Ethnomedicinal Plants from Iraq as Therapeutic Agents against Mycobacterium tuberculosis: A Review

Abstract

Mycobacterium tuberculosis is a highly infectious pathogen, which can affect both humans and animals. The metabolic products of this bacterium affect the pulmonary, nervous, lymphatic, and cardiovascular systems. The aim of this review is to provide information on certain local herbs from Iraq, which have been found to be effective against Mycobacterium tuberculosis. In this report, we have reviewed 13 medicinal plants and their anti-mycobacterial activities. The family, traditional medicinal uses, common local names, in vitro activity of the crude extract, and information about bioactive chemical composition of these plant species have been described. The crude extracts of these medicinal plants can be used to develop novel drugs against tuberculosis.

Full text

*Correspondence: alisamimicrobiology@gmail.com
(Received: 11 June 2019; accepted: 13 August 2019)
Citaon: Ali Sami Dheyab, Ekremah Kheun Shaker and Abdul jabbar Khaleel Ibrahim, Ethnomedicinal Plants from Iraq as
Therapeuc Agents against Mycobacterium tuberculosis: A Review, J Pure Appl Microbiol., 2019; 13(3): 1419-1427. hps://doi.
org/10.22207/JPAM.13.3.12
© The Author(s) 2019. Open Access. This arcle is distributed under the terms of the Creave Commons Aribuon 4.0 Internaonal License which
permits unrestricted use, sharing, distribuon, and reproducon in any medium, provided you give appropriate credit to the original author(s) and
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Dheyab et al. J Pure Appl Microbiol, 13(3), 1419-1427 | September 2019
Arcle 5760 | hps://doi.org/10.22207/JPAM.13.3.12
Print ISSN: 0973-7510; E-ISSN: 2581-690X
REVIEW ARTICLE OPEN ACCESS
www.microbiologyjournal.org1419Journal of Pure and Applied Microbiology
Ethnomedicinal Plants from Iraq as Therapeuc
Agents against Mycobacterium tuberculosis: A Review
Ali Sami Dheyab1*, Ekremah Kheun Shaker2 and Abdul jabbar Khaleel Ibrahim2
1Department of Medical Laboratory Techniques, Al Maarif University College, Alanbar, Iraq. 2Department of Medical
Laboratory Techniques, Al-Rasheed University College, Baghdad, Iraq.
Abstract
Mycobacterium tuberculosis is a highly infecous pathogen, which can aect both humans and animals.
The metabolic products of this bacterium aect the pulmonary, nervous, lymphac, and cardiovascular
systems. The aim of this review is to provide informaon on certain local herbs from Iraq, which have
been found to be eecve against Mycobacterium tuberculosis. In this report, we have reviewed 13
medicinal plants and their an-mycobacterial acvies. The family, tradional medicinal uses, common
local names, in vitro acvity of the crude extract, and informaon about bioacve chemical composion
of these plant species have been described. The crude extracts of these medicinal plants can be used
to develop novel drugs against tuberculosis.
Keywords: Medicinal plants; Mycobacterium tuberculosis; An-mycobacterial acvity; Iraq.

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Journal of Pure and Applied Microbiology
INTRODUCTION
Mycobacterium tuberculosis is an
acid-fast, Gram-positive bacterium that does
not form spores; it causes a zoonotic disease
known as tuberculosis (TB) in both humans and
animals1. The disease aacks several organs in
the body such as the lungs, skeletal system, brain,
lymphatic system, and cardiovascular system.
The severity of this disease depends on certain
factors, which include the genec characteriscs
of the host, environmental factors, and genec
polymorphisms2. Iraq is one of the countries with
high incidence of TB among the countries in the
Eastern Mediterranean Region3. A WHO report
estimated an incidence rate of approximately
20,000 TB paents with a combined mortality of
more than 4000 each year. Moreover, the esmated
number of mulple drug resistance-tuberculosis
(MDR-TB) cases is approximately 6.1% of all the
newly reported TB cases4. A previous study showed
the prevalence of TB in Baghdad between 2012
and 2016 and concluded that these cases occur
more frequently in women than in men3. This may
be due to lack of safety, low individual economic
status, irregular treatment courses, and also
because many cases go unreported. The incidence
of the disease can be improved by detecng the
disease early, implemenng adequate therapy, as
well as educang the people about the modes of
disease transmission5-7.
Irrespecve of whether the TB is latent
or active, antibiotics are generally used for
treang the infected paents. The drugs used
against TB include first, second and third-line
common anbiocs such as isoniazid, rifampin,
pyrazinamide, ethambutol, streptomycin,
amikacin, kanamycin, capreomycin, quinolone,
and ethionamide8. However, these antibiotics
have severe side-effects and Mycobacterium
tuberculosis can easily develop resistance towards
these drugs. In addion, the condion of most
paents starts declining within a year of treatment
due to non-compliance with the medication
course, resulting in a more severe, antibiotic-
resistant condition9-11. Due to the resistance
mechanism of Mycobacterium tuberculosis, it
somemes occurs along with HIV infecon, and
hence, there is an urgent need to develop novel
therapeuc agents. Acve compounds isolated
from herbal sources can be eecve and might be
used as substutes for the anbiocs used against
TB12-14.
METHODOLOGY
The informaon in this arcle takes the
reader through the following keywords: “extract”,
“medicinal plants” and “an-mycobacterial”. We
searched for these keywords using electronic
databases including Science Direct, Google scholar,
PubMed and Scopus. We included both in vivo and
in vitro studies in our review.
Ethno-therapy for treatment of tuberculosis
caused by Mycobacterium tuberculosis
We selected 13 plants, which have
been known to have potenal inhibitory eects
on Mycobacterium tuberculosis, in this study.
Between the years 2000 and 2018, the reports
published in Iraq included the following medicinal
plants: Apium graveolens, Arachis hypogaea,
Arganiaspinosa L, Camphor, Cinnamomum
cassia, Commiphora molmol, Cuminum cyminum,
Lepidium savum, Linum usitassumun, Nigella
sava, Pimpinella anisum, Piper nigerum, and
Trigonella foenumgraecum.
Apium graveolens
In Iraq, this plant is known as Karafs and
its common English name is Celery. It is commonly
culvated in the European region as a food crop
and it is also grown in Algeria, Egypt and the
central region of Kingdom of Saudi Arabia (KSA)15.
The seeds of Apium graveolens have been largely
used in local and tradional medicine to treat
hepac disorders, jaundice, arthris, high uric
acids levels and many inammatory diseases16-18.
Previous ethnomedicinal studies have shown that
celery alleviates digesble disturbances, central
nervous system and cardiovascular disorders,
and also has antimicrobial, anti-inflammatory,
and several other pharmacological effects19-21.
This study reviewed the eects of this plant on
Mycobacterium tuberculosis using 200 mg/ml of
whole-plant extract made using 70% ethanol and
found that it inhibited the growth of MTB (only 20
colonies appeared aer an incubaon period of 4
weeks)22.
Arachis hypogaea
This plant species is a member of the
Fabaceae family, which is known as Fusk Abeed
and Fusc wdani in Arabic and its common English
names are groundnut/peanut. It is mainly grown

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in tropical countries and also culvated in some
sub-tropical areas in dierent parts of the world23.
The parts of this plant have several tradional
medicinal uses such as the use of peanut oil to
treat crust formaon in certain skin diseases, for
neonatal care, to relieve itching of dermal areas in
cases of eczema and dry skin24. Modern research on
the peanut plant extract has shown its anoxidant
properties and in-vitro studies have shown
that it possesses free radical scavenging, an-
microbial, an-parasic and an-inammatory
properes25-27. Further clinical research has shown
that peanut skin has an an-allergic eect as it
contains large amounts of polyphenols28, 29. The
applicaon of 70% ethanol extract of this plant on
Mycobacterium tuberculosis (MTB) at 200 mg/ml
concentraon showed no growth of MTB22.
Arganiaspinosa L.
This plant is a small tree from the
Amaranthaceae family. It grows in North African
regions, especially in Morocco, and the oil-
producing varieties of this plant can also be
grown in jungles. In its nave country, this plant
is tradionally used for nutrive as well as several
other purposes30. On the other hand, modern
uses of argan oil, produced by this plant, have
shown an-bacterial acvity on diseases involving
Staphylococcus aureus (MRSA) and Pseudomonas
aeruginosa infections31, 32. In addition, several
papers have menoned the acvity of argan oil in
dierent diseases such as cancer, heart disease,
diabetes and thyroid hormone disturbances33.
The current review aims to elucidate the eects
of argan oil against Mycobacterium tuberculosis.
Its therapeuc eects depend on its rich chemical
composition including oleic, linoleic, palmitic,
stearic and linolenic acids and mixtures of these
chemicals at concentraons of 2.5:7.5 and 3:7
yielded good inhibitory eect on Mycobacterium
tuberculosis30.
Camphor
This chemical is from a plant belonging
to the Lauraceae family and it is derived from
the camphor wood laurel tree. It is white in color,
crystalline in texture, has a specific odor and
intense taste34. The tree is navely culvated in
India, Mongolia, Japan, Taiwan, and also in the
Southern region of USA35. The essenal oil from
this plant has been tradionally used to soothe
muscle pain, joint conditions, dermatological
conditions, cold, and bronchial congestion 36.
Latest studies have shown its pharmaceutical
applications as an analgesic, antipyretic, anti-
inammatory, an-spasmodic, mild expectorant
and for alleviang nasal disorders35, 37. The volale
oil, which has major medicinal properes, contains
safrole, linalool, eugenol, and terpineol and the
leaf of the plant is also a powerful source of linalool
(94.9%)38. The camphor plant extract showed clear
acvity at 200 mg/ml concentraon against MTB
with only 18 colonies appearing aer an incubaon
period of 4 weeks22.
Cinnamomum cassia
This plant is classied under the Lauraceae
family. It is commonly known as Chinese cassia,
and it is cultured in various regions in the world.
It is harvested from the inner cortex of the
tree belonging to the genus Cinnamomum 39.
The cinnamomum plant has been used for the
oldest tradional herbal medicine used and it
is also used in mouth fresheners and chewing
gums for its avor40, 41. In addion, the cinnamon
plant improves digestive ability and reduces
colon disorder42, 43. All parts of the cinnamon
tree, including the leaves, bark, root, or fruits,
possess medicinal properes. The bark and leaves
contain the volale oils in large amounts with
chemicals having medicinal and pharmaceucal
properes such as anmicrobial, anoxidant and
an-inammatory acvies41, 44. Latest studies
elucidang the local uses of Cinnamomum plants
have shown that they have anti-tuberculosis
acvity45.
Commiphora molmol
This plant is classified under the
Burseraceae family and its common name myrrh is
derived from the Arabic word Mur. Various species
of the Commiphora plant are culvated in dierent
regions of the world46. The tradional medicinal
use of this genus Commiphora includes treatment
of headache, wound care, joint pain, bone
fractures, and diarrhea47. Latest research shows
that the acve compound of commiphora extract
has an-cancer acvity and in vitro experiments
have shown its an-microbial acvity48, 49. Latest
studies on the applicaon of Commiphora molmol
in treang tuberculosis have shown its acvity
against clinical isolated TB sample at 200 mg/ml
concentraon, resulng in no growth of MTB22.

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Journal of Pure and Applied Microbiology
Cuminum cyminum
This plant species is a member of the
Apiaceae family, which is known as Kamoun in
Arabic and as Cumin in English50. It is culvated
and grown in the MENA regions - Middle East and
North Africa. In addion, the plant is also grown in
the United States of America, India and China50, 51.
The tradional medicinal uses of cumin include as
a treatment for diarrhea and jaundice, and it also
has diurec and astringent properes. The oil of
the cumin plant is used in food manufacturing for
making cheese and soups52. The extract of the
cumin seed has an-microbial and bactericidal
properes, as shown by in vitro experiments53.
Through phytochemical analysis of the parts of this
plant, the phenolic content in the methanol extract
was evaluated and found to exhibit an-oxidant
and an-inammatory acvies54, 55. The crude
plant extract made using 70% ethanol at 200 mg/
ml concentraon completely inhibited the growth
of MTB aer an incubaon period of 4 weeks22.
Lepidium savum
This species of herbs is a common garden
plant. It is classied under the Brassicaceae family
and is found in countries like Africa and Ethiopia.
However, it can also be found in dierent parts
of the world such as Southwest Asia56. The plant
has several names including garden pepper cress,
pepperwort and El Rashad57. It is used in the Arabic
countries as tradional medicine to treat asthma,
cough, bronchis and as an expectorant57, 58. The
chemicals found in this plant, such as oleic acid,
stearic acid, linoleic acid and ascorbic acid, have
several pharmaceucal eects. All of the chemicals
have signicant diurec, an-inammatory, an-
diarrheal, an-microbial, analgesic and laxave
acvies59-61. Through whole plant extracon using
70% ethanol solvent, its acvity against MTB was
shown; at 200 mg/ml concentraon, it completely
suppressed MTB growth (no colonies seen)9.
Linum usitassumun
This parcular plant species has been
culvated for its oil since a long me. Its common
name is flax or linseed and it belongs to the
Linaceae family62. The flax plant is native to
Egypt and it is commonly distributed between
the Arabic gulf and Red Sea. However, it can also
be found in certain other countries like India,
Pakistan, and Afghanistan63. There are quite a few
tradional medicinal uses of Linum usitassimum
and it has several therapeuc benets such as an
an-tussive, laxave, expectorant, and diurec64.
The linseed shell is characterized by its shape,
which is hard with dierent colors. Its chemical
composion is as follows: 41% fat, 28% ber, and
20% protein with high internal polyunsaturated
fay acids content65. In modern therapy, there
are abundant data available on the properes of
axseed such as its an-coagulant, an-diabec,
an-microbial, an-oxidave acvies as well as its
nephro-, hepato- and cardio-protecve eects66-68.
The ethanol extract of ax plant showed an-
tuberculosis acvity at 200 mg/ml concentraon
and only 25 MTB colonies grew aer the 4-week
incubaon period22.
Nigella sava
This plant is commonly known as black
seed in Arabic and its common English name
is black cumin69. It is a herb belonging to the
Ranunculaceae family70. Nigella seeds have been
used to improve human health, parcularly in the
Middle Eastern countries. This plant species is
culvated in many areas in the world, especially
in Arabic countries. It has been, in fact, menoned
by Prophet Mohammed as having the property to
enhance physical power and health 71, 72. Nigella
sava is commonly used in tradional medicine as
a diurec, and as a cure for liver disorders, digesve
system problems, fever, and jaundice72, 73. Dierent
studies describing the modern applicaons of
the black nigella seeds have shown that it has
therapeuc acvity against several condions such
as bacterial, fungal, parasic, and viral infecons
as well as in metabolic disorders, hypertension,
diabetes, gastrointestinal disease and hepatic
disorders69, 72. The published arcles on the black
seed plant show chemical composion consisng
of high oil content of approximately 28 to 36%
as well as dierent bio-acve chemicals such as
flavonoids and saponins. The pharmaceutical
benets exerted by these phytochemicals include
anti-cancer, anti-microbial, anti-inflammatory,
an-oxidant and detoxifying acvies73, 74. This
plant is also effective against Mycobacterium
tuberculosis and it showed signicant inhibitory
eect at a concentraon rao of 2.5:7.5 and 3:7
aer compleon of the incubaon period75.
Pimpinella anisum
Pimpinella anisum is one of the oldest
herbal medicinal plants that belongs to the

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Umbelliferae family. It is grass-like in shape and
is about 50 cm in length. Its common English
name is anise76. Pimpinella anisum is grown and
culvated in various areas such as Asia, Middle
Eastern regions like Iran and Egypt. It has also been
reported to grow in Europe and Mexico77. Every
year, the anise fruit is harvested between August
and September. Its traditional medicinal uses
include alleviaon of various condions such as
digesve disorders, GIT spasms, and conspaon
and also to increase the breast milk producon in
women76, 77. The secondary metabolism products
of this plant consist of various chemicals with
an-microbial and an-oxidant acvies [78-80].
Several studies in the medical eld have shown
that the essenal oils of this plant have many
posive health benets such as an-inammatory,
analgesic, an-convulsant and hepatoprotecve
acvies81-83. The 70% ethanol whole-plant extract
along with distilled water showed significant
inhibitory acvity at 200 mg/ml concentraon
against MTB growth in the 4-week incubaon
period as only 3 colonies were seen22.
Piper nigerum
Piper nigerum is commonly known as
black pepper and it is considered to be the oldest
medicinal herb in the world. It is grown in dierent
regions like Asia, Europe and Africa84. In Arabic,
it is known as Fill Aswad and it belongs to the
Piperaceae family85. It has several important uses
in tradional medicine and has been used to treat
preclinical cases such as asthma, skin disorder,
sore throat, snake bite and as an antipyretic
medication86. The black pepper seed contains
several potent chemicals. Many studies have
shown that it has an-bacterial, an-diarrheal,
anti-colic, anti-fungal and anti-inflammatory
acvity against various infecous diseases87, 88. In
this review, we have shown the an-mycobacterial
activity of Piper nigerum, which has potent
inhibitory acvity at 200 mg/ml concentraon and
suppresses the growth of MTB with only 4 colonies
seen aer the 4-week incubaon period22.
Trigonella foenum-graecum
This medicinal plant, commonly known as
fenugreek, is considered to be one of the oldest
plants used in tradional medicine. It belongs to the
Papilionaceae family89. It is culvated throughout
the world due to its adapve behavior90. Although
it is grown worldwide under various climatic
condions, it is especially found in Asia and Africa.
Due to its widespread distribuon, its medicinal
role has been well documented. For instance, in
Iran, the extract of this plant is used to lower blood
sugar level91. In China, its seeds are used to treat
digesve disorders, gastris, and gastric ulcers
and also, in food manufacturing90. Several studies
have reported the bioactive chemicals found
in this plant and have shown their applicaons
in the medical eld. Furthermore, it has many
pharmacological acvies such as hypoglycemic,
anti-diabetic, anti-lipidemic, anticancer, anti-
microbial and an-inammatory acvies92, 93. The
plant has clear an-mycobacterial eect as aer
compleon of the enre incubaon of 4 weeks,
no MTB growth was seen when it was used at 200
mg/ml concentraon22.
CONCLUSION
It is evident that the aforementioned
herbal medicinal plants from Iraq exhibit an-
mycobacterial acvity and hence, can be used
against Mycobacterium tuberculosis. There is
a significant positive correlation between the
traditional used of medicinal plants and their
an-mycobacterial acvity. Further research in
the eld of modern pharmaceucal science should
be conducted to isolate and idenfy the bioacve
chemical compounds from these plants. We expect
that these ndings will encourage the researchers
to engage in drug discovery and develop novel
natural products that may eventually facilitate the
development of a novel an-TB drug.
ACKNOWLEDGEMENTS
We are thankful to Al Maarif University
College (AUC) Alanbar, Iraq and the Dean of the
college for providing and supporng the study.
CONFLICT OF INTEREST
The authors declare that there is no
conict of interest.
FUNDING
None.
DATA AVAILABILITY
All datasets generated or analysed during
this study are included in the manuscript.

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Journal of Pure and Applied Microbiology
AUTHORS' CONTRIBUTION
All authors have made substanal, direct
and intellectual contribution to the work and
approved it for publicaon.
ETHICS STATEMENT
This research arcle does not contain
any studies involved with human parcipants or
animals.
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