By Dr. Colin Michie FRCPCH University of Central Lancashire.
The local herbalist Ropafadzo was known to use flame lilies. As children hiding in a banana tree on afternoons, we had watched her pulling them up – roots and all – when she collected her firewood. Early in the rainy season, local folk would collect these brilliant red and yellow flowers when going to visit her, although they were always scolded by her for doing so. It was rumoured she used flame lilies in her renowned treatments for hip pains. As children, we assumed she rode a hyena at full moon and had a few bats as friends. However, Ropafadzo did not match many of our childhood images of a true sorceress. She had a large welcoming bench with cushions under a tree outside her home for visitors; she always had many of these.
The flame lily, Gloriosa superba, is found in much of Africa, India and Australia. Its roots (and not those amazing flowers) are a store of several unusual compounds, including one named colchicine. Herbalists in these regions have traditionally used it to treat pain and arthritic problems. This same compound, an alkaloid, may be found in the roots of the meadow saffron or autumn crocus (Colchicum autumnale) that grows in the Black Sea countries (the land of Colchis). It is also known as the autumn crocus.
Preparations of both these plants have been used for thousands of years; their toxicity as well as their benefits have been known. By the sixth century, their value in treating joint problems was established in Greek therapies, more recently it was used by physicians to treat gout, a disease that causes sudden excruciating joint pain, usually in the big toe. Benjamin Franklin introduced this crocus plant to the US to help make a medication that might help manage his own gout.
Mysteries grew around colchicine when it was found the compound could help with plant breeding. It was used to develop watermelons without seeds, and improve flowers – some decorative plants such as snapdragons were made more spectacular and reliable by adding colchicine to the seeds. At the same time, it was observed that colchicine could stop certain inflammatory immune cells dividing. This power is based on its ability to stop these cells building micro-tubular structures within themselves. Microtubules are required for the processes of cell division; they are also needed to allow cells to move out of the circulation and cause inflammation within the blood vessels, or tissues such as the lining of joints. Colchicine therefore has a potential to become a useful treatment for several disorders.
Because it is toxic in large doses, colchicine has never been an over-the-counter medication. For the inflammation of a muscle ache or joint sprain, treatments such as aspirin or non-steroidal anti-inflammatories are sufficient and safe. They reduce pain by blocking chemical cascades. In painful conditions that last for some time, steroids can have great value: they alleviate suffering by reducing the level of inflammation produced within tissues by immune cells. However, in order to reduce long-term inflammation, colchicine has several advantages. This has attracted the attention of cardiologists. They found that in those patients using colchicine for gout, there was a reduction in atheromatous problems in their coronary arteries. There were fewer heart attacks than expected.
Atheroma is a collection of cholesterol, calcium and other products that builds up in the walls of arteries. This process begins in most of us in early adulthood, making arteries initially less elastic. With time, atheroma can result in narrowing of blood vessels. In coronary arteries, this leads to angina. Plaques of atheroma can rupture, causing heart attacks or strokes. So avoiding and reducing atheroma is a valuable goal. Treatments that achieve this might reduce the need for stents or carotid surgery which are directed at making safe arteries already threatened by atheroma.
In the early stages of atheroma, one can find evidence of inflammation with cells moving into the arterial walls from the circulation. The inflammatory changes damage the smooth lining of arteries, initiating the atheromatous plaques. Colchicine reduces many problems related to atheroma in the arteries of the heart, reducing strokes too. The uses for colchicine are expanding – no new risks have been found. Colchicine is approved as a second-line preventative treatment in patients with coronary disease.
It is highly likely colchicine will be used more in the future because of its unique properties. It may be useful to many of us as we age, helping keep our arteries youthful and elastic. Ropafadzo could not have known of these insights. But this cure of nature was understood by herbalists like her, on several continents, who over centuries have balanced the risks of using a potential poison to bring healing to others.
Dr. Colin Michie is currently the Associate Dean for Research and Knowledge Exchange at the School of Medicine in the University of Central Lancashire. He specializes in paediatrics, nutrition, and immunology. Michie has worked in the UK, southern Africa and Gaza as a paediatrician and educator and was the associate Academic Dean for the American University of the Caribbean Medical School in Sint Maarten a few years ago.
