Abstract
Tuberculosis is mainly treated with rifampicin, pyrazinamide, isoniazide, ethambutol and/or streptomycin; however, the first three cause hepato- and nephro-toxicity, then the patient abandons therapy. This cause contributes to the failure of the treatment and favors the appearance of drug-resistant strains. Currently, alternatives are being sought to counteract this hepatic-damage, and medicinal plants, natural compounds and/or biological products are of great interest. In this manuscript we describe current data on the hepato-protective effect from extracts of medicinal plants, compounds isolated from them and biological products that protect against liver damage caused by antitubercular (anti-TB) drugs caused by therapy in patients with tuberculosis (TB). The main consulted databases were: PubMed, Worldwidescience.org, and Scopus, including records between 2000 and 2018 years. Thus, we found many articles about hepatoprotective effect from medicinal plants and polyherbal preparations (Hepatoplus and Liv 52), the majority of these have an important effect (on preclinical study) due to their antioxidant compounds content. In addition, the hepatoprotective activity of biological products and/or natural compounds has been discussed and it should be noted that the quercetin (natural antioxidant compound)/ polyvinylpyrrolidone mixture protects against hepatic damage caused by therapy in patients with TB. Another interesting compound with good effect in TB patients is N-acetylcysteine (an oral marketed mucolytic drug) which could be repurposed as an hepatoprotective drug. We consider that these findings are of great interest for researchers and clinicians, also for the development of new agents as well as for the therapeutic use of hepatoprotective substances in patients with TB, which helps reduce the toxic effects that drugs cause.
Highlights
Tuberculosis (TB) is a disease that affects one third of the world population, and is a health problem in various developing countries, being one of the nine top causes of death by infectious processes
In the pages we present the most important contributions to the field divided in: a) HPP effects derived from medicinal plant extracts, classified by solvent used for extraction: aqueous extracts, ethanolic and methanolic extracts, and essential oils; b) HPP effect by polyherbal mixtures, especially those commercial ones; c) HPP effects found in pure natural or synthetic organic compounds; and d) Biological products with HPP effect
We found 30 manuscripts describing the HPP effect of the extracts of medicinal plants, one describing the effect of the essential oil, two articles describing the HPP effect of organic extracts, 4 articles describing the HPP activity from polyherbal preparation, 16 articles describing pure compounds and three describing the HPP effect for biological products
Summary
Tuberculosis (TB) is a disease that affects one third of the world population, and is a health problem in various developing countries, being one of the nine top causes of death by infectious processes. In 2016, 1.7 million people died and approximately 10.4 million developed the disease; of the latter, about 10-12% were HIVpositive. This co-infection being one of the main causes of death worldwide [1,2]. There has been an increase in the cases of MultidrugResistant (MDR-TB) and extensively drug-resistant strains (XDRTB). MDR cases are resistant to Rifampicin (RIF), Pyrazinamide (PZA) and Isoniazide (INH), basic drugs for the treatment of TB. XDR cases are resistant to RIF, INH, fluoroquinolones, and second-line injectable drugs (amikacin, capreomycin or kanamicin) [3,4]
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