Tu Youyou – Pharmaceutical Chemist/Malariologist

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Name: Tu Youyou

Life:  30/12/1930–Present

Born: Ningbo, China

Current Occupation: Chief professor of the China Academy of Chinese Medical Sciences (has worked here for sixty years)

“A handful of qinghao immersed in two liters of water, wring out the juice and drink it all” – the (translated) quote from Ge Hong’s two-thousand-year-old book that inspired Tu’s discovery of artemisinin.

[1][2]

Who is Tu Youyou?

Tu Youyou is a pharmaceutical chemist best known for her discovery — or, more accurately, rediscovery — of artemisinin (qinghaosu in Chinese). Since this discovery artemisinin-based therapies, including those using artemisinin derivatives, have been estimated to save millions of lives. In 2015, along with William C. Campbell and Satoshi Ōmura for their work on roundworm parasite infections, she was awarded a half share in the Nobel Prize in Medicine “for her discoveries concerning a novel therapy against Malaria”.[1][3]

Growing up

Tu was born in 1930 in Ningbo, where she lived with her parents and four brothers. Tu has said she is lucky to have received the education she did: and with good reason. The China she grew up in was a country which had low literacy levels for all ages, and the vast majority of the country was under the poverty line (less than $1.90 dollars a day per person). In contrast, Tu was lucky enough to go to some of the best private schools in her region and lived a relatively comfortable life due to her father’s job as a banker.

 At the age of sixteen Tu developed tuberculosis, and, as a result of this, she chose to delve into the world of medicine and in 1951 she began a pharmacology degree at Peking university.

[2][4][5]

Early career

During her degree, Tu was almost exclusively taught by ‘returnees’: Chinese academics who had gained the higher levels of their education at western universities. She had little to no training pertaining to traditional medicine, but this began to change when she went to work for the (then blooming) Academy of Traditional Chinese Medicine (now called the China Academy of Chinese Medical Sciences, or CACMS).  Over the following sixty years Tu would occupy many roles there; it was the experience and training in traditional medicines she obtained that would soon make her suitably equipped to combat malaria. [2]

Tu Youyou working in a lab with her professor in the 1950s

Revolution and resistance

Fast forward to the mid-1960s and the Chinese government have a problem: scientists. From their perspective they of course had many other problems (intellectuals, teachers, businesspeople, anyone who even slightly opposed China’s socialism etc), but the effect of the Cultural Revolution on scientific research is noteworthy here because of its effect on Tu’s career. Most research within the country was halted and hers was no exception. Unfortunately for the government they faced another problem, one potentially more damaging to the communist agenda than scientists: mosquitos.  

[2][6][7]

While the Cultural revolution was taking place in China, the Vietnam war was going strong with huge numbers of troops being killed regularly on each side. This was, in part, due to the parasitic resistance to chloroquine (the most common treatment for malaria at the time) that was spreading throughout South and South-East Asia. When combined with the camp conditions troops lived in, a deadly breeding ground was created. Both sides tried to find solutions to this. China, pressured by their North Vietnamese allies, created a top secret research programme in 1964. After five years of unsuccessful efforts, directors of the programme turned to the academy for traditional Chinese Medicine for help. Tu was made the head of a research group investigating possible treatments found in traditional medicines. She was just thirty-nine with two young kids, yet she found herself agreeing to this momentous task-in her words: “the work was top priority, so I was certainly willing to sacrifice my personal life.” This is, perhaps, a rather restrained way of alluding to her difficult decision to not see her children for three years, but the art of the understatement does appear to be something Tu has mastered.

[2][8][9]

Tu’s discovery of artemisinin

Tu’s research team started by searching through traditional literature, looking through some books as old as the Zhou dynasty (1046–256 BCE), and interviewing traditional Chinese medicine practitioners. Within a few months of starting the research project Tu had summarised over 600 of the most likely treatments and shared them with other research groups. They tested over a hundred extracts of the herbs mentioned in Tu’s summary; none showed any consistent success. Rather than give up hope on traditional medicine as a tool, Tu returned to the literature. One family of herbs she paid attention to was qinghao (also known as the artemesia family) since initial results had been promising but were difficult to reproduce, and, because it was a commonly used treatment by Chinese practitioners at the time. After more searching, she read a line from Ge Hong’s A Handbook of Prescriptions for Emergencies (≈340 CE): “A handful of qinghao immersed in two liters of water, wring out the juice and drink it all”. This was the inspiration Tu needed. Wondering if the boiling method used to extract plant components was damaging the various herbs’ effectiveness, she designed a low temperature extraction method. Put simply, it worked: the artemisia extracted using ethyl ether was extremely effective when tested on rodents with malaria. But this breakthrough moment in late 1971 was only the start of artemisinin’s journey towards being an effective treatment: the drug still needed approval.

[2] [10]

Drug approval

Drug approval is a laborious, yet necessary, task — for example, drug approval in the USA currently takes around ten years — and even in the early seventies in China during the Cultural Revolution drug approval was far from quick and straightforward. Arguments about its toxicity were preventing trials of artemisinin on humans and the 1972 malarial season was nearing its end, so, fearing trials would be pushed back a year, Tu and two more of her team members volunteered themselves. There were precedents for artemisinin being safe: if the previous paragraph proved anything it is that it had been used for two thousand years, just never in such high quantities per person. All three of the volunteers suffered only minor side effects, and, after additional volunteers from the research team, the drug entered clinical trials. A few variations of treatment were tried, and the drug was found to be safe and effective. Following this success Tu went on to derive dihydroartemisinin, a significantly more potent derivative of artemisinin.

[2][11]

Life as a breakthrough scientist

Even though Tu received some awards within China, international recognition for artemisinin and her was not forthcoming. It wasn’t until 1979 that Tu’s paper was published in English, and the World Health Organisation’s recommendation for artemisinin combination therapy (ACT) to be the first-line treatment for malaria only occurred in the 2000s. Nevertheless, since its discovery hundreds of millions of people have received ACT.

For her part, Tu has continued to work at CACMS and advocate for traditional medicine as a rich resource for novel treatments to diseases. She has received many awards for her work in China and grew in international status when she won the Lasker award honors in 2011 and the Nobel prize for medicine in 2015. She used both occasions to further praise the benefits of integrating western and traditional medicine — and importantly not just Chinese traditional medicine. Indeed, in her Lasker awards speech she talked about the discovery of quinine’s (another naturally occurring antimalarial) antimalarial properties being attributed to the traditional use of tree bark in Peru. What was left of her praise during these speeches she chose to bestow onto her research team. Through her acceptance manner and her general career, Tu has demonstrated her modesty, commitment to collaborative research, and to finding the genuine wisdom in ancient wisdom. Her work is a testament to this wisdom, and her ability to value such wisdom and use it to fight disease and save lives on a such a global scale is truly astonishing.

[12][13]

Author’s note:

There are many interesting avenues that I wish I could have explored in this article, and if you’re interested I strongly recommend you Google artemisinin resistance, and look into the reasons for the subsidy of ACTs even though the cost of treatment is less than a dollar (a good place to start is here: Executive Summary – Saving Lives, Buying Time – NCBI Bookshelf (nih.gov)). However, I wanted to briefly mention that Tu has never studied in a western country, never gained a doctorate, and never wrote her papers in English (although this last part was less uncommon when she first discovered malaria). Pursuing science while fitting this description is very difficult and I think this should be contemplated, particularly the need for non-native speakers to write in English for their work to be noticed. Even if you conclude these are unavoidable issues, it’s important to come to that conclusion after contemplation instead of before.

References:

[1] 💻 Nobel prize facts page: Tu Youyou – Facts – NobelPrize.org

[2] 💻 Biographical piece by Tu Youyou: Tu Youyou – Biographical – NobelPrize.org

[3] 💻 Business insider article reporting lives saved by ACTs: How the woman who won the Nobel Prize in Medicine saved millions of lives using ancient Chinese lore | Business Insider

[4] 💻 New York Times piece: China’s Long — but Uneven — March to Literacy – The New York  Times (nytimes.com)

[5] 💻 Our world in data Chinese poverty rates: The global decline of extreme poverty – was it only China? – Our World in Data

[6] 💻 Wikipedia: History of science and technology in the People’s Republic of China – Wikipedia

[7] 💻 Guardian article on the cultural revolution: The Cultural Revolution: all you need to know about China’s political convulsion | China | The Guardian

[8] 💻 Chloroquine resistance: The Origins of Antimalarial-Drug Resistance | NEJM

[9] 💻 Guardian article on Tu Youyou: Tu Youyou: how Mao’s challenge to malaria pioneer led to Nobel prize | Nobel prizes | The Guardian

[10] 💻 The Independent article: Nobel Prize in Medicine: Ancient Chinese mystic led Youyou Tu to develop prizewinning anti-malaria drug | The Independent | The Independent

[11] 💻 Timeline for U.S. drug approval: Drugs, Devices, and the FDA: Part 1: An Overview of Approval Processes for Drugs – ScienceDirect

[12] 💻 The Nobel Prize | Women who changed science | Tu Youyou

[13] 💻 The Lasker foundation (with a transcript of Tu’s acceptance remarks): Artemisinin therapy for malaria | The Lasker Foundation

Extra resources:

📹 Tu’s acceptance speech: YouYou Tu: Discovery of Artemisinin – A gift from Traditional Chinese Medicine to the World – YouTube

📹 Video by Shanghai Eye about Tu: Tu Youyou, the herbal healer – YouTube

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