Guardian

Medicinal properties of South American sangre de drago tree was underscored recently as Crofelemer, derived from the latex, got approved for the treatment of HIV-associated diarrhoea. WOLE OYEBADE reports.

THE South American sangre de drago tree and its variety of medicinal use are not new to local people in the region. The sap was used to treat wounds, hemorrhaging, diarrhoea, mouth ulcers, as general tonic and so on.

What is new is its efficacy in HIV/AIDS research with the discovery of crofelemer and it unprecedented acceptance in the medical community. And again, it further point the direction researchers must clinically look if the much awaited cure to current incurable diseases must be found.

Crofelemer is the first drug to be approved in the United States to treat HIV-associated diarrhoea. It relieves symptoms of diarrhoea in HIV/AIDS patients taking antiretroviral therapy (ART), a combination of medicines used to treat HIV infection.

Crofelemer is derived from the latex of the South American sangre de drago tree (dragon’s blood, Croton lechleri).

Croton lechleri is a species of flowering plant in the spurge family, Euphorbiaceae, that is, native to northwestern South America. It is commonly known as Sangre de Grado (Peruvian Spanish) or Sangre de Drago (Ecuadorian Spanish), both of which translate to “dragon’s blood.” They refer to the tree’s thick red latex. A red, blood-resembling latex leaks from the tree when its bark is cut.

The latex has medicinal properties, and is used by local peoples as a liquid bandage, applied to seal wounds, as it dries quickly to form a protective skin-like barrier.

Sangre de drago is a medium-sized to large tree that grows from 10–20 m high in the upper Amazon region of Peru, Ecuador, and Colombia. Although tall, the trunk is usually less than 30 cm in diameter and is covered by smooth, mottled bark.

It has large, heart-shaped, bright-green leaves and unique, greenish-white flowers on long stalks. Crotons are rich in active alkaloids, and several species are well-known medicinal plants used as purgatives and tonics.

Sangre de grado’s red sap or latex (and also its bark) has a long history of indigenous use in the rainforest and in South America. The earliest written reference dates its use to the 1600s, when Spanish naturalist and explorer P. Bernabé Cobo found that the curative power of the sap was widely known throughout the indigenous tribes of Mexico, Peru, and Ecuador.

For centuries, the sap has been painted on wounds to staunch bleeding, to accelerate healing, and to seal and protect injuries from infection. The sap dries quickly and forms a barrier, much like a “second skin.”

It is used externally by indigenous tribes and local people in Peru for wounds, fractures, and hemorrhoids, internally for intestinal and stomach ulcers, and as a douche for vaginal discharge.

Other indigenous uses include treating intestinal fevers and inflamed or infected gums, in vaginal baths before and after childbirth, for hemorrhaging after childbirth, and for skin disorders.

The latex also contains a number of chemicals, including taspine that have wound-healing properties. Its use by native people has led to scientific interest, which has confirmed its significant antioxidant activity.

Sangre de drago resin or sap is indeed a storehouse of phytochemicals including proanthocyanidins (antioxidants), simple phenols, diterpenes, phytosterols, and biologically active alkaloids and lignans.

Scientists have attributed many of the biologically active properties of the sap (especially its wound-healing capacity) to two main “active” constituents, taspine and a lignan named dimethylcedrusine.

In January 2013, crofelemer, under the trade name Fulyzaq, was approved by the FDA for the treatment of HIV-associated diarrhoea.

The latest discovery using Sangre de drago resin and breakthrough in HIV/AIDS research owe the success to a pioneering research carried out in the United States by a team of scientists, which included Nigeria’s Prof. Maurice Iwu, an acclaimed pharmacologist and tropical medicine expert. Others are Ms Lisa Conte, Dr. Steven King, Dr. Michael Tempesta.

U.S FDA’s approval of crofelemer marked the second time a botanical, and the first time an orally administered botanical, has received drug approval from the Administration.

The first botanical drug to be approved in the United States was a topical green tea extract, Veregen, in 2006. Both botanical drugs meet all U.S pharmaceutical requirements and can be dispensed only by prescription.

According to FDA’s press release regarding the approval, “the safety and efficacy of Fulyzaq were established in a clinical trial of 374 HIV-positive patients on stable antiretroviral therapy (ART) with a history of diarrhoea lasting one month or longer...

“Results showed that 17.6 per cent of patients taking Fulyzaq experienced clinical response compared with eight per cent taking placebo. In some patients, a persistent anti-diarrheal effect was seen for 20 weeks.”

Diarrhoea is experienced by many HIV/AIDS patients and is a common reason why patients discontinue or switch their antiretroviral therapies.

Fulyzaq is intended to be used in HIV/AIDS patients whose diarrhoea is not caused by an infection from a virus, bacteria, or parasite. Patients take Fulyzaq two times a day to manage watery diarrhoea due to the secretion of electrolytes and water in the gastrointestinal tract.

The herbal medicine and pharmaceutical communities have been expressing satisfaction with FDA’s decision, ushered out the door on the last day of the year — an action typical of FDA efforts to complete pending drug reviews before the end of each calendar year.

Salix, which owns the license for crofelemer’s development and submitted the product’s New Drug Application (NDA) for review, called the approval a “significant step forward in addressing the unmet medical need of people with HIV/AIDS on ART, who experience non-infectious diarrhea.”

According to a Salix press release, the company expects Fulyzaq to be available to patients in early 2013. A Bloomberg analysis estimates Crofelemer will bring the company sales of $18 million in 2013 and $26 million in 2014.

Glenmark Pharmaceuticals, Ltd., the India-based manufacturer and supplier of Crofelemer for the U.S market, experienced an increase in market shares of 3.4 per cent following the announcement.

Research has confirmed many of the indigenous uses of this powerful rainforest plant. It is a wonderful, sustainable rainforest resource that warrants consumer attention as it becomes more widely available in the marketplace. Applied directly to the affected area, it is helpful for all types of cuts, scrapes, external wounds, bites, stings, rashes, and skin problems, including skin and nail fungi.

Dr. James E. Williams, sums up sangre de drago‘s many uses by natural health practitioners, stating, “there is a wide range of potential applications for sangre de drago, including as a broad-spectrum anti-diarrheal agent from causes such as side effects of drugs, chemotherapy or radiation treatment, microbial infections of the intestine, traveler’s diarrhea, and viral-induced diarrhea as in AIDS.

“It may also have other uses in gastrointestinal disorders such as irritable bowel syndrome and ulcerative diseases. Its cytotoxic effects make it a possible antitumor agent and its cicatrizant properties provide wound-healing potential.

“In addition, the antimicrobial and anti-inflammatory effects of sangre de drago make it a useful compound in the clinical treatment of chronic viral diseases and as a natural antibacterial agent.”

In addition, several health practitioners in the U.S indicate benefits in using sangre de drago resin internally for diabetic neuropathy because of its previously documented effects on nerve endings, nerve pain and nerve inflammation. Benefits have also been reported with diabetes-related skin ulcers and sores (applied topically), which have refused to heal using other methods.