Artemisia annua (Sweet Annie), Other Artemisia Species, Artemisinin, Artemisinin Derivatives, and Malaria

Abstract

This paper reviews the use of whole-plant Artemisia annua (sweet Annie) as it pertains to malaria including history, chemistry, clinical efficacy, pharmacokinetics, dosing, safety, and resistance. Artemisinin, the sesquiterpene lactone found in the plant, and various semi-synthetic variants of it used as critical drugs around the world for malaria are discussed in comparison to the whole plant. The multifaceted potential of A. annua against malaria including as a mosquito larvicide and to prevent transmission is discussed. The critical importance of combination therapy with this herb (be it with well-studied synthetic drugs or as-yet poorly studied natural products with activity against malaria, notably curcumin) is reviewed. The relevance of non-artemisinin chemicals in A. annua is highlighted. The pharmacokinetic and pharmacodynamic limitations of A. annua and artemisinins for prophylaxis against malaria are presented. Other Artemisia species besides A. annua, whether they contain artemisinin or not, are also touched upon in the context of malaria.

Synergy in Herbal Medicines: Part 1

“…The sesquiterpene lactone artemisinin ( Figure 1) from A. annua is a potent antimalarial schizonticide. 5 Artemisinin (qinghaosu in Chinese) and various semisynthetic derivatives of it are among the most widely-used antiplasmodial drugs in the world. It seems to be largely assumed in mainstream medicine that this is the beginning and ending of the sweet Annie story: artemisinin is the silver bullet, and there is nothing else worth investigating further in the herb.…”

Assessment of Artemisinin Contents in Selected Artemisia Species from Tajikistan (Central Asia)

“…The mechanism of artemisinin action is controversial [12,13]. It is related to the presence of an endoperoxide bridge, which by breaking creates a powerful free radical form of the artemisinin, which attacks the parasite proteins without harming the host [14].…”

Antimalarial Plants Used across Kenyan Communities

“…At present, Artemisia annua [106,107], Azadirachta indica [108], and Vernonia amygdalina [111] have been subjected to clinical studies. Artemisinin from Artemisia annua is an ingredient of artemisinin-based combination therapy currently recommended for treatment of malaria [124]. As identified earlier, few clinical trials have been done on antimalarial plants.…”