On the evening of June 16, Xinhua News Agency threw out a heavy suspense!
Nobel Laureate and Chinese women scientist Tu Youyou's team will announce major scientific breakthroughs today. The message was accompanied by a video and a poem. In the video, Tu Youyou, winner of the Nobel Prize in Physiology or Medicine, said: "Once the malaria parasite becomes resistant to artemisinin combination therapy, malaria will be incurable, and humanity is bound to suffer a catastrophe." ”
Tu Youyou
This morning, the suspense unfolded. After years of hard work, Tu Youyou and his team have made new breakthroughs in "antimalarial mechanism research", "causes of drug resistance", "adjustment of treatment methods" and other aspects, and recently proposed a feasible treatment plan to deal with the problem of "artemisinin resistance", and made new progress in "artemisinin treatment of lupus erythematosus and other indications" and "traditional Chinese medicine scientific research works going out", which has been highly recognized by the World Health Organization and authoritative experts at home and abroad.
"China's Miracle Medicine" benefits hundreds of millions of people around the world
In January, the BBC launched the "Most Iconic Figures of the 20th Century" campaign and announced the list of honors. Tu Youyou is on the list of 28 candidates.
Tu Youyou is the only Asian face among the selected scientists and the only living candidate in the field of science. She defeated the cosmic explorer Stephen Hawking and the founder of quantum mechanics, Max Planck, and rivaled Einstein, Marie Curie and other pioneers.
For Tu Youyou's selection, the BBC gave three reasons: "still uphold scientific ideals in difficult times", "forge ahead and don't forget to look back at the past", "her achievements span things".
The BBC has also produced a special introductory short film to tell the legendary story of Tu Youyou's discovery of artemisinin: "If the greatness is measured by how many lives have been saved, then there is no doubt that Tu Youyou is the greatest scientist in history!"
Tu Youyou's name comes from the "Poetry Classic Xiaoya Luming": "Youyou deer singing, the apple of the wild." "Apple" is a kind of plant, specifically artemisia annua (that is, "mugwort"). All said, her name and her discovery were like fate. But Tu Youyou's discovery of artemisinin can be described as a process of difficulties and dangers.
In the 1960s, the 39-year-old Tu Youyou was appointed by the state to devote herself to the research and development of a cure for malaria. At that time, the whole world was suffering from malaria, a highly contagious disease that had been a nightmare that threatened human life for thousands of years. Data show that half of the world's population is at risk of developing malaria.
The United States has also spent a lot of money on research to solve this human problem, but unfortunately all of them have failed. People's so advanced technology is not good, the domestic conditions are even more difficult, with old equipment, can we do miracles? In the face of everyone's doubts, Tu Youyou said firmly: "There is no way, there is only the question of whether you are willing to persist." ”
Tu Youyou (data map)
Tu Youyou was a leading researcher at the China Academy of Traditional Chinese Medicine. After conducting the study, she traveled to Henan alone. When they were separated, their daughters were still young, and when they were reunited, their daughters could not recognize their own appearance. Tu Youyou kept moving forward in one experiment after another. Whether the test effect is good or bad, constantly trying to refine is the only way out.
Later, Tu Youyou was inspired by ancient Chinese books. She found that there was a sentence in the "Elbow Reserve Emergency": "Artemisia annua is held in one hand, stained with two liters of water, twisted to take the juice, and served it as much as possible." "It turned out that as early as the Eastern Jin Dynasty in 400 AD in China, artemisia annua had begun to use to cope with malaria.
So she began to go down this line of thought, and in a critical situation, she even tried the medicine with herself.
Finally, she discovered artemisinin, bringing a new antimalarial drug to the world.
Hundreds of millions of people around the world have benefited from this "Chinese miracle drug". Artemisinin-based combinations have thus become standard treatments for malaria, and the World Health Organization has included artemisinin and related agents in its essential medicines list.
In October 2015, Tu Youyou was awarded the Nobel Prize in Physiology or Medicine for her discovery of artemisinin.
Why global malaria control has stalled
However, the Tao is one foot high, and the devil is one foot tall. WHO's latest World Malaria Report 2018 shows that progress in malaria control worldwide has stalled, malaria remains one of the world's leading causes of death, and the phased target of "a 40% reduction in malaria infection and mortality by 2020" will be difficult to achieve.
The reason is that, in addition to factors such as insufficient funding for malaria control and insufficient coverage of core interventions, the resistance of malaria parasites to artemisinin-based antimalarial drugs is the biggest technical challenge facing global antimalarials.
Multiple studies by WHO and countries in South-East Asia have shown that in countries of the Greater Mekong Subregion, such as Cambodia, Thailand, Myanmar and Viet Nam, during a three-day cycle of treatment with artemisinin-based combination therapy ("artemisinin" and "other antimalarial formulations") for malaria-infected people, the malaria parasite clearance rate shows signs of slowness and develops resistance to artemisinin.
"Artemisinin combination therapy is currently a first-line antimalarial therapy vigorously promoted by WHO and is the most important weapon in the current global antimalarial resistance. Once the malaria parasite becomes widely resistant to it, the consequences will be very serious, and scientists around the world are very worried about the further deterioration of 'artemisinin resistance'. ”
Tu Youyou believes that in order to solve the problem of "artemisinin resistance", it is necessary to understand the mechanism of action of artemisinin. Wang Jigang, a member of Tu Youyou's team and a researcher at the Artemisinin Research Center of the Chinese Academy of Chinese Medical Sciences, said that the half-life of artemisinin in the human body (the time required for the concentration of the drug to drop by half in the organism) is very short, only 1 to 2 hours, while the clinically recommended combination therapy course of artemisinin is three days, and the truly efficient insecticidal window of artemisinin is only limited to 4 to 8 hours.
Existing drug-resistant insect strains take full advantage of the short half-life of artemisinin, altering the life cycle or temporarily entering a dormant state to avoid sensitive insecticidal periods. At the same time, the malaria parasite can also produce obvious resistance to the auxiliary drug "antimalarial formula" in artemisinin combination therapy, making artemisinin combination therapy "ineffective".
Old age to tackle the "artemisinin resistance"
Counting down, almost at the same time as winning the Nobel Prize, the elderly Tu Youyou has embarked on the road of fighting the "Malaria Parasite" again.
After more than three years of scientific research, Tu Youyou's team finally made new breakthroughs in "antimalarial mechanism research", "causes of drug resistance", "adjustment of treatment methods" and other aspects, and proposed a new treatment response plan: first, appropriately extend the medication time, from three days to five or seven days of therapy; second, replace the auxiliary drugs that have developed resistance in artemisinin combination therapy, and the effect is immediate.
The new English Journal of Medicine (NEJM), a top international medical authority, has recently published the major research results of Tu Youyou's team and the treatment response plan of "artemisinin resistance", which has aroused the attention of the industry.
Tu Youyou believes that it is of great significance to solve the problem of "artemisinin resistance": first, it has firmly established the direction of global artemisinin research and development, that is, for a long time in the future, artemisinin will remain the preferred and efficient drug for human antimalarials; second, because the price of artemisinin antimalarial drugs is low, each course of treatment is only a few DOLLARs, which is suitable for the population in the vast poverty-stricken areas of Africa where the epidemic area is concentrated, and it is more conducive to achieving the goal of global malaria eradication.
Pedro Alonso, Director of the WHO Global Malaria Programme
"Global malaria prevention and control is highly consistent with the main thrust of the Chinese government's initiative to build a community with a shared future for mankind." Pedro Alonso, Director of WHO's Global Malaria Programme, said: "To date, artemisinin combination therapies have cured billions of cases of malaria. The antimalarial scientific research work carried out by Tu Youyou's team is outstanding and the contribution is immeasurable. ”
Artemisinin for lupus erythematosus is dawning
At the same time as the new breakthrough in the research of "artemisinin resistance", Tu Youyou's team also found that dihydroartemisinin has a unique effect on the treatment of lupus erythematosus with high variability.
The traditional treatment of lupus erythematosus can only be conservatively treated with immune agents, which is difficult to cure and has the risk of secondary infection. However, the early clinical observations of Tu Youyou's team found that artemisinin was more than 90% and 80% effective in the treatment of discoid lupus erythematosus and systemic lupus erythematosus, respectively. Pedro Alonso affirmed this possibility, while arguing that clinical trials must be further designed and rigorously implemented in accordance with international standards to reach a final conclusion.
According to the "Drug Clinical Trial Approval" of the State Drug Administration, the application for "Clinical Trials for the Treatment of Dihydroartemisinin Tablets for systemic lupus erythematosus and discoid systemic lupus erythematosus" submitted by the Institute of Chinese Materia Medica of the Chinese Academy of Chinese Medical Sciences, where Tu Youyou's team is located, has been approved. Kunpharm Group Co., Ltd. is responsible for clinical trials.
According to Xue Qiao, medical manager of Kunpharm Group, under the guidance of Tu Youyou's team, the first phase of the clinical trial was officially launched in May 2018, with a total of 120 design samples, which were jointly carried out by 15 leading units across the country, including Peking Union Medical College Hospital, Peking University First Hospital, Affiliated Hospital of Inner Mongolia Medical University, People's Hospital of Xinjiang Uygur Autonomous Region, First Affiliated Hospital of Anhui Medical University, and Qilu Hospital of Shandong University.
"About 500 Chinese and foreign patients signed up for the clinical trial, and after strict screening through multiple processes such as 'disease activity score', the first batch of volunteer patients have been enrolled in the group to carry out the trial." Xue Qiao revealed, "From the current situation, there are no unexpected adverse events in volunteer patients. ”
Tu Youyou said: "There is a trend in the effectiveness of artemisinin in the treatment of lupus erythematosus, and we are cautiously optimistic about the success of the trial. ”
The reporter learned that clinical trials generally have three phases, and the sample size of the second and third phases of the test is larger, and it will take at least 7 to 8 years. If the trial goes well, it is expected that the new dihydroartemisinin tablets may be approved for marketing as soon as 2026.
Traditional Chinese medicine is expected to be included in authoritative medical textbooks
The scientific research papers on traditional Chinese medicine such as artemisinin, written by Tu Youyou's team members and Liao Fulong, researcher of the Chinese Academy of Chinese Medical Sciences, are expected to be included in the upcoming republishment of the international authoritative medical textbook "Oxford Medical Textbook (Sixth Edition)". The industry believes that this will become an important practical achievement of the "going out" of Chinese medicine culture.
At present, the chapter entitled "The Model of Traditional Medicine - Traditional Chinese Medicine" has been finalized, which is divided into four parts: "What is Traditional Medicine", "History of Discovery, Mechanism of Action and Clinical Application of Traditional Chinese Medicine such as Artemisinin", "Holistic View and Dialectical Treatment of Traditional Chinese Medicine" and "Traditional Medicine is Accessible". In April, the book's publisher, Oxford University Press, started proofreading and will be republished later this year.
Professor Cox, editor-in-chief of the Oxford Medical Textbook, said he was pleased that traditional Chinese medicine treatises would soon be included in the textbook. He said: "The TCM chapter is both important and profound. All this is the result of the outstanding efforts of Chinese scientists. ”
Authoritative experts such as Pedro Alonso believe that Tu Youyou's team has built a bridge between traditional medicine and modern medicine, so that TCM is not only widely used in China, but also recognized by more and more countries for its effective treatment. It is hoped that Chinese scientists will continue to make more noises on the international stage of artemisinin research.
New People's Eye Studio Pan Gaofeng
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