title: Local uses of Aristolochia species and content of nephrotoxic aristolochic acid 1 and 2--a global assessment based on bibliographic sources.
abstract: OBJECTIVE
  More than 100 cases of nephropathy over the last 10 years caused by the systemic and longer term application of Chinese snakeroot (Aristolochia fangchi) highlighted the risk of using preparations which contain aristolochic acids. On the other hand anecdotal evidence highlights the widespread use of Aristolochia species (Aristolochiaceae) in many regions of the world. Therefore, it was our objective to systematically assess the scientific literature available on the local and traditional use of Aristolochia spp. on a worldwide scale. Our review identifies core species which need to be investigated and which may need monitoring (esp. in national and international trade).
  
  
  METHODS
  An extensive review of the literature available in libraries in London on the uses of species of Aristolochia was undertaken. Relevant information was extracted and entered into a database for analysis.
  
  
  RESULTS
  Based on the assessment of 566 reference sources 685 individual sets of data were recorded. Seven species--Aristolochia indica L. (Asia), Aristolochia serpentaria L. (North America), Aristolochia debilis Sieb & Zucch. (China), Aristolochia acuminata Lam (India), Aristolochia trilobata L. (Central/South America, Caribbean), Aristolochia clematitis L. (Europe) and Aristolochia bracteolata Lam. (Africa)--are reported widely as being used medicinally. The medical uses vary, but of particular interest are uses in case of gastrointestinal problems, which is likely to result in repeated exposure to the botanical drugs by an individual. About half of all records relate to uses of Aristolochia species in Asia, one-third to the Americas, a continent which has so far received practically no attention in terms of assessing the risk of using species of Aristolochia. Of the 99 species (plus several identified at genus level only) for which we were able to summarise ethnobotanical information, preliminary phytochemical information is only available for 24 species and some of the most common ones including Aristolochia acuminata have so far not been studied phytochemically.
  
  
  CONCLUSIONS
  Species of Aristolochia are used medicinally in many regions of the world and both from an ethnopharmacological and a public health perspective this poses a risk. A systematic assessment of the content of aristolochic acids in the most widely used species is needed to evaluate whether their uses pose a potential health risk. In China and Europe species of Aristolochia have been associated with nephropathy and it is important to evaluate whether nephropathy occurs in other parts of the world, especially India and Central America where the use of species of Aristolochia are reported to be commonly used in traditional medicine.
authors.affiliation: Centre for Pharmacognosy and Phytotherapy, The School of Pharmacy, University London, 29-39 Brunswick Square, London WC1N1AX, UK. michael.heinrich@pharmacy.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Heinrich
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chan
authors.forename: Stefan
authors.initials: S
authors.lastname: Wanke
authors.forename: Christoph
authors.initials: C
authors.lastname: Neinhuis
authors.forename: Monique S J
authors.initials: MS
authors.lastname: Simmonds
mesh_terms: D000818:Animals; D030022:Aristolochia / Q000737:chemistry*; D034341:Aristolochic Acids / Q000494:pharmacology*; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D013045:Species Specificity
chemical_list: D034341:Aristolochic Acids; C000228:aristolochic acid I; C042310:aristolochic acid II