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Botanical Remedies May Be In Our Future

The big scary question: What will happen after antibiotics cease to work? And people start dying by the millions from infections that used to be easily treated? We are fast approaching that point of total antibiotic resistance, with superbugs that resist all antibiotics. More and more disease-causing bacteria are rapidly evolving immunity to every existing antibiotic (see short video). Soon routine surgeries and minor wounds or even scratches could kill a person. About 70% of antibiotics are currently being used (much of it unnecessary) in farm animals - why aren't governments putting a stop to that? Resistant bacteria already result in the deaths of about 700,000 people globally, but experts predict that by 2050 they will kill 10 million people annually.

What is to be done? New antibiotics? Big pharma generally isn't interested - not enough profit. Using good bacteria and other microbes to dominate over pathogenic microbes? (For example, using  L. sakei to treat chronic sinusitis) BacteriophagesEssential oils? The following is a wonderful article about another possibility: ethnobotany - the use of medicinal plants. Cassandra Quave is the ethnobotanist based at Emory University discussed in the article. From the New York Times:

Could Ancient Remedies Hold the Answer to the Looming Antibiotics Crisis?

Ethnobotany is a historically small and obscure offshoot of the social sciences, focused on the myriad ways that indigenous peoples use plants for food, shelter, clothing, art and medicine. Within this already-tiny field, a few groups of researchers are now trying to use this knowledge to derive new medicines, and Quave has become a leader among them. Equally adept with a pipette and a trowel, she unites the collective insights of traditional plant-based healing with the rigor of modern laboratory experiments. Over the past five years, Quave has gathered hundreds of therapeutic shrubs, weeds and herbs and taken them back to Emory for a thorough chemical analysis. 

No single strategy is likely to be sufficient, but ethnobotany offers a few distinct advantages. Instead of relying on random screenings of living creatures — an arbitrary scoop of soil or seawater — it is the only strategy that benefits from a pre-made guide to some of nature’s most potent drugs, honed by thousands of years of trial and error in traditional medicine. And as far as organic drug factories go, it’s difficult to beat the complexity and ingenuity of plants. Plants are nature’s chemical wizards. If a plant finds itself in an unfavorable situation — feasted on by pests, ignored by pollinators — it cannot kick up its roots and relocate. Instead, plants regulate the chemistry of their environment, perpetually suffusing the ground, air and their own tissues with molecular cocktails and bouquets intended to increase their chances of survival and reproduction. 

Botanical medicine, Quave learned, not only predates civilization — it is older than humanity itself.  Many animals appear to self-medicate with plants: In Panama, members of the raccoon family known as coatis rub minty tree resin through their fur to deter fleas, ticks and lice, and some great apes and monkeys swallow mildly toxic leaves seemingly to fight infestations of parasitic worms. Our earliest human ancestors continued such traditions, and until relatively recently, plants were our primary source of medicine....Between 50 and 70 A.D., while traveling with Emperor Nero’s armies, the Greek surgeon Dioscorides learned how to make balms, elixirs and anesthetics from about 600 plants, like peppermint, hemlock and cannabis. He published his findings in a pharmacopoeia eventually known as “De Materia Medica,” a standard reference for the next 1,500 years.

It was not until the late 19th century — as medical knowledge advanced and appreciation for indigenous cultures increased — that ethnobotany as a formal discipline began to take shape. Starting in 1941, the American biologist Richard E. Schultes, often regarded as the father of modern ethnobotany, spent 12 years living alongside indigenous peoples in the northwest Amazon Basin, participating in their rituals and ingesting numerous therapeutic and psychoactive plants. After returning to America, he trained several generations of ethnobotanists at Harvard University, some of whom are leaders in the field today.

Although ethnobotany and the longstanding co-evolution with plants that preceded it have provided us with some of our most essential medicines, their purified and generic final forms are so divorced from their origins that most of us are oblivious to this immense botanical debt. Aspirin is based on a compound found in the perennial herb meadowsweet; pseudoephedrine was inspired by the use of the dryland shrub Ephedra sinica in traditional Chinese medicine; morphine, codeine, thebaine and other opiates are still made from poppies; and many anticancer drugs come from plants, like vincristine and vinblastine, both extracted from the Madagascar periwinkle. As of 2003, at least 25 percent of modern medicines were derived from plants, yet only a tiny fraction of the estimated more than 50,000 medicinal plants used around the globe have been studied in the lab.

Around the globe, as people continue to abandon the countryside for urban areas, such botanical cures are increasingly forgotten or dismissed as old wives’ tales — and certainly some of them are. But to dismiss all of them, Quave thinks, would be a terrible oversight. “We’re showing it isn’t witchcraft or voodoo medicine,” she says. “It actually has some biological function.” In southern Italy, Quave discovered that healers use elmleaf blackberry to treat boils and abscesses..... When they added different combinations of blackberry molecules to brothy wells of MRSA — a particularly antibiotic-resistant species of Staphylococcus bacteria — the botanical extracts did not kill the microbes as typical antibiotics do. Rather, they prevented the bacteria from forming slimy, intractable mats called biofilms, which allow them to adhere to living tissues and medical devices like catheters in hospitals.

And that, Quave says, is exactly the kind of antibiotic that can foil the evolution of resistance. A few lone bacteria drifting about are not particularly worrisome. It’s when pathogenic microbes team up that they become a greater threat. Bacteria rely on a form of chemical communication known as quorum-sensing: When they form a critical mass, they start churning out toxins, exchanging genes for antibiotic resistance and protecting themselves with a thick shell of sugar molecules that are impermeable to many drugs. But if an antibiotic could disrupt bacteria’s ability to collaborate, instead of killing them outright, it could render them more vulnerable and “sidestep resistance,” as Quave puts it. “It’s like a magician’s trick. You’re distracting the bacteria, saying, ‘Look over here!’ Meanwhile your own immune system can clear away the microbes.” Because such an antibiotic would not be directly responsible for the microbes’ death, there would be much weaker evolutionary pressure to develop resistance against it. “Ever since Fleming discovered penicillin, we’ve been in the mind-set that we need to kill microbes,” Quave says. “What we need to do is find a balance.

Recently, Quave and her research team have discovered that an extract of Brazilian peppertree berries — an invasive species common in many warmer parts of the United States — prevents MRSA from forming skin lesions in mice and shrinks biofilms formed by the bacteria. “I really believe these kind of inhibitors are a major part of the solution to antibiotic resistance,” Quave says. “We can shut down bacteria’s most dangerous machinery without killing them.” She envisions using such drugs as prophylactics in surgeries with a high infection risk, or in combination with other antimicrobials if a serious infection is already established.

Given such promise and the desperate need for new antibiotics, you might think that the path from lab to pharmacy would be expedient. It is anything but. In many cases, plant-based remedies work best as complex mixtures of many distinct molecules, as opposed to a highly refined one- or two-molecule extract. In the past decade, the Food and Drug Administration has approved just two commercial botanical drugs: Veregen, a medley of green-tea-leaf compounds used to treat genital warts, and Fulyzaq, an antidiarrheal derivative of tree resin with so many molecular constituents that some remain unidentified. Despite these successes, there is continued opposition in the pharmaceutical industry to developing complex botanicals because they are perceived as too messy and too difficult to evaluate and standardize for mass production. University scientists often rely on drug companies to fund the costly and time-consuming clinical trials required for approval from the F.D.A., and major pharmaceutical companies have little interest in antibiotics. If a candidate antibiotic is some motley herbal treatment — if it has the whiff of mumbo-jumbo folklore — the opposition is stronger still.

The difficulties don’t end with regulators. Per the ethics of their field, ethnobotanists would also need to ensure that some of the profits from drug sales reach the people who originally developed a traditional botanical remedy. In 1992, more than 150 governments signed the Convention on Biological Diversity, a treaty establishing that nations retain sovereign rights over their indigenous medicines and that such resources should be shared only after mediation of equitable benefits. 

But above all else, the apathy of the pharmaceutical industry remains the biggest immediate roadblock. “The odds are sometimes disheartening,” she admits. “But this is my field, and I’m not going to abandon ship because today the market is not supporting antibiotic research. In the near future they’ll have to. Western medicine will stop without antibiotics.” Consider, for instance, that over the past eight years, Thailand, Cambodia and other Asian countries have reported increasingly common cases of artemisinin-resistant malaria. Yet a recent study demonstrates that feeding rodents sweet wormwood leaves in their entirety — as opposed to a synthesized derivative — overcomes this resistance. The modern, stripped-down version of this ancient medicine may very well sacrifice some beneficial chemical synergy present in the whole plant.

Elmleaf blackberry  Credit:Wikipedia

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