Tu Youyou: Bringer of Traditional Chinese Medicine to the World

By staff reporter LI WENZONG

THE Nobel Assembly at Karolinska Institute, Stockholm announced on October 5, 2015,  that one half of the 2015 Nobel Prize in Physiology or Medicine was to be awarded to Chinese medical scientist Ms. Tu Youyou, and the other half jointly to William C. Campbell and Satoshi Omura, for their achievements in treatment and research on parasitic diseases.

This was the first occasion on which a Chinese scientist whose research was carried out exclusively in China won a Nobel Prize. It is the highest award ever for the Chinese medical community and for traditional Chinese medicine.

China Today: First to Introduce Artemisinin to the World

Some people say this recognition has come late. And they are correct in some sense, as it is half a century since Tu Youyou discovered artemisinin.

In the late 1960s, Tu Youyou joined Project 523, whose purpose was to fight chloroquine-resistant malaria, and headed the Chinese Medical Team. In 1972, she and her team first isolated the pure artemisinin substance, and in 1975, the chemical structure of artemisinin was identified with the participation of Tu Youyou.

However, since Project 523 was top secret, Tu did not publish anything throughout the whole process. Consequently the world knew nothing about her findings.

 In 1979, the State Science and Technology Commission presented the National Invention Award to the research achievements of artemisinin, and Tu Youyou was singled out of the main research institute as the main discoverer. In August 1979, the English edition of China Today (then called China Reconstructs) published an article about artemisinin under the title “A New Kind of Anti-Malaria Drug.” It was this very article that introduced artemisinin to Western scientists and researchers.

The article told of an assistant professor at the China Academy of Traditional Chinese Medicine who was inspired by medical books of the Eastern Jin Dynasty (317-420) to find a new way of extracting artemisinin. The article was later widely cited in various English publications. For example, in 1985, an article about artemisinin in American Science magazine gave a detailed description of the achievements of Chinese scientists and researchers.

From then on, artemisinin was widely used in the treatment of malaria in China and other countries, but its discoverer remained unknown. Tu Youyou and her team’s contribution to world medical development were still unacknowledged.

Finally in 2011, infectious disease specialist Louis Miller from the American National Institute of Health (NIH) and his colleagues published their research findings in Cell, the most influential life sciences periodical. The article concluded: “We find that the greatest contribution has undoubtedly come from Tu Youyou.”

The same year, Tu won the Lasker Award – an accolade in medical sciences, and generally considered precursor to the Nobel Prize.

Honor for All Chinese Scientists

In the 1960s, plasmodium, the parasite that causes malaria, became resistant to quinine. This had huge and disastrous impact. A conference was held in China on May 23, 1967 to mobilize 500 scientists and researchers from over 60 institutes across the country to find through concerted efforts a new antimalarial drug. This project was later referred to as Project 523. A graduate from the Department of Pharmacology at Peking University, and having had rich research experience in Traditional Chinese Medicine, then 39-year-old Tu Youyou was appointed head of one of the teams at this critical moment.

Before this, both China and America had engaged in many antimalarial research trials, all of which failed. The U.S.A. selected almost 300,000 compounds, but without result. China organized seven provinces in 1967 to conduct antimalarial drug (including herbal medicine) research, and tested more than 40,000 compounds. However, there was not a single positive result. Tu Youyou and her colleagues read many classics on traditional Chinese medicine, visited large numbers of grass-roots physicians, and collected over 600 recipes that had proved effective in treating malaria, including artemisinin. They also tested on mice more than 380 kinds of extracts from 200 types of herbal medicine, but did not achieve a satisfactory result.

“Later, when re-reading the Handbook of Prescriptions for Emergencies by Ge Hong of the Eastern Jin Dynasty, I suddenly noticed that artemisinin was extracted by juice-twisting, not boiling. So it occurred to me that the process of boiling may damage some effective component of artemisinin. I then changed to ether, whose boiling point is much lower than water. Back then, nearly all pharmaceutical factories were out of operation, so we had no alternative but to use traditional methods of first immersing sweet wormwood in water and then in ether. By the time the 191st experiment was finished, we finally found the effective component. The extract we obtained through the ether method proved effective in suppressing malaria in mice and monkeys. To ensure safety, we still needed to test it on humans. All of us were willing guinea pigs,” Tu Youyou recalled.

At the Project 523 working conference held in Nanjing in March 1972, Tu Youyou made a report on their breakthrough. In early 1973, the Beijing Institute of Chinese Medicine produced the sweet wormwood crystal, which later proved effective in many other regions. The General Leading Office of Project 523 named it crystal artemisinin, and designated it a new kind of drug to be developed. Several years later, an organic chemist identified its structure, and in 1984, scientists finally successfully developed synthetic artemisinin.

Contribution to the World

“The discovery of artemisinin changed the fundamental treatment of parasitic diseases. Almost 200 million people are infected with malaria every year. Artemisinin has reduced the death rate by 20 percent and that among children by at least 30 percent worldwide. A total of 100,000 lives are saved annually in Africa alone,” the Nobel Committee for Physiology or Medicine said.

Before the discovery and wide application of artemisinin, at least one million people died from malaria every year. Those who became infected and died lived mainly in relatively poor sub-Saharan Africa. Since the year 2000, about 240 million people in this region have benefited from artemisinin combined therapy, and thanks to it 1.5 million have escaped death.

Upon hearing the news that Tu Youyou had been awarded the prize, many statesmen, experts, and ordinary people from African countries expressed on many occasions their deep gratitude to her for discovering artemisinin.

Vice president of the Union of Comoros Fouad Mohadji said, “Before 2007, two to three members of almost every family in the Union of Comoros, one of the poorest countries in the world, were in hospital with malaria. In 2007, China along with the government of the Union of Comoros started the compound artemisinin program to rapidly eradicate malaria. In 2014, no one in our country died of malaria and the number of infected people dropped by 98 percent.”

The Central Hospital in Lome, Republic of Togo, was built in 2010 with aid from the Chinese government. Director Yakub of this comprehensive hospital said: “Malaria has the highest morbidity in Togo. When treating malaria, artemisinin is our first option.” Now, 98 percent of all malaria patients are successfully treated in this hospital.

Worthy of mention is that China has helped to set up 30 antimalarial centers in African countries to train doctors and nurses in efforts to counteract the huge impact of malaria on the continent.

Nobel Prize Motivates Innovation in Traditional Chinese Medicine

Tu Youyou is the first Chinese scientist awarded a Nobel Prize who has conducted research exclusively in China. Besides Tu Youyou, the other catchphrase on China’s websites and social networks is “traditional Chinese medicine.”

Chairman Zierath of the Nobel Committee for Physiology or Medicine 2015 commented: “That Chinese woman scientist Tu Youyou extracted artemisinin from herbal medicine to treat malaria shows that traditional Chinese herbal medicine could bring new scientific inspiration. Purification through modern technology and its combination with modern medicine has enabled herbal medicine to achieve remarkable results in the treatment of malaria.”

Chen Qiguang, head of the investigating and surveying team of national conditions of Chinese Academy of Social Sciences, said that Tu Youyou’s winning of the Nobel Prize demonstrates that traditional Chinese medicine is scientific, reasonable and has huge potential.

Wang Jian, president of Anhui Chinese Medical University had mixed feelings after hearing the news. He said: “Chinese medicine is the crystallization of thousands of years of the Chinese nation’s trials, experience and wisdom, yet is also one of the traditional areas that has the greatest potential for innovation.”

As for the laureate herself, 85-year-old Tu Youyou said: “Winning the prize is not very important to me. But this recognition proves the immense value of traditional Chinese medicine.”

Tu Youyou emphasized that TCM and pharmacy are treasures, and that through inheritance, innovation and development their essence could be better understood and so make ever larger contributions to the world.

Tu Youyou said: “Since it has been my lifelong work, I hope artemisinin will be utilized to its full potential, and that a new incentive mechanism can be put in place to ensure that TCM produces more valuable drugs and gives even better protection of human health.”