1
|
Dulken BW, Bahceci D, Leung LS, Mahajan VB, Choi WT, Tan SY. Crystalline Hepatopathy Associated With Bietti Crystalline Dystrophy: A Striking Manifestation of Disordered Fatty Acid Metabolism. Am J Surg Pathol 2024:00000478-990000000-00358. [PMID: 38802997 DOI: 10.1097/pas.0000000000002253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Bietti crystalline dystrophy (BCD) is a rare heritable retinal disease characterized by crystal deposition primarily in the retina. It is associated with atrophy of the retinal pigment epithelium (RPE) and is caused by variants in CYP4V2, which encodes a cytochrome P450 hemethiolate protein superfamily member. CYP4V2 is involved in the selective hydrolysis of saturated medium chain fatty acids, and patients with BCD demonstrate abnormalities in fatty acid metabolism, including abnormal lipid profiles and the accumulation of the pathogenic crystals within the RPE, which leads to the visual pathologies characteristic of BCD. However, the precise identity of the crystals is currently unknown, and BCD has no established extraocular manifestations. Here, we report granulomatous hepatitis associated with abundant diffuse crystalline clefts in the hepatic parenchyma in 3 patients with retinal dystrophy and dyslipidemia: 2 with pathogenic CYP4V2 variants and 1 patient with clinical ophthalmologic findings suggestive of BCD but without available genetic testing. The unique and striking histologic features unifying the liver biopsies in all 3 patients strongly support a process related to abnormal fatty acid metabolism underlying the genetic disease of BCD, expanding the spectrum of BCD and shedding light on the importance of CYP4V2 in systemic fatty acid metabolism.
Collapse
Affiliation(s)
- Ben W Dulken
- Department of Pathology, Stanford University School of Medicine, Stanford
| | - Dorukhan Bahceci
- Department of Pathology, University of California San Francisco, San Francisco
| | - Loh-Shan Leung
- Department of Ophthalmology, Stanford University School of Medicine, Stanford
| | - Vinit B Mahajan
- Department of Ophthalmology, Stanford University School of Medicine, Stanford
- Molecular Surgery Laboratory, Stanford University
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Won-Tak Choi
- Department of Pathology, University of California San Francisco, San Francisco
| | - Serena Y Tan
- Department of Pathology, Stanford University School of Medicine, Stanford
| |
Collapse
|
2
|
Brenes F, Goldstein EV, Sarduy EL, Lazarus R, Fernandez G, Henriquez F, Asgarali D. Botánicas Function as Health Care Safety Nets Among Hispanic American Immigrants: A Brief Report. HISPANIC HEALTH CARE INTERNATIONAL 2024:15404153241247261. [PMID: 38619296 DOI: 10.1177/15404153241247261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
As the U.S. population becomes more racially/ethnically diverse, the Hispanic American immigrant population has slowly grown in recent years. In the face of anti-immigrant policies, limited access to care, fear of deportation, discrimination, stigmatization, poverty, and other stressors, Hispanic American immigrants seek services from botánicas for religious, spiritual, medical, and psychosocial health reasons, including the accessibility and affordability of services from folk practitioners in these herbal dispensaries. Hispanics are the primary consumers of herbal remedies and complementary and alternative medicines in the United States. The purpose of this article is to emphasize the critical role of botánicas in the health and wellness of Hispanic American immigrants. Recommendations for health professionals are provided in the care of Hispanic Americans who utilize folk, traditional, and herbal medicines for health and healing.
Collapse
Affiliation(s)
- Francisco Brenes
- Nichole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Evan V Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ernesto Lázaro Sarduy
- Nichole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Richard Lazarus
- Nichole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| | - Gabriela Fernandez
- Occupational Therapist, Sunshine Therapeutic Services of Florida, Wintersprings, FL, USA
| | | | - Dariel Asgarali
- Nichole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
| |
Collapse
|
3
|
Zhu KX, Wu M, Bian ZL, Han SL, Fang LM, Ge FF, Wang XZ, Xie SF. Growing attention on the toxicity of Chinese herbal medicine: a bibliometric analysis from 2013 to 2022. Front Pharmacol 2024; 15:1293468. [PMID: 38362153 PMCID: PMC10867220 DOI: 10.3389/fphar.2024.1293468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction: Despite the clinical value of Chinese herbal medicine (CHM), restricted comprehension of its toxicity limits the secure and efficacious application. Previous studies primarily focused on exploring specific toxicities within CHM, without providing an overview of CHM's toxicity. The absence of a quantitative assessment of focal points renders the future research trajectory ambiguous. Therefore, this study aimed to reveal research trends and areas of concern for the past decade. Methods: A cross-sectional study was conducted on publications related to CHM and toxicity over the past decade from Web of Science Core Collection database. The characteristics of the publication included publication year, journal, institution, funding, keywords, and citation counts were recorded. Co-occurrence analysis and trend topic analysis based on bibliometric analysis were conducted on keywords and citations. Results: A total of 3,225 publications were analyzed. Number of annal publications increased over the years, with the highest number observed in 2022 (n = 475). The Journal of Ethnopharmacology published the most publications (n = 425). The most frequently used toxicity classifications in keywords were hepatotoxicity (n = 119) or drug-induced liver injury (n = 48), and nephrotoxicity (n = 40). Co-occurrence analysis revealed relatively loose connections between CHM and toxicity, and their derivatives. Keywords emerging from trend topic analysis for the past 3 years (2019-2022) included ferroptosis, NLRP3 inflammasome, machine learning, network pharmacology, traditional uses, and pharmacology. Conclusion: Concerns about the toxicity of CHM have increased in the past decade. However, there remains insufficient studies that directly explore the intersection of CHM and toxicity. Hepatotoxicity and nephrotoxicity, as the most concerned toxicity classifications associated with CHM, warrant more in-depth investigations. Apoptosis was the most concerned toxicological mechanism. As a recent increase in attention, exploring the mechanisms of ferroptosis in nephrotoxicity and NLRP3 inflammasome in hepatotoxicity could provide valuable insights. Machine learning and network pharmacology are potential methods for future studies.
Collapse
Affiliation(s)
- Ke-Xin Zhu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Min Wu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Zhi-Lin Bian
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shi-Liang Han
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Li-Ming Fang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Feng-Feng Ge
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xue-Zhou Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Sheng-Fang Xie
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| |
Collapse
|
4
|
Shi W, Liu T, Yang H, Zhao J, Wei Z, Huang Y, Li Z, Li H, Liang L, Hou X, Chen Y, Gao Y, Bai Z, Xiao X. Isomaculosidine facilitates NLRP3 inflammasome activation by promoting mitochondrial reactive oxygen species production and causes idiosyncratic liver injury. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117063. [PMID: 37598766 DOI: 10.1016/j.jep.2023.117063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Dictamnus dasycarpus Turcz. (Dictamni Cortex, DC), a Chinese herbal medicine, is commonly used for treating chronic dermatosis and rheumatism, but can also cause herb-induced liver injury (HILI). Our study has demonstrated that DC can induce idiosyncratic HILI, but the mechanism remains unknown. The NLRP3 inflammasome has become a major target for addressing many diseases. The activation of NLRP3 inflammasome is responsible for many liver-related inflammatory diseases, including idiosyncratic HILI. AIM OF THE STUDY The objective of our study was to demonstrate the mechanism underlying the idiosyncratic HILI induced by DC and clarify the susceptible component in DC. MATERIALS AND METHODS Bone marrow-derived macrophages (BMDMs) and THP1 cells were selected to assess the effect of isomaculosidine (IMD) on NLRP3 inflammasome activation in vitro. Western blot, ELISA and Caspase-Glo® 1 Inflammasome Assay, flow cytometry and Immunofluorescence were employed to detect the mechanism of IMD on NLRP3 inflammasome activation. To assess the efficacy of IMD in vivo, mice were intravenously administrated with LPS and then IMD were injected intraperitoneally for 6 h. RESULTS The results of our in vitro studies demonstrate that IMD, the major constituent of DC, specifically promoted ATP- and nigericin-induced activation of NLRP3 inflammasome, but not NLRC4 and AIM2 inflammasomes. Additionally, IMD promoted nigericin-induced ASC oligomerization. Notably, synergistic induction of mtROS played a key role on the activation of NLRP3 inflammasome. IMD increased the mtROS production in the activation of NLRP3 inflammasome induced by nigericin. In addition, the results of our in vivo study showed that the combination of nonhepatotoxic doses of LPS and IMD can increase the levels of ALT, AST, and DBIL, leading to liver injury. CONCLUSIONS IMD specifically facilitated the activation of NLRP3 inflammasome induced by nigericin and ATP, which is responsible for DC-induced idiosyncratic HILI.
Collapse
Affiliation(s)
- Wei Shi
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China; School of Traditional Chinese Medicine, Capital Medical University, Beijing, China; Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Tingting Liu
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China; The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Huijie Yang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Jia Zhao
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Ziying Wei
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Yujiao Huang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyong Li
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Hui Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Longxin Liang
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaorong Hou
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yuanyuan Chen
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yuan Gao
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
| | - Zhaofang Bai
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China; China Military Institute of Chinese Materia, The Fifth Medical Center of PLA General Hospital, Beijing, China.
| | - Xiaohe Xiao
- Senior Department of Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China; China Military Institute of Chinese Materia, The Fifth Medical Center of PLA General Hospital, Beijing, China.
| |
Collapse
|
5
|
Madruga Dias J. Ethics and non-evidence based therapies: Portuguese perspective in a global setting. Monash Bioeth Rev 2023; 41:174-180. [PMID: 36586073 PMCID: PMC10654189 DOI: 10.1007/s40592-022-00172-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 01/01/2023]
Abstract
A contemporary serious lack of scientific knowledge by the general public and many decision-makers is now quite perceptible, both globally and in Portugal. Living in a science-driven technological world filled with scientific illiteracy is dangerous and a path toward disaster. Recent years brought a fairly strong global movement promoting the so-called "alternative therapy" that also affected Portugal. I propose an evidence-based ethics reflection and argumentation, both encompassing the global and the specific Portuguese reality. I debate the specific arguments used in favour of alternative therapies, demonstrating the inherent fallacies of thought, deliberate manipulation of words and concepts, and the dire consequences for global and local health politics by following this line of biased reasoning.
Collapse
Affiliation(s)
- João Madruga Dias
- Rheumatology Department, Unidade de Torres Novas, Centro Hospitalar do Médio Tejo EPE, R. Xanana Gusmão 45, 2350-754, Torres Novas, Portugal.
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa (NOVA Medical School), Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| |
Collapse
|
6
|
Ullah K, Parekh ADE, Shaikh OA, Khan M, Ochani S. Acute liver failure secondary to the use of unmonitored drugs and herbal supplements: an underreported and serious issue. Ir J Med Sci 2023; 192:2969-2971. [PMID: 36913077 DOI: 10.1007/s11845-023-03334-5] [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: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
Acute liver failure (ALF) is a potentially fatal illness marked by the abrupt development of jaundice, coagulopathy, and hepatic encephalopathy (HE) in persons having no previous history of hepatic disease. It is a relatively uncommon illness, having an incidence of 1 to 8 per million people. Hepatitis A, B, and E viruses have been documented as the most prevalent etiologies of acute liver failure in Pakistan and other developing nations. However, ALF may also occur secondary to toxicity caused by the unmonitored overdosing and toxicity of traditional medicines, herbal supplements, and alcohol. Similarly, in some instances, the etiology remains unknown. Herbal products, alternative, and complementary therapies are frequently practiced across the globe for treating various illnesses. In recent times, their use has gained much popularity. Indications and the use of these supplementary drugs vary significantly. The majority of these products have not gained approval from Food and Drug Administration (FDA). Unfortunately, the incidence of documented adverse effects linked to the usage of herbal products has increased recently, but still, these events are underreported, and the condition is known as drug-induced liver injury (DILI) and herb-induced liver injury (HILI). The estimated total herbal retail sales increased from $4230 million in 2000 to $6032 million in 2013, representing a total of 42 and 3.3% per annum increase. To reduce the occurrence of HILI and DILI, physicians in general practice settings should inquire about patients' understanding of potential toxicity with the consumption of hepatotoxic and herbal medicines.
Collapse
Affiliation(s)
- Kaleem Ullah
- Department of Liver Transplantation, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Pakistan
| | | | - Omer Ahmed Shaikh
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Maham Khan
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Sidhant Ochani
- Department Of Medicine, Khairpur Medical College, 66020, Sindh, Khairpur Mir's, Pakistan.
| |
Collapse
|
7
|
Monteiro-Alfredo T, Macedo MLR, de Picoli Souza K, Matafome P. New Therapeutic Strategies for Obesity and Its Metabolic Sequelae: Brazilian Cerrado as a Unique Biome. Int J Mol Sci 2023; 24:15588. [PMID: 37958572 PMCID: PMC10648839 DOI: 10.3390/ijms242115588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Brazil has several important biomes holding impressive fauna and flora biodiversity. Cerrado being one of the richest ones and a significant area in the search for new plant-based products, such as foods, cosmetics, and medicines. The therapeutic potential of Cerrado plants has been described by several studies associating ethnopharmacological knowledge with phytochemical compounds and therapeutic effects. Based on this wide range of options, the Brazilian population has been using these medicinal plants (MP) for centuries for the treatment of various health conditions. Among these, we highlight metabolic diseases, namely obesity and its metabolic alterations from metabolic syndrome to later stages such as type 2 diabetes (T2D). Several studies have shown that adipose tissue (AT) dysfunction leads to proinflammatory cytokine secretion and impaired free fatty acid (FFA) oxidation and oxidative status, creating the basis for insulin resistance and glucose dysmetabolism. In this scenario, the great Brazilian biodiversity and a wide variety of phytochemical compounds make it an important candidate for the identification of pharmacological strategies for the treatment of these conditions. This review aimed to analyze and summarize the current literature on plants from the Brazilian Cerrado that have therapeutic activity against obesity and its metabolic conditions, reducing inflammation and oxidative stress.
Collapse
Affiliation(s)
- Tamaeh Monteiro-Alfredo
- Coimbra Institute of Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical Academic Center of Coimbra, 3000-075 Coimbra, Portugal
- Research Group on Biotechnology and Bioprospection Applied to Metabolism and Cancer (GEBBAM), Federal University of Grande Dourados, Dourados 79804-970, MS, Brazil;
- Laboratório de Purificação de Proteínas e Suas Funções Biológicas (LPPFB), Federal University of Mato Grosso do Sul, Campo Grande 79070-900, MS, Brazil;
| | - Maria Lígia Rodrigues Macedo
- Laboratório de Purificação de Proteínas e Suas Funções Biológicas (LPPFB), Federal University of Mato Grosso do Sul, Campo Grande 79070-900, MS, Brazil;
| | - Kely de Picoli Souza
- Research Group on Biotechnology and Bioprospection Applied to Metabolism and Cancer (GEBBAM), Federal University of Grande Dourados, Dourados 79804-970, MS, Brazil;
| | - Paulo Matafome
- Coimbra Institute of Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical Academic Center of Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Health School (ESTeSC), Polytechnic University of Coimbra, Rua 5 de Outubro, 3046-854 Coimbra, Portugal
| |
Collapse
|
8
|
Kimura K, Kikegawa M, Kan Y, Uesawa Y. Identifying Crude Drugs in Kampo Medicines Associated with Drug-Induced Liver Injury Using the Japanese Adverse Drug Event Report Database: A Comprehensive Survey. Pharmaceuticals (Basel) 2023; 16:ph16050678. [PMID: 37242461 DOI: 10.3390/ph16050678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The current study aimed to identify the crude drugs associated with drug-induced liver injury (DILI) in 148 Kampo medicines prescribed throughout Japan using the Japanese Adverse Drug Event Report (JADER) database, a large-scale spontaneous reporting system in Japan. First, we tabulated the number of DILI reports from the report-based dataset and the background information from the patient-based dataset. Thereafter, we combined the 126 crude drugs into 104 crude drug groups to examine multicollinearity. Finally, the reporting odds ratios (RORs), 95% confidence intervals, p values for Fisher's exact test, and number of reports were calculated for each crude group to identify those associated with DILI. Notably, the number of adverse event reports for DILI (63,955) exceeded that for interstitial lung disease (51,347), the most common adverse event. In total, 78 crude drug groups (90 crude drugs) were reported to have an ROR > 1, a p < 0.05, and ≥10 reported cases. Our results highlight DILI as an essential issue, given that it was among the most frequently reported adverse drug reactions. We were able to clearly identify the crude drugs associated with DILI, which could help manage adverse drug reactions attributed to Kampo medicines and crude drugs.
Collapse
Affiliation(s)
- Kyosuke Kimura
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Kiyose 204-8588, Japan
- Datack, Inc., Tokyo 102-0072, Japan
| | - Mami Kikegawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Kiyose 204-8588, Japan
- Department of Kampo Medicine, Yokohama University of Pharmacy, Yokohama 245-0066, Japan
| | - Yusuke Kan
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Kiyose 204-8588, Japan
- Nanohana Pharmacy, Tomakomai 053-0021, Japan
| | - Yoshihiro Uesawa
- Department of Medical Molecular Informatics, Meiji Pharmaceutical University, Kiyose 204-8588, Japan
| |
Collapse
|
9
|
Qian W, Gong G, Su H, Zhao Y, Fu W, Wang Y, Ji W, Sun X, Zhang B, Ma L, Li J, Zhang X, Li S, Sheng E, Lu Y, Zhu D. Hepar-on-a-sensor-platform with hybridization chain reaction amplification strategy to intuitively monitor the hepatoxicity of natural compounds. Acta Biomater 2023; 160:73-86. [PMID: 36804823 DOI: 10.1016/j.actbio.2023.02.021] [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: 10/20/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
The irrational use of natural compounds in the treatment of diseases can lead to serious side effects, especially hepatoxicity, and its toxic effects are usually cumulative and imperceptible. Therefore, an accurate sensing platform is urgently needed to monitor the hepatotoxicity of natural compounds. Here, we deposited a thermo-responsive alginate-RGD/Pluronic hydrogel to construct an in vitro three-dimensional(3D) hepar-platform, and a thorough validation was adopted to evaluate the bioprinted hepatic constructs. The engineered hepar-platform was then employed to access its biological response toward Emodin (EM) and Triptolide (TP), two typical hepatotoxic natural compounds. Subsequently, we integrated it with a robust fluorescent sensor based on hybridization chain reaction amplification strategy (HCR) to monitor the early hepatotoxic biomarker - glutathione-S-transferase-alpha (GST-α) secreted by this 3D constructs. Our study was the first attempt to construct an accurate hepar-on-a-sensor platform that could effectively detect GST-α for monitoring the hepatoxic effects of natural compounds. The limit of detection of the platform was 0.3 ng ml-1 and the accuracy of this platform was verified by enzyme linked immunosorbent assay. Furthermore, the variation of GST-α induced by EM and TP was consistent with hepatotoxicity studies, thus providing an important application value for evaluating the hepatotoxicity of natural compounds. STATEMENT OF SIGNIFICANCE: 1. We deposited a thermo-responsive alginate-RGD/Pluronic hydrogel to construct an in vitro three-dimensional(3D) hepar-platform, and elucidated the essential reasons why hybrid bioinks more suitable for 3D extrusion from biomaterials itself. Also, a thorough validation associated with a series of important proteins and genes involved in liver cell metabolism was adopted to evaluate the bioprinted hepatic constructs accurately 2. Glutathione-S-transferase-alpha is a soluble trace biomarker for acute hepatotoxic injury, the hepatotoxic effects of natural compounds on the secretion of GST-α has not been reported to date. We integrated our 3D hepar-platform with recognition molecules-aptamers and HCR amplification strategy to monitor the variation of GST-α, aiming at developing a robust and stable fluorescent biosensing platform to monitor the hepatoxicity of natural compounds.
Collapse
Affiliation(s)
- Wenhui Qian
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China; Department of Pharmacy, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, PR China
| | - Guangming Gong
- Department of Pharmacy, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, PR China
| | - Hua Su
- Department of Pharmacy, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, PR China
| | - Yang Zhao
- Department of Biochemistry and Molecular Biology, School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, PR China
| | - Wenjuan Fu
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Yuting Wang
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Wenwen Ji
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Xuetong Sun
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Bei Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Lijuan Ma
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Jianting Li
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Xiangying Zhang
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Su Li
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Enze Sheng
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China
| | - Yin Lu
- School of Pharmacy, Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing 210023, PR China.
| | - Dong Zhu
- School of Pharmacy, Nanjing University of Chinese Medicine,Nanjing, Jiangsu 210023, PR China.
| |
Collapse
|
10
|
Quality by Design Assisted Optimization and Risk Assessment of Black Cohosh Loaded Ethosomal Gel for Menopause: Investigating Different Formulation and Process Variables. Pharmaceutics 2023; 15:pharmaceutics15020465. [PMID: 36839787 PMCID: PMC9966456 DOI: 10.3390/pharmaceutics15020465] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Black cohosh (Cimicifuga racemosa) (CR) is a popular herb and is medically lauded for ameliorating myriad symptoms associated with menopause. However, its pharmaceutical limitations and non-availability of a patient-compliant drug delivery approach have precluded its prevalent use. Henceforth, the current research premise is aimed at developing an ethosomal gel incorporating triterpene enriched fraction (TEF) obtained from CR and evaluating its effectiveness through the transdermal application. TEF-loaded ethosomes were formulated using solvent injection, optimized and characterised. The optimized ethosomes were then dispersed into a polymeric gel base to form ethosomal gel which was further compared with the conventional gel by in-vitro and ex-vivo experiments. Here, the quality by design (QbD) approach was exploited for the optimization and development of ethosomal gel. The elements of QbD comprising initial risk assessment, design of experimentation (DoE), and model validation for the development of formulation have all been described in detail. The optimized ethosomes (F03) showed a nanometric size range, negative zeta potential and good entrapment. The in vitro release profile of gel revealed a burst release pattern following the Korsmeyer Peppas model having Fickian diffusion. The transdermal flux of ethosomal gel was observed to be more than that of conventional gel. Texture analysis and rheological characterization of the gel, revealed good strength showing shear thinning and pseudoplastic behaviour. The confocal microscope investigation revealed the deeper skin permeation of ethosomal gel than conventional gel. This result was further strengthened by DSC, IR and histological assessment of the animal skin (Wistar rat), treated with the optimized formulation. Conclusively, the implementation of QbD in the formulation resulted in a better understanding of the process and the product. It aids in the reduction of product variability and defects, hence improving product development efficiencies. Additionally, the ethosomal gel was found to be a more effective and successful carrier for TEF than the conventional gel through the transdermal route. Moreover, this demands an appropriate animal study, which is underway, for a stronger outcome.
Collapse
|
11
|
Floreani A, Bizzaro D, Shalaby S, Taliani G, Burra P. Sex disparity and drug-induced liver injury. Dig Liver Dis 2023; 55:21-28. [PMID: 35843842 DOI: 10.1016/j.dld.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 12/31/2022]
Abstract
Drug-induced liver injury (DILI) is a potentially serious clinical condition that remains a major problem for patients, physicians and those involved in the development of new drugs. Population and hospital-based studies have reported incidences of DILI varying from 1.4 to 19.1/100.000. Overall, females have a 1.5- to 1.7-fold greater risk of developing adverse drug reactions and the female/male ratio increases after the age of 49 years, suggesting a clear susceptibility of DILI after menopause. Sex differences in pharmacokinetics and pharmacodynamic, sex-specific hormonal effects or interaction with signalling molecules that can influence drug efficacy and safety and differences in abnormal immune response following drug exposure are the main probable causes of the higher vulnerability observed among female patients. A novel phenotype of autoimmune-mediated DILI following the use of check-point inhibitors in oncology and haematology has been recently described. Finally, there have been increasing reports of DILI associated with use of herbal and dietary supplements that is more frequently reported in women.
Collapse
Affiliation(s)
- A Floreani
- Scientific Consultant Scientific Institute for Research, Hospitalization and Healthcare, Negrar, Verona, Italy; Senior Scholar, University of Padova, Padova, Italy.
| | - D Bizzaro
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - S Shalaby
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - G Taliani
- Department of Infectious and Tropical Diseases, La Sapienza University of Rome, Rome, Italy
| | - P Burra
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | | |
Collapse
|
12
|
Liu T, Xu G, Li Y, Shi W, Ren L, Fang Z, Liang L, Wang Y, Gao Y, Zhan X, Li Q, Mou W, Lin L, Wei Z, Li Z, Dai W, Zhao J, Li H, Wang J, Zhao Y, Xiao X, Bai Z. Discovery of bakuchiol as an AIM2 inflammasome activator and cause of hepatotoxicity. JOURNAL OF ETHNOPHARMACOLOGY 2022; 298:115593. [PMID: 35973629 DOI: 10.1016/j.jep.2022.115593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Psoralea corylifolia (P. corylifolia Linn.) is a traditional Chinese medicinal plant that exhibits significant aphrodisiac, diuretic, and anti-rheumatic effects. However, it has been reported to cause hepatic injury, but the precise mechanisms remain unclear. AIM OF THE STUDY To evaluate the safety and risk of P. corylifolia and to elucidate the underlying mechanisms of drug-induced liver injury. MATERIALS AND METHODS Western blotting, enzyme-linked immunosorbent assay (ELISA), immunofluorescence, quantitative polymerase chain reaction (Q-PCR), and flow cytometry were used to explore the effect of bakuchiol (Bak), one of the most abundant and biologically active components of P. corylifolia, on the AIM2 inflammasome activation and the underlying mechanism. Furthermore, we used the lipopolysaccharides (LPS)-induced drug-induced liver injury (DILI) susceptible mice model to study the Bak-mediated hepatotoxicity. RESULTS Bak induced the maturation of caspase-1 P20, and significantly increased the expression of IL-1β and TNF-α (P < 0.0001) compared with the control group. Moreover, compared to the Bak group, knockdown of AIM2 inhibited Bak-induced caspase-1 maturation and significantly decreased the production of IL-1β and TNF-α, but knockout of NLRP3 had no effect. Mechanistically, Bak-induced AIM2 inflammasome activation is involved in mitochondrial damage, mitochondrial DNA (mtDNA) release, and subsequent recognition of cytosolic mtDNA. Our in vivo data showed that co-exposure to LPS and non-hepatotoxic doses of Bak significantly increased the levels of ALT, AST, IL-1β, TNF-α, and IL-18, indicating that Bak can induce severe liver inflammation (P < 0.005). CONCLUSIONS The result shows that Bak activates the AIM2 inflammasome by inducing mitochondrial damage to release mtDNA, and subsequently binds to the AIM2 receptor, indicating that Bak may be a risk factor for P. corylifolia-induced hepatic injury.
Collapse
Affiliation(s)
- Tingting Liu
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China; Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China; Military Institute of Chinese Materia, the Fifth Medical Center of PLA General Hospital, Beijing, China; School of Traditional Chinese Medicine, Capital Medical University, Beijing, China; The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Guang Xu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
| | - Yurong Li
- Department of Military Patient Management, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Wei Shi
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Lutong Ren
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Zhie Fang
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Longxin Liang
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yan Wang
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yuan Gao
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xiaoyan Zhan
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Qiang Li
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Wenqing Mou
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Li Lin
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Ziying Wei
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Zhiyong Li
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Wenzhang Dai
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jia Zhao
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Hui Li
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jiabo Wang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yanling Zhao
- Department of Pharmacy, the Fifth Medical Center of PLA General Hospital, Beijing, China.
| | - Xiaohe Xiao
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China; Military Institute of Chinese Materia, the Fifth Medical Center of PLA General Hospital, Beijing, China.
| | - Zhaofang Bai
- Senior Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China; Military Institute of Chinese Materia, the Fifth Medical Center of PLA General Hospital, Beijing, China.
| |
Collapse
|
13
|
Kava Kava-Associated Acute Liver Failure? Am J Ther 2022; 29:e729-e731. [PMID: 33416242 DOI: 10.1097/mjt.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
14
|
Bai Z, Tao W, Zhou Y, Cao Y, Yu S, Shi Z. Xiao-Yao-San protects against anti-tuberculosis drug-induced liver injury by regulating Grsf1 in the mitochondrial oxidative stress pathway. Front Pharmacol 2022; 13:948128. [PMID: 36120303 PMCID: PMC9475289 DOI: 10.3389/fphar.2022.948128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Xiao-Yao-San (XYS) is a traditional Chinese prescription that regulates gastrointestinal function, improves mental and psychological abnormalities, and enhances liver function. However, the underlying mechanism of XYS for relieving anti-tuberculosis (AT) drug-induced liver injury is not clear. Objective: The current study examined whether XYS alleviated the symptoms of AT drug-induced liver injury in mice via the mitochondrial oxidative stress pathway. Methods: BALB/c male mice were randomly divided into four groups of 12 animals, including a control group, a model group, a 0.32 g/kg XYS group, and a 0.64 g/kg XYS group. The effect of XYS on the degree of liver injury was observed using haematoxylin and eosin staining (HE) and oil red O staining of pathological sections, biochemical parameters, and reactive oxygen species (ROS) levels. The protein expression of mitochondrial synthesis-related proteins and ferroptosis-related proteins was examined using Western blotting. Results: XYS improved the pathological changes in liver tissue and reduced the level of oxidative stress in liver-injured mice. XYS increased the expression of mitochondrial synthesis-related proteins and reversed the expression of ferroptosis-related proteins. Knockdown of G-rich RNA sequence binding factor 1 (Grsf1) expression with Grsf1 shRNA blocked the protective effects of XYS in liver injury. Conclusion: Our findings suggest that XYS alleviates AT drug-induced liver injury by mediating Grsf1 in the mitochondrial oxidative stress pathway.
Collapse
Affiliation(s)
- Zijun Bai
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, College of Pharmacy, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Weiwei Tao
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yiqun Zhou
- Department of Infectious Disease, Suzhou Integrated Chinese and Western Medicine Hospital, Suzhou, Jiangsu, China
| | - Yi Cao
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Shun Yu
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- *Correspondence: Shun Yu, ; Zheng Shi,
| | - Zheng Shi
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- *Correspondence: Shun Yu, ; Zheng Shi,
| |
Collapse
|
15
|
Mihajlovic M, Vinken M. Mitochondria as the Target of Hepatotoxicity and Drug-Induced Liver Injury: Molecular Mechanisms and Detection Methods. Int J Mol Sci 2022; 23:ijms23063315. [PMID: 35328737 PMCID: PMC8951158 DOI: 10.3390/ijms23063315] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022] Open
Abstract
One of the major mechanisms of drug-induced liver injury includes mitochondrial perturbation and dysfunction. This is not a surprise, given that mitochondria are essential organelles in most cells, which are responsible for energy homeostasis and the regulation of cellular metabolism. Drug-induced mitochondrial dysfunction can be influenced by various factors and conditions, such as genetic predisposition, the presence of metabolic disorders and obesity, viral infections, as well as drugs. Despite the fact that many methods have been developed for studying mitochondrial function, there is still a need for advanced and integrative models and approaches more closely resembling liver physiology, which would take into account predisposing factors. This could reduce the costs of drug development by the early prediction of potential mitochondrial toxicity during pre-clinical tests and, especially, prevent serious complications observed in clinical settings.
Collapse
|
16
|
Soares PF, Fernandes MTCF, Souza ADS, Lopes CM, Dos Santos DAC, Oliveira DPR, Pereira MG, Prado NMDBL, Gomes GSDS, Santos G, Paraná R. Causality imputation between herbal products and HILI: An algorithm evaluation in a systematic review. Ann Hepatol 2022; 25:100539. [PMID: 34555512 DOI: 10.1016/j.aohep.2021.100539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/04/2023]
Abstract
Algorithms can have several purposes in the clinical practice. There are different scales for causality imputation in DILI (Drug-Induced Liver Injury), but the applicability and validity of these for the HILI (Herb-Induced Liver Injury) evaluation is questionable for some scales. The purpose of the study was to determine the clinical and demographic profile of the patients with HILI, and the main algorithmic scales used in its causality assessment. The methodology was a systematic review of articles in English, Spanish, or Portuguese language, from 1979 to 2019, involving humans, with descriptors related to HILI. Qualitative and quantitative statistical analysis were performed. As a result, from a total of 60 articles, 203 HILI reports were selected: 59.9% were women, similar with other studies, and the average age was 45.8 years. Jaundice was the most frequent symptom and regarding the type of lesion, the hepatocellular was the most frequent. In regard to HILI severity, 3.0% were severe and 7.6% were fatal or required liver transplantation. In 72.3% of the cases, the most used algorithm was RUCAM (Roussel Uclaf Causality Assessment Method). The conclusion of the study is that RUCAM was the most used algorithm for causality assessment in HILI. The patients were predominantly female, jaundice was the main symptom, and HILI is reversible in the majority of cases.
Collapse
Affiliation(s)
- Pedro Felipe Soares
- School Medicine of Bahia- University Federal of Bahia, Av. Rector Miguel Calmon, S/N - Vale do Canela, 40110-100, Salvador - BA, Brazil.
| | | | | | - Caio Medina Lopes
- Faculty of Pharmacy - University Federal of Bahia, Salvador, BA, Brazil.
| | | | | | | | | | | | - Genário Santos
- Sciences of Health Post Graduation Program - University Federal of Bahia, Salvador, BA, Brazil.
| | - Raymundo Paraná
- School Medicine of Bahia- University Federal of Bahia, Av. Rector Miguel Calmon, S/N - Vale do Canela, 40110-100, Salvador - BA, Brazil.
| |
Collapse
|
17
|
Di Giacomo S, Briz O, Vitalone A, Di Sotto A. Editorial: Natural Products and Hepatic Health: Light and Shadows. Front Pharmacol 2022; 13:868207. [PMID: 35281943 PMCID: PMC8914257 DOI: 10.3389/fphar.2022.868207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Silvia Di Giacomo
- Deptartment of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Rome, Italy
- *Correspondence: Silvia Di Giacomo,
| | - Oscar Briz
- Laboratory of Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain
- Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, Madrid, Spain
| | - Annabella Vitalone
- Deptartment of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Rome, Italy
| | - Antonella Di Sotto
- Deptartment of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
18
|
Bessone F, Hernandez N, Tagle M, Arrese M, Parana R, Méndez-Sánchez N, Ridruejo E, Mendizabal M, Dagher L, Contreras F, Fassio E, Pessoa M, Brahm J, Silva M. Drug-induced liver injury: A management position paper from the Latin American Association for Study of the liver. Ann Hepatol 2022; 24:100321. [PMID: 33609753 DOI: 10.1016/j.aohep.2021.100321] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 02/06/2023]
Abstract
Idiosyncratic drug-induced liver injury (DILI) caused by xenobiotics (drugs, herbals and dietary supplements) is an uncommon cause of liver disease presenting with a wide range of phenotypes and disease severity, acute hepatitis mimicking viral hepatitis to autoimmune hepatitis, steatosis, fibrosis or rare chronic vascular syndromes. Disease severity ranges from asymptomatic liver test abnormalities to acute liver failure. DILI has been traditionally classified in predictable or intrinsic (dose-related) or unpredictable (not dose-related) mechanisms. Few prospective studies are assessing the real prevalence and incidence of hepatotoxicity in the general population. DILI registries represent useful networks used for the study of liver toxicity, aimed at improving the understanding of causes, phenotypes, natural history, and standardized definitions of hepatotoxicity. Although most of the registries do not carry out population-based studies, they may provide important data related to the prevalence of DILI, and also may be useful to compare features from different countries. With the support of the Spanish Registry of Hepatotoxicity, our Latin American Registry (LATINDILI) was created in 2011, and more than 350 DILI patients have been recruited to date. This position paper describes the more frequent drugs and herbs-induced DILI in Latin America, mainly focusing on several features of responsible medicaments. Also, we highlighted the most critical points on the management of hepatotoxicity in general and those based on findings from our Latin American experience in particular.
Collapse
Affiliation(s)
- Fernando Bessone
- Hospital Provincial del Centenario, Facultad de Medicina, Universidad Nacional de Rosario, Rosario, Argentina.
| | | | - Martin Tagle
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco Arrese
- Pontificia Universidad Católica de chile, Santiago de Chile, Chile
| | | | - Nahum Méndez-Sánchez
- Liver Research Unit, Medica Sur Clinic & Foundation, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico
| | - Ezequiel Ridruejo
- Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Buenos Aires, Argentina
| | | | - Lucy Dagher
- Policlínica Metropolitana y CMDLT, Caracas, Venezuela
| | | | - Eduardo Fassio
- Hospital Nacional Prof. Alejandro Posadas, Provincia de Buenos Aires, Argentina
| | | | | | | |
Collapse
|
19
|
Herb-Induced Liver Injury—A Challenging Diagnosis. Healthcare (Basel) 2022; 10:healthcare10020278. [PMID: 35206892 PMCID: PMC8872293 DOI: 10.3390/healthcare10020278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
Herb-induced liver injury (HILI) can be caused by supplements containing herbs, natural products, and products used in traditional medicine. Herbal products’ most common adverse reaction is hepatotoxicity. Almost every plant part can be used to make herbal products, and these products can come in many different forms, such as teas, powders, oils, creams, capsules, and injectables. HILI incidence and prevalence are hard to estimate and vary from study to study because of insufficient large-scale prospective studies. The diagnosis of HILI is a challenging process that requires not only insight but also a high degree of suspicion by the clinician. HILI presents with unspecific symptoms and is a diagnosis of exclusion. For diagnosis, it is necessary to make a causality assessment; the Council for International Organizations of Medical Sciences assessment is the preferred method worldwide. The most effective treatment is the suspension of the use of the suspected herbal product and close monitoring of liver function. The objective of this review is to highlight the necessary steps for the clinician to follow to reach a correct diagnosis of herb-induced liver injury. Further studies of HILI are needed to better understand its complexity and prevent increased morbidity and mortality.
Collapse
|
20
|
Yuan TH, Yue ZS, Zhang GH, Wang L, Dou GR. Beyond the Liver: Liver-Eye Communication in Clinical and Experimental Aspects. Front Mol Biosci 2022; 8:823277. [PMID: 35004861 PMCID: PMC8740136 DOI: 10.3389/fmolb.2021.823277] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
The communication between organs participates in the regulation of body homeostasis under physiological conditions and the progression and adaptation of diseases under pathological conditions. The communication between the liver and the eyes has been received more and more attention. In this review, we summarized some molecular mediators that can reflect the relationship between the liver and the eye, and then extended the metabolic relationship between the liver and the eye. We also summarized some typical diseases and phenotypes that have been able to reflect the liver-eye connection in the clinic, especially non-alcoholic fatty liver disease (NAFLD) and diabetic retinopathy (DR). The close connection between the liver and the eye is reflected through multiple pathways such as metabolism, oxidative stress, and inflammation. In addition, we presented the connection between the liver and the eye in traditional Chinese medicine, and introduced the fact that artificial intelligence may use the close connection between the liver and the eye to help us solve some practical clinical problems. Paying attention to liver-eye communication will help us have a deeper and more comprehensive understanding of certain communication between liver diseases and eyes, and provide new ideas for their potential therapeutic strategy.
Collapse
Affiliation(s)
- Tian-Hao Yuan
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of The Cadet Team 6 of School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Zhen-Sheng Yue
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guo-Heng Zhang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lin Wang
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guo-Rui Dou
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
21
|
Wu Z, Ke J, Liu Y, Sun P, Hong M. Lanthanide-based NIR-II Fluorescent Nanoprobes and Their Biomedical Applications ※. ACTA CHIMICA SINICA 2022. [DOI: 10.6023/a21120571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
22
|
Jiang HY, Bao YN, Lin FM, Jin Y. Triptolide regulates oxidative stress and inflammation leading to hepatotoxicity via inducing CYP2E1. Hum Exp Toxicol 2021; 40:S775-S787. [PMID: 34758665 DOI: 10.1177/09603271211056330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Triptolide (TP), the main active compound extracted from medicine-tripterygium wilfordii Hook f. (TWHF). It has anti-tumor and immunomodulatory properties. Our study aimed to investigate the mechanisms of hepatotoxicity treated with TP in vivo and in vitro, as well as their relationship with the NF-κB (p65) signal pathway; and to assess TP-induced hepatotoxicity after CYP2E1 modulation by the known inhibitor, clomethiazole, and the known inducer, pyrazole. Mice were given TP to cause liver injury and IHHA-1 cells were given TP to cause hepatocyte injury. The enzyme activity and hepatotoxicity changed dramatically when the CYP2E1 inhibitor and inducer were added. In comparison to the control group, the enzyme inducer increased the activity of CYP2E1, whereas the enzyme inhibitor had the opposite effect. Our findings suggest that TP is an inducer of CYP2E1 via a time-dependent activation mechanism. In addition, TP can promote oxidative stress, inflammatory and involving the NF-κB (p65) signal pathway. Therefore, we used triptolide to stimulate C57 mice and IHHA-1 cells to determine whether TP can promote oxidative stress and inflammation by activating CYP2E1 in response to exacerbated liver damage and participate in NF-κB (p65) signaling pathway.
Collapse
Affiliation(s)
- Hai-Yan Jiang
- Key Laboratory of Anti-inflammatory and Immune Medicines, Ministry of Education, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- Institute for Liver Diseases of Anhui Medical University, Hefei, China
| | - Yan-Ni Bao
- Key Laboratory of Anti-inflammatory and Immune Medicines, Ministry of Education, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- Institute for Liver Diseases of Anhui Medical University, Hefei, China
| | - Feng-Mei Lin
- Key Laboratory of Anti-inflammatory and Immune Medicines, Ministry of Education, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- Institute for Liver Diseases of Anhui Medical University, Hefei, China
| | - Yong Jin
- Key Laboratory of Anti-inflammatory and Immune Medicines, Ministry of Education, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- The Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, School of Pharmacy, 12485Anhui Medical University, Hefei, China
- Institute for Liver Diseases of Anhui Medical University, Hefei, China
| |
Collapse
|
23
|
Alves DDN, Martins RX, Ferreira EDS, Alves AF, de Andrade JC, Batista TM, Lazarini JG, Amorim LS, Rosalen PL, Farias DF, de Castro RD. Toxicological Parameters of a Formulation Containing Cinnamaldehyde for Use in Treatment of Oral Fungal Infections: An In Vivo Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2305695. [PMID: 34722758 PMCID: PMC8556081 DOI: 10.1155/2021/2305695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/04/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We aimed to define the safety and toxicity of both isolated and embedded cinnamaldehyde using a pharmaceutical formulation for the treatment of oral fungal infections in an in vivo study. MATERIALS AND METHODS Acute toxicity was assessed in studies with Galleria mellonella larvae and Danio rerio embryos (zebrafish), and genotoxicity was assessed in a mouse model. The pharmaceutical formulation (orabase ointment) containing cinnamaldehyde was evaluated for verification of both in vitro antifungal activity and toxicity in keratinized oral rat mucosa. RESULTS In Galleria mellonella larvae, cinnamaldehyde was not toxic up to the highest dose tested (20 mg/kg) and presented no genotoxicity up to the dose of 4 mg/kg in the model using mice. However, it was found to be toxic in zebrafish embryos up to a concentration of 0.035 μg/mL; LC50 0.311; EC50 0.097 (egg hatching delay); and 0.105 (Pericardial edema). In the orabase antifungal susceptibility test, cinnamaldehyde exhibited activity in concentrations greater than 200 μg/mL. As for safety in the animal model with rats, the orabase ointment proved to be safe for use on keratinized mucosa up to the maximum concentration tested (700 μg/mL). CONCLUSIONS At the concentrations tested, cinnamaldehyde was not toxic in vertebrate and invertebrate animal models and did not exhibit genotoxic activity. In addition, when used in the form of an ointment in orabase, having already recognized antifungal activity, it was shown to be safe up to the highest concentration tested.
Collapse
Affiliation(s)
- Danielle da Nóbrega Alves
- Department of Clinical and Social Dentistry, Graduate Program in Natural and Synthetic Bioactive Products (PgPNSB), Center for Health Sciences, Federal University of Paraiba, João Pessoa PB, Brazil
| | - Rafael Xavier Martins
- Graduate Program in Molecular and Cell Biology, Center for Health Sciences, Federal University of Paraiba, João Pessoa PB, Brazil
| | - Elba dos Santos Ferreira
- Experimental Pharmacology and Cell Culture Laboratory, Center for Health Sciences, Federal University of Paraiba, João Pessoa PB, Brazil
| | - Adriano Francisco Alves
- Department of Physiology and Pathology, Health Sciences Center, Federal University of Paraiba, João Pessoa PB, Brazil
| | - Jéssica Cabral de Andrade
- Graduate Program in Natural and Synthetic Bioactive Products (PgPNSB), Health Sciences Center, Federal University of Paraiba, João Pessoa PB, Brazil
| | - Tatianne Mota Batista
- Graduate Program in Natural and Synthetic Bioactive Products (PgPNSB), Health Sciences Center, Federal University of Paraiba, João Pessoa PB, Brazil
| | - Josy Goldoni Lazarini
- Graduate Program in Dentistry (PPGO), Health Sciences Center, University of Campinas, Campinas SP, Brazil
| | - Luana Souza Amorim
- Experimental Pharmacology and Cell Culture Laboratory, Health Sciences Center, Federal University of Paraiba, João Pessoa PB, Brazil
| | - Pedro Luiz Rosalen
- Department of Physiological Sciences, Center for Biological Sciences, Piracicaba Dental School, University of Campinas, Campinas, São Paula, Brazil
| | - Davi Felipe Farias
- Laboratory for Risk Assessment of Novel Technologies (LabRisk), Department of Molecular Biology, Federal University of Paraiba, Campus I, 58051-900 João Pessoa, Brazil
| | - Ricardo Dias de Castro
- Department of Clinical and Social Dentistry, Center for Health Sciences, Federal University of Paraiba, João Pessoa PB, Brazil
| |
Collapse
|
24
|
Metabolic Toxification of 1,2-Unsaturated Pyrrolizidine Alkaloids Causes Human Hepatic Sinusoidal Obstruction Syndrome: The Update. Int J Mol Sci 2021; 22:ijms221910419. [PMID: 34638760 PMCID: PMC8508847 DOI: 10.3390/ijms221910419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
Saturated and unsaturated pyrrolizidine alkaloids (PAs) are present in more than 6000 plant species growing in countries all over the world. They have a typical heterocyclic structure in common, but differ in their potential toxicity, depending on the presence or absence of a double bond between C1 and C2. Fortunately, most plants contain saturated PAs without this double bond and are therefore not toxic for consumption by humans or animals. In a minority of plants, however, PAs with this double bond between C1 and C2 exhibit strong hepatotoxic, genotoxic, cytotoxic, neurotoxic, and tumorigenic potentials. If consumed in error and in large emouns, plants with 1,2-unsaturated PAs induce metabolic breaking-off of the double bonds of the unsaturated PAs, generating PA radicals that may trigger severe liver injury through a process involving microsomal P450 (CYP), with preference of its isoforms CYP 2A6, CYP 3A4, and CYP 3A5. This toxifying CYP-dependent conversion occurs primarily in the endoplasmic reticulum of the hepatocytes equivalent to the microsomal fraction. Toxified PAs injure the protein membranes of hepatocytes, and after passing their plasma membranes, more so the liver sinusoidal endothelial cells (LSECs), leading to life-threatening hepatic sinusoidal obstruction syndrome (HSOS). This injury is easily diagnosed by blood pyrrolizidine protein adducts, which are perfect diagnostic biomarkers, supporting causality evaluation using the updated RUCAM (Roussel Uclaf Causality Assessment Method). HSOS is clinically characterized by weight gain due to fluid accumulation (ascites, pleural effusion, and edema), and may lead to acute liver failure, liver transplantation, or death. In conclusion, plant-derived PAs with a double bond between C1 and C2 are potentially hepatotoxic after metabolic removal of the double bond, and may cause PA-HSOS with a potential lethal outcome, even if PA consumption is stopped.
Collapse
|
25
|
Ahmad B, Ilahi I, Yousafzai AM, Attaullah M, Rahim A, Naz D, Hazrat A, Batiha GES, Nassan MA, Khalil AAK. Protective effects of Zizyphus oxyphyla on liver and kidney related serum biomarkers in (CCl4) intoxicate rabbits. BRAZ J BIOL 2021; 83:e246980. [PMID: 34468522 DOI: 10.1590/1519-6984.246980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
The study was aimed to evaluate the therapeutic effects of Zizyphus oxyphyla leaves methanolic (ZOX-LME), on serum liver, kidney and hematology along with other serum parameters in Carbon tetrachloride (CCl4) intoxicated rabbits. Experimental animals were divided into five groups, six rabbits in each. These were: group NC (normal control), group, TC (toxic control) and group ST i.e. silymarine administered group at dose rate (50) mg/kg body weight (BW). Group ET1 and group ET2 treated with (ZOX-LME) at dose 200 mg/kg BW and 400 mg/kg BW. CCl4 administration caused significant (P> 0.05) impairment in serum liver enzymes, blood factors and other serum indices. Treatment with (ZOX-LME) significantly (P<0.05) reduced and normalized the levels of serum alanine transaminase (ALT) aspartate transaminase (AST) and alkaline phosphatase (ALP) and hematological indices. Also significant (P< 0.05) reduction was observed in creatinine, urea, uric acid, blood urea nitrogen (BUN), and albumin and glucose concentrations. The altered levels of lipid profile and serum electrolytes (Ca, Mg, Cl, Na, K, and P) were significantly (P<0.05) change toward normal levels with (ZOX-LME) feeding. In addition (ZOX-LME) ingestion caused significant improvement in GSH, GST and CAT levels, while reducing the TBARS levels, exhibited antioxidant capacity. Also (ZOX-LME) showed increase inhibition against percent scavenging of 2, 2-diphenile-1-picrylehydrazyle (DPPH) free radical. Significant (P<0.05) normalizing effects were observed with high dose 400 mg/kg BW of (ZOX-LME and were equivalent to silymarine administered groups. The histological study of liver supported the hepatoprotective and renal curative activity of (ZOX-LME).
Collapse
Affiliation(s)
- B Ahmad
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - I Ilahi
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - A M Yousafzai
- Islamia College, Department of Zoology, Peshawar, Pakistan
| | - M Attaullah
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - A Rahim
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - D Naz
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - A Hazrat
- University of Malakand, Departments of Botany, Khyber Pakhtunkhwa, Pakistan
| | - G E-S Batiha
- Damanhour University, Faculty of Veterinary Medicine, Department of Pharmacology and Therapeutics, Damanhour, AlBeheira, Egypt
| | - M A Nassan
- Taif University, Turabah University College, Department of Clinical Laboratory Sciences, Taif, Saudi Arabia
| | - A A K Khalil
- National University of Medical Sciences, Department of Biological Sciences, Rawalpindi, Pakistan
| |
Collapse
|
26
|
Fan Q, Xu F, Liang B, Zou X. The Anti-Obesity Effect of Traditional Chinese Medicine on Lipid Metabolism. Front Pharmacol 2021; 12:696603. [PMID: 34234682 PMCID: PMC8255923 DOI: 10.3389/fphar.2021.696603] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/01/2021] [Indexed: 01/01/2023] Open
Abstract
With the improvement of living conditions and the popularity of unhealthy eating and living habits, obesity is becoming a global epidemic. Obesity is now recognized as a disease that not only increases the risk of metabolic diseases such as type 2 diabetes (T2D), non-alcoholic fatty liver disease (NAFLD), cardiovascular disease (CVD), and cancer but also negatively affects longevity and the quality of life. The traditional Chinese medicines (TCMs) are highly enriched in bioactive compounds and have been used for the treatment of obesity and obesity-related metabolic diseases over a long period of time. In this review, we selected the most commonly used anti-obesity or anti-hyperlipidemia TCMs and, where known, their major bioactive compounds. We then summarized their multi-target molecular mechanisms, specifically focusing on lipid metabolism, including the modulation of lipid absorption, reduction of lipid synthesis, and increase of lipid decomposition and lipid transportation, as well as the regulation of appetite. This review produces a current and comprehensive understanding of integrative and systematic mechanisms for the use of TCMs for anti-obesity. We also advocate taking advantage of TCMs as another therapy for interventions on obesity-related diseases, as well as stressing the fact that more is needed to be done, scientifically, to determine the active compounds and modes of action of the TCMs.
Collapse
Affiliation(s)
- Qijing Fan
- College of Chinese Materia Medica and Yunnan Key Laboratory of Southern Medicinal Utilization, Yunnan University of Chinese Medicine, Kunming, China
| | - Furong Xu
- College of Chinese Materia Medica and Yunnan Key Laboratory of Southern Medicinal Utilization, Yunnan University of Chinese Medicine, Kunming, China
| | - Bin Liang
- Center for Life Sciences, School of Life Sciences, Yunnan University, Kunming, China
| | - Xiaoju Zou
- College of Chinese Materia Medica and Yunnan Key Laboratory of Southern Medicinal Utilization, Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
27
|
Okaiyeto K, Oguntibeju OO. African Herbal Medicines: Adverse Effects and Cytotoxic Potentials with Different Therapeutic Applications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5988. [PMID: 34199632 PMCID: PMC8199769 DOI: 10.3390/ijerph18115988] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 01/01/2023]
Abstract
The African continent is naturally endowed with various plant species with nutritional and medicinal benefits. About 80% of the people in developing countries rely on folk medicines to treat different diseases because of indigenous knowledge, availability, and cost-effectiveness. Extensive research studies have been conducted on the medicinal uses of African plants, however, the therapeutic potentials of some of these plants has remained unexploited. Over the years, several studies have revealed that some of these African floras are promising candidates for the development of novel drugs. Despite the plethora of studies on medicinal plant research in Africa, there is still little scientific data supporting the folkloric claims of these plants. Besides, safety in the use of folk medicines has been a major public health concern over the year. Therefore, it has become mandatory that relevant authority should take measures in safeguarding the populace on the use of herbal mixtures. Thus, the present review extracted relevant information from different scientific databases and highlighted some problems associated with folk medicines, adverse effects on reproductive systems, issue about safety due to the toxicity of some plants and their toxicity effects with potential therapeutic benefits are discussed.
Collapse
Affiliation(s)
| | - Oluwafemi O. Oguntibeju
- Phytomedicine and Phytochemistry Group, Oxidative Stress Research Centre, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa;
| |
Collapse
|
28
|
Brodziak-Dopierała B, Fischer A, Ahnert B. Polish students’ knowledge of dietary supplements. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01481-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
The increasing intake of dietary supplements (DS) can be observed worldwide. These preparations are classified as a special category of foods and are subject to food law, not pharmaceutical regulations. As a result, the requirements for DS are much less restrictive than for medications.
Methodology
This research was conducted in a group of young Polish students of pharmacy at the Medical University of Silesia in Katowice (SUM) and of finance and accounting at the University of Economics in Katowice (UE). The survey contained questions concerning DS, such as difference to drugs, scope of use, and safety.
Results
The respondents answered questions about taking DS and the effects of their use. DS were used either currently or in the past by about 70% of the respondents, while about 30% of the surveyed population declared that they did not use these preparations. Women and UE students predominated among those not taking DS.
Conclusion
Multi-component products taken for a period of less than 3 months to supplement a deficit for a given component were used the most often. One product was taken at a time. The respondents read product information and followed the recommended doses. Over 50% of the studied population was aware of the negative effects of DS. Adverse symptoms of DS use were observed by 5% of the respondents.
Collapse
|
29
|
Ippoliti I, Menniti-Ippolito F, Mazzanti G, Di Giacomo S. Suspected adverse reactions to performance enhancing dietary supplements: Spontaneous reports from the Italian phytovigilance system. Phytother Res 2021; 35:3246-3261. [PMID: 33569860 DOI: 10.1002/ptr.7040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
Herbal tonic and adaptogens are often used to improve overall well-being. However, few clinical evidence supports their use and their safety is not known before marketing. In this context, the aim of our study was to analyze the spontaneous reports of suspected adverse reactions (ARs) to performance enhancing herbal dietary supplements collected by the Italian Phytovigilance System. Between March 2002 and September 2020, 110 spontaneous reports were collected, 58 of which related to products containing botanicals, alone or in association. Twenty-three serious reactions were reported, 21 of which required hospitalization, one was life-threatening and another caused disability. Dermatological and cardiovascular reactions were the most frequent. Hepatic ARs were the most serious (9 out of 10). A positive dechallenge was indicated in 69% of cases, while a positive rechallenge occurred in 15%. Concomitant use of other products was present in 18 reports (31%), while predisposing conditions were indicated in 17 (29%). Present data highlight safety concerns on herbal dietary supplements used as cognitive and physical performance enhancers, mainly due to their quality and use without expert supervision. Considering that postmarketing surveillance is not required for these products, spontaneous reports represent the only tool to point out risks related to food supplements.
Collapse
Affiliation(s)
- Ilaria Ippoliti
- National Centre for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | | | - Gabriela Mazzanti
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | - Silvia Di Giacomo
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| |
Collapse
|
30
|
Gui HL, Zhao CQ, Wang Y, Gu HT, Wang WJ, Cai W, Guo Q, Bao SS, Xu LM, Xie Q. Histological Outcome of Fuzheng Huayu plus Entecavir Combination Therapy in Chronic Hepatitis B Patients with Significant Liver Fibrosis. J Clin Transl Hepatol 2020; 8:277-284. [PMID: 33083250 PMCID: PMC7562803 DOI: 10.14218/jcth.2020.00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/02/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background and Aims: To evaluate the efficacy of Fuzheng Huayu (FZHY), a Chinese herbal formula, plus entecavir (ETV) in regression of liver fibrosis in chronic hepatitis B (CHB) patients with significant fibrosis/cirrhosis. Methods: The current study was a two-center, randomized, double-blind and placebo-controlled pilot study. Fifty-two currently untreated chronic hepatitis B patients with Ishak fibrosis score ≥3 points were identified and 1:1 randomized into FZHY plus ETV combination and placebo plus ETV groups. The second liver biopsy was performed after 48-week treatment. Necroinflammatory improvement and regression of fibrosis were assessed. Fine changes in different collagen features in paired liver biopsies were evaluated by dual-photon microscopy for both groups. Results: Forty-nine patients completed the full course of treatment; forty-six of them underwent second liver biopsy (for which twenty-two were in the combination group and twenty-four were in the control group). Compared to those in the control group, patients in the combination group had significantly higher rate of fibrosis regression (82% vs. 54%) (p<0.05). Furthermore, the necroinflammatory improvement was greater in the combination group than in the control group (59% vs. 25%, p<0.05). Among the more than 80 collagen parameters in the dual-photon analysis, 5 decreased significantly in the combination group compared to the control group (p<0.05). However, no significant improvement was detected in either biochemical, virologic or serologic responses between these two groups at week 48. Conclusions: The combination therapy of FZHY plus ETV for 48 weeks resulted in a higher rate of necroinflammatory improvement and fibrosis regression than ETV alone in chronic hepatitis B patients with significant fibrosis/cirrhosis. The clinical trial number is ChiCTR-TRC-11001377.
Collapse
Affiliation(s)
- Hong-Lian Gui
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Qing Zhao
- Department of Liver Cirrhosis, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Wang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hong-Tu Gu
- Department of Liver Cirrhosis, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei-Jing Wang
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Infectious Diseases, Ruijin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Cai
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Guo
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-San Bao
- Discipline of Pathology, School of Medicine Sciences and Bosch Institute, Charles Perkin Centre, University of Sydney, New South Wales, Australia
| | - Lie-Ming Xu
- Department of Liver Cirrhosis, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Correspondence to: Qing Xie, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Tel/Fax: +86-21-64454930, E-mail: ; Lie-ming Xu, Department of Liver Cirrhosis, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China. Tel/Fax: +86-21-20156520, E-mail:
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence to: Qing Xie, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Tel/Fax: +86-21-64454930, E-mail: ; Lie-ming Xu, Department of Liver Cirrhosis, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China. Tel/Fax: +86-21-20156520, E-mail:
| |
Collapse
|
31
|
Cao S, Han L, Li Y, Yao S, Hou S, Ma SS, Dai W, Li J, Zhou Z, Wang Q, Huang F. Integrative transcriptomics and metabolomics analyses provide hepatotoxicity mechanisms of asarum. Exp Ther Med 2020; 20:1359-1370. [PMID: 32742371 PMCID: PMC7388312 DOI: 10.3892/etm.2020.8811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/18/2020] [Indexed: 01/08/2023] Open
Abstract
Asarum is frequently applied in combination with other agents for prescriptions in practices of Traditional Chinese Medicine. A number of studies have previously indicated that asarum treatment induces lung toxicity by triggering inflammation. However, the potential effects of asarum in the liver and the underlying mechanisms have remained largely elusive. Therefore, transcriptomics and metabolomics approaches were used in the present study to examine the mechanisms of the hepatotoxicity of asarum. Specifically, mRNA and metabolites were obtained from rat liver samples following intragastric administration of asarum powder. RNA sequencing analysis was subsequently performed to screen for differentially expressed genes (DEGs), and a total of 434 DEGs were identified in liver tissue samples, 214 of which were upregulated and 220 were downregulated. Pathway enrichment analysis found that these genes were particularly enriched in processes including the regulation of p53 signaling, metabolic pathways and bile secretion. To investigate potential changes to the metabolic profile as a result of asarum treatment, a metabolomics analysis was performed, which detected 14 significantly altered metabolites in rat liver samples by gas chromatography-mass spectrometry. These metabolites were predominantly members of the taurine, hypotaurine and amino acid metabolic pathways. Metscape network analyses were subsequently performed to integrate the transcriptomics and metabolomics data. Integrative analyis revealed that the DEGs and metabolites were primarily associated with bile acid biosynthesis, amino acid metabolism and the p53 signaling pathway. Taken together, these results provide novel insight into the mechanism of asarum-mediated hepatotoxicity, which may potentially aid the clinical diagnosis and future therapeutic intervention of asarum poisoning.
Collapse
Affiliation(s)
- Sa Cao
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Lintao Han
- Department of Chinese Medicine Resource and Compound Prescription, Ministry of Education, Wuhan, Hubei 430065, P.R. China
| | - Yamin Li
- Department of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, P.R. China
| | - Shiqi Yao
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Shuaihong Hou
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Shi-Shi Ma
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Wangqiang Dai
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Jingjing Li
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Zhenxiang Zhou
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Qiong Wang
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Fang Huang
- Department of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| |
Collapse
|
32
|
Quan NV, Dang Xuan T, Teschke R. Potential Hepatotoxins Found in Herbal Medicinal Products: A Systematic Review. Int J Mol Sci 2020; 21:E5011. [PMID: 32708570 PMCID: PMC7404040 DOI: 10.3390/ijms21145011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
The risk of liver injury associated with the use of herbal medicinal products (HMPs) is well known among physicians caring for patients under a HMP therapy, as documented in case reports or case series and evidenced by using the Roussel Uclaf Causality Assessment Method (RUCAM) to verify a causal relationship. In many cases, however, the quality of HMPs has rarely been considered regarding potential culprits such as contaminants and toxins possibly incriminated as causes for the liver injury. This review aims to comprehensively assemble details of tentative hepatotoxic contaminants and toxins found in HMPs. Based on the origin, harmful agents may be divided according two main sources, namely the phyto-hepatotoxin and the nonphyto-hepatotoxin groups. More specifically, phyto-hepatotoxins are phytochemicals or their metabolites naturally produced by plants or internally in response to plant stress conditions. In contrast, nonphyto-hepatotoxic elements may include contaminants or adulterants occurring during collection, processing and production, are the result of accumulation of toxic heavy metals by the plant itself due to soil pollutions, or represent mycotoxins, herbicidal and pesticidal residues. The phyto-hepatotoxins detected in HMPs are classified into eight major groups consisting of volatile compounds, phytotoxic proteins, glycosides, terpenoid lactones, terpenoids, alkaloids, anthraquinones, and phenolic acids. Nonphyto-hepatotoxins including metals, mycotoxins, and pesticidal and herbicidal residues and tentative mechanisms of toxicity are discussed. In conclusion, although a variety of potential toxic substances may enter the human body through HMP use, the ability of these toxins to trigger human liver injury remains largely unclear.
Collapse
Affiliation(s)
- Nguyen Van Quan
- Transdisciplinary Science and Engineering Program, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima 739-8529, Japan; (N.V.Q.); (T.D.X.)
| | - Tran Dang Xuan
- Transdisciplinary Science and Engineering Program, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima 739-8529, Japan; (N.V.Q.); (T.D.X.)
| | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, 63450 Hanau, Germany
| |
Collapse
|
33
|
Teschke R, Zhu Y, Jing J. Herb-induced Liver Injury in Asia and Current Role of RUCAM for Causality Assessment in 11,160 Published Cases. J Clin Transl Hepatol 2020; 8:200-214. [PMID: 32832401 PMCID: PMC7438347 DOI: 10.14218/jcth.2020.00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/05/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Herb-induced liver injuries (HILI) by traditional herbal medicines are particular challenges in Asian countries, with issues over the best approach to establish causality. The aim of the current analysis was to provide an overview on how causality was assessed in HILI cases from Asian countries and whether the Roussel Uclaf Causality Assessment Method (RUCAM) was the preferred diagnostic algorithm, as shown before in worldwide evaluated cases of drug-induced liver injury (DILI). Using the PubMed database, publications in English language were preferred to allow for reevaluation by peers. Overall 11,160 HILI cases have assessed causality using RUCAM and were published by first authors working in Asian countries. With 21 evaluable reports, most publications came from mainland China, with Hong Kong and Taiwan, followed by Korea (n=15), Singapore (n=2), and Japan (n=1), while other Asian countries were not contributory. Most publications provided case and RUCAM data of good quality. For better presentation of future cases, however, the following recommendations are given: (1) preference of prospective study design with use of the updated RUCAM version; (2) clear separation of HILI cohorts from those of other herbal products or DILI; (3) case series for epidemiology studies should contain many essential data, possibly also as supplementary material; (4) otherwise, preference of single case reports providing individual case data and RUCAM-based causality gradings, and applying liver test threshold values; and (5) publication in English language journals. In conclusion, China and Korea are top in presenting RUCAM-based HILI cases, other Asian countries are encouraged to follow.
Collapse
Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/ Main, Frankfurt/Main, Germany
- Correspondence to: Rolf Teschke, Department of Internal Medicine II, Klinikum Hanau, Teaching Hospital of the Goethe University of Frankfurt/Main, Leimenstrasse 20, D-63450 Hanau, Germany. Tel: +49-6181-21859, Fax: +49-6181-2964211, E-mail:
| | - Yun Zhu
- The Fifth Medical Center, General Hospital of PLA, Beijing, China
| | - Jing Jing
- The Fifth Medical Center, General Hospital of PLA, Beijing, China
| |
Collapse
|
34
|
Zhang D, Lv J, Zhang B, Zhang X, Jiang H, Lin Z. The characteristics and regularities of cardiac adverse drug reactions induced by Chinese materia medica: A bibliometric research and association rules analysis. JOURNAL OF ETHNOPHARMACOLOGY 2020; 252:112582. [PMID: 31972324 DOI: 10.1016/j.jep.2020.112582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/06/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Chinese materia medica (CMM) has been widely used as an approach of ethnomedicine worldwide. Recently, there are growing concerns related to the potential cardiotoxicity of herbal medicines but comprehensive studies are limited. METHODS Comprehensive literature retrieval via publicly available electronic databases was performed to identify the case reports that focused on cardiac adverse reactions (ADRs) triggered by oral CMMs. And a bibliometric survey was conducted to analyze the most commonly suspected risk factors in terms of responsible CMMs, susceptible patients and clinical administration of cardiac ADRs. Moreover, the techniques of data mining were utilized to investigate the regularities and association between the ADRs status and major contributory factors. RESULTS The available evidence of current research indicated that many influential factors were strongly associated with cardiac ADRs caused by oral CMMs inevitably, including pediatric patients, poisonous CMMs (especially herbs of Aconitum species), overdose and self-medication. Specifically, the timely and effective resuscitation could attribute their favorable capacity to reduce mortality for cardiac ADRs. Notably, the cardiac ADRs cases had often concomitant the ADRs of the nervous system and digestive system. CONCLUSION The comprehensive features and risk factors of cardiac ADRs induced by oral CMMs can be discovered and elucidated through the approaches of bibliometric research, association rules analysis, and data mining technology, which raise the profile and awareness of the rational applications of CMMs and pharmacovigilance within relevant heart side effects.
Collapse
Affiliation(s)
- Dan Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Jintao Lv
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Bing Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China; Center for Pharmacovigilance and Rational Use of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China.
| | - Xiaomeng Zhang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Hao Jiang
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| | - Zhijian Lin
- Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, No. 11 North Three-ring East Road, Chao Yang District, Beijing, 100029, China.
| |
Collapse
|
35
|
Tan Y, Chen H, Zhou X, Sun L. RUCAM-based assessment of liver injury by xiang-tian-guo (Swietenia macrophylla) seeds, a plant used for treatment of hypertension and diabetes. Ann Hepatol 2020; 18:406-407. [PMID: 31056362 DOI: 10.1016/j.aohep.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Youwen Tan
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China.
| | - Hongbo Chen
- Department of Infection, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, China
| | - Xinbei Zhou
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China
| | - Li Sun
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China
| |
Collapse
|
36
|
Chang L, Xu D, Zhu J, Ge G, Kong X, Zhou Y. Herbal Therapy for the Treatment of Acetaminophen-Associated Liver Injury: Recent Advances and Future Perspectives. Front Pharmacol 2020; 11:313. [PMID: 32218738 PMCID: PMC7078345 DOI: 10.3389/fphar.2020.00313] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 03/03/2020] [Indexed: 12/13/2022] Open
Abstract
Acetaminophen (APAP) overdose is the leading cause of drug-induced liver injury worldwide, and mitochondrial oxidative stress is considered the major event responsible for APAP-associated liver injury (ALI). Despite the identification of N-acetyl cysteine, a reactive oxygen species scavenger that is regarded as an effective clinical treatment, therapeutic effectiveness remains limited due to rapid disease progression and diagnosis at a late phase, which leads to the need to explore various therapeutic approaches. Since the early 1990s, a number of natural products and herbs have been found to have hepatoprotective effects against APAP-induced hepatotoxicity in terms of acute liver failure prevention and therapeutic amelioration of ALI. In this review, we summarize the hepatoprotective effects and mechanisms of medicinal plants, including herbs and fruit extracts, along with future perspectives that may provide guidance to improve the current status of herbal therapy against ALI.
Collapse
Affiliation(s)
- Ling Chang
- Department of Gastroenterology, The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dongwei Xu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Zhu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guangbo Ge
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoni Kong
- Central Laboratory, Department of Liver Diseases, Institute of Clinical Immunology, ShuGuang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Shanghai, China
| | - Ying Zhou
- Department of Gastroenterology, The Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
37
|
Girish P, Jayanthi M, Gitanjali B, Manikandan S, Rajan S. Screening of Weight-Loss Herbal Products for Synthetic Anti-Obesity Adulterants: A Target-Oriented Analysis by Liquid Chromatography-Tandem Mass Spectrometry. J Diet Suppl 2020; 18:92-104. [PMID: 32081055 DOI: 10.1080/19390211.2020.1723774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The medical and social impact of being overweight, as well as the difficulty in making long-term changes in diet, physical activity, and pitfalls associated with allopathic management, lure obese individuals to over-the-counter weight-loss herbal products (WHPs). However, the safety of herbals is questionable, as reports from all over the world suggest adulteration with synthetic weight loss agents. Objective: The present study was carried out to develop a rapid and sensitive method to screen potential weight loss adulterants in WHPs. Methodology: We procured 33 licensed brands of WHPs that are available in Puducherry (India) and through web stores. Drug-free spiked herbal matrices were used for internal proficiency testing. Spiked herbal matrices and samples were extracted and centrifuged. The supernatant was collected and subjected to liquid chromatography-tandem mass spectrometry analyses. Isocratic elution was carried out by the mobile phase of methanol: 0.1% v/v formic acid (70%:30% v/v) through a C18 column. Analytes were monitored in electrospray ionization positive and negative modes, and an multiple reaction monitoring (MRM) scan was used. Results: Run time was 12 min. Intra- and inter-day precision was < 15% and recoveries were in the range of 99% to 115%. Limit of quantification (LOQ) of the analytes were in the range of 0.1 to 0.3 ng/ml. Conclusion: We developed a sensitive and rapid validated method for the detection of potential adulterants in WHPs. None of the WHPs analyzed were found to contain adulterants. The proposed method will be useful for routine monitoring. WHPs analyzed in this study were not adulterated indicating that WHPs from licensed sources are reliable.
Collapse
Affiliation(s)
- P Girish
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - M Jayanthi
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - B Gitanjali
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.,All India Institute of Medical Sciences, Bhubaneswar, India
| | - S Manikandan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - S Rajan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| |
Collapse
|
38
|
Chow HC, So TH, Choi HCW, Lam KO. Literature Review of Traditional Chinese Medicine Herbs-Induced Liver Injury From an Oncological Perspective With RUCAM. Integr Cancer Ther 2020; 18:1534735419869479. [PMID: 31405304 PMCID: PMC6693029 DOI: 10.1177/1534735419869479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Traditional Chinese medicine (TCM) herbs are commonly regarded to be safe with
minimal toxicities in Chinese communities. Cancer patients who are receiving
Western oncology therapy often concurrently take TCM herbs for anticancer and
symptom relief purposes. We performed a literature review for current evidence
on TCM herb–induced liver injury from an oncological perspective. A literature
search on PubMed was performed to identify publications regarding TCM herbs and
concoctions with hepatoprotective or hepatotoxic properties. Lists of commonly
used herbs and their causality levels were compiled. In view of the wide range
of evidence available, cases assessed by the well-established RUCAM (Roussel
Uclaf Causality Assessment Method) algorithm were categorized as the highest
level of evidence. More than one case of TCM herb–induced liver injury was
confirmed by RUCAM in the following herbs and concoctions: Lu Cha
(Camellia sinensis), Bai Xian Pi (Dictamnus
dasycarpus), Tu San Qi (Gynura segetum), Jin Bu
Huan (Lycopodium serratum), He Shou Wu (Polygoni
multiflora), Ge Gen (Pueraria lobata), Dan Lu Tong
Du tablet, Shou Wu Pian, Xiao Chai Hu Tang, Xiao Yin pill, and Yang Xue Sheng Fa
capsule. Finally, TCM with anticancer or symptom relief uses were discussed in
detail with regard to their hepatotoxic or hepatoprotective properties.
Collapse
Affiliation(s)
- Hei Ching Chow
- 1 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Tsz Him So
- 1 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Horace Cheuk Wai Choi
- 1 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ka On Lam
- 1 Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| |
Collapse
|
39
|
Teschke R, Eickhoff A, Brown AC, Neuman MG, Schulze J. Diagnostic Biomarkers in Liver Injury by Drugs, Herbs, and Alcohol: Tricky Dilemma after EMA Correctly and Officially Retracted Letter of Support. Int J Mol Sci 2019; 21:ijms21010212. [PMID: 31892250 PMCID: PMC6981464 DOI: 10.3390/ijms21010212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023] Open
Abstract
Liver injuries caused by the use of exogenous compounds such as drugs, herbs, and alcohol are commonly well diagnosed using laboratory tests, toxin analyses, or eventually reactive intermediates generated during metabolic degradation of the respective chemical in the liver and subject to covalent binding by target proteins. Conditions are somewhat different for idiosyncratic drug induced liver injury (DILI), for which metabolic intermediates as diagnostic aids are rarely available. Although the diagnosis of idiosyncratic DILI can well be established using the validated, liver specific, structured, and quantitative RUCAM (Roussel Uclaf Causality Assessment Method), there is an ongoing search for new diagnostic biomarkers that could assist in and also confirm RUCAM-based DILI diagnoses. With respect to idiosyncratic DILI and following previous regulatory letters of recommendations, selected biomarkers reached the clinical focus, including microRNA-122, microRNA-192, cytokeratin analogues, glutamate dehydrogenase, total HMGB-1 (High Mobility Group Box), and hyperacetylated HMGB-1 proteins. However, the new parameters total HMGB-1, and even more so the acetylated HMGB-1, came under critical scientific fire after misconduct at one of the collaborating partner centers, leading the EMA to recommend no longer the exploratory hyperacetylated HMGB1 isoform biomarkers in clinical studies. The overall promising nature of the recommended biomarkers was considered by EMA as highly dependent on the outstanding results of the now incriminated biomarker hyperacetylated HMGB-1. The EMA therefore correctly decided to officially retract its Letter of Support affecting all biomarkers listed above. New biomarkers are now under heavy scrutiny that will require re-evaluations prior to newly adapted recommendations. With Integrin beta 3 (ITGB3), however, a new diagnostic biomarker may emerge, possibly being drug specific but tested in only 16 patients; due to substantial remaining uncertainties, final recommendations would be premature. In conclusion, most of the currently recommended new biomarkers have lost regulatory support due to scientific misconduct, requiring now innovative approaches and re-evaluation before they can be assimilated into clinical practice.
Collapse
Affiliation(s)
- Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, D-63450 Hanau, Germany;
- Correspondence: ; Tel.: +49-6181-21859; Fax: +49-6181-2964211
| | - Axel Eickhoff
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, D-63450 Hanau, Germany;
| | - Amy C. Brown
- Department of Complementary and Integrative Medicine, University of Hawai’i at Manoa, Honolulu, HI 96813, USA;
| | - Manuela G. Neuman
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M2 R1 W6, Canada;
| | - Johannes Schulze
- Institute of Occupational, Social and Environmental Medicine, Goethe-University Frankfurt/Main, D-60590 Frankfurt/Main, Germany;
| |
Collapse
|
40
|
Acute Hepatitis Secondary to the Use of Ilex paraguariensis (Mate Tea): A Case Report and Review of Literature. Case Reports Hepatol 2019; 2019:8459205. [PMID: 31737383 PMCID: PMC6815554 DOI: 10.1155/2019/8459205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022] Open
Abstract
Drug induced liver injury is a very frequent cause of hepatotoxicity and within that group, herbal and dietary supplements are a well described subcategory. The following clinical vignette describes the case of a young man with acute hepatitis secondary to the use of Ilex paraguariensis, also known as yerba mate, which is a herbal product commonly drunk in South America. This is the first written case of mate tea induced hepatotoxicity.
Collapse
|
41
|
Philips CA, Augustine P, Rajesh S, Y PK, Madhu D. Complementary and Alternative Medicine-related Drug-induced Liver Injury in Asia. J Clin Transl Hepatol 2019; 7:263-274. [PMID: 31608219 PMCID: PMC6783675 DOI: 10.14218/jcth.2019.00024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Cyriac Abby Philips
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, Kerala, India
- *Correspondence to: Cyriac Abby Philips, Philip Augustine Associates, 35/194 B, Symphony, Automobile Rd, Palarivattom, Kochi, Kerala 682025, India. E-mail:
| | - Philip Augustine
- Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, Kerala, India
| | - Sasidharan Rajesh
- Interventional Radiology, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, Kerala, India
| | - Praveen Kumar Y
- Gastroenterology, Government Medical College, Thrissur, Kerala, India
| | - Deepak Madhu
- Gastroenterology, Aster MIMS, Calicut, Kerala, India
| |
Collapse
|
42
|
Gynura Rhizoma containing pyrrolizidine alkaloids induces the hepatic sinusoidal obstruction syndrome in mice via upregulating fibrosis-related factors. Acta Pharmacol Sin 2019; 40:781-789. [PMID: 30367152 DOI: 10.1038/s41401-018-0155-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022] Open
Abstract
Recently, hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal preparations containing pyrrolizidine alkaloids (PAs), such as Gynura Rhizoma (Tusanqi), has gained global attention. However, the lack of a reliable and reproducible animal model has greatly hampered mechanistic studies. Therefore, we aimed to establish a reproducible HSOS mouse model and investigate the hepatotoxic mechanism. The model was established by intragastrical administration of Gynura Rhizoma extract, i.e., 1.0 g extract/kg per day (equal to 16.7 g crude drug/kg per day based on extraction rate and 49.1 mg PA/kg per day based on the total PA content in the extract determined) for 40 successive days. Then, the mice were sacrificed, and their blood samples and livers were collected for analyses. Using hematoxylin-eosin (HE) and Masson staining, scanning electron microscopy imaging, clinical biomarkers, and other assays, we showed that the HSOS was successfully induced in our mouse model. Furthermore, we detected the key factors involved in liver fibrosis in the mice, revealing significantly increased hydroxyproline concentration; elevated expression of α-smooth muscle actin (α-SMA) and fibrosis-related genes such as Collagen-1, Collagen-3, Mmp2, Mmp13, Timp1, Timp3, and Activin, upregulated Smad3 phosphorylation, and increased serum TGF-β levels. Moreover, pro-inflammatory cytokines, including Tnf-α, Il-1β, and Il-6, were also increased in the model. All these results demonstrate the key roles of the TGF-β-Smad3 and inflammatory signaling pathways in this Gynura Rhizoma-induced HSOS mouse model, suggesting that blockade of fibrosis and/or inflammation should be an effective treatment for HSOS.
Collapse
|
43
|
He S, Ye T, Wang R, Zhang C, Zhang X, Sun G, Sun X. An In Silico Model for Predicting Drug-Induced Hepatotoxicity. Int J Mol Sci 2019; 20:E1897. [PMID: 30999595 PMCID: PMC6515336 DOI: 10.3390/ijms20081897] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 01/10/2023] Open
Abstract
As one of the leading causes of drug failure in clinical trials, drug-induced liver injury (DILI) seriously impeded the development of new drugs. Assessing the DILI risk of drug candidates in advance has been considered as an effective strategy to decrease the rate of attrition in drug discovery. Recently, there have been continuous attempts in the prediction of DILI. However, it indeed remains a huge challenge to predict DILI successfully. There is an urgent need to develop a quantitative structure-activity relationship (QSAR) model for predicting DILI with satisfactory performance. In this work, we reported a high-quality QSAR model for predicting the DILI risk of xenobiotics by incorporating the use of eight effective classifiers and molecular descriptors provided by Marvin. In model development, a large-scale and diverse dataset consisting of 1254 compounds for DILI was built through a comprehensive literature retrieval. The optimal model was attained by an ensemble method, averaging the probabilities from eight classifiers, with accuracy (ACC) of 0.783, sensitivity (SE) of 0.818, specificity (SP) of 0.748, and area under the receiver operating characteristic curve (AUC) of 0.859. For further validation, three external test sets and a large negative dataset were utilized. Consequently, both the internal and external validation indicated that our model outperformed prior studies significantly. Data provided by the current study will also be a valuable source for modeling/data mining in the future.
Collapse
Affiliation(s)
- Shuaibing He
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Tianyuan Ye
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Ruiying Wang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Chenyang Zhang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Xuelian Zhang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Guibo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Xiaobo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of New Drug Discovery Based on Classic Chinese Medicine Prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| |
Collapse
|
44
|
Byeon JH, Kil JH, Ahn YC, Son CG. Systematic review of published data on herb induced liver injury. JOURNAL OF ETHNOPHARMACOLOGY 2019; 233:190-196. [PMID: 30639232 DOI: 10.1016/j.jep.2019.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 05/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Herbal products have been widely used as a means of ethnomedicine worldwide. Recently, the potential hepatotoxicity of herbs has become a medical issue but comprehensive studies are limited. AIM OF THE STUDY This study aims to determine the clinical features of herb induced liver injury (HILI) including its constituent ratio among liver injury case cohorts that included both HILI and drug induced liver injury (DILI). MATERIALS AND METHODS A systematic review was conducted using a literature search for DILI/HILI in seven electric databases including PubMed, Cochrane and Embase. We analyzed the DILI/HILI cases and clinical characteristics in terms of herbs, conventional drugs, concomitant, or others. RESULTS Thirty-one studies met the necessary criteria and included 9 prospective and 22 retrospective studies. Among total number of overall DILI/HILI cases (7511, male 2819, female 3669 and unknown 1023), 25.0% (1874 cases) were implicated in herbs. HILI was relatively higher in females (69.8% vs. 30.2% male), compared to conventional drugs (57.3% female vs. 42.7% male, p < 0.01), while it was prone to induce hepatocellular injury (hepatocellular 78.8%, cholestatic 8.9%, mixed type 12.3%), contrary to conventional drugs (hepatocellular 56.7% vs. cholestatic 22.1% vs. mixed 21.2%), respectively (p < 0.01). The main herbs causing HILI included Polygonum multiflorum, Psoralea corylifolia, Corydalis yanhusuo, and Rheum officinale. CONCLUSIONS This review created the comparative and comprehensive feature of hepatotoxicity by herbal products, which provides reference data for the clinical applications and establishing pharmacovigilance system of herbs.
Collapse
Affiliation(s)
- Jung-Hwan Byeon
- Korean Medical College of Daejeon University, 62, Daehak-ro Dong-gu, Daejeon 301-716, Republic of Korea.
| | - Ji-Hye Kil
- Korean Medical College of Daejeon University, 62, Daehak-ro Dong-gu, Daejeon 301-716, Republic of Korea.
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, 62, Daehak-ro Dong-gu, Daejeon 301-716, Republic of Korea.
| | - Chang-Gue Son
- Liver and Immunology Research Center, Dunsan Oriental Hospital of Daejeon University, 75, Daedeok-daero 176, Seo-gu, Daejeon 35253, Republic of Korea.
| |
Collapse
|
45
|
Lin NH, Yang HW, Su YJ, Chang CW. Herb induced liver injury after using herbal medicine: A systemic review and case-control study. Medicine (Baltimore) 2019; 98:e14992. [PMID: 30921214 PMCID: PMC6456154 DOI: 10.1097/md.0000000000014992] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023] Open
Abstract
In Taiwan, traditional herbal medication was included in Taiwan's National Health Insurance (NHI) system since 1996 and in 9 out of 10 hospitals have developed their own departments of traditional medicine. This study aims to address the herb-induced liver injury (HILI) after using herbal medicine on the relationship between age, gender, epidemiology, laboratory data, pathogenesis, mobility, and mortality.We searched the PubMed database with "hepatitis after herbal medicine" and "in human" till 2018 April and returned 163 articles in a systemic review manner. Two cases reports describing in-vitro liver injury were excluded. Reviews and articles without the detailed report, laboratory data and history were excluded from this study. In the end, there were 53 articles enrolled in this study. These enrolled literatures are from France (n = 13), Germany (n = 12), Switzerland (n = 5) United States of America (n = 4), Korea (n = 4), Hong Kong (n = 4), Greece (n = 3), China (n = 2), Canada (n = 1), Italy (n = 1), Thailand (n = 1), Finland (n = 1), Taiwan (n = 1), and Japan (n = 1). The data were analyzed with a commercial statistical software Stata/SE 12.0 program Stata Corporation, College Station, TX, USA. Statistical χ tests were performed and the significance was set at a P value of less than .05 (2-tailed).The ages are ranged from 15 to 78 years with the mean ± SD (standard deviation) of 48.3 ± 16.2 years old. The majority of cases are female (n = 37). In elderly, man is more commonly seen than female in HILI (37.5% vs 10.5%, P = .02). Female is vulnerable to cholestatic type of HILI than male (21.1% vs 0.0%, P = .04). Of all the cases in HILI, using pure substance are more commonly seen than mixed substance (P = .02). In gender, male patients have higher alanine aminotransferase (GPT) (IU/L) level in HILI than female ones (1560 ± 819 vs 1047 ± 706, P = .03).In HILI, the female is more commonly seen than male, but less than male in the elderly. The pure substance more often happens to HILI than mixture substance. Female is predominant in the cholestatic type of HILI. The major prevalence of HILI is in Europe rather than Asia. HILI cases in Europe is 2.75-fold than in Asia. This could be due to fewer reports of the herb induced liver injury in Asia compared to Europe. Prevention of HILI is the best policy, because it needs to take 78 ± 59 days to recover.
Collapse
Affiliation(s)
- Nai-Hui Lin
- Emergency Department and Poison Center, Mackay Memorial Hospital, Taipei City
| | - Hsiu-Wu Yang
- Emergency Department and Poison Center, Mackay Memorial Hospital, Taipei City
| | - Yu-Jang Su
- Emergency Department and Poison Center, Mackay Memorial Hospital, Taipei City
- Department of Medicine, Mackay Medical College, New Taipei City
- Department of Oral Hygiene, College of Oral Medicine. Taipei Medical University, Taipei
- Yuanpei University of Medical Technology, Hsinchu
| | - Chen-Wang Chang
- Department of Medicine, Mackay Medical College, New Taipei City
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| |
Collapse
|
46
|
The prevalence, characteristics, expenditure and predictors of complementary medicine use in Australians living with gastrointestinal disorders: A cross-sectional study. Complement Ther Clin Pract 2019; 35:158-169. [PMID: 31003652 DOI: 10.1016/j.ctcp.2019.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/06/2019] [Indexed: 12/17/2022]
Abstract
AIMS To determine the prevalence, characteristics, expenditure and predictors of complementary medicine (CM) use in Australian adults living with gastrointestinal disorders (GID). METHODS A cross-sectional study involving 2,025 Australian adults was conducted. Participants were recruited through purposive convenience sampling. Descriptive statistics were conducted to report the prevalence of people living with GIDs and their CM use, including CM products, mind-body practices and CM practitioner services. Chi-square test and independent-samples t-test were used to determine the associations between sociodemographic or health-related variables with CM use. Binary logistic regression was conducted to determine the significant predictors of CM use in GID participants. Economic data was calculated based on the mean out-of-pocket expenditure on CM. RESULTS Of the 293 participants reporting a GID, 186 (63.5%) used CM products, 55 (18.8%) used a mind-body practice and 141 (48.1%) visited at least one CM practitioner in the last 12 months. Collectively, the majority of GID participants using any type of CM were female, aged 40-49 years, married and employed. The mean score for health-related quality of life was 49.6 out of 100 in GID participants and 68.2 in participants without a GID (p < 0.001). Average annual out-of-pocket expenditure on CM products was AUD127.29 by CM products users with a GID. The predictors of CM products, mind-body practices and CM practitioner services use differed. Of the 111 CM product users with a GID, 103 (92.8%) disclosed all or some of their CM use to general practitioner, 89 (80.2%) to specialist doctor, 79 (71.2%) to pharmacist and 69 (62.1%) to hospital doctor. CONCLUSIONS A substantial proportion of Australian adults living with GID use CM products, mind-body practices and CM practitioner services. This study provides important insights to inform and guide the development of a more coordinated health care services for individuals living with GID.
Collapse
|
47
|
Fu B, Wang N, Tan HY, Li S, Cheung F, Feng Y. Multi-Component Herbal Products in the Prevention and Treatment of Chemotherapy-Associated Toxicity and Side Effects: A Review on Experimental and Clinical Evidences. Front Pharmacol 2018; 9:1394. [PMID: 30555327 PMCID: PMC6281965 DOI: 10.3389/fphar.2018.01394] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022] Open
Abstract
Chemotherapy is nowadays the main treatment of human cancers. Chemotherapeutic agents target rapidly dividing cancer cells to suppress tumor progression, however, their non-specific cytotoxicity often leads to significant side effects that might be intolerable to cancer patients. Multi-component herbal products have been used for thousands of years for the treatment of multiple human diseases. This study aims to systematically summarize and evaluate the experimental and clinical evidences of the efficacy of multi-component herbal products in improving chemotherapy-induced side effect. Literature was retrieved from PubMed database and evaluated based on the side effects described. Multi-component herbal products were found to be effective in ameliorating the neurotoxicity, gastrointestinal toxicity, hematological toxicity, cardiotoxicity, hepatotoxicity and nephrotoxicity. Both experimental and clinical evidences were found, indicating the potential of applying multicomponent herbal products in the clinical treatment of chemotherapy-induced side effects. However, the lack of mechanistic and pharmacokinetic studies, inconsistency in product quality, as well as insufficient clinical evidence suggested that more investigations are urgently necessary. In all, our review shed light on the potential of using multi-component herbal products in the clinical management of chemotherapy-induced toxicity and side effects. We also discussed the potential threats of natural products for cancer treatment and compared the advantages of using herbs to conventional chemical drugs.
Collapse
Affiliation(s)
| | | | | | | | | | - Yibin Feng
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
48
|
Molecular Mechanisms Involved in Oxidative Stress-Associated Liver Injury Induced by Chinese Herbal Medicine: An Experimental Evidence-Based Literature Review and Network Pharmacology Study. Int J Mol Sci 2018; 19:ijms19092745. [PMID: 30217028 PMCID: PMC6165031 DOI: 10.3390/ijms19092745] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 12/20/2022] Open
Abstract
Oxidative stress, defined as a disequilibrium between pro-oxidants and antioxidants, can result in histopathological lesions with a broad spectrum, ranging from asymptomatic hepatitis to hepatocellular carcinoma in an orchestrated manner. Although cells are equipped with sophisticated strategies to maintain the redox biology under normal conditions, the abundance of redox-sensitive xenobiotics, such as medicinal ingredients originated from herbs or animals, can dramatically invoke oxidative stress. Growing evidence has documented that the hepatotoxicity can be triggered by traditional Chinese medicine (TCM) during treating various diseases. Meanwhile, TCM-dependent hepatic disorder represents a strong correlation with oxidative stress, especially the persistent accumulation of intracellular reactive oxygen species. Of note, since TCM-derived compounds with their modulated targets are greatly diversified among themselves, it is complicated to elaborate the potential pathological mechanism. In this regard, data mining approaches, including network pharmacology and bioinformatics enrichment analysis have been utilized to scientifically disclose the underlying pathogenesis. Herein, top 10 principal TCM-modulated targets for oxidative hepatotoxicity including superoxide dismutases (SOD), malondialdehyde (MDA), glutathione (GSH), reactive oxygen species (ROS), glutathione peroxidase (GPx), Bax, caspase-3, Bcl-2, nuclear factor (erythroid-derived 2)-like 2 (Nrf2), and nitric oxide (NO) have been identified. Furthermore, hepatic metabolic dysregulation may be the predominant pathological mechanism involved in TCM-induced hepatotoxic impairment.
Collapse
|
49
|
Crescioli G, Lombardi N, Bettiol A, Marconi E, Risaliti F, Bertoni M, Menniti Ippolito F, Maggini V, Gallo E, Firenzuoli F, Vannacci A. Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review. Intern Emerg Med 2018; 13:857-872. [PMID: 29802521 DOI: 10.1007/s11739-018-1880-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/17/2018] [Indexed: 02/07/2023]
Abstract
Herbal weight-loss supplements are sold as self-medication products, and are often used under the misconception that their natural origin guarantees their safety. Food supplements are not required to provide any benefit/risk profile evaluation before marketing; however, possible risks associated with use of herbal extracts in food supplements are becoming more and more documented in the literature. Some herbs are listed as the leading cause of herb-induced liver injury, with a severe or potentially lethal clinical course, and unpredictable herb-drug interactions. Garcinia cambogia (GC) extract and GC-containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we present four cases of acute liver failure in women taking GC extract for weight loss, and a literature review of clinical evidences about hepatic toxicity in patients taking dietary supplements containing GC extract.
Collapse
Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy.
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Ettore Marconi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Filippo Risaliti
- Division of General Medicine 2, New Hospital "Santo Stefano", Prato, Italy
| | - Michele Bertoni
- Division of General Medicine 2, New Hospital "Santo Stefano", Prato, Italy
| | | | - Valentina Maggini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Referring Center for Phytotherapy, Tuscany Region Careggi, University Hospital, Florence, Italy
| | - Eugenia Gallo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Referring Center for Phytotherapy, Tuscany Region Careggi, University Hospital, Florence, Italy
| | - Fabio Firenzuoli
- Referring Center for Phytotherapy, Tuscany Region Careggi, University Hospital, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| |
Collapse
|
50
|
Lee H, Lee S, Kang JW, Lee JD. Liver enzyme abnormalities of inpatients with rheumatic diseases: A 10-year retrospective study in a Korean medicine hospital. Phytother Res 2018; 32:1784-1794. [DOI: 10.1002/ptr.6111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/11/2018] [Accepted: 04/14/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Hyeonhoon Lee
- Department of Acupuncture and Moxibustion Medicine; Kyung Hee University Korean Medicine Hospital; 23 Kyungheedae-ro, Dongdaemun-gu Seoul 02447 Republic of Korea
- Department of Clinical Korean Medicine, Graduate School; Kyung Hee University; 26 Kyungheedae-ro, Dongdaemun-gu Seoul 02447 Republic of Korea
| | - Seunghoon Lee
- Department of Acupuncture and Moxibustion Medicine; Kyung Hee University Korean Medicine Hospital; 23 Kyungheedae-ro, Dongdaemun-gu Seoul 02447 Republic of Korea
| | - Jung Won Kang
- Department of Acupuncture and Moxibustion Medicine; Kyung Hee University Korean Medicine Hospital; 23 Kyungheedae-ro, Dongdaemun-gu Seoul 02447 Republic of Korea
- Department of Clinical Korean Medicine, Graduate School; Kyung Hee University; 26 Kyungheedae-ro, Dongdaemun-gu Seoul 02447 Republic of Korea
| | - Jae-Dong Lee
- Department of Acupuncture and Moxibustion Medicine; Kyung Hee University Korean Medicine Hospital; 23 Kyungheedae-ro, Dongdaemun-gu Seoul 02447 Republic of Korea
- Department of Clinical Korean Medicine, Graduate School; Kyung Hee University; 26 Kyungheedae-ro, Dongdaemun-gu Seoul 02447 Republic of Korea
| |
Collapse
|