2015 諾貝爾生理學或醫學獎

Nobel Prize in Medicine Awarded to 3 Scientists for Parasite-Fighting Therapies http://nyti.ms/1L1fhpj

2015 諾貝爾生理學或醫學獎

這次諾貝爾生理學或醫學獎令我注意的是這個藥「Ivermectin」，因為日前一位scabies患者被高雄長庚皮膚科醫師開了這個自費口服藥，效果神奇，紅疹和癢幾乎消除，不像之前用BB solution一樣，似有效似無效。查了文獻，才了解這個人畜共通治療藥物，「Ivermectin」。

這三位獲獎者都是利用現代實驗室科學方法來找出長久以來就存在於藥草或是土壤中對抗寄生蟲藥物，因而獲得諾貝爾獎。

Dr. Campbell and Dr. Omura developed Avermectin, the parent of Ivermectin, a medicine that has nearly eradicated river blindness and radically reduced the incidence of filariasis, which can cause the disfiguring swelling of the lymph system in the legs and lower body known as elephantiasis.

看到這段描述，讓我想起醫學院生活中，大一二的寄生蟲學，絲蟲病，會破壞人類的淋巴腺，造成象腿病水腫。Dr. Campbell和 Dr. Omura就是發現了Avermectin這個成份，後來進化成患者現在用的Ivermectin。

另一位是女性的Dr. Tu Youyou，是第一位以大陸籍獲諾貝爾科學獎項的公民（之前也許獲獎者都已不是大陸籍了） became the first citizen of the People’s Republic of China to win a Nobel Prize in the sciences, for discovering Artemisinin, a drug that is now part of standard antimalarial regimens.

“These two discoveries have provided humankind with powerful new means to combat these debilitating diseases that affect hundreds of millions of people annually,” the Nobel Committee said in a statement. “The consequences in terms of improved human health and reduced suffering are immeasurable” because parasitic diseases “represent a huge barrier to improving human health and well-being.”

Parasitic diseases are a threat to an estimated one-third of the world’s population, particularly among the poor in sub-Saharan Africa, South Asia and Latin America. Insects transmit both river blindness (black flies) and malaria (mosquitoes).

沒錯，絲蟲病或是瘧疾都是落後國家才有的傳染病，而且造成相當大的死亡，有了以上兩個藥物的發現「Artemisinin」和「Avermectin」，大大減少了這些拉丁美洲、南非和南亞洲國家人民的痛苦。

In 1987 Merck, which had profited handsomely from use of Ivermectin in domestic and farm animals, began distributing the drug free to people because those who needed it the most could not afford it.

這是個有良心的藥廠（Merck），生產以上這二種藥，免費的供給落後國家人民。

Dr. Omura applied what the Nobel Committee said were “extraordinary skills in developing unique methods” for scientifically characterizing natural products in Streptomyces 鏈黴菌屬 bacteria found in soil. Bacterial cousins have yielded antibiotics like streptomycin.

Dr. Omura carries a plastic bag to collect soil samples. From several thousand cultures of Streptomyces he focused on the 50 he thought showed the most promise against dangerous microbes.

After obtaining cultures from Dr. Omura, Dr. Campbell documented one that yielded a substance that was remarkably effective against parasites in domestic and farm animals. The sample came from a golf course near Tokyo. He named the purified substance Avermectin. Further chemical tests produced Ivermectin that killed parasites in infected humans. 

數十年磨一劍，這二位發現Avermectin的獲獎者，從數千個含鏈黴菌屬的土壤樣本中，慢慢縮小範圍，利用實驗室方法，提練出「Avermectin」。

另一位是大陸本產的諾貝爾獎得主，有中國傳統醫學相關背景，
Dr. Tu, born in 1930, is chief professor at the China Academy of Traditional Chinese Medicine and the first Chinese scientist to win a Nobel science award.

以下這句話看了真是令人會心一笑，諾貝爾獎單位強調這不是頒獎給中國傳統醫學，而是 ...
The Nobel Committee emphasized that it was not giving the award to traditional Chinese medicine but to a scientist who, inspired by it, went on to use sophisticated research methods to find a new therapy for malaria. The discovery came at a time when the parasites became resistant to more traditional drugs like quinine and chloroquine and as the number of infections surged.

文中報導，Dr. Tu篩選了瘧疾區的動物，想辦法找出治療瘧疾的藥物，但是一直沒有一個一致性的結果。後來，她看了古代中國醫書，發現藥草經過高溫煮沸後，雖然會釋放出裡面的成份，但是也會破壞其中活性成份，所以她改以其他方法來萃取純化，就成功找出可以治療瘧疾的「Artemisinin」（註：傳統quinine或是chloroquine，因為抗藥性的問題，效果已經大不如前了）