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Jobin PG, Stewart C, Vipani A, Perez-Alvarez I, Pepkowitz S, Klapper E, Berg A, Stillman K, Torbati S, Kuo A, Trivedi H, Yang JD, Steinberger J, Van Allan RJ, Friedman O, Cardoza K, Ayoub WS. Amanita Mushroom Toxin Poisoning in Los Angeles County. ACG Case Rep J 2024; 11:e01246. [PMID: 38162005 PMCID: PMC10754582 DOI: 10.14309/crj.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Mushroom (amatoxin) poisoning from ingestion is a rare but life-threatening medical emergency characterized by gastrointestinal symptoms before progression to multisystem organ failure in severe cases. Many therapies of amatoxin intoxication have been described, including supportive care, medical therapies, detoxification strategies, and liver transplant. The evidence supporting these therapies remains limited due to the rarity of amatoxin poisoning and challenge of a timely diagnosis. We report a case of amatoxin poisoning in Los Angeles causing severe liver injury without acute liver failure treated successfully using medical therapies, gallbladder drainage, and plasma exchange.
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Affiliation(s)
- Parker G. Jobin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Connor Stewart
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Aarshi Vipani
- Karsh Division Gastroenterology & Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ingrid Perez-Alvarez
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Samuel Pepkowitz
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Anders Berg
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kaytlena Stillman
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sam Torbati
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alexander Kuo
- Karsh Division Gastroenterology & Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hirsh Trivedi
- Karsh Division Gastroenterology & Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ju Dong Yang
- Karsh Division Gastroenterology & Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Oren Friedman
- Division of Pulmonary & Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kathryn Cardoza
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Walid S. Ayoub
- Karsh Division Gastroenterology & Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
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Badalamenti N, Vaglica A, Maggio A, Bruno M, Quassinti L, Bramucci M, Maggi F. Cytotoxic activity of several ent-kaurane derivatives of atractyligenin. Synthesis of unreported diterpenic skeleton by chemical rearrangement. PHYTOCHEMISTRY 2022; 204:113435. [PMID: 36154826 DOI: 10.1016/j.phytochem.2022.113435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Atractyloside, carboxyatractyloside, their aglycon atractyligenin, and several synthetic derivatives were tested and found to be active against a panel of human tumor cell lines. Atractyligenin was subjected to oxidation, bromination, and elimination reactions, obtaining several compounds. A singular skeleton was synthesized by chemical rearrangement starting from 3β-bromo-2,15-diketoatractyligenin methyl ester. The synthesized compounds resulted active against all cell lines tested. In particular, 15-ketoatractyligenin methyl ester and 3β-bromo-2,15-diketoatractyligenin methyl ester resulted the most active with IC50 values of 0.427 and 0.723 μM against A375 melanoma cell line. Excellent results were also obtained against the colon cancer cell line CaCo2, with slightly lower antiproliferative activity. An interesting extension of the study should be to analyze the atractyligenin derivatives also as target for human melanoma and human colon cancer cells.
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Affiliation(s)
- Natale Badalamenti
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Parco d'Orleans II, Palermo, 90128, Italy
| | - Alessandro Vaglica
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Parco d'Orleans II, Palermo, 90128, Italy
| | - Antonella Maggio
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Parco d'Orleans II, Palermo, 90128, Italy
| | - Maurizio Bruno
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Parco d'Orleans II, Palermo, 90128, Italy; Centro Interdipartimentale di Ricerca "Riutilizzo bio-based degli scarti da matrici agroalimentari" (RIVIVE), Università di Palermo, Viale delle Scienze, Parco d'Orleans II, Palermo, 90128, Italy.
| | - Luana Quassinti
- School of Pharmacy, Universitiy of Camerino, Via Gentile III da Varano, Camerino, 62032, Italy
| | - Massimo Bramucci
- School of Pharmacy, Universitiy of Camerino, Via Gentile III da Varano, Camerino, 62032, Italy
| | - Filippo Maggi
- Chemistry Interdisciplinary Project (ChIP), School of Pharmacy, University of Camerino, Via Madonna delle Carceri 9/B, 62032 Camerino, Italy
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Badaoui MI, Alabdul Magid A, Benkhaled M, Bensouici C, Harakat D, Voutquenne-Nazabadioko L, Haba H. Pyrroloquinolone A, a new alkaloid and other phytochemicals from Atractylis cancellata L. with antioxidant and anticholinesterase activities. Nat Prod Res 2019; 35:2997-3003. [PMID: 31698943 DOI: 10.1080/14786419.2019.1682575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A new alkaloid pyrroloquinolone A (1), along with fifteen known compounds 2-16 were isolated from the petroleum ether, EtOAc and n-BuOH extracts of the whole plant Atractylis cancellata L. Their structures were elucidated on the basis of extensive spectroscopic analysis including 1D- and 2D-NMR and HR-ESI-MS techniques. This is the first report of alkaloids in the genus Atractylis. Some of the isolated compounds and extracts were evaluated for their antioxidant potential (scavenging activity of DPPH and ABTS radicals, and reducing Fe+3 and Cu+2 power assays) and acetylcholinesterase and butyrylcholinesterase inhibitory activities. Compounds 8 and 11 showed good antioxidant capacity compared to ascorbic acid, BHA, and BHT used as standards, whereas compounds 1 and 2 exhibited good anticholinesterase activities compared to galantamine used as standard.
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Affiliation(s)
- Mohamed Ibrahim Badaoui
- Laboratoire de Chimie et Chimie de l'Environnement (LCCE), Département de Chimie, Faculté des Sciences de la Matière, Université de Batna-1, Batna, Algeria
| | - Abdulmagid Alabdul Magid
- Equipe Chimie des Substances Naturelles, Institut de Chimie Moléculaire de Reims (ICMR-UMR CNRS 7312), Reims, France
| | - Mohammed Benkhaled
- Laboratoire de Chimie et Chimie de l'Environnement (LCCE), Département de Chimie, Faculté des Sciences de la Matière, Université de Batna-1, Batna, Algeria
| | - Chawki Bensouici
- Centre de Recherche en Biotechnologie, Laboratoire de Biochimie, Division Biotechnologie et Santé, Constantine, Algérie
| | | | | | - Hamada Haba
- Laboratoire de Chimie et Chimie de l'Environnement (LCCE), Département de Chimie, Faculté des Sciences de la Matière, Université de Batna-1, Batna, Algeria
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Abstract
The surge in consumption of herbal remedies has been stimulated by several factors, including the notion that all herbal products are safe and effective, consumers becoming more proactive in self-treating, and lack of regulation by the Food and Drug Administration. Although herbal remedies are generally perceived as harmless, reports of hepatotoxicity associated with herbal use are accumulating, suggesting they are not completely innocuous. On the basis of various case reports, the liver injury from herbal remedies has ranged from mild elevations of liver enzymes to fulminant liver failure requiring liver transplantation. Although regulation by the Food and Drug Administration may be part of the solution, increasing public awareness and educating healthcare professionals about the potential dangers of herbal preparations will need to be implemented. This article reviews the hepatotoxicity of herbal remedies as reported in the literature and discusses issues related to regulation of herbal preparations.
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Affiliation(s)
- Eddy Pak
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
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Teschke R, Larrey D, Melchart D, Danan G. Traditional Chinese Medicine (TCM) and Herbal Hepatotoxicity: RUCAM and the Role of Novel Diagnostic Biomarkers Such as MicroRNAs. MEDICINES (BASEL, SWITZERLAND) 2016; 3:E18. [PMID: 28930128 PMCID: PMC5456249 DOI: 10.3390/medicines3030018] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023]
Abstract
Background: Traditional Chinese Medicine (TCM) with its focus on herbal use is popular and appreciated worldwide with increased tendency, although its therapeutic efficacy is poorly established for most herbal TCM products. Treatment was perceived as fairly safe but discussions emerged more recently as to whether herb induced liver injury (HILI) from herbal TCM is a major issue; Methods: To analyze clinical and case characteristics of HILI caused by herbal TCM, we undertook a selective literature search in the PubMed database with the search items Traditional Chinese Medicine, TCM, alone and combined with the terms herbal hepatotoxicity or herb induced liver injury; Results: HILI caused by herbal TCM is rare and similarly to drugs can be caused by an unpredictable idiosyncratic or a predictable intrinsic reaction. Clinical features of liver injury from herbal TCM products are variable, and specific diagnostic biomarkers such as microsomal epoxide hydrolase, pyrrole-protein adducts, metabolomics, and microRNAs are available for only a few TCM herbs. The diagnosis is ascertained if alternative causes are validly excluded and causality levels of probable or highly probable are achieved applying the liver specific RUCAM (Roussel Uclaf Causality Assessment Method) as the most commonly used diagnostic tool worldwide. Case evaluation may be confounded by inappropriate or lacking causality assessment, poor herbal product quality, insufficiently documented cases, and failing to exclude alternative causes such as infections by hepatotropic viruses including hepatitis E virus infections; Conclusion: Suspected cases of liver injury from herbal TCM represent major challenges that deserve special clinical and regulatory attention to improve the quality of case evaluations and ascertain patients' safety and benefit.
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Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, D-63450 Hanau, Teaching Hospital of the Medical Faculty of the Goethe University, Frankfurt/Main D-63450, Germany.
| | - Dominique Larrey
- Department of Liver and Transplantation-IRB-INSERM (Institut de Recherche Biologique-INstitut de la Santé Et de la Recherche Médicale) 1183, Saint Eloi Hospital, Montpellier University, 34295 Montpellier, France.
| | - Dieter Melchart
- Competence Centre for Complementary Medicine and Naturopathy (CoCoNat), Klinikum rechts der Isar, Technische Universität München, Munich D-80801, Germany.
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich CH-8091, Switzerland.
| | - Gaby Danan
- Pharmacovigilance Consultancy, Paris 75020, France.
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Abstract
BACKGROUND Collecting and consuming wild mushrooms is a historical tradition in many European countries, including The Republic of Macedonia. This activity is predominantly performed in the period between June and October, when the weather is warm and humidity in the air and soil is at higher levels.The Amanita genus consists of 500 different species of mushrooms; among these, Amanita phaloides, Amanita virosa and Amanita verna are most commonly found in oak forests in our country. These species are highly poisonous and because they can be similar to some edible mushrooms, they have often been misidentified. Their consumption causes severe intoxication. PURPOSE The aim of this case series report is to demonstrate a severe poisoning with Amanita mushrooms (A. verna) that occurred in 8 patients, all from 1 Macedonian family. RESULTS We show the differences in the clinical appearance and status of these patients, the wide spectrum of symptoms as well as the treatment and outcome of this rare poisoning. One patient, an 8-month-old baby, was excluded from the study because the infant was immediately transferred to the pediatric clinic after admission to our clinic. CONCLUSIONS Despite modern therapy, poisoning due to ingestion of Amanita mushrooms is a serious clinical and health problem that may even be potentially lethal. The most efficient way for the general public to protect itself against potential poisoning is to avoid ingesting mushrooms that may not be edible.
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Stein CM, Wu PE, Scott JA, Weinerman AS. Fulminant hepatic failure following ingestion of wild mushrooms. CMAJ 2015; 187:822-824. [PMID: 26170271 DOI: 10.1503/cmaj.150080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Corey M Stein
- Department of Medicine (Stein, Wu), University of Toronto; Division of Clinical Pharmacology and Toxicology (Wu, Scott), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Scott), University of Toronto; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Peter E Wu
- Department of Medicine (Stein, Wu), University of Toronto; Division of Clinical Pharmacology and Toxicology (Wu, Scott), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Scott), University of Toronto; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - James A Scott
- Department of Medicine (Stein, Wu), University of Toronto; Division of Clinical Pharmacology and Toxicology (Wu, Scott), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Scott), University of Toronto; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Adina S Weinerman
- Department of Medicine (Stein, Wu), University of Toronto; Division of Clinical Pharmacology and Toxicology (Wu, Scott), Sunnybrook Health Sciences Centre; Dalla Lana School of Public Health (Scott), University of Toronto; Division of General Internal Medicine (Weinerman), Sunnybrook Health Sciences Centre, Toronto, Ont.
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Chinese skullcap in move free arthritis supplement causes drug induced liver injury and pulmonary infiltrates. Case Reports Hepatol 2013; 2013:965092. [PMID: 25431706 PMCID: PMC4238172 DOI: 10.1155/2013/965092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/19/2013] [Indexed: 01/22/2023] Open
Abstract
Herbal medications are being increasingly used by the American population especially for common conditions like arthritis. They have been reported to cause adverse effects, including significant hepatotoxicity, but reporting remains sporadic. We report here a patient who developed drug induced liver injury following the intake of Move Free, which is an over-the-counter arthritis supplement. We propose that Chinese skullcap, which is one of the herbal ingredients of the medication, is responsible for the adverse event. There was a strong temporal association between the intake of supplement and onset of symptoms, and also there have been a few recent case reports implicating the same component. A unique observation in our case is the occurrence of pulmonary infiltrates simultaneously with the hepatotoxicity, and this side effect has not been well documented before. Both the hepatic and pulmonary complications completely resolved over few weeks after the patient stopped taking the medication. Since these supplements are readily available over the counter, we feel that it is important to document possible adverse outcomes to raise awareness in the medical community and also among patients.
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Sahu SC, Amankwa-Sakyi M, O'Donnell MW, Sprando RL. Effects of usnic acid exposure on human hepatoblastoma HepG2 cells in culture. J Appl Toxicol 2011; 32:722-30. [DOI: 10.1002/jat.1721] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 06/30/2011] [Accepted: 06/30/2011] [Indexed: 01/25/2023]
Affiliation(s)
- Saura C. Sahu
- Division of Toxicology; Office of Applied Research and Safety Assessment; Center for Food Safety and Applied Nutrition; US Food and Drug Administration; Laurel; MD; 20708; USA
| | - Margaret Amankwa-Sakyi
- Division of Public Health and Biostatistics; Office of Food Defense; Communication and Emergency Response; Center for Food Safety and Applied Nutrition; US Food and Drug Administration; Laurel; MD; 20708; USA
| | - Michael W. O'Donnell
- Division of Public Health and Biostatistics; Office of Food Defense; Communication and Emergency Response; Center for Food Safety and Applied Nutrition; US Food and Drug Administration; Laurel; MD; 20708; USA
| | - Robert L. Sprando
- Division of Toxicology; Office of Applied Research and Safety Assessment; Center for Food Safety and Applied Nutrition; US Food and Drug Administration; Laurel; MD; 20708; USA
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Lu X, Zhao Q, Tian Y, Xiao S, Jin T, Fan X. A metabonomic characterization of (+)-usnic acid-induced liver injury by gas chromatography-mass spectrometry-based metabolic profiling of the plasma and liver in rat. Int J Toxicol 2011; 30:478-91. [PMID: 21878557 DOI: 10.1177/1091581811414436] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Three doses of (+)-usnic acid (100, 200, and 240 mg/kg per d) were administered orally to Wistar rats for 8 days, and metabonomic characterization of (+)-usnic acid-induced liver injury based on gas chromatography-mass spectrometry metabolic profiles was evaluated. Serum biochemical analysis and histopathological examinations were simultaneously performed. The liver/body weight ratio was significantly increased in (+)-usnic acid-treated groups, whereas serum alanine aminotransferase and total bilirubin were significantly elevated. In liver sections of 200 and 240 mg/kg dosage groups, widespread hydropic degeneration of hepatocytes was observed. Clusters in partial least squares discriminant analysis score plots showed control and (+)-usnic acid-treated groups had an obvious separation. (+)-Usnic acid exposure can lead to disturbances in energy metabolism, amino acid metabolism, lipid metabolism, and nucleotide metabolism, which may be attributable to (+)-usnic acid toxicological effects on the liver through oxidative stress. The significant changes in 22 metabolites in liver might be adopted as potential biomarkers.
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Affiliation(s)
- Xiaoyan Lu
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, 866 YuHangTang Road, Hangzhou, 310058 People's Republic of China
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Black cohosh and suspected hepatotoxicity: inconsistencies, confounding variables, and prospective use of a diagnostic causality algorithm. A critical review. Menopause 2010; 17:426-40. [PMID: 20216279 DOI: 10.1097/gme.0b013e3181c5159c] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The data of 69 cases of initially suspected black cohosh (BC)-induced liver disease were reviewed and analyzed to clarify whether BC hepatotoxicity really exists as a disease entity in these cases comparable to toxic liver disease being caused by various drugs and dietary supplements. METHODS The cases comprised 11 published case reports and 58 spontaneous reports to national regulatory agencies. The analysis includes assessment of causality for BC, data quality of the presented cases, and their inconsistencies and confounding variables. RESULTS The assessed data raise serious doubts on the initial claims of causality for BC in these cases and provide clear evidence of their poor quality, especially when spontaneous reports are considered. There are major inconsistencies for the same patient regarding reported data. Moreover, the analysis of all cases disclosed confounding variables. These include poor case data quality, uncertainty of BC product, quality, and identification, undisclosed indication, insufficient adverse event definition, lack of temporal association and dechallenge, missing or inadequate evaluation of alcohol use, comedication, comorbidity, reexposure test, and alternative diagnoses. CONCLUSIONS The presented data do not support the concept of hepatotoxicity in a primarily suspected causal relationship to the use of BC and failure to provide a signal of safety concern, but further efforts have to be undertaken to dismiss or to substantiate the existence of BC hepatotoxicity as a special disease entity. The future strategy should be focused on prospective causality evaluations in patients diagnosed with suspected BC hepatotoxicity, using a structured, quantitative, and hepatotoxicity-specific causality assessment method.
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Furukawa M, Kasajima S, Nakamura Y, Shouzushima M, Nagatani N, Takinishi A, Taguchi A, Fujita M, Niimi A, Misaka R, Nagahara H. Toxic hepatitis induced by show-wu-pian, a Chinese herbal preparation. Intern Med 2010; 49:1537-40. [PMID: 20686286 DOI: 10.2169/internalmedicine.49.3509] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Herbal preparations are widely available and often regarded by the public as harmless remedies for a variety of medical ailments. However, some of these products or their metabolites can cause adverse effects such as liver damage. In this case report a 53-year-old female taking shou-wu-pian for 8 months presented with acute hepatitis. Histopathological assessment of liver tissue obtained by biopsy was consistent with a toxic reaction. Clinical and biochemical resolution was brought about following cessation of the drug. It is important for clinicians to consider Chinese herbal preparations as a potential cause of abnormal liver function test results.
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Dara L, Hewett J, Lim JK. Hydroxycut hepatotoxicity: A case series and review of liver toxicity from herbal weight loss supplements. World J Gastroenterol 2008; 14:6999-7004. [PMID: 19058338 PMCID: PMC2773866 DOI: 10.3748/wjg.14.6999] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dietary supplements represent an increasingly common source of drug-induced liver injury. Hydroxycut is a popular weight loss supplement which has previously been linked to hepatotoxicity, although the individual chemical components underlying liver injury remain poorly understood. We report two cases of acute hepatitis in the setting of Hydroxycut exposure and describe possible mechanisms of liver injury. We also comprehensively review and summarize the existing literature on commonly used weight loss supplements, and their individual components which have demonstrated potential for liver toxicity. An increased effort to screen for and educate patients and physicians about supplement-associated hepatotoxicity is warranted.
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Ribeiro-Santos G, Barbisan LF, Lopes FC, Spinardi-Barbisan ALT, da Eira AF, Kaneno R. Lack of chemopreventive activity of Agaricus blazei mushroom on the development of 1,2-dimethylhydrazine-induced colonic aberrant crypt foci in rats. Nutr Cancer 2008; 60:768-75. [PMID: 19005976 DOI: 10.1080/01635580802196115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chemopreventive and immunomodulatory potential of methanolic (MET) and dichloromethanic (DCl) extracts of Agaricus blazei mushroom were investigated in the postinitiation stage of colon carcinogenesis in male Wistar rats. Animals were initiated with 1,2-dimethylhydrazine (DMH) and treated i.g. with DCl or MET extracts. After 9 wk, animals were sacrificed for evaluation of aberrant crypt foci (ACF) development, crypt cellular proliferation, preneoplastic liver lesions (GST-P), proliferative response of spleen cells to mitogen, and natural killer activity. Administration of DCl extracts did not suppress DMH-induced colonic ACF nor did it affect the crypt multiplicity, but the highest dose of MET significantly reduced the development of preneoplastic lesions in the colon and liver. Lymphoproliferative response was slightly decreased in the initiated control group, which was restored by treatment with MET. No toxicity from DCl and MET extracts was observed (groups MET and DCl).
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Affiliation(s)
- Giovanna Ribeiro-Santos
- Department of Microbiology and Immunology, Institute of Biosciences, Sao Paulo State University-UNESP, Botucatu, SP, Brazil
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Herrera S, Bruguera M. Hepatotoxicidad inducida por el uso de hierbas y medicamentos para perder peso. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:447-53. [DOI: 10.1157/13125592] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Perceptions of safety and/or cultural mores prompt individuals to seek herbal slimming aids in preference to conventional dietary, physical activity and medication-based protocols. In recent years, terpenoid-containing dietary supplements have been implicated in causing severe and sometimes fatal hepatotoxicity. Teucrium polium (germander) was the first of these herbal products to be clearly linked to cases of acute liver failure. Subsequently, similar hepatotoxicity has been observed with other members of the Teucrium genus. While diterpenoid-derived reactive metabolites are central to germander hepatotoxicity, it may also be that the hepatic effects of compounds such as Sho-saiko-to, Centella asiatica and Black cohosh are linked to their triterpenoid content. Other non-terpenoid-containing herbal remedies marketed for weight reduction have been causally associated with significant liver injury. Important among these are preparations containing N-nitrosofenfluramine, usnic acid and ephedra alkaloids. Finally, we review recent data on known and emerging hepatotoxins such as Boh-Gol-Zhee, Kava, pyrrolizidine alkaloids and Shou-Wu-Pian. Better public and physician awareness through health education, early recognition and management of herbal toxicity and tighter regulation of complementary/alternative medicine systems are required to minimize the dangers of herbal product use.
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Affiliation(s)
- Shivakumar Chitturi
- Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
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Stickel F, Schuppan D. Herbal medicine in the treatment of liver diseases. Dig Liver Dis 2007; 39:293-304. [PMID: 17331820 DOI: 10.1016/j.dld.2006.11.004] [Citation(s) in RCA: 210] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 10/02/2006] [Accepted: 11/06/2006] [Indexed: 12/11/2022]
Abstract
Herbal drugs have become increasingly popular and their use is widespread. Licensing regulations and pharmacovigilance regarding herbal products are still incomplete and clearcut proof of their efficacy in liver diseases is sparse. Nevertheless, a number of herbals show promising activity including silymarin for antifibrotic treatment, phyllantus amarus in chronic hepatitis B, glycyrrhizin to treat chronic viral hepatitis, and a number of herbal combinations from China and Japan that deserve testing in appropriate studies. Apart from therapeutic properties, reports are accumulating about liver injury after the intake of herbals, including those advertised for liver diseases. Acute and/or chronic liver damage occurred after ingestion of some Chinese herbs, herbals that contain pyrrolizidine alkaloids, germander, greater celandine, kava, atractylis gummifera, callilepsis laureola, senna alkaloids, chaparral and many others. Since the evidence supporting the use of botanicals to treat chronic liver diseases is insufficient and only few of them are well standardised and free of potential serious side effects, most of these medications are not recommended outside clinical trials. Particularly with regard to the latter, adequately powered randomised-controlled clinical trials with well-selected end points are needed to assess the role of herbal therapy for liver diseases.
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Affiliation(s)
- F Stickel
- Institute of Clinical Pharmacology, University of Berne, Murtenstrasse 35, CH-3010 Berne, Switzerland.
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Escudié L, Francoz C, Vinel JP, Moucari R, Cournot M, Paradis V, Sauvanet A, Belghiti J, Valla D, Bernuau J, Durand F. Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation. J Hepatol 2007; 46:466-73. [PMID: 17188393 DOI: 10.1016/j.jhep.2006.10.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Revised: 09/23/2006] [Accepted: 10/04/2006] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Amanita phalloides poisoning is an uncommon cause of acute liver failure with an especially rapid course. The aim of this study was to re-assess transplantation criteria in patients with mushroom poisoning. METHODS Twenty-seven patients admitted for Amanita phalloides poisoning were studied. Previously reported transplantation criteria, including the recent Ganzert's criteria, were tested retrospectively. RESULTS The rate of fatal intoxication (death and/or transplantation) was 8/27 (30%). An interval between ingestion and diarrhea <8h was a very early predictor of a fatal outcome (accuracy of 78%). Later on, non-paracetamol and paracetamol King's College criteria were superior to Clichy's and Ganzert's criteria (accuracy of 100% compared to 85% and 85%, respectively). Encephalopathy and renal insufficiency were not constant in the fatal intoxication group. Prothrombin index below 10% 4 days or more after ingestion had a 100% accuracy for predicting a fatal outcome. CONCLUSIONS Liver transplantation should be strongly considered in patients with an interval between ingestion and diarrhea <8h. Encephalopathy should not be an absolute prerequisite for deciding transplantation. From day 4 after ingestion, prothrombin index lower than 10% ( approximately INR of 6) alone is a reliable tool for deciding emergency transplantation.
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Affiliation(s)
- Luc Escudié
- Hepatology Unit and INSERM U773, Hospital Beaujon, Clichy, France
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Cheong HK, Kim EA, Choi JK, Choi SB, Suh JI, Choi DS, Kim JR. Grand rounds: an outbreak of toxic hepatitis among industrial waste disposal workers. ENVIRONMENTAL HEALTH PERSPECTIVES 2007; 115:107-12. [PMID: 17366828 PMCID: PMC1797842 DOI: 10.1289/ehp.8951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CONTEXT Industrial waste (which is composed of various toxic chemicals), changes to the disposal process, and addition of chemicals should all be monitored and controlled carefully in the industrial waste industry to reduce the health hazard to workers. CASE PRESENTATION Five workers in an industrial waste plant developed acute toxic hepatitis, one of whom died after 3 months due to fulminant hepatitis. In the plant, we detected several chemicals with hepatotoxic potential, including pyridine, dimethylformamide, dimethylacetamide, and methylenedianiline. The workers had been working in the high-vapor-generating area of the plant, and the findings of pathologic examination showed typical features of acute toxic hepatitis. DISCUSSION Infectious hepatitis and drug-induced hepatitis were excluded by laboratory findings, as well as the clinical course of hepatitis. All cases of toxic hepatitis in this plant developed after the change of the disposal process to thermochemical reaction-type treatment using unslaked lime reacted with industrial wastes. During this chemical reaction, vapor containing several toxic materials was generated. Although we could not confirm the definitive causative chemical, we suspect that these cases of hepatitis were caused by one of the hepatotoxic agents or by a synergistic interaction among several of them. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE In the industrial waste treatment process, the danger of developing toxic hepatitis should be kept in mind, because any subtle change of the treatment process can generate various toxic materials and threaten the workers' health. A mixture of hepatotoxic chemicals can induce clinical manifestations that are quite different from those predicted by the toxic property of a single agent.
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Affiliation(s)
- Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Eun A Kim
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Korea
- Address correspondence to E.-A Kim, Center for Occupational Disease, Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency 34-4 Gusan-dong, Bupyeong-gu, Incheon, 430-711 Korea. Telephone: 82-32-510-0910. Fax: 82-32-518-0862. E-mail:
or
| | - Jung-Keun Choi
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Korea
| | - Sung-Bong Choi
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Korea
| | - Jeong-Ill Suh
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, Korea
| | - Dae Seob Choi
- Department of Diagnostic Radiology, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jung Ran Kim
- Department of Pathology, College of Medicine, Dongguk University, Gyeongju, Korea
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Sanchez W, Maple JT, Burgart LJ, Kamath PS. Severe hepatotoxicity associated with use of a dietary supplement containing usnic acid. Mayo Clin Proc 2006; 81:541-4. [PMID: 16610575 DOI: 10.4065/81.4.541] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Dietary supplements containing usnic acid are marketed for weight loss and have been associated with hepatotoxicity. The specific ingredient responsible for the hepatotoxicity is currently unknown. We describe 2 patients who developed severe hepatotoxicity within 3 months of taking a dietary supplement containing usnic acid. One patient developed fulminant hepatic failure requiring emergency liver transplantation; the other developed submassive hepatic necrosis but did not require transplantation. Thorough investigation, including histopathological examination of the liver, revealed no other cause of acute liver injury. Usnic acid hepatotoxicity should be considered as a possible etiologic factor in patients presenting with fulminant hepatic failure, especially if they have been taking dietary supplements for weight reduction.
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Affiliation(s)
- William Sanchez
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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24
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Ozçay F, Baskin E, Ozdemir N, Karakayali H, Emiroglu R, Haberal M. Fulminant liver failure secondary to mushroom poisoning in children: importance of early referral to a liver transplantation unit. Pediatr Transplant 2006; 10:259-65. [PMID: 16573619 DOI: 10.1111/j.1399-3046.2005.00452.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patients poisoned with toxic mushrooms have a spectrum of clinical presentations ranging from gastrointestinal symptoms to fulminant liver failure, and outcomes range from complete recovery to the need for liver transplantation. We reviewed the clinical presentation, course, outcome and management of four children poisoned with mushrooms who developed fulminant liver failure. Although one patient survived, two children died and one underwent living related liver transplantation. Early referral to specialized centers for treatment and for liver transplantation is emphasized.
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Affiliation(s)
- Figen Ozçay
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Başkent University Medical Faculty, Ankara, Turkey.
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Affiliation(s)
- Felix Stickel
- Department of Medicine, Salem Medical Center, Heidelberg, Germany
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26
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Daniele C, Dahamna S, Firuzi O, Sekfali N, Saso L, Mazzanti G. Atractylis gummifera L. poisoning: an ethnopharmacological review. JOURNAL OF ETHNOPHARMACOLOGY 2005; 97:175-181. [PMID: 15707749 DOI: 10.1016/j.jep.2004.11.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 11/15/2004] [Accepted: 11/16/2004] [Indexed: 05/24/2023]
Abstract
Atractylis gummifera L. (Asteraceae) is a thistle located in the Mediterranean regions. Despite the plant's well-known toxicity, its ingestion continues to be a common cause of poisoning. The toxicity of Atractylis gummifera resides in atractyloside and carboxyatractyloside, two diterpenoid glucosides capable of inhibiting mitochondrial oxidative phosphorylation. Both constituents interact with a mitochondrial protein, the adenine nucleotide translocator, responsible for the ATP/ADP antiport and involved in mitochondrial membrane permeabilization. Poisoned patients manifest characteristic symptoms such as nausea, vomiting, epigastric and abdominal pain, diarrhoea, anxiety, headache and convulsions, often followed by coma. No specific pharmacological treatment for Atractylis gummifera intoxication is yet available and all the current therapeutic approaches are only symptomatic. In vitro experiments showed that some compounds such as verapamil, or dithiothreitol could protect against the toxic effects of atractyloside, but only if administered before atractyloside exposure. New therapeutic approaches could come from immunotherapy research: some studies have already tried to produce polyclonal Fab fragments against the toxic components of Atractylis gummifera.
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Affiliation(s)
- C Daniele
- Department of Pharmacology of Natural Substances and General Physiology, University of Rome La Sapienza, P.le Aldo Moro 5, 00185 Rome, Italy.
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Peyrin-Biroulet L, Barraud H, Petit-Laurent F, Ancel D, Watelet J, Chone L, Hudziak H, Bigard MA, Bronowicki JP. Hépatotoxicité de la phytothérapie : données cliniques, biologiques, histologiques et mécanismes en cause pour quelques exemples caractéristiques. ACTA ACUST UNITED AC 2004; 28:540-50. [PMID: 15243386 DOI: 10.1016/s0399-8320(04)95009-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Laurent Peyrin-Biroulet
- Service d'Hépato-Gastroentérologie et Laboratoire de Pathologie Cellulaire et Moléculaire en Nutrition-INSERM E00-14, CHU Nancy-Brabois, allée du Morvan, 54511 Vandoeuvre-lès-Nancy
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Fu PP, Xia Q, Lin G, Chou MW. Pyrrolizidine Alkaloids—Genotoxicity, Metabolism Enzymes, Metabolic Activation, and Mechanisms. Drug Metab Rev 2004; 36:1-55. [PMID: 15072438 DOI: 10.1081/dmr-120028426] [Citation(s) in RCA: 368] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Pyrrolizidine alkaloid-containing plants are widely distributed in the world and are probably the most common poisonous plants affecting livestock, wildlife, and humans. Because of their abundance and potent toxicities, the mechanisms by which pyrrolizidine alkaloids induce genotoxicities, particularly carcinogenicity, were extensively studied for several decades but not exclusively elucidated until recently. To date, the pyrrolizidine alkaloid-induced genotoxicities were revealed to be elicited by the hepatic metabolism of these naturally occurring toxins. In this review, we present updated information on the metabolism, metabolizing enzymes, and the mechanisms by which pyrrolizidine alkaloids exert genotoxicity and tumorigenicity.
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Affiliation(s)
- Peter P Fu
- National Center for Toxicological Research, Jefferson, Arkansas 72079, USA.
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31
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Ribeiro LR, Salvadori DMF. Dietary components may prevent mutation-related diseases in humans. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2003; 544:195-201. [PMID: 14644321 DOI: 10.1016/j.mrrev.2003.06.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since it is not always possible to reduce human exposure to mutagens, attempts have been directed to identify potential antimutagens and anticarcinogens for use in protecting the population against environmental disease. The purpose of this paper is to provide the reader with information about the antimutagenic and anticarcinogenic potentials of some dietary constituents and foods widely consumed in Brazil, and to reinforce diet as a key factor in determining genomic stability and preventing human diseases. In this report, we have summarized data that show interactive effects between some dietary components and specific chemical mutagens or carcinogens using in vitro and in vivo short- or medium-term assays. The summary indicates that certain dietary compounds may be useful agents for disease prevention.
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Affiliation(s)
- Lúcia Regina Ribeiro
- Programa de Pós-Graduação em Patologia, Faculdade de Medicina de Botucatu-UNESP, 18618-000 Botucatu, SP, Brazil
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Pinheiro F, Faria RR, de Camargo JLV, Spinardi-Barbisan ALT, da Eira AF, Barbisan LF. Chemoprevention of preneoplastic liver foci development by dietary mushroom Agaricus blazei Murrill in the rat. Food Chem Toxicol 2003; 41:1543-50. [PMID: 12963007 DOI: 10.1016/s0278-6915(03)00171-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The chemopreventive potential of an Agaricus blazei (Ab) Murrill mushroom meal was investigated in a medium-term rat liver carcinogenesis assay. Male Wistar rats initiated for hepatocarcinogenesis with diethylnitrosamine (DEN, 200 mg/kg i.p.) were fed during a 6-week period with the dry powdered mushroom strains Ab 29 or 26, each one with opened (OB) or closed basidiocarp (CB), mixed at 10% level in a basal diet. All experimental animals and controls were subjected to partial hepatectomy at week 3 and killed at week 8. Chemopreventive activity of the mushroom meal was observed for the Ab 29 (OB and CB) and Ab 26 (CB) strains in terms of the number of putative preneoplastic altered foci of hepatocytes which express either the enzyme glutathione S-transferase, placental form (GST-P+) or the transforming growth factor-alpha, and for the Ab 29 (OB) and Ab 26 (CB) strains on the size of GST-P+ foci. This was associated with inhibition of foci cell proliferation in the animals fed the Ab 29 (OB) and Ab 26 (CB) strains. The results suggest that the protective influence of the Ab meal against the DEN potential for rat liver carcinogenicity depends on both the strain and period of mushroom harvest.
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Affiliation(s)
- F Pinheiro
- Departamento de Morfologia, Instituto de Biociências, Universidade Estadual Paulista, Botucatu, 18618-000, SP, Brazil
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Lin TJ, Su CC, Lan CK, Jiang DD, Tsai JL, Tsai MS. Acute poisonings with Breynia officinalis--an outbreak of hepatotoxicity. ACTA ACUST UNITED AC 2003; 41:591-4. [PMID: 14514003 DOI: 10.1081/clt-120023760] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In combination with other traditional Chinese medicines, Breynia officinalis, a species of Euphorbiaceae, has long been used to treat contusions, heart failure, venereal diseases, growth retardation, and conjunctivitis. B. officinalis, regarded as a poison, was mistaken for a similar plant, Securinega suffruticosa, and cooked in a soup used for the treatment of muscle soreness, lumbago, and as a tonic in this outbreak. CASE SERIES Nineteen patients, 11 males and 8 females (average age 49.2 +/- 9.1 years) consumed an average of 130 mL (30-900 mL) of soup containing B. officinalis stems. Fourteen patients developed diarrhea, 10 experienced nausea and chilly sensations, 9 had sensations of abdominal fullness, and 7 suffered from vomiting. The results of liver function tests (LFTs) indicated that the observed maximum median level of alanine aminotransferase (ALT) was 647U/L (range 89-9440 U/L), aspartate aminotransferase (AST) 314 U/L (range 47-7756 U/L), alkaline phosphatase 251 U/L (range 224-278 U/L), and gamma glutamyl transpeptidase 106 U/L (range 84-313 U/L). The median time to the observed median peak levels was 3 days for ALT, 2 days for AST, 5 days for alkaline phosphatase, and 12 days for gamma glutamyl transpeptidase. With supportive treatment, the majority of abnormalities in 14 of the cases resolved within 6 months of exposure. CONCLUSIONS The consumption of a soup containing B. officinalis Hemsley resulted in dose-related toxic effects. Clinical toxicity consisted primarily of gastrointestinal symptoms and signs and hepatotoxicity. Hepatocellular liver injury rather than cholestatic liver injury was observed. Marked jaundice did not develop.
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Affiliation(s)
- Tzeng-Jih Lin
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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34
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Affiliation(s)
- Mario Chojkier
- Department of Medicine and Center for Molecular Genetics, Veterans Affairs Healthcare System and University of California San Diego, VAMC (111-D), San Diego, CA 92161, USA.
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35
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Barbisan LF, Spinardi-Barbisan ALT, Moreira ELT, Salvadori DMF, Ribeiro LR, da Eira AF, de Camargo JLV. Agaricus blazei (Himematsutake) does not alter the development of rat diethylnitrosamine-initiated hepatic preneoplastic foci. Cancer Sci 2003; 94:188-92. [PMID: 12708495 PMCID: PMC11160270 DOI: 10.1111/j.1349-7006.2003.tb01417.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2002] [Revised: 11/11/2002] [Accepted: 11/14/2002] [Indexed: 11/30/2022] Open
Abstract
The modifying potential of crude extracts of the mushroom Agaricus blazei Murrill (Himematsutake) on the development and growth of glutathione S-transferase placental form (GST-P)-positive liver foci (liver preneoplastic lesion) was investigated in adult male Wistar rats. Six groups of animals were used. Groups 2 to 5 were given a single i.p. injection of 200 mg/kg b.w. of diethylnitrosamine (DEN) and groups 1 and 6 were treated with saline at the beginning of the experiment. After 2 weeks, animals of groups 3 to 6 were orally treated with three dose levels of aqueous extracts of the mushroom A. blazei (1.2, 5.6, 11.5, and 11.5 mg/ml of dry weight of solids) for 6 weeks. All animals were subjected to two-thirds partial hepatectomy at week 3 and sacrificed at week 8. Two hours before sacrifice, ten animals of each group were administered a single i.p injection of 100 mg/kg of bromodeoxyuridine (BrdU). Apoptotic bodies and BrdU-positive hepatocyte nuclei were quantified in liver sections stained for hematoxylin and eosin (H&E) (eosinophilic foci) and simultaneously stained for GST-P expression (GST-P-positive foci), respectively. The 6-week treatment with A. blazei did not alter the development (number and size) of GST-P-positive foci and did not affect the growth kinetics of liver normal parenchyma or foci in DEN-initiated animals. Our results indicate that the treatment with aqueous extracts of the mushroom A. blazei during the post-initiation stage of rat liver carcinogenesis does not exert any protective effect against the development of GST-P-positive foci induced by DEN.
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Affiliation(s)
- Luís Fernando Barbisan
- Departamento de Morfologia, Instituto de Biologia, UNESP, Botucatu, 18618-000, SP, Brazil
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36
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Baldwin PD, Gobel BH. Chemical Hepatitis. Clin J Oncol Nurs 2003. [DOI: 10.1188/03.cjon.99-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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37
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Sleeper RB, Kennedy SM. Adverse reaction to a dietary supplement in an elderly patient. Ann Pharmacother 2003; 37:83-6. [PMID: 12503940 DOI: 10.1345/aph.1c186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the case of an elderly patient who experienced hepatic enzyme elevations and symptoms of hepatitis associated with the administration of a dietary supplement. CASE SUMMARY A 92-year-old white woman with no history of hepatic disease developed jaundice and increased confusion associated with increased hepatic enzymes. The hepatitis panel, abdominal ultrasound, and antinuclear antibody screen indicated no abnormalities. A drug regimen review revealed that the patient was receiving a dietary supplement, Nutrilite Double X Multivitamin-Multimineral. Following discontinuation of the supplement, the patient's symptoms resolved and the hepatic enzymes decreased or returned to the reference range at evaluations occurring 1 week and 1 month after intervention. An objective causality assessment revealed this to be a probable adverse drug event. DISCUSSION While the association of certain herbal preparations with hepatotoxicity has been demonstrated, the potential for this adverse effect is easily overlooked. In this patient, infectious or autoimmune causes of acute hepatitis were ruled out, and drug-induced causes were considered. The resolution of symptoms and laboratory values following discontinuation of the supplement support a relationship between the dietary supplement and this episode of hepatitis. CONCLUSIONS Our case indicates that there was a probable relationship between the dietary supplement Nutrilite Double X Multivitamin-Multimineral and the development of acute hepatitis. Due to the multi-ingredient formulation of the product, as well as lack of data describing manufacturing procedures, it is difficult to determine which component may be associated with this effect. Over-the-counter supplements should be considered as a part of the differential diagnosis in patients presenting with increased liver enzymes and related symptoms.
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Affiliation(s)
- Rebecca B Sleeper
- Pharmacy Practice, Geriatrics, School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX 79430-8162, USA.
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Thyagarajan SP, Jayaram S, Gopalakrishnan V, Hari R, Jeyakumar P, Sripathi MS. Herbal medicines for liver diseases in India. J Gastroenterol Hepatol 2002; 17 Suppl 3:S370-6. [PMID: 12472966 DOI: 10.1046/j.1440-1746.17.s3.30.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The use of natural remedies for the treatment of liver diseases has a long history, starting with the Ayurvedhic treatment, and extending to the Chinese, European and other systems of traditional medicines. The 21st century has seen a paradigm shift towards therapeutic evaluation of herbal products in liver diseases by carefully synergizing the strengths of the traditional systems of medicine with that of the modern concept of evidence-based medicinal evaluation, standardization of herbal products and randomized placebo controlled clinical trials to support clinical efficacy. The present review provides the status report on the scientific approaches made to herbal preparations used in Indian systems of medicine for the treatment of liver diseases. In spite of the availability of more than 300 preparations for the treatment of jaundice and chronic liver diseases in Indian systems of medicine using more than 87 Indian medicinal plants, only four terrestrial plants have been scientifically elucidated while adhering to the internationally acceptable scientific protocols. In-depth studies have proved Sylibum marianum to be anti-oxidative, antilipidperoxidative, antifibrotic, anti-inflammatory, immunomodulating and liver regenerative. Glycyrrhiza glabra has been shown to be hepatoprotective and capable of inducing an indigenous interferon. Picrorhiza kurroa is proved to be anti-inflammatory, hepatoprotective and immunomodulatory. Extensive studies on Phyllanthus amarus have confirmed this plant preparation as being anti-viral against hepatitis B and C viruses, hepatoprotective and immunomodulating, as well as possessing anti-inflammatory properties. For the first time in the Indian systems of medicine, a chemo-biological fingerprinting methodology for standardization of P. amarus preparation has been patented.
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Affiliation(s)
- S P Thyagarajan
- Department of Microbiology, Dr ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, India.
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Acharya SK, Batra Y, Hazari S, Choudhury V, Panda SK, Dattagupta S. Etiopathogenesis of acute hepatic failure: Eastern versus Western countries. J Gastroenterol Hepatol 2002; 17 Suppl 3:S268-73. [PMID: 12472948 DOI: 10.1046/j.1440-1746.17.s3.12.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Etiopathogenesis of acute hepatic failure (AHF) in Eastern and Western countries is distinct. In the East hepatitis viruses cause AHF in more than 95% of such cases, while causes of AHF in the West are quite heterogenous. Hepatitis E virus is the major etiological agent of AHF in countries like India where the virus is hyperendemic. Occult HBV infection may also be causing AHF in a sizable proportion of cases in areas where chronic HBV infection frequency is high. Paracetamol causes AHF in about 70% cases in the UK and about 20% cases in USA, whereas in France and Denmark, non-steroidal anti-inflammatory drugs are more frequently associated with AHF. Hepatitis B virus causes AHF in about one-third of cases in the latter two countries.
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Affiliation(s)
- S K Acharya
- Department of Gastroenterology and Pathology, All India Institute of Medical Sciences, New Delhi, India.
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Verucchi G, Calza L, Attard L, Chiodo F. Acute hepatitis induced by traditional Chinese herbs used in the treatment of psoriasis. J Gastroenterol Hepatol 2002; 17:1342-3. [PMID: 12423285 DOI: 10.1046/j.1440-1746.2002.02887.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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41
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Barbisan LF, Miyamoto M, Scolastici C, Salvadori DMF, Ribeiro LR, Eira AF, de Camargo JLV. Influence of aqueous extract of Agaricus blazei on rat liver toxicity induced by different doses of diethylnitrosamine. JOURNAL OF ETHNOPHARMACOLOGY 2002; 83:25-32. [PMID: 12413704 DOI: 10.1016/s0378-8741(02)00171-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The modifying potential of prior administration of an aqueous extract of the mushroom Agaricus blazei Murrill (Agaricaceae) (Ab) on hepatotoxicity induced by different doses of diethylnitrosamine (DEN) in male Wistar rats was evaluated. During 2 weeks, animals of groups G3 (Ab+DEN(50)), G5 (Ab+DEN(100)), G7 (Ab+DEN(200)), and G8 (Ab-treated) were treated with the A. blazei through drinking water. After this period, groups G2 (DEN(50)), G3 (Ab+DEN(50)), G4 (DEN(100)) G5 (Ab+DEN(100)), G6 (DEN(200)), and G7 (Ab+DEN(200)) were given a single i.p. injection of 50, 100 and 200 mg/kg of DEN, respectively, while groups G1 (non-treated) and G8 (Ab-treated) were treated with 0.9% NaCl only. All animals were killed 48 h after DEN or NaCl treatments. The hepatocyte replication rate was estimated by the index of the proliferating cell nuclear antigen (PCNA) positive hepatocytes and the appearance of putative preneoplastic hepatocytes through expression of the enzyme glutathione S-transferase placental form (GST-P). After DEN-treatment, ALT levels, PCNA labeling index, and the number of GST-P positive hepatocytes were lower in rats that received A. blazei treatment and were exposed to 100 mg/kg of DEN. Our findings suggest that previous treatment with A. blazei exerts a hepatoprotective effect on both liver toxicity and hepatocarcinogenesis process induced by a moderately toxic dose of DEN.
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Affiliation(s)
- L F Barbisan
- Departamento de Morfologia, Instituto de Biologia, UNESP, Botucatu 18618-000, SP, Brazil
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Dourakis SP, Papanikolaou IS, Tzemanakis EN, Hadziyannis SJ. Acute hepatitis associated with herb (Teucrium capitatum L.) administration. Eur J Gastroenterol Hepatol 2002; 14:693-5. [PMID: 12072605 DOI: 10.1097/00042737-200206000-00016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Drug-induced hepatotoxicity due to medicinal plant administration has been infrequently reported. This case describes a 62-year-old Caucasian man with hypercholesterolaemia and hyperglycaemia, who started daily consumption of a tea containing the medicinal plant Teucrium capitatum L. Four months after initiation of this therapy he developed an acute icteric hepatitis-like illness. Other causes of acute hepatocellular necrosis were excluded. Liver histology demonstrated changes consistent with acute hepatitis with bridging necrosis. The medicinal plant was withdrawn. The patient recovered clinically and serum bilirubin and aminotransferases returned to normal levels within a 9-week time period. To the best of our knowledge, this is the first description of acute hepatitis associated with T. capitatum administration. This case suggests that T. capitatum can induce acute icteric hepatocellular necrosis, which could be clinically confused with acute viral hepatitis, and that some medicinal plants are not as safe as they are widely considered.
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Affiliation(s)
- Spyros P Dourakis
- Academic Department of Medicine, Hippokration General Hospital, Athens University, Athens, Greece.
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43
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Andrade RJ, Lucena MI, García-Cortés M. [Hepatotoxicity due to herbal infusion]. GASTROENTEROLOGIA Y HEPATOLOGIA 2002; 25:327-32. [PMID: 11985805 DOI: 10.1016/s0210-5705(02)79029-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R J Andrade
- Unidad de Hepatología. Servicio de Aparato Digestivo. Hospital Universitario. Virgen de la Victoria. Facultad de Medicina. Málaga. Spain.
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Affiliation(s)
- Christine A Haller
- California Poison Control System and Department of Medicine, Division of Clinical Pharmacology Box 1220 University of California, San Francisco (UCSF) San Francisco, CA 94143-1220, USA.
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45
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Broussard CN, Aggarwal A, Lacey SR, Post AB, Gramlich T, Henderson JM, Younossi ZM. Mushroom poisoning--from diarrhea to liver transplantation. Am J Gastroenterol 2001; 96:3195-8. [PMID: 11721773 DOI: 10.1111/j.1572-0241.2001.05283.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mushroom poisoning from the genus Amanita is a medical emergency, with Amanita phalloides being the most common species. The typical symptoms of nausea, vomiting, abdominal pain, and diarrhea are nonspecific and can be mistaken for gastroenteritis. If not adequately treated, hepatic and renal failure may ensue within several days of ingestion. In this case series, patients poisoned with Amanita virosa are described with a spectrum of clinical presentations and outcomes ranging from complete recovery to fulminant hepatic failure. Although there are no controlled clinical trials, a few anecdotal studies provide the basis for regimens recommended to treat Amanita poisoning. Use of i.v. penicillin G is supported by most reports. Silibinin, although preferred over penicillin, is not easily available in the United States. In those with acute liver failure, liver transplantation can be life saving.
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Affiliation(s)
- C N Broussard
- Department of Gastroenterology, The Cleveland Clinic Foundation, Ohio, USA
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Abstract
Noncirrhotic portal hypertension represents a heterogeneous group of conditions that have distinct clinical and hemodynamic features that often help distinguish them from cirrhosis. [figure: see text] The sites of portal flow resistance may not be precisely localized to one area of the hepatic lobule and may extend beyond the site where the pathogenetic process began. Even in patients with portal hypertension caused by an increased flow, there may be subsequent development of increased resistance. The prognosis is variable; outcomes are better in patients with presinusoidal portal hypertension. A good understanding of the presentation of the various noncirrhotic conditions that cause portal hypertension will help determine the cause, the site of resistance, and the therapeutic plan. Ascites is not a feature of presinusoidal portal hypertension, whereas it may be the predominant feature in postsinusoidal portal hypertension.
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Affiliation(s)
- E Molina
- Center for Liver Diseases, University of Miami School of Medicine, Miami, Florida, USA
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Park GJ, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001; 16:115-7. [PMID: 11206309 DOI: 10.1046/j.1440-1746.2001.02309.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Herbal preparations are widely available and generally regarded by the public as harmless remedies for a variety of medical ailments. We report the first case in Australia of acute hepatitis associated with the Chinese herbal medicine Shou-Wu-Pian, prepared from Polygonum multiflorum. Cholestatic hepatitis developed in a Chinese woman taking this preparation for the greying of her hair, and liver biopsy was consistent with a toxic reaction. Clinical and biochemical resolution occurred following cessation of the drug.
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Affiliation(s)
- G J Park
- Department of Gastroenterology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
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48
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Hepatitis aguda por ingestión de infusiones con Teucrium chamaedrys. GASTROENTEROLOGIA Y HEPATOLOGIA 2001. [DOI: 10.1016/s0210-5705(01)70162-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Abstract
The incidence of drug-induced liver disease appears to be increasing, reflecting the increasing number of new agents that have been introduced into clinical use over the past several decades. Among the topics covered, the author discusses incidence, diagnosis, risk factors, clinical presentations, hepatitis, and vascular injury. The author also reviews the hepatic injury seen with commonly prescribed drugs, emphasizing newer developments in the field and recent publications and reports.
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Affiliation(s)
- J H Lewis
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
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50
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Haouzi D, Lekéhal M, Moreau A, Moulis C, Feldmann G, Robin MA, Lettéron P, Fau D, Pessayre D. Cytochrome P450-generated reactive metabolites cause mitochondrial permeability transition, caspase activation, and apoptosis in rat hepatocytes. Hepatology 2000; 32:303-11. [PMID: 10915737 DOI: 10.1053/jhep.2000.9034] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Although cytochrome P-450 (CYP)-generated reactive metabolites can cause hepatocyte apoptosis, the mechanism of this effect is incompletely understood. In the present study, we assessed the hepatotoxicity of skullcap, a diterpenoid-containing herbal remedy. Male rat hepatocytes were incubated for 2 hours with skullcap diterpenoids (100 microg/mL). This treatment decreased cell glutathione and protein thiols and increased cell [Ca(2+)]. This activated Ca(2+)-dependent tissue transglutaminase, forming a cross-linked protein scaffold, and also opened the mitochondrial permeability transition pore, causing outer mitochondrial membrane rupture, increased cytosolic cytochrome c, activation of procaspase 3, internucleosomal DNA fragmentation, and ultrastructural features of apoptosis. Cell death was increased by a CYP3A inducer (dexamethasone) or a sulfur amino acid-deficient diet increasing glutathione depletion. In contrast, cell death was prevented by decreasing CYP3A activity (with troleandomycin), preventing glutathione depletion (with cysteine or cystine), blocking Ca(2+)-modulated events (with calmidazolium), preventing mitochondrial permeability transition (with cyclosporin A), or inhibiting caspase 3 (with acetyl-Asp-G u-Va-Asp-a dehyde). Both calmidazolium and cyclosporin A also prevented the increase in cytosolic cytochrome c and procaspase 3 activation. In conclusion, CYP3A activates skullcap diterpenoids into reactive metabolites that deplete cellular thiols and increase cell [Ca(2+)]. This activates Ca(2+)-dependent transglutaminase and also opens the mitochondrial permeability transition pore, causing outer mitochondrial membrane rupture, cytochrome c release, and caspase activation. Preventing mitochondrial permeability transition pore opening and/or caspase activity blocks apoptosis, showing the fundamental role of these final events in metabolite-mediated hepatotoxicity.
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Affiliation(s)
- D Haouzi
- INSERM U481 and Centre de Recherche sur les Hépatites Virales (Association Claude Bernard), Hôpital Beaujon, 92118 Clichy, France
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