A recent study published in PLOS genetics on a genetic audit of Traditional Chinese Medicines (TCMs) was widely covered in the news. The headlines are a bit confusing as they said different things. Some headlines say “Dangers of Chinese Medicine Brought to Light by DNA Studies“, others that Bear and Antelope DNA are Found in Traditional Chinese Medicine, and still others more neutrally: Breaking down traditional Chinese medicine.
What have Bunce and his group really done and what is the newsworthiness of this article?
The researchers from the the Murdoch University, Australia, have applied Second Generation, high-throughput sequencing to identify the plant and animal composition of 28 TCM samples (see Fig.). These TCM samples had been seized by Australian Customs and Border Protection Service at airports and seaports across Australia, because they contravened Australia’s international wildlife trade laws (Part 13A EPBC Act 1999).
Using primers specific for the plastid trnL gene (plants) and the mitochondrial 16S ribosomal RNA (animals), DNA of sufficient quality was obtained from 15 of the 28 (54%) TCM samples. The resultant 49,000 amplicons (amplified sequences) were analyzed by high-throughput sequencing and compared to reference databases.
Due to better GenBank coverage, the analysis of vertebrate DNA was simpler and less ambiguous than the analysis of the plant origins.
Four TCM samples – Saiga Antelope Horn powder, Bear Bile powder, powder in box with bear outline and Chu Pak Hou Tsao San powder were found to contain DNA from known CITES- (Convention on International Trade in Endangered Species) listed species. This is no real surprise, as the packages were labeled as such.
On the other hand some TCM samples, like the “100% pure” Saiga Antilope powder, were “diluted” with DNA from bovids (i.e. goats and sheep), deer and/or toads. In 78% of the samples, animal DNA was identified that had not been clearly labeled as such on the packaging.
In total 68 different plant families were detected in the medicines. Some of the TCMs contained plants of potentially toxic genera like Ephedra and Asarum. Ephedra contains the sympathomimetic ephedrine, which has led to many, sometimes fatal, intoxications, also in Western countries. It should be noted however, that pharmacological activity cannot be demonstrated by DNA-analysis. Similarly, certain species of Asarum (wild ginger) contain the nephrotoxic and carcinogenic aristolochic acid, but it would require further testing to establish the presence of aristolochia acid in the samples positive for Asarum. Plant DNA assigned to other potentially toxic, allergic (nuts, soy) and/or subject to CITES regulation were also recovered. Again, other gene regions would need to be targeted, to reveal the exact species involved.
Most newspapers emphasized that the study has brought to light “the dangers of TCM”
For this reason The Telegraph interviewed an expert in the field, Edzard Ernst, Professor of Complementary Medicine at the University of Exeter. Ernst:
“The risks of Chinese herbal medicine are numerous: firstly, the herbs themselves can be toxic; secondly, they might interact with prescription drugs; thirdly, they are often contaminated with heavy metals; fourthly, they are frequently adulterated with prescription drugs; fifthly, the practitioners are often not well trained, make unsubstantiated claims and give irresponsible, dangerous advice to their patients.”
Ernst is right about the risks. However, these adverse effects of TCM have long been known. Fifteen years ago I happened to have written a bibliography about “adverse effects of herbal medicines*” (in Dutch, a good book on this topic is ). I did exclude interactions with prescription drugs, contamination with heavy metals and adulteration with prescription drugs, because the events (publications in PubMed and EMBASE) were to numerous(!). Toxic Chinese herbs mostly caused acute toxicity by aconitine, anticholinergic (datura, atropa) and podophyllotoxin intoxications. In Belgium 80 young women got nephropathy (kidney problems) after attending a ”slimming” clinic because of mixup of Stephania (chinese: fangji) with Aristolochia fanghi (which contains the toxic aristolochic acid). Some of the women later developed urinary tract cancer.
In other words, toxic side effects of herbs including chinese herbs are long known. And the same is true for the presence of (traces of) endangered species in TCM.
In a media release the complementary health council (CHC) of Australia emphasized that the 15 TCM products featured in this study were rogue products seized by Customs as they were found to contain prohibited and undeclared ingredients. The CHC emphasizes the proficiency of rigorous regulatory regime around complementary medicines, i.e. all ingredients used in listed products must be on the permitted list of ingredients. However, Australian regulations do not apply to products purchased online from overseas.
Thus if the findings are not new and (perhaps) not applicable to most legal TCM, then what is the value of this paper?
The new aspect is the high throughput DNA sequencing approach, which allows determination of a larger number of animal and plant taxa than would have been possible through morphological and/or biochemical means. Various TCM-samples are suitable: powders, tablets, capsules, flakes and herbal teas.
There are also some limitations:
- DNA of sufficient quality could only be obtained from appr. half of the samples.
- Plants sequences could often not be resolved beyond the family level. Therefore it could often not be established whether an endangered of toxic species was really present (or an innocent family member).
- Only DNA sequences can be determined, not pharmacological activity.
- The method is at best semi-quantitative.
- Only plant and animal ingredients are determined, not contaminating heavy metals or prescription drugs.
In the future, species assignment (2) can be improved with the development of better reference databases involving multiple genes and (3) can be solved by combining genetic (sequencing) and metabolomic (for compound detection) approaches. According to the authors this may be a cost-effective way to audit TCM products.
Non-technical approaches may be equally important: like convincing consumers not to use medicines containing animal traces (not to speak of endangered species), not to order TCM online and to avoid the use of complex, uncontrolled TCM-mixes.
Furthermore, there should be more info on what works and what doesn’t.
*including but not limited to TCM
- Coghlan ML, Haile J, Houston J, Murray DC, White NE, Moolhuijzen P, Bellgard MI, & Bunce M (2012). Deep Sequencing of Plant and Animal DNA Contained within Traditional Chinese Medicines Reveals Legality Issues and Health Safety Concerns. PLoS genetics, 8 (4) PMID: 22511890 (Free Full Text)
- Adverse Effects of Herbal Drugs 2 P. A. G. M. De Smet K. Keller R. Hansel R. F. Chandler, Paperback. Springer 1993-01-15. ISBN 0387558004 / 0-387-55800-4 EAN 9780387558004
- DNA may weed out toxic Chinese medicine (abc.net.au)
- Bedreigde beren in potje Lucas Brouwers, NRC Wetenschap 14 april 2012, bl 3 [Dutch]
- Dangers in herbal medicine (continued) – DNA sequencing to hunt illegal ingredients (somethingaboutscience.wordpress.com)
- Breaking down traditional Chinese medicine. (green.blogs.nytimes.com)
- Dangers of Chinese Medicine Brought to Light by DNA Studies (news.sciencemag.org)
- Chinese herbal medicines contained toxic mix (cbc.ca)
- Screen uncovers hidden ingredients of Chinese medicine (Nature News)
- Media release: CHC emphasises proficiency of rigorous regulatory regime around complementary medicines (http://www.chc.org.au/)