From Healing to Harm: Exploring Moroccan Herbalists' Insight Into the Nephrotoxicity and Cancer Threats of Aristolochiaceae Tropical Journal of Natural Product Research
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Abstract
The Aristolochiaceae family consists of hundreds of species. In Morocco, four species have been identified and sold under the vernacular name «Berreztem» in unregulated markets. The aim of this study is to evaluate herbalists’ knowledge, particularly regarding the identification, toxicity, and side effects of Aristolochiaceae plants in eastern Morocco. An ethnobotanical survey was conducted among herbalists and plant sellers including those with fixed premises and street vendors, in the cities of Oujda and Guercif, Morocco. All herbalists were interviewed by the same person using a 30-item questionnaire. Ninety herbalists were included in the study. Men comprised nearly nine out of ten herbalists. Most of them believed that there is only one species of Aristolochia in Morocco. Only 15.6% of the herbalists mentioned that the plant can cause chronic kidney disease. Additionally, 33.3% of the interviewees prescribed Aristolochia when needed, and 77.8% continued selling it. According to the interviewed herbalists, Aristolochia is predominantly used in the treatment of cancerous diseases, followed by skin diseases and wounds, digestive disorders, and able bowel syndrome. The majority (97.8%) believes that Aristolochia can not cause cancer. Despite the documented dangers of Aristolochia, including kidney damage (nephrotoxicity) and increased cancer risk (carcinogenicity), the plant remains readily available for purchase in Moroccan herbal shops. This suggests a lack of awareness among some herbalists and/or a disregard for the severity of these health risks.
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Aigbe FR, M.Sofidiya O, B.James A, A.Sowemimo A, K.Akindere O, O.Aliu M, A.Dosunmu A, C.Chijioke M, O.Adeyemia O. Evaluation of the toxicity potential of acute and sub-acute exposure to the aqueous root extract of Aristolochia ringens Vahl.(Aristolochiaceae). J Ethnopharmacol. 2019;244:112150. doi:https://doi.org/10.1016/j.jep.2019.112150
Nortier JL, Pozdzik A, Roumeguere T, Vanherweghem JL. Aristolochic Acid Nephropathy ("Chinese Herb Nephropathy"). Nephrol. Ther. 2015;11(7):574-588. doi:https://doi.org/10.1016/j.nephro.2015.10.001
Latha S, Selvamani P, Dhivya P, Benaseer Begam R. A review on pharmacological activities of Aristolochia species. Eur. J. Biomed. Pharm. Sci. 2015;2(5):160-167.
Yamani A, Bunel V, Antoine M, Husson C, Stévigny C, Duez P, Elachouri M, Nortier J. Substitution between Aristolochia and Bryonia genus in North-Eastern Morocco: toxicological implications. J Ethnopharmacol. 2015;166:250-260. doi:https://doi.org/10.1016/0140-6736(93)92984-2
Louati N, EL Jaoudi R. The Herbalist Profession in Morocco: What Legal Status? JEMED. 2022;5(2):1-12.
Fennell CW, Lindsey KL, McGaw LJ, Sparg SG, Stafford GI, Elgorashi EE, Grace OM, Van Staden J. Assessing African medicinal plants for efficacy and safety: pharmacological screening and toxicology. J Ethnopharmacol. 2004;94(2-3):205-217. doi:https://doi.org/10.1016/j.jep.2004.05.012
Ouarghidi A, Powell B, Martin GJ, De Boer H, Abbad A. Species substitution in medicinal roots and possible implications for toxicity of herbal remedies in Morocco. Econ Bot. 2012;66(4):370-382. doi:https://doi.org/10.1007/s12231-012-9215-2
El Yahyaoui El Idrissi A, Khouchlaa A, Bakri Y, Tijane M. Ethnobotanical study on the Bereztem Plant (Aristolochia longa) used in the treatment of some diseases in the cities of Rabat, Sale and Temara (Morocco). J. Mater. Environ. Sci. 2018: 1914-1921.
doi:https://doi.org/10.26872/jmes.2018.9.6.211
Chaloob FA, Al-Mayah QS, Jawed TI. Diagnostic Value of Neutrophil-Lymphocyte Ratio in Diagnosis of Asthma: A Case Control Study in Baghdad. Trop. J. Nat. Prod. Res. 2020;4(9):523-526. doi:https://doi.org/10.26538/tjnpr/v4i9.5
Xu X-L, Yang L-J, Jiang J-G. Renal toxic ingredients and their toxicology from traditional Chinese medicine. Expert Opin. Drug Metab. Toxicol. 2016;12(2):149-159. doi:https://doi.org/10.1517/17425255.2016.1132306
Bourhia M, Ait Haj Said A, Chaanoun A, El Gueddari F, Naamane A, Benbacer L, Khlil N. Phytochemical screening and toxicological study of Aristolochia baetica linn roots: histopathological and biochemical evidence. J. Toxicol. 2019b: 8203832. doi:https://doi.org/10.1155/2019/8203832
Srirama R, Santhosh Kumar J, Seethapathy G, Newmaster SG, Ragupathy S, Ganeshaiah K, Uma Shaanker R, Ravikanth G. Species adulteration in the herbal trade: causes, consequences and mitigation. Drug Saf. 2017;40:651-661. doi:10.1007/s40264-017-0527-0
Jelaković B, Dika Ž, Arlt VM, Stiborova M, Pavlović NM, Nikolić J, Colet J-M, Vanherweghem J-L, Nortier JL. Balkan endemic nephropathy and the causative role of aristolochic acid. Semin Nephrol. 2019;39(3):284-296. doi:https://doi.org/10.1016/j.semnephrol.2019.02.007
Stiborová M, Arlt VM, Schmeiser HH. DNA adducts formed by aristolochic acid are unique biomarkers of exposure and explain the initiation phase of upper urothelial cancer. Int. J. Mol. Sci. 2017;18(10):2144. doi:https://doi.org/10.3390/ijms18102144
Jadot I, Declèves A-E, Nortier J, Caron N. An integrated view of aristolochic acid nephropathy: update of the literature. Int. J. Mol. Sci. 2017;18(2):297. doi:https://doi.org/10.3390/ijms18020297
Bourhia M, Abdelaziz Shahat A, Mohammed Almarfadi O, Ali Naser F, Mostafa Abdelmageed W, Ait Haj Said A, El Gueddari F, Naamane A, Benbacer L, Khlil N. Ethnopharmacological survey of herbal remedies used for the treatment of cancer in the greater Casablanca-Morocco. Evid. Based Complement. Altern. Med. 2019a: 1613457. doi:https://doi.org/10.1155/2019/1613457
Xu Z, Deng M, Xu Z, Deng M. Aristolochiaceae. Identification and Control of Common Weeds: Volume 2; 2017: 163-169.
Anger EE, Yu F, Li J. Aristolochic acid-induced nephrotoxicity: molecular mechanisms and potential protective approaches. Int. J. Mol. Sci. 2020;21(3):1157. doi:https://doi.org/10.3390/ijms21031157
Yang B, Xie Y, Guo M, Rosner MH, Yang H, Ronco C. Nephrotoxicity and Chinese herbal medicine. Clin. J. Am. Soc. Nephrol. 2018;13(10):1605-1611. doi:10.2215/CJN.11571017
Nortier JL, Martinez MCM, Schmeiser HH, Arlt VM, Bieler CA, Petein M, Depierreux MF, De Pauw L, Abramowicz D, Vereerstraeten P. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J Med. 2000;342(23):1686-1692.
doi:http://dx.doi.org/10.1056/NEJM200006083422301
Nortier JL, Schmeiser HH, Martinez MCM, Arlt VM, Vervaet C, Garbar CH, Daelemans P, Vanherweghem JL. Invasive urothelial carcinoma after exposure to Chinese herbal medicine containing aristolochic acid may occur without severe renal failure. Nephrol Dial Transplant. 2003;18(2):426-428. doi:https://doi.org/10.1093/ndt/18.2.426
Poivre M, Antoine M-H, Kryshen K, Atsapkina A, Shikov AN, Twyffels L, Nachtergael A, Duez P, Nortier J. Assessment of the Cytotoxicity, Mutagenicity, and Genotoxicity of Two Traditional Chinese Herbs: Aristolochia baetica and Magnolia officinalis. Toxins. 2023;15(1):52.
Merouani N, Boukhebti H, Belhattab R. Ethnobotanical Study, Anatomical Study and Phytochemical Screening of Aristolochia longa L. J. Drug Deliv. Ther. 2020;10(4):112-124. doi:https://doi.org/10.22270/jddt.v10i4.4160
El Omari N, El Blidi O, Bouyahya A, Sayah K, Bakrim S, Fettach S, Tahri R, Taghzouti K, Chokairi O, Barkiyou M. Toxicological investigations of Aristolochia longa root extracts. J. Toxicol. 2020;2020(1):7643573. doi: https://doi.org/10.1155/2020/7643573
Guinnin FF, Klotoe JR, Ategbo JM. Acute toxicity evaluation of ethanolic extract of Aristolochia albida duch. leaves on wistar rats liver and kidney functions. Int. J. Pharm. Pharm. Sci. 2017;9(7):35. doi:http://dx.doi.org/10.22159/ijpps.2017v9i7.16887
Fatima Zahra Benaddi, Abdelilah Ouahbi, Meryem Bellahmar, Chakir S. The acute toxicity of the aqueous extract of Aristolochia longa l, « Morocco » prepared by the traditional method. World J. Pharm. Life Sci. 2020: 29-33.
Benarba B, Boumedienne M. Ethnobotanical study, antifungal activity, phytochemical screening and total phenolic content of Algerian Aristolochia longa. J. Intercult. Ethnopharmacol. 2014;3(4):150. doi:http://dx.doi.org/10.5455/jice.20140826030222
Yamani A, Bunel V, de Prez E, Husson C, Stévigny C, Elachouri M, Duez P, Nortier J. Traditional remedies based on birthwort and dioecious bryony in eastern Morocco: risk of poisoning of exposed populations. Nephrol. Ther. 2014;10(5):277.
doi:https://doi.org/10.1016/j.nephro.2014.07.342Get
Bouhaous L, Miara MD, Bendif H, Souilah N. Medicinal plants used by patients to fight cancer in northwestern Algeria. Bull. Cancer. 2021: 296-306. doi:https://doi.org/10.1016/j.bulcan.2021.09.017
Najem M, Ibijbijen J, Nassiri L. Quantitative ethnobotanical study of toxic plants used in the traditional pharmacopoeia of the central Middle Atlas-Morocco. Ethnobot. Res. Appl.. 2019;18:1-17. doi:http://dx.doi.org/10.32859/era.18.36.1-17
Maggini V, Menniti-Ippolito F, Firenzuoli F. Aristolochia, a nephrotoxic herb, still surfs on the Web, 15 years later. Int. Emerg. Med. 2018;13(5):811-813. doi:https://doi.org/10.1007/s11739-018-1813-2