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Patel S, Tareen K, Patel C, Rosinski A. Herbal and Non-Herbal Dietary Supplements for Psychiatric Indications: Considerations in Liver Transplantation. Curr Psychiatry Rep 2024; 26:436-446. [PMID: 38941032 DOI: 10.1007/s11920-024-01517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE OF REVIEW Traditional, complementary, and integrative medicine (TCIM) modalities are widely employed. However, TCIM, specifically herbal and non-herbal dietary supplements, can pose challenges in the context of organ transplantation. In this review, we discuss common supplements used for psychiatric purposes and highlight important considerations for candidates and recipients of liver transplants. RECENT FINDINGS Ashwagandha, kava kava, green tea extract, skullcap, turmeric, and valerian have known idiosyncratic hepatotoxic potential and may complicate the liver transplantation course. Multiple supplements reportedly carry a lower risk of hepatotoxicity, though evidence for widespread use in those at risk for or with hepatic impairment is limited. Psychiatrists caring for candidates and recipients of liver transplants must recognize that patients may find supplements helpful in alleviating psychiatric symptoms, despite an overall limited evidence base. Evaluating benefit versus risk ratios and reviewing drug-drug interactions is essential to promote transplant candidacy and mitigate the possibility of native or graft liver dysfunction.
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Affiliation(s)
- Shivali Patel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
- Department of Psychiatry, Henry Ford Health, 2799 W Grand Blvd., Detroit, MI, 48202, USA.
| | - Kinza Tareen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Chandni Patel
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Amy Rosinski
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Ghasemzadeh Rahbardar M, Hosseinzadeh H. The ameliorative effect of turmeric (Curcuma longa Linn) extract and its major constituent, curcumin, and its analogs on ethanol toxicity. Phytother Res 2024; 38:2165-2181. [PMID: 38396341 DOI: 10.1002/ptr.8165] [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] [Received: 07/26/2023] [Revised: 12/09/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
Ethanol toxicity is a major public health problem that can cause damage to various organs in the body by several mechanisms inducing oxidative stress, inflammation, and apoptosis. Recently, there has been a growing interest in the potential of herbal medicines as therapeutic agents for the prevention and treatment of various disorders. Turmeric (Curcuma longa) extracts and its main components including curcumin have antioxidant, anti-inflammatory, and anti-apoptotic properties. This review aims to evaluate the literature on the ameliorative effects of turmeric extracts and their main components on ethanol toxicity. The relevant studies were identified through searches of Google Scholar, PubMed, and Scopus without any time limitation. The underlying mechanisms of turmeric and curcumin were also discussed. The findings suggest that turmeric and curcumin ameliorate ethanol-induced organ damage by suppressing oxidative stress, inflammation, apoptosis, MAPK activation, TGF-β/Smad signaling pathway, hyperlipidemia, regulating hepatic enzymes, expression of SREBP-1c and PPAR-α. However, the limited clinical evidence suggests that further research is needed to determine the efficacy and safety of turmeric and curcumin in human subjects. In conclusion, the available evidence supports the potential use of turmeric and curcumin as alternative treatments for ethanol toxicity, but further high-quality studies are needed to firmly establish the clinical efficacy of the plant.
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Affiliation(s)
| | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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3
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Ferronato M, Lalanne C, Quarneti C, Panico ML, Guidi M, Lenzi M, Muratori L. The evolving phenotype of autoimmune hepatitis across the millennium: The 40-year experience of a referral centre in Italy. Liver Int 2024; 44:791-798. [PMID: 38230826 DOI: 10.1111/liv.15829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/28/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND AIMS During recent years, there have been major insight into the pathogenesis, diagnosis and treatment of autoimmune hepatitis (AIH). We aim to evaluate modifications of the clinical-epidemiological phenotype of AIH patients from 1980 to our days. METHODS Single-centre, tertiary care retrospective study on 507 consecutive Italian patients with AIH. Patients were divided into four subgroups according to the decade of diagnosis: 1981-1990, 1991-2000, 2001-2010 and 2011-2020. We assessed clinical, laboratory and histological features at diagnosis, response to treatment and clinical outcomes. Acute presentation is defined as transaminase levels >10-fold the upper limit and/or bilirubin >5 mg/dL. Complete response is defined as the normalization of transaminases and IgG after 12 months. Clinical progression is defined as the development of cirrhosis in non-cirrhotic patients and hepatic decompensation/hepatocellular carcinoma development in compensated cirrhosis. RESULTS Median age at diagnosis increased across decades (24, 31, 39, 52 years, p < .001). Acute onset became more common (39.6%, 44.4%, 47.7%, 59.5%, p = .019), while cirrhosis at diagnosis became less frequent (36.5%, 16.3%, 10.8%, 8.7%, p < .001). Complete response rates rose (11.1%, 49.4%, 72.7% 76.2%, p < .001) and clinical progression during follow-up decreased (54.3%, 29.9%, 16.9%, 11.2%, p < .001). Anti-nuclear antibodies positivity increased (40.7%, 52.0%, 73.7%, 79.3%, p < .001), while IgG levels/upper limit progressively decreased (1.546, 1.515, 1.252, 1.120, p < .001). Liver-related death and liver transplantation reduced from 17.1% to 2.1% (p < .001). CONCLUSIONS In the new millennium, the typical AIH patient in Italy is older at diagnosis, more often presents with acute hepatitis, cirrhosis is less frequent and response to treatment is more favourable.
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Affiliation(s)
- Marco Ferronato
- DIMEC, Università di Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudine Lalanne
- DIMEC, Università di Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Chiara Quarneti
- DIMEC, Università di Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Luisa Panico
- DIMEC, Università di Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marcello Guidi
- DIMEC, Università di Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Lenzi
- DIMEC, Università di Bologna, Bologna, Italy
| | - Luigi Muratori
- DIMEC, Università di Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Hepatological Disease (ERN RARE-LIVER), Department of Medicine Martinistraße, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Lubna S, Ahmad R. Clinical and biochemical understanding of Zinc interaction during liver diseases: A paradigm shift. J Trace Elem Med Biol 2023; 77:127130. [PMID: 36641955 DOI: 10.1016/j.jtemb.2023.127130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Zinc (Zn) is an essential and the second most abundant trace element after Iron. It can apply antioxidant, anti-inflammatory, and anti-apoptotic activity. It is assumed to be indispensable for cell division, cellular differentiation and cell signalling. Zinc is essential for proper liver function which is also the site of its metabolism. Depleted Zn concentrations have been observed in both acute and chronic hepatic diseases. It is reported that Zn deficiency or abnormal Zn metabolism during majority of liver diseases is attributed to deficient dietary intake of Zn, augmented disposal of Zn in the urine, activation of certain Zn transporters, and expression of hepatic metallothionein. Undoubtedly, Zn is involved in generating many diseases but how and whether it plays role from acute to fulminant stage of all chronic liver diseases remains to be cleared. Here, we will discuss the role of Zn in development of different diseases specifically the involvement of Zn to understand the aetiology and intricate mechanism of dynamic liver diseases.
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Affiliation(s)
- Shiba Lubna
- Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh 202001, India
| | - Riaz Ahmad
- Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh 202001, India.
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Fontana RJ, Liou I, Reuben A, Suzuki A, Fiel MI, Lee W, Navarro V. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology 2023; 77:1036-1065. [PMID: 35899384 PMCID: PMC9936988 DOI: 10.1002/hep.32689] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Robert J. Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Iris Liou
- University of Washington, Seattle, Washington, USA
| | - Adrian Reuben
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - M. Isabel Fiel
- Department of Pathology, Mount Sinai School of Medicine, New York City, New York, USA
| | - William Lee
- Division of Gastroenterology, University of Texas Southwestern, Dallas, Texas, USA
| | - Victor Navarro
- Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
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Hauer M, Rossi AM, Wertheim BC, Kleppel HB, Bea JW, Funk JL. Dietary Supplement Use in Women Diagnosed with Breast Cancer. J Nutr 2023; 153:301-311. [PMID: 36913466 PMCID: PMC10196584 DOI: 10.1016/j.tjnut.2022.12.007] [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] [Received: 10/21/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Vitamins, minerals, and natural product (NP)-derived dietary supplements are commonly used among women with breast cancer, where interactions with treatments and the disease are possible, emphasizing the importance for health care providers to be aware of supplement use. OBJECTIVES The study aimed to investigate current vitamin/mineral (VM) and NP supplement use among those diagnosed with breast cancer, including usage based on tumor type or concurrent breast cancer treatments and primary information sources for specific supplements. METHODS Social media recruiting to complete an online questionnaire self-reporting current VM and NP use and breast cancer diagnosis and treatment information primarily attracted US participants. Analyses, including multivariate logistic regression, were performed on 1271 women who self-reported breast cancer diagnosis and completed the survey. RESULTS Most participants reported current VM (89.5%) and NP (67.7%) use, with 46.5% (VM) and 26.7% (NP) using at least 3 products concurrently. Top-reported (>15% prevalence) products were vitamin D, calcium, multivitamin, and vitamin C for VM and probiotics, turmeric, fish oil/omega-3 fatty acids, melatonin, and cannabis for NP. Overall, VM or NP use was higher among those with hormone receptor-positive tumors. Although overall NP use did not differ according to current breast cancer treatments, VM use was significantly less common among those currently undergoing chemotherapy or radiation, but higher with current endocrine therapy. Among current chemotherapy users, specific VM and NP supplements with possible adverse effects were still used by 23% of respondents. Medical providers were the primary information source for VM, whereas NP information sources were more varied. CONCLUSIONS Because women diagnosed with breast cancer commonly reported concurrent use of multiple VM and NP supplements, including those with known or underexplored risks (or benefits) in breast cancer, it is important for health care providers to inquire about and facilitate discussions regarding supplement use in this population.
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Affiliation(s)
- Meg Hauer
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Betsy C Wertheim
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Jennifer W Bea
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA; Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Janet L Funk
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA; School of Nutritional Sciences & Wellness, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA.
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7
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Turmeric-Associated Drug-Induced Liver Injury. ACG Case Rep J 2022; 9:e00941. [PMID: 36600786 PMCID: PMC9794274 DOI: 10.14309/crj.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023] Open
Abstract
Turmeric is a common herbal supplement used for its possible anti-inflammatory and other properties. It is marketed as safe with few reports of major adverse effects directly related to oral supplementation. We report a case of turmeric supplement-induced liver injury in a 49-year-old woman admitted with elevated aspartate aminotransferase and alanine aminotransferase with no history of liver disease or alcohol use disorder. Thus, this case re-emphasizes the importance of evaluating herbal and dietary supplements as potential drug-induced liver injury causes.
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8
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Gurley BJ, McGill MR, Koturbash I. Hepatotoxicity due to herbal dietary supplements: Past, present and the future. Food Chem Toxicol 2022; 169:113445. [PMID: 36183923 PMCID: PMC11404749 DOI: 10.1016/j.fct.2022.113445] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022]
Abstract
Dietary supplements (DS) constitute a widely used group of products comprising vitamin, mineral, and botanical extract formulations. DS of botanical or herbal origins (HDS) comprise nearly 30% of all DS and are presented on the market either as single plant extracts or multi-extract-containing products. Despite generally safe toxicological profiles of most products currently present on the market, rising cases of liver injury caused by HDS - mostly by multi-ingredient and adulterated products - are of particular concern. Here we discuss the most prominent historical cases of HDS-induced hepatotoxicty - from Ephedra to Hydroxycut and OxyELITE Pro-NF, as well as products with suspected hepatotoxicity that are either currently on or are entering the market. We further provide discussion on overcoming the existing challenges with HDS-linked hepatotoxicity by introduction of advanced in silico, in vitro, in vivo, and microphysiological system approaches to address the matter of safety of those products before they reach the market.
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Affiliation(s)
- Bill J Gurley
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA; Center for Dietary Supplement Research, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Mitchell R McGill
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Center for Dietary Supplement Research, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Igor Koturbash
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Center for Dietary Supplement Research, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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9
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Pharmacological Profile, Bioactivities, and Safety of Turmeric Oil. Molecules 2022; 27:molecules27165055. [PMID: 36014301 PMCID: PMC9414992 DOI: 10.3390/molecules27165055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
The pharmacological attributes of turmeric have been extensively described and frequently related to the action of curcuminoids. However, there is also scientific evidence of the contribution of turmeric oil. Since the oil does not contain curcuminoids in its composition, it is crucial to better understand the therapeutic role of other constituents in turmeric. The present review discusses the pharmacokinetics of turmeric oil, pointing to the potential application of its active molecules as therapeutic compounds. In addition, the bioactivities of turmeric oil and its safety in preclinical and clinical studies were revised. This literature-based research intends to provide an updated overview to promote further research on turmeric oil and its constituents.
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Liu S, Liu J, He L, Liu L, Cheng B, Zhou F, Cao D, He Y. A Comprehensive Review on the Benefits and Problems of Curcumin with Respect to Human Health. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27144400. [PMID: 35889273 PMCID: PMC9319031 DOI: 10.3390/molecules27144400] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022]
Abstract
Curcumin is the most important active component in turmeric extracts. Curcumin, a natural monomer from plants has received a considerable attention as a dietary supplement, exhibiting evident activity in a wide range of human pathological conditions. In general, curcumin is beneficial to human health, demonstrating pharmacological activities of anti-inflammation and antioxidation, as well as antitumor and immune regulation activities. Curcumin also presents therapeutic potential in neurodegenerative, cardiovascular and cerebrovascular diseases. In this review article, we summarize the advancements made in recent years with respect to curcumin as a biologically active agent in malignant tumors, Alzheimer’s disease (AD), hematological diseases and viral infectious diseases. We also focus on problems associated with curcumin from basic research to clinical translation, such as its low solubility, leading to poor bioavailability, as well as the controversy surrounding the association between curcumin purity and effect. Through a review and summary of the clinical research on curcumin and case reports of adverse effects, we found that the clinical transformation of curcumin is not successful, and excessive intake of curcumin may have adverse effects on the kidneys, heart, liver, blood and immune system, which leads us to warn that curcumin has a long way to go from basic research to application transformation.
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Affiliation(s)
- Siyu Liu
- Post-Graduate School, Hunan University of Chinese Medicine, Changsha 410208, China; (S.L.); (J.L.); (L.L.); (F.Z.)
| | - Jie Liu
- Post-Graduate School, Hunan University of Chinese Medicine, Changsha 410208, China; (S.L.); (J.L.); (L.L.); (F.Z.)
| | - Lan He
- The First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, China; (L.H.); (B.C.)
| | - Liu Liu
- Post-Graduate School, Hunan University of Chinese Medicine, Changsha 410208, China; (S.L.); (J.L.); (L.L.); (F.Z.)
| | - Bo Cheng
- The First Clinical College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410007, China; (L.H.); (B.C.)
| | - Fangliang Zhou
- Post-Graduate School, Hunan University of Chinese Medicine, Changsha 410208, China; (S.L.); (J.L.); (L.L.); (F.Z.)
- Hunan Provincial Engineering and Technological Research Center for Prevention and Treatment of Ophthalmology and Otolaryngology Diseases with Chinese Medicine and Protecting Visual Function, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Deliang Cao
- Post-Graduate School, Hunan University of Chinese Medicine, Changsha 410208, China; (S.L.); (J.L.); (L.L.); (F.Z.)
- Correspondence: (D.C.); (Y.H.)
| | - Yingchun He
- Post-Graduate School, Hunan University of Chinese Medicine, Changsha 410208, China; (S.L.); (J.L.); (L.L.); (F.Z.)
- Hunan Provincial Engineering and Technological Research Center for Prevention and Treatment of Ophthalmology and Otolaryngology Diseases with Chinese Medicine and Protecting Visual Function, Hunan University of Chinese Medicine, Changsha 410208, China
- Hunan Provincial Key Laboratory for the Prevention and Treatment of Ophthalmology and Otolaryngology Diseases with Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha 410208, China
- Correspondence: (D.C.); (Y.H.)
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Funk JL, Schneider C. Perspective on Improving the Relevance, Rigor, and Reproducibility of Botanical Clinical Trials: Lessons Learned From Turmeric Trials. Front Nutr 2021; 8:782912. [PMID: 34926556 PMCID: PMC8678600 DOI: 10.3389/fnut.2021.782912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Plant-derived compounds, without doubt, can have significant medicinal effects since many notable drugs in use today, such as morphine or taxol, were first isolated from botanical sources. When an isolated and purified phytochemical is developed as a pharmaceutical, the uniformity and appropriate use of the product are well defined. Less clear are the benefits and best use of plant-based dietary supplements or other formulations since these products, unlike traditional drugs, are chemically complex and variable in composition, even if derived from a single plant source. This perspective will summarize key points-including the premise of ethnobotanical and preclinical evidence, pharmacokinetics, metabolism, and safety-inherent and unique to the study of botanical dietary supplements to be considered when planning or evaluating botanical clinical trials. Market forces and regulatory frameworks also affect clinical trial design since in the United States, for example, botanical dietary supplements cannot be marketed for disease treatment and submission of information on safety or efficacy is not required. Specific challenges are thus readily apparent both for consumers comparing available products for purchase, as well as for commercially sponsored vs. independent researchers planning clinical trials to evaluate medicinal effects of botanicals. Turmeric dietary supplements, a top selling botanical in the United States and focus of over 400 clinical trials to date, will be used throughout to illustrate both the promise and pitfalls associated with the clinical evaluation of botanicals.
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Affiliation(s)
- Janet L Funk
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Claus Schneider
- Department of Pharmacology, Vanderbilt University, Nashville, TN, United States
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12
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Hv S, V Thomas J, Hs V, K S. An open label, single arm, prospective clinical study to evaluate liver safety and tolerability of PUREMERIC™ (standardized extract from Curcuma longa) in healthy subjects. Toxicol Rep 2021; 8:1955-1959. [PMID: 34917487 PMCID: PMC8646164 DOI: 10.1016/j.toxrep.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
PUREMERIC™ is a standardized turmeric extract containing not less than 95 % curcuminoids. 12-week supplementation of 1g/day of PUREMERIC did not alter the liver function parameters of healthy human volunteers. The safety of the extract was further confirmed by the insignificant changes in the hematological parameters and vital signs. No serious adverse events were recorded during the study.
Objective Turmeric is a culinary spice valued since ancient time for its medicinal properties, mostly attributed to curcumin, the major polyphenol present. The safety of curcumin is well established in humans. However, the tolerability of curcumin is largely determined either in subjects with existing health problems, or in healthy individuals at low doses. More recently the safety of turmeric supplementation is opposed following some case reports on the occurrence of acute hepatitis due to its consumption. Method Here we have investigated the safety and tolerability of a standardized turmeric extract containing 95 % curcuminoids (PUREMERIC™) in an open label, single arm, prospective clinical study. Twelve healthy subjects aged 18–50 years received 500 mg PUREMERIC capsules twice daily for 90 days. Results After PUREMERIC supplementation, the liver function parameters such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total and direct bilirubin, gamma-glutamyl transpeptidase (GGT), and lactate dehydrogenase (LDH) were not significantly altered in the serum compared to baseline. The hematological parameters were within the normal range. Conclusion Collectively, these data contradict the turmeric- induced liver damage and establishes the safety of the extract in healthy individuals.
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Affiliation(s)
- Sudeep Hv
- R&D Center for Excellence, Vidya Herbs Pvt. Ltd, #14A, Jigani I Phase, Bangalore, 560 105 Karnataka, India
| | - Jestin V Thomas
- Leads Clinical Research and Bio Services Private Ltd., Bangalore, India
| | - Vasavi Hs
- R&D Center for Excellence, Vidya Herbs Pvt. Ltd, #14A, Jigani I Phase, Bangalore, 560 105 Karnataka, India
| | - Shyamprasad K
- R&D Center for Excellence, Vidya Herbs Pvt. Ltd, #14A, Jigani I Phase, Bangalore, 560 105 Karnataka, India
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Fu K, Wang C, Ma C, Zhou H, Li Y. The Potential Application of Chinese Medicine in Liver Diseases: A New Opportunity. Front Pharmacol 2021; 12:771459. [PMID: 34803712 PMCID: PMC8600187 DOI: 10.3389/fphar.2021.771459] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
Liver diseases have been a common challenge for people all over the world, which threatens the quality of life and safety of hundreds of millions of patients. China is a major country with liver diseases. Metabolic associated fatty liver disease, hepatitis B virus and alcoholic liver disease are the three most common liver diseases in our country, and the number of patients with liver cancer is increasing. Therefore, finding effective drugs to treat liver disease has become an urgent task. Chinese medicine (CM) has the advantages of low cost, high safety, and various biological activities, which is an important factor for the prevention and treatment of liver diseases. This review systematically summarizes the potential of CM in the treatment of liver diseases, showing that CM can alleviate liver diseases by regulating lipid metabolism, bile acid metabolism, immune function, and gut microbiota, as well as exerting anti-liver injury, anti-oxidation, and anti-hepatitis virus effects. Among them, Keap1/Nrf2, TGF-β/SMADS, p38 MAPK, NF-κB/IκBα, NF-κB-NLRP3, PI3K/Akt, TLR4-MyD88-NF-κB and IL-6/STAT3 signaling pathways are mainly involved. In conclusion, CM is very likely to be a potential candidate for liver disease treatment based on modern phytochemistry, pharmacology, and genomeproteomics, which needs more clinical trials to further clarify its importance in the treatment of liver diseases.
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Affiliation(s)
| | | | | | | | - Yunxia Li
- State Key Laboratory of Southwestern Chinese Medicine Resources, Key Laboratory of Standardization for Chinese Herbal Medicine, Ministry of Education, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Stati G, Rossi F, Sancilio S, Basile M, Di Pietro R. Curcuma longa Hepatotoxicity: A Baseless Accusation. Cases Assessed for Causality Using RUCAM Method. Front Pharmacol 2021; 12:780330. [PMID: 34776989 PMCID: PMC8586077 DOI: 10.3389/fphar.2021.780330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Curcuma longa is a perennial herb that belongs to the Zingiberaceae family. To date, literature includes more than 11.000 scientific articles describing all its beneficial properties. In the last 3 decades various surveys by the U.S. Food and Drug Administration (FDA) concluded that curcumin, the most active ingredient of the drug, is a "generally safe" compound with strong anti-oxidant effects. Curcuma longa was introduced in the daily diet by ayurvedic teachers due to its beneficial effects on health. Nonetheless, recently several reports, from the various global surveillance systems on the safety of plant products, pointed out cases of hepatotoxicity linked to consumption of food supplements containing powdered extract and preparations of Curcuma longa. The latest trend is the use of Curcuma longa as a weight-loss product in combination with piperine, which is used to increase its very low systemic bioavailability. Indeed, only 20 mg piperine, one of the alkaloids found in black pepper (Piper nigrum), assumed at the same time with 2 g curcumin increased 20-fold serum curcumin bioavailability. This combination of natural products is now present in several weight loss supplements containing Curcuma longa. The enhanced drug bioavailability caused by piperine is due to its potent inhibition of drug metabolism, being able to inhibit human P-glycoprotein and CYP3A4, while it interferes with UDP-glucose dehydrogenase and glucuronidation activities in liver. While only few cases of hepatotoxicity, assessed using Roussel Uclaf Causality Assessment Method (RUCAM) method, from prolonged intake of piperine and curcumin have been reported, it would be reasonable to speculate that the suspected toxicity of Curcuma longa could be due to the concomitant presence of piperine itself. Hence, not only there is the need of more basic research to understand the etiopathology of curcumin-related hepatotoxicity and of the combination curcumin-piperine, but human trials will be necessary to settle this dispute.
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Affiliation(s)
- Gianmarco Stati
- Department of Medicine and Ageing Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Rossi
- Department of Molecular Sciences and Nanosystems, Ca’ Foscari University, Venice, Italy
- Biophysics Group, Department of Physics and Astronomy, University College London, London, United Kingdom
| | - Silvia Sancilio
- Department of Medicine and Ageing Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Mariangela Basile
- Department of Medicine and Ageing Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Roberta Di Pietro
- Department of Medicine and Ageing Sciences, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
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15
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Mechanistic Insight into the Effects of Curcumin on Neuroinflammation-Driven Chronic Pain. Pharmaceuticals (Basel) 2021; 14:ph14080777. [PMID: 34451874 PMCID: PMC8397941 DOI: 10.3390/ph14080777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
Chronic pain is a persistent and unremitting condition that has immense effects on patients' quality of life. Studies have shown that neuroinflammation is associated with the induction and progression of chronic pain. The activation of microglia and astrocytes is the major hallmark of spinal neuroinflammation leading to neuronal excitability in the projection neurons. Excessive activation of microglia and astrocytes is one of the major contributing factors to the exacerbation of pain. However, the current chronic pain treatments, mainly by targeting the neuronal cells, remain ineffective and unable to meet the patients' needs. Curcumin, a natural plant product found in the Curcuma genus, improves chronic pain by diminishing the release of inflammatory mediators from the spinal glia. This review details the role of curcumin in microglia and astrocytes both in vitro and in vivo and how it improves pain. We also describe the mechanism of curcumin by highlighting the major glia-mediated cascades in pain. Moreover, the role of curcumin on inflammasome and epigenetic regulation is discussed. Furthermore, we discuss the strategies used to improve the efficacy of curcumin. This review illustrates that curcumin modulating microglia and astrocytes could assure the treatment of chronic pain by suppressing spinal neuroinflammation.
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16
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Pancholi V, Smina TP, Kunnumakkara AB, Maliakel B, Krishnakumar IM. Safety assessment of a highly bioavailable curcumin-galactomannoside complex (CurQfen) in healthy volunteers, with a special reference to the recent hepatotoxic reports of curcumin supplements: A 90-days prospective study. Toxicol Rep 2021; 8:1255-1264. [PMID: 34195017 PMCID: PMC8233102 DOI: 10.1016/j.toxrep.2021.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
CGM did not cause adverse effects or significant variations in clinical parameters. Liver and renal function markers were in normal range after CGM supplementation. CGM was proved to be devoid of adjuvants, synthetic curcumin and contaminants. CGM has 100 % natural clean label status comprising vegan, allergen-free ingredients.
Recently, there is a growing concern about the use of curcumin supplements owing to a few reported hepatotoxicity related adverse events among some of the long-term consumers. Even though no clear evidence was elucidated for the suspected toxicity, the addition of adjuvants that inhibits body’s essential detoxification pathways, adulteration with synthetic curcumin, and presence of contaminants including heavy metals, chromate, illegal dyes, non-steroidal anti-inflammatory agents, and pyrrole alkaloids were suggested as plausible reasons. Considering these incidences and speculations, there is a need to critically evaluate the safety of curcumin supplements for prolonged intake. The present study is an evaluation of the safety of curcumin-galactomannoside complex (CGM), a highly bioavailable curcumin formulation with demonstrated high free curcuminoids delivery. Twenty healthy human volunteers were evaluated for toxic manifestations of CGM when supplemented with 1000 mg per day (∼380 mg curcuminoids) for 90-days. CGM supplementation did not cause any adverse effects or clinically significant variations in the vital signs, hematological parameters, lipid profile and renal function markers of the volunteers, indicating its safety. Liver function enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and bilirubin were in the normal range after 90-day supplementation of CGM. In summary, no adverse effects were observed under the conditions of the study. CGM can be considered as a safe curcumin supplement for regular consumption and is devoid of any adulterants or contaminants.
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Affiliation(s)
- Vaibhavi Pancholi
- Department of General Medicine, Medistar Hospital & Research Center, Vadodara, Gujarat, India
| | | | - Ajaikumar B Kunnumakkara
- Department of Biosciences and Bioengineering, Indian Institute of Technology-Guwahati, Assam, India
| | - Balu Maliakel
- R&D Centre, Akay Natural Ingredients, Cochin, Kerala, India
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17
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Kim SB, Bisson J, Friesen JB, Bucchini L, Gafner S, Lankin DC, Chen SN, Pauli GF, McAlpine JB. The Untargeted Capability of NMR Helps Recognizing Nefarious Adulteration in Natural Products. JOURNAL OF NATURAL PRODUCTS 2021; 84:846-856. [PMID: 33710886 PMCID: PMC8049841 DOI: 10.1021/acs.jnatprod.0c01196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Curcuma longa (turmeric) has an extensive history of ethnomedical use for common ailments, and "curcumin"-containing dietary supplements (CDS) are a highly visible portion of today's self-medication market. Owing to raw material cost pressure, CDS products are affected by economically motivated, nefarious adulteration with synthetic curcumin ("syncumin"), possibly leading to unexpected toxicological issues due to "residual" impurities. Using a combination of targeted and untargeted (phyto)chemical analysis, this study investigated the botanical integrity of two commercial "turmeric" CDS with vitamin and other additives that were associated with reported clinical cases of hepatotoxicity. Analyzing multisolvent extracts of the CDS by 100% quantitative 1H NMR (qHNMR), alone and in combination with countercurrent separation (CCS), provided chemical fingerprints that allowed both the targeted identification and quantification of declared components and the untargeted recognition of adulteration. While confirming the presence of curcumin as a major constituent, the universal detection capability of NMR spectroscopy identification of significant residual impurities, including potentially toxic components. While the loss-free nature of CCS captured a wide polarity range of declared and unwanted chemical components, and also increased the dynamic range of the analysis, (q)HNMR determined their mass proportions and chemical constitutions. The results demonstrate that NMR spectroscopy can recognize undeclared constituents even if they represent only a fraction of the mass balance of a dietary supplement product. The chemical information associated with the missing 4.8% and 7.4% (m/m) in the two commercial samples, exhibiting an otherwise adequate curcumin content of 95.2% and 92.6%, respectively, pointed to a product integrity issue and adulteration with undeclared synthetic curcumin. Impurities from synthesis are most plausibly the cause of the observed adverse clinical effects. The study exemplifies how the simultaneously targeted and untargeted analytical principle of the 100% qHNMR method, performed with entry-level high-field instrumentation (400 MHz), can enhance the safety of dietary supplements by identifying adulterated, non-natural "natural" products.
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Affiliation(s)
- Seon Beom Kim
- Center for Natural Products Technologies (CENAPT), Program for Collaborative Research in the Pharmaceutical Sciences, Pharmacognosy Institute, and Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - Jonathan Bisson
- Center for Natural Products Technologies (CENAPT), Program for Collaborative Research in the Pharmaceutical Sciences, Pharmacognosy Institute, and Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - J Brent Friesen
- Center for Natural Products Technologies (CENAPT), Program for Collaborative Research in the Pharmaceutical Sciences, Pharmacognosy Institute, and Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
- Physical Sciences Department, Rosary College of Arts and Sciences, Dominican University, River Forest, Illinois 60305, United States
| | | | - Stefan Gafner
- American Botanical Council, Austin, Texas 78723, United States
| | - David C Lankin
- Center for Natural Products Technologies (CENAPT), Program for Collaborative Research in the Pharmaceutical Sciences, Pharmacognosy Institute, and Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - Shao-Nong Chen
- Center for Natural Products Technologies (CENAPT), Program for Collaborative Research in the Pharmaceutical Sciences, Pharmacognosy Institute, and Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - Guido F Pauli
- Center for Natural Products Technologies (CENAPT), Program for Collaborative Research in the Pharmaceutical Sciences, Pharmacognosy Institute, and Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
| | - James B McAlpine
- Center for Natural Products Technologies (CENAPT), Program for Collaborative Research in the Pharmaceutical Sciences, Pharmacognosy Institute, and Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, United States
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18
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Chand S, Hair C, Beswick L. Author reply. Intern Med J 2021; 51:154. [PMID: 33572009 DOI: 10.1111/imj.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sheital Chand
- Department of Gastroenterology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Christopher Hair
- Department of Gastroenterology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Lauren Beswick
- Department of Gastroenterology, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Victoria, Australia
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19
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Philips CA, Ahamed R, Rajesh S, George T, Mohanan M, Augustine P. Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs. World J Hepatol 2020; 12:574-595. [PMID: 33033566 PMCID: PMC7522561 DOI: 10.4254/wjh.v12.i9.574] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/16/2020] [Accepted: 08/15/2020] [Indexed: 02/06/2023] Open
Abstract
With growing antipathy toward conventional prescription drugs due to the fear of adverse events, the general and patient populations have been increasingly using complementary and alternative medications (CAMs) for managing acute and chronic diseases. The general misconception is that natural herbal-based preparations are devoid of toxicity, and hence short- and long-term use remain justified among people as well as the CAM practitioners who prescribe these medicines. In this regard, Ayurvedic herbal medications have become one of the most utilized in the East, specifically the Indian sub-continent, with increasing use in the West. Recent well-performed observational studies have confirmed the hepatotoxic potential of Ayurvedic drugs. Toxicity stems from direct effects or from indirect effects through herbal metabolites, unknown herb-herb and herb-drug interactions, adulteration of Ayurvedic drugs with other prescription medicines, and contamination due to poor manufacturing practices. In this exhaustive review, we present details on their hepatotoxic potential, discuss the mechanisms, clinical presentation, liver histology and patient outcomes of certain commonly used Ayurvedic herbs which will serve as a knowledge bank for physicians caring for liver disease patients, to support early identification and treatment of those who present with CAM-induced liver injury.
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Affiliation(s)
- Cyriac Abby Philips
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India.
| | - Rizwan Ahamed
- Gastroenterology and Advanced GI Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
| | - Sasidharan Rajesh
- Division of Hepatobiliary Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
| | - Tom George
- Division of Hepatobiliary Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
| | - Meera Mohanan
- Anesthesia and Critical Care, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
| | - Philip Augustine
- Gastroenterology and Advanced GI Endoscopy, Cochin Gastroenterology Group, Ernakulam Medical Center, Kochi 682028, Kerala, India
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20
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Hassanzadeh K, Buccarello L, Dragotto J, Mohammadi A, Corbo M, Feligioni M. Obstacles against the Marketing of Curcumin as a Drug. Int J Mol Sci 2020; 21:E6619. [PMID: 32927725 PMCID: PMC7554750 DOI: 10.3390/ijms21186619] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022] Open
Abstract
Among the extensive public and scientific interest in the use of phytochemicals to prevent or treat human diseases in recent years, natural compounds have been highly investigated to elucidate their therapeutic effect on chronic human diseases including cancer, cardiovascular disease, and neurodegenerative disease. Curcumin, an active principle of the perennial herb Curcuma longa, has attracted an increasing research interest over the last half-century due to its diversity of molecular targets, including transcription factors, enzymes, protein kinases, growth factors, inflammatory cytokines, receptors, and it's interesting pharmacological activities. Despite that, the clinical effectiveness of the native curcumin is weak, owing to its low bioavailability and rapid metabolism. Preclinical data obtained from animal models and phase I clinical studies done in human volunteers confirmed a small amount of intestinal absorption, hepatic first pass effect, and some degree of intestinal metabolism, might explain its poor systemic availability when it is given via the oral route. During the last decade, researchers have attempted with new pharmaceutical methods such as nanoparticles, liposomes, micelles, solid dispersions, emulsions, and microspheres to improve the bioavailability of curcumin. As a result, a significant number of bioavailable curcumin-based formulations were introduced with a varying range of enhanced bioavailability. This manuscript critically reviews the available scientific evidence on the basic and clinical effects and molecular targets of curcumin. We also discuss its pharmacokinetic and problems for marketing curcumin as a drug.
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Affiliation(s)
- Kambiz Hassanzadeh
- European Brain Research Institute (EBRI) Rita Levi Montalcini Foundation, Viale Regina Elena 295, 00161 Rome, Italy; (K.H.); (L.B.); (J.D.)
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 66177-15175, Iran;
| | - Lucia Buccarello
- European Brain Research Institute (EBRI) Rita Levi Montalcini Foundation, Viale Regina Elena 295, 00161 Rome, Italy; (K.H.); (L.B.); (J.D.)
| | - Jessica Dragotto
- European Brain Research Institute (EBRI) Rita Levi Montalcini Foundation, Viale Regina Elena 295, 00161 Rome, Italy; (K.H.); (L.B.); (J.D.)
| | - Asadollah Mohammadi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 66177-15175, Iran;
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, 20144 Milano, Italy;
| | - Marco Feligioni
- European Brain Research Institute (EBRI) Rita Levi Montalcini Foundation, Viale Regina Elena 295, 00161 Rome, Italy; (K.H.); (L.B.); (J.D.)
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, 20144 Milano, Italy;
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21
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Skiba MB, Hopkins LL, Hopkins AL, Billheimer D, Funk JL. Nonvitamin, Nonmineral Dietary Supplement Use in Individuals with Rheumatoid Arthritis. J Nutr 2020; 150:2451-2459. [PMID: 32805045 PMCID: PMC7540062 DOI: 10.1093/jn/nxaa197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/27/2020] [Accepted: 06/18/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Over-the-counter, natural product-based (nonvitamin, nonmineral) dietary supplement (NVNM DS) use is common in adults with rheumatoid arthritis (RA), a group at risk for drug-DS interactions, due to polypharmacy, but this use is underreported to health care providers. Recent dramatic changes in US sales of specific NVNM DS suggest that the prevalence and types of NVNM DS used in RA populations may also have shifted. OBJECTIVES A study was undertaken to identify current and past use of specific NVNM DS for RA disease treatment and to examine associations between use of NVNM DS, RA pharmaceuticals, and/or vitamin or mineral (VM) DS. METHODS We developed a survey instrument to capture current and ever use of specific NVNM DS, VM DS, and RA pharmaceuticals, with 696 subjects self-reporting an RA diagnosis recruited online or in clinic for survey participation. Analyses were limited to 611 subjects reporting RA diagnosis after age 18 y and treatment with specific RA pharmaceuticals. RESULTS Most participants reported DS use, with current usage prevalence 49.6% (n = 303), 83.5% (n = 510), or 87.6% (n = 535) for NVNM, VM, or any DS, respectively. While not having appeared in previous RA surveys, turmeric and ginger were among the top 3 NVNM DS in current use, along with fish oil/ω-3 (n-3) PUFA. Concurrent NVNM DS use was reported by 48.2% (n = 243) of participants currently using RA pharmaceuticals (n = 504) and was more common in those using disease-modifying antirheumatic drugs only (no biologics). Most methotrexate users (83%) reported concurrent folate supplementation, with one-third also using turmeric, which is notable because methotrexate and turmeric have been associated with hepatotoxicity. CONCLUSION Individuals with RA commonly use NVNM DS in combination with RA pharmaceuticals, including a previously undocumented but popular use of turmeric or ginger supplements with an unclear risk/benefit ratio.
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Affiliation(s)
- Meghan B Skiba
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA,Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Laura L Hopkins
- Department of Medicine, University of Arizona, Tucson, AZ, USA,Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Allison L Hopkins
- Department of Anthropology, Texas A&M University, College Station, TX, USA
| | - Dean Billheimer
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
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22
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Lombardi N, Crescioli G, Maggini V, Ippoliti I, Menniti-Ippolito F, Gallo E, Brilli V, Lanzi C, Mannaioni G, Firenzuoli F, Vannacci A. Acute liver injury following turmeric use in Tuscany: An analysis of the Italian Phytovigilance database and systematic review of case reports. Br J Clin Pharmacol 2020; 87:741-753. [PMID: 32656820 DOI: 10.1111/bcp.14460] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Several cases of acute non-infectious cholestatic hepatitis recently appeared in Italy following consumption of Curcuma longa-containing dietary supplements. The aim of this research was to describe the Tuscan (Italy) cases of acute hepatitis and to compare them with similar cases of hepatotoxicity published in the literature by performing a systematic review. METHODS Records of Tuscan cases of acute hepatitis were obtained from the Italian Phytovigilance system. Each spontaneous report was analysed in order to collect all relevant clinical information of patients and information concerning the Curcuma longa-containing dietary supplement. Moreover, both the RUCAM and WHO-UMC systems were used to evaluate the causal relationship between the use of dietary supplement and acute hepatitis. A systematic literature review was performed in MEDLINE and Embase and all case-reports and case-series published in English were included. RESULTS Seven cases of acute hepatitis occurring in Tuscany up to September 2019 are described. In all cases, hepatotoxicity was associated with Curcuma longa formulations with high bioavailability and high dosage of curcumin/curcuminoids. The causal relationship was also supported by the positive dechallenge observed in most cases. In the 23 cases identified through the systematic review, the majority of patients were concomitantly exposed to at least one other medication and 16 of them experienced a positive dechallenge. CONCLUSIONS Within the frame of poorly controlled and regulated products, such as dietary supplements, the evaluation of Italian cases of Curcuma longa-induced acute hepatitis and the systematic review of literature confirmed the association between Curcuma longa and liver injury.
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Affiliation(s)
- Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Valentina Maggini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
| | - Ilaria Ippoliti
- National Centre for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | | | - Eugenia Gallo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
| | - Valentina Brilli
- Toxicology Unit and Poison Centre, Careggi University Hospital, Florence, Italy
| | - Cecilia Lanzi
- Toxicology Unit and Poison Centre, Careggi University Hospital, Florence, Italy
| | - Guido Mannaioni
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy.,Toxicology Unit and Poison Centre, Careggi University Hospital, Florence, Italy
| | - Fabio Firenzuoli
- CERFIT, Research and Innovation Center in Phytotherapy and Integrated Medicine, Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
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23
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Abstract
Turmeric is a popular herbal dietary supplement that has been considered safe and even shown to have hepatoprotective properties. In the recent times, however, there have been a few case reports of turmeric-induced liver injury. We report a 55-year-old woman with chronic turmeric consumption whose initial diagnosis was acute autoimmune hepatitis. She declined steroid treatment, and hence, we recommended discontinuing her long-term turmeric usage. A month after discontinuation, her liver function returned to normal. This case demonstrates the importance of recognizing the potential adverse effects of herbal dietary supplement.
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24
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Drug Induced Liver Injury Attributed to a Curcumin Supplement. Case Rep Gastrointest Med 2019; 2019:6029403. [PMID: 31781418 PMCID: PMC6855017 DOI: 10.1155/2019/6029403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/15/2019] [Accepted: 08/30/2019] [Indexed: 02/08/2023] Open
Abstract
More severe reactions, higher acute liver failure rates, and higher recurrence rates on re-challenge occur with supplement-related Drug Induced Liver Injury (DILI) (Medina-Caliz et al., 2018). We report a case of curcumin-induced hepatocellular DILI in a 78-year old female admitted with jaundice, with a one-month latency. Extensive evaluation for alternative etiologies of hepatotoxicity was unremarkable. The Roussel Uclaf Causality Assessment Method (RUCAM) score of 6 for the supplement indicated a probable association (score >8: highly probable association). Peak levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were >20 times upper limit of normal. A 48% decrease in AST and ALT levels was observed 7 days after discontinuation of the supplement, and resolution of transaminitis was observed in 42 days. No re-challenge was performed. In conclusion, this case emphasizes the importance of recognizing curcumin supplements as DILI triggers. Furthermore, it reiterates the need for careful evaluation of herbal and dietary supplements (HDS) consumed by patients to identify potential DILI culprits, and to ultimately prevent DILI reactions with significant morbidity and mortality.
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25
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Vollono L, Falconi M, Gaziano R, Iacovelli F, Dika E, Terracciano C, Bianchi L, Campione E. Potential of Curcumin in Skin Disorders. Nutrients 2019; 11:E2169. [PMID: 31509968 PMCID: PMC6770633 DOI: 10.3390/nu11092169] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/05/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022] Open
Abstract
Curcumin is a compound isolated from turmeric, a plant known for its medicinal use. Recently, there is a growing interest in the medical community in identifying novel, low-cost, safe molecules that may be used in the treatment of inflammatory and neoplastic diseases. An increasing amount of evidence suggests that curcumin may represent an effective agent in the treatment of several skin conditions. We examined the most relevant in vitro and in vivo studies published to date regarding the use of curcumin in inflammatory, neoplastic, and infectious skin diseases, providing information on its bioavailability and safety profile. Moreover, we performed a computational analysis about curcumin's interaction towards the major enzymatic targets identified in the literature. Our results suggest that curcumin may represent a low-cost, well-tolerated, effective agent in the treatment of skin diseases. However, bypass of limitations of its in vivo use (low oral bioavailability, metabolism) is essential in order to conduct larger clinical trials that could confirm these observations. The possible use of curcumin in combination with traditional drugs and the formulations of novel delivery systems represent a very promising field for future applicative research.
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Affiliation(s)
- Laura Vollono
- Dermatology Unit, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy
| | - Mattia Falconi
- Department of Biology, University of Rome "Tor Vergata", Via della Ricerca Scientifica, 1-00133 Rome, Italy
| | - Roberta Gaziano
- Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy
| | - Federico Iacovelli
- Department of Biology, University of Rome "Tor Vergata", Via della Ricerca Scientifica, 1-00133 Rome, Italy
| | - Emi Dika
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Via Massarenti, 1-40138 Bologna, Italy
| | - Chiara Terracciano
- Neurology Unit, Guglielmo de Saliceto Hospital, 29121-29122 Piacenza, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy
| | - Elena Campione
- Dermatology Unit, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy.
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26
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Luber RP, Rentsch C, Lontos S, Pope JD, Aung AK, Schneider HG, Kemp W, Roberts SK, Majeed A. Turmeric Induced Liver Injury: A Report of Two Cases. Case Reports Hepatol 2019; 2019:6741213. [PMID: 31214366 PMCID: PMC6535872 DOI: 10.1155/2019/6741213] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/17/2019] [Indexed: 02/08/2023] Open
Abstract
Turmeric is a commonly used oral herbal supplement with purported anti-inflammatory and antineoplastic properties. It is promoted as safe, with limited reports of severe adverse effects directly related to oral turmeric thus far in the literature. Herein we report two cases of turmeric supplement induced severe hepatitis. These cases highlight the need for physicians to be aware of patients taking this common supplement and the potential risks that exist.
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Affiliation(s)
- Raphael P. Luber
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Gastroenterology and Liver Transplantation, The Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Clarissa Rentsch
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
- Department of Pharmacy, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Steve Lontos
- Department of Gastroenterology and Liver Transplantation, The Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, Australia
| | - Jeffrey D. Pope
- Clinical Biochemistry Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Ar Kar Aung
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of General Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Hans G. Schneider
- Clinical Biochemistry Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
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