Scientific rationale for traditional use of plants to treat tuberculosis in the eastern region of the OR Tambo district, South Africa

Ethnopharmacological relevance: Tuberculosis (TB) remains a major health problem for humans worldwide, and was responsible for 1.4 million human deaths in 2015 alone. Although there is treatment for TB, emerging multi drug, extensively drug and totally drug resistant forms of this disease, as well as co-infection with human immunodefiency virus (HIV) continue to worsen the situation. South Africa is among countries with reported traditional use and published documentation of such knowledge concerning the use of plants against TB. Based on a previous study where plants used traditionally for treating TB in the eastern region of OR Tambo district, South Africa, were documented, the present study aimed to determine the antimycobacterial effect, cytotoxicity and genotoxicity of plants selected from that list. Material and methods: Acetone, 70% ethanol, cold and hot water extracts were tested for antimycobacterial activity against saprophytic Mycobacterium species including M. aurum, M. bovis BCG, M. gordonae, M. fortuitum, and M. smegmatis using a microdilution method. Extracts with MIC values less than 1 mg/ml against at least three Mycobacterium strains were evaluated for antimycobacterial activity against pathogenic Mycobacterium strains including M. tuberculosis H37RV, M. tuberculosis and M. bovis, cytotoxicity (against Vero monkey kidney and bovine dermis cells), and genotoxicity (against Salmonella typhimurium TA98 and TA100). Results: The MIC values of the extracts ranged from 0.02 to 2.50 mg/ml, LC50 values of twenty-nine extracts ranged from 0.001 to > 1 mg/ml and the highest selectivity index was 79.50, an extremely promising value. Phymaspermum acerosum roots and leaves (ethanol and water) extracts had the best MIC value (0.02 mg/ml) against at least one Mycobacterium strain. It was interesting to note the lack of cytotoxicity of these extracts with the highest selectivity index value of 39.75. Pterocelastrus echinatus bark acetone and Protorhus longifolia leaf hot water extracts were the most cytotoxic with LC50 = 0.001 and 0.008 mg/ml, respectively, whereas Pittosporum viridifiorum bark water extract was genotoxic. Among non-pathogenic strains, M. gordonae, M. aurum, M. smegmatis showed good correlation of activity with pathogenic M. tuberculosis H37Rv, M. tuberculosis and M. bovis, however, M. aurum was the best predictor with Mycobacterium tuberculosis H37Rv (correlation coefficient value = 0.73). Conclusion: The results indicate that Heteromorpha trifoliata and Phymaspermum acerosum should be investigated further for antimycobacterial efficacy against drug resistant strains of Mycobacterium.