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Medicinal Plants: Advances in Phytochemistry and Ethnobotany

Dâmaris silveira.

1 Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia 70910-900, Brazil

Fabio Boylan

2 School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland

Prance once defined Ethnobotany as an interdisciplinary Science combining Anthropology and Botany [ 1 ]. However, it can also involve Phytochemistry, Pharmacology, Nutrition, and other uses of plants by a traditional community. Furthermore, Ethnobotanical studies often consider ecological aspects of the traditional use of such plants, either because of their importance for the community environment or the non-rational exploitation of some species. Thus, Ethnobotany can bring together the know-how of a local community and scientific knowledge, contributing to achieving biocultural conservation [ 2 ]. Moreover, it can contribute to carrying plants from local markets to a global trade situation, valuing and preserving traditional knowledge.

In 2022, the global herbal medicines market was worth USD 170 billion, and the expectation is that this market has the potential to reach USD 600 billion by 2033, with a compound annual growth rate (CAGR) of 15% from 2023 to 2033 [ 3 ]. Considering dry herbs, such as oregano, rosemary, sage, savoury, mint, thyme, and bay leaves in the form of the whole plant or powdered material, the global market grew from USD 5.8 billion in 2022 to USD 6.17 billion in 2023 (a CAGR of 6.3%), and there is an expectation it will reach USD 7.93 billion in 2027 [ 4 ]. Considering more elaborate forms, such as capsules, tablets, and extracts, the global market forecast is USD 117 billion by 2029, with a CAGR of 7.3% [ 5 ].

This Special Issue of Plants , dedicated to Ethnobotany and Phytochemistry, received 27 manuscript submissions from almost all world regions. From those, 13 papers were of a high quality and were published. They comprise a wide range of Ethnobotany or Phytochemical aspects, mostly involving native species.

Monari et al. (2022) analysed published Italian studies involving Ethnobotany and medicinal plants and collected data from 1117 species from 75 papers. The information helps to develop and preserve knowledge of those plants [ 6 ]. Through an ethnobotanical survey, Odebunmi et al. (2022) registered species from 29 families used by Nigerian people to treat COVID-19 and related symptoms (flu and cough). The most cited plants by the 56 participants of the study were Zingiber officinale Roscoe and Citrus limon (L.) Osbeck [ 7 ]. Berlowitz et al. (2023) described the medicinal use of Nicotiana rustica L. to treat a woman with several mental disorders in the Peruvian Amazon [ 8 ].

The family Amaryllidaceae was the subject of two studies. In the first paper, Tallini et al. (2022) described the chemical profile of three Peruvian species from the genus Rauhia [ 9 ]. The authors identified 30 different alkaloids by GC-MS in the extracts of Rauhia staminosa Ravenna, R. decora Ravenna, and R. multiflora Ravenna. Rauhia multiflora presented the highest acetylcholinesterase inhibition, followed by R. staminosa and R. decora. In the second paper, Gomes-Copeland et al. (2022) showed the activity of Hippeastrum stapfianum (Kraenzl.) R.S.Oliveira & Dutilh, a Brazilian species, on acetylcholinesterase inhibition and interacting with the nuclear receptors PPAR-α and PPAR-γ [ 10 ].

Carneiro et al. (2022) described an extract of Morus nigra L. presenting agonism on both PPAR-α and PPAR-γ and its capacity to reduce the production of ROS, NO, and TNF-α on RAW 264.7 cells [ 11 ].

The isolation of natural compounds presenting pharmacological activity plays an important role in the valorisation of plants traditionally used as food or medicine. The cytotoxic activity of tylophorinidine, a phenanthroindolizidine alkaloid isolated from Tylophora indica (Burm.f.) Merr, an Indian native species, was described by Mostafa et al. (2022). The compound presented IC 50 values of 6.45, 4.77, and 20.08 μM in MCF-7, HepG2, and HCT-116 cell lines, respectively [ 12 ]. The in vitro cytotoxic and anti-migratory effects of extracts from Marantodes pumilum Blume Kuntze, a Malaysian plant, as well as of an isolated compound from the chloroform fraction, 5-henicosene-1-yl-resorcinol, on prostate cancer cells (PC3) was shown by Hanafi et al. (2023). The authors found that the mechanism of action involves apoptosis, inhibition of both migration and invasion, and inhibition of angiogenesis [ 13 ].

Souza et al. (2023) showed the diuretic action of hesperidin, a flavanone glycoside from Citrus fruits, in hypertensive rats. The authors suggested that the activity is associated with the cholinergic pathway [ 14 ].

Essential oil has played a vital role in Ethnobotany since ancient times. Alsharif et al. (2022) characterised the volatiles in the leaves of Capparis cartilaginea Decne from Saudi Arabia. The GC-MS analysis led to the identification of isopropyl isothiocyanate, 2-methylbutanenitrile, 2-butyl isothiocyanate, isobutyronitrile, and 3-methyl-butane nitrile [ 15 ]. Neves et al. (2022) evaluated the essential oil from the Brazilian Campomanesia lineatifolia Ruiz & Pav. on four Helicobacter pylori strains. The essential oil inhibited the growth of all strains, with an MIC = 6 L/mL [ 16 ]. Additionally, the essential oil from Pulicaria dysenterica (L.) Bernh., collected in Serbia, was tested on acute toxicity, antimicrobial and antispasmodic activity, acetylcholinesterase inhibition, and cytotoxic properties by Radulovic et al. (2022). The authors identified a new natural compound (3-methoxycuminyl 2-methylbutanoate) and another rare one (3-methoxycuminyl 3-methylbutanoate) [ 17 ].

Finally, Sarapan et al. (2023) discussed some botanical aspects of Disporopsis longifolia Craib, a traditional Asian medicinal plant. The findings of this research are useful for the quality control of this plant drug [ 18 ].

Therefore, if well conducted, Ethnobotany research and the interaction between academics and traditional communities can help to preserve biodiversity, improve the local economy, and rescue and protect traditional knowledge.

Author Contributions

Conceptualization, D.S. and F.B.; writing—original draft preparation, D.S. and F.B.; writing—review and editing, D.S. and F.B.; visualization, D.S. and F.B. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest.

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Medicinal Plants: Biodiversity, Biotechnology and Conservation pp 327–341 Cite as

Conservation and Sustainable Use of Medicinal Plants

• Maura Lins dos Santos 4 ,
• Deepak Chandran 5 ,
• A. S. Lejaniya 6 &
• Luiz Everson da Silva 4  
• First Online: 08 July 2023

343 Accesses

Part of the book series: Sustainable Development and Biodiversity ((SDEB,volume 33))

The research of natural products has reached, in the last years, a wide amplitude and diversification in the chemical area. Its importance is revealed by its application in the most diverse fields of knowledge, with studies directed to the understanding and use of biodiversity. Besides the economic interest, aiming at the use of these metabolites in the production of perfumes, dyes, medicines, pesticides, etc., one must consider the scientific knowledge that contributes to the development of several areas of science, such as pharmacology, botany, organic chemistry, evolution, and chemical ecology. In this chapter, we have discussed the sustainable use of medicinal plants in a conservation perspective focused on the use of plant resource, sustainable use of biodiversity, bioprospecting, adding value to biodiversity products, biological activities, essential oil, seasonality effect, socioeconomic approaches, and some future prospects.

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dos Santos, M.L., Chandran, D., Lejaniya, A.S., da Silva, L.E. (2023). Conservation and Sustainable Use of Medicinal Plants. In: Jha, S., Halder, M. (eds) Medicinal Plants: Biodiversity, Biotechnology and Conservation. Sustainable Development and Biodiversity, vol 33. Springer, Singapore. https://doi.org/10.1007/978-981-19-9936-9_13

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REVIEW ARTICLE

Medicinal plant cultivation for sustainable use and commercialisation of high-value crops

Motiki M. Mofokeng I, II ; Christian P du Plooy I ; Hintsa T. Araya I, II ; Stephen O. Amoo I, III ; Salmina N. Mokgehle I, * ; Kgabo M. Pofu II ; Phatu W. Mashela II

I Agricultural Research Council -Vegetables, Industrial and Medicinal Plants (ARC-VIMP), Pretoria, South Africa II Green Biotechnologies Research Centre, University of Limpopo, Polokwane, South Africa III Department of Botany and Plant Biotechnology, University of Johannesburg, Johannesburg, South Africa

Correspondence

Many traditional healing systems are based on natural biological resources, and there is a general shift in most parts of the world towards natural medicine, with direct implications on the demand and supply of medicinal plants. This review highlights the economic importance of medicinal plants, their contribution to healthcare systems, and potential opportunities for rural economic development through cultivation. A systematic literature review with specific search terms related to medicinal plants was used to collect scientific and non-scientific information from peer-reviewed literature and grey literature databases. The findings indicate that trade in medicinal plants is increasing, and although they are considered minor crops compared to major food crops, their value is among the highest in the list of traded plants globally. The trade also serves as a revenue source for many rural livelihoods, with women playing a significant role. Medicinal plants contribute to primary health care in many developing countries, and they are also an essential source of modern drug discovery. Cultivation of medicinal plants offers emerging rural farmers an opportunity to grow these plants as new and alternative crops, thus reducing unsustainable wild harvesting and competition with established commercial farmers who mostly focus on food crops. Furthermore, medicinal plant cultivation should be promoted as one of the options for local economic development and sustainability through job creation, the revival of the rural economy, and income generation for small businesses, such as the transport businesses, involved in the value chain. Land accessibility, financial resources, and direct market access for rural communities can elevate their contribution to the industry. Formalisation of the lower levels of the medicinal plant trade is also recommended. SIGNIFICANCE : • Cultivation is a viable option for biodiversity conservation of medicinal plants and ensuring a good-quality supply of plant materials. • Cultivation of medicinal plants - a source of natural products used in product development - can contribute to job creation, income generation, and rural economies in developing countries. • This review underlines the importance of medicinal plants in product development, the contribution of the industry to economies of different countries, and the potential for cultivation.

Keywords : traditional medicine, medicinal use, unsustainable use, medicinal plant trade, medicinal plant industry

Introduction

Plant biodiversity fulfils various needs for daily human livelihoods, including health care. 1 The contribution of medicinal and aromatic plants to the agriculture output is relatively small compared to food crops. Still, their value in terms of volumes traded is among the highest in the list of traded plants. Thus they are amongst the high-value minor crops. 2 Notwithstanding the potential contribution to national agriculture through commercial cultivation, medicinal plants contribute to primary health care in many developing countries, and they are also an important source in modern drug discovery. 3 There is a general shift in many countries from acute disease incidences and management, towards chronic disease incidence, with implications on pharmaceutical demand and supply. 4 Many traditional healing systems are based on natural biological resources, particularly plants. For example, 20% of India's flora, 18.9% in China, 17.1% in Vietnam, 16.5% in Sri Lanka, 15.5% in Thailand 3 , and 10% in South Africa 5 are used as medicinal plants. Guided by the indigenous use of many plant species, several plant-based health supplement products are produced and marketed globally with the resultant increasing demands on good-quality plant raw materials.

Developmental pressure, with related habitat destruction and unsustainable harvesting, result in biodiversity loss. 6 Cultivation of medicinal plants provides several opportunities, including preservation of indigenous knowledge, access to primary health care through traditional medicine, local economic development, and job creation. 7,8 The developments mentioned above can be achieved through micro-enterprise development by indigenous and rural communities. 9 However, the cultivation of medicinal plants can sometimes be unprofitable due to competition with freely accessible wild-harvested plant materials. 10 Commercial wild harvesters can cause significant damage to medicinal plant populations and the environment. 6 This could be attributed to the pressure to generate income, with less concern for conservation. Recent statistics on medicinal plant trade and consumption are scanty, with limited information as medicinal plant trade is mostly part of an informal economy. 7 This review highlights the global trade and use of medicinal plants, the effects of cultivation practices on bioactivity, and perspectives on cultivated medicinal plants.

Methodology

A systematic literature review was used to collect scientific and non-scientific information related to the aim of the study. Search terms were created to extract sources from peer-reviewed literature on the Web of Science, Scopus, Science Direct, and grey literature databases such as Google. The search terms were "commercialization of medicinal plants", "trade in medicinal plants", "cultivation of medicinal plants", "use of medicinal plants", and "acceptance of cultivated medicinal plants". Scientific articles and non-scientific literature published between 1995 and 2021, at the time of submission of the manuscript, were considered. To minimise non-target articles, less relevant publications were excluded after scanning through their titles and abstracts. To develop a list of selected medicinal plants and compounds isolated from their different parts for medicinal use, medicinal plants that were already commercialised or had the potential to be commercialised, originating from Africa or naturalised through cultivation, were considered.

The global trade in medicinal plants

The development of plant-based drugs has been listed as the next significant development in commercial biotechnologies as it would offer an opportunity to supply low-cost, quality pharmaceuticals to marginalised communities in developing countries. 4 The trade in medicinal plants occurs at three primary levels: national (within countries), regional (across borders on a continent), and international (the formal export trade). 11 At all levels, the value of medicinal plants is not only in financial income but also in health care, cultural identity, and livelihood security. The global trade in medicinal plants is dominated by a few countries, with three international trade centres: Germany, the USA, and Hong Kong. 12

The formal trade in plant-based medicine has had an attractive return on investment over the past years. The global traditional medicine industry was estimated to be worth USD60 billion in 2006. 2 In 2014, the worldwide trade in plant-based medicine was worth USD940 billion. 4 This shows an increase in the global trade from the estimated USD30 billion in 2000. 13 Accurate estimates in the trade are difficult because medicinal plants are also used for other non-medicinal purposes, and also because the increased global interest in medicinal plants has led to an 'underground' trade which is mostly not recorded. 13 In general, the reports show an increase in investment in the trade by individual countries, despite differences in the figures reported. For example, compared to USD800 million in 1980 4 and USD1.6 billion in 1999 14 , USD17 billion was spent in the USA on traditional medicine in 2000 15 , which was a relative increase of 20-25%. The traditional Chinese medicine industry alone was estimated to be worth USD83 billion in 2012. 15 In India, the trade in herbal products was estimated to be worth USD120 billion in 2015 and is expected to reach USD7 trillion by 2050. 16 In general, Europe imports from Africa and Asia an estimated 400 000 tonnes of medicinal plants per annum, to the value of USD1 billion. 2,17 The supply of raw materials in Germany was approximately 30 700 tons with a value of EUR84 million (USD 101 938 200) in 2019, with 90% of the plant materials being imported. 18 Pakistan exported therapeutic plant materials valued at USD10.5 million and similarly imported materials valued at USD130 million in 2012. 2 Overall, high-income countries such as Germany, Japan, and USA, with only 15% of the world population, dominated the formal trade with an increase in shared value from 89.1% in 1985 to 92.9% in 1999. 4 In contrast, the combined shared value of low-income countries for the same period decreased from 10.9% to 7.1%. 4 The international status, in terms of demand, of many South African medicinal plant species is increasing. For example, wild ginger (Siphonochilus aethiopicus (Schweinf.) B.L. Burtt) and African potato (Hypoxis hemerocallidea Fisch., C.A.Mey. & Avé-Lall.) have become more prominent as a growing number of venture companies started utilising them in their formulations. 19

The national and regional trade is characterised by informal markets ( Figure 1 ) managed by harvesters, hawkers, healers, small traditional medicine chemists, and large traditional medicine markets. The majority of people, between 200 000 and 300 000 in South Africa alone, involved in the value chain of this 'hidden economy' come from rural households and disadvantaged socio-economic backgrounds. 19,20 The informal medicinal plant trade in Africa has a significant socio-economic role as it enables millions of people living in rural areas to generate income. 21 In 1998, an estimated 20 000 tons of South African medicinal plant materials were traded at a value of USD38 million. 21 Thirteen years later, in 2011, the total value of the South African bioprocessing segment, which includes primary and secondary processing of indigenous resources, was estimated at ZAR482 million. 22 Based on the average 2011 currency exchange rate (ZAR7.27 = USD1 23 ), this translated to USD66 million. There are, however, variations reported in the value of the medicinal plant trade. For example, other reports estimated that the total value of the trade was ZAR2.9 billion per annum in 20 0 6 24 , whereas Myles et al. 25 estimated the value to be approximately ZAR520 million in the same period (2006 exchange rate 23 : ZAR6.78 = USD1). This could be because the trade is mostly informal and, at times, there is supplementation of the plant materials in South Africa with materials from neighbouring countries such as Botswana, Lesotho, Zimbabwe, and Mozambique. 24 Most of the cross-border trade in medicinal plants that was reported between Malawi and other SADC countries such as Botswana, Lesotho, Zimbabwe, Zambia, Mozambique, and South Africa, is illegal 26 and thus poorly recorded. For example, although there was no record of trade in Mondia whitei (Hook. F.) Skeels - an endangered species of high demand in South Africa - the government of Malawi reported evidence of trade in this species between the two countries. 26

Plant secondary metabolites and their global use in medicines

Plant secondary metabolites play an essential role in plants' interaction with the environment, protecting plants against or helping them to survive biotic and abiotic stress. 27 The production of secondary metabolites in plants is dependent on growth conditions and the physiological responses of plants to different environmental conditions. 28 Plant-specific secondary metabolites include phytoalexins, which are antimicrobial compounds synthesised by plants after infection with microorganisms, and may act individually, additively, or synergistically to improve human health. 27,29,30 Secondary metabolites play a role in the signalling and regulation of primary metabolic pathways in plants. 31

Natural products from plants (phytochemicals) play an important role in drug development processes. The use of some medicinal plants has led to the discovery and isolation of drugs used in the treatment of various human diseases and ailments. 29 For instance, artemisinin from Artemisia annua L. has been successfully used as an effective anti-malarial. 28,32 Ellipticine from elliptic yellowwood (Ochrosia elliptica Labill.) has been used as an anti-cancer drug. 28 Extracts from African geranium (Pelargonium sidoides DC.), which contains coumarins, have promising lead candidates for developing herbal drugs for HIV management. 33 Some of the phytochemicals from African potato corms - including daucosterol, beta-sitosterol, and hypoxoside - have therapeutic properties 34 , which have been exploited in the management of HIV/AIDS, cancer, and sexually transmitted diseases 35-37 . Aloe ferox Mill. leaf gel, which contains aloin as an active ingredient, and Lessertia frutescens (syn. Sutherlandia frutescens L.; Fabaceae) containing pinitol and canavanine, were found to be promising in alleviating or preventing non-communicable diseases such as cancer, neurodegeneration, diabetes, and cardiovascular diseases. 30,38 The cited examples demonstrate some crucial roles that plant-based medicines can play in managing chronic and acute diseases. Some plant bioactive compounds used in modern therapeutics are listed in Table 1 .

Medicinal plants also have potential in combating or managing pandemic diseases of viral origin due to some plant secondary metabolite antimicrobial (antivirus, antibacterial and antifungal) properties or their attenuating effect on the disease. At least four medicinal plants (Azadirachta indica A. Juss., Eurycoma longifolia Jack, Nigella sativa L., and Vernonia amygdalina Delile) showed potential in the management of COVID-19 due to their antiviral, anti-inflammatory and immunomodulatory properties. 39 Four bioactive compounds, which are arabic acid, L-canavine, hypoxoside, and uzarin from Acacia Senegal (L.) Willd. (syn. Senegalia Senegal (L.) Britton), Sutherlandia frutescens, Hypoxis hemerocallidea, and Xysmalobium undulatum (L.) W.T Aiton, respectively, all of which are South African medicinal plants, may be exploited as therapeutic agents against SARS-CoV-2 based on their molecular modelling. 40

Globally, more than 25% of pharmaceutical drugs are of plant origin. 11 Between the years 2000 and 2005, five medicinal plant-based drugs were developed in the USA, and seven more were in clinical trials. 3 In Germany, more than 90% of the citizenry reportedly used herbal medicines alongside pharmaceutical drugs. 15 Alternative and complementary medicine, which relies on extracts from plant materials, gained popularity in America, where more than 62% of the populace was reportedly using plant-based remedies. 19 Close to 50% of the Australian and French populations reportedly used traditional medicine. 16 In China, approximately 40% of the consumed medicine was attributed to traditional herbal medicine. 17 The Chinese government made public their intentions to integrate traditional Chinese medicine into their healthcare system by 2020. 15 The intentions popularised the value of plant-based medicine in treating human ailments. Ayurvedic medicine ('Ayurveda' for short), which is one of the oldest holistic healing systems developed more than 3000 years ago in India, uses over 1200 medicinal plant species and has been included in the national healthcare system in India. 15,16 The national health policy of Bhutan, a landlocked country in South Asia, integrates the traditional medicine system into its healthcare system, with the traditional medicine hospitals providing a free healthcare service. 3 At least 90% of the Ethiopian population was reported to be using herbal remedies for primary health care. 30

Cultivation effects on the medicinal value of medicinal plants

The increasing threat of extinction coupled with the scarcity of several medicinal plants, such as Warburgia salutaris (G. Bertol.) Chiov. and Siphonochilus aethiopicus, as well as the related genetic loss warrants cultivation as a solution. 65 The commercialisation of selected medicinal plants and their medicinal value is driving and directing medicinal plant cultivation research ( Figure 2 ); for example, research on understanding the growth requirements and genetics of medicinal plant species. Cultivation is a crucial element in conservation strategies due to increasing urbanisation, habitat loss, population growth, and industrial developments. 66 Cultivation of medicinal plants can provide opportunities for improving purity and quality, consistency and bioactivity, and biomass production of raw materials. 65 Sustainable production of a number of innovatively developed plant-based products is often hampered by the inconsistent supply of high-quality plant raw materials. Cultivation can improve biomass production for sustainable supply without negatively affecting the bioactivities of the medicinal plants through the manipulation of the growing conditions. For example, the cultivation of P. sidoides under well-watered conditions increased the total biomass significantly, without significant alteration in the content of active compounds. 67 Similar results have been reported, where greenhouse cultivation of P. sidoides did not result in significant reductions in umckalin concentrations compared to the wild-collected plant material. 68

Additionally, in vitro cloned and greenhouse-acclimatised P. sidoides plants retained their phytochemical composition, based on phenolic compound profiling. 69 Greenhouse-grown, tissue-culture-derived tubers of Harpagophytum procumbens (Burch.) DC. ex Meisn. had a significantly higher total iridoid content than wild-harvested tubers. 66 Active compound concentrations can be affected by a number of factors such as the ecotype, age of plant, size, and season of collection. 66 Although the tubers were collected from different sites, the results indicated that cultivation could maintain the active compound content of the medicinal plant. Application of chemical fertilisers and irrigation improved the concentrations of the potent volatile compounds in Siphonochilus aethiopicusJ 0 A study by McAlister and Van Staden 71 showed that high levels of nitrogen, phosphorus, and potassium are necessary for increasing the biomass of Hypoxis hemerocallidea. However, once the plants are established, the nutrient application can be discontinued to increase the hypoxoside concentrations. This perhaps suggests that hypoxoside synthesis is enhanced when plants are under nutrient stress conditions, providing an opportunity to manipulate the growing conditions by altering the nutrient supply during plant growth.

When bulbs of cultivated Bowiea volubilis Harv. ex Hook. f. plants were compared to the wild-harvested ones sold in markets, there was no wide variation in the biological activities. 72 P. sidoides extracts from greenhouse-acclimatised plants demonstrated similar antimicrobial and antioxidant properties compared to the extracts from wild-collected plants, supporting the feasibility for large-scale cultivation. 69 The above studies indicate that the bioactivity of medicinal plants could be increased or maintained through the manipulation of agronomic practices.

Although cultivation of medicinal plants is recognised as being important for the development of the formal medicinal plant industry 73 and as a conservation strategy, there remains a paucity of information on the response of several commercially important medicinal plants to cultivation practices. Yet, as illustrated above, different agronomic practices, including irrigation, spacing, fertilisation, and plant growth management, influence not only yield but the quality of cultivated medicinal plants. Hence, the use of standardised and optimised cultivation procedures for each commercially important species becomes important to ensure a consistent supply of good-quality medicinal plant raw materials for the industry. However, some species are difficult to cultivate because of certain biological features or ecological requirements. 74 Other medicinal plants, particularly those whose underground parts are used medicinally, may take a long time to reach maturity, and some growers may not be able to afford to wait more than a year before harvesting due to economic feasibility challenges that may arise with initial capital investment requirement. 74 Research can play a significant role in technology development and transfer as a contribution to the medicinal plant industry and supporting the development of cultivation sites which can create jobs and revive rural economies. Availability of and access to plant materials can also contribute to the preservation of the indigenous knowledge related to various medicinal plants through continued use and generational information dissemination.

A paradigm shift on the use of cultivated medicinal plants?

Many users of traditional medicine view cultivated medicinal plants with much uncertainty, and this is because they are aware of the effect of the environment on the 'medicinal power' of the plants. 75 Many refer to the risk of 'metaphysical' dangers destroying the 'medicinal power' of medicinal plants cultivated outside their natural environment. 24 For example, nitrogen application resulted in reduced and unstable quantities of the active compounds in Salvia miltiorrhiza Bunge compared to the content in wild populations. 76 Such results highlight the need for further investigations into environmental factors or stimulus of secondary metabolites, such as water stress, soil type, and shading, which could influence the active ingredient quantities. Nonetheless, traditional healers and traditional knowledge holders are also aware that traditional health care is at risk because medicinal plants are becoming scarce. 76,77 For example, traditional healers in Zimbabwe recommended the cultivation of two threatened species, Warburgia salutaris, and Alepidea amatymbica Eckl. & Zeyh., to meet future demands of the species. 78 Furthermore, as many as 98 medicinal plant species were listed as being 'allowed' to be cultivated, whereas 68 were 'not allowed' to be cultivated by traditional healers in KwaZulu-Natal and Gauteng Provinces of South Africa. 9 Cultivation of medicinal plants has been recommended in many platforms, by traditional health practitioners, leading to efforts by the South African government to develop medicinal plant nurseries in various provinces.

Kelatwang 75 reported that 77% of the traditional healers interviewed appreciated a decline in populations of medicinal plants, a further indication of their understanding of the risk of extinction of some medicinal plants. About 69% of traditional healers interviewed in a survey by Dzerefos et al. 79 perceived a decrease in populations of medicinal plants, and the development of medicinal plant nurseries was recommended as the majority (58%) of the traditional healers mentioned that nursery-grown plants were acceptable for use. It seems that traditional health practitioners are now accepting cultivated medicinal plants, as 83% of those interviewed by Nefhere 80 showed interest in cultivating the plants, whereas 80% were willing to buy cultivated medicinal plant species. Similarly, 74% and 83% of the traditional healers and traders, respectively, accepted cultivation as a solution for declining medicinal plant populations. 10 Furthermore, 88% of street traders and vendors of medicinal plants were willing to buy cultivated medicinal plants. 80 Due to the time requirement of cultivation, 58% of the interviewed traditional healers and traders recommended farmers for commercialising medicinal plant cultivation. 10

On the other hand, pharmaceutical companies need consistency in the quality and market value of herbal products. 30 Appropriate standard operating procedures and proper management of raw materials through cultivation have been advocated as a strategy for quality assurance because medicinal plant materials can be collected from the same area and grown under the same conditions over a period. The optimisation of propagation and cultivation techniques will ensure the supply of good-quality planting materials for local growers and the supply of good-quality harvested materials to the industry. 14 Cultivation of medicinal plants is of great interest to pharmaceutical companies as it allows for the sustainability of supply, reliability in botanical identification of the plant materials, and guaranteed chemical homogeneity. At the same time, it allows for optimisation of secondary metabolite production through manipulation of the growing plants' environment. 14,24,76 Cultivation can also provide an opportunity for increasing the yields of secondary metabolites. As an example, the 'trichome management' technique not only increased biomass yields of leaves and stems and the related glandular trichome density, but it also increased the production and alkaloid (camptothecin) yield in trichomes of Camptotheca species. 76 The need for increased cultivation is a reality. For example, in Germany, 750 farmers were reported to be cultivating medicinal plants in a total area of 12 240 ha, and this area was reported to be only 12% of the area required to meet the industry needs 18 as domestic consumption was increasing.

Recommendations and conclusion

South Africa is faced with challenges in job creation, enterprise development, and revival of the economy. The medicinal plant industry can play a critical role in addressing these challenges as farming is a labour-intensive sector. The medicinal plant industry makes significant contributions to the economies of developing countries, such as South Africa. This contribution is through job creation, rural economy revival, and income generation for small businesses, such as the transport businesses, involved in the value chain. Furthermore, rural communities use medicinal plants for primary health care, as they are affordable and accessible. Cultivation of medicinal plants, which are in most cases harvested unsustainably from the wild, offers opportunities over and above the conservation of the species. These opportunities include more jobs, as more people will be needed to maintain the cultivated fields, increased income, and improved livelihoods of communities. Better prices can also be negotiated because quality and traceability can be guaranteed. However, land, financial resources, and direct market access for rural communities should be addressed as these can also unlock the industry. Research efforts optimising practices for improved yield without compromising quality should be intensified with appropriate funding support for technology development and transfer. In South Africa, different research institutions, government departments - such as the Departments of Science and Innovation (DSI), Trade, Industry and Competition (DTIC), Small Business Development (DSBD), Forestry, Fisheries and Environment (DFFE) - in collaboration with knowledge holders, are already putting in significant efforts in an attempt to formalise the medicinal plant industry. However, there is room for improvements, especially to ease the administrative and compliance burden placed on researchers. Government regulations should be balanced to protect the environment but also to promote sustainable use of natural resources. With enough support, research findings can inform conservation and biodiversity management strategies for effective protection and efficient use of South African biodiversity.

Oversupply of medicinal plant materials can have a negative impact on prices. Therefore, production needs to be managed in relation to market demand. It is also essential to formalise the local medicinal plant trade, especially because traditional health practitioners are starting to accept cultivated medicinal plants so that the contribution to the economy can be recognised. The local trade can be used to develop the emerging growers of medicinal plants, such that they can understand the industry and then graduate to the cross-border trade and ultimately to the international trade where they can supply international pharmaceutical companies.

Competing interests

We have no competing interests to declare.

Authors' contributions

M.M.M.: Conceptualisation; writing - the initial draft. C.Pd.P: Critical review; commentary; writing -revisions. H.T.A.: Conceptualisation; review of the draft. S.O.A.: Critical review. S.N.M.: Inputs in writing the initial draft. K.M.P.: Inputs in writing the initial draft. P.W.M.: Critical review, commentary; writing - revisions.

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75. Kelatwang TS. The acceptability of medicinal plant gardens: Healers' perspective from Nkomanzi East Region [master's dissertation]. Pretoria: University of Pretoria; 2002.         [  Links  ]

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Received: 01 Sep. 2021 Revised: 27 Jan. 2022 Accepted: 18 Feb. 2022 Published: 28 July 2022

EDITOR: Teresa Coutinho FUNDING: None * Current: School of Agricultural Sciences, University of Mpumalanga, Mbombela, South Africa

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Tam, Chun Fung. "Microscopic identification of western medicinal herbs." HKBU Institutional Repository, 2008. http://repository.hkbu.edu.hk/etd_ra/917.

Tshidino, Shonisani Cathphonia. "Efficacy of two medical plant extracts and metformin in the prevention of diet induced fatty liver." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/9066.

Wong, Queenie Lai Lai. "Pharmacognostic studies on folk medicinal herb xihuangcao." HKBU Institutional Repository, 2015. https://repository.hkbu.edu.hk/etd_oa/215.

Xu, Jun. "Improved approaches and strategies for analyzing decoctions of medicinal herbs." HKBU Institutional Repository, 2015. https://repository.hkbu.edu.hk/etd_oa/216.

Van, Rooyen Anzel. "The effect of in vitro digestion on selected biological activities of Hypoxis sobolifera corms." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020058.

Sagbo, Idowu Jonas. "Phytochemical analysis and antibacterial properties of aqueous and ethanol extracts of Brachylaena elliptica (Thurb.) dc. and Brachylaena ilicifolia (Lam.) Phill & Schweick." Thesis, University of Fort Hare, 2015. http://hdl.handle.net/10353/d1021289.

Zhang, Qi. "The study of novel dioxin antagonist-euxanthone and its derivatives." HKBU Institutional Repository, 2003. http://repository.hkbu.edu.hk/etd_ra/507.

Mngeni, Nasipi Zamanala. "Bioactive compounds from selected medicinal plants used in antidiabetic treatment." Thesis, Cape Peninsula University of Technology, 2017. http://hdl.handle.net/20.500.11838/2665.

Wu, Menghua. "Pharmacognostical studies on medicinal spices : ethnobotanical, bencaological and plant taxonomic studies." HKBU Institutional Repository, 2013. http://repository.hkbu.edu.hk/etd_ra/1497.

Boukes, Gerhardt Johannes. "The in vitro biological activities of three Hypoxis species and their active compounds." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1228.

Tsang, Hing Yan. "Anti-tumour and anti-angiogenic effects of euxanthone." HKBU Institutional Repository, 2001. http://repository.hkbu.edu.hk/etd_ra/363.

Adefuye, Ogheneochuko Janet. "Anti-diabetic and phytochemical analysis of sutherlandia frutescens extracts." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/3549.

Zhu, Peili. "Anti-hepatocellular carcinoma mode and mechanism of action of antrodia camphorata mycelia." HKBU Institutional Repository, 2019. https://repository.hkbu.edu.hk/etd_oa/605.

Su, Tao. "Chemical and pharmacological basis for processing pinelliae rhizoma with ginger juice and alumen." HKBU Institutional Repository, 2016. https://repository.hkbu.edu.hk/etd_oa/333.

Odeyemi, Samuel Wale. "A comparative study of the in vitro antidiabetic properties, cytotoxicity and mechanism of action of Albuca bracteata and Albuca setosa bulb extracts." Thesis, University of Fort Hare, 2015. http://hdl.handle.net/10353/3154.

藍永豪. "薑科藥材的藥用部位與功效的共性探討." HKBU Institutional Repository, 2010. http://repository.hkbu.edu.hk/etd_ra/1137.

Wei, Wei. "Immunomodulating effects of natural polysaccharides isolated from astragali radix and dendrobii officinalis caulis /Wei Wei." HKBU Institutional Repository, 2016. https://repository.hkbu.edu.hk/etd_oa/350.

Muwanga, Catherine. "An assessment of Hypoxis hemerocallidea extracts, and actives as natural antibiotic, and immune modulation phytotherapies." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3303_1184589097.

In South Africa, the crude aqueous extract from Hypoxis hemerocallidea is used by AIDS patients to treat opportunistic infections, such as tuberculosis. The rapid emergence of multidrug-resistant tuberculosis, and extreme drug resistant tuberculosis, in recent years, is a major threat to human health. The treatment of TB, nosocomial bacterial infections, and fungal infections is now a clinical challenge, especially in the immuno-compromised individual. There is a dire need for novel antibiotic alternatives with phytotherapies and plant-derived compounds as potentially promising alternatives. The main objective of this study was to investigate the antimycobacterial activity of Hypoxis hemerocallidea, a South African medicinal plant, using Mycobacterium smegmatis.

Harris, Taahir. "Bambara groundnut (Vigna subterranean) from Mpumalanga province of South Africa: phytochemical and antimicrobial properties of seeds and product extracts." Thesis, Cape Peninsula University of Technology, 2017. http://hdl.handle.net/20.500.11838/2789.

Garnett, Khanungnit Kym. "British Indo-Asians with diabetes mellitus : their adherence and use of medicinal plants." Thesis, University of Warwick, 2004. http://wrap.warwick.ac.uk/39296/.

Yengkopiong, P. J. "The assessment of the therapeutic and toxicological properties of carpobrotus acinaciformis and schkuhria pinnata used in traditional medicine in South Africa." Thesis, University of Limpopo (Medunsa Campus), 2005. http://hdl.handle.net/10386/846.

Xie, Haiyan. "The inhibitory activities of constituents of the three main categorites in ginkgo biloba towards amyloidi-ß peptide aggregation." HKBU Institutional Repository, 2014. https://repository.hkbu.edu.hk/etd_oa/68.

Wang, Jingrong. "Phytochemical and pharmacological studies of the root of ilex pubescens." HKBU Institutional Repository, 2008. http://repository.hkbu.edu.hk/etd_ra/899.

Komperlla, Mahesh Kumar. "The formulation and evaluation of rapid release tablets manufactured from Artemisia Afra plant material." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&amp.

Infusions, decoctions, alcoholic preparations and other dosage forms of Artemisia afra are frequently used in South African traditional medicine. Generally when these preparations are made without applying good manufacturing practices they do not meet microbial quality control standards, safety and toxicity criteria and encourage poor patients compliance. To overcome the aforementioned disadvantages of traditional dosage forms a sold dosage form, i.e. a table might be recommended. The first objective of this study was to formulate and manufacture a rapid release tablet dosage of Artemisia afra that would contain an amount of plant material equivalent to that found in its traditional liquid dosage forms and that would meet conventional pharmaceutical standards. The second objective was to conduct a pilot study to obtain a preliminary profile of the bioavailability of select flavonoids presents in both the tablet and traditional liquid preparation of Artemisia afra in humans.

Yang, Xiaotong, and 楊曉彤. "The anticancer mechanisms of polysaccharide peptide (PSP) derived fromthe Chinese medicinal fungus coriolus versicolor." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31246229.

Cardoso, Gabrielle Aparecida. "Efeito do consumo de chá verde aliado ou não ao treinamento de força sobre a composição corporal e taxa metabólica de repouso em mulheres com sobrepeso ou obesas." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/11/11141/tde-18102011-155801/.

Guo, Hui. "A study on the anti-inflammatory activity and mechanism of action of herba siegesbeckiae (Xixiancao)." HKBU Institutional Repository, 2018. https://repository.hkbu.edu.hk/etd_oa/533.

羅美珍. "雲芝現代藥學及其抗腫瘤作用文獻研究." HKBU Institutional Repository, 2008. http://repository.hkbu.edu.hk/etd_ra/966.

Manana, Jabulile Vuyiswa. "Identification of commonly used traditional medicines by planar chromatography for quality control purposes." Diss., University of Pretoria, 2003. http://hdl.handle.net/2263/28107.

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South African Medicinal Plants Used in the Treatment of Human Bacterial Infections: An updated Review

Department of Life and Consumer Sciences, School of Agriculture and Life Sciences, University of South Africa, Private Bag X06, Florida, South Africa.

Corresponding Author e-mail: [email protected]

DOI : https://dx.doi.org/10.13005/bpj/2771

Traditional medicine based on the use of medicinal plants plays an important role in the preservation of health and well-being of many people globally. Today herbal medicine application is progressively finding more significance especially with the acknowledgement of the challenges of antibiotic resistance. The aim of this review was to collect literature based on the traditional application of South African medicinal plant species used in South Africa to prevent and treat various pathogenic bacterial infections. The search was carried out using key electronic scientific databases including PubMed, Google Scholar, SpringerLink, ProQuest, Science Direct, Elsevier, BioMed Central. Other sources of literature included scientific articles, book chapters, dissertations, theses and websites. It was found that Bacillus spp., Escherichia coli , Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently investigated bacterial pathogens which have developed resistance to most of the available standard antibiotics. Organic and aqueous extracts of many South African plants including Acacia karroo , Psidium guajava, Punica granatum , Eucomis autumnalis, Vernonia amygdalina  and Cyathula uncinulata have demonstrated potent antibacterial efficacy against the aforementioned pathogens.  This review exemplifies that South African medicinal plants have the potential to be considered as new leads for the development of antibacterial agents against resistant pathogens.

Antibiotic resistance, Antimicrobials; Human bacterial infections; Medicinal plants; South Africa

Introduction

Medicinal plants play an important role in the preservation of health and well-being of many people and animals across the globe 1-2 . In the past, many people have relied on indigenous herbs with remedial actions for the prevention and treatment of infectious diseases 3 . There is a growing amount of literature on the use of medicinal plants and their benefits, across the world including South Africa 4-5 .

According to ethnobotanical survey, South Africa has a strong history of traditional healing and anchors a rich biodiversity of more than 30 000 plant species 6-8 . However, over 4000 species are recognised to have ethnobotanical importance, with more than 3000 plants used for medicinal purposes 9-10 . Notably, more than 10% of the world’s higher plant species of medicinal value grow in South Africa 7-8 . Furthermore, most of these plant species are native species while a few are exotic species which were accidentally or deliberately introduced to South Africa over the years 11 .

The use of medicinal plants to treat vast diseases by inhabitants of Sub-Saharan Africa is enormous so that the traditional medicine has been understood as part of African culture 12 . According to researchers, medicinal plants have a myriad of diverse bioactive compounds with complex chemical profiles that contributes to their massive usage in the treatment and prevention of many diseases 7, 13, 14 .These diseases include, but not limited to, asthma, diabetes, cancer, food borne diseases, nosocomial infections, mental and gynaecological problems, hypertension as well as tuberculosis 4, 15, 16 .

However, the majority of the diseases are caused by organisms of bacterial origin including but not limited to Staphylococcus aureus, Escherichia coli, Mycobacterium tuberculosis, bacillus spp., Klebsiella spp., Streptococcus spp. and Pseudomonas aeruginosa 15, 17 . Many scientific investigators have reported these bacterial pathogens of being resistant to a majority of the mainstream antibiotics design to kill them including those of last resort such as carbapenems, colistin, and tigecycline 18-20 . Due to this phenomenon, the frail are left with no other choice but to explore medicinal herbs as an alternative means to regain health 21-23 . 16 , have reported the potential incorporation of traditional medicine with the Western counterparts as part of its primary healthcare approach in South Africa.

Scientific studies depicted that plants growing in South Africa have been used to remedy many bacterial infections including but not limited to diarrhoea, dysentery, skin and wound diseases, tuberculosis and pneumonia 17, 24-26 .  Also, 10 recounts the historical systematic use of medicinal plants in South Africa to treat bacterial diseases and the progress that has been made which could lead to future exploration of these plants as new pharmaceuticals. Today, South Africa has a good documented record of medicinal plant use to cure infectious diseases including those of bacterial origin 17 .  Therefore, the aim of the study was to report on South African medicinal plant used in the treatment of human bacterial infections.

Materials and methods

The search was carried out using key electronic scientific databases including PubMed, Google Scholar, SpringerLink, ProQuest, Science Direct, Elsevier, BioMed Central. Other sources of literature included scientific articles, book chapters, dissertations, theses and websites.  The key words such as “medicinal plants”, “antioxidants”, “bacterial infections”, “traditional medicines”, “bioactive compounds”, and “South Africa”, were used to get the trimmed searches. 

Parts of medicinal plants frequently used

It has been reported that the herbal preparations used during various treatments comes either from whole plant or from parts including the leaves, flowers, tubers, stems, roots, fruits and barks 27-28 . However, the parts of plants reported as frequently used in traditional medicine practices in South Africa includes but not limited to the ones listed below:

Tree barks are made of a hard outer layer of actively dividing living cells which functions to transport nutrients, acts as a physical barrier and protects the plant 29-30 . Some researchers have reported that the barks of most medicinal plants contain substantial amounts of bioactive substances necessary to prevent and cure a variety of infections 31-32 . According to 33 , more than 30% of the woody plant bark used in the Limpopo province in South Africa have been reported to have high medicinal values. In South Africa, more than one third of the plant materials used in traditional medicine comes from the bark of plants 32, 34 .

The leaf of a plant is an important structure as it manufactures food that the plant needs for its growth and survival through the process of photosynthesis 35 . The leaf is also fused with green substances known as chlorophyll which absorbs sunlight that aids in the conversion of carbon dioxide and water to glucose needed for plant’s growth 35 . However, some of the leaves used during traditional medicine practices are known to contain bioactive substances  including the leaves of Burkea Africana,   Lippia javanica and Leucaena leucocephala 36-38 .

Plants roots help to anchor the plant to a surface by creating resistance and helps to transport substances necessary for its growth from the soil to the rest of the plant 39 . In traditional medicine, the application of plant roots either independently or in combination with other plant parts is common as reported by 40-41 . Research has demonstrated that most roots of plants used in traditional medicine contains important  phytochemicals 42-43 . Some of the plants that have their roots used as medicine includes but not limited to devil’s claw root, stinging nettle root and ginseng 42, 44 .

According to 41 , most traditional healers are convinced that the roots and bulbs of plants or any part hidden beneath the earth contains higher healing powers than any other plant part. In line with this, a research by 40 found out that the roots and other under-ground parts of plants holds elevated concentrations of plant natural substances. According to an ethnobotanical survey conducted by 27-28 , the roots and barks are the most used and preferred over other parts by the indigenous people. Furthermore 45 ,  was in agreement with this and reported on similar findings that the bark and roots are the most favoured parts of plants used by the Tsonga people of Mpumalanga province in South Africa, as illustrated in Figure 1.

 Antimicrobial ethno-medicinal plants used in South Africa

According to World Health Organisation, more than 60% of people depend on traditional medicine for the purpose of preventing and treating diseases 46 . This includes 80% of the populations from underdeveloped and developing countries including South Africa 45, 47 . The traditional application of medicinal plants as medicine is one of the key sources of health care in South Africa 16 . Additionally, South Africa is reputable for traditional healing using medicinal plants and it is estimated that over 27 million people in both townships and the rural communities prefer and rely on traditional medicine for their primary health care 9, 45, 48 . Of this, 16 reports that 72% of the population are the Black Africans including the Zulus, the Xhosa, the Bapedi, the Venda people,  the Northern and the Southern Sotho people make use of traditional herbal medicine the most. A recent survey conducted by 16 , on the use of natural plant products to treat human diseases in the Limpopo province of South Africa had similar findings. However, the remainder of the population including the Whites, mixed race, Indians and Chinese also use traditional medicine but at a lesser extent 49 . Numerous ethnobotanical surveys done in South Africa revealed that a significant amount of plant species are used as medicine especially in regions including KwaZulu-Natal and Limpopo to relieve symptoms of bacterial, fungal and viral infections as shown in Table 2 5, 45, 50 .

In addition, 27 reported on parts from one plant species frequently used during the preparation of natural product medicine than a mixture of species. However, it is logical to speculate that harvesting and using parts from one plant species especially the roots as medicine is not sustainable as the plant survival is endangered. This practice of overharvesting and exploitation can kill the plant resulting to devastating consequences including species extinction 51 . This is particularly true for slow-growing and protected species 50 . 

Table 1 below shows the various plant species used to treat human ailments, parts, methods of preparation, parts of the plants that are commonly used, traditional therapeutic uses, and the distribution of plant in South Africa.

Bacterial diseases treated with indigenous medicinal plants in South Africa

It is not new that people use medicinal herbs to treat common health problems 16, 58, 92 . Previously published ethnobotanical reports elucidates that some of the illnesses and/ infections commonly prevented or treated with local medicinal plants in South Africa includes, but not limited to, oral infections, heart and lung problems, sexually transmitted infections (STIs), diabetes mellitus, headaches, infertility, erectile disorder, skin problems, gastrointestinal infections including diarrhoea, Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome (HIV/AIDS) and related infections, wounds, cancer, cardiovascular diseases, respiratory ailments including coughs and tuberculosis (TB), just to name a few 12, 16, 25, 28, 32,57-58 .  

According to past and resent research, South Africa has an elevated level of infectious diseases burden notably from bacterial origin 5, 93 ; even though viral, protozoal and helminthic, as well as yeast infectious agents have also been reported 17, 94-96 . This is in consistence with the research by 93, 95, 95 , who reports that a larger proportion of the deaths in South Africa results from  infectious diseases including tuberculosis, sexually transmitted infections (STIs) and diarrhoea.

Tuberculosis

The bacterium, Mycobacterium tuberculosis (TB) is the causative pathogen for tuberculosis which is problematic to the medical community and causes more than 1.5 million deaths in a year worldwide 89, 97 . In South Africa it is estimated that 28% of TB infection burden is due to HIV it its population, thus ranking fourth largest globally 98 . According to a review by 94 , in the year 2013 alone South Africa recorded 860 TB cases per 100 000 people. It is worth noting that tuberculosis has been reported as the leading cause of death in South Africa 5, 65, 95 .

A substantial number of studies have reported TB resistance to many pharmaceutical medications giving rise to multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) 95, 99-100 . However, plant natural material has been widely applied to treat TB infections due to the presence of its chemical constituents including alkaloids, glycosides, tannins, phenolics, xanthones, quinones, sterols and triterpenoids   30, 97, 101 .

The Bapedi traditional healers in the Limpopo province use a variety of plants including Psiadia punctulata (DC.), Vatke and Xerophyta retinervis Baker to cure TB and its associated secondary infections 5 . The Jongilanga local community in Mpumalanga also apply medicinal plants to remedy conditions of cancer, TB and acne 45 . According to a research by 101 , some herbs that are used by the inhabitants of the Free State Province to treat TB are active at very smaller concentrations and these includes   Dicoma anomala (0.195 – 6.25 mg/ml) , Hermannia depressa (0.78 – 1.56 mg/ml) , Senecio harveianus (0.195 – 0.39 mg/ml) and Lotononis lanceolate (0.195 – 0.65 mg/ml).

 Sexually transmitted infections (STIs)

Venereal diseases also called sexually transmitted infections (STIs) are mostly caused by bacterial pathogens including Treponema pallidum which causes syphilis, Neisseria gonorrhoeae which causes gonorrhoea and Chlamydia trachomatis which causes chlamydia infections 102-104 . However viral and parasitic pathogens have been reported to also cause STIs 76, 104 . It is estimated that in a year, in South Africa more than 11 million STI infections are recorded in the health registers 103, 105 .  The misconceptions and stigma attached to STIs in South Africa cause most of the people to favour traditional homemade remedies using medicinal plants over hospitals and local clinics visits 105 . Apart from that, undesirable effects as well as resistance to most STI orthodox medications have been reported 103 .

Many ethnobotanical surveys in South Africa have reported that most indigents apply a vast number of medicinal plants for the treatment of STIs including but not limited to Acacia karroo, Bidens pilosa, Carica papaya, Diospyros mespiliformis, Ficus abutilifolia, Rhoicissus tridentata subsp. cuneifolia, Ximenia caffra, Vachellia karroo, Trichilia dregeana , Terminalia sericea Cambess, Typha capensis Rohrb and Ziziphus mucronata Wild. subsp. mucronata 28, 50, 68, 103-104 . According to a research conducted by 104 , the root extracts of Acacia karroo and Rhoicissus tridentata subsp. cuneifolia plantswere active against Neisseria gonorrhoeae with MIC value of 0.8 mg/ml and 0.4 mg/ml respectively.

Similarly, the aqueous extracts of Bidens Pilosa leaf (mean MIC 83.2 mg/ml) and Ximenia caffra root (mean MIC 62.1 mg/ml) showed inhibitory activity against Neisseria gonorrhoeae pathogen 104 . Also, Trichilia dregeana produces a mean MIC of 2.0 mg/ml against Treponema pallidum 104 . A review by 57, 105 , agrees with this and reports on similar findings on the use of medicinal plants to treat STIs in South Africa.

According to 106 , diarrhoea is a common symptom that is usually related with the disorders of the gastrointestinal tract and is typically characterised by increased in the regularity of bowel movement associated with watery stools. Infectious diarrhoea other gastrointestinal illnesses are frequently triggered by resistant strains of medically important bacteria including B. cereus , E. coli, S. aureus , Salmonella typhimurium ( S. typhimurium ), Proteus vulgaris (P. vulgaris), and Shigella spp.,   107-108 . Similarly, viral as well as parasitic diarrhoea has been reported 107 . Diarrhoea has been reported as the major cause of death in low and middle income countries with over 6.9% death rate reported 108-109 .

In South Africa, the indigents usually apply various medicinal plants to remedy gastrointestinal diseases and conditions associated with diarrhoea 12, 108 . The pomegranate plant ( Punica granatum ), has been widely used to alleviate many health conditions including diarrhoea due to its rich phytochemical constituents such as flavonoids, alkaloids, saponins, tannins, phenols and anthocyanins 109-110 . According to 132 , the fruit peel extract of Punica granatum inhibits the growth of MRSA with zones of inhibition ranging from 22.0 mm to 11.3 mm. Similar research by   112 agrees with this and adds that the juice of pomegranate fruit shows inhibitory properties against B. cereus , E. coli, and S. aureus and produces 26.0 mm, 20.0 mm and 26.0 mm as diameter of inhibition respectively. Notwithstanding, the bark extract of Sclerocarya birrea shows activity against diarrhoeal pathogens with low MIC values including S. typhimurium (0.20 mg/ml), B. cereus (0.29 mg/ml), S. aureus (0.35 mg/ml), P. vulgaris (0.75 mg/ml) and E. coli (0.95 mg/ml) 108 . On the other hand, the extract from the leaf of  Psidium guajava ( P. guajava ) shows killing properties against B. cereus , S. typhimurium and S. aureus with MIC values of 0.34, 0.65 and 0.93 mg/ml respectively 108 . Additionally,   25 had similar findings and reports on the MIC values of various medicinal plants in South Africa against diarrhoeal entero-pathogens including Aloe arborescence against S. aureus (0.018 mg/ml), Eucomis comosa against Enterococcus faecalis (0.078 mg/ml) and Acacia mearnsii against S. typhimurium (0.039 mg/ml). This is consistent with the research conducted by 113 on the use of indigenous herbal plants in South Africa to treat diarrhoea caused by enteropathogenic bacterial organisms.

In a majority of instances, reports showed that one plant can be useful in curing multiple conditions and/ diseases (mono-therapy), for example garlic scientifically known as Allium sativum, is used to treat throat infections, TB, asthma, stomach diseases 60, 62 . Similarly, the cape aloe ( Aloe ferox ) is used in KwaZulu-Natal to remedy burns, sunburn, acne, insect bites, skin irritation, toothaches, stomach problems, sinusitis 7, 10 .

Even though indigenous plants have proven very useful to mankind, however over-exploitation of these plants threatened some species to disappear or near disappear on earth 34 . Due to this, the government of South Africa has introduced regulations and thus label some plants as endangered, and/or protected species including Curtisia dentata commonly called “assegai” in Afrikaans, Warburgia salutaris known as pepper-bark tree, and Zanthoxylum capense – a protected tree 34 . It is interesting to note that, while some of the plants used as medicine are largely distributed in the wild or grown in gardens at home, a majority are indigenous 37 . Of this, a smaller proportion are exotic and/ endemic in some parts in South Africa including Limpopo, Mpumalanga and KwaZulu Natal provinces 11 .

Pathogenic bacterial infections

Infectious diseases are major cause of mortality and disability, and remain the second leading cause of death across the globe 3, 5, 114-115 . This phenomenon is further exacerbated by the emergence of both old familiar and new unrecognised infectious disease pandemics 116-118 . Microbial infectious diseases cause more than 50% of all the deaths that occur in the underdeveloped nations particularly African countries 3, 21, 100 .

There is a rising amount of information to indicate that most of the diseases which are problematic to human health are said to be infectious and are mostly caused by pathogenic microorganisms including bacteria, viruses, parasites and fungi 95, 115, 119-120 . It is of importance to note that infectious diseases occurring as a result of bacterial infections are reported to be the number one killer disease than any other category of disease globally 95, 114 . These bacterial infections accounts for 43% mortality rate recorded in the underdeveloped countries whilst only 1% of the mortality rate is recorded in the developed countries 121 .

The high level of infectious disease burden in a population with minimal health resources, comes with the associated ramifications including death. According to Stats 95 , recorded deaths in South Africa for the period between 2014-2017 caused by infectious and parasitic diseases was 78 562 amounting to 17.2% demises.  A substantial amount of health-care costs in South Africa has also been incurred as a result of infectious diseases 25 .

Plants as alternative source of antimicrobials

Plants are generally known to be the biggest stores of naturally occurring biochemical compounds and are capable of manufacturing diverse natural chemical constituents including toxins and/ pheromones as a form of defence mechanism against other organisms or for pollination respectively 3, 122-123 . These chemical substances are of course not placebo but are fused with low molecular weight potent bioactive constituents also known as secondary metabolites 124-125 .

As early as the 1850s, plants’ secondary metabolites have received intense investigation 125-126 . Currently, more than 12,000 bioactive compounds from plants have been isolated and are further classified based either on their chemical composition and structure, their biosynthetic origin or their solubility 124, 127 . Due to this, the compounds were further segregated as alkaloids, terpenoids, phenolics, saponins, lipids and carbohydrates 128-129 . These chemicals have promising therapeutic effects on which human beings rely on 14 . The presence of these phytochemical constituents in plants perhaps explains their countless applications in traditional medicine 129-130 .

The inhibitory properties of South African medicinal plants against bacterial pathogens

After unsuccessful attempts to eliminate pathogens with conventional medicines due to drug resistance, some plant secondary metabolites were considered. Numerous scientific studies have revealed significant antibacterial activities of some plants against multidrug-resistant pathogens of bacterial origin 128, 130-131 (Table 2).

According to 132 ; organic and aqueous extracts of Vernonia amygdalina shows antibacterial effect against Pseudomonas aeruginosa , Klebsiella spp., Streptococcus spp., Bacillus cereus , Bacillus pumilus , Bacillus subtilis , Enterobacter cloacaem , E. coli and Staphylococcus aureus . In a research conducted by 25 , plant extracts from Psidium guajava,   Eucomis autumnalis and Cyathula uncinulata showed promising antibacterial effect against S. aureus with minimum inhibitory concentration (MIC) values ranging from 0.018 mg/ml to 2.5 mg/ml. Correspondingly, 101 reported  that the extracts from the leaves of Eucomis autumnalis was active against Bacillus pumilus, Escherichia coli and Staphylococcus aureus   at a minimum inhibitory concentration (MIC) of 0.098 mg/ml, 0.130 mg/ml and 0.098 mg/ml respectively. This is in consistence with the research conducted by 105 , in which the Bolusanthus speciosus bark used by the Veda indigents to treat venereal diseases showed good inhibitory activity against E. coli and S. aureus with ranges of MIC values between 0.012 mg/ml and 0.098 mg/ml. This validates the idea that plants could be used as alternative source of antibiotics.

Table 2: South African medicinal plants with promising antimicrobial activity against a variety of susceptible and resistant pathogenic strains .

The reviewed publications are focussed on biological activities, antioxidant and antimicrobial activities of South African plants used to treat human bacterial infections.  Yet additional data and published clinical trials are still needed to confirm therapeutic properties of the researched medicinal plants.  The practice of traditional medicine through the application of plant natural product still plays a vital role in fulfilling the rudimentary health care needs of the people of South Africa. Acacia karroo, Bidens pilosa, Diospyros mespiliformis and Ximenia caffra were the commonly applied herbs for the treatment of venereal diseases. On the other hand, diarrhoea and other stomach related ailments caused by pathogenic bacteria were remedied with Allium sativum, Eucomis comosa, Psidium guajava, Punica granatum and Aloe spp . Moreover, Aloe barbadensis, Cassia abbreviata, Helichrysum caespititium, Hypoxis colchicifolia and Sutherlandia frutescens were mostly used by HIV positive patients to alleviate opportunistic infections including TB, diarrhoea and skin infections. The leaves, bark and root were frequently used plant parts while the preferred methods of preparation were decoction and infusion. This study demonstrates the usefulness of plant natural product as medicine to prevent and treat human pathogenic infections caused by resistant bacteria in South Africa.

Acknowledgements

The authors would like to thank the staff members of the Department of Life and Consumer Sciences for their support in writing this paper.   

Conflict of interest

The authors declare no conflict of interest.

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Search for dissertations about: "medicinal plants"

Showing result 1 - 5 of 35 swedish dissertations containing the words medicinal plants .

1. Macrocyclic polypeptides from plants

Author : Ulf Göransson ; David Craik ; Uppsala universitet ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; Pharmaceutical chemistry ; Farmaceutisk kemi ; Pharmaceutical chemistry ; Farmaceutisk kemi ; Pharmacognosy ; Farmakognosi ;

Abstract : The aim of this work was to explore the structural and functional diversity of polypeptides that are found in plants. Expanding knowledge of simililarities between plant use of these compound and animal use promises exceptional opportunities for finding, from plant research, new structures with biomedical and biotechnological potential. READ MORE

2. Secondary Metabolites from Mozambican Plants

Author : Julião Monjane ; Centrum för analys och syntes ; [] Keywords : Secondary metabolites ; Mozambique ; Medicinal plants ; Isolation ; Structural elucidation ; Antileishmanial activity ;

Abstract : Products derived from different natural sources have been used for thousands of years by human beings for their everyday needs. Out of these natural sources, plants were the most affordable. Plant-derived products were used for shelter, food, and as medicines. READ MORE

3. Discovery of Secondary Metabolites from Rwandese Medicinal Plants : Isolation, Characterization and Biological Activity

Author : Daniel Umereweneza ; Máté Erdélyi ; A Gogoll ; Théoneste Muhizi ; Yngve Stenstrøm ; Uppsala universitet ; [] Keywords : Natural products ; Nuclear Magnetic Resonance NMR ; Dihydrochalcones ; Iridoids ; Silphiperfolanols ; Pyrrolizidine alkaloids PAs ; Rwandese Medicinal Plants ; Chemistry with specialization in Organic Chemistry ; Kemi med inriktning mot organisk kemi ;

Abstract : Plants have served as the principal source of medicines in different parts of the world through the ages. Herb-derived medicines have been used as decoctions, infusions, tinctures or single substance drugs. READ MORE

4. Nutri-medicinal plants used in the management of HIV/AIDS opportunistic infections in western Uganda : documentation, phytochemistry and bioactivity evaluation

Author : Savina Asiimwe ; Anna Karin Borg Karlsson ; Jasper Ogwal-Okeng ; KTH ; [] Keywords : Ethnobotanical study ; Medicinal plants ; HIV ; AIDS ; opportunistic infections ; bacteria ; fungi ; GC-MS ; phytochemistry ; SPME ; antioxidant ; histopathology ; biochemistry ; hematology ; western Uganda. ; Kemi ; Chemistry ;

Abstract : As a result of the AIDS epidemic, many people are immunocompromised and opportunistic infections are common. Medicinal plants constitute one of the fundaments of HIV treatment and are commonly used in management of HIV–related ailments, and also to counteract the side effects of antiretroviral therapy. READ MORE

5. Natural Products from Cameroonian Medicinal Plants

Author : Apollinaire Tsopmo ; Centrum för analys och syntes ; [] Keywords : NATURVETENSKAP ; NATURAL SCIENCES ; Växtbiokemi ; Plant biochemistry ; antiplasmodial. ; antitrypanosomal ; diarylheptanoids ; terpenoids ; flavonoids ; aframodial ; Aframomum ; Reneilmia cincinnata ; Dorstenia ; Euphorbia ; Lepidobotrys staudtii ; Pentadiplandra brazzeanea ; Vernonia guineensis ; Natural products ; Myrica arborea ;

Abstract : Natural product chemistry is a main research area in Cameroon, as well as for the division of Bioorganic Chemistry at Lund Institute of Technology. A review of the results obtained recently with Cameroonian medicinal plants shows that a large number of compounds, many with complex structures, have been isolated and characterised, and the work presented in this thesis is part of this effort. READ MORE

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New PHHP scholarship supports students who have overcome significant challenges

By Jill Pease

When Laura J. Artale was born in 1976 with cystic fibrosis, the average lifespan of someone with the disease was just 16 years.

With encouragement from her parents to follow her medical regimen and dream big, Laura Artale went on to receive three degrees from the University of Florida: a bachelor’s in health science and a master’s in rehabilitation counseling from the UF College of Public Health and Health Professions , and a doctorate in education from the UF College of Education .

As she finished up her doctoral dissertation in higher ed leadership, Laura Artale’s health worsened and she received a double lung transplant. The organ transplant allowed Laura Artale, who is described by loved ones as “small but mighty,” to live a full life for nearly 20 years, including work, travel, marriage and even competitive tennis before her health deteriorated. She passed away in 2021 at age 45.

“After Laura died, I decided to set up a foundation and do things that would have put a smile on her face.” — Joe Artale

To honor her life and the obstacles she overcame to follow her passions, her father Joe Artale has created the Dr. Laura Joe Artale ’97, ’99, ’03 Memorial Scholarship . The fund awards scholarships to College of Public Health and Health Professions students who have overcome challenges in pursuing their degree and have persevered. Recipients may have faced unexpected and/or significant adversity, such as health, personal or financial challenges.  

“After Laura died, I decided to set up a foundation and do things that would have put a smile on her face,” Joe Artale said. “We were both big believers in higher education, health related professions and supporting people who have challenges. She had scholarships when she was a student and I know that every little bit helped.”

The college has awarded the first scholarships to 11 students who are pursuing bachelor’s, master’s and doctoral degrees.

“With this scholarship, I’m hoping to play one little part in the students’ lives that will help them in this stage of their journey,” Joe Artale said. “I hope that knowing this scholarship was established in memory of a person who overcame significant challenges in her life has a lot of meaning for them.”

Joel Bialosky, Ph.D., a clinical professor in the department of physical therapy and chair of the college’s scholarship committee, said committee members were struck by the level of adversity experienced by one student after another as they reviewed the compelling stories of scholarship applicants. These included students who experienced debilitating health issues, both physical and mental. Among the applicants were international students who, not long after arriving in the U.S., needed to deal with unexpected health or financial issues in a new country and without the benefit of a strong support system. Other students had taken on the burden of debt associated with grad school to pursue a degree they are passionate about, only to have a significant financial problem arise that appeared to place that dream out of reach.

“Pursuing a degree should be an amazing time in a student’s life,” Bialosky said. “A very hard-working time, but also enjoyable and fulfilling. As we’ve learned, sometimes life gets in the way and the fact that students were not only able to overcome these challenges, but to excel, is amazing.”

For Katharine McNamara, M.H.S., a Ph.D. student in One Health in the PHHP department of environmental and global health , receiving the Dr. Laura Joe Artale ’97, ’99, ’03 Memorial Scholarship, felt like a validation of the difficulties she has undergone over the past few years and a recognition that students may have complex life issues going on behind the scenes, just like everyone else.

“These experiences have been really, really hard, but they have also given me different insight into my work.” — Katharine McNamara

McNamara, whose research focuses on the intersection of human, plant and environmental health, had just received a Fulbright Hayes Doctoral Dissertation Research Abroad Award to fund her study of medicinal plant use in Ecuador when the COVID-19 pandemic hit. After a more than year-and-a-half pandemic delay, McNamara was in Ecuador just five days when she learned her father had been diagnosed with terminal cancer. McNamara went home to Tampa to care for her father, who passed away a year later. Without a safety net of funding during this time, McNamara wondered if she may be able to eventually complete her degree. Fortunately, she was able to continue her studies and she recently returned to the U.S. after 15 months conducting research in Ecuador.

“These experiences have been really, really hard, but they have also given me different insight into my work,” said McNamara, who plans to graduate in December. “I am definitely a more compassionate researcher. My dad was really the one who taught me about plants; I grew up in his garden. So the work itself has taken on a much deeper meaning to me and I think also helps me connect with people.”

Scholarship recipient Cary Carr, M.P.H., lived through significant mental health and financial challenges in the first year of her Ph.D. in social and behavioral sciences , which helped fuel her research interest in ending violence against people who are marginalized. Carr’s dissertation is focused on improving the response to and prevention of violence against sex workers in the U.S.

“It was validating to hear that my experiences resonated with others, as I often felt stigmatized and alone because of what I went through.” — Cary Carr

“The scholarship has allowed me to reduce the levels of stress I have been experiencing by focusing less on finances and more on the passion I have for my research,” she said. “It also was validating to hear that my experiences resonated with others, as I often felt stigmatized and alone because of what I went through.” 

Carr is currently working on a research project along with representatives of sex worker organizations to better understand how they use social media to discuss violence and resistance. She plans to defend her dissertation this summer and pursue a career that combines her research skills with her community-based work.

“Beyond that, I’m excited to spend more time with my daughter, who has been a shining light for me throughout the program,” she said.

The stories of this year’s Dr. Laura Joe Artale ’97, ’99, ’03 Memorial Scholarship recipients demonstrate the importance of scholarship programs like these, Bialosky said.

“When you look at the scholarship applicants, these students are superstars,” he said. “These are people who are excelling academically, who are doing great research, who are on track to change the world. It is awful to think that people with this kind of potential would not be able to fulfill it because of something like financial limitations, or lack of mental health care or so many other issues.”

To contribute to the Dr. Laura Joe Artale ’97, ’99, ’03 Memorial Scholarship or discuss other ways you can impact the lives of PHHP students, please contact M. Blake Harrison, PHHP director of advancement, at [email protected] or 352-294-5731. Gifts may also be made directly to the Artale Scholarship through online giving .