Palm wine and malaria

In a large scale clinical trial with malaria infected patients in RDCongo comparing ACTs with Artemisia infusion we observed a gender difference. Whilst both genders responded equally well to Artemisia, in the ACT-treated arm there was significantly more gametocyte carriage in females than males for days 14-28. Having no valid explanation for this observation, one may wonder if it due to differences in enzyme between males and females, like those which are responsible for a lower susceptibility of males to alcohol consumption. It is well known on the other hand that alcohol consumption, especially palm wine, is much higher for males than for females in tropical countries.
Jerome Munyangi; Lucile Cornet-Vernet, M.D.; Michel Idumbo; Chen Lu; Pierre Lutgen; Christian Perronne; Nadège Ngombe; Jacques Bianga; Bavon Mupenda; Paul Lalukala; Guy Mergeai; Dieudonné Mumba; Melissa Towler; Pamela Weathers. Artemisia annua and Artemisia afra tea infusions were equal to or better than artesunate-amodiaquine (ACT) in treating Plasmodium falciparum malaria in a large scale, double blind, randomized clinical trial. Submitted to Phytomedicine for publication Jan 2018
Chrostek L, Jelski W, Szmitkowski M, Puchalski Z. Gender-related differences in hepatic activity of alcohol dehydrogenase isoenzymes and aldehyde dehydrogenase in humans. J Clin Lab Anal. 2003;17(3):93-6.
During gametocytogenenesis malaria parasites hide in the bone marrow. Ethanol has an effect on bone marrow. Biopsies from 30 alcohol-dependent individuals were investigated. The findings took the form of heightened ineffective erythropoiesis in bone marrow associated with impaired iron utilization. Both may be detrimental to the survival of the gametocytes.
Michot F, Gut J. Alcohol-induced bone marrow damage. A bone marrow study in alcohol-dependent individuals. Acta Haematol. 1987;78(4):252-7.
The effect of ethanol on the in vitro growth of the malaria parasite Plasmodium falciparum was investigated during six days of incubation. A significant growth inhibition for ethanol concentrations was observed on each day. Malarial parasites are strongly inhibited by ethanol concentrations.
Lell B, Binh VQ, Kremsner PG. Effect of alcohol on growth of Plasmodium falciparum. Wien Klin Wochenschr. 2000 May 19;112(10):451-2.
N.F. Milan et al., Alcohol consumption as self-medication against blood-borne parasites in the fruit fly, Current Biology, 2012.01.04, 2012.
Fever is accompanied by glycogen destruction. This was already discovered more than 100 years ago. Glycogen disappears from the liver during tetanus, diphteria and pneumonia. A natural way of our body to fight parasites and diseases. It makes thus complete nonsense to fight fever in the early stages of a malaria infection.
G Graham EP Poulton. The Influence of High Temperature on Protein Metabolism with reference to Fever, Inter. Journal of Medicine, Volume os6, Issue 1, 1 October 1912, Pages 82–124.
Colla A, Archiv Ital de Biologie, 1896, XXVI, p120
Alcohol also removes glycogen from the liver.
W Salant. The Influence of Alcohol on the Metabolism of Hepatic Glycogen. Proceedings of the Society for Experimental Biology and Medicine, 1905, iii, p 58.
Chronic ethanol consumption also results in a dramatic decrease in liver glycogen concentrations, which could be related to either a depressed rate of synthesis or an increased rate of breakdown.
Van Horn CG, Ivester P, Cunningham CC. Chronic ethanol consumption and liver glycogen synthesis. Arch Biochem Biophys. 2001 Aug 1;392(1):145-52.
Macrophages, including Kuppfer cells, appear to increase their production of cytokines in patients with alcoholic liver disease. Precursors of macrophages, i.e. monocytes with alcohol induced hepatitis produce greater amounts of TNF-α and reactive oxygen species. These data have been confirmed in animals. Malaria parasites are destroyed by oxidative species, like NO, H₂O₂ or artemisinin peroxides.
Wheeler MD, Endotoxin and Kupffer cell activation in alcoholic liver disease. Alcohol Res Health. 2003;27(4):300-6.
Honchel R, Ray MB, Marsano L, Cohen D, Lee E, Shedlofsky S, McClain CJ. Tumor necrosis factor in alcohol enhanced endotoxin liver injury. Alcohol Clin Exp Res. 1992 Aug;16(4):665-9.
Sheth NK, Wisniewski TR, Franson TR Survival of enteric pathogens in common beverages: an in vitro study. Am J Gastroenterol. 1988 Jun;83(6):658-60.
Wine is efficient against other pathogens. An in vitro study was undertaken to determine the potential for survival of enteric pathogens in common drinking beverages. Three carbonated soft drinks, two alcoholic beverages, skim milk, and water were inoculated with Salmonella, Shigella, and enterotoxigenic Escherichia coli, and quantitative counts were performed over 2 days. The study showed poorest survival of all three organisms in wine, and greatest growth in milk and water.
Long-term intake of alcohol affects the immune system. Serum levels of immunoglobulins (total IgE, IgG, IgM, and IgA) therefore, were analyzed in adult chronic alcoholics in Indian population and were correlated with different epidemiological and alcohol-related parameters. The results showed that 98% of alcoholics had abnormal immunoglobulin levels and 92% showed high or very high total serum IgE levels compared to 24% of the control group. Several other studies have shown that that total serum IgE concentrations are increased in moderate alcohol consumers with respect to abstainers. This increase is independent of cofounders such as age, sex, liver disease, cigarette smoking,
Yashwant Kumar, Lakshmi PVM, Ranjana Walker Minz, Evaluation of Serum Immunoglobulins IgG, IgA, IgM and Total IgE in Chronic Alcoholics: A Community-based Study. Immunochemistry & Immunopathology. 2015, 1,1, 1000102
Lomholt FK, Nielsen SF, Nordestgaard BG. High alcohol consumption causes high IgE levels but not high risk of allergic disease, J Allergy Clin Immunol. 2016 Nov;138(5):1404-1413.e13. doi: 10.1016/j.jaci.2016.05.022.
C Vidal. Influence of alcohol consumption on serum IgE levels. Alcohol Clin Exp Research. 2002, 26, 59-64
A Gonzalez-Quintela, C Vidal, ++Alcohol-induced alterations in serum immunoglobulin IgE levels in human subjects Front bioscop 2002, 1:7, 234-44
In a recent paper we have shown how IgE contributes to malaria prophylaxis.
Pierre Lutgen, Antibodies, Prophylaxis, Transmission. Pharm Pharmacol Int J 2018, 6(2): 00155
Alcohol can increase the solubility of poorly soluble drugs and hence increase their bioavailability. And increases the intestinal permeability to indigested macromolecules.
Jonas H. Fagerberg, Erik Sjögren, Christel A.S. Bergström. Concomitant intake of alcohol may increase the absorption of poorly soluble drugs. European Journal of Pharmaceutical Sciences. Volume 67, 25 January 2015, Pages 12-20
Worthington BS, Meserole L, Syrotuck JA. Effect of daily ethanol ingestion on intestinal permeability to macromolecules. Am J Dig Dis. 1978 Jan;23(1):23-32.
Palm wines
A study from Niger showed that palm wine consumption may deplete the body’s antioxidants against free radical attacks and render the body in a state of oxidative stress.
Ogunro PS, Ologunagba PO. The effect of palm wine on lipid peroxidation and antioxidant status of rural dwellers in South West Nigeria. Niger Postgrad Med J. 2011 Sep;18(3):186-90.
In Nigeria a face-to-face ethno-medical survey on 1000 randomly selected families in confirmed the use of palm wines as antimicrobial agents and prophylactic agents against malaria. The hypothesized mechanism is that the ethanol content of the palm wines may increase membrane fluidity, altering ion channels and K⁺ content of the infected erythrocytes thereby impairing motor performance of Plasmodia.
Ibegbulem CO, Alisi CS, Medicinal values of Elaeis guineensis and Raphia hookeri wines. Journal of Research in Biology 2012, 2, 6, 589-595
Chi LM, Wu WG, Mechanism of hemolysis of red blood cell mediated by ethanol. Biochimica and Biophysica Acta 1991, 1062, 46-50
Medicinal herbs can be infused in palm wine. Palm wine is added to the decoctions of bitter herbs to increase their palatability.
Palm wine is very rich in potassium, sodium is only present in traces, a situation very similar to that of Artemisia annua.
Chukwujindu M A Iwegbue, A survey of metal profiles in some traditional alcoholic beverages in Nigeria. Food Sci Nutr. 2014 Nov; 2(6): 724–733.
Many palmwines are rich in anthocyanins concentrated in the pericarp. Anthocyanins have a strong effect on hemozoin inhibition like in black or red grapes or in pomegranate (Mutaz Akkawi , personal communication).
Rajinder Singh, Eng-Ti L. R Sambanthamurthi The oil palm VIRESCENS gene controls fruit colour . Nature Communications 2014, volume 5, Article number: 4106
Mutaz Akkawi, Saleh Abu-Lafi, Qassem Abu-Remeleh, Marah Kiswani, Mutaz Qutob, Sameh Nusseibeh, Pierre Lutgen. HPLC separation of phenolic phytochemicals from grape peels and seeds water extracts and their invitro antimalarial activities. Pharm Pharmacol. Int. J. Volume 6 Issue 4 – 2018

Conclusion
It is hard to outline a conclusion. Heavy alcohol drinking certainly never should be recommended. Alcoholism is a health problem. Lets rather listen to the French” Boire du vin rouge modérément est bon pour la santé”.
Pierre Lutgen

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