Bread contaminated w Aristolochia clematis S causing nephropathy in the Balkans

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Hi All,

 

See this

 

A ProMED-mail post <http://www.promedmail.org>

ProMED-mail is a program of the International Society for Infectious

Diseases <http://www.isid.org>

 

9 Jul 2007; Source: New Scientist [edited]

<http://www.newscientist.com/article/dn12220-mysterious-kidney-disease-

blamed-on-bad-bread.html>

 

Farmers in the Balkans can't find the cause of a kidney disease,

according to a new study that appears to have resolved a decades-long

mystery.

 

The contamination of the region's wheat by the birthwort plant seems

to be the source of an unusual form of kidney failure and urinary

tract cancer that afflicts many people in countries such as Croatia and

Serbia.

 

Researchers believe the finding should spark action by public health

officials to save lives by clearing the birthwort plant from grain

fields across the region.

 

Since it was 1st formally recognized in 1956, the disease, called

endemic Balkan nephropathy, has perplexed experts, who have

considered various explanations, including groundwater contamination.

 

Unlike most patients with kidney failure, people with the Balkan

illness often have healthy blood pressure. Nonetheless, as their

kidneys begin to fail, they require dialysis, and about half of them

eventually develop a rare cancer of the upper urinary tract.

 

Arthur Grollman of the University at Stony Brook, New York, US did

not expect to discover birthwort as the cause of this kidney disease

when he set out for the region a few years ago. Instead, he had

hypothesized that herbal remedies were to blame for this nephropathy.

 

He knew about the disastrous mix-up in which thousands of healthy

Belgium women developed severe kidney failure requiring transplants

after accidentally receiving the Chinese herbal drug guang fang ji

instead of the similar-sounding han fang ji.

 

Grollman suspected a similar cause behind the endemic Balkan

nephropathy, so he surveyed patients in dialysis clinics in the

region on whether they had taken any herbal medicines. But none

reported taking such supplements.

 

Disappointed that his theory had proven wrong, Grollman headed for

home, but not before spending a final afternoon in a library in

Zagreb, the Croatian capital. There, he came across a striking

description from the 1930s about how horses in the region had

developed kidney failure after grazing on a plant known as

_Aristolochia clematis_, also known as birthwort. Grollman

immediately cancelled his flight and set off to meet Balkan farmers.

 

A survey of their fields and mills revealed that some of their wheat

was indeed contaminated with _Aristolochia clematis_ seed. Back in

the lab, Grollman and his colleagues examined kidney samples from

Croatian nephropathy patients. They found the same telltale signs of

DNA damage linked to _Aristolochia clematis_ as seen in animal studies.

 

For example, they found specific cancerous mutations in a gene called

p53 known to arise from the aristolochic acid, a chemical found in

birthwort. And chemical analysis revealed metabolites of the plant

stuck to the patients' DNA in a disruptive way.

 

Grollman says 100 000 people are at risk of nephropathy in the

Balkans as a result of inadvertently eating birthwort. He says he

would " like to make sure that the public health officials take action

on this. " Local farmers need government assistance to weed out the

plant, as many of them cannot afford herbicide, he adds.

 

Grollman also notes that birthwort has been used as an herbal remedy,

being given to mothers following birth because it reputedly helped to

expel the placenta. But he doubts birthwort has any genuine medicinal

value and stresses that " the toxic effects far outweigh any potential

good effects. "

 

Journal reference:

<http://www.pnas.org/cgi/doi/10.1073/pnas.0701248104>, Proceedings of

the National Academy of Sciences (DOI:10.1073/pnas.0701248104).

 

[byline: Roxanne Khamsi]

 

--

Communicated by: ProMED-mail Rapporteur Mary Marshall

 

[it is not uncommon for grains to become contaminated with various

other grains, weeds, or mycotoxins. Aflatoxin in corn is an example,

as is ergot in rye. Birthwort is of the family _Aristolochiaceae_, so

it stands to reason it may contain aristocholic acid.

 

Aristolochia means " excellent birth " and refers to the traditional

use of the fresh juice to induce labor. (Ingestion would be toxic, so

it is likely used externally as some type of rub or poultice.) The

Indian Root (possibly another name for the plant) was used mainly in

childbirth. In England, it was known as birthwort and used for this

purpose (assisting in birth, expelling the child or the afterbirth).

 

Theophrastus (c. 372-286 BCE) records that the plant was used to

treat disorders of the uterus, reptile bites, and sores to the head.

(The reference does not tell us what disorders of the uterus.)

 

Of the 350 or so species of _Aristolochia_, several carry the common

name of snakeroot because many of the species were used by Native

Americans to treat snake bites. They also employed the plants to

treat stomachaches, toothaches, and fevers.

 

In the 16th century, when Francisco Hernandez was cataloging the

flora of " New Spain, " he came across a plant that looked the same as

the herb he knew back in Europe. The Mexican species, however, can

have enormous flowers. He reported that the Aztecs used it to treat

abscesses, dysentery, deafness, and various other ailments.

 

Other uses of the plant have been identified as:

 

--Birthwort was formerly used induce labor, and, when taken after

childbirth, it prevented infection while inducing menstruation.

 

--A decoction was taken to heal ulcers as well as for asthma and bronchitis.

 

--It was also used to treat wounds, sores, and snakebites. Poultices

and infusions were used by Native Americans for snakebites. It was

also used for this purpose in the Amazon.

 

--Although used in China for lung disorders, pain, and fluid

retention, Germany has banned the plant because of the toxicity of

aristolochic acid. It is used in a wide variety of ways in nearly all

European countries.

 

--It was also considered a strong fever remedy.

 

--In the Sudan, it is used for scorpion stings.

 

--In Iran, the European variety is used as a tonic and to induce menstruation.

 

--In India, it is used as a contraceptive.

 

--In Mexico, it has long been recommended for snake bite, and,

interestingly, half a world away in Taiwan, a 1974 study of another

species also effectively inactivated snake venom.

 

--It is used to stimulate the immune system as well as in the

treatment of allergic gastrointestinal and gallbladder colic.

 

--In Chinese medicine, it is used for joint pain, stomachache,

malaria, and abscesses.

 

--Homeopathic uses include gynecological disorders and in the

treatment of wounds and ulcers.

 

--It has been used in treatment after major surgery and in

ear-nose-throat treatments.

 

--Duck Flower has a number of reported uses in Central America.

Generally not available in the US, it is available south of that

border. Michael Balick and Rosita Arvigo state that it is one of the

most popular herbal remedies used in Belize, where decoctions and

infusions are commonly made from the vine. It can often be seen

soaking in a bottle of rum in saloons, since it is taken by the shot

for hangovers, flu, flatulence, late menstrual periods, and irregular

heartbeat. However, it is advised that it be used under the guidance

of a knowledgeable professional, as it is poisonous and contains a

mutagen and carcinogenic.

 

Birthwort is _Aristolochia clematitis_. The root and stem are

poisonous (19). The plant contains aristolochic acid, which,

according to some, has received rather mixed reports on its toxicity.

According to one report, aristolochic acid stimulates white blood

cell activity and speeds the healing of wounds, but is also

carcinogenic and damaging to the kidneys (254). Another report says

that it is an active anti-tumor agent but is too toxic for clinical

use (218). Another report says that aristolochic acid has anti-cancer

properties and can be used in conjunction with chemotherapy and

radiotherapy and that it also increases the cellular immunity and

phagocytosis function of the phagocytic cells (176).

 

Birthwort has a very long history of medicinal use, though it has

been poorly researched scientifically and has been barely used by

present-day herbalists (254, 268). It is an aromatic tonic herb that

stimulates the uterus, reduces inflammation, controls bacterial

infections and promotes healing (238). The juice from the stems was

used to induce childbirth (268). The plant contains aristolochic

acid, which, while stimulating white blood cell activity (presumably

this is to increase immunity) and speeding the healing of wounds, is

also carcinogenic and damaging to the kidneys (254). The flowering

herb, with or without the root, is abortifacient, anti-inflammatory,

antispasmodic, diaphoretic, an emmenagogue, febrifuge, oxytocic and a

stimulant (7, 9, 21, 100, 200). Another report says that the root is

used on its own (238), while a 3rd says that either the fresh

flowering herb or the dried rootstock can be used (268) (for

medicinal purposes). The plant should not be used internally without

experienced supervision; externally, it is used in the treatment of

slow-healing cuts, eczema, infected toes and fingernails, etc. (9).

Use with caution; internal consumption can cause damage to the

kidneys and uterine bleeding (7, 9, 21). It should not be used by

pregnant women (238).

 

Best regards,