Stony Brook teacher solves medical mystery

A chemical compound found in birthwort plants is responsible for sickening people in Eastern Europe for decades, a Stony Brook University professor has found in a discovery that solved a major medical mystery.

The discovery, experts said last week, has implications outside Europe because the plants are widely used in folk and traditional medicines in cultures circling the globe.

The plants are found worldwide and throughout vast regions of the United States, including New York, said Michael Balick, vice president for botanical science and director of the New York Botanical Garden's Institute of Economic Botany in the Bronx.

"There are a whole bunch of species," Balick said. "It's like asking 'Do daisies grow in the United States?' The birthwort family is huge."

For at least a half century, people in several Balkan countries were inexplicably developing kidney failure and kidney cancer. Dr. Arthur Grollman, who teaches pharmacological sciences at Stony Brook's medical school, led a team of researchers who not only studied kidney damage occurring among people in Bosnia, Croatia and Serbia, but also examined what people there ate.

The Balkan kidney problems were largely limited to rural areas and characterized by progressive kidney failure and the development of a form of kidney cancer. Grollman and colleagues traced the Balkan illness to the chemical aristolochic acid, found in birthwort. The birthwort was growing amid wheat fields in the Danube River basin. It was being harvested along with the wheat and being baked into bread, the researchers found.

Grollman's investigation, reported in the online edition of Kidney International, confirms earlier U.S. government-backed studies linking aristolochic acid to kidney damage. The specific kidney problems caused by the chemical "represent a long-overlooked global disease and an international public health problem of significant magnitude," Grollman said in a statement.

Grollman echoed Balick by underscoring that plants containing aristolochic acid are used in herbal medicines worldwide.

The Department of Health and Human Services' National Toxicology Program's Report on Carcinogens last month listed aristolochic acid as a human carcinogen. The Food and Drug Administration has long barred from the country herbal preparations that contain it.

But Balick said despite the restrictions, plants containing the compound are virtually everywhere.

"There are four species native to the Northeast and at least 500 species worldwide," Balick said.

In the 1990s, a herbal weight-loss drug used in Europe resulted in the death of a person poisoned by aristolochic acid, Balick said.

Dr. Shaobai Wang, a medical doctor and expert in traditional Chinese medicine in Syosset, said the Chinese medicinal herb, mu tong, contains aristolochic acid. Mu tong, he said, has been prescribed for water retention, joint problems and low energy.

He noted that practitioners of traditional Chinese medicine have used mu tong for 3,000 years and have developed ways to use it safely. "In Chinese medicine, all herbal pills have restrictions, and we never use one herb by itself," he said. "We may use five, six, 20 different herbs [together] in very tiny amounts."