Hepatotoxicity associated with Garcinia cambogia: A case report

BACKGROUND Herbal supplements(HS) for weight loss are perceived to be "safe" and"natural", as advertised in ads, however, hepatotoxicity can be associated with consumption of some HS. Use of HS may be missed, as the patient may not report these unless specifically asked about these products, since they are often not thought of as medications with potential side effects or interaction potential.CASE SUMMARY We reported a case of a 21-year-old female with morbid obesity who presented with abdominal pain for 1 wk associated with nausea, vomiting, anorexia and myalgias. She denied smoking tobacco, drinking alcohol, usage of illicit drugs,hormonal contraceptives, or energy drinks. There was no significant past medical or family illnesses. Her laboratory workup revealed acute liver failure. The workup for possible etiologies of acute liver failure was unremarkable. She was using a weight loss herbal supplement "Garcinia cambogia" for 4 wks. This case demonstrates the association of acute liver failure with Garcinia cambogia.CONCLUSION Medical reconciliation of HS should be performed in patients with suspected acute liver failure and early discontinuation of HS can prevent further progression of drug induced hepatoxicity.     

Liver Injury from Herbal,Dietary, and Weight Loss Supplements: a Review

Herbal and dietary supplement usage has increased steadily over the past several years in the United States. Among the non-bodybuilding herbal and dietary supplements, weight loss supplements were among the most common type of HDS implicated in liver injury. While drug induced liver injury is rare, its consequences are significant and on the rise. The purpose of this review is to highlight case reports of weight loss products such as Hydroxycut and OxyElite Pro as one form of HDS that have hepatotoxic potential and to characterize its clinical effects as well as pattern of liver injury. We also propose future strategies in the identification and study of potentially hepatotoxic compounds in an effort to outline a diagnostic approach for identifying any drug induced liver injury.     

Acute liver failure caused by 'fat burners' and dietary supplements: a case report and literature review

Globally, people are struggling with obesity. Many effective, nonconventional methods of weight reduction, such as herbal and natural dietary supplements, are increasingly being sought. Fat burners are believed to raise metabolism, burn more calories and hasten fat loss. Despite patient perceptions that herbal remedies are free of adverse effects, some supplements are associated with severe hepatotoxicity. The present report describes a young healthy woman who presented with fulminant hepatic failure requiring emergent liver transplantation caused by a dietary supplement and fat burner containing usnic acid, green tea and guggul tree extracts. Thorough investigation, including histopathological examination, revealed no other cause of hepatotoxicity. The present case adds to the increasing number of reports of hepatotoxicity associated with dietary supplements containing usnic acid, and highlights that herbal extracts from green tea or guggul tree may not be free of adverse effects. Until these products are more closely regulated and their advertising better scrutinized, physicians and patients should become more familiar with herbal products that are commonly used as weight loss supplements and recognize those that are potentially harmful.     

Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders

Herbal traditional Chinese medicine (TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providing effective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in PubMed and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn’s disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmatic modern medicine by bridging the gap between the two medicinal cultures.     

Bee sting therapy-induced hepatotoxicity: A case report

The use of bee venom as a therapeutic agent for the relief of joint pains dates back to Hippocrates,and ref-erences to the treatment can be found in ancient Egyp-tian and Greek medical writings as well.Also known as apitherapy,the technique is widely used in Eastern Europe,Asia,and South America.The beneficial effects of bee stings can be attributed to mellitinin,an anti-in-flammatory agent,known to be hundred times stronger than cortisone.Unfortunately,certain substances in the bee venom trigger allergic reactions which can be life threatening in a sensitized individual.Multiple stings are known to cause hemolysis,kidney injury,hepatotoxicity and myocardial infarction.The toxicity can be immedi-ate or can manifest itself only weeks after the exposure.We describe hepatotoxicity in a 35-year-old female,following bee sting therapy for multiple sclerosis.She presented to our clinic 3 wk after therapy with a his-tory of progressive jaundice.The patient subsequently improved,and has been attending our clinic now for the last 9 mo.     

Prolonged cholestasis after raloxifene and fenofibrate interaction： A case report

Assigning causality in drug-induced liver injury is challenging particularly when more than one drug could be responsible. We report a woman on long-term therapy with raloxifen who developed acute cholestasis shortly after starting fenofibrate. The picture evolved into chronic cholestasis. We hypothesized that an interaction at the metabolic level could have triggered the presentation of hepatotoxicity after a very short time of exposure to fenofibrate in this patient. The findings of an overexpression of vascular endothelial growth factor in the liver biopsy suggest that angiogenesis might play a role in the persistance of toxic cholestasis.     

Lapatinib-induced hepatitis: a case report

Lapatinib is an inhibitor of the tyrosine kinases of human epidermal growth factor receptor type 2 (HER2) and epidermal growth factor receptor type 1, with clinical activity in HER2-positive metastatic breast cancer. We present here a 60 year-old patient with metastatic breast cancer who presented with jaundice and increased serum aminotransferase levels and who had been treated with lapatinib for the previous 14 days. Laboratory tests excluded other causes of acute liver injury. Liver biopsy revealed lesio...     

中药复方合剂减轻大鼠心肌梗死后心肌纤维化

目的探讨中药复方合剂能否减轻心肌梗死后心肌纤维化。方法通过结扎冠状动脉前降支制造大鼠心肌梗死模型。将60只SD大鼠分为六组:14天和56天非治疗组,14天和56天治疗组,14天和56天假手术组。模型制作24h后,14天和56天治疗组开始灌胃给药。结果假手术组、非治疗组、治疗组在第14天及第56天时,体重差异无显著性(P>0.05)。14天非治疗组全心重、左心室重量、全心重/体重、左心室重量/体重与14天假手术组差异均无显著性(P>0.05),而56天非治疗组上述各项指标(分别为1054±22mg,850±21mg,2.77±0.08,2.23±0.04)均显著高于56天假手术组(分别为990±14mg,786±14mg,2.58±0.04,2.05±0.03)(P<0.01)。14天治疗组上述各项指标(分别为778±13mg,607±11mg,2.54±0.04,1.98±0.03)显著低于14天非治疗组(分别为802±14mg,630±16mg,2.69±0.07,2.10±0.06)(P<0.01),56天治疗组上述各项指标(分别为1031±14mg,822±14mg,2.65±0.04,2.11±0.02)显著低于56天非治疗组(P<0.01),但高于56天假手术组(P<0.01)。治疗组第14天及第56天心肌胶原含量(分别为4.37±0.57mg/g,6.04±0.69mg/g)均显著低于非治疗组(分别为5.22±0.52mg/g,4.37±0.57mg/g)(P<0.01),但仍高于假手术组(分别为3.65±0.41mg/g,4.33±0.51mg/g)(P<0.01)。心肌组织病理学检查发现治疗组心肌间质纤维化明显减少。结论中药复方合剂有明显的抑制心肌胶原增生的作用,可减轻心肌梗死后心肌纤维化程度。     

补肾健脾方对去势大鼠骨骼肌Bcl-2、Caspase蛋白表达的影响

目的 探讨补肾健脾方对去势大鼠骨骼肌中Bcl-2、Caspase蛋白表达的影响.方法 48只6月龄的雌性SD大鼠随机分为空白组、模型组、中药组、西药组各12只.治疗12 w后收集左侧股骨、股直肌分别行骨矿含量(BML)、骨密度(BMD)测量,同时检测Bcl-2、Bax、Caspase-3和Caspase-9表达水平.结果 最后纳入研究的动物40只.模型组的BMD和BMC均低于空白组(P＜0.05);中药组和西药组的BMD高于模型组(P＜0.05).与对照组相比,模型组骨骼肌中Caspase-3和Caspase-9表达水平明显上升(P＜0.05).使用药物干预后,中药组能显著降低大鼠骨骼肌中Caspase-3和Caspase-9的表达水平(P＜0.05).模型组骨骼肌中Bcl-2表达水平下降,Bax表达水平上升,与空白组相比,只有Bax蛋白的表达水平有显著性差异(P＜0.05);经过药物干预后,中药组能提高骨骼肌中Bcl-2蛋白表达,降低Bax表达,与模型组比较,差异有统计学意义(P＜0.05).结论 补肾健脾方对去势大鼠有明显的治疗作用,能明显提高BMD;显著减低Caspase-3和Caspase-9含量,同时提高抗凋亡蛋白的表达水平,降低促凋亡蛋白的表达水平.     

Drug-induced liver injury due to ＂natural products＂ used for weight loss： A case report

Taking herbal-extracts to lose weight is an underestimated health hazard. Often, these products contain active agents that can cause acute liver damage. In this case report, a 22-year-old female patient, who presented with a feature of cholestatic syndrome, was so sure that the ＂natural products＂were not dangerous that she did not inform her physicians that she had taken them, making their task that much more challenging. Clinical presentation mimicked acute cholecystitis and the patient underwent a cholecystectomy. Surgery was without any consequences and complications, although it did not completely cure the illness. She later admitted to having taken herbal remedies and this led to the correct diagnosis of phytotherapy-related hepatotoxicity and a successful therapeutic approach. The true incidence of phytotherapy-related hepatotoxicity and its pathogenic mechanisms are largely unknown. It is important to increase the awareness of both clinicians and patients about the potential dangers of herbal remedies.     

Green tea extract:A potential cause of acute liver failure

The use of herbal products has increased significantly in recent years.Because these products are not subject to regulation by the Food and Drug Administration and are often used without supervision by a healthcare provider,the indication for and consumption of these supplements is quite variable.Moreover,their use is generally regarded as safe and natural by the lay-public.Unfortunately,there has been an increase in the number of reported adverse events occurring with the use of herbal products.We present a case of acute impending liver failure in an adolescent male using a weightloss product containing green tea extract.Our case adds to the growing concern surrounding the ingestion of green tea extract and serves to heighten healthcare provider awareness of a potential green tea extract hepatotoxicity.Despite the generally touted benefits of green tea as a whole,clinical concern regarding its use is emerging and has been linked to its concentration in multiple herbal supplements.Interestingly,the suspected harmful compounds are those previously proposed to be advantageous for weight-loss,cancer remedy,and anti-inflammatory purposes.Yet,we emphasize the need to be aware of not just green tea extract,but the importance of monitoring patient use of all dietary supplements and herbal products.     

Suppression of Alcohol Intake after Administration of the Chinese Herbal Medicine, NPI-028, and Its Derivatives

The Chinese herbal medicine, NPI-028, has been used for centuries in China to counteract alcohol intoxication. The present study used a number of different experimental conditions to determine whether NPI-028 and its derivatives might selectively influence alcohol intake in rodents that naturally exhibit high alcohol intakes. It was determined that intraperitoneal (IP) injections of NPI-028 (0.5, 0.75, and 1.0 g/kg) suppressed alcohol intake by up to 30% in both alcohol-preferring P and Fawn-Hooded (FH) rats during a continuous access schedule. These injections did not significantly affect food or water intakes, nor did the highest dose of NPI-028 (1 g/kg) alter blood ethanol levels after an IP injection of 2.5 g/kg of ethanol. In P rats, it was found that NPI-028 was orally active with the dose of 1.5 g/kg having a greater effect on ethanol intake than the 1.0 g/kg dose; once again, food and water intakes were not significantly altered. In FH rats maintained on a limited access schedule (1 hr/day), alcohol intake was completely abolished by 1.5 g/kg of NPI-028. Chronic IP administration of NPI-028 (0.75 g/kg) for four consecutive days in FH rats maintained on a continuous access schedule did not lead to any diminution of its alcohol-suppressant effects. Thus, NPI-028 has significant effects on alcohol intake without much effect on water and food intake, and tolerance does not readily develop to these effects. The IP administration of a partially purified extract (NPI-031) of NPI-028, obtained by countercurrent chromatography, also dose-dependently suppressed ethanol intake in FH rats, but the highest dose (200 mg/kg) also significantly decreased food intake. Finally, the IP administration of puerarin (NPI-31G), an isoflavone isolated from NPI-031 by countercurrent chromatography, significantly reduced ethanol intake in FH rats without affecting food or water intake. Therefore, NPI-028 and one of its pure components, NPI-031G, selectively reduced ethanol intake in alcohol-preferring rats.     

中药方剂治疗迈氏唇鞭毛虫感染1例

本文报道1例迈氏唇鞭毛虫感染者,并对其诊断和中医药治疗过程进行总结.     

Liver injury induced by high-dose methylprednisolone therapy: a case report and brief review of the literature

Corticosteroids are used widely to treat many types of disease. In general, these drugs are considered safe for the liver; however, recent reports have demonstrated that high-dose methylprednisolone (MT) may cause severe liver injury. Here, we report a case of a 24-year-old female who was given pulsed MT therapy for multiple sclerosis. MT induced icteric hepatitis and impaired liver synthetic function. Hepatotoxicity developed several weeks after drug exposure, and the causal association with MT was confirmed by unintentional rechallenge test. A brief review of the literature on corticosteroid-induced hepatotoxicity is presented.     

On the Use of Herbal Medicines in Management of Inflammatory Bowel Diseases: A Systematic Review of Animal and Human Studies

Because of potential adverse events and lack of effectiveness of standard therapies, the use of complementary and alternative medicines (CAM), particularly of herbal therapies, for inflammatory bowel disease (IBD) is increasing. Results from the use of herbal therapies for managing IBD are promising, and no serious adverse events have been reported from them. Herbal therapies show their benefit in managing IBD by different mechanisms such as immune system regulation, antioxidant activity, inhibition of leukotriene B4, inhibition of nuclear factor-kappa B (NF-κB), and antiplatelet activity. In this paper, all reported herbal therapies established in animal IBD models or used for managing human IBD are systematically reviewed and their possible mechanisms of action discussed. Conducting clinical trials with high quality and validity (randomized, double blinded, controlled, on a large number of patients) to obtain more conclusive results about the use of herbal therapies in IBD is recommended.     

Herbal and dietary supplement induced liver injury: Highlights from the recent literature

Herbal-induced liver injury(HILI) is an important and increasingly concerning cause of liver toxicity, and this study presents recent updates to the literature. An extensive literature review was conducted encompassing September 2019 through March 2021. Studies with clinically significant findings were analyzed and included in this review. We emphasized those studies that provided a causality assessment methodology, such as Roussel Uclaf Causality Assessment Method scores. Our review includes reports of individual herbals, including Garcinia cambogia, green tea extract, kratom as well as classes such as performance enhancing supplements, Traditional Chinese medicine, Ayurvedic medicine and herbal contamination. Newly described herbals include ashwagandha, boldo, skyfruit, and ‘Thermo gun'. Several studies discussing data from national registries, including the United States Drug-Induced Liver Injury(DILI) Network, Spanish DILI Registry, and Latin American DILI Network were incorporated. There has also been a continued interest in hepatoprotection, with promising use of herbals to counter hepatotoxicity from anti-tubercular medications. We also elucidated the current legal conversation surrounding use of herbals by presenting updates from the Federal Drug Administration. The highlights of the literature over the past year indicate interest in HILI that will continue as the supplement industry in the United States grows.     

Pathogenic variants of PROC gene caused type II activity deficiency in a Chinese family: A case report

Rationale:Hereditary Protein C (PC) deficiency is a rare genetic disorder caused by PROC gene mutation. In this article, we report a case of PC deficiency in a Chinese family due to a novel PROC gene mutation.Study Subject:The proband presented with recurrent cerebral infarction over the course of the previous 3 years. He was admitted to the hospital due to signs of mental retardation.Diagnoses:Physical examination, laboratory tests, and magnetic resonance imaging demonstrated that the proband had a manifestation of PC deficiency that included acute cerebral infarction. DNA sequencing analysis revealed a missense variant, c.1015G > A (p.V339 M from valine to methionine) in exon 9 of the PROC gene. In addition, Sanger sequencing confirmed that the proband''s son was heterozygous for the same variant. Therefore, the PROC gene mutation was transmitted in an autosomal dominant inheritance manner.Interventions:The patient was treated with a daily dosage of Warfarin (3.5 mg) and was scheduled to undergo regular blood coagulation tests.Outcomes:At the 3-month follow-up appointment, the patient showed improvements in his overall health condition.Lessons:We identified a novel missense mutation in the PROC gene in a Chinese family which caused a decrease in the PC antigen level and recurrent cerebral infarction.