Clinic diagnosis and treatment of herb-induced liver injury

doi:10.19803/j.1672-8629.20220661

Abstract

Abstract: Objective To introduce the clinical features of herb-induced liver injury (HILI) for better prediction and prevention of HILI. Methods The clinical epidemiology, risk signals and clinical diagnosis, risk factors and pathogenesis, management, treatment and medication of HILI were reviewed based on the latest research at home and abroad. Results and Conclusion The clinical manifestations of HILI are diverse and the toxic mechanism is complex, which is more prominent in drug induced liver injury, so, brings great challenges to the clinical prevention and treatment of HILI. Clinical awareness of drug safety and attention to the detection and screening of HILI cases should be continuously raised. Long-term follow-up cohorts should be established and integrated with clinical, pharmacological and clinical epidemiological disciplines to improve the clinical prevention and treatment of HILI and promote the level of clinical safety in the use of Chinese medicine.

Key words: herb-induced liver injury, epidemiology, diagnosis, pathogenesis, prevention, treatment

CLC Number:

R961
R994.11

LI Meng, LI Rongrong, LIU Chenghai. Clinic diagnosis and treatment of herb-induced liver injury[J]. Chinese Journal of Pharmacovigilance, 2023, 20(2): 127-131.

References

[1] ZHU ZY.Sheng Nong's Herbal Classic(神农本草经)[M]. Beijing: People's Sanitary Publishing Press, 2018.
[2] State Pharmacopoeia Commission.Pharmacopoeia of the people's Republic of China, 2020 edition(中华人民共和国药典2020年版)[M]. Beijing: China Medical Science Press, 2020.
[3] KULLAK-UBLICK GA, ANDRADE RJ, MERZ M, et al.Drug-induced liver injury: recent advances in diagnosis and risk assessment[J]. Gut, 2017, 66(6): 1154-1164.
[4] State Drug Administration.Technical guidelines for clinical evaluation of liver injury induced by traditional Chinese medicine[J]. Journal of Clinical Hepatology(临床肝胆病杂志), 2018, 34(7): 1403-1409.
[5] ROBLES-DIAZ M, GONZALEZ-JIMENEZ A, MEDINA-CALIZ I, et al.Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids[J]. Aliment Pharmacol Ther, 2015, 41(1): 116-125.
[6] SHEN T, LIU Y, SHANG J, et al.Incidence and etiology of drug-induced liver injury in mainland China[J]. Gastroenterology, 2019, 156(8): 2230-2241.
[7] BJÖRNSSON ES, BERGMANN OM, BJÖRNSSON HK, et al. Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland[J]. Gastroenterology, 2013, 144(7): 1419-1425.
[8] NAVARRO VJ, LUCENA MI.Hepatotoxicity induced by herbal and dietary supplements[J]. Semin Liver Dis, 2014, 34(2): 172-193.
[9] MELCHART D, HAGER S, ALBRECHT S, et al.Herbal traditional Chinese medicine and suspected liver injury: a prospective study[J]. World J Hepatol, 2017, 9(29): 1141-1157.
[10] OU P, CHEN Y, LI B, et al.Causes, clinical features and outcomes of drug-induced liver injury in hospitalized patients in a Chinese tertiary care hospital[J]. Springerplus, 2015, 4: 802.
[11] GAO H, LI N, WANG JY, et al.Definitive diagnosis of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids[J]. J Dig Dis, 2012, 13(1): 33-39.
[12] The Study of Drug Induced Liver Disease of Chinese Medical Association. Diagnosis and treatment guideline on drug-induced liver injury[J]. Chinese Journal of Hepatology(中华肝脏病杂志), 2015, 23(11): 810-820.
[13] Cooperative Group For Hepatic and Gall Diseases, Chinese Society of Gastroenterology, Chinese Medical Association. Expert consensus on diagnosis and treatment of pyrrolidine alkaloids-related sinusoidal obstruction syndrome(2017, Nanjing)[J]. Journal of Clinical Hepatology(临床肝胆病杂志), 2017, 33(9): 1627-1637.
[14] MA LJ, KONG XN, GAO YQ.Research progress of Chinese herbal medicine-related liver injury[J]. Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases(中西医结合肝病杂志), 2021, 31(7): 665-668.
[15] XI C, PENG S, WU Z, et al.Toxicity of triptolide and the molecular mechanisms involved[J]. Biomedicine & pharmacotherapy, 2017, 90: 531-541.
[16] LI J, XIAO Y, YAN WT, et al.Research development of liver toxicity and toxicity alleviation of huangyaozi (dioscorea bulbifera)[J]. Chinese Archives of Traditional Chinese Medicine(中华中医药学刊) , 2020, 38(12): 100-103.
[17] YUAN Z, YUAN Z, HASNAT M, et al.A new perspective of triptolide-associated hepatotoxicity: the relevance of NF-κB and NF-κB -mediated cellular FLICE-inhibitory protein[J]. Acta Pharm Sin B, 2020, 10: 861-877.
[18] WANG Z, XU G, WANG H, et al.Icariside Ⅱ, a main compound in Epimedii Folium, induces idiosyncratic hepatotoxicity by enhancing NLRP3 inflammasome activation[J]. Acta Pharm Sin B, 2020, 10(9): 1619-1633.
[19] TU C, JIANG BQ, ZHAO YL, et al.Comparison of processed and crude Polygoni Multiflori Radix induced rat liver injury and screening for sensitive indicators[J]. China Journal of Chinese Materia Medica(中国中药杂志), 2015, 40(4): 654-660.
[20] HENG QQ, BIAN Y, LI L, et al.Effect of radix et rhizoma glycyrrhizae co-administered with sargassum pallidum, radix euphorbiae pekinensis, euphorbiae kansui radix and flos genkwa on mouse intestinal function[J]. Chinese Journal of Pharmacology and Toxicology(中国药理学与毒理学杂志), 2013, 27(3): 374-378.
[21] LIU LN, JIN HY, SUN L, et al.General investigation and preliminary risk assessment of aflatoxins in traditional Chinese medicines and their preparations[J]. Chinese Pharmaceutical Journal(中国药学杂志), 2015, 50(17): 1541-1546.
[22] POSADZKI P, WATSON L, ERNST E.Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews[J]. Eur J Clin Pharmacol, 2013, 69(3): 295-307.
[23] CRISPE IN.Immune tolerance in liver disease[J]. Hepatology, 2014, 60(6): 2109-2117.
[24] LI C, RAO T, CHEN X, et al.HLA-B*35:01 Allele is a potential biomarker for predicting Polygonum multiflorum-Induced Liver Injury in Humans[J]. Hepatology, 2019, 70(1): 346-357.
[25] BJÖRNSSON ES, ANDRADE RJ. Long-term sequelae of drug-induced liver injury[J]. J Hepatol, 2022, 76(2): 435-445.
[26] FONTANA RJ, SEEFF LB, ANDRADE RJ, et al.Standardization of nomenclature and causality assessment in drug-induced liver injury: summary of a clinical research workshop[J]. Hepatology, 2010, 52(2): 730-742.
[27] MAO YM, LIU XL, CHEN CW.Introduction to the 2013 FDA guidelines for drug-induced liver injury-Pre-marketing clinical evaluation of pharmaceutical R&D enterprises[J]. Chinese Hepatology(肝脏), 2013, 18(5): 325-330.
[28] Chinese Society for Tuberculosis, Chinese Medical Association. Guidelines for the diagnosis and treatment of antituberculous drug-induced liver injury (2019 edition)[J]. Chinese Journal of Tuberculosis and Respiratory Disease(中华结核和呼吸杂志), 2019, 42(5): 343-356.
[29] ZHANG ZJ.Treatise on Cold Pathogenic and Miscellaneous Diseases (伤寒杂病论)[M]. Beijing: China Press Traditional Chinese Medicine, 2019.
[30] LI M, LUO Q, TAO Y, et al.Pharmacotherapies for drug-induced liver injury: a current literature review[J]. Front Pharmacol, 2022, 12: 806249.
[31] DEKHUIJZEN PN.Antioxidant properties of N-acetylcysteine: their relevance in relation to chronic obstructive pulmonary disease[J]. Eur Respir J, 2004, 23(4): 629-636.
[32] CHEN DF, SUN WJ.The application of the anti-inflammatory and hepatoprotective drugs on drug-induced liver disease[J]. Chinese Journal of Hepatology(中华肝脏病杂志), 2011(3): 232-233.
[33] LIU X, ZHAO M, MI J, et al.Protective effect of bicyclol on anti-tuberculosis drug induced liver injury in rats[J]. Molecules, 2017, 22(4): 524.
[34] Committee of The Treatment with Polyenphosphatidylcholine in Patients with Liver Diseases. Experts consensus on the treatment with polyenphosphatidylcholine in patients with liver diseases[J]. Chin. J. Exp. Clin. Infect. Dis.(Electronic Edition), 2017, 11(4), 313-319.
[35] BEUERS U, NATHANSON MH, ISALES CM, et al.Tauroursodeoxycholic acid stimulates hepatocellular exocytosis and mobilizes extracellular Ca++ mechanisms defective in cholestasis[J]. J Clin Invest, 1993, 92(6): 2984-2993.
[36] LIEBER CS.Role of S-adenosyl-L-methionine in the treatment of liver diseases[J]. J Hepatol, 1999, 30(6): 1155-1159.
[37] WANG Y, ZHUGE YZ, ZHANG F, et al.Treatment for gynura segetum caused hepatic vein occlusive disease: a single-center retrospective study[J]. Chinese Journal of Digestion(中华消化杂志), 2016, 36(12): 811-815.
[38] BJÖRNSSON ES, VUCIC V, STIRNIMANN G, et al. Role of corticosteroids in drug-induced liver injury. a systematic review[J]. Front Pharmacol, 2022, 13: 820724.
[39] European Association for the Study of the Liver. Easl clinical practice guidelines: drug-induced liver injury[J]. J Hepatol, 2019, 70(6): 1222-1261.
[40] LIU CM, CHEN HP, TAN LP, et al.Pharmacological effect and toxicity of Xanthii fructus[J]. Chinese Journal of Experimental Traditional Medical Formulae(中国实验方剂学杂志), 2019, 25(9): 207-213.
[41] HUANG Y, JIANG JL, WANG WL, et al.Research progress in hepatotoxicity mechanism of several traditional Chinese medicines from medicine and food homology plants[J]. Chinese Journal of Pharmacology and Toxicology(中国药理学与毒理学杂志), 2022, 36(2): 149-154.
[42] HUANG W, SUN R.Study on hepatotoxicity on rats caused by crude extracts of total saikosaponins and correlation with oxidative damage mechanism[J]. China Journal of Chinese Materia Medica(中国中药杂志), 2010, 35(13): 1745-1749.