Online Exclusives

Combating Malaria with Atemisinin Compounded Therapies

By Joanna Cosgrove, Online Editor | November 12, 2012

A South African company is hoping its work with an indigenous botanical will be a remedy for its region’s malaria epidemic and a boost for the local economy.

Malaria is an infectious disease caused by two protozoan parasites—Pasmodium falciparum and Plasmodium vivax—that multiply in the liver then infect red blood cells, causing fever, headache, and vomiting, which if left untreated, can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.
Although the disease is transmitted exclusively through the bite of a specific species of mosquito (Anopheles) and the intensity of the transmission depends on factors related to the parasite, the vector, the human host and the environment, the Centers for Disease Control (CDC) and the World Health Organization (WHO) estimated that in 2010, an estimated 216 million cases of malaria occurred worldwide and 655,000 people died, most (91%) in the African Region.
At present, WHO recommends Atemisinin Compounded Therapies (ACTs) for the treatment of uncomplicated malaria because there is no reliably conclusive evidence suggesting malaria carrying parasites are resistant to artemisinin, which is derived from the leaves of Arteminsia annua, also known as sweet wormwood. The plant has a long history of traditional use for reducing fevers as well as for treating malaria. Afriplex, a South Africa-based company, is working on an ACT project in the quest for a natural, cost-effective remedy for the treatment of malaria.

The Industrial Development Corportation (IDC) and Afriplex have a cooperation agreement to co-fund the feasibility study phase of the project. Research was conducted over a period of three years focusing on the sustainable production of a remedy.

According to Danie Nel, CEO of Afriplex, the project is the first step in an attempt for sustainable and cost effective provision of anti-malarials to the African population. “Cost-effective provision can only be achieved by shortening the production chain from propagation to medicine formulation, thereby impacting positively on the overall production cost and ensuring long-term feasibility and sustainability,” said Mr. Nel.
The main objective of the project is to produce ACT products from locally cultivated Artemisia annua (A.annua) plant material. The overall goal is to evaluate the agronomic potential, extraction and production efficiency for the commercial production of Artemisinin and ACTs in South Africa.
“The production of artemisinin-based combination therapies is a first for a South African company and long overdue—especially against the backdrop of the increasing threat this disease holds for Africa and its people,” Mr. Nel said. While AIDS is often cited as the deadliest disease of the 21st century, malaria is a lesser known, but deadly threat to public health, spreading rapidly across the globe. Malaria is one of the world’s most common and easily preventable diseases, yet it is estimated at killing 2.7 million people a year worldwide. “It is reported that one child dies every 30 seconds from this familiar but forgotten disease,” Mr. Nel remarked. “With global warming, international travel and drug resistance, malaria is indeed returning with a vengeance.”
The unacceptable rise in malaria mortality is due in part to the fact that Plasmodium falciparum, the deadliest malaria parasite, has acquired resistance to nearly all available antimalarial drugs— the only exception being the artemisinin derivatives. Artemisinin-based combination therapies have become the cornerstone of malaria case management.
Mr. Nel explained that a unique extraction process was developed whereby the atemisinin component, together with other derivatives of A. annua was selectively extracted and refined. The resulting extract will be formulated and, after stability testing and clinical trials, marketed internationally, but with an emphasis on the Sub-Saharan region of Africa.
“It is probably accurate to state that African plants and remedies are not yet well known to the world,” said Donnie Malherbe, director of Afriplex’s extract division. “Unfortunately, very little research has been conducted on most of Africa’s plant remedies. As costly efficacy and safety tests are a pre-requisite for competing in the international arena, one will often find that the natural potential offered by African plants is slow to ‘unlock.’”
But the company plans to invest the resources to do just that. Afriplex reported that a demand of 120-140 tons of artemisinin per annum is projected for the next 10 years, subject to emergence of resistant strains of the malaria parasite. In the same time period estimated worldwide production capacity is 90-150 tons per annum. The involvement of local communities with regard to plant propagation, combined with the extraction and product formulation activities will result in significant job creation. “The aim is to have a formulated product developed within the next two to three years,” said Mr. Malherbe, director of Afriplex’s extract division. “The main objective will be cost efficiency and affordability for Africa’s people.”