheir, Urology and Nephrology Center , El Gomhoria Street, Mansoura 35516 , Egypt Schistosomiasis is a widespread helminthic disease. Treatment of schistosomiasis is based on chemotherapy with praziquantel, which is the drug of choice. Since resistance to praziquantel has been demonstrated, alternative drugs must be considered. Myrrh is an oleo-gum resin from the stem of the plant Commiphora molmol. This study was carried out on 204 patients with schistosomiasis. The drug was given at a dose of 10 mg/kg of body weight/day for three days, and induced a cure rate of 91.7%. Re-treatment of cases who did not respond with a dose of 10 mg/kg of body weight/day for six days gave a cure rate of 76.5%, increasing the overall cure rate to 98.09%. The drug was well tolerated, and side effects were mild and transient. Twenty cases provided biopsy specimens six months after treatment and none of them showed living ova. - Schistosomiasis is a widespread helminthic disease.1 Globally, schistosomiasis infects one in 30 people.2 Treatment of schistosomiasis is based on chemotherapy with praziquantel or oxamniquine.3 8 Praziquantel is the drug of choice because it is more effective than oxamniquine, specially for the treatment of mansoniasis.9 Drug resistance to praziquantel has been demonstrated by Brindley,10 Fallon and Doenhoff,11 Ismail and others,7,9 and Stelma and others.12 Based on these reports, an alternative safe and effective schistosomicidal drug is urgently needed. Herbal products are not only safe, but can also have effective antihelminthic activity. Ndamba and others13 found that extracts from Abrus precatorius (Leguminosae), Pterocarpus angolensis (Leguminosae), and Ozoroa insignis (Anacardiaceae) were lethal to adult Schistosoma hematobium. Myrrh is an oleo-gum resin obtained from the stem of the plant Commiphora molmol. It is a safe, natural flavoring substance and has been approved by the U.S. Food and Drug Administration.14,15 In experimental studies on Swiss albino mice, myrrh from C. molmol showed no mutagenicity, and was found to be a potent cytotoxic drug against Ehrlich solid tumor cells with no clastrogenic effect. The anti-tumor potential of C. molmol was comparable with that of the standard cytotoxic drug cyclophosphamide.16 Studies with hamsters demonstrated the anti-schistosomal activity of myrrh (Massoud A and others, unpublished data). Myrrh given to patients with active intestinal schistosomiasis complicated with hepatosplenomegaly was found to be safe and effective (Massoud A and others, unpublished data). The aim of the present study was to assess the efficacy, toxicity, and side effects of myrrh, as well as to determine the most effective dosage schedule for the treatment of schistosomiasis in different stages of the disease. September 1998 and July 1999. It included 204 patients ranging in age from 12 to 68 years (mean SD 37.9 12.5 years). These included 169 males and 35 females selected randomly. Twenty healthy non-infected age- and sexmatched volunteers were also studied. All patients and volunteers gave informed consent prior to participating in the study. The protocol was reviewed and approved by the ethical committee of the Urology and Nephrology Center at Mansoura University. Patient groups. The patients were divided into two groups. Group I was composed of 86 patients with schistosomal colitis ranging in age from 13.2 to 62 years (mean SD 32.6 12.9 years). Group II was composed of 118 patients with hepatosplenic schistosomiasis. The latter group was further divided into two subgroups. Subgroup IIa was composed of 77 patients with compensated hepatosplenic schistosomiasis ranging in age from 12 to 58 years (mean SD 40.2 11.01 years) and subgroup IIb was composed of 41 patients with decompensated hepatosplenic schistosomiasis ranging in age from 19 to 68 years (mean SD 45.1 9.5 years). All patients had been previously treated with praziquantel except for 12 cases, four of whom were intolerant since they vomited immediately on ingesting the drug. Of the remaining patients, 156 received repeated courses of praziquantel at a dose of 50 mg/kg of body weight/day repeated three times (every other day). Thirty-six patients received one or two doses of praziquantel (40 mg/kg/day). All patients provided a medical history and underwent a clinical examination with emphasis on symptoms before and after treatment. Routine liver and kidney function tests (i.e., serum bilirubin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], and serum creatinine) were done, especially in cases of decompensated hepatosplenic schistosomiasis. A standard 12-lead electrocardiogram was done before and one week after starting treatment in 10 cases of decompensated hepatosplenic schistosomiasis who were given myrrh in a dose of 10 mg/kg/day for six days. Diagnosis of schistosomiasis was based on the presence of living schistosoma ova either in urine, stool, or in colonic and rectal mucosal biopsies. Sigmoidoscopy and colonic and Use of praziquantel None 12 (5.9) Complete 156 (76.5) Incomplete 36 (17.6) * NS not significant; HSS hepatosplenic schistosomiasis. Calculated using Fishers exact test. Calculated using the chi-square test. rectal mucosal biopsies were done using a rigid sigmoidoscope (model no. 73332; Welch Allyn, New York, NY) before starting therapy to verify the presence of living schistosoma ova and to determine species (S. hematobium, S. mansoni, or mixed infections). Biopsies were repeated two months after the end of therapy to assess cure by demonstrating viability of the ova. Biopsy snips were examined by the transparency technique after being compressed between two glass slides.17 All patients and healthy volunteers were given a combination of resin and volatile oil extracted from myrrh at a dose of 10 mg/kg/day for three days on an empty stomach 1 hr before breakfast. Patients who still showed living ova two months after treatment in colonic plus rectal mucosal biopsy specimens were given a second course of 10 mg/kg/ day for six days, and biopsy specimens were obtained two months later to assess cure. Twenty patients provided biopsy specimens six months after treatment. Statistical analysis. Statistic (...truncated)