Journal of Ethnopharmacology 181 (2016) 214–220
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Ethnopharmacological survey of plant species used in folk medicine against central nervous system disorders in Togo Yendube T. Kantati a,n, K. Magloire Kodjo a, Koffi S. Dogbeavou a, David Vaudry b, Jérôme Leprince b, Messanvi Gbeassor a a b
Laboratory of Physiology/Pharmacology, University of Lomé, Po Box: 1515 Lomé, Togo INSERM U982, Neurotrophic Factors and Neuronal Differentiation Team, University of Rouen, Place E. Blondel, 76821 Mont-Saint-Aignan, France
art ic l e i nf o
a b s t r a c t
Article history: Received 9 October 2015 Received in revised form 4 February 2016 Accepted 6 February 2016 Available online 8 February 2016
Ethnopharmacological relevance: Neurological diseases are rising all around the world. In a developing country such as Togo, although plant-based medicines are the only means, still very little is known regarding the nature and efficiency of medicinal plants used by indigenous people to manage central nervous system (CNS) disorders. Aim of the study: This study, an ethnobotanical survey, aimed to report plant species used in traditional medicine (TM) for the management of various CNS disorders in Togo. Materials and methods: 52 traditional actors (TA) including 33 traditional healers (TH) and 19 medicinal plant sellers (MPS) were interviewed, using a questionnaire mentioning informants' general data and uses of medicinal plants. Results: The present study reports 44 medicinal plant species distributed into 26 families, mentioning scientific and common local names, plant organs used, preparation method, root of administration and putative applications. Conclusion: It appears that there is a real knowledge on medicinal plants used for traditional treatment of CNS disorders in Togo and that the local flora abounds of potentially neuroactive plants which could be useful for the discovery of antipsychotic or neuroprotective molecules. & 2016 Elsevier Ireland Ltd. All rights reserved.
Keywords: Ethnopharmacological survey Togo Traditional medicine CNS disorders
1. Introduction Neuroprotection refers to the strategies and relative mechanisms able to defend the central nervous system (CNS) against neuronal injury due to both acute (stroke and traumatic brain injury) and chronic neurodegenerative disorders (Alzheimer's disease and Parkinson's disease; Iriti et al., 2010). With the ageing of the population, these pathologies and other brain disorders (Epilepsy and Dementia) are rising all around the world and thus represent a relevant health problem. In spite of many years of research and trials, there is no efficient cure for neurodegenerative diseases and current therapies available mainly provide symptomatic improvement (Desai and Grossberg, 2005; Whiteley et al., 2014). Many recent experimental observations lead to the conclusion that among all the mechanisms involved in neurodegenerative disorders, free radical damages may constitute a common important pathway leading to cell death (Nakamura and Lipton, 2010; Shukla et al., 2011; Oliveira et al., 2014). Antioxidant n
Corresponding author. E-mail address: [email protected] (Y.T. Kantati).
http://dx.doi.org/10.1016/j.jep.2016.02.006 0378-8741/& 2016 Elsevier Ireland Ltd. All rights reserved.
compounds are thus valuable candidates for the development of neuroprotective strategies (Moosmann and Behl, 2002; Albarracin et al., 2012; Dale, 2014). During last decades, many herbal plants and their active components have emerged and have been subject of extensive scientific research all around the world (Arias and Ramón-Laca, 2005; Uprety et al., 2010; Yessoufou et al., 2013; Ahmad et al., 2014). In fact, there is growing evidence that exposure to antioxidant compounds and relatives present in plants may provide health benefits. According to the World Health Organization (WHO), about 65–80% of the world's population in developing Countries, such as Togo, depends essentially on plants for their primary healthcare due to poverty and lack of access to modern medicine (Awoyemi et al., 2012). As complementary and alternative therapy, herbal medicine refers to the medical use of plant organs (leaves, stems, roots, flowers, fruits and seeds) for their curative properties (Iriti et al., 2010). Traditional medical knowledge of medicinal plants and their use by indigenous healers are not only useful for conservation of cultural traditions and community healthcare, but also contribute to drug development in the future. In this perspective, it appears very important to collect data on medicinal plants and draft repertories that will be used in further pharmacological studies. In Togo, some ethnobotanical surveys have been conducted (Koudouvo
Y.T. Kantati et al. / Journal of Ethnopharmacology 181 (2016) 214–220
et al., 2011; Karou et al., 2012; Tchacondo et al., 2012), but they have not focused on CNS disorders. The purpose of this study was thus to fulfill the lack of data on plant species used in folk medicine for the treatment of neurological disorders in Togo by interviewing traditional healers and medicinal plant sellers. This work constitutes the first step for the study of plants from Togo potentially active for the treatment of neurodegenerative diseases and should be followed by phytochemical and pharmacological studies.
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2. Methods 2.1. Area Togo is a country located in western Africa. The country is limited in the north by Republic of Burkina Faso, in the east by Republic of Benin, in the west by Republic of Ghana and in the south by the Atlantic Ocean. Togo is divided into five economic
Fig. 1. Map of Togo showing the study areas, regions and principal localities.
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Fig. 2. Distribution of interviewees by gender (A) and level of education (B).
regions from north to south: Savannah region, Kara region, Central region, Plateaux region and Maritime region. The present ethnomedicinal survey was conducted among populations of the principal districts of these five regions: Lomé, Assahoun, Tsevié in the Maritime region, Atakpamé in the Plateaux region, Sokodé in the Central region, Kara in the Kara region and Dapaong in the Savannah region (Fig. 1). These districts were selected because they are inhabited by people from different ethnic groups and have public markets gathering numerous medicinal plant sellers of the region. Sellers and traditional healers from those regions could provide useful data for a country-wide baseline study. In each district, traditional healers were interviewed at home when exchanges with medicinal plant sellers stood in the herbal stands of public markets. 2.2. Data collection 52 traditional actors (TA) including 33 traditional healers (TH) and 19 medicinal plant sellers (MPS) were surveyed. A questionnaire was prepared including informant's name, age, sex, level of education; local names of plants species, mode of preparation, mode of administration and the neurological affections or symptoms that are managed by their remedies. Terms: dementia, memory loss, confusion, disorientation, muscular rigidities, tremors and other relatives well known symptoms were frequently used during the survey to present neurological disorders to TA. Because of the variety of ethnic groups in the country, questionnaires were translated into local language by a field assistant. The link with some neurodegenerative disease not known in the local concepts such as Parkinson disease and Alzheimer disease was made later when analyzing the results. Data were collected over a 3-month period from July to September 2014. Botanical materials were bought or sampled for further systematic identification and deposited in the Herbarium of the Botany Department, Faculty of Science of University of Lomé (Togo). Identities of sampled plants collected were confirmed by comparison with available voucher specimens in the Herbarium by botanists of the Botany Department, Faculty of Science of University of Lomé. The taxonomic keys of online databases of PROTA (PROTA4U, Plant resources of Tropical Africa) available on the website: www.pro ta4u.info were used in this process and the nomenclature of species was done using the online data base of IPNI website: www. ipni.org/ipni/plantnamesearchpage.do. 2.3. Data analysis MS Excel spread sheet were used to make simple calculations and determine each plant' frequency of citation with the formula: FC (%) ¼(Number of remedies containing the plant/Total of remedies collected) 100.
3. Results 3.1. Personal data of informants interviewed Of the thirty-three (33) traditional healers surveyed, 28 were men (M-TH: 54% of the total) and 5 were women (F-TH: 10%). The nineteen (19) medicinal plant sellers were exclusively women (MPS: 36% of the total; Fig. 2A). With an average age of 53 years, people interviewed for this survey were mostly illiterate (72%). Only 28% have received a formal education which level does not exceed the secondary (Fig. 2B). 3.2. Medicinal plants A total of 44 medicinal plants species distributed in 26 families were identified with their scientific and local names to be used for the treatment of CNS disorders and relative symptoms as presented in Table 1. Most of these plants recorded during the survey and listed in this table appeared to be prescribed in case of symptoms related to neurodegenerative disorders. This table also lists usage of plants species recorded: mode of preparation, concoctions mode of administration, and frequencies of citation in composition of remedies. Respectively with 25% and 23.07% of frequency of citation, Zanthoxylum zanthoxyloides (Rutaceae) and Rauwolfia vomitoria (Apocynaceae) were the most cited species during this survey. Family Fabaceae with 07 species, Rutaceae, Rubiaceae and Asclepiadaceae with 03 species were the most represented in the remedies (Fig. 3). A study of the literature presented in the last column of Table 1 showed that some of these plants such as Rauwolfia vomitoria, Allium sativum, and Stereospermum kunthianum have been cited in studies elsewhere in the world. 3.3. Plants parts used and preparation The traditional actors of Togo use different parts of the plants for their concoctions. Leaves and roots are the most used parts (Fig. 4). Other parts such as stem barks, root barks, rhizomes, fruit, seeds and the whole plants are less used.
4. Discussion Plants play a key role in many health care systems, particularly in developing countries where modern drugs are often not affordable for the majority of the populations (Newman et al., 2003). In many cases, herbal medicines substitute the unavailability of modern medicines. But many traditional communities all around the world are in the process of losing traditional knowledge, possibly due to the changing lifestyle and formal education (Voeks,
Table 1 Plants species used for the care of CNS disorders in Togo. Plant species
Families
Voucher specimen number
Local name
Used part FC %
Mode of preparation/ administration
Abrus precatorius L. Acanthospermum hispidum DC.
Fabaceae Asteraceae
Oblekou (a) Afegban (e)
Le Le
3.84 Dec/Orl 7.69 Dec/Orl
Aframomum melegueta K. SChum
Zingiberaceae
05592TG 749TG Clt/AK CNE
Atakou (e)
Rt
19.23 Mac/Orl
Allium sativum L. Annona muricata L.
Liliaceae Annonaceae
21.15 Dec, Mac/Orl 7.69 Dec/Orl
Annona senegalensis Pers.
Type of CNS disorder
Previous citations
Epilepsy, memory loss Parkinson disease, stroke
Moshi et al. (2005) NRAS
Memory loss, stroke, traumatic brain injury, Epilepsy, paralysis, stroke Alzheimer disease epilepsy, dementia traumatic brain injury Dementia, epilepsy
Fatumbi (1995)
Bu Le
Tchoutchoudè (t)
Rt
1.92 Dec/Orl
Anthocleista djalonensis A.Chev. Calotropis procera (Ait.) W.T.Ait.
Loganiaceae Asclepiadaceae
2326FDS/UL 02213TG
Assoubabissao (t, k) Gboloba (e)
Le Rt
3.84 Dec/Orl 1.92 Dec, Mac/Orl
Cassia sieberiana DC. Cissus aralioides Planch.
Fabaceae Vitaceae
12520TG 1838*
Gati-gati (e), Kansi (m), Bodi (t)
Rt Rt
5.75 Dec, Mac/Orl 1.92 Dec/Orl
Citrus aurantifolia (Christm.) Swingle
Rutaceae
02480TG Clt/AK Rutaceae CNE Combretaceae 00597TG Amaryllidaceae 09475TG Ebenaceae 02922TG
Edonti (e), Akanka (t) Gbodo n'ti (e) Kinkeliba (e, m, t, a, k) Aholisablè(e) Gabongue (m)
Le
15.38 Dec/Orl
Epilepsy, paralysis Epilepsy, Parkinson disease, paralysis, stroke Epilepsy, paralysis, stroke Dementia, epilepsy, memory loss Paralysis, Parkinson disease
Fr Le Bu Stb
19.23 15.38 21.15 3.84
Jui/Orl Dec/Orl Dec/Orl Dec/Orl
Epilepsy, paralysis Dementia, memory loss Epilepsy, paralysis Stroke, traumatic brain injury
Euphorbiaceae
03193TG
Wp
9.61
Dec/Orl
Alzheimer disease, memory loss Kumar et al. (2010)
Rubiaceae
07354TG Clt/AK 02514TG 09207TG Clt/AK 06355TG
Anonsika (e), Kovoyoyilim (k, t) Flifèti (e), Kaou (k, t) Bariè (k) Avudati (e)
Le
7.69 Dec/Orl
Epilepsy, Parkinson disease
Stafford et al. (2008)
Le Stb
3.84 Dec/Orl 7.69 Dec, Mac/Orl
NRAS NRAS
Ferè (k)
Wp
9.61
Dementia, memory loss Alzheimer disease, epilepsy, Parkinson disease, stroke Paralysis
07498TG Clt/AK 07535TG Clt/AK 04199TG Clt/AK CNE
Zanklan (e)
Rt
15.38 Dec/Orl
Epilepsy, stroke
Elufioye et al. (2010)
Ketetchelo (t, k), Nyimon (e)
Le Le
Traumatic brain injury Paralysis Epilepsy, stroke
Bum et al. (2009)
Kozossoga (t, k), Ahamè (e)
19.23 Dec/Orl Mac/Bba 21.15 Dec, Mac/Orl
Plampoti (e)
Le
NRAS
Doug (m), Soulou (t) Assiviaton (e)
Stb Rt
Stroke paralysis Epilepsy Alzheimer disease, dementia
Tchacondo et al. (2012) NRAS
Kponkeke (e), Yambiong (m)
Rt
Epilepsy, memory loss, stroke
Cheikhyoussef et al. (2011)
Kpankéké(e) Péyati (e) Seniséniyo (t) Ditotorè (t)
Le Le Wp Rt
5.76 11.53 9.61 3.84
Dementia, epilepsy Paralysis, stroke Epilepsy Dementia, epilepsy, memory loss Alzheimer disease, dementia, epilepsy, stroke Paralysis, Parkinson disease Paralysis
NRAS Ojewole and Amabeoku (2006) NRAS Tchacondo et al. (2012)
Citrus maxima (Burm.) Merr. Combretum micranthum G. Don Crinum nubicum Hann. Diospyros mespiliformis Hochstex A. DC. Euphorbia hirta L. Gardenia ternifolia Schumach. & Thonn. Heliotropium indicum L. Lippia multiflora Moldenke
Boraginaceae Verbenaceae Fabaceae
Inf/Orl
Rubiaceae
Nauclea latifolia Sm.
Rubiaceae
Occimum canum Sims.
Lamiaceae
Oxytenanthera abyssinica Munro
Poaceae
Parkia biglobosa Br. ex G. Don Paullinia pinnata L.
Fabaceae Sapindaceae
Pergularia daemia (Forssk.) Chiov.
Asclepiadaceae
Pergularia extensa (Jacq.) N.E. Br. Persea americana Mill. Phyllantus amarus Schum. & Thonn. Pseudocedrela kotschyi Harms.
Asclepiadaceae Lauraceae Euphorbiaceae Meliaceae
9468FDS/UL 08181TG Clt/AK 02310TG Clt/AK CNE CNE 03349TG 04671TG
Rauwolfia vomitoria Afzel
Apocynaceae
02111TG
Dodemakpo (e)
Rtb
23.07 Dec, Mac/Orl
Rourea coccinea Benth. Saccharum officinarum L.
Connaraceae Poaceae
12607TG 11350TG
Tomegavi (e) Fonfoti (e)
Rt Le
11.53 Dec/Orl 5.76 Dec/Orl
5.76
Dec, Mac/Orl Mac/Bba 9.61 Dec/Orl 15.38 Dec, Mac/Orl 3.84 Dec/Orl Dec/Orl Dec/Orl Dec/Orl Dec/Orl
Tchacondo et al. (2012) and Konate et al. (2012) Tchacondo et al. (2012) Upadhyay (2014) NRAS NRAS Pultrini et al. (2006) Sheik et al. (2014) NRAS Refaat et al. (2013) NRAS
Sonibare et al. (2012)
Stafford et al. (2008)
Ekong et al. (2014) NRAS NRAS
217
Lonchocarpus cyanescens (Schum. & Thonn.) Benth. Morinda lucida Benth.
Ray et al. (2011) N’Gouemo et al. (1997)
Y.T. Kantati et al. / Journal of Ethnopharmacology 181 (2016) 214–220
Ayo (e, m, t, k) Yevounyigli (e)
Annonaceae
10856 02267TG Clt/AK 01883TG
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Table 1 (continued ) Families
Voucher specimen number
Local name
Used part FC %
Securidaca longepedonculata Fresen.
Polygalaceae
06925TG
Rtb
Sterculia setigera Del. Stereospermum kunthianum Cham.
Sterculiaceae Bignoniaceae
08655TG 02467TG
Fozi (t, k), ipalg (m), tchritu (e) Natoufégligue (m) Nanelig (m), Sogbeliya (t)
Le Rt
Dec, Mac/Orl Mac/Bba 15.38 Dec/Orl 11.53 Dec/Orl
Tephrosia purpurea (L.) Pers. Tephrosia villosa L. Thevetia neriifolia Juss. ex A.DC. Uraria picta (Jacq.) Desv.
Fabaceae Fabaceae Apocynaceae Fabaceae
Domkpo (e) Domkpo (e) Prin prin (a) Somika (t), Vénaviwoda (e)
Wp Wp Le Wp
7.69 13.46 3.84 17.30
Dec/Orl Dec/Orl Dec/Orl Dec/Orl
Vitellaria paradoxa C.F.
Sapotaceae
06684TG 06692TG CNE 06714TG Clt/AK 08239TG
Se
21.15
Oint/Mas
Zanthoxylum zanthoxyloides Lam.
Rutaceae
Rtb
Zingiber officinale Roscoe
Zingiberaceae
Somou (t), Ayokoumiti (e) Sankpasang (m) Exeti (e), Polou (m), N'goné (k), Frou (t) Dotè (e)
25.00 Dec, Mac/Orl Sau/Orl 19.23 Dec, Mac/Orl
08061TG Clt/AK CNE
Rz
Mode of preparation/ administration
21.15
Type of CNS disorder
Previous citations
Dementia, epilepsy, memory loss, stroke paralysis Epilepsy Epilepsy, paralysis, traumatic brain injury Dementia, epilepsy, paralysis Stroke Epilepsy, memory loss Alzheimer disease, dementia
Stafford et al. (2008) and Adeyemi et al. (2010) Atakpama et al. (2012) Ching et al. ( 2009)
Epilepsy, dementia, paralysis, Parkinson disease stroke Memory loss, paralysis, traumatic brain injury
Tchacondo et al. (2012)
Asuntha et al. (2010) NRAS Nasir and Kabidul (2014) Garg et al. (2012) and Saxena et al. (2014) Paralysis, traumatic brain injury Tchacondo et al. (2012)
Khodaie and Sadeghpoor (2015)
Local names: a ¼ Akposso, e¼Ewe, k ¼Kabyè, m¼ Moba, t ¼ Tem. Used parts: Stb¼ stem barks, Le ¼leaves, Rtb ¼root barks, Fr ¼fruit, Wp ¼whole plants, Rt ¼roots, Rz¼ rhizomes, Bu ¼bulbs, Se ¼ seeds. Mode of preparation and administration routes: Dec/Orl¼ decoction and oral route, Mac/Orl¼ maceration and oral route, Dec, Mac/Orl¼ decoction or maceration and oral route, Mac/Bba ¼maceration and body bath, Sau/Orl¼ sauce and oral route, Jui/Orl¼ juice and oral route, Oint/Mas ¼ ointment/massage. Previous citations: NRAS ¼ no reported studies.
Fig. 3. Plant species distribution among families in Togo.
Fig. 4. Plants and their organs used in remedies.
2004; Case et al., 2005). It seems then very important to keep the memory of these ancestral knowledge, in order to preserve the potential of medicinal plants. In Togo, plant materials are directly sold in market places or transformed in several concoctions by traditional healers in their houses. The preponderance of men in the repartition of traditional actors found in this study, also reported by Tchacondo et al. (2012) in Central region of Togo, suggests that authentic ancient knowledge on the preparation of remedies has been essentially transmitted in families from generation to generation to men. Experience gain seems to be also important in the acquisition of these knowledge as shown by the average age of respondents. In addition, their illiteracy confirms the importance of oral traditions in the transmission of secrets on medicinal remedies across generations, without any writing system. The country is subdivided into five ecological zones, based on geoclimatic factors (Ern, 1979). Some of the species recorded during this survey such as Zanthoxylum zanthoxyloides and Securidaca longepedunculata are widespread throughout the five zones. In addition, Zanthoxylum zanthoxyloides widely used as chewing stick for tooth cleaning in west Africa (Kassim et al., 2005) and as a condiment in preparation of sauces. The inter-ethnic marriages, friendships and kinships between neighboring ethnic groups could
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Plant species
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favor knowledge exchange on some plants such as Rauwolfia vomitoria widely used in Asian and West African countries (Amole et al., 2009) and provide another explanation to these high frequencies of citation. The limited presence of species such as Cissus aralioides and Annona senegalensis in the composition of remedies may then be mostly related to their ecological repartition in the country. In these remedies for brain disorders leaves and roots are mostly used, as also found in the ethnobotanical studies conducted on antimalarial plants by Koudouvo et al. (2011) in Togo Maritime Region, Mesfin et al. (2013) in Northern Ethiopia Gemad District and Yetein et al. (2013) in Benin plateau of Allada. This observation is correlated with the conclusions of many studies that have highlighted the variations in concentration of secondary metabolites from plant to plant species as well as in the different parts of a plant, leaves and roots being the preferential sites of accumulation of these compounds (Hyder et al., 2002; Springer et al., 2002). But comparatively to leaves, utilization of root parts highly affects the survival and ecological aspect of the plant so urgent measures must be taken to protect these species. A controlled agriculture operation of the plants containing recognized active secondary metabolites could also contribute to the economic development of these regions. Secondary metabolites involved in neuroprotection are molecules often present in complex mixtures of active components such as isoprenoids, alkaloids, vitamins or non-enzymatic phenolic scavengers, which make it difficult to determine which component (s) of the herb(s) has biological activity (Adams et al., 2007; McClatchey et al., 2009; Iriti et al., 2010). However, it may be possible to identify some molecules of interest by focussing on their capacity to act on specific important mechanisms such as oxidative stress, which results from mitochondrial dysfunction and has been established to be involved in many neurodegenerative diseases (Kann and Kovacs, 2007). Indeed, although the brain accounts for less than 2% of the body weight, it consumes about 20% of the oxygen available through respiration. Therefore, because of its high oxygen demand, the brain is the most susceptible organ to oxidative damage (Halliewll, 1992; Floyd, 1999). In this regard, some plant extracts with antioxidant properties have already been reported to exhibit preventive or therapeutic neuroprotective effects in experimental models (Ray et al., 2011; Francik et al., 2014; Komolafe et al., 2014; Tsai et al., 2015; Kanno et al., 2015). In this regard, Allium sativum, one of the plants collected during this survey, exhibits potential neuroprotective properties against oxidative damages, by lowering β-amyloid peptide (Aβ) plaques and also preserving pre-synaptic proteins (synaptosomal associated protein of 25 kDa, SNAP25 and synaptophysin) both in cellular and animal models of Alzheimer disease (Ray et al., 2011). Although being very important, antioxidant mechanisms are not the only in the protection of central nervous system. More precisely among the other mechanisms, GABAergic neurotransmission, emphasized by the widespread use of antiepileptic drugs targeting postsynaptic GABA receptors is studied as a potential therapeutic target in neuroprotection (DeFazio et al., 2009). The review of Asif (2013) showed interestingly that ethanolic extracts of Citrus maxima leaves, Nauclea latifolia root bark, Paulinia pinnata stem bark and Stereospermum kunthianum root bark, four plants species recorded during this survey, exhibit dose dependent anticonvulsant effects in both maximal electro shock (MES) and pentylenetetrazol (PTZ) seizure models. The latex proteins of another plant recorded in the present survey, Calotropis procera, showed anticonvulsant and sedative properties in mouse models of PTZ-induced seizure in the study of Lima et al. (2012). These observations provide some scientific evidences for the use of the local flora in the folk medicine of Togo to treat CNS diseases.
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5. Conclusion Traditional medicinal knowledge still provides tools to pharmacological research in many fields. In Togo, there was a lack in data on medicinal plants used for CNS diseases management. Our study, the first report in this field, showed that real knowledge on medicinal plants used in the treatment of these diseases existed in the area. The local flora abounds of potentially neuroactive and neuroprotective plants that could be useful for further neuropharmacological studies, neuroprotective and CNS drugs discovery, in accordance with ecological imperatives.
Acknowledgments The authors thank the traditional healers and medicinal plants sellers for sharing their precious knowledge on medicinal plants used to heal CNS diseases. Especially, we thank the coordinator and all traditional healers of the non-governmental organization CERMETRA-RC. We are also grateful to the staff members of the Togo Herbarium, for their assistance in voucher specimen's identification.
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Contents lists available at ScienceDirect
Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jep
Ethnopharmacological survey of plant species used in folk medicine against central nervous system disorders in Togo Yendube T. Kantati a,n, K. Magloire Kodjo a, Koffi S. Dogbeavou a, David Vaudry b, Jérôme Leprince b, Messanvi Gbeassor a a b
Laboratory of Physiology/Pharmacology, University of Lomé, Po Box: 1515 Lomé, Togo INSERM U982, Neurotrophic Factors and Neuronal Differentiation Team, University of Rouen, Place E. Blondel, 76821 Mont-Saint-Aignan, France
art ic l e i nf o
a b s t r a c t
Article history: Received 9 October 2015 Received in revised form 4 February 2016 Accepted 6 February 2016 Available online 8 February 2016
Ethnopharmacological relevance: Neurological diseases are rising all around the world. In a developing country such as Togo, although plant-based medicines are the only means, still very little is known regarding the nature and efficiency of medicinal plants used by indigenous people to manage central nervous system (CNS) disorders. Aim of the study: This study, an ethnobotanical survey, aimed to report plant species used in traditional medicine (TM) for the management of various CNS disorders in Togo. Materials and methods: 52 traditional actors (TA) including 33 traditional healers (TH) and 19 medicinal plant sellers (MPS) were interviewed, using a questionnaire mentioning informants' general data and uses of medicinal plants. Results: The present study reports 44 medicinal plant species distributed into 26 families, mentioning scientific and common local names, plant organs used, preparation method, root of administration and putative applications. Conclusion: It appears that there is a real knowledge on medicinal plants used for traditional treatment of CNS disorders in Togo and that the local flora abounds of potentially neuroactive plants which could be useful for the discovery of antipsychotic or neuroprotective molecules. & 2016 Elsevier Ireland Ltd. All rights reserved.
Keywords: Ethnopharmacological survey Togo Traditional medicine CNS disorders
1. Introduction Neuroprotection refers to the strategies and relative mechanisms able to defend the central nervous system (CNS) against neuronal injury due to both acute (stroke and traumatic brain injury) and chronic neurodegenerative disorders (Alzheimer's disease and Parkinson's disease; Iriti et al., 2010). With the ageing of the population, these pathologies and other brain disorders (Epilepsy and Dementia) are rising all around the world and thus represent a relevant health problem. In spite of many years of research and trials, there is no efficient cure for neurodegenerative diseases and current therapies available mainly provide symptomatic improvement (Desai and Grossberg, 2005; Whiteley et al., 2014). Many recent experimental observations lead to the conclusion that among all the mechanisms involved in neurodegenerative disorders, free radical damages may constitute a common important pathway leading to cell death (Nakamura and Lipton, 2010; Shukla et al., 2011; Oliveira et al., 2014). Antioxidant n
Corresponding author. E-mail address: [email protected] (Y.T. Kantati).
http://dx.doi.org/10.1016/j.jep.2016.02.006 0378-8741/& 2016 Elsevier Ireland Ltd. All rights reserved.
compounds are thus valuable candidates for the development of neuroprotective strategies (Moosmann and Behl, 2002; Albarracin et al., 2012; Dale, 2014). During last decades, many herbal plants and their active components have emerged and have been subject of extensive scientific research all around the world (Arias and Ramón-Laca, 2005; Uprety et al., 2010; Yessoufou et al., 2013; Ahmad et al., 2014). In fact, there is growing evidence that exposure to antioxidant compounds and relatives present in plants may provide health benefits. According to the World Health Organization (WHO), about 65–80% of the world's population in developing Countries, such as Togo, depends essentially on plants for their primary healthcare due to poverty and lack of access to modern medicine (Awoyemi et al., 2012). As complementary and alternative therapy, herbal medicine refers to the medical use of plant organs (leaves, stems, roots, flowers, fruits and seeds) for their curative properties (Iriti et al., 2010). Traditional medical knowledge of medicinal plants and their use by indigenous healers are not only useful for conservation of cultural traditions and community healthcare, but also contribute to drug development in the future. In this perspective, it appears very important to collect data on medicinal plants and draft repertories that will be used in further pharmacological studies. In Togo, some ethnobotanical surveys have been conducted (Koudouvo
Y.T. Kantati et al. / Journal of Ethnopharmacology 181 (2016) 214–220
et al., 2011; Karou et al., 2012; Tchacondo et al., 2012), but they have not focused on CNS disorders. The purpose of this study was thus to fulfill the lack of data on plant species used in folk medicine for the treatment of neurological disorders in Togo by interviewing traditional healers and medicinal plant sellers. This work constitutes the first step for the study of plants from Togo potentially active for the treatment of neurodegenerative diseases and should be followed by phytochemical and pharmacological studies.
215
2. Methods 2.1. Area Togo is a country located in western Africa. The country is limited in the north by Republic of Burkina Faso, in the east by Republic of Benin, in the west by Republic of Ghana and in the south by the Atlantic Ocean. Togo is divided into five economic
Fig. 1. Map of Togo showing the study areas, regions and principal localities.
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Y.T. Kantati et al. / Journal of Ethnopharmacology 181 (2016) 214–220
Fig. 2. Distribution of interviewees by gender (A) and level of education (B).
regions from north to south: Savannah region, Kara region, Central region, Plateaux region and Maritime region. The present ethnomedicinal survey was conducted among populations of the principal districts of these five regions: Lomé, Assahoun, Tsevié in the Maritime region, Atakpamé in the Plateaux region, Sokodé in the Central region, Kara in the Kara region and Dapaong in the Savannah region (Fig. 1). These districts were selected because they are inhabited by people from different ethnic groups and have public markets gathering numerous medicinal plant sellers of the region. Sellers and traditional healers from those regions could provide useful data for a country-wide baseline study. In each district, traditional healers were interviewed at home when exchanges with medicinal plant sellers stood in the herbal stands of public markets. 2.2. Data collection 52 traditional actors (TA) including 33 traditional healers (TH) and 19 medicinal plant sellers (MPS) were surveyed. A questionnaire was prepared including informant's name, age, sex, level of education; local names of plants species, mode of preparation, mode of administration and the neurological affections or symptoms that are managed by their remedies. Terms: dementia, memory loss, confusion, disorientation, muscular rigidities, tremors and other relatives well known symptoms were frequently used during the survey to present neurological disorders to TA. Because of the variety of ethnic groups in the country, questionnaires were translated into local language by a field assistant. The link with some neurodegenerative disease not known in the local concepts such as Parkinson disease and Alzheimer disease was made later when analyzing the results. Data were collected over a 3-month period from July to September 2014. Botanical materials were bought or sampled for further systematic identification and deposited in the Herbarium of the Botany Department, Faculty of Science of University of Lomé (Togo). Identities of sampled plants collected were confirmed by comparison with available voucher specimens in the Herbarium by botanists of the Botany Department, Faculty of Science of University of Lomé. The taxonomic keys of online databases of PROTA (PROTA4U, Plant resources of Tropical Africa) available on the website: www.pro ta4u.info were used in this process and the nomenclature of species was done using the online data base of IPNI website: www. ipni.org/ipni/plantnamesearchpage.do. 2.3. Data analysis MS Excel spread sheet were used to make simple calculations and determine each plant' frequency of citation with the formula: FC (%) ¼(Number of remedies containing the plant/Total of remedies collected) 100.
3. Results 3.1. Personal data of informants interviewed Of the thirty-three (33) traditional healers surveyed, 28 were men (M-TH: 54% of the total) and 5 were women (F-TH: 10%). The nineteen (19) medicinal plant sellers were exclusively women (MPS: 36% of the total; Fig. 2A). With an average age of 53 years, people interviewed for this survey were mostly illiterate (72%). Only 28% have received a formal education which level does not exceed the secondary (Fig. 2B). 3.2. Medicinal plants A total of 44 medicinal plants species distributed in 26 families were identified with their scientific and local names to be used for the treatment of CNS disorders and relative symptoms as presented in Table 1. Most of these plants recorded during the survey and listed in this table appeared to be prescribed in case of symptoms related to neurodegenerative disorders. This table also lists usage of plants species recorded: mode of preparation, concoctions mode of administration, and frequencies of citation in composition of remedies. Respectively with 25% and 23.07% of frequency of citation, Zanthoxylum zanthoxyloides (Rutaceae) and Rauwolfia vomitoria (Apocynaceae) were the most cited species during this survey. Family Fabaceae with 07 species, Rutaceae, Rubiaceae and Asclepiadaceae with 03 species were the most represented in the remedies (Fig. 3). A study of the literature presented in the last column of Table 1 showed that some of these plants such as Rauwolfia vomitoria, Allium sativum, and Stereospermum kunthianum have been cited in studies elsewhere in the world. 3.3. Plants parts used and preparation The traditional actors of Togo use different parts of the plants for their concoctions. Leaves and roots are the most used parts (Fig. 4). Other parts such as stem barks, root barks, rhizomes, fruit, seeds and the whole plants are less used.
4. Discussion Plants play a key role in many health care systems, particularly in developing countries where modern drugs are often not affordable for the majority of the populations (Newman et al., 2003). In many cases, herbal medicines substitute the unavailability of modern medicines. But many traditional communities all around the world are in the process of losing traditional knowledge, possibly due to the changing lifestyle and formal education (Voeks,
Table 1 Plants species used for the care of CNS disorders in Togo. Plant species
Families
Voucher specimen number
Local name
Used part FC %
Mode of preparation/ administration
Abrus precatorius L. Acanthospermum hispidum DC.
Fabaceae Asteraceae
Oblekou (a) Afegban (e)
Le Le
3.84 Dec/Orl 7.69 Dec/Orl
Aframomum melegueta K. SChum
Zingiberaceae
05592TG 749TG Clt/AK CNE
Atakou (e)
Rt
19.23 Mac/Orl
Allium sativum L. Annona muricata L.
Liliaceae Annonaceae
21.15 Dec, Mac/Orl 7.69 Dec/Orl
Annona senegalensis Pers.
Type of CNS disorder
Previous citations
Epilepsy, memory loss Parkinson disease, stroke
Moshi et al. (2005) NRAS
Memory loss, stroke, traumatic brain injury, Epilepsy, paralysis, stroke Alzheimer disease epilepsy, dementia traumatic brain injury Dementia, epilepsy
Fatumbi (1995)
Bu Le
Tchoutchoudè (t)
Rt
1.92 Dec/Orl
Anthocleista djalonensis A.Chev. Calotropis procera (Ait.) W.T.Ait.
Loganiaceae Asclepiadaceae
2326FDS/UL 02213TG
Assoubabissao (t, k) Gboloba (e)
Le Rt
3.84 Dec/Orl 1.92 Dec, Mac/Orl
Cassia sieberiana DC. Cissus aralioides Planch.
Fabaceae Vitaceae
12520TG 1838*
Gati-gati (e), Kansi (m), Bodi (t)
Rt Rt
5.75 Dec, Mac/Orl 1.92 Dec/Orl
Citrus aurantifolia (Christm.) Swingle
Rutaceae
02480TG Clt/AK Rutaceae CNE Combretaceae 00597TG Amaryllidaceae 09475TG Ebenaceae 02922TG
Edonti (e), Akanka (t) Gbodo n'ti (e) Kinkeliba (e, m, t, a, k) Aholisablè(e) Gabongue (m)
Le
15.38 Dec/Orl
Epilepsy, paralysis Epilepsy, Parkinson disease, paralysis, stroke Epilepsy, paralysis, stroke Dementia, epilepsy, memory loss Paralysis, Parkinson disease
Fr Le Bu Stb
19.23 15.38 21.15 3.84
Jui/Orl Dec/Orl Dec/Orl Dec/Orl
Epilepsy, paralysis Dementia, memory loss Epilepsy, paralysis Stroke, traumatic brain injury
Euphorbiaceae
03193TG
Wp
9.61
Dec/Orl
Alzheimer disease, memory loss Kumar et al. (2010)
Rubiaceae
07354TG Clt/AK 02514TG 09207TG Clt/AK 06355TG
Anonsika (e), Kovoyoyilim (k, t) Flifèti (e), Kaou (k, t) Bariè (k) Avudati (e)
Le
7.69 Dec/Orl
Epilepsy, Parkinson disease
Stafford et al. (2008)
Le Stb
3.84 Dec/Orl 7.69 Dec, Mac/Orl
NRAS NRAS
Ferè (k)
Wp
9.61
Dementia, memory loss Alzheimer disease, epilepsy, Parkinson disease, stroke Paralysis
07498TG Clt/AK 07535TG Clt/AK 04199TG Clt/AK CNE
Zanklan (e)
Rt
15.38 Dec/Orl
Epilepsy, stroke
Elufioye et al. (2010)
Ketetchelo (t, k), Nyimon (e)
Le Le
Traumatic brain injury Paralysis Epilepsy, stroke
Bum et al. (2009)
Kozossoga (t, k), Ahamè (e)
19.23 Dec/Orl Mac/Bba 21.15 Dec, Mac/Orl
Plampoti (e)
Le
NRAS
Doug (m), Soulou (t) Assiviaton (e)
Stb Rt
Stroke paralysis Epilepsy Alzheimer disease, dementia
Tchacondo et al. (2012) NRAS
Kponkeke (e), Yambiong (m)
Rt
Epilepsy, memory loss, stroke
Cheikhyoussef et al. (2011)
Kpankéké(e) Péyati (e) Seniséniyo (t) Ditotorè (t)
Le Le Wp Rt
5.76 11.53 9.61 3.84
Dementia, epilepsy Paralysis, stroke Epilepsy Dementia, epilepsy, memory loss Alzheimer disease, dementia, epilepsy, stroke Paralysis, Parkinson disease Paralysis
NRAS Ojewole and Amabeoku (2006) NRAS Tchacondo et al. (2012)
Citrus maxima (Burm.) Merr. Combretum micranthum G. Don Crinum nubicum Hann. Diospyros mespiliformis Hochstex A. DC. Euphorbia hirta L. Gardenia ternifolia Schumach. & Thonn. Heliotropium indicum L. Lippia multiflora Moldenke
Boraginaceae Verbenaceae Fabaceae
Inf/Orl
Rubiaceae
Nauclea latifolia Sm.
Rubiaceae
Occimum canum Sims.
Lamiaceae
Oxytenanthera abyssinica Munro
Poaceae
Parkia biglobosa Br. ex G. Don Paullinia pinnata L.
Fabaceae Sapindaceae
Pergularia daemia (Forssk.) Chiov.
Asclepiadaceae
Pergularia extensa (Jacq.) N.E. Br. Persea americana Mill. Phyllantus amarus Schum. & Thonn. Pseudocedrela kotschyi Harms.
Asclepiadaceae Lauraceae Euphorbiaceae Meliaceae
9468FDS/UL 08181TG Clt/AK 02310TG Clt/AK CNE CNE 03349TG 04671TG
Rauwolfia vomitoria Afzel
Apocynaceae
02111TG
Dodemakpo (e)
Rtb
23.07 Dec, Mac/Orl
Rourea coccinea Benth. Saccharum officinarum L.
Connaraceae Poaceae
12607TG 11350TG
Tomegavi (e) Fonfoti (e)
Rt Le
11.53 Dec/Orl 5.76 Dec/Orl
5.76
Dec, Mac/Orl Mac/Bba 9.61 Dec/Orl 15.38 Dec, Mac/Orl 3.84 Dec/Orl Dec/Orl Dec/Orl Dec/Orl Dec/Orl
Tchacondo et al. (2012) and Konate et al. (2012) Tchacondo et al. (2012) Upadhyay (2014) NRAS NRAS Pultrini et al. (2006) Sheik et al. (2014) NRAS Refaat et al. (2013) NRAS
Sonibare et al. (2012)
Stafford et al. (2008)
Ekong et al. (2014) NRAS NRAS
217
Lonchocarpus cyanescens (Schum. & Thonn.) Benth. Morinda lucida Benth.
Ray et al. (2011) N’Gouemo et al. (1997)
Y.T. Kantati et al. / Journal of Ethnopharmacology 181 (2016) 214–220
Ayo (e, m, t, k) Yevounyigli (e)
Annonaceae
10856 02267TG Clt/AK 01883TG
218
Table 1 (continued ) Families
Voucher specimen number
Local name
Used part FC %
Securidaca longepedonculata Fresen.
Polygalaceae
06925TG
Rtb
Sterculia setigera Del. Stereospermum kunthianum Cham.
Sterculiaceae Bignoniaceae
08655TG 02467TG
Fozi (t, k), ipalg (m), tchritu (e) Natoufégligue (m) Nanelig (m), Sogbeliya (t)
Le Rt
Dec, Mac/Orl Mac/Bba 15.38 Dec/Orl 11.53 Dec/Orl
Tephrosia purpurea (L.) Pers. Tephrosia villosa L. Thevetia neriifolia Juss. ex A.DC. Uraria picta (Jacq.) Desv.
Fabaceae Fabaceae Apocynaceae Fabaceae
Domkpo (e) Domkpo (e) Prin prin (a) Somika (t), Vénaviwoda (e)
Wp Wp Le Wp
7.69 13.46 3.84 17.30
Dec/Orl Dec/Orl Dec/Orl Dec/Orl
Vitellaria paradoxa C.F.
Sapotaceae
06684TG 06692TG CNE 06714TG Clt/AK 08239TG
Se
21.15
Oint/Mas
Zanthoxylum zanthoxyloides Lam.
Rutaceae
Rtb
Zingiber officinale Roscoe
Zingiberaceae
Somou (t), Ayokoumiti (e) Sankpasang (m) Exeti (e), Polou (m), N'goné (k), Frou (t) Dotè (e)
25.00 Dec, Mac/Orl Sau/Orl 19.23 Dec, Mac/Orl
08061TG Clt/AK CNE
Rz
Mode of preparation/ administration
21.15
Type of CNS disorder
Previous citations
Dementia, epilepsy, memory loss, stroke paralysis Epilepsy Epilepsy, paralysis, traumatic brain injury Dementia, epilepsy, paralysis Stroke Epilepsy, memory loss Alzheimer disease, dementia
Stafford et al. (2008) and Adeyemi et al. (2010) Atakpama et al. (2012) Ching et al. ( 2009)
Epilepsy, dementia, paralysis, Parkinson disease stroke Memory loss, paralysis, traumatic brain injury
Tchacondo et al. (2012)
Asuntha et al. (2010) NRAS Nasir and Kabidul (2014) Garg et al. (2012) and Saxena et al. (2014) Paralysis, traumatic brain injury Tchacondo et al. (2012)
Khodaie and Sadeghpoor (2015)
Local names: a ¼ Akposso, e¼Ewe, k ¼Kabyè, m¼ Moba, t ¼ Tem. Used parts: Stb¼ stem barks, Le ¼leaves, Rtb ¼root barks, Fr ¼fruit, Wp ¼whole plants, Rt ¼roots, Rz¼ rhizomes, Bu ¼bulbs, Se ¼ seeds. Mode of preparation and administration routes: Dec/Orl¼ decoction and oral route, Mac/Orl¼ maceration and oral route, Dec, Mac/Orl¼ decoction or maceration and oral route, Mac/Bba ¼maceration and body bath, Sau/Orl¼ sauce and oral route, Jui/Orl¼ juice and oral route, Oint/Mas ¼ ointment/massage. Previous citations: NRAS ¼ no reported studies.
Fig. 3. Plant species distribution among families in Togo.
Fig. 4. Plants and their organs used in remedies.
2004; Case et al., 2005). It seems then very important to keep the memory of these ancestral knowledge, in order to preserve the potential of medicinal plants. In Togo, plant materials are directly sold in market places or transformed in several concoctions by traditional healers in their houses. The preponderance of men in the repartition of traditional actors found in this study, also reported by Tchacondo et al. (2012) in Central region of Togo, suggests that authentic ancient knowledge on the preparation of remedies has been essentially transmitted in families from generation to generation to men. Experience gain seems to be also important in the acquisition of these knowledge as shown by the average age of respondents. In addition, their illiteracy confirms the importance of oral traditions in the transmission of secrets on medicinal remedies across generations, without any writing system. The country is subdivided into five ecological zones, based on geoclimatic factors (Ern, 1979). Some of the species recorded during this survey such as Zanthoxylum zanthoxyloides and Securidaca longepedunculata are widespread throughout the five zones. In addition, Zanthoxylum zanthoxyloides widely used as chewing stick for tooth cleaning in west Africa (Kassim et al., 2005) and as a condiment in preparation of sauces. The inter-ethnic marriages, friendships and kinships between neighboring ethnic groups could
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Plant species
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favor knowledge exchange on some plants such as Rauwolfia vomitoria widely used in Asian and West African countries (Amole et al., 2009) and provide another explanation to these high frequencies of citation. The limited presence of species such as Cissus aralioides and Annona senegalensis in the composition of remedies may then be mostly related to their ecological repartition in the country. In these remedies for brain disorders leaves and roots are mostly used, as also found in the ethnobotanical studies conducted on antimalarial plants by Koudouvo et al. (2011) in Togo Maritime Region, Mesfin et al. (2013) in Northern Ethiopia Gemad District and Yetein et al. (2013) in Benin plateau of Allada. This observation is correlated with the conclusions of many studies that have highlighted the variations in concentration of secondary metabolites from plant to plant species as well as in the different parts of a plant, leaves and roots being the preferential sites of accumulation of these compounds (Hyder et al., 2002; Springer et al., 2002). But comparatively to leaves, utilization of root parts highly affects the survival and ecological aspect of the plant so urgent measures must be taken to protect these species. A controlled agriculture operation of the plants containing recognized active secondary metabolites could also contribute to the economic development of these regions. Secondary metabolites involved in neuroprotection are molecules often present in complex mixtures of active components such as isoprenoids, alkaloids, vitamins or non-enzymatic phenolic scavengers, which make it difficult to determine which component (s) of the herb(s) has biological activity (Adams et al., 2007; McClatchey et al., 2009; Iriti et al., 2010). However, it may be possible to identify some molecules of interest by focussing on their capacity to act on specific important mechanisms such as oxidative stress, which results from mitochondrial dysfunction and has been established to be involved in many neurodegenerative diseases (Kann and Kovacs, 2007). Indeed, although the brain accounts for less than 2% of the body weight, it consumes about 20% of the oxygen available through respiration. Therefore, because of its high oxygen demand, the brain is the most susceptible organ to oxidative damage (Halliewll, 1992; Floyd, 1999). In this regard, some plant extracts with antioxidant properties have already been reported to exhibit preventive or therapeutic neuroprotective effects in experimental models (Ray et al., 2011; Francik et al., 2014; Komolafe et al., 2014; Tsai et al., 2015; Kanno et al., 2015). In this regard, Allium sativum, one of the plants collected during this survey, exhibits potential neuroprotective properties against oxidative damages, by lowering β-amyloid peptide (Aβ) plaques and also preserving pre-synaptic proteins (synaptosomal associated protein of 25 kDa, SNAP25 and synaptophysin) both in cellular and animal models of Alzheimer disease (Ray et al., 2011). Although being very important, antioxidant mechanisms are not the only in the protection of central nervous system. More precisely among the other mechanisms, GABAergic neurotransmission, emphasized by the widespread use of antiepileptic drugs targeting postsynaptic GABA receptors is studied as a potential therapeutic target in neuroprotection (DeFazio et al., 2009). The review of Asif (2013) showed interestingly that ethanolic extracts of Citrus maxima leaves, Nauclea latifolia root bark, Paulinia pinnata stem bark and Stereospermum kunthianum root bark, four plants species recorded during this survey, exhibit dose dependent anticonvulsant effects in both maximal electro shock (MES) and pentylenetetrazol (PTZ) seizure models. The latex proteins of another plant recorded in the present survey, Calotropis procera, showed anticonvulsant and sedative properties in mouse models of PTZ-induced seizure in the study of Lima et al. (2012). These observations provide some scientific evidences for the use of the local flora in the folk medicine of Togo to treat CNS diseases.
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5. Conclusion Traditional medicinal knowledge still provides tools to pharmacological research in many fields. In Togo, there was a lack in data on medicinal plants used for CNS diseases management. Our study, the first report in this field, showed that real knowledge on medicinal plants used in the treatment of these diseases existed in the area. The local flora abounds of potentially neuroactive and neuroprotective plants that could be useful for further neuropharmacological studies, neuroprotective and CNS drugs discovery, in accordance with ecological imperatives.
Acknowledgments The authors thank the traditional healers and medicinal plants sellers for sharing their precious knowledge on medicinal plants used to heal CNS diseases. Especially, we thank the coordinator and all traditional healers of the non-governmental organization CERMETRA-RC. We are also grateful to the staff members of the Togo Herbarium, for their assistance in voucher specimen's identification.
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