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Ciornolutchii V, Ismaiel A, Sabo CM, Al Hajjar N, Seicean A, Dumitrascu DL. A Hidden Cause of Hypertransaminasemia: Liver Toxicity Caused by Chelidonium Majus L. : Report of Two Cases of Herb-Induced Liver Injury and Literature Review. Am J Ther 2024; 31:e382-e387. [PMID: 38820341 DOI: 10.1097/mjt.0000000000001708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND In instances where individuals manifest elevated transaminase levels without a clearly discernible cause, a comprehensive patient history proves invaluable in unveiling latent triggers. In this report, we present 2 cases of herb-induced liver injury (HILI) characterized by severe hypertransaminasemia attributed to the consumption of Chelidonium majus L . (also known as greater celandine [GC]), an agent considered an alternative therapeutic remedy. AREAS OF UNCERTAINTY Exploring the occurrence and range of clinical manifestations in HILI linked to Chelidonium majus L ., while also investigating the potential triggers and predisposing factors for hepatotoxic reactions post Chelidonium majus L. usage, remains challenging due to the absence of definitive laboratory tests to identify the causative agent. DATA SOURCES Two case reports were detailed, and a systematic literature review using PubMed was conducted including published literature till March 2023. Moreover, a manual search of reference lists of pertinent articles was performed to identify any additional relevant missed publications. RESULTS In the first case, a 64-year-old woman presented with jaundice, revealing a 1-month history of using GC capsules to manage gallstones. Diagnostic assessment identified HILI, gallstones, and choledocolithiasis, with transaminase levels exceeding 1000 IU/L. After discontinuing GC and receiving intravenous therapy with amino acids and phospholipids, the patient's condition significantly improved. Subsequently, she underwent endoscopic common bile duct stone removal and cholecystectomy. In the second case, a 66-year-old woman presented with elevated liver function test results discovered incidentally during musculoskeletal pain evaluation. Upon further questioning, the patient disclosed regular consumption of GC tea for "health promotion." Following intravenous therapy using amino acids and phospholipids, her transaminase levels returned to normal. The literature review identified 38 cases of HILI associated with GC preparations, primarily in adult women aged 27-77 years, with a predominant reporting location in Germany. Various forms of GC were used, with treatment durations ranging from 1 week to a year. Discontinuation of GC generally led to recovery in these cases. CONCLUSION Chelidonium majus L ., a potent herb often used in alternative medicine, has significant hepatotoxic potential, requiring physicians to be vigilant in cases of unexplained liver injury.
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Affiliation(s)
- Vera Ciornolutchii
- 2nd Department of Internal Medicine, Cluj County Clinical Emergency Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Abdulrahman Ismaiel
- 2nd Department of Internal Medicine, Cluj County Clinical Emergency Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Maria Sabo
- 2nd Department of Internal Medicine, Cluj County Clinical Emergency Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Andrada Seicean
- Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan L Dumitrascu
- 2nd Department of Internal Medicine, Cluj County Clinical Emergency Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Intas K. Scotch pine-induced liver injury: A case report. HEPATOLOGY FORUM 2024; 5:47-48. [PMID: 38283266 PMCID: PMC10809342 DOI: 10.14744/hf.2022.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/12/2023] [Accepted: 05/23/2023] [Indexed: 01/30/2024]
Abstract
Herbal medicines are widely used worldwide to treat minor ailments and prevent disease. Scotch pine (Pinus sylvestris) has many medicinal applications but is most well-known for its antiseptic properties and beneficial effects on the respiratory system. Herbal products can cause adverse side effects like liver injury, which is referred to as herb-induced liver damage (HILI). In this article, we present a patient who used Scotch pine to treat asthma and developed HILI. To the best of our knowledge, this is the first case of Scotch pine-related HILI described in the literature.
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Affiliation(s)
- Kadir Intas
- Department of Internal Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkiye
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Ma ZT, Shi Z, Xiao XH, Wang JB. New Insights into Herb-Induced Liver Injury. Antioxid Redox Signal 2023; 38:1138-1149. [PMID: 36401515 PMCID: PMC10259609 DOI: 10.1089/ars.2022.0134] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Significance: Herbs are widely used worldwide. However, inappropriate use of some of the herbs can lead to herb-induced liver injury (HILI). Intriguingly, HILI incidents are on the rise, and our understanding of the underlying etiologies is in progress, and hence, an update on the current status of incidents as well as our understanding on the etiologies of HILI is appropriate. Recent Advances: HILI reports due to the use of some herbs that are traditionally considered to be safe are also on the rise. Furthermore, HILI due to the use of certain herbs in combination with other herbs (herb-herb interaction [HHI]) or non-herb components (herb-drug interaction [HDI]) has also been reported, suggesting a potentially important new type of inappropriate use of herbs. Critical Issues: Updated overviews focus on the epidemiology, etiology, phenotypes, and risk factors of HILI, as well as HDI and HHI, and analysis on several types of newly reported "toxic" effects of herbs based on types of hepatotoxicity and the HILI mechanisms. Future Directions: HILI will continue to be a significant public health challenge in the near future. In the light of the lack of broadly available guidelines and regulations for proper and safe uses of herbs worldwide, raising the public awareness of HILI will remain one of the most effective measures. In particular, it should include a better understanding of the contributing factors; a more detail subclassification and description of HILI, better characterization of the components/substances that could induce HILI; and development of HILI diagnosis based on the Roussel Uclaf Causality Assessment Method (RUCAM). Antioxid. Redox Signal. 38, 1138-1149.
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Affiliation(s)
- Zhi-Tao Ma
- Department of Pharmaceutics of Chinese Materia Medica, School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zhuo Shi
- China Military Institute of Chinese Medicine, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Xiao-He Xiao
- China Military Institute of Chinese Medicine, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jia-Bo Wang
- Department of Pharmaceutics of Chinese Materia Medica, School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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Mathavan A, Mathavan A, Krekora U, Daily K. Immune-mediated herb-induced liver injury: a potential association with herbal artemisinin use as supported by the updated RUCAM. BMJ Case Rep 2023; 16:e251852. [PMID: 37142282 PMCID: PMC10163430 DOI: 10.1136/bcr-2022-251852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Immune-mediated herb-induced liver injury (HILI) is an acute or chronic inflammatory liver disease precipitated by a hepatotoxic agent with a presentation similar to acute autoimmune hepatitis. It is distinguished in clinical course from true autoimmune hepatitis by remission on drug discontinuation and immunosuppressive treatment. We report a potential case of immune-mediated HILI associated with artemisinin use, an herb underlying first-line malarial treatments, in a woman undergoing radiotherapy for right-sided pelvic sarcoma. A probable association in this case is supported by causality assessment using the updated Roussel Uclaf Causality Assessment Method (score of 6). She achieved clinical improvement with a course of oral corticosteroids and remained stable without relapse following discontinuation. Increased awareness of this complication is imperative, as literature to date only documents direct hepatocellular and cholestatic liver injury from artemisinin use, and should augment clinician counsel regarding complementary medicine administration, especially in high-risk individuals like those with cancer.
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Affiliation(s)
- Akash Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Akshay Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Urszula Krekora
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Karen Daily
- Hematology and Oncology, University of Florida, Gainesville, Florida, USA
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Jia X, Zhang X, Yan M, Sun D, Li R, Yang N, Luo Z. Increased TG to HDL-C ratio is associated with severity of drug-induced liver injury. Sci Rep 2023; 13:6897. [PMID: 37106083 PMCID: PMC10140261 DOI: 10.1038/s41598-023-34137-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
We investigated the relationship between dyslipidemia and drug-induced liver injury (DILI), especially the level of triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) in severe DILI. In this single-centered retrospective study, of 326 patients with DILI, 221 patients were analyzed. Control groups include medication using group and acute hepatitis B group. The relationship between dyslipidemia and DILI was estimated. Demographic and clinical features were analyzed. Dyslipidemia and TG/HDL-C ratios were compared between DILI and control groups, DILI mild group and severe group. The area under the receiver-operating characteristic curve (AUC) was used to evaluate the credibility of the relationship and to find cut-off points. Dyslipidemia is related to DILI when compared with medication using control group (AOR 4.60; 95% CI 2.81-7.54; P < 0.01) and compared with acute hepatitis B group (AOR 2.12; 95% CI 1.37-3.29; P < 0.01). Dyslipidemia is associated with the severity of DILI (AOR 25.78; 95% CI 7.63-87.1; P < 0.01). TG/HDL-C ratio is higher in DILI group than that of medication using control group, also higher in severe DILI group than that of mild DILI group. AUCs for TG/HDL-C ratio to indicate the severity of DILI was 0.89 (P < 0.05), the cut-off point was 2.35. Dyslipidemia and TG/HDL-C ratio were related to DILI occurrence. Severe liver injury in DILI was associated with dyslipidemia and elevated TG/HDL-C ratio.
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Affiliation(s)
- Xiaoqing Jia
- Department of Gastroenterology, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Xiaoting Zhang
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Ming Yan
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Dalong Sun
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Rong Li
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Na Yang
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China
| | - Zheng Luo
- Department of Geriatric Medicine, Qilu Hospital, Shandong University, 107 West Wenhua Road, Jinan, Shandong, 250012, People's Republic of China.
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Jiang N, Qian L, Lin G, Zhang Y, Hong S, Sun B, Wang H, Huang M, Wang J, Jiang Q. Maternal blood parameters and risk of neonatal pathological jaundice: a retrospective study. Sci Rep 2023; 13:2627. [PMID: 36788268 PMCID: PMC9929053 DOI: 10.1038/s41598-023-28254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
This study aims to investigate the association between maternal blood parameters and the risk of neonatal pathological jaundice. A retrospective case-control study of 1309 newborns and their mothers from 2019 to 2020 in a single-center tertiary hospital. All mothers received a complete routine blood test prior to delivery, and outcome was neonatal pathological jaundice. We performed stepwise logistic regression modeling to identify maternal blood factors associated with neonatal pathological jaundice. 258 neonates (19.71%) were diagnosed with pathological jaundice. Logistic regression results showed that the odds ratio for pathological jaundice in neonates of mothers with high white blood cell (WBC) count was 1.512 (95% CI 1.145-1.998; P = 0.004). Besides, neonates whose mothers had a high mean corpuscular volume (MCV) during pregnancy doubled the odds of developing pathological jaundice (OR = 1.967; 95% CI 1.043-3.711; P = 0.037). Among neonates, those whose mothers had high levels of WBC count and MCV were at increased risk of pathological jaundice. Regular obstetric examinations and routine blood tests are essential to initiate adapted care.
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Affiliation(s)
- Nan Jiang
- grid.8547.e0000 0001 0125 2443Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Lu Qian
- The People’s Hospital of Pingyang County, Wenzhou, 325400 Zhejiang China
| | - Guankai Lin
- grid.517665.6Wenzhou Center for Disease Control and Prevention, 490 Shifu Road, Wenzhou, 325000 Zhejiang China
| | - Yuxin Zhang
- grid.8547.e0000 0001 0125 2443Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Sumiao Hong
- The People’s Hospital of Pingyang County, Wenzhou, 325400 Zhejiang China
| | - Baochang Sun
- grid.517665.6Wenzhou Center for Disease Control and Prevention, 490 Shifu Road, Wenzhou, 325000 Zhejiang China
| | - Hexing Wang
- grid.8547.e0000 0001 0125 2443Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Min Huang
- The People's Hospital of Pingyang County, Wenzhou, 325400, Zhejiang, China.
| | - Jiwei Wang
- Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032, China.
| | - Qingwu Jiang
- grid.8547.e0000 0001 0125 2443Key Lab of Health Technology Assessment of Ministry of Health, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
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Yang Y, Ge FL, Tang JF, Qin SL, Zeng R, Yao ML, Xiao XH, Bai ZF, Tang CL. A review of herb-induced liver injury in mainland china. Front Pharmacol 2022; 13:813073. [PMID: 36304164 PMCID: PMC9592926 DOI: 10.3389/fphar.2022.813073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/26/2022] [Indexed: 01/30/2023] Open
Abstract
Traditional medicines have greatly contributed to people’s health worldwide. However, in recent years, the frequent occurrence of herb-induced liver injury (HILI) has raised public concerns regarding the safety of herbs. HILI not only severely impacts public health, thus increasing its medical burden, but also consumes medical resources. However, the pharmacoepidemiology and risk factors of HILI are still unclear due to the complexity of herbs (medication theory, drug composition, dual properties of drugs and food, etc.). China is the country with the most extensive use of herbs and cases of HILI worldwide. The safety profile of herbs (especially with respect to HILI) has also affected the use of herbs internationally. Therefore, this review focuses on the epidemic situation of HILI in mainland China to compile its characteristics, while focusing on the three main aspects of patients, drugs, and unreasonable prescriptions to explore the potential risk factors. Our objective was to provide a reference for HILI pharmacovigilance and risk prevention and control and contribute to Chinese knowledge of the realisation of the “Medication without Harm” global safe medication strategic goal of the World Health Organization.
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Affiliation(s)
- Yan Yang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Fei-Lin Ge
- Department of Chinese Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin-Fa Tang
- Department of Pharmacy, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shuang-Lin Qin
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Rui Zeng
- School of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Meng-Lin Yao
- School of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Xiao-He Xiao
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Xiao-He Xiao, ; Zhao-Fang Bai, ; Cheng-Lin Tang,
| | - Zhao-Fang Bai
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Xiao-He Xiao, ; Zhao-Fang Bai, ; Cheng-Lin Tang,
| | - Cheng-Lin Tang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
- *Correspondence: Xiao-He Xiao, ; Zhao-Fang Bai, ; Cheng-Lin Tang,
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Gangadharan GG, Mahajan V. Response to Tinospora cordifolia (Giloy)-induced liver injury during the COVID-19 pandemic-Multicenter nationwide study from India. Hepatol Commun 2022; 6:2993-2994. [PMID: 35616295 PMCID: PMC9347749 DOI: 10.1002/hep4.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/10/2022] [Indexed: 11/11/2022] Open
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Ishida T, Kawada K, Jobu K, Kawazoe T, Tamura N, Miyamura M. Analysis of Drug-Induced Liver Injury from Bofutsushosan Administration Using Japanese Adverse Drug Event Report (JADER) Database. Biol Pharm Bull 2022; 45:460-466. [DOI: 10.1248/bpb.b21-00887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Kei Kawada
- Department of Pharmacy, Kochi Medical School Hospital
| | - Kohei Jobu
- Department of Pharmacy, Kochi Medical School Hospital
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Soares PF, Fernandes MTCF, Souza ADS, Lopes CM, Dos Santos DAC, Oliveira DPR, Pereira MG, Prado NMDBL, Gomes GSDS, Santos G, Paraná R. Causality imputation between herbal products and HILI: An algorithm evaluation in a systematic review. Ann Hepatol 2022; 25:100539. [PMID: 34555512 DOI: 10.1016/j.aohep.2021.100539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023]
Abstract
Algorithms can have several purposes in the clinical practice. There are different scales for causality imputation in DILI (Drug-Induced Liver Injury), but the applicability and validity of these for the HILI (Herb-Induced Liver Injury) evaluation is questionable for some scales. The purpose of the study was to determine the clinical and demographic profile of the patients with HILI, and the main algorithmic scales used in its causality assessment. The methodology was a systematic review of articles in English, Spanish, or Portuguese language, from 1979 to 2019, involving humans, with descriptors related to HILI. Qualitative and quantitative statistical analysis were performed. As a result, from a total of 60 articles, 203 HILI reports were selected: 59.9% were women, similar with other studies, and the average age was 45.8 years. Jaundice was the most frequent symptom and regarding the type of lesion, the hepatocellular was the most frequent. In regard to HILI severity, 3.0% were severe and 7.6% were fatal or required liver transplantation. In 72.3% of the cases, the most used algorithm was RUCAM (Roussel Uclaf Causality Assessment Method). The conclusion of the study is that RUCAM was the most used algorithm for causality assessment in HILI. The patients were predominantly female, jaundice was the main symptom, and HILI is reversible in the majority of cases.
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Affiliation(s)
- Pedro Felipe Soares
- School Medicine of Bahia- University Federal of Bahia, Av. Rector Miguel Calmon, S/N - Vale do Canela, 40110-100, Salvador - BA, Brazil.
| | | | | | - Caio Medina Lopes
- Faculty of Pharmacy - University Federal of Bahia, Salvador, BA, Brazil.
| | | | | | | | | | | | - Genário Santos
- Sciences of Health Post Graduation Program - University Federal of Bahia, Salvador, BA, Brazil.
| | - Raymundo Paraná
- School Medicine of Bahia- University Federal of Bahia, Av. Rector Miguel Calmon, S/N - Vale do Canela, 40110-100, Salvador - BA, Brazil.
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Bahramikia S, Hemmati Hassan Gavyar P, Yazdanparast R. Teucrium polium L: An updated review of phytochemicals and biological activities. AVICENNA JOURNAL OF PHYTOMEDICINE 2022; 12:224-240. [PMID: 36186937 PMCID: PMC9482711 DOI: 10.22038/ajp.2021.19155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/01/2021] [Accepted: 09/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Medicinal plants and their components are potential novel sources for developing drugs against various diseases. Teucrium polium L. (syn Teucrium capitatum L. or felty germander) from the Lamiaceae family, is widely distributed in the dry and stony places of the hills and deserts of almost all Mediterranean countries, southwestern Asia, Europe, and North Africa. Based on traditional Iranian medicine (TIM), T. polium is used for treating many diseases, including abdominal pain, indigestion, and type 2 diabetes. MATERIALS AND METHODS In our previous review article published in 2012 and based on 100 articles published from 1970 to 2010, the main compounds purified from T. polium were terpenes, terpenoids, and flavonoids with antioxidant, anticancer, anti-inflammatory, hypoglycemic, hepatoprotective, hypolipidemic, antibacterial, and antifungal activities. RESULTS In this article, the phytochemistry and pharmacological activities of the plant reported from 2011 to 2020 have been evaluated. Therefore, a search was done in the databases PubMed, Science Direct and Google Scholar, Scopus, and Web of Science with the terms "T. polium," "T. capitatum." and felty germander', which included about 100 articles published since 2011 about T. polium pharmacological activities and isolated compounds. Most studies of this review focused on the antioxidant and antidiabetic effects of the plant. CONCLUSION Considering the position of T. polium in folk medicine, mainly as an antidiabetic agent, purification, structural and biological characterization of the active components appears essential for effective use of the plant.
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Affiliation(s)
- Seifollah Bahramikia
- Department of Biology, Faculty of Science, Lorestan University, Khorramabad, Iran,Corresponding Author: Tel: +98-6633120621, Fax: +98-6633120621,
| | | | - Razieh Yazdanparast
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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Squires JE, Alonso EM, Ibrahim SH, Kasper V, Kehar M, Martinez M, Squires RH. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Diagnosis and Management of Pediatric Acute Liver Failure. J Pediatr Gastroenterol Nutr 2022; 74:138-158. [PMID: 34347674 DOI: 10.1097/mpg.0000000000003268] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Pediatric acute liver failure (PALF) is a rare, rapidly progressive clinical syndrome with significant morbidity and mortality. The phenotype of PALF manifests as abrupt onset liver dysfunction, which can be brought via disparate etiology. Management is reliant upon intensive clinical care and support, often provided by the collaborative efforts of hepatologists, critical care specialists, and liver transplant surgeons. The construction of an age-based diagnostic approach, the identification of a potential underlying cause, and the prompt implementation of appropriate therapy can be lifesaving; however, the dynamic and rapidly progressive nature of PALF also demands that diagnostic inquiries be paired with monitoring strategies for the recognition and treatment of common complications of PALF. Although liver transplantation can provide a potential life-saving therapeutic option, the ability to confidently determine the certainness that liver transplant is needed for an individual child has been hampered by a lack of adequately tested clinical decision support tools and accurate predictive models. Given the accelerated progress in understanding PALF, we will provide clinical guidance to pediatric gastroenterologists and other pediatric providers caring for children with PALF by presenting the most recent advances in diagnosis, management, pathophysiology, and associated outcomes.
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Affiliation(s)
- James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Estella M Alonso
- Department Pediatric Hepatology, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois, USA
| | - Samar H Ibrahim
- Department of Pediatrics, Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Vania Kasper
- Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, Hasbro Children's Hospital, Providence, RI
| | - Mohit Kehar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mercedes Martinez
- Department of Pediatrics, Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Robert H Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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Khan Z, Karataş Y, Kıroğlu O. Evaluation of Adverse Drug Reactions in Paediatric Patients: A Retrospective Study in Turkish Hospital. Front Pharmacol 2021; 12:786182. [PMID: 34867419 PMCID: PMC8638749 DOI: 10.3389/fphar.2021.786182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022] Open
Abstract
Drug safety in paediatric patients is a serious public health concern around the world. The paediatric patients are more prone to adverse drug reactions (ADRs) than adults. Moreover, there is a scarcity of information about ADRs in paediatric patients. This study was conducted to determine the frequency, causality, severity, preventability of paediatric patients’ ADRs reported in a tertiary care hospital in Adana, Turkey. A retrospective study was conducted on all spontaneously reported ADRs between January 01, 2020, to July 30, 2021, in paediatric patients. The ADRs reports were evaluated in terms of gender, age, ADR characteristics, suspected drugs and reporting source. All included ADRs reports were characterized according to the Naranjo Algorithm/World Health Organization (WHO) causality scales, Hartwig/Siegel and Common Terminology Criteria for Adverse Events (CTCAE) severity scales, the modified Schoumock and Thornton preventability scale and hospital pharmacovigilance center criteria for seriousness. Therapeutic groups were also coded using the WHO-Anatomical Therapeutic and Chemical (ATC) classification. During the study period, 8,912 paediatric patients who were admitted had 16 ADRs with 1.7 ADRs/1,000 admissions. The majority of ADRs were found in infants (31.2%) and children (56.2%) as compared to adolescents (12.5%). ADRs were observed more in females (81.2%) than males. Skin (62.5%) was the most affected organ due to the ADRs, and maculopapular rash and erythema multiforme were the most commonly reported symptoms. Most ADRs were probable/likely (93.7%), severe (50%), preventable or probably preventable (43.7%) and serious (37.5%). Antibiotics (93.7%) were found to be the most common cause of ADRs in paediatric patients. The majority of ADRs were associated with vancomycin (68.7%). Most of the ADRs were reported by a medical doctor in this study. This small sample size study highlights significant problems of ADRs in paediatric patients, mainly caused by antibiotics and with a majority of ADRs manifest as skin reactions. Furthermore, a high proportion of the identified ADRs were found to be preventable. More focused efforts are needed at the national level to avoid preventable ADRs in hospitals. Monitoring and management of ADRs and future studies would be beneficial for better patient care and safety.
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Affiliation(s)
- Zakir Khan
- Department of Pharmacology, Institute of Health Sciences, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Yusuf Karataş
- Department of Pharmacology, Institute of Health Sciences, Faculty of Medicine, Cukurova University, Adana, Turkey.,Pharmacovigilance Specialist, Balcali Hospital, Faculty of Medicines, Cukurova University, Adana, Turkey
| | - Olcay Kıroğlu
- Department of Pharmacology, Institute of Health Sciences, Faculty of Medicine, Cukurova University, Adana, Turkey
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Tong X, Li M, Li D, Lao C, Chen J, Xu W, Du J, Zhang M, Yang X, Li J. Aloe vera gel extract: Safety evaluation for acute and chronic oral administration in Sprague-Dawley rats and anticancer activity in breast and lung cancer cells. JOURNAL OF ETHNOPHARMACOLOGY 2021; 280:114434. [PMID: 34274443 DOI: 10.1016/j.jep.2021.114434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Aloe vera (L.) Burm. f. is a typical traditional Chinese medicine (TCM) collected in the Pharmacopoeia of the People's Republic of China (version 2015). It has been traditionally used for the treatment of constipation, and its potential therapeutic activities have been widely evaluated, including anti-tumor, anti-inflammatory and immune regulatory effects. The wide application of Aloe vera in food and therapy has raised safety issues and there are multiple safety assessments with a diverse toxicity and adverse effects from clinics and animals. AIM OF THE STUDY This study aimed to investigate the safety of Aloe vera barbadensis extract C (AVBEC) in rats and analyze its anticancer activity in cell lines. MATERIALS AND METHODS We administrated AVBEC orally in an acute toxicity study and a 6-month chronic toxicity study to observe and confirm its safety in Sprague-Dawley (SD) rats. Additionally, we explored the cytotoxicity of AVBEC in cancer cells and non-cancer cells. We further investigated the anti-tumor activity of AVBEC, and in the meantime, probed the function of component from AVBEC. RESULTS No deaths or substance-relative toxicity were observed in the acute toxicity study or the 6-month chronic toxicity study with doses of 44.8 g·kg-1 and 4.48 g·kg-1, respectively. In the chronic toxicity study, AVBEC did not cause organ toxicity, including crucial organ structure and chemical function, and peripheral and central immune system damage. Additionally, we found that AVBEC could induce cancer cell apoptosis with a relatively higher apoptotic ratio than in non-cancer cells by decreasing adenosine triphosphate (ATP) concentration and enhancing reactive oxygen species (ROS) production. We also identified components in AVBEC using high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) and probed the function of malic acid. This demonstrated that under the same circumstances, malic acid induced cell necrosis in cancer cells and non-cancer cells, while AVBEC did not. CONCLUSIONS These results reveal a novel mechanism of aloe gel extract in regulating cancer cell apoptosis via modulating the mitochondrial metabolism and imply a possible application of AVBEC for the treatment of malignant cancer with the safety evaluation from rats and anticancer investigation from cancer cells and non-cancer cells.
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Affiliation(s)
- Xueli Tong
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China
| | - Min Li
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China
| | - Di Li
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China
| | - Chunqin Lao
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China
| | - Jingmian Chen
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China
| | - Weijie Xu
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China
| | - Junxi Du
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China
| | - Meijiao Zhang
- Department of Drug Safety Evaluation Center, Guangzhou University of Chinese Medicine Science and Technology Industrial Park Co., Ltd., Guangzhou, 510000, China
| | - Xiangcai Yang
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China.
| | - Jiejing Li
- Department of R&D, Biotech&Science Company of UP, Ltd., Guangzhou, 510000, China.
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Evaluation of the Anti-cancer Effect of Syzygium cumini Ethanolic Extract on HT-29 Colorectal Cell Line. J Gastrointest Cancer 2021; 52:575-581. [PMID: 32506290 DOI: 10.1007/s12029-020-00439-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION GLOBOCAN 2018 data indicates the incidence and mortality of colorectal cancer that is the third lethal and fourth most diagnosed cancer in the world. There has been significant progress in cancer therapy while the ability of cancerous cells to survive is one of the main challenges in cancer research. Still, conventional therapies like surgery, chemo, and radiotherapy are widely used options. Therefore, efforts put in action by researchers in the field of drug design, molecular genetics, and biomedicine to come across safer substances with the minimum unwanted side effects to be utilized in cancer treatment. Plant-derived compounds are ideal options as they might have a better outcome with minimal side effects. METHODS In the current research, the anti-cancer effect of Syzygium cumini ethanolic extract (SCE) was evaluated on the HT-29 colorectal cancer cell line. To this end, the apoptosis rate and proliferation of HT-29 cell lines after exposure to SCE were investigated through MTT, and other methods including DNA damage assessment and scratch test also employed to evaluate the metastasis and cell migration capacity of HT-29 after treatment with SCE. Behind that, expression ration of genes involved in the process of apoptosis has been studied, including Bax and Bcl-2 that were measured by qRT-PCR. RESULTS Based on the MTT test, SCE suppresses the growth of HT-29 cell lines drastically. Expression analysis of the ratio of desired genes (Bax: Bcl-2) also changed significantly after treatment by SCE. DNA damage test confirmed DNA lost its integrity and gone through apoptosis, and wound healing suggests the lower change of metastasis after treatment by SCE. CONCLUSION The outcome of this study suggests that Syzygium cumini might be contemplating as a future chemotherapeutic agent and suitable candidate for in vivo trial.
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Teschke R, Eickhoff A, Schulze J, Danan G. Herb-induced liver injury (HILI) with 12,068 worldwide cases published with causality assessments by Roussel Uclaf Causality Assessment Method (RUCAM): an overview. Transl Gastroenterol Hepatol 2021; 6:51. [PMID: 34423172 PMCID: PMC8343418 DOI: 10.21037/tgh-20-149] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022] Open
Abstract
Herbal products including herbal medicines are worldwide used in large amounts for treating minor ailments and for disease prevention. However, efficacy of most herbal products has rarely been well documented through randomized controlled trials in line with evidence-based medicine concepts, which could be used to estimate the benefit/risk ratio. Instead, much better documented are adverse reactions such as liver injury associated with the consumption of some herbal products, so called herb-induced liver injury (HILI), which represents a clinical challenge. In order to establish HILI as valid diagnosis, the use of a diagnostic algorithms such as Roussel Uclaf Causality Assessment Method (RUCAM) is widely recommended, although physicians in some countries are reluctant to use RUCAM for their HILI cases. This review on worldwide HILI and RUCAM, developed as part of the artificial intelligence ideas, reveals that China is the leading country with 24 publications on HILI cases that were all assessed for causality using RUCAM, followed by Korea with 15 reports, Germany with 9 reports, the US with 7 reports, and Spain with 6 reports, whereas the remaining countries provided less than 4 reports. The total number of assessed HILI cases is 12,068 worldwide derived from 80 publications but in each report HILI case numbers were variable in a range from 1 up to 6,971. This figure compares with 46,266 cases of drug-induced liver injury (DILI) published worldwide from 2014 to early 2019 also assessed for causality by RUCAM. The original version of RUCAM was validated and established in 1993 and updated in 2016 that should be used in future HILI cases. RUCAM is an objective, structured, and validated method, specifically designed for liver injury. It is a scoring system including case data elements to be assessed and scored individually to provide a final score in five causality gradings. Among the 11,404/12,068 HILI (94.5%) cases assessable for evaluation, causality gradings were highly probable in 4.2%, probable in 15.5%, possible in 70.3%, and unlikely or excluded in 10.0%. To improve the future reporting of RUCAM based HILI cases, recommendations include the strict adherence to instructions outlined in the updated RUCAM and, in particular, to follow prospective data collection on the cases to ensure completeness of case data. In conclusion, RUCAM can well be used to assess causality in suspected HILI cases, and additional efforts are now required to increase the quality of the reported cases.
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Affiliation(s)
- Rolf Teschke
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Klinikum Hanau, Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/ Main, Frankfurt/Main, Germany
| | - Axel Eickhoff
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Klinikum Hanau, Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/ Main, Frankfurt/Main, Germany
| | - Johannes Schulze
- Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Gaby Danan
- Pharmacovigilance consultancy, Paris, France
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Metabolomic analysis to discriminate drug-induced liver injury (DILI) phenotypes. Arch Toxicol 2021; 95:3049-3062. [PMID: 34274980 PMCID: PMC8380240 DOI: 10.1007/s00204-021-03114-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022]
Abstract
Drug-induced liver injury (DILI) is an adverse toxic hepatic clinical reaction associated to the administration of a drug that can occur both at early clinical stages of drug development, as well after normal clinical usage of approved drugs. Because of its unpredictability and clinical relevance, it is of medical concern. Three DILI phenotypes (hepatocellular, cholestatic, and mixed) are currently recognized, based on serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) values. However, this classification lacks accuracy to distinguish among the many intermediate mixed types, or even to estimate the magnitude and progression of the injury. It was found desirable to have additional elements for better evaluation criteria of DILI. With this aim, we have examined the serum metabolomic changes occurring in 79 DILI patients recruited and monitored using established clinical criteria, along the course of the disease and until recovery. Results revealed that free and conjugated bile acids, and glycerophospholipids were among the most relevant metabolite classes for DILI phenotype characterization. Using an ensemble of PLS-DA models, metabolomic information was integrated into a ternary diagram to display the disease phenotype, the severity of the liver damage, and its progression. The modeling implemented and the use of such compiled information in an easily understandable and visual manner facilitates a straightforward DILI phenotyping and allow to monitor its progression and recovery prediction, usefully complementing the concise information drawn out by the ALT and ALP classification.
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Ballotin VR, Bigarella LG, Brandão ABDM, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: Systematic review and meta-analysis. World J Clin Cases 2021; 9:5490-5513. [PMID: 34307603 PMCID: PMC8281430 DOI: 10.12998/wjcc.v9.i20.5490] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/03/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of herbal supplements and alternative medicines has been increasing in the last decades. Despite popular belief that the consumption of natural products is harmless, herbs might cause injury to various organs, particularly to the liver, which is responsible for their metabolism in the form of herb-induced liver injury (HILI). AIM To identify herbal products associated with HILI and describe the type of lesion associated with each product. METHODS Studies were retrieved using Medical Subject Headings Descriptors combined with Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE, BIREME, LILACS, Cochrane Library for Systematic Reviews, SciELO, Embase, and Opengray.eu. Languages were restricted to English, Spanish, and Portuguese. There was no date of publication restrictions. The reference lists of the studies retrieved were searched manually. To access causality, the Maria and Victorino System of Causality Assessment in Drug Induced Liver Injury was used. Simple descriptive analysis were used to summarize the results. RESULTS The search strategy retrieved 5918 references. In the final analysis, 446 references were included, with a total of 936 cases reported. We found 79 types of herbs or herbal compounds related to HILI. He-Shou-Wu, Green tea extract, Herbalife, kava kava, Greater celandine, multiple herbs, germander, hydroxycut, skullcap, kratom, Gynura segetum, garcinia cambogia, ma huang, chaparral, senna, and aloe vera were the most common supplements with HILI reported. Most of these patients had complete clinical recovery (82.8%). However, liver transplantation was necessary for 6.6% of these cases. Also, chronic liver disease and death were observed in 1.5% and 10.4% of the cases, respectively. CONCLUSION HILI is normally associated with a good prognosis, once the implied product is withdrawn. Nevertheless, it is paramount to raise awareness in the medical and non-medical community of the risks of the indiscriminate use of herbal products.
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Affiliation(s)
| | | | - Ajacio Bandeira de Mello Brandão
- Post-Graduate Program in Medicine, Division of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-110, RS, Brazil
| | - Raul Angelo Balbinot
- Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
| | - Silvana Sartori Balbinot
- Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
| | - Jonathan Soldera
- Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
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Aldossary B, Hassan A, Moussa M, Alsaif HS, Alfaraj D. Fulminant hepatic failure in a patient testing re-positive for SARS-CoV-2: a case report. Int J Emerg Med 2021; 14:24. [PMID: 33882839 PMCID: PMC8058753 DOI: 10.1186/s12245-021-00349-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Background Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may not elicit lifelong protective immunity and reinfection could occur. Liver function impairment is a common manifestation of coronavirus disease 2019 (COVID-19). However, acute hepatic failure in the setting of COVID-19 is very rare. Case presentation We report the case of a 47-year-old woman who presented with acute abdominal pain and vomiting. Abdominal examination revealed a soft and lax abdomen with mild tenderness in the right upper quadrant. The patient recovered from COVID-19 2 months previously with negative results on reverse transcription-polymerase chain reaction (RT-PCR). Laboratory investigations revealed markedly elevated transaminases with normal results on viral hepatitis serology panel and undetectable blood paracetamol level. Prior to admission, the patient underwent RT-PCR for SARS-CoV-2, which revealed a positive result. The patient experienced rapid deterioration in the neurological status with a remarkable increase in the liver enzyme levels. Despite aggressive resuscitation, the patient suffered irreversible cardiac arrest and died. Conclusion Fulminant hepatic failure is a rare manifestation in patients with re-positive RT-PCR tests for SARS-CoV-2. Clinicians should maintain a high index of suspicion for hepatic injury with active monitoring of liver enzymes.
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Affiliation(s)
- Bader Aldossary
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Ali Hassan
- Department of Radiology, Salmaniya Medical Complex, Manama, Bahrain.
| | - Mohamed Moussa
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Hind S Alsaif
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Dunya Alfaraj
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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Lee NH, Lee GY, Park CR, Kim SK, Ahn YC, Cho JH, Son CG. Risk levels of herb-induced liver injury in Korea: from a meta-analysis. Integr Med Res 2020; 10:100705. [PMID: 33665093 PMCID: PMC7903345 DOI: 10.1016/j.imr.2020.100705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 01/16/2023] Open
Abstract
Background As the use of herbal medicines increased worldwide, there has been concern about the risk of herb-induced liver injury (HILI). Many clinical studies have assessed the risk of HILI in Korea. Methods Therefore, we conducted a meta-analysis of the incidence of HILI in Korea, by analyzing nine clinical studies. These involved 8625 participants (3274 males; 5351 females), including 436 outpatients (three studies) and 8189 inpatients (six studies). Results As a result, the overall incidence of HILI in Korea was 0.49% (95% CI 0.33–0.74%), and it was 0.57% in males and 0.30% in females. We found a similar incidence of HILI in prospective (0.51%) and retrospective (0.50%) studies. The incidence of HILI was higher in inpatients (0.62%) than outpatients (0.03%). Conclusion Although there are limitations regarding study quality and the number of participants, we systematically estimated the risk of HILI in Korea. We anticipate this study would be a helpful information for prescribing herbal medicines and researching the safety of herbs.
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Affiliation(s)
- Nam-Hun Lee
- Department of Hepatology & Hematology, Cheonan Korean Medicine Hospital of Daejeon University, Cheonan, Republic of Korea
| | - Ga-Young Lee
- Department of Hepatology & Hematology, Cheonan Korean Medicine Hospital of Daejeon University, Cheonan, Republic of Korea
| | - Chan-Ran Park
- Department of Hepatology & Hematology, Cheonan Korean Medicine Hospital of Daejeon University, Cheonan, Republic of Korea
| | - Sul-Ki Kim
- Liver & Immunology Research Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, Daejeon, Republic of Korea
| | - Jung-Hyo Cho
- Liver & Immunology Research Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Chang-Gue Son
- Liver & Immunology Research Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
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Zhang C, Wu Y, Yuan S, Dou X, Sheng Q, Wang J, Tian W, Yao L, Ding Y. Characteristics of Drug-Induced Liver Injury in Northeast China: Disease Spectrum and Drug Types. Dig Dis Sci 2020; 65:3360-3368. [PMID: 31907771 DOI: 10.1007/s10620-019-06030-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/22/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to determine the disease spectrum and drug types causing drug-induced liver injury (DILI) in northeast China, so that the affected population can be reminded of the need to increase their post-medication monitoring. METHODS A total of 470 DILI patients hospitalized at Shengjing Hospital between 2013 and 2016 were involved in this retrospective study. RESULTS There were significant differences in the disease spectrum of the different age groups (P < 0.001) and genders (P = 0.009). Drugs used to treat osteopathies, dermatitis and infections, as well as health care supplements, each accounted for > 10% of all drugs that caused DILI. The percentage of DILIs related to Chinese herbal medicines (CHMs) gradually increased with patient age (P = 0.002). The percentage of males taking health supplements or CHMs was significantly lower compared with females. Total bilirubin (β = 0.01, OR = 1.01, P < 0.001) and INR (β = 0.74, OR = 2.11, P < 0.001) were found to be independent predictors of liver damage. CONCLUSIONS The main type of drug that causes DILI in northeast China is a CHM. There are differences in the disease spectrum found in DILI patients of different ages and gender. Making appropriate changes in the drug-taking habits of high-risk groups and the drugs used to treat high-risk underlying diseases, as well as increasing patient monitoring, may help to reduce the incidence of DILIs.
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Affiliation(s)
- Chong Zhang
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Yuyu Wu
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Suyu Yuan
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Xiaoguang Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Qiuju Sheng
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Jingyan Wang
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Wenyue Tian
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Lan Yao
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China
| | - Yang Ding
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39 Huaxiang Road, Tiexi District, Shenyang City, 110022, Liaoning Province, China.
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Enioutina EY, Job KM, Krepkova LV, Reed MD, Sherwin CM. How can we improve the safe use of herbal medicine and other natural products? A clinical pharmacologist mission. Expert Rev Clin Pharmacol 2020; 13:935-944. [PMID: 32730191 DOI: 10.1080/17512433.2020.1803739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Three major classes of natural products (NPs) for medicinal purposes or improving wellbeing are generally available in the US: conventional drugs of herbal origin, botanical drugs, and dietary supplements (DSs). Consumer consumption of DSs is growing annually. The U.S. FDA regulates conventional and botanical drugs for safety and efficacy; however, DSs are minimally regulated. AREAS COVERED This article will: i) highlight the importance of NP as a significant source of prescription drugs; ii) discuss differences in the regulation of conventional drugs of NP product, botanical drugs, and DSs; iii) discuss the safety and efficacy of DSs and iv) make recommendations for improvement of safety for minimally regulated NPs. EXPERT OPINION Toxicities associated with the use of NPs, including vitamins and DSs, are mainly due to excessive use and interactions with conventional drug(s) and may represent challenges for clinicians. Conventional and botanical-based prescription drugs are rarely associated with unknown toxicities. However, DSs are minimally regulated and can produce severe adverse effects. We believe that clinical pharmacologists can have a role in developing criteria for DS safety analysis. There is also the potential for a standardized NP stewardship program(s) and the development of NP policies and practices nationally and globally.
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Affiliation(s)
- Elena Y Enioutina
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, UT, USA
| | - Kathleen M Job
- Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine , Salt Lake City, UT, USA
| | - Lubov V Krepkova
- Toxicology Department, Center of Medicine, All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR) , Moscow, Russia
| | - Michael D Reed
- School of Medicine, Case Western Reserve University , Cleveland, OH, USA
| | - Catherine M Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine/Dayton Children's Hospital , Dayton, OH, USA
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Philips CA, Rajesh S, George T, Ahamed R, Kumbar S, Augustine P. Outcomes and Toxicology of Herbal Drugs in Alcoholic Hepatitis - A Single Center Experience from India. J Clin Transl Hepatol 2019; 7:329-340. [PMID: 31915602 PMCID: PMC6943206 DOI: 10.14218/jcth.2019.00043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 12/23/2022] Open
Abstract
Background and Aims: We aimed to study clinical outcomes and liver biopsy features of alcoholic hepatitis (AH) patients on complementary and alternative medicines (CAMs) and to analyze the retrieved drugs for chemical and toxic components linked to drug-induced liver injury. Methods: We retrospectively assessed clinical, biochemical and liver biopsy features of AH patients on CAM with drug-induced liver injury (AH-CAM, n = 27) and compared them to a control group (classical AH, n = 29) on standard of care. Patients without liver biopsy evaluation and other causes for liver disease were excluded. Samples of the CAMs (n = 42) from patients were retrieved and assessed for chemical and toxins. Results: All were males, and significantly worse clinical presentation, biochemical severity, and liver disease scores were notable in patients with AH-CAM. Traditional Ayurvedic-polyherbal formulations were the most commonly used CAM. On liver histology, varying grades of severe-necrosis, severe hepatocellular, canalicular, cholangiolar cholestasis with predominant lymphocytic-portal-inflammation and varying grades of interface-hepatitis were noted in AH-CAM. Analysis of CAMs revealed presence of heavy metals up to 100,000 times above detectable range and adulterants, such as antibiotics, chemotherapy agents, nonsteroidal anti-inflammatory drugs, alcohols, antidepressants, anxiolytics, and recreational drugs. On follow up, a significantly higher number of patients with AH on CAM died at end of 1, 3- and-6-months compared to controls (37% vs. 83%, 29% vs. 62%, 18% vs. 52% respectively; p < 0.001). Conclusions: Patients with AH and CAM-related drug-induced liver injury have extremely poor short-term survival in the absence of liver transplantation compared to those patients with AH on evidence-based management. Early transplant referral and educating on and curbing of CAM use in severe liver disease through strict monitoring of unregulated traditional health practices can help ease the burden of liver-related death.
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Affiliation(s)
- Cyriac Abby Philips
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala, India
- Correspondence to: Cyriac Abby Philips, The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, Symphony, Automobile Road, Palarivattom, Cochin 682025, India. Tel/Fax: +91-484-2907000, E-mail:
| | - Sasidharan Rajesh
- Interventional Radiology, Department of Gastroenterology and Hepatology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala, India
| | - Tom George
- Interventional Radiology, Department of Gastroenterology and Hepatology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala, India
| | - Rizwan Ahamed
- Gastroenterology and Advanced G.I. Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala, India
| | - Sandeep Kumbar
- Gastroenterology and Advanced G.I. Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala, India
| | - Philip Augustine
- Gastroenterology and Advanced G.I. Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi, Kerala, India
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24
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Teschke R, Eickhoff A, Brown AC, Neuman MG, Schulze J. Diagnostic Biomarkers in Liver Injury by Drugs, Herbs, and Alcohol: Tricky Dilemma after EMA Correctly and Officially Retracted Letter of Support. Int J Mol Sci 2019; 21:ijms21010212. [PMID: 31892250 PMCID: PMC6981464 DOI: 10.3390/ijms21010212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023] Open
Abstract
Liver injuries caused by the use of exogenous compounds such as drugs, herbs, and alcohol are commonly well diagnosed using laboratory tests, toxin analyses, or eventually reactive intermediates generated during metabolic degradation of the respective chemical in the liver and subject to covalent binding by target proteins. Conditions are somewhat different for idiosyncratic drug induced liver injury (DILI), for which metabolic intermediates as diagnostic aids are rarely available. Although the diagnosis of idiosyncratic DILI can well be established using the validated, liver specific, structured, and quantitative RUCAM (Roussel Uclaf Causality Assessment Method), there is an ongoing search for new diagnostic biomarkers that could assist in and also confirm RUCAM-based DILI diagnoses. With respect to idiosyncratic DILI and following previous regulatory letters of recommendations, selected biomarkers reached the clinical focus, including microRNA-122, microRNA-192, cytokeratin analogues, glutamate dehydrogenase, total HMGB-1 (High Mobility Group Box), and hyperacetylated HMGB-1 proteins. However, the new parameters total HMGB-1, and even more so the acetylated HMGB-1, came under critical scientific fire after misconduct at one of the collaborating partner centers, leading the EMA to recommend no longer the exploratory hyperacetylated HMGB1 isoform biomarkers in clinical studies. The overall promising nature of the recommended biomarkers was considered by EMA as highly dependent on the outstanding results of the now incriminated biomarker hyperacetylated HMGB-1. The EMA therefore correctly decided to officially retract its Letter of Support affecting all biomarkers listed above. New biomarkers are now under heavy scrutiny that will require re-evaluations prior to newly adapted recommendations. With Integrin beta 3 (ITGB3), however, a new diagnostic biomarker may emerge, possibly being drug specific but tested in only 16 patients; due to substantial remaining uncertainties, final recommendations would be premature. In conclusion, most of the currently recommended new biomarkers have lost regulatory support due to scientific misconduct, requiring now innovative approaches and re-evaluation before they can be assimilated into clinical practice.
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Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, D-63450 Hanau, Germany;
- Correspondence: ; Tel.: +49-6181-21859; Fax: +49-6181-2964211
| | - Axel Eickhoff
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, D-63450 Hanau, Germany;
| | - Amy C. Brown
- Department of Complementary and Integrative Medicine, University of Hawai’i at Manoa, Honolulu, HI 96813, USA;
| | - Manuela G. Neuman
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M2 R1 W6, Canada;
| | - Johannes Schulze
- Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt/Main, D-60590 Frankfurt/Main, Germany;
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25
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Jack BU, Malherbe CJ, Mamushi M, Muller CJF, Joubert E, Louw J, Pheiffer C. Adipose tissue as a possible therapeutic target for polyphenols: A case for Cyclopia extracts as anti-obesity nutraceuticals. Biomed Pharmacother 2019; 120:109439. [PMID: 31590126 DOI: 10.1016/j.biopha.2019.109439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
Obesity is a significant contributor to increased morbidity and premature mortality due to increasing the risk of many chronic metabolic diseases such as type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle modifications such as energy restriction and increased physical activity are highly effective first-line treatment strategies used in the management of obesity. However, adherence to these behavioral changes is poor, with an increased reliance on synthetic drugs, which unfortunately are plagued by adverse effects. The identification of new and safer anti-obesity agents is thus of significant interest. In recent years, plants and their phenolic constituents have attracted increased attention due to their health-promoting properties. Amongst these, Cyclopia, an endemic South African plant commonly consumed as a herbal tea (honeybush), has been shown to possess modulating properties against oxidative stress, hyperglycemia, and obesity. Likewise, several studies have reported that some of the major phenolic compounds present in Cyclopia spp. exhibit anti-obesity effects, particularly by targeting adipose tissue. These phenolic compounds belong to the xanthone, flavonoid and benzophenone classes. The aim of this review is to assess the potential of Cyclopia extracts as an anti-obesity nutraceutical as underpinned by in vitro and in vivo studies and the underlying cellular mechanisms and biological pathways regulated by their phenolic compounds.
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Affiliation(s)
- Babalwa U Jack
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa.
| | - Christiaan J Malherbe
- Plant Bioactives Group, Post-Harvest and Agro-processing Technologies, Agricultural Research Council, Infruitec-Nietvoorbij, Stellenbosch, South Africa
| | - Mokadi Mamushi
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa; Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Christo J F Muller
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa; Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Department of Biochemistry and Microbiology, University of Zululand, Kwa-Dlangezwa, South Africa
| | - Elizabeth Joubert
- Plant Bioactives Group, Post-Harvest and Agro-processing Technologies, Agricultural Research Council, Infruitec-Nietvoorbij, Stellenbosch, South Africa; Department of Food Science, Stellenbosch University, Stellenbosch, South Africa
| | - Johan Louw
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa; Department of Biochemistry and Microbiology, University of Zululand, Kwa-Dlangezwa, South Africa
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa; Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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