96 Am. J. Trop. Med. Hyg., 65(2), 2001, pp. 96–99 Copyright  2001 by The American Society of Tropical Medicine and Hygiene PRELIMINARY STUDY OF THERAPEUTIC EFFICACY OF A NEW FASCIOLICIDAL DRUG DERIVED FROM COMMIPHORA MOLMOL (MYRRH) AHMED MASSOUD, SAWSAN EL SISI, OSAMA SALAMA, AND AFAF MASSOUD Tropical Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo; Kasr El-Aini Blood Bank, Cairo University, Cairo; Pharmacognosy Department, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt Abstract. Myrrh (from the stem of the Commiphora molmol tree) is an oleo gum resin that may prove efficacious for the treatment of fascioliasis. We studied 7 patients who were passing Fasciola eggs in their stools and treated them with myrrh. The drug (a formulation consisting of 8 parts of resin and 3.5 parts of volatile oils, all extracted from myrrh) was given in a dose of 12 mg/kg per day for 6 consecutive days in the morning on an empty stomach. Patients were followed for 3 months. The therapy proved to be effective, with pronounced improvement of the general condition and amelioration of all symptoms and signs. A dramatic drop in the egg count was detected at the end of treatment. Eggs were no longer detectable in the feces 3 weeks after treatment and after a follow-up period of 3 months. High eosinophilic counts, elevated liver enzymes, and Fasciola antibody titers returned to nearly normal. No signs of toxicity or adverse effects were observed. We conclude that the formulation of myrrh is safe, well tolerated, and effective for treating fascioliasis. INTRODUCTION Fascioliasis is a zoonotic disease caused by Fasciola (a liver fluke that infects sheep, goats, and cattle), for which humans act as an accidental host. 1 Human fascioliasis is becoming an increasingly important problem in many countries, including Egypt, with increasing frequency in many governorates. 2–10 Outbreaks have occurred in other countries. 11 Myrrh is an oleo gum resin obtained from the stem of Com- miphora molmol (family Burseraceae), a tree that grows in northeast Africa and the Arabian Peninsula. The drug is chiefly collected in Somalia. Much of the resin is obtained by collect- ing it from spontaneous exudation from the cracks and fissures that commonly form in the plant’s bark. Myrrh contains 7–17% volatile oil, 25–40% resin, 57–61% gum, and 3–4% impurities. Myrrh is approved by the U.S. Food and Drug Administration for food use (21 Code of Federal Registration–CFR 172.510) and was given generally recognized as safe (GRAS) status as a flavor ingredient (No. 2765) by the Flavor Extract Manufac- turer’s Association (FEMA). 12,13 The council of Europe included myrrh in the list of plants and parts thereof that are acceptable for use in foods. 13,14 Because drugs that act on schistosomiasis may also act on other parasites, and because myrrh was found to be effective in the treatment of schistosomiasis (with a high cure rate and without side effects 15 ), we decided to try a myrrh-derived drug on patients with fascioliasis to see if it proved beneficial. The present study was designed to investigate the efficacy of a new fasciolicide that may offer a new promising approach in the treatment of fascioliasis. MATERIALS AND METHODS We chose 7 patients for inclusion in our study during the period January–October 1997. Patients were referred to us from different centers and hospitals and by colleagues. Patients pre- sented with positive clinical or laboratory manifestations sug- gesting fascioliasis; all 7 patients were passing Fasciola eggs in their stools. All 7 completed the follow-up period of the study for 3 months. Their ages ranged from 10 to 41 years (mean, 23.7  4.1 years). Five patients were boys or men and 2 were girls or women. All patients provided a full medical history, and all submitted to clinical examination and a number of laboratory investigations, as detailed below. Full medical history included the following: age, sex, oc- cupation, residence, dietary habits (including whether the pa- tients ate raw green vegetables or drank from a contaminated water supply), family medical history, history of fever, abdom- inal pain, abdominal distension, and anorexia, vomiting, diar- rhea, dysentery, jaundice, itching, fatigue, and chest symptoms (e.g., cough and chest pain). Each patient was thoroughly clinically examined for fever, abdominal tenderness, jaundice, pallor, palpable liver and spleen, masses, and ascites. Chest and heart examinations were performed. Laboratory investigations included the following: each pa- tient’s feces were analyzed by means of the modified Kato- Katz 16 technique after the patient had maintained a liver-free diet for at least 7 days; 17 complete laboratory investigations of blood included the following assessments: total leucocytic count, hemoglobin, eosinophilic count, and erythrocyte sedi- mentation rate; liver function tests included alanine transpep- tidase (ALT), aspartate transpeptidase (AST), alkaline phospha- tase, gamma glutamyl transpeptidase, and total serum bilirubin; renal function tests included blood urea and serum creatinine; and serologic diagnosis by use of indirect hemagglutination test (IHAT) was used to detect Fasciola antibodies. 18 A myrrh formulation consisting of 8 parts of resin and 3.5 parts of volatile oils was given orally in a dose of 12 mg/ kg per day for 6 consecutive days in the morning on an empty stomach. The same dose was given to 10 normal, healthy volunteers (age and sex matched) with negative stool analysis and negative IHAT. All patients and normal vol- unteers were followed-up for 3 months. Clinical and stool examinations were performed at the end of treatment and then every week for 3 months. Other investigations were done at the end of treatment and every 2 weeks for 3 months. Patients assumed responsibility for being treated with the myrrh-based drug. All patients gave informed consent. This study was approved by Al-Azhar Medical School Review Board. Three infected members were from a single family. Farag