Journal of Ethnopharmacology 80 (2002) 49 Á/66
www.elsevier.com/locate/jethpharm
Herbal medicines for sexually transmitted diseases and AIDS
Kavita Vermani, Sanjay Garg *
Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Sector 67, SAS Nagar, Punjab 160 062, India
Received 20 September 2001; received in revised form 13 October 2001; accepted 19 December 2001
Abstract
Sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) are gaining significant importance at
present due to rapid spread of the diseases, high cost of treatment, and the increased risk of transmission of other STDs and AIDS.
Current therapies available for symptomatic treatment of STDs and AIDS are quite expensive beyond the reach of common man
and are associated with emergence of drug resistance. Many patients of STDs and AIDS are seeking help from alternative systems of
medicines such as Unani, Chinese, Ayurvedic, naturopathy, and homeopathy. Since a long time, medicinal plants have been used for
the treatment of many infectious diseases without any scientific evidence. At present there is more emphasis on determining the
scientific evidence and rationalization of the use of these preparations. Research is in progress to identify plants and their active
principles possessing activity against sexually transmitted pathogens including human immunodeficiency virus (HIV) with an
objective of providing an effective approach for prevention of transmission and treatment of these diseases. In the present review,
plants reported to possess activity or used in traditional systems of medicine for prevention and treatment of STDs including AIDS,
herbal formulations for vaginal application, and topical microbicides from herbal origin, have been discussed. # 2002 Elsevier
Science Ireland Ltd. All rights reserved.
Keywords: Sexually transmitted diseases; AIDS; Vagina; Microbicides; Herbal medicine
1. Introduction tions, trichomoniasis, vaginitis and vulvovaginitis are
some of the sexually transmitted infections (STIs).
In normal healthy women, vaginal cavity is inhabited Sexual contact is the most common but not the only
by a number of microorganisms, existing in a dynamic means of transmission of these infections. It is now well
microenvironment. Any disturbance to this ecosystem established that STDs (both ulcerative and non-ulcera-
leads to a number of infectious conditions and diseases. tive) increase the risk of transmission of other STIs,
Sexually transmitted diseases (STDs), also known as including AIDS because of changes in the normal
venereal diseases are infections caused by a variety of vaginal epithelium (Wasserheit, 1992).
pathogens including bacteria (Neisseria gonorrhoea , Current therapies for AIDS and other STDs include
Treponema pallidum , Haemophilus ducreyi , Gardnerella drug administration by various routes including oral,
vaginalis ), viruses (human immunodeficiency virus parenteral, and topical (vaginal and rectal). Since sexual
(HIV), herpes simplex virus, human papilloma virus mode of transmission is the most common cause of
(HPV)), Chlamydia (Chlamydia trachomatis ), and para- occurrence of STDs, vaginal and rectal approaches are
sites (Trichomonas vaginalis , Giardia lambia ) (Hardin, becoming significant for prevention of their transmis-
1996). Acquired immunodeficiency syndrome (AIDS), sion. In the last decade, major advancements have been
genital herpes, genital warts, chlamydial genital infec- reported in the field of ‘microbicides’, i.e. compounds or
formulations which when applied topically (vaginal or
rectal) can prevent the transmission of STDs including
Abbreviations: HIV, human immunodeficiency virus; AIDS, AIDS (Forbes, 2000). These include a few from plant
acquired immunodeficiency syndrome; STDs, sexually transmitted sources such as gossypol derivatives, Praneem polyher-
diseases; HSV, herpes simplex virus; HPV, human papilloma virus.
* Corresponding author. Tel.: '91-172-214682 Á/87; fax: '91-172-
bal preparations, and plantibodies.
214-692. Medicinal plants have a long history of use and their
E-mail address: gargsanjay@yahoo.com (S. Garg). use is widespread in both developing and developed
0378-8741/02/$ - see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved.
PII: S 0 3 7 8 - 8 7 4 1 ( 0 2 ) 0 0 0 0 9 - 0
50 K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
countries. Herbal medicines provide rational means for 2. Acquired immunodeficiency syndrome
the treatment of many diseases that are obstinate and
incurable in other systems of medicine. These are AIDS is a clinical syndrome resulting from infection
gaining popularity because of several advantages such with HIV that causes profound immunosuppression. It
as often fewer side effects, better patient tolerance, is a complex multifactorial disease associated with
relatively less expensive and acceptance due to long immunodeficiency and autoimmune inflammation.
history of use. Medicinal effects of plants tend to HIV produces gradual effects on the body’s defense
normalize physiological function and correct the under- mechanisms thereby leading to cancers and opportunis-
lying cause of the disorder (Murray and Pizzorno, 1999). tic infections involving multiple systems of the body
Medicinal plants are renewable in nature unlike the such as immune, gastrointestinal, genitourinary, endo-
synthetic drugs that are obtained from non-renewable crine, dermatologic, and nervous systems. Symptoms
associated with AIDS include persistent fever, night
sources of basic raw materials such as fossil sources and
sweat, weight loss (wasting syndrome), headache, lym-
petrochemicals (Samanta et al., 2000). Cultivation and
phademopathy, skin rashes, diarrhea, thrush, recurrence
processing of plants often is environment friendly unlike
of varicella zoster virus infection, Kaposi’s sarcoma,
the pollution by chemical industry. Cultivation of
Pneumocystis carinii pneumonia, cryptococcal meningi-
medicinal plants can also be a source of income for tis, Candida esophagitis, Toxoplasma encephalitis, and
poor families. Many of the medicinal plants are locally disseminated atypical mycobacterial infection (Kapus-
available, especially in developing and underdeveloped nik-Uner, 1996; Murray and Pizzorno, 1999).
countries. Also, plants are often less prone to the In Europe, herbal treatments have been considered as
emergence of drug resistance. Due to all these advan- the most popular complementary medicine used by HIV
tages, plants continue to be a major source of new lead infected individuals (Ozsoy and Ernst, 1999). Substan-
compounds. tial amount of research has been done and a lot more is
A large number of active agents are available for the in progress to isolate the active leads from plants for
symptomatic treatment of STDs and AIDS. Emergence prevention of transmission of HIV and treatment of
of drug resistant strains and dose limiting toxic effects AIDS. These active principles may act by different
has complicated the treatment of these infectious mechanisms, targeting critical steps within the replica-
diseases. These complications have necessitated the tion cycle of HIV. Recently, a review (Yang et al., 2001)
search for new antimicrobial substances from various on natural products under development for anti-HIV
sources. Extracts of plants and phytochemicals have activity has been published by National Cancer Institute
been shown to possess activity against sexually trans- (USA). Several natural products based anti-HIV sur-
mitted pathogens and may be a good source of new face-active agents, reverse transcriptase inhibitors, non-
active agents. Several plants have been screened for nucleoside reverse transcriptase inhibitors, integrase
activity against STDs on the basis of ethnopharmaco- inhibitors and protease inhibitors have been reported.
logical data (Vlietinck and Berghe, 1991; Mekkawy et Vlietinck et al. (1998) have summarized many com-
al., 1995; Matsuse et al., 1999; Kambizi and Afolayan, pounds of plant origin that inhibit HIV during various
2001; Rajbhandari et al., 2001) and some of these stages of life cycle. These include several alkaloids,
screening programs have yielded potential leads. carbohydrates, coumarins, flavonoids, lignans, pheno-
In Europe, the use of medicinal plants for sympto- lics, proteins, quinines/xanthones, phospholipids, tan-
matic treatment of STDs dates back at least to 1574 nins, and terpenes from various plants. Several studies
have been conducted to screen the plants used in folk
when ‘sarsaparilla’ (Smilax officinalis , family Liliaceae)
medicine for anti-HIV activity. These include plants
was first introduced for the treatment of syphilis.
from Panama (Matsuse et al., 1999), Indonesia (Otake et
Sarsaparilla was a better alternative to mercury, the
al., 1995), Egyptian folk medicine (Mekkawy et al.,
standard medical treatment for syphilis during that
1995), folk medicine of Iberian Peninsula (Bedoya et al.,
period. In clinical studies, sarsaparilla was observed to 2001), and Ayurvedic medicine (Kusumoto et al., 1995).
be effective in about 90% cases of acute syphilis and 50% Table 1 summarizes the plants that have been shown to
chronic cases (Murray and Pizzorno, 1999). Since then, possess activity against HIV, their active principles, the
medicinal plants have been used for the treatment of models used for anti-HIV testing, and suggested me-
STDs and AIDS without any scientific evidence in chanisms of action.
traditional systems of medicine. In the last century
enormous efforts have been made to select the plants,
isolate the active principles and screen the crude extract/ 3. Genital herpes
fractions/compounds for activity against various sexu-
ally transmitted pathogens, and elucidate their mechan- Genital herpes is an acute inflammatory infection
ism of action. caused by herpes simplex virus (HSV-1 and HSV-2).
Table 1
List of plants that possess anti-HIV activity, their active principles/extracts and mechanism of action
Species (family) Vernacular name and tradi- Indigenous to Active constituents/extracts In vitro/in vivo assay model Mechanism of action References
tional uses tested
Achillea millefolium Yarrow Á/ Quercetagetin Á/ Á/ Ono et al., 1990
Alexia leiopetala Sand- Á/ Guyana, Vene- Castanospermine, 6,7 diepi- In vitro model for syncytium for- Interferes with syncytium for- Nash et al., 1988
with (Leguminoseae) zuala, Brazil, castanospermine, australine, mation CD4' cell line H9 infected mation and viral infectivity,
Amazon Basin alexine with HIV, in vivo mice model inhibition of a-glucosidase I
located in endoplasmic reticu-
lum
Ancistrocladus ab- Á/ Cameroon Michellamine A and B In vitro, MT-2 and CEM-SS cell Inhibits HIV-1 during early Manfredi et al.,
breviatus (Ancistrocla- lines phases of viral infection of T- 1991
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
daceae) lymphocytes
Andrographis paniculata Sambiloto, kalmegh Indonesia, In- Aqueous extract of leaves Inhibition of HIV-1 induced cyto- Inhibition of HIV protease and Otake et al., 1995
Nees. (Acanthaceae) dia pathogenicity in MT-4 cells reverse transcriptase
Anogeissus acuminata No known traditional uses Bangladesh, Anolignan A HIV-1 reverse transcriptase assay Inhibition of HIV -1 reverse Rimando et al.,
Roxb. Ex DC. Guill. India, Burma, transcriptase 1994
and Perr. (Combreta- Thailand, Viet-
ceae) nam
Areca catechu Linn. Betel nut India, Eastern Seed extract, procyanidins, Á/ HIV protease inhibition Kusumoto et al.,
(Palmae) Archipelago arecatannin B1 1995
A. indica A. Juss. (Me- Neem, margosa; used for anti- India, Asia Seed and leaf extracts Á/ Á/ Talwar et al.,
liaceae) bacterial, antipyretic, and anti- 1997, 2000
inflammatory properties
Bersama abyssinica Fre- Azamer, bersama, lolchisa; used Ethiopia Methanol extract of leaf, In vitro, inhibition of viral cyto- Á/ Asres et al., 2001
sen. (Melianthaceae) in rabies, ascariasis, ulcers, methanolic and acetone ex- pathic effect in MT-4 cells
diarrhoea, worm infestations, tract of root bark
and cholera
Buchenavia capitata Á/ Dominican Re- O -dimethyl-buchenavianine In vitro, cultured human lympho- Inhibition of reverse transcrip- Beutler et al., 1992
Vahl Eichl. (Combreta- public blastoid CEM-SS cells tase
ceae)
Callophyllum inophyl- Á/ Malaysia Inophyllums coumarin deri- Á/ Inhibition of reverse transcrip- Patil et al., 1993
lum Linn. (Clusiaceae) vatives tion
Callophyllum lanigerum Á/ Malaysia Calanolides coumarin deri- Inhibition of in vitro replication of Inhibition of reverse transcrip- Kashman et al.,
Miq. (Clusiaceae) vatives HIV-1 and cytopathic effects in T tion, inhibition of DNA and 1992; Boyer et al.,
cell lines CEM-SS and MT-2 cells RNA dependent DNA poly- 1993
merase activities of HIV-1 re-
verse transcriptase
Camellia sinensis Linn. Used as anti-inflammatory China, Japan, Epigallocatechin gallate, Á/ Inhibition of reverse transcrip- Nakane and Ono,
(Theaceae) agent and cholerectic India epicatechin gallate tase HIV-1 and HIV-2 and 1990
cellular RNA and DNA
Canavalia ensiformis Á/ Á/ Concanavalin A Á/ Inhibition of syncytium forma- Hansen et al.,
tion 1989
Castanospermium aus- Á/ Á/ Castanospermine In vitro model for syncytium for- Interferes with syncytium for- Gruters et al.,
trale (Leguminoseae) mation CD4' cell line H9 infected mation and viral infectivity, 1987; Sunkara et
with HIV, in vivo mice model inhibition of a-glucosidase I al., 1987; Nash et
located in endoplasmic reticu- al., 1988; Ru-
lum precht et al., 1989
51
52
Table 1 (Continued )
Species (family) Vernacular name and tradi- Indigenous to Active constituents/extracts In vitro/in vivo assay model Mechanism of action References
tional uses tested
Cephaelis ipecacuanha Ipecac; used as emetic, expec- Brazil Psychotrine O -methylpsy- In vitro Inhibition of reverse transcrip- Tan et al., 1991
Brotero A. Richard torant, amoebicide and for chotrine tase
(Rubiaceae) treatment of gout
Chassalia parvifolia Á/ Á/ Circulin A and B In vitro, XTT based anti-HIV Á/ Gustafson et al.,
(Rubiaceae) assay 1994
Combretum paniculatum Baye, gabai, shaga; used for Ethiopia Ether, dicholoromethane, In vitro, inhibition of viral cyto- Á/ Asres et al., 2001
Vent. (Combretaceae) tonsillitis, cold, constipation, acetone and methanolic ex- pathic effect in MT-4 cells
rheumatism, and as haemostatic tracts of leaf
Conospermum incurvum Á/ Western Aus- Conocurvon, organic ex- In vitro, T lymphoblastic cell line Mechanism not fully resolved, Decosterd et al.,
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
Lindley (Protreaceae) tarlia tracts of stem, twigs, leaves infected with HIV-1 CEM-SS cells inhibition of late phases of viral 1993; Dai et al.,
and flowers replication cycle 1994
Curcuma aeruginosa Temu, ireng Indonesia Aqueous extract of rhizome Inhibition of HIV-1 induced cyto- Inhibition of HIV protease and Otake et al., 1995
Roxb. (Umbelliferae) pathogenicity in MT-4 cells reverse transcriptase
C. longa Linn. (Umbel- Haldi; used as a spice, food India Curcumin In vitro integrase, E. coli integrase Inhibition of HIV-1 integrase, Barthelemy et al.,
liferae) colorant and for various medic- assay, HeLa H 12 cells, transacti- inhibition of Tat-mediated 1998
inal purposes vation assay transactivation of HIV-1 long
terminal repeat
Detarium microcarpum Á/ Á/ Epicatechin, epicatechin-3- Á/ Irreversible interaction with Mahmood et al.,
O -gallate glycoprotein gp120 1993
Dianthus caryophyllus Á/ Á/ Antiretroviral proteins Á/ Ribosome inactivating protein, Lee-Huang et al.,
(DAP 30 and DAP 32) inhibition of transcription and 1991
transactivation
Dodonaea angustifolia Kitkita, teramin, tasos; used in Ethiopia Ether, dicholoromethane, Á/ Á/ Asres et al., 2001
L.f. (Sapindaceae) wound dressing, and for treat- acetone and methanolic ex-
ment of skin diseases, fever, sore tracts of leaf
throat, rhinitis, sinusitis, influ-
enza, flu, and piles
Eugenia caryophyllata Clove; used as antiemetic China Tannins eugenin, casuaric- Á/ Inhibition of virus cell fusion, Kim et al., 2001
Thun. (Myrtaceae) tin, tellimagrandin, chro- inhibition of syncytium forma-
mones biflorin and tion
isobiflorin
Eugenia jambolona Á/ Á/ Extract of bark Á/ HIV protease inhibition Kusumoto et al.,
Lam. 1995
Euodia roxburghiana Á/ Thailand, Asia, Buchapine, 3,-3-methyl-2- In vitro, inhibition of cytopathic Inhibition of reverse transcrip- McCormick et al.,
Benth. (Rutaceae) Australia butenyl-4-[3-methyl-2-bute- effect in cultured human lympho- tase 1996
nyloxy]-21H-quinolinone blastoid CEM-SS cells infected
with HIV-1
Euphorbia kansui Liou. Kansui; used for edema, asutes, China Ingenol, ingenol triacetate In vitro, MT-4 and MOLT-4 cells Inhibition of virus adsorption Fujiwara et al.,
(Euphorbiaceae) and cancer infected with HIV-1 and HTLV- to host cells 1996
IIIB
Euphorbia watanabei Á/ Á/ Putranjivain A Á/ Inhibition of HIV reverse Mekkawy et al.,
(Euphorbiaceae) transcriptase 1995
Fagara xanthoxyloides Á/ Á/ Fagaronine HIV-1 reverse transcriptase inhi- Inhibition of HIV reverse Tan, 1991
Lam. bition assay transcriptase
Table 1 (Continued )
Species (family) Vernacular name and tradi- Indigenous to Active constituents/extracts In vitro/in vivo assay model Mechanism of action References
tional uses tested
Galanthus nivalis Snowdrop Á/ Mannose-specific aggluti- Interference with virus-cell fu-
In vitro, MT-4 cells infected with Balzarini et al.,
(Amaryllidaceae) nines lectins HIV-1 and HIV-2 sion, inhibition of syncytium 1991
formation between HIV in-
fected and uninfected cells
Gelonium multiflorum Á/ Á/ Antiretroviral protein (GAP Á/ RIP, inhibition of transcription Lee-Huang et al.,
31) and transactivation 1991
G. glabra Linn. (Legu- Liquorice; used as demulcent England, Spain Glycyrrhizin, Licochalcone HIV infected OKM-1 and MOLT- Inhibition of giant cell forma- Ito et al., 1987,
minoseae) and expectorant A, glycocoumarin, licopyra- 4 cells tion of HIV-infected cells, in- 1988; Hatano et
nocoumarin terference with viral adsorption al., 1988
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
and protein kinase C
G. radix (Legumino- Á/ Á/ Glycyrrhizin, licopyranocou- Á/ Interference with viral cell Ito et al., 1988;
seae) marin binding Balzarini et al.,
1991
Gossypium spp (Malva- Cotton seed India, East In- Gossypol In vitro Á/ Lin et al., 1989;
ceae) dies, China, Polsky et al., 1989
Egypt
Helicteras isora Linn. Kiules Indonesia Aqueous extract of fruit Inhibition of HIV-1 induced cyto- Inhibition of HIV protease and Otake et al., 1995
pathogenicity in MT-4 cells reverse transcriptase
Hippeastrum hybrid Amaryllic Á/ Mannose-specific aggluti- In vitro, MT-4 cells infected with Interference with virus-cell fu- Balzarini et al.,
(Amaryllidaceae) nines lectins HIV-1 and HIV-2 sion, inhibition of syncytium 1991
formation between HIV in-
fected and uninfected cells
Homoalanthus nutans Diverse medicinal purposes Samoa Prostratin (a phorbol diter- In vitro, CEM and MT-2 cells Mechanism not well under- Gustafson et al.,
Forster Pax. (Euphor- penoid) stood, possible mechanisms 1992a
biaceae) are */down regulation of CD 4
expression in CEM and MT-2
cells, interference in protein
kinase C enzyme pathway
Hypericum perforatum Saint John’s wort; used in de- Á/ Hypericin and pseudohyper- Á/ Interference with assembly of Meruelo et al.,
(Hypericeae) pression and mental illness icin virions and secondary spread, 1988; Fanet et al.,
interaction with proviral DNA 1998; Lavie et al.,
integration, interference with 1989
viral infection, prevention of
virus spreading and budding
Jacobinia suberecta Á/ Á/ Moranoline Á/ Inhibition of HIV reverse Ratner and Hey-
transcriptase den, 1993
Lepidobotrys staudtii Á/ Cameroon 1,3,4,5-tetra-O -galloylquinic In vitro, CEM-SS cells Inhibition of reverse transcrip- Bokesch et al.,
Engl. (Lepidobotrya- acid tase 1996
ceae)
Listera ovata (Orchida- Twayblade Á/ Mannose-specific aggluti- In vitro, MT-4 cells infected with Interference with virus-cell fu- Balzarini et al.,
ceae) nins, lectins HIV-1 and HIV-2 sion, inhibition of syncytium 1991
formation between HIV in-
fected and uninfected cells
53
54
Table 1 (Continued )
Species (family) Vernacular name and tradi- Indigenous to Active constituents/extracts In vitro/in vivo assay model Mechanism of action References
tional uses tested
Loranthus parasiticus L. Benalu teh Indonesia Water extract of stem and HIV-1 infected MT-4 cells Suppression of syncytium giant Otake et al., 1995
Merr. bark cell formation, protease inhibi-
tion, reverse transcriptase inhi-
bition
Macaranga sinensis Á/ Á/ Putranjivain A Á/ Inhibition of HIV reverse Mekkawy et al.,
transcriptase 1995
Maesa lanceolata For- Á/ Á/ Maesasaponins (triterpenoid Microtray assay, colorimetric as- Á/ Apers et al., 2001
sskal (Myrsinaceae) saponins) say
Mallotus japonicum Á/ Á/ Mallotojaponin, mallato- Á/ Inhibition of reverse transcrip- Nakane et al.,
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
(Euphorbiaceae) chromene tase 1991
Maprounea africana Á/ Central Afri- Triterpenes of maprounic HIV-1 and HIV-2 reverse tran- Inhibition of reverse transcrip- Beutler et al.,
Muell-Arg. (Euphorbia- can Republic, acid/aleuritolic acid class scriptase inhibition assay tase 1995; Pengsuparp
ceae) Tanzania et al., 1994
Momordica charantia Bitter melon, karela; used for China, India Antiretroviral protein (MAP Á/ Inhibition of transcription and Lee-Huang et al.,
Linn. (Cucurbitaceae) antiviral, antitumor and immu- 30) transactivation, inhibition of 1990, 1995; Wang
nopotentiating purposes and as viral integrase et al., 1999
hypoglycaemic
Morus spp . (Moraceae) Á/ Á/ Moranoline Á/ Inhibition of HIV reverse Ratner and Hey-
transcriptase den, 1993
Myrica rubra and Myr- Á/ Á/ Myricetin Á/ Á/ Ono et al., 1990
ica nagi (Myriaceae)
Omphalea diandra Linn. Á/ Panama Deoxynojirimicin, a-homo- In vitro, microtiter infection assays Inhibition of HIV infectivity by Kite et al., 1988;
(Euphorbiaceae) jirimicin, 1-deoxymannojiri- using MT-2 cells, syncytium inhi- the enzymes glycosidase and Montefiori et al.,
micin bition assay H-9/HTLV-IIIB cell mannosidase, blocks syncytium 1988
line formation
Papaver somniferum Poppy, opium India, Asia Papaverine Á/ Interference with expression of Turano et al., 1989
Linn. (Papaveraceae) HIV proteins especially envel-
ope precursor protein gp 120
Phyllanthus emblica Amla; used in jaundice and viral Á/ Methanol extract, Putranji- Reverse transcriptase inhibition Inhibition of HIV reverse Mekkawy et al.,
Linn. (Euphorbiaceae) diseases vain A assay transcriptase 1995
Phytolacca americana Poke root Á/ Pokeweed antiviral protein In vitro, acutely and chronically Conjugation to antibody spe- Uckun et al., 1998
(Phytolaccaceae) infected lymphocytes and macro- cific to cell surface receptors
phages anti-CD 7 which facilitate cel-
lular internalization of antiviral
protein
Plumeria rubra Linn. Á/ Á/ Fulvoplumierin HIV-1 reverse transcriptase assay Inhibition of HIV reverse Tan, 1991
(Apocyanaceae) transcriptase
Pothomorphe peltata L. Á/ Dominican Re- Prenylated catechol dimers, Á/ Á/ Gustafson et al.,
Miq. (Piperaceae) public peltatols 1992b
Psidium guajava L. Á/ Á/ Procyanidin B2 In vitro enzyme reverse transcrip- Inhibition of reverse transcrip- Kakiuchi et al.,
tase assay tase 1991
Punica granatum Linn. Pomegranate, anar Á/ Punicacortein D, Punicala- In vitro, H-9 lymphocyte cells Inhibition of HIV reverse Nonaka et al.,
(Punicaceae) gin, Punicalin infected with HIV-1 transcriptase 1990
Table 1 (Continued )
Species (family) Vernacular name and tradi- Indigenous to Active constituents/extracts In vitro/in vivo assay model Mechanism of action References
tional uses tested
Quercus myrsinaefolia , Á/ Á/ Aqueous and Methanol ex- In vitro, H-9 lymphocyte cells Inhibition of HIV reverse Mekkawy et al.,
Q. stenophylla , Quercus tracts, 1,3,4-tri-O -galloyl- infected with HIV-1 transcriptase and HIV cell 1995
pedunculata quinic acid, 3,4,5-Tri-O - growth
galloylquinic acid
Rauwolfia serpentina Sarpgandha India, Paki- Papaverine Á/ Á/ Turano et al., 1989
(Apocyanaceae) stan, Burma,
Thailand, Java
Rumex cyprius (Polygo- Á/ Á/ Aqueous and Methanol ex- Á/ Inhibition of HIV reverse Mekkawy et al.,
naceae) tract transcriptase 1995
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
S. indica Linn. (Legu- Asoka Á/ Extract of bark Á/ HIV protease inhibition Kusumoto et al.,
minoseae) 1995
Schumanniophyton mag- Á/ Á/ Schumannificine Á/ Irreversible binding to gp 120 Houghton et al.,
nificum 1994
Sindora sumatrana Miq. Supratul Indonesia Aqueous extract of fruit Inhibition of HIV-1 induced cyto- Inhibition of HIV protease and Otake et al., 1995
pathogenicity in MT-4 cells reverse transcriptase
Swertia frachetiana Á/ Á/ Swertifrancheside Á/ Inhibition of DNA polymerase Pengsuparp et al.,
activity of HIV-1 reverse tran- 1995
scriptase
Symphonia globulifera Á/ Tanzania Guttiferone A In vitro, CEM-SS cells Á/ Gustafson et al.,
(Clusiaceae) 1992b
Syzygium claviflorum Á/ Á/ Betulinic acid, Platanic acid In vitro, CEM-SS and MT-4 cells Interference with virus-cell fu- Nakashima et al.,
(Myrtaceae) Betulinic acid derivatives sion, effect on glycoprotein 1992; Fujioka et
gp41 al., 1994
Terminalia arjuna Wight Arjuna Á/ Extract of stem bark Á/ HIV protease inhibition Kusumoto et al.,
et Arn. (Combretaceae) 1995
Terminalia bellerica Bahera Á/ Aqueous and methanol ex- Á/ Inhibition of HIV reverse Nonaka et al.,
Roxb. (Combretaceae) tracts, chebulagic acid, pu- transcriptase, inhibition of viral 1990; Weaver et
nicalin, punicalagin, and adsorption to cells al., 1992; Mekka-
punicacortein wy et al., 1995
T. chebula Ritz (Com- Harida, myrobalan Á/ Aqueous and methanol ex- Á/ Inhibition of HIV reverse Nonaka et al.,
bretaceae) tracts, chebulagic acid, pu- transcriptase, inhibition of viral 1990; Weaver et
nicalin, punicalagin, and adsorption to cells al., 1992; Mekka-
punicacortein wy et al., 1995
Terminalia horrida Á/ Á/ Aqueous and methanol ex- Inhibition of HIV reverse Nonaka et al.,
Staud, (Combretaceae) tracts, chebulagic acid, pu- transcriptase, inhibition of viral 1990; Weaver et
nicalin, punicalagin, and adsorption to cells al., 1992; Mekka-
punicacortein wy et al., 1995
Trichosanthes kirilowii Used as anti-inflammatory China a-trichosanthin In vitro, VB cell line, macrophage Inhibition of transcription and Chow et al., 1990
Maxim. agent and detoxifier assays cells chronically infected, in transactivation
vitro with exogenous virus; and
cells infected in vivo i.e. culture of
macrophages isolated from blood
of HIV infected patients
Urtica diocia (Urtica- Stinging nettle Á/ Acetylglucosamine-specific Á/ Interference with virus-cell fu- Balzarini et al.,
ceae) lectin sion 1991
55
56
Table 1 (Continued )
Species (family) Vernacular name and tradi- Indigenous to Active constituents/extracts In vitro/in vivo assay model Mechanism of action References
tional uses tested
Ximenia americana L. Enkoi, huda, mellau; used in Ethiopia Methanol extract of stem Á/ Á/ Asres et al., 2001
(Oleaceae) contagious diseases, stomach bark
complaints, and worm infesta-
tions
Xylopia spp. (Annona- Á/ Peru Xylopinic acid In vitro, CEM-SS cells Á/ Fuller et al., 1996
ceae)
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66 57
Transmission of virus by direct contact of recipient’s exhibit anti-HSV activity in mice and guinea pig models,
mucous membranes or skin with infected sexual partner and potentiate the activity of acyclovir (Kurokawa et
leads to development of primary genital herpes. The al., 1995; Nakano et al., 1998).
primary symptoms of HSV infection include prodromal In a study, several compounds were tested in vitro by
flu like syndrome with fever, headache, malaise, diffuse plaque reduction assay and found active against HSV-2.
myalgias followed by local symptoms consisting of Among the active compounds, cineole, eugenol, and
genital itching, tenderness, dysuria, lesions, painful curcumin prevented the transmission of HSV-2 in a
papules over genital regions and ulceration (Hardin, mouse model of intravaginal HSV-2 challenge. Eugenol
1996; Murray and Pizzorno, 1999). was also found to provide protection in guinea pig
Acyclovir is the most commonly used drug for model of HSV (Bourne et al., 1999).
treatment of HSV infections. A serious problem with
acyclovir is the drug resistance in patients. Therefore,
there is a need of developing new anti-HSV drugs. 4. Genital warts
Various phytochemicals have been traditionally used for
the treatment of viral infections and have been shown to HPV causes venereal infections known as genital
possess in vitro and in vivo antiviral activity against warts or condylomata acuminata. HPV are easily
HSV. Some of the plants reported to possess antiviral transmitted during sexual intercourse. Condylomata
activity against HSV are summarized in Table 2. acuminata is frequently asymptomatic, with occasional
A concentrated extract of Melissa officinalis (lemon clinical symptoms including anogenital pruritis and
balm) is one of the most widely used topical prepara- burning. Penis, anus, vagina, vulva and cervix are
tions in the treatment and prevention of herpes. Melissa common sites of genital warts (Hardin, 1996).
cream had been reported to interrupt the infection, Topical application of small amount of 10Á/25%
promote healing of symptoms, and prevent the recur- solution of plant resin, podophyllotoxin in compound
rence of herpes (Wolbing and Leonhardt, 1994). An- tincture of benzoin has been the most common initial
other popular topical preparation (Pompei et al., 1980) treatment of warts. Podofilox (0.5% solution), the most
for preventing and treating herpes outbreaks contains active component of podophyllotoxin, has been ap-
glycyrrhetinic acid, a triterpenoid component of Glycyr- proved by U.S. FDA for treatment of external genital
rhiza glabra (liquorice root). Glycyrrhizin has been warts (Hardin, 1996). Condylox (Oclassen Pharmaceu-
found to improve the resistance of thermally injured ticals, Inc.), a gel containing podofilox has been
mice to opportunistic infection of HSV-1 through approved by FDA for treatment of anogential warts
induction of CD4' contrasupressor T cells (Utsuno- including external genital warts and perianal warts
miya et al., 1995). (http://www.fda.gov/cder/da/da.htm).
Inhibitory effects of various Ayurvedic, Panamanian
and South American medicinal plants on infection of
HSV-1 have been studied (Hattori et al., 1995; Abad et 5. Chlamydial genital infections
al., 1999). Some of the plants found to be active against
HSV-1 are Eupatorium articulatum , Baccharis trinervis , C. trachomatis is also transmitted through sexual
Heisteria acuminata , Strychnos potatrum , Rhus acumi- contact and leads to diseases such as non-gonooccal
nata , and Saraca indica. Traditional herbal medicines urethritis, cervicitis, pelvic inflammatory disease, and
such as Kakkon-to, Kanzo-bushi-to, Shigyako-to etc. lymphogranuloma venereum.
have been used historically for the treatment of in- Berberine is effective in treatment of ocular C.
fectious diseases in China. Efficacy of these traditional trachomatis and is expected to be equally effective in
medicines, in HSV-1 has been studied in vitro and in genital chlamydia infections. Berberine containing
vivo. Kakkon-to was found to induce strong delayed douches and vaginal depletion pack can be used for
type hypersensitivity in HSV infected mice, leading to local application in chlamydial infections. Tinctures,
localization of skin lesions and reduction of mortality in powdered dried root, fluid and solid extracts of Hy-
mice model (Nagasaka et al., 1995). Kanzo-bushi-to and drastis canadensis , Berberine vulgaris , and Berberis
Shigyako-to (contains medicinal plant extracts from aquifolium can be used orally for treatment (Murray
Zingiberis siccatum rhizoma, Aconiti tuber and Glycyr- and Pizzorno, 1999). A polyherbal formulation, Pra-
rhiza radix ) have been found to increase the resistance neem (contains purified extracts from Azadirachta
of thermally injured mice (infected with HSV-1) through indica and saponins from Sapindus mukerrosi ) has
the activation of contrasupressor T cells and CD8' T been reported to possess activity against Chlamydia in
cells (Ikemoto et al., 1994; Matsuo et al., 1994). Some of clinical studies (Garg et al., 1994). Out of 28 patients of
the traditional medicinal plants such as Rhus javanica chlamydial cervicitis, 22 patients recovered clinically and
Linn, Geum japonicum Thunb, Syzygium aromaticum microbiologically after 7 Á/21 days of application of
Linn, and Terminalia chebula Retuz have been shown to Praneem cream.
58
Table 2
List of plants reported to possess anti-HSV activity
Species (family) Vernacular name and traditional uses Indigenous to Active constituent/fraction/extract In vitro or in vivo assay References
model
A. catechu Linn. (Palmae) Betel nut India, China, Methanol and aqueous extracts of seed Plaque inhibition assay of Hattori et al., 1995
Asia HSV-1 in Vero cells
B. trinervis Pers. (Com- Á/ Á/ Aqueous extract In vitro HeLa cells infected Abad et al., 1999
positae) with HSV
Bauhinia vahlii Wight and Bhorla; used for treatment of cuts and Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996a
Arnott wounds
Camptotheca acuminata Á/ China 10-Methoxycamptothecin Plaque reduction assay Tafur et al., 1976
(Nyssaceae)
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
Carissa carandus Linn. Karondath; used in diarrhea and dysen- Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996a
(Apocyanaceae) try
D. caryophyllus Á/ Á/ Dianthin 32, ribosome inactivating protein Plaque reduction assay Tomasi et al., 1982
E. articulatum Á/ Á/ Aqueous extract In vitro, HeLa cells in- Abad et al., 1999
fected with HSV
Gelonium multiforum Á/ Himalaya Antiretroviral protein GAP31 HSV infection assay, Pla- Tomasi et al., 1982;
que reduction assay Bourinbaiar and Lee-
Huang, 1996
G. japonicum Thunb. Á/ Á/ Eugenin Plaque reduction assay on Kurokawa et al., 1995,
Vero cells, murine infection 1998
model
G. glabra Linn. (Legumi- Liquorice; used as demulcent, expector- England, Spain Glycyrrhizin, glycyrrhizic acid Inhibition of viral growth Pompei et al., 1979;
noseae) ant in HSV infected cell cul- Utsunomiya et al.,
tures, mice model 1995
Gossypium spp (Malva- Cotton seed India, East In- Gossypol, apogossypol Á/ Wichmann et al., 1982
ceae) dies, Egypt
H. acuminata Á/ Á/ Ethanolic extract In vitro Abad et al., 1999
Holoptelia integrifolia Used in rheumatic swellings Á/ Methanol extract of bark In vitro, Vero cells Rajbhandari et al.,
Plance (Ulmaceae) 2001
Hypericum cordifolium Marmhendo; used in fever Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996b
Choisy (Hypericeae)
Limonium sinense Girard Used in fever, hemorrhage, and men- China Ethanolic extract, flavonoids isodihydrosyrengetin, Plaque inhibition assay of Lin et al., 2000
Ktze strual disorders (()epigallocatechin-3-O -gallate, samarangenin, HSV-1 in Vero cells
myrecetin, gallic acid, (()epigallocatechin
Macaranga pustulata Malato, kala; used in topical treatment Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996b
King ex Hook f. (Eu- of skin blemishes
phorbiaceae)
M. lanceolata Forsskal Á/ Á/ Maesasaponins triterpenoid saponins Microtray assay, colori- Apers et al., 2001
(Myrsinaceae) metric assay
Maesa macrophylla Wall. Bhogati; used in tonsillitis Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996b
A. DC. (Myrsinaceae)
Malotus philippensis Lam. Sindure, Kamala; used in diarrhea and India, Pakistan, Methanol extract In vitro, Vero cells Taylor et al., 1996a
(Euphorbiaceae) dysentry East Indies, Ne-
pal
M. officinalis (Labiatae) Lemon mint balm; used as carminative, Á/ Á/ Á/ Wolbing and Leon-
antispasmodic, sedative hardt, 1994
Table 2 (Continued )
Species (family) Vernacular name and traditional uses Indigenous to Active constituent/fraction/extract In vitro or in vivo assay References
model
Milettia extensa Bentham Gaujo; used in infected wounds and Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996a
Baker (Euphorbiaceae) scabies
M. charantia Linn. (Cu- Bitter melon, karela; used for antiviral, China, India Antiretroviral protein MAP30 HSV infection assay, Pla- Tomasi et al., 1982;
curbitaceae) hypoglycaemic, antitumor, and immu- que reduction assay Bourinbaiar and Lee-
nopotentiating purposes Huang, 1996
Myristica fragrans Van Nutmeg Á/ Methanol extract of aril Plaque inhibition assay of Hattori et al., 1995
Houtt. (Myristaceae) HSV-1 in Vero cells
Nerium indicum Mill. Used in swelling, skin infection Á/ Methanol extract In vitro, Vero cells Rajbhandari et al.,
(Apocyanaceae) 2001
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
P. americana (Phytolac- Poke root Tropical Ameri- Pokeweed antiviral protein PAP-S Plaque reduction assay Tomasi et al., 1982
caceae) ca, South Africa
Pongamia glabra Vent. Á/ Á/ Methanol extract of bark and roots Plaque inhibition assay of Hattori et al., 1995
(Leguminoseae) HSV-1 in Vero cells
Potamogeton malaianus Á/ Á/ Potamogetonyde, potamogetonol, and potamogeto- Vero cell line kidney fibro- Kittakoop et al., 2001
Miq. nin blast of an African green
monkey
Punica gratum Linn. (Pu- Pomegranate, anar Á/ Methanol extract of pericarp Plaque inhibition assay of Hattori et al., 1995
nicaeae) HSV-1 in Vero cells
R. acuminata L.f. (Ana- Á/ Á/ Aqueous extract of gall Balb/c mice model Hattori et al., 1995
cardiaceae)
R. javanica Linn. (Ana- Used in treatment of chronic diseases China and Japan Aqueous extract, Moronic acid Plaque reduction assay, Kurokawa et al., 1995,
cardiaceae) such as gastric and duodenal ulcers guinea pig model, mouse 1997, 1999; Nakano et
model al., 1998
Rumex hastatus D. Don Annile; used in tonsillitis and sore throat Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996a
(Polygonaceae)
S. indica Linn. (Legumi- Asoka Á/ Aqueous extract, Methanol extract of bark Balb/c mice model, Plaque Hattori et al., 1995
noseae) reduction assay of HSV-1
on Vero cells
Sibbaldia micropetala Bhui pasari jhar; used in diarrhea and Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996b
(Rosaceae) dysentry
Stephania cepharantha Á/ Á/ Methanol extract of root and tubers, 13 bisbenzyli- In vitro plaque reduction Nawawi et al., 1999
soquinoline 1 protoberberine, 2 morphinamine assay on Vero cells, in vivo
Balb/c mice model
Streblus asper Loureiro Sehor; used in diarrhea and dysentry Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996a
(Moraceae)
S. potatrum L.f. (Loga- Á/ Á/ Methanol extract Plaque inhibition assay of Hattori et al., 1995
niaceae) HSV-1 on Vero cells, Balb/
c mice model
S. aromaticum L. Merr. et Clove Molucca Eugenin Plaque reduction assay on Kurokawa et al., 1997,
Perry (Myrtaceae) Vero cells, Mouse infection 1998
model
Terminalia alata Heyne ex Saj; used in diarrhea and dysentry Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996a
Roth (Combretaceae)
T. chebula Retz. (Com- Harida, myrobalan Á/ Aqueous extract of fruit Plaque reduction assay, Kurokawa et al., 1995,
bretaceae) Balb/c mice model 1997
59
60
Table 2 (Continued )
Species (family) Vernacular name and traditional uses Indigenous to Active constituent/fraction/extract In vitro or in vivo assay References
model
Tridex procumbens Linn. Kurkure; used in cuts and wounds Nepal Methanol extract In vitro, Vero cells Taylor et al., 1996a
(Asteraceae)
Tripterygium wilfordii Á/ Á/ Triptofordin C-2 In vitro Hayashi et al., 1996
Hook fil.
Withania somnifera L. Ashwagandha Israel Methanol extract Plaque inhibition assay of Hattori et al., 1995
(Solanaceae) HSV-1 in Vero cells
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66 61
6. Trichomoniasis of vaginitis include N. gonorrhoea , herpes simplex virus
and C. trachomatis (Ruggiero, 1996; Murray and
Trichomoniasis, caused by the flagellated, motile Pizzorno, 1999).
protozoan T. vaginalis , is usually transmitted sexually. Traditionally, herbal preparations have been used for
Clinical symptoms of the disease include malodorous the treatment of various STDs. In Central America and
yellowish-green vaginal discharge, vaginal itching, red- Caribbean, 101 plants are claimed to be used in
ness of the vulva and/or vagina, painful intercourse, traditional medicine for treatment of gonorrhoea. In a
abdominal pain, and painful urination (Hardin, 1996; study, tinctures from 44 plants used for STDs in
Murray and Pizzorno, 1999). Up to 50% of the women Guatemala were screened for in vitro activity against
infected with trichomoniasis are asymptomatic. Tricho- N. gonorrhoeae . Extracts of bark of Bixa orellana , fruits
monas is known to degrade secretory leukocyte protease of Parmentiera edulis , leaf of Diphysa robinioides ,
inhibitor, a substance that is believed to protect the cells Eupatorium odoratum , Gliricidia sepium , Physalis angu-
of vaginal mucous membrane from HIV infection, lata , Piper aduncum and Prosopis juliflora , root of
thereby increasing the risk of HIV transmission. Casimiroa edulis , and whole Clematis dioica were found
A 0.4% solution of Melaleuca alternifolia (tea tree) oil to be active against N. gonorrhoea (Caceres et al., 1995).
in 1 l of water as daily vaginal douche was found to be In another study, active substances from medicinal
an effective treatment for trichomoniasis (Pena, 1962). plants of Rwanda (Central Africa) that were indigen-
Dried roots, rhizomes, tincture and fluid extracts of ously used for gonorrhoea were screened for their
botanicals containing berberine such as H. canadensis , antimicrobial activity against N. gonorrhoea , N. menin-
Echinacea angustifolia , and Angelica species are being gitidis , Streptococcus pyogenes , and Staphylococcus
prescribed for treatment of trichomonal infections aureus . Plants showing greatest activity against these
(Murray and Pizzorno, 1999). In another study, extracts organisms include Hygrophila auriculata , Vernonia ae-
of bark and leaves of Mikania cordifolia , leaves of
nulans , V. crudia , Euphorbia grantii , Cajanus cajan ,
Neurolaena lobata and bark of Scutia buxifolia have
Orthosiphon australis , Rumex abyssinicus and Lanatana
been reported to inhibit the growth of T. vaginalis in
trifolia .
vitro. Some essential oils including those obtained from
Allium sativum (garlic) possesses antibacterial, anti-
Mentha piperita and Lavandula angustifolia have also
viral and antifungal properties. Douching solutions and
been reported to possess strong antitrichomonal proper-
gauze containing garlic may be used as a tampoon/
ties (Jankov et al., 1968).
suppository for most of the infectious vaginitis. G.
glabra contains isoflavonoids that are reported to be
effective against Candida. Water-soluble chlorophyll
7. Vaginitis and vulvovaginitis can also be added to the douching solutions to provide
relief in vaginitis. Atrophic vaginitis due to lack of
Vaginitis is one of the most common mixed vaginal estrogens may be treated by the use of phytoestrogens
infections and may reflect symptoms of a more serious obtained from plants such as Ribes nigrum , Foeniculum
underlying STD. Vaginal infections may increase the vulgare , Illicium verum , Panax ginseng , Medicago
risk of transmission of HIV and other sexually trans- sativa, Trifolia repens and G. glabra (Murray and
mitted pathogens. Bacterial vaginosis had been reported Pizzorno, 1999).
to be associated with increased susceptibility to HIV Tea tree oil, an essential oil from Australian plant M.
infection (Murray and Pizzorno, 1999). alternifolia , has a wide spectrum of antimicrobial
Major symptoms of vaginitis are vaginal discharge activity with a minimal effect on commensal lactobacilli
with a foul odor, itching, burning and inflammation in vagina (Hammer et al., 1999). An alcoholic extract of
(Murray and Pizzorno, 1999). Vaginitis may be caused M. alternifolia (tea tree) diluted with water has been
by: used as a douche combined with saturated tampoons in
the treatment of vaginitis (Pena, 1962). In addition to
a) hormonal changes in postmenopausal women (hor-
monal vaginitis), extract, its vaginal pessaries have also been reported to
b) physical or chemical agents which cause damage to treat bacterial vaginosis (Blackwell, 1991). Praneem
vaginal membranes (irritant vaginitis), and polyherbal products have been reported to be effective
c) disturbance of ecology of the healthy vagina (in- in treating patients with abnormal vaginal discharge due
fectious vaginitis). to microbial infections (Mittal et al., 1995).
Ayurveda also prescribes some drugs that can be
Infectious vaginitis may be caused by the prevalence of applied vaginally for the treatment of vaginal disorders.
microorganisms such as Candida albicans (vaginal These include Subhakari vati, Somanath rus and
candidiasis), T. vaginalis (trichomonal vaginitis), and Soubhagya vardhana tel (Essential ayurvedic drugs for
G. vaginalis (non-specific vaginitis). Less frequent causes dispensaries and hospitals, 2000).
62 K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66
8. Vaginal formulations of herbal origin Praneem polyherbal had completed phase I safety and
acceptability trials in India. It was found to be effective
V-gel and PH 5 are examples of vaginal formulations in post-coital tests in women and produced a curative
based on herbal extracts, available in Indian market. V- effect in women with vaginal discharge as per studies
gel, a polyherbal formulation of The Himalaya Drug conducted in India, Egypt and Dominican Republic.
Company (Bangalore, India), is indicated for vaginal Viracea, a proprietary formula of Destiny BioMediX
infections of varied etiology such as vaginitis, cervicitis, Corporation, is a topical microbicide consisting of
vaginal candidiasis and vaginal discharge. It contains benzalkonium chloride and phytochemicals derived
the extracts of Emblica officinalis , Terminalia belerica , from Echinacea purpurea . Viracea has been reported to
T. chebula , Rosa centifolia , Elletaria cardamomum , possess antiviral activity against Acyclovir resistant as
Boerhaevia diffusa , Parmelia perlata , Curcuma longa well as susceptible strains of HSV-1 and HSV-2
and Vitex negundo. V-gel has been found effective in (Thompson, 1998).
treating diseases caused by microorganisms such as G.
vaginalis , Moniliasis , T. vaginalis , Gonococcus vaginalis ,
C. albicans and other non-specific organisms. In clinical
studies, it was found that V-gel provides symptomatic
relief within 4 Á/5 days of application and complete 9. Plantibodies as topical microbicides
cessation of symptoms within 7Á/14 days of treatment.
The formulation was found to be safe and can be used An innovative approach to microbicide development
by pregnant women, during pelvic inflammatory dis- is the use of genetically engineered plants to produce
ease, and in postnatal cases (Mitra et al., 1997; Umadevi human monoclonal antibodies, ‘plantibodies’, active
and Swarup, Dec1998Á/Feb1999; Narmada and Va- against a range of STIs. Even though plantibodies are
nitha, 1999). not based on indigenous empirical knowledge, these are
PH 5 (Zoic Pharmaceuticals, Delhi) has been claimed briefly mentioned because of their potential activity
to restore normal vaginal pH, reduce leucorrhoea and against STIs. With this technology, it is possible to
various vaginal discharges, and possess astringent, anti- deliver anti-HIV antibodies directly to the vagina,
inflammatory, antiseptic and bacteriostatic effects. The allowing them to combat pathogens before actual
vaginal pessaries consist of herbal extracts enclosed in infection occurs (Forbes, 2000). Mass production of
small bags made of cloth. It contains the extracts of human antibodies using genetically engineered plants is
Quercus infectoria , Sausurea lappa and Tamarix gallica. relatively inexpensive as compared to those pro-
A vaginal depletion pack (‘Vag pack’) is regularly duced by fermentation technology and transgenic ani-
used and prescribed by naturopathic physicians for mals (Harvesting Monoclonal Antibodies from Plants,
treatment of various vaginal disorders over the last 50 1999).
years (Murray and Pizzorno, 1999). Efficacy of this pack From a public health perspective, monoclonal anti-
has not been studied in controlled clinical trials, but it bodies provide a promising approach for preventing
has a long history of use, which dates back to 19th reproductive tract infections and are expected to play an
century. The ‘Vag pack’ consists of a tampoon contain- important preventive role in future emerging disease
ing a mixture of H. canadensis tincture, Thuja occiden-
epidemics (Zeitlin et al., 1999). Corn has been geneti-
talis oil, M. alternifolia oil, bitter orange oil, anhydrous
cally engineered to produce human antibodies against
magnesium stearate, vita minerals and glycerin.
herpes and sperm. Research is in progress to produce
Praneem polyherbal cream, tablets and suppositories
anti-HIV antibodies. Herpes antibody has been found to
are under clinical development and possess wide spec-
protect mice against infection, and a sperm antibody has
trum antibacterial, antifungal and antiviral effects
against sexually transmitted pathogens (Talwar et al., prevented pregnancy in rabbits. Corn has been proposed
1995, 1997, 2000). Praneem contains purified extract of as a cheap and safe potential source of antibodies for
A. indica (neem) and saponins extracted from Sapindus contraceptive antimicrobial activities. Plantibodies are
mukerrossi (reetha). These have been reported to inhibit very potent, specific, and have the potential to be used in
the clinical isolates of different species of Candida (C. novel ways such as personal lubricants, gels, or con-
albicans , C. tropicalis and C. krusei ), N. gonorrhoea trolled-release devices for vaginal insertion. Topical gels
(including penicillin resistant strains), G. vaginalis , and containing plantibodies for HSV-1 and HSV-2 are under
multi drug resistant Escherichia coli and S. aureus. preclinical development. Application of these antibodies
Intravaginal inoculation of these formulations pre- to the mice vagina has been shown to prevent the
vented lesions and vaginal transmission of HSV-2 and infection with genital herpes. A more potent herpes
C. trachomatis in progestin-sensitized mice. In addition, plantibody to prevent mother to child transmission of
they have also been found to possess virucidal activity herpes is under development (Harvesting Monoclonal
against HIV at doses non-toxic to cells in culture. Antibodies from Plants, 1999).
K. Vermani, S. Garg / Journal of Ethnopharmacology 80 (2002) 49 Á/66 63
10. Conclusion Blackwell, A.L. 1991. Tea tree oil and anaerobic (bacterial) vaginosis.
Lancet 337, 300.
Bokesch, H.R., McKee, T.C., Currens, M.J., Gulakowski, R.J.,
Several plant extracts and their constituents possess McMohan, J.B., Cardellina, J.H., Boyd, M.R. 1996. HIV inhibi-
activity against sexually transmitted diseases indicating tory natural products. Part 27. HIV inhibitory gallotannins from
their huge potential as an effective measure for preven- Lepidobotrys staudtii . Natural Products Letters 8, 133 Á/136.
tion and treatment of STDs including AIDS. Plant Bourinbaiar, A.S., Lee-Huang, S. 1996. The activity of plant-derived
derived microbicides and plantibodies are some of the antiretroviral proteins MAP30 and GAP31 against herpes simplex
virus infection in vitro . Biochemistry Biophysics Research Com-
new approaches for prevention of HIV and other
munications 219, 923 Á/929.
sexually transmitted pathogens. Herbal medicines can Bourne, K.Z., Bourne, N., Reising, S.F., Stanberry, L.R. 1999. Plant
be developed as a safe, effective and economical alter- products as topical microbicide candidates: assessment of in vitro
native to drugs presently approved for symptomatic and in vivo activity against herpes simplex virus 2. Antiviral
treatment of STDs and AIDS. Research 42 (3), 219 Á/226.
Boyer, P.L., Currens, M.J., McMohan, J.B., Boyd, M.R., Hughes,
S.H. 1993. Analysis of non-nucleoside drug resistant variants of
human immunodeficiency virus type 1 reverse transcriptase.
Journal of Virology 67, 2412 Á/2420.
Acknowledgements Caceres, A., Menendez, H., Mendez, E., Cohobon, E., Samayoa, B.E.,
Jauregui, E., Peralta, E., Carrillo, G. 1995. Antigonorrhoeal
The authors would like to acknowledge the support activity of plants used in Guatemala for the treatment of sexually
from the Department of Biotechnology (DBT), Govern- transmitted diseases. Journal of Ethnopharmacology 48 (2), 85 Á/88.
ment of India and Contraception Research and Devel- Chow, T.P., Feldman, R.A., Lovett, M., Piatak, M. 1990. Isolation
and DNA sequence of a gene encoding alpha-trichosanthin, a type
opment Program (CONRAD), United States, under the
I ribosome-inactivating protein. Journal of Biological Chemistry
‘Indo-US collaborative Program in Contraceptive and 265, 8670 Á/8674.
Reproductive Health Research’. The vews expressed by Dai, J.R., Decosterd, L.A., Gustafson, K.R., Cardellina, J.H., Gray,
the authors do not necessarily reflect the views of DBT G.N., Boyd, M.R. 1994. Novel naphthaquinones from Conosper-
or CONRAD. mum incurvum . Journal of Natural Products 57, 1511 Á/1516.
Decosterd, L.A., Parsons, I.C., Gustafson, K.R., Cardellina, J.H.,
McMohan, J.B., Cragg, G.M., Murata, Y., Pannell, L.K., Steiner,
J.R., Clardy, J., Boyd, M.R. 1993. Structure, absolute stereochem-
istry and synthesis of conocurvone, a potent, novel HIV inhibitory
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