Various approaches have been adapted in an effort to find agents that can prevent or reduce the occurrence of crises in sickle cell disease (SCD). In the recent years, bone marrow transplantation has been found to be an efficient way of treating SCD. However, the cost implications, availability of necessary expertise and the problems of finding suitable donors constituted a major setback to this approach in developing countries.Currently, in clinical practice, drugs and chemical compounds such as hydroxyurea and erythropoietin are used in SCD management. But the side effects of these drugs limit their clinical use and as such, more efforts by several researchers into understanding whether herbal remedies and medicinal plants products long used in folk medicine were more safe and efficacious in the management of sickle cell disease.For instance, studies have shown that extracts of Pterocarpus santolinoides (red sandalwood or uturukpa leaf in Igbo), Parquetina nigrescens (kwankwanin in Hausa, mgbidim gbe in Igbo, ewidun in Yoruba, inuwu elepe in Yoruba (Ife) and Aloe vera inhibits sickling of red blood cells under laboratory conditions.In addition, root extracts of Fagara zanthoxylloides (uko in Igbo, atako in Itsekiri, ujo in Urhobo, atufi in Yekhee, ata in Yoruba) and Terminalia catappa (Indian almond in English), were shown to prevent easy breakdown of sickle red blood cells.Research on plants used in treatment of SCD in the community has led to the development of Niprisan (an herbal based drug), which has been patented by the National Institute for Pharmaceutical Research and Development (NIPRD), Abuja, Nigeria and produced to meet increasing global demand by sufferers of SCD.Currently more researchers are looking into other plants that are used in folklore medicine with a view to determining their suitability to be ungraded like Niprisan.One of such is the traditional recipe that included the roots of Uvaria chamae and Plumbago zeylanica as part of the constituents, which is used in the management of sickle cell anemia in South Western part of Nigeria.Uvaria chamae, commonly known as finger root or bush banana is a climbing large shrub or small tree native to tropical West and Central Africa. The common name refers to the fruit growing in its small bunches; the fruit is edible and widely eaten. U. chamae is a medicinal plant used throughout its range to treat fevers and has antibiotic properties. P. zeylanica (commonly called Leadwort) is native to West Africa where its folklore medicinal uses include the treatment of arthritis, rheumatism, haemorrhoids, leprosy, stomach troubles, cutaneous and subcutaneous parasitic infection to mention a few.In the parlance of herbal therapy, the need to understand the role of each component of a therapeutic mixture of plants is necessary if such is to be upgraded. In this regard, a group of Nigerian scientists looked at the antisickling activities of Plumbago zeylanica and Uvaria chamae, with a view of gaining insight on the possible role that these plants might be playing in the recipe for SCD management which contains them.These were Olufunmilayo. E. Adejumo; Oladimeji. P. Roleola; and Lateef. S. Kasim from the Department of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmacy, Olabisi Onabanjo University, Sagamu, Ogun State in collaboration with Adelodun. L. Kolapo from the Department of Microbiology, University of Agriculture, Abeokuta, Ogun State.They collected, dried and made into powder the roots P. zeylanica and U. chamae and then assessed whether their crude methanol extract and its aqueous fraction exhibited anti-sickling properties under laboratory conditions.The scientists, aside justifying their use in folklore medicine for sickle cell disease, found that the antisickling potential of the extracts of the investigated plant decreased after one hour when compared to that of the positive control whose antisickling potential was maintained throughout the two hours incubation.They declared 'this present report further indicates the specific phytochemicals that are being contributed by each of the P. zeylanica and U. chamae. Anthraquinones act on the gastro-intestinal tract to increase the peristalsic action. In cases where sickle cell patients complain of constipation, the anthraquinones present in the investigated plant may be useful as a mild laxative.'According to them, 'a recipe that contain U. chamae root may be potent to relieve symptoms of cardiac insufficiency, coughs and circulatory problems. It then becomes evidently clear that each constituent of the traditional recipe used in SCD management have a peculiar role that it is performing.'Meanwhile, Carica papaya (pawpaw) dried leaves have been indicated in sickle cell anemia management by local indigenous folk. For instance, a recent scientific research that examined the effect of crude extract and the various leaf extract fractions of dried pawpaw leave, experts found it inhibits the formation of sickle cells.The study entitled 'Analyses of antisickling potency of Carica papaya dried leaf extract and fractions' was published in the 2010 of the Journal of Pharmacognosy and Phytotherapy. It was carried out by Ngozi Awa Imaga and Olusegun A. Adepoju from the Department of Biochemistry, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos State.Pawpaw leaves are used as a poultice for wounds and also taken internally as worm expellant. Recent research shows that unripe pawpaw fruit and dried leaves have been indicated in sickle cell anemia management. Scientists have reported that extracts of pawpaw's unripe fruit and the dried leaves have definite antisickling property.Aside a previous study carried out to assess whether it was toxic, which confirmed it to be safe, this 2010 study published in the Journal of Pharmacognosy and Phytotherapy found that pawpaw leaf extract had appreciable potent antisickling activity in a dose-dependent manner.They wrote:' These results further indicate the possibility of pawpaw as a potential phytomedicine for SCD therapy. The extract may apply a target hit on HbS polymerization in attenuating SS cell sickling. Patients given this herb will benefit from its total inhibition of the sickling phenomenon at 10 mg/ml dose concentrations.'Meanwhile, they declared that identification and purification analytical studies on the active phytochemicals and biochemicals present in the potent antisickling extracts and fractions are an on-going.There is currently no universal cure for sickle. But Segun I. Folasade, Odukoya A. Olukemi and Moody O. Jones in a study titled 'Management of Sickle Cell Anaemia in Nigeria with Medicinal Plants: Cationic Evaluation of Extracts and Possible Effects on the Efficacy,' also evaluated 11 aqueous plant extracts from eight traditionally used Nigerian medicinal plants. These included Adasonia digitata, Cajanus cajan, Parquetina nigrescens, Bryophyllum pinnatum and Cissus populnea.Adasonia digitata is commonly called baobab in English (usi in Edo, bakko in hausa and luru in Yoruba). Bryophyllum pinnatum is called never die or resurrection plant in English (Abamoda or eru-odundun in Yoruba or odaa opue in Igbo). Cajanus cajan is Pigeon pea in English (aduwa in Hausa, agadagbulu in Igala, and otili in Yoruba). Cissus populnea is daafaaraa in Hausa and ogbolo in Yoruba. Parquetina nigrescens is kwankwanin in Hausa, mgbidim gbe in Igbo, ewidun in Yoruba, inuwu elepe in Yoruba (Ife).
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