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WORLDWIDE, the greatest fear is that the malaria parasite might develop resistance to the drug of choice, Artemisinin Combination Therapy (ACT).

In fact, health experts are worried that more people may become ill or die due to the rapid speed of these drug-resistant malaria parasites, especially in the rainy season when malaria cases are on the rise.

Scientists have been working for years to target increasing partial resistance to the top anti-malarial drug, artemisinin. Focus has been on identifying herbs that can boost the effectiveness of artemisinin, as a treatment for malaria.

In the 20th century, the development of resistant strains of infectious diseases such as leprosy, tuberculosis, and human immunodeficiency virus has led to the development of combination therapy as the standard treatment for these and other diseases, which is also recommended for treatment of malaria.

In sub-Saharan Africa, where there is a high prevalence of malaria, a combination of traditionally used antimalarial plants with known antimalarial drugs could be a practical strategy to combat the disease.

In a new study, scientists found Stemonocoleus micranthus stem effective for treating malaria. Its extract in combination with artemisinin enhanced the antimalarial potency of the two drugs involved, compared to when used as individual drugs. Stemonocoleus micranthus is known as “nre” in the South-east of Nigeria. Its stem bark decoction is most widely used traditionally as a remedy for various diseases such as malaria and boil.

They said that the extract of the stem bark of Stemonocoleus micranthus in combination with antimalarial artesunate 10 mg kg−1, will possibly reduce the ease of resistance to either of the drugs and that it has no untoward toxic effect on internal organs in the body at the tested dose range.

For the study, the scientists tested the antimalarial effect of the stem bark of Stemonocoleus micranthus in single and combination with different doses of artesunate (2.5, 5 and 10 mg kg−1) against Plasmodium berghei in mice. It was in the 2022 edition of the South African Journal of Botany.

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The parameters measured were curative effect against established infection, mean survival time (MST), weight loss, rectal temperature changes and packed cell volume (PCV). Histopathological study was done on concerned internal organs.

The daily monitored the curative effect of its extract used singly and in combination with artesunate showed a daily, dose-dependent and progressively reduction of the malaria parasite. Ethyl acetate fraction of Stemonocoleus micranthus used alone showed a poor onset of activity but long-acting effect.

Also, in another study, researchers found the combination of Securidaca longipedunculata with Artemether and Lumefantrine a more potent antimalarial treatment in combating resistance.

Securidaca longipedunculata, commonly called Violet tree,  “uwar maganigunar” in Hausa,  “Ipeta” in Yoruba and “ezeogwu” in Ibo has been used as a remedy for various disease conditions in traditional medicine, including sexually transmitted infections, chest pain, headache, inflammation, infertility problems, Tuberculosis, constipation, malaria, stomach ache, sleeping sickness, hernias, cough, rheumatism, and wound dressing.

In the Nsukka community of Enugu State, a poultice of the root bark of S. longipedunculata is popularly used for the treatment of rheumatic conditions and inflammation.

For the study, Artemether and lumefantrine were separately combined and tested with extracts of Securidaca longipedunculata, a plant widely used to treat malaria, at fixed extract–drug ratios of 4:1, 3:1, 1:1, 1:2, 1:3, and 1:4.

These combinations were tested for antiplasmodial activity against three strains of Plasmodium falciparum (W2, D6, and DD2), and seven field isolates that were characterized for molecular and drug resistance profiles.

Synergism was observed across all fixed doses when roots extracts were combined with artemether against D6 strain and stems extract combined with lumefantrine against DD2 strain as well as field isolates. Similarly, synergism was observed in all ratios when leaves extract were combined with lumefantrine against W2 strain. Synergism was observed in most combinations indicating the potential use of S. longipedunculata in combination with artemether and lumefantrine in combating resistance.

Previously, scientists found stem bark of Khaya grandifoliola, bitter leaf, Cryptolepis sanguinolenta (paran pupa in Yoruba), mangosteen rind, Gynostemma pentaphyllum (Asofeyeje in Yoruba) and Moringa oleifera (Ewe Igbale or drumstick tree) leaf extracts as partner drugs of artemisinin for treating malaria. Their combination with artemisinin had a very strong antimalarial effect and as such a low dose of artesunate will be required in treating malaria.

In 2016, Thailand scientists tested the effect of Gynostemma pentaphyllum or Moringa oleifera leaf extracts on the effectiveness of artesunate in treating malaria.

In animals under laboratory conditions, the combination with G. pentaphyllum leaf extract was more effective than the combination that had Moringa oleifera leaf extract.

Additionally, artesunate combined with these extracts had a higher antimalarial activity, compared to extract treated alone G. pentaphyllum leaf extract or M. oleifera leaf extract.

Written in the Journal of Tropical Medicine, the scientists concluded: “the addictive effect of these extracts with artesunate is important in the context that offers opportunities to further standardise new ACT as a possible antimalarial combination.”

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