| Chapter 67 Artemisia annua (Sweet Wormwood) Eric L. Yarnell, ND, RH(AHG), Kathy Abascal, BS, JD, RH(AHG) Chapter Contents General Description Chemical Composition History and Folk Use Pharmacology Antimalarial Effects, Antiparasitic Effects, Antineoplastic Effects, Clinical Applications Malaria, Schistosomiasis, Dosage Toxicity Drug Interactions Artemisia annua (family: Asteraceae) … Bot. Artemisinin is an endoperoxide sesquiterpene lactone that is effective against multidrug-resistant malaria and is also known to act on P. falciparum, the Plasmodium species that causes cerebral malaria. Phylogenetic tree of plant DXS proteins. A. annua have AChE inhibitory activity and are able O O CH3 O H3C O O CH3 1 O OCH3 O OH 2 O O H3CO H3CO OH OCH3 OCH3 OH 3 O O H3CO H3CO OCH3 OH OH OH 4 O HO OH OH HO O 5 Fig. Introduction Artemisia annua L is a medicinal plant traditionally used for treatment of malaria and other diseases in China. Functional characterization of the three genes encoding 1-deoxy-D-xylulose 5-phosphate synthase in maize. Only recently has it come to the attention of researcher’s because of its potent anti-malarial properties. Tan HX, Xiao L, Zhou Z, Zhang L, Chen WS. The leaves are green or yellow–green, with dotted glands distributed on the surface in a honeycomb pattern. However, although these synthetic and semisynthetic molecules are being tested widely, malaria remains a big threat to poorer countries, where these modern antimalarial drugs are not available to the general public. In recent decades, the later steps of artemisinin biosynthesis have been thoroughly investigated; however, little is known about the early steps of artemisinin biosynthesis. ied Microbiology Appl Biotechnology, 72: 11-20. A few are mentioned here, but most that are effective in significantly reducing the yeast population in the gut will work. Artemisia Annua specifically, has been well known in Chinese folk medicine for the last 2000 years. Background: Artemisia annua L, artemisinin and artesunate reveal profound activity not only against malaria, but also against cancer in vivo and clinical trials. Liu C, Zhao Y, Wang Y (2006). Int J Mol Sci. If you lived in China a thousand years ago and had a fever, inflammation, or malaria, a tea made from a flowering plant called Artemisia annua might have been your treatment. Tea tree oil may be used in adults on an occasional basis, applied sparingly to the areas of intense scaling after wetting the scalp. The evergreen plant Artemisia annua contains artemisinin 22, a potent natural antimalarial, but efforts to cultivate the plant and extract the compound for large-scale production have proved difficult and expensive. ARTEMISIA ANNUA. Kingston, in The Practice of Medicinal Chemistry (Fourth Edition), 2015. It is also reported that although parasites are showing drug resistance in malaria patients in Southeast Asia, the same strains are not being identified as resistant in laboratory studies, suggesting that the relationship between laboratory studies and patient treatment is not direct. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, Amino acid sequence alignment of DXS proteins of. This site needs JavaScript to work properly. THANK YOU. The Korean annual weed, Artemisia annua L., has been used as a folk medicine for treatment of various diseases. COVID-19 is an emerging, rapidly evolving situation. Heinz Lüscher Artemisia annua Dr. med. The herb is native to Asian lands having a temperate climate. -, Carretero-Paulet L., Cairo A., Talavera D., Saura A., Imperial S., Rodriguez-Concepcion M., et al. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Many analogues and derivatives of artemisinin have been prepared in attempts to improve its activity and utility. Hunt S, Stebbings S, McNamara D. An open-label six-month extension study to investigate the safety and efficacy of an extract of Artemisia annua for managing pain, stiffness and functional limitation associated with osteoarthritis of the hip and knee. (2013). 2019 Nov 29;20(23):6034. doi: 10.3390/ijms20236034. Nobel laureate Tu Youyou won the 2015 prize for Medicine/Physiology for the discovery of artemisinin, a drug therapy for malaria that has saved millions across the globe.This book traces the path of discovery beginning with Chairman Mao's 1964 instruction to Chinese researchers to find a cure for malaria, a disease that plagued the military and civilians alike in endemic regions. Cultivation of Artemisia annua in Africa and Asia (Antony Ellman Outlooks on Pest Management Volume 21(Antony Ellman, Outlooks on Pest Management, Volume 21, Number 2, April 2010) Artemisinin Conference, Madagascar, 12–14 October 2010 21. PART USED: Above ground- harvested in Summer before the flowers bloom. Bot. Olofsson L, Engström A, Lundgren A, Brodelius PE. Plant Biol. Simonnet X et al. The next question to address is how quickly malaria will evolve resistance to artemisinin. Additionally, pharmacological interactions between the two catechins and artemisinin showed enhancement of the antiplasmodial effects of 22 when the latter was administered in sublethal doses. A team of researchers from Canada and the United Kingdom studied parasites obtained from travelers who returned to Canada with malaria after trips abroad (11 from Africa, including Angola, Cameroon, Congo, Ghana, Kenya, Liberia, Nigeria, and Tanzania) between April 2008 and January 2011. Relative expression of genes of terpene metabolism in different tissues of Artemisia annua L. [Molecular cloning and characterization of the 2-C-methyl-D-erythritol 4-phosphate cytidylyltransferase gene from Artemisia annua L.]. Tudjuk jól, hogy a kemoterápia az egyik legszörnyűbb dolog, aminek valaki alávetheti magát. Abstract. [5] For instance, it was reported that malarial parasites from sub-Saharan Africa may be acquiring mutations that make them resistant to artemisinin, the backbone of new antimalarial therapy. These compounds have increased solubility in vaccines and have improved antimalarial activities. 2020 Nov 22:1-16. doi: 10.1007/s12033-020-00287-3. Would you like email updates of new search results? Here, we isolated and characterized polyphenols from Korean A. annua L (pKAL). E-mail: … In this chapter, studies on pharmacological actions of A. annua beyond antimalaria are summarized. Although Asian A. annua is now being grown on the African continent, A. afra, commonly referred to as African wormwood, is more commonly used in traditional medicine against infections and malarial fever. See this image and copyright information in PMC. However, owing to its remedial benefits, it is now cultivated throughout the world. Various essential oils may be useful for their incorporation in scalp sebaceous lipids and antimicrobial action against Malassezia. This officially listed herbal medicine is used mainly as an antimalarial agent. Appendages on the base are extremely short, with slight points. The artemisinic acid produced was easily transported out of the yeast in high yield and transformed to 22 via established chemistry <1992JOC3610, 1994USP5310946>. And it is in A Handbook of Prescriptions for Emergencies (Zhou Hou Bei Ji Fang) by Hong Ge, a physician of the Eastern Jin Dynasty, that A. annua L. was first recorded as a herbal medicine that could cure malaria by “administering the juice wrung out of fresh A. annua L.”, In Artemisinin-Based and Other Antimalarials, 2018. Artemisia annua is a ANNUAL growing to 3 m (9ft) by 1 m (3ft 3in) at a fast rate. The ability to determine artemisinin and its known analogs in plant extracts is an especially difficult task because the compounds are present in low concentrations, are thermolabile, and lack ultraviolet or fluorescent chromophores. Unravelling the regulatory mechanisms that modulate the MEP pathway in higher plants. Artemisinin was first isolated in 1972 and has served as prototype for many semisynthetic versions such as arteether and artemether. Clear Summer Heat; especially with low fever, headache, dizziness, and a stifling sensation in the chest. The involucre is smooth, hairless, and green, with linear, oval outer bracts. The yeast farnesyl pyrophosphate biosynthetic pathway was manipulated to increase production and prevent an alternative sterol synthesis pathway from competing. The style is shorter than the stamen, with a thin, slightly bisected stigma, which has cilia on the top. (2011). Artemisia annua, known in China as Qinghaosu, contains artemisinin, which has antimalarial activity. Kingston, in, The Practice of Medicinal Chemistry (Fourth Edition), Six-membered Rings with One Heteroatom, and their Fused Carbocyclic Derivatives, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition). A gene for amorphadiene synthetase from A. annua was inserted into the modified yeast that converts farnesyl pyrophosphate into amorphadiene, an important artemisinin intermediate. Artemisia annua is a commonly used Chinese herbal medicine, which is bitter in taste and cold in nature. -, Cordoba E., Porta H., Arroyo A., Roman C. S., Medina L., Rodriguez-Concepcion M., et al. Rick M. Fairhurst, Thomas E. Wellems, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition), 2015, Artemisinin is derived from Artemisia annua (qing hao), an herbal plant used in China for 2000 years as therapy for fevers.574 Artemisinin and its derivatives (artesunate, artemether, and dihydroartemisinin) are highly effective against multidrug-resistant parasites and result in rapid clearance of parasitemia and clinical improvement, usually within 24 to 36 hours. In the wild, it reaches heights of 30–150 cm. This is the first comprehensive book to cover the importance of Artemisia annua in the global health crisis and in the treatment against diseases.. A component and extract, artemisinin, is the source of other derivatives which are also suitable for pharmaceutical use. FLAVOR: Bitter, pungent, fragrant CHANNEL: Liver, Gall Bladder, Kidney FUNCTIONS GROUP: Clearing Internal Heat- Clear Summer Heat-Clearing empty Heat.1. Finally, a novel cytochrome P450 that oxidizes amorphadiene to artemisinic acid over the course of three steps was introduced. [Advances in molecular regulation of artemisinin biosynthesis]. Recently, Keasling and co-workers have engineered a yeast to produce 22 in quantities comparable to the evergreen plant but in much less time <2006NAT940>. Other potential antimalarial natural products are described in two recent reviews [258,268]. Artemisinin-derivatives are recommended as part of a combination treatment for uncomplicated malaria. According to the Newly Compiled Materia Medica of the Tang Dynasty, “crude stalks of Artemisia annua can be applied to incised (metal-inflicted) wounds, and effectively stop bleeding, promote tissue regeneration and alleviate pain.” In addition, Peaceful Holy Benevolent Prescriptions and Miraculous Emergency Prescriptions also mentioned that A. annua had been used for treating “unstoppable purulence in ears” and “dental swelling and pain.” In modern times, a great many explorative studies have been conducted on the pharmacological actions of A. annua. Artemisia (Artemisia annua L.) is a bush type plant, and is one of the most distributed genus of asteraceae genus.Members of this genus have a distinctive aroma or unique taste and have benefits in the medical field. They found that 11 of the 28 parasites grown in the laboratory had a mutation that made them resistant to artemether. Mol Biotechnol. [Molecular mechanism of artemisinin biosynthesis and regulation in Artemisia annua]. Artemisia annua is a well-known medicinal plant that has been utilized for a number of purposes, including malaria, for centuries. Heinz Lüscher The Artemisia plant Artemisia annua is an annual plant that grows to a man-sized bush in summer and thrives well in our latitudes. Grapefruit seed extract and Artemisia annua can also be added to reduce the yeast population. The active ingredient, artemisinin, was isolated by Chinese scientists in 19722. Species description (Flora Helvetica 2018) 20-150(-200) cm hoch, stark verzweigt, +/- kahl, aromatisch.Blätter 3-4fach regelmässig kammartig gefiedert, mit spitzen, ca. (6) 6 product ratings - Grapefruit Seed Extract with Echinacea & Artemisia Annua, High Potency, 125 mg, The Chinese plant Artemisia annua was used for the treatment of fevers in Chinese medicine as long ago as 340 CE, but its active constituent was not identified by Chinese scientists as qinghaosu (Figure 5.18; artemisinin) until 1971 [260]. Background:Artemisia annua is a Chinese medicinal herb. The tree was constructed with the neighbor-joining method using MEGA program 3.0 with 1,000 bootstrap values. Its use in treating malaria has been known in China for over 2000 years. Artemisia annua is a medicinal plant whose use has long been reported in China, where it is locally known as qinghao. Another natural product that has exhibited antimalarial activity is the polyphenol (−)-epigallocatechin-3-gallate 23. eCollection 2020. Amino acid sequence alignment of DXS proteins of Artemisia annua and Arabidopsis thaliana…, Phylogenetic tree of plant DXS proteins. 574 Artemisinin and its derivatives (artesunate, artemether, and dihydroartemisinin) are highly effective against multidrug-resistant parasites and result in rapid clearance of parasitemia and clinical improvement, usually within 24 to 36 hours. Artemisia annua (Quing-hao), (Fig. 60 2933–2943. Fravel, in Comprehensive Heterocyclic Chemistry III, 2008. The word “Artemisia” in wormwood’s botanical name is a tribute to the Greek goddess Artemis, who was worshiped or invoked to influence matters of birth and chastity. NIH Several derivatives of the original compound have proved effective in the treatment of Plasmodium falciparum malaria and are currently available in a variety of formulations: artesunate (intravenous, rectal, oral), artelinate (oral), artemisinin (intravenous, rectal, oral), dihydroartemisinin (oral), artemether (intravenous, oral, rectal), and artemotil (intravenous). Subcellular localization analysis indicated that all three AaDXS proteins are targeted to chloroplasts, which is consistent with the presence of plastid transit peptides in their N-terminal regions. 1 Unlocking the full (medicinal) potential of Artemisia annua: A LC-MS and NMR investigation of the tea infusion Julia Moutona and Frank van der Kooyb* a Natural Products Laboratory, Institute of Biology, Leiden University, PO Box 9502, 2333 CC Leiden, the Netherlands. A particularly noteworthy finding was the effectiveness of these agents for strains of Plasmodium that are resistant to the common antimalarial drug chloroquine. Comparative transcriptomics of glandular and fila … Artemisinin: current state and perspectives for biotechnological production of an antimalarial drug. -, Cordoba E., Salmi M., Leon P. (2009). Artemisinic acid (qinghao acid), the precursor of artemisin, is present in the plant in a concentration up to ten times that of artemisinin. Also known as Sweet wormwood, A. annua yields artemisinin and the derivatives of this compound are potent antimalarial drugs. The use of fiber products such as psyllium and of other vegetable fiber is essential to maintain rapid passage of treated organisms through the bowel. The plant itself is hairless and naturally grows from 30 to 100 cm tall, although in cultivation it is possible for plants to reach a height of 200 cm. 13 51–58. Artemisia annua L., Geneva, World Health Oraganization 5. Its stem is erect brownish or violet brown. USA.gov. Like daisy and sunflower, which belong to the same family, sweet wormwood small yellow flowers bestow gentle aroma along with its other herbal properties. 214 304–316. New Phytol. By continuing you agree to the use of cookies. GLANDULAR TRICHOME-SPECIFIC WRKY 1 promotes artemisinin biosynthesis in Artemisia annua. The anther is thin, with long pointed appendages. The importance of artemisinin has led to several synthetic and semisynthetic approaches to its production to complement its isolation from A. annua. The tree was constructed with the neighbor-joining…, Images of tobacoo mesophyll protoplasts expressing the transit peptides of the AaDXS genes…, Relative expression levels of AaDXS1–3 in leaves, flowers, stems, and roots. Artemisia annua is an annual shrub indigenous to China, but able to grow in a wide range of sub-tropical and temperate environments. 10.1093/jxb/erq393 Zhang M, Xiang LE, Wang H, Lan XZ, Chen M, Liao ZH. We analyzed the expression of these three genes in different tissues in response to multiple treatments. Since the WHO recommended the use of artemisinin-based combination therapies for malaria in 2001, a number of other forms of A. annua L. have appeared as antimalarial remedies, including tea bags made from the plant’s leaves. Avocado may contain oils and sugars30 that are helpful in controlling SD. The analogues dihydroartemisinin, artemether, artemotil, and artesunate have all found clinical use [266], while the fully synthetic arterolane and various oxime and other dimers [267] have promising activities (Figure 5.18). J. Exp. Longitudinal observations on the efficacy of A. annua in patients are, however missing as of yet. Artemisia annua has a long history of use in traditional Chinese medicine and this plant is currently the only source of artemisinin; therefore, extensive molecular genetic and chemical studies to find the gene for biosynthesis of this sesquiterpenoid have been … It is in flower from August to September, and the seeds ripen from September to October. Because it is a potent allergen, I do not recommend it for regular, ongoing use. Histochemical staining assays demonstrated that AaDXS2 was mainly expressed in the trichomes of Arabidopsis leaves. -. Together, these results suggest that AaDXS2 might be the only member of the DXS family in A. annua that is involved in artemisinin biosynthesis. Artemisinin’s unusual endoperoxide bridge is a key to its mechanism of action, although the details of this mechanism are still being sorted out. Artemisin proved to be an excellent antimalarial agent, and artemisinin-based combination therapies (ACTs) are currently the preferred first-line antimalarial treatment for Plasmodium falciparum, although resistance has been observed in the Cambodia–Thailand border area [261]. 10.1111/j.1438-8677.2009.00306.x Its functions and uses have been documented in historical works about Chinese materia medica. (2017). Artemisinin, a sesquiterpene lactone obtained from Artemisia annua (Asteraceae), is a new and highly effective antimalarial drug (see Chapter 1.16). B.W. AIDS: Artemisia annua anamed (A-3) and Moringa We have received remarkable news from Musoma in Tanzania. Title: Microsoft PowerPoint - Antony_Ellman [Compatibility Mode] We use cookies to help provide and enhance our service and tailor content and ads. Assigned to hepatic, biliary, and renal meridians, it has the traditional functions of clearing summer heat, removing hectic heat and antimalaria. | The most fruitful current approach is the chemical conversion of artemisinic acid, produced by engineered strains of Saccharomyces cerevisiae [263] to artemisinin [264,265]. The extract of leaves of the plant has been demonstrated in-vitro to have potent anti HIV effects and in vivo to improve levels of lymphocytes in laboratory animals. The cauline leaves on the midsection are bipinnately divided, with the leaves on the upper section having no stems and relatively smaller and fewer pinnae. Expression analyses revealed that the expression pattern of AaDXS2 in specific tissues and in response to different treatments, including methyl jasmonate, light, and low temperature, was similar to that of artemisinin biosynthesis genes. The clinical efficacy of this drug and its derivatives is demonstrated by an immediate and rapid reduction of parasitemia following treatment [23]. The artemisinin derivatives are the subject of a separate monograph. Artemisia annua is a promising and potent antimalarial herbal drug. Caretto S., Quarta A., Durante M., Nisi R., De Paolis A., Blando F., et al. Srinath M, Shailaja A, Bindu BBV, Giri CC. | They are well tolerated and safe in adults, children, and pregnant women.575,576 Millions of people have taken artemisinins with no significant adverse or treatment-limiting effects being reported.577 Two large, multicenter, randomized trials conducted in Southeast Asian adults578 and sub-Saharan African children579 concluded that parenteral artemisinins reduce mortality from severe falciparum malaria by 22% to 35% compared with parenteral quinine. Application of aloe has been shown to be useful in seborrhea.29. all shared the involvement of A. annua L. as a herbal medicine. Artemisia annua L. is commonly used in traditional Chinese medicine (TCM) and it has a history of more than 2000 years. Expression and molecular analysis of the Arabidopsis DXR gene encoding 1-deoxy-D-xylulose 5-phosphate reductoisomerase, the first committed enzyme of the 2-C-methyl-D-erythritol 4-phosphate pathway. In this study, we have cloned three 1-deoxy-D-xylulose 5-phosphate synthase (DXS) genes from A. annua (AaDXS1, AaDXS2, and AaDXS3); the DXS enzyme catalyzes the first and rate-limiting enzyme of the MEP pathway. They appear in large numbers, dispersed or drooping, on short pedicels that form long, tiered, cone-shaped panicles. A recent computational study suggested that artemisinin gets activated by iron, which in turn inhibits the calcium pump PfATP6 [262]. Pau d’arco tea is another product with reported antiyeast activity. In Meyler's Side Effects of Drugs (Sixteenth Edition), 2016. Tea tree oil, honey, and cinnamic acid have been shown to reduce Malassezia and SD.27 Tea tree oil and cinnamic acid, as well as other essential oils, however, can cause contact dermatitis, especially in inflamed skin, and honey is messy to use on the scalp. There have therefore been differences in the standard names used in botanical classification and in Chinese herbal medicine.4 In the Pharmacopoeia of the People’s Republic of China, the plant containing artemisinin is termed qinghao, described as “the dry, above-ground portions of huanghuahao (A. annua L.) of the Asteraceae family.”5, M. Fawzi Mahomoodally, Ameenah Gurib-Fakim, in Fighting Multidrug Resistance with Herbal Extracts, Essential Oils and Their Components, 2013. Around 300 different species of Artemisia (mugwort, wormwood) are found, mostly in temperate climate zones. Absinthium comes from the Greek word “absinthion,” which means “undrinkable,” referring to … Monarda fistulosa, a distinctive-smelling herb from the mint family, has also been reported to yield an essential oil that is effective against seborrhea.28. Several derivatives of the original compound have proved effective in the treatment of Plasmodium falciparum malaria and are currently available in a variety of formulations: artesunate (intravenous, rectal, oral), artelinate (oral), artemisinin (intravenous, rectal, oral), dihydroartemisinin (oral), artemether (intravenous, oral, rectal), and artemotil (intravenous). Amikor az ember rákbeteg lesz, azonnal alternatív terápiák keresésébe veti magát először. The stem is erect, ridged, and of green, yellow–green, or violet–green; in the late growth stage, it becomes brown or violet–brown. 2003 Nov;19(6):646-50. -, Chen M., Yan T., Shen Q., Lu X., Pan Q., Huang Y., et al. Recent observations in Southeast Asia and sub-Saharan Africa have been worrying. Later, Shen Nong’s Herbal Classic (Shen Nong Ben Cao Jing), Grand Materia Medica (Da guan Ben Cao) and Compendium of Materia Medica (Ben Cao Gang Mu), etc. These have spotlike glands and a thin stigma with a blunt top, which projects out of the smooth, tubelike corolla. BMC Plant Biol. In Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions (Fifteenth Edition), 2006. This particular polyphenol, which is extracted from green tea leaves, has been launched as a key ingredient for a variety of health-enhancing applications in the food industry. The species is hermaphrodite (has both male and female organs) and is pollinated by Insects. Unfortunately, trials also confirmed that recrudescence was high and, hence, monotherapy with A. annua could not be recommended as a potential alternative treatment for this disease [24,25]. Please enable it to take advantage of the complete set of features! Clinically, it is used for the treatment of symptoms such as fever due to Yin deficiency, affection due to exogenous summer heat, and malaria and jaundice due to dampness heat. 2011 Mar 9;11:45. doi: 10.1186/1471-2229-11-45. (A)…, Relative expression levels of AaDXS1–3 under low temperature (4°C). 62 2023–2038. 10.1016/j.gene.2012.10.071 Agronomics and Biology of Artemisia annua L. Artemisinin-Based and Other Antimalarials, Harnessing Traditional Knowledge to Treat Existing and Emerging Infectious Diseases in Africa, M. Fawzi Mahomoodally, Ameenah Gurib-Fakim, in, Fighting Multidrug Resistance with Herbal Extracts, Essential Oils and Their Components, Natural Products as Pharmaceuticals and Sources for Lead Structures*, David J. Newman, ... David G.I. Recent in vitro and in vivo studies have confirmed the pharmacologic efficacy of these plant extracts [17]. A. afra essential oil is exceptionally variable and its composition depends on its geographical origin. f) Nees. Sheng Wu Gong Cheng Xue Bao. 1) a fern-like weed, has been used in Chinese medicine for more than 2000 years in the treatment of fever. The study that proves the effectiveness of Artemisia Annua in destroying cancerous cells Today we know that the active ingredient present in Artemisia Annua , artemisinin, is extremely effective in the treatment of Malaria , one of the worst epidemics on the planet that kills over 2 million victims every year in Third World countries. It was observed that after 7 days of medication, cure rates were high (74%). Artemisinin is derived from Artemisia annua (qing hao), an herbal plant used in China for 2000 years as therapy for fevers. Methyl jasmonate and miconazole differently affect arteminisin production and gene expression in Artemisia annua suspension cultures. In June 2007, the Walter Reed Army Institute for Research and the CDC received FDA approval for a collaborative IND protocol: “Intravenous Artesunate for Treatment of Severe Malaria in the United States.” Artesunate is provided by the CDC to hospitals upon request and on an emergency basis to treat malaria patients who need intravenous treatment for severe disease, who have high parasitemias, who are not able to take oral medications, who do not tolerate quinidine, who may have an adverse reaction to quinidine, or in those whom quinidine treatment has proven ineffective. Several semisynthetic derivatives have been developed from dihydroartemisinin (11). The active principle, artemisinin (quinghaosu, QHS, artenuin), a sesquiterpene lactone with a characteristic peroxide bridge, was isolated by Chinese scientists in 1972 from the leafy portion of the plants ( Klayman 1985 ). ScienceDirect ® is a registered trademark of Elsevier B.V. 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URL: https://www.sciencedirect.com/science/article/pii/B9780128116555000064, URL: https://www.sciencedirect.com/science/article/pii/B9780444537171003358, URL: https://www.sciencedirect.com/science/article/pii/B0444510052010937, URL: https://www.sciencedirect.com/science/article/pii/B9780128116555000015, URL: https://www.sciencedirect.com/science/article/pii/B9780128131336000020, URL: https://www.sciencedirect.com/science/article/pii/B978012398539200015X, URL: https://www.sciencedirect.com/science/article/pii/B9780124172050000055, URL: https://www.sciencedirect.com/science/article/pii/B978008044992000609X, URL: https://www.sciencedirect.com/science/article/pii/B9780323358682000761, URL: https://www.sciencedirect.com/science/article/pii/B9781455748013002769, Studies on Pharmacological Actions of Artemisia annua, Meyler's Side Effects of Drugs (Sixteenth Edition), Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions (Fifteenth Edition).
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