17 Feb Repurposed Chinese Herbal Antimalarial May Protect Against Hemorrhage and Shock
MedicalResearch.com Interview with:
Professor Chris Thiemermann
Centre for Trauma Sciences
Queen Mary University of London
Medical Research: What is the background for this study? What are the main findings?
Prof. Thiemermann: Trauma is a leading cause of death with five million victims a year. About 40 per cent of trauma deaths are due to hemorrhagic shock, which is when severe blood loss makes it difficult for the heart to pump sufficient blood around the body, leading to multiple organ failure.
Multiple organ failure affects one in three severely injured patients, and one in four of those will die. Those that survive still experience prolonged periods in intensive care, infections and other complications. But despite its catastrophic impact, there are still no specific treatments for organ failure.
We’ve now discovered that the drug Artesunate, which has already been used by thousands of people with malaria, is also effective for treating severe haemorrhage and blood loss in rats. Artesunate is based on an ancient Chinese herbal remedy, produced in large quantities in China, and is recommended by the World Health Organization as the treatment of choice for severe malaria. It has also been shown to have anti-cancer, anti-viral and anti-inflammatory effects.
My study, which was funded by the Wellcome Trust and the Department of Health, shows that when injured rats were administered Artesunate, the drug had a marked protective impact on organ failure.
The drug appears to work by enhancing the protection of organs by reducing the body’s excessive inflammatory response to injury and blood loss, and by activating well-known cell-survival pathways.
The lower dose of Artesunate shown in the study to be effective in hemorrhagic shock is identical to the dose used in patients with malaria, many of which also have multiple organ dysfunction.
Medical Research: What should clinicians and patients take away from your report?
Prof. Thiemermann: On the basis of these laboratory tests, a new clinical trial TOP-ART is being set up at the Royal London Hospital Major Trauma Centre, UK. For two years, Artesunate will be administered as an intravenous injection to a sample of code red patients with major haemorrhage, in the helicopter, ambulance, or on arrival in A&E. Patient outcomes will be measured during their hospital stay and following discharge.
If this human trial is as successful as our pre-clinical studies, the implications for trauma patients at risk of organ failure are potentially very positive. Artesunate is extremely safe, having already been tested in over 180 clinical trials. The repurposing of this safe drug could therefore be a highly effective option for the NHS, and help save the lives of major trauma patients in the UK and around the world.
Medical Research: What recommendations do you have for future research as a result of this study?
Prof. Thiemermann: We still have some way to go to fully understand the epidemiology of multiple organ dysfunction syndrome (MODS) in the trauma patient population. More research is needed to deepen our understanding of the incidence, pattern and severity of the systemic inflammatory response associated with MODS and its impact on patients. Towards that end, another study called ORDIT is being conducted across the UK this year. ORDIT is a one month, prospective point prevalence cohort study of all trauma patients (≥16 years) admitted to UK Major Trauma Centre (MTC) adult critical care units.
ORDIT’s objectives include: identifying the prevalence of MODS in patients admitted to UK critical care units following major traumatic injury, documenting the incidence and mode of mortality, and analysing the impact of multiple organ dysfunction syndrome on other clinical outcomes.
MedicalResearch: Is there anything else you would like to add?
Prof. Thiemermann: TOP-ART is a Health Innovation Challenge Fund trial supported by the Wellcome Trust and the Department of Health. The pre-clinical study is published in the Annals of Surgery.”
Regina Sordi, Kiran K. Nandra, Fausto Chiazza, Florence L. Johnson, Claudia P. Cabrera, Hew D. Torrance, Noriaki Yamada, Nimesh S. A. Patel, Michael R. Barnes, Karim Brohi, Massimo Collino, Christoph Thiemermann.
Artesunate Protects Against the Organ Injury and Dysfunction Induced by Severe Hemorrhage and Resuscitation. Annals of Surgery, 2016; 1 DOI:10.1097/SLA.0000000000001664
Professor Chris Thiemermann (2016). Repurposed Chinese Herbal Antimalarial May Protect Against Hemorrhage and Shock