Homegrown solutions in Viet Nam: bringing C. asiatica compounds forward as candidates to treat liver cancer

Liver cancer is a critical problem in Viet Nam, killing 25 thousand Vietnamese individuals each year - more than any other cancer. The problem is especially acute in Viet Nam because of the convergence of overlapping risk factors: hepatitis B and C are prevalent; alcohol consumption is very high; dioxins persist in the environment stemming from the use of Agent Orange during the Viet Nam War; and cultural and economic factors mean that patients frequently present for modern medicine only at a very advanced stage, relying first on traditional herbal remedies.
However, Viet Nam also presents unique opportunities. Its traditional medicine is largely empirical i.e. based on experience rather than philosophical convictions. There is therefore opportunity for the discovery of natural products with therapeutic efficacy, which could be developed as approved drugs in an informed way through chemistry and biology. Centella asiatica is a popular medicinal herb, and our Vietnamese partners have discovered that one of its natural products, madecassic acid, is active against liver cancer, with chemical derivatives showing further improved potential.
In this project we will work on a number of fronts to bring madecassic acid derivatives forward as potential new therapeutics against liver cancer, which could be produced within Viet Nam. This involves optimisation of growth conditions for maximal madecassic acid production (using analytical chemistry), improvement of chemical extraction processes, broadening the range of chemical derivatives in hand, in-depth studies using chemical biology of the cellular effects of madecassic acid, and exploration of use of polymers to control the rate of release in the body. This work will be underlined and supported by networking activities with stakeholders (doctors, industrialists, farmers, policy makers) in Viet Nam, and survey work to assess attitudes of the population to medicines which cross over the traditional-modern divide.

The impact of this work is oriented towards the benefit of Viet Nam in accordance with the UN's Sustainable Development Goals (SDGs). To ensure that these impacts are always kept in focus, we have assembled an Advisory Board comprised of representatives of the major stakeholders in Viet Nam, including a cancer clinician, the general director of a Vietnamese pharmaceutical company, the director of the farming cooperative in Hue province with whom we will work, and a regional politician. We will also have on our Advisory Board scientists from the UK who are involved in the plant-to-drug pipeline at all stages, along with a UK-based liver cancer clinical expert. This team, as well as further stakeholders, will be invited to workshops in the UK and Viet Nam to ensure maximal impact.
We will generate healthcare impact (SDG3) through research towards the development of drugs for liver cancer, which is the most pressing healthcare need in Viet Nam. To bring the drug to clinical trials and to market is a long term goal which extends beyond this grant, but we will ensure that this is always in mind, assisted by the advisory board, as well as the successful experience of Prof Sung and Prof Garrett in the discovery, development and clinical approval of drugs.
We will create economic impact (SDG1, 8, 9) in the short term by providing farmers in Hue province, a very poor area of Viet Nam, with the capacity to produce and extract Centella asiatica in much higher quantities; there is a very large market for these products in Viet Nam and across southeast Asia. In the longer term, they will be involved in producing the starting materials for any molecule which progresses from this project into an approved drug - this means that the opportunity for industry and innovation surrounding the production of a new drug will be centred on the poorest of the country. In the long term we will also improve Viet Nam's economic situation by reducing the financial burden of treatment of liver cancer which puts many families in serious hardship.
Environmental impact (SDG15) will be generated through development of organic farming practices, and social and political impact (SDG3, 10) will be produced by quantifying the extent to which drugs which cross the tradition/modern medicine divide will be seen favourably by the people of Viet Nam. We will also build capacity in Viet Nam for further research through consolidation of this partnership. Gender equality (SDG5) has been taken fully into account, with the majority of the project partners being women, equality being considered in recruitment, and both men and women being consulted equally in the survey component. Although liver cancer is more common in men than women in Viet Nam, the production of a new treatment will provide benefits to the whole of society.
All of these impacts complement the conventional academia and innovation aspects which are also encompassed within this work.