ethnopharmacological survey of herbal remedies...

Research ArticleEthnopharmacological Survey of Herbal Remedies Used for theTreatment of Cancer in the Greater Casablanca-Morocco

Mohammed Bourhia 1 Abdelaaty Abdelaziz Shahat 23 Omer Mohammed Almarfadi2

Fahd Ali Naser2 Wael Mostafa Abdelmageed24 Amal Ait Haj Said5 Fatiha El Gueddari1

Abderrahim Naamane1 Laila Benbacer 6 and Naima Khlil1

1Laboratory of Chemistry Biochemistry Nutrition and Environment Faculty of Medicine and PharmacyUniversity Hassan II Casablanca Morocco2Department of Pharmacognosy (Medicinal Aromatic and poisonous Plants Research Center) College of PharmacyKing Saud University PO Box 2457 Riyadh 11451 Saudi Arabia3Chemistry of Medicinal Plants Department National Research Centre 33 El-Bohouth St PO Box 12622 Dokki Giza Egypt4Pharmacognosy Department Faculty of Pharmacy Assiut University Assiut 71526 Egypt5Laboratory of Pharmacognosy Faculty of Medicine and Pharmacy of Casablanca Hassan II University Casablanca Morocco6Life Science Division National Centre for Energy Sciences and Nuclear Techniques BP 1382 RP 10001 Rabat Morocco

Correspondence should be addressed to Mohammed Bourhia bourhiamohammedgmailcomand Abdelaaty Abdelaziz Shahat ashahatksuedusa

Received 29 April 2019 Revised 26 June 2019 Accepted 14 July 2019 Published 21 July 2019

Academic Editor Luigi Milella

Copyright copy 2019 Mohammed Bourhia et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Medicinal plants played an important role in traditional medicine for the treatment of diseases since antiquities The aim of thestudy is to carry out an ethnobotanical survey on medicinal plants used traditionally in cancer treatment in the region of GreaterCasablanca-Morocco and to enhance the traditional herbal medicine knowledge 110 traditional healers in the study area wereinterviewed face to face to response a survey questionnaire including the names of plants used in cancer treatment used partsmethods of preparation and route of administration Indices of Fidelity Level (FL) Use Value (UV) and Relative Frequency ofCitation (RFC)were calculated to identify themost effective plants used for cancer treatment Eight species were specified includingAristolochia baetica Aristolochia paucinervis Bryonia dioica Aquilaria malaccensis Marrubium vulgare Lavandula maroccanaEphedra alata and Euphorbia resinifera belonging to 7 families Aristolochiaceae Aquilariaceae and Cucurbitaceae were the mostuseful families in cancer treatment with high significant indices of UV FL and RFCwith values of 1 100 and 1 respectively Rootsand leaves were the most commonly used plant parts Decoction and powder mixed with honey were the frequently used methodfor remedies preparationThe present study showed that the people living in Moroccorsquos economic capital are still highly dependenton traditional herbal medicine for the treatment of cancer Therefore it seems that herbal medicine still plays a crucial role in theprimary healthcare system for the local population During this survey it was reported that even some plant families are highly toxicfor humans like Aristolochiaceae that are frequently used in cancer treatment in the study area As many people still rely on naturaltraditional medicine considering (it is safe with no side effects) so combined effort between all social categories including scientistsand traditional healers should be established for involving the scientific validity of the used plants in the treatment of diseases

1 Introduction

The conventional utilization of medicinal plants for thetreatment of different disease around the world is in practicesince incident timewith the development of civilization Bothanimals and plants have gifted potential for the discovery

of drugs [1 2] Medicinal plants are utilized for the healingof different infections and contributed as a foundation ofmotivation for novel therapeutic agents 80 of the worldstill depend on the traditional uses of medicinal plants[3 4] Cancer is defined as a disease in which abnormalcells divide in an uncontrolled way within the body of

HindawiEvidence-Based Complementary and Alternative MedicineVolume 2019 Article ID 1613457 9 pageshttpsdoiorg10115520191613457

2 Evidence-Based Complementary and Alternative Medicine

aberrational forms of the bodyrsquos own cells All cancer typesdrain through a series of steps described by progressiveloss of normal growth control Cancer can affect peopleat all ages even fetus however the risk for most varietiesincreases with age [5] Cancer has an enormous impact onthe healthcare economy and represents a great health burdenand exhausts healthcare resources worldwide It is estimatedthat 76 million people died from cancer in the world in 2007[6] In Morocco nearly 40000 new cases are diagnosed withcancer each year [7] About 70 to 80 of patients in Africaare treated by traditional medicine due to the high costsof conventional medicines many other people still rely ontraditional medicine considering herbal medicines that haveno side effects because of their natural origins and are oftenconsidered as safe drugs [8]

In Morocco more than 50 of the population live inrural areas where access to conventional healthcare facilitiesis rare Moreover this access is so difficult if the geographicallocation is mountainous Taking into account these condi-tions local people rely strongly on folkloric herbal medicinethan current synthetized drugs [9] Morocco is recognizedfor its ecological diversity due to its geographical location asone of the Mediterranean countries with a long history inmedical tradition and ancestral know-how of folkloric herbalmedicine [10] The knowledge of using medicinal plantsand the procedures applied to their preparation has beeninherited from one generation to upcoming either verballyor in writing [11] The traditional inheritance may be facingextinction if it is not transmitted to next generation [12]many other factors causing a rapid loss of this knowledge likealteration of physical and biological environments expertiseloss due to death of the elderly migration rural exodusacculturation and modernization [13] Serval authors havestudied the traditional pharmacopeia in Morocco whereasvery little or no information was listed on the medicinalplants used for cancer treatment [14]

Willing to contribute to the safeguarding of herbal tra-ditional remedies knowledge and to make it easy to find touse and to be more familiarized with cancer treatment thepresent workwas conducted to highlight themedicinal plantsused in the traditional preparation for cancer treatment Usedparts methods of preparation and route of administrationwere investigated

2 Material and Methods

21 Study Area Casablanca is the largest Moroccan citylocated 90 km south of Moroccan capital (Rabat) stretchedon the Atlantic Ocean and limited to Chaouia - Ourdigharegion to the northeast (33∘ 311015840 599910158401015840 N -7∘ 341015840 599910158401015840 W)The city has grown from a small port at the beginning of the20th century to one of the biggest African cities

22 Economic Interest Nowadays Casablanca is consideredas the most economic and commercial capital of the King-dom Casablanca not only plays a key role in trading eco-nomics for the African-European region but also is thestrongest industrial centre of Morocco with more than half

of the countryrsquos factories investment and half of Moroccorsquoscommercial banking transactions [15]

23 Surface Greater Casablanca region is one of the sixteenMoroccan regions covering an area of 114054 km2 Actuallythe urban area is the most densely populated with 22782 km2per square kilometers or 188 In early 1980 the urban areascovered about 1000 per square kilometers Casablanca regionboasting a population of 3359818 people according to datafrom 2014 [16]

24 Climate The climate conditions in Greater Casablancaare very important for vegetation diversity for numerousreasons The climate of Greater Casablanca is characterizedby as mild winter with average temperature of about 13∘Cand dry summer is influenced by semiarid climates andmaximum temperature of 3840∘C The spring is describedas mild weather in which the average temperature rises to2830∘C while the autumn is characterized by the return ofAtlantic weather in which the average temperature reaches20∘C [17]

25 Vegetation In the Greater Casablanca region vegetationis an essential aspect of land cover the dominant plants inthe study area are palms cactuses pines and Mediterraneansclerophyllous Forests found naturally in Grand Casablancaregion are characterized by high vegetal diversity and areattractive locations for collecting plants More than threegreat forests cover Casablanca land The forest of OuedNfifikh located in the north of Casablanca and the east ofMohammedia city Bouskoura forest is the biggest forest inthe region situated nearly south of Casablanca city Otherforests are situated in the study area like Echellalat forestslocated at the western border of Oued El Maleh The regionsof Greater Casablanca especially those covered by mainlyproductive types of vegetation are irrigated croplands orgrasslands on fertilized soils that reach the water fromnatural sources including rivers which play a crucial role inmaintaining the vegetation sustainability in the study area[18]

26 Data Collection The ethnobotanical survey was con-ducted from December 2018 to April 2018 During thisperiod different places throughout Casablanca city werevisited (Figure 1) The study was effectuated by interviewswith different herbalists and traditional healers who usedherbal remedies in the treatment and prevention of cancer(Figure 2)

During the data collection we used a survey question-naire for explaining to herbalists and traditional healers theobjectives of the study and the importance of providing theinformation in order to obtain their agreement to participateand to maintain transparency in the study Data collectionwas carried out depending on the interviews following thesurvey questionnaire written for the circumstance Duringthe interview 110 traditional herbalists were selected ran-domly throughout Casablanca city and were asked to answera face-to-face questionnaire focused on the following points

Evidence-Based Complementary and Alternative Medicine 3

Casablanca map

Anfa

Hay Hassani

Ma rifMers

Sultan

El FidaSidi

Othmane

Sbata

My Rachid

Sidi Moumen

Sidi Bernoussi

Tanger-Tetouan-

Al Hoceima

Rabat-Sal -K nitra

Casablanca-Settat

F s-Mekn s

Oriental

Dra -Tafilalet

B niMellal-Kh nifra

Marrakech-Safi

Souss-Massaur-

Zaer

Guelmim-Oued Noun

La youne-SakiaEl Hamra

Dakhla-OuedEd Dahab

Aiumln Chock

Aiumln Seba

RochesSidi

Belyout

BenMSick

HayMohammadiNoires

acirc

acirc

acirc

acirc

Figure 1 Map of the study area (Greater Casablanca location)

Figure 2 Shops of interviewed herbalists

(i) Local names of the plants used in the treatment ofcancer

(ii) Parts of the plants used

(iii) Routes of administration

(iv) Preparation methods

The major collected plants during the survey wereidentified and voucher specimens have been depositedin the Herbarium of Scientific Institute of UniversityMohammed VndashRabatndashMorocco under numbers Aristolochiabaetica 101544 Aristolochia paucinervis 101545 Bryoniadioica 101547 Aquilaria malaccensis 101549 Marrubiumvulgare 101551 Lavandula maroccana101552 Ephedra alata101553 and Euphorbia resinifera 101555

27 Statistical Analysis

271 Fidelity Level (FL) The collected data from the surveyquestionnaire were analyzed using a quantitative methodincluding Fidelity Level (FL) Use Value (UV) and RelativeFrequency of Citation (RFC)Thismethod enables us tomakea consensus of the plant species which is frequently usedto treat cancer FL indicates the percentage of informants


pronounce to use plant species for the same purpose regard-ing diseases treatment Fidelity level is calculated using thefollowing Equation

FL () =NPN

times 100 (1)

whereNp indicates the number of interviewed that claimed touse a plant species to treat a particular disease andN indicatesthe interviewed that used herbs as a medicine to cure anydisease [19]

272 Use Value (UV) UVwas calculated using the followingEquation UV=Un

where U indicates the number of species cited by eachinterviewee and n is the total number of informants [20]

273 Relative Frequency of Citation (RFC) RFC index wascalculated according to the following Equation

RFC =FCN

(0 lt RFC lt 1) (2)

where FC indicates the number of interviewed claimed touse species in the treatment and N is the total number ofinterviewees [19]

3 Results and Discussion

31 Demographic Characteristics of Interviewees 110 tradi-tional healers from Greater Casablanca participated in thestudy 10 informants were women and 100 were men Theirage ranges from 30 to 60 years All the informants use herbalmedicine alone in the treatment of cancer It was reported thatthe people in the region depend on the traditional treatmentof cancer including natural preparation for the followingreasons

(i) The accessibility and the very low cost of herbaltreatment compared to conventional treatment takinginto account the low income of Moroccan people

(ii) Some of who believe that the medicinal plants aremore effective against cancer disease than synthesizeddrugs

(iii) Other interviewees considered the medicinal plantshave no side effects compared to conventional drugs

It was reported that the women traditional healers have fullknowledge regarding the herbs used in alternative medicinecompared to men traditional healers The women inheritedtraditional medicine knowledge from their parents and saveit for the future generation The frequency of using themedicinal plants in the treatment increased with age Forthese reasons the present study is in agreement with else-where reported in the literature [21] It was reported that thepercentage of people aged more than 50 40 and 20 years usethe herbs in the treatment of diseases with frequency valuesof 57 18 and13 respectively [12]

1 1 1 1 1 1

2

Aris

tolo

chia

ceae

Aqui

laria

ceae

Lam

iace

ae

Euph

orbi

acea

e

Ephe

drac

eae

Lava

ndul

acea

Cucu

rbita

ceae

Figure 3 Number of medicinal species per botanical family

32 Medicinal Plants Used by the Local Population Duringthe survey period we collected information on 8 plantspecies among 7 families and 7 genera used in cancertreatment in theGreaterCasablanca region as listed inTable 1

The plant families reported in this inventory areAristolochiaceae including two species AquilariaceaeLamiaceae Euphorbiaceae Ephedraceae Lavandulacea andCucurbitaceaewith one species in each Data are summarizedin Figure 3

It was reported that themost popular plant family used inGreater Casablanca for cancer treatment is AristolochiaceaeThe use of this family in cancer treatment is not limited to thestudied area but it is also sold by traditional healers through-out all Moroccan cities for the same purpose of cancertreatment [22] This ethnobotanical survey agrees with otherscientific literature took place inNorthAfrica which reportedthat the Aristolochiaceae belongs to the most effective familyused in traditional treatment of cancer [23] Lamiaceae isanother family inventoried among the medicinal plants usedin alternative medicine for cancer treatment [24] It seemsthat the plantrsquos families cited during the present survey arenot used randomly in the traditional treatment of cancerTherefore several literatures have been seeking the scientificbasis of using the mentioned plants families in this study inwhich it was reported that Aristolochiaceae Euphorbiaceaeand Aquilariaceae families have an interesting antitumoractivity [25ndash27] Lamiaceae Cucurbitaceae Ephedraceaeor their derivatives have been shown antiproliferative andcytotoxic effects against cancer cell lines [28ndash30]

All the medicinal herbs listed in the ethnobotanicalsurvey carried out in the region of Greater Casablanca werewild species (Table 2) The results of the study showed alarge vegetal diversity of plant species used in the traditionaltreatment of cancer in the study area The knowledge depthon traditional uses of herbs in the treatment of diseaseswas reported as a key factor explaining the spreading of theenormous quantity of medicinal plants in the studied regionfor consideration for diseases treatment

The results of the biological analysis of plant form usedin the treatment of cancer in the studied region showed thepresence of Shrubs subshrubs and herbswith a percentage of25 in each Liana and trees were other biological forms listedwith the percentage of 125 in each (Figure 4) The results


Table 1 Plants used for cancer treatment in the Greater Casablanca region

Plant family Plant species Vernacularname

Usedparts Preparation method Administration

route UV FL RFC

AristolochiaceaeAristolochia baetica

Aristolochiapaucinervis

bertzem khal roots powder mixed withhoney oral 1 100 1

Aquilariaceae Aquilaria malaccensis ighris bark powder mixed withhoney oral 1 100 1

Lamiaceae Marrubium vulgare meroute leaves decoction oral 05 40 018Euphorbiaceae Ephedra alata daghmous leaves decoction oral 015 35 015Ephedraceae Ephedra alata elaalnda stem decoction oral 011 20 009

Lavandulacea Lavandula maroccana kouhila leafystem infusion oral 007 10 009

Cucurbitaceae Bryonia dioica berztem byad roots powder mixed withhoney oral 1 100 1

Table 2 Type of plants and habit

Plant family Plant species Type of plants Hbits

Aristolochiaceae Aristolochia baeticaAristolochia paucinervis Spontaneous Shrub

Aquilariaceae Aquilaria malaccensis Spontaneous TreesLamiaceae Marrubium vulgare Spontaneous HerbsEuphorbiaceae Ephedra alata Spontaneous SubshrubEphedraceae Ephedra alata Spontaneous SubshrubLavandulacea Lavandula maroccana Spontaneous HerbsCucurbitaceae Bryonia dioica Spontaneous Liana

0

10

20

30

Her

bs

Shru

bs

Subs

hrub

Lian

a

Tree

s

Freq

uenc

y (

)

Figure 4 Growth forms (habits) of reportedmedicinal plant speciesused for the treatment of cancer in the Greater Casablanca

of this study were used to perform a comparison [12] thatresulted in that herbsrsquo formwas themost biologically effectiveform used in traditional treatment of disease in Morocco

33 Ethnobotanical Indices Fidelity Level (FL) indicates thechoice by which the traditional healer uses a plant species fortreatment a given disease Use Value (UV) indicates the mostcited plants Relative Frequency of Citation (RFC) indicatesthe most desired plants for cancer treatment Regardingthese indices the values of each species cited in the studyare calculated from the available formula mentioned in the

statistical section FL and UV values of collected plants inthe region of Greater Casablanca range from 10 to 100and 007 to 1 respectively RFC value ranges from 009 to 1(Table 1) For screening the important medicinal herbs usedin the region of Greater Casablanca for cancer treatment wemay analyze the obtained results of ethnobotanical indicesof each plant species reported in the survey 4 over 8 plantspecies such as Aristolochia baetica Aristolochia paucinervisBryonia dioica and Aquilaria malaccensis were cited withthe highest values of FL UV and RFC (Table 1) Thereforethe most useful plant species in the treatment of cancer areAristolochia baetica Aristolochia paucinervis Bryonia dioicaand Aquilaria malaccensis with high RFC (1) The findings ofour study were in consent with other studies showing the useof Aristolochia and Bryonia species in traditional treatmentof cancer in Morocco [31]

It seems that in the region of Greater Casablanca a greatconflict takes place between traditional healers regarding theplant collection and resources conservation It was reportedthat many species in the region suffer extinction due to highcollection conducted by the traditional healersThe results ofthe present study agree with another study [21] reportingthat the collection pressure exercised on plants leads some-times to uproot the whole plant instead of the required partThis collectionmanner combinedwith environmental factorscan seriously compromise the sustainability of medicinalplants


0 10 20 30 40Frequency ()

Used part of plant

Stem

Bark

Leaves

Roots

Figure 5 Frequency of plant parts used in natural preparation forcancer treatment

Preparation method

Infusion

Decoction

Powder mixed with honey

6040200Frequency ()

Figure 6 Frequency of preparation method of plant drugs

34 Plant Parts Used Roots and leaves were the major plantparts used in cancer treatment with a percentage of 375 ineach followed by stem and bark with a percentage of 125 ineach (Figure 5)

The use of leaves in alternative medicine could beattributed to accessibility and the facility of collection thanroots as mentioned in the literature [32] Agreeing with ourresults it was reported that the aerial parts are the most plantpart used in the natural preparation for many years ago [33]

35 Preparation Method and Administration Route of PlantDrugs 50 of cited species including Aquilaria malaccensisAristolochia baetica Aristolochia paucinervis and Bryoniadioica are ground into a fine powder after drying at roomtemperature a small quantity (around 1 gram ) of thispowder is mixed with honey (around 1 gram) and sometimeswith salted butter (around 05 gram) then prepared to beingested orally Sometimes the powder is mixed with teafor enhancing the oral administration 375 of the listedspecies in the present study including Euphorbia resiniferasEphedra alata and Marrubium vulgare are prepared forcancer treatment using decoction method It was reportedthat 125 of the inventoried species including Lavandulamaroccana are prepared by the infusion method Sometimesthe same plant could be administered in different preparationforms The prepared remedies are always taken orally forcancer treatment (Figure 6)

Figure 7 Aristolochia baetica

Figure 8 Aristolochia paucinervis

36 Probable Mechanism of Actions of Plants Involved inCancer Treatment Dysregulation of apoptosis is still one ofthe current ways involved in cancer treatment [34] Controlof cancerous cell growing still depends on the ability ofthese cells to undergo apoptosis [35] The most studiedmechanism of actions of plants involved in cancer treatmentas reported in earlier reports was the apoptosis throughthe mitochondrial intrinsic pathway as shown in the effectinduced by aqueous extract ofA longa and Bryonia dioica onBL41 cancer cell lines [36]

37 Harmful Effects of Inventoried Plants Aristolochia baetica(Figure 7) and Aristolochia paucinervis (Figure 8) usedfor cancer treatment in the region of Greater Casablancawere the most toxic plants [22 37] The toxic effects ofthese medicinal plants or their derivatives like aristolochicacids were largely investigated in several literatures [38] Itwas reported that Aristolochia species induced renal failureand affected negatively the biochemical parameters in miceexposed to conditions of subacute toxicity Bryonia dioica(Figure 9) is known for its acute toxicity as reported inthe literature the LD

50of Bryonia dioica roots estimated at

340 mgkg with oral administration to mice [39] Euphorbiaresinifera (Figure 10) calcified belongs to the toxic plant alsoit was reported that exposure to its latex induces oral dermaland ocular symptoms This species was also having some


Figure 9 Bryonia dioica

Figure 10 Euphorbia resinifera

Figure 11 Aquilaria malaccensis

irritant reaction with small concentration [40] For acute andsubacute toxicity study of Aquilaria malaccensis (Figure 11)no toxic effect was detected in treated mice with 2000mgkg[41] Regarding the other cited plants in the present worksuch asMarrubium vulgare (Figure 12) Lavandulamaroccana(Figure 13) and Ephedra alata (Figure 14) no big data wereavailable on their toxicities

Figure 12Marrubium vulgare

Figure 13 Lavandula maroccana

Figure 14 Ephedra alata

4 Conclusion

The present study provided data on the most popular medic-inal plants used in cancer treatment in Greater CasablancaUsed parts methods of preparation and administrationroutes were also investigated It also identified the knowledgeserving anticancer herbs of local origin It seems that someplant species listed in the survey have not been used ran-domly in cancer treatment but scientifically they representedantiproliferative effects on cancer cell lines as reported inthe literature As some medicinal plants exhibiting a hightoxic effect on humans were also used in remedies for cancer


treatment it became very important to pay more attention tostudy the medicinal plants safety

Data Availability

The data used to support the findings of this study areincluded within the article

Conflicts of Interest

The authors declare that there are no conflicts of interest

Acknowledgments

The authors extend their appreciation to the Deanship ofScientific Research at King Saud University for funding thiswork through research group no RGP -262

References

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[2] H Rahman I Khan A Hussain et al ldquoGlycyrrhiza glabraHPLC fractions identification of aldehydo isoophiopogononeand liquirtigenin having activity against multidrug resistantbacteriardquo BMC Complementary and Alternative Medicine vol18 no 1 p 140 2018

[3] A A Shahat R Ullah A S Alqahtani M S Alsaid H AHusseiny and O T R Al Meanazel ldquoHepatoprotective effectof eriobotrya japonica leaf extract and its various fractionsagainst carbon tetra chloride induced hepatotoxicity in ratsrdquoEvidence-Based Complementary and Alternative Medicine vol2018 Article ID 3782768 8 pages 2018

[4] M A Aziz M Adnan A H Khan A A Shahat M S Al-Saidand R Ullah ldquoTraditional uses of medicinal plants practicedby the indigenous communities at Mohmand Agency FATAPakistanrdquo Journal of Ethnobiology and Ethnomedicine vol 14no 1 p 2 2018

[5] A Suganthi and S Libina ldquoSurvey of medicinal and anticancerplants from Vengad Sree Kurumba Kavu sacred grove KannurKeralardquo Journal of Medicinal Plants Studies vol 3 no 6 pp 46ndash50 2015

[6] MO Soladoye N A Amusa S O Raji-Esan E C Chukwumaand A A Taiwo ldquoEthnobotanical survey of anti-cancer plantsin Ogun State Nigeriardquo Annals of Biological Research vol 1 no4 pp 261ndash273 2010

[7] S Benjelloun ldquoNutrition transition in Moroccordquo Public HealthNutrition vol 5 no 1a pp 135ndash140 2002

[8] A NYIKA ldquoEthical and regulatory issues surrounding africantraditional medicine in the context of HIVAIDSrdquo DevelopingWorld Bioethics vol 7 no 1 pp 25ndash34 2007

[9] F Msanda A El Aboudi and J-P Peltier ldquoBiodiversite etbiogeographie de lrsquoarganeraie marocainerdquo Cahiers Agriculturesvol 14 no 4 pp 357ndash364 2005

[10] R Mehdioui and A Kahouadji ldquoEtude ethnobotanique aupresde la population riveraine de la foret drsquoAmsittene cas de laCommune drsquoImi nrsquoTlit (Province drsquoEssaouira)rdquo Bulletin delrsquoInstitut Scientifique Rabat vol 29 pp 11ndash20 2007

[11] S O Okeniyi and S Garba ldquoPhytochemical screening cytotox-icity antioxidant and antimicrobial activities of stem and leaveextracts of euphorbia heterophyllardquo Journal of Biology and LifeScience vol 4 no 1 2012

[12] M Abouri A El Mousadik F Msanda H Boubaker B Saadiand K Cherifi ldquoAn ethnobotanical survey of medicinal plantsused in the Tata Province Moroccordquo International Journal ofMedicinal Plant Research vol 1 no 7 pp 99ndash123 2012

[13] M R Gonzalez-Tejero M Casares-Porcel C P Sanchez-Rojaset al ldquoMedicinal plants in the Mediterranean area synthesis ofthe results of the project Rubiardquo Journal of Ethnopharmacologyvol 116 no 2 pp 341ndash357 2008

[14] H Jouad M Haloui H Rhiouani J El Hilaly and MEddouks ldquoEthnobotanical survey of medicinal plants used forthe treatment of diabetes cardiac and renal diseases in theNorth centre region of Morocco (Fez-Boulemane)rdquo Journal ofEthnopharmacology vol 77 no 2-3 pp 175ndash182 2001

[15] M Nachoui ldquoCasablanca ville glocalerdquo Espace GeographiqueSociete Marocaine 22 2018

[16] H Bahi H Rhinane A Bensalmia U Fehrenbach and DScherer ldquoEffects of urbanization and seasonal cycle on thesurface urban heat island patterns in the coastal growing citiesa case study of CasablancaMoroccordquoRemote Sensing vol 8 no10 p 829 2016

[17] H-J Bolle Mediterranean Climate Variability and TrendsSpringer 1st edition 2003

[18] T Deelstra and H Girardet ldquoUrban agriculture and sustainablecitiesrdquo inGrowing Cities Growing Food N BakkMDubbelingU Sabel-Koshella and U Zeeuw Eds pp 43ndash66 UrbanAgriculture on the Policy Agenda 2000

[19] A Katiri M Barkaoui F Msanda and H Boubaker ldquoEthnob-otanical Survey of Medicinal Plants Used for the Treatmentof Diabetes in the Tizi nrsquo Test Region (Taroudant ProvinceMorocco)rdquo Journal of Pharmacognosy amp Natural Products vol3 no 1 pp 2472-0992 2017

[20] J Friedman Z YanivADafni andD Palewitch ldquoApreliminaryclassification of the healing potential of medicinal plantsbased on a rational analysis of an ethnopharmacological fieldsurvey among Bedouins in the Negev Desert Israelrdquo Journal ofEthnopharmacology vol 16 no 2-3 pp 275ndash287 1986

[21] M Bahmani A Zargaran M Rafieian-Kopaei and K SakildquoEthnobotanical study of medicinal plants used in the manage-ment of diabetes mellitus in the Urmia Northwest Iranrdquo AsianPacific Journal of Tropical Medicine vol 7 no 1 pp S348ndashS3542014

[22] G Benzakour M Amrani and M Oudghiri ldquoA histopatholog-ical analyses of in vivo anti-tumor effect of an aqueous extractof aristolochia longa used in cancer treatment in traditionalmedicine in Moroccordquo International Journal of Plant Researchvol 2 no 2 pp 31ndash35 2012

[23] B Benarba A Pandiella and A Elmallah ldquoAnticancer activityphytochemical screening and acute toxicity evaluation of anaqueous extract ofAristolochia longa Lrdquo International Journal ofPharmaceutical and Phytopharmacological Research vol 6 no1 pp 20ndash26 2017

[24] J M Alves-Silva A Romane T Efferth and L SalgueiroldquoNorth african medicinal plants traditionally used in cancertherapyrdquo Frontiers in Pharmacology vol 8 article no 383 2017

[25] B BenarbaGAmbroise AAoues BMeddah andAVazquezldquoAristolochia longa aqueous extract triggers the mitochondrialpathway of apoptosis in BL41 Burkittrsquos lymphoma cellsrdquo Interna-tional Journal of Green Pharmacy vol 6 no 1 pp 45ndash49 2012


[26] P Cataluna and S Rates ldquoThe traditional use of the latex fromEuphorbia tirucalli Linnaeus (Euphorbiaceae) in the treatmentof cancer in South Brazilrdquo Acta Horticulturae no 501 pp 289ndash296 1999

[27] J-L Cui S-X Guo and P-G Xiao ldquoAntitumor and antimi-crobial activities of endophytic fungi from medicinal parts ofAquilaria sinensisrdquo Journal of Zhejiang University SCIENCE Bvol 12 no 5 pp 385ndash392 2011

[28] N-H Nam C-W Lee D-H Hong H-M Kim K-H Baeand B-Z Ahn ldquoAntiinvasive antiangiogenic and antitumouractivity of Ephedra sinica extractrdquo Phytotherapy Research vol17 no 1 pp 70ndash76 2003

[29] H J Kim J H Park and J Kim ldquoCucurbitacin-I a naturalcell-permeable triterpenoid isolated fromCucurbitaceae exertspotent anticancer effect in colon cancerrdquo Chemico-BiologicalInteractions vol 219 pp 1ndash8 2014

[30] I Berdowska B Zielinski I Fecka J Kulbacka J Saczko andA Gamian ldquoCytotoxic impact of phenolics from Lamiaceaespecies on human breast cancer cellsrdquo Food Chemistry vol 141no 2 pp 1313ndash1321 2013

[31] A Yamani V Bunel M Antoine et al ldquoSubstitution betweenAristolochia and Bryonia genus in North-Eastern Moroccotoxicological implicationsrdquo Journal of Ethnopharmacology vol166 pp 250ndash260 2015

[32] F Tra Bi G Irie K NrsquoGaman and C Mahou ldquoEtudes dequelques plantes therapeutiques utilisees dans le traitementde lrsquohypertension arterielle et du diabete deux maladiesemergentes en Cote drsquoIvoirerdquo Sciences amp Nature vol 5 no 1pp 39ndash48 2008

[33] B Saadi F Msanda and H Boubaker ldquoContributions of folkmedicine knowledge in Southwestern Morocco the case ofrural communities of Imouzzer Ida Outanane Regionrdquo Interna-tional Journal of Medicinal Plant Research pp 135ndash145 2013

[34] M M Chamorro J D Regan L A Opperman and PR Kramer ldquoEffect of storage media on human periodontalligament cell apoptosisrdquoDental Traumatology vol 24 no 1 pp11ndash16 2008

[35] G M Cohen ldquoCaspases the executioners of apoptosisrdquo Bio-chemical Journal vol 326 no 1 pp 1ndash16 1997

[36] B Benarba B Meddah and A Aoues ldquoBryonia dioica aqueousextract induces apoptosis throughmitochondrial intrinsic path-way in BL41 Burkittrsquos lymphoma cellsrdquo Journal of Ethnopharma-cology vol 141 no 1 pp 510ndash516 2012

[37] M Bourhia A A H Said A Chaanoun et al ldquoPhytochemicalscreening and toxicological study of Aristolochia baetica linnroots histopathological and biochemical evidencerdquo Journal ofToxicology vol 2019 Article ID 8203832 7 pages 2019

[38] FDDebelle J LNortier EGDePrez et al ldquoAristolochic acidsinduce chronic renal failure with interstitial fibrosis in salt-depleted ratsrdquo Journal of theAmerican Society ofNephrology vol13 no 2 pp 431ndash436 2002

[39] M Bnouham F ZMerhfourM Elachoui et al ldquoToxic effects ofsomemedicinal plants used inMoroccan traditional medicinerdquoMoroccan Journal of Biology vol 2 pp 21ndash30 2006

[40] B R Thapa and A Walia ldquoLiver function tests and theirinterpretationrdquo The Indian Journal of Pediatrics vol 74 no 7pp 663ndash671 2007

[41] S S Dahham L E A Hassan M B K Ahamed A SAbdul Majid A M S Abdul Majid and N N Zulkepli ldquoInvivo toxicity and antitumor activity of essential oils extractfrom agarwood (Aquilaria crassna)rdquo BMC Complementary andAlternative Medicine vol 16 no 7 p 236 2016

Stem Cells International

Hindawiwwwhindawicom Volume 2018


MEDIATORSINFLAMMATION

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EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

Hindawi Publishing Corporation httpwwwhindawicom Volume 2013Hindawiwwwhindawicom

The Scientific World Journal

Volume 2018

Immunology ResearchHindawiwwwhindawicom Volume 2018

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ObesityJournal of



Computational and Mathematical Methods in Medicine


Behavioural Neurology

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinsonrsquos Disease

Evidence-Based Complementary andAlternative Medicine

Volume 2018Hindawiwwwhindawicom

Submit your manuscripts atwwwhindawicom


aberrational forms of the bodyrsquos own cells All cancer typesdrain through a series of steps described by progressiveloss of normal growth control Cancer can affect peopleat all ages even fetus however the risk for most varietiesincreases with age [5] Cancer has an enormous impact onthe healthcare economy and represents a great health burdenand exhausts healthcare resources worldwide It is estimatedthat 76 million people died from cancer in the world in 2007[6] In Morocco nearly 40000 new cases are diagnosed withcancer each year [7] About 70 to 80 of patients in Africaare treated by traditional medicine due to the high costsof conventional medicines many other people still rely ontraditional medicine considering herbal medicines that haveno side effects because of their natural origins and are oftenconsidered as safe drugs [8]

In Morocco more than 50 of the population live inrural areas where access to conventional healthcare facilitiesis rare Moreover this access is so difficult if the geographicallocation is mountainous Taking into account these condi-tions local people rely strongly on folkloric herbal medicinethan current synthetized drugs [9] Morocco is recognizedfor its ecological diversity due to its geographical location asone of the Mediterranean countries with a long history inmedical tradition and ancestral know-how of folkloric herbalmedicine [10] The knowledge of using medicinal plantsand the procedures applied to their preparation has beeninherited from one generation to upcoming either verballyor in writing [11] The traditional inheritance may be facingextinction if it is not transmitted to next generation [12]many other factors causing a rapid loss of this knowledge likealteration of physical and biological environments expertiseloss due to death of the elderly migration rural exodusacculturation and modernization [13] Serval authors havestudied the traditional pharmacopeia in Morocco whereasvery little or no information was listed on the medicinalplants used for cancer treatment [14]

Willing to contribute to the safeguarding of herbal tra-ditional remedies knowledge and to make it easy to find touse and to be more familiarized with cancer treatment thepresent workwas conducted to highlight themedicinal plantsused in the traditional preparation for cancer treatment Usedparts methods of preparation and route of administrationwere investigated

2 Material and Methods

21 Study Area Casablanca is the largest Moroccan citylocated 90 km south of Moroccan capital (Rabat) stretchedon the Atlantic Ocean and limited to Chaouia - Ourdigharegion to the northeast (33∘ 311015840 599910158401015840 N -7∘ 341015840 599910158401015840 W)The city has grown from a small port at the beginning of the20th century to one of the biggest African cities

22 Economic Interest Nowadays Casablanca is consideredas the most economic and commercial capital of the King-dom Casablanca not only plays a key role in trading eco-nomics for the African-European region but also is thestrongest industrial centre of Morocco with more than half

of the countryrsquos factories investment and half of Moroccorsquoscommercial banking transactions [15]

23 Surface Greater Casablanca region is one of the sixteenMoroccan regions covering an area of 114054 km2 Actuallythe urban area is the most densely populated with 22782 km2per square kilometers or 188 In early 1980 the urban areascovered about 1000 per square kilometers Casablanca regionboasting a population of 3359818 people according to datafrom 2014 [16]

24 Climate The climate conditions in Greater Casablancaare very important for vegetation diversity for numerousreasons The climate of Greater Casablanca is characterizedby as mild winter with average temperature of about 13∘Cand dry summer is influenced by semiarid climates andmaximum temperature of 3840∘C The spring is describedas mild weather in which the average temperature rises to2830∘C while the autumn is characterized by the return ofAtlantic weather in which the average temperature reaches20∘C [17]

25 Vegetation In the Greater Casablanca region vegetationis an essential aspect of land cover the dominant plants inthe study area are palms cactuses pines and Mediterraneansclerophyllous Forests found naturally in Grand Casablancaregion are characterized by high vegetal diversity and areattractive locations for collecting plants More than threegreat forests cover Casablanca land The forest of OuedNfifikh located in the north of Casablanca and the east ofMohammedia city Bouskoura forest is the biggest forest inthe region situated nearly south of Casablanca city Otherforests are situated in the study area like Echellalat forestslocated at the western border of Oued El Maleh The regionsof Greater Casablanca especially those covered by mainlyproductive types of vegetation are irrigated croplands orgrasslands on fertilized soils that reach the water fromnatural sources including rivers which play a crucial role inmaintaining the vegetation sustainability in the study area[18]

26 Data Collection The ethnobotanical survey was con-ducted from December 2018 to April 2018 During thisperiod different places throughout Casablanca city werevisited (Figure 1) The study was effectuated by interviewswith different herbalists and traditional healers who usedherbal remedies in the treatment and prevention of cancer(Figure 2)

During the data collection we used a survey question-naire for explaining to herbalists and traditional healers theobjectives of the study and the importance of providing theinformation in order to obtain their agreement to participateand to maintain transparency in the study Data collectionwas carried out depending on the interviews following thesurvey questionnaire written for the circumstance Duringthe interview 110 traditional herbalists were selected ran-domly throughout Casablanca city and were asked to answera face-to-face questionnaire focused on the following points


Casablanca map

Anfa

Hay Hassani

Ma rifMers

Sultan

El FidaSidi

Othmane

Sbata

My Rachid

Sidi Moumen

Sidi Bernoussi

Tanger-Tetouan-

Al Hoceima

Rabat-Sal -K nitra

Casablanca-Settat

F s-Mekn s

Oriental

Dra -Tafilalet

B niMellal-Kh nifra

Marrakech-Safi

Souss-Massaur-

Zaer

Guelmim-Oued Noun


Dakhla-OuedEd Dahab

Aiumln Chock

Aiumln Seba

RochesSidi

Belyout

BenMSick

HayMohammadiNoires

acirc

acirc

acirc

acirc












FL () =NPN

times 100 (1)





RFC =FCN

(0 lt RFC lt 1) (2)








1 1 1 1 1 1

2

Aris

tolo

chia

ceae

Aqui

laria

ceae

Lam

iace

ae

Euph

orbi

acea

e

Ephe

drac

eae

Lava

ndul

acea

Cucu

rbita

ceae











route UV FL RFC












0

10

20

30

Her

bs

Shru

bs

Subs

hrub

Lian

a

Tree

s

Freq

uenc

y (

)







0 10 20 30 40Frequency ()

Used part of plant

Stem

Bark

Leaves

Roots


Preparation method

Infusion

Decoction


6040200Frequency ()



















4 Conclusion




Data Availability




Acknowledgments


References















































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















Casablanca map

Anfa

Hay Hassani

Ma rifMers

Sultan

El FidaSidi

Othmane

Sbata

My Rachid

Sidi Moumen

Sidi Bernoussi

Tanger-Tetouan-

Al Hoceima

Rabat-Sal -K nitra

Casablanca-Settat

F s-Mekn s

Oriental

Dra -Tafilalet

B niMellal-Kh nifra

Marrakech-Safi

Souss-Massaur-

Zaer

Guelmim-Oued Noun


Dakhla-OuedEd Dahab

Aiumln Chock

Aiumln Seba

RochesSidi

Belyout

BenMSick

HayMohammadiNoires

acirc

acirc

acirc

acirc












FL () =NPN

times 100 (1)





RFC =FCN

(0 lt RFC lt 1) (2)








1 1 1 1 1 1

2

Aris

tolo

chia

ceae

Aqui

laria

ceae

Lam

iace

ae

Euph

orbi

acea

e

Ephe

drac

eae

Lava

ndul

acea

Cucu

rbita

ceae











route UV FL RFC












0

10

20

30

Her

bs

Shru

bs

Subs

hrub

Lian

a

Tree

s

Freq

uenc

y (

)







0 10 20 30 40Frequency ()

Used part of plant

Stem

Bark

Leaves

Roots


Preparation method

Infusion

Decoction


6040200Frequency ()



















4 Conclusion




Data Availability




Acknowledgments


References















































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of





















FL () =NPN

times 100 (1)





RFC =FCN

(0 lt RFC lt 1) (2)








1 1 1 1 1 1

2

Aris

tolo

chia

ceae

Aqui

laria

ceae

Lam

iace

ae

Euph

orbi

acea

e

Ephe

drac

eae

Lava

ndul

acea

Cucu

rbita

ceae











route UV FL RFC












0

10

20

30

Her

bs

Shru

bs

Subs

hrub

Lian

a

Tree

s

Freq

uenc

y (

)







0 10 20 30 40Frequency ()

Used part of plant

Stem

Bark

Leaves

Roots


Preparation method

Infusion

Decoction


6040200Frequency ()



















4 Conclusion




Data Availability




Acknowledgments


References















































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of























route UV FL RFC












0

10

20

30

Her

bs

Shru

bs

Subs

hrub

Lian

a

Tree

s

Freq

uenc

y (

)







0 10 20 30 40Frequency ()

Used part of plant

Stem

Bark

Leaves

Roots


Preparation method

Infusion

Decoction


6040200Frequency ()



















4 Conclusion




Data Availability




Acknowledgments


References















































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of




















0 10 20 30 40Frequency ()

Used part of plant

Stem

Bark

Leaves

Roots


Preparation method

Infusion

Decoction


6040200Frequency ()



















4 Conclusion




Data Availability




Acknowledgments


References















































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of



























4 Conclusion




Data Availability




Acknowledgments


References















































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of





















Data Availability




Acknowledgments


References















































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of








































of




Disease Markers



OncologyJournal of





PPAR Research



Volume 2018


Journal of

ObesityJournal of



















ethnopharmacological survey of herbal remedies...

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