Dr. Ali Ahmadi: Drug interactions of some herbal medicinal products are not clear

Dr. Atousa Ali Ahmadi said in an interview with Public Relations Office of Shahid Beheshti University (SBU): “The drug interactions of some herbal medicinal products used in the society are not clear and this can be dangerous.”

Dr. Ali Ahmadi is an assistant professor at the Department of Biology in the Medicinal Plants and Drugs Research Institute at SBU. She has been working in the research institute since she was a student, and has published many important research articles. Here is part of our interview with her:

•    Please explain about the activities of the research institute. What is the special work of the research institute? What areas do its different departments focus on?

In our research institute, we have four educational and research departments. Two departments, namely phytochemistry and agriculture, admit students in addition to research work, and the other two departments, namely biology and chemical engineering, only involve in research activities. The phytochemistry department offers two programs of phytochemistry and medicinal chemistry in the master's and PhD levels, and the agriculture department only admits students in the master's level.
In the phytochemistry department, the activities extend from the isolation and identification of effective medicinal compounds that may be known or unknown, to the synthesis or semi-synthesis of compounds that can be used medicinally. Among the great works performed with the cooperation of different departments, we can refer to the identification of Taxol and Taxotere, a kind of formulation of Taxol. In the phytochemistry department, apart from the semi-synthesis of compounds that can be used medicinally, plant compounds that are or can be medicinally effective are identified, and valuable researches have been conducted on nanoparticles. Also, various formulations based on natural compounds such as some essences and heavy metals, and drug delivery systems including encapsulation have been researched mainly in the chemical engineering and phytochemistry departments. Thanks to the efforts of all faculty members of the institute, especially Dr. Ghasempour, our research institute has the honor of being one of the few research centers in the country that enjoys the required equipment and expertise, especially in the fields of small molecules, proteins and peptides. In terms of Mass Spectrometry knowledge and equipment, it can be said that the Medicinal Plants and Drugs Research Institute is unique in the country. With the supervision of Dr. Samad Nejad Ebrahimi, valuable researches in the field of molecular modeling and computational drug design have been conducted and are being conducted in the institute. The goals of these researches are to achieve new structures and compounds and help to reduce the costs of experiments. Isolation and identification of chemical compounds in various plants is performed by different professors, mainly with the supervision of Dr. Mahdi Moridi Farimani.
In the agriculture department, we also have master's degree students, and the faculty members of the department work on various topics from the biotechnology of medicinal plants to the localization of medicinal plants that are not native to Iran or are not native to a certain region in Iran. It is very important to localize these plants and cultivate them on a large scale. The study of the physiology of medicinal plants and the creation and optimization of medicinal plants cell culture, which leads to higher yields, are among other activities that are carried out in the department, mainly under the supervision of Dr. Mohammad Hossein Mirjalili. The analysis of essences that can be obtained from populations of plant species in different parts of Iran is also very important and is still being pursued. In this way, it is possible to find, in an area of Iran, a variety of a certain plant species that has a higher effectiveness, and this information can be used to produce essences commercially. Another valuable work in this department, which is being done under the supervision of Dr. Mohsen Farzaneh, is the biological control of plant pests and fungal toxins.
In the biology department, researches are mainly carried out in three areas. One area is the identification of medicinal plants, which is being performed with the efforts of Dr. Ali Sonboli and Dr. Mohammad Reza Kanani. The research institute has an herbarium of medicinal plants, which is internationally registered and is well-known in the region and the world. If a plant is not identified well from the beginning, all the subsequent research will be called into question, and that is why this important issue has been addressed in the research institute. Bioassays are the second most important part of research in this department, which fall into two main categories: the assays that are carried out under my supervision in the field of antimicrobial substances and the investigation of substances in terms of their anticancer properties, which is carried out under the supervision of Dr. Hossein Behboudi. Of course, it should be noted that research on diseases such as Alzheimer's has been carried out for a long time in the research institute, especially in the biology department, using animal cell models, and I hope we can resume this activity.
In the chemical engineering department, the formulation of effective pharmaceutical compounds, which is very important in drug delivery, is researched under the supervision of Dr. Hassan Raf’ati. If a substance has a medicinal effect, it must be delivered to the target point in the body and its biological provision must be done well. In particular, detailed research has been carried out on different medicinal compounds and some natural compounds such as essences that can have antibacterial effects.

•    The question of many non-specialists is whether there is a preference between drugs of herbal and chemical origin? There is a belief among the common people that chemical medicines should not be used as much as possible and herbal medicines should be used instead, but sometimes these compounds may not be used with awareness and knowledge or they may not have the necessary effectiveness. Please provide explanations in this regard.

Some available drugs are only synthesized using chemical processes and may have problems in the manufacturing process. Sometimes the synthesis of a drug is more difficult than its isolation from a natural source such as a plant. In the discussion of chirality, for example, a certain substance exists in two different forms, and only one form of it is supposed to have the desired medicinal effect. Sometimes even the different shape of the molecule causes problems (such as thalidomide). In chemical processes, it may be very difficult to extract that particular form, whereas the same expected compound is produced in high purity, perhaps even in complete purity, in bacteria, plants, fungi and even animal models. So, apart from what opinion and desire the society has, the production of synthetic drugs is not necessarily easier than other drugs. Another issue in the discussion of herbal medicines is that it is necessary to be careful whether we are referring to the use of herbal distillates and decoctions and the like, or to, for example, aspirin obtained from plants. In your question, you probably mean the herbal medicine that is common among the people, i.e., the first category. If you mean this, the point is that drug interactions can occur with any product, just as they are mentioned in drug brochures (both herbal and synthetic). Unfortunately, nowadays in the traditional medicine available at the community level (not what exists in specialized faculties), it is not clear with what scientific and technical support people without expertise prepare and sell capsules and pills. Both at this level and at the level of buying herbal distillates from Apothecaries, it should be known that drug interactions may exist. In the case of chemical drugs, since we deal with pure substances, the substances have been fully investigated and their information is available in the relevant brochure, and we know that, for example, this medicine increases blood sugar by acting on blood sugar medicine. Sometimes these interactions may even cause death. In this way, we avoid these possible problems. In the products that exist at the community level, the state of interactions is not clear and especially in the case of people who are elderly or use certain drugs for medical reasons, the use of any combination in this way, if not with a doctor's prescription, can be dangerous. On the other hand, it should be noted that capsules, tablets and syrups that are produced and prescribed by unauthorized people usually do not have a chemical quality control certificate or a microbial quality control certificate. A few years ago, one of these people came to the research institute to get the necessary certificates for his "medicines" to submit them to the Food and Drug Organization. After conducting preliminary tests on 5 out of 75 types of products that he was prescribing, he stopped conducting the tests at the research institute, because the microbial contamination of the tablets was so high that there was no need for chemical tests! On another level, when you go to an apothecary to buy a medicinal plant, the possibility of fraud is very high; fraud or optimistically, a mistake in the identity of the plant offered!

•    So, can we conclude that using these herbal products as medicines not as supplements without knowledge can have dangerous side effects?

Yes, that's right. Unfortunately, these materials are not used solely as supplements. Sometimes I have seen and heard that, for example, a person who has diabetes and takes medicine, does not consider his medical care to be complete, and just with the idea that herbal products are harmless because they are plants, he consumes all kinds of completely basic, unprocessed products. The point is that only part of the problem is drug interactions. Another important issue is that the durability of the active ingredients in these plants is very important. Commercial drugs sold in pharmacies obviously have a longer shelf life. Necessary tests are performed on these drugs and their expiration dates are known. When a person buys a raw product from an apothecary, whose expiration date is not known, nor its compounds and microbial contamination, he takes a big risk. Even more importantly, there may have been the possibility of frauds. There is a broad discussion on frauds regarding herbal distillates. One case that I have personally come across is rose water, which, apart from cooking, can even be used for cosmetics and hygiene. If I say this, you might not go for herbal distillates anymore (laughing), at least the ones produced by unknown people, no… even reputable companies! A few years ago, my colleagues and I worked on a project, in which we randomly prepared several types of distillates available in the market and checked them in terms of effective compounds and microbial quality. I'm sorry to say this, but the result was awful. For example, the rose water, which women may use as a cosmetic-hygiene product on their facial skin, were full of skin disease-causing bacteria. In the chemical analysis of effective compounds, we also noticed that many compounds are either fake or have very low purity. We also had a sample that was excellent in terms of microbial contamination, but I do not recommend using such a product in any way, because it was full of preservatives or maybe antibiotics! So, the issue of fraud is very important here. Another issue is that these materials are not stable at all. Of course, there are many topics in this regard and I have shared with you only a few of them.