Herbal Drug use in Sickle Cell Disease Management; Trends and Perspectives in Sub-Saharan Africa - A Systematic Review

Abstract

Introduction: Nigeria has the largest burden of Sickle Cell Disease (SCD) with estimated 100,000 new born affected annually. SCD is a Hemoglobin (Hb) disorder with the major form resulting from the substitution of a polar glutamate (Glu) by non-polar Valine (Val) in an invariant region of Hbβ chain-subunit. Species of Hb found in the sickle cell trait are HbA and HbS in a 60:40 proportion, in SCD only HbS, in the HbC disease only HbC, and in the SC disease it's HbS and HbC in a 50:50 equal proportion. Objective: This paper reviews herbal medicines usage in sub-Saharan Africa (sSA) to ameliorate the crisis associated with SCD. The model Hb tetramer suggests a higher membrane affinity of HbS and HbC, promoting dehydration of RBCs, with concomitant in vivo crystallization. Some drawbacks using these herbal drugs include; poor bioavailability and the lack of proper pharmacovigilance monitoring procedures arising from weak governance structure combined with under reporting of herbal usage to physicians were discussed. Probable epigenetic loci that could be targeted using phytomedicines for effective SCD management were also discussed. Methods: Using search engines, several databases including Google scholar, PubMed, Academic Resource Index were utilized as a source for relevant publications/ literature. The protein coordinates for the Hb tetramer were obtained from the Protein Data Bank (PDB). Conclusion: Manipulation of epigenetics to achieve better SCD management involves careful thinking. Herein, we discuss some epigenetic interactions that could be putatively tweaked with a view of enhancing soluble bioactive small molecular components with the potential to reactivate γ -globin genes, thereby boosting immune response in patient with SCD.

Recent Progress in Drug Repurposing Using Protein Variants and Amino Acids in Disease Phenotypes/Disorders

“…Histone modifications are subject to rapid changes (in seconds/minutes), giving room for the cell to respond to external stimuli. Furthermore, many of the known enzymes responsible for modifying histone residues have numbers of non-histone substrates such as transcription factors [80,81].…”

“…Understanding the etiology of some of these diseases, from PPI, protein DNA/RNA interaction is important as it will herald in more robust drug treatments for patients Recent Progress in Drug Repurposing Using Protein Variants and Amino Acids in Disease… DOI: http://dx.doi.org/10.5772/intechopen.102571 with specific disease phenotypes. Along this line, Okoh et al [81] recently, using available data, espoused the need for the combination of herbal medicine to target some epigenetic markers by way of epigenetic engineering (site-specific DNA binding module fusions with DNA demethylating enzymes for epigenetic induction of for instance; fetal hemoglobin (HbF) for therapy of sickle cell disease (SCD)). This is in consonance with earlier postulation [83,84], implying such technique may provide a better way to activate/or repress inherent gene expression, bearing transient modification of DNA and histones should remain stable over many cell divisions helping in delaying HbF switching [83,84].…”

“…Moreover, Okoh et al [81], suggested that the de-methylation of DNA at the CpGs site on both DNA strands may be possible using the combination of herbal medicine, foods rich in flavonoids could be vital in tweaking histone acetylation, which can modulate gene expression. The figure below postulates the complex interplay between, epigenetics and phyto-compound modifiers towards enabling gene transcription for proper protein translation (Figure 3).…”

In Vitro Biological Activities of Drepanoalpha® Ethanolic Extract, A Justicia Secunda and Moringa Oleifera-Based Phytomedicine Proposed for The Symptomatic Treatment of Sickle Cell Disease

“…3 It is estimated that more than 300,000 babies are born worldwide each year with severe forms of this hemoglobinopathy. 1,4,5 Management of the disease is difficult in developing countries, particularly in the Democratic Republic of Congo (DRC), where, with some 25 % AS genotypes, nearly 2 % of the population is affected with SS genotypes. 6 Indeed, poverty conjugates to the absence of a welfare system, with huge difficulties in meeting medical costs.…”

“…5,7 As for many diseases, the relative costs of treatments and their associated adverse effects make the recourse to herbal medicines attractive or even essential, especially for rural populations. 4,8 Effectively, an estimated 80 % of the Sub-Saharan population uses traditional medicine for health care; some plants have already proven their effectiveness, and bioactive molecules have been identified. 1,4,9,10 The growing interest and use of phytomedicines to treat sickle cell disease are also probably linked to the assumption that medicinal plants are "natural" and "safe".…”