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Artemisinin is the most effective malaria treatment yet discovered. Peter Seeberger has found a way to to make it from the waste products of its current manufacture

Artemisinin, a drug extracted from the sweet wormwood plant, is the most effective treatment for malaria ever discovered. Every year, millions of doses of artemisinin combination therapies (ACTs) are donated to Africa and Asia, greatly reducing the worldwide burden of the parasitical disease. But extracting artemisinin is expensive and because it takes time to cultivate the plant there are often bottlenecks in supply.

But Peter H Seeberger, the director of the Max Planck Institute of Colloids and Interfaces in Potsdam, Germany, has just announced that he and colleague François Lévesque have discovered a simple and cost-effective way of synthesising artemisinin from the waste products of the plant. Their discovery has the potential to make the drug more affordable for the 225 million people affected by malaria every year.

Artemisinin belongs to the endoperoxide class of anti-malarial drugs and has been called a beautiful molecule, but why is it such bad news for the malaria parasite?

Artemisinin consists of four rings closely tied together. One of the rings is bridged via two oxygen atoms that sit next to each other, but the bond is not very stable and likes to break down. Artemisinin acts on the blood stage of the malaria parasite. Although the exact mechanism is not known, it is thought the endoperoxide ring reacts with the heme or the iron-bearing part of the red blood cell, destroying the parasite in the process. There are no other compounds like this in nature and it is this feature that is responsible for the extraordinary biological activity of artemisinin.

What were the challenges you faced trying to make artemisinin synthetically?

Although it was first synthesised in 1982, in practice it has been very difficult to scale up the process, hence our continued dependence on the plant product. However, we knew from the work of other researchers that two of the byproducts of the plant – artemisinic acid and dihydroartemisinic acid – were good starting points for synthesis. At present, these compounds are thrown away. Our idea was to see if we could make artemisinin from artemisinic acid using reactive molecules called singlet oxygen and the process of flow chemistry.

Singlet oxygen? Flow chemistry?

Singlet oxygen is produced by shining ultraviolet light on oxygen molecules and acts as a bridge between artemisinic acid and artemisinin. However, scaling up the procedure to industrial level is difficult because the larger the reaction vessel, the less light it lets in and the less reactive oxygen is produced. The idea of flow chemistry is to perform the chemical reactions in a narrow pipe rather than a large pot, thereby greatly increasing the volume of the mixture that is exposed to light. In this way, the reaction conditions stay the same and increasing amounts are made by running the reaction continuously. In the first stage, artemisinic acid is reduced to dihydroartemisinic acid. This product and the oxygen are then pumped into the flow reactor, a flexible 2mm-5mm pipe wrapped around the light source. The light activates the oxygen, which reacts with the acid. All it takes is the addition of one further acid to produce the artemisinin. The beauty of this process is its simplicity and the fact that we don't have to clean up between each step.

Your solution is certainly ingenious, but when do you expect it to become commercially viable?

The reactor we used in the original study cost €50,000. We have further refined the process so that the new reactor now costs about €10,000 and requires a lot less energy and space. One such reactor can make about 800g of artemisinin per day. In theory, by running 400 such reactors continuously for a year we could make the entire world supply of the drug for a one-time investment of around €4m. We are looking at working with people who are isolating artemisinin from plants and who have plenty of waste product, or companies like Amyris and Sanofi who are experimenting with engineering yeast to produce artemisinic acid directly. The key here is to make as much artemisinin as the world needs at the lowest possible price. With the right partner, we could have commercial production up and running in six months.

It all sounds very complicated. Aren't there simpler, less technology-dependent ways of helping people with malaria?

Malaria is a complicated disease and we need to fight it with all the means at our disposal. Insecticide-treated bed nets are very effective, but nets are often expensive or of poor quality. That is why a few years ago I set up the Tesfa-Ilg "Hope for Africa" Foundation with some like-minded individuals in Switzerland. As we had limited resources, we focused on Ethiopia, the home country of my friend Dawit Tesfaye, an Ethiopian-born Swiss. Together with some NGOs, the foundation brought two Ethiopian state-run enterprises and built a factory that now employs more than 200 workers, mainly women, who sew the nets and apply the insecticides. Prevention is a wonderful thing – if you don't get bitten, you don't get sick. Plus we are providing jobs for local people.

Much of your research is on the synthesis of oligosaccharides. What fascinates you about this type of molecule?

Oligosaccharides are key components of information transfer in our bodies, but while DNA and proteins are well understood, oligosaccharides are not. A big reason is the fact that access to pure oligosaccharides from natural sources is really difficult, so chemists can make a real difference if they can come up with straightforward and automated means to make these complex molecules. The automated synthesis of DNA enabled entire industries; I want to do the same thing for oligosaccharides.

I understand that one of the applications may be for the design of malaria vaccines?

Yes, oligosaccharides are chains of sugars that make up complex glycans. These glycans are found attached to proteins or lipids on the surface of living cells. My idea is to develop an anti-toxin vaccine that can recognise a complex glycan on the surface of the malaria parasite. Antibodies against these have been detected in children above the age of two in malaria-endemic areas of Africa. The problem is children below two cannot make such antibodies, which is why malaria often proves so deadly to young infants. But if you can give them a combination of a glycan and a protein, their bodies can be trained to mount an antibody response against the parasite. The preliminary results of our research in animal models is looking great but it's been a challenge pushing forward. ButHowever I'm determined to continue with it. Working on a malaria vaccine is probably the least likely to make me any money but it's most likely to have a really large impact on humanity.

What would you say to a person thinking of pursuing a career in organic chemistry?

My chemistry teacher in high school told us that as organic chemists we could make things that nobody had ever made before. He called it, "playing God". I am not sure that is the right way to look at it, but to make totally new molecules or ones we previously got from nature is a wonderful feeling.

Health researchers claim maintaining healthy lifestyle and eating well could prevent as many as a third of all cancers

Foodstuffs and drinks need to contain less sugar, salt and fat in order to help combat the growing number of people developing cancer, campaigners against the disease have said.

The call from the World Cancer Research Fund (WCRF) came as it released fresh estimates that the number of Britons being diagnosed with cancer annually will rise to almost 400,000 by 2030.

The UK will see about 396,000 new cases of cancer a year in 2030 – a 30% rise on the 304,000 seen in 2008 – according to WCRF projections released today to mark World Cancer Day.

Its analysis of the likely increase in cancer cases in all 27 EU member states by 2030 says that the UK will have the 16th biggest proportionate rise and Ireland the biggest with a predicted 72% jump, followed by Cyprus (55%), Luxembourg (53%) and Malta (49%).

The WCRF identified the ageing population as the key factor behind the rise, because cancer affects mainly the over-60s. But it also said improvements in lifestyles, such as eating better, maintaining a normal weight and taking exercise could prevent as many as a third of all cancers.

"Measures to tackle the fat, sugar and salt content of food and drinks and to improve the opportunities for physical activity are the type of developments we need to cut these predictions of future cancer cases," said Dr Kate Allen, the science and communications director at WCRF International.

It wants to see mean salt intake fall to 5g a day by 2025, a big drop from the current average in the UK of about 8g, and for total fat intake to make up just 15-30% of people's energy intake by the same date.

To achieve that it wants action to "encourage nutrient-dense relatively unprocessed foods and discourage sugary and alcoholic drinks".

Cancer incidence is rising, and experts expect it to keep rising, mainly due to ageing, but also obesity and alcohol misuse. But WCRF's estimate of a 30% rise by 2030 is lower than Cancer Research UK's prediction, made last October, of a 45% leap to around 432,0000 cases by the same date.

The trend has prompted concern that the NHS may not be able to keep pace.

"We know the numbers of people getting this disease is increasing and these figures by the WCRF should signal alarm bells for the NHS and how we plan future cancer services. Macmillan Cancer Support's own research showed that four in 10 people will now get cancer in their lifetime," said Ciaran Devane, the charity's chief executive.

On current trends the number of people in the UK who have been diagnosed with cancer will double from two to four million over the next 20 years, added Devane.

Dr Emily Power, health information manager at CRUK, said: "With more cancers being diagnosed, it's crucial that cancer services worldwide prepare for the growth in demand. It's also important that we do everything we can to improve the early diagnosis of cancer."

But medical and scientific advances mean patients diagnosed with cancer are twice as likely to survive it as they were 40 years ago, Power added.

The Department of Health said: "This data shows the challenges we face from an ageing population and the rising burden of cancer. That is why we are investing more than £750m over the next four years to make sure people are diagnosed with cancer earlier and have better access to the latest treatments. This includes a range of public awareness campaigns on the signs and symptoms of cancer.

"Through our investment and modernisation of the NHS, we will save 5,000 more lives every year by 2015 - closing the gap in cancer survival between us and the best-performing countries in the world.

"But we know that up to half of all cancers could be prevented by changing our lifestyles - eating better, doing more exercise, drinking less and stopping smoking.

"That's why through Change4Life we are encouraging everyone to make small lifestyle changes that really make a difference, like being more active, eating more fruit and veg, fewer calories and less fatty foods. We will shortly launch a campaign to raise awareness of the risks of drinking too much alcohol."

Malaria does not just kill babies and children under five – it kills adults too, in nearly as large proportions

Decades of assumptions about the lethality of malaria have been overturned by the publication of a paper in the Lancet from an academic institute in Seattle which says the disease kills twice as many as everybody thought. Even more extraordinary – it would seem that conventional wisdom about the disease has been wrong all this time.

It does not just kill babies and children under five — it kills adults too, in nearly as large proportions.

The Institute of Health Metrics and Evaluation has astounded the global health community by claiming it has been fighting malaria apparently with one hand behind its back. The death toll has come down since 2004, thanks to huge efforts to get insecticide-impregnated bednets to households and treat those who are sick with better drugs, but all the while an older age group has been neglected.

"These are certainly results which surprised us when we first did the analysis," said Steve Lim, one of the authors of the Lancet paper. "It is new to what is taught in public health and medical school, which is that when kids are exposed to malaria at a very young age, it conveys immunity."

Only last year the World Malaria Report gave mortality figures which are half those the institute has found – 655,000 deaths compared to 1.2 million. It is an extraordinary gulf and there will be lots of debate about the statistical methods used by the Seattle team.

But the institute has form. This is part of a five-year project, funded by the Bill and Melinda Gates Foundation, to obtain the best possible data for the toll of death and disease from various causes in the developing world.

Its director Christopher Murray and colleagues have already published on maternal mortality. They found that the half a million deaths on pregnancy and childbirth that had been trotted out for years was wrong – the real figure was nearer a third of a million.

Estimates can go up as well as down. For malaria, they say there has been under-reporting. One of the main reasons is that assumption that older children and adults do not die of it – so deaths may be classified as "fever" when malaria was to blame.

Good national data on mortality in poor countries is extremely difficult to find. Deaths, like births, go unrecorded in most of sub-Saharan Africa. There are no registers.

The institute has gone to great lengths to find reliable data as possible that can be relied on from a wide variety of sources.

Mostly these are studies carried out by scientific researchers. But they have incorporated studies that others might not, such as "verbal autopsies", for instance where a relative, usually, tells the researchers about the health of the deceased, their symptoms and the way they died.

It is not a doctor's diagnosis and there are no blood or tissue tests for confirmation, but some causes of death can be fairly securely identified in this way.

Lim describes what they have been doing as "a really systemic effort to collect all the world's data and all the studies that measure mortality". That data all has to be validated, in so far as it can be.

He points out that because they are working on all causes of death, they do not have a vested interest in malaria. And if malaria cases go up, then other causes of death must go down (as they did for women in childbirth) – although they also recognise that the total number of deaths in the world is not known.

Asked why other reports have not come up with similar figures, he said: "It is a little bit difficult for us to know exactly what's been done by other groups. Their methods are not always particularly described."

However, there have been some studied in specific locations that have indicated relatively high levels of mortality in adults, he added.

Malaria kills 1.2 million people every year, a finding that has implications for global efforts to eliminate the disease

Malaria kills twice as many people every year as formerly believed, taking 1.2 million lives and causing the deaths not only of babies but also older children and adults, according to research that overturns decades of assumptions about one of the world's most lethal diseases.

The findings from the research, published on Friday, which has reanalysed 30 years of data on the disease using new techniques, will force a rethink of the huge global effort that has been under way to eliminate malaria. That ambition now looks highly unlikely by the UN target date of 2015.

It also raises urgent questions about the future of the troubled Global Fund to Fight Aids, TB and Malaria, which has provided the money for most of the tools to combat the disease in Africa, such as insecticide-impregnated bed nets and new drugs. The fund is in financial crisis and has had to cancel its next grant-making round.

The research comes from the highly respected Institute for Health Metrics and Evaluation (IHME), based in Seattle, and is published in the Lancet medical journal.

Dr Christopher Murray and colleagues have systematically collected data on deaths from all over the world over a 30-year period, from 1980 to 2010, using new methodologies and inventive ways of measuring mortality in countries where deaths are not conventionally recorded. The work on malaria is part of a much bigger project which has already led to new estimates of the death rates of women in childbirth and pregnancy and from breast and cervical cancer.

Their figure of 1.2 million deaths for 2010 is nearly double the 655,000 estimated in last year's World Malaria Report.

The good news is that they have confirmed the downward trend that the World Health Organisation's report showed, as a result of efforts by donors, aid organisations and governments to tackle the disease.

The bad news is that the decline comes from a much higher peak – deaths hit 1.8 million in 2004, they say. That means the interventions such as better treatment and bed nets are working, but there is much further to go than everybody had assumed.

The study demolishes conventional thinking on malaria – that almost all the deaths are in babies and small children under the age of five. The study found that 42% were in older children and adults.

"You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults," said Murray, IHME director and the study's lead author. "What we have found in hospital records, death records, surveys and other sources shows that just is not the case."

Most deaths are still in children, but a fifth are among those aged 15 to 49, 9% are among 50- to 69-year-olds and 6% are in people over 70, so a third of all deaths are in adults. In countries outside sub-Saharan Africa, more than 40% of deaths were in adults.

In Africa, though, the contribution of malaria to children's deaths is higher than had been thought, causing 24% of their deaths in 2008 and not 16% as found by a report by Black and colleagues, whose methodology was used in the World Malaria Report.

That means that malaria needs a higher priority if the millennium development goal of cutting child mortality by two-thirds between 1990 and 2015 is to be achieved, say the authors.

They add: "That malaria is a previously unrecognised driver of adult mortality also means that the benefits and cost-effectiveness of malaria control, elimination and eradication are likely to have been underestimated."

There is a need, they say, to pay attention to the risks malaria poses to adults and they support the recent strategy to hand out insecticide-impregnated bed nets to protect all members of the household against mosquitoes carrying malaria parasites, instead of insisting they are only for babies and pregnant women, as was originally the case.

Malaria deaths have come down by 32% from 1.8 million in 2004 to 1.2 million in 2010 because of the sustained effort to get bed nets into homes, indoor spraying and new artemisinin combination drugs – older anti-malarials do not work in many areas because the parasite has developed resistance to them.

More than two-thirds of this has been paid for by the Geneva-based global fund, which has suffered from donors' unwillingness to invest more money.

"The announcement by the global fund that round 11 of funding would be cancelled raises enormous doubts as to whether the gains in malaria mortality reduction can be built on or even sustained," say the authors.

"From 2003 to 2008, the global fund provided 40% of development assistance for health targeted towards malaria. This reduction in resources for malaria control is a real and imminent threat to population health in endemic countries."

Professor Rifat Atun, director of strategy, performance and evaluation at the fund, said more than $2.5bn (£1.6bn) had been disbursed for malaria control between 2009 and 2011. By the end of 2011, 235m bed nets had been distributed. Money that had been pledged was still coming in, he said, which meant it would be able to invest substantially this year and next. "What we are not able to achieve is the rate of increase in investment of the last few years. The trajectory we have been able to establish will not be realised," he said. "Given the new burden that Christopher Murray has been able to show, we really need to ramp up investments in malaria and that really needs more funding. The mortality figures are much, much larger. We need to double our efforts to address the burden that we have." The Department for International Development said: "We are committed to helping halve malaria deaths in at least 10 of the worst affected countries. We will do this by increasing the number of bednets used by women and children; improving the diagnosis and treatment of malarial; and strengthening health information systems to better monitor progress and target interventions."

Sugar is as toxic to the liver as alcohol and is at the root of obesity and certain types of liver disease, claim US scientists

Sugar should be regulated in the same way as alcohol and tobacco because its increasing use in processed foods poses a significant danger to public health, according to a group of scientists. They advocate controlling sales to children under 17 and taxing sugary foods.

Sugar, they argue, is as toxic to the liver as alcohol and overconsumption is at the root of growing public health problems including obesity and certain types of liver disease.

In an opinion article for the journal Nature, Robert Lustig, Laura Schmidt and Claire Brindis of the University of California, San Francisco (UCSF), said that, over the past 50 years, consumption of sugar had trebled worldwide. "Authorities consider sugar as 'empty calories' – but there is nothing empty about these calories. A growing body of scientific evidence is showing that fructose can trigger processes that lead to liver toxicity and a host of other chronic diseases. A little is not a problem, but a lot kills – slowly."

For the first time in human history, long-term diseases such as heart disease, cancer and diabetes now pose a greater health burden worldwide than infectious diseases, according to the United Nations, contributing to 35m deaths annually. "There are now 30% more people who are obese than who are undernourished," said the UCSF scientists. "Economic development means that the populations of low- and middle-income countries are living longer, and therefore are more susceptible to non-communicable diseases; 80% of deaths attributable to them occur in these countries."

International bodies concerned with public health must consider limiting people's intake of sugars such as fructose, high-fructose corn syrup and sucrose, said the scientists. Rather than focusing on limiting fat and salt, food regulators should turn their attention to "added sugar", which the UCSF team defined as any sweetener containing fructose that is added to food during processing.

Sugar induces many of the diseases associated with "metabolic syndrome", including high blood pressure, diabetes and accelerated ageing. "It can also be argued that fructose exerts toxic effects on the liver that are similar to those of alcohol," said the UCSF scientists. "This is no surprise, because alcohol is derived from the fermentation of sugar."

Preliminary studies have also linked sugar consumption to cancer and cognitive decline. "Consequently, we propose adding taxes to processed foods that contain any form of added sugars," wrote Lustig, Schmidt and Brindis. "This would include sweetened fizzy drinks (soda), other sugar-sweetened beverages (for example, juice, sports drinks and chocolate milk) and sugared cereal … Another option would be to limit sales during school operation, or to designate an age limit (such as 17) for the purchase of drinks with added sugar, particularly soda."

Dr Tim Lobstein, director of policy and programmes at the International Obesity Task Force, said sugar consumption was a major battleground for public health. "The large food manufacturers are very reluctant to see any restrictions on the use of cheap, bulk ingredients like sugars and starches. In the UK we have seen a gradual decline in sugar purchases, but this has been amply made up by an increase in sugar added to manufactured products, including ready meals, soups, snack foods and alcoholic drinks, and the last decade has seen record purchases of confectionery and soft drinks, despite endless health education campaigns.

"There is certainly rising interest in taxing sugary foods, and treasuries will see this as an opportunity to boost state income while helping improve our diets."

One of the main reasons sugar has become such a problem is that it is impossible to avoid in modern society, argued the UCSF scientists. "Evolutionarily, sugar was available to our ancestors as fruit for only a few months a year (at harvest time), or as honey, which was guarded by bees. But in recent years, sugar has been added to nearly all processed foods, limiting consumer choice. Nature made sugar hard to get; man made it easy."

A spokesperson for Sugar Nutrition UK, a group funded by sugar producers, said that over many years, a number of expert committees, including those from the European Food Safety Authority and the World Health Organisation, had examined the scientific evidence relating to the consumption of sugar and other carbohydrates. "All have concluded that the balance of available evidence does not implicate sugar at the level currently consumed in any of the 'lifestyle diseases' such as obesity, diabetes, coronary heart disease, or cancer at any site."

However, Dr Julie Sharp, senior science information manager at Cancer Research UK, said: "Research suggests that excess bodyweight is linked to up to 17,000 cases of cancer a year in the UK, making it one of the most important risk factors for cancer after smoking. Foods high in sugar have lots of 'empty calories', meaning they can contribute to weight gain but don't have much nutritional value.

"Limiting sugar intake is just one thing people can do to try and maintain a healthy weight, along with eating a balanced diet high in fibre, fruit and vegetables and low in red and processed meat, saturated fat and salt."