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Bahari H, Shahraki Jazinaki M, Rashidmayvan M, Taheri S, Amini MR, Malekahmadi M. The effects of silymarin consumption on inflammation and oxidative stress in adults: a systematic review and meta-analysis. Inflammopharmacology 2024; 32:949-963. [PMID: 38372848 DOI: 10.1007/s10787-023-01423-6] [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: 09/23/2023] [Accepted: 12/24/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Owing to the rich phytochemical content of Silymarin, it may effectively manage inflammation and oxidative stress. We, therefore, aimed to examine the existing evidence on the effect of Silymarin consumption on inflammation and oxidative stress factors by conducting a systematic review and meta-analysis of randomized controlled trials. METHODS A systematic literature search up to September 2023 was completed in PubMed/Medline, Scopus, and Web of Science, to identify eligible RCTs. Heterogeneity tests of the selected trials were performed using the I2 statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as weighted mean differences with a 95% confidence interval. RESULTS Fifteen RCTs were included in this meta-analysis. Our findings showed that Silymarin consumption significantly decreased CRP (WMD, - 0.50 mg/L; 95% CI, (- 0.95 to - 0.04); p = 0.03), MDA (WMD, - 1.19 nmol/mL; 95% CI, (- 1.99 to - 0.38); p = 0.004), and IL-6 (WMD, - 0.44 pg/ml; 95% CI, (- 0.75 to - 0.12); p = 0.006). Silymarin consumption had no significant effects on IL-10, TAC, and GSH. A significant non-linear relationship was observed between the duration of the intervention and MDA changes. CONCLUSIONS Silymarin can help reduce inflammation in patients with diabetes and thalassemia by reducing MDA as an oxidative stress marker and CRP and IL-6 as inflammatory markers.
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Affiliation(s)
- Hossein Bahari
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Shahraki Jazinaki
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Rashidmayvan
- Department of Nutrition, Food Sciences and Clinical Biochemistry, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
| | - Shaghayegh Taheri
- Department of Clinical Biochemistry, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammad Reza Amini
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Malekahmadi
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Foghis M, Tit DM, Bungau SG, Ghitea TC, Pallag CR, Foghis AM, Behl T, Bustea C, Pallag A. Highlighting the Use of the Hepatoprotective Nutritional Supplements among Patients with Chronic Diseases. Healthcare (Basel) 2023; 11:2685. [PMID: 37830722 PMCID: PMC10572698 DOI: 10.3390/healthcare11192685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
Cross-sectional studies, while not considered glamorous endeavors, are firmly anchored in data and statistics, providing essential insights about public health. The aim of the study is to see the frequency of hepatoprotective (HP) nutritional supplement consumption among patients with chronic diseases (other than chronic liver disorders) and analyzes the habits related to the consumption of nutritional supplements among these patients. A total of 954 patients, seeking medical prescriptions for chronic diseases under various payment arrangements (compensated, gratuity, or full payment) were carefully selected over a 12-month period from four private pharmaceutical facilities. We examined the frequency of HP consumption in relation with a number of prescribed medications for chronic conditions. All these patients were invited to complete a questionnaire about their supplement consumption habits and were provided the option to participate in a nutritional status assessment. One hundred ninety-five patients consented to participate in the survey, and 65 patients agreed to undergo a nutritional status evaluation. Of the 954 patients, 77.2% incorporate HP into their regimen. The most frequent consumption (83.33%) was recorded in a group with seven drugs, followed by a group with three drugs (82.84%). Women have a higher usage rate of HP (80.58%; 444 from 551) compared to men (62.60%; 293 from 383), and most of the patients (59.5%) used extracts of Silybum marianum L. In the survey, 64.61% of participants were using supplements, with most (59.52%) consuming HP. Only 32.54% of patients rely on recommendations from healthcare professionals. Of the patients who use supplements, 55.56% reported improvements in their health status. Furthermore, patients who integrate supplements into their daily routine tend to achieve better overall nutritional status.
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Affiliation(s)
- Monica Foghis
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.F.); (A.P.)
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.F.); (A.P.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.F.); (A.P.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Timea Claudia Ghitea
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Csaba Robert Pallag
- MSc International Economy and Business Program of Study, Corvinus University of Budapest, 1093 Budapest, Hungary;
| | - Andreea Monica Foghis
- Medicine Program of Study, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Tapan Behl
- School of Health Sciences & Technology, University of Petroleum and Energy Studies, Dehradun 248007, India;
| | - Cristian Bustea
- Department of Surgery, Oradea County Emergency Clinical Hospital, 410169 Oradea, Romania;
| | - Annamaria Pallag
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (M.F.); (A.P.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
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Öngel ME, Yildiz C, Başer Ö, Yilmaz B, Özilgen M. Thermodynamic Assessment of the Effects of Intermittent Fasting and Fatty Liver Disease Diets on Longevity. ENTROPY (BASEL, SWITZERLAND) 2023; 25:227. [PMID: 36832594 PMCID: PMC9955784 DOI: 10.3390/e25020227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Organisms uptake energy from their diet and maintain a highly organized structure by importing energy and exporting entropy. A fraction of the generated entropy is accumulated in their bodies, thus causing ageing. Hayflick's entropic age concept suggests that the lifespan of organisms is determined by the amount of entropy they generate. Organisms die after reaching their lifespan entropy generation limit. On the basis of the lifespan entropy generation concept, this study suggests that an intermittent fasting diet, which means skipping some meals without increasing the calories uptake in the other courses, may increase longevity. More than 1.32 million people died in 2017 because of chronic liver diseases, and a quarter of the world's population has non-alcoholic fatty liver disease. There are no specific dietary guidelines available for the treatment of non-alcoholic fatty liver diseases but shifting to a healthier diet is recommended as the primary treatment. A healthy obese person may generate 119.9 kJ/kg K per year of entropy and generate a total of 4796 kJ/kg K entropy in the first 40 years of life. If obese persons continue to consume the same diet, they may have 94 years of life expectancy. After age 40, Child-Pugh Score A, B, and C NAFLD patients may generate 126.2, 149.9, and 272.5 kJ/kg K year of entropy and have 92, 84, and 64 years of life expectancy, respectively. If they were to make a major recommended shift in their diet, the life expectancy of Child-Pugh Score A, B, and C patients may increase by 29, 32, and 43 years, respectively.
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Affiliation(s)
- Melek Ece Öngel
- Department of Physiology, Faculty of Medicine, Yeditepe University, Kayısdagi, Atasehir, Istanbul 34755, Turkey
| | - Cennet Yildiz
- Department of Food Engineering, Yeditepe University, Kayısdagi, Atasehir, Istanbul 34755, Turkey
| | - Özge Başer
- Department of Physiology, Faculty of Medicine, Yeditepe University, Kayısdagi, Atasehir, Istanbul 34755, Turkey
| | - Bayram Yilmaz
- Department of Physiology, Faculty of Medicine, Yeditepe University, Kayısdagi, Atasehir, Istanbul 34755, Turkey
| | - Mustafa Özilgen
- Department of Food Engineering, Yeditepe University, Kayısdagi, Atasehir, Istanbul 34755, Turkey
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Liu Y, Tzang B, Yow J, Chiang Y, Huang C, Hsu T. Traditional Chinese medicine formula T33 inhibits the proliferation of human colorectal cancer cells by inducing autophagy. ENVIRONMENTAL TOXICOLOGY 2022; 37:1007-1017. [PMID: 34995006 PMCID: PMC9304163 DOI: 10.1002/tox.23460] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/30/2021] [Accepted: 12/29/2021] [Indexed: 05/15/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of cancer-related death globally. Although surgery is still the major method for CRC therapy, the adoption of alternative treatments, such as traditional Chinese medicine (TCM), for CRC treatment is increasing. Our previous study has indicated the anti-breast cancer activity of T33 (a TCM formula). Interestingly, a major ingredient in T33, Baishao (Paeoniae Radix Alba), was reported to have antiproliferative effects on CRC cells. Therefore, this study further validated the influences of T33 on HT-29 and Caco2 cells both in vitro and in vivo. Viability and migration assays were performed to analyze the influences of T33 on proliferation and migratory activity of HT-29 and Caco2 cells. Immunofluorescence (IF) staining and immunoblotting were performed to confirm T33-induced autophagy in HT-29 and Caco2 cells. Xenograft HT-29 tumors were generated to test the effects of T33 in vivo. Significantly reduced survival and migratory activity were observed in both HT-29 and Caco2 cells treated with T33 along with apparently increased LC3-II protein. Significantly decreased p62/SQSTM1 protein, increased LC3-II/LC3-I ratio, and elevated amounts of Atg7, Atg5, and Beclin-1 proteins were detected in both HT-29 and Caco2 cells treated with T33. Moreover, the volume of xenograft HT-29 tumors was significantly lower in mice receiving 200 or 600 mg/kg T33 than in control-treated mice. These findings indicate that T33 exerts anti-CRC activity by inducing autophagy and suggest the potential of T33 for CRC treatment.
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Affiliation(s)
- Yu‐Te Liu
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Bor‐Show Tzang
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Biochemistry, School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Immunology Research CenterChung Shan Medical UniversityTaichungTaiwan
- Department of Clinical LaboratoryChung Shan Medical University HospitalTaichungTaiwan
| | - JiaLe Yow
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Biochemistry, School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Yi‐Hsuan Chiang
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Chih‐Yang Huang
- Cardiovascular and Mitochondrial Related Disease Research CenterHualien Tzu Chi Hospital, Buddhist Tzu Chi Medical FoundationHualienTaiwan
- Graduate Institute of Biomedical SciencesChina Medical UniversityTaichungTaiwan
- Center of General Education, Buddhist Tzu Chi Medical FoundationTzu Chi University of Science and TechnologyHualienTaiwan
- Department of Medical Research, China Medical University HospitalChina Medical UniversityTaichungTaiwan
- Department of BiotechnologyAsia UniversityTaichungTaiwan
| | - Tsai‐Ching Hsu
- Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
- Immunology Research CenterChung Shan Medical UniversityTaichungTaiwan
- Department of Clinical LaboratoryChung Shan Medical University HospitalTaichungTaiwan
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Wang MK, Yu XL, Zhou LY, Si HM, Hui JF, Hou DY, Li WP, Yang JS. COVID-19 and liver dysfunction: What nutritionists need to know. World J Gastroenterol 2022; 28:1526-1535. [PMID: 35582132 PMCID: PMC9048466 DOI: 10.3748/wjg.v28.i15.1526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field. Patients with COVID-19 usually have respiratory symptoms. However, liver dysfunction is not an uncommon presentation. Additionally, the degree of liver dysfunction is associated with the severity and prognosis of COVID-19. Prevention, diagnosis, and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19, especially in those with liver dysfunction. Recently, a large number of studies have reported that nutrition therapy measures, including natural dietary supplements, vitamins, minerals and trace elements, and probiotics, might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant, antiviral, anti-inflammatory, and positive immunomodulatory effects. This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction, nutritional and metabolic characteristics, nutritional status assessment, and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.
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Affiliation(s)
- Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xue-Lu Yu
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Li-Yun Zhou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Hong-Mei Si
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ju-Fen Hui
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Deng-Yong Hou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Wei-Peng Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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A Collaborative Integrative and Ayurvedic Approach to Cirrhosis in the setting of Autoantibody Negative Autoimmune Hepatitis. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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7
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Zhao S, Lian R, Zhang R, Wang F, Chen H, Wan R. Effect of Taijiquan assisted rehabilitation for breast cancer patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25380. [PMID: 33787643 PMCID: PMC8021325 DOI: 10.1097/md.0000000000025380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Taijiquan, as a supplementary and alternative method, has attracted more and more attention in the treatment of breast cancer. But up to now, no systematic review has been performed to evaluate the efficacy of Taijiquan in the treatment of breast cancer. In this study, Cochrane systematic review method will be used to evaluate the effect of Taijiquan in the rehabilitation process of breast cancer patients after treatment. METHODS PubMed, Embase. com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be searched to identify relevant studies up to May 31, 2021. We will include randomized controlled trials (RCTs) of the application of Taijiquan in post-treatment breast cancer patients. We will use the Cochrane bias risk assessment tool to assess the quality of included RCTs. We will use Stata 13.0 to perform pairwise meta-analyses using the inverse variance method. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSION This study will comprehensively evaluate the efficacy of Taijiquan in the rehabilitation treatment of breast cancer. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.
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Affiliation(s)
- Sihua Zhao
- Lanzhou University First Hospital Nursing Department (School of Nursing Lanzhou University)
| | - Rongna Lian
- The First Clinical Medical College of Lanzhou University
| | - Ruinian Zhang
- The First Clinical Medical College of Lanzhou University
| | - Fanghong Wang
- General Surgery Department of The First Hospital of Lanzhou University
| | - Hao Chen
- Lanzhou University Second Hospital Oncology Center
| | - Run Wan
- Lanzhou University Second Hospital Nursing Department, Lanzhou, China
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The effect of the drug "Cobazin" on the productive indicators of bee colonies. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the study was to determine the effectiveness of the drug "Cobazin" on the productivity of bee colonies during the increase in strength (increase in the number of young bees in the bee colony) in spring and autumn.
Materials and methods. Control and experimental groups were formed to test "Cobazin" feed supplement. It was fed 5 times with an interval of 5 days. Bee colonies from the control group received a pure sugar solution (1:1) in the amount of 0.5 liters per bee colony, and the experimental group received a sugar solution of 0.5 liters per bee colony (1:1) with the addition of the drug "Cobazin" in the amount of 2.5 g.
Indicators characterizing the development of bee colonies were determined by a measuring frame of 5x5 cm in size, for 12 days to cover the total number of eggs laid by the queen bee during feeding. Four measurements were performed during the study. The results of the control and experimental groups were compared and the significance of the differences between them was established. There was a comparison of the difference between groups of bees both fed pure sugar syrup in a ratio of 1:1 and syrup with the addition of the drug "Cobazin".
Results. It is proved that during the feeding period the number of brood in bee colonies that received feed supplement "Cobazin" increased significantly by 76 % (71 % in the group that received only sugar solution without this drug). Live weight of queen bees in colonies that were stimulated with "Cobazin" was actually 2 % higher compared to the control group.
It was found that at the end of the bee season, bee colonies fed in May with the feed supplement "Cobazin" had significantly higher values of strength, number of sealed brood and live queen bees compared to those who received pure sugar solution. The brood in the control group was 25 % lower than in the experimental group.
Conclusions. For the first time it was proved that the use of feed supplement "Cobazin" in combination with sugar solution has a positive effect on the features that characterize the development of bee colonies (strength, number of sealed brood) and their health productivity. The positive impact is observed not only during feeding, but also in subsequent periods of colony development.
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Effects of taraxasterol against ethanol and high-fat diet-induced liver injury by regulating TLR4/MyD88/NF-κB and Nrf2/HO-1 signaling pathways. Life Sci 2020; 262:118546. [PMID: 33035580 DOI: 10.1016/j.lfs.2020.118546] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
Studies have reported that taraxasterol (TAR) is effective in the treatment of immune liver injury and alcoholic liver injury. The mechanism of action is mainly related to the inhibition of inflammation. To determine the key molecular mechanisms for the effect of TAR on alleviating ethanol and high-fat diet-induced liver injury, pathological morphology, biochemistry, oxidative stress, inflammatory response and lipid metabolism were examined. Our results showed that TAR could inhibit ethanol-induced hepatocyte death or lipid accumulation, and suppress oxidative stress, inflammatory response and lipid metabolism disorders. More specifically, ethanol-induced TLR-4 and MyD88 inflammatory response were down-regulated, when treated with TAR. Production of CYP2E1, Nrf2 and HO-1, which produced in response to increased oxidative stress, were regulated in TAR treated, ethanol-induced hepatocytes. In summary, TAR could inhibit the inflammatory response and oxidative stress, which was related to the regulation of TAR on TLR-4/MyD88/NF-κB and Nrf2/HO-1 pathways.
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Darvishi-Khezri H, Kosaryan M, Karami H, Salehifar E, Mahdavi M, Alipour A, Aliasgharian A. Can Use of Silymarin Improve Inflammatory Status in Patients with β-Thalassemia Major? A Crossover, Randomized Controlled Trial. Complement Med Res 2020; 28:123-130. [PMID: 32971524 DOI: 10.1159/000509829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In β-thalassemia major (β-TM) patients, iron overload is one of the main causes of inflammation. This study investigated whether use of silymarin could improve inflammatory status in patients with β-TM and iron overload, through a placebo-controlled, crossover study. METHODS Silymarin (140 mg, 3 times a day) or placebo were prescribed to all patients (n = 82) for 12 weeks, and after a 2-week washout period, patients were crossed over to the other group. The efficacy of silymarin was assessed by measuring serum C-reactive protein (CRP) (mg/dL), interleukin (IL)-6 (pg/mL), and IL-10 (pg/mL). RESULTS Sixty-nine patients completed the study. Data analysis showed that compared to the placebo, silymarin could decrease CRP, IL-6, and raise IL-10 significantly (the p values for all variables were <0.001). Cohen's d for CRP adjusted according to the baseline CRP value was -1.72, the 95% confidence interval (CI) -2.12 to -1.33. The adjusted Cohen's d equal to -1.12, 95% CI -1.48 to -0.76, and 0.78, 95% CI 0.43-1.12, were also estimated for IL-6 and IL-10, respectively. CONCLUSION The results of the current study demonstrate that the combination of iron chelation therapy with silymarin can improve inflammatory status in patients with β-TM in the clinical setting.
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Affiliation(s)
- Hadi Darvishi-Khezri
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehrnoush Kosaryan
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Karami
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Salehifar
- Phamaceutical Science Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran,
| | - Mohammadreza Mahdavi
- Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Department of Community Medicine, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Aily Aliasgharian
- Medical Microbiology, Thalassemia Research Center (TRC), Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
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11
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Carino A, Biagioli M, Marchianò S, Fiorucci C, Bordoni M, Roselli R, Di Giorgio C, Baldoni M, Ricci P, Monti MC, Morretta E, Zampella A, Distrutti E, Fiorucci S. Opposite effects of the FXR agonist obeticholic acid on Mafg and Nrf2 mediate the development of acute liver injury in rodent models of cholestasis. Biochim Biophys Acta Mol Cell Biol Lipids 2020; 1865:158733. [PMID: 32371093 DOI: 10.1016/j.bbalip.2020.158733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022]
Abstract
The farnesoid-X-receptor (FXR) is validated target in the cholestatic disorders treatment. Obeticholic acid (OCA), the first in class of FXR agonist approved for clinical use, causes side effects including acute liver decompensation when administered to cirrhotic patients with primary biliary cholangitis at higher than recommended doses. The V-Maf avian-musculoaponeurotic-fibrosarcoma-oncogene-homolog-G (Mafg) and nuclear factor-erythroid-2-related-factor-2 (Nrf2) mediates some of the downstream effects of FXR. In the present study we have investigated the role of FXR/MafG/NRF2 pathway in the development of liver toxicity caused by OCA in rodent models of cholestasis. Cholestasis was induced by bile duct ligation (BDL) or administration of α-naphtyl-isothiocyanate (ANIT) to male Wistar rats and FXR-/- and FXR+/+ mice. Treating BDL and ANIT rats with OCA exacerbated the severity of cholestasis, hepatocytes injury and severely downregulated the expression of basolateral transporters. In mice, genetic ablation FXR or its pharmacological inhibition by 3-(naphthalen-2-yl)-5-(piperidin-4-yl)-1,2,4-oxadiazole rescued from negative regulation of MRP4 and protected against liver injury caused by ANIT. By RNAseq analysis we found that FXR antagonism effectively reversed the transcription of over 2100 genes modulated by OCA/ANIT treatment, including Mafg and Nrf2 and their target genes Cyp7a1, Cyp8b1, Mat1a, Mat2a, Gss. Genetic and pharmacological Mafg inhibition by liver delivery of siRNA antisense or S-adenosylmethionine effectively rescued from damage caused by ANIT/OCA. In contrast, Nrf2 induction by sulforaphane was protective. CONCLUSIONS: Liver injury caused by FXR agonism in cholestasis is FXR-dependent and is reversed by FXR and Mafg antagonism or Nrf2 induction.
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Affiliation(s)
- Adriana Carino
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy
| | - Michele Biagioli
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy
| | - Silvia Marchianò
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy
| | - Chiara Fiorucci
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy
| | - Martina Bordoni
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy
| | - Rosalinda Roselli
- Dipartimento di Farmacia, Università di Napoli ' Federico II', Napoli, Italy
| | - Cristina Di Giorgio
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy
| | - Monia Baldoni
- Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - Patrizia Ricci
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy
| | | | - Elva Morretta
- Dipartimento di Farmacia, Università di Salerno, Salerno, Italy
| | - Angela Zampella
- Dipartimento di Farmacia, Università di Napoli ' Federico II', Napoli, Italy
| | - Eleonora Distrutti
- SC di Gastroenterologia ed Epatologia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Stefano Fiorucci
- Dipartimento di Scienze Biomediche e Chirurgiche, Università di Perugia, Perugia, Italy.
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12
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Abstract
Malnutrition is a change in body composition owing to disordered nutrition associated with a decrease in function and poor clinical outcomes. Malnutrition can result from overnutrition, undernutrition and inflammatory activity. Patients with alcoholic liver disease are at increased risk for malnutrition. In this article, we discuss the different methods used to assess malnutrition, prevalence of malnutrition, potential mechanisms underlying malnutrition, and its treatments in patients with alcoholic liver disease.
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Affiliation(s)
- Brett Styskel
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yamini Natarajan
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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13
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Koop AH, Mousa OY, Pham LE, Corral-Hurtado JE, Pungpapong S, Keaveny AP. An Argument for Vitamin D, A, and Zinc Monitoring in Cirrhosis. Ann Hepatol 2018; 17:920-932. [PMID: 30600288 DOI: 10.5604/01.3001.0012.7192] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Malnutrition is prevalent in cirrhosis. Vitamin and mineral deficiencies, including vitamin D, vitamin A, and zinc, are common and have been shown to correlate with survival. Our aim was to review the mechanisms of vitamin D, vitamin A, and zinc deficiencies in cirrhosis and the clinical assessment of affected patients, their outcomes based on the current literature, and management. This is a narrative review including the relevant literature for cirrhosis and vitamin D, vitamin A, and zinc deficiencies. Vitamin D deficiency has important effects in cirrhosis, regardless of the cause of chronic liver disease.These effects include associations with fibrosis and outcomes such as infections, hepatocellular carcinoma, and mortality. Vitamin A deficiency is associated with liver disease progression to cirrhosis and clinical decompensation, including occurrence of ascites or hepatic encephalopathy. Zinc deficiency can lead to hepatic encephalopathy and impaired immune function. Such deficiencies correlate with patient survival and disease severity. Caution should be applied when replacing vitamin D, vitamin A, and zinc to avoid toxicity. Identification and appropriate treatment of vitamin and mineral deficiencies in cirrhosis may reduce specific nutritional and cirrhosis-related adverse events. Routine monitoring of vitamin A, vitamin D and zinc levels in cirrhosis should be considered.
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Affiliation(s)
- Andree H Koop
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Omar Y Mousa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Ly Elaine Pham
- Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Surakit Pungpapong
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Andrew P Keaveny
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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14
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Darvishi-Khezri H, Salehifar E, Kosaryan M, Karami H, Alipour A, Shaki F, Aliasgharian A. The impact of silymarin on antioxidant and oxidative status in patients with β-thalassemia major: A crossover, randomized controlled trial. Complement Ther Med 2017; 35:25-32. [DOI: 10.1016/j.ctim.2017.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 02/08/2023] Open
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15
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McClain CJ. Nutrition in Patients With Cirrhosis. Gastroenterol Hepatol (N Y) 2016; 12:507-510. [PMID: 27917086 PMCID: PMC5114497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Craig J McClain
- Professor of Medicine, Pharmacology, and Toxicology Division of Gastroenterology, Hepatology, and Nutrition University of Louisville Robley Rex Veterans Administration Medical Center Louisville, Kentucky
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16
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Lam P, Cheung F, Tan HY, Wang N, Yuen MF, Feng Y. Hepatoprotective Effects of Chinese Medicinal Herbs: A Focus on Anti-Inflammatory and Anti-Oxidative Activities. Int J Mol Sci 2016; 17:465. [PMID: 27043533 PMCID: PMC4848921 DOI: 10.3390/ijms17040465] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/12/2022] Open
Abstract
The liver is intimately connected to inflammation, which is the innate defense system of the body for removing harmful stimuli and participates in the hepatic wound-healing response. Sustained inflammation and the corresponding regenerative wound-healing response can induce the development of fibrosis, cirrhosis and eventually hepatocellular carcinoma. Oxidative stress is associated with the activation of inflammatory pathways, while chronic inflammation is found associated with some human cancers. Inflammation and cancer may be connected by the effect of the inflammation-fibrosis-cancer (IFC) axis. Chinese medicinal herbs display abilities in protecting the liver compared to conventional therapies, as many herbal medicines have been shown as effective anti-inflammatory and anti-oxidative agents. We review the relationship between oxidative stress and inflammation, the development of hepatic diseases, and the hepatoprotective effects of Chinese medicinal herbs via anti-inflammatory and anti-oxidative mechanisms. Moreover, several Chinese medicinal herbs and composite formulae, which have been commonly used for preventing and treating hepatic diseases, including Andrographis Herba, Glycyrrhizae Radix et Rhizoma, Ginseng Radix et Rhizoma, Lycii Fructus, Coptidis Rhizoma, curcumin, xiao-cha-hu-tang and shi-quan-da-bu-tang, were selected for reviewing their hepatoprotective effects with focus on their anti-oxidative and ant-inflammatory activities. This review aims to provide new insight into how Chinese medicinal herbs work in therapeutic strategies for liver diseases.
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Affiliation(s)
- Puiyan Lam
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China.
| | - Fan Cheung
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China.
| | - Hor Yue Tan
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China.
| | - Ning Wang
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China.
| | - Man Fung Yuen
- Division of Gastroenterology and Hepatology, Queen Mary Hospital and Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Yibin Feng
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China.
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17
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Potential Effects of Silymarin and Its Flavonolignan Components in Patients with β-Thalassemia Major: A Comprehensive Review in 2015. Adv Pharmacol Sci 2016; 2016:3046373. [PMID: 26997953 PMCID: PMC4779508 DOI: 10.1155/2016/3046373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/21/2016] [Accepted: 01/27/2016] [Indexed: 02/08/2023] Open
Abstract
Major β-thalassemia (β-TM) is one of the most common inherited hemolytic types of anemia which is caused as a result of absent or reduced synthesis of β-globin chains of hemoglobin. This defect results in red blood cells lysis and chronic anemia that can be treated by multiple blood transfusions and iron chelation therapy. Without iron chelation therapy, iron overload will cause lots of complications in patients. Antioxidant components play an important role in the treatment of the disease. Silymarin is an antioxidant flavonoid isolated from Silybum marianum plant. In the present study, we reviewed clinical and experimental studies investigating the use of silymarin prior to September 1, 2015, using PubMed, ISI Web of Knowledge, Science Direct, Scopus, Ovid, and Cochrane Library databases and we evaluated the potential effects of silymarin on controlling the complications induced by iron overload in patients with β-TM. Based on the results of the present study, we can conclude that silymarin may be useful as an adjuvant for improving multiple organ dysfunctions.
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18
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Lin CJ, Chiu CC, Chen YC, Chen ML, Hsu TC, Tzang BS. Taurine Attenuates Hepatic Inflammation in Chronic Alcohol-Fed Rats Through Inhibition of TLR4/MyD88 Signaling. J Med Food 2015; 18:1291-8. [PMID: 26090712 DOI: 10.1089/jmf.2014.3408] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Accumulating evidence indicates that overconsumption of ethanol contributes in many ways to the pathogenesis of hepatic injury. Although studies indicate that taurine decreases lipogenesis, oxidative stress, and inflammatory cytokines, the protective effect of taurine against alcohol-induced liver injury is still unclear. To clarify the precise signaling involved in the beneficial effect of taurine on alcohol-induced liver injury, rats were randomly divided into four treatment groups: (1) control (Ctl), (2) alcohol (Alc), (3) Alc+taurine (Tau), and (4) Alc+silymarin (Sil). The Tau and Sil groups had lower lymphocyte infiltration and significantly lower TLR-4/MyD88 and IκB/NFκB compared to the Alc group. The inducible nitric oxide synthase (iNOS), C-reactive protein (CRP), tumor necrosis factors (TNF)-α, interleukin (IL)-6, and IL-1β were also significantly lower in the Tau and Sil groups than in the Alc group. The experimental results indicated that hepatoprotection against alcohol-induced inflammation may be mediated by decreased TLR-4/MyD88 signaling.
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Affiliation(s)
- Chao-Jen Lin
- 1 Department of Pediatrics, Changhua Christian Hospital , Changhua, Taiwan
| | - Chun-Ching Chiu
- 2 Institute of Microbiology and Immunology, School of Medicine, Chung Shan Medical University , Taichung, Taiwan .,3 Department of Neurology, Changhua Christian Hospital , Changhua, Taiwan .,4 Department of Medical Intensive Care Unit, Changhua Christian Hospital , Changhua, Taiwan
| | - Yi-Chen Chen
- 5 Department of Animal Science and Technology, National Taiwan University , Taipei, Taiwan
| | - Mu-Lin Chen
- 6 Institute of Biochemistry and Biotechnology, School of Medicine, Chung Shan Medical University , Taichung, Taiwan
| | - Tsai-Ching Hsu
- 2 Institute of Microbiology and Immunology, School of Medicine, Chung Shan Medical University , Taichung, Taiwan .,7 Clinical Laboratory, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Bor-Show Tzang
- 6 Institute of Biochemistry and Biotechnology, School of Medicine, Chung Shan Medical University , Taichung, Taiwan .,7 Clinical Laboratory, Chung Shan Medical University Hospital , Taichung, Taiwan .,8 Department of Biochemistry, School of Medicine, Chung Shan Medical University , Taichung, Taiwan
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19
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The role of iron in alcohol-mediated hepatocarcinogenesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 815:89-112. [PMID: 25427903 DOI: 10.1007/978-3-319-09614-8_6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alcoholic liver disease (ALD) is the major liver disease in the developed world and characterized by hepatic iron overload in ca. 50% of all patients. This iron overload is an independent factor of disease progression, hepatocellular carcinoma and it determines survival. Since simple phlebotomy does not allow the efficient removal of excess iron in ALD, a better understanding of the underlying mechanisms is urgently needed to identify novel targeted treatment strategies. This review summarizes the present knowledge on iron overload in patients with ALD. Although multiple sides of the cellular and systemic iron homeostasis may be affected during alcohol consumption, most studies have focused on potential hepatic causes. However, it should not be overlooked that more than 90% of the major iron pool, the hemoglobin-associated iron, is efficiently recycled within the human body and it is also strongly affected by alcohol. The few available studies suggest various molecular mechanisms that involve iron regulatory protein (IRP1), transferrin receptor 1 (TfR1), and the systemic iron master switch hepcidin, but not classical mutations of the HFE gene. Notably, reactive oxygen species (ROS), namely, hydrogen peroxide (H2O2), are powerful modulators of these iron-steering proteins. For instance, depending on the level, H2O2 may both strongly suppress and induce the expression of hepcidin that could partly explain the anemia and iron overload observed in these patients. More studies with appropriate ROS models such as the novel GOX/CAT system are required to unravel the mechanisms of iron overload in ALD to consequently identify molecular-targeted therapies in the future.
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20
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Bemeur C. Neurological complications post-liver transplantation: impact of nutritional status. Metab Brain Dis 2013; 28:293-300. [PMID: 23129292 DOI: 10.1007/s11011-012-9352-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/22/2012] [Indexed: 12/11/2022]
Abstract
Nutritional status is significantly altered in patients with end-stage liver disease (cirrhosis). Malnutrition is a common complication of cirrhosis and is known to be associated with a greater risk of post-operative complications and mortality, especially following liver transplantation. Neurological complications occur frequently after transplant and the nature and extent of these complications may relate to nutritional deficits such as protein-calorie malnutrition as well as vitamin and micronutrient deficiencies. A consensus document from the International Society on Hepatic Encephalopathy and Nitrogen metabolism (ISHEN) has been established in order to address these concerns. Careful assessment of nutritional status followed by prompt treatment of nutritional deficits has the potential to impact on transplant outcome and, in particular, on post-transplant neurological disorders in patients with cirrhosis.
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Affiliation(s)
- Chantal Bemeur
- Department of Nutrition, University of Montreal, Montreal, Québec, Canada.
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21
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Fardet A, Chardigny JM. Plant-Based Foods as a Source of Lipotropes for Human Nutrition: A Survey of In Vivo Studies. Crit Rev Food Sci Nutr 2013; 53:535-90. [DOI: 10.1080/10408398.2010.549596] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Abstract
Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients with cirrhosis due to etiologies other than alcohol. The mechanisms for malnutrition are multifactorial, and malnutrition frequently worsens in the hospital due to fasting for procedures and metabolic complications of liver disease, such as hepatic encephalopathy. Aggressive nutritional support is indicated in inpatients with ALD, and patients often need to be fed through an enteral feeding tube to achieve protein and calorie goals. Enteral nutritional support clearly improves nutrition status and may improve clinical outcome. Moreover, late-night snacks in outpatient cirrhotics improve nutritional status and lean body mass. Thus, with no FDA-approved therapy for ALD, careful nutritional intervention should be considered as frontline therapy.
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Affiliation(s)
- Craig J McClain
- Department of Medicine, University of Louisville School of Medicine, Kentucky 40292, USA.
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23
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Evaluation of the toxicological properties and hepatoprotective effects of PAI-N002, a mixture of herbal extracts, in rats. Mol Cell Toxicol 2010. [DOI: 10.1007/s13273-010-0033-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Michelfelder AJ, Lee KC, Bading EM. Integrative medicine and gastrointestinal disease. Prim Care 2010; 37:255-67. [PMID: 20493335 DOI: 10.1016/j.pop.2010.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Common disorders of the gastrointestinal (GI) tract account for about 50 million visits per year to physicians trained in traditional allopathic or osteopathic medicine. Sometimes patients turn to more alternative treatments because standard medical therapy is either not producing the most desired result or may have side effects, or patients may see complementary or alternative therapies as more natural. In the United States, the overall expenditure for complementary and alternative medicine (CAM) is in the tens of billions of dollars per year. Because physicians need to be aware of the latest evidence for different complementary and alternative therapies used for gastrointestinal disorders, this article focuses on the most common and most studied CAM therapies for selected common gastrointestinal disorders.
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Affiliation(s)
- Aaron J Michelfelder
- Department of Family Medicine, Loyola University Chicago Stritch School of Medicine, Fahey Building Room 260, 2160 South First Avenue, Maywood, IL 60153, USA.
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25
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Silymarin modulates doxorubicin-induced oxidative stress, Bcl-xL and p53 expression while preventing apoptotic and necrotic cell death in the liver. Toxicol Appl Pharmacol 2010; 245:143-52. [PMID: 20144634 DOI: 10.1016/j.taap.2010.02.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 01/27/2010] [Accepted: 02/01/2010] [Indexed: 01/08/2023]
Abstract
The emergence of silymarin (SMN) as a natural remedy for liver diseases, coupled with its entry into NIH clinical trial, signifies its hepatoprotective potential. SMN is noted for its ability to interfere with apoptotic signaling while acting as an antioxidant. This in vivo study was designed to explore the hepatotoxic potential of Doxorubicin (Dox), the well-known cardiotoxin, and in particular whether pre-exposures to SMN can prevent hepatotoxicity by reducing Dox-induced free radical mediated oxidative stress, by modulating expression of apoptotic signaling proteins like Bcl-xL, and by minimizing liver cell death occurring by apoptosis or necrosis. Groups of male ICR mice included Control, Dox alone, SMN alone, and Dox with SMN pre/co-treatment. Control and Dox groups received saline i.p. for 14 days. SMN was administered p.o. for 14 days at 16 mg/kg/day. An approximate LD(50) dose of Dox, 60 mg/kg, was administered i.p. on day 12 to animals receiving saline or SMN. Animals were euthanized 48 h later. Dox alone induced frank liver injury (>50-fold increase in serum ALT) and oxidative stress (>20-fold increase in malondialdehyde [MDA]), as well as direct damage to DNA (>15-fold increase in DNA fragmentation). Coincident genomic damage and oxidative stress influenced genomic stability, reflected in increased PARP activity and p53 expression. Decreases in Bcl-xL protein coupled with enhanced accumulation of cytochrome c in the cytosol accompanied elevated indexes of apoptotic and necrotic cell death. Significantly, SMN exposure reduced Dox hepatotoxicity and associated apoptotic and necrotic cell death. The effects of SMN on Dox were broad, including the ability to modulate changes in both Bcl-xL and p53 expression. In animals treated with SMN, tissue Bcl-xL expression exceeded control values after Dox treatment. Taken together, these results demonstrated that SMN (i) reduced, delayed onset, or prevented toxic effects of Dox which are typically associated with hydroxyl radical production, (ii) performed as an antioxidant limiting oxidative stress, (iii) protected the integrity of the genome, and (iv) antagonized apoptotic and necrotic cell death while increasing antiapoptotic Bcl-xL protein levels and minimizing the leakage of proapoptotic cytochrome c from liver mitochondria. These observations demonstrate the protective actions of SMN in liver, and raise the possibility that such protection may extend to other organs during Dox treatment including the heart.
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Abstract
GOALS To examine a wide range of sociodemographic and clinical characteristics as potential predictors of complementary and alternative medicine (CAM) use among chronic liver disease (CLD) patients, with a focus on CAM therapies with the greatest potential for hepatotoxicity and interactions with conventional treatments. BACKGROUND There is some evidence that patients with CLD commonly use CAM to address general and CLD-specific health concerns. STUDY Patients enrolled in a population-based surveillance study of persons newly diagnosed with CLD between 1999 and 2001 were asked about current use of CAM specifically for CLD. Sociodemographic and clinical information was obtained from interviews and medical records. Predictors of CAM use were examined using univariate and multivariate logistic regression analysis. RESULTS Of the 1040 participants, 284 (27.3%) reported current use of at least 1 of 3 CAM therapies of interest. Vitamins or other dietary supplements were the most commonly used therapy, reported by 188 (18.1%) patients. This was followed by herbal medicine (175 patients, 16.8%) and homeopathy (16 patients, 1.5%). Several characteristics were found to be independent correlates of CAM use: higher education and family income, certain CLD etiologies (alcohol, hepatitis C, hepatitis C and alcohol, and hepatitis B), and prior hospitalization for CLD. CONCLUSIONS Use of CAM therapies that have the potential to interact with conventional treatments for CLD was quite common among this population-based sample of patients with CLD. There is a need for patient and practitioner education and communication regarding CAM use in the context of CLD.
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Webster CRL, Cooper J. Therapeutic use of cytoprotective agents in canine and feline hepatobiliary disease. Vet Clin North Am Small Anim Pract 2010; 39:631-52. [PMID: 19524797 DOI: 10.1016/j.cvsm.2009.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Many medicinal, nutraceutical, and botanic extracts have been used as cytoprotective agents in liver disease. This article explains the mechanisms of action, pertinent pharmacokinetics, side effects, and clinical indications for the use of S-adenosylmethionine, N-acetylcysteine, ursodeoxycholic acid, silymarin, and vitamin E. The literature pertaining to in vitro studies, laboratory animal models, and human and veterinary clinical trials is reviewed with regards to the efficacy and use of these cytoprotective agents in hepatobiliary disease.
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Affiliation(s)
- Cynthia R L Webster
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, 200 Westborough Road, North Grafton, MA 01589, USA
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28
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Abstract
Drug-induced hepatotoxicity is underreported and underestimated in the United States. It is an important cause of acute liver failure. Common classes of drugs causing drug-induced hepatotoxicity include antibiotics, lipid lowering agents, oral hypoglycemics, psychotropics, antiretrovirals, acetaminophen, and complementary and alternative medications. Hepatotoxic drugs often have a signature or pattern of liver injury including patterns of liver test abnormalities, latency of symptom onset, presence or absence of immune hypersensitivity, and the course of the reaction after drug withdrawal.
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Lu SC. Antioxidants in the treatment of chronic liver diseases: why is the efficacy evidence so weak in humans? Hepatology 2008; 48:1359-61. [PMID: 18697215 DOI: 10.1002/hep.22463] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Shelly C Lu
- Division of Gastroenterology and Liver Diseases, University of Southern California Research Center for Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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30
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Bares JM, Berger J, Nelson JE, Messner DJ, Schildt S, Standish LJ, Kowdley KV. Silybin treatment is associated with reduction in serum ferritin in patients with chronic hepatitis C. J Clin Gastroenterol 2008; 42:937-44. [PMID: 18458640 DOI: 10.1097/mcg.0b013e31815cff36] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
GOALS The goal of this study was to examine the effect of a standardized silybin and soy phosphatidylcholine complex (IdB 1016) on serum markers of iron status. BACKGROUND Milk thistle and its components are widely used as an alternative therapy for liver disease because of purported antioxidant, anti-inflammatory, and iron chelating properties. STUDY Thirty-seven patients with chronic hepatitis C and Batts-Ludwig fibrosis stage II, III, or IV were randomized to 1 of 3 doses of IdB 1016 for 12 weeks. Serum ferritin, serum iron, total iron binding capacity, and transferrin-iron saturation were measured at baseline, during treatment, and 4 weeks thereafter. Wilcoxon signed rank tests were used to compare baseline and posttreatment values. RESULTS There was a significant decrease in serum ferritin from baseline to end of treatment (mean, 244 vs. 215 mug/L; median, 178 vs. 148 mug/L; P=0.0005); 78% of subjects had a decrease in serum ferritin level. There was no significant change in serum iron or transferrin-iron saturation. Multivariate logistic regression analysis in a model that included dose, age, sex, HFE genotype, history of alcohol use, and elevated baseline ferritin levels demonstrated that stage III or IV fibrosis was independently associated with decreased posttreatment serum ferritin level. CONCLUSIONS Treatment with IdB 1016 is associated with reduced body iron stores, especially among patients with advanced fibrosis stage.
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Affiliation(s)
- Julie M Bares
- Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
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31
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Shah SH, Engelhardt R, Ovbiagele B. Patterns of complementary and alternative medicine use among United States stroke survivors. J Neurol Sci 2008; 271:180-5. [DOI: 10.1016/j.jns.2008.04.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 03/28/2008] [Accepted: 04/10/2008] [Indexed: 11/28/2022]
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32
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Dimri U, Sharma MC, Swarup D, Ranjan R, Kataria M. Alterations in hepatic lipid peroxides and antioxidant profile in Indian water buffaloes suffering from sarcoptic mange. Res Vet Sci 2008; 85:101-5. [PMID: 17884119 DOI: 10.1016/j.rvsc.2007.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 06/01/2007] [Accepted: 07/26/2007] [Indexed: 11/22/2022]
Abstract
The present study was aimed to examine the status of antioxidants in water buffaloes with sarcoptic mange. Sixty-three buffaloes were divided into three groups, healthy control (group I, n=19), subclinical sarcoptic mange (group II, n=22) and clinical sarcoptic mange (group III, n=22). Lipid peroxides (LPO), superoxide dismutase (SOD), catalase (CAT), zinc and copper in hepatic tissues and serum alpha-tocopherol concentrations were measured. In comparison to group I, LPO was significantly (P<0.05) higher, while SOD and CAT were significantly (P<0.05) lower in group III. LPO and SOD activities were comparable between group I and II, but CAT was significantly (P<0.05) lower in group II. In group III, zinc, copper and alpha-tocopherol concentrations were significantly (P<0.05) lower than group I. Decrease in antioxidant enzyme activities and trace mineral concentrations suggested that sarcoptic mange in buffaloes is associated with compromise in antioxidant defense and oxidative stress may play important role in pathogenesis.
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Affiliation(s)
- U Dimri
- Division of Medicine, Indian Veterinary Research Institute, Izatnagar 243 122, Uttar Pradesh, India.
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33
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Seeff LB, Curto TM, Szabo G, Everson GT, Bonkovsky HL, Dienstag JL, Shiffman ML, Lindsay KL, Lok ASF, Di Bisceglie AM, Lee WM, Ghany MG. Herbal product use by persons enrolled in the hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial. Hepatology 2008; 47:605-12. [PMID: 18157835 DOI: 10.1002/hep.22044] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Herbal products, used for centuries in Far Eastern countries, are gaining popularity in western countries. Surveys indicate that persons with chronic hepatitis C (CHC) often use herbals, especially silymarin (milk thistle extract), hoping to improve the modest response to antiviral therapy and reduce side effects. The Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial, involving persons with advanced CHC, nonresponders to prior antiviral therapy but still willing to participate in long-term pegylated interferon treatment, offered the opportunity to examine the use and potential effects of silymarin. Among 1145 study participants, 56% had never taken herbals, 21% admitted past use, and 23% were using them at enrollment. Silymarin constituted 72% of 60 herbals used at enrollment. Among all participants, 67% had never used silymarin, 16% used it in the past, and 17% used it at baseline. Silymarin use varied widely among the 10 participating study centers; men were more frequent users than women, as were non-Hispanic whites than African Americans and Hispanics. Silymarin use correlated strongly with higher education. No beneficial effect of silymarin was found on serum alanine aminotransferase or hepatitis C virus (HCV) RNA levels. Univariate analysis showed significantly fewer liver-related symptoms and better quality-of-life parameters in users than nonusers, but after reanalysis adjusted for covariates of age, race, education, alcohol consumption, exercise, body mass index, and smoking, only fatigue, nausea, liver pain, anorexia, muscle and joint pain, and general health remained significantly better in silymarin users. In conclusion, silymarin users had similar alanine aminotransferase and HCV levels to those of nonusers but fewer symptoms and somewhat better quality-of-life indices. Because its use among these HALT-C participants was self-motivated and uncontrolled, however, only a well-designed prospective study can determine whether silymarin provides benefit to persons with chronic hepatitis C.
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Affiliation(s)
- Leonard B Seeff
- Division of Digestive Diseases and Nutrition, National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
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Yang YS, Ahn TH, Lee JC, Moon CJ, Kim SH, Jun W, Park SC, Kim HC, Kim JC. Protective effects of Pycnogenol on carbon tetrachloride-induced hepatotoxicity in Sprague-Dawley rats. Food Chem Toxicol 2007; 46:380-7. [PMID: 17900780 DOI: 10.1016/j.fct.2007.08.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 06/29/2007] [Accepted: 08/10/2007] [Indexed: 01/09/2023]
Abstract
Oxidative damage is implicated in the pathogenesis of various liver injuries. In the present study the ability of Pycnogenol (PYC) as an antioxidant to protect against CCl4-induced oxidative stress and hepatotoxicity in rats was investigated. Four experimental groups of six rats each were constructed: a vehicle control group received the respective vehicles (distilled water and corn oil) only; a CCl4 group received a 14-day repeated intraperitoneal (i.p.) dose of distilled water and then a single oral dose of CCl4 at 1.25 ml/kg; and the CCl4&PYC 10 and CCl4&PYC 20 groups received a 14-day repeated i.p. dose of PYC 10 and 20 mg/kg, respectively, and then a single oral dose of CCl4 at 1.25 ml/kg. Hepatotoxicity was assessed 24 h after the CCl4 treatment by measurement of serum aminotransferase (AST) and alanine aminotransferase (ALT) activities, hepatic malondialdehyde (MDA) and glutathione (GSH) concentrations, and catalase, superoxide dismutase (SOD), and glutathione-S-transferase (GST) activities. The results were confirmed histopathologically. The single oral dose of CCl4 produced significantly elevated levels of serum AST and ALT activities. Histopathological examinations showed extensive liver injuries, characterized by extensive hepatocellular degeneration/necrosis, fatty changes, inflammatory cell infiltration, congestion, and sinusoidal dilatation. In addition, an increased MDA concentration and decreased GSH, catalase, SOD, and GST were observed in the hepatic tissues. On the contrary, PYC treatment prior to the administration of CCl4 significantly prevented the CCl4-induced hepatotoxicity, including the elevation of serum AST and ALT activities and histopathological hepatic lesions, in a dose-dependent manner. Moreover, MDA and GSH levels and catalase, SOD, and GST activities in hepatic tissues were not affected by administration of CCl4, indicating that the pretreatment of PYC efficiently protects against CCl4-induced oxidative damage in rats. The results indicate that PYC has a protective effect against acute hepatotoxicity induced by the administration of CCl4 in rats, and that the hepatoprotective effects of PYC may be due to both the inhibition of lipid peroxidation and the increase of antioxidant activity.
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Affiliation(s)
- Young-Su Yang
- Department of Toxicology, College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, Republic of Korea
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Sawalha AF. Complementary And Alternative Medicine (CAM) in Palestine: Use And Safety Implications. J Altern Complement Med 2007; 13:263-9. [PMID: 17388770 DOI: 10.1089/acm.2006.6280] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM Utilization of complementary and alternative medicine (CAM) is exponentially rising. There are no published data available about the attitude and use of CAM in Palestine. The purpose of this study was to investigate the attitude, pattern of use, and reasons for CAM utilization among a random sample of people in north Palestine. METHODS A questionnaire was used to carry out the objective of the study. The questionnaire was distributed to a random sample of people in north Palestine during the month of October 2005. The questionnaire included three sections: demographic factors and attitude toward CAM, types of CAM encountered by the respondents in the last year, and reasons that motivated CAM use. Data collected from the returned questionnaire were coded and entered into the Statistical Package for Social Sciences program (SPSS) version 10 (SPSS Software, Inc., Chicago, IL). RESULTS 72.8% of respondents have used at least one type of CAM in the last year. CAM users were mainly middle-aged, low-income, educated women. Herbal therapy, prayers, and honey were the most commonly utilized types of CAM. Respondents have used CAM mainly to treat respiratory and gastrointestinal disorders. Respondents have utilized CAM mainly because they believed that it is all natural and safe. DISCUSSION AND CONCLUSIONS CAM utilization in Palestine is very common. Some of the types of CAM used in Palestine are common elsewhere, whereas other types were unique to this area. The herbal products used by the respondents were mainly collected from nature. Safety of such products is questionable, and contamination cannot be ruled out. Awareness of potential adverse effects and proven benefits of various types of CAM needs to be raised.
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Affiliation(s)
- Ansam F Sawalha
- Poison Control and Drug Information Center (PCDIC), An-Najah National University, Nablus, Palestine.
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Abstract
Liver disease secondary to alcohol ranges from alcoholic fatty liver disease to acute hepatitis to cirrhotic liver disease. It is imperative that alcohol be discontinued to allow for any potential improvement in liver function, with most benefit being seen in the early stages of the disease. Alcoholic liver disease has a profound effect on nutrient intake, nutrition status, and metabolism, contributing to a high prevalence of malnutrition in this population. Early intervention with nutrition therapy may improve response to treatment, alleviate symptoms, and improve quality and quantity of life. In this review, nutrition assessment parameters and medical nutrition therapy goals for alcoholic liver disease are discussed.
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Affiliation(s)
- Sara R DiCecco
- William J. von Liebig Transplant Center, Mayo Clinic Rochester, 201 W. Center Street, Rochester, MN 55902, USA.
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Kumpf VJ. Parenteral nutrition-associated liver disease in adult and pediatric patients. Nutr Clin Pract 2006; 21:279-90. [PMID: 16772545 DOI: 10.1177/0115426506021003279] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There are essentially 3 types of hepatobiliary disorders associated with parenteral nutrition (PN) therapy: steatosis, cholestasis, and gallbladder sludge/stones. Reported prevalence rates of PN-associated liver disease (PNALD) vary greatly, and there are distinct differences between adult and pediatric patients. Various etiologic factors have been evaluated for significance in contributing to PNALD, including enteral feeding history, septic events, bacterial overgrowth, length of intestinal resection, and prematurity/low birth weight. Etiologic factors specifically related to the PN formulation or nutrient intake have also been evaluated, including excessive calorie intake, dextrose-to-lipid ratio, amino acid dose, taurine deficiency, IV fat emulsion (IVFE) dose, carnitine deficiency, choline deficiency, and continuous vs cyclic infusion. Minor increases in serum aminotransferase concentrations are relatively common in patients receiving PN therapy and generally require no intervention. The primary indicator of cholestasis is a serum conjugated bilirubin >2 mg/dL. When a patient receiving PN develops liver complications, it is necessary to rule out all treatable causes and minimize other risk factors. All potential hepatotoxic medications and herbal supplements should be eliminated. Modifications to the PN regimen that may be helpful include reduction of calories, reduction of IVFE dose to <1 g/kg/d, supplementation of taurine in the infant, and use of cyclic infusion. Initiation of even small amounts of enteral nutrition and use of ursodiol may be beneficial in stimulating bile flow. In the long-term PN patient with severe and progressive liver disease, intestinal or liver transplantation may be the only remaining treatment option.
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Affiliation(s)
- Vanessa J Kumpf
- Vanderbilt University Medical Center, Center for Human Nutrition, 1211 21st Ave South, Suite 514 Medical Arts Building, Nashville, TN 37232, USA.
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