Issue: 70 Page: 58-60
Tamiflu and Star Anise: Securing Adequate Supplies of the Oral Antiviral for Avian Flu Treatment
by Dennis V.C. Awang, Mark Blumenthal
HerbalGram. 2006; 70:58-60 American Botanical Council
Tamiflu and Star Anise: Securing Adequate Supplies of the Oral Antiviral for Avian Flu Treatment
by Dennis V.C. Awang, PhD,
FCIC, and Mark Blumenthal
The incipient concern over an impending bird flu pandemic
has fueled an almost desperate effort to secure supplies of the most promising
oral antiviral against avian flu to date—Tamiflu® (oseltamivir). During last
year’s influenza season, approximately 1.7 million prescriptions were written
for oseltamivir in the United States, and according to the manufacturer, nearly
twice as much of the drug was produced for this year’s season.1
Tamiflu is part of a new class of medicines called
neuraminidase inhibitors. The surface of an influenza virus contains
neuraminidase proteins that enable new virus particles to bud on the surface of
the host cell. The neuraminidase enzyme breaks the bonds that hold these new
virus particles to the outside of an infected cell, setting them free to infect
other cells and spread infection. Neuraminidase inhibitors block the enzyme’s
activity and prevent new virus particles from being released, thereby limiting
the spread of infection.2
The current sole manufacturer of Tamiflu, the Swiss-based
Roche Pharmaceuticals, had previously suspended public sales of the drug in the
wake of a widespread assault on pharmacy supplies. The company’s action is
claimed justified on the basis of preserving supplies of the drug for
governmental agencies and institutions caring for the most vulnerable patients.
In the meantime, efforts are increasing to develop more efficient,
cost-effective synthetic approaches to the drug.
In addition to announcing that it would increase its own
production of Tamiflu, in December Roche stated that it would cooperate with a
group of companies to produce higher quantities of the drug to meet increasing
world demand.3
Currently the most satisfactory commercial route to the
production of Tamiflu is based on extraction of shikimic acid from the fruits
of Chinese star anise (Illicium verum
Hook f., lliciaceae; bajiao in
Mandarin). However, this plant, a small tree up to 10 meters tall, is
notoriously difficult to cultivate and also matures at a very slow rate,
flowering only after 6 years.4 Roche so far has commanded roughly 90%
of the world’s supply of Chinese star anise, which is grown only in 4 Chinese
provinces. Alarmingly, almost all of this year’s star anise crop has been
reportedly destroyed by a series of mudslides produced by unseasonably severe
tropical storms.5
Because the star anise connection as a starting material for
the production of Tamiflu has some potential media value—i.e., the drug is
based on a chemical derived from a traditional spice and medicinal
plant—numerous articles have appeared in the mainstream media focusing on star
anise and its relative scarcity in relation to the mushrooming demand for
Tamiflu.3,6 A report in the China Daily states that the price of star anise had almost
doubled in one week in November. In Guangxi province, the price rose from 5
yuan (US $0.60) per kilogram to 8.2 yuan (US $1.00) per kilo, according to a
wholesaler in Wuzhou, who reportedly had taken stock of 60 tons of the fruit,
even before Roche had purchased available stocks.7 The New
York Times reported in November that the
cost of shikimic acid in China rose from $40 to over $400 per kilo.3
Shikimic acid is also a constituent of the toxic fruit of
Japanese, or bastard, star anise, also called sacred anise (I. anisatum L.). This species, termed shikimi-no-ki in Japanese, is cultivated near Buddhist temples and
used in religious ceremonies, such as branches for decorating graves.4,8
The relative abundance of shikimic acid in the fruits of I. anisatum and I. verum, and any significant differences in ease of extraction, are not evident
in the available literature. However, concern has been expressed regarding the
adulteration of Chinese star anise with Japanese star anise, due to the
documented neurologic and gastrointestinal toxicities of purported Chinese star
anise tea administered to infants.9,10 A rapid and efficient method
for detecting I anisatum in I.
verum powder has been recently published.11
The procedure involves a combination of microscopy (fluorescence and scanning
electron) and gas chromatography, which easily detects the presence of eugenol,
methoxyeugenol, and 2,6-dimethoxy-4-allyphenol, compounds not present in I.
verum. However, the distinction between
these two species of Illicium is
of concern primarily for the purpose of ensuring the purity of Chinese star anise
for food use (e.g., herbal teas). For the production of shikimic acid suitable
for synthetic production of oseltamivir, this distinction does not appear to be
of significance as only the shikimic acid is isolated and purified for further
chemical elaboration into oseltamivir.
Considerable interest has been expressed by reporters in the
mistaken and dangerous belief that drinking star anise extracts can be an
effective treatment for the avian flu (N.R. Farnsworth oral
communication to D.V.C. Awang, November 4, 2005). However, neither such
extracts nor shikimic acid itself and its metabolites have been demonstrated to
have such efficacy. Expressing concerns about the misuse of star anise as an
herbal preventive or treatment for avian flu, a coalition of herb and dietary
supplement industry trade associations have stated categorically that such
activity is not only not recommended but is strongly discouraged.12
Due to the initially high cost ($50 per gram) of research
quantities of shikimic acid, Roche contracted with Michigan State University
(MSU) scientist J. W. Frost to develop a fermentation process for production of
(-)-shikimic acid. Frost discovered a strain of E. coli that overproduces the acid when fed glucose, which
eventually led to bacterial growth on a commercial scale. Roche now obtains
large quantities (measured in tons) of shikimic acid both by fermentation and
star anise fruit extraction, but isolation and purification are time-consuming.13
The current semi-synthetic manufacture of Tamiflu from
shikimic acid is a complex, time-consuming, 10-step process, involving
potentially explosive azide chemistry. Roche claims that from raw material
sourcing to production of Tamiflu capsules takes a complete year. Shikimic acid
is first converted to a diethyl ketal intermediate, which is then reduced in 2
steps to an epoxide that is finally transformed to Tamiflu in 5 subsequent
steps, 3 of which involve highly toxic explosive azide intermediates.13
Despite this apparent complexity, it was reported in the November 3rd edition
of the Wall Street Journal Asia14
that Roche’s claim as to the difficulty of producing Tamiflu is greatly
exaggerated. Rather than the claimed full year required for synthesis from
shikimic acid, Taiwan’s National Health Research Institutes claims to have
produced a small quantity of the antiviral in 18 days! Also, Cipla Ltd., an
Indian generic drug manufacturer, claims to have been successful in a pilot
phase production of the drug.14 However, these relatively
small-scale productions can be expected to be much less time-consuming than
large-scale manufacture under good manufacturing practices (GMPs).
Roche and MSU scientist Frost have explored chemical and
microbial means to obviate azide intermediates: an azide-free allylamine route
from epoxide to Tamiflu and microbial production of aminoshikimic acid as a
starting material were developed. Also, two other routes that do not involve
shikimic acid have been explored. However, so far, no alternative has been
found to surpass the shikimic acid-azide commercial route in terms of cost and
efficiency.13
Perhaps future chemical synthetic innovation and/or a
lower-cost, more productive source of shikimic acid will satisfy the urgent
demand for increased supplies of Tamiflu. In the meantime, doctors have
discovered that teaming Tamiflu with a low-cost generic drug used in World War
II to extend scarce supplies of penicillin, doubles the antiviral’s
effectiveness: the “helper” drug probenecid reduces Tamiflu excretion in urine,
thereby elevating blood levels roughly twofold.15
Recently, the Canadian generic drug manufacturer Biolyse
Pharma Corp., which specializes in extracting chemicals from plants at its
plant in St. Catharines, Ont., revealed plans to extract shikimic acid from
Christmas trees.16 Extractable shikimic acid, reportedly constitutes
2 to 3% of the biomass from various pine spruce, and fir trees. The shikimic
acid from this source will be considerably cheaper than its current price,
which has soared to more than $500 (US) a kilogram from $45 over the past year
due to shortages of Tamiflu and skyrocketing demand.
The question then arises as to how much Tamiflu can be
produced from the scarce shikimic acid supplies. The New York Times article cites an unnamed Roche chemist who said that
13 grams of star anise could produce 1.3 grams of shikimic acid, which then
could be used to make 10 Tamiflu capsules, the amount required to treat one
person. Thus, one ton of shikimic acid could treat 770,000 people. However, the
Times article also cites another
expert, Y.K. Hamied, PhD, a chemist and Chairman of Cipla, who says that the
figure was more realistically about 300,000 as newcomers to the Tamiflu
production business would probably not be able to enjoy the production
efficiencies currently attained by Roche. Other potential sources of shikimic
acid reportedly considered by Gilead Sciences Inc. of Foster City, California,
are cinchona bark (Cinchona spp.,
Rubiaceae, source of quinic acid, a precursor of shikimic acid), ginkgo trees (Ginkgo
biloba L., Ginkgoaceae), and the needles of
giant sequoias (Sequoiadendron giganteum [Lindl.] J. Buchholz, Cupressaceae).3
Dennis V. C. Awang, PhD, FCIC, is president of MediPlant
Consulting, Inc., White Rock, BC, Canada, a natural products consulting group.
Before retiring after 24 years at Health Canada, he was the Head of the Natural
Products Section in the Bureau of Drug Research at the Canadian Health
Protection Branch. He is currently revising the classic Herbs of Choice: The Therapeutic Use of Phytomedicinals
(Haworth Press), initially authored by the late Professor Varro E.
Tyler.
Mark Blumenthal is founder and executive Director of the
American Botanical Council and Editor of HerbalGram.
References
1. Hayden
FG. Antiviral resistance in influenza viruses — Implications for management and
pandemic response. New Engl J Med. February
23, 2006;354:785-788.
2. Woods
JM, Bethell RC, Coates JA, et al. 4-guanidino-2, 4-dideoxy-2,
3-dehydro-N-acetylneuraminic acid is a highly effective inhibitor both of the
sialidase (neuraminidase) and of growth of a wide range of influenza A and B
viruses in vitro. Antimicrob Agents Chemother. 1993;37(7):1473-1479.
3. Pollack
A. Is bird flu drug really so vexing? Debating the difficulty of Tamiflu. New
York Times, November 5, 2005. Available at:
http://www.nytimes.com/2005/11/05/business/05tamiflu.html?ei=5070&en=e0d5349d5f7dd5ae&ex=1136350800&pagewanted=all.
4. Small
E. Confusion of common names for toxic and edible “star anise” (Illicium) species. Econ Bot. 1996;50(3):337-339.
5. Slow-growing
star anise wiped out by mudslides. Vancouver Sun. October 27, 2005.
6. Goodman
PS. Star Rises in Fight Against Bird Flu. Washington Post. November 18, 2005.
7. Wang
ZQ. Star anise soars to surprise fame. China Daily. November 2, 2005.
8. Hocking
GM. A Dictionary of Natural Products.
Medford, NJ: Plexus Publishing, Inc.; 1997:391.
9. Ize-Ludlow
D, Ragone S, Bernstein JN, Bruck IS, Duchowny M, Garcia Pena BM. Chemical
composition of Chinese star anise (Illicium verum) and neurotoxicity in infants. JAMA. 2004;291(5);562-563.
10. Ize-Ludlow
D, Ragone S, Bruck I, Bernstein J, Duchowny M, Garcia Peña B. Neurotoxicities
in Infants Seen With the Consumption of Star Anise Tea. Pediatrics. October
18, 2004; 114;653-656. Available at:
http://www.pediatrics.org/cgi/content/full/114/5/e653.
11. Jashi
VC, Srinivas PV, Khan IA. Rapid and easy identification of Illicum verum Hook. f. and its adulterant Illicium
anisatum Linn. by fluorescent microscopy
and gas chromatography. J AOAC Int.
2005;88(3):703-706.
12. Industry
Coalition Advises Against Use of Dietary Supplements as Remedy for Avian Flu
[press release]. American Herbal Products Association, Consumer Healthcare
Products Association, Council for Responsible Nutrition, National Nutritional
Foods Association, November 18, 2005.
13. Yarnell
A. Complexity of Tamiflu manufacturing may hamper on demand production. Chem
& Eng News. 2005; 83(35): 22-23.
14. Zamiska
N, Dean J. Generics Challenge Roche’s Tamiflu Claims. Wall Street Journal. November 3, 2005.
15. Spears
T. Generic ‘helper drug’ can stretch Tamiflu ingredient. National Post (Canada), November 2, 2005.
16. Zehr L. Christmas trees to provide key Tamiflu ingredient. The
Globe and Mail (Toronto); December 2005:B3,
23.
Sidebar:
The Fermented Cabbage Connection
Recent Korean research has found that a culture filtrate of
the bacterium Leuconostoc kimchi
(prepared from the Korean spiced fermented cabbage dish kimchi), when administered to chickens infected with the
bird flu virus, led to recovery of 11 of 13 birds. However, while surging sales
of kimchi across Asia suggest that consumers believe that it may protect them
against bird flu, the bacterial preparation has not yet been tested on bird flu
in humans, even though it has shown a “very potent effect” against human flu in
vitro.1
Europeans claim that the Korean process for kimchi
production is exactly the same as that for the popular European fermented
cabbage dish sauerkraut, but the Korean researchers have stated that their
research cannot be used to demonstrate similar benefits for sauerkraut,
stressing that the antiviral effect of the bacterial product is
“strain-specific.”1
Reference
1. Patton
D. Cabbage dish gaining popularity as flu-fighter. November 16, 2005. Available
at:
http://www.nutraingredients.com/news/ng.asp?n=63932-kimchi-sauerkraut-bird-flu.
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