AIDS TREATMENT NEWS Issue #78, May 5, 1989
John S. James
We have also heard that some health-food stores are exploiting the situation and promoting a dried root or extract by suggesting that it contains compound Q. People should know (1) that the root also contains lectins, which are poisonous when injected because they cause blood cells to clump together, which can cause heart attacks or strokes, and (2) that compound Q (which is a protein called trichosanthin) is almost certainly destroyed by drying, so the dried root used as an herbal medicine for other purposes does not contain the active ingredient.
It is generally believed that a good-quality equivalent of compound Q does exist in China, and has been used there for other purposes for several years (see AIDS TREATMENT NEWS #77, pages 1-2 and page 5). However, this drug is tightly controlled and very difficult to obtain. We have heard from knowledgeable persons (but have not yet been able to confirm independently) that only half a million doses a year are manufactured, all by one factory in or near Shanghai, and that some of it did reach a few persons with AIDS in the U.S. While extracting the active ingredient (trichosanthin) from the Chinese cucumber root is not too difficult for a protein chemist, there are practical prob- lems, especially the need to obtain large quantities of the fresh or frozen root, as well as the usual difficulties of setting up effective manufacturing and quality control for pharmaceuticals.
Any credible, good-quality data which may develop from use of the Chinese compound-Q equivalent would be very important in speeding the authorized clinical trials. At this time, the only clinical trial planned anywhere in the world is a "phase I" study to take place at San Francisco General Hospital. This trial may be slowed by the current budget crisis of the City and County of San Francisco, since hospitalization is required for the study but there is not enough funding to staff the nursing support for the hospital beds.
The San Francisco trial will also be slow because it is designed primarily to test for toxicity and determine the maximum tolerated dose, not to determine whether the drug can help patients. A tiny dose which no one believes could be effective will be tried first, followed by a wait to look for side effects. This process will be repeated several times, with a wait each time. This dose-escalation study could take as little as three to six months, or as long as a year. By contrast, "underground" users of the Chinese drug will test reasonable doses right away -- the same which have already been used in China -- so they can get results far ahead of the official trials. If such use should happen to produce credible evidence that the drug is useful in treating AIDS, then far more pressure would develop to speed the research and regulatory system and make compound Q available through authorized channels. If you have any information about anti-HIV use of the Chinese "crystalized" grade of trichosanthin, please send it to AIDS TREATMENT NEWS at the address above, or call us at 415/255-0588.
We have heard that a phase II trial is now being designed, and could be started before phase I is finished.
We will continue to report on compound Q as we learn more about it.
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