Scientists from King's College London are warning that millions of people may be exposed to risk of developing kidney failure and bladder cancer by taking herbal medicines that are widely available in Asia. The medicines, used for a wide range of conditions including slimming, asthma and arthritis, are derived from a botanical compound containing aristolochic acids. These products are now banned in the USA and many European countries but the herbs containing this toxic acid can still be bought in China and other countries in Asia and are also available worldwide over the internet.
The scientists reviewed worldwide cases of aristolochic acid nephropathy (AAN) – a type of kidney failure caused by the intake of these acids. They explain the clinical basis for the disease and propose strategies to help doctors identify it and treat patients more effectively. They suggest that there may be many thousands of cases across Asia that are undiagnosed or misdiagnosed. With the outcome of their study, the researchers hope to raise awareness of the risks of aristolochic acids and reduce the global disease burden from this severe condition.
Lead author Professor Graham Lord, Director of the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Guy's and St Thomas' NHS Foundation Trust and King's College London, said: 'We have found evidence that many millions of people continue to be exposed to significant health risk due to these herbal medicines, widely used in China and India.' He added: 'There is also a striking lack of good quality evidence that might help guide the diagnosis and management of AAN.'
The paper, published in Annals of Internal Medicine, indicates that regulatory measures that have so far been adopted by national and international agencies may be inadequate in preventing harmful exposure to aristolochic acid. The compound is linked to many cases of kidney diseases and urothelial cancer, a form of cancer of which bladder cancer is the most known variant.
The authors reviewed the latest data on the epidemiology of AAN. They used several search engines to include all publications that are about or refer to aristolochic acid and Chinese herbal nephropathy and identified 42 different case studies and one trial relating to the management of the disease.
While explaining the origin and development of the disease, they propose a protocol which should make it easier to diagnose AAN. In addition, they suggest a new disease classification to help international clinicians better identify AAN patients, and draft guidelines for the treatment of these patients.
The research team consisted of an international collaboration of scientists from Belgium, Czech Republic, Germany and the UK. Dr Refik Gökmen, co-author from King's, said: 'This research is a great demonstration of how international scientific collaboration is vital in helping to describe how a toxin used in widely available products can lead to cancer.'
The study was funded in part by the Association for International Cancer Research and Professor Graham Lord is supported by the NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London.
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King's College London
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NOTES TO EDITORS
'The epidemiology, diagnosis and management of Aristolochic Acid nephropathy: a narrative review'. Annals of Internal Medicine 2013
About King's College London
King's College London is one of the top 30 universities in the world (2011/12 QS World University Rankings), and the fourth oldest in England. A research-led university based in the heart of London, King's has nearly 23,500 students (of whom more than 9,000 are graduate students) from nearly 140 countries, and some 6,000 employees. King's has an outstanding reputation for providing world-class teaching and cutting-edge research.
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.
About the National Institute for Health Research
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.
The NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London focuses on translational research through four 'research clusters': experimental medicine and therapeutics; biomarkers, co-diagnostics and imaging; population sciences; the school of translational and experimental medicine. Research within these clusters is based around eight research themes: cancer; cardiovascular disease; cutaneous medicine; environmental and respiratory health; imaging and bio-engineering; infection & immunity; translational genetics; and transplantation. Our aim is to take advances in basic medical research out of the laboratory and into the clinical setting to benefit patients at the earliest opportunity. Access to the uniquely diverse patient population of London and the south east enables us to drive forward research into a wide range of diseases and medical conditions. http://www.guysandstthomasbrc.nihr.ac.uk
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