Medicinal plants used in the treatment of infectious diseases in the state of Paraíba, Brazil: Perspectives for the development of new antimicrobials based on clinical evidence

Medicinal plants used in the treatment of infectious diseases in the state of Paraíba, Brazil: Perspectives for the development of new antimicrobials based on clinical evidence

• Author
• José Jailson Lima Bezerra
• Abstract

• Medicinal plants used in the treatment of infectious diseases in the state of Paraíba, Brazil: Perspectives for the development of new antimicrobials based on clinical evidence

   

  Introduction

  Antimicrobials are medications active against a variety of infections caused by pathogenic microorganisms, including bacteria (antibiotics), viruses (antivirals), fungi (antifungals), and parasites (antimalarials and leishmanicides) (Biharee et al., 2020). Antimicrobial resistance occurs when different pathogens mutate over time and no longer respond to any pharmacological agent, making infections resistant to available treatments (Arip et al., 2022). Despite efforts to control infectious diseases, the antibiotic resistance crisis is global, highlighting the problem of inappropriate use of drugs by the population and the lack of development of new antimicrobial agents (Pacios et al., 2020; Eldin et al., 2023). 

  Recent studies on antimicrobials of plant origin have demonstrated that these natural products act in a similar way to conventional drugs and constitute a promising alternative to assist in the treatment of infectious diseases (Wang et al., 2020; Uddin et al., 2021; Eldin et al., 2023). In the state of Paraíba, Brazil, ethnobotanical and ethnopharmacological surveys have reported that several plant species are widely used in traditional medicine to treat infections caused by pathogenic microorganisms (Coutinho et al., 2018; Silva et al., 2018; Medeiros et al., 2019; Felix et al., 2019; Ferreira et al., 2021; Maia et al., 2021).  

   

  Aims

  Considering the medicinal potential of the flora of Paraíba, the present study aimed to carry out a survey of the plants used to treat infections by local communities and identify the species that have already been investigated in clinical trials.

   

  Methods

  Scientific documents were retrieved from Google Scholar, PubMed®, ScienceDirect®, SciELO, SpringerLink®, Scopus®, and Web of ScienceTM databases. Regarding the inclusion criteria, only scientific articles that reported ethnomedicinal uses in the state of Paraíba and clinical trials of herbal products used to treat infections were selected. Review articles, e-books, book chapters, undergraduate theses, Masters’ theses, PhD theses, and works published in technical or scientific events were excluded. A total of 36 articles published in the last 20 years (2003-2023) were included in the present study.  

   

  Results and Discussion

  According to the scientific documents analyzed, it was possible to observe that 31 species distributed in 22 families are used to treat infectious diseases in 15 municipalities in the state of Paraíba, including: Campina Grande (Alves et al., 2007; Souza et al., 2013), Queimadas (Barbosa, 2011; Santos et al., 2012), Lagoa (Lucena et al., 2012), Pombal (Andrade et al., 2012), Baía da Traição (Leite and Marinho, 2014), Bananeiras (Cavalcante and Silva, 2014), Pitimbu (Brito et al., 2015), Solânea (Silva et al., 2015), Picuí (Costa and Marinho, 2016), Amparo (Coutinho et al., 2018), Remígio (Silva et al., 2018), Patos (Medeiros et al., 2019), Serra Branca (Felix et al., 2019), Araçagi (Ferreira et al., 2021), and Jacaraú (Maia et al., 2021). Fabaceae was the family with the largest number of species (5 spp.), followed by Amaranthaceae (2 spp.), Anacardiaceae (2 spp.), Arecaceae (2 spp.), Bignoniaceae (2 spp.), and Lamiaceae (2 spp.). The leaves (29%), bark (27%), and roots (17%) are the parts most used in the preparation of herbal medicines by local populations. 

  Of the 31 species used medicinally to treat infections in Paraíba, only 7 were evaluated in randomized clinical trials. The results of these studies indicated that herbal medicines based on Kalanchoe pinnata (Lam.) Pers. (Torres?Santos et al., 2003), Phyllanthus niruri L. (Sarisetyaningtyas et al., 2006; Diarsvitri et al., 2018), Copaifera langsdorffii Desf. (Silva et al., 2012; Valadas et al., 2021), Aloe vera (L.) Burm.f. (Sargolzaie et al., 2016; Pattnaik et al., 2022), Anacardium occidentale L. (Gomes et al., 2016), Punica granatum L. (Sedigh-Rahimabadi et al., 2017; Eltay et al., 2021), and Illicium verum Hook.f. (Assiry et al., 2021; Salem et al., 2023) showed potential against several diseases caused by pathogenic microorganisms that affect humans.

  Products based on A. vera (babosa), A. occidentale (cajueiro), and P. granatum (romã) have been the target of several dental applications. According to clinical evidence, the effectiveness of mouthwashes containing these plants is similar to commercial mouthwashes in controlling bacterial plaque and gingivitis (Ahuja et al., 2011; Gomes et al., 2016; Sargolzaie et al., 2016; Vangipuram et al., 2016; Sedigh-Rahimabadi et al., 2017; Eltay et al., 2021; Pattnaik et al., 2022). Therefore, these herbal products can be a natural alternative to chemically formulated mouthwashes. Furthermore, Prabhakar et al. (2015) reported that ethanolic extracts of A. vera can be used as effective cavity disinfectants to prevent the appearance of secondary caries, contributing to the long-term success of restoration. 

  Clinically, infectious diseases such as cutaneous leishmaniasis, varicella, and HIV (human immunodeficiency virus) have been treated with herbal medicines from K. pinnata (courama) and P. niruri (quebra-pedra). According to Torres-Santos et al. (2003), a 36-year-old man diagnosed with active cutaneous leishmaniasis was treated with K. pinnata for 14 days. During treatment, the lesion stopped growing and decreased slightly, demonstrating the effectiveness of this plant. Sarisetyaningtyas et al. (2006) reported that P. niruri extract administered to children diagnosed with varicella accelerated the appearance and abortion of crusts compared to the placebo group. In a pilot study carried out with HIV patients, it was observed that the combination of antiretroviral therapy with P. niruri extract was more effective in increasing the absolute CD4 cell count compared to the administration of antiretroviral therapy alone (Diarsvitri et al., 2018).   

  Although some traditional communities in Paraíba use Cnidoscolus urens (L.) and Syagrus cearensis Noblick to treat urinary infections (Santos et al., 2012; Felix et al., 2019), the anti-infectious potential of these species has been little investigated and reported in the scientific literature. Only two recent studies have evaluated the in vitro antimicrobial activity of S. cearensis (Farias et al., 2022; Sampaio et al., 2023); while Saraiva et al. (2012) and Costa et al. (2013) pointed out that extracts and fractions of C. urens showed low activity against pathogenic bacteria and fungi. From this perspective, considering the urgency in developing new broad-spectrum antimicrobials, it is necessary to focus on other species that have demonstrated high activity against multidrug-resistant strains in in vitro, preclinical and clinical trials. 

   

  Conclusion

  This is the first study that brings together literature publications on the medicinal potential of Paraíba flora used in the treatment of infectious diseases. A total of 31 species distributed in 22 families are used against infections by traditional communities in different municipalities in this Brazilian state. However, only 7 species have had their herbal products evaluated in clinical trials. Mouthwashes based on Aloe vera, Anacardium occidentale, and Punica granatum have been targets of dental applications to assist in the treatment of bacterial plaque and gingivitis. It is recommended that new randomized clinical trials be developed to investigate the traditional uses of other medicinal plants reported in the present study against infectious diseases caused by pathogenic microorganisms.

   

  Acknowledgment

  Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq - Brazil) (167916/2022-0) and Fundação de Amparo à Ciência e Tecnologia de Pernambuco (FACEPE - Brazil) (BCT-0737-2.10/22).

   

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• Keywords
• Drug discovery, Ethnopharmacology, Fabaceae, Herbal medicine, Microbial resistance
• Modality
• Pôster
• Subject Area
• Biology, Pharmacology and Physiology