A report on Artemisia annua

Artemisia annua
Seeds

Common type of wormwood native to temperate Asia, but naturalized in many countries including scattered parts of North America.

- Artemisia annua

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Figure 1. Biosynthesis of Artemisinin

Artemisinin

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Artemisinin and its semisynthetic derivatives are a group of drugs used in the treatment of malaria due to Plasmodium falciparum.

Artemisinin and its semisynthetic derivatives are a group of drugs used in the treatment of malaria due to Plasmodium falciparum.

Figure 1. Biosynthesis of Artemisinin
Artemisia annua

Artemisinin is extracted from the plant Artemisia annua, sweet wormwood, a herb employed in Chinese traditional medicine.

Artesunate

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Medication used to treat malaria.

Medication used to treat malaria.

It is in the class of medications known as artemisinins, which are derivatives from "qinghao," or sweet wormwood plant (Artemisia annua).

Antimalarial medication

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Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target groups, young children and pregnant women.

Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target groups, young children and pregnant women.

It is derived from the plant Artemisia annua, with the first documentation as a successful therapeutic agent in the treatment of malaria is in 340 AD by Ge Hong in his book Zhou Hou Bei Ji Fang (A Handbook of Prescriptions for Emergencies).

Tu in Stockholm, December 2015

Tu Youyou

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Chinese pharmaceutical chemist and malariologist.

Chinese pharmaceutical chemist and malariologist.

Tu in Stockholm, December 2015

One compound was effective, sweet wormwood (Artemisia annua), which was used for "intermittent fevers," a hallmark of malaria.

Malaria parasite connecting to a red blood cell

Malaria

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Mosquito-borne infectious disease that affects humans and other animals.

Mosquito-borne infectious disease that affects humans and other animals.

Malaria parasite connecting to a red blood cell
Main symptoms of malaria
The life cycle of malaria parasites. Sporozoites are introduced by a mosquito bite. They migrate to the liver, where they multiply into thousands of merozoites. The merozoites infect red blood cells and replicate, infecting more and more red blood cells. Some parasites form gametocytes, which are taken up by a mosquito, continuing the life cycle.
Micrograph of a placenta from a stillbirth due to maternal malaria. H&E stain. Red blood cells are anuclear; blue/black staining in bright red structures (red blood cells) indicate foreign nuclei from the parasites.
Electron micrograph of a Plasmodium falciparum-infected red blood cell (center), illustrating adhesion protein "knobs"
The blood film is the gold standard for malaria diagnosis.
Ring-forms and gametocytes of Plasmodium falciparum in human blood
An Anopheles stephensi mosquito shortly after obtaining blood from a human (the droplet of blood is expelled as a surplus). This mosquito is a vector of malaria, and mosquito control is an effective way of reducing its incidence.
Man spraying kerosene oil in standing water, Panama Canal Zone, 1912
Walls where indoor residual spraying of DDT has been applied. The mosquitoes remain on the wall until they fall down dead on the floor.
A mosquito net in use.
An advertisement for quinine as a malaria treatment from 1927.
Deaths due to malaria per million persons in 2012
Past and current malaria prevalence in 2009
Ancient malaria oocysts preserved in Dominican amber
British doctor Ronald Ross received the Nobel Prize for Physiology or Medicine in 1902 for his work on malaria.
Chinese medical researcher Tu Youyou received the Nobel Prize for Physiology or Medicine in 2015 for her work on the antimalarial drug artemisinin.
Artemisia annua, source of the antimalarial drug artemisinin
U.S. Marines with malaria in a field hospital on Guadalcanal, October 1942
Members of the Malaria Commission of the League of Nations collecting larvae on the Danube delta, 1929
1962 Pakistani postage stamp promoting malaria eradication program
Malaria clinic in Tanzania
Child with malaria in Ethiopia
World War II poster
Disability-adjusted life year for malaria per 100,000 inhabitants in 2004
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<10
0–100
100–500
500–1000
1000–1500
1500–2000
2000–2500
2500–2750
2750–3000
3000–3250
3250–3500
≥3500

The medicinal value of Artemisia annua has been used by Chinese herbalists in traditional Chinese medicines for 2,000 years.

Artemisia (plant)

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Large, diverse genus of plants with between 200 and 400 species belonging to the daisy family Asteraceae.

Large, diverse genus of plants with between 200 and 400 species belonging to the daisy family Asteraceae.

Artemisia pycnocephala (beach sagewort) flowers
Artemisia abrotanum
Artemisia annua
Artemisia absinthium
Artemisia californica (California sagebrush) leaves
Artemisia mauiensis (Maui wormwood)
Artemisia nilagirica (Indian wormwood)
Artemisia pontica (Roman wormwood)

Notable species include A. vulgaris (common mugwort), A. tridentata (big sagebrush), A. annua (sagewort), A. absinthium (wormwood), A. dracunculus (tarragon), and A. abrotanum (southernwood).

Artemisia annua, the source of the artemisinin

Project 523

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Code name for a 1967 secret military project of the People's Republic of China to find antimalarial medications.

Code name for a 1967 secret military project of the People's Republic of China to find antimalarial medications.

Artemisia annua, the source of the artemisinin
Tu Youyou (right) and her tutor Lou Zhicen at the China Academy of Chinese Medical Sciences.

Another early candidate was huanghuahao (sweet wormwood or Artemisia annua).

Artemether

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Medication used for the treatment of malaria.

Medication used for the treatment of malaria.

Artemether is a methyl ether derivative of artemisinin, which is a peroxide-containing lactone isolated from the antimalarial plant Artemisia annua.

Plasmodium falciparum

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Unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans.

Unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans.

Laveran's drawing of various stages of P. falciparum as seen on fresh blood (1880).
Blood smear from a P. falciparum culture (K1 strain - asexual forms) - several red blood cells have ring stages inside them. Close to the center is a schizont and on the left a trophozoite.
Ring forms in red blood cells (Giemsa stain)
Life cycle of Plasmodium

Tu Youyou discovered artemisinin in the 1970s from sweet wormwood (Artemisia annua).

Traditional Chinese medicines/dried goods shop in Kowloon, Hong Kong

Traditional Chinese medicine

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Alternative medical practice drawn from traditional medicine in China.

Alternative medical practice drawn from traditional medicine in China.

Traditional Chinese medicines/dried goods shop in Kowloon, Hong Kong
A prescription section of a pharmacy in Nanning, Guangxi, China selling prepackaged Chinese and Western medicine (left) and Chinese medicinal herbs (right).
The Compendium of Materia Medica is a pharmaceutical text written by Li Shizhen (1518–1593 CE) during the Ming dynasty of China. This edition was published in 1593.
Acupuncture chart from Hua Shou (fl. 1340s, Yuan dynasty). This image from Shi si jing fa hui (Expression of the Fourteen Meridians). (Tokyo: Suharaya Heisuke kanko, Kyoho gan 1716).
Yin and yang symbol for balance. In traditional Chinese Medicine, good health is believed to be achieved by various balances, including a balance between yin and yang.
Interactions of Wu Xing
Old Chinese medical chart on acupuncture meridians
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Assorted dried plant and animal parts used in traditional Chinese medicines, clockwise from top left corner: dried Lingzhi (lit. "spirit mushrooms"), ginseng, Luo Han Guo, turtle shell underbelly (plastron), and dried curled snakes.
Chinese red ginseng roots
A bile bear in a "crush cage" on Huizhou Farm, China.
Dried seahorses are extensively used in traditional medicine in China and elsewhere.
Dried human placenta (Ziheche (紫河车) is used in traditional Chinese medicine.
Artemisia annua, traditionally used to treat fever, has been found to have antimalarial properties.
Galena (lead ore) is part of historical TCM. 
Standard American TCM practice considers lead-containing herbs obsolete.
Needles being inserted into the skin
A bronze acupuncture statue from the Ming Dynasty being displayed inside a museum
An example of a traditional Chinese medicine used in tui na
Acupuncture and moxibustion after cupping in Japan
Gua sha
The Chinese traditional medicine at one of Chinese traditional medicine shop at Jagalan Road, Surabaya, Indonesia.
Seirogan, a type of antidiarrhoeal drug in Japan developed based on Kanpo medicine theory
The logo of the Dutch Association of Traditional Chinese Medicine (or 中 Zhong - Nederlandse Vereniging voor Traditionele Chinese Geneeskunde), the largest of the professional organisations that is recognised by private health insurance companies in the Netherlands.

There had been success in the 1970s, however, with the development of the antimalarial drug artemisinin, which is a processed extract of Artemisia annua, a herb traditionally used as a fever treatment.