The birthwort plant, which commonly grows all over the Balkan Peninsula, is found to have toxic compounds called aristolochic acids (AAs). The toxins have been linked to a severe kidney disease called Balkan endemic nephropathy, or BEN.
Kidney damage caused by Balkan endemic nephropathy is usually paired with upper tract urothelial carcinoma, a type of bladder cancer. Currently, there have been no developed treatments for BEN.
Scientists believe that the disease may be affecting more than 100,000 people in the Balkan region, which consists of the countries Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo, Montenegro, North Macedonia, Romania, Serbia, and Slovenia.
Around 400 million to over two billion people all over the world suffer from kidney disease with unknown causes, which may mean that these people have been exposed to AA, according to nephrologist Nikola Pavlović from the University of Niš.
However, birthwort, or Aristolochia clematitis, have been used as traditional medicine, especially in Asia. Researchers have linked the plants to ancient Egypt as well as ancient Greeks and Romans using birthwort to treat postpartum bleeding.
A Global Problem
Despite the plant's healing properties, continuous consumption of AAs is said to poison the kidney and eventually lead to cancer. Scientists have compared the harmful effects of the toxic compounds to aflatoxin, which is produced by fungi infecting food crops and result in liver cancer.
Kidney damage caused by Balkan endemic nephropathy is usually paired with upper urothelial carcinoma, a type of bladder cancer. Currently, there have been no developed treatments for BEN. Arthur Grollman from Stony Brook University in New York discovered that Balkan villagers make herbal remedies from birthwort. The villagers make some sort of tea for various treatments such as snakebites and gout.
He also noticed that the weeds would be mixed with grain, which was milled for bread. As Grollman studied the DNA of Balkan villagers to discover biomarkers of the disease, the AA toxins were matched with patients who had urothelial cancer in Taiwan. This link revealed AA toxicity to be a global problem.
Yinsheng Wang from the University of California describes AA poisoning as "one of the best-characterized systems of how exposure to a toxin can give rise to cancer and other diseases."
Moreover, another team of researchers from the Hong Kong University of Science and Technology collaborated with Pavlović to see if AAs from birthwort were found elsewhere, such as crops and soil. The team found traces of AAs in several other vegetables as well as groundwater, suggesting that the toxin is more widespread than previously assumed by scientists.
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Medicinal Properties
In 2000, the US Food and Drug Administration had already banned supplements containing AAs. Several Asian countries have done the same, but herbal remedies containing the toxin are still widely available on the internet.
Despite the mounting evidence that the Aristolochia plants are toxic, Pavlović wanted to see if it truly had therapeutic effects. Using artificial intelligence, his team continues to test the effects of the AA toxins of the plant as well as other compounds.
By synthesizing the plant's organic structure, scientists are testing it against several diseases to mimic herbal medicine. If successful, they can potentially extract the medicinal properties of the plants without including the harmful AAs.
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