Research Advances on Hepatotoxicity of Herbal Medicines in China

Serum pharmacochemistry combined with network pharmacology reveals the hepatotoxicity mechanism of Alangium chinense (Lour.) Harms

ETHNOPHARMACOLOGICAL RELEVANCE

Alangium chinense (Lour.) Harms, commonly known as A. chinense, is a member of the Alangiaceae family. This plant is traditionally utilized by the Miao nationality of Guizhou as a medicinal remedy for rheumatic discomfort, employing a method that targets and eliminates toxins. Research has demonstrated its efficacy in dispelling wind, reducing dampness, breaking up blood stagnation, and alleviating pain. Nonetheless, there have been indications that A. chinense may possess toxic properties; however, the exact mechanism underlying its toxicity remains not fully understood.

AIM OF THE STUDY

Employing an integrated strategy that combines serum metabolomics and network pharmacology, this work intends to elucidate the toxic elements and comprehensively explore the fundamental processes of toxicity connected to A. chinense.

MATERIALS AND METHODS

Rats were divided into thirteen groups, including normal control group and low-medium-high dose groups of water extract and ethanol extract of fibrous root and root, over 14 consecutive days. Toxic effects were evaluated through serum biochemistry and pathohistological examinations. Serum metabolomics were analyzed using UPLC-MS/MS to identify the main blood-absorbed constituents of A. chinense. Additionally, hepatotoxicity-related targets were compiled from OMIM, CTD, GeneCards, and DisGeNET databases alongside primary blood-absorbed component targets sourced from TCMSP and Swiss Target Prediction databases. We elucidated the toxic mechanism of A. chinense through compound-target and target-pathway networks. Finally, we verified the mechanism of A. chinense-induced hepatotoxicity in rats by molecular docking, qRT-PCR, western blotting and in vitro experiments.

RESULTS

In vivo experiments revealed that A. chinense increased the levels of AST and ALT in serum. The sectioning results indicated that different medicinal parts and different extracts of A. chinense caused varying degrees of liver damage in a dose-dependent manner, with the water extract of fibrous root resulting in the greatest damage. The UPLC-MS/MS analysis revealed 75 blood-absorbed components in A. chinense, with 18 significantly linked to liver injury factors, such as Anabasine, Brucine, Tricin, and quercetin-3,4'-dimethyl ether. Additionally, network pharmacology revealed 123 potential targets associated with A. chinense-induced hepatotoxicity. KEGG pathway analysis revealed 247 signaling pathways associated with these common targets, emphasizing key pathways such as the PI3K-Akt signaling pathway, lipid and atherosclerosis signaling pathway, and chemical carcinogenesis-receptor activation signaling pathway. Molecular docking studies demonstrated that Mansonone D, Sudachitin, Mansonone E, Tricin, Brucine, and (-)-Anabasine exhibit strong affinity and low binding energy with PIK3CA, AKT1, mTOR, MAP2K1, and MAPK1 among the identified blood-absorbed ingredients. In addition, qRT-PCR combined with Western blotting analysis showed that compared with the control group, A. chinense water extract significantly increased the mRNA expression of PIK3CA, AKT1, mTOR, MAP2K1, MAPK1 and rheb in rat liver tissue. Abnormal activation of pmTOR/mTOR, pPI3K/PI3K, pAKT/AKT protein expression levels and the enzyme activity levels of caspase 3/7 and caspase 1, thereby activating PI3K/AKT/mTOR pathway to play hepatotoxic role through autophagy or apoptosis. This suggests an intensive activation of this specific biochemical transformation channel. Finally, the in vitro experiment showed that Anabasine, the alkaloids of fibrous root and root could significantly increase AST and ALT levels in mouse AML-12 cells.

CONCLUSIONS

Through network pharmacology and serum metabolomics analysis, we investigated the possible mechanism of A. chinense's hepatotoxicity and confirmed that A. chinense may be caused by abnormal activation of PI3K/AKT/mTOR signaling pathway. This study elucidates the potential mechanism of A. chinense-related hepatotoxicity, provides a theoretical basis for in-depth exploration of its toxicity mechanism and mitigation strategies, and provides valuable insights and scientific support for understanding the intrinsic toxicity mechanism of ethnomedicine from a holistic perspective.

Investigating the Potential Effects of 6PPDQ on Prostate Cancer Through Network Toxicology and Molecular Docking

(1) Background: N-(1,3-Dimethylbutyl)-N'-phenyl-p-phenylenediamine-quinone (6PPDQ), as a newly discovered environmental toxin, has been found more frequently in our living conditions. The literature reports that damage to the reproductive and cardiovascular system is associated with exposure to 6PPDQ. However, the relationship between 6PPDQ and cancer still requires more investigation. This research aims to investigate the association between 6PPDQ and prostate cancer. (2) Methods and Results: Based on the data retrieved from the Pharmmapper, CTD, SEA, SwissTargetPrediction, GeneCard, and OMIM databases, we summarized 239 potential targets utilizing the Venn tool. Through the STRING network database and Cytoscape software, we constructed a PPI network and confirmed ten core targets, including IGF1R, PIK3R1, PTPN11, EGFR, SRC, GRB2, JAK2, SOS1, KDR, and IRS1. We identified the potential pathways through which 6PPDQ acts on these core targets using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Ultimately, through molecular docking methods, 6PPDQ binds closely with these ten core targets. These findings indicate that 6PPDQ may influence the proteins related to prostate cancer and may be linked to prostate cancer via several known signaling pathways. (3) Conclusions: This article employs innovative network toxicology to elucidate the prostate carcinogenic effects of 6PPDQ through its modulation of specific vital genes and signaling pathways, thereby establishing a foundational platform for future investigations into the impact of 6PPDQ on prostate cancer and potentially other tumors.

Dendrobium huoshanense in the treatment of ulcerative colitis: Network pharmacology and experimental validation

ETHNOPHARMACOLOGICAL RELEVANCE

Dendrobium huoshanense C. Z. Tang et S. J. Cheng (DH) is a traditional medicinal herb with a long history of medicinal use. DH has been recorded as protecting the gastrointestinal function. Modern pharmacology research shows that DH regulates intestinal flora, intestinal mucosal immunity, gastrointestinal peristalsis and secretion of digestive juices. At the same time, some studies have shown that DH has a good therapeutic effect on ulcerative colitis, but its mechanism of action has not been fully elucidated.

AIMS OF THIS STUDY

To investigate the mechanism and effect of Dendrobium huoshanense C. Z. Tang et S. J. Cheng (DH) in the treatment of ulcerative colitis (UC) by combining network pharmacology and in vivo experimental validation.

METHODS

A network pharmacology approach was used to perform component screening, target prediction, PPI network interaction analysis, GO and KEGG enrichment analysis to initially predict the mechanism of DH treatment for UC. Then, the mechanism was validated with the UC mouse model induced by 3% DSS.

RESULTS

Based on the network pharmacological analysis, a comprehensive of 101 active components were identified, with 19 of them potentially serving as the crucial elements in DH's effectiveness against UC treatment. Additionally, the study revealed 314 potential core therapeutic targets along with the top 5 key targets: SRC, STAT3, AKT1, HSP90AA1, and PIK3CA. In experiments conducted on live mice with UC, DH was found to decrease the levels of IL-6 and TNF-α in the blood, while increasing the levels of IL-10 and TGF-β. This led to notable improvements in colon length, injury severity, and an up-regulation of SRC, STAT3, HSP90AA1, PIK3CA, p-AKT1 and PI3K/AKT signaling pathway expression in the colon tissue.

CONCLUSIONS

In this study, the active components and main targets of DH for UC treatment were initially forecasted, and the potential mechanism was investigated through network pharmacology. These findings offer an experimental foundation for the clinical utilization of DH.

A comprehensive review of the classical prescription Yiguan Jian: Phytochemistry, quality control, clinical applications, pharmacology, and safety profile

ETHNOPHARMACOLOGICAL RELEVANCE

Yiguan Jian (YGJ) is a classical prescription, which employs 6 kinds of medicinal herbs including Rehmanniae Radix, Lycii Fructus, Angelicae sinensis Radix, Glehniae Radix, Ophiopogonis Radix, and Toosendan Fructus. YGJ decoction is originally prescribed in Qing Dynasty (1636 CE ∼ 1912 CE) in China, and is commonly used to treat liver diseases. There remain abundant literature investigating YGJ decoction from multiple aspects, but few reviews summarized the research and gave a precise definition, which impedes further applications and commercialization of YGJ decoction.

AIM OF THE REVIEW

The aim of this review is to provide comprehensive descriptions of YGJ decoction, tackling with issues in the research and development of YGJ decoction.

MATERIALS AND METHODS

The literature and clinical reports were obtained from the databases including Web of Science, Science Direct, PubMed, Google Scholar, China National Knowledge Infrastructure, China Science Periodical Database, China Science and Technology Journal Database, and SinoMed since 2000. The phytochemical characteristics, quality control, pharmaceutical forms, clinical position, pharmacological effects, and toxic events of YGJ decoction were included for analysis.

RESULT

This review firstly summarized the progress of the chemical existences of YGJ decoction and discussed the advanced methods in monitoring quality of YGJ decoction and its herbal ingredients, particularly in the form of granules. Whilst this review aims to identify the pharmacological actions and clinical impacts of YGJ decoction, the medicinal materials that could provide these benefits were observed in the remaining herbs to exert the anti-fibrotic effects, anti-inflammatory activities, anti-cancer, and anti-diabetic effects, and to universally treat liver and gastric diseases. This review provided supplementary descriptions on the safety issues, especially in Glehniae Radix and Toosendan Fructus, to define the alterations between hepatoprotective activities and unclear toxics in YGJ decoction application.

CONCLUSIONS

Our comprehensively organized review discussed the chemical characteristics and the research in altering or identifying these essences. The effects of YGJ decoction on the non-clinical and clinical tests exert the good management of sophisticated diseases. In this review, current issues are discussed to inform and inspire subsequent research of YGJ decoction and other classical prescriptions.

Sub-chronic toxicity of an aqueous extract of Epimedium sagittatum (Sieb. Et Zucc.) Maxim. in rats

Epimedium sagittatum (Sieb. et Zucc.) Maxim., a traditional medicinal plant in Asia, is widely used in clinical settings but its safety in vivo is unclear. This study investigated the sub-chronic toxicity of E. sagittatum aqueous extract to rats with a 13-week daily intragastric administration of 7.5, 15, or 30 g/kg. Nine constituents of the aqueous extract were identified by ultra-performance liquid chromatography (UPLC). Organ weights, organ coefficients, serum biochemistry parameters, histopathology, and metabolomic analysis were performed. In female rats, treatment increased the liver, thymus, and adrenal gland coefficients (p < 0.05). Liver, pancreas, and adrenal gland injury were observed. The levels of six metabolites were altered by the treatment (p < 0.05). In male rats, treatment altered liver, heart, and thymus coefficients (p < 0.05) and liver, adrenal gland, and heart injury were observed. The levels of 11 metabolites were altered (p < 0.05). The no-observed-adverse-effect level was not determined but would be below 7.5 g/kg in rats treated for 13 weeks. In female rats, E. sagittatum may injure the liver and pancreas and dysregulate the biosynthesis of phenylalanine, tyrosine, tryptophan, valine, leucine, and isoleucine and the metabolism of phenylalanine. In male rats, the extract may injure the liver and adrenal gland and dysregulate the biosynthesis of valine, leucine, and isoleucine and the metabolism of pyruvate.

Jaundice and its associated factors among neonates admitted to selected referral hospitals in southwest oromia, Ethiopia: Multi-center cross-sectional study

Background

Jaundice is a common clinical problem during the first month of birth throughout the world. Mainly, it is the leading cause of neonatal morbidity and mortality in developing countries.

Objectives

The aimed of this studied was to assess predictors of jaundice among neonates admitted to selected referral hospitals in southwest Oromia, Ethiopia, 2021.

Methods

An Institutional based cross-sectional study was implemented among 205 admitted neonates at selected referral hospitals in southwest Oromia, Ethiopia from October 05 to November 5, 2021. Jimma medical center (JMC), Wollega University referral hospital (WURH), and Ambo University Referral hospital (AURH) were selected by simple random sampling technique. A pretested structured interviewer-administered questionnaire and medical record review was used to collect data. Both binary and multivariable logistic regression analyses were performed to identify factors associated with neonatal jaundice. Logistic regression analyses were performed to identify factors associated with neonatal jaundice. Statistical Significance was declared at P-value less than 0.05 in the final model, and if the confidence interval does not include the null hypothesis value.

Results

The prevalence of neonatal jaundice was 20.5% (95%CI: 1.74-1.85). The mean age of neonates was 8.6 ± 7.8 days. Traditional medicine use during current pregnancy (AOR: 5.62, 95%CI: 1.07, 9.52), Rh incompatibility (AOR: 0.045, 95%CI: 0.01, 0.21), gestational age (AOR: 4.61, 95%CI: 1.05, 10.3), premature rupture of membrane (AOR: 3.76, 95%CI: 1.58, 8.93) and hypertension (mother) (AOR: 3.99, 95%CI: 1.13, 14.02) were factors significantly associated with neonatal jaundice.

Conclusion

Neonatal jaundice was relatively higher in the current study. Traditional medicine use, Rh incompatibility, premature ruptures of membrane, hypertension, and preterm gestational age were factors associated with neonatal jaundice.

A review of herb-induced liver injury in mainland china

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.

Epimedium koreanum Nakai-Induced Liver Injury-A Mechanistic Study Using Untargeted Metabolomics

Epimedii Folium is widely used worldwide as an herbal supplement, and the risk of its induced liver damage has emerged in recent years. Our preliminary study has found that, among several Epimedii Folium species specified in the Chinese Pharmacopoeia, Epimedium koreanum Nakai has a more severe propensity for hepatotoxicity. However, the mechanism of hepatotoxicity of Epimedium koreanum Nakai is still unclear. In this study, untargeted metabolomics was performed to analyze the serum and liver tissue to explore the mechanism of hepatotoxicity of Epimedium koreanum Nakai. The results of experiments in vivo showed that, after 28 days of exposure to Epimedium koreanum Nakai ethanol extract (EEE), the liver weight, levels of AST, ALP, TBIL, etc. in serum of rats in the EEE group were significantly increased, as well as severe cytoplasmic vacuolation appeared in the liver tissue, which suggested that EEE has significant hepatotoxicity. Subsequently, the results of metabolomics revealed significant changes in the metabolic profile in the liver and serum of rats after EEE exposure, in which metabolites in serum such as flavin mononucleotide, phenylacetylglycine, glutathione, l-tryptophan, and sphingomyelin were able to accurately identify liver injury caused by EEE and could be used as serum markers to reflect EEE-induced liver injury. The KEGG pathway enrichment analysis revealed that EEE caused extensive effects on rats' metabolic pathways. Some of the most affected pathways included glutathione metabolism, glutamate metabolism pathway, primary bile acid biosynthesis pathway, and sphingolipid metabolism pathway, which were all directed to the biological process of ferroptosis. Then, the main markers related to ferroptosis in the liver were examined, and the results demonstrated that the content of malondialdehyde was significantly increased, the activity of superoxide dismutase was significantly reduced, the ferroptosis inhibitory proteins GPX4 and System xc - were significantly downregulated, and the ferroptosis-promoting protein ACSL4 was significantly up-regulated. Judging from these results, we concluded that the mechanism of hepatotoxicity of Epimedium koreanum Nakai was probably related to the induction of ferroptosis in hepatocytes.

Metabolic Activation of the Toxic Natural Products From Herbal and Dietary Supplements Leading to Toxicities

Currently, herbal and dietary supplements have been widely applied to prevent and treat various diseases. However, the potential toxicities and adverse reactions of herbal and dietary supplements have been increasingly reported, and have gradually attracted widespread attention from clinical pharmacists and physicians. Metabolic activation of specific natural products from herbal and dietary supplements is mediated by hepatic cytochrome P450 or intestinal bacteria, and generates chemical reactive/toxic metabolites that bind to cellular reduced glutathione or macromolecules, and form reactive metabolites-glutathione/protein/DNA adducts, and these protein/DNA adducts can result in toxicities. The present review focuses on the relation between metabolic activation and toxicities of natural products, and provides updated, comprehensive and critical comment on the toxic mechanisms of reactive metabolites. The key inductive role of metabolic activation in toxicity is highlighted, and frequently toxic functional groups of toxic natural products were summarized. The biotransformation of drug cytochrome P450 or intestinal bacteria involved in metabolic activation were clarified, the reactive metabolites-protein adducts were selected as biomarkers for predicting toxicity. And finally, further perspectives between metabolic activation and toxicities of natural products from herbal and dietary supplements are discussed, to provide a reference for the reasonable and safe usage of herbal and dietary supplements.

Multi-Omics Integration to Reveal the Mechanism of Hepatotoxicity Induced by Dictamnine

Herb-induced liver injury (HILI) has become a great concern worldwide due to the widespread usage of herbal products. Among these products is Dictamni Cortex (DC), a well-known Traditional Chinese Medicine (TCM), widely used to treat chronic dermatosis. Dictamni Cortex has drawn increasing attention because of its hepatotoxicity caused by the hepatotoxic component, dictamnine. However, the potential hepatotoxicity mechanism of dictamnine remains unclear. Therefore, this study aimed to use the multi-omics approach (transcriptomic, metabolomic, and proteomic analyses) to identify genes, metabolites, and proteins expressions associated with dictamnine-induced hepatotoxicity. A study on mice revealed that a high dose of dictamnine significantly increases serum aspartate aminotransferase (AST) activity, total bilirubin (TBIL), and direct bilirubin (DBIL) levels, the relative liver weight and liver/brain weight ratio in female mice (P < 0.05 and P < 0.01), compared to the normal control group. Liver histologic analysis further revealed a high dose of dictamnine on female mice caused hepatocyte vesicular steatosis characterized by hepatocyte microvesicles around the liver lobules. The expressed genes, proteins, and metabolites exhibited strong associations with lipid metabolism disorder and oxidative stress. Dictamnine caused increased oxidative stress and early hepatic apoptosis via up-regulation of glutathione S transferase a1 (GSTA1) and Bax/Bcl-2 ratio and down-regulation of the antioxidative enzymes superoxide dismutase (SOD), catalase, and glutathione peroxidase 1 (GPx-1). Besides, the up-regulation of Acyl-CoA synthetase long-chain family member 4 (ACSL4) and down-regulation of acetyl-coa acetyltransferase 1 (ACAT1) and fatty acid binding protein 1 (FABP-1) proteins were linked to lipid metabolism disorder. In summary, dictamnine induces dose-dependent hepatotoxicity in mice, which impairs lipid metabolism and aggravates oxidative stress.

The key issues and development strategy of Chinese Classical Formulas pharmaceutical preparations

It is well-known that Prof. Tu Youyou won the Nobel Prize in Physiology or Medicine in 2015 due to the research on artemisinin treating malaria, and this can be regarded as the milestone of modernization of Traditional medicine. This first Nobel Prize in Traditional Chinese medicine (TCM) has aroused profound impetus in the investigation of TCM and attracted global attention to the ancient books of TCM. Three new medicines for the treatment of COVID-19 derived from Chinese Classical Formula (经典名方, CCF) have been approved in 2021 due to their effectiveness for the treatment of COVID-19. This article introduced the research background of CCF pharmaceutical preparation (CCFPP), explained the ideas for the modernization of CCF and analyzed related issues involved in the development process of CCFPP, including the origin of medicinal materials, processing methods, dosages and the preparation process of CCF Material Reference. The strategy for industrialization was proposed in terms of the evaluation of the pharmaceutical properties, industrialization considerations, and clinical positioning of CCFPP. The key contents and requirements for the development CCFPP were also summarized according to the recently published registration guidance by the Center for Drug Evaluation in China. In addition, the safety issues of CCFPP were described, including the discussion on the non-clinical safety evaluation and analyzation on the international registration of Traditional herbal medicines. This article is aimed to provide references for enterprises, researchers, and relevant personnel of government departments that are engaged in the development of CCF to speed up the developing process of CCFPP.

Antimalarial, Antioxidant, and Toxicological Evaluation of Extracts of Celtis africana, Grosseria vignei, Physalis micrantha, and Stachytarpheta angustifolia

In many parts of the world, malaria undoubtedly poses a serious threat to health care systems. Malaria treatment has increasingly become complicated, primarily due to the emergence of widespread resistance of the malaria parasites to cheap and affordable malaria therapeutics. The use of herbal remedies to treat various ailments, including malaria and malaria-like ailments in Ghana is common. We herein report on the antiplasmodial and antioxidant activities as well as toxicological evaluation of four medicinal plants (Celtis africana, Grosseria vignei, Physalis micrantha, and Stachytarpheta angustifolia) commonly used to treat malaria in Ghana. Following Soxhlet extraction of plant samples in ethanol, extracts were screened against Plasmodium falciparum (3D7 strain) in an in vitro antiplasmodial assay. The phosphomolybdenum and DPPH (1, 1-diphenyl-2 picrylhydrazyl) assays were used to evaluate antioxidant activities while toxicity assessment was carried out in mice using the acute toxicity test and kidney and liver function tests. Extracts from Celtis africana and Physalis micrantha were very active towards the parasites with half-maximal inhibitory concentrations (IC50's) of 29.1 and 3.5 µg/mL, respectively. Extracts of Grosseria vignei and Stachytarpheta angustifolia were inactive, having IC50 values greater than 50 µg/mL. All extracts exhibited excellent total antioxidant capacities (>800 mg/g AAE) and good DPPH radical scavenging potential (IC50 range of 300-900 µg/mL). The median lethal dose (LD50) of all extracts in the toxicological evaluation was greater than 2000 mg/kg and there was no effect of extracts on the levels and activities of key biomarkers of liver and kidney function. The activities of these plants obtained in this study partly give credence to their folkloric use in herbal medicines and suggest that they could provide promising lead compounds for malaria drug discovery programs.

Biological Efficacy and Toxicological Evaluation of Ethanolic Extract of Cassia nodosa Buch.-Ham. (Leguminosae)

Medicinal plants are used worldwide to treat various diseases. However, scientific validation of the therapeutic potential of most medicinal plants is absent, and little to no information on their potential toxicity exists. It is therefore important to assess the efficacy and toxicity of various medicinal plants commonly used in traditional herbal medicine. The main goal of this study was to evaluate the efficacy and toxicity of the ethanolic extract of Cassia nodosa, a plant used in the treatment of fever, cold, gastric pain, diabetes mellitus, and malaria in Ghana. The stem bark extract of Cassia nodosa was obtained by cold maceration. Following phytochemical examination via standard procedures, the extract was screened for antiplasmodial, anti-inflammatory, and antioxidant activities. The extract was also evaluated for acute oral toxicity and its toxicity to the liver and kidney of rats. Phytochemicals present in the extract included sterols, alkaloids, tannins, glycosides, and coumarins. In the in vitro antiplasmodial activity test, the Cassia nodosa extract showed moderate antiplasmodial activity with an IC50 value of 23.98 ± 2.07 µg/ml. An ED50 value of 8.52 ± 2.83 mg/kg in the anti-inflammatory test indicated that the Cassia nodosa extract administered orally was very active in reducing inflammation. The total antioxidant capacity of the extract was determined to be 48.49 ± 5.24 gAAE/100 g with the total phenolic content being 28.48 ± 3.13 (gGAE/100 g) extract. In the DPPH radical scavenging assay, the concentration required for 50% inhibition of DPPH radical was found to be 78.71 ± 6.84 µg/mL. There was a gradual increase in the body weight of rats in both treated and control groups during the acute toxicity test. Clinical biochemical tests did not show any significant differences between control and treated groups of animals in terms of liver and renal functions, 14 days after administration of Cassia nodosa extracts. Taken together, these results provide scientific validation for the use of the plant in traditional medicine.

Involvement of Reactive Oxygen Species in the Hepatorenal Toxicity of Actinomycin V In Vitro and In Vivo

The high toxicity of actinomycin D (Act D) severely limits its use as a first-line chemotherapeutic agent in the clinic. Actinomycin V (Act V), an analog of Act D, exhibited strong anticancer activity in our previous studies. Here, we provide evidence that Act V has less hepatorenal toxicity than Act D in vitro and in vivo, associated with the reactive oxygen species (ROS) pathway. Compared to Act D, Act V exhibited considerably stronger sensitivity for cancer cells and less toxicity to human normal liver LO-2 and human embryonic kidney 293T cells using the MTT (3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide) assay. Notably, Act V caused less damage to both the liver and kidney than Act D in vivo, indicated by organ to body weight ratios, as well as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and serum creatinine (Scr) levels. Further experiments showed that the ROS pathway is involved in Act V-induced hepatorenal toxicity. Act V generates ROS and accumulates malondialdehyde (MDA), reducing levels of superoxide dismutase (SOD) and glutathione (GSH) in LO-2 and 293T cells. These findings indicate that Act V induces less hepatorenal toxicity than Act D in vitro and in vivo and merits further development as a potential therapeutic agent for the treatment of cancer.

Profile of herbal and dietary supplements induced liver injury in Latin America: A systematic review of published reports

Hepatotoxicity related to HDS is a growing global health issue. We have undertaken a systematic review of published case reports and case series from LA from 1976 to 2020 to describe the clinical features of HDS related hepatotoxicity in this region. We search in PubMed, Web of Science, Scopus and specific LA databases according to PRISMA guidelines. Only HILI cases published in LA that met criteria for DILI definition were included. Duplicate records or reports that lacked relevant data that precluded establishing causality were excluded. Finally, 17 records (23 cases) were included in this review. Centella asiatica, Carthamus tinctorius, and Herbalife® were the most reported HDS culprit products, the main reason for HDS consumption was weight loss. The clinical characteristics of HDS hepatotoxicity in our study were compared to those of other studies in the USA, Europe and China showing a similar signature with predominance of young females, hepatocellular damage, a high rate of ALF and mortality, more frequent inadvertent re-challenge and chronic damage. This study underscores the challenge in causality assessment when multi-ingredients HDS are taken and the need for consistent publication practice when reporting hepatotoxicity cases due to HDS, to foster HDS liver safety particularly in LA.

Similar hepatotoxicity response induced by Rhizoma Paridis in zebrafish larvae, cell and rat

Rhizoma Paridis, as a Traditional Chinese Medicine (TCM), has been used in clinic for thousands of years. Recently, the hepatic toxicity was reported in some published articles while its hepatotoxicity mechanisms have not been well established. Therefore, the present study was performed to determine the effect of Rhizoma Paridis treatment on the lipid deposition and metabolism, oxidative stress and mitochondrial dysfunction, and explore the underlying molecular mechanism through L02 cell, rat and zebrafish larvae. Rhizoma Paridis could diminish cell activity and cell proliferation, brought on cell apoptosis and elevated the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) compared with the control group, as evaluated in cell cultures. Rhizoma Paridis could result in the change of the liver structure and the liver function in the rat model and zebrafish larvae. Our results showed that Rhizoma Paridis could increase hepatic lipid accumulation, which was similar to the previous study and probably exerted toxic effect through intensive fatty acid lipogenesis, inhibition of fat degradation. Meanwhile, this experiment highlighted the importance of the oxidative stress, mitochondrial dysfunction, ER function, and the inflammation response in Rhizoma Paridis-induced disorder of hepatic lipid metabolism, which proposed a novel mechanism for interpretation of Rhizoma Paridis exposure inducing the disorder of lipid metabolism in vertebrates. Furthermore, the result of this experiment suggested that the toxicity response of zebrafish larvae was similar to the conventional model with a significant advantage.

Classification, hepatotoxic mechanisms, and targets of the risk ingredients in traditional Chinese medicine-induced liver injury

Traditional Chinese medicine (TCM) has become a crucial cause of drug-induced liver injury (DILI). Differ from chemical medicines, TCM feature more complex and mostly indefinite components. This review aimed to clarify the classification, underlying mechanisms and targets of the risk components in TCM-induced liver injury to further guide the secure application of TCM. Relevant studies or articles published on the PubMed database from January 2008 to December 2019 were searched. Based on the different chemical structures of the risk ingredients in TCM, they are divided into alkaloids, glycosides, toxic proteins, terpenoids and lactones, anthraquinones, and heavy metals. According to whether drug metabolism is activated or hepatocytes are directly attacked during TCM-induced liver injury, the high-risk substances can be classified into metabolic activation, non-metabolic activation, and mixed types. Mechanisms of the hepatotoxic ingredients in TCM-induced hepatotoxicity, including cytochrome P450 (CYP450) induction, mitochondrial dysfunction, oxidative damage, apoptosis, and idiosyncratic reaction, were also summarized. The targets involved in the risk ingredient-induced hepatocellular injury mainly include metabolic enzymes, nuclear receptors, transporters, and signaling pathways. Our periodic review and summary on the risk signals of TCM-induced liver injury must be beneficial to the integrated analysis on the multi-component, multi-target, and multi-effect characteristics of TCM-induced hepatotoxicity.

Toward a better understanding of metabolic and pharmacokinetic characteristics of low-solubility, low-permeability natural medicines

Today, it is very challenging to develop new active pharmaceutical ingredients. Developing good preparations of well-recognized natural medicines is certainly a practical and economic strategy. Low-solubility, low-permeability natural medicines (LLNMs) possess valuable advantages such as effectiveness, relative low cost and low toxicity, which is shown by the presence of popular products on the market. Understanding the in vivo metabolic and pharmacokinetic characteristics of LLNMs contributes to overcoming their associated problems, such as low absorption and low bioavailability. In this review, the structure-based metabolic reactions of LLNMs and related enzymatic systems, cellular and bodily pharmacological effects and metabolic influences, drug-drug interactions involved in metabolism and microenvironmental changes, and pharmacokinetics and dose-dependent/linear pharmacokinetic models are comprehensively evaluated. This review suggests that better pharmacological activity and pharmacokinetic behaviors may be achieved by modifying the metabolism through using nanotechnology and nanosystem in combination with the suitable administration route and dosage. It is noteworthy that novel nanosystems, such as triggered-release liposomes, nucleic acid polymer nanosystems and PEGylated dendrimers, in addition to prodrug and intestinal penetration enhancer, demonstrate encouraging performance. Insights into the metabolic and pharmacokinetic characteristics of LLNMs may help pharmacists to identify new LLNM formulations with high bioavailability and amazing efficacy and help physicians carry out LLNM-based precision medicine and individualized therapies.

Complementary and Alternative Medicine-related Drug-induced Liver Injury in Asia

The use of complementary and alternative medicines (CAMs) for treatment of acute and chronic diseases is on the rise world over, especially in Asian countries, and mostly in China and India. Drug-induced liver injury (DILI) due to CAM is increasingly reported in the literature from multiple centers all around the world and with large-number patient series published from the West, mostly based on nation-wide DILI networks and multicenter collaboration. Comprehensive DILI networks are lacking among major Asian countries with high incidence of CAM practices. Chinese medical societies dealing with drug toxicity, CAM practice and hepatobiliary disease have adopted an integrated approach to establishing identification, diagnosis and treatment of CAM-related DILI, representing a systematic approach that could be iterated by other countries for improving patient outcomes. In this exhaustive review, we provide published data on CAM-related DILI in Asia, with detail on incidences along with analysis of patient population and their clinical outcomes. Concise and clear discussion on commonly implicated CAM agents in major Asian countries and associated chemical and toxicology analyses as well as descriptions of liver biopsy findings are discussed with future directions.

Translating new knowledge on drug-induced liver injury into clinical practice

Drug-induced liver injury (DILI) is one of the main reasons for drug withdrawal from the market, and a cause of worldwide morbidity. Although several issues on DILI are still unsolved, there have been significant advances in new definitions and diagnosis tools. DILI is the result of a complex interaction between genetic and environmental factors, and constitutes an expanding area of investigation. DILI can mimic virtually all known hepatopathies, including vascular disorders and liver tumours. As part of this broad spectrum of clinical presentations, DILI severity ranges from asymptomatic elevations of aminotransferases to acute liver failure. Although biomarkers are emerging as valuable diagnostic tools, they are not available in clinical practice. Accurate DILI diagnosis is a challenging issue, particularly the establishing of causal relationships with the culprit agent and the exclusion of competing causes of liver injury. Given that the understanding of the mechanisms inducing DILI is growing, and both DILI causality assessment scales and the performance of international DILI networks have been improved, hepatotoxicity may be recognised earlier in clinical practice. In this review, advances and results obtained by DILI registries around the world, case characterisations, particularly those relevant to newer definitions in DILI, and the behaviour of chronic liver disease induced by drugs will be updated. In addition, recently published data on herbal and dietary supplements and new predictive scores for acute liver failure assessment will also be discussed.

Herb-Induced Liver Injury: Phylogenetic Relationship, Structure-Toxicity Relationship, and Herb-Ingredient Network Analysis

Currently, hundreds of herbal products with potential hepatotoxicity were available in the literature. A comprehensive summary and analysis focused on these potential hepatotoxic herbal products may assist in understanding herb-induced liver injury (HILI). In this work, we collected 335 hepatotoxic medicinal plants, 296 hepatotoxic ingredients, and 584 hepatoprotective ingredients through a systematic literature retrieval. Then we analyzed these data from the perspectives of phylogenetic relationship and structure-toxicity relationship. Phylogenetic analysis indicated that hepatotoxic medicinal plants tended to have a closer taxonomic relationship. By investigating the structures of the hepatotoxic ingredients, we found that alkaloids and terpenoids were the two major groups of hepatotoxicity. We also identified eight major skeletons of hepatotoxicity and reviewed their hepatotoxic mechanisms. Additionally, 15 structural alerts (SAs) for hepatotoxicity were identified based on SARpy software. These SAs will help to estimate the hepatotoxic risk of ingredients from herbs. Finally, a herb-ingredient network was constructed by integrating multiple datasets, which will assist to identify the hepatotoxic ingredients of herb/herb-formula quickly. In summary, a systemic analysis focused on HILI was conducted which will not only assist to identify the toxic molecular basis of hepatotoxic herbs but also contribute to decipher the mechanisms of HILI.

Safety effect of fractions from methanolic leaf extract of Ocimum gratissimum on reproduction in male wistar rats

This study evaluates the reproductive toxicity of ethyl acetate and butanolic fractions from crude methanolic leaf extract of Ocimum gratissimum in male Wistar rats. Acute toxicity was assessed to determine the safety dose, Sub-chronic reproductive toxicity studies were carried out by administering daily 25, 100 and 400 mg/kg body weight doses of the fractions to respective group of animals and 1 ml of normal saline daily for the control group for 28 days. Blood, epididymis and testes were harvested for reproductive hormones, sperm parameters, and histopathologic analysis respectively. There was significant (P < 0.05) increase in serum levels of testosterone, body-weight gain, sperm count. There was also apparent increase in mean-testicular weight and preservation of testicular histology with increase spermatogenesis in both the ethyl acetate and butanolic fraction treated groups compared with control. Serum levels of luteinising hormone was however significantly (P < 0.05) decrease across the groups compared to control. These effects were more pronounced in the butanolic fraction group compared to the ethyl acetate treated group. Sperm motility was also significantly (P < 0.05) higher in the ethyl acetate treated group compared to control. Findings from this studies demonstrate that these fractions were non-toxic at the tested doses with regards to male reproduction but, rather, exhibited fertility enhancing effects which was better with the butanolic fraction. Our findings also shows that the ethyl acetate fraction may be safer than the butanolic fraction.

Zhuang Gu Guan Jie Wan: Reasonable Application Can Alleviate the Liver Injury for Osteoarthritis Treatment

The potential toxicity of herbal drugs, particularly drug-induced liver injury (DILI), has received extensive attention as the use of Chinese herbal medicine has rapidly increased globally. As a classic Chinese patent medicine, Zhuang Gu Guan Jie Wan (ZGGJW) has been brought into focus recently because of its satisfactory therapeutic effects on osteoarthritis (OA) as well as its unanticipated side effects. This study aimed to decipher the puzzling phenomenon of liver injury developing in response to ZGGJW that varies by the subtype of OA. Normal, anterior cruciate ligament transaction (ACLT) and partial medial meniscectomy (MMx) induced OA and ovariectomy combined with ACLT and partial MMx induced rat models were used and treated orally with ZGGJW or distilled water for 30 days. The results from histopathology, biochemistry, and immunohistochemistry showed that ZGGJW induced liver injury, increased the level of malondialdehyde (MDA), and decreased the levels of total antioxidation capability (T-AOC), superoxide dismutase (SOD), interleukin-22 (IL-22), and signal transducer and activator of transcription factor 3 (STAT3) in the liver of normal rats, while liver injury was alleviated and showed different tendencies in the above markers for ACLT and partial MMx induction rats and ovariectomy combined with ACLT and partial MMx induction rats after ZGGJW treatment. In the OA disease states, hepatic injury induced by ZGGJW could be associated with an impairment in antioxidant capacity and the high levels of IL-22 and STAT3 after ZGGJW treatment may be responsible for the slight hepatic injury of ZGGJW based on the subtype of OA. This study provides a novel approach to better understanding of the risks and limitations when using potentially toxic Chinese patent medicine in clinical applications.

Acute and chronic liver injury induced by Chinese patent medicine: Causes and precautions

Chinese patent medicines are popular due to their definite clinical efficacy, reliable quality, and good safety. However, Chinese medicine and its preparations are one of the main causes of drug induced liver damage. The hepatotoxic ingredients of Chinese patent medicines and the irrational application of Chinese patent medicines are the two main reasons for their hepatotoxicity. However, there are no systematic studies on the causes, types, and preventive measures for liver injury caused by Chinese patent medicines. This article aims to briefly review the causes and preventive measures of acute and chronic liver injury caused by Chinese patent medicines.

Retrospective Study of Reported Adverse Events Due to Complementary Health Products in Singapore From 2010 to 2016

The objective of this study is to collate and analyse adverse event reports associated with the use of complementary health products (CHP) submitted to the Health Sciences Authority (HSA) of Singapore for the period 2010-2016 to identify various trends and signals for pharmacovigilance purposes. A total of 147,215 adverse event reports suspected to be associated with pharmaceutical products and CHP were received by HSA between 2010 and 2016. Of these, 143,191 (97.3%) were associated with chemical drugs, 1,807 (1.2%) with vaccines, 1,324 (0.9%) with biological drugs (biologics), and 893 (0.6%) with CHP. The number of adverse event reports associated with Chinese Proprietary Medicine, other complementary medicine and health supplements are presented. Eight hundred and ninety three adverse event reports associated with CHP in the 7-year period have been successfully collated and analyzed. In agreement with other studies, adverse events related to the "skin and appendages disorders" were the most commonly reported. Most of the cases involved dermal allergies (e.g., rashes) associated with the use of glucosamine products and most of the adulterated products were associated with the illegal addition of undeclared drugs for pain relief. Dexamethasone, chlorpheniramine, and piroxicam were the most common adulterants detected. Reporting suspected adverse events is strongly encouraged even if the causality is not confirmed because any signs of clustering will allow rapid regulatory actions to be taken. The findings from this study help to create greater awareness on the health risks, albeit low, when consuming CHP and dispelling the common misconception that "natural" means "safe." In particular, healthcare professionals and the general public should be aware of potential adulteration of CHP. The analysis of spontaneously reported adverse events is an important surveillance system in monitoring the safety of CHP and helps in the understanding of the risk associated with the use of such products. Greater collaboration and communication between healthcare professionals, regulators, patients, manufacturers, researchers, and the general public are important to ensure the quality and safety of CHP.

Protective effect of Hua Tan Qu Shi decoction against liver injury in rats with nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD), is currently a worldwide health problem. None of the existing treatment medications had got a satisfactory effect. Hua Tan Qu Shi (HTQS) decoction is a Chinese herbal formula, which has been used clinically to treat NAFLD for years. However, the underlying mechanisms are still unclear.

METHODS

High-fat diet (HFD) induced non-alcoholic fatty liver disease rats treated with or without HTQS decoction by gavage for 10 weeks and examined by serology, 24-h albuminuria, histology, immunohistochemistry, and molecular analyses.